Characterisation of an associate 17-beta-hydroxysteroid dehydrogenase activity and affinity labelling of the 3-alpha-hydroxysteroid dehydrogenase of Pseudomonas testosteroni.

The 3-alpha-hydroxysteroid dehydrogenase and the 3-beta-hydroxysteroid dehydrogenase of Pseudomonas testosteroni were purified to homogeneity by polyaerylamide gel electrophoresis using the following stages: DEAE cellulose chromatography, affinity chromatography on oestrone-aminocaproate sepharose and Sephadex gel filtration. The pure 3-alpha-hydroxysteroid dehydrogenase was completely devoid of 3-beta-hydroxysteroid dehydrogenase activity but could oxidize estradiol 17-beta at an appreciable rate. This activity accounts for about 40 per cent of the total 17-beta-estradiol dehydrogenase of the crude bacterial extract. Affinity labelling of pure 3-alpha-hydroxysteroid dehydrogenase was carried out using 5-beta-pregnane 3,20-dione-12-alpha-iodoacetate and 5-alpha-androstane 3-one-17-beta-bromoacetate. With both reagents, inactivation was obtained only in the presence of coenzyme, the substrate protected against inactivation and the enzyme was fully inhibited with covalent binding of 1 mole of reagent per mole of subunit suggesting an active site directed inhibition. Histidine and methionine were identified as the labelled aminoacid residues.


Characterization of Triton X 100 extracted colipase from porcine pancreas.

Colipase was isolated from porcine pancreas homogenate prepared in the presence of detergent (Triton X 100). After precipitation by ammonium sulfate and ethanol, the cofactor was purified by chromatography on SP-Sephadex in the presence of Triton X 100 and on DEAE-cellulose in the absence of detergent. Two molecular forms of porcine colipase were obtained. They represent 80 per cent (colipase A) and 20 per cent (colipase B), respectively, of the total colipase. Valine is the N-terminal residue of both proteins. Their aminoacid composition is similar to that found by Borgstrom for the two forms of porcine colipase. Determination of the sequence of the first sixteen residues at the N-terminal end of colipase A indicates that the cofactor undergoes no proteolytic degradation in this region of the molecule when extraction is carried out in the presence of detergent. The recovery of colipase is about 30 per cent.


[Partial synthesis of aminoglycosidic antibiotics. I. An enzymatic reactor model using cofactors].

In order to produce specifically N-monoalkylated derivatives of aminoglycoside antibiotics of potential therapeutic values, we have developed an enzymatic reactor. This system uses the aminoglycoside acetyltransferase as catalyst and acetylcoenzyme A as acetyl donor. The immobilization of one aminoglycoside acetyltransferase on different resins has been studied. The coreticulation of this enzyme on DEAE cellulose in the presence of glutaraldehyde gives rise to an enzymatic resin of high efficiency. On the other hand, we have also studied the acetylation of coenzyme A in a simple manner. Acetylation occurs in a quantitative yield when the reaction is performed in the presence of polyvinyl-4 pyridine/divinylbenzene 2 per cent. These conclusions enabled to develop two types of acetylating reactors which give rise without purification to 3-acetyl gentamicin.


[Clinical prognostic factors in breast cancer].

Five year survival of 683 mammary carcinomas would confirm the prognostic value of T.N.M. classification (UICC), of tumor particular characteristics (size, fixation to neighbouring structures) and presence or absence of clinical nodes. A clinical-histological relationship was studied for axillary nodes: in our experience, clinical determination is more reliable for estimation of N0 and N2 than N1. Three groups of age were considered; the age, T and N corrected five year survival show a higher mortality for patients older than 60 years with T3-T4, N greater than 0 carcinomas. The study of this prospective computerised register confirms the prognostic value of developping growth tumors (PEV) described by P. Denoix. In fact, inflammatory carcinomas (PEV 2-PEV 3) show a poor 5 year survival and PEV 1 is an intermediate pronostic group between stable and inflammatory carcinomas. PEV 1 was showed to be an independant clinical factor from T and N characteristics.


[Prognostic factors in epitheliomas of the breast].

Prognostic factors in breast carcinoma were studied on material which consisted of 733 patients with a follow-up of over 5 years and on 361 with a follow-up of over 10 years. In the first part of the study the prognostic factors are related to the physical characteristics of the primary tumour such as its situation and size and its relationship to skin and deep tissues. Clinical examination of the axilla, studied in detail, has proved a reliable guide to prognosis. The second part deals with such factors as age, hormonal status, age at first pregnancy and parity. A critical analysis of the T.N.M. classification ends the study, with special reference to the prognostic factors which relate to the primary tumour.


[Prognostical factors of breast neoplasms without metastasis. Synthesis by a multifactoral analysis].

Multifactorial analysis by dichotomous split was applied to a consecutive series of 541 female breast cancer patients without detectable metastasis at onset of treatment. These patients were entirely treated in the same institution (Fondation Bergonié), in the years 1960-1974. This multifactorial analysis sets a hierarchical order among the different prognostic factors and defines groups of patients homogeneous for metastatic risks. The significant prognostic factors in these series are : number of malignant axillary nodes; location and size of tumour; state of adjacent skin; relations with thoracic wall; pre or post-menopausal status; inflammatory signs; thermographic and mammographic data.


[The anatomopathological factors of prognostic value in breast cancer].

A prospective study on the progress of 356 women with unilateral carcinoma of the breast treated throughout at the Institut Gustave-Roussy, by a Halsted or Patey type radical mastectomy. Between 1-1-68 and 31-12-71 293 patients without any previous treatment were operated on, and 63 after irradiation according to the dosage-schedule then in force. In the first group no prognostic importance could be attached to the character of the tumour margin nor to its stroma. Two features thought to be bound up with survival on first analysis were not found to have significance when the other prognostic factors were kept constant and these are microscopic spread of tumour outside the nipple and transcapsular spread of tumour in the axillary nodes. Only four parameters were found to have a real prognostic value and these were the size of the tumour, its Bloom grading, microscopic spread to the nipple and the number of nodes invaded, with a threshold at three involved nodes. With regard to irradiated carcinomas, whose number were really too small for such an intense analysis, only two parameters were related to survival: Bloom grading and the number of axillary nodes invaded.


[Breast cancer: histological prognosis from biopsy material].

Two histological factors to be taken into consideration for prognosis in pretreatment schedules of breast cancer have been studied on a group of 352 cases treated by non-mutilating therapeutics at the Fondation Curie between 1960 and 1970. The tumour material the slides of which we have reexamined "blindly", i.e. ignoring the evolution of the case had been obtained mostly by drill-biopsy. Histological groups and types have been determined following an analytical classification for computer purpose. The degree of malignancy was calculated with the method of Scarff-Bloom-Richardson. The analyzed data have been memorized on computer and then confronted with the elements of the T.N.M. classification and the survival of the patients involved. It appeared that if drill-biopsie have been performed correctly the histological type may be defined in eighty percent of cases. And it is likewise possible to calculate the histological grade of malignancy for each mammary cancer. With such a material the value for prognosis by means of the Scarff-Bloom-Richardson method still remains if applied only to adenocarcinoma of the "common infiltrating type".


[Xeroradiographic and thermographic contributions to the diagnosis and prognosis of operable breast cancer].

The methods of paraclinical investigation of breast cancer, advantageously assisted by cytology, do not compete with the biopsy. A clinico-pathologic examination is necessary, prior to any treatment, to ascertain the presence of a cancer and to determine its degree of malignancy. These methods mainly aim at:--discovering the tumor as early as possible,--determining its various morphologic and dynamic aspects, especially its growth rate,--guiding the biopsy and combining this surgical act with coherent therapeutic tactics. The xeroradiographic plate has all the qualities of an excellent detecting device, but in order to replace the mammography on film in daily practice the technical aspects need to be improved. Thermography gives an original and valuable point of view concerning breast tumors. We feel it is one of the most reliable prognostic elements.


[Isotopic bone examination in operable breast cancer].

In the pre-treatment work-up in breast carcinoma cases the bone scan findings could be of major interest. If the presence of occult metastases is discovered management may be modified accordingly. In a group involving 78 cases of breast carcinoma, classified as primary, operable, in three cases only scintigraphy revealed bone metastases before they produced clinical and radiological signs. In two of them there was agreement, in one disagreement over the findings. Moreover, in 5 cases a bone metastasis was revealed and immediately confirmed on a complete bone assessment.


Curability of breast cancer.

Long term follow-up suggests 30-40 per cent of "early" cases are "cured" by treatment. The proportion cured is probably related to the biological characteristics of the tumour rather than to the primary treatment. Careful staging is the best prognostic indicator available at present. Efforts should be made to learn more about the behaviour of tumours and to continue long term follow up.


[Radical mastectomy and modified radical mastectomy in the treatment of breast cancer. Indications and results].

We studied first the long term results in a series of 1 139 immediately operable breast cancers, treated by a protocol which gave an important role to extended radical mastectomy (radical mastectomy with internal mammary node dissection). No difference in survival was noted according to the surgical procedure used, and the extended mastectomy does not seem to have demonstrated its superiority. Its value could be judged in a more rigorous manner thanks to the results of an international therapeutic trial, comparing radical mastectomy with extended radical mastectomy. Results were improved by the extended procedure in only one sub-group of patients, whose tumours was located in central or inner quadrants, T1 or T2, with positive axillary nodes: these patients represents 13 per cent of patients with immediately operable tumors. Taking these results into account a new protocol has been adopted at the Institut Gustave-Roussy: T1 cancers will be the object of a therapeutic trial between conservative treatment and modified radical mastectomy. T2 (internal or central) cancers, with axillary nodal involvement will be treated by extended radical mastectomy. T2 tumors (external) and all T3 tumors will be treated by a modified radical mastectomy.


[Breast cancer: limited excision followed by irradiation. Results and therapeutic indications in 150 cases treated at the Curie Foundation in 1960-1970].

