Social-demographic aspects in the attitudes towards mental illness in a Finnish population.

Attitudes towards mental illness were studied in a random population of 1,000 subjects from southern and northern Finland using a Likert-type attitude scale. Correlations between attitudes and social-demographic variables were studied with one-way variance analysis and with specific multivariable techniques (AID and MCA). The best correlations were established between educational standard and attitudes, and between age and attitudes; higher education and younger age correlated with positive attitudes. Even social group and attitudes seemed to be distinctly correlated: the higher the social status, the more positive the attitudes. No difference could be demonstrated between residents from southern and northern Finland; rural subjects, however, possessed distinctly more negative attitudes than urban residents. According to the authors the most striking result was the observation that females show somewhat (statistically very significantly) more negative attitudes than males. It could also be established that the attitudes of female subjects varied greatly in various groups of variables.


Oxypurine and 6-thiopurine nucleoside triphosphate formation in human erythrocytes.

A variety of oxypurines and 6-thiopurines could be transformed by intact erythrocytes to their nucleoside triphosphate forms when incubations were extended for up to 24 hrs. The specific nucleotide monophosphate kinases which accomplish these reactions in erythrocytes were not identified but their ability to utilize 6-thioIMP, 6-thioXMP and 6-methylthioGMP as substrates, albeit very slowly, is clearly implied by these results. S-methylation of 6-thiopurines was demonstrated in erythrocytes incubated with physiological amounts of methionine-(CH3-3H). 6-Methylthioguanosine triphosphate and 6-methylmercaptopurine riboside triphosphate were formed in micromolar amounts, probably from the corresponding thiopurine nucleotides by methyl transfer from S-adenosylmethionine.


Oncocytic cysts of the larynx.

Oncocytic cysts make up a pathologically well-defined sub-group of cystic lesions in the larynx. As a rule they originate from the ventricle and occur in middle-aged or elderly persons. Clinically these tumours are uncharacteristic. Such oncocytic cysts are interpretable as retention cysts rather than actual new growths. The question concerning their rare occurrence is discussed on the basis of 5 cases diagnosed within a period of 2 months.


Metabolism of intravenous adenine in the pig.

1. Adenine administered either parenterally or orally is less toxic to the pig than to other species; doses of 100 mg/kg are rapidly catabolised and excreted largely as soluble purine end-products in the urine. 2. The low toxicity is explained by the excretion of less than 1% of the dose as 2,8-dihydroxyadenine. 3. These results suggest that adenine dosages which give rise to kidney damage must be above a threshold-like level which varies in the different mammalian species, and is higher in the pig than in the rat, dog, rabbit or man.


Purine and pyrimidine nucleotide concentrations in cells with decreased hypoxanthine-guanine-phosphoribosyltransferase (HGPRT) activity.

1. In order to investigate the role of purine ribonucleotides in the regulation of de novo purine synthesis in living human cells deficient in HGPRT, intracellular ribonucleotide concentrations have been measured in HGPRT lymphoblasts, fibroblasts and erythrocytes and in appropriate HGPRT controls by high pressure liquid chromatography. 2. Purine Purine ribonucleotide concentrations were not reduced in HGPRT cells, supporting the hypothesis that accelerated purine biosynthesis de novo results from increased availability of PP-ribose-P and not from altered feedback regulation by purine ribonucleotides in HGPRT deficient cells. 3. Striking increases in intracellular concentrations of some pyrimidine nucleotides and nucleotide sugars were detected in HGPRT lymphoblasts and erythrocytes, but not in fibroblasts. 4. The possibiiity that this abnormality of pyrimidine metabolism might result from coordinate regulation of purine and pyrimidine synthesis de novo by PP-ribose-P was not substantiated by measurements of rates of pyrimidine synthesis and experimental elevation of intracellular concentrations of PP-ribose-P following incubation of cells with inorganic phosphate.


Effects of inosine on purine synthesis in normal and HGPRT-deficient human fibroblasts.

1. Incubation of normal and HGPRT-deficient fibroblasts with inosine results in increased PP-ribose-P concentrations. 2. The increased PP-ribose-P concentrations are accompanied by decreased rates of purine synthesis de novo, more marked in normal cells 3. Increased purine nucleotide concentrations during incubation with inosine provide a likely explanation for the inhibition of purine synthesis in normal cells 4. The lack of accelerated purine synthesis in mutant cells under these conditions is not fully explained by consideration of PP-ribose-P and purine nucleotide concentations.


Serum uric acid levels in England and Scotland.

A survey of serum uric acid levels in 766 subjects in England and 337 in Glasgow was carried out. There was no difference in the frequency distribution of uric acid or the mean levels in the two countries. A serum uric acid of 7 mg/100 ml or over was found in 7.2% of the men and 0.4% of the women. The previously described sex difference and association of serum uric acid with weight were confirmed. No association was found with social class. The suggestion of an increase in uric acid levels in the United Kingdom over the past 14 years is discussed.


Gout disease. Its natural history based on 1,000 observations.

Gout disease in our country as both exogenous factors (dietary habits, professions, etc.) and endogenous factors (sex, inheritance, etc.) play a polygenic role in its incidence. Those conditions resulting in hyperuricemia (diseases, drugs, etc.) facilitate the clinical manifestations. But a genetic determinant in the articular reaction in front of an accumulation of uric acid crystals or in the development of such crystallization is a fundamental factor in the manifestation of the disease. In our series we were able to confirm the high incidence of arterial hypertension, renal lithiasis and renal participation in gout. The role of lead and of certain professions in favouring the hyperuricemia is suggested. A classification of gout, from a functional point of view, must include both the clinical form and the analysis of the whole renal function, and the renal handling of uric acid. This is mandatory not only for the diagnosis and prognosis of the disease but to set the basis of its adequate management.


Recurrent gouty phlebitis without articular gout.

A case of recurrent, superficial phlebitis in the lower extremities, with raised blood uric acid levels, responsive to colchicine and to urate pool depletion, but unassociated with articular complaint is reported. The possibility that such a phlebitis may represent an isolated, critical manifestation of acute gout is stressed.


Typing of uric acid level in cerebrospinal fluid in neurological and psychiatric diseases.

The increasing number of latent and manifest hyperuricemia is important concerning differential diagnosis in neurological and psychiatric diseases. The pathological importance of hyperuricemia in these diseases is particularly unknown. The possibility of a physiological regulative function of uric acid in central nervous system may be discussed. Therefore uric acid typing in cerebrospinal fluid were made of 173 patients with neurological and psychiatric diseases. On an average the uric acid level in cerebrospinal fluid is 1:10 of the blood uric acid level. In advanced age a lower level could be found. High level for example were found after L-Dopa treatment and epileptical seizures. These results and possible pathophysiological correlation to the correspondant diseases are discussed.


