The chemiluminescence response of human platelets.

Human platelets and platelet particulate fractions were found to emit a burst of chemiluminescence during incubation with arachidonic acid. The magnitude of light emission was directly related to the number of platelets in the reaction mixture and varied little for the same individual from day to day. The chemiluminescence response of platelets was localized to the particulate fraction and was almost totally oxygen dependent. In addition to arachidonate, seven other polyunsaturated fatty acids, including several that are not prostaglandin precursors, also induced platelet chemiluminescence.A correlation was sought between chemiluminescence and platelet prostaglandin synthesis. Platelets incubated in low concentrations of aspirin, or platelets from subjects who had ingested aspirin, had markedly decreased arachidonic acid-induced chemiluminescence. Salicylic and sulfosalicylic acid had no inhibitory effect. A time-response curve of aspirin inhibition of arachidonate-induced chemiluminescence closely paralleled a time-response curve of aspirin inhibition of malondialdehyde production. Linoleic acid-induced platelet chemiluminescence was also markedly inhibited using aspirin-incubated platelets or platelets from subjects who had ingested aspirin. These studies implicate activation of the enzyme prostaglandin synthetase in the arachidonate-induced platelet chemiluminescence. They provide evidence that linoleic acid may also specifically activate platelet cyclooxygenase to produce electronically excited species capable of light emission.


A short screening battery of tests to detect organic brain dysfunction.

Constructed a short screening device to measure organic brain dysfunction, suitable for literate and non-literate populations. A battery that consisted of 8 tests and 22 scoring variables was administered to 65 brain-damaged Ss and 65 normal Ss. The two groups were matched on a person-to-person basis with respect to age, sex and years of schooling. Stepwise multiple regression technique was used to develop a procedure for discriminating organics from normals. At a selected cut-off point the battery could discriminate between organics and normals with only 6% misclassification of normals and 16% misclassification of organics. The classificatory system was validated further against a fresh sample of 33 Ss. The battery proved to have satisfactory discriminatory capacity.


Reduced thrombin binding and aggregation in Bernard-Soulier platelets.

Platelets from two patients with Bernard-Soulier disease showed a reduction in their ability to bind human thrombin. Thrombin binding studies in the high affinity range showed 1,500 sites for the Bernard-Soulier platelets as against 4,000 for normal controls. However, the dissociation constant was the same for both normals and patients (4.4 nM) indicating identical affinity for thrombin at the available sites. In the low affinity range, the Bernard-Soulier platelets showed 8,800 thrombin binding sites as against 24,000 for the controls, but again with identical values of Kd (37 nM). In addition, platelets from these Bernard-Soulier patients showed a decreased rate of aggregation with thrombin at both optimal (300 mU/ml) and suboptimal (60 and 120 mU/ml) thrombin concentrations. The decreased amount of thrombin which can bind to Bernard-Soulier platelets and the decrease in thrombin-induced aggregation may partly explain the hemostatic defect in these patients. In addition, the identical ratios of high affinity and low affinity binding sites in normals and in patients (0.37 and 0.36, and 0.36, respectively) supports the idea of a single class of binding sites for thrombin on the platelet surface.


Standard scores for Wechsler memory scale subtests.

Equations are provided for the calculation of age-corrected standard scores with a mean of 10 and a standard deviation of 3 for the Mental Control, Logical Memory, Visual Reproduction, and Associate Learning subtests of the Wechsler Memory Scale. Use of the standard scores is expected to facilitate intersubtest comparisons.


A procedure for the rapid computation of WISC-R factor scores.

Presents a table that provides a simplified procedure for obtaining WISC-R factor scores expressed as IQ equivalents. Three factors, based on Kaufman's recent analysis of the 1974 Revised WISC, were included: (1) Verbal Comprehension (Information, Similarities, Vocabulary, and Comprehension); (2) Perceptual Analytic (Picture Completion, Picture Arrangement, Block Design, Object Assembly, and the optional subtest, Mazes); and (3) Attention Concentration (Arithmetic, Digit Span, and Coding). The techniques for deriving the factor score equivalents and the use of the table, both procedurally and clinically, are discussed.


Verbal fluency: normative data.

Administered a verbal fluency task and a WAIS to two groups of Ss (one that ranged from 20 to 59 years and the other from 60 to 94 years). In the younger group there were no significant differences in verbal fluency across three IQ or across four decade age ranges. In the older group there were no significant differences across the four decade age ranges, but there were significant differences across the three IQ ranges. A comparison across the three IQ ranges of a ratio of easy letters with many associations to hard letters with few associations was not significant for either group, which suggests that IQ did not interact with task difficulty.


A Yudin-type short form of the WISC-R: two aspects of validation.

Provided validity data for a Yudin-type short form of the WISC-R for N equal to 70 middle-class children (34 males and 36 females, X age equal to 7.6 years, SD equal to 2.58 months) of above-average intelligence (means: VIQ equal to 115.55, PIQ equal to 122.27, FIQ equal to 121.02). Short- to long-form validity coefficients were all above .90 for Verbal, Performance, and Full Scale IQ scores. Highly similar predictive validity coefficients were found for the short and long forms of the WISC-R when compared with the Metropolitan Achievement and Otis Lennon Mental Ability tests. In contrast, little support was found for the validity of the short-form profile data as assessed by Cattell's rp coefficient of profile similarity.


Modification of problem interation in mother-child dyads by modeling and behavior rehearsal.

Eighteen mother-child dyads who previously had reported difficulties in solving problems were assessed behaviorally in situations in which they attempted to resolve conflicts. Half the dyads then were given two treatment sessions that consisted of modeling and rehearsal designed to improve their skills in resolving problem situations. In the pretest assessment a number of significant correlations between mother and child responses were found. Notably, when mothers blamed or used direct arbitrary power with their children, the children in turn emitted oppositional behaviors, but when the mothers made tentative proposals, their children reciprocated with positive responses. In the posttest assessment, treatment mothers employed the expression of feelings to their children as a conflict resolution strategy significantly more often than did control mothers. There was also a tendency for the treatment children to acquiesce less to their mothers' demands than did control children in the problem situations.


Depression and daydreaming; an analysis based on self-ratings.

Investigated the relationship between depression and daydreaming characteristics in a non-hospitalized sample. Level of depression was determined by the Beck Depression Inventory, the Zung Self-Rating Depression Scale, and the Lubin Depression Adjective Check Lists. Daydreaming characteristics were determined from a self-report retrospective questionnaire, the Imaginal Processes Inventory. The sample consisted of 91 university undergraduates and 29 male correctional institution inmates. The full-scale global measures of depression were found to be related directly to the neurotic, anxious, dysphoric, and negative dimension of daydreaming. Specific direct relationships were noted between mental agitation and distractibility, between indecisiveness-personal devaluation and mental slowing, and between personal devaluation-poor body image and fear of failure daydreams. Inverse relationships were noted between a sense of punishment and useful-positive aspects of daydreaming and between psychomotor-activity level and internally stimulated mental activity. The suicidal ambivalance, appetite-weight loss, and fatigability dimensions of depression were found to be unrelated to daydreaming.


An indirect method for increasing the rate of social interaction in an autistic child.

The treatment of a 9-year-old autistic boy who manifested a low rate of social interaction with his parents and older sister is described. Previous attempts to persuade the parents to devote more time to interacting with the child had failed. The parents then were instructed to give the child training in handwriting. A dramatic improvement in the S's ability to reproduce the alphabet was observed. More importantly, a great increase in the rate of interaction between the child and the members of his family was documented. The percent of 10-second intervals in which the S spoke to his family or they spoke to him jumped from 19% during baseline to 89% during the intervention phase. Post-intervention rates of interaction continued to be higher than during baseline.


On the relationship of client satisfaction to client characteristics and outcome of treatment.

Administered to former psychiatric patients a client satisfaction scale and two general questions about satisfaction with hospitalization. Regression analyses that used the client satisfaction measures as dependent variables indicated that the client satisfaction scale was related more to other treatment outcome measures, especially length of stay and goal attainment. The two general questions on satisfaction had correlated highly with each other, but little relation to other outcome measures. The need for a clearer definition of client satisfaction is discussed.


Comparative effectiveness of directive vs. nondirective group therapist style on client problem resolution.

This study was designed to determine the utility of two newly developed self-report measures of group therapy effectiveness. Repeated administrations of these instruments indicated that group therapy was effective in inducing significant problem resolution and that these changes were stable on a 3-month follow-up. One of the measures also suggested that the nondirective style of therapy appeared to be more effective than the directive style. Results suggest that two self-report measures may be useful in studies designed to determine both the outcome as well as the process of group psychotherapy.


Does personal future outlook cause self-esteem?

Melges et al. (1971) presented evidence that a client's sense of self-worth is highly correlated with his degree of optimism about his personal future. In the present study, the cross-lagged panel correlation (CLPC) technique was used to test their hypothesis that changes in personal future outlook lead to changes in self-esteem. Ninety-four outpatients in the private psychiatric practice of the senior author filled out the Decision-Making Evaluation Instrument used by Melges et al. to assess these two constructs as well as decision-making and outcome. Results did not support their implication that personal future outlook is causally predominant over self-esteem, nor did the results support their assumption that they were measuring a distinct construct of self-esteem.


Effectiveness of complementary projection in reducing stress.

Threatened Ss in five stress groups with electric shock, while Ss in a sixth group were not threatened. In one of the stress groups Ss were encouraged to project causality for their feelings that resulted from the threat of shock to the E instead of to the shock, while Ss in the remaining stress groups were not encouraged to project causality for the threat-produced affects to the E. Physiological and self-report measures indicated that Ss who projected their anxiety and nervousness to the E were just as distressed by the veridical source of arousal as were Ss who did not project. Implications of these results for the hypothesized stress-reducing effectiveness of complementary projection were discussed.


Measuring psychosocial aspects of treatment outcome among compulsive drug users.

