The nature of the receptor for complement (C3b) in the human renal glomerulus.

The physicochemical nature of the human glomerular complement receptor was studied. Receptor activity was measured by determining the avidity of glomeruli of normal human renal tissue for fluorescein-labeled bacteria (S.typhi) coated with C3b. Maximal binding of C3b-coated bacteria to normal human glomeruli took place in phosphate-saline buffers of pH 6.5 and 0.08 to 0.15 mu ionic strength. Pretreatment of renal tissue with neuraminidase enhanced receptor activity. On the other hand, binding of C3b-coated bacteria to the glomeruli was diminished by pretreatment of the tissue with proteolytic enzymes, phospholipase C and certain lipid solvents. The binding of C3b-coated bacteria to the glomeruli was also diminished by pretreatment of the tissue with fluid-phase C3b, or by pretreatment of the bacteria with C3b inactivator. Normal human serum and purified fluid-phase C3 or the absence of magnesium and calcium ions had little effect on glomerular complement receptor activity.


Preservation of erythrocytes using metabolic regulators and mutrients. V. Inosine and methylene blue.

Methylene blue and inosine have been shown to stimulate glycolytic metabolism in the erythrocytes, increasing the concentration of 2.3-diphosphoglycerate (2,3-DPG), which is necessary for hemoglobin function, by regulating oxidative metabolism and providing a five-carbon nutrient for glycolysis, respectively. However, a recent study suggested that the methylene blue effect was dependent on the presence of inosine. This study was designed to establish, if possible, the existence of a methylene blue effect and to confirm the usefulness of inosine. The optimal concentration of inosine for increasing 2,3-DPG synthesis in a CPD-adenine preservative is confirmed to be 10--15 mM. Concentrations of 2,3-DPG were maintained in the erythrocytes at normal or higher levels for 21 days of storage with 10 or 15 mM inosine, whether the methylene blue was present or not. However, when methylene blue was present, 2,3-DPG concentrations were significantly better maintained.


The medical usefulness of Stat tests.

Although Stat tests are one of the most important features of clinical laboratory performance, the indexed literature is devoid of significant discussion of the subject. The authors, undertook a study by querying hospital laboratories about their current practices and received 38 useable answers dealing with the types of tests done on an urgent basis, the turn-around time for reports, the limitations on ordering, the use of special Stat laboratories and instruments, and decisions regarding priorities.


An approach to cost analysis of clinical laboratory services.

The authors have developed a system that provides information about costs related to specific laboratory tests. These costs are derived from: (1) labor and material actually used for specific tests; (2) allocation of costs for labor and material shared by several different tests; (3) allocation of supervisory and management costs. The "cost" of a specific procedure is a theoretical construct that is significantly affected by the method chosen for allocation. We know of no cost-analysis system generally accepted by all clinical laboratories. Since third-party payers may base future reimbursement on costs rather than charges, accurate systems for clinical laboratory cost analysis may have some practical value.


Growth and cytopathic effect of rubella virus in primary and progeny guinea pig kidney cells.

A culture system useful for the demonstration of cytopathology of rubella virus in guinea pig kidney cells is described. Not only were cytopathic rubella infections dependent on cell type (primary lung cells were not responsive), but infection early in primary passage was also necessary. Secondary-passage kidney cells were unresponsive. The cytopathic phenomenon did not appear to depend on any special medium or on inhibition of the normal interferon response.


Agranulocytosis during therapy with orally administered cloxacillin.

Agranulocytosis developed in a patient with staphylococcal osteomyelitis after 35 days of treatment with orally administered cloxacillin. The patient had fever, prostration, pharyngitis, and profound leukopenia, which subsequently abated upon withdrawal of the drug. Cloxacillin should be included in the growing list of drugs capable of producing leukopenia and agranulocytosis.


Epithelioma cuniculatum pedis, a variant of squamous cell carcinoma.

The rare lesion of epithelioma cuniculatum pedis may be recognized by the gross appearance of a slow-growing, bulky, "squashy," non-healing, exophytic mass of long duration on the sole, exuding foul-smelling purulent keratin debris from numerous sinuses, and biopsies showing extensive infiltrating plaques of keratinizing, well-formed, squamous epithelium forming walls for numerous sinuses filled with purulent material. The rarity of the lesion, the slow growth, and biopsies showing relatively benign-appearing well-differentiated squamous epithelium caused considerable diagnostic difficulty to clinicians and pathologists. The tumor failed to heal, extensively penetrated the soft tissues, ultimately destroyed the metatarsal bones, and invaded the skin of the dorsum of the fott. The lesion should be treated as a slow-growing, well-differentiated squamous cell carcinoma by wide local excision or by amputation when extensive growth causes deformity of the foot or penetration of the metatarsal bones.


Immobilization hypercalcemia after single limb fractures in children and adolescents.

Immobilization hypercalcemia following a single limb fracture of one weight bearing bone has been reported rarely in the pediatric age group. Nevertheless, in six of 12 patients immobilization hypercalcemia developed, associated with elevations in the urinary calcium/creatinine ratio and serum levels of ionized calcium after a single limb fracture of a weight-bearing bone during this two-year study period. We suggest that immobilization hypercalcemia occurs frequently in both children and adolescents after a single limb fracture of one weight-bearing bone, exercises in bed fail to prevent immobilization hypercalcemia, serial measurements of the serum ionized calcium and the urinary calcium/creatinine ratio are critical measures in treating such patients, and though complete mobilization is curative, transient calcitonin therapy is highly effective in reversing the disorders in calcium metabolism.


Rubella, measles and mumps antibodies following vaccination of children. A potential rubella problem.

One hundred sixty-eight children immunized by one suburban Minneapolis clinic during routine pediatric visits had serum antibodies measured to determine the efficacy of rubella (HPV77 DE5 strain), measles (Edmonston B and Moraten strains), and mumps (Jeryl Lynn strain) vaccines. Serologic failure rates at the mean postvaccination times tested were as follows: rubella, 36% (4.7 years); measles, 18% (6.5 years); and mumps, 9% (4.5 years). Antibody titers shortly after vaccination were not done, so seronegative subjects may never have responded or their titers may have declined with time; our rubella data suggest the former. Children vaccinated with rubella and measles at less than 14 months of age had higher failure rates than those vaccinated at a later age. This supports postponement of rubella and measles vaccinations until at least 15 months of age. In addition to current measles reimmunization policies, consideration also should be given to reimmunizing girls who were given rubella vaccine at less than 14 months of age. Twenty-four percent (19/79) of children vaccinated with HPV77 DE5 strain rubella at 14 months or older had rubella hemagglutination-inhibiting titers less than 8. This is disturbing and, if confirmed by others, would prompt the use of a different strain of rubella vaccine for routine immunization.


Yersinia enterocolitica osteomyelitis in a child.

Yersinia enterocolitica systemic infections are uncommon and osteomyelitis due to this organism is very rare. We report a 9-year-old girl with thalassemia major, liver cirrhosis, and hemosiderosis who developed osteomyelitis of the rib caused by Y enterocolitica type 0:3. Serologic response to the infection was confirmed. No definite source of infection was identified.


Osteomyelitis of the pelvis. A diagnostic problem.

Osteomyelitis of the pelvis occurs more frequently than generally recognized. Three cases are presented that illustrate the diagnostic difficulties involved. All of the cases of pelvic osteomyelitis seen at The Children's Hospital, Denver, from 1943 to 1977 are summarized.


Prevalence and correlates of poor sleep among adolescents.

The Stanford Sleep Inventory was given to 639, 11th- and 12th-grade students to assess the prevalence and correlates of poor sleep among an adolescent population. Of the sample reported, 49.8% had no sleep problems, whereas 37.6% reported occasional sleep disturbance and 12.6% reported chronic and severe sleep disturbance. Students complaining of disturbed sleep were more likely than good sleepers to describe negatively their physical and personality characteristics. The clinical implications of these data for developing educationally-based nondrug treatment of the complaint of insomnia among adolescents are discussed.


Blood pressure response to isometric and dynamic exercise in healthy black children.

One hundred seventy healthy black boys and girls (76 boys and 94 girls) had their systolic blood pressure (BP) determined at rest, during submaximum and maximum dynamic exercise, and in response to isometric exercise. Differences in BP between boys and girls were not significant. Blood pressure response to both dynamic and isometric exercise correlated with age and body surface area. Differences between resting BP and the BP during isometric exercise (BPiso), submaximum dynamic exercise (deltaBP170) and maximum dynamic exercise (deltaBPmax) for boys were: deltaBP150 18 +/- 9, deltaBP170 40 +/- 16 and deltaBPmax 55 +/- 17. Corresponding values for girls were: 16 +/- 8, 36 +/- 14 and 47 +/- 16. The higher the resting BP the less was the percentage change in BP to each stress.


Exercise electrocardiography of health black children.

Exercise electrocardiography was performed on 170 healthy black children 7 to 14 years of age in order to determine the normal childhood electrocardiographic response to exercise. R-wave amplitude decreased from 27 +/- 8 (SD) to 22 +/- 8 mm (P less than .01) and the S-wave amplitude increased from 6.9 +/- 4.4 to 7.8 +/- 5 mm (P less than .01), indicating a shift of the mean QRS vector to the right at maximum exercise. J-point depression of 1.0 mm or greater was observed in 2.3% of children at maximum exercise, using the PR isoelectric line. ST-segment slope increased from 1.5 +/- 0.7 to 4.3 +/- 1.5 mV/sec at maximum. T-wave duration decreased with exercise and T-wave amplitude initially decreased with mild exercise but exceeded resting values at maximum exercise. No dysrhythmias were observed during or after the exercise study.


Corrosive esophagitis in children. Assessment by the esophagogram.

The roentgenograms of 27 children aged 10 months to 13 years with endoscopically confirmed corrosive esophagitis were reviewed. The initial barium esophagogram showed 19 to have strictures. The length and irregularity of the strictures were recorded and related to the severity of the illness and the treatment required. In the remaining eight patients, the initial study gave normal results, but two were later shown to have developed strictures.


Hereditary fructose intolerance in childhood. Diagnosis, management, and course in 55 patients.

