Effects of a verbal warning and overcorrection on stereotyped and appropriate behaviors.

In Experiment I, the effects of a verbal warning, such as is used in Overcorrection, delivered contingently on the stereotyped mouthing behavior of two autistic/retarded children were examined. A multiple baseline design across subjects was used. The results indicated that the mouthing of one child was reduced to a near-zero level and mouthing of the second child was moderately reduced. Appropriate toy play and inappropriate object manipulation failed to show systematic changes in occurrence when mouthing was decelerated. In Experiment II, the same subjects and experimental design were used to assess the effects of a positive practice Overcorrection procedure delivered contingent on mouthing behavior. Overcorrection reduced the mouthing of both subjects. There were no systematic changes in inappropriate object manipulation but one subject did demonstrate an increased occurrence of appropriate toy play. In addition, this subject often engaged in aggressive/escape behaviors during Overcorrection, suggesting that the procedure was aversive to him.


Lead and hyperactivity: lead levels among hyperactive children.

Previous work has demonstrated an association between hyperactivity and increased body lead burdens in school-age children. In the present study it is shown that within a group of hyperactive children those for whom an organic etiology is present have lead burdens lower than in those for whom no apparent cause could be found. These data lead us to reject the notion that hyperactivity per se is responsible for the acquisition of elevated lead levels, and further strengthen the suspicion that for some children lower lead level absorption may be implicated in the development of the hyperkinetic disorder.


Reducing stimulus overselectivity in autistic children.

It has been repeatedly reported that when presented with a discrimination task involving multiple cues, autistic children, as compared to normal children, tend to respond on the basis of only a restricted portion of the component cues. This phenomenon has been called "stimulus overselectivity" and has been implicated as a possible basis for some of the pronounced behavioral deficits charactertistic of autism. Examination of the results of several previous studies suggests that the overselectivity effect might be reduced with repeated exposure to testing. However, since the previous studies were not designed to test this hypothesis, no conclusions were drawn regarding variables influencing the reduction of the overselectivity phenomenon. The present investigation was therefore conducted to determine if stimulus overselectivity in autistic children is changed as a function of repeated exposure to testing. Nineteen autistic children were trained on a discrimination task with a cue complex composed of two visual cues. After the children reached criterion on the task, they were exposed to a testing phase with probe trials where the cue components were presented singly. The results indicated that 16 of the children initially showed overselectivity and 3 responded to both cues. Of the 16 children who showed overselectivity, 13 decreased their level of overselectivity with continued testing. These results are discussed in relation to variables in the testing procedure itself and to the literature on selective attention.


An experimental analysis of peer social initiations on the behavior of withdrawn preschool children: some training and generalization effects.

In this study, positive social initiations by an age-peer was evaluated as an intervention for isolate preschool children in training and generalization sessions. During baseline, the confederate made few social approaches to the target subjects. The confederate greatly increased his rate of positive social initiations during the first intervention, decreased social approaches during a second baseline, and increased social approaches again in a second intervention phase. Increases in confederate initiations resulted in an immediate acceleration in the frequency of subjects' positive social behavior during training sessions. Additionally, for two of the three subjects, positive social behaviors were also observed to increase during generalization sessions. The results suggest that (a) peers may be trained successfully to set the occasion for positive social behaviors by withdrawn classmates, (b) increased social responding by withdrawn children in the presence of frequent peer social initiations may also generalize beyond the training setting, and (c) the magnitude of direct and generalization effects appears to be related to the entry-level repertoire of target children.


Recurrent meningitis due to congenital fistula of stapedial footplate.

A case of recurrent meningitis due to a stapes footplate fistula in a child with Klippel-Fiel syndrome is reported. The relationship of deafness to this latter syndrome is noted and theories for the aetiology of the fistula discussed. A stapedectomy was performed and the oval window was obliterated using a Schuknecht fat-wire prosthesis with further packing of the middle ear with muscle.


Bell's palsy--Varicella Zoster and meningitis.

Two cases with Bell's palsy due to Varicella Zoster virus in children are reported. It is suggested that pyogenic meningitis resulting in lowered body resistance reactivated the latent V.Z. virus.


Transverse trachero-oesophagoplasty a new one-stage operation for construction of a 'Neo-Larynx'.

A new one-stage operation of constructing a 'Neo-Larynx' after total laryngectomy, transverse tracheo-oesophagoplasty, for a good alaryngeal ('Tracheo-Oesophageal') speech is described. A 'Neo-Epiglottis' is constructed from the posterior tracheal wall and a 'Pseudo-Glottis' in the tracheo-oesophagenal partition wall with a valvular mechanism for preventing aspiration into the trachea during deglutition. No extraneous tissue is used for the construction of the 'Neo-Larynx' and no practice is necessary on the part of the patient for developing alaryngeal 'Tracheo-Oesophageal' speech. The patient can phonate immediately after removal of the feeding tube and the silastic sheet and is ready for discharge five weeks after operation. Adequate surgical ablation is ensured and at the same time good functional rehabilitation is offered without jeopardizing the principles of cancer surgery, i.e. to be on the overdoing side rather than on the underdoing one in a futile attempt at retaining the function.


Hypoplasia of the nasal bones.

A case of nasal bone hypoplasia is presented. It resulted in mild respiratory obstruction due to collapse of overlying soft tissue on inspiration. A brief note on the growth of the nasal bones is made. All previously reported cases, which could be found in the literature, on absence or hypoplasia of nasal bones have been reviewed. A number of possible conditions which could result in loss of the nasal bone is discussed.


Goldenhar syndrome: a case report with review of literature.

A case of Goldenhar Syndrome, in an adult male, with the typical triad of auricular appendages, epibulbar dermoid and vertebral anomalies is presented. The relevent literature is review. The differential diagnosis of this Syndrome from a few similar syndromes is stressed.


Effect of penicillamine on the sensori-neural deafness of retinitis pigmentosa.

Four confirmed patients with retinitis pigmentosa and varying degrees of sensori-neural deafness were treated with penicillamine. The results indicated that the deafness improves with the therapy.


[Quantitative determination of aromatic carboxylic acids with glass-capillary-columns (author's transl)].

With a glass-capillary column 20 aromatic acids, probably present in urine, were analysed quantitatively. In comparison with a packed column the capillary column offers several advantages: a higher resolution; a greatly reduced analysis time, an increased sensitivity. Though a split system is used, repeatability and linearity are suitable for quantitative analysis. The advantages are best recognized by the analysis of urine specimens of patients with a metabolic disorder (phenylketonuria).


[A new method for the determination of sugars in cerebrospinal fluid (author's transl)].

The determination of fructose, galactose, glucose, mannose, rhamnose and ribose, using a newly developed liquid chromatography sugar analyzer is reported. High sensitivity (detection limit: 0.05 to 0.23 microgram per compound), resolution and specifity of the method permits the routine detection of carbohydrates in biological fluids without prior extraction and enrichment. The procedure opens new possibilities in medicinal diagnosis.


[Isolation and identification of some metabolites of clofedanol from human urine (author's transl].

10 excretory products of Clofedanol (1-(o-chlorphenyl)-1-phenyl-3-dimethylaminopropanol) were identified in human urine. The following five products were extracted with chloroform at pH 1--2: o-(chlorphenyl)-phenylmethane (I), benzophenone (II), o-chlorbenzophenone (III), benzhydrol (IV), and o-(chlorphenyl)-beta-phenylacrolein (V). Two compounds were extracted with chloroform at pH 13--14: unchanged Clofedanol and 1-(o-chlorphenyl)-1-phenyl-3-dimethylaminopropene-1 (VI). N,N-dimethylamino-acetic acid (VII) was also identified in urine. Clofedanol and metabolite IV were present as free compounds, and they were also found after hydrolysis of metabolites VIII and IX with beta-glucuronidase.


[Mathematical analysis of the error distributions in flow-systems and consequences for the determination of new method-specific control limits (author's transl)].

In connection with the determination of method adapted control limits for the Technicon Autoanalyzer SMA 12/60 (Na+, K+, C1-, Total Protein, Albumin, P, Cholesterol, Urea Nitrogen, Calcium, Creatinine, Bilirubin, Uric Acid) we have investigated the representation of the control variable error distributions by mathematical formulae. The application of orthogonal functions (Gram-Charlier's series type A) proved to be not practicable because of the oscillations occuring at the ends of the distributions. Considerably improved results were obtained by a modified expression of a Gram-Charlier's series of type C, although the tails of the distributions (which are particularly important for the calculation of the fractiles) could not be optimally approximated. However, a very satisfactory approximation of the empirical density functions was obtained when we interpreted the control variables as non-additive superposition of two or three normally distributed quantities with different variances. This enables us to calculate channel specific alarm and control limits, thereby replacing the conventional quality control parameters previously checked and based on the assumption of normal distributions. Thus, an adequate monitoring of the reliability of flow-systems can be achieved.


[A flow-through method for the O2-sensitive, enzymatic analysis of glucose (author's transl)].

A flow-through glucose-analyser is described based on an oxygen-sensitive enzymatic system. Leak-current-proof welded PTFE-membranes contribute considerably to an easy maintenance of the O2-sensors. Soluble or immobilized glucose oxidase may be used in automatic analysers. As a primary instrument of analysis, the oxygen pO2-electrode lends itself to the measurement of other enzymatic reactions that involve oxygen.


A new method for determination of inorganic phosphorus in serum without deproteinization.

A simple method was developed for the determination of inorganic phosphorus in serum without deproteinization. The method is based on the use of formic acid as protein solubilizer and glycerol as stabilizer for the assay system. The optimal conditions for colour development were determined. The results obtained with the new method correlate well with those obtained after deproteinization of serum with trichloroacetic acid. The present method could be fully mechanized, and its application to the determination of serum phosphatases is discussed.


Ultrastructure of platelets of the vitamin E-deficient rats.

The platelets of vitamin E-deficient rats show a remarkable structural destruction of the mitochondria, mainly in the membrane, and a considerable decrease in the number of mitochondria. In addition, significant decreases are manifested in the numbers of microtubules, alpha-granulomers, dense bodies and glycogen particles, accompanied by remarkable vacuole formation. The longer the vitamin E-deficient period, the more remarkable the changes are. Rats deficient in vitamin E for 58 weeks showed the highest degenerative changes in the platelets.