Addressed three questions in a study designed to identify problems in adapting psychosocial measures for outcome evaluation of drug abuse treatment. Answers were sought by comparing samples of consecutive admissions to a drug dependence treatment center (N = 201) and to an inpatient psychiatric unit (N = 159) on home and community adjustment ratings (Personal Adjustment and Role Skills scales, Ellsworth, 1975) by self and significant others. For question one (Are there unique problems in gathering outcome data?), drug users' informants returned significantly fewer ratings: return rates were higher for drug users more seriously disturbed. For question two (Are data "reliable?"), comparable agreement was observed between self and other ratings for both drug users and psychiatric Ss; drug users' outcome data are as "reliable," but not as retrievable, as psychiatric outcome data. For question three (Is outcome change unique?), drug users rated as improving significantly more than psychiatric Ss in employment and in drug abuse. Several methodological issues must be resolved, however, before psychosocial outcome data may be used in comparative studies of drug abuse treatment effectiveness.


Drug abuses in the military: correlates of successful rehabilitation.

Investigated the relationships among motivation for drug abuse, successful rehabilitation, and personality/demographic variables. The Ss, 20 airmen who had completed successfully a local USAF Drug Abuse Rehabilitation Program, were administered the 16PF Qestionnaire, the Tennessee Self-Concept Scale, and the Sensation Seeking Scale. Multivariate correlative analyses showed that those Ss who progressed most rapidly through the rehabilitation program could be best identified by their scores on the Sensation Seeking Scale, while specific subscales of the Tennessee Self-Concept Scale and the 16PF contributed somewhat to the predictive value. It was concluded the the SSS has potential value in predicting successful rehabilitation of military drug abusers.


A self-control program for drinking antecedents: the role of self-monitoring and control orientation.

Assessed the effects of a self-control program on increasing personal control and ameliorating alcohol abuse. Ss attended two groups per week for 3 weeks and were administered the Experienced Control scale (Tiffany, 1967) before and after treatment and on follow-up. All Ss showed increased control over internal stresses across treatment. Internally oriented Ss in the experimental group showed increased control over external stresses, while internals in the control condition showed no change. Self-monitoring externals did not change over treatment, but increased significantly over follow-up. Control externals changed over treatment, but not on follow-up. Internally oriented Ss both monitored frequently and appeared to benefit from the use of self-monitoring of drinking antecedents. Externals showed more indefinite results, as self-monitoring Sc evidenced a slower, somewhat "delayed" increase in adaptive self-control when compared to self-monitoring internals.


Intellectual assessment in a Midwestern alcoholism treatment population.

A study of 867 patients at a midwestern alcoholism treatment center which used Shipley-Hartford Institute of Living Scale scores and WAIS scores indicates that intellectual differences in this population are due to age and socioeconomic differences than to alcoholism. However, these real differences can be used to plan dismissal and rehabilitation policies for individual patients.


Determinants of locus of control orientation in male alcoholics.

Investigated various demographic correlates of locus of control orientation in 123 male alcoholics. The social functioning of alcoholics was associated significantly with locus of control. It was suggested that conflicting results among similar studies probably are due to the differing social or demographic characteristics of the samples that were used.


Schizophrenic performance on the Halstead-Reitan battery.

Compared Halstead-Reitan Battery scores of hospitalized male schizophrenics with scores of normals and brain-damaged Ss to determine performance patterns that differentiate the groups. Schizophrenics performed less well than normals on the Categories, TPT-Memory, and TPT-Location subtests and better than brain-damaged Ss on all subtests except Categories. In general, the effects of medication produced nonsignificant results.


Suicidal age and childhood onychophagia among neurotic veterans.

Investigated the relationship between childhood onychophagia (fingernail biting) and the suicidal and non-suicidal mean age among 60 hospitalized neurotic veterans. The results show no significant mean age difference between suicidal and non-suicidal veterans; neither does the childhood onychophagia variable "focal suicide" significantly lower either the mean age of suicidal veterans or the mean age of non-suicidal veterans.


Verbal conditioning of male and female schizophrenics as a function of experimenter proximity.

Verbal conditioning of male and female schizophrenics and nonschizophrenics was observed as Ss sat at different distances and orientations from an E who delivered a positive word/positive tone reinforcer ("Good"). Results indicated that the presence vs. absence of diagnostic differences in learning depended on (a) the sex of the Ss; and (b) the distance that Ss sat from the E. The absence of overall diagnostic group differences in learning and the finding that in some proxemic conditions schizophrenics learned more than nonschizophrenics are consistent with the view that under appropriate conditions schizophrenics emit behaviors that are incompatible with an assumption of schizophrenic deficit.


Weakness and instability of time expectancy in schizophrenia.

Duration of a tachistoscopically presented dark dot was estimated by schizophrenics and alcoholics. The dot was preceded by the auditory warning signal of viariable duration of up to 9 seconds. The duration of the warning signal constituted foreperiod duration. Estimation was a monotonically increasing function of foreperiod duration for both schizophrenics and alcoholics when the probability distribution of foreperiods was constant. However, this monotonicity was eliminated when changes in foreperiod duration became infrequent. When intrusion of extraneous stimulus accompanied such infrequent changes, the effect of foreperiod duration on estimation of stimulus duration became curvilinear, with the maximum estimation at the mid-range. For alcoholics, the monotonically increasing effect of foreperiod duration was independent of relative frequency of foreperiod changes and intrusion of extraneous stimulus. Weakness and instability of time expectancy as characteristics unique to schizophrenia were demonstrated.


The effects of unilateral and bilateral ECT on verbal and visual spatial memory.

Investigated the effects of unilateral left (UL), unilateral right (UR), and bilateral (B) ECT on the performance of right-handed male patients on the Wechsler Memory Scale and two tests of the Williams battery, which provided eight independent measures of verbal memory and two of visual-spatial memory. Patients were tested three times: (1) within 1 week prior to ECT; (2) within 30 minutes after the sixth ECT; (3) 10 days after the sixty ECT. Double blind procedures were maintained carefully. Results showed a significant loss on second testing followed by a significant improvement 10 days later for all ECT groups compared with matched controls. There was some tendency for the UR group to show the least impairment on verbal measures and the UL group to show the least impairment on visual-spatial memory test of the WMS, but most of the differences between UL and UR groups and between each of these and the B group were not significant. The most sensitive test in differentiating among the ECT groups was the brief Verbal Learning subtest of the Williams battery.


Admitting personal problems and outcomes in hospitalized psychiatric patients.

Willingness to admit that one has a serious emotional problem is part of a complex of attitudes that have a significant effect on behavioral outcomes of hospitalized psychiatric patients. Specifically, patients who admitted emotional problems were more likely to want to change than non-admitters. Further, admitters stayed in the hospitals a significantly shorter time and were less likely to return to the hospital within a year than patients not willing to admit problems. Other similar findings indicated that admitting problems and desire to change were better predictors of patients' outcome than staff physicians' opinions.


Neuropsychological discrimination between violent and nonviolent men.

Compared 40 violent and 40 nonviolent male prisoners on a 31-variable neuropsychological test battery and the MMPI. The two groups differed significantly in their responses to both neuropsychological tests and the MMPI. Ss could be classified correctly as violent or nonviolent with 95% accuracy by use of the neuropsychological test battery alone. The MMPI alone correctly classed 79%. The relative behavioral impairment seen on neuropsychological tests is interpreted as part of a general pattern of poor intellectual integration cortical inhibition associated with the presumed greater prevalence of brain dysfunction in samples of violent persons. Simple and rather specific perceptual, cognitive, and psychomotor tests such as found in neuropsychological assessment batteries add significantly to the identification of potentially violent persons and appear more powerful for this purpose than personality inventories.


The BSRI M, F, and androgyny scores are bipolar.

Demonstrates that the Bem Sex-Role Inventory (BSRI) masculinity (M), femininity (F), and Androgyny scores reflect a bipolar dimension rather than two independent dimensions and their unique derivative. The mean endorsement of the BSRI M and F items was calculated for 50 males and 50 females separately and as a combined group. The BSRI M and F items then were scored in a bipolar fashion. A total Bipolar Androgyny score was calculated for each S by summing the S's Bipolar Androgyny scores on the M and F items. The data indicated that (1) Bem's M scores and the derived Bipolar Androgyny scores based on Bem's M items were highly correlated (congruent to .90); (2) Bem's F scores and the Bipolar Androgyny scores based on Bem's F items were highly correlated (congruent to .90); and (3) Bem's Androgyny scores and the total Bipolar Androgyny scores were highly correlated (congruent to .90). These results indicate that the BSRI Androgyny score reflects a bipolar dimension.


Differentiation of neurologic and pseudo-neurologic patients with combined MMPI mini-mult and pseudo-neurologic scale.

Patients who were complaining of neurologic symptomagology completed the MMPI Mini-Mult plus the Shaw and Matthews Pseudo-Neurologic Scale to determine whether Pseudo-Neurologic and Neurologic patients could be separated. This was done with statistical significance, but not with clinical utility. There were no significant differences among the mean Mini-Mult profiles for the neurologic subcategory groups. Mean profiles for the Neurologic, Pseudo-Neurologic, and Mixed groups also were not significantly different, but analyses of the individual profiles in the Neurologic and Pseudo-Neurologic groups produced statistical and clinical significance. Presenting complaints of all Ss were investigated to see whether the Scale could predict differentially for patients in each of these groups. Only the complaint of weakness predicted with statistical significance and clinical utility. Attempts to create a new, more effective scale were disappointing despite statistical significance as misclassification decreased clinical utility.


Validity of the MMPI 168 on private clinic subpopulations.

The diagnostic efficiency of the MMPI 168 and the standard MMPI was compared on three private psychiatric subpopulations: a hospitalized adult inpatient sample, a hospitalized adolescent inpatient sample, and an outpatient sample composed of vocational rehabilitation referrals. The MMPI 168 was found to be a viable alternative to the standard Form R on all three groups by separating invalid from valid profiles, normal from abnormal profiles, and by differentiating among neurotic, psychotic, characterological, and indeterminate profiles.


