Cutaneous basophil anaphylaxis. Immediate vasopermeability increases and anaphylactic degranulation of basophils at delayed hypersensitivity reactions challenged with additional antigen.

Many delayed-type reactions contain large infiltrates of basophils whose function is unknown. We have studied these cutaneous basophil hypersensitivity (CBH) reactions in guinea-pigs to ascertain whether basophils that are recruited to delayed reaction sites could be triggered for immediate reactivity. We compared 24 h CBH reactions with nearby skin for immediate hypersensitivity by challenging each site with small amounts of antigen. CBH sites had augmented immediate increases in vascular permeability detected by extravasation of Evan's blue dye. The ability to elicit this augmented anaphylactic phenomenon correlated with the local presence of basophils, and light microscopy at CBH reactions 15 min after antigen challenge showed a 50% decline in basophil counts. Electron microscopy showed that progressive anaphylactic-type degranulation of local basophils occurred within minutes following reintroduction of antigen. There was fusion of vacuoles containing granules, exocytosis of granules, and dissolution of granules, without ultrastructural disruption of cellular integrity. These results establish that basophils in CBH reactions can be triggered with soluble antigen to undergo anaphylactic degranulation, with the immediate release of vasoactive mediators. We have termed this phenomenon 'cutaneous basophil anaphylaxis'. Thus, one function of basophils at sites of delayed hypersensitivity may be to provide the potential for augmented, local, immediate anaphylactic reactivity.


Experimental bovine trypanosomiasis. Changes in the catabolism of serum immunoglobulins and complement components in infected cattle.

The turnover of serum proteins of calves experimentally infected with Trypanosoma congolense was compared to that of normal uninfected cattle. All proteins examined had much increased catabolic rates in infected animals. In normal animals the average half-lives in days for each protein were: IgG1 17.4, IgG2 22.4, IgM 4.8, IgA 3.4, IgE 1.9, C1 5.6 and C3 2.9. In trypanosome infected cattle the average half-lives were IgG1 1.9, IgG2 1.7, IgM 0.9, IgA 1.2, IgE 0.9, C1 1.2 and C3 1.1 days.


Experimental bovine trypanosomiasis. Changes in serum immunoglobulins, complement and complement components in infected animals.

In three calves experimentally infected with Trypanosoma congolense the amounts of IgG1 and IgG2 were little changed and similar to those of normal animals. IgM increased in amount early in the infection and the amount of the increase appeared related to the parasite burden. The amounts of IgA and IgE were both much decreased and this also appeared related to the numbers of parasites in the blood. There was a decrease in the amounts of total haemolytic complement and complement components C1, C1q and C3 in the infected calves. Furthermore the amounts of properdin fluctuated with the cyclical changes in numbers of T. congolense parasites in the individual calves. No significant change in the amount of C8 was observed. It is considered that activation of both the alternative and the classical complement pathways occurs in trypanosome infected animals but that neither pathway goes to its terminal stages.


The mode of interaction with macrophages of two ordered synthetic polypeptides which differ in their thymus dependency.

The mode of interaction with macrophages of two ordered synthetic polypeptides (Tyr-Tyr-Glu-Glu)-poly(DLAla)--poly(Lys), (T-T-G-G)-A--L, and (Tyr-Glu-Tyr-Glu)-poly(DLAla)--poly(Lys), (T-G-T-G)-A--L, which differ in their requirements for T-B cell co-operation in the process of antibody production, was compared. The binding of the two radiolabelled antigens to the surface of peritoneal adherent cells, their uptake by the cells and the rate of their degradation were investigated. Macrophages were found to be capable of degrading both poly-peptides with the same efficiency. (T-G-T-G)-A--L, the antigen which is less T-dependent, was bound to macrophage surfaces more readily than (T-T-G-G)-A--L, the T-dependent antigen, however, its uptake by the cells was found to be lower. Thus, (T-G-T-G)-A--L remains for a longer period in the form of a membrane bound polyvalent antigen.


A study of urinary creatinine and creatinine coefficient in healthy young adults.

Daily urinary creatinine excretion and creatinine coefficient of eighty-four healthy medical students have been studied for three consecutive days. Daily creatinine excretion has been observed to be higher in the male subjects compared to the female counterparts. Creatinine excretion has been observed to be dependent on body weight of the subjects. The variability from subject to subject was higher than observed by most other workers. Day to day consistency within the same subject was rather low. Creatinine coefficient was computed per kg of body weight as well as per kg of lean body weight. In both the cases, it has been found to be higher in the males than in the females. Though an important factor, yet body weight of a subject alone could not explain satisfactorily wide variability of creatinine excretion in the present study. The possible influencing factors have been discussed along with clinical implications.


The effects of excess calcium on the acetylcholine turnover from the minced and incubated rat's brain.

The incubation of brain mince in ERL and ERL with excess calcium was done separately for periods ranging from 30 min to 3 hrs, along with simultaneous determination of free and bound values of Acetylcholine (Ach). Zero and 5 min values were also determined for each incubation experiment before any substantial increase in enzymatic activity. Ach was bioassayed on Rat's blood pressure. In ERL incubations, the release and synthesis of Ach increased along with time, highest being at 3 hrs the release is found to be greater than the synthesis. With excess calcium, there is a slight but gradual increase in free and bound Ach. In the first 30 min incubation, synthesis is more than the release whereas in the latter periods reverse is the case, though they were low when compared to normal at 3 hrs. The effects of excess calcium in the ERL controlling the membrane permeability and enzymatic system of the nerve cell are discussed.


Beta blockade and anticonvulsant activity of propranolol.

Racemic and dextro forms of propranolol were equipotent in their anticonvulsant activity in normal rats by the MES test. In an attempt to determine any difference in the anticonvulsant activity of the two forms a variety of adrenergic agents were used, viz. phenoxybenzamine, reserpine, alphamethyl dopa and acetazolamide. There was no difference between the two forms, in the absence or presence of several adrenergic drugs employed. However, racemic but not dextro propranolol reduced MET, in normal as well as in nialamide primed rats.


Effect of acetazolamide on insulin sensitivity in dogs with alloxan diabetes.

The effect of acetazolamide on the sensitivity to exogenous insulin in the alloxanised diabetic dogs was studied. The administration of acetazolamide caused acidosis and insulin resistance. The liver insulinase activity of diabetic dogs after acetazolamide administration was also studied to evaluate the role of this enzyme for the destruction of exogenous insulin. It was observed that insulinase did not play role for the development of insulin resistance after acetazolamide administration.


Monoamine oxidase activity in the pituitary of mice after estrogen, progesterone and centchroman treatment.

Monoamine oxidase activity (MAO) was estimated in the pituitary of ovariectomized mice after a single administration of estradiol-dipropionate (0.01 mg/kg; im), progesterone (1 mg/kg; im) and centchroman (1.25 mg/kg ip). Estrogen and progesterone were found to decrease the enzymic level, as compared to control, while centchroman remarkably increased it. The significance of dissimilarity in the pituitary threshold for steroidal and nonsteroidal molecule is discussed.


Effect of administration of isatin on alkaline phosphatase of various organs of rat.

In vivo administration of isatin (200 mg/kg) significantly lowered the activity of rat kidney alkaline phosphatase after 5 hr but enhanced the activity of rat duodenal and jejunal enzyme after 2 and 5 hr (P less than 0.01). The increased activity of the duodenal and jejunal alkaline phosphatase might be due to the induction of the enzyme by isatin.


Effectiveness of N-N-bis-P-chlorophenyl-3p-tolyl glutaric acid diamide (SRC-3605) as a hypocholesterolaemic compound in hypercholesterolaemic female weanling and adult rats.

SRC-3605, N-N-bis-P-chlorophenyl 3-p-tolyl glutaric acid diamide, was studied for its hypocholesterolaemic effect on serum and liver cholesterol in hypercholesterolaemic weanling and adult female rats. Weanlings were administered doses of SRC-3605 ranging from 100 to 300 mg/kg body weight for 4 or 8 consecutive days. The greatest hypocholesterolaemic effect was observed with doses of 150, 200 and 250 mg, although a progressive decreases in serum cholesterol was noted with increasing doses. Hepatic cholesterol decreases supported the serum data, but were inconsistent. Hypercholesterolaemic adult animals received 50, 100, 150 or 200 mg/kg body weight of either SRC-3605 or clofibrinic acid for 4 days. A decrease in serum cholesterol levels was observed only with the 200 mg SRC-3605. No clear-cut influence of the either compounds was found on hepatic cholesterol. The results indicated that SRC-3605 possesses the property to reduce both serum and liver cholesterol in hypocholesterolaemic weanling female rats.


An improvised technique for the measurement of influence of drugs on the spontaneous motility (S.M.A.) of rats.

An improvised, yet simple technique for the evaluation of drugs affecting voluntary activity is described with certain modifications and incorporation of common instruments. The technique imparts semi quantitative information which is lacking in the many described in the literature.


Local anaesthetic activity of some sec-amino-N-(aryl-aralkyl)-ethyl acetamides.

Six basic amides were screened for local anaesthetic activity and compared with procaine and lignocaine. Amongst the basic amides screened, piperidino-N-(alpha-4-ethoxy phenyl- beta-phenyl) ethyl and Diethylamino-N (alpha-4-ethoxy- beta-phenyl) ethyl acetamide were found to be more effective as compared to lignocaine. They were found to be non-irritant, and non-toxic even in high doses.


Developments in the prevention of road injuries.

Selected studies of road injury causation since 1960 are reviewed together with corresponding methods of prevention. British road accident deaths have remained relatively low in spite of greatly increased numbers of vehicles. Though not the only factors, improvements in car design and in safety equipment of vehicles have contributed to injury prevention.


The management of knife wounds of the neck.

Eighteen cases of knife wounds of the neck are presented. Urgent operation was required in each case. Clinical assessment and resuscitation are discussed and a plan of management, with specific reference to major vascular injuries, is outlined. The operative approaches are described in detail. Methods of repair, results and complications are discussed.