The early manifestations of hereditary fructose intolerance are described in a series of 55 patients. Management of this metabolic disorder depends on the severity of liver impairment. When the patients are given a fructose-free diet, the improvement is a dramatic but liver enlargement and fatty vacuolization of liver cells often persist. These hepatic findings were also observed in the five homozygous infants who were given a fructose-free diet from birth; this outcome may support the hypothesis that minimal amounts of fructose are esential for human beings.


Multiple pterygium syndrome.

After treating a 12-year-old patient with multiple pterygium syndrome, we ascertained the minimal diagnostic criteria of pterygia in the neck, axilla, antecubital, and even popliteal areas; evidence supports autosomal recessive inheritance for this syndrome.


Increase in platelet aggregation following a rise in plasma free fatty acids.

Platelet aggregation was studied following intravenous injection of heparin to nine healthy adults. Heparin is known to produce an increase in the concentration of free fatty acids (FFA) within 10 minutes of intravenous injection. A significant correlation was found between the intensity of primary platelet aggregation and changes in plasma FFA levels. No correlation was found between plasma FFA levels and the intensity of secondary platelet aggregation.


Murine hemopoietic colonies in culture containing normoblasts, macrophages, and megakaryocytes.

Murine marrow cells, when incubated in methylcellulose culture in the presence of erythropoietin and conditioned medium for two weeks, produced large macroscopic bursts containing normoblasts, macrophages, and often megakaryocytes. The clonal nature of these mixed colonies was supported by linearity studies and analysis of the percentages of constituent cells in different plating conditions. Time course observations and studies of the effects of L-cell-conditioned medium revealed that colony-forming cells for the mixed colonies (CFU-mix) are at earlier stages of hemopoietic development than burst-forming units (BFU-E). The mean of the modal sedimentation velocities of CFU-mix was 3.4 mm/hr and was in close agreement with that reported for the spleen colony-forming units. Almost none of the CFU-mix was in a DNA synthetic phase as measured by short-term exposure to tritiated thymidine. These results strongly indicate that CFU-mix represent a population of pluripotent hemopoietic stem cells in murine marrow.


Two dimensional view of combination chemotherapy in vitro.

A newly developed micromethod to evaluate the cytotoxic effects of drugs on rapidly growing lymphoid cell lines is described, which permits evaluation of more than one variable. This technique allows a checkerboard titration of two drugs to determine the optimum concentration of each needed for the augmentation of the other's cell-killing activity. Such studies have shown that the minimum concentration of vincristine capable of killing a human lymphoid cell population is 5.6 ng/ml. The addition of prednisolone at a concentration of 460 ng/ml reduces the minimum lethal concentration of vincristine to 1.6 ng/ml. When prednisolone is added to vincristine at concentrations of 2.8 mu/ml (a level readily achieved in the serum in vivo) concentrations of vincristine as low as 200 pg/ml are clearly cytotoxic. Similar potentiation of cytotoxicity following the addition of prednisolone has been demonstrated for cytosine arabinoside, but not for daunorubicin and only slightly for methotrexate. The micromethod for the study of optimal doses to be used in drug combinations is simple and gives healthy reproducible results. It should be of considerable utility to anyone interested in screening a wide variety of drug combinations for augmentation or synergistic effects.


Cytotoxicity of a factor from normal and abnormal human spleens for allogenic leukemia cells.

A search for an endogenous cytotoxic factor (ECF) was made by analyzing 103 spleens from normal humans and patients suffering from hematopoietic malignancies, solid tumors, inflammatory diseases, and congestive and hyperplastic splenomegalies. A highly purified ECG was obtained by a combination of gel filtration and ion-exchange column chromatography. The factor is a low-molecular-weight (less than 2,000) substance and is probably a peptide or peptide-nucleotide complex. The biologic activity of EC was assayed on myelogenous and lymphatic leukemia cells of human origin. The spleens from normal individuals produced and/or stored the largest quantity of the ECF. The amount of ECF extractable from the pathologic spleen was drastically diminished regardless of the disease or therapeutic regimen. The ECF was significantly more cytotoxic for lymphatic than for myelogenous leukemia cells.


Sequential pure red cell and megakaryocyte aplasia associated with chronic liver disease and ulcerative colitis.

The clinical course of a patient with chronic hepatitis and previous ulcerative colitis who subsequently developed pure red cell aplasia (PRCA) is described. The PRCA remitted initially with corticosteroid therapy. A subsequent relapse responded to cyclophosphamide therapy following splenectomy. This was followed by a fatal third episode of red cell aplasia associated with megakaryocyte aplasia.


Deformability characteristics of sickle cells by microelastimetry.

Deformability of normal and sickle erythrocytes was measured by means of micropipette elastimetry with determination of intrinsic membrane rigidity (P) and total cell deformability (Pt). In the elastimetric technique employed, negative pressure at the pipette tip was generated and measured continuously. Membrane rigidity is defined as the negative pressure, in mm H2O, required to induce a hemispherical projection of the cell surface into the micropipette, and total cell deformability as the negative pressure required to aspirate the entire cell into the pipette lumen. Membrane rgidity for oxygenated sickle discocytes was not statistically different from that of control normal discocytes, but Pt measurements were significantly higher for sickle than normal discocytes. Irreversibly sickled cells (ISCs) had markedly increased membrane rigidity and whole cell deformability when compared to control normal cells. Mildly deformed ISCs and severely deformed ISCs at ambient pO2, both showed significantly higher mean membrane rigidity values than sickle discocytes and reversibly sickled cells. Sickle and normal discocytes both showed membrane elasticity with reversion to original cell shape following release of the cell from its aspirated position at the pipette tip. ISCs, however, exhibited elastic deformation of the membrane. These studies provide further evidence of progressive alteration of the sickle cell membrane induced by the sickling-unsickling process, culminating in formation of the ISC, and suggest a role for the ISC membrane abnormality in the pathologic rheology of sickle cell disease.


Medical and human genetics 1977: trends and directions.

Our field is in a rapid state of evolution. The broader concerns of human genetics not of immediate medical interest such as behavioral genetics are often investigated by persons not trained or identified as human geneticists. Both medical genetics and human genetics in general have prospered when various biologic techniques have been applied to genetic concepts. A search for novel biologic methods may provide new insights and may bridge the gulf between Mendelian and biometric approaches in studies of behavior and of common diseases. Medical geneticists need to broaden their fields of interest to encompass other fields than those of pediatric interest alone. We need to attract more basic scientists. Our field is evolving from a largely research oriented science to a service-oriented specialty. This logical development is a sign of increasing maturity and makes available to the public the results of our research. The resulting stresses and strains need careful watching to prevent their slowing the momentum of our science which can contribute continued insights into the many problems of behavior, health, and disease.


Heat-labile enzymes in circulating erythrocytes of a progeria family.

Cultured skin fibroblasts from subjects with progeria contain an increased fraction of heat-labile enzymes and other altered proteins. To determine whether freshly obtained cells are similarly affected, erythrocytes from a progeric female and her clinically normal parents were analyzed for heat-lability of glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase. Hemolysates of the child's whole erythrocyte populations and young erythrocytes isolated by equilibrium density centrifugation contained significantly higher heat-labile fractions of both enzymes compared to control hemolysates. Values in both parents were intermediate to those of their daughter and controls, consistent with autosomal recessive inheritance in this family. The primary source of these multiple protein defects is unknown but may reside in a mutant gene producing abnormal protein turnover or defective DNA repair. An increased fraction of thermolabile enzymes in circulating erythrocytes should be useful in identifying persons at risk for progeria and other disorders of premature aging.


Ornithine ketoacid transaminase deficiency in gyrate atrophy of the choroid and retina.

Gyrate atrophy of the choroid and retina is a chorioretinal degeneration associated with hyperornithinemia with an autosomal recessive mode of inheritance. Cultured skin fibroblasts from five affected patients showed a virtual absence of ornithine ketoacid transaminase (OKT) (L-ornithine:2-oxoacid aminotransferase E.C.2.6.1.13) activity. Fibroblasts from four carrier parents showed a 42%-65% reduction in OKT activity. Increasing the concentration of pyridoxal phosphate (vitamin B6 in the assay media resulted in partial restoration of OKT activity in fibroblasts from one out of five patients studied. We conclude that OKT deficiency is closely associated with the genetic defect in gyrate atrophy of the choroid and retina and that genetic heterogeneity exists in this disease.


Effects of reproductive compensation and genetic drift on X-linked lethals.

A revival of interest in Haldane's equilibrium theory for X-linked lethals has been stimulated by the introduction of accurate tests for the detection of female heterozygotes in Lesch-Nyhan disease. Application of these tests appears to indicate an excess of familial cases. This excess can be attributed to ascertainment bias, a difference in female and male mutation rates, genetic drift, and reproductive compensation. Reproductive compensation will be particularly effective in increasing the proportion of familial cases if (1) birth control is widespread; (2) selection against affected males acts in utero; (3) affected sons show symptoms at an early age; and (4) sons are more highly valued than daughters. We demonstrate how only a few generations of reproductive compensation are sufficient to achieve an approximate equilibrium between selection and mutation showing a high proportion of familial cases. We also discuss the random fluctuations around equilibrium caused by genetic drift.


Population genetic studies of the Philippine Negritos. I. A pilot survey of red cell enzyme and serum protein groups.

Electrophoretic surveys of red cell enzyme and serum protein systems representing 21 genetic loci were carried out on 129 blood samples of the Negritos of Pampanga, Central Luzon, the Philippines. Nine (out of 16) red cell enzyme loci and four (out of five) serum protein loci showed polymorphic variation. Low frequencies of ACP 1A, GPTs1, ESD2, and Hp1, and a markedly high frequency of PGM12 were contrasted to those in non-Negrito Filipinos. Variant ESD phenotypes with a slowly migrating isozyme occurred in high frequency. The new allele designated as ESD3Negrito (ESD3N) had a frequency of .10 +/- .019. In AK, a variant phenotype indistinguishable from AK 2-1 was observed in 14% of the sample. In the Gc system, a fast migrating variant was discovered in high frequency which was distinct from Gc Ab and Gc J. The variant allele, denoted GcNegrito (GcN), had a frequency of .21 +/- .025. A relatively high degree of allelic diversity in the Negrito sample was also suggested by the average heterozygosity for 21 loci screened (.165), which is compared to that of the Japanese population (.140).


