Hypopituitarism following pituitary irradiation for acromegaly.

Endocrine evaluation is reported in 8 acromegalic patients who received 5,500 rad to the pituitary from a linear accelerator. There was a mean decrease in hGH levels of 72%. Plasma testosterone levels were low in 1 of the 6 male patients prior to pituitary irradiation and were below normal in all male patients on the final evaluation (3.1 +/- 0.2 SD years postirradiation). Deficiency of TSH secretion developed in 2 patients following irradiation. This rather high incidence of postirradiation partial hypopituitarism was not anticipated, and is thought to be related to radiation necrosis of the normal pituitary tissue which surrounds the adenoma.


Adrenergic and dopaminergic control of growth hormone secretion in urethan anesthetized adult male rats.

The effects of drugs which interfere with alpha-adrenergic and dopaminergic mechanisms, involved in GH and PRL secretion, have been analyzed in urethane anesthetized rats. Clonidine induced a dose-dependent release of GH (0.0032--0.1 mg/kg i.v.) as well as of PRL (0.032--1.0 mg/kg i.v.). The lowest dose of clonidine, when given into the third ventricle, provoked a very pronounced release of GH. Phentolamine, given intravenously, inhibited the clonidine-induced GH release in a dose-dependnet manner. L-Dopa administered intravenously and apomorphine administered intravenously or intraventricularly did not affect basal secretion of GH bu- produced a dose-dependnet inhibition of clonidine-induced GH release. Pimozide did not change basal GH secretion. Furthermore pimozide did not attenuate the inhibition of clonidine-induced GH secretion seen after apomorphine administration, however, it completely reversed apomorphine-induced PRL inhibition. These findings demonstrate that an alpha-adrenoceptor-mediated stimulatory mechanism is involved in GH and PRL secretion. An inhibitory dopaminergic mechanism is confirmed for PRL secretion and suggested for GH secretion.


Decreased fructose concentrations in coagulating glands of prepuberal rats treated with testosterone and LH.

Doses of testosterone propionate from 2.5 to 320 microgram and doses of LH from 2 to 360 microgram given over 1--3 days generally decreased fructose/body weight ratios in the coagulating glands of late prepuberal rats. The ratios of testes, seminal vesicles, coagulating glands and ventral prostates to body weight were increased after different treatment regimes with testosterone propionate. These changes in the variables measured could be detected by computer analysis in spite of the rapid growth rates of organs of rats of this age. LH increased the weights of only the seminal vesicles and coagulating glands, and then, only at the highest doses given.


Effects of melatonin and natural and synthetic analogues of arginine vasotocin on plasma prolactin levels in adult male rats.

A significant elevation in plasma prolactin was observed 10 min following the intravenous injection of 100 microgram of melatonin into either estrogen-progesterone (EP) primed or into nonsteroid-treated male rats. 60 min postinjection in the EP primed rat, the groups treated with 100 microgram or 10 mg of melatonin had signficantly elevated plasma prolactin levels while no effect was observed with these same doses in the nonsteroid-treated rats. Compared to diluent-treated controls, a significant elevation in plasma prolactin was observed at 10, 20 and 60 min following the intravenous injection of either 1 microgram arginine vasotocin (AVT) or 1 mg melatonin into EP primed male rats. A consistent rise in plasma prolactin was also evident after the injection of 1 microgram of either arginine vasopressin, lysine vasopressin or AVT. Oxytocin had no effect on plasma prolactin values. The intravenous administration of 1 microgram of (deamino-1,6 dicarba, 8-arginine)-vasotocin caused a significant elevation of plasma prolactin 10 and 20 min after injection. However, the injection of another analogue of AVT, (4-leucine, 8-arginine)-vasotocin, had no effect on prolactin release at the time points measured.


[The interaction between phosphate and protein, and the respiration of the llama, the human fetus and the horse (author's transl)].