Effect of thiamine deficiency, pyrithiamine and oxythiamine on pyruvate metabolism in rat liver and brain in vivo.

Rats were fed either a thiamine-deficient diet of diets containing pyrithiamine or oxythiamine. When symptoms of thiamine deficiency appeared, the animals were injected intraperitoneally with [2-14C] pyruvate six to twelve minutes prior to sacrifice. Free glutamic and aspartic acids were isolated from liver and brain and degraded. The results indicate that, in thiamine-deficient or oxythiamine-treated rats, pyruvate metabolism in liver and brain is similar to that in normal animals. In contrast, pyrithiamine drastically decreases the oxidative decarboxylation of pyruvate by rat liver.


Increase in cytochrome contents of liver mitochondria on feeding rats a low casein diet.

Williams et al. (1) investigated the changes in amounts of total mitochondrial protein and cytochromes in the liver of rats fed a protein-free diet for a long period, and found that there was a marked similarity between changes in amount of total mitochondrial protein and that of cytochromes. Present experiments were performed to clarify whether under a more mild protein-deficient state the relationships found by Williams are applicable or not by investigating the changes in contents of cytochromes per unit amount of mitochondrial protein when rats were fed a low case diet. A 4% casein diet was used as a low casein diet, and a 25% casein diet was used as a control diet. Rats were fed the test diets for 70 to 90 days. The results show that the contents of all cytochromes a, b, and c1 + c assayed and expressed as nmoles per mg of mitochondrial protein were significantly higher in rats fed a low casein diet than those in rats fed a control diet. These suggest that relationships found by Williams in a severe protein-deficient state would not be applicable in a more mild protein-deficient state.


Effect of essential fatty acid deficiency on lipid of skin surface of rat.

A study on how EFA deficiency affects lipid metabolism of rat skin, especially lipid on skin surface, was made. The total amount of lipid on skin surface of rat increased due to EFA deficiency, but not significantly. The sterol ester in skin surface lipid was maintained at a normal level in a EFA deficient rat, but the free sterol level was higher than that of the control rat. The glycerides decreased markedly due to EFA deficiency. It was recognized that branched fatty acids increased in each lipid fraction on skin surface. It was considered that such changes in skin surface lipid were characteristic to skin. It was not predictable whether these changes resulted directly from EFA deficiency or secondary from the occurrence of dermal symptoms.


Correlation between lability and relative turnover rate of soluble protein of the rat liver.

A study was made on whether or not the lability of protein generally correlates with its metabolic turnover rate. Two fractions of soluble protein were prepared from rat liver. Using the double isotope method, it was revealed that fraction precipitated with half-saturated ammonium sulfate had a larger turnover rate than the supernatant one. Both dietary protein depletion and starvation, though they significantly decreased total protein content, did not affect the ratio of the amount of protein in the precipitate to that of the supernatant fraction. These results suggested that both fractions, though they had a different turnover rates, were equally influenced by dietary protein depletion or fasting. In consequence, the results imply that the lability of protein does not necessarily in parallel with the metabolic turnover rate.


Nutritive efficiencies of lactalbumin and wheat gluten at very low levels of intake in adult rats.

The nutritive values of proteins in relation to their intake levels were evaluated by feeding adult male rats weighing 250 g diets containing 0%, 0.39%, 0.78%, 1.56%, 2.34%, 3.90%, 7.79% and 15.58% lactalbumin or wheat gluten for three weeks. The biological values (BV) of both proteins were high at low levels of protein intake but decreased with increase in protein intake. The BV of wheat gluten was estimated to be about 100 at a level of intake of 1.56% but only 25 at a level of 15.58%. Similarly, the BV of lactalbumin decreased with increase in the protein level, being 67 at a level of 7.79%. The BVs of both proteins at low levels of dietary protein (below 2.34% of lactalbumin or 0.78% of wheat gluten) were apparently more than 100 because urinary N excretion was less than endogenous N. The BVs also decreased with time during the three-week test period. It is concluded that BV of a protein is not a fixed value but varies with the experimental conditions especially with changes in the amount of intake, and that differences in the qualities of various proteins cannot be compared quantitatively at a single level of protein. The results were briefly discussed in relation to protein requirements.


Amblyopia: a long-term follow-up.

This report concerns the late results of therapy in the treatment of strabismic amblyopia. Of the patients who achieved a visual acuity of 20/40 or better (56%), 40 percent maintained this on prolonged follow-up. Those whose visual acuity deteriorated, the majority lost two lines or less in their acuity. Close follow-up and repeated patching of such patients is indicated. Eccentric fixation at the onset of amblyopia treatment is a poor prognostic sign. Two-thirds of those who were eccentric at the onset were eccentric at the final follow-up examination.


Surgical correction of dissociated vertical deviations.

The surgical treatment and results of 17 patients with DVD is presented. Supermaximum recessions of the superior rectus muscle were performed on the deviating eye. No lid changes or any limitation of elevation were noted following the surgery. The manifest deviation was converted to less than ten prism diopters in all except one case. Four over-corrections of two to six prism diopters of hypotropia resulted. There was no change in eye preference to the operated eye. Saccadic velocities showed no change in the acceleration or velocity of the operated superior rectus. Discussion of this technique compared to other modalities is made.


Isolated unilateral gaze palsy.

A case of an isolated unilateral horizontal gaze paralysis is presented. The abnormality has remained static and in isolation for more than three years. A review of the benign causes of pontine gaze palsies is presented. The unique features of this case is the fact that the gaze paralysis is unilateral and unassociated with any other neurologic or systemic abnormality.


Uveitis and ophthalmoplegia complicating chickenpox.

Two cases of unilateral uveitis which appeared in association with chickenpox are presented. In one of them internal ophthalmoplegia was seen. Possible pathogenic mechanisms are discussed. The unusual cycloplegia which was present in one case can be caused by viral lesion to the ciliary nerves.


Atypical ocular toxocariasis.

The case presented emphasizes that Toxocara Canis can involve the anterior segment of the eye as an isolated disease process. Most cases of ocular Toxocara Canis are not associated with the other features of the visceral larva migrans syndrome but certainly represents a spectrum of the same parasitic disease. At present, an eosinophil count and isohemagglutinin titers against A and B blood groups appear the easiest hematologic studies to perform and are fairly reliable indicators of active Toxocara infestation. The VLM syndrome is usually a benign, self-limited disease but occasionally severe ocular, pulmonary or CNS involvement may result. The diagnosis should be considered in any child with a unilateral ocular inflammatory disease, especially if there is a history of geophagia or exposure to dogs. Treatment must take into account the severity of the disease, the organ involved, and the tendency to produce an inflammatory process upon the death of the organism. Elimination of the disease requires surveillance of dogs, especially puppies, and avoidance of geophagia.


Periorbital cellulitis.

Sixty-seven cases of orbital cellulitis from BGSM are reported and 247 cases from the literature reviewed. Staphylococcus aureus was the predominant pathogen except in the age group from three months to three years where a significant number of cases yielded Hemophilus influenzae and Diplococcus pneumoniae. The frequent association of paranasal sinus involvement and orbital cellulitis has been confirmed. Orbital cellulitis is a multifaceted disease which, for proper management, requires close cooperation among pediatricians, ophthalmologists, and nursing service as a multidisciplinary approach for optimal therapy and decreased frequency of complications and sequelae.


Selective Activation of peripheral nerve fibre groups of different diameter by triangular shaped stimulus pulses.

1. The differential block of cutaneous nerve fibres has been achieved with a simple method of electrical stimulation, employing a single pair of active electrodes. 2. The method allows the selective activation of 95% of small myelinated (delta) axons, without activation of the larger (beta) ones; and activation of unmyelinated (C) fibres, without A fibre activation. Asynchronous firing of myelinated axons was absent in the majority of the experiments. 3. The method employs triangularly shaped electrical pulses, with a steep rise front and a slow exponential decay. The outward flow of current at the cathode fires conducted impulses in both larger and smaller axons, and the inward flow inactivates differentially the conduction in the smaller ones. 4. The differential effect of anodal currents rests upon the greater internal conductance and greater conduction velocity of larger fibres. 5. The method has the advantage over the conventional polarization block of simpler surgical preparation, longer nerve survival and minimal latency distortion. However, it cannot be applied in experiments requiring physiological stimulation of peripheral receptors.


Epibulbar rhabdomyosarcoma without proptosis.

Orbital rhabdomyosarcoma presenting as a localized, epibulbar mass is unusual, but common enough for the clinician to be aware of it. Although there has been a recent trend toward simple biopsy followed by irradiation and chemotherapy, cases presenting in this manner may sometimes be managed by total excision with preservation of the globe, follwed by irradiation and chemotherapy. A case of such an epibulbar rhabdomyosarcoma is presented as an illustrative example.


A possible origin of circulating gastrin component IV in cats.

1. Blood circulating in the cat is known to contain relatively large concentrations of gastrin components corresponding to Rehfeld's Components III and IV, whereas human blood has mostly Components II and III. 2. Synthetic cat gastrin 17NS was continuously injected into chloralose anaesthetized cats and at 1, 10 and 40 min after the start of injection there were significantly greater concentrations of immunoreactive gastrin Component IV than Component III in arterial blood (P less than 0.025 in each case). These concentrations were also greater than the total arterial gastrin concentration in the basal state. 3. Cat blood with EDTA incubated at 37 degrees C with synthetic cat and natural porcine gastrins 17NS produced Component IV. Hunan blood with EDTA incubated in a similar way with natural and synthetic human gastrins 17NS did not produce any detectable Component IV. Cat blood incubated with natural porcine and synthetic cat gastrin 17NS at 0 degrees C did not produce any Component IV. 4. We conclude that there may be an enzyme or enzymes in cat blood which cause the conversion of gastrin 17NS to Component IV.


Mesoectodermal dysgenesis: familial iris anomaly.

