Fluorescent lighting: a purported source of hyperactive behavior.

Seven first-grade children with conduct disorders and/or hyperactivity attended full-day sessions at a laboratory school classroom. During an 8-week period, the classroom lighting conditions alternated at the end of each week. During odd-numbered weeks, the classroom was illuminated by a standard cool-white fluorescent system. On even-numbered weeks, illumination was a daylight-simulating fluorescent system of equal footcandles with controls for purported soft X rays and radio frequency (RF). There were no effects of lighting conditions on hyperactive behavior as assessed by (a) independent observations of task orientation or (b) ratings of activity level. A Critical Flicker Fusion (CFF) measure, a reported indicator of visual-sensory fatigue, indicated that the daylight-simulating condition was associated with a decreasing CFF across weeks.


Hyperactivity from fluorescent lighting--fact or fancy: a commentary on the report by O'Leary, Rosenbaum, and Hughes.

The following commentary is designed to explain the experimental differences between the foregoing negative article by O'Leary, Rosenbaum, and Hughes and the original articles in this field, whose results were positive. These differences fall under the general categories of subjects, lights, measurements, and design.


Sensory extinction: a procedure form eliminating self-stimulatory behavior in developmentally disabled children.

This study was designed to investigate the role of sensory reinforcement in the motivation of self-stimulation. If self-stimulatory behavior is maintained by its sensory consequences, such as the proprioceptive, auditory, or visual stimulation it produces, then such behavior should extinguish when those sensory consequences are not permitted. The present study introduces a new procedure, Sensory Extinction, in which certain sensory consequences are masked or removed, to examine whether self-stimulation is operant behavior maintained by sensory reinforcement. The effectiveness of Sensory Extinction was assessed by a reversal design for each of three autistic children, and the results showed the following. First, self-stimulation reliably extinguished when a certain sensory consequence was removed, then increased when that consequence was permitted. This was replicable within and across children. Second, different Sensory Extinction procedures were required for different self-stimulatory behaviors, since the sensory reinforcers supporting them were idiosyncratic across children. Finally, regarding clinical gains, the data suggest that Sensory Extinction may be a relatively convenient and rapid alternative for the treatment of self-stimulation. The present findings extend the efficacy of extinction as a behavior-modification technique to instances in which the reinforcer is purely sensory. The implications of these results for the treatment of other forms of deviant behavior are discussed.


The hyperactive child at adolescence: cognitive, emotional, and social functioning.

In view of the paucity of detailed follow-up studies on hyperactive children, the performance of 15 adolescents diagnosed hyperactive 5 years previously was compared to that of a control group of equivalent age, sex, intelligence, and social class. Eleven cognitive tests measuring sustained attention, visual-motor and motor skills, abstraction, and reading ability, as well as three self-assessment tests examining self-esteem, activity level, social functioning, academic status, and career aspirations were administered. The hyperactives performed significantly worse than the controls on the sustained attention, visual-motor, and motor tasks, and on two of the four reading tests. They also gave themselves significantly lower ratings on some of the self-esteem and sociability items. It would appear that the hyperactives at adolescence still have attentional and stimulus-processing difficulties, which affect not only their academic performance but also their social functioning.


Body movement and inattention in learning-disabled and normal children.

Four experiments were conducted to test various aspects of an optimal level of arousal model of hyperactivity in learning-disabled children. Vigilance performance and level of body movement were measured while learning-disabled and control children performed in an auditory vigilance task. The results suggested that body movement increased throughout the vigilance task, increased rates of external stimulation result in decreased level of body movement, and learning-disabled children differed from controls in showing higher levels of body movement and poorer vigilance performance. The results were discussed in terms of changes in arousal level and compensatory stimulus-seeking behavior.


Behavioral correlates of the hyperactivity factor of the Conners Teacher Questionnaire.

The present study assesses whether ratings on the Conners Teacher Questionnaire, Hyperactivity Factor, corresponded to observed behavioral and attitudinal differences in hyperactive and nonhyperactive males. Boys in the present study were rated on the questionnaire and then observed in a free-play situation. The boys' scores on the Teacher Questionnaire were later compared with their activity level, judgments about their behavior, and interview questions about their experience in the study. Several of these measures were found to correlate significantly with the Teacher Questionnaire scores, suggesting that it successfully taps observable dimensions of hyperactivity in novel situations.


Prevalence of maladaptive behavior in retarded children as a function of IQ and age.

One hundred and twenty-eight mentally retarded children, ages 6 to 14, from a special school were assessed by teachers in terms of nine maladaptive behaviors. The results indicated that the prevalence of some maladaptive behaviors changed as a function of IQ and age, and that there were splits of such changes as IQ-dependent and as age-dependent by maladaptive behavior.


Developing and maintaining social interaction in profoundly retarded young males.

Social interaction was increased in five profoundly retarded males using formal training, stimulus control, and rewarded generalization procedures. Seven behaviors were monitored for each boy to determine whether correlated changes occurred in maladaptive behaviors as social interaction varied over the several phases of a withdrawal design that included multiple-baseline features. All five boys increased their social interaction and reduced unoccupied and self-stimulatory behavior. These changes were maintained as continuous reinforcement was reduced to a single response-contingent reinforcer per 15-minute session. Four follow-up probes showed the stability of the changes.


Aspects of body image perception in obese and normal-weight youngsters.

Perceptual and projective aspects of body image in obese youngsters (not in psychological treatment) and normal-weight youngsters 8-9 years of age and 12-13 years of age were investigated. The results indicate that perceptual distortions in estimating various body dimensions of oneself are primarily a function of age rather than weight status. The accuracy of estimating the weight of peers and an adult showed an association with the sex of the subject. No group differences were found in terms of projective aspects of body image as measured by barrier and penetration responses. This study suggests that obese youngsters in the middle childhood and entering puberty periods in comparison to normal-weight youngsters of the same age do not manifest differences in perceptual factors of body image.


Affective communication differences between distressed and nondistressed mother--adolescent dyads.

An assessment technique of having mothers and young adolescents describe in brief written form what they like and dislike about each other was evaluated. Distressed dyads (N = 38) produced responses that were rated significantly more negative (Demanding, Personal Attack, Anger and Hostility, Complaining About Unfairness or Disrespect) and less positive (Good Relationship, Appreciation of Other, Complimentary, and Enjoyment) than nondistressed dyads (N = 40). Evidence of reliability was reported. Ratings of the written responses correlated significantly with independently obtained codings of tape-recorded interactions, thus offering support for validity of the method.


Evaluation of behavioral group counseling for parents of learning-disabled children.

The present study evaluated the effectiveness of a behavioral group counseling program for parent members of the Association for Children with Learning Disabilities. Twenty-two mothers were assigned to two treatment groups (N = 5 and N = 6) and a control group (N = 11). Treatment-group mothers received a series of eight weekly 1 1/2-hour sessions in which they were taught basic principles and procedures of behavior modification which they could apply to specific child-rearing problems. Multiple-success criteria (maternal reports, direct observation, frequency counts, and attitudinal measures) were employed to provide a broad-based measurement of outcome. Results indicated that treatment ratings of childrens' conduct and disruption and parental postbehavioral observations of mother-child interactions showed improvement for the behavioral-counseling groups while control-group ratings and behavior observations remained the same. All treatment-group changes were maintained at 3-month follow-up. Consistency of treatment-group data across measures and over time suggests the effectiveness of this approach as a training method. Implications for future research were discussed.


A comparison of the disturbingness of behaviors related to learning disability and emotional disturbance.

Behaviors thought to be characteristic of emotional disturbance or learning disabilities were investigated through ratings of teachers with regard to the relative disturbingness of the behaviors. Obtained differences suggested that behaviors characteristic of emotional disturbance were rated as more disturbing than those of learning disabilities; differences within sets of characteristic behaviors were also indicated. Results are discussed with regard to implications for teacher expectancies and labeling research.


Stimulus-governance and the hyperkinetic syndrome.

The hypothesis that hyperkinetic children are stimulus-governed was tested. In a sample of 39 nonmedicated hyperkinetic boys 26 were found to be stimulus-governed. In a control sample of 20 nonmedicated boys 6 were found to be stimulus-governed. An association was found between the hyperkinetic syndrome and stimulus-governance. The hypothesis is raised that response to methylphenidate is related to stimulus-governance. Several issues raised by the research are discussed.


A laboratory evaluation of immune complexes in patients on inhalant immunotherapy.

Patients with allergic rhinitis receiving maintenance inhalant immunotherapy and two control groups were studied for evidence of circulating immune complexes. The first control group contained patients with allergic rhinitis who had never received immunotherapy. The second control group contained normal volunteers. Patients in the treatment group had no proteinuria. When compared with the control group, the treatment group had no statistically significant differences in incidence of Clq binding immune complexes, cryoglobulinemia, rheumatoid factor, or complement depletion. This initial study suggests that maintenance immunotherapy does not result in an increase of circulating immune complexes.


Acquired angioedema associated with rectal carcinoma and its response to danazol therapy. Acquired angioedema treated with danazol.

Cases of the acquired form of angioedema have been recognized as a separate entity since 1972. Previously reported cases have been related to various hematologic malignancies. We have recently studied a patient with rectal carcinoma who manifests a complement pattern compatible with the acquired form of angioedema. No previous personal or family history of allergic disease or angioedema was present. Because the episodes of angioedema were laryngeal in location and required emergency intubation to maintain an adequate airway, a trial of danazol prophylaxis, which has been shown to be effective in hereditary angioedema, was undertaken. His beneficial response to this form of therapy is also documented.


Small vessel vasculitis caused by hepatitis B virus immune complexes. Small vessel vasculitis and HBsAG.