Comparison of hyperactive and emotionally-behaviorally disturbed children on the Devereux Child Behavior Rating Scale: a potential aid in diagnosis.

Comparison was made between Devereux Child Behavior Rating Scale (DCB) ratings of matched groups of hyperactive and emotionally-behaviorally disturbed children. The emotionally behaviorally disturbed group was chosen to represent a population with presenting symptoms similar to hyperactivity. Ratings of the two groups exceeded the normative population on all DCB factors. The hyperactive group received higher scores on 16 factors and was significantly higher than the emotionally-behaviorally disturbed group on 8 factors. The hyperactive group received the most extreme scores on behavioral dimensions generally described as characteristic of the hyperactive syndrome. The results suggested that the DCB can assist in differentiating hyperactive children from children with presenting symptoms similar to those of hyperactivity.


The Coopersmith Self-Esteem Inventory: analysis and partial validation of a modified adult form.

Determined the factor structure of an adult form of the Coopersmith Self-Esteem Inventory (SEI), tested several hypotheses related to its content, and assessed the utility of the five derived scores for differentiating psychiatric outpatients from normals. The modified Self-Esteem Inventory and six other scales were completed by 200 local-government employees. A principal components analysis of correlations among 58 SEI items and two marker variables revealed five factors. The rotated dimensions were labelled (1) anxiety; (2) defensiveness; (3) negative social attitude; (4) rejection of self; and (5) inadequacy of self. Fifty psychiatric outpatients were compared with 100 normals with respect to the five derived factor scores. Tests of significance indicated that the two groups differed significantly on all measures except the defensiveness or lie scale factor. It is concluded that the Coopersmith Inventory is complex and measures several characteristics in addition to self-esteem.


Psychological mindedness, intelligence, and item subtlety endorsement patterns on the MMPI.

Investigated the relationship between psychological mindedness (measured by the Psychological Mindedness [Py] scale of the California Psychological Inventory [CPI]), intelligence (estimated by American College Test [act] scores), and item subtlety endorsement patterns of Ss asked to answer the MMPI under standard, fake-good, and fake-bad response sets. Male (N equal to 30) and female (N equal to 30) undergraduate students completed the Py scale and two MMPI protocols--one under standard test-taking instructions and the other under either a fake-good or a fake-bad set with order of administration and sex counterbalanced. Under the standard response set, Ss who scored high on the CPI-Py endorsed more very subtle and somewhat subtle items and fewer neutral, somewhat obvious, and very obvious items than Ss who scored low on this scale. Intellectual ability was not related to the endorsement of subtle or obvious items under standard or fake-good response sets. Under instructions to fake-bad, more intelligent individuals endorsed fewer somewhat subtle items and more very obvious items than less intelligent individuals. These results were discussed in reference to the utility of subtle items as unobstrusive measures of personality or as indicators of certain response sets.


Relating personality characteristics to juvenile offense categories: differences between status offenders and juvenile delinquents.

Examined the Jesness Inventories of 72 male juvenile offenders to see whether personality differences existed between the profiles of juvenile delinquents and status offenders. Of the 10 scales of the Jesness, analyses of variance yielded significant mean differences for 3 of the scales; 2 approached significance. A discriminant analysis also clearly discriminated between the two statutorily defined groups; status offenders appeared more rather than less disturbed than the juvenile delinquents. Results were discussed in terms of treatment ramifications and in providing empirical evidence to aid policy makers presently involved in deciding the appropriateness of court jurisdiction over status offenders.


Psychological and social adjustment of blind subjects and the 16PF.

Determined whether individuals who adapted well or poorly to the loss of their vision could be differentiated on the basis of the Cattell 16PF. Well adjusted individuals were defined as those who displayed minimal depression and high social independence, while poorly adjusted individuals were highly depressed and socially dependent. By the use of discriminant analysis based upon the standard 16PF, 84.5% of highly depressed and 81% of the minimally depressed group were classified accurately. In a second analysis, 75% of socially independent and 73% of socially dependent individuals were classified correctly. Premorbid characteristics of well and poorly adjusted blind Ss were described.


Relationship between the "Barnum effect" and personality inventory responses.

Hypothesized that rating bogus "personality feedback" and answering personality inventory items are both instances of the same general behavior. After undergraduates were administered personality inventories, they were asked to evaluate the accuracies of personality descriptors under differing instructional sets. In support of the hypothesis, a Barnum Group's (N equal to 24) personality inventory responses and "personality feedback" ratings correlated significantly and as highly as Reliability Controls' (N equal to 24) alternate forms reliability coefficient. Inventory responses and "feedback" ratings were affected equally by the descriptors' favorability and by the Ss' defensiveness. Contrary to the hypothesis, descriptors were rated as more personally accurate when presented as "feedback" than when presented as test items. Theoretical and applied implications of the findings are discussed.


Ultrastructure of Ebola virus particles in human liver.

Electron microscopy of tissues from two necropsies carried out in the Sudan on patients with Ebola virus infection identified virus particles in lung and spleen, but the main concentrations of Ebola particles were seen in liver sections. Viral precursor proteins and cores were found in functional liver cells, often aligned in membrane-bound aggregations. Complete virions, usually found only extracellularly, were mainly seen as long tubular forms, some without cores. Many tubular forms had 'enlarged heads' or 'spores' and some branched and torus forms were identified. The size and structure of the Ebola virus forms appear to be virtually indistinguishable from those of Marburg virus.


Chemotactic activity of cerebrospinal fluid in pyogenic meningitis.

Cerebrospinal fluid from patients with pyogenic meningitis was found to be chemotactic for polymorphonuclear neutrophil leucocytes. No significant difference was found between the mean chemotactic activity of cerebrospinal fluid obtained from patients with pneumococcal meningitis or meningococcal meningitis. The chemotactic factor present in cerebrospinal fluid is probably a low molecular weight protein, perhaps a complement component.


Flavobacterium meningosepticum as an opportunist.

Flavobacterium meningosepticum was isolated from the cerebrospinal fluid of an adult immunodeficient female. In spite of prompt therapy the patient succumbed to the infection. The opportunistic role of the organism is discussed.


Some interesting isolates from a diagnostic laboratory.

Citrobacter koseri, Plesiomonas shigelloides, Edwardsiella tarda, Yersinia enterocolitica, Alkalescens dispar, Vibrio parahaemolyticus, and Vibrio alginolyticus were seven interesting microorganisms isolated recently in our diagnostic laboratory.


Polyene antibiotics in assessing significance of antistreptolysin O activity.

Antistreptolysin O activity in serum is due either to antibody or to altered lipoprotein molecules. The latter can be inhibited by performing antistreptolysin tests using a polyene antibiotic such as amphotericin B as diluent.


Paraganglioneuroma of the duodenum: an evolutionary hybrid?

On light microscopy the neural component of a hybrid neural and endocrine duodenal tumour was characterised by ganglion cells and the endocrine component by epithelioid cells which were both argentaffin and argyrophil. Spindle-shaped cells of indeterminant lineage were also present. Electron microscopy revealed 'pale' and 'dark' cells, the former corresponding to the epithelioid cells and containing many membrane-bound neurosecretory granules, the latter probably corresponding to the spindle cells and containing large numbers of neurofilaments. Occasional cells contained both neurofilaments and secretory granules arranged in a consistent pattern in the cytoplasm. These composite cells may have represented an incompletely differentiated precursor of both the neural and endocrine elements of the tumour.


Congenital syphilis in aborted second trimester fetus: diagnosis by histological study.

A case of congenital syphilis in an aborted fetus in the second trimester of pregnancy was documented by demonstration of spirochaetes in the fetal liver, despite the fact that diagnostic studies had not been performed on the mother. Suspicion was aroused by the gross and microscopic appearance of the placenta, which appeared identical with the described in proven cases of congenital syphilis. Although these changes have been alleged to be non-specific, the rarity with which such well-developed lesions are encountered in placentas in other circumstances dictates the necessity for further study when they are observed.


Internal sphincter and haemorrhoids: a pathological study.

Histological examination of the lower margin of the internal sphincter has demonstrated an increased amount of fibrous tissue in patients with haemorrhoids compared with controls. This finding may be of relevance to the treatment of haemorrhoids by maximal anal dilatation.


Abridged differential leucocyte counts provided by a Coulter Channelyzer in a routine haematology laboratory.

We have used automated differential leucocyte counts by volume analysis for the past six months after initial evaluation had shown several advantages--namely, accuracy, simplicity, speed, and low cost. We describe the operation of the Coulter Channelyzer Model C-1000, which is linked to a Coulter Model S cell counter, analyse the cost, and comment on the clinical and laboratory consequences of adopting this method.


Measuring IgG anti-A/B titres using dithiothreitol (DTT).

In comparing the use of the sulphydryl compounds 2-mercaptoethanol (2ME) and dithiothreitol (DTT) a rapid one-stage technique for titrating IgG anti-A and anti-B using DTT in an antiglobulin test was tried. The results correlated well with those obtained by either of the two-stage methods using 2ME or DTT.


Antibody to hepatitis B surface antigen in haemophiliacs on long-term therapy with Scottish factor VIII.

Thirty-five patients with haemophilia A were studied clinically and serologically between 1971-2 and 1975-6 for evidence of hepatitis B infection. One patient suffered from clinical hepatitis B, and a further eight patients showed antibody responses to hepatitis B surface antigen (HBsAg) consistent with exposure to HBsAg during this period. No evidence for HBsAg exposure was found in 14 patients, while the remaining 12 patients had high titres of antibody to HBsAg at both times and no inferences could be drawn about HBsAg exposure. All patients had received exclusively replacement factor VIII material prepared locally from HBsAg-screened voluntary Scottish blood donations. From the details of the therapy given we calculated that the rate of HBsAg seroconversion in these patients represented about 0.3 HBsAg-containing donations/1000 donations.


Lazy leucocyte syndrome--disorder of the granulocyte membrane?