The authors studies 150 cases of mammary cancer treated at La Fondation Curie between 1960 and 1970 by lumpectomy followed by irradiation. At the 5th year the survival rate without recurrence is 85 p. 100 (128 out of 150 cases) and is 72 p. 100 (56 out of 78) at the 10th year. There were 17 local/regional recurrences in the first 5 years, say 11 p. 100, of which one was supraclavicular and one "acute". Of the 15 cases operated on 7 are alive without sign of recurrence at more than 5 years. Satisfactory conservation of the breast has been achieved since in the 128 cured patients the breast was preserved 123 times (96%). In the 78 cases followed for 10 years there were 13 local/regional recurrences, say 17 p. 100, of which one was "acute". In the 56 cured cases the breast was preserved in 49 (87%). The combination of lumpectomy/irradiation seems to be a viable therapeutic modality but with these limitations: 1. That the diagnosis of carcinoma should be pre- or per-operative and the lumpectomy generous. 2. That the radiotherapy dosage should be relatively moderate. 3. That the indications be strictly adhered to--only treat tumours less than 3 cm, taking due note of the respective volumes of tumour and breast without apparent involvement of axillary nodes. If these conditions are adhered to the results are good both aesthetically and curatively.


[Conservative treatment of breast cancer. A therapeutic trial in progress at the Cancer Institute of Milan].

The report describes a clinical trial on conservative surgery in progress at the National Cancer Institute of Milan, Italy. The randomized clinical trial compares radical mastectomy with a more conservative procedure consisting of mammary resection plus axillary dissection plus radiotherapy. The resection comprises an entire quadrant of the breast together with the overlying skin. After surgery the patients receive 6 000 rads to the residual breast tissue over five to six weeks, starting 15 days after operation. The cosmetic results are satisfactory in the majority of cases. The trial is limited to cases with tumors less than 2 cm (T1N0M0). Patients with histologically positive lymph nodes (N+) are submitted to adjuvant chemotherapy with CMF for one year. From September 1973 to October 1976, 331 cases entered the trial. One hundred sixty seven were treated with radical mastectomy and 164 with conservative procedure. Axillary metastases were found in 23 per cent of the radical and in 29 per cent of the conservative surgery group. Four local-regional recurrences have occurred till now, two in each group. Five cases in the radical mastectomy group and one in the conservative group had distant metastases. The clinical trial will collect some 500 cases by the end of 1977 and significant preliminary results are expected to be available from the beginning of 1979.


[The Stockholm preoperative radiotherapy of operable breast cancer. Preliminary report].

The 4 year results of a prospective clinical trial on the treatment of operable breast cancer, comparing the effects of preoperative radiotherapy followed by surgery with those of surgery followed or not by postoperative radiotherapy are presented for patient groups of approximately 100 each. At 4 years 85 per cent survive after preoperative radiotherapy plus surgery, as against 77 per cent after surgery only and 81 per cent after surgery plus postoperative radiotherapy. These differences are not statistically significant. The incidence of local recurrence after radiotherapy was reduced to 1/4 of that seen after surgery only. The radiation could be shown to induce temporary damage in a number of immunological parameters. No correlation could be demonstrated between these findings and the clinical course of the disease.


[The place and limitations of therapeutic regimens in the management of breast epitheliomas. 10 year results].

Between 1960 and 1966, 258 carcinomas of the breast with a follow up of 10 years or more formed a group which had been treated conservatively. Two conservative approaches were used, either lumpectomy followed by irradiation, or irradiation, alone, surgery being reserved for failures. At 10 years the survival rate of 51 p. 100 with no sign of recurrence is comparable with the results of radical or modified mastectomy. Among those living with no sign of recurrence 61 p. 100 had retained their breast almost always with a satisfactory aesthetic result. The place of lumpectomy followed by irradiation is reserved for single lumps of small volume and unaccompanied by axillary lymph node enlargement.


[Radical radiotherapy of breast cancer. Experience of Créteil].

Since 1961, we have treated 400 cases of breast cancers by radical radiotherapy (December 1976). The TNM classification of cases is: 25 per cent T1, 55 per cent T2, 20 per cent T3. 80 per cent of patients are N0 or N1a, 20 per cent are N1b. The therapeutic protocal is: for T1 lesions, lumpectomy plus radical radiotherapy, then boost dose with electrons to the axilla (24 Gy) and to the internal mammaryzone (15 Gy), and finally boost dose to the zone of the breast tumor by Iridium 192 implant therapy (25 Gy);--for T2 and T3 lesions, radiotherapy alone with a higher boost dose to the breast tumoral zone (37 Gy). The mammary tumor (or the tumoral zone) receives a total dose between 70 Gy (T1) and 90 Gy (T2 and T3). The five year results for 328 patients with at least one year follow up (actuarial calculations) yield a survival of 89 per cent T1, 84 per cent T2, and 66 per cent T3. The local recurrences are 8 per cent T1, 10 per cent T2, and 26 per cent T3; they can be rectified, under the condition of regular surveillance, by radical surgery. As to the cosmetic results, they are in one half of the cases quite good, in most others satisfactory, in a few poor. We add a prophylactic chemotherapy in the cases with high metastatic risk, i.e. T3 or N1b cases. This therapeutic protocol seems to be highly recommendable for T1 tumors, acceptable for T2, disputable for T3.


[Use of omental flap in the course of evolution of treated breast cancer. Apropos of 20 omental flaps done at the Gustave-Roussy Institute].

Some of the complications which occur after classical treatment of breast cancer can best be treated by use of the omental flap described by Kiricuta. These include radionecrosis of the chest wall, skin defects occuring after radical mastectomy combined with maximal irradiation, and local recurrence taking place after classical treatment. The results from the Gustave-Roussy Institute, which include experience with twenty omental flaps performed in breast cancer patients, confirm the exceptional qualities of this flap, especially reconstructing defects in irradiated tissue.


Extension of health service coverage in Costa Rica.

Costa Rica's National Health Plan for 1971-1980 has given top priority to extension of health coverage--focusing especially on marginal rural and periurban areas. By June 1977 implementation of this plan had provided coverage for over 80 per cent of Costa Rica's scattered rural population. Community participation was being encouraged, together with an integrated approach to the problems of these marginal regions.


The nutrition problem in Latin America: definition, causes, and remedial actions.

Clinical, dietary, and biochemical surveys have shown that on the whole Latin America faces a serious nutrition problem. This article reviews the nature and extent of that problem, especially its effects on maternal and child health, and suggests various approaches for researchers, health professionals, and political authorities that would contribute to its resolution.


Nurse-midwifery in the caribbean.

Nurse-midwives provide the bulk of maternal and child health care in the Caribbean Area. Their contribution over the years has been a major one, and as national health programs have become more comprehensive, so too have nurse-midwives' roles and functions.


Analysis, interpretation, use, and dissemination of surveillance information.

Surveillance data lay the groundwork for effective large-scale health actions. Sometimes, however, it is hard to obtain surveillance data, to determine the reliability of collected data, or to ensure that the data will be used to maximum advantage. This article provides a basic review of these three problems and ways to approach them, drawing illustrative examples from various sources, including the author's own experience.


Extension of health service coverage using primary care and community participation strategies.

PAHO's Directing Council recently requested a special Health Ministers' meeting to examine the subject of extended health coverage and to look into adjustments needed to achieve goals established in this field with all possible speed. The present document, which was prepared for that meeting, outlines the basic concepts involved in extending health coverage through adapted and expanded primary care and community participation. Its principal purpose is to serve as a reference source for subsequent analyses that PAHO's member countries will wish to carry out.


Survival rate after resection for bronchial carcinoma.

Among factors influencing long-term survival of patients how had undergone resection for carcinoma of the lung, the most important seems to be the extent of the cancer at the time of resection, determined by histopathological studies of the resected specimen.


Cortical thickness measurements and photon absorptiometry for determination of bone quantity.

Reproducibility of estimates of cortical bone quantity in the appendicular skeleton by two methods was studied in healthy individuals and patients undergoing long-term hemodialysis. Repeated measurements of cortical thickness (CT) at the midpoint of the second metacarpal were taken from single radiographs of both hands by two independent observers. Repeated measurements by the same observer were more reproducible and the degree of reproducibility was far greater in healthy subjects than in dialysis patients. Repeated measurements were made of bone mineral content (BMC) and bone width (W) of the distal radius by photon absorptiometry. Repeated BMC/W determinations were highly reproducible in both healthy subjects and dialysis patients. High correlation was found between BMC and cross-sectional cortical area and between both simple cortical thickness and cortical area/width. Thus the photon absorptiometric technique is superior for the serial monitoring of bone quantity, particularly in patients with uremic osteodystrophy, but results obtained by the two methods in group studies should be comparable.


Prevalence of ankylosing spondylitis and HLA-B27 in a North American Indian population: a pilot study.

The value of an epidemiologic approach to the diagnosis of ankylosing spondylitis was assessed in a pilot study of an Amerind population. In 103 adult volunteers aged 20 to 42 years on a Cree reservation lumbar flexion and chest expansion were measured and HLA typing was performed on peripheral blood lymphocytes. Of the 14 subjects with HLA-B27, 2 had radiologic evidence of sacroiliitis but none could be said to have definite ankylosing spondylitis on clinical grounds.


Case-control study of recidivist drivers involved in fatal highway accidents in Alberta in 1970-72.

A 3-year enpidemiologic study of fatal motor vehicle accidents was carried out by the Alberta Task Force on Highway Accidents. It was found that 11.1% of culpable drivers had been driving while impaired by alcohol on at least one occasion prior to the fatal accident, while only 3.3% of exonerated drivers had previous records. This significant difference led to a case-control study that demonstrated that the recidivist drivers (case group) differed significantly in a number of aspects from the innocent drivers (control group)--notably, age distribution, sex, whether drinking before the accident, blood alcohol concentration, ethnic distribution, class of accident and type of collision. Thus the recidivist driver is a greater threat to highway safety than the innocent driver and needs special attention by legislators and law enforcement agencies.


Lung density: clinical method for quantitation of pulmonary congestion and edema.