A family is described with hypoplasia of the anterior iris stroma, no angle anomalies, and no glaucoma. The pedigree is suggestive of an autosomal dominant mode of inheritance. This is compared to the main peripheral malformations of the anterior chamber cleavage syndrome and other disease entities with similar iris changes. The pedigree represents a point on the continuum of mesoectodermal dysgenesis or anterior chamber cleavage syndrome.


The effect of an increase in aortic pressure upon the inotropic state of cat and dog left ventricles.

1. The effect of increased aortic pressure on the inotropic state of the left ventricle was studied in isolated cat hearts, perfused with bovine red cells in Tyrode solution, ejecting into a hydraulic model with the same input impedance as that of the cat aorta.2. Inotropic state was assessed at a controlled left ventricular end-diastolic pressure by interpolating single isovolumic beats by means of an occluder in the aortic cannula.3. When such isovolumic beats during periods of raised aortic pressure were compared with those during control periods, the difference in peak isovolumic pressure ranged from -0.3 to +0.5 kPa indicating differences in inotropic state which were small and inconsistent in direction.4. The maximum rate of rise of left ventricular pressure (dP/dt(max).) of ejecting beats was little affected by a rise of aortic pressure and the direction of changes was inconsistent.5. The effect of increased aortic pressure was studied in intact dogs after cardiac denervation; left ventricular end-diastolic pressure was uncontrolled and therefore rose to a higher steady level.6. No consistent change of dP/dt(max). was found during the period of increased aortic pressure.7. All flow and pressure variables remained steady during the period of increased aortic pressure after the higher level of left ventricular end-diastolic pressure had been established.8. These results demonstrate that neither the positive inotropic effect nor the negative inotropic effect of increased load dominates in these preparations. This may be the result of a balance between the two effects, or they may be of unimportant magnitude under physiological conditions.


The effect of 2,3-diphosphoglycerate on the oxygen dissociation curve of human haemoglobin.

1. Oxygen dissociation curves for concentrated human haemoglobin solutions (1.6 mmol dm-3 in haem) have been measured by mixing known quantities of oxy- and deoxyhaemoglobin solutions and measuring the resulting partial pressure of oxygen with an oxygen electrode. 2. Observations in the presence of 2,3-diphosphoglycerate support previous conclusions derived from experiments at low haemoglobin concentrations, the validity of which has been questioned. 3. The two affinity state model of Monod, Wyman & Changeux (1965) does not fully describe the actions of 2,3-diphosphoglycerate and a model in which this allosteric effector not only binds preferentially to the T state but also lowers the oxygen affinity of this state gives an improved fit to the data.


Vagal control of lower oesophageal sphincter motility in the cat.

1. The effects of vagal efferent fibre stimulation on the smooth muscle of the lower oesophageal sphincter have been studied on the anaesthetized animal and on the isolated and perfused organ.2. In both muscle layers (longitudinal and circular) vagal stimulation elicits two types of electromyographic (e.m.g.) potentials: (a) excitatory junction potentials (e.j.p.s) where there is a depolarization of the smooth muscle fibres. E.j.p.s can give rise to spike potentials inducing a contraction of the sphincter; (b) inhibitory junction potentials (i.j.p.s) where there is hyperpolarization of the smooth muscle fibres, often followed by a transient depolarization which may initiate spikes (post-inhibitory rebound).3. Pure i.j.p.s are observed after atropine treatment which suppresses e.j.p.s. Under these conditions, a long lasting vagal stimulation induces a long duration hyperpolarization concomitant with an opening of the lower oesophageal sphincter followed after the cessation of stimulation by a powerful rebound leading to a strong contraction which closes the sphincter.4. Several arguments, pharmacological (action of acetylcholine (ACh), atropine and hexamethonium) and physiological (threshold and latency of responses) lead to the following conclusions. Preganglionic vagal fibres are cholinergic and they activate (a) intramural excitatory cholinergic neurones; (b) intramural non-adrenergic inhibitory neurones (purinergic neurones). Preganglionic fibres leading to inhibition have a higher threshold than those leading to excitation. Both excitatory and inhibitory pathways are interconnected inside the intramural network. In particular, activation of intramural inhibitory neurones, by relaxing the oesophagus orally to the lower oesophageal sphincter, inhibits intramural excitatory neurones and subsequently blocks vagal excitatory responses.5. Two functions may be attributed to the vagal extrinsic innervation: (a) closure of the lower oesophageal sphincter by maintaining the basal tone of the sphincter; this would imply that at rest the inhibitory control is supplanted by the excitatory one; (b) sphincter opening during swallowing by suppressing the excitatory stimulus and reinforcing the inhibitory one (it may be recalled that after bilateral vagotomy, swallowing is no longer followed by a relaxation of the sphincter).


A modified Schirmer test: the fine-thread method for measuring lacrimation.

Fine cotton thread is used instead of the filter paper of the Schirmer test. One end stained with fluorescein is inserted into the lateral upper conjunctival sac for 5-30 seconds. The length of the soaked portion is measured in millimeters and the two eyes are compared with each other. One test consists of several consecutive measurements. This new method has many advantages over the conventional Schirmer test: (1) It takes less time (5-30 seconds, compared to Schirmer's method which takes five minutes); (2) It is less injurious to the eye than the stiff and rather large absorbing paper; (3) A diagnosis of lacrimal deficiency must be based on several consecutive measurements and the comparison between two eyes in each measurement (the lacrimation normally is very irregular in the same person). It is difficult to measure consecutively with filter paper; (4) The fine thread itself acts as a potent mechanical trigeminal stimulator and as absorbing agent; (5) The thread maintains a stable position in the eye, while the filter paper which hangs on the lower lid sometimes shifts out of place; (6) The fluorescein dye disappearance and dilution tests can be performed simultaneously; (7) This method can be applied to children.


Interaction between longitudinal and circular muscle in intestine of cat.

1. Slow waves recorded from isolated longitudinal muscle averaged 13 mV and had slow rate of rise (0.04 V/sec) whereas when recorded from intact segments the amplitude averaged 27 mV and the rate of rise was more rapid (0.09 V/sec), often with a notch between the initial peak and the plateau. Membrane potentials of longitudinal muscle were similar in isolated and intact preparations (- 66 mV). Resting potentials of circular muscle averaged - 67 mV.2. Small bundles of circular muscle tested in the double sucrose gap produced activity, either spontaneously or in response to stimulation, which fell into three categories: fast spikes (50-200 msec duration), slow spikes (1-5 sec duration), and small graded responses. The duration of fast spikes could be increased severalfold by the addition of TEA; the graded responses were converted to full-sized spikes by TEA.3. Treatment of circular muscle with Ca-free Krebs solution eliminated spikes, and in intact preparations reduced the amplitude and rate of rise of slow waves and eliminated the notch on slow waves.4. Current-voltage curves of longitudinal muscle show delayed rectification in the depolarizing quadrant; similar curves of circular muscle show anomalous rectification, i.e. a region where a very small current causes a large voltage change.5. Non-polarized electrotonic coupling between longitudinal and circular layers indicates low-resistance pathways. Apparent space constants of longitudinal muscle are greater when attached to circular muscle than when isolated.6. It is concluded that small slow potentials originate rhythmically in longitudinal muscle, that these spread passively to circular muscle where a regenerative amplification occurs which depends on Ca conductance and the amplified slow waves spread back to the longitudinal layer. In the intact intestine pacemaking is, therefore, separate from propagation and the circular muscle provides the bulk of depolarizing current for propagation.


Non-equivalence of impulse blockade and denervation in the production of membrane changes in rat skeletal muscle.

1. A complete and long lasting blockade of nerve impulses was established in the sciatic nerve of rats, by implanting silastic cuffs of critical internal diameters. Either marcaine-impregnated or plain cuffs were used. The contralateral sciatic nerve was sectioned. 2. At various days after the initial procedures, the extensor digitorum longus muscles of the two sides were examined with intracellular electrodes. 3. Decrease in resting membrane potential, fibrillatory activity and resistance of the action potential to tetrodotoxin developed not only in the denervated but also in the impulse-blocked muscles. In the latter, the fibres were normally innervated since they displayed miniature end-plate potentials and were excitable by nerve stimulation distal to the blocking cuff. 4. However, all of the above mentioned denervation-like changes were significantly less pronounced in the blocked muscles than in the denervated ones. 5. It is concluded that in addition to loss of nerve impulses, some other neural factor must be taken into account to explain the origin of muscle changes induced by denervation. The possible relation of this additional factor with nerve degeneration is discussed.


Hallermann-Streiff-Francois syndrome.

This is a typical case of Hallermann-Streiff-Francois Syndrome in which the glaucomatous complication may be caused by developmental malformations in the anterior segment of the eye. Bilateral trabeculectomy succeeded in controlling the tension after a follow-up of two years. Glaucomatous complication seems to be frequent and as important as the other described cardinal symptoms. The histologic examination of the skin confirmed the atrophic changes that were observed clinically.


Cell replacement and changing transport function in the neonatal pig colon.

1. Measurements of intracellular methionine concentration in pig colon, following in vitro incubation in methionine containine medium, have been carried out during the first 10 days of post-natal life. 2. The new-born pig colon concentrates methionine within its mucosa. Autoradiography of 3H-labelled phenylalanine shows it to be accumulated to greatest extent in cells located in the surface epithelium. 3. The ability of the colonic mucosa to concentrate methionine disappears during the first few days of post-natal life. 4. Radioactive thymidine, injected at birth, shows cell mitosis to be confined to the lower third of each colonic crypt. Labelled cells later migrate out of the crypts on to the surface epithelium. The cell replacement time is 105 h. 5. The time course for the fall in the ability of the pig colon to actively accumulate methionine corresponds to that predicted if cells synthesized from birth were unable to transport this amino acid. 6. The ability of the new-born pig colon to transport amino acids, though transient, may be physiologically important. The nature of the signal which changes the physiological function of cells synthesized post-natally remains to be determined.


Retinal involvement in tuberous sclerosis.

In two infants hospitalized at the ages of three and one-half months and 11 months because of epileptic seizures, the diagnosis of tuberous sclerosis was reached upon the basis of retinal astrocytomas found in the fundus examination. It is recommended that indirect ophthalmoscopy be performed in all infants and young children referred with signs possibly related to this disease.