Multi-centre trial of naproxen and phenylbutazone in acute gout.

Naproxen 750 mg as a single dose followed by 250 mg three times daily has been compared with phenylbutazone 200 mg four times daily for 48 hours followed by 200 mg three times daily for the treatment of acute gout in an open study on 41 patients. The drugs were equally effective with few and relatively mild side effects. Naproxen is a useful alternative agent for the treatment of acute gout.


Purine excretion in complete adenine phosphoribosyltransferase deficiency: effect of diet and allopurinol therapy.

1. Abnormal amounts of adenine, 8-hydroxyadenine and 2,8-dihydroxyadenine are found in the urine of homozygotes for APRTase deficiency and are diagnostic of this condition. 2. The renal complication is due to the excessive amounts of 2,8-dihydroxyadenine excreted since it is removed by allopurinol which blocks 2,8-dihydroxyadenine formation. 3. Uric acid metabolism and the excretion of the other minor purine bases is normal, at least in childhood, in homozygotes for APRTase deficiency. 4. Patients with the defect appear to be very sensitive to dietary purine. At least some of the adenine metabolites may have a dietary origin.


Regional flaps in ablative surgery in the head and neck.

Nondelayed regional skin flaps for reconstruction following radical ablative surgery in the head and neck have become a significant advance. Radical extirpation of large, recurrent or postirradiation persistent cancer would be prohibitive without the use of regional skin flaps in reconstruction. The incorporation of portions of rib, clavicle or scapula within a skin flap has allowed reconstruction of the mandible for both functional and cosmetic improvement.


The couvade syndrome.

This is a psychophysiologic reaction to a woman's pregnancy on the part of  her spouse. Nausea, vomiting, cramps or appetite disturbance occur in the husband early in pregnancy or near term. Anthropologists have found that ritual couvades dates back to ancient rituals regulating the behavior of the husband of a woman in labor. The modern syndrome is usually a self-limited condition but may indicate fears and anxieties that can be relieved by the understanding approach of the family physician.


Comparative effects of ajmaline on intermittent bundle branch block and the Wolff-Parkinson-White syndrome.

Phase 4 or phase 3 block or both occurred in the His bundle branch system of 11 patients with intermittent bundle branch block and in the anomalous bundle of 6 of 46 patients with the Wolff-Parkinson-White syndrome (13%). Administration of a single dose of ajmaline (50 mg intravenously) in these patients caused a similar response: expansion of the range of phase 3 and phase 4 block at the expense of the intermediate normal conduction range and total interruption of conduction in the affected fascicle when the effect of the drug was maximal. The great similarity in physiologic behavior and pharmacologic response in these groups of patients suggests that the anomalous bundle was probably diseased or abnormal in the six patients with Wolff-Parkinson-White conduction. In addition, ajmaline caused the first appearance of phase 4 or phase 3 block, or both, but not total interruption of conduction in 26 of the 46 patients with Wolff-Parkinson-White conduction (56.5%). Ajmaline does not cause fascicular block in normal subjects; thus this finding suggests either that the anomalous bundle is diseased or that the safety margin for conduction in the anomalous bundle is much narrower than in the bundle branch system. The conduction-depressing action of ajmaline may be greater at relatively rapid or relatively slow rates of stimulation, and smaller or absent at intermediate rates.


Systolic and diastolic ventricular function in cardiac amyloidosis. Studies in six cases diagnosed with endomyocardial biopsy.

Five cases of cardiac amyloidosis diagnosed after endomyocardial biopsy are described. Systolic function was normal in three cases as assessed by cardiac index, ejection fraction and maximal velocity of contractile element shortening at zero developed pressure. The diastolic dip and plateau wave form was a characteristic but not an invariable finding. Increased ventricular end-diastolic pressure but normal end-diastolic volume indexes in all cases implied a disorder of diastolic compliance. The diastolic pressure-volume plots suggested a sudden decrease in distensibility after normal early filling of the ventricle. The functional defect did not necessarily differ from that of other diseases of heart muscle. Therefore, hemodynamic data should not be relied upon for diagnostic purposes. Electron microscopy was the most reliable aid in making the diagnosis from the endomyocardial biopsy specimens especially in the presence of fibrosis. It may not be valid to assume a diagnosis of cardiac amyloidosis from the finding of amyloid in other organs.


Chronotropic effect of acetylstrophanthidin infusion into the canine sinus nodal artery.

Studies were performed to determine the chronotropic effect of acetylstrophanthidin during constant infusion through cannulation of the sinus nodal artery. Ten mongrel dogs weighing 13.5 to 18 kg were studied under sodium thiamylal anesthesia. Epicardial atrial and ventricular electrograms were recorded. The sinus nodal artery was cannulated and infused for 20 minutes at a rate of 2 cc/min with a solution containing acetylstrophanthidin, 0.5 microng/cc. Mean results for the group of 10 animals were determined. There was a gradual acceleration of the atrial rate of 45 beats/min after 6 to 8 minutes of infusion. The peak atrial rate of 175 beats/min was achieved by 10 to 12 minutes. This tachycardia persisted for 2 to 4 minutes without atrioventricular block or premature beats. By 12 to 14 minutes, there was a gradual slowing of atrial rate followed by bradycardia, sinus pauses and atrial arrest. Sinus nodal arterial infusion of acetylstrophanthidin produces an initial positive chronotropic effect and, if maintained, a depression of atrial rate and, terminally, atrial arrest. The gradual time course of development and decline of the tachycardia suggests that the "paroxysmal" atrial tachycardia caused by digitalis excess is the result of enhanced pacemaker automatically rather than reentry, and thus is not truly paroxysmal.


New practical treadmill protocol for clinical use.