The density of a defined volume of the human lung can be measured in vivo by a new noninvasive technique. A beam of gamma-rays is directed at the lung and, by measuring the scattered gamma-rays, lung density is calculated. The density in the lower lobe of the right lung in normal man during quiet breathing in the sitting position ranged from 0.25 to 0.37 g.cm-3. Subnormal values were found in patients with emphsema. In patients with pulmonary congestion and edema, lung density values ranged from 0.33 to 0.93 g.cm-3. The lung density measurement correlated well with the findings in chest radiographs but the lung density values were more sensitive indices. This was particularly evident in serial observations of individual patients.


Eczemas due to mites and microorganisms.

Eczema is a specific clinical, morphologic and microscopic reaction pattern of the skin. It has many causes, including external and internal chemicals and the action of various microorganisms--bacteria, fungi, yeasts, viruses and mites--and their products. Peripheral vesicles with undermined borders are a feature of all eczemas caused by fungi, yeasts and bacteria and are thus a useful diagnostic finding.


Antibiotic-associated pseudomembranous colitis.

Two cases of pseudomembranous colitis, one associated with administration of ampicillin and the other associated with administration of ampicillin and trimethoprim-sulfamethoxazole, are reported. Both patients presented with diarrhea, abdominal pain, fever and an elevated leukocyte count. Pseudomembranous colitis was diagnosed by sigmoidoscopy and biopsy. Both patients recovered with conservative management.


Endoscopic removal of a foreign body perforating the duodenum.

Perforation of the intestine by an ingested foreign body usually results in peritonitis or abscess formation and the treatment is surgical. In one case the duodenum was perforated by a toothpick, and hemorrhage from the upper gastrointestinal tract occurred 3 months later. Diagnosis and management were accomplished by operative endoscopy.


Intraocular lens providing good vision 23 years after placement.

A Ridley Perspex lens was placed in the posterior chamber of a man's eye 23 years ago; 20/25 vision has been maintained since. This technique, first carried out in 1949, has been abandoned because of the high incidence of lens dislocation and glaucoma, but many modified versions of the lens have been produced. Implantation of intraocular lenses is still considered experimental, though careful selection of cases and meticulous surgical procedure can yield good results.


3. Current approaches to popliteal artery repair.

Trauma to the popliteal artery is potentially dangerous, and limb loss may result, especially with delayed diagnosis. Three anatomic factors contribute to the seriousness of the outcome: proximity of the artery to bone, superficial position of the artery and consequent lack of protection, and frequent associated injury to associated collateral blood vessels. Diagnosis of injury to the popliteal artery rests on suspicion and vigilance; the Doppler transcutaneous flow detector and angiography are often useful aids to diagnosis. Methods of treatment that have been used include arterial repair, grafting and fasciotomy, together with management of associated injuries. The bypass principle of vascular reconstruction may improve overall results.


2. Newer aids in the diagnosis of blunt abdominal trauma.

The assessment of a case of blunt abdominal trauma can be complicated by many factors, and the resultant inaccurate or delayed diagnoses have contributed to the unacceptable mortality for this type of injury. Recently several useful diagnostic techniques have been developed that, if applied intelligently, may be instrumental in decreasing the high mortality among patients who present with ambiguous abdominal signs after sustaining blunt trauma. Although hematologic investigation and routine radiography have facilitated detection of intraperitoneal injury, peritoneal lavage has become the single most helpful aid. Scanning procedures are sometimes useful in recognizing splenic and hepatic defects especially; these may be confirmed or clarified by angiography. Although ultrasonography may be no more valuable than scintigraphy in outlining splenic and hepatic abnormalities, it is an important technique, especially in the diagnosis of retroperitoneal masses of traumatic origin. Laparoscopy also may be helpful in investigation if surgeons become more familiar with the procedure.


4. Intracranial pressure and cerebral blood flow monitoring in head injuries.

Increased intracranial pressure is a frequent complication of head injuries. Direct measurement of intracranial pressure is now possible; it is a useful guide to therapy and allows detection of pressure under circumstances where clinical examination is unreliable or when increased intracranial pressure is unexpected. It is also useful in monitoring the efficacy of treatment by such agents as mannitol. Measurements of cerebral blood flow are still at an investigative stage but the accumulating valuable data have influenced the treatment of head injuries.


6. Changing concepts in the diagnosis and treatment of closed renal injuries.

Direct force is responsible for all closed kidney injuries except those involving the pedicle. Underlying parenchymal disease strongly predisposes the kidney to injury. Accurate diagnosis is crucial to rational treatment, and this is accomplished by infusion pyelography, angiography, retrograde pyelography and scanning. Treatment of kidney injuries has classically been conservatives, except when the clinical course or the nature of pre-existing diseases make an operation essential, but the current trend is towards more aggressive surgical treatment. This applies not only to pedicle injuries but also to major parenchymal trauma, and it is rendered feasible by precise diagnosis and improved surgical technique.


8. Self-compressing implants in the management of fractures.

Internal fixation of fractures has become increasingly important since the introduction of self-compressing implants. Rigidity of fixation thus ensured permits primary bone healing. Two types of self-compressing implants are available--screws and plates. The former produces compression between fracture fragments, the latter, along the long axis of the bone. Two common types of plates are the dynamic compression plate and the Osteo self-compressing plate. Use of self-compressing implants requires familiarity with the technique, a definite plan of operation, and strict asepsis and lack of infection in the patient. Indications for the technique include failure or unsuitability of closed reduction of fractures, care of associated serious soft-tissue injuries, and displaced intra-articular fractures. Use of self-compressing plates hastens rehabilitation, lessens joint stiffness and reduces the duration of hospitalization. The incidence of nonunion with self-compression techniques is lower than with traditional methods of fracture management.


DiGeorge syndrome presenting as severe congenital heart disease in the newborn.

In seven infants with DiGeorge syndrome the major clinical manifestation was cardiac failure in the 1st week of life. All had severe congenital heart disease: five had interruption of the aortic arch and associated lesions, one had a ventricular septal defect and a cervical aorta, and one had truncus arteriosus. All but one died by 2 weeks of age. Necropsy data lent support to the hypothesis of a relation between the cardiovascular anomalies and defective development of structures derived from the third and fourth pharyngeal pouches.


Conservative management of intraepithelial cervical neoplasia.

In a prospective trial cryotherapy was performed in 164 patients with preinvasive cervical neoplasia, most of whom desired future childbearing. Their disease had been evaluated by repeat cytology, colposcopy and colposcopically directed punch biopsies, with endocervical curettage when necessary. This conservative treatment eradicated the disease in 147 (89.6%) of the patients. The remaining 17 underwent complete reinvestigation. The focal residual disease in 12 was successfully treated by conservative means--repeat cryotherapy, focal electrocautery or punch biopsy. The other five required either cone biopsy or hysterectomy because of more extensive lesions.


Hemodynamic and therapeutic effects of intravenous dopamine.

The effects of intravenous dopamine were evaluated in 10 patients with severe but stable coronary artery disease, 17 consecutive patients with primary cardiogenic shock and 3 with severe congestive heart failure and oliguria. Dopamine infusion at 10 mug/kg.min in the 10 patients increased cardiac output by 35%, left ventricular peak dP/dt by 38%, left ventricular minute work index by 44% and mean systolic ejection rate by 7% (P < 0.01); heart rate, aortic pressure, left ventricular end-diastolic pressure and tension-time index were unchanged. For oxygen, potassium and lactate, arterial and coronary sinus values, coronary arteriovenous oxygen differences and myocardial extraction were unchanged. Hemodynamically 13 of the 17 patients in shock responded favourably to dopamine infusion (0.5 to 15 mug/kg.min), with decrease in heart rate, increase in systolic arterial pressure from 75 to 100 mm Hg (P <0.001), decrease in ventricular filling pressure from 20 to 16 mm Hg (P < 0.01) and increase in urine output from 10 to 100 ml/h (P < 0.01). Eleven of those patients survived the shock episode. A close relation was observed between the hemodynamic response to dopamine, survival from the shock episode and the time between onset of shock and initiation of therapy. Low rates of dopamine infusion induced diuresis in the three patients with severe cardiac failure.Dopamine thus seems to improve the mechanical efficiency of the heart in coronary artery disease. Cardiac output is selectively increased and myocardial ischemia does not appear to be induced; those beneficial effects as well as presumably specific action on renal flow and natriuresis, improve immediate survival from cardiogenic shock and severe heart failure.


'Morphology of immune lymphocytes in homograft lymph'.

Uropod-bearing lymphocytes (UBLs) resembling cytotoxic cells found in vitro were identified in lymph collected from rabbit hind-limbs bearing homografts. UBLs were found in lymph leaving the regional lymph node (efferent), both before and after rejection, but not in that draining the homograft (afferent) even though they were present in the graft tissue itself. UBLs may represent the sub-class of immune lymphocytes which induce necrosis of the grafted cells. Mitotic lymphocytes and cells resembling lymphocytes transformed by phytohaemagglutinin were also found in efferent homograft lymph.


Variation in the volume of coated vesicles isoalted from human placenta.

Electron microscopic analysis of 500 negatively stained coated vesicles isolated from human placenta showed that they exist within limits in a continuous range of volumes with an unimodal distribution. Some vesicles were larger than the frequently quoted maximum size of these organelles (diameter 100nm). The ratio of hexagonal to pentagonal facets in the clathrin lattice of the vesicle wall appears to be variable. This feature may be important in morphogenesis since the mean volume of prolate vesicles is larger than that of spherical vesicles. Empty lattices had a mean volume smaller than that of lattices containing phospholipid bilayers.


Hydrocortisone effects on cell proliferation: specificity of response among various cell types.

The effect of 14 micrometer hydrocortisone (HC) on the proliferative activity of various vertebrate cell lines has been measured. Such activity in human deploid cell line WI-38 was enhanced by HC addition whereas in a number of other vertebrate cell lines under identical conditions HC was inhibitory to growth. We examined the effects of HC on normal human diploid cells other than WI-38; some were stimulated, some inhibited and some were unresponsive. The results suggest that cells derived from different human tissues retain in vitro some aspects of their cell-specific hormonal responses.


The surface structure of the tegument of Schistosoma haematobium.