The sequence analysis of llama (Lama glama, Camelidae) hemoglobin is described. The chains were separated, cleaved by trypsin as previously described, quantitatively characterized and sequenced in the sequenator. The llama hemoglobin differs from the human hemoglobin in that it has 25 different amino acids in the alpha chain and 24 different amino acids in the beta chain. The interaction between protein and phosphate is discussed. The earlier finding that the O2 affinity of the llama hemoglobin is dependent on its content of 2, 3-bisphosphoglycerate is interpreted here as a mutation of the 2, 3-bisphosphoglycerate contact position beta2 His in human hemoglobin to beta2 Asn in llama hemoglobin, whereby one of the four 2, 3-bisphosphoglycerate contact points is interrupted. This interruption gives rise to a diminished reduction of intrinsic oxygen affinity in the hemoglobin molecule and explains, on a molecular basis, the increased oxygen affinity of the llama hemoglobin, and consequently, the high-altitude respiration of the llama. By analogy, the increased O2 affinity of human fetal hemoglobin is interpreted according to previous physiological investigations on blood and fetal hemoglobin by the inactivation of the phosphoglycerate contact point beta143 His in the adult hemoglobin by mutation to gamma 143 Ser in the fetal hemoglobin. With respect to respiration in horses (2, 3-bisphosphoglycerate contact beta2 Gln), measurement of atomic parameters show that the amido group of the glutamine is situated close enough to the 2, 3-bisphosphoglycerate oxygen to build a hydrogen bond with the phosphate. Consequently, the explanation of the low-altitude respiration of the horse lies in the fact that glutamine and histidine fulfill sterochemically an identical function.


Investigations on the functional role of rat liver carboxylesterase isoenzymes.

We have compared the substrate specificities of two isoenzymes of rat liver esterase. Isoenzyme E1 which we isolated earlier, and isoenzyme EA, the isolation of which is reported here, have very similar molecular weights, subunit weights, and isoelectric points. In contrast, the two enzymes have distinctly different substrate optima when tested with a series of esterase substrates. Our finding poses the question, as to whether the rather unspecific in vivo behaviour of liver carboxylesterase could be explained by an ensemble of isoenzymes with overlapping substrate specificitites and mutually complementary substrate optima. The biological function of esterase isoenzymes appears to represent an extension of the range of hydrolytic competence of a single enzyme.


A radioimmunoassay for measurement of human pancreatic secretory trypsin inhibitor in different body fluids.

A radioimmunoassay for measurement of human pancreatic secretory trypsin inhibitor in nanogram quantities has been developed. The sensitivity of the assay now permits examination of the inhibitor content of various body fluids, wherein other methods exhibit serious short-comings. In healthy blood donors the serum level was 8.1 microgram/l. In patients with acute pancreatitis levels as high as 320 microgram/l have been measured, and patients who underwent endoscopic retrograde cholangiopancreatography showed an elevated inhibitor level in serum immediately after the examination without any clinical signs of disease, the highest registered value being 128 microgram/l. In peritoneal lavage fluid from patients with severe acute pancreatitis levels of 5-304 microgram/l have been measured. In urine the inhibitor level is about 14 microgram/l in healthy persons. The urine from one patient with proteinuria of glomerulo-tubular type contained 380 microgram/l.


Immunoreactive trypsin in serum and peritoneal fluid in acute pancreatitis.

High levels of immunoreactive cathodal trypsin are shown to be present in serum and peritoneal fluid in acute pancreatitis. The immunoreactive material is contained in two fractions with different molecular weights: free trypsinogen and trypsin in complex with protease inhibitors, mainly alpha1-antitrypsin. The presence of trypsin in complex with protease inhibitors indicates the formation of active trypsin during acute pancreatitis.


Studies of ligand binding to cholera toxin, III. Cooperativity of oligosaccharide binding.

Binding parameters for the interaction of cholera toxin and choleragenoid with monosialo-gangliotetraose, the oligosaccharide moiety of ganglioside II3 NeuAc-GgOse4-Cer, have been measured by equilibrium displacement dialysis. The experimental data were evaluated by a curve fitting computer program. The binding curves obtained at 6 degrees C reflected positive cooperativity with average Hill coefficients in the range of 1.16 to 1.25. The cholera toxin as well as its ganglioside-binding protomer B-protein bind 4 mol of monosialogangliotetraitol per mol of protein. The presence of disulfide-cleaving agents like 2-mercaptoethanol did not eliminate the cooperativity of the binding characteristics, but increased the Hill coefficient.


A study of microsomal oxidative functions with the aid of a series of N-colchiceyl derivatives.