Site of intestinal dipeptide hydrolysis.

1. Sacs of everted small intestine of the hamster have been used to study the site of final hydrolysis of twelve dipeptides. 2. The results suggest that L-alanyl-glycine, glycyl-glycine, L-valyl-L-valine, L-alanyl-L-valine, L-valyl-L-alanine and L-prolyl-glycine are hydrolysed beyond the locus of the active transport mechanism for D-glucose, perhaps even within the cell. These may be designated class 1 (deep) dipeptides. 3. In contrast, superficial (perhaps even surface) hydrolysis seems to occur with L-alanyl-L-alanine, L-leucly-L-leucine, glycyl-L-alanine, L-alanyl-L-leucine, L-leucyl-L-alanine and glycyl-L-proline. These may be designated class 2 (superficial) dipeptides. 4. All the dipeptides were able to partially inhibit D-glucose active transport, the findings supporting the view that more than one mechanism may exist for the active absorption of the sugar.


Comparison of chloride concentration and osmolality in proximal tubular fluid, peritubular capillary plasma and systemic plasma in the rat.

1. Chloride concentration and osmolalities were compared in consecutively collected samples of proximal tubular fluid, peritubular capillary plasma and systemic plasma. 2. Mean chloride concentrations (m-mole/l) were 141.3+/-2.6 in tubular fluid, 114.8+/-1.7 in peritubular capillary plasma and 119.4+/-1.8 in systemic plasma. 3. Mean osmolalities (m-osmole/kg H2O) were 297+/-2.2 in tubular fluid, 293+/-2.4 in peritubular capillary plasma and 299+/-1.8 in systemic plasma. 4. These differences are discussed in relation to the anatomical and functional organization of the peritubular capillaries and renal tubules.


The contribution of excitatory and inhibitory inputs to the length preference of hypercomplex cells in layers II and III of the cat's striate cortex.

1. The GABA antagonist bicuculline has been applied to hypercomplex cells in layers II and III of the cat's striate cortex in an attempt to test the hypothesis that their length preference derives from the action of a GABA mediated post-synaptic inhibitory input.2. Iontophoretic application of bicuculline to these cells resulted in a reduction but not an elimination of the length preference. The reduction in length preference was only observed in the case of slits extended to one side of the receptive field or to slits only partially covering what appeared to be inhibitory flanking regions either side of the field centre. In cells normally showing a clear and stable length preference it was never possible to produce by the application of bicuculline a significant response to a slit fully extended to cover both flanking regions.3. The orientation tuning was basically eliminated by the application of bicuculline. In contrast the directional specificity was relatively unaffected.4. The action of bicuculline on hypercomplex cell orientation tuning supports the view that GABA mediated inhibitory inputs were effectively blocked and suggests that the partial effect on length preference and lack of effect on directional specificity reflect the varying degree of involvement of a GABA mediated inhibitory input to these receptive field properties.5. These observations introduce the possibility that the excitatory input to the superficial layer hypercomplex cells exhibits directional specificity, length preference with respect to a slit extended to both sides of the field and a low degree of orientation selectivity. Evidence is presented indicating that certain layer V cells with hypercomplex type receptive field properties exhibit some of the characteristics required of this input.


The spatial extent of excitatory and inhibitory zones in the receptive field of superficial layer hypercomplex cells.

1. An investigation has been made of the extent of inhibitory and excitatory components in the receptive field of superficial layer hypercomplex cells in the cat's striate cortex and the relation of the components to the length preference exhibited by these cells.2. Maximal responses were produced by an optimal length stimulus moving through a restricted region of the receptive field. The length of this receptive field region was less than the total length of the excitatory zone as mapped with a very short slit. Slits of similar length to the excitatory zone produced a smaller response than an optimal length slit.3. An increase of slit length so that it passed over receptive field regions either side of the excitatory zone resulted in an elimination of the response. When background discharge levels were increased by the iontophoretic application of D, L-homocysteic acid slits of this length were observed to produce a suppression of the resting discharge as they passed over the receptive field. They did not modify the resting discharge level when it was induced by the iontophoretic application of the GABA antagonist bicuculline. This data is taken to indicate that long slits activate a powerful post-synaptic inhibitory input to the cell.4. Maximal inhibitory effects were only observed if the testing slit passed over the receptive field centre. That is slits with a gap positioned midway along their length so as to exclude the optimal excitatory response region surprisingly tended to produce excitatory effects rather than the expected inhibitory effects. It appears that simultaneous stimulation of the receptive field centre is a precondition for the inhibitory effect of stimulation of regions either side of the excitatory zone to be activated.5. It is suggested that the interneurones mediating the inhibitory input to the superficial layer hypercomplex cells are driven both by cells in adjacent hypercolumns with receptive fields spatially displaced to either side of the excitatory zone and by cells in the same column, optimal inhibitory effects only being achieved when both sets of input to the interneurone are activated.


Anaerobic and aerobic metabolism in articular cartilage.

Articular cartilage explants were incubated at various oxygen tensions and the results of 35SO4 and 3H-thymidine incorporation indicate that proteoglycan and DNA synthesis is depressed at low oxygen tensions. The studies of oxygen consumption and glucose/lactate metabolism in the cartilage suggest a shift in energy pathways as the oxygen environment is altered. In low O2 tensions chondrocytes follow anaerobic glycolysis while at physiologic oxygen tensions chondrocytes follow a combination of both aerobic and glycolytic metabolism. The data suggest that hypoxia, frequently found in inflammatory arthritides, would have deleterious effects on chondrocyte metabolism and would significantly impair any reparative potential of the injured chondrocytes.


The effect of age on glycosaminoglycan synthesis in rabbit articular and costal cartilages.

The rates of synthesis of chondroitin 4- and 6-sulfate were compared for articular and costal cartilage from rabbits of three different ages. Cartilages were labeled in vitro with 3H glucosamine and 35SO4. The glycosaminoglycans were isolated and separated and assayed for radioactivity and uronic acid content. The data obtained showed that in immature articular cartilage the rate of synthesis of chondroitin 4-sulfate is considerably greater than for chondroitin 6-sulfate and that this condition is reversed as the animal ages. These results are concordant with the known variation in distribution of the glycosaminoglycans with age and suggest that the chondrocyte alters its synthetic activity with advancing age.


Glomerular deposition of renal tubular epithelial antigen in patients with systemic lupus erythematosus: its possible role in lupus nephritis.

Fifty-three renal specimens from 48 patients with SLE were examined for the presence of RTE in the glomeruli. Glomerular RTE, presumably in immune complex form was detected in 60% of the tissues. The deposition of these complexes was related to the severity of histologic changes and activity of SLE. In addition, glomerular localization of RTE was associated with decreased renal function and increased proteinuria. The association between the presence of glomerular RTE antigen, the severity of renal histologic changes and the decreased renal function suggested a possible role for this antigen in the pathogenesis of lupus nephritis.


Inhibition of adjuvant arthritis in the rat by an oxonate diet: sequential studies.

To study the mechanism by which oxonate-induced hyperuricemia inhibits the development of adjuvant arthritis in the rat, we initiated blocking or releasing experiments by changing the oxonate diet of rats at selected times. We were able to define oxonate dietary effects on four specific periods in the development of this experimental arthritis. The inhibition of the primary inflammation at the site of the injection was weak. The inhibition of the secondary reaction was greater than the decrease of the primary inflammation and was more effective when the first two periods (sensitization to antigen and production of immunocompetent cells) were blocked. The reduction in the disease was more marked in the non-injected paw than in the injected paw. Thus, the effect of the oxonate diet is more immunosuppressive than anti-inflammatory. Release of the first period, which provoked an unexpected increase in the severity of the disease, suggests a possible influence of oxonate on pyrimidine metabolism.


Cellular immune reactivity in patients with rheumatoid arthritis and effects of levamisole.

Cellular immune reactivity was examined in control subjects and in 16 patients with rheumatoid arthritis before and after administration of levamisole. Prior to levamisole treatment, this population of patients with rheumatoid arthritis had diminished cellular immunity as measured by skin test reactivity, lymphocyte stimulation by antigen and by PHA, lymphocyte count and percentage and absolute numbers of long-incubation rosette-forming cells (RFC). Administration of levamisole caused enhancement of skin test reactivity and flares at dinitrochlorobenzene (DNCB) test sites which were not paralleled by an increase in lymphocyte stimulation by the same antigens in vitro or enhancement in the PHA response. The increase in lymphocyte count and RFC was borderline (p = .06). Of the 16 patients who received levamisole for three months, nine patients showed at least one physical sign of improvement, five patients remained unchanged, and two patients experienced progression of their disease.


Serum ferritin levels in anemia of rheumatoid arthritis.

Thirty-five anemic patients with rheumatoid arthritis were studied to determine the relationship between serum ferritin levels and body iron status, as assessed by the grading of bone marrow iron stores. The incidence of greatly reduced or absent marrow iron stores was 60%. Peripheral blood smear, RBC indices, serum iron, and iron binding capacity correlated poorly with stainable marrow iron. Serum ferritin levels only correlated approximately with iron stores, and in iron deficient rheumatoid patients the levels were higher than would be expected in patients with uncomplicated iron deficiency. The study shows that reduced marrow iron stores is common in patients with rheumatoid arthritis, and that the serum ferritin concentration may provide a useful indication of reduced body iron stores in these subjects, but only if a range of normal values can be established for this disease.


Histocompatibility antigens in progressive systemic sclerosis (scleroderma).

A study was undertaken to determine the distribution of major histocompatibility (HLA) antigens in progressive systemic sclerosis (PSS) (scleroderma). A total of 106 patients with PSS and 208 normal controls were tested for the presence of 18 different HLA antigens by the microcytotoxicity technique. These patients were equally divided between patients with classical diffuse scleroderma (53 patients) and those with the CREST syndrome variant of the disease (53 patients). When the P values were multiplied by 18, to correct for the number of antigens studied, no significant alteration in the frequency of any HLA antigen was found for the entire group of scleroderma patients or for either of the two subpopulations.


Histocompatibility antigens in vertebral ankylosing hyperostosis.