A new continuous treadmill protocol (USAFSAM) has been designed using a constant treadmill speed (3.3 miles/hour) and regular equal increments in treadmill grade (5%/3min). The constant treadmill speed requires only initial adaptation in patient stride, reduces technician adjustments and produces less electrocardiographic motion artifact than do protocols using multiple or higher treadmill speeds, or both. The regular equal increments in treadmill grade are easy to implement and provide a larger number of work loads than do protocols that are discontinuous or require larger changes in work load. The USAFSAM protocol was compared with the older Balke-Ware protocol in 26 healthy men (aged 30 to 59 years). Each fasting subject completed two maximal treadmill tests from each protocol. Measurements included minute heart rate from the electrocardiogram, auscultatory blood pressures and oxygen consumption obtained with standard techniques. Similarities in between-protocol measurements for submaximal and maximal treadmill efforts were impressive; differences were small and unimportant. Further, both protocols showed equal reproducibility for the measurements noted. Importantly, time to maximal effort was reduced by 24% with the USAFSAM protocol. The USAFSAM treadmill protocol has since been used in more than 500 clinical and screening examinations, thus confirming its advantages and practicality for routine clinical stress testing. Normal reference values previously established for the Balke-Ware protocol are shown to apply to the new USAFSAM protocol as well.


Desmosome-like junctions between Sertoli and germ cells in the rat testis.

Desosome-like junctions between Sertoli cells and germ cells (spermatogonia, spermatocytes and non-elongate spermatids) were observed in the adult rat testis. At all levels, certain features were characteristic of this relationship, the most prominent being a densification of the subsurface aspect of the plasma membranes of each cell. The Sertoli cell counterpart demonstrated an abundance of cytoplasmic fibrils which converged on the density, but no such feature was evident in the germ cell counterpart. The width of the intercellular space was variable, ranging in some regions from approximately 3-5 nm, to other regions of approximately 14-18 nm, the latter being representative of most areas of contact. A poorly represented, and often discontinuous, intermediate dense line was observed in the intercellular space. Hypertonic fixative solutions containg dextrose were utilized to provoke tissue shrinkage and exaggeration of the intercellular space within the basal compartment of the testis. Cell separation was evident over most regions of the cells, except where desmosome-like contacts were present. Forces transmitted from one cell to another at desmosome-like contacts resulted in tearing of cellular fragments, while junctional regions of both cells remained intact. These observations indicate that desmosome-like junctions are strong adhesive sites between germ cells and Sertoli cells.


Movement of spermatocytes from the basal to the adluminal compartment of the rat testis.

The progressive movement of primary spermatocytes from the basal to the adluminal compartment of the seminiferous tubule was studied after testes were fixed with standard and hypertonic solutions. In stages VI, VII and VIII of the cycle (classification of Leblond and Clermont, '52), preleptotene spermatocytes were observed within the basal compartment of the seminiferous tubule. Resting on the basal lamina, these cells were bound tightly to neighboring Sertoli cells by desmosome-like junctions. In late stage VIII and early stage IX, basal processes of Sertoli cells were observed between the newly formed leptotene cells and the basal lamina, and in stage IX, the Sertoli processes met to form a junction of the zonula adherens type. This junction formed a permeability barrier which restricted the free access of fixative into the spaces around leptotene cells. Evidence for this was found in the absence of the shrinkage artifact produced with hypertonic solutions in earlier stages. In longitudinal sections, the permeability barrier was first observed in an area of the tubule in which sperm release was also taking place. In mid-stage IX and in stage X, sertoli-Sertoli junctional specializations formed de novo below the leptotene spermatocyte, while those from the preceding stages, present above the leptotene spermatocytes, remained intact. Thus, tight junctions were in evidence for a considerable period of the time, both above and below the leptotene spermatocytes. At no time in the process of germ cell movement toward the lumen did these cells exhibit evidence of amoeboid movement or lose desmosome-like contacts with the surrounding Sertoli cells. From this study it is concluded that the Sertoli cells play an active role in the transfer of spermatocytes to the adluminal compartment. A transient intermediate compartment of the seminiferous tubule is described, one which allows for the continual maintenance of the blood-testis barrier during transit of spermatocytes from the basal to the adluminal compartment.


The ultrastructure of endocrine cells in the corpus of the stomach of human fetuses.

The ultrastructural development of endocrine cells from the corpus of fetal human stomachs is described. Samples were taken from fetuses ranging in fertilization age from 6-8 to 22 weeks. The identifying features used for the classification of the various types of endocrine cells were their basal locations in the epithelium, the presence and morphology of their characteristic granules and the sizes of the mitochondria. Five types of endocrine cells with specific granules were found:D, EC, ECL, AL and D1. The type and number of endocrine cells increased as development proceeded. The endocrine cells were confined to the epithelium, they did not reach the lumen and they appeared to develop in situ. The D, EC and ECL cells were the most numerous. The fetal endocrine cells resembled morphologically those found in the stomachs of various adult animals. The EC, ECL and D1 cells contained small slender mitochondria with few cristae. Intramitochondrial granules were absent in all the cell types. Agranular electron-lucent cells with small mitochondria were considered to be immature endocine cells. The advanced stage of differentiation observed in these cells suggest that they may be capable of producing and storing biogenic amines and polypeptide hormones. Their possible involvement in the synthesis of serotonin, enteroglucagon and intrinsic factor is discussed.


A retropharyngeal approach to the avian brain stem.

The surgical steps used to expose the ventral surface of the chicken's rhombencephalon are detailed. Both acute and chronic experimental preparations can be obtained with this technique. Text material and illustrations provide information on the morphological relationships of the brain stem, skull and other significant structures encountered during the operative procedure.


Spatial distribution of DNA-synthesizing cells in colonic crypts of the guinea pig.

The ascending colon of a guinea pig injected with tritiated thymidine was cut serially, autoradiographed and stained with periodic-acid Schiff-hematoxylin. Maps of transversely sectioned crypts were prepared with the use of a microscope eye-piece projector. The number and angular positions of pulselabelled (DNA-synthesizing) cells around the circumference of transverse sections of the crypt were recorded. A method of 'statistics of the circumference' was applied in order to find the variances of angular distances between labelled cells and thereby to find the type of arrangement of DNA-synthesizinbg cells in the crypt. The spatial distribution of DNA-synthesizing cells both around the crypt circumference and along the crypt, was found to be non-random. While the pattern of non-randommess around the crypt circumference is such that the DNA-synthesizing cells tend to occupy positions in the crypt circumference at maximal distances from each other, DNA-synthesizing cells along the crypt tend to occupy positions at minimal distances from each other. DNA-synthesizing cells are arranged in the crypt in rows, each consisting of several cells and each parallel to the long axis of the crypt. Apparently the dividing cell of the crypt produces either two proliferating or two differentiating cells. No evidence of differential mitosis could be found.


The caudal luminous organs of lanternfishes: general innervation and ultrastructure.