Detection of genetic variation with radioactive ligands. III. genetic polymorphism of transcobalamin II in human plasma.

We detected genetically determined, electrophoretic variants of vitamin B12 binding proteins, most probably transcobalamin II, in human plasma. Polymorphic variants were observed in all populations tested; the two most common alleles (of at least four detected to date) attain frequencies of greater than 40% in Caucasians and Orientals. The variants are autosomally inherited and are seen as doublets in homozygotes, and four-banded patterns, the sum of two dissimilar homozygote patterns, in heterozygotes. The technique used in this survey, polyacrylamide gel electrophoresis (PAGE) autoradiography of plasma and serum labeled in vitro with 57Co-vitamin B12 is particularly applicable to the study of trace proteins such as the transcobalamins (10(-9)M). Possible functional variation in the TC II allele products is described, and the selective significance of this worldwide polymorphism is considered.


Consultant approach to improving drug-related services to chronic hemodialysis patients.

A consultant role for the pharmacist in solving a drug-related problem of another hospital department is described. The head of a 16-patient-per-day hemodialysis unit requested assistance from the pharmacy to improve the medication records for hemodialysis patients. Investigation uncovered several additional problems such as contradictory medication orders, poor patient compliance and evidence of drug abuse. The pharmacy devised and assisted in the implementation of new mechanisms for initiating, recording and charting medications. A patient education program and a system for assuring availability of medications for self-administration were also instituted. After nursing personnel were trained by the pharmacy, responsibility for maintaining the revised services was transferred to the hemodialysis staff. Documentation of medication orders, drug knowledge of the hemodialysis staff and patient compliance improved as a result of the revisions instituted by the pharmacy.


Computerized drug-drug interaction screening system.

A pharmacy automated drug interaction screening (PADIS) system is described which detects possible drug interactions by screening patient medication profiles. The data base contains approximately 24,000 drug interaction combinations of drugs marketed in the U.S. and also foreign and investigational drugs that have been implicated to cause drug interactions. It is updated on a monthly basis. The PADIS system operates as a batch run program which screens all patient medication profiles on a daily schedule. A patient drug interaction profile is printed by the computer for use by the pharmacist to suggest alternative therapy to the physician. The computer detects potential drug interactions in approximately 9% of the patients per day at the 635-bed hospital at which the system was developed.


Confirmation of a computer-derived nomogram to predict gentamicin serum concentrations in postsurgical patients.

The applicability of a previously reported nomogram to predict serum gentamicin levels in postsurgical patients was investigated. Seventeen patients accounting for 20 courses of gentamicin were studied. A total of 72 peak serum gentamicin levels were measured by a microbiological assay and compared with predicted serum levels determined by the dosing nomogram. Eighty-five percent of the measured peak gentamicin serum levels agreed with nomogram-predicted levels. This figure was reduced to 65% when certain unforeseen factors (i.e., patient interference with intravenous lines, dosage miscalculation and extra routes of gentamicin elimination) were identified. The nomogram is a particularly useful tool for the clinician to whom serum gentamicin levels are unavailable and who needs a method to predict serum gentamicin concentration based upon a given dosage.


Pharmaceutical services in a medical screening clinic.

Pharmaceutical services in a medical screening clinic are described. Services provided include medication refills, patient education and medication histories. During the first year 1,067 patients were interviewed, evaluated and received these services from the pharmacist. The majority of these patients were seen for medication refills. A clinical assessment was made by the pharmacist of the current drug therapy, evidence of new or drug-related problems, and compliance with medication regimens. One hundred seventy-six patients were found to be receiving inappropriate drug therapy, 69 patients were found to have drug-related problems and 248 patients were found to be noncompliant with their drug regimens. Patients received 1,633 refills and 24 new prescriptions. One hundred fifty patients were refused refills because the medications were being abused or were not indicated. Many patients (564) received extensive education about their medications and diseases. One hundred eleven laboratory tests were ordered and 323 clinic appointments were made. The pharmacist is providing services which are an asset to both patients and other members of the health care team.


Drug therapy review as part of a medical audit process.

A method of chart review that focuses on the role of drugs as both therapeutic and iatrogenic agents in the sum of health care given to a patient is presented. A team of 11 to 16 health care professionals evaluated ambulatory health care systems funded by HEW. All clinician evaluators participated in the medical audit segment of the evaluation. Drug therapy review was based on an assessment of the relationship between patient, drug and other factors. Discussed also are the nine assessment options open to the evaluator and the mechanisms used to incorporate findings into the larger system review process. A by-product of the use of this process was increased prescribed-pharmacist cooperation and contribution in performance of the medical audit.


Intropin (dopamine hydrochloride) intravenous admixture compatibility, Part 3: stability with miscellaneous additives.

The compatibility of dopamine hydrochloride (Intropin) with various additives in 5% Dextrose Injection, USP, was studied. Dopamine hydrochloride stability for 24 hours in the admixture was established by colorimetric and thin-layer chromatographic procedures. Dopamine hydrochloride solutions are generally stable at an acidic pH and all admixtures produced a slightly acidic solution. Additives tested and found stable for 24 hours in the presence of Intropin included heparin sodium, lidocaine hydrochloride, neutral cephalothin sodium, oxacillin sodium and gentamicin sulfate. The chemical stability of methylprednisolone sodium succinate and hydrocortisone sodium succinate was not established. Potassium chloride, calcium chloride and calcium gluceptate may be assumed to be stable in the presence of Intropin. Above pH 5.0, the calcium gluceptate-Intropin admixture exhibited a color change indicating physical incompatibility. The pH and physical compatibility of all admixtures were established. In order to avoid a fixed combination of potent drugs, it is recommended that a "piggyback" administration set or administration into a second injection site be employed when another drug is to be administered with Intropin.


Taste preference test for oral liquid theophylline preparations.

Taste preferences among three oral liquid theophylline preparations were evaluated in 54 males. The products tested, and their theophylline concentrations, were Elixophyllin Pediatric Suspension (Cooper Laboratories, Inc.), 100 mg/5 ml; Somophyllin Oral Liquid (Fisons Corporation), 90 mg/5 ml; and Theophyl-225 Elixir (Knoll Pharmaceutical Company), 37.5 mg/5 ml. Generally-recommended procedures for taste tests were followed. The results indicated a taste preference for Theophyl-225 Elixir, followed by Elixophyllin Pediatric Suspension, followed by Somophyllin Oral Liquid. The results were statistically significant (p = 0.05). Product concentration and formulation were suggested to be major factors in determining taste preference.


Comparison of the taste and acceptance of three potassium chloride preparations.

The palatability and acceptance of three commercially available potassium chloride solutions were evaluated. Adult ambulatory patients routinely self-administering potassium chloride solution rate the palatability and acceptance of each preparation. An open-label, three-treatment crossover study design was used. The taste of Klorvess was rated significantly more palatable than Kaochlor (p less than 0.01) or KayCiel (p less than 0.05). Klorvess was rated significantly more acceptable if taken over a long period of time than Kaochlor (p less than 0.01) or KayCiel (p less than 0.01). The average amount consumed of all three products was 57% of the prescribed amount. The amount of Klorvess returned was significantly less than the amount of either KayCiel (p less than 0.01) or Kaochlor (p less than 0.01). The flavoring agents are described and the importance of ensuring that the patient uses an accurate measuring spoon is discussed.


Can pharmacists influence drug prescribing? A look at eight of the top 25 drug products for 1976.

The most frequently prescribed drug products were reviewed for insights into prescribing and dispensing patterns for ambulatory patients. The indications for eight of the "top" drug products were considered to be pharmacologically or therapeutically questionable. The drug products were: tetracycline, systemic; Dimetapp; Empirin Compound with Codeine; Actified; Darvon Compound 65; Darvocet-N; Donnatal; and Keflex. Drug prescribing review and prescriber education are crucially needed, as well as formulary controls when feasible.


Uremic pulmonary edema.

Pulmonary edema fluid analyses and hemodynamic evaluations were performed in two uremic patients with acute pulmonary edema. The colloid osmotic pressure of the pulmonary edema fluid ranged from 57 per cent to 93 per cent that of the serum. Although cardiac function was normal in both patients, the serum colloid osmotic pressure--pulmonary artery wedge pressure gradients were markedly reduced. Uremic pulmonary edema is the result of alterations of pulmonary intravascular Starling forces and increases in pulmonary capillary membrane permeability, allowing for the efflux of protein-rich fluid from the capillaries into the lung.


The control of chronic lymphocytic leukemia with mediastinal irradiation.

Forty patients with chronic lymphocytic leukemia have been treated with mediastinal irradiation. A full remission was achieved in 18 (45 per cent) patients, a partial response in eight (20 per cent), "WBC control" in eight (20 per cent) and no response in 6 (15 per cent). Although mediastinal irradiation benefited all stages of disease, earlier stages of disease correlated with more complete and longer response to mediastinal irradiation. Toxicity was mild and transient and included leukopenia in five patients (12 per cent), thrombocytopenia in eight patients (20 per cent), mild esophagitis in 12 patients (30 per cent) and pneumonitis in four patients (10 per cent). There were no toxic deaths and mediastinal irradiation did not adversely effect survival. Treatment was readily given on an ambulatory basis and completed within four weeks. In five of 11 patients, abnormal immunoglobulins became normal. Eleven patients had abnormal lymphocyte transformation with PHA, five had marked improvement and three had partial improvements following mediastinal irradiation. This improvement appeared to correlate with response and survival but further study is necessary to confirm this relationship. Although most patients required additional therapy within two years, eight patients have required no further therapy for periods of twenty-eight months to thirteen years.


Supravalvular aortic stenosis with parafollicular cell (C-cell) hyperplasia.