All known A, B, and C HLA antigens were determined in 50 white patients with vertebral ankylosing hyperostosis. A statistically significant decrease was found for the A9 and A11 specificities. Only three (6%) of the patients possessed the B27 antigen, a frequency which is not different from that of a control population. B27 therefore does not seem to be linked to abundant new bone formation.


Polymyalgia rheumatica and temporal arteritis in blacks--clinical features and HLA typing.

Reports of polymyalgia rheumatica and temporal arteritis in blacks are rare. We analyzed five cases of polymyalgia rheumatica and one case of temporal arteritis appearing in blacks. Polymyalgia rheumatica and temporal arteritis in blacks have the same presentation, course, and response to treatment as in Caucasians. A previously unrecorded case of polymyalgia rheumatica and biopsy-proven temporal arteritis in a black had a similar presentation and course as cases in whites. HLA typing of five cases of polymyalgia rheumatica in blacks revealed an increased incidence of AW30 and BW16 in comparison to whites and polymyalgia.


Artificial insemination with the husband's semen after the husband's death.

Artificial insemination using the husband's semen (AIH) has always seemed more acceptable than the same procedure using donor semen. However, the layman may not even have thought of the legal problems or the moral dilemma if in fact a woman is inseminated using her husband's frozen semen after his death. In the USA there are already sperm banks set up by private individuals, generally for the use of those marriage partners when the husband has had a vasectomy and afterwards a child is desired. If such private sperm banks were set up in Britain complex legal problems would follow, quite apart from the moral issue as to whether it was desirable to bring a child into the world deliberately having deprived him of a father from the start. These are the issues which Mr Cusine thinks should be carefully considered before doctors, lawyers and the women potentially concerned are confronted with a new dilemma.


Gifts, exchanges and the political economy of health care. Part I: should blood be bought and sold?

Should blood be bought and sold is in crude terms the question asked and answered by Richard Titmuss in his recent book The Gift Relationship. Dr Raymond Plant, a lecturer in philosophy at Manchester University, analyses Titmuss' arguments in a paper which we are printing in two parts. Titmuss has taken the provision of blood as his example of the gift relationship--and by extension that of health care generally. Dr Plant considers in turn each of Titmuss' arguments that blood should not be a marketable commodity, the moral objections to which seem to be the erosion of freedom and of truth telling, the separation of society through the cash nexus, and its converse that the provision of health care is a means for the integration of society. Dr Plant also examines the views of other commentators on the Titmuss' theory of the value of a 'free' blood transfusion service and other medical care as a means of integration in society, and ends with his promise that in the second part of his paper he will examine Titmuss' principles not in terms of the market but rather as related to the principle of social justice.


Privacy, confidentiality and automated health information systems.

Professor Vuori's paper, first presented at the fourth Medico-legal Conference in Prague in the spring of this year, deals with the problem of the maintenance of confidentiality in computerized health records. Although more and more information is required, the hardware of the computer systems is so sophisticated that it would be very expensive indeed to 'break in' and steal from a modern data bank. Those concerned with programming computers are becoming more aware of their responsibilities concerning confidentiality and privacy, to the extent that a legal code of ethics for programmers is being formulated. They are also aware that the most sensitive of all relationships--the doctor-patient relationship--could be in danger if they failed to maintain high standards of integrity. An area of danger is where administrative boundaries between systems must be crossed--say between those of health and employment. Protection of privacy must be ensured by releasing full information about the type of data being stored, and by maintaining democratic control over the establishment of information systems.


The teaching of medical ethics at Southampton University Medical School.

For centuries medical schools in Britain and elsewhere had a fairly static curriculum based on what might be called the 'three Rs' of medicine, and consequently had to make room for new subjects as the need arose in a fashion which was sometimes makeshift. However, Southampton University has only had a medical school for six years, and therefore their course on medical ethics and legal medicine was carefully integrated into the curriculum after some preliminary experiments carried out by a subcommittee which is continually reviewing the situation. Medical ethics has now a definite place in the fourth year, preceded by an introduction to ethical problems encountered in medicine in the first year. Not only do members of the medical faculty participate in this teaching but also members of the faculties of law and the arts.


Recurrence risks in complex inheritance with special regard to pyloric stenosis.

A large body of data on segregating families is used to generate specific recurrence risks conditional on sex and birth order for the best-fitting model of polygenes plus maternal effect. The method is general for diseases of complex inheritance, and lies within the competence of any serious genetic clinic. The question of whether consultees demand as much specificity should be subordinate to the question of whether counsellors are justified in providing less.


Genetics of Möbius syndrome.

A study of the sibs and parents of 15 children diagnosed as having the Möbius syndrome suggests that the inclusion of primary skeletal defects as obligatory in the diagnosis of the syndrome helps to exclude the high risk monogenic disorders of muscle and anterior horn cell, which present with a Möbius-like facies in infancy.


Endocrine abnormalities and myopathy in Bloom's syndrome.

Abnormal endocrine indices and myopathy have been variably present in two brothers with Bloom's syndrome (congenital teleangiectatic erythema, hypersensitivity to light, and growth retardation). These consisted of: (1) growth retardation with height and weight below the third centiles; in the younger one at age 14, hypoglycaemia failed to elicit a rise in growth hormone but did so in the older one at age 17; (2) serum TSH was raised in the older one in whom serum FSH and LH were also above the normal range; and (3) myopathy characterised by pronounced dilatation of the sarcoplasmic reticulum was present in the younger one; distinct reduction of muscle strength was shown in his older brother with ultrastructural alteration of skeletal muscle of unknown significance.


Haemoglobin Porto Alegre in a Cuban family.

During a screening programme for abnormal haemoglobins in Habana, one case of Hb Porto Alegre was found in 23 000 cases analysed. The ability of this variant to polymerise in vitro and the absence of clinical features in the carriers have been confirmed. These observations are now explained by the findings of high levels of glutathione in the red cells of subjects heterozygous for Hb Porto Alegre: it is suggested that the increase of glutathione is responsible for the absence of in vivo polymerisation and accounts for the lack of clinical symptoms.


Congenital, hypotonic-sclerotic muscular dystrophy.

Four cases of congenital, hypotonic-sclerotic muscular dystrophy are presented. The patients showed clinically prominent features described by Ullrich, i.e. congenital muscle weakness, hypotonia, and hyperextensibility of distal joints, contractures of proximal joints, high-arched palate, hyperhidrosis, posterior protrusion of calcaneus, and no progression. Muscle biopsies revealed dystrophic changes. Ullrich suggested that this condition was a new entity, but the disease has received little attention. In the present cases superior intelligence and tendency to recurrent upper respiratory tract infections were stressed as characteristics of this disorder. Insufficient cellular immunity was suspected and this may contribute to the recurrent upper respiratory tract infections and pneumonia often observed. This disease is considered a distinct entity of multisystemic involvement inherited as an autosomal recessive trait.


Partial deletion of long arm of chromosome 11[del(11)(q23)]: Jacobsen syndrome. Two new cases and review of the clinical findings.

Two cases, a boy and a girl, with the 11q-(Jacobsen) syndrome are reported. Findings common to both and typical for this chromosome aberration include a narrow protruding forehead, hypertelorism, non-horizontal position of the eyes, ptosis, strabismus, broad root, and short upturned tip of thenose, carp mouth, receding chin, misshapen ears, simian creases, and severe mental retardation. In addition, one patient had pyloric stenosis and an inguinal hernia. Growth retardation and microcephaly were not found in either of them. The karyotypes revealed de novo-deletions of the long arm of one chromosome 11,del(11)(q23).


Supernumerary small ring chromosome.

A supernumerary small ring chromosome was found in 30% of cultured peripheral leucocytes and 50% of skin fibroblasts in a 6-year-old boy with mild mental retardation and midline cleft palate. The extra chromosome appeared to carry a densely staining region on Giemsa banding. The banding patterns of the remaining 46 chromosomes were normal. C banding indicated that the ring chromosome contained mainly centromeric constitutive heterochromatin. Chromosome analysis of both parents showed normal karyotypes by both conventional and banding techniques; thus the origin of the ring chromosome could not be determined.


Ring chromosome 8 in a boy with multiple congenital abnormalities and mental retardation.

A ring chromosome 8 was found in peripheral blood cells in a boy, whose chromosomes were studied because of multiple congenital anomalies. Examination of skin cells revealed a 46,XY/46,XY,8r pattern. Application of several banding techniques suggested a duplication of the most distal bands of both arms in the ring. The terminal end of 8q appeared to have been retained as could be shown by R-banding. The anaesthesia and surgery the mother underwent in the first month of her pregnancy is considered as a possible cause  of the chromosome abnormality.


An interstitial deletion of chromosome 9 in a girl with multiple congenital anomalies.

An infant with peculiar facies, coloboma of both eyes, and developmental retardation was found to have d de novo interstitial deletion of the secondary constriction and some adjacent euchromatin on one of her No. 9 chromosomes, del(9)(q11q21). Since studies on duplications, variants, and the molecular composition of the secondary constriction suggest that it contributes little if any information necessary to normal development, deletion of the euchromatin alone is most probably responsible for the clinical findings.


Partial trisomy 8 (trisomy 8q2106 leads to 8qter).

A case of trisomy for part of the long arm of chromosome 8, confirmed by G-banding analysis, in a white male infant is described. The mother carried a reciprocal translocation between chromosome 8 and chromosome 13 (46,XX,t(8;13),(q21:q34). The patient had inherited the translocated chromosome 13 and was thus trisomic for the distal half of the long arm of chromosome 8. He had many of the clinical features of the full trisomy 8 syndrome. As compared with previously reported cases with trisomy of the distal end of chromosome 8, he was more dysmorphic and showed greater developmental retardation.


Absence of distal interphalangeal fold causing difficulty in extending fingers.

A 13-year-old girl sought medical advice, saying that for two years it had been increasingly difficult for her to extend her little finger. An examination revealed that all her fingers, with the exception of her thumbs, had no interphalangeal fold. Her mother had less pronounced signs of the same type. This abnormality seemed to be the result of an autosomal gene with dominant transmission.


Case report: an attendant-administered contingency management programme for the treatment of a toileting phobia.