Stimulation of human NK-cell activity by cultured cells. I. Response of normals.

Natural cell-mediated cytotoxicity, observed on co-cultivation of peripheral blood lymphocytes (PBL) with malignant melanoma tumor cells (M4), is described. The activity was inhibited when PBL were cultured in autologous serum. Studies using competitive inhibition with cold targets and stimulation of PBL with other tumor cell lines failed to detect specificity.


Effect of ricin and abrin on survival of L1210 leukemic mice and on leukemic and normal bone-marrow cells.

The effect of ricin and abrin on the survival of mice treated with L1210 leukemic cells intraperitoneally or intravenously was studied. In mice given 1 X 10(5) L1210 leukemia cells intraperitoneally a single dose of ricin (2.1 microgram/kg) intraperitoneally gave the best results, an increased life span (ILS) of 59%. Abrin also increased the life span of such animals although to a lesser extent. The effect of ricin was superior to that of 5-fluorouracil, but inferior to that of adriamycin, which gave a maximum ILS of 280%. In mice given L1210 cells intravenously no increase in life span was obtained with ricin, abrin or adiramycin, whereas 5-fluorouracil gave an ILS of 40-50%. In spleen colony assays the differential effect of ricin and abrin on the proliferative capacity of normal hematopoietic and leukemic colony-forming cells in bone marrow was studied. The differential effect of ricin was as good as that of adriamycin and considerably better than that of 5-fluorouracil. Abrin had a much smaller effect than ricin on both normal and leukemic cells. The effect of abrin on the leukemic cells was too small to be of therapeutic value. The results warrant exploration of the use of ricin in the treatment of human leukemia.


Immunotherapy with an intralesionally administered synthetic cord factor analogue.

Injection of emulsified 6,6'-di-O-2-tetradecyl-3-hydroxyoctadecanoyl-a, a trehalose designated C76, a synthetic analogue of the mycobacterial glycolipid trehalose-6,6'-dimycolate (TDM), into transplants of an established, syngeneic murine fibrosarcoma induced complete regression of tumor in a number of animals. The number of animals in which tumor regressed completely dependent on the amount of oil in the emulsion. On a weight basis, C76 was at least as active as TDM. Intralesional injection of an emulsified mixture of C76 and endotoxin (ET) or of TDM and ET caused regression of an established transplant of a guinea-pig hepatoma in syngeneic animals. In mice, intravenously administered emulsions of C76 were less toxic and less granulomagenic than those made with TDM.


Induction of a tumor with greatly increased metastatic growth potential by injection of cells from a low-metastatic H-2 heterozygous tumor cell line into an H-2 incompatible parental strain.

An H-2 heterozygous sarcoma, MDAY, originally induced with methylcholanthrene in an (A X DBA/2)F1 ((H-2a X H-2d) hybrid host was selected for growth in the H-2d homoxygous parental DBA/2 strain by serial intraperitoneal transplantation of ascites tumor cells. An apparent variant, designated MDAY-D2, was obtained which showed the expected loss of the private and public H-2Kk haplotype antigens normally associated with the A strain parent and the original MDAY tumor. Comparison of the original and variant lines revealed a wide variety of a cell surface antigen and receptor differences. Both tumors were found to be highly anaplastic and histologically unclasssifiable. Examination of the two tumor lines growing in vivo revealed a remarkable difference in their metastatic growth potential. The original MDAY line showed little propensity to spread to any organ site, with the occasional exception of liver, after subcutaneous inoculation of (A X DBA/2)F1 mice. In striking contrast, there was a rapid and massive spread of MDAY-D2 to liver, spleen, lungs and kidneys within 12-16 days: liver and spleen could be totally replaced by tumor within 2-3 weeks. These characteristics were observed in both (A X DBA/2)F1 and DBA/2 mice. The tendency to metastasize, as well as loss of the H-2Kk haplotype, appeared stable and irreversible. Although the precise origin of MDAY-D2 is not clear, its metastasizing properties are unique, making it a useful and desirable model to study the biology of metastasis.


Cytotoxic activity of guinea-pig lymph node cells stimulated in vitro.

Guinea-pig lymph-node cells (LNC) cultured for 5 days in medium containing fetal calf serum (FCS) were cytotoxic to various target cells. LNC cultured in medium supplemented with fresh, autologous guinea-pig serum (GPS) instead of FCS were not detectably cytotoxic unless agents that stimulate lymphocyte proliferation were added to the culture medium. The stimulating agents we studied were 2-mercaptoethanol (2-ME), syngeneic tumor cells, allogeneic peritoneal exudate cells (PEC) and the T-cell mitogens concanavalin A (Con A) and phytohemagglutinin (PHA). LNC cultured in the presence of these agents were cytotoxic to normal syngeneic fibroblasts and to syngeneic, allogeneic or xenogeneic tumor cells but not to PHA-induced lymphoblasts. Potentiation of cytotoxicity in vitro was accompanied by a marked proliferation of the cultured LNC; the combination of several stimulatory agents had an additive effect on the generation of cytotoxicity in culture.


Enhancement of thermal killing by polyamines. I. Survival of Chinese hamster cells.

Exposure of Chinese hamster cells to polyamines at an elevated temperature (42 degrees C) results in synergistic cell killing. The effectiveness of polyamines in potentiating thermal killing decreases in the following order: spermine greater than spermidine greater than cadaverine greater than putrescine. The magnitude of the synergism increases with exposure time. The survival curves, when plotted as a function of polyamine concentration, display a shoulder during 1 h exposure at 42 degrees C, followed by exponential cell killing. Longer exposure times eliminate the shoulder and result in steeper slopes of the survival curves. The effect is maximal when exposure to polyamines and heat is simultaneous. Separation in time between the two treatments causes a rapid disappearance of the synergism. The order of application is of only minor importance in this regard. The results suggest that the intracellular level of spermine may be a major factor in determining heat sensitivity of Chinese hamster cells.


Enhancement of thermal killing by polyamines. II. Uptake and metabolism of exogenous polyamines in hyperthermic Chinese hamster cells.

The uptake and metabolism of the polyamines spermine, spermidine, cadaverine and putrescine, previously shown to potentiate heat sensitivity, were studied in cultured Chinese hamster cells. Heat (42 degrees C) causes enhanced uptake of exogenously supplied polyamines into the acid-soluble fraction of the cells. Putrescine is taken up exceptionally fast at 37 degrees C, about 10 times faster than its homologue, cadaverine. This uptake is slower at 42 degrees C. The polyamines taken up were metabolized to some extent and the metabolites were similar at 37 degrees C and 42 degrees C except in the case of putrescine. These results suggest that potentiation of heat-sensitivity is probably mediated by the polyamines as such and not by their metabolites. Polyamines slightly protect the cells against the inhibitory effect of heat on RNA and protein synthesis. It is suggested that exogenous polyamines interact with nucleic acids inside the cell, and this interaction may underlie their synergism with heat. The exact nature of this interaction and the way it leads to enhanced thermal sensitivity are still obscure.


Cancer and "cancer related" colorectal lesions in São Paulo, Brazil.

A series of 832 necropsy specimens were studied grossly with a magnifying lens and all lesions identified were studied microscopically. The age and sex-specific prevalence of adenomatous and hyperplastic polyps is reported and results are compared with those of other populations. A correlation was made between polyps and cancer of the colon and rectum (407 cases). The data suggest that São Paulo is a community in a transitional stage between intermediate and high risk of cancer of the colon. The epidemiologic characteristics of lower rectum cancer are peculiar to some populations and appear unrelated to colon cancer. The black population of São Paulo has a higher prevalence than that reported for African negroes. The data also implicate adenomatous polyps, diverticulosis and hemorrhoids as being probably related diseases.


Abnormalities in evening plasma prolactin levels in nulliparous women with benign or malignant breast disease.

In the present study the assay results of prolactin concentrations in serial samples of blood obtained from premenopausal women with benign or malignant disease of the breast are compared with--and discussed in relation to--findings reported in earlier studies based on single samples of blood taken at various times from a large and ostensibly normal population of women. The finding of an abnormality in nycthemeral prolactin levels in the established disease is considered to strengthen the concept that the same abnormality found in high-risk groups is of aetiological importance.


An abnormal early evening peak of plasma prolactin in nulliparous and obese post-menopausal women.

Plasma specimens were obtained in the afternoon (13.30 to 17.29 h) from 668 post-menopausal women and in the evening (17.30 to 20.30 h) from 219 further women. The mean evening plasma prolactin level was significantly higher than that found in the afternoon (p less than 0.0007). Mean afternoon prolactin levels were not related to nulliparity and body weight. In nulliparous obese women the mean of the evening peak prolactin concentrations was double that of comparable women studied in the afternoon (p less than 0.003).


Oral contraceptives and breast disease in premenopausal Northern Albertan women.

The results of a prospective study on oral contraceptive use and breast disease in northern Alberta are presented. The study groups comprised all women aged 30 to 49 examined in diagnostic breast clinics at the Cross Cancer Institute between 1971 and 1974. Three hundred and one patients had breast cancer, 692 had a subsequent biopsy for a benign breast condition, and 548 had no subsequent biopsy. A tendency for an increased relative risk (RR) of breast cancer in women taking oral contraceptives for periods of 1 to 5 years was evident, with relative risk decreased or unaffected in users of less than 12 months (RR = 0.6) or more than 5 years (RR = 1.0). A slightly increased risk was apparent in patients using oral contraceptives within a year prior to attendance at the clinic (recent users); this increase was emphasized when recent users with a prior biopsy for benign breast disease were analyzed alone (RR = 5.0). In women with a prior breast biopsy, use of oral contraceptives for more than 5 years increased risk of breast cancer nine-fold. Former users who had taken oral contraceptives for less than a year showed a significant reduction in breast cancer risk (RR = 0.3). The risk of benign breast disease was also reduced in former users (RR = 0.6) as well as in long-term users (RR = 0.5).