Neuroanatomical, light and electron microscopic investigations of the caudal luminous organs of two lanternfish species, Stenobrachius leucopsarus and Parvilux ingens, were conducted in a search for morphological correlates underlying their luminescent behavior and control mechanisms. Complex neural pathways involving the spinal nerves and the sympathetic nerve chain of the caudal peduncle are associated with profuse segmental innervation to both the supracaudal and infracaudal organs. Neural composition of these segmental subunits indicates that pre-ganglionic (spinal) as well as post-ganglionic (sympathetic) fibers are involved in the neural control of luminescence of these organs. Neuro-photocyte units, in which multiple nerve branches are sandwiched between two lamellar photocytes and establish large surface areas of close appposition, as well as gap junctions apparently interconnecting all photocytes throughout the luminous organs, may account for the very rapid and simultaneous displays of spontaneous or electrically driven luminescence. The organization of the caudal luminous organs is compared with that of lanternfish photophores. Relatively few granular and agranular synaptic vesicles are present in some nerve processes of the photocyte units, suggesting that adrenergic neurotransmission as well as electrotonic spread of excitation may be involved at the neuro-photocyte junctions.


Light and electron microscopic observations on noradrenergic nerves and striated muscle cells of the guinea pig urethra.

Neurohistochemical and electron microscopic techniques have been used to determine the arrangement and distribution of noradrenergic nerves and striated muscle in the wall of the guinea pig urethra. Fluorescent, catecholamine - containing nerves were observed among striated muscle cells only in the junctional zone between an inner layer of smooth muscle and an outer layer of striated cells. In this region considerable intermixing of the two types of muscle cell occurred. Electron microscopy has shown that noradrenergic terminal regions containing characteristic small dense-cored vesicles were invariable associated with smooth muscle cells; such nerves were never observed forming neuroeffector relationships with striated cells. These findings indicate that noradrenergic 'sympathetic' fibres are not directly involved in the functional control of urethral striated muscle.


Observations on destruction of spermatozoa in the cauda epididymidis and proximal vas deferens of non-seasonal male mammals.

The electron microscope has been used to examine luminal spermatozoa from the cauda epididymidis and proximal vas deferens of rats, mice, hamsters and guinea pigs. Free in the lumen of all species are accumulations of a dense material within which are vesicles, granules and dense bodies, as well as spermatozoa. The spermatozoa are undergoing a process of degeneration as judged by a loss of plasma membrane from both heads and tails and further disruption of acrosomal membranes, mitochondrial sheaths and outer dense fibers. Disruption of spermatozoa also occurs outside these obvious dense masses when the luminal protein precipitated by the fixation procedure has contact with the spermatozoon. Intact spermatozoa are separated from luminal material by a clear "halo".


The influence of egg consumption on the serum cholesterol level in human subjects.

The influence of whole fresh eggs on the serum cholesterol level in men and women was studied independently in hospitalized patients in Sofia, Prague and Urbana-Champaign. The patients were fed two eggs or the equivalent of two eggs in a custard base or milk shake in addition to the foods that were consumed in their diet pattern. The serum cholesterol level was determined before and at periods varying from 5 hr to 54 days after the consumption of the eggs. The mixed fatty acid composition of the total lipids in the serum and the erythrocytes was also determined. In the majority of patients, the serum cholesterol level did not change significantly 5 hr after the consumption of 465 mg of cholesterol in an egg custard base or milk shake or after up to 54 days of continued consumption of two whole eggs per day. The serum cholesterol level of some subjects increased and others decreased at all three experimental sites. A comparison of the mixed fatty acid composition of the total serum lipids obtained from men and women who had received treatment for other reasons than cardiovascular disease with those that had been treated for cardiovascular disease indicated that the serum from both groups contained a substantial amount of polyunsaturated fatty acids. The lipids extracted from the red blood cells obtained from patients in Urbana-Champaign and Sofia did not differ significantly in linoleic and arachidonic acid content.


Milk composition and thiamine transfer in thiamine deficient rats.

Milk composition was determined in rats maintained on a thiamine deficient diet from the 10th day of pregnancy. Percentage of thiamine transfer was reduced after the 14th postpartum day. Milk composition of thiamine deficient dams 18 days postpartum revealed similar protein and amino acid levels in both thiamine deficient and control rats, whereas milk protein fractions showed some differences. Milk lactose levels were depressed in thiamine deficient rats. Fatty acid content was higher in milk of thiamine deficient than in pair fed and adlibitum controls. The supply of a larger proportion of calories from lipids rather than carbohydrates may have clinical significance.


Factors affecting the exchange of tocopherol between red blood cells and plasma.

The purpose of this study was to clarify factors that affect the equilibrium distribution of alpha-tocopherol between red blood cells and plasma. Plasma labeled with 14C-alpha-tocopherol was incubated with red cells for 4 to 6 hr and the distribution of the tocopherol determined in the two compartments (red blood cell (RBC: plasma ratio). Use of heparin as anticoagulant gave a higher RBC: plasma ratio than acid citrate dextrose. The RBC:plasma ratio was affected by the hematocrit of the incubation mixture, higher ratios being obtained with lower hematocrits. The ratio was not related to the plasma concentration of alpha-toxopherol, indicating that the red cell was not saturated up to four times normal plasma levels. Of possible clinical significance was the finding that the RBC: plasma ratio was related to the total lipid concentration of plasma. Red cell content of alpha-tocopherol decreased as plasma lipids increased, until at three times normal plasma lipid concentration the red cells had one-third or less of their normal concentration of alpha-tocopherol. The implications of this observation on the relationship between plasma and tissue aplha-tocopherol are discussed.


Newborn body compositon and its relationship to linear growth.

Anthropometric measurements were made on 4,952 newborns from a Peruvian urgan population. Newborns characterized by high subcutaneous fat and high muscle had significantly greater birth weights and recumbent lengths when compared to their counterparts with low subcutaneous fat and muscle. Similarly, newborns characterized by high muscle and low fat had significantly greater birth weights and recumbent lengths that newborns characterized by low muscle and high fat. It is postulated that an increase in newborn protein and calorie reserves results in a greater increase in birth weight and recumbent length than an increase in calorie reserves alone. Evaluations of maternal antropometric characteristics indicate that variations in birth weight and recumbent length of the newborn are affected more by maternal nutritional status than by maternal stature.


Vitamin E status of Chinese population in Taiwan.