A fifteen-year-old mentally retarded child, institutionalised for eleven years, displayed an intense fear of urinating in a toilet. As a result, he wet his pants at a frequent rate. In an attempt to eliminate this fear a variety of response-contingent consequences were programed (token reinforcement, social reinforcement, time-out). The effects of introducing structured contingencies resulted in a steady reduction in the frequency of pants wettings. During a follow-up phase of evaluation, when programmed contingencies were discontinued, the problem behaviour had been completely eliminated. At that time the child was initiating his own bathroom visits and toileting himself in an appropriate manner.


A comparison of three intelligence tests for the assessment of mental retardation.

Thirty-six mentally retarded adolescents were administered the Wechsler Intelligence Scale for Children (WISC), the Peabody Picture Vocabulary Test (PPVT), and the Slosson Intelligence Test (SIT) to determine reliability and comparable performance among the three intelligence tests. Correlations as a function of IQ and MA, by sex, were computed among the three tests. All were significant (p less than .01), but the WISC and SIT had consistently higher relationships than any other comparisons on both IQ and MA. Analyses also indicated that the PPVT produced higher IQ scores than the WISC or SIT and that MA in the PPVT was influenced by the previous administration of the SIT. It was concluded that, as a screening device, the SIT is more reliable and approximates WISC scores more consistently than the PPVT.


Interchromosomal duplication for the short arm of chromosome no. 9: report of three cases due to a familial translocation t(9; 11) and one case with a de novo 47, XX, +9p karyotype.

Four cases of the 9p duplication syndrome are described. Three affected sibs resulted from a maternal t(9;11) translocation and have a duplication of the segment 9p13 leads to 9pter. They have the typical facies, hands and other features of the syndrome but are relatively mildly retarded. The fourth case has a de novo duplication of the short arm of chromosome 9. Her features are also typical although she is more retarded, particularly in expressive speech, than the other three individuals and had club feet. These observations further confirm the distinctive clinical features of this type of duplication, and support previous suggestions that the severity is roughly correlated with the length of the duplicated segment.


Acute epiglottitis - 25 years' experience in management, The Montreal Children's Hospital.

Acute epiglottitis is the most treacherous inflammatory process that can affect the respiratory tract. It can be a cause of sudden death in children. The clinical features of this entity are reviewed and our experience with its management at The Montreal Children's Hospital during the past 25 years is presented. The establishment of a "secure" airway by tracheostomy and in recent years, by nasotracheal intubation has decreased to practically nil the mortality of children who arrive alive at this hospital with acute epiglottitis.


Newborn infant hearing screening - a five year pilot project.

The criteria for screening infants' hearing in the newborn nursery are reviewed. The problems encountered are discussed and a screening program outlined. Over 12,000 newborn infants were screened for hearing over a five year period and a total of eight were confirmed deaf - an incidence of one in 1,500 live births.


Acute epiglottitis in children - the morbidity of management by elective tracheostomy.

Acute epiglottitis is a pediatric airway emergency. No deaths occurred in 61 cases treated by elective tracheostomy at The Montreal Children's Hospital between 1966 and 1974. Seven patients (11.5%) showed evidence of aspiration pneumonia prior to tracheostomy and seven others developed pulmonary atelectasis in the first 24 hours following tracheostomy but only 9.8% of the total had a complication which continued in evidence 24 hours following surgery. A further 19.5% developed further complications unrelated to this earlier morbidity prior to discharge from hospital. The mean cannulation time was seven days and the mean hospital stay was nine days. Of these patients, 32 (52.4%) were seen between a year and seven-and-a-half years later. Twenty were completely asymptomatic with a small, neat scar. Twelve patients had experienced some upper respiratory problem or minor problems related to the tracheostomy incision.


Facial palsy and regional trauma.

A 28 year old female with Melkersson-Rosenthal syndrome developed an acute, peripheral facial paralysis following mucosal biopsy of the ipsilateral upper lip. The sole, previous facial palsy had occurred 24 years earlier. Immunological and virological studies were non-contributory. The occurrence of facial palsy secondary to regional trauma is briefly reviewed, and the possible influence of autonomic dysfunction discussed.


A method of percutaneous laryngeal electromyography.

A method of percutaneous laryngeal electromyography is described. The technique is simple, safe and it allows a sampling of muscles within the superior laryngeal and recurrent laryngeal territories. The procedure can be performed on an out-patient basis in a conventional electromyography laboratory, and complications have not been encountered.


Laryngeal electromyography - techniques, applications, and a review of personal experience.

The techniques and observations of earlier authors on laryngeal electromyography are briefly reviewed. Our personal experience with the use of a percutaneous method in a series of 27 patients is described and discussed. The percutaneous technique is a simple, safe method and permits the examination to be performed on a routine out-patient basis. The presence of denervation, the degree of paralysis, evidence of recovery, can be readily obtained and this permits a more accurate assessment and prognosis to be made.


[Comparison between two current methods of surgical treatment for otosclerosis].

Statistical comparison is established between two methods of stapedectomy, the first one being the "Teflon-interposition", the second being Schuknecht's method (gelfoam and preformed wire). There is statistical evidence that the Teflon-interposition method is better. The results are also compared with those of other workers.


Correlations between ultrastructural findings and electrocochleographic recordings in experimental aminoside intoxication.

Correlations are made between the electrocochleographic aspects and the ultrastructural findings in 60 guinea pigs intoxicated with either Gentamycin or Tobramycin. Small cochlear lesions are studied in order to identify the electrical aspect corresponding to the earliest anatomical cell alterations. The wave shape seems to be more important than the classical input-output functions as first signs of the inability of the organ of Corti to clear the aminoside antibiotics. The reversal of N1 and N2 and later the accentuation of P1, frequently correspond to early signs of cell intoxication such as disruption of the regular arrangement of the endoplasmic reticulum and proliferation of lysosomes. A similar situation may obtain in humans intoxicated with aminosides.


Basic medical implications of scuba diving.

The rapid growth of scuba diving as a sport and the vast expansion of underwater exploration for energy has made it necessary for all physicians to become familiar with diving emergencies. The basic principles of scuba diving and related clinical implications are outlined to provide a more meaningful understanding of problems which may affect a diver.


Suppressing effects of purified eosinophils derived from guinea pigs sensitized with Ascaris antigen on lymphocyte-blastformation.

Highly purified eosinophil (EOS) fractions were obtained from peritoneal exudate cells of guinea pigs immunized with with Ascaris lumbricoides suum antigen (Asc). These Eos suppressed the in vitro DNA synthesis of the lymph node cells (LNC) sensitized with Asc and then activated by this antigen or phytohemagglutinin (PHA). Although addition of Eos did not effect the viability of LNC in vitro, the blastformation of LNC was suppressed remarkably when 5-10 X 10(5) purified Eos were added to 10(6) LNC within 48 hr after the start of stimulation by Asc. The suppressive effects of Eos on the blastformation of LNC immunized with complete Freund's adjuvant with or without ovalbumin were observed when stimulated with purified protein derivates or ovalbumin. Such suppression were observed beyond the barrier of animal strain specificity; Eos from Hartley guinea pigs suppressed proliferation of LNC from either strain 13 or strain 2, and Eos from strain 13 suppressed that from strain 2. Such suppressing activity of Eos was reduced by heating them at 56 C for 1 hr or by sonication.


Comparison of physical characteristics, body temperature and basal metabolism between Thai and Japanese in a neutral temperature zone.

The aim of this research is to compare the physical status, basal metabolism and some other physiological characteristics between native Thai in Bangkok, Thailand, and native Japanese in Japan, and discuss the results regarding acclimatization to tropical climate. Measurements of the Thai were made in September in Bangkok, while those of native Japanese were done in August at Nishinomiya (Japan). The subjects were adult males (20-22 years old) in both cases. Physically the Thai are generally a little shorter and more slender than Japanese in the mean value. The mean skinfold thickness for Thai was 8.4 mm, which is significantly less than that of Japanese (11.0 mm). The mean oral temperature measured under basal conditions was the same between both subject groups. The Thai showed a slightly lower basal metabolism per unit body surface, and mean skin temperature measured in a similar environmental condition was lower for Thai than for Japanese. The results of anthropometric measurements and physiological characteristics measured were discussed in view of physiology of acclimatization ot tropical climate.


Electrical potentials of the subtectorial space in the guinea pig cochlea.

Precipitation of cobalt ions and iontophoretic marking by Alcian Blue were utilized in examination of physiological properties of the subtectorial space in the guinea pig cochlea. Cobalt ions injected into the scala media were sulfurated and observed as a black precipitation in cross sections. Precipitation was seen on the upper and the lower surface of the tectorial membrane, and on the reticular membrane. Alcian Blue was the most suitable dye for marking in the organ of Corti. Recording sites of potentials in the subtectorial space were identified by Alcian Blue marking. The potentials were similar to those measured in the scala media. These facts verify that the subtectorial space communicates with the scala media through the outermost margin of the tectorial membrane. Thus the sensory hairs of hair cells are bathed in the endolymph of high potassium concentration, and the condition for optimum sensitivity of their receptor function is maintained.


Mobilization of cellular calcium and contraction-relaxation of vascular smooth muscle.

In order to clarify the Ca2+ mediated regulatory mechanism of vascular smooth muscle, the correlation between Ca2+ movements in the cell and mechanical response was investigated using isolated rat aorta and bovine basilar artery. K+ induced contraction of vascular smooth muscle required Ca2+ in the medium, and the contraction was always associated with a large increase in Ca2+ influx. In the absence of external Ca2+, norepinephrine (NE) or serotonin (5HT) induced rapid contraction of the aorta and basilar artery, respectively. Caffeine (20 mM) also induced tension in the absence of Ca2+. The results obtained in these experiments suggest that at least four kinds of calcium exist in bound from in the cell, i. e., (1) loosely and (2) tightly bound calcium on the external surface of the cell membrane, (3) calcium localized in the internal surface of the cell membrane and (4) calcium stored in the intracellular store site, such as the sarcoplasmic reticulum. The intracellulary stored calcium, both (3) and (4), which can be mobilized by the action of certain drugs (NE, 5HT or caffeine), probably plays an important role for the regulation of the mechanical activity of vascular smooth muscle.