An adult with long-standing neutropenia had the functional granulocyte abnormalities typical of the lazy leucocyte syndrome. Scanning electron microscopy of the patient's neutrophils showed alteration in the surface configuration of the cell with coarsening of the normal fine ruffles and the appearance of knob-like projections. Similar functional and anatomical changes were induced in normal neutrophils by treatment with vinblastine. The lazy leucocyte syndrome may be a consequence of altered membrane microfilamentous protein structure or function, and undue rigidity of the affected neutrophils may explain the clinicopathological features of the disease.


Role of imprint cytology in intraoperative diagnosis: value and limitations.

Imprints prepared from fresh surgical specimens give excellent cytological clarity. Used intraoperatively, the imprint method can provide valuable information when frozen-section interpretation is equivocal. However, cytologically well-differentiated tumours and tumours with a dense fibrous stroma, constituting 6% of the cases in the present series, cannot be diagnosed by this method. To increase diagnostic accuracy we recommend the combined use of imprints and frozen sections. The imprint technique requires little additional work and does not delay the frozen-section procedure.


Fluorimetric assay of mycobacterial group-specific hydrolase enzymes.

Fluorigenic substrates prepared from 4-methylumbelliferone provide a simple, convenient method for detecting and assaying group-specific hydrolase activity in small quantities of whole mycobacteria. Physico-chemical properties of the enzymes such as pH dependence and heat stability may also be studied. A technique is described for studying glycosidase, hexosaminidase, acid phosphatase, and acyl esterase activity in seven mycobacterial species. Such techniques will be a useful aid to the taxonomy, identification, and quantification of mycobacteria, especially slowly growing strains in which biochemical properties are very difficult to detect by other techniques.


Rapid estimation of volume of distribution after a short intravenous infusion and its application to dosing adjustments.

A simple and a rapid method to estimate the apparent volume of distribution of drug after single or during multiple short-term intravenous infusion is proposed. This is based on the back extrapolation to the midpoint of infusion. An equation simpler than one previously reported in the literature is also derived to calculate the maintenance dose for multiple short-term intravenous infusion. In addition, an equation to estimate the "priming dose" for infusion during multiple infusion regimen is also derived. The derivations of the equations are based on a linear one-compartment open model for drug disposition in patients. The prposed method is thought to be adequate for the purpose of rapid individualization of dosage regimens. The simplicity of the method, in particular, the solution by the graphic method for estimation of the apparent volume of distribution, might be specially useful for clinicians not well versed in mathematics in applying clinical pharmacokinetics to drug therapy.


A cytologic study of Grandry corpuscle development in chicken toe skin.

The developmental sequence of Grandry corpuscles was traced in the toe skin of embryonic, young and adult chickens by light and electron microscopy. The developing Grandry cells as well as Schwann cells can first be identified at stage 38 (approximately 12 days of incubation) due to the cytoplasmic content of scattered secretory granules of approximately 100 nm in diameter. Such developing Grandry cells are always associated with nerve fibers. During late stages (stages 40-42, 14-16 days of incubation) several immature Grandry cells formed cell clusters in the dermis. Such cell clusters were always in contact with growing nerve tips of Schwann cells. Immature Grandry cells were separated from one another and dispersed in the connective tissue compartment at stages 44-45 (near hatching). By the time of hatching the developing Grandry cells began to have the morphological characteristics of adult cells. They were relatively large in cell diameter (approximately 10 micron) containing numerous secretory granules and bundles of filamentous material. These cells had finger-like cytoplasmic processes. The Grandry cells at this time had an intimate relationship with nerve fibers and satellite cells. The fact that Grandry cells were always associated with nerve fibers throughout development would support the hypothesis that Grandry cells are derived from neural elements, perhaps neural crest. Satellite cells of Grandry corpuscles are apparently derived from Schwann cells. Grandry cells and corpuscles are adult in form by two to three months of age.


Bethanidine dose, plasma levels, and antihypertensive effects.

Bethanidine dose, plasma levels, and hypotensive effects were evaluated in twelve hypertensive patients. Diuretic therapy with benzthiazide was started two weeks before and continued during the study. Bethanidine was given three times daily. After two to 12 months of therapy in 11 of the patients, the mean standing diastolic pressure was reduced from 112 to 91 mm Hg. The mean total daily bethanidine dose was 79 mg (range 30--150 mg). The mean plasma bethanidine was 0.65 micrometer (range 0.1--2.8 micrometer), which correlated with the bethanidine dose. There was less correlation between dose and antihypertensive effect. The effects of sudden withdrawal from chronic bethanidine dosing were observed in six patients. The orthostatic effect of bethanidine was lost within 12 hours, but the half-time of elimination of bethanidine from plasma was 39 hours. Based upon the present findings, recommendations are presented for initiation and maintenance of antihypertensive therapy with bethanidine.


An autoradiographic study of midbrain-diencephalic projections to the inferior olivary nucleus in the opossum (Didelphis virginiana).

Techniques of intra-axonal transport were utlizied to elucidate the organization of diencephalic and midbrain projections to the inferior olivary nucleus of the Virginia opossum. Retrograde transport of horseradish peroxidase injected into the olive suggests that terminals within it arise from the subparafascicular nucleus of the caudal thalamus, the nucleus of Darkschewitsch, the fields of Forel, the interstitial nucleus of Cajal, the periaqueductal grey, the caudal pretectal nucleus, the tegmentum dorsomedial to the red nucleus, the red nucleus (minimal), the nucleus linearis, as well as the dorsolateral midbrain tegmentum and tectum (Henkel et al., '75). Tritiated leucine injections were made into each of the above-mentioned cell groups so that the olivary terminals of their axons could be demonstrated autoradiographically. In general, the projection systems show three basic patterns of organization. Ventromedial areas of the midbrain, including the ventral periaqueductal grey, the interstitial nucleus of Cajal, part of the red nucleus and the tegmentum dorso-medial to it, provide a substantial and topographically organized projection to the principal nucleus of the olive, as well as minor inputs to the accessory nuclei. Secondly, neurons within the subparafascicular nucleus, the nucleus of Darkschewitsch and the fields of Forel project most heavily to parts of the medial accessory nucleus, although they also provide input to the other major subdivisions of the olive. Third, axons from the dorsolateral tegmentum and tectum completely avoid the principal nucleus, while supplying small regions of the accessory nuclei.


Indomethacin disposition and indomethacin-induced platelet dysfunction in premature infants.

Indomethacin failed to produce permanent ductal closure in any of four premature infants with patent ductus arteriosus to whom the drug was given. Indomethacin half-lives measured in two premature infants were 21 and 24 hours, respectively, much longer than in full-term newborns or adults. Platelet function, as measured by platelet aggregation, was grossly abnormal for two to four days after indomethacin administration, normal values returning only by the ninth and tenth days. Gastrointestinal bleeding and transient renal dysfunction occurred in one infant. Measurement of plasma indomethacin concentrations in sick, low-birthweight infants could help guide indomethacin dose and dosage interval, prevent drug accumulation, and reduce toxicity. Further studies of potential toxicity seem to be indicated before instituting widespread indomethacin administration for ductal closure in premature infants.


The organization of olivo-cerebellar projections in the opossum, Didelphis virginiana, as revealed by the retrograde transport of horseradish peroxidase.

The retrograde transport of horseradish peroxidase was utilized to map olivo-cerebellar projections in the Virginia opossum. The spinal cerebellum (anterior lobe, paramedian lobule and pyramis) receives input from several separate regions in the dorsal accessory nucleus, the medial accessory nucleus and portions of the principal nucleus. Evidence is present for a topographical organization whereby specific regions of the olive project to restricted longitudinal zones. The visual-auditory region of the posterior vermis receives input from small areas within the caudal part of the medial accessory nucleus. From a distinctly separate region of the caudal medial accessory nucleus (as well as the principal nucleus), axons project to the uvula. The vestibulo-cerebellum is the recipient of axons from the cap of Kooy and from two spatially separate regions of the medial accessory nucleus. The cerebellar hemisphere (Crus I and II, lobus simplex) is the target of axons from parts of all three olivary nuclei and it is possible that the projections from the different nuclei are targeted upon separate zones. The paraflocculus was found to receive an input from the rostral part of the medial accessory nucleus and from the principal nucleus. The present results suggest that a distinct olivary region may project to several widely separate areas of the cerebellum, and that one cerebellar region may receive input from several areas of the olive. The organization of the olivocerebellar projection is highly complex, but when considered in light of known inputs to the olive, certain patterns emerge.


Spinal projection to the dorsolateral nucleus of the caudal basilar pons in the cat.

In the cat, a spinal projection to a restricted area of the basilar pontine grey has been revealed with use of anterograde degeneration technique (Fink-Heimer). The area was ipsilateral to the spinal lesion, restricted to the far caudal limit of the pons, and included the dorsal and the dorsolateral subdivisions of the pontine nuclei (PN). Comparisons following high cervical, midthoracic and upper lumbar spinal lesions did not reveal any somatotopic organization. Only a few spinopontine fibers had origins below segmental level L4. Lesions of various quadrants of the cord indicated that the spinopontine fibers ascended through the dorsolateral funiculus, and not through either the dorsal or the ventral funiculi. Comparison with the degeneration effects of cerebral cortical lesions showed that the spinal projection to the PN overlapped to some extent with the projection from the first sensorimotor and second somatosensory cortices. In the rat no comparable spinopontine projection was found. It is suggested that the spinopontine pathway might forward information to the cerebellum from visceral sensory receptors or perhaps from pools of spinal interneurons.


The vestibular nuclei in the domestic hen (Gallus domesticus) III. Ascending projections to the mesencephalic eye motor nuclei.