N-Colchiceyl derivatives are presented as a class of substances which, provided certain structural requirements are met, are oxidatively degraded by microsomal suspensions both at the nitrogen-linked side chain at ring C and at the oxygen-linked side chain(s) at Ring A. The chemical structures of unknown metabolites have been elucidated by comparison with authentic samples whose syntheses are described. Comparative studies indicate structure-dependent preferred sites for the introduction fo oxygen, whose extent correlates rather closely with the partition coefficient in the system n-octanol/ethanol/water. The results demonstrate, with the inclusion of some inhibition data, the suitability of N-colchiceyl derivatives for detailed investigations of microsomal degradative processes.


Transfer of C2-units across the mitochondrial membrane. Direct recording of citrate, acetate and acetoacetate production rates.

Methods are described for the direct optical assay of citrate, acetate, and acetoacetate production by isolated, incubated rat liver mitochondria. Each metabolite is converted into acetyl-CoA, using ATP: citrate lyase or acetyl-CoA synthetase or acetoacetyl-CoA synthetase and acetyl-CoA acetyltransferase, respectively. Arylamine acetyltransferase acts as auxiliary enzyme. It was shown that isolated rat liver mitochondria produce citrate, acetate and acetoacetate, and that production rates are stimulated by pyruvate and hexanoate. It was concluded that these three products might contribute to the transport of acetyl units across the mitochondrial membrane and thus serve as precursors in fatty acid synthesis. The rate of acetyl transfer does not seem to be rate-limiting with regard to the overall-process of fatty acid synthesis from carbohydrates.


Snake venoms. The amino-acid sequence of protein S5C4 from Dendroaspis jamesoni kaimosae (Jameson's mamba) venom.

A major component (S5C4) was purified from Jameson's mamba by gel filtration on Sephadex G-50 and by ion-exchange chromotography on CM-cellulose. Protein S5C4 contains 60 amino acid residues and is cross-linked by four intrachain disulphide bridges. The complete primary structure of the protein has been elucidated. The toxicities, the immunochemical properties, the sequence and the invariant amino acid residues of protein S5C4 resemble subgroup II of the angusticeps-type proteins.


Determination of the superoxide dismutating activity of D-penicillamine copper.

The superoxide dismutating activity of the D-penicillamine copper complex was determined and compared with the activities of Cu-Zn and Mn superoxide dismutase in four O2 ground negative earth generating systems. I. Nitrite formation from hydroxylamine. II. Crocin destruction by xanthine/xanthine oxidase. III. Ethylene production by isolated chloroplasts. IV. Nitrite formation from hydroxylamine by chloroplasts in the presence of diquat (1, 1'-dimethylene-2,2'-bipyridylium dibromide). In all four test systems a high dismutative activity of the complex was found, which is not sensitive to KCN as demonstrated with test system III. The results are discussed with regard to the antiinflammatory activity of D-penicillamine.


Quality control in histopathology and diagnostic cytology.

The need for quality control in diagnostic histopathology and cytology is analysed together with a discussion of previously reported experience in this field. The philosophical and mathematical inferences of this type of exercise are debated also in relationship to personally observed experiences in respect of uterine cervical cytology and histology. The desirability of methods of monitoring of diagnostic quality and of obtaining quality improvement are emphasized and suggestions made regarding the techniques most suited to these objectives.


Pulmonary histological appearances in fatal paraquat poisoning.

The paper describes the histological appearances in the lungs from 11 fatal cases of paraquat poisoning. The study originated as an attempt to define the sequential changes in the condition and, from them, to assess the mode of action of the herbicide in the human. The main features of the "paraquat lung" include haemorrhage, extrusion of macrophages, oedema, "honeycombing", fibrosis and, rarely, epithelial hyperplasia. The indications are that the changes are progressive once a threshold tissue concentration has been reached. The appearances are compared to those in poisoning by hyperbaric oxygen and it is hypothesized that the toxic action of paraquat is to sensitize the lungs to oxygen at atmospheric pressure.


The rectal biopsy appearances in Salmonella colitis.