Autopsy examination of a patient with well-documented supravalvular aortic stenosis and other characteristic features of the idiopathic infantile hypercalcemia syndrome revealed previously unreported hyperplasia of parafollicular cells (C cells). Immunohistochemical analysis demonstrated up to 30 calcitonin-containing cells per high power field, whereas normal glands contain only 4 to 10 cells per low power field in areas of highest concentration. The parathyroid glands were found to be normal both grossly and microscopically, whereas the bones showed thickened trabeculas, normal Haversian canals and no apparent increase in osteoblast or osteoclast activity, suggesting normal parathyroid hormone, but increased thyrocalcitonin activity. We suggest that C-cell hyperplasia has occurred in response to a persistent, rather than transient, elevation in serum calcium levels and that thyrocalcitonin function is augmented, rather than impaired in this disorder. The primary biochemical defect promoting hypercalcemia remains to be clarified, as well as the role, if any, such a defect plays in producing significant pathology in the central nervous system and in the cardiovascular, renal and skeletal systems.


Predicting school failure from information available at birth.

Information available from birth certificates was used to predict the psychological and educational status of approximately 1,000 randomly sampled first-grade children. The purpose of the research was to explore the feasibility of using birth certificate information as a cost-effective mechanism to identify children who were likely to need special educational services at public school entry. Multiple-regression and discriminant-function analyses revealed the following factors to be important in predicting psychoeducational status: birth order, race, educational status of the mother, month prenatal care began, survivorship of older siblings, and the child's legitimacy.


Neurological and intellectual sequelae of Reye's syndrome.

Eleven survivors of Reye's syndrome ranging in age from 9 months to 12 years were evaluated for neurological and psychoeducational sequelae. Seven children showed significant neuropsychological sequelae, ranging from severe global psychomotor retardation to mild specific perceptual and/or language impairments and from spastic quadriplegia and decorticate posturing to mild dysarthria. The severity of sequelae was inversely related to age of the child at onset of the disease. Whereas those children developing the syndrome when they were less than 1 year of age were seriously impaired, 3 children developing it in late childhood sustained no sequelae. Biochemical and neurological status at disease onset did not predict neuropsychological outcome. The results parallel the pattern of sequelae for other encephalopathies and suggest the importance for both child and family of early developmental evaluation following recovery from the disease.


Effect of increased space on the social behavior of institutionalized profoundly retarded male adults.

The social behavior of a group of institutionalized profoundly mentally retarded male adults was observed under conditions of increased space. The findings demonstrated that an increase in space of 29 percent significantly reduced the frequency of aggressive acts occurring within the group. Also observed was the effect of increased space on the residents' mobility and nonaggressive interactions. Results were discussed in relation to the residents' need for space.


Use of testing-the-limits procedures in the assessment of intellectual capabilities in children with learning difficulties.

Various testing-the-limits procedures were employed in administering the Raven Coloured Progressive Matrices test to 108 subjects with learning difficulties (age range 8.4 to 12.9 years). Both the picture and the puzzle forms of the test were employed in a repeated-measures format. Results revealed significant improvement in performance due to testing condition, test version, and repeated testing. Testing conditions involving verbalization and feedback were most salient. Performance on the second testing was higher than on the first testing. Localization of these effects was made to subgroupings of items on the test. The results were discussed in theoretical and practical terms.


Motor components in the choice reaction time of mildly retarded adults.

The contributions of specific motor-coordination disabilities and general slowness of motor function to the choice reaction times (RTs) of retarded subjects were examined in two experiments. RTs for the same stimulus-response (S-R) pairs were markedly shorter when presented in 2-choice than in 8-choice RT situations. Furthermore, in an 8-choice task, large RT differences between retarded and nonretarded subjects decreased markedly when processes of stimulus discrimination and S-R translation were minimized by direct stimulation of the response mechanisms.


Increasing initial interactions among integrated EMR students and their nonretarded peers in a game-playing situation.

Two ways of increasing the initial interaction among integrated EMR students and their nonretarded classmates in a game-playing situation were examined. Three hundred and four randomly assigned intermediate school students observed classmates about to play a simple game and were asked to select partners and opponents from two pairs of students matched on sex and grade. The experimental pair had 1 EMR student and 1 nonretarded student; the control pair had 2 nonretarded students. The subjects' past knowledge of the pair members served as a covariate in the design to determine whether past knowledge influenced their selections of pair members. Each subject was also provided information regarding the competency level of each pair member in relation to the particular game. Results indicated that the covariate was not a significant factor in the selection process; however, the appended competency statement and the game-playing option were found to be highly significant in influencing selection of the pair members and increasing the selection of the EMR child by his nonretarded classmate.


Technician turnover and absenteeism in public residential facilities.

Residential institutions have historically had problems attracting and retaining reliable unskilled personnel to fill technician-level positions. Even though there is little empirical evidence to support a relationship between staff stability and resident habilitation, there assuredly are such effects. A first step toward assessing these effects, and toward controlling costly technician withdrawal behavior (specifically, turnover and absenteeism), is the use of a common set of measures. The precipitants of employee withdrawal may be categorized into three areas that are subject to empirical investigation and intervention: extra-institutional factors, intra-institutional management, and factors surrounding the individual worker. Predictive research, for selection purposes, has not yielded much information that would be of use to administrators. Traditional and more recent explanations were reviewed and some direction suggested for further research.


Environmental noise in a residential institution for mentally retarded persons.

The present study was designed to survey the noise characteristics in residence halls housing young mentally retarded children and test the effects of this noise on speech-discrimination performance of the residents. The noise survey indicated that the mean level of the noise was 75 dB SPL (WIth the level greater than 70 dB SPL during 71 percent of the sampling time). The spectrum was similar in configuration to the long-time speech spectrum. Selected residents were tested for speech discrimination in quiet and noise conditions. Mean scores on the Word Intelligibility by Perception Identification test were 73.9 percent correct in the quiet and 44 percent correct in the noise conditions. We concluded that the residents, who already had a primary language-learning handicap, were being subjected to a possible secondary impediment resulting from their living environment.


Cognitive training for EMR children: choosing the best alternative.

Twenty-eight EMR children participated in an 8-week training program on choosing the best alternative. The training was presented within the context of small-group discussions of familiar social problems and participation in table games. A control group (n = 28) engaged in similar activities but without specific cognitive training. The experimental group's posttest scores were far superior (p is less than .001) to those of the control group, an finding that suggests a major experiential component in the deficit in problem-solving skills typical of EMR children and provides strong support for the efficacy of early intensive cognitive training.


Reflection-impulsivity in retarded adolescents and nonretarded children of equal MA.

Educable mentally retarded (EMR) adolescents and nonretarded children of equal MA were given the preschool and elementary forms of the Matching Familiar Figures Test to assess reflection-impulsivity. We found that the EMR adolescents did not differ significantly in accuracy and had somewhat longer response latencies than did the nonretarded children. In view of these results, it is unlikely that impulsivity contributed to the previously reported performance decrement displayed by retarded individuals on problem-solving tasks.


Vocational adjustment of EMR youth in a work-study program and a work program.

Adjustment measures for students who took part in two work programs for EMR graduates of special schools were compared. Fifty students took part in a work program (direct placement in the work) and 50 students, a work-study program. The students, their parents, and their employers were interviewed regarding vocational satisfaction and adjustment. The work-study program graduates were significantly more stable, satisfied, and adjusted than were the work-program graduates (p is less than .001), but their professional opportunities (reflected by the number of different jobs held) were limited.


Optic nerve infarction.

In three cases infarction in the inferotemporal prelaminar portion of the optic disk resulted in shallow cupping and arcuate visual field defects. Such changes occurred acutely, were not progressive, and required no treatment.


Hereditary hemorrhagic macular dystrophy.

Four members of a family with dominantly inherited macular dystrophy demonstrated the essential features of hereditary hemorrhagic macular dystrophy. They reported decreased visual acuity in the third decade and eventually developed bilateral disease. Fundus evaluations revealed hemorrhagic and exudative maculopathy associated with pigment atrophy, pigment clumping, and eventual glial scar formation. Early stages of the disease manifested a macular subretinal neovascular network. Photocoagulation treatment of subretinal neovascularization was successful in Case 3, unsuccessful in Case 1. Follow-up of these four brothers lasted over a period of two to 12 years. After they reached the cicatricial phase, the size of the lesion and visual symptoms remained stable. Visual function tests in the early and late stages indicated a local or geographic disease. We differentiated this dystrophy from other hereditary causes for subretinal neovascularization. We recommend early obliteration of the subretinal neovascular network with intense photocoagulation because the outcome of untreated hereditary hemorrhagic macular dystrophy is legal blindness.


The effect of corneal section on early increased intraocular pressue after cataract extraction.

Increased intraocular pressure in the immediate postoperative period commonly occurs after cataract extraction. We compared a series of patients operated on through a limbal section to a series operated on through a corneal section. The incidence of increased IOP was significantly lower in the corneal section group. This supports the theory that trabecular damage is a major factor in causing early increased IOP after cataract extraction.


Hard contact lens wear as an environmental risk in keratoconus.

We studied 162 keratoconus patients in an attempt to clarify the role of hard contact lens wear in the development of keratoconus. Forty-three (26.5%) of these 162 patients developed keratoconus while wearing hard contact lenses. In a group of 1,248 controls who were fitted for soft contact lenses and observed by us from one year to six years, only one patient developed keratoconus. We demonstrated a circumstantial association between hard contact lens wear and the development of keratoconus, but no cause-effect relationship can be drawn from the existing data. However, we concluded that hard contact lenses do not retard or halt progression of the cone. Hard contact lens wear could not be ruled out as the specific environmental risk factor triggering keratoconus in 26.5% of the patients. If we identify the genetic risk present in this subpopulation, eliminating environmental risks would be an effective means of preventing keratoconus in those predisposed individuals.


Occlusion of the central retinal artery after retrobulbar corticosteroid injection.

Occlusion of the central retinal artery with loss of all vision occurred in a 38-year-old white woman given a retrobulbar injection of betamethasone acetate and betamethasone disodium phosphate (Celestone Soluspan) for the treatment of a retrobulbar neuritis. Ophthalmoscopy revealed embolic, whitish material within several of the small retinal arterioles and capillaries. This, together with the absence of any signs of retrobulbar hemorrhage, suggested that the corticosteroid material was accidentally injected into a branch of the central retinal artery and subsequently passed into the main vessel.


The HLA and ABO antigens in pigment dispersion syndrome.