In a comprehensive study of 80 patients with vasculitis, 4 had concurrent hepatitis B virus (HBV) infection. Polyarteritis nodosa was present in 2 and in the other 2, cutaneous vasculitis, presenting clinically as palpable or Henoch-Schönlein purpura. In one of these patients skin biopsies demonstrated granular deposits of IgM, C3, C4, and the hepatitis B surface antigen (HBsAg) and electron-dense deposits of aggregated 20-nm particles resembling HBsAg in postcapillary venules. Evidence for circulating HBsAg-immune complexes included increased serum Clq binding activity, decreased serum complement, and a cryoprecipitate containing both HBsAg and IgM anti-HBs. Aggregated 20-nm particles resembling intact HBsAg were also seen by negative staining electron microscopy of the serum cryoprecipitate. This patient fulfills all the criteria for a specific immune complex vasculitis caused by his immune response to a chronic HBV infection. These findings emphasize that HBV infection may be associated with small vessel vasculitis as well as polyarteritis nodosa, mixed cryoglobulinemia, and glomerulonephritis. A similar immune response to other viral infections may be expressed as palpable (Henoch-Schönlein) purpura also.


Cyclic platelet dysfunction in IgE-mediated allergy.

Diminished platelet aggregation responses to one or more aggregating agents were found in 25 of 32 patients with nasal allergy studied at the peak of the allergy season. Abnormal in-season platelet aggregation induced by epinephrine and collagen was significantly improved when repeated out-of-season, while incomplete platelet aggregation induced by adenosine diphosphate (ADP) and thrombin was unchanged. Recombination of an in-season serum factor with autologous, out-of-season normally aggregating platelets caused market inhibition of platelet aggregation. Mean bleeding times of 20 symptomatic patients were also prolonged during the height of the pollination season. These data suggest that the allergic diathesis is a model for the study of cyclic, nondrug induction of platelet dysfunction.


The radioallergosorbent test in the diagnosis of canine atopic disease.

The radioallergosorbent test (RAST) was adapted for use in the dog employing purified anti-canine IgE. The agreement between positive RAST and positive skin test ranged from 82% for ragweed to only 12.5% for dandelion. Agreement between negative tests in the case of all allergens was 100%. Further developmental studies of canine RAST are warranted in view of the value of the dog as an experimental model of atopic disease.


Suppression of reaginic antibody formation in guinea pigs by anti-idiotypic antibodies.

Syngeneic immunization of strain 2 and strain 13 guinea pigs with purified antibodies against benzyl-penicilloyl bovine IgG (BPO-BGG) produces anti-idiotypic antibodies which specifically inhibit antigen-induced T cell proliferation in vitro. In sensitized guinea pigs, passive administration (either intravenously or subcutaneously in complete Freund's adjuvant [CFA] of these anti-idiotypic antibodies has a reversible suppressive effect on IgG and IgM responses. In addition, preimmunization with idiotypes effects a long-term and specific suppression of the production of homocytotropic antibodies against a hapten-protein conjugate (BPO-BGG). The suppression of the homocytotropic antibody response in already sensitized outbred guinea pigs was attampted by immunization with autologous serum, autologous antibodies, or autologous lymphoid cells. With all immunization procedures used so far, no significant suppressive effects could be demonstrated. The significance of these findings, in terms of the practical potential of autoanti-idiotypic immunization for the management of allergic diseases, is briefly discussed.


Benzylpenicillin preparations can evoke a systemic anaphylactic reaction in guinea pigs.

All of the five commercially available benzylpenicillin preparations obtained from different sources and a PcG preparation prepared by filtration of a commercial PcG on Sephadex G10 elicited the systemic anaphylactic reactions in guinea pigs which had been immunized with benzylpenicilloyl (BPO)-Ascaris extract conjugate (BPO-As) mixed with aluminum bydroxide gel. These preparations could evoke no such reactions in guinea pigs immunized with BPO-bovine gamma globulin conjugate (BPO-BGG) emulsified with complete Freund's adjuvant. The severity of the systemic anaphylactic reactions correlated significantly with the titers of either 8-day passive cutaneous anaphylactic (8-day PCA) reactions or 4-hr PCA reactions evoked with the same benzylpenicillin preparations. In vitro benzylpenicillin preparation contracted the tracheas of the guinea pigs immunized with BPO-As. These results indicated that the commercially available benzylpenicillin preparations have enough antigenicity to evoke systemic anaphylactic reactions in guinea pigs immunized with BPO-As mixed with aluminum hydroxide gel. Such guinea pigs represent an animal model for investigation of penicillin allergy.


Normal human monocytes inhibit tumor cell growth in vitro.

Normal human monocytes were evaluated in an in vitro assay of growth inhibition of tumor cells. Monocytes were isolated from the blood of 6 normal subjects by Ficoll-Hypaque separation and adherence to plastic microtest wells. Cervical carcinoma cells (HeLa) were added to the microwells to result in a ratio of 50 monocytes to one HeLa cell. Cultures were then incubated for 6 to 46 hr. Growth inhibition was evaluated by measuring the uptake of 3H-thymidine over a 4-hr pulse period after 2, 18, or 42 hr of monocyte-HeLa interaction. Inhibition of HeLa growth by monocytes was 23.8% +/- 8.6% over 6 hr, 22.0% +/- 8.9% over 22 hr. and 68.3% +/- 7.5% over 46 hr. Growth inhibition of HeLa cells was confirmed by direct enumeration of HeLa cells at the end of coincubation. Attachment of monocytes to the HeLa cells was confirmed by light and scanning electron micrographs. Granulocytes, lymphocytes, and other cell lines did not comparably inhibit HeLa growth and media replenishment did not ablate the effect. These data demonstrate that normal human monocytes can inhibit the growth of a malignant cell line in vitro in the absence of overt activation procedures.


Poylmerized whole ragweed: an improved method of immunotherapy.

A single-blind study compared the effectiveness of glutaraldehyde-treated polymerized ragweed with nonpolymerized monomeric ragweed. These studies are an extension of those previously reported for polymerized AgE using a readily available ragweed preparation containing all ragweed antigens. Nineteen ragweed-sensitive patients were randomized into 2 groups; 10 received the polymerized form and 9 received the monomeric form. Four parameters were followed: serum-specific IgE against antigen E, total blocking antibody against antigen E, local and systemic reactions to injection therapy, and symptom score indices. Pretreatment levels of antigen E--specific IgE and blocking antibody activity were similar in both groups. After a total of 15,000 protein nitrogen units (PNU) had been given, blocking antibody activity in the monomer group rose from a mean of 170 ng AgE bound per ml to a mean of 2,813. The rise in blocking antibody activity in the polymer group was from a mean of 181 ng AgE bound per ml to 1,574. At 15,000 PNU, blocking antibody activity levels were not statistically different in the 2 groups. After 1 year of treatment, no consistent decrease in postseasonal specific IgE rise could be shown in either group. Forty times less erythema and 15 times less induration were found with polymerized ragweed. There were 7 systemic reactions with the monomer and none with the polymer. Both groups experienced symptomatic improvement with treatment.


In vitro activation of the alternative pathway of complement by settled grain dust.

Settled grain dust was collected from several active grain elevators in the Superior-Duluth areas of the United States. Particle size distribution (47% less than 5 micrometer) and endotoxin contamination (429 ng/gm) of the dust were similar to those reported for the airborne parent dust. Human complement uas activated in vitro in a dose-response manner which could be quantified. This hemolytic consumption was via the alternative pathway as defined by ethylenediaminetertraacetic acid/ethylene-glycol-bis-(beta-amino-ethyl ether) N,N'-tetraacetic acid (EDTA/EGTA) differential serum chelation, factor B conversion, and complement reductions in serum from guinea pigs deficient in C4. It is proposed that continuous low-dose exposure to aerosolized, biologically active rafter dust could contribute to the respiratory insult of grain workers.


School nutrition programs in perspective.

From a meager beginning with the passage in 1946 of the initial National School Lunch Act, school nutrition programs have grown until today they are "big business," employing some 350,000 persons in more than 89,000 units, and representing more than $1 billion in volume. As programs have expanded, the need for more professionalism in the field has been felt, and a number of educational and certifying programs have emerged. A new aspect, just being implemented as a result of 1977 legislation, is the nutrition education facet implicit in serving school meals. A driving force in meeting nutritional goals of school foodservice programs is the American School Food Service Association, an organization of some 67,000 members.


Consumption and plate waste of menu items served in the National School Lunch Program.

Plate waste was determined in fifty-eight elementary and high schools in the USDA Western, Midwestern, and Southwestern Regions. By weighing sample trays and edible waste, the percentage of food served that was consumed was measured for 23,000 lunches. Highest consumption was recorded for milk, with 88 and 94 per cent consumed in the fifth and tenth grades respectively. Most entrées and starches were well consumed; vegetables and salads showed much less acceptability. Regional differences in food acceptability were minor, and high school students consistently wasted less food in all categories than did elementary pupils.


Automated purchasing: Forecasts to determine stock levels and print orders.

An automated purchasing system to optimize inventory levels of frozen foods, including meat items, while minimizing stock outages, was developed and implemented. Menu item forecast data were coordinated with on-hand quantities to automate the calculation of order quantities and printing purchase requisitions. The model selected also incorporated: (a) Safety stock level, (b) accumulated forecasts, and (c) accumulated orders already placed. The project was smoothly integrated into an on-going computer-assisted management system. All programs functioned as planned; computer documents were complete and accurate. The system design was retained for use in the foodservice operation.


Thermal destruction of folacin in microwave and conventional heating.

Folacin derivatives were found to vary greatly in thermal stability. It is worth mention that pteroylmonoglutamic acid (PGA), the folate used therapeutically and in food supplementation, was extremely stable to heat under the experimental conditions, that is, at 100 degrees C. in neutral solution. Under these conditions, 5-formyl-THFA also exhibited marked stability; neither form was affected significantly by microwave radiation. In view of the increasing data indicating the abundance of 5-methyl-THFA and other derivatives of THFA in foods, the thermal lability of these forms was especially interesting. THFA was found to be an extremely labile folate, while 5-methyl-THFA had intermediate stability among the forms tested. Microwave heating of 5-methyl-THFA resulted in a faster rate of degradation than conventional heating at the same temperature. The mechanism of this action needs further research.


Nutritional assessment of Virgin Islands school children.