The effect of fibre size on the in vitro biological activity of three types of amphibole asbestos.

Three standard (UICC) samples of amphibole asbestos were subjected to ball-milling; the main effect of this procedure was to reduce the length of the fibres present in each sample. The numbers of fibres in unit masses, and the distribution of fibre sizes in all the samples, both parent and milled, were estimated from electron micrographs. The ability of all the samples to reduce the plating efficiency of V79-4 cells is compared, on the basis of mass, fibre number and fibre number number above various length thresholds. This biological activity of all the samples correlated best with the number of fibres above a threshold length of 6.5 micron. This is compared with the sizes of fibre previously reported to induce mesotheliomata when implanted into the pleural cavities of rats.


Effects on in vitro tumor growth of murine macrophages isolated from sarcoma lines differing in immunogenicity and metastasizing capacity.

Macrophages were isolated from the strongly immunogenic, non-metastasizing FS6 sarcoma transplanted in syngeneic C57BL/6 mice and from a weakly immunogenic, spontaneously metastasizing line (mFS6) of the same tumor. Macrophages isolated from the FS6 sarcoma non-specifically inhibited growth and DNA synthesis of tumor cells in vitro. After culture FS6 macrophages rapidly lost their cytotoxic activity and became capable of non-specifically stimulating tumor growth in vitro. Macrophages obtained from the mFS6 tumor non-specifically enhanced the proliferative activity of tumor target cells and this capacity was maintained when the macrophages were cultured.


Serum methadone as an aid in managing methadone maintenance patients.

Serial serum methadone levels were obtained in two patients who were experiencing significant difficulties (including subjective and objective evidence of the opiate withdrawal syndrome) while on methadone maintenance. A precipitous drop in blood levels of methadone was recorded 2 to 6 hours after ingestion. It was during this same time period that withdrawal symptoms were most severe. When methadone was administered on a divided dosage regimen, there was a dramatic clinical improvement in both patients and a marked flattening of the curve of serum methadone levels. This pilot study suggests that the current practice of administering methadone as a single daily dose to all patients needs reconsideration; serial serum methadone levels may be helpful in determining which patients do better on a divided dosage regimen.


An evaluation of services provided drug abusers in an emergency room.

This study examines the services provided to drug abusers seen in an emergency room. Research was conducted soley via an examination of hospital records. Patient characteristics were related to the level of services provided, i.e., admission, referral, etc. It was determined that services delivered were generally appropriate to the needs of the patients. However, there appeared to be somewhat of a lack of early intervention services for patients who did not exhibit acute distress. Possible means of enhancing these services are discussed.


Client demographics and therapeutic approach as predictive factors in the in-treatment outcomes of opiate users.

This study examines the effect of pretreatment role involvements and therapeutic environment on the level of in-treatment client perfromance in a sample of 704 nonopiate users. Within the sample, treatment type is found to have minimal predictive utility for success on selected measures of performance.


Drug usage as determined under conditions of anonymity and high questionnaire return rate.

The present study had three principal purposes: (1) to collect, on one sample, information concerning lifetime usage of major drugs, overall frequency of usage, places and situations of initial usage, and exposure to drug usage through social group contacts; (2) to assure subjects of absolute anonymity in order to avoid biases introduced by identification of subjects; and (3) to obtain high questionnaire return rates in order to assure reduction of sample biases. A drug survey questionnaire dealing with marijuana, amphetamines, heroine, hallucinogens, tranquilizers, and antidepressants was administered in classroom settings to a total of 332 college students. Subjects did not record their names and thus were assured of complete anonymity. The return rate for questionnaires was 99.4%. Data were subgrouped for analysis to differentiate freshmen and upperclassmen and to differentiate males and females. For various subgroups, lifetime usage of marijuana and LSD ranged from 55 to 80.6% and from 14 to 30%, respectively. Current use ranged from 30.1 to 62.5% for marijuana and from 2.5 to 9.1% for hallucinogens. Sex differences were minimal, and usage levels were generally higher in upperclassmen than in freshmen.


Contingency management in a methadone maintenance program: availability of reinforcers.

A survey was conducted to identify clinic privileges that might serve as reinforcers for a group of methadone maintenance clients. Fifty-three clients ranked nine clinic privileges according to their desirability. The opportunity to take medication home from the clinic on 4 days of the week was ranked as most desirable, on the average, followed by receiving cash payments ($30 and $10) and the opportunity for limited dosage self-control. Medication take-home privileges appear to be the most potent potential reinforcer available in the context of a methadone clinic.


Family life and levels of involvement in an adolescent heroin epidemic.

Family life was examined in relation to different levels of heroin involvement, use of other drugs, and deviant behavior. The study population included heroin addicts, experimenters, persons exposed but not using heroin, and a comparison sample of persons who neither used nor were exposed to heroin. More elements of family life were related to heroin use by females than males. The relationship with the opposite sex parent had the strongest impact on both male and female heroin users.


Early adolescent antecedents of narcotic abuse.

A retrospective study of the sociocultural and behavioral characteristics of 200 persons under treatment for narcotic addiction was done and the results compared with those of 200 matched nonaddict peers. Twenty-eight of the original 104 items tested were found to discriminate between the two samples at the 5% level of significance. A factor analysis of these items indicated that a general delinquency behavior factor and three family background factors accounted for most of the variance in the data.


Focus on the family as a factor in differential treatment outcome.

The prognostic relationship between prehospital living arrangements and treatment outcome was explored. Drug (N = 17) and alcohol (N = 19) patients who had lived with parents, wives, nonrelatives, or alone before voluntary admission to an inpatient substance abuse program were compared on changes in social dysfunctioning and symptomatology as a result of treatment. Ratings on each patient's level of dysfunctioning and symptomatology were made following intake into the program and within a 3-day period after receiving a regular discharge. While treatment had a positive effect on all groups, multivariate analysis of covariance showed a significant (P less than .009) differential rate of improvement between the pretreatment residential setting groups. Those who had lived alone or with nonrelatives prior to admission changed the most, becoming significantly less dysfunctional and symptomatic. Those coming from parental families changed the least improvement, while those who had lived with their spouses showed moderate improvement. Findings were consistent for both drug and alcohol patients. Results indicate that the type of home environment from which substance abusers come before engaging in treatment significantly influences their receptivity to rehabilitation. Findings suggest the need for assessment of the family environment and utilization of community resources as a means of enhancing adjustment.


The effect of prior treatment on treatment success.

The characteristics of clients discharged from federally funded treatment facilities reporting to CODAP are analyzed in terms of several variables. These are the reasons for discharge (treatment completed, transfer or referral, or treatment not completed), the primary drug of abuse at admission (opiates and nonopiates), and the number of prior treatment experiences. Two independent replications using data for two consecutive quarters produced the same results, finding that the likelihood of completing treatment decreases as the number of prior treatment experiences increases. This relationship was found to apply to both opiate and nonopiate users. Although large differences exist in completion rates between opiate and nonopiate users without prior treatment experience, only small differences exist between opiate and nonopiate users who have had prior treatment. The largest difference in treatment outcome occurs between those with no prior treatment and those who have been treated before. Having one or more prior treatment experiences does not seem to have a major impact on the probability of completing treatment.


Positive reactions of alcoholic men to sensory deprivation.

Ten male alcoholics who had been abstinent for 2 to 9 weeks volunteered to participate in a study on the effects of sensory deprivation. After 8 hours of lying on a bed in a dark, silent room, they indicated on various measures that they had found the experience to be quite pleasant; in fact, they indicated that they had more frequent positive experiences and less frequent negative experiences than in normal life. This finding indicates that sensory deprivation may be an acceptable treatment modality for alcoholics, as it has been for other clinical population.


An investigation of procedures reported to increase potency of marijuana: a chemical analysis and psychological interpretation.

Three basic procedures from the "underground press" for increasing the potency of marijuana were tested quantitatively: Black Merta, Dry Ice, and isopropanol--water extraction. In all methods there was not significant change in THC, CBN, or CBD content before and after treatment. The persistence of procedures which have no measurable effect on the chemical properties of the drug is presented as additional evidence for the importance of psychological factors in perceived drug effects.


Opiate addiction: a study identifying three systematically related psychological correlates.

The present study attempted to make a contribution to the badly needed body of systematic psychological knowledge about the contemporary heroin addict. Addicts and nonaddict controls were contrasted in terms of three psychological dimensions: selfesteem (SE), future time perspective (FTP), and locus of control (LC). These constructs were chosen on the basis of their status as important personality and rehabilitation variables. When contrasted with nonaddict controls, heroin addicts were clearly shown to have low SE, a foreshortened FTP, and an external LC. While further empirical studies are necessary, these constructs, as a group, may have utility as addiction criterion or rehabilitation variables for the understanding, treatment, and prevention of opiate addiction.


The effects of alcoholism training on the knowledge, attitudes, and drinking behavior of college students in the human services.

This study reports on the impact of clinically oriented alcoholism training on undergraduate students in the human services preparing for entry level counseling positions. Specifically, this study was designed to determine whether training in alcoholism influences students' knowledge and attitudes toward alcohol and alcoholism and their personal drinking behavior.


Alcohol use in the opiate use cycle of the heroin addict.

Ninety-six methadone maintained patients selected at random from a private clinic were interviewed to explore lifetime patterns of alcohol use in relation to opiate use. The results indicated that most addicts who ever drank excessively (in alcoholic, problem, or heavy patterns) did so primarily during two periods: prior to becoming addicted to narcotics and during periods of voluntary abstinence from narcotics. Further, most of the addicts who were drinking in excessive patterns while maintained on methadone had pretreatment histories of similar alcohol use.


Predicting initial use of marijuana from correlates of marijuana use: assessment of panel and cross-sectional data 1969--1976.