Vitamin E status of Chinese population with different age groups was studied by determining plasma vitamin E levels (PE) and hydrogen peroxide-induced erythrocyte hemolysis (HPEH). The mean PE of 99 adults, ages 23 to 78, was 1.05 +/- 0.47 mg/100 ml. There was no significant difference between sexes. PE was negatively correlated with HPEH (P less than 0.01). There was a significant positive correlation (P less than 0.01) between PE and plasma cholesterol level. The mean PE of four young men of Yami tribesmen, ages 16 to 19, was 0.60 +/- 0.10 mg/100 ml. HPEH was low. After daily supplementation of 200 mg dl-alpha-tocopheryl acetate for 16 days, PE increased 54%, but the plasma cholesterol was not affected. The mean PE of 39 elementary school children ages 12 to 13, was 0.70 +/- 0.31 mg/100 ml. The mean PE of 20 newborn infants was 0.23 +/- 0.08 mg/100 ml. HPEH was as high as 56.5 +/- 31.9% indicating a state of vitamin E deficiency. PE of total population was positively correlated with age (P less than 0.01). It was concluded that the vitamin E status of Chinese population in Taiwan was comparable to that of population groups in many other parts of the world.


Metabolic regulation as a control for lipid disorders. II. Influence of (--)-hydroxycitrate on genetically and experimentally induced hypertriglyceridemia in the rat.

These studies were designed to determine whether genetically and experimentally induced hypertriglyceridemia were correlated with hyperlipogenesis, and whether inhibiting fatty acid synthesis would reduce serum triglyceride levels. Hypertrigylceridemia, resulting from genetic obesity in Zucker rats and fructose feeding or Triton administration to Charles River rats, was examined in relation to in vivo rates of heatic fatty acid synthesis, and the influence of (--)-hydroxycitrate (a potent competitive inhibitor of ATP citrate lyase) on serum triglyceride levels and lipogenesis was determined. Zucker obese rats demonstrated significantly increased rates of fatty acid synthesis and levels of serum triglycerides compared to their lean litter mates; lipogenic rates and circulating triglycerides were reduced markedly by the oral administration of (--)-hydroxycitrate. Fructose administered in the diet or drinking water induced a hypertriglyceridemia which was associated with a marked increase in hepatic lipogenesis, and (--)-hydroxycitrate reduced significantly both parameters. In contrast to the significant role that increased rates of lipogenesis apparently played in the development of hypertriglyceridemia in the Zucker rat and fructose-fed rat, Triton given intravenously produced a marked rise in serum triglycerides which could not be accounted for, to an appreciate extent, by increased rates of fatty acid synthesis. (--)-Hydroxycitrate reduced serum triglyceride levels and hepatic lipogenic rates equivalently in the Triton-treated and nontreated rats.


Variation among commercial activated partial thromboplastin time reagents in response to heparin.

The activated partial thromboplastin time (APTT) has been advocated for monitoring heparin effect. This study was designed to determine the in vitro sensitivity to heparin of commercially available APTT reagents. Heparin was added in increasing concentrations to pooled citrated plasma. Fibrometer APTT determinations were performed at each concentration using General Diagnostics, Ortho, Dade, Hyland, and BBL reagents. A tilt-tube kaolin-activated partial thromboplastin time was also tested using a Sigma partial thromboplastin prepared by the method of Bell and Alton. The General Diagnostics, Sigma, and Ortho reagents displayed linear heparin sensitivity; the General Diagnostics APTT was prolonged 1 1/2-2 1/2 times in a plasma heparin range that prolonged a modified in-vitro Lee-White clotting times 2-3 times. The other reagents were either insensitive, too sensitive, or nonlinear in heparin response. Thus, commercial reagents vary widely in their in-vitro sensitivity to heparin.


Correlates of successful outcome in crisis intervention therapy.

The present study examines the correlates of successful outcome (subsequent inpatient or outpatient treatment) of 305 outpatient cases treated by crisis intervention therapy. Although the two measures of outcome were correlated with each, the respective relationships with the predictor variables were sometimes different. Demographic variables and therapist's characteristics were not correlated with either outcome measures. Past responses to stress (prior state hospitalization and suicidal behavior) were predictors of subsequent inpatient treatment, but not subsequent outpatient treatment. On the other hand, current precipitating events did not predict inpatient treatment, but did predict subsequent outpatient treatment. Several statistically nonsignificant relationships which either replicate or disagree with previous findings are also discussed.


A partial evaluation of an introductory training program in behavior modification for psychatric nurses.

The paper describes the procedures and evaluation of a four-session introductory training program in behavior modification. The program focuses on (a) basic operant therapy principles and techniques, (b) behavioral observation and recording procedures, (c) major steps in developing individual behavior modification programs, (d) an overview of target behaviors to which behavioral techniques have been successfully applied, and (e) clarification of the psychiatric nurse's role as a behavioral engineer. Training utilized lecturettes, group discussion, practice in recording behavior seen on videotape, daily practice in behavior observation, and a film demonstrating behavioral techniques. Nurses improved signifcantly in basic behavior observation skill, program planning, and in their perceptions of the changeability of a variety of behaviors . Improvements were not maintained at a 4-month follow-up. The importance of continuing training beyond an introductory stage is discussed. Subsequent stages of training necessary are described.


A systems approach to the child, school, family, and community in an urban area.

Fifteen eighth-grade students, their parents, teachers, and relevant school administrators received a multilevel systems consultation from a community mental health center. Clients were conceptualized and worked with in terms of the subsystem to which they belonged and with regard to the interrelationships of the other subsystems comprising the school-community system. Theoretical considerations following Lewin's life-space concept are described as a basis for this approach in contrast to more traditional ones which typically fail to treat directly, simultaneously, and/or sequentially all client subsystems, e.g., child, school, family, and community. The consultation is described as a case example with each client contributing to the evaluation of the intervention. Although the consultation could not be carried out entirely along the lines originally conceived, it serves as a helpful model for making a more potent impact in school interventions.


Coping patterns of law enforcement officers in simulated and naturalistic stress.

Psychophysiological and self-report measures of reactivity were obtained from 135 police deputies exposed to a stressful film. Subjects categorized according to trait anxiety level and character defense pattern were encouraged to anticipate benign or threatening experiences or were given no preparatory information. In general, information abetted stress reduction; individual personality variables also influenced reactivity. The vigilant coper group uniformly demonstrated intolerance for uncertainty, whereas the responses of the neutral and avoider groups were separable according to anxiety level, in which lower anxiety facilitated adaptation to the stressor. The dramatic correspondence of supervisory ratings of field performance and the data for the no-warning condition suggests that the demands for success in law enforcement service were approximated by the simulated stress procedure.


The dimensions of life quality in a community.