A group of 427 students on St. Thomas, Virgin Islands was studied to obtain baseline data on some anthropometric measures, biochemical values, food habits, and educational parameters. Body weight was similar for four-to-seven-year-old students. Nine per cent of the sample appeared to be excessively stout. The mean hemoglobin and hematocrit levels exceeded "acceptable" ranges of the Ten-State Nutrition Survey. Differences were noted in the food habits of students in public vs. parochial schools and by birth place. The reasons for the differences were not determined. When comparisons were made with a previous survey of V.I. adolescents, mean intakes of the vegetable-fruit and meat groups were higher. A trend existed between poor academic achievement and low food score. The extent of the contribution of the various factors on the assessed status needs to be appraised.


Nebraska physicians' attitudes and practices in the field of infant feeding and nutrition.

A questionnaire was mailed to all pediatricians, family practitioners, and general practitioners in Nebraska to determine their attitudes and practices concerning infant feeding and nutrition. One hundred seventy responded. Their attitudes and practices regarding infant feeding and nutrition generally seemed to be positive. Areas in which they were undecided were often nutrition concerns which are currently being researched.


Dietary treatment of tyrosinemia type I: importance of methionine restriction.

A patient with tyrosinemia type I was treated with formula 3200 AB. This dietary approach lowered the elevated plasma phenylalanine and tyrosine levels but failed to eliminate the hypermethioninemia and the concomitant clinical abnormalities of ascites and other abnormal liver functions. Strict control of dietary intake of methionine, as well as phenylalanine and tyrosine, by a synthetic amino acid mixture or by a combination with formula 3200 AB maintained all plasma amino acids within the normal limits, permitted normal physical growth, and eliminated all hepatic and renal abnormalities. We suggest that restriction of only phenylalanine and tyrosine is inadequate in treating tyrosinemia type I during the acute phase. In such cases, the dietitian should use 3200 AB formula with caution until the acute phase of the disease subsides and plasma methionine levels return to normal.


Nutrient intakes of children on the hyperkinesis diet.

The nutrient intakes of fifty-four hyperactive children during a baseline period and while following the hyperkinesis diet were calculated. During both periods, mean dietary intakes compared favorably with the Recommended Dietary Allowances. A comparison of three-day food records showed that, relative to baseline values, nutrient intakes did not change significantly while the children followed the hyperkinesis diet. The majority of the children reported intakes sufficient to meet the recommended allowances during both the baseline and diet periods.


Programmed instruction in institutional purchasing for dietetic students.

A programmed instruction unit in institutional purchasing for dietetic students was developed and evaluated. The unit is compact, simple to use, and could serve as an overview or review of institutional purchasing by dietetic students. Subjects were forty-five dietetic students in coordinated undergraduate dietetic programs, dietetic internships, and dietetic traineeships, with two institutions represented in each group. The programmed unit was effective, because cognitive achievement post-test scores were significantly higher (24 per cent) than pre-test scores. The unit was equally effective with the three groups, which did not differ significantly in pre- and post-test scores, gain test scores, or attitude toward programmed instruction scale scores at the end of the unit. Interns had higher grad point averages (GPA) than students in coordinated undergraduate programs. All students spent an average of 1 hr. completing the unit, although trainees used more times. An attitude scale showed favorable attitudes by the students toward programmed instruction. Significant positive relationships were found between pre-test scores and GPAs, and post-test scores and GPAs. A questionnaire showed that instructors liked the unit, found it useful, and would use it again. The findings of this study suggest that programmed instruction units in other phases of dietetic education could be developed and used to present factual material, give an overview of a topic, help students to review, and/or save time in classroom instruction.


HACCP models for quality control of entrée production in hospital foodservice systems. I. Development of hazard analysis critical control point models.

HACCP models were developed as part of a research project for quality control of entrée production in three types of hospital foodservice systems: Conventional, cook/chill, and cook/freeze. Critical control points at process stages were identified. Time-temperature was a critical control point throughout entrée production in each model; time-temperature parameters were established for critical control points. Equipment sanitation and personnel sanitation are critical control points for which standards must be established by each foodservice system. Determination of the effectiveness of control measures included continuous monitoring of critical control points for time-temperature. Sanitation of equipment and personnel should be monitored using standards established by the foodservice system.


HACCP models for quality control of entrée production in hospital foodservice systems. II. Quality assessment of beef loaves utilizing HACCP models.

HACCP models were developed for quality control of entrée production in three hospital foodservice systems: Conventional, cook/chill, and cook/freeze (1). The three systems were stimulated in a laboratory to evaluate the effectiveness of the HACCP models for quality control and to generate quantitative data for evaluating and comparing the quality of beef loaves produced under controlled conditions. Attributes measured were weight (yield) and microbiologic, nutritional, and sensory qualities. The only significant difference in the beef loaves among systems was sensory quality. Scores for overall acceptability of beef loaves in the conventional system were significantly greater (P less than 0.05) than for those of the cook/chill and cook/freeze systems. The HACCP models were effective quality control tools for entrée production; implementation of the HACCP system is recommended for hospital foodservices. The importance of the time-temperature critical point for monitoring control points in hospital foodservice systems is emphasized.


The evolution of geriatric medicine.

The evolution of geriatric medicine has been associated with increasing knowledge about aging--social, psychologic and biologic--and its effect on the clinical presentation of illness. It also has been associated with varying patterns of the historical development of medical care in different countries. Overall, two main forms of geriatric medicine are developing worldwide--one an accredited specialty practiced within a State medical service, the other based in large hospitals for the aged where physicians train themselves but are not accredited. The system of geriatric care in Great Britain is described and the importance is emphasized of: 1) assessment before admission, 2) progressive care of the patient, and 3) the day hospital. Future developments in relation to internal medicine and family practice are considered. Research into the causes of atheromatous vascular disease and senile dementia is of fundamental importance for the whole future of geriatric medicine.


Spectrum of severity and control of diabetes mellitus in skilled nursing facilities.

A descriptive and quality assessment study was made of 359 elderly patients with a diagnosis of diabetes mellitus in 39 Skilled Nursing Facilities (SNF) in upstate New York. The diagnostic prevalence of diabetes was about 12 percent--similar to that in a National Health Survey of nursing homes, but higher than that reported for the non-institutional elderly. Greater frequency and severity were observed among the females, but the median age for all the diabetic patients was about the same as that for the general SNF population. Several of the other disorders believed to be associated with diabetes were found to be of greater frequency in the SNF diabetic group, but some were not; also, inadequate control of diabetes was associated with some, but not all of these disorders. The severity of diabetes in this elderly SNF population with adult-onset diabetes was usually mild, with a low frequency of complications and of poor control. Problems arose with respect to the ascertainment and recording of diagnostic and control data, most often related to the responsibilities of the attending physicians. There were also problems of uncertainty as to the cause-and-effect relationship between thecontrol of blood glucose levels and treatment outcomes. The establishment of criteria and standards for medical care evaluation studies is discussed.


Genitourinary disorders of old age: therapeutic considerations including counseling for sexual dysfunction.

Genitourinary tissues undergo physical changes with advancing age, due partly to hormonal alterations. However, the greatest influence on continuing sexual function during aging is emotional and is directly related to the psychologic history of the individual patient. The interested professional can help his patient substantially by simply taking time to listen, a process which permits identification of any psychogenic basis for the sexual dysfunction. The entire approach and method of counseling presuppose that psychogenic impotence is the most common form of the problem. This preliminary effort can do no harm. Should it fail, the patient can be referred to other consultants who use more protracted or sophisticated modalities. With the elderly, the clinician can advise patients to share interpersonal warmth and to enjoy the satisfaction of body contact at any age at which this desire and capacity persist. To the aging person, the totality of sexual meaning is more significant than performance or technique. The sympathetic counselor who renders supportive reassurance to the patient usually can expect beneficial results.


Major gynecologic surgical procedures in the aged.

The results of major gynecologic operations in 160 women over the age of 65 were reviewed and compared with the results in 120 younger women 40--55 years old. Most of the complaints of the elderly group were related to genital prolapse. These conditions caused daily discomfort and anxiety. Contrary to the practice in the younger group, most of the operations in the elderly were vaginal. Vaginal hysterectomy was the preferred procedure in most cases of uterine prolapse. Spinal anesthesia was used, as it is rarely contraindicated in the elderly. Postoperative complications were few and did not cause prolongation of hospital stay. There was only one postoperative death, a mortality rate of 0.6 percent. When care is exercised in medical evaluation, choice of anesthesia, and performance of the operation, the elderly patient usually can tolerate major gynecologic surgical procedures well, and should not be lightly disqualified from receiving the benefits.


Duodenal stump tumor.

A rare case of duodenal stump tumor is described. The patient was an 84-year-old woman who had undergone a subtotal gastrectomy nine years previously. The polypoid tumor of the duodenal stump may have been a factor in the production of extrahepatic biliary obstruction, for which surgical treatment was required. The aged patient withstood the operation well.


Senile-presenile dementia: follow-up data on an effective psychotherapy-anticoagulant regimen.

This report contains follow-up data on the effects of an anticoagulant-psychotherapy regimen in presenile and senile dementia. Over a two-year period, 49 such patients who were seriously ill were treated with a Coumadin-psychotherapy regimen; 34 (69 percent) improved (4 of them dramatically) and 15 (31 percent) did not improve or became worse. The underlying pathologic processes are discussed, with the rationale for therapy.


Depression in old age.

We are increasingly becoming a society of older people. The most prevalent emotional disturbance in this group is depression. Its management is an urgent concern to professionals in the mental health field. A review is presented of the clinical management of depression in old age in the special out-patient setting of an Affective Disorders Clinic. Sociologic, psychologic, and biologic factors as they affected the aging process are discussed in the frame of a developmental approach to aging. Illustrative clinical material shows the value of this approach in the assessment and management of depression in the aged.


Health habits in relation to aging.