The surface structure of the tegument of adult S. haematobium (Egyptian strain) was studied by scanning electron microscopy. Most of the dorsal surface of the male is studded by prominent, spine-covered tubercles, or bosses, not found in the female. Structural details of the oral and ventral suckers and sensory organelles, and local variations in the tegument are described.


Regulation of cycle progression in plant cells.

Induction of polynucleate cells in onion root meristems by inhibition of two sequential cytokineses is used to study controls operating in cell cycle progression. Triggering of both replication and metaphase occurs synchronously in nuclei sharing a common cytoplasm, independent of their ploidy or intracellular position. The replication rate appears to be activated by the simultaneous intracytoplasm presence of other replicating nuclei. On the other hand, central position of a nucleus in the cell as well as increase in ploidy leads to slowing down of replication rate. The relative advance and lag of S period in the different nuclei in a common cytoplasm is partially counter-balanced by differential times of G2. Moreover prophase lengthening in the fast interphase nuclei points ot a negative control exerted by the lagging nuclei mediated by cytoplasm. Finally, it could be worth emphasizing similarities in the control mechanism operating in cycle progression both in animal and plant cells.


Unusual degenerated forms of human sperms.

Many spheric bodies with radiating, needle-like filaments are present in semen of patients with fertility problems. These bodies are most likely degenerated sperm. The intermediate forms and a sequential series of degeneration are discussed.


Alkaline phosphatase phenotypes in tumour and non-tumour cell lines: not an invariable marker for neoplastic transformation.

The cytochemical localisation and presumed isoenzyme type (based on selective inhibition experiments) of alkaline phosphatase in 5 cell lines derived frrom normal human, rat, mouse and hamster tissues, 6 human lymphoblastoid lines and 6 human and mouse tumour-derived cell lines are described. Enzyme activity varied between the cell lines. An isoenzyme inhibited by L-phenylalanine was present in 3 normal lines, 3 lymphoblastoid lines and 2 tumour lines. The presence of this isoenzyme cannot be used as a marker of neoplastic transformation.


Rapid tubulin synthesis during ciliated cell differentiation.

Using pulse-chase conditions in culture we have investigated the incorporation of 3H-leucine into tubulin of isolated oviducts from 5 day-old mice. Label appears in soluble, particulate and axonemal fractions minutes after incubation. In the latter two fractions, but not in the soluble fraction, this label is rapidly diluted under chase conditions. The data do not fit a simple model of sequential transfer of radioactively labeled, newly synthesized tubulin from a soluble fraction through centriole precursors to assembled ciliary axonemes.


Application of the theory of transition probability in "ageing" WI 38 cells; similar behaviour of clonogenic cells from early and late passage cultures.

Analysis of genealogies of WI 38 clones reveals: 1. The proliferation behaviour of the cells can be adequately described in terms of the transition probability model, despite non-steady state kinetics. 2. Early and late clones show nearly identical behaviour.


Surface proteins of young and senescent cultured avian fibroblasts.

Proliferation of senescent cultured chick fibroblasts is arrested at densities that are 3-4 fold lower than densities inhibiting growth of young cells. The effects of density and growth rate of young and aged cultures on the accessibility of their surface proteins to external iodination were studied. LETS glycoprotein and a protein of 110,000 daltons are the major iodinated proteins of resting, highly dense and of sparse young cells, respectively. By contrast, LETS is minimally exposed on undividing, relatively disperse old cells. Therefore, exposure of LETS is correlated with cell density rather than with growth rate.


Electron microscopical identification of the committed precursor cell of the megakaryocyte compartment of rat bone marrow.

In the rat bone marrow, cells of the megakaryocyte line of differentiation are the only hemopoietic cells which show cytochemically demonstrable Acetylcholineesterase activity (AchE; EC 3.1.1.7). A small number of morphologically unrecognizable cells exhibit AchE activity in their Golgi complexes. These cells are identified as committed precursor cells of the MK compartment.


Repair of the sublethal and mutational damage induced by x-rays in Chinese hamster HAI cells in vitro.

The ability of Chinese hamster hai cells to repair damage related to cell death and mutational change induced by X-rays were examined by using a sensitive forward mutation system from prototrophic CH-hai Cl 23 cells to auxotrophs. The results obtained from the split dose experiments seem to suggest that Chinese hamster hai cells have the repair mechanisms for the sublethal and mutational damage induced by X-rays and that the repair mechanisms act in common for the repair of both cases of damage.


Fibronectin matrix: antibody-induced reorganization in human fibroblast cultures.

Fibronectin, a major pericellular glycoprotein of adherent cells, was predominantly present in fibrillar structures in human fibroblast cultures as shown by indirect immunofluorescence. In conventional "patching experiments" where one day old cells were exposed to anti-fibronectin IgG in the cold, washed, and reincubated at 37 degrees no redistribution was seen. However, continuous exposure of the cultures to IgG at 37 degrees resulted in redistribution. The fibrillar structures were lost and fibronectin aggregates (patches) were found. Fab-fragments had no such effect. These results support the findings that fibronectin is predominantly a matrix protein and show that matrix components may be redistributed in cell culture conditions.


[Intrahepatic calculosis].

After a short synthesis of the elements characterising intrahepatic calculosis, and evaluation of the five cases considered, the value of cholangiography (both intravenous and instrumental) and of radio-scintiscanning with Bengal Rose marked with I131 in pre-operative diagnosis is stressed. The intra-operative use of choledochoscopy in conjunction with cholangiography is recommended. With regard to treatment, it must ensure removal of the calculi and create an ample biliodigestive communication (papillectomy or, even better, hepaticojejunostomy on excluded Roux loop) in order to prevent recurrences. In order to visualise the intrahepatic branches of the bile ducts, the removal of the hilar plaque is advised, possibly combined with sagittal scissurectomy or mobilisation of the 4th segment. In conclusion it is asserted that correctly performed surgical treatment is the only means of offering permanent cure.


[Intraoperative cholangiography. Considerations on a special method].

The Authors report their experience in the field of transcistic peroperating colangiography performed by the use of polythene cannulae and discuss the advantages of this procedure based on the results of more than 350 cases. The simplicity of the procedure, its quick employment and-most of all-its harmlessness in comparison to other techniques is underlined.


[Myocardial protection during open heart operations].

The need for adequate protection of the myocardial tissue during open heart operations has proved to be of considerable importance in view of the conditioning value of the functional anatomical state of the myocardial fibre on the outcome of the surgery itself. After a review and description of the most widely used methods of protection, the Authors draw on the data in literature in order to trace a critical profile of each method, outlining its merits and defects in the light of present experience.


[Traumatic and foreign body lesions of the colon and rectum. Clinical and therapeutic considerations].

On the basis of observations made in 69 patients with traumatic lesions and those caused by foreign bodies in the colon and rectum, supplemented by the data emerging from literature, some clinical and therapeutic considerations are expressed on the subject. A tactic of treatment based on the material examined and, in the present state, advisable as a possible plan of treatment for the said lesions is also proposed.


[Anomalous origin of the left coronary artery from the pulmonary artery (description of a case)].

The Authors report a new case of anomalous origin of the left coronary artery from the pulmonary artery in a 3 and a half month old boy. Its clinical and angiographic findings are described. A new method of surgical repair (end-to-end anastomosis between left coronary artery and a collateral of subclavian artery) is presented.


[Scintigraphic diagnosis of pancreatic diseases: random analysis of 100 patients].

After a brief statement on the procedure of selection of the patients, the article describes how the cases were studied, since some difficulties arose through the lack of homogeneity of the subjects. The cases are then commented and an effort is made to evidence the outstanding data which can be deduced, and in particular a study is made of the percentage of overall unreliability of scintillographic examination, the "false positives" and the "false negatives", which are rather low. The Authors conclude with the consideration that scintiscanning of the pancreas now constitutes a valid method of investigation of pancreatic pathology.


[Experimental arterialization of the portal vein in the rat].

The article reports an original technique of arterialisation of the portal vein in the rat, after porto-cava shunt, with termino-latreal anastomosis between the proximal stump of the portal vein and the aorta; compared with other techniques, this method has the advantage of avoiding right nephrectomy.


Hilar irradiation in early stage Hodgkin's disease.

We conclude that inclusion of the hilar region adds little morbidity, while failure to treat is associated with a finite risk of hilar recurrence. It therefore would seem advisable to include the lung roots in "mantle" field techniques in patients with good pulmonary reserve. Our experience with this group of patients, and with others not included here, suggests that the risk of hilar involvement may be particularly pronounced in patients who present with intradiaphragmatic disease. On the other hand, the relapse rate in the hila is sufficiently small that straight-edged mediastinal fields can be used with relative safety in patients with emphysema or other pre-existing dysfunction for whom inclusion of the additional volume might lead to pulmonary insufficiency.


Nutrition of the intervertebral disk. An in vivo study of solute transport.

The main mechanism for solute transport within the intervertebral disk is passive diffusion. The 2 routes for the exchange of solutes with the blood vessels outside the disk are via the periphery of the annulus, and through the end-plates. While the periphery of the annulus is completely permeable, the bone--disk interface is only partially so. In the region of the nucleus the effective area through which solute transport is taking place constitutes some 85% of the actual bone/disk interface; in the region of the inner annulus it is reduced to only 35% while the bone--disk interface at the outer annulus is almost completely impermeable. These figures, calculated from tracer diffusion experiments correlate very well with the qualitative observations of blood vessel contact. Apart from its dependence on the permeability of the endplate, solute diffusion is also determined by the nature of the solute. For example, a negatively charged solute such as the sulphate ion is considerably excluded from the nucleus, which limits its rate of penetration via the endplates. The sulphate uptake by the disk cells to produce glycosaminoglycans is low and comparable to that in articular cartilage.


Intradiskal pressure, intra-abdominal pressure and myoelectric back muscle activity related to posture and loading.