Data from two college-student samples, collected through a panel design from 1969 to 1973 and a cross-sectional design in 1976, were analyzed to address three questions regarding initial marijuana use: (1) Which variables, believed associated with marijuana use, are most salient to predicting initial use of the drug? (2) Are variables salient to predicting initial use of marijuana consistent in predicting initial over time? (3) Do any salient variables operate in combination to predict initial marijuana use? Results indicated that salience of the variables to predicting initial marijuana use changed over time. Implications for drug-use prediction are offered based on the findings.


Placebo attribution in methadone patients.

The effect of external cues on the attributed effectiveness of a placebo was evaluated with methadone patients and a nonaddict control group. Two sources of external feedback, implicit dosage strength (liquid drug color) and explicit performance information (pursuit rotor feedback), were varied along with drug usage. The results indicated that the methadone patients made significantly greater placebo attributions and relied more upon the external cues in making those attributions than did the nonaddict control group. Implications for drug therapy are presented.


Methadone maintenance: an assessment of potential fluctuations in behavior between doses.

Thirty methadone maintenance outpatients were measured 1 and 25 hours after ingestion of methadone on auditory threshold, distance perception, simple and differential reaction time, time perception, attention span, and short-term memory. The results revealed a small but statistically significant difference between the two tests for distance perception. In addition, treatment interacted with preparatory interval on differential reaction time and with sex on attention span.


Gamblers Anonymous in Israel: a participant observation study of a self-help group.

This participant observation study of the first Gamblers Anonymous group in Israel is designed to show (1) the ways in which the group helps it members rehabilitate themselves, (2) the three stages through which they must go in order to ensure success, and (3) the reason why some participants fail to do so. The article concludes with a number of observations concerning the extent of gambling in Israel and the different ways that should be developed for dealing with the problem.


Predictors of drinking and signs of heavy drinking among high school students.

This paper reports an investigation of factors associated with drinking and heavy drinking among high school students. The relative importance of social characteristics, parental drinking and parental rejection and control are assessed. Data were obtained from 1,439 students in two high schools. It is found that most students drink, but most drink infrequently (less than once a week and one or two drinks at time). Multivariate analysis using the MCA program indicates that students who frequently get drunk are those who are heavy drinkers, drink away from home and in cars, and whose drinking is not known to their parents. Parents' drinking and parental rejection and control have little unique explanatory power. It is suggested that parental modeling may be of most importance at the outset of drinking, whereas place and extent of drinking is most important in predicting the signs of heavy drinking.


"Compulsive" gambling: the problem of definition.

A model depicting 16 varieties of healthy and pathological gambling is presented. The 16 varieties are formed by combinations of 4 variables--money (won or lost), time devoted to gambling (a lot or a little), other people (negatively affected or not affected), and the gambler's feelings (feels good or bad about his gambling). The model has a logical base and is multifaceted. Its purpose is to force the serious student of gambling to consider alll 16 forms, not just the pathological forms. Certain philosophical, ethical, social, and scientific questions arise.


Effects of client characteristics on admission activity in United States federally funded drug treatment facilities.

Utilizing data from the National Institute on Drug Abuse's CODAP, this paper examines the effect of client characteristics and drug of abuse on certain admission activity variables. It generally sustains the hypotheses (1) that the demographic characteristics of clients (i.e., sex, age, race-ethnicity, and education) admitted to treatment have no effect on admission activity and (2) that type of primary drug problem (opiates, marijuana, alcohol, barbiturates, and amphetamines) at admission is strongly associated with admission activity. The implications of these data for nondiscriminatory admissions policies; for effective utilization of intake, treatment, and follow-up resources; and for training treatment agents are discussed.


Prevention of drug overdosage: current strategies and implications for policy.

The efficacy of using secondary and tertiary prevention approaches for drug overdosage has been questioned. This paper examines new approaches that are required and the manner in which they can be implemented as part of a public policy that emphasizes primary prevention. Rather than viewing self-injury as a manifestation of individual pathology, we need to focus on the role of acceptability and availability of drugs in the use and misuse of psychoactive substances. The potential utility of such a model is extrapolated from previous research on alcohol, and alternative plans are outlined.


A comparison of chronic versus casual marijuana users on personal values and behavioral orientations.

Fifty-one chronic (daily) long-term marijuana smokers and 32 casual (1 to 3 times per week) users were interviewed and given a Rokeach Value Survey, a Personal Orientation Inventory (POI), and a Zuckerman Multiple Affect Adjective Check List. Value survey results showed that the two groups had the same general value structure. The POI showed no differences between the groups, and the adjective self-ratings were similar. The groups were significantly different on a number of social variables; number of user friends, longest period without drugs, perceived risk, etc., which indicated "drug subculture involvement." Results are discussed from a sociological point of view.


Research design in drug abuse prevention: review and recommendations.

This paper highlights the strengths and notes the deficits in recent drug abuse prevention research design. Then it recommends that future studies include: (1) a longer follow-up period than 2 years, (2) a population "at risk" for drug abuse, (3) a "natural setting," (4) random assignment to program and nonprogram groups, and (5) objective drug use interviews along with unotrusive measures of the correlates of drug abuse. The rationale behind each recommendation is discussed.


Value comparisons between alcoholics, nonalcoholics, and therapists.

The values of clients, alcoholics and nonalcoholics (N = 118), were compared to the values of therapists (N = 45). Value comparisons were also made between alcoholics and nonalcoholics as well as between these subgroups and therapists. Distinctive value patterns emerged which were peculiar to therapists and to clients and differentiated them from each other. Value priorities of therapists were those which loaded on factors of self-expansion, competence, and other directedness, whereas the value priorities of clients were those which load on factors of self-constriction, religious morality, and inner-directedness. Few values were found to discriminate between the alcoholic and nonalcoholic. The alcoholic placed a higher value on "self-control," "social recognition," and "a sense of accomplishment" than the nonalcoholic. The results are discussed in the light of a deprivation hypothesis and the implication they have for therapeutic intervention with the alcoholic.


Migration of physicians and nurses: a world wide picture.

WHO's Multinational Study of the International Migration of Physicians and Nurses, the subject of this paper, was the first step of WHO's response to a mandate calling for a study of health manpower migration and for collaborative efforts to regulate such migration where found to be undesirable. The study, which is both diagnostic and prescriptive, is based on an extensive library of published and unpublished literature. Major reports emanating from the study were: an analytical review of the literature; a statistical report on stocks and flows of migrant physicians and nurses for each of 137 countries; and a final report which provides an in-depth analysis of the characteristics of the migrants, the dimensions, directions, possible determinants, and consequences of the migration, and the actions taken by countries to regulate migration. It also suggests options for dealing with undesirable migration. Perhaps the most important finding is that countries which produce far more physicians and nurses than they can economically afford become donors of such manpower and those that produce fewer than they can afford become recipients. Almost all other factors either derive from or are secondary to the economic factor.


Benign and malignant breast tumours: epidemiological similarities.

Reproductive risk factors were estimated for 783 cases of cystic disease of the breast, 155 fibroadenoma, 94 miscellaneous breast conditions, and 284 breast cancers. Controls were matched for age, race, ever-married status, time of hospitalization and pay status. The most consistent attributes are a tendency to be still premenopausal, to have had her first pregnancy beyond the age of twenty-five years (or to have had none), and to have had fewer total pregnancies than the control. All are associated with a longer menstrual life prior to onset of the disease than the controls. Findings for cystic disease are compared with other studies. Patients with benign breast disease share some of the demonstrated risk factors for breast cancer.


Excess mortality and influenza surveillance in Taiwan.

Excess mortality has proven to be a useful epidemiologic tool for influenza surveillance in the temperate zone. A retrospective analysis of the epidemiology of influenza in Taiwan was undertaken to explore the usefulness of this technique in the tropical--subtropical zone. Excess mortality similar to that observed during influenza epidemics in the temperate zone was noted during periods of previously recognized influenza epidemics in Taiwan. For the very young and the elderly excess mortality was observed to be even higher than in the temperate zone. Virus isolations, increased school absenteeism, and high clinical attack rates were also noted during influenza epidemics. Use of these epidemiologic techniques in Taiwan proved to be a useful approach to describe the impact of influenza.


Influenza and ischaemic heart disease--a possible trigger for acute myocardial infarction?

Prompted by a clinical observation of an increase in hospital admissions for acute myocardial infarction during an influenza outbreak, a study was designed to examine the number of deaths from ischaemic heart disease (IHD) at the time of influenza. Deaths from IHD were found to be increased at all ages, and particularly in younger age groups when deaths attributed specifically to acute myocardial infarction are considered. The question of whether influenza could act as a precipitating factor in acute myocardial infarction is discussed, together with a possible mechanism.


Screening of the thyroid function of newborns in Southern Belgium.

Data on T4 and TSH values derived from a voluntary screening programme of thyroid function in Belgium are presented. Significant differences in T4 values according to sex, maturity and birthplace are shown.


Prevalence at birth of congenital malformations in Athens, Greece, 1955--1965.

The prevalence at birth of congenital malformations in Athens was studied in a sample of 74,390 live and stillborn infants, born to women attending a large University Maternity Hospital during 1955--1965. A total of 1534 malformed infants was identified (20.62 per 1000 newborn). The prevalence of anencephalus and spina bifida is lower in Athens than in the United Kingdom, whereas the frequency of other malformations in rather similar in the two countries.


Sex roles as variables in the interpretation of morbidity data: a methodological critique.

Data on sex differences in morbidity are summarized: explanations are sought in the methods of data collection. It is shown that sex differences in morbidity are affected by data collection processes. It is suggested that these effects are a function of variation in the social norms that govern the behaviour of men and women when confronted with physical discomfort, health interviews and medical practitioners.


Uniform basic data sets for health statistical systems.

The United States approach to coordinating health statistics involves introduction of multipurpose basic data sets describing health status and the health care system. Standard reporting procedures have been used for many years for vital statistics. Recently designated data sets cover health manpower, inpatient facilities, short-stay hospital discharges, and use of ambulatory care services. A data set for long-term health care is in the design stage. Advantages of this approach in the United States and internationally are: basic comparisons can be made between health care settings are geographic areas while maintaining the variety and flexibility of existing public and private information systems; shared local, regional, and national data systems can be set up; and better coordination can be achieved between government-sponsored general-purpose and administrative data systems. Problem areas are: avoiding undue proliferation, e.g. of disease-specific data sets; adhering to the principle of minimal requirements; linking data sets and coordinating them with census and other social indicators; promoting widespread use; assuring data quality; establishing mechanisms for review and revision; and extending the concept internationally.