A review of the literature and a study of 52 patients of the 80+ age group confirmed the premise that good health habits have a positive effect on the quantity and quality of life. Not all persons can live beyond 80, but those who do can lead a better life if they live properly. A profile of these 52 subjects aged 80 or older revealed that they were of average size or thin, and of a happy temperament; they ate well and regularly, slept adequately, avoided excessive amounts of alcohol, did not smoke, used drugs sparingly, and led an active life, physically and mentally. Also, it was apparent that the rugged elderly can withstand the impact of a major illness or a surgical operation with associated anesthesia. The following factors are important for longevity: 1) pick the right grandparents, 2) keep active physically and mentally, 3) eat properly, 4) stay thin, 5) drink alcohol moderately if at all, and 6) do not smoke.


Fatal cerebral injury in the elderly.

A medical examiner's series of 71 elderly patients with fatal internal cerebral injuries demonstrated age differences with respect to the type of cerebral lesion and the causal incident. The elderly showed relatively fewer severe cerebral contusions than did a young group, but a higher incidence of subdural and intraparenchymal hematomas. Falls, the most common cause of injury in the elderly, were often precipitated by physical illness or ingestion of alcohol. Consumption of alcohol was also a prominent factor in the fatal assault cases.


Fever of unknown origin in the elderly.

An extensive literature survey was performed and hospital records were reviewed in order to identify cases of fever of undetermined origin in patients aged 65 or older. Analysis of the 111 cases discovered demonstrates a characteristic but not unique spectrum of underlying disorders. Potentially curable entities such as abdominal abscess, bacterial endocarditis, tuberculosis and giant-cell arteritis account for more than half of the serious illnesses presenting with prolonged pyrexia in elderly subjects. A diagnostic approach to the management of the persistently febrile geriatric patient is discussed.


Fractures of the hip: a three-year survey in one hospital, including experience with the Pugh nail procedure.

Records were reviewed on 445 patients with fracture of the hip admitted to St. Paul's Hospital, Vancouver, Canada, during the period 1973--1975 inclusive. The epidemiologic factors were analyzed: age, sex, where and when the accident occurred, site of the fracture, the treatment procedure, length of time in hospital, complications, associated conditions, and final placement of the patient. Of the patients, 286 (64 percent) were more than 70 years of age. Among the 260 causal accidents in the patients' home living space or in the hospital, 35 involved toileting. The great majority of the fractured hips (330) were treated by open operation and internal fixation with the Pugh nail; the remainder were treated by conservative methods, various other devices, or arthroplasty. Within 30 days, 121 patients were discharged to their own homes and 68 to a major rehabilitation hospital. A total of 289 patients eventually returned to their own homes. The Pugh nail method of fixation permits early physiotherapy and early walking exercises, beginning within the first few days postoperatively. This largely accounts for the low complication rate, rapid achievement of functional status, and reduced hospital stay. Among the 445 patients there were 43 deaths, including 10 which occurred before operation could be undertaken.


Problems in rehabilitation after age sixty-five.

Of 100 patients on the Rehabilitation Service of a general hospital (New England Memorial), 75 were past 65 years of age. In this age group, recovery from illness or an accident is longer and slower, with many more complications. Rehabilitation that accomplishes independence in daily-living skills is extremely important for the elderly and those who care for them. Of the 75 elderly in this study, 40 could be discharged to their own homes; 36 had to be transferred to extended care facilities chiefly because of complications secondary to associated disorders. Even the patients who did not attain the conference-determined rehabilitation goal still benefited from the coordinated rehabilitation procedure. The value of rehabilitation services for the disabled elderly should not be minimized.


Contribution of the consultant pharmacist to rational drug usage in the long-term care facility.

In a rural 116-bed skilled nursing facility, a study was made of the influence of a Consultant Pharmacist on drug usage over a one-year period. Lines of communication were established with the six attending physicians by means of work rounds, telephone calls, and both official and unofficial memoranda. Daily pharmacy rounds were conducted with health-care students and the nursing supervisor, who facilitated physician-pharmacist communication. The physician-nurse-pharmacist team studied each patient's problems, the status of the therapeutic endpoint, and the need of and usage of each regularly scheduled or pro re nata (PRN) drug. Stop-order and standing-order protocols were developed. During the one-year period, the number of regularly scheduled drugs per patient was reduced from 3.30 to 2.66 (19.4 percent decrease), and of PRN drugs from 3.92 to 2.12 (45.9 percent decrease). The overall significant reduction was associated with the protocol and stop-order discontinuances of routinely scheduled drugs, and with the duplicated orders for drugs to relieve pain, nausea, vomiting, diarrhea, colds and cough. Implications for optimal care of the patients, and for the economics of this federally-mandated system of consultant pharmacists are discussed.


Dopamine and the aged.

Regardless of the age of the patient, dopamine is a valuable agent for treating shock associated with an abdominal catastrophe. However, when the time is appropriate for withdrawal of dopamine, the aged do not react as do younger patients. Despite apparent adequate hydration, additional volume loading is required to avert renal failure, and the dosage of dopamine has to be decreased gradually until withdrawal is complete.


A corneal irritation uniquely produced by hydrogel lathed lenses and its resolution.

This paper discusses the presence of an irritation (arc-line abrasion) on the corneas of some patients wearing hydrogel lenses. The author discusses many procedures for resolution and many failures. Only when fenestrations were employed did the irritation subside and disappear.


Optometric residency programs.

Residency programs are very new to the optometric profession. In order for optometry to continue its growth, Residency programs must attain its appropriate role in the development of the profession. A committee has been established to support the concept of specialized residency programs in many aspects of optometric care. Initial goals and objections of the committee as well as future endeavors are discussed.


Biofeedback treatment of strabismus: case studies.

This project demonstrates the use of neuromuscular reeducation biofeedback as a treatment for strabismus. Of the three subjects treated, an exotrope and an esotrope were cured according to pre-defined criteria and an exotrope with a dense monocular cataract was improved. Treatment consisted of monitoring eye positions using infrared sensors and feeding back information on relative ocular deviations coded in the form of a tone.


Interdisciplinary health care: part II.

There are a number of problems which facilitate against the development and implementation of a successful effective team. These problems include the traditional model of separating the teaching of professional students, the feelings of omnipotence of the physician, the social and psychological barriers among professionals, the lack of role responsibilities of professionals, the fear of identity loss of allied health profession, the feeling of autonomy by independent health professionals and others. These problems are being studied because the benefits of team care, e.g. increased quality and quantity of care, professional recognition and decreasing the cost of care, are important to the delivery of health care.


A comparison of two fixation disparity targets.

A simple homemade fixation disparity test is compared with the standard Mallett Test. Sixty-four clinical patients were tested and 25 percent of them were found to have fixation disparity on either one or both tests. Age distribution is shown. Comparisons are made as to the direction of fixation disparity and magnitude of associated heterophoria found with each test.


Functional relationship between myopia, accommodative stress and against-the-rule astigmia: a hypothesis.

A model is proposed to explain the well-established tendency for against-the-rule astigmatism to precede and be predictive of the later development of myopia. It is hypothesized that the against-the-rule astigmatism is a functional adaptation to reduce near point stress by permitting reduced accommodative output (increased lag of accommodation) while maintaining resolution for the primarily vertically-oriented characters of the English language.


Dimensional stability of lathe cut C.A.B. lenses.

Measurements of the back central optical radius in the course of 336 hours of hydration of lathe cut corneal lenses disclosed changes in curvature which were more rapid and of greater magnitude than those previously reported for poly (methyl methacrylate) lenses.


Easier and more productive study and desk work.

This article is a uniquely optometric public service. Working from an optometric model of vision, the authors collected and condensed extensive information from many professions and scientific fields, developed additional material, field-tested the information, and created an original, easy-to-apply handbook to help the very large segment of the population that does near tasks. Only an optometric model of vision can tell us how near tasks produce a general tightening of the musculature and undesirable changes in visual status, which in turn lower efficiency at near tasks; and that the way to counteract this process is to have minimal obstructions to movement at such tasks (thus, the information on chair and table design, shoes, etc.). Only an optometric model of vision makes us aware of the value of breaks to offset tightening, and tells us when to take breaks, what to do during breaks, and specific exercises to reduce near task stress. Only an optometric model tells us that the lighting which others consider adequate is often excessive and leads to fatigue, and allows us to determine the proper amount of lighting in general and for the individual. And only an optometric model of vision tells us of the value of adjustable arm typing stands. Because of its approach, "Easier and More Productive Study and Desk Work" reinforces the view of optometry as a broad-based discipline which relates vision to all areas of human performance.


Interdisciplinary health care: part III.

Since the spring of 1974, the University of Houston, College of Optometry has been involved in teaching optometry students the benefits of interdisciplinary health care. Optometry students have worked and learned with allied health, dietetic, nursing, pharmacy and social work students in a disadvantaged area in Houston. The primary purposes of the course were to assist students to learn about the expertise of other professional students, to work in an interdisciplinary team, and to learn about the multifaceted components of health care and the health resources of a community. This paper discusses the program and suggests this model of the Houston experience as one way of teaching interdisciplinary care.


Effectiveness of optometric vision therapy.

One hundred consecutive optometric vision therapy patients' records were evaluated to determine what changes occurred in the visual processing system. An ordinal visual performance scale was utilized to rate visual functioning on a one hundred point scale. The scale divides the visual processing system into 10 functions of 10 points each. Each of the 10 functions improved at the .001 level of significance as a consequence of the binocular vision therapy treatment program.


Glaucomatous cupping--appearance, pathogenesis, detection.

Increased optic disc cupping has long been associated with glaucoma. In this paper the appearance, pathogenesis, and detection of glaucomatous cupping is reviewed. Emphasis is given to the increase in cup-disc ratio and appearance of the peripapillary area as being diagnostic of glaucomatous atrophy. The vascular theory for producing these changes is outlined and represents the most comprehensive attempt at explaining the changes of the disc in glaucoma.


Maturational variations and genetic-dynamic issues.