In this study the dimensions of the quality of life construct were investigated; 454 residents of a large suburban community were asked questions on life changes, psychiatric distress, happiness, and effective participation in life concerns. Selected variables from this survey were factor-analyzed in order to define the dimensions of life quality and six demographic variables; age, sex, marital status, education, income, and religious participation were studied to see how they influenced those dimensions. The results of the analysis revealed that life quality is measurable in terms of a person's happiness, his community participation, and his preferences, answering three major questions that person may pose for himself: (1) How well do I like the life I lead? (2) In what meaningful ways do I spend my time? (3) Why? Each of the six demographic variables influenced these dimensions. Marital status and age, two life-cycle statistics, had the most powerful effects on quality-of-life ratings.


The syndrome of abuse dwarfism (psychosocial dwarfism or reversible hyposomatotropism).

In abuse dwarfism the behavioral signs include some or all of the following: (1) a history of unusual eating and drinking behavior, reversible on change of domicile, such as eating from a garbage can and drinking from a toilet bowl, stealing food, alleged picky eating and rejecting food at the table, polydipsia and polyphagia, possibly alternating with vomiting and possibly also with self-starvation; (2) a history of such behavioral symptoms as enuresis, encopresis, social apathy or inertia, defiant aggressiveness, sudden tantrums, crying spasms, insomnia, eccentric sleeping and waking schedule, pain agnosia, and self-injury, all occurring only in the growth-retarding environment; (3) retarded motor development, with improvement on removal of the child from the domiclle of abuse; (4) retarded intellectual growht, reversible on change of domicile by as much as 30 to 50 IQ points; and (5) a history of pathologic family relationships, including unusual cruelty and neglect, either somatic or psychic or both.


Immunological studies on an aberrant form of ataxia telangiectasia.

We describe two brothers with ataxia telangiectasia (AT) of which one was unique in that he had no detectable IgG and IgA concentrations in the serum or saliva. The other brother had the more common IgA deficiency in the serum and saliva. Neither patient had a history of undue sinopulmonary infections. In spite of the absence of these immunoglobulins in the sera, there were cells in the bone marrow and peripheral blood that stained with fluorescein-labeled anti-IgG and anit-IgA. Both patients had demonstrable humoral antibody and cell-mediated immune responses to the antigens tested. We also discuss possible pathophysiological mechanisms causing the above defects.


Hypopituitarism following extirpation of a pharyngeal pituitary.

A neonate without external malformation had undergone removal of a nasopharyngeal mass containing anterior and posterior pituitary tissue. Numerous endocrine evaluations since that time have confirmed polyhormonal hypopituitarism. Endocrine replacement has resulted in a healthy, normal child except for short stature. The literature dealing with pharyngeal pituitary, congenital absence of the pituitary, cyclopia, and other malformations of the pituitary suggests only vague theories to explain the infrequent anomalies found in this area. We propose that laminagrams of the sphenoid of newborns with sighus may aid in early diagnosis and appropriate replacement therapy.


Urinary excretion of phenobarbital in a neonate having withdrawal symptoms.

Utilizing methods of gas chromatography-mass spectrometry-computer systems operated in a chemical ionization mode, metabolites of mephobarbital were demostrated in urines collected from two infants whose mother was treated with mephobarbital during pregnancy. Identification of the major metabolite in one infant was possibe for 22 days after delivery. The urinary half-life of mephobartial was 30 hours and the half-life of phenobarbital was 48 hours. Both infants demonstrated withdrawal symptoms for four to six months and manifested the physical phenotype of infants exposed in utero to anticonvulsant agents.


Vertigo as a presenting symptom of multiple sclerosis in childhood.

We describe a case of childhood multiple sclerosis with vertigo as a presenting finding. A review of 14 casts at The Children's Hospital of Denver disclosed that vertigo was a presenting symptom in four of these. This ratio closely approximates the adult incidence. With the application of objective vestibular testing, this rate is probably much higher. Pediatricians should bear in mind childhood multiple sclerosis when faced with unexplained vertigo in a child.


Colonoscopic polypectomy in children.

Three children, 30 to 36 months of age, had solitary juvenile polyps in the sigmoid colon and rectal bleeding of varying severity, In all three patients, the polyps were removed without the use of general anesthesia through a standard 100-cm colonoscope used to examine adult patients. No untoward effects were encountered. Colonoscopic polypectomy is an effective therapeutic procedure and obviates the need for either anxious waiting in the mildly symptomatic patient or colotomy and polypectomy in the child with profuse rectal bleeding.


Comparison of the effects of cholic acid and chenic acid feeding on rates of cholesterol synthesis in the liver of the rat.

To compare the ability of cholic acid and chenic acid to suppress cholesterol synthesis in the liver, these two bile acids were fed in varying amounts to rats for either 66 hr or 6 weeks. In both instances there were significant changes in the bile acid pool in the small intestine and suppression of the rate of cholesterol synthesis in the liver. The administration of cholic acid, however, consistently produced greater suppression of the rate of cholesterol synthesis from octanoate or of microsomal HMG CoA reductase activity than did the administration of a similar amount of chenic acid. Furthermore, this difference was present whether the rates of cholesterogenesis were measured at high-substrate concentrations, ie, under conditions where Vmax was apparently achieved, or under circumstances where there was essentially no extracellular substrate present. These findings do not support the view that the superiority of chenic acid for dissolution of gallstones is secondary to its greater effect as an inhibitor of hepatic cholesterol synthesis.


Intractable diarrhea. Intestinal perfusion studies and plasma VIP concentrations in patients with pancreatic cholera syndrome and surreptitious ingestion of laxatives and diuretics.

Small-intestinal perfusion studies with a triple-lumen tube were performed in the jejunum and ileum of 11 patients with a presumptive diagnosis of pancreatic cholera syndrome (PCS). Ultimately PCS was proven to be present in only 3 patients, whereas 6 were discovered to be taking either laxatives or diuretics surreptitiously. In 2 of the 11 patients the cause of the diarrhea could not be determined. In PCS the major abnormality which we observed was that the jejunal mucosa secreted rather than absorbed when perfused with a plasma-like solution. By contrast, the ileum of the PCS patients absorbed a plasma-like solution in a normal fashion; however, one patient failed to absorb sodium and chloride when a solution with low (50 mM) sodium chloride concentration was perfused in the ileum. The volume of endogenous fluid was high in both the jejunum and ileum, presumably because of proximal small-intestinal secretion. Glucose stimulated sodium movement in an absorptive direction in each patient. Studies were repeated in one PCS patient after tumor removal, and his intestinal absorption of water and electrolytes was normal. Patients with diarrhea due to surreptitious ingestion of laxatives and diuretics showed normal absorption in the jejunum and ileum. This study shows that proximal small-bowel secretion was the major cause for diarrhea in our 3 patients with PCS. This cannot be a consequence of diarrhea per se since it was not found in patients with long-standing diarrhea due to surrepitious drug ingestion. Small-intestinal perfusion studies may be helpful in the diagnosis and management of selected cases of severe chronic diarrhea. On the other hand, measurement of plasma VIP concentration, especially by methods currently used in the United States, is of little use and may be misleading.