Cardiac arrhythmia induced by electrical stimulation of the fastigial nucleus in cats.

Electrical stimulation of the fastigial nucleus produced a pressor response with cardiac arrhythmia in cats. The arrhythmic response was abolished by tetrodotoxin (3 microgram/kg, i.v.), atropine (0.5 mg/kg, i.v.) or vagotomy, and suppressed slightly by propranolol or verapamil (0.5-1.0 mg/kg, i.v.). It was not abolished by the carotid sinus nerve section. The effects of the drug suggest that arrhythmia seems to be due to an interplay of sympathetic and parasympathetic influences with the latter effect predominating. The pressor and arrhythmic response to stimulation of the fastigial nucleus was increased by stimulation, and decreased by lesion of the posterior hypothalamus, indicating that some connection between the two structures exists.


The effect of Na, K and Cl ions on the resting membrane potential of sino-atrial node cell of the rabbit.

The resting membrane potential of S-A node cell was investigated by observing the response of the membrane potential to change in [K+]O or [Cl-]O under the presence or absence of Na ion. The slope of the change in membrane potential per decade change in [K+]O increased from 12.3 to 44 mV by removal of Na ion from the external medium, suggesting an extensive contribution of Na ion to the resting membrane potential. To determine the relative conductance between Na and K ions, Cl ion in Tyrode solution was substituted with SCN ion, which is 2.1 times more permeable than Cl ion, in order to eliminate the contribution of Cl concentration cell to the resting membrane potential. The contribution of the Cl ion to the resting membrane potential could be examined only in Na-free medium. Acetate ion has been reported to be 0.5 times less permeable than Cl ion. The replacement of Cl ion by acetate ion in various proportions caused a transient depolarization. The slope of this transient depolarization per decade change of [Cl-]O between 10 to 100 mM was determined to be -6.8mV. Under the assumption that the resting membrane potential could be determined by the parallel concnetration cells for Na, K and Cl, relative conductance ratio between K, Na and Cl was calculated to be 1:0.58:0.15.


Effects of norepinephrine on uptake and oxidation of plasma free fatty acids in cold-acclimated rats.

In order to know the mode of action of norepinephrine in enhanced utilization of plasma free fatty acids (FFA) in cold acclimation, albumin-bound 14C-palmitate was infused intravenously at a constant rate into cold- and warm-acclimated rats under pentobarbital anesthesia with and without norepinephrine infusion. Rectal temperature, CO2 output and plasma FFA, from which the rates of FFA uptake and oxidation were calculated, were determined simultaneously. Similar fractions, that is, 7 and 5% of the total uptake of plasma FFA by the tissue were immediately oxidized in both cold- and warm-acclimated rats, respectively. Norepinephrine infusion caused a significant increase in all the parameters examined. In addition, during hormone infusion the percentage of FFA uptake oxidized was elevated from 22% in control to 50% in cold-acclimated rats. This increment was accompanied with greater increases in rectal temperature and CO2 output. Similarly, in functionally eviscerated cold-acclimated rats, norepinephrine induced a greater increase in the percentage of FFA uptake oxidized than in eviscerated controls. These results indicate that although the FFA uptake was increased simultaneously norepinephrine infusion casued a more marked acceleration of the oxidation of plasma FFA in the cold-acclimated rats than in control rats.


Properties of excitable sites in the squid axon membrane as revealed by use of chemical stimulants and a spectrum analyzer.

Properties of the excitable sites in the squid axon membrane were studied by using various chemical stimulants and a real-time spectrum analyzer. Intact squid axons immersed in media with a reduced divalent cation concentration develop very small electric responses (1-30 micronV in amplitude) which repeat at more-or-less regular intervals. The frequency of repetition of these miniature responses falls when the temperature of the axon is lowered. Replacement of a small fraction of the external Na-ion with K-ion is a powerful means of generating miniature responses. Passage of an outwardly directed current through the axonal membrane also evokes miniature responses. This effect of an electric current is attributed to a transport of intracellular K-ion into the axonal membrane. The results of the effects of external application of the salts of Li-, Rb- and Cs-ion indicate that the ability of alkali metal ions to induce miniature response falls in the following order: K, Rb is greater than Cs is greater than Na is greater than Li.


[Acute and chronic influences of transection of extrinsic nerves on extension of the strip of dog's stomach (author's transl)].

25 adult dogs for acute experiments and 15 for chronic experiments in 3 months after transection of extrinsic nerves were employed under Nembutal anesthesia. The strip preparation which had been made on gastric corpus and had maintained innervation and blood supply was stretched by means of a poise load of 10 g, 20 g and 30g every 1 minute. The length of extension of strip was measured at an interval of 10 seconds till 1 minute at every load. On the rate of extension, the load/length of extension and the length of extension/time were investigated. The length of extension had a tendency to become shorter and its slope descended slowly after vagotomy or splanchnicotomy compared to the intact one. These facts were obtained on both acute and chronic experiments. It may be concluded that the transection of both extrinsic nerves supplied to the stomach produced the elevation of intragastric pressure.


[The motility of the lower esophageal sphincter (author's transl)].

Changes in lower esophageal sphincter (LES) motility have been mainly studied by intraluminal manometry. However, it is not suitable for continuous measurement of LES pressure. With extraluminal force transducers developed and constracted in our laboratory, we measured changes in contractile activity of the LES. Three anesthetized mongrel dogs were used for preliminary experiment. A transducer was sutured on the serosal surface of the LES immediately inferior to the phrenoesophageal membrane. A catheter with a side hole was simultaneously passed into the stomach through a mouth so that the side hole was anchored at the highest pressure zone of the gastroesophageal junction. It was found that dose-related changes in motor activity of the LES to pentagastrin were obtained by both methods. This result indicate changes obtained by transducers represent those in intraluminal pressure measured manometory. Transducers were chronically implanted on the LES and the gastric body and antrum to record changes in contractile activity in conscious state. It was found that a group of contractions lasting for 25 +/- 2.5 min occurred at regular intervals of quiescence until next meal. Furthermore, these motor increase precisely coincided with the interdigestive contractions of the stomach.


Quantitative analysis of renal medullary anatomy in rats and rabbits.

The mean renal tubular diameters, number of tubules per unit of cross-sectional area, and fraction of the total volume occupied by each medullary structure were determined at various levels of the renal medulla of the rat and rabbit. Statistical estimates of anatomic variables were made using spatial sampling techniques on histologic sections. Osmotic diuresis and renal venous occlusion were used to allow fixation of renal tubules and blood vessels in an open state. The distribution of volume fractions of medullary structures are similar in rats and rabbits. Diameters of outer medullary tubular segments and inner medullary thin limbs of Henle are also similar in rats and rabbits. Marked differences between rats and rabbits, however, are seen in the size and number of collecting ducts in the inner medulla. Rabbit inner medullary collecting ducts increase in diameter and decrease in number in the papillary direction relatively closer to the cortex than do those of the rat. Luminal diameters of papillary collecting ducts are more than twice as great in the rabbit as in the rat. An additional finding was that short loops of Henle in the rabbit have their bends relatively closer to the cortex than those of the rat. The quantitative anatomic data derived in this study, when combined through mathematical modeling with knowledge of transport properties of renal tubular membranes, should lead to a clearer understanding of renal function.


Electrical characteristics of the mammalian distal tubule: Comparison of Ling-Gerard and macroelectrodes.

Studies were performed to 1) systematically compare Ling-Gerard microelectrodes and electrodes with large tips (3 to 5 mu O.D.) in the measurement of the transepithelial potential difference (PD) in the mammalian distal tubule and 2) to examine the sign and magnitude of the transepithelial PD along the length of the distal tubule. Recordings made with the tips of both types of electrodes placed together in the same tubule segment demonstrated no difference in transepithelial PD. Rapid influx of tubular fluid into the macroelectrode, however, was found to depolarize the tubular membrane, as recorded by both types of electrodes simultaneously. Technical critera were therefore established to prevent rapid influx of fluid and efflux of potassium chloride, filling the electrode, in the use of exploring electrodes with large tips. The sign of the transepithelial PD in early distal tubule was found to be negative and averaged -17.7 +/- 9.4 (mean +/- SEM) in Sprague-Dawley rats and approximately -12 mV in Wistar-Munich rats. The site of puncture was identified by dye transit time rate, microdissection, and cell morphology. The transepithelial PD increased along the length of the distal tubule and averaged -41.9 +/- 8.5 in the last portion accessible to examination.


Mechanisms of the defect in glomerular ultrafiltration associated with gentamicin administration.

Micropuncture studies were performed in three groups of Munich-Wistar rats: eight normal hydropenic controls (group I) and two groups (eight rats each) which were treated with gentamicin in doses of either 4 or 40 mg/kg/day for ten days (groups II and III, respectively). Following gentamicin administration, values for single nephron (SN) GFR were reduced markedly, from the control mean of 31 +/- 0.7 (SEM) nl/min to 22.4 +/- 1.5 and 20.5 +/- 0.9 for groups II and III, respectively. Declines in whole kidney GFR paralleled these falls in SNGFR. The primary cause of the reduction in SNGFR was a marked decline in glomerular capillary ultrafiltration coefficient, Kf, in both gentamicin treatment groups. None of the other determinants of glomerular ultrafiltration were significantly affected in the low dose group (group II). In the high dose group (group III), however, mean values for initial glomerular plasma flow rate and mean transglomerular hydraulic pressure difference were significantly lower than in the control group, accounting for the somewhat greater decline in SNGFR observed in group III. Electron microscopic examination of kidney tissue from rats treated with both doses of gentamicin revealed no obvious abnormalities of the glomerular capillary wall, whereas the previously described morphologic aberrations of proximal convoluted tubule cells were readily demonstrable.


Tetracycline fluorescence in uremic and primary hyperparathyroid bone.