Psychic issues may influence apparatus functioning, and thus may lead to maturational variations. However, in this papper I have emphasized the converse: the influence of maturational variations on psychic issues. I have singled out for discussion three areas of the originally autonomous sphere: perception, motility, and language. The variations on which I have elaborated include: special sensitivities, maturational delays, and lags in achievement which we may perceive in the genetic background of our analytic patients. If such variations occur in the beginning of life, they primarily affect ego structuring, and anxiety and aggression potentials. In addition, they may leave imprints which may find later psychological expression as well. If they occur after the emergence of speech, symbolic thinking, and selfawareness, the resultant problems will contribute mainly to neurotic elaborations. Most important in tracing variations and their effects appears to be the organizing, integrative function. This function, already at work at the start of life, develops in accordance with its own biologically predetermined timetable. Viewed in this way, I would suggest that the organizing function itself may well be autonomous, since it does not arise out of conflict, and since, to use Hartmann's phrasing, it is "not acquired," but "rests on constitutional givens."


Boyhood gender aberrations: treatment issues.

Although it is not yet clear what boyhood behaviors indicate an adult homosexual outcome, femininity is one reliable marker. The earlier and greater the femininity, the more likely will it be resistant to treatment, in childhood or adult life. Once an evaluation has revealed the femininity is intense, treatment should quickly begin and, when possible, include both mother and father. If the boy is to become more masculine, his mother will have to allow--encourage--him finally to separate from her, and his father will have to start serving as an adequate model for masculinity.


[Foetoscopy (author's transl)].

Foetoscopy consists of the introduction into the ovular cavity, at the beginning of the second trimester of pregnancy, of an optical device in order to be able to observe the foetus and the foetal surface of the placenta. It may be used to detect certain foetal malformations which are not seen by echography and to collect foetal red cells by direct puncture of a placental vein. Its major indication is the prenatal diagnosis of homozygous forms of haemoglobinopathies: sickle cell disease and beta-thalassaemia. It is a dangerous investigation which requires great experience and perfect organisation.


[The pregnancy occuring during oral contraception or intra uterine device (i.u.d.) (author's transl)].

It seems possible to answer most of the questions asked by our patients after failure of the contraception. The pill stopped within the first five weeks of gestation has never been responsible of congenital malformations. When this treatment is prolonged during the pregnancy, a risk of masculinisation of female fetus exists. No severe malformations has been reported. The I.U.D. does not play a role in the frequency of tubal pregnancy. The I.U.D. must be removed when a pregnancy occurs to prevent the risk of sepsis.


[Post-partum contraception (author's transl)].

The authors have come to the conclusion that the ideal time to start female contraception is when the periods return following delivery. They arrived at this conclusion after studying the disadvantages of the various methods of hormone contraception and of mechanical female contraception immediately following delivery. Directly after delivery contraception should be in the hands of the man and not the woman. If better information is given to the couple during pregnancy and in the postnatal period it should direct them towards such formations of contraception. The problem, however, of grand multipara who are feckless, ignorant and of low social class, still remains. Medroxyprogesterone, if it is used at all immediately after delivery, should be given in a dose of 150 mg. As far as tubal ligation by mini-laparotomy after delivery goes this is permanent contraception and its indications should be considered with very great care.


[Avoidable perinatal deaths and prenatal consultation (author's transl)].

Perinatal deaths may be avoided by the prenatal consultation. We show that women with a previous preterm delivery may have a term child if they are correctly followed, that adolescent pregnancies can have term birth with good social support and medical support. We show that uterine height (pubis-fundus) is a good measure of fetal development, giving a better prediction of term weight compared to echotomography from 28 to 36 weeks, afterwhat echo is obviously better. This means that simple clinical measures can reduce during pregnancy important causes of perinatal deaths.


[The avoidable neonatal injuries during delivery (author's transl)].

The authors describe their approach which was designed to meet three imperatives, namely: --to prevent severe foetal distress, --to detect severe foetal distress by systematic use of the cardiotocography, --to avoid unnecessary interventions by supervising the metabolic state of the mother and the foetus which makes it possible to distinguish foetal acidosis by hypoxia necessitating rapid intervention from foetal acidosis of maternal origin for which extraction is not generally necessary. Their action has made it possible to reduce the number of caesarian during labour which achieving extremely low perinatal mortality and morbidity rates.


[The pathological secretion of prolactin (author's transl)].

The problem of hyperprolactinaemia is dominated by the search for an active pituitary adenoma, which, if it is at all large, requires neuro-surgical operation. In cases where a microadenoma is responsible or where the pathological secretion of prolactin is istrogenic, the most serious consequence is sterility. Hyperprolactinaemia in fact works at two levels: on cyclical gonadotrophic activity and on luteal function. Whatever the cause is, bromocriptine allows hyperprolactinaemia to be corrected together with the disturbances of ovulation resulting from it.


[Instruments in microsurgery (author's transl)].

Instruments are at the basis of microsurgery. An operating microscope is the main element and the most important and expensive thing to buy. Yet it is possible to begin with a simple microscope as the ZEISS OMPI 1, or its copy by BAG. Five or six intruments are necessary except irrigation set up, clamps, bipolar coagulation. Suture material will be selected for each times. Microsurgery demands an important training before applying it in the operating room. A good operating position will also be required in order to perform efficiently.


[Tubal microsurgery: methodology (author's transl)].

--A few assessments concerning general methodology of microsurgery and surgical repair of the Fallopian tubes are presented. --Some serials on the operating room setting-up are proposed on a practical point of view. --The value of the microsurgical approach is then reviewed for each particular technique of tuboplasty.


[The value of echography in cases of threatened abortion in the first trimester of pregnancy (author's transl)].

Echographic examination brings to the screening and determination of the seriousness of a threatened abortion features of prime importance. These are such as to change greatly the management. They are concerned with: --on the one hand the morphology of the oocyte, --and on the other hand the recognition and evaluation objectively of the criteria of the viability of the embryo and the activity of its heart and its motility.


[Artificial insemination with the sperm of the husband (author's transl)].

--128 women underwent artificial insemination with husband's semen (A I H) after an over 3 years period of sterility. --The most frequently recorded indication was low sperm density and/or reduced sperm motility. To increase sperm concentration and motility split ejaculates were most often utilised but also different other methods. --The pregnancy rate was 31 p. 100 and the success rate per cycle was 5 p. 100.


[Hirsutism (author's transl)].

Hirsutism may arise from two different causes: an increased production of active androgens by the adrenals and/or an increased utilization of circulating androgens by the target cells of the skin i.e. idiopathic hirsutism. Plasma testosterone and androstenedione levels are the best indexes of androgen production. Testosterone 5 alpha-reductase capacity in the skin and urinary 3 alpha-androstanediol reflect androgen utilization. In most hirsutisms, the only plasma testosterone level give sufficient information: it is normal with normal ovulatory cycles in idiopathic hirsutism, it is slightly elevated in ovarian dystrophy, the most frequent causes of hirsutism. More sophisticated investigations are only needed when testosterone levels appear to be over 1.50 ng/ml. In these cases, one could expect an uncommon etiology such as virilizing tumor on a delayed onset of congenital adrenal hyperplasia.


[The onset of labour. A reminder of its physiology (author's transl)].

Until recently the onset of labour was considered to be due to changes in maternal hormone levels which were represented by a drop in the progesterone and a rise in the oxytocin levels. Recent work has shown that onset of labour is associated with several phenomena which take place parallel to one another, and they are immunological, haemodynamic, biochemical, mechanical, psychological and hormonal. The last of these are far and away the most important and have three sources: a placental source; a maternal source of sex steroids, oxytocin and prostaglandins and; of fetal origin, adrenal and posterior pituitary hormones. It seems that the prostaglandins and the maturation of the fetal brain are at present considered to be all-important. Better knowledge of the physiology of the onset of labour has led to greater success in pharmaco-dynamically induced labour, but this is not yet truly physiological. Therefore except in cases of pathology it does not seem right to undertake the risks of inducing labour more or less systematically.


Pharmacological alterations in the clotting mechanism: use in microvascular surgery.

At the present time there is confusion as to what pharmacological adjuncts are helpful toward increasing patency rates of microvascular repairs. To select a drug rationally, an understanding of the clotting mechanism in small vessels is essential so that agents may be selected that alone or in combination will react with the elements of the blood and will allow for continued perfusion without risk of hemorrhage or toxicity. Drugs which are Federal Drug Aministration approved and currently available are drugs having nonspecific effects involving more than one aspect of the clotting mechanism; they often in undesirable as well as desirable effects. Further development will result in the use of more selective and sophisticated agents. Presently it would appear desirable to employ agents to (1) increase blood flow and decrease blood viscosity, such as dextran 70; (2) decrease platelet functions, such as aspirin-type drugs; (3) mitigate against the actions of thrombin on platelets and fibrinogen using low-dose heparin; (4) reduce anxiety and vasospasm using chlorpromazine or Thorazine.


Free muscle transplantation to provide active finger flexion.

Free muscle transplatation is a procedure which involves the transfer of a skeletal muscle from one location in the body to another. Viability is maintained by microvascular anastomoses of the muscle's artery and vein to a suitable artery and vein in the recipient site. Voluntary muscle contraction is obtained by suturing of the muscle's motor nerve to an appropriate motor nerve in the recipient site. Two cases are presented; one using the gracilis and the other using the pectoralis major muscle. The indication for each transplantation was the traumatic loss of long flexor musculature to the digits. In both cases transplanted muscles survived and are functioning well. Excellent grip strength and nearly a full range of finger movement were provided by the transplanted muscle.


Intraosseous wiring of the digital skeleton.

One hundred cases of osteosynthesis done by the use of intraosseous wiring are presented. Two techniques of wiring are described, one used in transverse fractures and arthrodeses in which an additional Kirschner wire is employed, the other in which No. 0 monofilament wire can be placed perpendicular to the line of osteosynthesis. Forty-seven fractures were treated and there was union in all cases; 53 arthrodeses were performed, with failure in five, due, it is believed, to a failure to observe the essential elements of the technique, namely the need to obtain congruous bone ends and to maintain all internal fixation until there is clinical evidence of union. Overall, 83.2% of the maximum attainable total active range of motion was achieved in the 100 cases.