Intradiskal pressures, intra-abdominal pressures and myoelectric activities of posterior back muscles have been measured simultaneously in vivo in 4 subjects. Five different angles of forward flexion were studied while externally loading the trunk with 200N. At 30 degrees of forward flexion studies were made when the load was increased from 0 to 300N. Asymmetric loading was studied with the trunk erect, in lateral flexion and in rotation. The measurement parameter values all increased when the angle of flexion increased and when the external load was increased at a fixed angle of flexion. Linear relationships were established. During asymmetric loading pressure values and the myoelectric activity increased. The increase in myoelectric activity was comparatively greater on the contralateral side of the lumbar region and on the ipsilateral side of the thoracic region. The disk pressure, the intra-abdominal pressure, and the FRA-values were higher throughout when the trunk was loaded in rotation, than in lateral flexion.


Moiré topography in scoliosis screening.

Moiré topography, a simple technique for three-dimensional quantitation, was used to provide interference fringe photographs of the human back with sufficient accuracy to be used for detecting children with asymmetry due to scoliosis. Experimental equipment, built and tested at the National Research Council of Canada, was used in a pilot screening program, involving 1100 children from the 10 to 12 year age group. Each child was examined clinically by the bending test and photographed by the moiré method. All subjects with positive bending tests, asymmetrical fringe patterns or both were submitted to radiographic examination and the results correlated. The moiré technique disclosed 94% of the cases which were found to be positive by X-ray examination, while the bending test disclosed only 46%. The percentages of false positive results were approximately the same for the 2 screening methods.


Clinical review of cervical spine injuries in children.

Clinical presentation is made of 18 cervical fractures occurring in children age 15 and under. Seven of 18 patients sustained neurological complications. The incidence of childhood cervical spine injury increases with age. Sixteen of 18 lesions were found in the C1 through C4 area in contrast to a greater involvement in adults in levels of C4 through C7. Although normal variations and anomalies are frequent in cervical spines in children, over treatment, at least initially, is recommended in all cases in which the diagnosis is in doubt.


The effect of radiation on the shear strength of acrylic bone cement.

Bone loss due to secondary neoplastic disease of bone has frequently presented the orthopedic surgeon with difficult or insoluble problems of surgical management. Local radiation is the most effective, and widely used form of therapy for this type of metastatic disease. Levels of radiation in vitro comparable to therapeutic doses, as well as levels 6 times that commonly used in vivo on patients, demonstrate no significant effect on the mechanical properties of acrylic bone cement.


Ankylosing spondylitis and its variants. A review of recent developments for orthopedic surgeons.

Recent developments in genetic tissue typing have altered concepts of ankylosing spondylitis (AS) or variants of this spondylitic arthritis. It is now apparent that AS is separate and distinct from rheumatoid arthritis; and the term "rheumatoid" should be avoided except as it applies to the latter, usually characterized by rheumatoid factor or nodules and symmetrical arthritis of peripheral joints. Classical definitions of AS require X-ray evidence of sacroiliitis and/or restriction of chest expansion. Recent studies suggest that many patients, especially women, may have symptoms of AS without typical roentgenographic or clinical findings. Use of the HL-A B27 genetic test is useful for identifying AS patients. Radioisotope bone or joint scanning techniques further augment present diagnostic capabilities. Atypical AS may be a very common form of morbidity among patients with back pain in the United States. Since patients have a tendency to form osseous reankylosis after total hip replacement, it is especially important for orthopedic surgeons to identify incipient AS and related disorders. Inappropriate treatment or procedures may be avoided by use of these newer clinical tools in the evaluation of patients with chronic back or skeletal pain.


Mobility in the lumbosacral spine after fusion studied with the aid of roentgen stereophotogrammetry.

Twelve cases operated upon with fusion in the lumbosacral spine were studied with a roentgen stereophotogrammetric method. With this method the movements in the area supposed to be fused can be studied with high accuracy in 3 dimensions. The precision is 0.3 degrees for the rotation about the x-axis (transversal axis), 0.2 degrees for the rotation about the y-axis (longitudinal axis), and 0.1 degrees for that about the z-axis (sagittal axis) and of the magnitude of 0.1 mm for the translations. It was found that the possible stabilization of a fusion takes place within 180 days. The supposed gain of internal fixation with a sacral bar device was not verified. It was recommended that the supine and erect standing positions should be investigated and compared with this method and that standing with flexion should be added as soon as the healing process is supposed not to be injured by flexion movements.


Comparison of horizontal and vertical unidirectional (laminar) air-flow systems in orthopedic surgery.

The microbiological evaluation of a horizontal walled unit, a horizontal wall-less unit and a vertical wall-less unidirectional airflow unit revealed a statistical reduction in the wound and back table air settle plate counts for the 2 horizontal systems as compared to the vertical system.


An evaluation of narrowing following intradiskal injection of chymopapain.

Lateral X-rays of lumbosacral spines of 76 patients who received chymopapain injection for lumbar disk lesions after a positive myelogram and diskogram were examined and measured to determine the degree of narrowing which occurred after injection of the enzyme. There were 2 groups of patients, those with clinically good results after injection, and those with poor results. Measurements were made of the injected and adjacent noninjected disk spaces. The validity of the method used with established by a correlation of 0.95 over a period of time for the uninjected disks. The narrowing after injection was significant at the p less than 0.01 level for both clinical successes and failures, but the degree of narrowing was significantly greater for the clinically good results.


Fracture of the femoral neck. II. Relative importance of primary vascular damage and surgical procedure for the development of necrosis of the femoral head.

The opinion is widely held that interruption of the arterial flow through the retinacular arteries to the femoral head is the main cause of avascular necrosis after fracture of the neck. In this study the state of the vascular supply to the femoral head was assessed--prior to osteosynthesis--by means of intramedullary pressure measurements in the femoral head and neck in 72 patients with medial neck fractures. The patients were followed 2 or 3 years or until avascular necrosis became evident. The relative importance of primary avascularity and surgical technique for the development of necrosis suggests that damage to the retinacular arteries may not be the single decisive factor in the pathogenesis of femoral head necrosis. Proper fracture reduction with extensive contact between the cancellous bone surfaces and stable fixation seemed to be more important, probably because they offer the best possibilities for re-establishment of transosseous blood flow across the fracture site.


Surgery for intervertebral disk disease of the lumbar spine.

There is little doubt that surgical treatment of lumbar spine pain is often unsatisfactory. It is likely that we are using a cannon when a peashooter properly aimed would do a better job. Various injection techniques, especially injection of the disk itself would seem to be a rational approach. Scarring around the spinal nerves and dura is an unsolved problem. The search for an interposition membrane goes on. Fat grafts are being advocated, but it is too early to evaluate their efficacy. The problem of how to adequately decompress the nerves in spinal stenosis without jeopardizing spinal stability is still unsolved. Interbody fusion still carries a high failure rate as far as fusion is concerned, but what is worse, failure to relieve the pain for which it was done remains frequent. Spine pain programs concentrating upon training in exercises, training in the proper way to perform the activities of daily living and especially psychological counseling and operant conditioning probably represent the greatest single recent advance in the rehabilitation of the low back sufferer. Finally, there is an unfulfilled need for more accurate reporting of our subjective clinical results if advances are to be made in this area, where pain is the principal problem.


Femoral anteversion and physical performance in adolescent and adult life.

The relationship between excessive idiopathic femoral anteversion and physical performance in adolescent and adult subjects is explored in 9 adults with excessive anteversion and in 10 age-matched controls subjected to extensive physical performance testing. Two hundred and forty-nine high school students were studied by assessing running speed and measuring hip rotation. Those with greatest internal rotation were isolated and compared with the total group. In both studies no relationship could be found between excessive anterversion and physical performance.


Pigmented villonodular synovitis of the knee presenting as a loose body. A case report.

A 21-year-old woman with a history of internal derangement of the knee and a palpable loose body was found to have localized villonodular synovitis at surgical exploration.


Septic arthritis of the hip in a hemophiliac. Report of a case.

Septic arthritis of the hip occurred in a 32-year-old hemophiliac with circulating Factor VIII antibodies. The clinical presentation suggested a soft tissue hematoma, but failure of early resolution with immobilization and Factor VIII replacement led to a correct diagnosis. A non-invasive method of management is essential if antibodies to Factor VIII are present. Compression and Plaster of Paris immobilization of the joint with adequate antibiotic therapy allows resolution of the infection and return to normal function. To avoid the serious complication of septic arthritis in hemophilia, expeditious treatment of all foci of infection is a necessity.


Bilateral traumatic dislocation of the distal radioulnar joint, ulna dorsal: case report and review of the literature.

Bilateral dislocation of the distal radioulnar joint seems not to have been reported in the literature. This is a report of a 22-year-old man successfully treated with closed reduction and immobilization in long arm casts. Limited forearm rotation and wrist pain after a twisting injury are typical findings. In ulna dorsal dislocation the patient's forearm is locked in pronation. In ulna volar dislocation the wrist appears narrow and the forearm is locked in supination. The mechanism of injury for dorsal dislocations is hyperpronation; for volar dislocations it is hypersupination. Dislocation of the distal radioulnar joint injures the triangular disk and/or fractures the ulnar styloid. Suspicion is important in making the diagnosis. Fifty per cent of unilateral cases reported in the literature were missed initially or were diagnosed late. The acute case is easily treated by closed reduction under local anesthesia and immobilization in a long arm cast. Treatment of the chronic dislocation includes various soft tissue reconstructions or resection of the distal ulna depending on the degree of arthrosis.


Strain gauge analysis of knee ligaments.

Mercury strain gauges were sutured onto the tibial collateral anterior and posterior cruciate ligaments to quantitatively determine the relative strain or deformation of each of these ligaments as a function of joint position. The results were obtained on 5 amputation specimens by subjecting them to flexion, extension, rotation, valgus--varus and anteroposterior forces. The tibial collateral ligament is most lax in full flexion and stretches with extension, valgus and external rotation. The cruciate ligaments are most lax at 35 degrees flexion and stretch with both flexion and extension. Internal rotation and varus stretch and anterior cruciate ligament. These principles allow us a better understanding of injury patterns. The most advantageous position for immobilization following acute injuries or reconstructions is better understood knowing that minimal tension on ligamentous fibers occurs as follows: Anterior cruciate, 35 degrees; Posterior cruciate, 35 degrees; Tibial collateral ligament, 45--90 degrees (or as much flexion as the patient will tolerate).