Rectal biopsies were examined from 22 patients with Salmonella infection of food-poisoning type and from seven patients with inflammatory bowel disease and coincidental Salmonella infection. In the former group the changes observed were mucosal oedema with acute inflammation of varying severity but with preservation of the crypt architecture. Crypt abscesses were present in a few cases but were usually localized in the crypt and mucus depletion only occurred with severe inflammation. These features are not specific and are similar to those seen in other types of infective colitis such as Shigella dysentery, gonococcal proctitis and amoebic colitis. In the majority of cases of infective colitis the appearances are usually sufficiently distinctive, however, to distinguish them from those seen in ulcerative colitis and Crohn's disease. The changes in the biopsies from the seven patients with coincidental Salmonella infection were in general those of the underlying idiopathic inflammatory bowel disease.


Morphological changes in the placenta and decidua after induction of abortion by extra-amniotic prostaglandin.

Seventeen placentae from second trimester abortions induced by the injection of extra-amniotic prostaglandin have been examined. The extraplacental membranes, the chorionic plate of the placenta, the placental intervillous space and the placental villi were normal in all cases. In all but one specimen lesions were, however, noted in the decidua, these including focal decidual necrosis, intradecidual haemorrhage, thrombosis of maternal vessels and dilatation and congestion of the maternal vasculature. Similar decidual lesions were also seen in placentae from spontaneous and surgical second trimester abortions and it is concluded that prostaglandins do not produce any specific lesions in the placenta or decidua. It is suggested that the negative findings of this study indicate that prostaglandins do not induce abortion by either direct injury to the placenta or by provoking utero-placental ischaemia.


Presence of satellite cells in a cardiac rhabdomyoma.

Cardiac rhabdomyoma is the most common tumour of the heart in infancy and childhood. The clinical presentation, diagnosis and histopathological characteristics have been extensively studied; however, reports on the ultrastructure and histogenesis of this lesion are scanty and inconclusive. The case to be discussed is that of a 10-year-old male who presented with a cardiac rhabdomyoma occupying almost the entire ventricular apex. Ultrastructurally, the rhabdomyoma cells have a central, deeply-indented nucleus surrounded by an admixture of mitochondria and sarcomeres. The remainder of the cytoplasm is occupied by pools of glycogen granules, randomly-orientated myofibrils and small mitochondria. Intercellular junctions are numerous and consist of alternating zonula occludens and macula adherens. Typical satellite cells, sharing a common basement lamina are seen apposed to the rhabdomyoma cells. It is tempting to postulate that the proliferation of the rhabdomyoma cells is accomplished by differentiation of satellite cells, a process known to occur in skeletal muscle. Ultrastructurally, the rhabdomyoma cells are indistinguishable from Purkinje cells. The presence of Purkinje-like cells in ectopic locations within the heart and their association with satellite cells is likely a form of embryological atavism.


Therapists', patients', and inpatient staff's views of treatment modes and outcomes.

Data were gathered on 199 consecutive admissions to a community mental health center in an exploratory study to compare patients, therapists, and inpatient staff's perceptions of inpatient treatment. The three groups showed little agreement on the identification of patients' symptoms or on assessments of change for those cases in which they agreed on the symptoms. There was also little concurrence between the inpatient staff and therapists in reporting which major therapeutic modalities they used, and in identifying cases in which there were communication problems between therapist and staff. However, neither the use of different treatment approaches nor the existence of communication problems was related to longer lengths of stay or poorer outcomes. The authors note that many of the findings are consistent with comparisons elsewhere of patients' and caregivers' perceptions of outpatient psychotherapy and general medical care.


Literacy skills of long-term hospitalized mental patients.

The authors tested 48 patients who had lived in a state psychiatric hospital for extended periods to determine their literacy levels. Measures used were the reading test portion of the Adult Basic Learning Examination (ABLE) and selected questions from the Adult Performance Level (APL) test, which attempts to assess competencies necessary to function effectively in society. Nearly half of the patients scored at the fourth-grade level or below on the ABLE, and their scores on the APL were well below norms for other groups. No correlation was found between number of years of hospitalization and test performance. From the findings the authors conclude that both in-hospital and aftercare programs must recognize that literacy level is an important factor in the the rehabilitation or recidivism of patients.


Movable group therapy for institutionalized patients.