We found no statistically significant differences in phenotype frequencies of the 36 different HLA antigens or the ABO antigens when we compared 27 white patients with pigment dispersion syndrome (18 without glaucoma and nine with glaucoma) with 323 white controls. An increase was suggested in the incidence of B7 in patients without glaucoma, and of B13 among patients with glaucoma.


Cholinergic supersensitivity of the iris sphincter in Adie's tonic pupil.

In patients with unilateral Adie's syndrome, we compared the relative supersensitivity of the tonic pupil to methacholine hydrochloride (Mecholyl 2.5%) and pilocarpine 0.125%. We tested a large series of patients and photographed the pupils before and 30 minutes after the eyedrops. In a group of 36 patients, Mecholyl was positive in 64% of the tests; and in a group of 20 patients, pilocarpine 0.125% was positive in 80% of the tests. Eight patients who failed to show supersensitivity with Mecholyl were tested with pilocarpine and five of the eight were shown to be supersensitive. We concluded that pilocarpine, in this concentration is not only an adequate substitute for Mecholyl 2.5%, but is a more sensitive testing substance in unilateral cases, simply because it has a slightly stronger miotic action.


Penetration routes of topically applied eye medications.

Tritium-labeled hydrocortisone acetate and pilcarpine hydrochloride solutions were topically applied to the eyes of rabbits. In one group of animals, the drugs were excluded from contact with the cornea by a cylindrical well glued to the eye surface. In another group, the drug solutions were allowed contact with the entire anterior surface of the eye. Total application time in all cases was five minutes, then the eyes were flushed with saline. Samples of aqueous humor, stroma, and iris-ciliary body were taken after five, 20, 35, 65, and 125 minutes and counted in a liquid scintillation counter. With hydrocortisone, up to 70 times more drug reached the stroma when the cornea was exposed; 40 times more reached the iris. Peak stromal levels occurred by 20 minutes, dropping to one third of peak value by two hours. With pilocarpine, about five times more drug reached the iris-ciliary body when corneal access was allowed; the level peaked in about five minutes. These results illustrate the important role of tear film distribution and blinking in delivering remotely applied drugs over the cornea with subsequent entry to interior sites.


The insulin concentration in human ocular fluids.

We measured immunoreactive insulin concentrations in ocular fluids and serum of 19 patients. In rhegmatogenous retinal detachment patients without diabetes mellitus, the serum insulin level was 7 +/- 2 (SE) microunits/ml and the subretinal fluid insulin levels were mostly undetectable. By contrast, in rhegmatogenous retinal detachment patients with diabetes mellitus, serum insulin was 35 +/- 5 microunits/ml and the subretinal fluid always contained low but detectable amojnts of insulin. The data may suggest a small leak of insulin into the subretinal fluid of rhegmatogenous retinal detachment patients with diabetic retinopathy. In vitrectomy patients with diabetes mellitus there was no insulin in the vitreous in eight out of nine cases.


Square wave jerks in Friedreich's ataxia.

We observed a brother and sister with Friedreich's ataxia during steady fixation. They both had abnormal eye movements consisting of randomly occurring, small amplitude, conjugate horizontal saccades away from the fixation target. The saccades were followed by maintenance of this eccentric position for a brief period, and finally, a corrective saccade back to the original position. Electro-oculographic recordings showed these eye movements to be square wave jerks. They had an amplitude ranging from 1.5 to 10.7 degrees and a duration averaging less than 200 msec. Square wave jerks were also superimposed on pursuit movements in both patients. Square wave jerks are an additional ocular finding that may signify chronic cerebellar dysfunction. More specifically, they are an additional neuro-ophthalmological finding that may be observed in Friedreich's ataxia.


A clinicopathologic study of 56 cases of intraocular medulloepitheliomas.

A clinicopathologic and follow-up study of 56 intraocular medulloepitheliomas in the Registry of Ophthalmic Pathology revealed a mean age of five years at the time of definitive diagnosis, most patients having had a delay in surgical therapy of more than one year after onset of signs or symptoms. Histologic evidence of malignancy was observed in 37 tumors, and follow-up studies revealed four patients to have died of metastatic disease. Heteroplastic elements (brain tissue, cartilage, or rhabdomyoblasts) were observed in four benign and 17 malignant tumors; these 21 were designated teratoid medulloepitheliomas. The most important prognostic feature was extraocular extension, observed in ten cases. All four of the known tumor deaths were preceded by clinically obvious orbital spread. In four additional cases with orbital involvement the patients were lost to follow-up. We concluded, therefore, that the prognosis is worse than the results of this study would indicate, especially among those cases observed to habe extraocular extension.


An endoscope for ophthalmology.

An endoscope with a 1.7-mm diameter shaft has unique properties of focus, magnification, and large field of view that make it useful for both orbital and intraocular surgery.


The use of continuous-wear silicone contact lenses in the optical correction of aphakia.

Forty-two aphakic eyes of 37 patients were fitted with oxygen-permeable silicone rubber corneal contact lenses. Thirty-four eyes had the lens after two to 11 months of continuous use. Visual results, comfort, and patient acceptance were good, but the deposition of mucus on the lenses remains a problem.


Corneal edema in divers wearing hard contact lenses.

Polymethylmethacrylate (hard) contact lens-wearing Navy divers involved in hyperbaric research complained of ocular discomfort, halos, specular highlights, and decreased visual acuity during and immediately after the decompression phase of dry chamber dives. These symptoms were related to bubbles in the tear film between the cornea and hard contact lens. The bubbles developed during the decompression phase of the dive and represented the trapping (by the hard contact lens) of nitrogen outgassing from the cornea and precorneal tear film. The bubbles effected nummular patches of corneal epithelial edema persisting up to two hours after diving. Gas trapping and corneal edema were not observed in uncovered corneas or corneas covered with membrane lenses.


Mechanism of fixation of two-loop iridocapsular lenses.

I used seven eyes obtained postmortem to study the mechanism of fixation of a Binkhorst two-loop iridocapsular lens. During the first postoperative weeks, vitreous pressure and traction on the posterior lens capsule exerted by the zonular fibers pushed the loops of the iridocapsular lens against the iris. The zonular traction maintained the posterior capsule taut so that the vitreous pressure was distributed equally over the entire surface of the capsular diaphragm. Lens epithelial cells proliferated around the margin of the capsular breaks and defects and formed plaques or masses of spindle-shaped cells. This pseudofibrous tissue bridged and sealed capsular defects and caused adhesions between the anterior and posterior lens capsule and between the anterior capsule and the iris pigment epithelium. Fixation of the lenses may be reinforced by proliferation of the iris pigment epithlium and of the fibrous tissue arising from the iris stroma.


Plasma cortisol and elective cataract surgery.

Plasma cortisol was measured before and after elective cataract surgery in 19 patients given local anesthesia and in 11 patients given general anesthesia. In eight patients control plasma cortisols were measured at times corresponding to the surgical determinations. These eight patients demonstrated the circadian pattern of a fall in plasma cortisol. Only seven (37%) of 19 patients given local anesthesia failed to demonstrate the four-hour decrease in plasma cortisol (4-hr. p.o./8 A.M.0 greater than or equal to 0.80) following surgery, but this occurred in ten (91%) of 11 patients under general anesthesia (P less than .005). The 8:00 A.M. value was increased on the first postoperative day (8 A.M.1/8 A.M.0 greater than or equal to 1.37) in five (26%) of 19 patients given local anesthesia, but this occurred in 8 (73%) of 11 patients undergoing general anesthesia (P less than .025). The cortisol response to cataract surgery was significantly both more frequent and of greater magnitude in those patients undergoing general anesthesia.


Electrophysiological responses in hydranencephaly.

We recorded electrophysiological responses, both electroretinograms (ERGs) and visual evoked responses (VER), at 4 and 21 months of age in a child with hydranencephaly. As expected, the ERG was normal. Despite the apparent absence of most of the cerebral cortex, a VER was present at both visits. The child's visual performance definitely improved both subjectively and electrophysiologically. The VER contained multiple early components in contrast to previous reports, where only a slow, monophasic response was detected.


Patient tolerance to carbonic anhydrase inhibitors.

We evaluated carbonic anhydrase inhibitors in a crossover study with a placebo and random allocation of treatment administration. Drugs evaluated included acetazolamide tablets and Sequels, dichlorphenamide, ethoxzolamide, methazolamide, and an ascorbic acid placebo. The best tolerated drug was acetazolamide Sequels. Methazolamide was next. The least tolerated drugs were ethoxzolamide, acetazolamide tablets, and dichlorphenamide.


Management of posterior lenticonus complicated by unilateral cataract.

We studied 21 patients with 23 eyes with posterior lenticonus. Twenty-one of the eyes developed progressive cataractous changes that required lens aspiration in 19 eyes when vision reduction was 6/30 (20/100) or less. The inherent weakness of the diaphanous portion of the posterior lens capsule contributed to disruption of the normal lamellar arrangement of the lens fibers resulting in cataractous changes. Amblyopia was the most significant visual problem associated with posterior lenticonus. Fifteen of the 19 operated eyes in this study were amblyopic and nine of the 15 were improved to 6/15 (20/50) or better vision with occlusion therapy, after surgical aspiration of the cataractous lens and contact lens therapy.


A histopathologic study of retinal arterial aneurysms.

An isolated retinal arterial aneurysm was found postmortem in the eye of a 75-year-old hypertensive woman, and multiple aneurysms were in the enucleated eye of a 68-year-old hypertensive man with neovascular glaucoma. The aneurysmal sites showed thickening of the vessel walls with hyaline, fibrin, and foamy macrophages. Fresh or organized thrombus partially filled the aneurysmal lumina. Trypsin digestion preparations in Case 2 showed a progressive severity of aneurysmal changes from the simplest "cuff" type to the hemorrhagic "b;pwout" aneurysms with a linear split in the vessel wall. Atheroma was present in the larger arterial branches and fat was in most of the aneurysmal walls. These findings suggested that damage to the arterial wall by cholesterol or other emboli, or by occlusive disease, may predispose especially hypertensive patients to arterial aneurysm formation.


Relative afferent pupillary defect in optic tract hemianopias.