Acute myocardial infarction in Stockholm--a medical information system as an epidemiological tool.

The objects of the present study were to perform an epidemiological study of acute myocardial infarction in Stockholm County and to investigate and develop the methods by which the medical information system in Stockholm can be used as an epidemiological tool. The possible sources of error were enumerated and their importance assessed. It is concluded that the available routinely collected computer data are useful for estimation of incidence, mortality, and case fatality. Incidence, and case fatality rates are shown to be similar to results from other Swedish studies.


The estimation of disease frequency using a population sample. International Journal of Epidemiology, 1978, 7: 277--284.  A method of determining disease frequency is developed. The statistical theory allows the estimation of incidence or prevalence credibility intervals both for the collection of all cases and where resources are such that only a representative sample of all cases is used. The sampling technique may be of value in areas where financial and manpower resources are limited. In most situations a single, professional investigator could produce satisfactory results.


Cancer morbidity and mortality among the insured population of the Social Security Institute of Antioquia, Colombia.

Data of incidence and mortality of cancers of various sites for a population of workers covered by the Social Security Institute of Antioquia are reported and compared with other available data.


Female fat distribution--a photographic and cellularity study.

A new method of classifying women according to their pattern of fat distribution is discribed. Standard linear-discriminant analysis of data from somatotype photography shows that the most important measurements are those of thigh and waist diameters and a simple ratio of these is proposed as a fat distribution (FD) score, ie one which distinguishes an android or central-type fat distribution from a gynoid or peripheral-type fat distribution: FD score = 26 log10 (formula: see text) The score is shown to correlate positively with age, actual weight and relative weight in 90 subjects, showing that older, fatter women are more likely to have a central-type of fat distribution. The score is also significantly positively correlated with the size of fat cells in the arm and waist measured in 46 subjects, showing that women with central-type fat distribution have larger fat cells in the upper parts of their bodies compared with women with peripheral-type fat distribution. Analysis of FD score before and after weight loss showed no significant correlation between the change in FD score and the degree of weight loss. This suggests that the pattern of female fat distribution as defined by the FD score is relatively constant.


Dietary and anticholinergic effects on intravenous glucose tolerance and insulin secretion.

Six normal-weight subjects were fed five separate diets [isocaloric--20, 40 and 80 per cent carbohydrate (CHO) and hypercaloric 20 and 40 per cent CHO] for 5 days each. Intravenous glucose-tolerance tests were performed on on Day 6. Insulin responses were positively related to caloric and CHO content of the diets, both of which affected insulin secretion independently of each other. Glucose disappearance rates were highly correlated (r = 0.80) with the acute insulin response to glucose. Fasting plasma-glucose levels (FPG) were also affected by both calories and CHO content, but in a more complex manner. Raising CHO content in isocaloric diets or increasing calories in diets of normal CHO content increased FPG. However, if either calories or CHO content were high, increasing the other had no further effect on FPG. Thus, there was an interaction between calories and CHO on FPG. In 18 instances, the diet was continued on Day 6 and another intravenous glucose tolerance test was performed the following morning, 90--120 minutes after 30mg of propantheline bromide by mouth. Glucose disappearance rates were increased in 16 of the 18 paired tests (P less than 0.005) after the anticholinergic agent. There was no effect on FPG or the insulin response to glucose. both calories and CHO content are positively related to insulin secretion after 5 days of dietary manipulation. Glucose disappearance rates are also influenced, probably via the effect on insulin secretion. Both increased calories and CHO content will raise FPG; but each will have this effect only in the presence of a normal intake of the other. Thus, unless possible interactions between calories and CHO are taken into consideration in the design and interpretation of future dietary studies, erroneous conclusions may be reached. Finally, cholinergic blockade will enhance the disposal of intravenous glucose in the absence of any effect on peripheral insulin levels.


The treatment of obesity with a very-low-calorie liquid-formula diet: an inpatient/outpatient comparison using skimmed-milk protein as the chief protein source.

Fifty obese patients were givena 1.34 MJ (320 kcal) formula diet (containing 44 g/day carbohydrate, milk protein supplying 24--29 g protein/day in a total of 31 g/day, fat 2 g/day and the RDA of minerals and vitamins) for four to 12 weeks, either as inpatients (22) or outpatients (28). This regime was followed by a 3.35 MJ (800 kcal) conventional diet as outpatients. All but six outpatients completed the trial. Substantial weight losses were achieved in all patients with a total mean loss of 8.4 kg at four weeks and 11.0 kg at eight weeks. At four weeks the mean weight loss was 9.6 kg for inpatients and 7.2 kg for outpatients (P less than 0.05). There was no statistical difference in weight between the groups at eight weeks. Patients who continued on the 1.34 MJ formula diet for 12 weeks continued to lose weight but those on the 3.35 MJ conventional diet did not. Nitrogen-balance studies were carried out on the inpatients. During the first four weeks there was a small net loss of nitrogen (56 g, equivalent to 350 g protein) but equilibrium was achieved by the fifth or sixth week. There was no evidence of protein deficiency as judged by unchanged serum total protein, albumin, haemoglobin, RBC and PCV. Equilibrium between intake and excretion of sodium and potassium was also achieved throughout, and serum electrolytes were unchanged. A large number of other routine clinical and laboratory tests showed the treatment was safe. Serum bilirubin was elevated (18--48 per cent) and increased slightly above normal in two outpatients. Serum cholesterol was decreased by 21 per cent and triglycerides by 45 per cent after three weeks. Serum lipids in hyperlipaemic patients were normalised. It is concluded that the very-low-calorie formula diet provides a safe and very effective method of weight reduction, and the advantages of hospital compared with outpatient treatment are small.


Psychosocial adjustment to breast cancer: a review of selected literature.

The following is a review of the clinical and research literature concerning women's emotional adjustment to the detection of breast cancer and its subsequent management. The review is organized into ten themes which focus on three general areas: 1) women's response to the diagnosis of breast cancer; 2) involvement of spouse, family and professional providers; and 3) the patient's milieu--how it impinges on the course of her treatment and rehabilitation. Also noted is the paucity of systematic research dealing with the effectiveness of support interventions, their content and duration, and the appropriate individual to provide such support.


Individual and family coping with polycystic kidney disease: the harvest of denial.

A multigeneration family with polycystic kidney disease (PCKD) was studied by personal interviews of all affected and most suspected-affected adults. A clear pattern of denial was identified, which strongly influenced individuals' awareness of PCKD and individuals' taking actions appropriate to that awareness, as well as family cohesion and communication. Time lags--in fact, availability, awareness and action-taking had serious consequences in terms of continued genetic transmission, future "burden" to the family and society, and the psychological stability of individual family members. The potentially important roles of the family physician in this type of familial disease are discussed as: a source of information, a facilitator of awareness and appropriate action, and a counselor in assisting adaptation to this major life stress.


A social systems approach to consultation-liaison psychiatry.

Consultation-liaison psychiatry traditionally has emphasized an approach to clinical practice based upon an understanding of the ways in which intrapsychic dynamics, personality characteristics and biological phenomena interact in a process that can be understood to relate to symptoms and disease in the individual. More recently the field has considered the interaction of interpersonal and group phenomena with individual characteristics and their influence upon patient pathology. Currently, however, there is limited understanding of the significance of organizational variables for the work of the consultation-liaison psychiatrist. In this paper, several organizational themes are discussed in terms of social systems theory and the relevance of these themes are applied to case material taken from a year's experience of consultation-liaison in a hemodialysis unit of a general hospital (HUGH).


Photocoagulation in diabetic retinopathy: II. Methodology.

There is now evidence from clinical trials that patients with diabetic retinopathy have their visual lives prolonged by photocoagulation. However, the exact indications for treatment have not yet been established and are undergoing continuous reevaluation. For many years, the presence of fibrous tissue either on the optic disc or the retina was considered to be a contraindication to treatment. However, recently treatment has been possible using gentle photocoagulation. It is hoped that over the next few years the exact indications for treatment will be established. It may be found in the future that the treatment of patients with maculopathy by panretinal photocoagulation and focal treatment and similarly patients with a few peripheral new vessels, by panretinal photocoagulation may prevent further progression and remove the necessity for treatment. It is important to limit as much as possible the number of visits to the opththalmologist that the patient must make. It is therefore important to establish a technique that requires as few treatment sessions as possible. Ultimately, follow up should be done by the well trained physician. The difficulty with the development of this type of technique is that diabetic retinopathy is a progressive disease and therefore new abnormal areas may well develop in patients who have had seemingly adequate treatment. Also, relatively mild background retinopathy or maculopathy may progress ultimately to proliferative retinopathy. However, with improvements in technique and establishment of safe treatment regimens, the goal of single treatment may be achieved.


Mental health in primary care training and practice: an innovative approach.

The need to augment the number of primary care physicians throughout the nation has been well documented. Moreover, there is increasing recognition of the importance of mental health in primary care practice. The authors present a working definition of primary care practice, discuss the role of mental health in primary care, and describe an innovative program developed in Houston which integrates primary care mental health training into the education of primary care physicians and mental health professionals.


Photocoagulation in diabetic retinopathy: III. Complications.

We have reviewed the unwanted effects that follow the treatment of diabetic retinopathy with photocoagulation. Complications are uncommon, and those side effects that occur regularly are acceptable in relation to the benefits to be gained from treatment.


Observed responses of medical students in a sex education seminar on obstetrics and gynecology.