Following injections of horseradish peroxidase in the oculomotor and the trochlear nuclei in the hen, the occurrence of labeled cells was plotted in the vestibular nuclei. The majority of labeled cells was localized in the superior, the medial, and the tangential nucleus. Within the superior nucleus the cells were found mainly caudally, extending medially and ventrally in central areas. In the medial nucleus labeled cells were localized exclusively in its rostral half, mainly in ventrolateral regions. Most, if not all, cells in the nucleus tangentialis project rostrally. In addition, rostrally projecting vestibular cells were found in the cell group A and the rostrolateral part of the descending nucleus. The projection to the oculomotor nuclear complex is from the superior nucleus and the cell group A bilateral but chiefly ipsilateral, from the medial nucleus bilateral, from the tangential nucleus and the rostral pole of the descending nucleus chiefly contralateral. Massive labeling was found in the abducens nucleus, somewhat less in the reticular formation, mainly in the lateral regions of the medial part at the level of the abducens and facial nuclei. Labeled cells were, in addition, found in the deep layers of the optic tectum, and scattered cells in the nucleus raphe. The findings are discussed in the light of what is known of the organization of the vestibular nuclei in the hen and the rostral projection of the vestibular nuclei in mammals.


Superior colliculus connections with the extraocular motor nuclei in the cat.

Direct and indirect projections from the cat superior colliculus to the extraocular motor nuclei were studied using the orthograde autoradiographic tracing method, the retrograde horseradish peroxidase technique, and Golgi methods. The results show that the superior colliculus projects to the central gray matter directly overlying the oculomotor complex. This projection arises almost entirely from the rostral third of the colliculus, and it terminates most heavily over the rostral half of the oculomotor complex. Dendrites of oculomotor cells extend into this tectal termination zone, making direct tecto-oculomotor contacts possible. Central gray cells within this termination zone project bilaterally to the abducens nuclei. It is proposed that the superior colliculus projection to the supraoculomotor central gray matter and the projection from the central gray matter to the abducens nuclei play a role in convergent eye movements. The superior colliculus projects lightly to a cell group directly ventrolateral to the trochlear nucleus. The superior colliculus sends a small direct projection to the contralateral abducens nucleus and a substantial projection to wide regions of the reticular formation that have been shown previously to project, in turn, to the abducens nucleus. Colliculus cells projecting to the abducens nucleus and adjacent reticular formation are located only in the caudal three-fourths of the colliculus, where they become increasingly concentrated at successively more caudal levels. It is proposed that the graded density of the cells of origin of this projection is the basic structural mechanism by which the colliculus generates horizontal foveating saccades of different amplitudes. Laminar analysis of the origin of all the superior colliculus projections to the extraocular motor regions described here revealed that they arise mostly from the stratum griseum intermedium.


The morphology of the spinal cord efferent and afferent neurons contributing to the ventral roots of the cat.

Horseradish peroxidase was applied to proximal ventral roots of the coccygeal and sacral spinal cord of cats. Subsequent histochemical reaction resulted in extensive staining of spinal cord neurons that had processes in the ventral roots. This procedure was used to study four issues concerning ventral root neurons. (1) Extensive transverse dendritic arborizations were revealed for large and small neurons presumed to be alpha and gamma motoneurons respectively. Dendrites from these neurons were found to project heavily into the ipsilateral white matter, both laterally and ventrally. Dendrites also projected extensively through the anterior commissure, attaining the contralateral grey and white matter. (2) Medially-located efferent neurons were found to contribute the contralateral dendrites as well as some dorsally-directed dendrites. Laterally-located neurons projected dendrites extensively into the lateral and ventral white matter. (3) Stained neurons were found in the intermediolateral cell column, and were presumed to be preganglionic efferent neurons. Some of these neurons projected dendrites into the marginal zone of the dorsal horn, while others sent dendrites medially toward the central canal. (4) Stained fibers, presumed to be primary afferents, were found to enter from the ventral roots and course to the dorsal horn. Most of these fibers were small in diameter and distributed boutons predominantly to the substantia gelatinosa. A few large ventral root afferent fibers were observed that distributed boutons mostly to the nucleus proprius.


Three types of horizontal cells in the stingray retina: their morphology and physiology.

Histological and electrophysiological features of horizontal cells were studied in the stingray retina in which the ratio of rods to cones was about five to one. There were three distinct sublayers of horizontal cells; external, middle and internal. The type of horizontal cells recorded was identified by dye injection after recording. Relatively thick external horizontal cells sent their short dendrites into both rod and cone terminals to make synaptic contacts. The response recorded from them was not color-coded but showed a Purkinje shift depending on the adaptational state. Middle horizontal cells were flat and usually two or three of them overlying each other constituted the middle sublayer. Their response, which was difficult to record in the light-adapted retina, was characterized by a slow time course, a prolongation of the response to bright flashes and a maximum sensitivity in the green region of the spectrum without any sign of Purkinje shift. Internal horizontal cells were color-coded. They responded with hyperpolarization at shorter wavelengths and with depolarization at longer wavelengths. It was concluded that the internal horizontal cells receive inputs from cones and the middle horizontal cells from rods, whereas the external horizontal cells receive inputs from both rods and cones.


Extraocular muscle representation in the brainstem of the carp.

The representation of the extraocular muscles in the oculomotor nuclei in the brainstem of the carp was studied with the horseradish peroxidase technique. Some normal anatomical features of the various oculomotor nuclei are described. Following intramuscular HRP injections in the eye muscles and applying survival times of up to 25 days labeled perikarya were found in the various nuclei of the oculomotor complex. Rectus inferior, rectus internus, and obliquus inferior are represented in the ipsilateral nucleus oculomotorius, while the rectus superior was found to be innervated from the contralateral n III. The efferent cells innervating the obliquus superior are located mainly in the contralateral nucleus trochlearis and for a low percentage in the ipsilateral counterpart of the n IV. The rectus externus is represented in the rostral and caudal subnuclei of the ipsilateral nucleus abducens. These results show a remarkable resemblance with data on mammalian extraocular muscle representation, although the overlap of the various cell populations is larger in fish.


The developmental morphology of Torpedo marmorata: electric organ--myogenic phase.

The early development of the electric organ of Torpedo marmorata has been examined by light and electron microscopy to the 40-mm stage of embryo growth. The myogenic nature of this tissue is confirmed ultrastructurally by the presence of myoblasts and myotubes both containing myofibrils cross striated with Z,A and I bands. Fusion between these cells is also found taking place. A scheme is presented to explain the development of the overall structural plan of the organ and specifically the formation of the future electrocyte columns. AT 40 mm, a series of morphological transformations signals the onset of a divergent developmental pattern ultimately leading to the establishment of mature electrocyte columns. These features include rounding up of myotubes, dissolution of myofibrils and the appearance of intermediate size filaments (11 nm) and perhaps a non-muscular actin (5.5 nm). This early myogenic phase of development occurs in the absence of any specific nervous contact even though electromotor nerves are always in close proximity.


Atlas of the distribution of monoamine-containing nerve cell bodies in the brain stem of the cat.

The distribution and morphological characteristics of monoamine (MA)-containing neuronal somata in the brain stem of kittens and of adult cats were studied by means of the Falck-Hillarp histofluorescence method. This investigation has shown, among other things, that in the midbrain of the cat the catecholamine (CA) perikarya are chiefly confined to the pars compacta of the substantia nigra, the ventromedial tegmental area, the nucleus linearis rostralis and the nucleus parabrachialis pigmentosus. Numerous CA neurons are also present in the dorsolateral part of the pontine tegmentum but also within the nucleus subcoeruleus, in nuclei lemnisci lateralis dorsalis and in nuclei parabrachialis lateralis and medialis. In the medulla, a few CA neuronal somata are lying near the hypoglossal nucleus whereas a larger number of CA cell bodies occur at the level of nucleus reticularis lateralis and in nucleus paragigantocellularis lateralis. On the other hand, most of the serotonin (5-HT) perikarya are confined to the raphe nuclei of the brain stem: nuclei raphe dorsalis, centralis superior, raphe pontis, raphe magnus, raphe pallidus and raphe obscurus. Some 5-HT neuronal somata are also found lateral to the pyramidal tract and to the inferior olivary complex. The various similarities and differences in respect to the pattern of the topographical distribution of MA neurons in the brain stem of the cat as compared to that of other mammals are discussed.


Regional variations in glia and neuropil within the hypothalamic ventromedial nucleus.

The normal fine structure of glia and neuropil in the various regional subdivisions of the hypothalamic ventromedial nucleus in the adult male albino rat is described in this report. Although most HVM astrocytes throughout the nucleus appear ordinary in cytology, certain astrocytes found in the posterior ventrolateral subdivision of the nucleus appear somewhat reactive, in that they contain numerous thick fascicles of gliofibrils and pleomorphic dense bodies. The processes of these reactive astrocytes elaborate multiple, concentric lamellae which encapsulate small, round, pyknotic masses (probably degenerate axonal elements). These degenerate profiles, which are greatly outnumbered by normal HVM boutons, may represent synaptic contacts that deteriorate spontaneously in the normal adult HVM. Other signs of spontaneous degeneration occurring within this neuropil include the occasional presence of large masses of necrotic debris which appear engulfed by microglia. These findings suggest the presence in the normal adult HVM neuropil of a low-grade degenerative process with attendant gliosis, which is topographically centered about the posterior ventrolateral region of the nucleus. Regions of neuropil containing degenerate boutons also contain altered neuronal processes, some of which may be growth cones. The topographic proximity of the degenerating boutons to possible signs of axonal or dendritic regeneration indicates that certain synaptic circuits in the normal adult HVM may be plastic, and subject to spontaneous remodelling.


The optic nerve of the brush-tailed possum, Trichosurus vulpecula: fibre diameter spectrum and conduction latency groups.