We saw four patients with optic tract lesions and complete homonymous hemianopia. In each patient, the visual acuity was good in both eyes. All four patients had a relative afferent pupillary defect in the eye with the temporal field loss. This pupillary sign is to be expected in all such cases and may serve to differentiate acute optic tract lesions from acute geniculostriate lesions when the characteristic midnasal pallor of the nerve head has not had time to develop.


Retinal detachment and miotic therapy.

We studied a series of 34 eyes in 31 patients in whom retinal detachment occurred during miotic therapy. In 14 eyes, the duration of miotic use before the development of detachment was two months or less. Most detachments occurred in detachment-prone eyes either by virtue of myopia (62%), aphakia (24%), ipsilateral lattice degeneration (38%) or retinal pathology, in the fellow eye (50%). Virtually all detachments were rhegmatogenous. Distributions of retinal breaks are similar to the corresponding profiles in detached eyes not receiving miotics. The observed phenomena may be accounted for mechanistically, either with or without the role of miotics, so a specific causal role cannot be assigned to any given miotic in any given case. However, our data suggest that detachment-prone eyes may be at increased risk with miotic use, and thus demand careful retinal evaluation and prophylaxis when ominous peripheral symptoms are present.


Platform tying scissors.

A platform tying scissor incorporates the functional parts of a scissors and tying forceps in one design.


Ocular toxicity of styrene.

We completed histories and ocular examinations of 345 workers in a styrene plant in order to determine the ocular toxicity of styrene. Despite previous case reports of retrobulbar neuritis and central retinal vein occlusion (associated with a toxic hematopoietic disorder), no such conditions were found in these workers. Conjunctival irritation from styrene was found in 22% of the workers and correlated with intensity of exposure, thus confirming previous reports.


Peripheral corneal infiltrates following intravenous injection of diatrizoate meglumine.

A 66-year-old white man developed bilateral peripheral corneal infiltrates on two separate occasions after intravenous injections of a radiopaque dye containing iodide. To our knowledge this is the first case of drug-induced ocular hypersensitivity reaction associated with the administration of these dyes and manifesting with peripheral corneal infiltrates.


Cyclocryotherapy of chronic open-angle glaucoma in aphakic eyes.

Twenty-six eyes of 25 patients with chronic open-angle glaucoma and surgical aphakia with inadequate control of intraocular pressure (IOP) despite maximal medical treatment were treated with cyclocryotherapy, according to a prospective protocol and specific technique. (Neovascular and synechial glaucoma were excluded from this series.) In most cases topical medications were resumed after cyclocryotherapy. During follow-up of seven to 95 months (average, 46 months), IOP was reduced to 19 mm Hg or lower in 24 out of 26 eyes (92%). In two eyes, persistent decrease in visual acuity, unrelated to reduction of IOP, occurred after cyclocryotherapy. On the basis of the long-term benefits obtained by this procedure, we concluded that cyclocryotherapy should be considered the procedure of choice in the treatment of primary open-angle glaucoma in surgically aphakic eyes when pressure cannot be adequately reduced by maximally tolerated medical treatment.


Cortical blepharoptosis.

A 59-year-old man with a previous left frontal lobe infarction sustained an infarction of the right frontal lobe. The patient manifested a bilateral symmetrical blepharoptosis that resolved in two months. Eyelid movements seem to be bilaterally represented in the frontal lobes. Bilateral cortical disease can produce supranuclear eyelid abnormalities such as blepharoptosis, difficulty maintaining eyelid position, and difficulty initiating eyelid movement.


Pupil cycle time in optic neuritis.

A thin slit-lamp beam illuminating the pupil margin produced clearly visible pupil oscillations. These oscillations were timed with a stopwatch, thus producing a measurement of the "pupil cycle time". The pupil cycle time was remarkably stable in various testing situations and repeatable within +/- 3% over extended periods of time. When the iris muscles were normally innervated and responsive, the pupil cycle time was dependent on the speed of conduction and the number and strength of optic nerve impulses. Pupil cycle time can be measured in most persons with active or inactive optic neuritis. In the few patients whose light reflex is so poor that the pupil cycle time cannot be measured, the inability to induce cycling can itself be taken as a definite abnormality of the light reflex arc. Only 5% of normal persons 12 to 50 years of age are expected to have a pupil cycle time in either eye longer than 954 msec, or a difference in pupil cycle time between the two eyes longer than 70 msec. Pupil cycle time was significantly longer in patients with optic neuritis, with a P-value less than .001. The pupil cycle time is similar to visual evoked response latency time in that it can detect and quantitate subclinical defects in optic nerve conduction time. Pupil cycle time is objective and quantitative for each eye individually. It is a fast, simple, and reliable clinic test of optic nerve function.


Solitary keratoacanthoma of the conjunctiva.

Two ranch workers had rapidly-growing crateriform conjunctival nodules excised without recurrence. Histopathologically, these lesions consisted of acanthotic epithelium characterized by prominent keratin formation both within cells and in horn pearls. Although both clinically and histologically they resemble squamous cell carcinoma, keratoacanthomas are benign tumors commonly thought to arise in hair follicles. The presence of these lesions on conjunctiva and other epithelia without hair in the two cases described was evidence against this hypothesis.


Postvitrectomy keratopathy.

Twenty-six of 75 eyes undergoing pars plana vitrectomy developed significant corneal complications requiring treatment. Slow or nonhealing epithelial abrasions, recurrent corneal erosion, and microcystoid and striate keratitis were among the most frequent problems. Significant predisposing factors included diabetes, surgical trauma such as epithelial debridement and prolonged operative time, aphakia, and postoperative glaucoma or hyphema. Corneal complications may be minimized with careful preoperative and operative precautions.


Current surgical management of the vitreous wick syndrome.

We successfully treated three consecutive cases of the vitreous wick syndrome by combining repair of the fistula with closed vitrectomy to remove vitreous gel from the anterior chamber and from the internal aspect of the fistula. In two cases, the fistula seemed to be formed by the tract of an externally tied corneoscleral suture. In two cases the external opening of the fistula was large, and we covered it by a partial-thickness, anteriorly hinged scleral flap. One patient developed an epithelial ingrowth, which was successfully treated by transscleral and transcorneal cryotherapy combined with the use of an intraocular gas bubble to provide a thermal insulating effect to enhance the cryotherapy.


Chronic fibrous tenonitis with vitreous hemorrhage and choroidal indentation.

A 45-year-old white man had a bulbar subconjunctival mass, eyelid edema, and choroidal indentation. Biopsy of the subconjunctival mass revealed acute and chronic inflammation. One year later a spontaneous vitreous hemorrhage, choroidal folds, increased choroidal indentation, and serous retinal detachment were present. B-mode ultrasonography, operative findings, and biopsy revealed a chronic inflammatory mass with fibrosis confined to Tenon's capsule. Initial treatment with systemic corticosteroids resulted in no improvement, but mild progression occurred when the corticosteroids were tapered. Improvement occurred to the previous level of involvement when corticosteroids were reinstituted.


Explosive intraocular foreign bodies.

We examined two patients, each with a foreign body composed of smokeless gunpowder in the vitreous body of one eye and multiple similar foreign bodies in the eyelids, conjunctiva, and cornea. No damage to the eye was caused by the retention of these foreign bodies for over three years in one case and two years in the other. The composition of these foreign bodies appeared to be nontoxic to the eye and thus, extraction of the foreign bodies did not seem to be necessary.


Orbital fracture evaluation by coronal computed tomography.

Coronal computed tomography produces orbital scans in a plane that is analogous to Caldwell-view x-ray films. Coronal computed tomography permits simultaneous visualization of the orbital walls and the orbital soft tissues, including all extraocular muscles. Using coronal computed tomography, we studied a series of patients with radiographically proven orbital floor fractures. We studied in detail three of these patients, one with a linear orbital floor fracture, one with a depressed orbital floor fracture, and one with a severely comminuted orbital floor. In two patients, coronal computed tomography showed inferior rectus muscle entrapment, which was confirmed at the time of surgery. In each patient, some bone fragments could be seen more discreetly on coronal computed tomography than on conventional polytomes. Coronal computed tomography may be used to help confirm extraocular muscle entrapment in patients with orbital floor fractures. Coronal computed tomography can also be used to examine patients with possible intraorbital foreign bodies, unexplained reduction of vision, or severely displaced bone fragments.


Increased aqueous lactate dehydrogenase in Coats' disease.

A 3-year-old boy had glaucoma and a total left retinal detachment that displayed peripheral intraretinal telangiectasis. The most probable clinical diagnosis was Coats' disease. A suspicion of retinoblastoma also existed, and an aqueous aspirate was assayed for lactate dehydrogenase (LDH) and found to contain three times the level present in a matching sample of serum. We enucleated the eye and verified the diagnosis of Coats' disease pathologically. The results of aqueous LDH determinations in eyes with glaucoma, phthisis, or large numbers of histiocytes, erythrocytes, and polymorphonuclear leukocytes should be interpreted with caution.


Human retinal dysplasia.

We studied the ultrastructure of the four types of dysplastic rosettes and compared them with retinoblastoma rosettes. Dysplastic rosettes have morphologic characteristics intermediate between the normal photoreceptor layer and retino-blastoma rosettes; Müller cells contribute to the formation of dysplastic but not neoplastic rosettes. Abnormality in the relationship between the retina and the retinal pigment epithelium is frequent in cases with spontaneously occurring retinal dsyplasia and is consistent with previous observations that the retinal pigment epithelium influences the development of retinal morphology and function. We believe the normal developmental sequence of cell death and disappearance of necrotic cells may have gone awry in retinal dysplasia.


A new magnetic technique for the treatment of giant retinal tears.

Using surgical techniques similar to those for closed vitreous surgery, we introduced a small magnetic sphere into the intraocular cavity of experimental animals. The sphere was subsequently maneuvered gently over the retina to unfold and reposition it with a small external permanent magnet probe. We used 68 enucleated canine eyes; eight eyes were operated in vivo and then examined microscopically. Retinal damage was caused by friction and excessive pressure when we used external magnets that were too strong or spheres that were too large. When small intraocular magnetic spheres coated with silicone or teflon or encased in a hollow oversize epoxy sphere were used the damage to the retina was minimal, or absent. We suggest using this same technique to treat retinal tumors through the introduction of radioactive material or antitumoral drugs. The intraocular magnetic sphere of this type would be left inside the eye in contact with the lesion for an extended period (seven days to three months) by suturing a small magnet to the sclera over the lesion.