This article describes the typology of negative responses in a medical student sex education seminar. Seventy medical students were observed during participation in sex education seminars during a seven month period. Their behavior in class was generally appropriate. Negative responses sometimes did occur, however. These were manifested more frequently in men than in women students and were characterized by hostility or withdrawal in males, and subgroup formation in females.


Studies in family-oriented crisis intervention with hemodialysis patients.

This article describes a family-oriented crisis intervention approach to help patients with chronic renal failure adjust to the unique demands of home dialysis. In particular, home dialysis necessitates a working patient-dialysis partner relationship that has very adaptive problem solving skills. A couple whose permorbid relationship is dysfunctional will soon manifest this under the stress of home dialysis. The family-oriented therapist initiates only the minimal change necessary in the relationship to achieve successful dialysis. In the home training stage the premorbidly dysfunctional couple seems best treated in individual interviews, whereas premorbidly functional couples respond more favorably to conjoint interviews which capitalize on their underlying strengths. Couples in crisis who are dialyzing at home may require a highly structured, behaviorally-oriented contractual approach which includes all relevant family members. This "band-aid" approach temporarily reinstitutes successful dialysis while purchasing more time for the couple to develop new coping mechanisms. Finally, four case studies are presented, including one in which crisis intervention efforts failed.


A behavioral method for efficient screening of visual acuity in young infants. II. Clinical application.

Visual performance in 130 infants was assessed in a clinical setting with the forced-choice preferential looking (FPL) method described by Dobson et al.5 Over 90% of infants completed testing. Testing usually required less than 10 min. One group of infants tested also underwent complete ophthalmic examination. The second, larger group was screened with handlight examinations and FPL testing; any abnormalities detected were evaluated by full ophthalmic examination. Results so far indicate that the FPL test accurately identifies babies with binocular visual problems and that, when coupled with a handlight examination, it provides efficient screening for ocular problems in infants 0 through 16 weeks of age (postterm).


The oscillatory potentials of the mudpuppy retina.

The properties of the oscillatory potentials (OPs) of the mudpuppy electroretinogram (ERG) were studied and compared with the properties of the b-wave of the ERG and the proximal negative response (PNR). Both transretinal and intraretinal ERGs were recorded in response to full-field as well as 200 and 500 microgram spot illumination. The OPs differed in behavior from the b-wave in terms of voltage-response relations and the effects of repetitive stimuli. Thus the OPs appear to have a different origin from that of the b-wave. The laminar profile of the OPs was also compared with both the PNR and the b-wave. The OPs reverse in polarity as a function of retinal depth and therefore appear to reflect radial flows of currents within the retina. Thus the origin of the OPs seems different also from that of the PNR, which appears to represent tangential current flows around the amacrine cells. The earlier OPs arise more proximally within the retina than the later ones, suggesting that the individual oscillatory peaks are likely to have different origins. We propose that the OPs may represent feedback loops within retina. In support of this notion, it was found that the OPs were selectively depressed by GABA, glycine, glutamate, and dopamine. Acetylcholine and carbacholine did not affect the oscillatory responses, suggesting perhaps that the OPs are generated by inhibitory feedback synaptic circuits.


Studies on the hormonal control of circadian outer segment disc shedding in the rat retina.

Previous work suggested that the circadian burst of outer segment disc shedding that occurs soon after the onset of light in the morning might be mediated by the pineal gland. In the present study the pineal glands of albino rats were either surgically removed or deafferented by bilateral superior cervical ganglionectomy. Neither surgical procedures affected the burst of disc shedding at 2, 3, or 11 weeks postoperatively. In addition, neither hypophysectomy nor parathyroidectomy and thyroidectomy perturbed the burst of disc shedding. Therefore the burst of disc shedding appears to occur independent of pineal, pituitary, and parathyroid-thyroid gland control.


Effects of transcorneal freezing on protein content of aqueous humor and intraocular temperature in rabbit and cat.

The effects of transcorneal freezing on protein content of aqueous humor and intraocular temperature at the posterior surface of the cornea, the angle, the iris, and the ciliary processes were determined in rabbits and cats. Normal aqueous protein concentration was 40 +/- 2 mg/dl in rabbits and 43 +/- 4 mg/dl in cats. In rabbits, total aqueous protein content reached its highest level (2790 +/- 302 mg/dl) for 3 hr after transcorneal freezing, decreased by 50% after 4 hr, and was not significantly different than normal at 7 days. In cats, total aqueous protein content also reached its highest level (1610 +/- 290 mg/dl) 3 hr after corneal freezing. Fluctuations occurred thereafter, but protein content was not significantly different from normal after 7 days. The temperature at the corneal endothelium always decreased to below 0 degrees C with a 10 to 25 sec application of the cryoprobe to the cornea in rabbit and cat. Intraocular temperature did not decrease below 24 degrees C  at the angle or ciliary processes during application of the cryoprobe for up to 25 sec, whereas the temperature at the pupillary margin of the iris sometimes decreased to near 0 degrees C with a 15 to 25 sec application.


Etiology of corneal sensitivity changes accompanying contact lens wear.

Corneal touch threshold was monitored while corneal edema was experimentally induced by exposing the cornea to either an oxygen-free environment or hypotonic saline. No change in sensitivity occurred during these conditions. Contact lens wearers who were fully adapted to their lenses and did not develop corneal edema during wear showed an increase of 96% in corneal touch threshold. Refitting these subjects with an experimental contact lens which caused a 6% increase in corneal thickness did not further alter the corneal sensitivity. The decrease in corneal sensitivity accompanying contact lens wear is independent of corneal edema and is likely a result of sensory adaptation to a mechanical stimulant.


Vitreous fluorophotometry evaluation of xenon photocoagulation.

An abnormal increase in the permeability of the outer blood-retinal barrier was induced in the eyes of adult pigmented rabbits after retinal xenon arc photocoagulation. The alteration of the blood-retinal barrier, which was assessed by vitreous fluorophotometry after systemic administration of sodium fluorescein, followed a well-defined pattern. Higher values, which were recorded during the first three days after photocoagulation, recovered progressively afterward. The permeability of the blood-retinal barrier returned to near-normal levels between 10 and 14 days after photocoagulation. A direct correlation was observed between higher initial values and heavier photocoagulation.


Cortical responses evoked by laser speckle.

Human cortical evoked responses elicited by patterns are very size and focus dependent, but those produced by moving laser speckle patterns (LASCERs) remain similar in amplitude and subjective sharpness over a wide (+/- 20 D) variation in added lens power. Moreover, cortical signal amplitudes evoked by speckle displays with high average spatial frequencies are significantly larger than those reported for check stimuli equivalent in spatial frequency.


The marked myocardial depressant effect of verapamil.

An experiment was designed to measure accurately the primary effect of verapamil on myocardial contractility by infusion of the drug directly into the coronary artery of open-chested anesthetized dogs. A marked myocardial depressant effect, which was dose and time dependent, was noted during verapamil infusion at the infused area only. The percent decrease in contractile force ranged from 8.8 at an infusion rate (mg/min) of 0.55 X 10(-2) to 36.8 at 5.5 X 10(-2). Similar changes were observed in the first derivative of the contractile force. No changes were observed in the left ventricular systolic or end-diastolic pressure and only a mild increase in contractile force was noted in the control (noninfused) area. The depressant effect of verapamil was sustained. Recovery time after 5 min of verapamil infusion was dose dependent, ranging from 10 to 45 min. During the recovery period, an overshoot of the contractile force was observed in dogs on the higher doses only. We concluded that verapamil in clinically relevant doses has a marked negative inotropic effect of long duration and therefore should be used with caution in patients with depressed left ventricular function. Cessation of the verapamil treatment may cause a transient increase in myocardial contractility, which might be hazardous in patients with angina pectoris who have compromised coronary blood flow.


Polysplenia syndrome. A study of five new cases.

Five children with polysplenia syndrome are described. Cardiac catheterization or postmortem examination revealed the following cardiac anomalies: interruption of the inferior vena cava with azygos (or hemiazygos) continuation to the left superior vena cava and a single atrium or a large atrial septal defect in all five children; a ventricular septal defect in three; and a primitive ventricle in one case. Other anomalies found were: central liver in all five; a right-sided stomach in three; and multiple small spleens and bilateral left, bilobed lungs--found on autopsy--in two of the children. In four of the five patients, whose ECG was available, a negative P wave was present in leads II, III and AVF. This leftward and superiorly directed P wave axis should suggest a diagnosis of polysplenia syndrome in an infant with congenital heart disease. The cardiac anomalies are surgically correctable; therefore, early recognition of this syndrome is of practical importance.


Rubella in Jerusalem. 1. Seroepidemiologic findings in children born after the 1972 rubella epidemic.

Nine hundred and sixty-nine babies born after a severe rubella epidemic were tested at the age of eight months for the presence of hemagglutination inhibition antibodies to the disease. There were 208 (21.9%) seropositive babies with titers of greater than or equal to 1:16. Seven cases of congenital rubella were diagnosed at birth, 14 were confirmed by eight months and two babies, who were considered normal at the age of eight months, developed late signs of the disease. Less than 3% of the mothers of the seropositive babies had had clinically recognized rubella in pregnancy. If positive hemagglutination inhibition antibody to rubella accurately reflects congenitally acquired rubella infection, between 8.1 and 21.9% of the 969 babies had serologic evidence of the disease. For cases of congenital rubella diagnosed by the age of three years, the limits are between 8.9 and 23.7 per 1,000 live births for the risk of the disease at the height of the epidemic. Rubella vaccine was not available in Israel until after the 1972 epidemic, the effects of which justify the continued search for and immunization of seronegative women of childbearing age, in addition to routine immunization of young girls.


Blood pressures in a highly inbred community--Abu Ghosh, Israel. 1. Original survey.

Abu Ghosh is an Israeli Moslem Arab village located 11 km west of Jerusalem. Its population of about 2,200 has a common ancestry and is highly inbred. Blood pressures, weights, heights and other pertinent data were recorded for 1,881 (93.3%) of 2,017 subjects aged two years and over who were available for study. Mean blood pressures in children up to the age of 15 years were similar to those reported elsewhere. Among adults, the prevalence of hypertension, especially diastolic hypertension, was high. The relative effects of genes and environment on familial similarity in blood pressures are discussed.