The association of heartburn with gastritis.

Esophageal, fundal, antral, and duodenal mucosal biopsies from 10 patients with heartburn were compared with biopsies from 18 patients with dyspepsia but without heartburn or radiographic or endoscopic evidence of peptic ulcer disease, gastric retention, or esophageal stricture. There was a highly significnt correlation between heartburn and antral gastritis and duodentitis (P less than 0.01). It is suggested that histologic reflux changes are determined by the severity of reflux and reparative potential of the esophageal mucosa. Heartburn, on the other hand, is more related to the nature of the refluxed fluid. The fluid most likely to induce heartburn is one containing duodenal fluid, which is also believed to be an important cause of antral gastritis.


Is reduced release of gastrin the mechanism of ulcer healing after gastroenterostomy?

Until recently in this unit gastroenterostomy was the operation of choice for patients with duodenal ulcer whose maximal acid output (MAO) is less than 30 mmol/hr. Ulceration (jejunal) has recurred in only 2.1%. Unlike partial gastrectomy, which has a peak incidence of ulcer recurrence in the first two years, the incidence of ulcer recurrence remains constant throughout the years after gastroenterostomy. In looking for the explanation of this low recurrence rate we have studied the effect of the operation upon serum gastrin responses to standardized test meals 3 weeks and 26 weeks after operation in 9 patients. Nine normal subjects acted as controls. Six months after operation the responses were significantly lowered, a fall in the serum levels of gastrin at 30, 45, 60 and 90 min after means suggesting that gastroenterostomy reduces both the gastric and intestinal phases of acid secretion. The mean integrated gastrin response (IGR) throughout the postprandial 90 min is also significantly lower 6 months after surgery. The overall mean reduction was 31.1%.


Possible relationship between the rate of ethanol metabolism and the severity of hepatic damage in chronic alcoholics.

The rate of ethanol metabolism (EMR) was determined in alcoholic patients with or without hepatic necrosis, steatosis, and/or cirrhosis. Fifty six cases were studied after 9-25 days of abstinence (mean 15 days). A significant increase in EMR (P less than 0.01) was found in alcoholics with hepatic necrosis (265 +/- 20.5 mg/kg/hr) compared with alcoholics with normal liver histology (154 +/- 17) and nonalcoholic controls (159 +/- 15). In alcoholics with liver steatosis but without necrosis a lesser increase in EMR (207 +/- 20, P less than 0.05 was also observed. Patients with slight fibrosis but without other abnormalities in their liver biopsies and cirrhotics with overt liver failure (jaundice, ascites) showed EMR similar to controls.


Endogenous hypergastrinemia and cell proliferation in the fundic mucosa in dogs.

Endogenous hypergastrinemia (P less than 0.01) was produced in 4 dogs with a Heidenhain pouch through surgical exclusion of the pyloric antrum. This was followed by acid hypersecrection and increased DNA synthesis and mitotic activity (P less than 0.01) in the mucosa of the Heidenhain pouch. The acid hypersecretion induced by histamine in beeswax in 4 other dogs did not increase the proliferative parameters in the pouch mucosa of the latter. A positive correlation (r = 0.84, P less than 0.01) was found between the serum gastrin levels and the DNA synthesis index values measured in the 4 animals before antral exclusion, after antral exclusion, and after antrectomy. These data support the hypothesis that the trophic effect of gastrin on the fundic mucosa can be elicited by physiological doses of endogenous hormone.


The influence of prednisolone on hepatic function in normal subjects. Effects on galactose elimination capacity, sulfobromophthalein transport maximum and storage capacity, and D-glucaric acid output.

In view of the importance of liver tests in the follow-up of patients under treatment with corticosteroid hormones, 20 mg of prednisolone were given by mouth to normal volunteers for 4 days and hepatic function was assessed before and during treatment. Despite significant falls in plasma cortisol and serum bilirubin concentrations, the galactose elimination capacity, the BSP tests, and the urinary D-glucaric acid output remained essentially unchanged. Consequently no pharmacological effect of this corticosteroid hormone on the examined tests could be detected.


Effect of bile duct obstruction on pancreatic enzyme secretion and intestinal proteolytic enzyme activity in the rat.

The role of bile in regulation of intestinal proteolytic activity in rats was investigated by studying the effects of bile diversion and bile duct obstruction on pancreatic protease secretion and on recovery of protease from the intestine. Diversion of bile and pancreatic juice from the intestine caused a large increase in pancreatic enzyme secretion; replacement of bile partially suppressed this response. Bile duct obstruction resulted (3-4 days postobstruction) in a threefold increase in pancreatic juice chymotrypsin but caused a large decreases in intestinal trypsin and chymotrypsin activities and total proteolytic activity. Recovery of pancreatic juice protein (labeled with 14C) from intestinal contents was markedly decreased in bile duct obstruction, indicating a more rapid rate of degradation and absorption of pancreatic jucie protein. The evidence suggests that interruption of bile flow results in an accelerated rate of degradation of pancreatic proteolytic enzymes, and that the increase in pancreatic enzyme secretion is an adaptation to decreased intestinal proteolytic activity.


Reevaluation of triethers as markers for triglycerides during gastric emptying.

The validity of using triethers as markers for triglycerides during gastric emptying was investigated. Rats were given a lipid mixture containing [75Se]triether plus [131I]triolein or [3H]triether plus [14C]triolein intragastrically. Similar studies were performed on humans using a homogenized test meal to which was added [75Se]triether plus corn oil. Analysis of gastric contents at various time intervals after administration of the test meal did not show evidence of separation of triglyceride and triether in the stomach. It is discussed that the disappointing results of other workers using [3H]triether may be due to an artifact associated with instability of the tritium-to-triether bond in the preparation used.


Untreated gastric pseudolymphoma.