Polydactyly and the triphalangeal thumb.

Polydactyly associated with triphalangeal thumb is not rare, as among the records of 1,269 patients with congenital deformation of the upper extremity at the University of Iowa there were 21 patients with 32 hands with such involvement. More detailed classification based on Wassel's work was made. Treatment should be early, with removal of the radial digit if equal in size, excision of all accessory parts including delta bone when present, reconstruction of joint ligaments or joint fusion and osteotomy for correction of deviations. Care should be taken to avoid leaving a narrow first web space.


Immune competence and diabetes mellitus: pyogenic human hand infections.

An unexpectedly high incidence of diabetes mellitus was found in 12 patients with pyogenic hand infections. Three patients had overt diabetes, four had latent diabetes, and only five were normal when tested after resolution of the acute inflamatory state. Cellular immunity, assessed in five patients by intradermal injections of common antigens and the topical application of the neoantigen, dinitrochlorobenzene, appeared to be grossly normal in all patients. If changes in immunity were present, it is likely that the skin tests were not sensitive enough to detect these alterations.


Doppler hemodynamic assessment of obscure symptomatology in the upper extremity.

Thirty-eight patients were studied because of symptoms thought to be vascular in origin. In 18 patients in whom angiography was performed, the presence or absence of hemodynamically significant vascular occlusive lesions was predicted correctly by Doppler ultrasound techniques. Normal Doppler studies in the remaining 20 patients expedited nonvascular diagnostic evaluation and treatment and helped to avoid unnecessary angiography. Studies required 15 to 20 minutes and no complications occurred. Noninvasive Doppler evaluation is inexpensive, free of risk, and provides an accurate means of determining alterations in upper extremety hemodynamics.


The spiral oblique retinacular ligament (SORL).

A procedure is described for reconstruction of the oblique retinacular ligament using a small tendon graft in a spiral fashion to act as a dynamic tenodesis to restore distal interphalangeal extension and to restrain proximal interphalangeal hyperextension. The method has been uniformly successful in the treatment of post-traumatic "swan-neck" or "mallet" deformity. Although the concept is simple, the procedure demands thorough understanding of digital anatomy for successful completion.


Palmaris longus tendon transfer for augmentation of the thenar musculature in low median palsy.

The palmaris tendon may be lengthened by a distal strip of palmar fascia and transferred subcutaneously to the tendon of insertion of the abductor pollicis brevis for augmentation of thumbs elevation from the palm. The transfer attempts to duplicate abductor brevis function in the complex act of opposition. The palmaris has appropriate strength, excursion, and direction for this purpose. It is properly phased for pinch activity and requires minimal retraining. Twenty-eight cases of transfer have been performed successfully and without difficulty. The uses of the transfer have included cases of carpal tunnel syndrome with thenar atrophy, injury to thenar muscles, and direct trauma to the median nerve in the forearm.


The S-H-A-F-T syndrome in the upper extremity.

The S-H-A-F-T syndrome is a passive form of Munchausen's syndrome in which a patient submits to multiple surgical procedures to a part of the upper extremity. Apart from the obvious connotation, the title emphasizes that the patients are sad, hostile, anxious, frustrating, and tenacious, with psychological problems similar to those of patients with Munchausen's disease--problems which are aimed at secondary gain from a psychological and/or financial nature. Three representative patients are described who had a total of 25 operations as well as multiple injections of cortisone performed by 11 doctors in five different states. Early recognition to avoid progressively mutilating operations is urged.


A study of bacteria contaminating refrigerated cooked chicken; their spoilage potential and possible origin.

Cooked chicken was allowed to spoil in a normal kitchen refrigerator (variable temperature) and at a standard 4C. After 10 days' storage, bacteria were isolated from the chicken. It was found that the numbers of organisms at variable refrigeration temperature were tenfold higher than those at a uniform 4C. In an attempt to find the sources of contamination, swabs were made of different areas of the kitchen. Many of the bacteria isolated from the spoiled chicken, were also isolated from the kitchen environment. When pure cultures of organisms isolated from spoiled chicken were inoculated into sterile cooked chicken and held at 4C, the main spoilage organisms were found to be Pseudomonas putida and Aeromonas hydrophila, which were also isolated from the refrigerator where the chickens were stored in the kitchen. Aeromonas hydrophila was found in significantly high numbers on plates, cutting knives, chopping boards and cold water taps.


The problem of paralytic poliomyelitis in the urban and rural population around Lucknow, India.

A house to house survey was done from October 1972 to March 1974, covering 528952 individuals of urban population at Lucknow and 50,156 individuals of rural population of Unnao district, to find out the incidence of polio-like paralysis in our population. Among 12874 urban children up to 8 years old 8.2/1000 had polio-like paralysis while 4.6/1000 children of the rural population of 13554 children were affected. The incidence was significantly higher in the urban population. In the preschool age group almost 1 out of every 100 children was affected. A higher number of children were affected during 1968-9 and 1971-2, though it did not reach epidemic proportion. The findings show that paralytic polio is a serious problem in our country where poliomyelitis is endemic: this is contrary to the views generally held so far.


Field trials of brodifacoum (WBA 8119) against the house mouse (Mus musculus L.).

The anticoagulant rodenticide brodifacoum was tested against house mice (Mus musculus L.) infesting farm buildings. In six trials, treatment success was assessed from the results of census baitings conducted before and after treatment. With 0.005% brodifacoum in canary seed/corn oil bait, the control achieved ranged between 92.7% and 100%, mean 98.8%. Two mouse populations were eradicated in 3 to 4 weeks but a few individuals survived each of the other four treatments which lasted 6 weeks. The effectiveness of brodifacoum against mice is compared with that of 0.1% calciferol and 0.025% warfarin in combination. It is concluded that brodifacoum and calciferol warfarin are equally effective in controlling M. musculus but that brodifacoum treatments need to be conducted for a relatively longer period.


Klebsiella serotyping by counter-current immunoelectrophoresis.

The development of a Klebsiella serotyping method by counter-current immunoelectrophoresis (CIE) is described. Antisera were prepared against the capsular antigens of 72 type strains and tested for the specificity and strength of their precipitin reactions with antigens from homologous and heterologous serotypes. All antisera produced strong reactions with their homologous antigen: when diluted to titre 63 were highly specific, 3 cross-reacted strongly and 6 weakly with one other antigen. Pools of antisera for screening purposes were constructed on the basis of common crossreactions: component serotypes of each pool could be detected strongly and specifically. The technique is simple to perform, fairly rapid, and economical in the use of antisera. Results can be read easily and quickly and the intensity of cross-reactions compared directly. The technique appears to be more specific and is less time consuming than the Quellung method, but further assessment of its efficacy in typing routine clinical cultures is necessary.


Myxomatosis in the Mallee region of Victoria, Australia.

Sharp reductions in the wild rabbit (Oryctolagus cuniculus (L.)) population in the Mallee are associated with annual myxomatosis epizootics. The extent to which the population reductions are the direct result of the epizootics varies with time of epizootic occurrence. All grazing animals in the Mallee are under nutritional stress each summer and autumn. When the epizootic occurs during the early summer heavy losses occur in a previously healthy population. Similar losses which occur in the late summer and autumn are the result of a nutritional stress - epizootic complex. The end result in each case is a population reduction of about 80%. This reduction occurs in a population which is the most resistant to myxomatosis known in Victoria and in association with epizootics caused by field strains of myxoma virus of moderate virulence only. The earlier summer epizootics are of considerable economic importance because they sharply reduce the pressure on the limited food available for other grazing animals.


Myxomatosis: the occurrence of antibody to a soluble antigen of myxoma virus in wild rabbits, Oryctolagus cuniculus (L.), in Victoria, Australia.

The occurrence of antibody of myxoma virus in wild rabbits following epizootics is highest in the semi-arid north-west of Victoria and lowest in temperate southern Victoria. Occurrence ranges up to about 90% in the north-west and to about 70% in the south except on the Western Plains where epizootics are rare and antibody occurrence seldom exceeds 30%. The establishment of the European rabbit flea may be changing the pattern of occurrence of antibody in the north-west by causing spring outbreaks of myxomatosis. It is suggested that the effects of the replacement of a simple recurring system of epizootic and breeding season several months apart by the occurrence of myxomatosis twice in the same year, once coincident with the breeding season, will be complex. The occurrence of detectable antibody may be less dependent on the infection rate and may be dependent to some extent on the relative timing of spring myxomatosis and the breeding season.


A survey of Nairobi sheep disease antibody in sheep and goats, wild ruminants and rodents within Kenya.

The distribution of antibody to Nairobi sheep disease in sheep and goats in Kenya was found to coincide closely with that of the tick, Rhipicephalus appendiculatus. The proportions of a population in an enzootic area with antibody was similar in the different age groups. No antibody to the virus was found in rodent sera and while some low titres were found in some wild ruminant sera, these were considered to be most likely cross reactions with antibody to related viruses.


Nairobi sheep disease in Kenya. The isolation of virus from sheep and goats, ticks and possible maintenance hosts.

Nairobi sheep disease was seen principally upon movement of susceptible animals into the enzootic areas. This occurred most frequently for marketing purposes near the main centres of population. Other outbreaks followed local breakdowns in tick control measures. The disease did not occur in epizootic form during the period under consideration. Nairobi sheep disease was isolated from pools of Rhipicephalus appendiculatus but not from many pools of other tick species. No virus was isolated from the blood or tissues of a range of wild ruminants and rodents.


Contaminated roof-collected rainwater as a possible cause of an outbreak of salmonellosis.

Roof-collected rainwater is a common water source in subtropical regions and has not been associated with human illness. In Trinidad, the West Indies, a church group, attending a rural camp, developed gastrointestinal illness, caused by Salmonella arechevalata. This rare serotype was isolated from stool specimens of campers, foods eaten at the camp, and a water tap, which was supplied by a storage tank of roof-collected rainwater. The surface of the roof, used as water catchment, was covered with bird faeces. It is postulated that rainwater, falling on the roof, washed off animal excrement which contained S. arechevalata and led to the outbreak of salmonellosis through camper ingestion of contaminated food and water.