The principal findings of this report on the morphology and electrophysiology of the possum optic nerve are: (i) There are about 230,000 fibres in the optic nerve. This fibre count, based on electron microscopy, is slightly less than a previously reported estimate of the total number of ganglion cells in the possum retina. (ii) The majority (greater than 98%) of the fibres of the optic nerve are myelinated axons of retinal ganglion cells. The diameters of these fibres range from 0.4--4.6 micrometer (axon diameter range: 0.3--3.8 micrometer) and the frequency distribution of the fibre diameters (and axon diameters) is positively skewed and unimodal. (iii) The antidromic compound action potential of the possum optic nerve shows four negative peaks following stimulation of the optic chiasm. These peaks are associated with four conduction latency groups of fibres which have been designated t1, t2, t3 and t4 in order of increasing conduction latency. (iv) The mean peak conduction velocities of the fibres in the conduction latency groups are 13.1 ms-1 (t1), 8.1 ms-1 (t2), 5.7 ms-1 (t3) and 3.1 ms-1 (t4). (v) There is no direct correlation between the frequency distribution of fibre (or axon) diameters as measured by electron microscopy of transverse sections of fixed optic nerve and the conduction latency groups. (vi) The reconstruction of the possum optic nerve compund action potential on the basis of either axon or fibre diameter frequency distribution does not provide an acceptable, indirect correlation between the morphology and the electrophysiology of this optic nerve.


Electron microscopic analysis of postnatal histogenesis in the cerebellar cortex of staggerer mutant mice.

Postnatal development of the cerebellar cortex has been compared in staggerer mutant and unaffected littermate mice. From postnatal day 3 to about day 21 the external granular layer in staggerer mice is decreased in thickness and area, and the number of postmitotic granule cell neurons is reduced. Those granule cells that are generated seem to differentiate normally, with the remarkable exception that they form only primitive junctions with Purkinje cell dendritic shafts. These specialized junctions are not superseded by the normal parallel fiber:Purkinje spine synapses and disappear by the third week. Purkinje cell somata and dendrites are smaller than normal at all stages examined. The dendrites are not confined to the sagittal plane as in the normal and, unique among mutant or other animals described to date, they exhibit virtually no branchlet spines. All other cortical synaptic relations of granule and Purkinje cells, including climbing fiber:Purkinje spine synapses, appear qualitatively normal. However, by 28 days virtually all staggerer granule cells have degenerated. While the primary genetic defect remains unknown, we postulate that the morphological abnormalities may be attributable to a block in the normal developmental relationship between granule cells and Purkinje cells. The small cell size and failure to form branchlet spines suggest that the Purkinje cell abnormality may be closer to the primary effect of the mutant gene than the more flagrant hypoplasia and degeneration of granule cell neurons.


Influence of storage, heat, and homogenization upon xanthine oxidase activity of milk.

Xanthine oxidase activity in milk was determined by measuring the rate of formation of vanillic acid from vanillin. Raw milk received at a dairy plant had .208 units xanthine oxidase activity per ml and after 24-h storage at 4 C, .228 units per ml. Upon further storage activity decreased. Heating the fresh raw milk in a water bath to 55 C increased xanthine oxidase activity to .236 units per ml. Partial inactivation of the enzyme occurred when milk was heated at 60, 65, or 70 C for 5 min, and destruction was almost complete with heat at 75 C for 5 min. Raw milk heated at 48 C for 5 min and homogenized at pressures between 70.3 and 281.2 kg/cm2 had xanthine oxidase activities which were a linear function of pressure and showed that each additional kg/cm2 pressure resulted in additional xanthine oxidase activity of .16 milliunits per ml of  milk.


Transport of bovine milk xanthine oxidase into mammary glands of the rat.

This research investigated transport of bovine milk xanthine oxidase into mammary glands of the lactating rat. Transport capability suggested an exogenous, nonmammary, source for the enzyme. Five lactating rats were injected intracardially with 100 microgram of purified iodine-125 labeled xanthine oxidase and five were injected with 100 microgram of the enzyme unpurified. Four hours later the rodents were hand-milked, and radiation was confirmed in all samples by liquid scintillation counting. Counts were recorded per volume of milk and the percentage radiation was computed. Autoradiographs of the rats indicated radiation almost exclusively associated with the mammary glands. Greatest concentration of radioactivity was in the micellar casein fraction of milk, and a compound of high molecular weight, presumably [iodine-125]xanthine oxidase, was confirmed by gel filtration of the casein. Results suggest that the compound was transported into the mammary glands. The degree of transport was dependent upon the stage of lactation.


Change in udder health and overmilking.

Removing milker units as soon as milk flow stopped was compared to milking for a fixed time of 12 min in an 8-wk trial with 60 cows. Teats were dipped in broth culture of approximately 10(9) colony forming units per ml of Staphylococcus aureus, Streptococcus agalactiae, and Streptococcus uberis for 4 wk. More new infections of quarters occurred in the 12-min group. In trials 2 and 3, 20 additional cows were milked with automatic milking machine detachers and 20 cows were milked with a flow control unit for 12 min each trial. New infection rates were highest in the two groups milked for 12 min. Age for lactation and cows were associated with most of the variation in the new infection rate. Cows with pointed teat ends had the highest rate of new infection. Effects of fixed-time milking on increased mammary infection and clinical mastitis were small.


Effect of technical grade pentachlorophenol on rumen microorganisms.

The toxicity of technical grade pentachlorophenol to rumen microorganisms was tested by an in vitro fermentation procedure. Rumen fluid was collected from a fistulated mature steer fed a diet of all alfalfa hay. The compound was dissolved in absolute ethanol and added in vitro at concentrations ranging from 0 to 100 ppm. Digestion of cellulose and production of volatile fatty acids over 24 and 48 h of incubation was used to assess toxicity. Both cellulose digestion and propionic acid production were decreased at the 10 ppm concentration. The results suggest that technical grade pentachlorophenol has the potential to interfere with utilization of cellulose in ruminants.


Federal legislation and agency actions concerning self-care dialysis.

Since the passage of the renal disease provisions of the Social Security Law, the percentage of patients in the United States utilizing self-care treatment has declined from 40% to about 15%. The background and provisions of the Rostenkowski Bill, H.R. 8423, are summarized. Primary aims of the bill are to remove disincentives for use of self-dialysis, remove certain disincentives to transplatation, and to provide for peer review and goal setting for network use of various treatment modalities. Studies of the Health Standards and Quality Bureau, and activities of the Veterans Administration and the Artificial Kidney - Program of the National Institute of Arthritis, Metabolism, and Digestive Diseases relevant to self-care dialysis are briefly summarized.


Quality assurance in dialysis: the role of the social worker.

With the need for accountability in the delivery of End-Stage Renal disease services, social workers are beginning to establish standards defining the quality and effectiveness of their practice as members of a multidisciplinary treatment team. This paper delineates minimum ways for mandated social service to be delivered and made accountable. It also explores the role of the social worker as a member of the Network Coordinating Council and Medical Review Board. Some implications for social work involvement in larger policy issues resulting from the ESRD legislation are suggested.


A comparison for extracorporeal and travenol coils for the conduct of short haemodialysis: a consumer report.

A cross-over study carried out over a 24 week period during 1975-76 was designed to test the relative merits of Extracorporeal versus Travenol coils for thrice weekly short periods of haemodialysis for patients with end-stage renal failure. Predictability of and capacity for ultrafiltration were excellent and equally good for both products. Leak rates in Travenol coils were 9.3% as compared to 4.3% for Extracorporeal coils. Dialysances of BUN, creatinine, and phosphate were significantly higher with Travenol coils than with Extracorporeal coils, but this increase was not as great as might be expected from the greater surface area of the Travenol coil. Despite the greater functional efficiency of the Travenol coils we could detect no difference in the degree of biochemical control of the patients as judged by standard pre and post dialysis blood chemistries. Residual blood volumes averaged 9 mls for the Travenol coils as compared to 1.6 mls for Extracorporeal coils.


Endocarditis in hemodialysis patients with systemic disease.

The presence of systemic disease may further increase the risk of bacterial endocarditis in the patient on chronic hemodialysis. Three patients are described; one with primary amyloidosis, a second with insulin dependent diabetes mellitus, and a third with heroin nephropathy who developed S.B.E. While the presence of the uremic state may hinder the recognition of endocarditis, the development of transient neurologic deficits, recent access infections and recurrent bacteremic episodes should be looked for as early clues to the diagnosis in this patient population.


Analysis of tonic muscle activity and muscle cramps during hemodialysis.

A problem associated with some patients undergoing hemodialysis is the presence of muscle cramps. As the etiology of these cramps is still unknown, the purpose of this study was to evaluate tonic muscle activity and muscle cramps during hemodialysis. Forty-six complete dialysis treatment sessions were studied. Electromyographic (EMG) activity was recorded from a leg muscle in patients who cramped and control patients who did not cramp. EMG was analyzed via a minicomputer for each minute of recording time. Results indicated the mean muscle cramp latency from start of dialysis was 248 minutes. Average muscle cramp was 10 minutes in duration and took three minutes to develop and seven minutes to fully dissipate. Tonic EMG activity in patients with muscle cramps showed a continued increase throughout the latter part of dialysis whereas the control patients showed a continual decline. The results suggest that the latent increase in EMG activity may be causally related to muscle cramps and may be a useful predictor as to the onset of muscle cramps during hemodialysis.


Planning closure of a surgical wound.

The decision as to whether to close or not close a surgical wound, and by what method if closure is decided upon, must be individualized for each patient and each wound. This paper suggests a mental calculation that can be worked out rapidly by the operator in order to make judicious decisions expeditiously.


Cosmetic principles in surgery on the face.

Excisions from the face are performed to cure diseases and to remove blemishes. Satisfactory cosmetic appearances can be achieved in most cases, even when large defects result from the excisions, if the surgeon employs cosmetic surgical principles and techniques in the repairs. Some esthetic concepts and artful methods are presented to illustrate this feasibility.


Defective monocyte and polymorphonuclear leukocyte chemotaxis in atopic disease.