Serum lipid concentration in newborns from various ethnic groups in Israel.

Serum cholesterol was determined in the cord blood of 438 newborns and repeated on venous samples from the same infants at the ages of 6 and 18 months. Of 36 infants who were originally defined as hypercholesterolemic, 28 had normal values by the age of six months. The prevalence of hypercholesterolemia at birth was 8%. No differences were noted among the five ethnic groups examined. The results suggest that serum cholesterol level at birth is of limited value for the early detection of familial hypercholesterolemia.


Effect of uremia on tumor growth in mice.

Outbred Swiss mice of the Hebrew University strain were subtotally nephrectomized. The experimental and control animals were both divided into two subgroups, with one group kept on a regular animal house diet and one on a low-protein diet. All the animals were injected with Ehrlich's ascites tumor cells s.c. into the neck region. Two weeks later, the animals were killed and the tumor was excised and weighed to the nearest milligram. Tumor size in the uremic animals--the nephrectomized animals kept on a regular diet--was significantly smaller than in all other groups, which had blood urea nitrogen levels well within the normal range. It is suggested that urea may be a factor responsible for inhibiting tumor growth.


[Stuccokeratoses. Review and own observations].

Stuccokeratoses are typical, verruca plana-like lesions mostly on the distal parts of the extremities of elderly people. Male persons are preferentially affected. Nosology, histopathology, pathogenesis and differential diagnosis are discussed, and three own cases presented. Stuccokeratoses are probably a special variant of verrucae seborrhoicae seniles.


[Nevoid hair bundles in man].

Between the different forms of multiple hairs the circumscribed occurence of compound hairs is a rare nevoid hair-abnormality. It is caused by merging of several follicles in the middle or upper corium. The deep parts and the papillae are independent units. The pathogenesis, clinical relevance and therapy of compound hairs are discussed on the basis of an own observation.


[Congenital, plaque-like osteoma of the skin in an infant].

A plaque-like cutaneous osteoma in a male infant is described and compared with 12 remarkably similar cases from the literature. An important differential diagnosis is that of pseudohypoparathyroidism and it has to be excluded by the examination of the calcium and phosphorus metabolism. There are two possible explanations for the etiologie of osteoma cutis, an osseous hamartom, or a metaplasia of mesenchym cells. Because of some important reasons we prefer the hamartom concept.


[Intrafocal BCG therapy of metastasizing malignant melanoma].

Therapeutical possibilities and side effects of intrafocal BCG-vaccination into metastases of malignant melanomas are discussed. Only in one of our three cases, this special method of unspecific immunstimulation induced a remarkable regression of tumor size. The second patient showed a partial remission and in the third there was no effect at all. Besides local irritation with ulceration we observed severe generalized side effects in all patients. A granulomatous hepatitis, which represents the most severe complication of this therapeutical method, occurred in one case. Its successful treatment with tuberculostatic agents favors the assumption of an infectious genesis.


[Hyperkeratotic variant of Darier's disease. Successful oral treatment using an aromatic retinoid (Ro 10-9395)].

Oral aromatic retinoid (Ro 10-9359) in the treatment of a patient with hyperkeratotic Darier's disease yielded excellent results, which could be maintained over a period of 14 months by continuous administration of the drug. No serious side effects occurred which would have necessitated discontinuation of the therapy.


[Nodose lues exanthema].

An unusual form of secondary syphilis is reported. Because of the exceptionally large nodular cutaneous lesions, reticulosis or sarcoidosis was clinically suspected. The results of the serologic tests for syphilis and the concurrent histologic examinations established soon the correct diagnosis.


[Clinical picture and diagnosis of bee-venom allergy. A comparison between skin tests and RAST determinations].

Of a group of 53 anamnestically assured bee venom allergies 81.1% positive skin tests (bee whole body extract) as well as 79% positive RAST (bee venom) could be proven. A statistical connection between skin test and clinic reaction degree, as well as between "RAST-clinic reaction degree" and "skin test--RAST" could not be found. The agreement between skin test and RAST results was of 71.7%, the positive correlation of 66%. The problem of the diagnosis and the therapy of allergy to hymenopteren stings is briefly described.


[Immunocytoma simulating chronic acrodermatitis atrophicans].

A 76 year old female developed an acrodermatitis-chronica-atrophicans-(ACA)-like lesion on her foot. Histological examination and quantitative determination of immunoglobulins in homogenates from the skin lesion revealed an immunocytoma of the IgM type. Malignant lymphoma originating in ACA lesions or concomitting ACA are well known. The case described here indicates that primary malignant lymphoma of the skin clinically can simulate ACA and creates diagnostic, therapeutic and prognostic problems.


[In-vitro stimulation of sperm motility using a deproteinized hemodevivative and a luteinizing hormone].

The effect of a commercial deproteinized blood extract--on motility of human spermatozoa was examined in vitro. The improvement of motility as seen after addition of 5 and 10 percent of this deproteinized blood extract, is supposed to be due to amounts containing different concentrations of LH. The extract was ruled out as a source of kallikrein, but not as a source of kininogens.


[Palmoplantar epidermal cyst].

Epidermal cysts of the palms and sole of feet are rare. They originate from traumatic implantation of the epidermis into the dermis or subcutis. Three cases (one on the palm and two on the sole of the feet) are reported.


[The acquired digital fibrokeratoma].

A case of acquired digital fibrokeratoma is presented. The asymptomatic cylindrical tumor preferably occurs during the third to sixth decade of life and affects mainly the fingers. Histologically one finds a cylindriform connective tissue proliferation surrounded by an akantholytic band of epidermis with papillomatous changes and hyperkeratosis. For differential diagnosis rudimentary supernumerary digit, cutaneous horn and granuloma pyogenicum are to be considered. Therapy consists of excision of this benign tumor of hitherto unknown origin.


[Antibiotic prophylaxis in intensive care].

Of 611 prospectively studied patients in a surgical intensive care unit, 177 developed hospital infections (29%): urinary tract infections (37.2%), pneumonia (22.5%), sepsis (19.7%), wound infections (9.6%), etc. The commonest pathogens were Pseud. aeruginosa, E. coli, Staph. aureus, enterococci, Klebsiella pneumoniae and Proteus mirabilis. In preventing and combating hospital infections in intensive care units, priority should be given not to antibiotics but to hygiene in the hospital. Systemic antibiotic prophylaxis prevents neither hospital-contracted pneumonia, sepsis nor urinary tract infections. There is an urgent need for controlled studies on the necessity and selection of locally active antibacterial and antimycotic substances to prevent germ ascension in vein and bladder catheters.


[Preventive antibiotic therapy in neurosurgery].

The swiss neurosurgeons were asked to give their own politics on prophylactic antibiotics. The results of this enquiry are given. Post-operative infections in the Neurosurgical Clinic of Geneva in a four-year period were at a satisfactorily low rate and demonstrated the importance of many factors of risk. Guide lines for a reasonable prophylaxis in three groups of operations are given, with a precise schedule for each group. It is suggested that ones own surgical technique be severely criticized before considering prophylactic antibiotics.


[Preventive antibiotic therapy in orthopedic surgery].

Prophylactic antibiotics are useful if the right substance hits the right place at the right moment. Wound contamination and infection rates are generally low in clean orthopaedic wounds. Systematic treatment is therefore not justified for all patients. The high risk must nevertheless be protected. The indications for antibiotherapy, systemic or local, of eight Swiss clinics are discussed. 86% patients left these clinics without having received any systemic antibiotics at all.


[Antibiotic prophylaxis in plastic reconstructive surgery].

In plastic reconstructive surgery the use of prophylactic antibiotics is considered for wounds in which tissue trauma can not exactly be delineated as in gun shot wounds, bites, contusions; for extensive surgery lasting more than three hours in the oral area, with opening of the maxillary sinuses; when large foreign bodies are implanted; if there is massive intraoperative contamination and for patients with reduced antibacterial defence mechanisms. A principal factor leading to infection is reduced tissue oxygenation, which can be reversed by the use of benzopyrones as experimentally demonstrated.


[The infected total hip replacement prosthesis].

In a series of 48 cases of infected hip prosthesis the different therapeutic possibilities are being discussed. In 30 instances a one stage exchange operation with the use of antibiotic bone cement as described by BUCHHOLZ was performed. Provided good stability of the new prosthesis is obtained, the signs of infection as well as most pathologic X-ray aspects will disappear, in spite of the introduction of additional implant material. After an observation time of up to 5 years more than half of the cases appeared clinically healed. The poor results generally manifest themselves within the first postoperative year. As palliation against infection a good general condition of the patient, the absence of infectious foci as well as a good operative technique and discipline to us seem more important than the number of germs in the operation theater.


[Comparison of different methods of treatment of per- and subtrochanteric femoral fractures].

In the time between 1970 and 1977 142 patients, 72% older than 75 years, with per- and subtrochanteric fractures of the femur were treated operatively; 38 cases with AO-angle-plates, 53 cases with Küntscher-nails and 51 cases with Ender-nails. Regarding peroperative blood loss, early mobilization and days of hospitalization, it was the group of Ender-nail treated patients which showed the most favorable results.


[The position of scintigraphy in traumatology].

A report on the findings of skeletal scintigraphy in 80 cases of traumatic bone lesions is discussed. After a short survey on the physiological process in the activity ensilage, the assertion of the scintigraphy is compared to the X-ray. The indication which has been approved in practice is discussed and described. In correct indication scintigraphy is a valuable diagnostic measure and it may influence the procedure.


[Special aspects of fracture healing in cranio-cerebral injuries].