Optic disk neovascularization in hemoglobin SC disease.

A 37-year-old black man had a clinically documented case of optic disk neovascularization associated with hemoglobin SC disease. Through medical evaluation, we ruled out other disorders associated with proliferative retinopathy. Extensive areas of retinal nonperfusion were associated with vasoproliferative retinopathy at the junction of the perfused and nonperfused retina; and a delicate network of neovascularization extended from the optic disk into the vitreous gel in one eye.


Ball-bearing keratometry.

We obtained steel test balls for keratometer calibration at nominal cost by using a selected set of steel ball bearings, readily available for nonoptical purposes. The set of keratometer tests balls each have an accuracy of greater than one part in 1,000.


A new surgical drape support.

A lightweight, malleable surgical drape support attaches to the patient's forehead by sterile tape strips and rests comfortably over the patient's nose. It keeps the surgical drape from occluding the nasal and oral airway of the patient, allowing for comfort as well as observation during an ophthalmic surgical procedure performed under local anesthesia. It is sterilizeable and compact and thus does not impede the surgeon or assistant during microsurgical procedures.


Slit-lamp beamsplitter for two stereoscopic views.

A double binocular beamsplitter, compatible with Zeiss optics, splits the light from each optical train of a slip-lamp microscope to provide an observer the exact stereoscopic view of the examiner. It has advantages in teaching slit-lamp examination techniques. Further, in surgery at the slit lamp, it allows the observer to function as an assistant and the surgeon to have both hands free.


Transmissible ileal hyperplasia of hamsters. I. Histogenesis and immunocytochemistry.

Transmissible ileal hyperplasia (TIH) was experimentally induced in weanling hamsters, and the development of lesions was characterized. Ileal lesions developed in two phases: a hyperplastic phase which was detected by Day 10 and an inflammatory phase which began by Day 20. Hyperplasia began as focal lengthening of villi with expansion of crypt-type epithelium onto villus walls. Diffuse hyperplasia of distal ileum developed; dilated, tortuous crypts penetrated subjacent supporting tissues; but metastases were not seen. Inflammation began in association with focal or segmental necrosis of crypt epithelium, and crypt abscesses developed. Severe pyogranulomatous inflammation of the ileal wall, focal peritonitis, mesenteric lymphadenitis, and portal hepatitis were common in advanced lesions. Development of ileal lesions was closely correlated with accumulation of particulate antigen, detectable by immunofluorescence, in the cytoplasm of mucosal epithelial cells. Antigen was also detected in ileal granulomas, mesenteric lymph nodes, and liver. There was simultaneous development of serum antibody specific for intracytoplasmic antigen. These studies comfirm that mucosal hyperplasia is the primary lesion in TIH.


Transmissible ileal hyperplasia of hamsters. II. Ultrastructure.

The ultrastructure of developing ileal lesions was characterized in weanling hamsters with experimentally induced transmissible ileal hyperplasia (TIH). The primary lesion was mucosal hyperplasia with progressive replacement of mature villus columnar absorptive cells by undifferentiated crypt-type cells. The undifferentiated, mitotically active cells expanded onto villus walls from their normal location in crypts by Day 10 and reached villus tips by Day 14. Aggregates of slightly curved, 0.3 X 1.5 mu, rod-shaped bacteria were detected in the apical cytoplasm of crypt epithelium by Day ;. They replicated intracellularly and accumulated in progressively greater numbers in hyperplastic cells. Active penetration of cells by intralumenal bacteria was not seen. The appearance and distribution of TIH-associated antigen, demonstrated by indirect immunofluorescence, was identical to that observed for intracellular bacteria. Hyperplastic, bacteria-laden crypt epithelium penetrated adjacent supporting tissues. Dilated crypts with flattened epithelium ruptured and released organisms into surrounding tissues. Pyogranulomatous inflammation began at 17 to 25 days and preceded or accompanied penetration of the muscle layers by expanding crypts. Macrophages and neutrophils in inflammatory lesions contained many phagocytized bacteria. In some advanced lesions mature, bacteria-free absorptive cells and goblet cells reappeared. These observations support the hypothesis that intestinal bacteria cause TIH.


Hyperplasia of vagal and carotid body paraganglia in patients with chronic hypoxemia.

Vagal and carotid body paraganglia were obtained from 43 randomly selected autopsies performed at the National Naval Medical Center. In each case, tissue from both sides was step sectioned and comparatively studied. The mean combined weight of carotid bodies in 37 control patients was 25.9 mg. There was good correlation between size and number of separate paraganglia comprising the vagal body (seven left, six right). Lobules were closely related to the ganglion nodosum and were actually within it in three instances. Tissue resembling parathyroid was encountered within 4 of the 86 resected vagus nerves. Lymphocytic infiltration occurred in carotid and vagal body paraganglia of 28% and 16% of patients, respectively. There was Schwann cell proliferatation in carotid body lobules of 2 patients; in another patient, talc emboli were present. The mean combined weight of carotid bodies in 6 patients with chronic hypoxemia was 47.6 mg, significantly greater than in the control group; in each case, lobules were enlarged. Chief cell hyperplasia occurred in vagal body paraganglia of 2 patients; in two other patients, lobules were large with equal proliferation of constituent cells. These morphologic findings indicate that in patients with chronic hypoxemia some vagal body paraganglia can be ascribed a chemoreceptor role similar to but probably less important than that of the carotid body.


Phospholipase A2 contamination of cobra venom factor preparations. Biologic role in complement-dependent in vivo reactions and inactivation with p-bromophenacyl bromide.

Cobra venom factor (CoF), the anticomplementary protein in Naja naja cobra venom, is usually purified by sequential ion exchange and gel filtration chromatography. CoF prepared in this manner contains small but significant quantities of phospholipase A2 activity. This acyl hydrolase activity can be simply and efficiently removed on a large scale by treatment of CoF with p-bromophenacyl bromide (BPB), an irreversible modifier of the histidine residue in the active site of phospholipase A2. BPB treatment does not alter the anticomplementary activity of CoF. In vivo experiments utilizing intratracheal injections of control and BPB-treated CoF, as well as pure phospholipase A2, revealed that contaminating phospholipase A2, and not the anticomplementary protein, was responsible for the observed acute neutrophil-associated lung injury. However, phospholipase A2 had no effect on the hypotensive and thrombocytopenic effects of CoF infected intravenously into rabbits. Depletion of circulating C3-C9 by intraperitoneal injections of CoF was not altered by removal of phospholipase A2 activity with BPB.


Fine structural alterations induced in erythocytes by phorbol myristate acetate.

Prevous studies have demonstrated that PMA is a potent membrane-active agent causing cell-wall derived vacuole formation in neutrophils and granule labilization in platelets. The present investigation demonstrates that PMA also has marked effects on red blood cells. Erythrocytes exposed to PMA were converted into stomatocytes and stomatospherocytes. The effects of PMA on red cells were concentration-dependent, required removal of plasma, and occurred maximally at 37 C. Although the response of the red cell to PMA was not identical to that of other blood cells tested previously; the similarities suggest that the capacity of the agent to produce membrane invagination may be fundamental to its mode of action.


Motility of human polymorphonuclear leukocytes. Roles of hydroxy fatty acids, other lipids, and cations.

Rapid ionic fluxes across local areas of leukocyte plasma membranes result in local swelling, ie, ruffling or blebbing. These fluxes are stimulated either locally or generally over the cell membranes by hydrophobic chemotactic peptides. This swelling is associated with migration of the cells in the direction of the swollen area of the cell. Hydroxy fatty acids, other lipids, and Ca++ ionophores activate a Ca++-dependent migratory activity of the cell, whereas acidic peptides activate a monovalent cation-dependent migratory activity. These two processes are therefore additive. The swelling due to the peptides results in an increase in urea space but no change in inulin space, whereas, swelling due to permeant cations and anions causes a massive increase in both spaces. Migration appears to result from the pushing of cellular contents, nucleus and cytoplasm, into the more swollen area of the cell by unopposed contraction of the unswollen area of the cell.


The influence of experimental deformation on craniofacial development in rats.

Cranial deformation was produced experimentally in rats 8 to 40 days old for the purpose of studying the rotation of the craniofacial bones and the modification of the growth rates of the functional cranial components. One hundred and twenty four skulls (65 males and 59 females) were employed, classified as: deformed , deformed-hydrocephalic, sham-operated and controls. A midsagittal diagram was drawn for each skull and the angle subtended by each bone with respect to the vestibular plane was measured. Growth indices were worked out for both the neural skull and the facial skull. Deformation altered the rotation of the parietal, interparietal and basisphenoidal bones and restricted the rotation of the fronto-ethmo-facial complex. Alteration of the longitudinal growth rates of the dorsal and basilar components of the neurocranium and the splanchnocranium produced the persistence of the klinorynchal state.


The relationship between brain weight and head circumference from birth to age 18 years.

A relation between head circumference and brain weight of humans is generally believed to exist, but the literature contains only two studies which exhibit a quantitative aspect of the relation, showing that brain weight is proportional to the cube of the head circumference from birth through age 3.5 years. By assembling data from autopsy records, we have been able to show that this cubic relationship holds through brain maturation at around age 18 years.


Preservation of proteins in mummified tissues.

Protein material was extracted from the dessicated tissues of several Egyptian mummies and a frozen Eskimo. The distribution and degree of preservation of high molecular weight protein was analyzed by gel filtration, protein assays, amino acid analysis, and polyacrylamide gel electrophoresis. The protein has undergone considerable degradation although some high molecular weight protein (C. 130,000 daltons) remains intact. Amino acid analysis of the extracted protein indicates the basic amino acids have undergone a chemical modification and may represent a point of preferential breakdown in the polypeptide chain. Atomic absorption spectrophotometry of tissue cations suggests a correlation between degree of preservation of mummified tissue and levels of sodium salts (natron) in the tissue.


Crown diameters of the deciduous teeth in Australian Aboriginals.