Monocyte (MN) and polymorphonuclear (PMN) leukocyte chemotaxis was studied in 17 atopic children with hyperimmunoglobulinemia E (IgE), 9 age- and diagnosis-matched children with normal IgE levels, 10 pediatric controls, and 45 adult controls. Twenty-one of the 26 atopic patients had eczema, while 5 had only respiratory allergies. All patients were free of infection and receiving no systemic corticosteroids. Depressed PMN chemotaxis was found in only one patient. Defects of MN chemotaxis were detected in 8 of 17 atopic children with IgE and 2 of 9 with normal IgE values. Seven of 21 patients with atopic eczema and 3 of 5 with respiratory allergies had depressed MN chemoatxis. No evidence was found for a cell-directed chemotactic inhibitor in the plasma of patients with abnormal MN chemotaxis. These data demonstrate that: (1) MN chemotaxis is frequently depressed in uninfected atopic patients; (2) this abnormality occurs in patients with respiratory allergies as well as in those with eczema and is more prevalent in atopics with IgE; and (3) PMN chemotactic defects are uncommon in allergic patients. Whether abnormal MN chemotaxis is a primary or a secondary event in atopy requires further investigation.


Effects of tolerogenic conjugates in a canine model for reaginic hypersensitivity. I. suppression of hapten-specific IgE antibody response.

Intraperitoneal administration to dogs of conjugates consisting of the 2,4-dinitrophenyl (DNP) groups coupled to nonimmunogenic macromolecules such as the copolymer of D-glutamic acid and D-lysine (DNP16-DGL) prior to sensitization with DNP2-ovalbumin led to the development of hapten-specific tolerance with respect to the IgE antibody response. Administration of these same conjugates to sensitized dogs resulted in complete abrogation of the ongoing anti-DNP IgE antibody production. A similar hapten-specific suppression of the ongoing anti-DNP response was also observed using the conjugates of DNP9-canine gamma globulins, and the tolerogenic effect was dose-dependent. The state of hapten-specific immunosuppression induced by these two types of tolerogenic conjugates was maintained despite repeated booster injections of the sensitizing antigens at biweekly inervals.


Evidence for nonlikage of genes for HLA and hereditary angioedema.

Since the genes for several disorders of the complement system have been found to be linked to the HLA loci on chromosome 6, studies of the inhibitor of the activated first component of complement (Cl INH) and HLA in two families with hereditary angioedema (HAE) were undertaken. A total of 17 individuals were found to be affected in these three-generation families. Evidence was provided against close linkage of the genes for HLA and HAE. Other genetic markers studied were generally noninformative, although evidence was obtained against close linkage of the loci for HAE and ABO and HAE and transferrins. The reliable identification of individuals affected with HAE by Cl INH assay provides potential for establishing linkage relationships in the various phenotypes of this dominantly inherited condition.


Administration of local anesthetics to patients with a history of prior adverse reaction.

The clinical histories of 71 patients evaluated for suspected local anesthetic (LA) allergy were reviewed retrospectively. The clinical histories were classified into (1) immediate generalized reactions (15%), (2) localized swelling at the injection site (25%), (3) nonspecific systemic symptoms (42%), and (4) other histories (17%). Serial dilutional intradermal skin tests were performed with mepivacaine, lidocaine, and procaine in 59 patients. There were 5 skin test--positive patients found, and each had a positive reaction to an LA to which, by history, they had not reacted. In 50 patients, when an LA was subsequently required, a subcutaneous challenge was performed with an LA chosen for chemical nonsimilarity. No significant reactions were observed in this group. Three patients tolerated a challenge with an LA to which they were skin test--positive. These data indicate (1) the low incidence of reactions compatible with a systemic IgE-mediated mechanism by history in patients referred for evaluation of LA allergy, (2) the lack of specific and clinically relevant information provided by dilutional skin tests, and (3) the apparent safety and usefulness of careful challenge with an alternative LA.


Behavioral science and nutrition: a new perspective.

Increasing collaboration of nutritionists and behavioral scientists is needed in order to bring about desirable long-term changes in eating patterns. The National Heart, Lung, and Blood Institute's growing interest in this area is described, and recent examples of such collaboration are noted. The two papers which follow--one emanating from the area of social psychology, the other from behavior modification--are introduced.


Applying behavioral methods to nutritional counseling.

A brief survey of what appear to be the most effective and promising techniques of human behavioral change, as applied to nutritional counseling, is presented. Three critical environments of the patient require assessment and intervention: (a) The physical environment, or the physical setting in which the patient functions; (b) the social environment, or other people with whom the patient comes in contact; and (c) the  private environment which consists of thoughts, emotions, and basic physiologic systems. Specific assessment and treatment procedures to effect change in each of these environments are outlined, and some suggestions are made concerning the appropriate use of self-help materials.


Social-psychologic perspective in motivating changes in eating behavior.

Some reasons for difficulties in motivating changes in eating behavior are outlined, and the application of the major principles of social psychology relevant to dietary management are reviewed. Locus of control and varying communication models are discussed in the context of nutritional counseling. The importance of the patient assuming responsibility for his/her own behavioral change is reviewed in terms of attribution theory. Specific suggestions for helping nutritionists motivate patients to change their eating behavior are made.


Family cooperation and effectiveness in a cholesterol-lowering diet.

An average reduction in serum cholesterol approximating 10 per cent was achieved in a short-term, family-centered study in which intakes of cholesterol and saturated fats were decreased and sunflower oil and margarine were added as the major sources of polyunsaturated fats. Dietary Achievement Scores demonstrated shifts in food consumption between baseline and diet periods. Changes were evident in all fat-containing food groups; meat was the least altered. A high degree of cooperation was evident in participating families, implying the possibilities for complete family cooperation in preventive or therapeutic dietary programs. Approximately three months after the end of the test period, cholesterol levels had returned to pre-diet levels, indicating the need for continuation of the changed regimen if cholesterol-lowering is to be maintained.


Influence of a nutrition education program (EFNEP) on infant nutrition in East Harlem.

An assessment of the effectiveness of aides working in the Expanded Food and Nutrition Education Program (EFNEP) to improve the nutritional status of infants was conducted with a group of 118 infants attending a well-baby clinic in a low-income area of New York City. In addition to clinic care, the fifty-seven study infants received home visits from a nutrition aide whose role was to reinforce nutritional advice received at the clinic. The sixty-one control infants received only regular clinic care. The benefits of having an aide were suggested by three observations: Reduction in the practice of introducing whole cow's milk to young infants, familiarizing older infants with a variety of foods, and reducing the prevalence of iron-deficiency anemia. Few of the differences between study and control infants achieved statistical significance, although trends consistently indicated that the presence of aides was beneficial. The problems of assessing the effectiveness of nutrition education programs with healthy infants are discussed.


Serum lipid changes in medical students.

Changes in serum lipids and reasons for these changes were evaluated in 108 medical students, Class of 1975. Serum cholesterol and serum triglycerides were analyzed in their freshman and senior years. A self-administered questionnaire was used to determine if the education in medical school or the knowledge of their freshman lipid vales motivated the students to change their diet and exercise habits. During this four-year period, there was a statistically significant decrease in the mean cholesterol levels (-10 mg. per 100 ml.), while the values increased slightly but not significantly for mean triglyceride (3 mg. per 100 ml.) and weight (2 lb.). Students with abnormal lipid values in their freshman year changed their diets more frequently than those with normal values. When the students were grouped by their change in diet and exercise habits, the largest decrease in lipid values was in those who changed both their diet and exercise. However, the changes in lipid values could not be totally attributed to the students' change in habits. Results suggest that detection and education may contribute to changes in certain risk factors associated with coronary heart disease in young medical students.


Logical bases for action in nutrition and aging.

Logical bases (five of which are outlined) underlie action in nutrition and aging. First, nutrition, health, and aging form an integral triad affecting all. This basis has been applied to the conceptualization of the Nutrition Program for Older Americans (NPOA). Second, in North America, malnutrition is a sequitur of disease, whether physical, metabolic, emotional, or attitudinal. This basis is being applied by NPOA and other programs in an effort of cope with the pathologic conditions that bar proper nutrition. Third, since aging is a lifelong process, good nutrition and health practices must be applies throughout life. This basis will become effective only when the present image of the aged improves to the point that younger persons will strive for effective longevity. Fourth, changes in lifestyle to avoid risks have positive value. This basis requires professional and political leadership if it is to become widely adopted. Fifth, acute illnesses and accidents require immediate attention to nutritional and other factors if needless morbidity and mortality are to be avoided. This basis requires far more education of health professionals and lay persons to obviate such tragedies. All these bases are the infastructure for other actions directed at improving the image of today's aged and thereby diminishing the fatalism of younger persons and augumenting their determination to adopt lifestyles compatible with long, active, happy and productive lives.


Etiology of primary osteoporosis: an hypothesis.

By convention, osteoporosis has been described in two categories: 1) primary (involutional or postmenopausal), and 2) secondary, in association with a wide variety of pathologic disorders. Primary osteoporosis is the ultimate consequence of progressive bone loss, which starts in the middle of the fourth decade. Given the apt name of "adult bone loss," it is considered to be a universal phenomenon in that it afflicts all people of all races and both sexes. However, careful analysis of past studies generates evidence that not every person of advanced age loses bone. The etiology of "adult bone loss," and thus of primary osteoporosis, is conceded to be unknown or at least controversial. Nevertheless, the complex dependencies of bone metabolism on the functional integrity of major organ systems imply a multifactorial etiology. The age-related progressive declines in functional reserves of major organ systems may indicate that primary osteoporosis evolves secondarily to a protracted suboptimal metabolic support of bone remodeling. Further confirmation of this hypothesis may have important implications for the prophylactic management of primary osteoporosis.


Are the aged a minority group?

The aged resemble minority groups in three ways, i.e. they suffer from prejudice, discrimination, and deprivation. On the other hand, they are not born into their age group, and they have little sense of group identity or political unity. The most descriptive term would seem to be "quasi-minority group." However, the aged are becoming less and less like minority groups as society seems to be moving toward an "age-irrelevant" era.


Bromide intoxication in the elderly.

Four patients with dysfunction of the central nervous system secondary to bromide intoxication are reported. Three of them were referred because of symptoms of "senility," which appeared to preclude further independent living. After diagnosis and treatment of the bromism, they were able to continue living at home. The development of bromide toxicity with relatively low serum bromide levels in the elderly is discussed. The importance of a home visit to establish the diagnosis of drug-induced cognitive dysfunction is emphasized.