The safety of the Trexler isolator as judged by some physical and biological criteria: a report of experimental work at two centres.

We have assessed the effectiveness of flexible-film negative-pressure isolators by physical and biological means. We found that they afford a high degree of containment and therefore also of safety to hospital staff. We offer some recommendations on the operation of these isolators to ensure the optimum degree of protection.


Absence of binding of MDP, a synthetic immunoadjuvant, to anti-peptidoglycan antibodies.

The binding of the synthetic immunoadjuvant N-acetyl-muramyl-L-alanyl-D-isoglutamine (MDP, for muramyl dipeptide) to human and rabbit sera containing peptidoglycan (PG) antibodies was investigated. Studies were performed by employing the corresponding 14C or 125I-labeled compounds in Farr-type binding and inhibition assays. Whereas MDP did not react with naturally occurring or experimentally induced PG-antibodies, the analog of MDP MDP-L-Lys-D-Ala did bind to hyperimmune rabbit anti-PG sera, but not to the human sera tested. These studies indicate that the radioimmunoassays employed basically are applicable for the selection of nonimmumogenic MDP analogs possessing immunoadjuvant activity.


The effect of complement depletion on the course of Sindbis virus infection in mice.

The course of Sindbis virus infection in 12-day-old BALB/c mice was altered significantly in animals depleted of the third component of complement (C3) by treatment with purified cobra venom factor (CoVF). Although the same percentage of C3-depleted and normal animals died (30%) after the subcutaneous inoculation of 1000 PFU Sindbis virus, the mean day of death was later in C3-depleted mice (8.4 days) than in controls (6.5 days). In addition, morbidity was prolonged in C3-depleted mice. Growth of virus at the inoculation site in the foot was not different; however, viremia was prolonged and the amount of virus in the brain was 1000-fold greater 6 days after infection in C3-depleted animals. These studies demonstrated that complement plays an important role in the host's response to Sindbis virus infection by participating in both beneficial and immunopathologic responses to the infection.


Regulation of human lymphocyte function by a soluble extract from normal human liver.

The blastogenic and DNA synthetic response of human peripheral blood lymphocytes (PBL) to phytohemagglutinin (PHA) and allogeneic cells can be inhibited by a nontoxic aqueous extract (LEx) of normal human liver. LEx reversibly inhibits the activation of PBL by PHA, arrests ongoing DNA synthesis, and limits the duration of the DNA synthetic response to PHA at concentrations as low as 0.7 to 1.5 microgram LEx protein/culture. In contrast, human T lymphocyte E rosette formation is unaffected by LEx concentrations in excess of 900 microgram/culture. LEx has been partially purified by ultracentrifugation, ammonium sulfate precipitation, and molecular exclusion chromatography and appears to be a heat labile protein with a m.w. of approximately 65,000 and an isoelectric point of approximately 4.08. LEx is distinct from other previously described human immunoregulatory molecules and is potentially releasable in vivo from injured or necrotic liver cells. Because of its potency and anatomic distribution LEx may potentially modulate immunopathogenetic events responsible for assorted inflammatory and neoplastic liver diseases.


Kinetic analysis of antibody-dependent cellular cytotoxicity: evidence for noncompetitive inhibition by autologous lymphoid cells.

Inhibition of antibody-dependent cellular cytotoxicity (ADCC) by autologous lymphocytes was analyzed by using classical techniques for enzyme-substrate interactions. We determined empirically that the interaction of murine spleen cells with antibody-coated targets to produce lysis was analogous to the interactions that have been described for an enzyme with its substrate. Varying numbers of antibody-coated target cells ("substrate") were mixed with a constant number of spleen cells ("enzyme") and the number of target cells killed ("product") was measured as a function of time. By analogy with Michaelis-Menten enzyme kinetics, two parameters of the reaction were determined: Vmax, the maximum velocity of lysis that is proportional to the number of killer cells present, and K1/2, an intrinsic property of the killer cells. These parameters were found to be independent variables. Addition of autologous lymph node cells produced a dose-dependent decrease in Vmax whereas K1/2 was not significantly changed. By analogy with enzyme kinetics, this inhibition is noncompetitive, suggesting that the autologous lymphocytes inactivate the killer cells rather than competing for the cell-cell binding sites.


Myeloma-induced immunosuppression: a multistep mechanism.

Hosts of plasma cell tumors have a depressed primary antibody response. We have investigated the ability of cell homogenates and culture fluids from short-term cultures of spleen cells and tumor cells of mice bearing the MOPC-315 plasmacytoma to suppress the in vivo primary antibody response to sheep red blood cells. The homogenates and culture fluids of both MOPC-315 spleen cells and tumor cells suppress the antibody response in a dose-dependent manner. Culture fluids of spleen cells from tumor-bearing mice contain a 10,000- to 20,000-dalton immunosuppressive factor. Culture fluids of non-adherent tumor cells contain a high m.w. suppressor. Injection of the high m.w. tumor suppressive factor into normal mice induces the expression or appearance of host cells that secrete the 10,000- to 20,000-dalton immunosuppressor. The tumor suppressive factor, but not the spleen factor, causes an alteration of lymphocyte membranes such that the anti-DNP activity of the MOPC-315 myeloma protein can be detected on the circulating lymphocytes of injected mice.


Clonal nature of the immune response to phosphocholine. VI. Molecular uniformity of a single idiotype among BALB/c mice.

The molecular heterogeneity of IgG antibodies to phosphocholine (PC) having a defined idiotype was examined in BALB/c mice immunized with PC-keyhole limpet hemocyanin (KLH). Specific antibodies were separated by isoelectric focusing in polyacrylamide gels and characterized for PC-binding, idiotype, and isotype by direct in situ labeling with 125I-labeled reagents followed by autoradiography. After immunization with PC-KLH, BALB/c produce 20 to 100 microgram/ml of IgM and 80 to 300 microgram/ml of IgG anti-PC antibody. The dominant fraction of anti-PC antibodies in BALB/c (and a lesser fraction in other strains) possesses idiotypic determinants found on a PC-binding myeloma, TEPC-15. Among 65 BALB/c examined, all produced an identical spectrotypic pattern of antibodies possessing T15 idiotypic determinants. Three major sets of T15-idiotype bearing bands were observed, but they belonged to three different IgG subclasses: IgG1, IgG2, and IgG3. These data support the germ line origin for this dominant set of antibodies in the anti-PC repertoire of BALB/c and indicate that they arise from a single rather than multiple VH-VL pairs.


Target antigens of cell-mediated lympholysis discrimination of HLA subtypes by cytotoxic lymphocytes.

The evolution of HLA specificities has been toward ever-increasing refinement; one example is a subdivision of HLA-B5, the supertype specificity originally defined as 4a. HLA-B5 can now be further subdivided into Bw51 amd Bw52 by serologic means. Whereas the specificity Bw51 can be detected by specific sera, the identification of Bw52 must frequently be deduced from knowledge of B5 and Bw51, although serology has progressed rapidly. There has been no comparable development in identifying fine specificities by cellular cytotoxicity in populations. We have now found that cytotoxic effectors of exquisite specificity can be generated against Bw52 by sensitization of cells from a Bw51 donor and vice versa; Bw51 and Bw52 can in this way be recognized with equal ease. This may set a precedent for recognizing fine specificities of other HLA antigens that cannot yet be identified serologically or can be identified only imprecisely. These fine distinctions may have great relevance in allotransplantation and in understanding disease susceptibility.


Double expression of VH region a2 and a3 allotypes in individual rabbit lymphocytes.

This study provides evidence that two VH region a group allotypic specificities are synthesized by individual peripheral blood lymphocytes from a2,3 rabbits. After removal of both allotypes from the cell surface with pronase, three types of allotype-bearing cells, a2, a3, and a2,3 were demonstrable after overnight culture in serum-free medium. Frequently, greater than 50% of the cells that contained allotype on the surface resynthesized both allotypes. In culture, reappearance of allotype was first detectable at 4 hr and increased progressively thereafter to a maximum at 18 hr. During regrowth, the relative proportion of cells showing both markers was maintained. The predominance of cells exhibiting only a3 over those displaying only a2 was also maintained. Reappearance of allotype was inhibited by cycloheximide but was manifested when the antibiotic was washed out. Monospecific anti-a2 antibodies could completely suppress the resynthesis of homologous allotype in culture and prevent the regeneration of a2 in double-bearing cells. Likewise, anti-a3 in cultures was usually specifically suppressive for a3 allotype; however, the double producers were only partially depleted.


Biosynthesis of the first component of complement by human and guinea pig peritoneal macrophages: evidence for an independent production of the C1 subunits.

The first component of complement, C1, was produced by human as well as guinea pig macrophages. Supernatants from serum-free cultured macrophage monolayers, tested separately for C1q and C1 activity, showed a ratio of 15:1, respectively, and a different time course of C1q and C1 production, indicating that the subcomponents of C1 are synthesized independently. Heat-inactivated fetal calf or guinea pig serum (2 hr, 56 degrees C), added to the culture medium, were found to be inhibitory for C1 but not for C1q activity, obviously due to still active C1 inhibitor in these sera. De novo synthesis was confirmed by reversible inhibition of C1 and C1q production by cycloheximide (0.5 microgram/ml) and puromycin (1 microgram/ml), by incorporation of radiolabeled amino acids into the C1s subcomponent, and by uptake of incorporated radioactivity by EA, which was sensitive to EDTA. In additional experiments, 2,2'-dipyridyl markedly reduced C1q and also C1 secretion in the supernatants. Inhibition of the prolyl and lysyl hydroxylation and, as a consequence, structural instability of the collagenous region in the C1q molecule, is discussed as the cause of this effect which is analogous to collagen biosynthesis.


An automatic multi-programmed affinity chromatographic system.