Coccidioidomycosis of the extensor tenosynovium of the wrist. A case report.

A 59-year-old man had isolated coccidioidomycosis infestation of the tenosynovium of the wrist extensor tendons resistent to surgical and amphotericin chemotherapy. Some improvement has been noted on Miconazole chemothearapy, but neither the long term side effects nor clinical results are known.


Osteosclerotic lesions in sarcoidosis. Report of a case.

In a 36-year-old black American male, sarcoidosis produced multiple osteoblastic lesions instead of the lytic lesion characteristic of the disease.


Total claviculectomy for pathological fractures.

Two patients with pathological fractures of the clavicle were treated by total claviculectomy with relief of symptoms. Subsequent drooping of the shoulder with mild weakness of the affected upper extremity seems related to the loss of normal arcuate shoulder motion that is dependent upon the yardarm function of the clavicle.


The nature of bone carbonate.

Models of the bone salt and its synthetic analogues have been strenuously, and sometimes emotionally debated since the late nineteenth century. The main protagonist in the drama is the ubiquitous CO3=ion whose role has never been clearly understood. Initially regarded as an essential part of the calcium phosphate crystal complex, it came to be dubiously designated as a separate phase CaCO3, as an adsorbed ion, or even as a mere contaminant. More recent studies provide evidence that the original impression may be more nearly correct. Of particular interest in defining the role of CO3= in bone are the reactions involved in the formation of CO3-apatite under conditions approximating the physiological. These observations suggest that the synthesis of bone mineral involves hydrolysis of an initial acidic calcium phosphate precipitate to octacalcium phosphate, which is then converted to octacalcium phosphate carbonate (OCPC) by virtue of the replacement of PO4 identical to (HPO4=) by CO3=. OCPC satisfies many criteria for a satisfactory definition of the nature of the bone mineral. It can explain its solubility behavior and the intrinsic relationship between PO4 identical to (HPO4=) and CO3=, the normal variations in bone composition, the sequence of events in bone mineral maturation, and the loss of CO3= under normal and pathological conditions.


Vitamin D prophylaxis and the lowered incidence of fractures in anticonvulsant rickets and osteomalacia.

Small doses of vitamin D can probably prevent catastrophic skeletal demineralization in patients taking antiseizure medication. Moderate doses of vitamin D can reverse this degree of demineralization once it has occurred. Prophylactic vitamin D therapy was associated with a lowered incidence of seizure patients in the overall fracture census and a decrease in the number of in-hospital days for treatment of seizure patients with fractures. Vitamin D therapy should probably be used as a routine dietary supplement in all seizure patients at dosage levels of approximately 400 units daily. Much larger doses (50,000 units once or twice weekly) should be as necessary when these patients sustain fractures or other injuries.


Chondrocyte-to-osteocyte transformation in grafts of perichondrium-free epiphyseal cartilage.

When perichondrium-free pieces of embryonic quail epiphyseal cartilage are incubated on the chorioallantoic membranes of chick embryos, 2 developmental changes are observed. First, most grafts develop a periosteum in which the osteoblasts and osteocytes are of donor, i.e., chondrocytic origin. No such periosteum is observed around explants of demineralized, inductive bone matrix. Second, the matrix surrounding some chondrocytes within the original graft became more bone-like with respect to staining pattern, birefringence and collagen morphology. We conclude that, under some conditions, the avian chondrocyte may in situ or subsequent to release from the cartilage lacuna synthesize a bone-like matrix and, in this sense, be thought to have undergone a "transformation" into an osteocytic or osteoblastic type of cell.


Corticosteroid-induced enhanced mineralization in neonatal condylar cartilage.

Neonatal mice were treated with triamcinolone hexacetonide and the cartilage of their mandibular condyle was studied biochemically and histochemically. Three days following the hormonal treatment the condylar protein content decreased significantly but a marked increase was noted in the tissue's calcium and phosphate. The condylar mineralization front extended up to the chondroblastic and proliferative zones. Triamcinolone arrest cartilage cell proliferation and enhanced an atypical hypertrophy of chondroblasts. One week following the hormonal treatment the condyle revealed clear signs of weight loss and changes in its size and form. Glucocorticoids enhance the mineralization of neonatal cartilage via: a direct effect upon chondrocytic metabolic and control systems (genom) and possibly also through an indirect adverse effect upon other organ systems.


Activation of the resting periosteum.

A single para osteal injection of an aqueous extract of immature bovine bone doubles the diameter of the rat radius and ulna, within 7 days. Bone is formed by activation and prolifeation of cells in the cambium layer of the periosteum. The fibrous periosteum remains intact and appears to adapt by stretching. New trabeculae are oriented radailly about the diphyses. The organic matrix, mainly new bone collagen is elaborated primarly during the first 72 hours and mineralized, in the last 4 days of study. The response is interpreted as an example of cell activation, rather than osteogenic induction and demonstrates tha rapid and massive osteogensis can be trigegered by an appropriate exogenous stimulus.


The effect of varus stress on the moving rabbit knee joint.

Unicompartmental osteoarthritis was produced by applying varus stress to moving rabbit knee joints. Degenerative changes were confined to the medial tibial and the medial femoral articular surfaces. Within the range of varus stress used, duration appears to be more important than magnitude of varus stress in determining the severity of cartilage damage. The calcified zone remained histologically unchanged despite advanced changes in the noncalcified zone superficial to the tidemark. Intrachondral degenerative cysts were frequently found in the basilar layers of the noncalcified cartilage adjacent to the tidemark where shear stresses were likely to be highest and diffusible nutrients least available. Highly cellular cartilaginous tissue was noted in the subchondral marrow spaces in the specimens with advanced cartilage degeneration. These areas appeared to be continuous with the overlying degenerated cartilage through gaps in the calcified cartilage. Subchondral bone did not show remarkable trabecular thickening despite advanced degenerative changes in the articular cartilage.


Nerve roots and spinal nerves in degenerative disk disease.

After 43 years of investigating the intervertebral disk, the long term results of the management of patients from the standpoint of pain are not significantly different than they were prior to the identification of the herniated disk nor do they seem to be significantly different than no treatment at all. This should at least suggest that the phenomena of low back pain is far more complex than can be accounted for on the basis of a simple mechanical-pressure theory of disk derangement. There is a significant volume of literature that would point to the neural tissues themselves as the most logical structures for future research that attempts to interfere with the natural history of this disease from the standpoint of pain. It seems most appropriate to attack lumbar disk disease from this standpoint because except in uncommon cases, the pathological process is benign and self limiting. It also seems logical that major advancements in the management of "diskogenic" back pain will depend upon an appreciation of the importance of controlling neural inflammation in the early phases of the disease rather than developing new techniques of managing irreversible neural lesions and their iatrogenetic or psychiatric sequelae.


Chemical radiculitis. A clinical, physiological and immunological study.

Chemical radiculitis is an inflammatory condition of the nerve root due to the rupture of the annulus fibrosus and dissemination of disk fluid along the nerve root sheath. The inflammatory component of disk fluid is glycoprotein. The inflammation is a reaction to repeated injuries of the spinal column, as for example, in occupational lifting of heavy loads. Rupture of the annulus fibrosus and liberation of disk fluid into the tissues also evokes circulating antibody response and auto immune reaction. A high titer to glycoprotein at 3 weeks after an acute attack of back pain is evidence of the presence of a significant disk lesion. In selected cases immediate relief from pain occurs after administration of cortisone or a suitable cortisone-derivative. Prolonged rest may be contraindicated because of the risk of formation of radicular adhesions.


Present status of chymopapain and chemonucleolysis.

An analysis of recent events and newly published data on Chymopapain and the technique of Chemonucleolysis including an objective analysis of clinical and basic research as well as the circumstances leading to the FDA curtailment of the use of Chymopapain in the United States, indicate that the drug should be reapproved for investigational use.


Degenerative disk disease of the lumbar spine: immunological implications.

The evidence for an autoimmune mechanism in degenerative disk disease is derived from the presence of a cellular reaction using both the leukocyte-migration inhibition test as well as the lymphocyte transformation test. The associated inflammatory reaction is the basis of the clinical syndrome and the chronicity of sign and symptoms.


Behavior modification of chronic pain: a treatment program by a multidisciplinary team.

A treatment program for chronic pain is reported which focuses on modification of patient pain behavior. After an outpatient pain clinic screening by a multidisciplinary team, the patient with chronic pain (duration of 6 months or longer) is admitted for a 7--8 week inpatient program followed by a 4-week outpatient period. The first week of the inpatient program is used for evaluation of pain behaviors, recording use of pain medications, activity levels, and tolerance for special conditioning exercises. The program is aimed at extinguishing pain behaviors and use of pain medications, increasing activity level, reinforcing well behaviors, and returning patients to full active lives, normal for their sex and age. Of the 34 patients completing the program and returning to full active normal lives, 74% (25) have maintained this attained goal at the time of follow-up from 6 months to 7 years later.


Pharmacokinetic study of a patient intoxicated with 2,4-dichlorophenoxyacetic acid and 2-methoxy-3,6-dichlorobenzoic acid.

A simultaneous pharmacokinetic study of two chemicals has been conducted on a clinically stabilized human who had intentionally ingested a mixture of 2,4-D and Dicamba. The information developed can be useful to the clinical toxicilogist in the management of similar cases.


Meprobamate overdosage: a continuing problem.

Meprobamate was implicated in 50 (6.5%) of 773 admissions to Massachusetts General Hospital due to psychotropic drug overdosage between 1962 and 1975. Estimated doses ingested reached as high as 40 gm. Serious intoxication was common. In 25 cases deep coma (grade 3 or 4) was reached; 23 patients became hypotensive, and 16 required assisted ventilation. Two patients died, one of whom ingested an estimated 12 to 20 gm of meprobamate apparently with no other drugs. The findings indicate that overdosage with meprobamate, even when taken alone, produces intoxication that is often serious and sometimes fatal. Although meprobamate is a relatively inexpensive anti-anxiety agent, its questionable efficacy and the potential for life-threatening intoxication are important drawbacks to the clinical use of this drug.