Primary empty sella syndrome and bipolar affective illness: case report.

This report concerns an elderly woman with primary empty sella syndrome and bipolar affective illness. She had no endocrine, visual, or neurologic dysfunction and had received electroconvulsive therapy with no long-term adverse effects. Remission of the affective illness has been maintained for five years with lithium carbonate therapy.


Nursing home medication costs.

The cost of discarded drugs at a level-III nursing home was calculated for a four-year period. A significant percentage of the cost seemed to be the result of poor prescribing practices. Prescriptions for antibiotics and for psychotropic drugs (particularly PRN orders) are discussed in some detail. Medication policies were developed to improve physicians' prescribing habits in order to reduce these costs without jeopardizing the quality of care.


Individual psychotherapy with the depressed elderly outpatient: an overview.

A review is presented of the status of geriatric psychotherapy with the depressed elderly community resident, over the past 20 years. Feelings of helplessness and hopelessness accompanying or following a significant loss are often chief features of the depressive syndrome in elderly persons who seek help. The experiences of those involved in treating this disorder in the elderly can be most rewarding to both therapist and patient.


Determination of atrazine in runoff water by high performance liquid chromatography.

A procedure is described for the determination of atrazine in runoff water from agricultural areas. Extraction and preconcentration are accomplished with a column of macroreticular resin. Separation and quantification are performed with high performance liquid chromatography with a microparticle reverse phase column. No interference is observed from either organics already present in the runoff water or from some 34 selected organic compounds. Excellent linearity is obtained for concentrations of atrazine from 0--120 PPB. Relative standard deviations of the overall procedure are 1--5%.


Transient-phase and steady-state kinetics of lipase-catalyzed ester hydrolysis.

An experimental study has been made of both the steady-state and the transient-phase (presteady-state) kinetics of the hydrolyses of several saturated aliphatic esters of p-nitrophenol catalyzed by wheat germ lipase. The analysis of the presteady- 1 Presented in part at the 173rd ACS National Meeting, New Orleans, L.A., U.S.A., March 20--25, 1977. 2 Correspondence should be addressed to M.H. Sadar, E.S.D., E.H.C., Health and Welfare Canada, Tunney's Pasture, Ottawa, Ontario, Canada, K1A OL2. 3 Department of Chemistry, University of Ottawa, Ottawa, Ontario, Canada. state part revealed two transients indicating that lipase-catalyzed reactions proceed via a two-intermediate mechanism suggested for other esterases. The possibility of more than one species of the enzyme engaged in catalytic activity is discussed and a reaction mechanism scheme is proposed accordingly.


[The use of prostaglandins to perform terminations of pregnancy in the second trimester (author's transl)].

The authors report 48 cases of termination of pregnancy between the 12th and the 20th week using prostaglandins. Two methods were used: An injection of 40 mg of Prostaglandin F2 alpha (1) intra-amniotically: used on 38 women in group i. 10 patients had 5 mg of 15 (S) 15 methylprostaglandin F2 alpha administered vaginally in group ii. In the first group all women aborted with a mean induction expulsion time of 16 hours and 20 minutes. In the second group 9 women aborted with a mean time of 14 hours and 2 minutes. Side effects were very marked in the second group, whereas they seemed to be acceptable in the first group.


[Effect of ergot alkaloid derivatives on milk secretion in the immediate postpartum period].

30 women received an intramuscular injection of 0.2 mg of methylergobasine immediately after delivery and then 3 tablets of 1 mg of ergotamine tartrate per mouth daily for 6 days post-partum. 28 women received no treatment after delivery. The selection of the two groups was random. The treatment with rye ergot derivatives did not have a significant effect on the quantity of milk that the infant took, nor on the infant's weight gain in the 6 first days of life.


[Total asthenospermia with an ultrastructural anomaly of the flagellum in two sterile brothers (author's transl)].

The two sterile brothers were found to have the same sperm abnormalities. The flagella were short or absent. The constituent elements of the flagellum were disorganized, and the axone structure was disturbed. These abnormalities give rise to a problem of explaining the genetic origin of certain sperm defects similar to those found particularly in mice.


[The endolymphatic myosis: a low grad stromal endometrial sarcoma. I. Pathology (author's transl)].

The authors present 6 cases of endolymphatic myosis of endometrial stroma. All patients with known evolutions were alive between 4 months and 17 years after treatment in spite of 2 relapses. Pathological aspect of this rare lesion is characterized by penetration of stromal endometrial tumoral tissue without glands in both lymphatic and venous myonatrial vessels. In certain cases, the presence of polypes of this structure allows the diagnostic by dilatation and analogy Progestine induces a predecidual transformation of this lesion. The myosis belongs to the endometrial stromal sarcoma. The lesion is however different by its low mitotic index.


[The role of mycoplasma in sterility. A study of 150 sterile women (author's transl)].

150 women who were being treated for sterility had their cervical mucus searched for T. mycoplasma. Group I: 123 women who had no obvious cause for sterility. 45.5 per cent had T. mycoplasma (56/123). Group II: Out of 27 women who had a major cause for sterility there were 48 per cent (13/27) who were carriers of T. mycoplasma. The incidence of T. mycoplasma in control fertile women was 53 per cent (16/30). After treatment with Doxycycline: 5 pregnancies were obtained out of Group I, which is 8.9 per cent. none in Group II. The mycoplasma seems to play a very minor role in sterility. Its incidence is identically the same in women who are sterile or normally fertile. With treatment only a very small percentage (8.9 per cent) of pregnancies were obtained in carriers of mycoplasma who did not have another obvious cause for their sterility.


[Fetal maternal anti-HLA sensitization. Its relationship with the pathology of pregnancy and/or the neonate (author's transl)].

The frequency of maternal anti HLA sensitization was studied in 1401 normal and pathological pregnancies. The analysis of the obstetrical history showed in patients with sensitization, a stabilical highs indications of preceding abortion and premature labors and of actual anemies and premature labors. The signification of such, an association remains to be found.


[Pregnancy and severe pancreatitis (author's transl)].

We studied the relationship between pregnancy and pancreatitis together with reviewing the bibliography after having had 4 cases. As far as the aetiology is concerned there does not seem to be a mechanical factor associated with the pregnant uterus but a vesicular factor (gall bladder) of stasis and hypersecretion, with hyperlipidaemia of pregnancy and pancreatic oversecretion in pregnancy, all of which are finally associated with a neuro-vegetative lack of tone and with the part played by certain drugs that are often prescribed in pregnancy. The fetal prognosis is relatively good except for the risks of premature delivery. Management of a case of acute severe pancreatitis is difficult to work out. All the same, the treatment should be above all conservative, which means medical. Surgery should be reserved for those cases with definite indications such as progressive deterioration in spite of medical treatment with the knowledge beforehand that it will not make much difference to the final prognosis.


[The dystocias of the start of labour and their treatment with a beta sympatho-mimetic drug (author's transl)].

The authors have studied 106 cases of dystocia of the start of labour, which is defined as an abnormal increase in the length of the time of dilatation before the cervix reaches three centimetres dilated, in spite of contractions that apparently are of good quality. The contractions can be stopped by a beta sympatho-mimetic drug (Ritodrine) easily and the immediate problem is resolved, in that the woman is allowed a rest during which she can recover for a few hours. The labour starts off after this normally, but the percentage of Caesarean sections is very high (26.4 per cent) because in fact these dystocias of the start of labour are often associated with disproportion or a poorly flexed posterior position. There has been no serious secondary effect of the treatment nor any ill effects observed on the fetuses.


From shared cost to block funding and beyond: the politics of health insurance in Canada.

This paper takes as its starting point recent major changes in arrangements between the federal and provincial government in Canada concerning the sharing of costs for health insurance programs. The switch from a shared cost (conditional grant) to a modified block funding system was motivated by federal desires to limit and make predictable their expenditures, by provincial desires to increase the flexibility of their allocation of funds and by a mutual desire to limit any growth of health care costs as a proportion of GNP. Concerns related directly to improving medical care delivery were insignificant The changes will effectively centralize responsibility for program financing and program delivery, thus providing a powerful incentive for provincial governments to apply very strong measures to control costs. For reasons largely external to the relationship between public sector insurers and the suppliers of medical services, these attempts are unlikely to be successful in the short run. The probable impact of this difficulty on government and members of the health care delivery system is assessed.


The politics of health care regulation: the case of the National Health Planning and Resources Development Act.

This paper examines the political and bureautic dynamics of health regulation under the National Health Planning and Resources Development Act and, to a lesser extent, the Carter Cost Proposal now before Congress. A number of underlying issues that affect the day-to-day exercise of health planning are considered, including the contest between state and local and federal government for program control, jurisdictional conflict between state and local planning agencies, and the unsettled roles to be played by professional planners, consumers, and providers. When we assess regulatory policy in health, these complicating factors must be added to the long list of handicaps that already exist. One important finding is that local planning agencies have embraced the task of health regulation somewhat more fully than had generally been expected. A number of explanations for this are offered. In short, the controlling factors in health planning are political, not technical, and there is more occurring at the state and local levels than many had predicted, although any impact is not likely to be dramatic.


Infarct as a stress agent: life history and personality characteristics in improved versus not-improved patients after severe heart attack.

Fifty-eight male subjects admitted to an intensive coronary care unit were interviewed and underwent psychometric testing on the second--third day after a severe heart attack (infarct). Seven-ten days following admission, the clinical condition of the patients was evaluated by the attending cardiological staff and rated on a three point scale. The patients were divided, on the basis of the clinical rating, into two groups: improved (N = 25) and non-improved (N = 33). Life history characteristics, MMPI personality profiles, and State-Trait anxiety scores were then compared for the two groups. The not-improved group showed the higher scores on almost all the MMPI scales, higher anxiety scores and more work-related problems than the improved group. Such data give some empirical support to the hypothesis that the physiological and hemodynamical conditon of the cardiac patient is in some way correlated with the patient's style of coping with stress, and his history of previous life stress situations.