This study demonstrates the changes of concentration and elimination of calcium, phosphate and zinc, as well as alteration of serum alkaline phosphatase and acid phosphatase especially in patients with severe brain injuries in connection with bone fractures. Because the study has not been completed, the presently acquired results should only demonstrate possible development of the examined parameters. To find out the pathogenesis of overgrowing callus in brain-injured patients, further examinations are being carried out to find the histochemical activities of alkaline and acid phosphatase, lactate dehydrogenase, adenosine triphosphatase and acetylcholine esterase.


[Scintigraphy in the diagnosis of osteitis].

The report on the experience with skeletal scintigraphy in case of osteitis discusses the clinical use of this method. It is shown that with correct indication scintigraphy can furnish early diagnosis and in many cases additional valuable information.


[Osteomyelitis after osteosynthesis].

In reparative surgery, and particularly reosteo-synthesis, latent or apathogenic germ invasion of "old" wounds must always be reckoned with. Antiinfectious measures, which must be pursued untiringly, are to be placed beside equivalent surgical measures which should go beyond mere operative care of traumatic tissue damage.


[Plate fixation and open wound treatment in infected intramedullar nails].

In treating patients who present with an extensive non-union due to infected intramedullary nail, bone healing can be achieved within a few weeks through a policy of active management. Following excision of the infected tissue and thorough irrigation, the fracture site is stabilized by a plate fixation and a packet with cancellous bone. The wound overlying the bone is left open to granulate. No complications were observed during the course of healing in 7 cases (5 tibia, 2 femur) managed this way. The method is based on classical principles of orthopedics and the treatment of infection. Such has been its impressive success, that it would seem to warrant not only close attention but also strong recommendation.


[What advantage are there in using gentamycin-PMMA-chains in the treatment of posttraumatic osteomyelitis, osteoarthritis and soft tissue infections?].

The use of gentamicin-polymethylmethacrylate (PMMA) bead chains permits the depositing of a high dose of gentamicin at the place of the infection. Short indications on the experimental basis and hints regarding the practical application are given. It follows the discussion of the results in 34 patients with chronic posttraumatic osteomyelitis, arthritis due to infection, diabetic and arteriosclerotic gangrene and the infections of the soft tissues. Primary wound healing was achieved in 70%. Discussion of interesting cases. The advantages of the use of gentamicin-PMMA bead chains in infection cases are emphasized.


[Conservative versus surgical treatment of spinal fractures].

Not only fractures of joints and shafts may benefit from internal fixation, but also certain fractures of the spine. Stable spine fractures still are suitable for closed treatment. Instable fractures, however especially those with neurological disorders, can be much improved in their results by adequate surgery, by open reduction, rigid fixation and decompression of the medullary canal in case of paraplegia. As simple as closed treatment of the stable fractures is, as difficult is surgery of instable fractures. For all the different types of instable fractures and different types of compression syndromes, individual surgical approaches, decompression and fixation techniques are to be familiar to the surgeon. The basics of such individualized treatment of fractures of the spine are described as it has become standard base on an experience with 750 fractures of the spine, 90 of them having had surgery.


[Indication for prosthesis in pertrochanteric fractures].

Trochanteric fractures with concomitant osteoarthrosis of the hip joint present a clear indication for total hip replacement there by treating both the fracture and the joint disease. Trochanteric fractures with an otherwise normal hip joint are usually treated by internal fixation. Under certain conditions (old patient, simple fracture) femoral head or total hip replacement may, however, be preferable. As a rule, duration and technical difficulty of such an operation should not exceed that of any classical method of internal fixation.


[Indications for osteosynthesis in fractures in children].

Surgical treatment for fractures in childhood should be rare. Indications for open reduction and internal fixation is given especially in fractures within the joint region, which includes namely epiphyseal fractures, dislocated joint fractures (patella, olecranon, femoral neck, radial head, flake fractures) and dislocated ligament injuries. The same is true in children's fractures with accompanied vascular- or nerve-injuries and in multiple fractures, multiple injuries and open fractures grade III. A very relative indication to osteosynthesis is given in severe axial deviations which can not be corrected conservatively. In given in severe axial deviations which can not be corrected conservatively. In the last group the indication depends on the age of the child, localization of the fracture and the mainly displaced plane, but also depends on whether the department in question is experienced in and can fully exploid the conservative possibilities of closed reduction and stabilization.


[Treatment of tibial fractures seen in the light of long-term results].

The intra-articular fracture of the lower extremity of the tibia is an injury which often produces functional problems in the ankle joint, sometimes leaving the patient incapable of continuing his original employment. Conservative treatment is often unsatisfactory because of the difficulty of closed reduction of the fracture, and the difficulty in maintaining the reduction. Open reduction and stable internal fixation frequently gives good results, even in cases of complicated fractures. The diagnosis is essentially based on standard X-ray examination of the ankle (face and profiles) with obliques, and occasionally by tomography. A new classification proposed by ALLGOWER permits one to see more precisely the degrees of difficulty of reconstruction, and to have a more exact prognosis.


[Hemodilution--methodological problems].

To achieve normovolemic hemodilution two methods have established themselves: the acute preoperative hemodilution and the therapy with different blood constituents. The ever increasing consumption of blood and blood products shows the absolute necessity of using all the available constituents, especially the erythrocytes. A proved and standardized transfusion program is shown, which --allows blood substitution with specific hemodilution without additional expenses of time and organization or technical difficulties, --shows means of substituting 80% of the blood consumption with packed red cells (Erythrozytenkonzentrate), --helps save blood and blood products, --unites the plasma production with that of the erythrocytes.


Measuring relative electrophoretic mobilities of mutant hemoglobins and globin chains.

A system of calculating relative mobilities of mutant hemoglobins and globin chains in four methods of zone electrophoresis is described. In electrophoresis on cellulose acetate, TEB buffer, pH 8.5, mobilities are calculated as ratios of the mobility of simultaneously analyzed Hb C. In electrophoresis on citrate agar, pH 6.0, anodic mobilities are also related to Hb C, cathodic ones to Hb F. In globin electrophoresis in urea 2-mercaptoethanol buffers, pH 6.0 and 8.9, mobilities of the mutant globin chains are calculated in relation to the mobilities of normal alpha and beta chains. These calculations provide objective comparisons of mobilities of hemoglobins, including those analyzed at different times. The combined data permit recognition of many mutant hemoglobins.


Enzyme layers on glass as a new model for the quantitative study of capture reactions in cytochemistry, with special attention to acid phosphatase.

A model system is described for the study of capture reactions for diffusable compounds in enzyme cytochemistry. The model, which allows the investigation of the influence of the composition of the cytochemical medium, the enzymatic activity, and the dimensions of the enzymatic site on the capture reaction, consists of very thin homogeneous layers of enzyme (0.01-0.1 micrometer thick) on glass, which are incubated in the cytochemical medium. The fraction of the total amount of liberated product precipitated in the enzyme layer is dependent not only on the trapping efficiency of the cytochemical medium but also on the concentration of the primary reaction product that can be built up in the enzyme layer. Calculations were performed to determine the steady-state concentration of the primary reaction product that can be built up in the enzyme layer. Acid phosphatase was used as enzyme. The problems associated with the model and its applicability to other types of cytochemical reactions are discussed.


Succinate dehydrogenase activity in the wall of rabbit aorta. The histochemical use of PMS and exogenous coenzyme Q10 as intermediate carriers.

An investigation of succinate dehydrogenase activity in the wall of rabbit aorta was carried out. The level of succinate dehydrogenase per se in the smooth muscle cells was found to be fairly high, while the mitochondrial level of carrier CoQ was low. The latter may explain the low level or lack of activity of succinate dehydrogenase in these cells as noticed by previous authors. A reliable image of the actual level of succinate dehydrogenase was obtained only by adding CoQ10 to the incubation system. PMS should be avoided, as it induced a "Nothing dehydrogenase" reaction even at low concentrations.


[Is surgery for infections of the maxilla and face still justified? (author's transl)].

Based on the authors' studies and on publications by others from the Vienna Department of Maxillo-facial surgery over the past 60 years common infections of the maxilla and face and the incidences and prognosis of their life-threatening complications and reviewed. Fatalities as expected became substantially less frequent after the introduction of antibiotics, but the number of deaths due to septicaemic abscesses in contrast to those due to local complications has fallen only slightly since penicillin usage. The danger of overrating the therapeutic potential of antibiotics is emphasized, and despite major advances in chemotherapy the discrimination between pathologies preferably treated surgically or conservatively has by no means changes.


[A clinical report of luetic hearing loss (author's transl)].

Three patients with syphilitic hearing losses are reported. In these patients, the impairment of cochleovestibular function progressed rapidly and quite often with fluctuations. The prognosis of inner ear damage is generally poor. However, in one 24-year old patient, treatment with penicillin and cortisone was successful in arresting hearing loss. This loss began early in the second stage of the disease so that its luetic origin could be recognized at the onset of the otological symptoms.


[First observations of a cochlear-implant operation (author's transl)].

We report on our observations following our first cochlear-implant operation in a patient, and have found that the implantation of a single electrode can allow the patient to realize background noise.


[The treatment of psychogenic aphonia in two adolescents (author's transl)].

Psychogenic aphonia is rare in childhood and adolescence and its management is therefore problematic. Two examples, one of a hypofunctional aphonia in a 14 year old with a stutter and another of psychogenic aphonia confirm the necessity after psychiatric assessment and treatment of speech therapy in order to restore the voice to normal. The place of the laryngologist and speech therapist is discussed.


[The cervical syndrome in children (author's transl)].

The aetiology of the cervical syndrome in children as seen in otolaryngological practice is discussed, and its successful treatment by manipulation is described. Recurrent head pain especially is an indication for manipulation.


[Consequences of gunshot injuries of the face (author's transl)].

During a 5 year period 59 patients with gunshot wounds were treated in the Department of Maxillo-facial Surgery at Munich University. Two patients, who developed local problems secondary to latent infection due to missiles retained for 31 and 32 years, are presented. These missiles were surgically removed. Today, compared to the past, the interval between the gunshot injury and the surgical removal of the missile from the mandible because of the use of antibiotics and improved surgery may be considerable.