Chronic psychotic inpatients at the Rochester (N.Y.) Psychiatric Center participated in a normalization program in which group therapy sessions were held in parks and restaurants in the community. The only guideline given patients was that no one observing the group should have reason to think members were from the state hospital. The patients were transported in an unlabeled car. The therapist consulted with staff before and after outings, thus providing integration with the over-all treatment plan. After one year 20 of the original 40 patients had been discharged; after three years only eight were still hospitalized. The author emphasizes the dynamics of observed emotional growth and symptom relief and cautions about interpretation of the rate of discharge.


The positive group: a therapeutic technique in the hospital treatment of adolescents.

Many adolescents on inpatient units have a low selfesteem and do not recognize their own strengths. To help such patients, the San Antonio Children's Center includes in its treatment program a weekly group session in which adolescents and staff meet together to review each patient's progress during the week; only positive comments are allowed. A different person--patient or staff member--acts as chairman of each meeting. The chairman initially provides some structure by reminding participants that it is a positive group. He then makes positive statements about himself and about others in the group. Through role-modeling, adolescents learn to accept and to make positive comments.


The medical model and the responsible patient.

At Bryce Hospital patients whose illnesses are considered to have a biochemical basis, such as schizophrenia or manic-depressive illness, are assigned to a "responsible patient" class in which they are taught the rights and obligations of responsible patients: to know about the illness, to participate in treatment planning, and to follow treatment routines. The class is a segment of the instruction given in the hospital's Psychological Learning Center and is based on the medical model. The authors describe the class, the learning center, and the historical and theoretical antecedents of such an approach.


A one-year report on rights violations under Michigan's new protection system.

A total of 1034 complaints were received in the first 11 months after the implementation of Michigan's new system to safeguard the rights of recipients of services from state institutions. Twenty-eight per cent of the complaints resolved during that period were substantiated as violations of statutorily protected rights. Both the volume of complaints and the number of substantiated violations were far higher in hospitals for the mentally ill than in facilities for the mentally retarded; however, facilities for the retarded had twice the percentage of substantiated complaints. There were significant differences in the numbers and categories of complaints and substantiated violations both between the two types of institutions and between large and small institutions. The findings sugtest directions for further action by the institutions and by the state office of recipient rights, which was established to oversee the system.


A conceptual approach to deinstitutionalization.

Many serious problems in deinstitutionalization result from conceptual oversights or confusion. Understanding deinstitutionalization as a process and a philosophy, as well as a fact, permits planning that will accommodate the variety of patient populations that are the products of the deinstitutionalization movement. The role and possible contributions of the state hospital in caring for chronic patients must be assessed objectively. Effective program planning for chronic patients during this period of deinstitutionalization depends on a careful and realistic definitiin of what individuals are to be treated in the community. Such planning must not only attempt to match patients and appropriate treatment settings but must aim at enhancing rehabilitation, where feasible, through a skills training approach.


Effects of community mental health services on state hospital admissions: a clinical-demographic study.

In a study to refine the methodology for evaluating the impact of community mental health centers on state hospital admissions, data were gathered on hospital patients' demographic and clinical characteristics as well as on total admission rates. The study covered total inpatients admissions to a Pennsylvania state hospital from two counties for ten time periods, both before and after the establishment of local community mental health services. The authors found few consistent changes on most of the clinical and demographic factors for patients from either county, which indicated that the expansion of community services did not lead to changes in the type of patients admitted to the state hospital. However, the data did suggest that the expanded community services reduced the state hospital admission rates and shortened the length of hospital stay.


A study of former patients placed in private proprietary homes.

The authors report on a study of 1999 residents of 26 private proprietary homes for adults in the metropolitan New York City area; 76 per cent of the residents were former psychiatric inpatients. The former patients were compared with the other residents in areas of physical and psychiatric functioning and social performance; the former patients showed more dysfunction due to psychological problems than the other residents, who tended to be older and suffer from physical problems. The former patients were also categorized into three groups according to whether their needs were considered greater than, less than, or consistent with the level of services provided in the homes; the results suggest that a substantial proportion of former patients may be more appropriately placed in other facilities.


Assessing the performance of hospital support services.

A simple to operate, nontechnical quality assurance program was developed to evaluate the support services provided at this Veterans Administration hospital. The program has received unanimous support from the entire hospital staff and promises to be a highly effective, and practical, program.


Does biomedical research need an artificial watchdog?