Mesiodistal and buccolingual crown diameters were measured from dental casts representing the deciduous dentitions of 197 Aboriginal children from the Northern Territory of Australia. Double determination analysis indicated that the semi-automatic recording procedure used was reliable leading to observer errors of no practical significance. Tooth-size was greater in the male subjects but the sexual dimorphism was less marked than in the permanent teeth of the same subjects. The mandibular teeth were more uniform than maxillary with respect to buccolingual size relative to mesiodistal. Extremes of general tooth-size were more marked in the deciduous dentition than in the permanent as a consequence of the relatively large deciduous second molar which in Aboriginals approximates in size the permanent first molar of many other ethnic groups.


Age at menarche in Iceland.

The purpose of this study was to elucidate the mean age at menarche in Icelandic girls and compare it with results from other Scandinavian populations as well as in other ethnic groups. The study was performed during the school year 1972-1973 on a cross-sectional sample of 682 girls (aged 8.5 to over 17 years), constituting 9.5% of the girls from the third to eleventh forms in all the primary and secondary schools of Reykjavik. The mean age at menarche in Iceland, elicited by the status quo method, proved to be 13.06 +/- 0.10 years (S.D. 1.17 years). According to the information given by the girls (recall method), the earliest time of menstruation was 9.83 years and the latest 15.17 years, at which age all but one of the girls were menstruating.


Skin colorimetry in Belize. I. Conversion formulae.

Comparisons between skin colorimetry reports have been hampered by the common use of two different types of portable reflectometers, which sample reflectances at different wavelengths. In an attempt to provide direct comparability between the two machines, multiple linear regression equations were derived from reflectance spectrophotometry readings on 308 Black Caribs and 175 Creoles in Belize, Central America, using both machines. Cross validation tests show the coefficients presented are applicable to independent data sets and generally applicable to other heavily pigmented populations. Comparisons with previously published conversion formulae, which were from very small samples using simple linear regression, show a definite improvement in predictive accuracy when using multiple regression equations based on a large sample.


ABO blood groups and ABH saliva secretion in Reddis and Kammas of Southern Andhra Pradesh.

ABO blood groups and ABH saliva secretion were investigated in two caste populations, Reddis and Kammas of Southern Andhra Pradesh, and compared with the data of other populations. In ABO gene frequencies, the present series of Reddis and Kammas approach the values from other Andhra caste data. Moderate gene frequency of non-secretor gene in both Reddis and Kammas are noted.


Natural history of male psychological health: VI. Correlates of successful marriage and fatherhood.

The author examines the relationship between quality of object relations and health on the basis of data from a prospective 35-year follow-up of 95 men selected for health. Judges blind to other data made independent ratings of physical health at 52, childhood environment, psychopathology, and maturity of defenses. These ratings were highly correlated with independent ratings of high school social adjustment, adult friendship patterns, marital satisfaction, and outcome of children. The author speculates that the capacity for object relations may be a relatively stable dimension of adult personality--a continous that stretches from mature, generative mental health to schizophrenia.


Transient situational disturbances: course and outcome.

The validity and usefulness of the diagnostic category transient situational disturbance were evaluated by studying the course and outcome for 2,078 hospitalized naval personnel. The condition was found to be less severe and disabling than other major psychiatric disorders in terms of chronicity, length of hospitalization, and disposition. Outcomes in terms of rehospitalization rates and work effectiveness also were relatively favorable. Based on three or more years of follow-up, a substantial proportion of patients originally diagnosed as having a transient situational disturbance subsequently manifested personality disorder problems. The results suggest that clearer criteria are needed to define situational disturbances operationally and to identify patients with underlying personality disorders.


Levodopa-induced psychosis: a kindling phenomenon.

Of 88 patients with idiopathic Parkinson's disease, without prior psychotic symptoms, and without significant dementia, nearly half had experienced vivid dreams, hallucinations, illusions, and nonconfusional as well as confusional psychoses as side effects of chronic levodopa therapy within the previous year of treatment. It was found that 61.3% of all hallucinations were associated with preexistent or concurrent vivid dream phenomena, that all psychotic states were associated with preexistent or concurrent vivid dreams and/or hallucinations, and that nonconfusional psychotic states tended to become confusional. These findings raise the possibility that chronic levodopa therapy may result in dopaminergic kindling and support the hypothesis that chronic dopaminergic agonism may, via such a kindling mechanism, play a role in the development of some types of psychoses.


Mid-adult development and psychopathology.

The authors studied a group of 193 psychiatric outpatients with varying diagnoses and a comparison group of 136 nonpatients across nine measures: sense of self; feelings about marriage, sex, career, and leisure time; relationship to parents, friends, and children; and sense of time passing. They found significant differences between the groups at specific ages in the areas of sense of self, feelings about career and sex, and relationship to parents, children, and friends. They discuss these results with a view toward identifying and elucidating normal and pathological factors in the adult life cycle.


Observations on 67 patients who took Erhard Seminars Training.

The author describes the effects of Erhard Seminars Training (est) on 67 patients--49 who took est during the course of psychotherapy with him and 18 who were seen for evaluation, consultation, or treatment after having taken est. Responsiveness to est was assessed in terms of individually predefined psychodynamics and treatment goals. Of the 49 patients who took est during therapy, 30 were judged to show some positive response and 19 were rated unchanged. The author believes that est often has a strong influence toward psychotherapeutic movement in patients with good ego strength who are motivated to change.


Sexual identity of 37 children raised by homosexual or transsexual parents.

The author reports on 37 children who are being raised by female homosexuals or by parents who have changed sex (transsexuals): 21 by female homosexuals, 7 by male-to-female transsexuals, and 9 by female-to-male transsexuals. The children range in age from 3 to 20 years (mean = 9.3) and have lived in the sexually atypical households for 1-16 years (mean = 4.9). Thirty-six of the children report or recall childhood toy, game, clothing, and peer group preferences that are typical for their sex. The 13 older children who report erotic fantasies or overt sexual behaviors are all heterosexually oriented.


Pathological tolerance.

Pathological tolerance is a symptom that occurs in a stable triadic relationship with certain characteristics, including the sharing of a sexual partner. The term refers to inappropriate acceptance of the triangular relationship by the member of the primary dyad who is of the same sex as the "triadic addition." The author suggests that the intrapsychic and interpersonal dynamics of pathological tolerance are identical with those of pathological jealousy and include the reenactment of earlier conflictual relationships through symbolic representation, expression of homoerotic drives, and a variety of interpersonal patterns. He presents three case reports and recommendations for treatment.


Comparing clinic and private practice of psychiatry.

The author compared data on 2,020 cases treated by private psychiatrists with those on 2,052 cases treated by clinic psychiatrists in California. He also compared data on private treatment in California with those from a national survey of private psychiatrists. Private psychiatrists in California treated as many psychotic patients and used relatively brief psychotherapy about as often as clinic psychiatrists and were more likely to use hospitalization and to see patients individually. In comparison with the national sample, private psychiatrists in California treated more children and patients with situational disturbances and were more likely to receive payment from government sources.


Anticholinergic activity of two tricyclic antidepressants.

Using a double-blind crossover Latin square design, the authors evaluated the peripheral anticholinergic and central nervous system effects of three dose levels of two tricyclic antidepressants in female volunteers. Results showed that 5 hours after drug administration, desipramine (50 and 100 mg) caused significantly less reduction in salivation than did amitriptyline. Amitriptyline produced more sedation (Clyde Mood Scale) and a greater number of subjective complaints than did desipramine. These results are consistent with anticholinergic profiles from animal experiments and suggest that clinically meaningful differences may exist among tricyclic antidepressants.


S-adenosylmethionine-dependent N-methyltransferase activity in autopsied brain parts of chronic schizophrenics and controls.

The transmethylation hypothesis of schizophrenia proposes that the disease results from excessive accumulation of methylated derivatives of biogenic amines. To test the hypothesis that an abnormality in S-adenosylmethionine-dependent N-methyltransferase (SAM enzyme) might play a role in schizophrenia, the authors compared SAM enzyme activity of in vitro preparations of 6 brain regions obtained at autopsy from chronic schizophrenics and nonschizophrenic controls. An analysis of variance demonstrated statistically significant differences among brain regions but not between schizophrenics and controls.


The family practitioner as psychiatrist.

The author describes attitudes held by nonpsychiatric physicians that are responsible for poor psychological handling of patients, including low interest in psychosocial aspects of illness, judgment of and disinterest in hypochondriasis or conversion reaction, avoidance of psychotic or terminally ill patients, and anger toward patients with unpleasant characteristics. He discusses reasons for these attitudes and suggests that medical schools increase psychological education and psychiatry departments increase the relevance of their teaching.


Attitudes toward issues in psychiatry among third-year residents: a brief survey.

The authors surveyed 378 third-year psychiatric residents on their attitudes toward psychiatric training, forms of psychotherapy, and the medical model; their treatment preferences for 4 given psychiatric disorders; and their career plans. Correlation coefficients and analysis of variance indicated clustering of attitudes along a dynamic-biological continuum, with medical education and experience with drug therapy rated highest of the training aspects and personal analysis or psychotherapy, training in psychoanalysis, and research rated lowest.


Symptom passing in a transvestite father and three sons.

Three sons of a transvestite father engaged in cross-dressing beginning in early adolescence. The literature suggests that observation may play a role in determining the specificity of the symptoms of conflicted sexual identity. These cases of transvestism in offspring are unusual in that the father played an important role in symptom choice and modeling. It is hoped that in future studies of transvestism in the father will be examined in a more intensive way as a figure with whom an active identification process may evolve.


Creativity and self-actualization in the aging personality.

Twenty-five residents (sixty-nine to ninety-three years old) of two Israeli homes for the elderly were investigated in order to see if there was a correlation between the creative attitude (self-actualizing personality) and the way of coping with the process of aging and attitude toward death. The results showed that the more creative-actualizing a personality, the better the coping with aging phenomena and the less denial of death.


Depression in children on a general pediatric service.

Masked depression in the hospitalized child is precipitated by maternal separation and anxiety aggravated by environmental, somatic, and existing personality factors. Age, stage of ego development, and comprehension are important influences. Psychiatrically oriented as well as somatically indicated therapy is essential for a favorable outcome. Parents require supportive consideration also.