Actions and metabolism of codeine (methylmorphine) administration by continuous intravenous infusion to humans.

Miosis produced by codeine is not antagonized by nalorphine until large oral doses are administered for several days. The present experiment was conducted in order to further study this characteristic of the codeine effect. Eight healthy male volunteers, who were former drug users, were divided into two groups. Subjects in the first group were given a continuous infusion of codeine, 30 mg/hr for 11-16 hr. No subjective effects were reported by the volunteers. In three of the individuals definite miosis antagonized by nalorphine was observed at 9.5 hr. The dose of codeine for the second group was 60 mg/hr for 11 hr. Mild but definite subjective effects were experienced by each of the participants in this group. Miosis appeared between 2 and 6 hr. Challenges at 4 and 6 hr were positive in two subjects and negative or equivocal in the other two. Codeine was excreted in the urine as free and conjugated codeine, morphine, and norcodeine. Maximum rates of excretion were similar for both groups, suggesting that the maximum amount of codeine that can be metabolized is equal or less than 30 mg/hr. Also codeine clearance, being greater than creatinine clearance, suggests that codeine might be excreted by glomerular filtration and tubular secretion. Blood levels of codeine in the 60 mg/hr group were about 10 times those reported as therapeutic. However, morphine or norcodeine were not detectable by the methods used.


Evaluation of a charcoal-sorbitol mixture as an antidote for oral aspirin overdose.

The preparation of charcoal in a 70% sorbitol solution results in a suspension that is more palatable and less gritty than an aqueous slurry of charcoal. Although the charcoal-sorbitol mixture may be slightly less effective in reducing the extent of aspirin absorption compared with a charcoal slurry, it may prove to be of particular value in those cases where acceptance of a charcoal slurry presents a problem.


Heparin adsorption on activated charcoal.

By vitro studies have shown that sodium heparin adsorbs significantly at pH 7.4 conditions onto a typical activated charcoal. These results imply that enhanced heparin removal from blood should be anticipated in hemoperfusion systems that utilize uncoated charcoals.


Application of the programmable calculator in reporting emergency toxicology data.

The use of a programmable calculator in reporting the results of emergency toxicology analyses by personnel who do not routinely perform such analyses has eliminated the problems previously encountered due to unfamiliarity with a particular test or tests. The program that is used alerts the physician to those drugs that could possibly interfere in the screening tests used for emergency toxicology analyses and, in addition, provides him or her with an updated listing of popular street and recreational drugs and drugs of abuse in this area in the event that one of these is not detectable in the screening procedure.


The chemical constituents of ginseng plants.

The dried roots and rhizomes of ginseng (P. ginseng C. A. Meyer) contain many physiologically important constituents. These include ginseng saponins, ginseng oils and phytosterol, carbohydrates and sugars, organic acids, nitrogenous substances, amino acids and peptides, vitamins and minerals, and certain enzymes that have been isolated and characterized. Among these, ginseng saponins are proven to be the principal and most active constituents. Chemical research, therefore, has been focused on these saponins--their extraction, purification, identification, isolation of aglycones (genins), and biosynthesis. So far 13 saponins have been isolated and identified and these, which have been called ginsenosides or panaxosides, are triterpenes of dammarane and oleanane structures. Although American, Japanese, San-ch'i, Himalayan, and Siberian ginseng roots contain many saponins similar to those found in ginseng, the overall components in these ginseng species are quite different. The above-ground parts, particularly the leaves, of these ginseng plants contain many of the saponins normally present in the roots. The search for economical sources of ginseng saponins from nature and even chemical synthesis may likely become the active ginseng research of the future. Continued, meticulous studies are undoubtedly needed to develop these natural panacea into useful, efficacious modern remedies.


Effects of acupuncture on tissue-oxygenation of the rat brain.

Acupuncture has been claimed to be effective in restoring consciousness in some comatose patients. Possible mechanisms to explain alleged acupuncture-induced arousal may include vasodilatory effects caused by sympathetic stimulation which leads to an augmentation of cerebral microcirculation and thereby improves oxygen supply to the brain tissue. Experiments were performed in ten albino rats (Wistar) employing PO2 microelectrodes which were inserted into the cortex of the animals through small burholes. Brain tissue PO2 was continuously recorded before, during, and after acupuncture. Stimulation of certain acupuncture loci (Go-26) resulted in immediate increase of PO2 in the frontal cortex of the rat brain. This effect was reproducible. The effect was comparable to that obtained with increase of inspiratory CO2 known to induce arterial vasodilatation and thus capillary perfusion pressure. The effect was more significant as compared to tissue PO2 increases obtained after increase of inspiratory oxygen concentration from 21% to 100%. It appears that acupuncture causes an increase of brain tissue perfusion which may be, at least in part, responsible for arousal of unconscious patients. Dilatation of cerebral vascular vessels and improvement of autoregulation in the brain by acupuncture stimulation may also explain the effectiveness of acupuncture in the treatment of migraine headache.


The hemostatic effects of orally administered Yunnan Bai Yao in rats and rabbits.

The effects of orally administered Yunnan Bai Yao were studied on the bleeding time in rats and the blood clotting time in rabbits. Significant decreases were seen in both the bleeding and clotting times, observed over a 4 h period following administration. These effects were seen as early as 1/2 h and were still present at 4 h. Graded doses of Yunnan Bai Yao produced dose-related decreases in blood clotting times in the rabbits. The findings suggest that some active principle, able to affect the hemostatic mechanism, is absorbed after oral administration of the herbal preparation.


On the possible specific role of acupuncture loci in therapeutics.

The case history of a patient with thoracic vertebra fracture and following pain syndrome of the inferior limbs is reported. As a result of acupuncture treatment the pain was significantly reduced, but it could be reinduced by stimulation of the B1-31-33 loci during treatment. On needling the connecting locus of the related meridian of the bladder (Ki-6) the pain disappeared; otherwise stimulation of other loci showed a failure to stop the pain induced by the stimulation of B1-31-33 loci. It is remarkable that both the bladder's and the Ki-6 loci belong to the lumbal 4 spinal segment. The problem of the specific role of the acupuncture loci also is discussed.


Dural arteriovenous malformation associated with subdural and intracerebral hematoma: a CT scan and angiographic correlation.

Computed tomography of a case of hemorrhage from a dural arteriovenous malformation depicts an occipital varix with dilated venous channels, an intracerebral hematoma, a subdural hematoma and a subfacial hernation. The angiographic and surgical findings are described.


[The use of computerized tomography in the detection of intra-orbital foreign bodies].

Use of the CT scanner as an instrument for foreign body detection and localization was explored under experimental  conditions. The results show that a sufficiently dense radiopaque foreign body as small as 0.7mm3 can be detected and localized by presently available scanners.


Direct coronal computerized tomography.

The computerized tomographic examination is routinely performed in the axial plane. However, with several available CT units images in the coronal plane are easily obtained. These images are especially useful in the diagnosis of diseases of the facial bones, sinuses, orbits and parasellar area. This paper describes one year's clinical experience with direct coronal computerized tomography.


A graphic display system for use with a computerized tomographic scanner.

A system for the display and analysis of computerized axial tomography scans has been developed. Selected regions of scans can be outlined using a joystick, allowing rapid statistical analysis. The difference between two scans can be displayed, and coronal and sagittal sections as well as projected displays, can be produced from a series of transverse sections. A special purpose software system has been developed to allow programming on a logical level. The system is used both for the analysis of current scans and the retrospective accumulation of data from past scans.


The effects of psilocybin on primary process content in language.

The hypothesis that psilocybin induced primary process thinking was assessed. On four separate occasions, a subject was asked to write before, during, and after the hallucinogenic experience induced by doses ranging between 80 and 200 microgram/kg of psilocybin. Texts produced at the drug peak contained significantly more primary process content and were significantly more stereotyped on several measures than those written before or after the drug peak.


The relevance of ideas and beliefs to immigration as it is seen from a theory of personality point of view.

In the realm of human culture, ideas and beliefs are studied in the disciplines of sociology, philosophy, not psychology. Although human spiritual abilities, that is, the ability to speak, think, yield thoughts, ideas, beliefs are maybe that which best characterize the human being as such, they are not considered part of the study of human personality. The levels-of-organization model of personality, which is presented here, considers human spiritual powers as part and parcel of human personality, and ascribes to it a very important specialized role. According to it, the highest stage of human growth are his spiritual abilities. Consequently, whatever a person does depends a great deal on what he thinks and believes. The importance of human spiritual powers is best manifested in crisis situations. This presentation will consider immigration as an example to stress, and examine the contribution of human ideas and beliefs to human ability to overcome this kind of stress.


[The correct relationship to time].

Time, in a human life, has been defined in modern philosophy, psychology and psychopathology as a well-organized structure. The question concerning the right relation to time has not been treated so often. Hereby, different aspects have to be considered. (1) Inasfar as time can be seen as a perpetually flowing stream, the duty arises to fit in (one-self), in the right way, without haste and without tarrying, in the course of time. This demands the virtue of imperturbability. (2) From the experience of continuous wane results the desire for steadiness in eternity. The penetration into temporality is successful in two ways: in the absolute determination of existence, and in the experience of the great, overwhelming happiness. But these moments are rare. (3) In the relation to the future, again two interrelated possibilities have to be distinguished. On one side, it has to be planned responsibly but, on the other side, all plans are limited by fate and accident. Opposite to the deeply experienced threat lies the true hope as a last structure of time by man, which must be seized resolutely against all temptations.


Plasmalemmasome development in Trichophyton mentagrophytes grown at suboptimal temperature.

When the dermatophytic fungus Trichophyton mentagrophytes is cultivated at the suboptimal temperature of 19 degrees C, the plasmalemma of the youngest cells appears to be associated with a variety of membranous bodies, the number of which is much greater than at the optimum temperature of 28 degrees C. These structures can be indicated as plasmalemmasomes both for morphological characteristics and cytochemical reactivity. A possible correlation between the suboptimal condition and plasmalemmasome ontogeny and function is proposed.