The establishment of an ethical watchdog group to monitor biomedical research was a major recommendation in the preliminary report of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Although the American public generally views scientific advances in a positive light, society still needs to be informed of and involved in decisions about future technology.


No smoking, please!

In an effort to be responsive to the needs of its nonsmoking patients, Louis A. Weiss Memorial Hospital, Chicago, established a no-smoking patient care floor. The program has been enthusiastically accepted by patients, the public, and hospital employees. In fact, the no-smoking unit has consistently had the highest occupancy rate of any medical-surgical unit in the hospital.


Counseling and peer review are key disciplinary procedures.

The best approach to the problem of an employee with a disciplinary problem is not always termination. When performance slips at this hospital, supervisors work closely with the employee to bring about improvement. The secret to the system is early recognition of problems, followed by intense problem solving.


Panel provides 1978 update on hospital social work.

In a roundtable discussion, three hospital social workers explain some of the special problems and issues confronting them in their individual and interdisciplinary roles in health care settings.


Creative responses needed in controlled environment.

Faced with an increasingly regulatory environment, hospitals must find innovative ways by which, first, to survive and, then, to respond constructively to externally applied constraints. Decertification of beds and a move to ambulatory care programs are only two of many possible responses. The key to success will be the measure of cooperation between health care providers, insurers, and government.


Administrators, boards, physicians must help change health system.

Change in the health care system is inevitable, and hospital administrators, boards, and medical staffs must learn not only to accept it but also to participate in effecting it. They must promote cooperation among hospitals, become more informed about the system's problems and pressures for change, and participate in activities of HSAs and other health-related groups that plan and influence change.


Hospital bed needs defy cut-and-dried planning.

The types and uses of hospital beds vary widely, so bed need cannot be adequately determined by strict planning models and cannot adequately indicate a community's total health care needs. Health planners must recognize these limitations and must use more sensitive methods to determine needs of patients, health care institutions, and communities.


Interdisciplinary task force designs risk management program.

When a hospital decided to self-insure, it also realized that it needed a more comprehensive risk management program to protect its operating assets. To develop this program, an interdisciplinary task force and its five subcommittees involved as many staff members as possible in studying and proposing risk management efforts related to policies and procedures, hiring practices, staffpatient interactions, staff and community education, and claims review.


Survey updates unionization activities.

Survey conducted in 1976 shows that the 1974 amendments to the National Labor Relations Act have speeded unionization of U.S. hospitals. Marked variations in unionization according to hospital type, size, and location continue. Overall, 23 percent of all hospitals have at least one union contract.


Nosocomial infection: the hidden cost in health care.

Excessive length of stay due to nosocomial infections is contributing enormously to the high cost of health care. The authors suggest ways to reduce the incidence of infection and, thereby, decrease hospital lengths of stay and lower patient bills while improving the quality of patient care.


New sharing arrangements meet hospitals' technical support needs.

Just within thid decade, a variety of multihospital arrangements have been developed that make clinical engineering services available to hospitals on a shared basis. This article summarizes available data to describe the diverse approaches and organizational structures into which these programs are evolving.


Function of hospital-based planner must match organizational need.

Different types of hospital-based planners perform different functions and assume different degrees of authority. A hospital must assess its planning needs and the characteristics of each type of planner in order to hire properly. The hospital staff members and the planner then must accommodate each other's work styles and function to cooperate in achieving the hospital's goals.


There's more to patient care than medicine.

There is a side to patient care that goes beyond caring for physical complaints. Here the patient's psychological and spiritual needs are dealt with. At holistic health center, the attitude of caring for the whole patient is an essential ingredient of the care system. Because of the success of these centers, hospitals have become interested in establishing similar hospital-based models.


Hospital child care center yields high dividends.

In an effort to reduce staff turnover and to improve employee morale, a medical center established an around-the-clock, hospital-based child care center. A developmental atmosphere is maintained in the center by establishing goals for each child enrolled in the program and monitoring each child's progress on a regular basis.


Experts exchange views on grievance procedures in hospitals.

Four participants in a roundtable discussion examined the specific grievance procedures of a nonunionized, not-for-profit, medium-sized hospital and of a partially unionized, not-for-profit, large teaching hospital. In doing so, they also raised questions, considerations, and guidelines that may be of interest to hospitals that already have or that are planning grievance procedures.