Twenty-five patients with end-stage renal disease, nine of whom were receiving pharmacologic doses of vitamin D, and seventeen patients with primary hyperparathyroidism underwent bone biopsy following a three-day course of tetracycline administration. The mean width of the fluorescent tetracycline bands were significantly greater in the bones of patients with uremia than in those with primary hyperparathyroidism. This difference was due to wide labels present in the patients with uremia who had not been treated with vitamin D, as no differences existed in mean label widths of patients with uremia who had received this compound and the patients with primary hyperparathyroidism. Comparison of the maximum label widths distinguished not only primary hyperparathyroid patients from those with uremia, but uremic patients who had recieved vitamin D from those who had not been so treated. Quantitative microscopy of standard, nonfluorescent histologic features failed to make this latter distinction. These data are consistent with the presence of a wide zone of instantaneously fluorescing material in uremic bone following tetracycline administration, which does not relate to bone apposition occurring during antibiotic administration. This phenomenon probably represents a delay in mineral maturation which is normalized by vitamin D. Furthermore, it is apparent that the use of a continuously administered (single) tetracycline label will result in an overestimation of bone formation rates, particularly in osteomalacic states.


Electromicroscopic study of histoid leprosy with special reference to its histogenesis.

Biopsies from 2 patients clinically diagnosed and confirmed by histopathological studies as histoid leprosy were examined using and electronmicroscope. The cells that form the nodule are found to contain far more solid bacilli and much less electron transparent substance than those in lepromatous lesions. They have the characteristics of both macrophages and fibroblasts. It is reasonable to conclude that they are histiocytes produced by local multiplication in response to stimulation by rapidly proliferating M. leprae rather than from accumulation of blood monocytes at the site of inflammation as lepromatous lesions.


Evaluation of thyroid functions in leprosy. I. Thyroid function tests.

Twenty six patients of different types of leprosy were studied for radio active iodine uptake (I131) and serum levels of triiodothyronine (T3), thyroxine (T4) and thyroid stimulating hormone (TSH). None of the patients had clinical evidence of thyroid involvement. No significant difference was found between the values obtained in patients and normals and in different varieties of leprosy.


Evaluation of thyroid functions in leprosy. II. Histopathology of the thyroid.

Open thyroid biopsies from seven patients of bacilliferous leprosy were studied for leprous granuloma or amyloid deposition. None of the patients had clinical evidence of thyroid involvement. Histopathology did not reveal any specific abnormality.


Fatal proliferative glomerulonephritis in lepromatous leprosy.

A patient of lepromatous leprosy with recurrent erythema nodosum leprosum developing acute renal failure proving fatal within 8 weeks is reported. The renal lesion demonstrated acute proliferative glomerulonephritis. Its pathogenesis in relation to ENL is discussed.


Polambakkam splint for treatment of plantar ulcer in leprosy.

An open type of short leg splint is described and illustrated for the treatment of plantar ulcer in leprosy. Its fabrication, method of application, advantages and disadvantages are discussed as compared to the other methods of immobilisation. In our short experience we have found that with the use of this splint, ulcers heal in a period of about 6 weeks and in many cases even earlier than this period.


Recruitment and discharge patterns of single motor units during speech production.

Recruitment and discharge patterns of single motor units (MUs) in the anterior belly of digastric were studied during speech in three subjects, using electrodes facilitating selective recording at high force levels. Fixed recruitment order was observed in over 99% of all comparisons. Later recruited units invariably possessed muscle action potentials of higher amplitude, suggesting that units were activated in accordance with the "size principle." Additional evidence for this was that later recruited units, of a set of three studied during speech, motor unit training, and isometric force ramps, showed greater sensitivity to input, and greater dynamic range than earlier recruited units. Units in this set were much more sensitive to rapid changes in input associated with speech gestures than to static activation even at high force levels. Several significant relations between discharge characteristics and aspects of movement dynamics were observed, including relations between (1) recruitment interval (MU1 to MU3) and latency of mandibular lowering, (2) onset of initial discharge of MU1 and relative mechanical advantage of the mandible, (3) number of MUs active and velocity and displacement of the mandible, and (4) discharge rate of MU3 and velocity and displacement of the mandible.


Contextual-coarticulatory inconsistency of /r/ misarticulation.

Ten children who misarticulated /r/ participated in a task designed to survey inconsistent misarticulatory behavior. Children repeated 51 sentences during each of three trials. All sentences contained a single occurrence of an allophone of /r/ in systematically permuted, lexically constrained (LC) or nonlexically constrained (NLC) CrV contexts or nonlexically constrained (NLC) contexts. Results suggested that reliable judgment procedures were employed and that a high degree of internal consistency was present for the sentence repetition task. All children demonstrated inconsistent misarticulation of the target phonemes. Target allophones, in order of least to more often correctly produced, were (NCL) [r], (LC) [r], and (NLC). Correct production of [r] within NLC contexts occurred more frequently when preceded by /k/ and when followed by the vowels /i/, /ae/, and /u/. The target allophone [r] in LC clusters was produced correctly more often within /k/ and /t/ contexts than in /p/ contexts. Vocalic was produced correctly more often within and contexts than when in others in which /k/, /n/, /t/, and /p/ were permuted. Data suggest that certain anticipatory and carry-over coarticulatory variables result in positive influences during inconsistent misarticulatory behavior.


Subjective evaluation of articulatory effort.

Thirty-two adult speakers repeated pairs of CV syllables, each embedded in a carrier phrase, and designated the consonant member of the pair they believed required more articulatory effort. The task was performed under three speaking conditions (1) normal conversational speech, (2) whispered speech, and (3) pantomimed speech. Voicing and fricative manner of production appeared to be related to judgments of greater articulatory effort. Highly consistent responses across the three speaking conditions suggest other psychological factors to which subjects respond during conditions of normal as well as subvocal modes of speaking. Analyses yielded significant correlations between articulatory effort responses and current data concerning children's phonological acquisition, children's phoneme substitution patterns, and frequency of occurrence of consonants in conversational English.


Calibration force levels for bone conduction vibrators.

Two bone conduction vibrators (Radioear B71 and B72) and a headband (Radioear P-3333) have been developed to meet specifications of both the International Electrotechnical Commission and the American National Standard Institute. Pure-tone thresholds for air conduction and bone conduction were obtained from 24 normal-hearing young adults at audiometric frequencies between 250 and 4000 Hz. Results of this study are in good agreement with the standard air conduction threshold sound pressure levels (ANSI) and with bone conduction threshold force levels reported in the literature.


Laryngeal behavior during stuttering.

Laryngeal behavior associated with 101 stutterings (part-work repetitions, sound prolongations, and broken words) produced by a group of 10 stutterers was observed by means of a flexible fiberoptic naso-laryngoscope. Results indicated that 60% of part-word repetitions were different from fluent productions of the same speech segment in terms of laryngeal behavior, and 72% of sound prolongations were similar to fluent productions of the same speech segment. Findings indicate that there are differences in laryngeal behavior among the various types of stutterings.


Loudness perception for short-duration tones in masking noise.

The effect of masking noise on the temporal summation of loudness is investigated here by performing loudness balances between a standard 500-msec tone burst (1000 Hz at either 20-, 50-, or 80-dB SPL) and either masked or unmasked comparison tone bursts (1000 Hz with durations between 10 and 640 msec). In all but two instances, the obtained functions relating SPL for equal loudness to stimulus duration could be plotted as two line segments that met to form a knee. The slopes of the line segments at durations less than the kneepoints are altered by the masking noise, becoming less steep with increased masking. The rate of the slope decrease is related to the standard sound pressure level (SPL) and is greatest using the 80-dB SPL standard and least with the 20-dB SPL standard. Temporal summation of loudness continues at durations above the kneepoints. However, the obtained slopes are less than those found below the knee, and are independent of the test conditions. The slope changes are found to be related to the noise producing a power transformation on the operating characteristics of the auditory system. These latter findings are discussed in relation to Zwislocki's quantitative theory of the temporal summation of loudness.


Effect of auditory prestimulation on naming in aphasia.

In five aphasic subjects, picture naming alone was compared with picture naming in the presence of four different auditory cues. Eighty words represented by pictures were associated with the following auditory cues: the first phoneme of the target word; an open-ended sentence designed to elicit the target word; three words, one of which was the target word; three words, all semantically related to the target word. Three conditions--the phonetic cue, the open-ended sentence, and the set of three words containing the target word--facilitated naming significantly. The condition making use of semantically related words resulted in a significant decrease in naming performance. Implications of these findings for theories of verbal recall, impairment of verbal recall in aphasia, and language therapy are discussed.


Oral sensory and motor behaviors of children with /s/ or /r/ misarticulations.

Measurements of lingual two-point discrimination, oral form discrimination, and alternate motion rate of the tongue were made in 15 children who had normal articulation, 15 children who misarticulated /s/, and 15 children who misarticulated /r/. The two groups of children with misarticulations were found to differ from each other as well as from normal children on various aspects of oral sensation and motor abilities. These findings are interpreted as evidence for the existence of different bases for the misarticulations of the two disordered groups.


Delayed judgment speech-sound discrimination and /r/ or /s/ articulation status and improvement.

A delayed judgment test of speech-sound discrimination was correlated with measures of articulation status and articulation improvement with training in two groups of subjects, an /r/ group and an /s/ group. While the discrimination measures were reliable and internally consistent, discrimination-articulation correlations were low. Several possible psychometric explanations for the nonsignificant results are ruled out, and subject and task variables that might interfere with children's performance on discrimination measures are discussed.


A comparison of four hearing aid measurement systems.

Measurements of hearing aid performance were made using four different electroacoustic systems. Nine hearing aids were evaluated three times in each of the four systems: a standard Bruel and Kjaer apparatus, a Fonix 5000, and both a Phonic Ear HC 1000 and HC 2000. Tests included frequency response and, when possible, total harmonic distortion, second harmonic distortion, and third harmonic distortion. Results were equivalent for frequency response and second harmonic distortion, whereas significant differences occurred for total harmonic distortion and third harmonic distortion at both the low and high frequencies. The degree to which the sum of second harmonic distortion and third harmonic distortion fails to equal the total harmonic distortion was also examined. In the low frequency region, second harmonic distortion plus third harmonic distortion yielded values considerably less than the total harmonic distortion, although good agreement was found in the midfrequencies.