A scanning electron microscopic study of IAA-induced tumors in bean (Phaseolus vulgaris L.) embryos.

A scanning electron microscopic study of indole-3-acetic acid (IAA) induced tumour in the hypocotyl region of bean embryos shows a distinct morphological, structural and topographical change from the non-treated bean embryos. The IAA-induced tumour surface, in the hypocotyl region, shows distinct cell enlargement, some cellular proliferation in the parenchymatous tissue, total destruction of the epidermis and stomata and some variation in trichome structures. In dole-3-acetic acid inhibits the normal growth of the epicotyl, and, as age progresses, adventitious roots appear all over the surface. When IAA-depletion occurs, epicotyl growth resumes, which indicates that this tumour formation in bean embryos is an IAA-dependent tumour.


Temperature and the progression of HeLa S-3 cells from G2 into mitosis in the presence and absence of the amino acid analogue, para-fluorophenylalanine.

HeLa cells grown in suspension at 37.5 degrees C show an immediate reduction in the rate of progression from G2 into mitosis at suboptimal temperatures. The rate of progression becomes slower the longer the cells reside at the lower temperatures. Shifting cells back to 37.5 degrees C from 33.5 degrees C results in an immediate increase in the flow of cells from G2 into mitosis but not to the optimal (37.5 degrees C) rate of traverse found in unshifted controls. The longer cells reside at 33.5 degrees C before being shifted to 37.5 degrees C, the slower the rate of G2 traverse. G2 cells allowed to incorporate p-fluorophenylalanine (in the absence of phenylalanine) are inhibited from entering mitosis at 37.5 and 39.5 degrees C, partially inhibited at 33.5 and 35.5 degrees C, but remain uninhibited at 32 degrees C. Greater incorporation of 3H-p-fluorophenylalanine and of 3H-leucine in the presence of 0.2 mM p-fluorophenylalanine seen at the lower temperatures than at 37.5 and 39.5 degrees C. Although protein synthetic rates and progression of cells to mitosis at different temperatures show a close correlation, they do not appear to be casually related.


Informational molecules in amoebae: an attempt to follow injected fractions using autoradiography.

Cytoplasmic fractions from Amoeba discoides contain informational molecules which, when injected into A. proteus, may influence the characters of resulting clones. An attempt was made to follow and locate these molecules by autoradiography. Using either 3H-uridine or 3H-leucine, radioactive fractions of A. discoides were microinjected into A. proteus and cells examined at varying times after injection. A. discoides were injected with the same preparations to serve as controls. Grain counts were compared for equivalent areas of nucleus and cytoplasm, and results expressed in terms of the ratio between nucleus and cytoplasm. When the light microsomal or the supernatant fractions were injected, the level of labelled molecules was higher in the nucleus than the cytoplasm in over 50% of the cells examined after 6 h, except for those cells injected with 3H-leucine-labelled supernatant material when only 15% cells showed a nuclear/cytoplasmic grain count greater than 1.1. After some purification by sucrose density gradient centrifugation, 'information-containing' peaks '13' from the light microsomal fraction, and '16' from the supernatant fraction were injected. A different pattern of results was obtained. The problems of interpreting these results in the light of known migratory molecules and strain incompatibility are discussed.


On the distinction between fear and wariness.

The study seeks to illuminate the mechanisms that mediate avoidant reactions in young humans. 40 babies repeatedly were observed throughout their second year in a variety of mildly challenging situations, and then again in a series of follow-up assessments at age 3 1/2. Analysis of the covariance patterns among the repeated measurements supports positing 2 distinct types of avoidant mechanism--an inclination to be "wary" of the unfamilar, and a proclivity to be "fearful" after exposure to a mildly difficult situation. Each type of phenomena constituted an independent source of individual differences. Behaviors that differed as a result of prior experience proved fairly predictive of future social orientations; variations in initial wariness did not.


Infant crying and maternal responsiveness: a rejoinder to Gewirtz and Boyd.

The criticisms leveled by Gewirtz and Boyd focus on 1 of 6 analyses upon which Bell and Ainsworth based their interpretation of findings--namely, cross-quarter correlations of measures of infant crying and maternal response. It is maintained that these measures were approximate, and that they were independent of each other in cross-quarter correlations. It is also maintained that the statistical procedures were appropriate to a small sample of subjects in naturalistic, longitudinal research. The three "illustrative" cases offered by Gewirtz and Boyd as ways of testing a contrary hypothesis are considered. These cases assumed maternal behavior patterns which, it is argued, do not occur. Finally, other evidence is cited, both from other studies and from within the Bell-Ainsworth paper itself, that supports the interpretation that Gewirtz and Boyd claim to have been unjustified.


Attachment of kibbutz infants to mother and metapelet.

122 children, born and reared on Israel kibbutzim, were observed in a cross-sectional study of infant attachment behaviors. Their reaction to either mother or metapelet (caretaker) separation and reunion was recorded over a 13-sequence experimental paradigm. Results indicated that children protested equally to either mother or metapelet separation when left with a stranger. Reunion behaviors seemed to be sensitive to the different attachment relationships the infant had with each caretaker, while separation behaviors were not. The  quality of the infant-mother interactions as it is related to the infant's ordinal position had a significant effect on infant attachment behavior in the experimental situation. Firstborn (only) children were more anxious than later-borns during the session. Speculation as to the origin of these significant ordinal differences is discussed.


Sex differences in parent-infant interaction during free play, departure, and separation.

20 18-month-olds were observed with their mothers and 20 with their fathers in laboratory free-play, departure, and separation situations. Parent and infant behaviors were allowed to vary naturally. Although there were no parent sex or infant sex differences in infants' free-play behavior, there were parent sex X infant sex differences in parental free-play behaviors. Parents talked to, sat on the floor more with, and tended to share play more with same-sexed than opposite-sexed infants, and the patterning of free-play behaviors was different for mothers and fathers. During departure, fathers talked to the infants more than mothers. Infants were more distressed in the absence of same-sexed than opposite-sexed parents. There were infant sex X parent sex differences in the relationships between separation distress and parental free-play and departure behaviors. The implications of these findings for understanding differential roles of mothers and fathers, the development of sex differences, and the determinants of separation distress are discussed.


Sex differences in parent and infant behavior in the home.

Observations were made in the homes of 32 families, each with a child aged around 12 or 24 months. 16 of the children were boys and 16 girls. Boys showed more active play, play with transportation toys, and play generally forbidden by parents. Girls played more with soft toys and dolls. On questionnaire responses many parents rated these and other behaviors as sex appropriate. However, actual sex differences in immediate parental response to children were few or undetected. Sex differences in children's behavior did not appreciably increase from 12 to 24 months. Also, there was no correlation with how stereotyped parents' questionnaire responses were and the degree to which their children exhibited sex-typed behavior.


Initiating day care at three years of age: effects on attachment.

Using the Ainsworth-Wittig strange situation, 12 42-month-old children with approximately 6-months of day-care experience were compared with individually matched children who had not had group child-rearing experience; 8 members of each experience group were female, and 4 members were male. While the day-care children showed less distress than the home-care children in the latter parts of the laboratory situation, the 2 groups were not different with respect to most other behaviors, including those toward the mother. However, day-care experience appeared to have differential effects as a function of sex; large differences were often found between the scores of the male subgroups, whereas the differences between the female subgroups were usually small. The day-care males exhibited the most exploratory manipulation, and the home-care males showed the most approach and proximity seeking toward the mother and the strongest approach toward and avoidance of the stranger. These results did not support the idea that day-care experience impair attachment to the mother.


Aggression and peer acceptance in adolescent boys: two short-term longitudinal studies of ratings.

2 longitudinal studies covering a 1-year and a 3-year interval, respectively were conducted on 2 samples of boys aged 13 years (N1=85, N2=201). On the basis of an adaptation of multimethod-multivariable analysis and other analyses it was found that information contained in the 4 rating dimensions under study to an overwhelming degree reflected characteristics of the boys, not rater biases. The results indicated very high or high degrees of stability over time in the dimensions studied concerning aggression and peer acceptance. The results for the aggressive area were construed as strong evidence for assuming relatively stable, individual-differentiating reaction tendencies or motive systems within the boys. The findings also provided strong evidence that certain aspects of each boy's interpersonal environment were stably different for different boys.


Development of sex-trait stereotypes among young children in the United Staes, England, and Ireland.

The Sex Stereotype Measure II (SSM II), a 32-item revision of the Williams, Bennett, and Best Sex Stereotype Measure, was developed to assess children's knowledge of conventional, sex-trait stereotypes defined by American university students. The procedure employed brief stories and human figure silhouettes which were individually administered to 5- and 8-year-old children in the United States, England, and Ireland and group administered to 11-year-olds in the United States. In the United States, knowledge of sex-trait stereotypes was found to develop in a linear fashion between the ages of 5 and 11, with more male traits than female traits being known at each age level. Cross-nationally, there was a high degree of similarity in the nature of the sex stereotypes being learned by the children in the 3 countries, although the rate of learning appeared slower among the Irish children. In all countries there was a clear progression in sex-stereotype learning from age 5 to age 8. English boys had greater knowledge of stereotypes than English girls, but this was not true in Ireland and the United States. Generally, knowledge of male stereotype traits appeared to develop earlier while knowledge of the female traits increased more rapidly between ages 5 and 8. The similarity in sex-stereotype learning in the 3 countries is discussed, and studies in progress in other countries of greater cultural diversity are noted.


Behavioral and fantasy measures of fear of success in children.

Fear of success was assessed for 61 fifth-, seventh-, and ninth-grade children using Horner's and Baruch's "fantasy" measures and a behavioral measure developed by the authors. Males and females did not differ significantly on fear of success as measured by the fantasy technique. Developmentally, male fear of success remained unchanged in the three grades tested, while female fear of success decreased from grade 5 to grade 7. The behavioral measure of fear of success tapped a drop in achievement striving in grade 7 for the female subjects. Results are discussed in light of a "situational" versus personality theory of the development of fear of success.