An automatic immunospecific affinity-chromatographic system for continuous operation is described. The system comprises time-controlled sample application, washing and elution steps and automatic dialysis of eluted fractions. The applicability of the system is illustrated by the purification of pregnancy zone protein on immunosorbent gel.


A simple, sensitive assay for determining DNA in mononuclear phagocytes and other leukocytes.

An assay for determining the DNA content of mononuclear phagocytes is described. The assay is efficient and very sensitive, measuring as little as 1 microgram of DNA. Content of DNA is a linear function of the number of mononuclear phagocytes in the sample. One million murine macrophages contain 10.1 +/- 0.36 microgram of DNA. Consequently, samples of as few as 100,000 macrophages can be accurately quantified to be related to other biochemical analyses.


A modified Marbrook chamber which is cheap and disposable.

The conventional Marbrook culture system has several disadvantages; the preparation and assembly of the chambers is time consuming, the size of the culture vessels limits the number of replicates that may be set up, and placing the cells in the inner chamber is a cumbersome and slow process. We have modified this system by the introduction of a glass ring to make the culture chamber; this is small enough to fit inside a plastic Petri dish which serves as the outer reservoir. The modified Marbrook cultures are easy to manipulate, cheap to produce, disposable, and give comparable results to those obtained with the conventional system.


Quantitation of protein adsorbance to glass and plastics: investigation of a new tube with low adherence.

Four different tubes were tested for adherence of human albumin, aggregated and non-aggregated human IgG and rabbit IgG: glass, polystyrene and cellulose nitrate tubes, and a new plastic tube, Minisorp. From the viewpoint of low protein adherence, the new tube was superior to the others, in the following test situation: (i) low concentration of proteins; (ii) 0.9% NaCl used as diluent; and (iii) when detergents in the tests are undesirable.


Modification of the Farr assay using ethanol-ammonium acetate precipitation and its application to the measurement of affinity of anti-HCG produced in several species.

A double isotope modified Farr assay was used to determine the total binding sites and affinity of antibodies to human chorionic gonadotrophin. Precipitation of the antigen--antibody complex at equilibrium with ammonium sulphate gave very high levels of nonspecific binding. Good discrimination over background was observed using a specific anti-immunoglobulin serum. However since we were interested in measuring the affinity of antibodies raised in several animal species it was more appropriate to use a single nonspecies precipitating reagent. We found that the use of a mixture of ethanol-ammonium acetate gave very low levels of non-specific binding in baboons, marmosets, rabbits and mice.


Phagocytosis of technetium-99m sulfur colloid by human polymorphonuclear leukocytes.

This study characterizes a new phagocytic assay system utilizing technetium-99m sulfur colloid as the phagocytic particle. Uptake of sulfur colloid by human polymorphonuclear leukocytes is a time and temperature dependent process that requires glucose for optimal uptake. In contrast to many other systems, sulfur colloid phagocytosis appears to be serum and divalent cation independent. An attractive feature of this system is the 10-fold increase in particle uptake with phagocytosis as compared to that at zero time.


A rapid photoelectric method for reading cell migration.

A rapid photoelectric method for reading macrophage migration is described which eliminates drawing and planimetry of cell fans. The results obtained are shown to be concordant with those obtained by planimetry. The time required to read a cell migration experiment is reduced from several hours to a few minutes.


Immune adherence: a quantitative and kinetic analysis.

Quantitative and kinetic analysis of the immune-adherence reaction (IA) between C3b fragments and IA receptors as an agglutination reaction is difficult. Analysis is possible, however, by use of radio-iodinated bovine serum albumin as antigen at low concentrations (less than 200 ng/ml) and optimal concentration of antibody to avoid precipitation of antigen--antibody complexes with human erythrocytes without participation of complement. Antigen and antibody are reacted at 37 degree C, complement is added, the mixture incubated and human erythrocytes added; after further incubation, ice-cold EDTA containing buffer is added and the erythrocytes centrifuged and assayed for radioactivity. Control cells reacted with heated guinea pig serum retained less than 5% of the added radioactivity. The method facilitates measurement of IA reactivity and permits more detailed analysis of the mechanism underlying the reaction.


Epidermodysplasia verruciformis: viral particles in early malignant lesions.

Two cases of epidermodysplasia verruciformis were studied histologically and electron microscopically. Four lesions examined were histologically benign, and had viral particles morphologically similar to that of common human warts. Two lesions on the forehead and the face were histologically in the stages of malignant transformation, the intraepidermal epithelioma and the early invasive squamous cell carcinoma. Similar viral particles were also observed in the upper layers of these 2 lesions. These results suggest that at least some of the virus-induced lesions of epidermodysplasia verruciformis actually become malignant.


The stability of vitamin A-induced metaplasia of mouse vibrissa follicles in vitro.

Tests were made of the stability of the previously described glandular morphogenesis and mucous metaplasia of embryonic mouse vibrissa follicles produced in vitro by excess vitamin A. The changes in individual follicles were observed in living tissue explants and serial sections. Upper lip skin of 13.5-day embryos underwent budding from vibrissa follicles to form branching glands which secreted mucus after 10--14 days in medium containing 4.7 microgram/ml retinol. If this medium was replaced with standard medium after 7 days, glandular morphogenesis and metaplasia continued unaffected, although some hair follicle bases returned to their original morphogenetic program. Similar results were obtained with skin of 13-day embryos treated with vitamin A (6.0 MG/ML) for only 3 days. The moderate degree of glandular morphogenesis in 15-day skin with vitamin A (4.7 microgram/ml) was not altered by the simultaneous addition of a high dose of cortisol (18 microgram/ml). It is suggested that the initiation of glandular morphogenesis of follicles differs from the initiation of mucous metaplasia in embryonic chick epidermis by vitamin A, in that it resembles a new secondary embryonic induction rather than a modulation of the epithelium.


Plasma membranes in psoriatic cells. A freeze-fracture study.

A freeze-fracture study of affected and unaffected psoriatic skin has demonstrated the presence of marked modification of the plasma membrane in the psoriatic lesion. In the lower layers of the epidermis, an increase of membrane associated particles was observed in many keratinocytes, possibly representing the morphological intramembranous equivalent of changes in the outer cell membrane demonstrated with cytochemical techniques. Furthermore, in the malphighian layer, numerous gap junctions have been found, which may be interpreted as a phenomenon compensating the uncontrolled proliferation, and may represent a point of differentiation between cell proliferation in psoriasis and neoplasia. This technique confirmed the poor tendency to adhesion of keratinocytes in extrajunctional areas, which had already been shown by other morphological techniques.


Greater promotion in sister chromatid exchanges by trimethylpsoralen than by 8-methoxypsoralen in the presence of UV-light.

The number of sister chromatid exchanges (SCEs) was determined in normal human leukocytes following exposure in vitro to UV light (365 nm, UV-A) and either 8-methoxypsoralen (8-MOP) or 4,5'8 trimethylpsoralen (TMP). Both psoralens produced an increase in SCEs, proportional to UV dose and concentration of drug. Neither drug alone nor UV alone promoted SCEs. The number of SCEs per cell was greater in leukocytes irradiated in the presence of TMP than in the presence of equimolar 8-MOP. At equimolar concentrations, TMP formed more cross-links than did 8-MOP. The difference in the effects of these 2 agents on various cell functions may relate to quantitative and qualitative differences in the photoadducts they form.


The evaluation of topical anti-inflammatory activity on rat ears subjected to thermal injury.

Topical anti-inflammatory activity of steroidal and non-steroidal agents was assessed on inflammation produced by heat. A burn was produced on the ears of rats and the inflammation was quantitated gravimetrically. Steroidal anti-inflammatory agents were ranked in order of decreasing activity: triamcinolone acetonide, dexamethasone, prednisolone and hydrocortisone acetate. The nonsteroidal agents phenylbutazone and indomethacin were also effective in inhibiting the inflammation. Cholesterol, a steroid devoid of anti-inflammatory activity, was inactive in this test. Hydrocortisone acetate, in particular, appears to be less effective in inhibiting this type of inflammation than inflammation produced by croton oil.


The epidermolytic toxin of Staphylococcus aureus: its failure to bind to cells and its detection in blister fluids of patients with bullous impetigo.

Radioiodinated staphylococcal epidermolytic toxin was found not to bind to erythrocytes, blood leukocytes, trypsin-dispersed keratinocytes, epidermis or whole skin. Moreover the toxin could not be found to bind to murine epithelia by indirect immunofluorescence methods. However, the toxin, measured by radioimmunoassay, could be eluted from the skin of mice undergoing epidermolysis following intraperitoneal injection of toxinogenic Staphylococcus aureus. Furthermore, epidemolysin was measured in the blister fluid of 3 of 5 children with bullous impetigo but not in blister fluid from control patients with other blistering eruptions. Thus epidermolysin has been demonstrated to be present in lesions of the staphylococcal epidermolytic toxin syndrome but its mechanism of action does not involve binding to cells.


Therapy with hyperbaric oxygen for experimental osteomyelitis due to Staphylococcus aureus in rabbits.

Hyperbaric oxygen (HBO) is used as adjunctive therapy of chronic osteomyelitis, but its efficacy remains controversial. A recently developed rabbit model for osteomyelitis due to Staphylococcus aureus was used to compare the results of treatment with HBO, cephalothin, a combination of both, or no treatment. Cultures of bone were positive in 10 (91%) of 11 control animals (untreated), five (36%) of 14 animals treated with HBO, eight (47%) of 17 treated with cephalothin, and six (40%) of 15 treated with HBO plus cephalothin. All three treatment groups differed significantly from untreated controls in the number of positive cultures obtained (P less than 0.01), but there were no significant differences among treatment groups. In vitro growth and killing curves (1.0 microgram of cephalothin/ml) constructed after exposure to HBO revealed no change from parallel control studies in ambient air. These data demonstrate that therapy with HBO is at least as effective as antibiotic therapy. The therapeutic effectiveness of HBO does not appear to be related to antibacterial activity.