Gastric pseudolymphoma is an inflammatory process that may simulate malignancy. In most reported cases, the initial diagnosis has been malignant lymphoma and treatment has been applied accordingly. We report a case of gastric pseudolymphoma wherein the diagnosis was made from multiple surgical biopsies, and follow-up now exceeds 11 years. To our knowledge no other case of untreated gastric pseudolymphoma has been reported. This case may more closely represent the biologic nature of this presumably benign condition.


Levels of satisfaction among hospital pharmacists.

Hospital pharmacists in a Midwestern, metropolitan area were surveyed to determine levels of job satisfaction. Of the 195 pharmacists who received the 120-item questionnaire, 132 (68%) responded. The questionnaire included facet-free questions which reflect the overall satisfaction of an individual with his job. Results to these questions were compared to those for professional, managerial and nonprofessional workers in two University of Michigan Surveys of Working Conditions. Also included in the survey were facet-specific job satisfaction measures from the Minnesota Job Satisfaction Questionnaire. The study found an overall pattern of less satisfaction among hospital pharmacists than among workers included in the Michigan surveys. The data indicate that hospital pharmacists might be less committed to their jobs and more likely to change jobs than other employees. Compared to other employees, hospital pharmacists showed a greater commitment to the work ethic and were more dissatisfied with their general life situation. The average general job satisfaction score of the respondents was 2.53, on a five-point scale, indicating something less than "satisfied". Pharmacists were least satisfied with the lack of opportunity for advancement, staffing practices, employer's policies and practices, and compensation practices. Compensation relative to others and amount of compensation were the sources of greatest satisfaction. Staff pharmacists had the lowest level of satisfaction; clinical pharmacists the highest--other personnel categories compared were directors, associate and assistant directors, and supervisors. The profession of pharmacy should decide whether or not to be concerned with the general low level of satisfaction among hospital pharmacists.


Involving staff pharmacists in management decisions.

Various administrative techniques used to bring staff pharmacists in a decentralized, satellite pharmacy system into the managerial decision-making process are discussed. These techniques include a staff pharmacist on-call procedure to discourage absenteeism, and the concept of a head pharmacist to serve as a link with departmental administration. The head pharmacist works in the satelite pharmacy, is responsible for its daily operation and is the spokesman for the satellite. Active roles for the head pharmacist in the selection and evaluation of technicians are outlines. Management skills are developed in head pharmacists through a program of special classes and discussion groups. It is concluded that this program has improved the credibility of administrative decisions and has tapped an underused source of ideas and talent.


Model for drug usage review in a hospital.

A five-component conceptual model for drug usage review is discussed as it applies to hospitals. The components of the model are: (1) authority, (2) operational and demographic characteristics of the delivery system and the population served, respectively, (3) the existing profile of drug usage, (4) standards of appropriateness and review of drug usage, and (5) scheme of evaluation to measure the impact of review. A drug usage review program in a hospital should: (1) improve the level of patient care and often reduce the cost of care, (2) improve the management and use of hospital resources, (3) clarify the drug component of patient care and better integrate pharmaceutical services with other hospital services, and (4) improve the fact-finding capacity that can help identify and solve hospital problems.


In vitro technetium-99m red blood cell labeling using commercial stannous pyrophosphate.

A simple and rapid technique of preparing technetium-99m-labeled erythrocytes using commercial stannous pyrophosphate as the reducing agent was developed. The technique involves incubating red cells with stannous pyrophosphate, centrifugation, and addition of Tc-99m pertechnetate to the red cell fraction. A mean red cell labeling efficiency of 94% was achieved in 10 patient samples and less than 5% in vitro dissolution of Tc-99m red blood cells occurred up to two hours after preparation.


Stability of aspirin in propoxyphene compound dosage forms.

The stability of aspirin in propoxyphene compound capsules made by three manufacturers, stored under a variety of temperature and humidity conditions, was compared. The cotton packing was removed from 100-capsule bottles, and the containers were stored (capped) under the following conditions: 25 c37 C and 50 C at both high (90%) and low (10%) humidity. No desiccant was removed from the bottles if originally present. The products tested were Darvon Compound-65 (two formulations) (Lilly), SK-65 Compound (Smith Kline & French) and Dolene Compound-65 (Lederle). Under all conditions, the stability of aspirin in the SK-65 Compound product was greater than that of Darvon Compound-65 which in turn was greater than Dolene Compound-65. Further, the rate of aspirin decomposition was greater in the latter product than in the others.


Estimation of acetylcysteine and its preparations.

A sensitive, reproducible spectrophotometric procedure using Ellman's reagent for the determination of acetylcysteine in pharmaceutical dosage froms is presented. The method is based on the measurement of the absorbance of the anion of 2-nitro-5-thiolbenzoic acid at 412 nm, liberated as a result of the reaction of acetylcysteine and an alkaline solution of 5-5'-dithiobis-(2-nitrobenzoic acid). The optimum conditions for the reaction, speed of reaction and linearity relationship between concentration and absorbance are reported. It is concluded that the proposed method is simple, rapid and accurate for the determination of small quantities of acetylcysteine.


The 'problem' radical hysterectomy.

This is a study of 243 radical hysterectomy and pelvic lymphadenectomy procedures performed for gynecologic malignancy. The term 'problem' radical hysterectomy was applied to those patients with one of the following conditions: (1) recent cervical conization (within 21 days). (2) previous total or supravaginal hysterectomy, (3) pregnancy, or (4) previous pelvic radiation. There were 88 patients in theses categories. One hundred and fifty-five patients had none of these predisposing problems which might influence operative or postoperative complications. There were two deaths (0.82 per cent). There was no statistically significant difference in operative injuries to the bladder, ureters, or rectum or in the mean operative time and mean blood loss across the categories. However, there was a statistically significant difference across the categories in postoperative complicatons, both major and minor. The greatest incidence of such complications occurred in patients who had previous radiation therapy and the second greatest incidence was in patients who had recent cervical conization. Pregnant patients had the least number of complications.


Laser treatment of cervical and vaginal neoplasia.

The conservative management of cervical intraepithelial neoplasia (with electrodiathermocautery and cryosurgery) is unsuitable for the treatment of similar vaginal lesions because of complications of scarring, stenosis, and fistulas. A new modality of treatment with the use of a carbon dioxide laser beam was evaluated for the treatment of cervical and vaginal intraepithelial neoplasia. Histopathologic examination of cervical tissue after laser beam therapy showed that most of the tissue destruction resulted from evaporation of tissue and that the zone of tissue necrosis was much less than after cryosurgery or electrocautery. Laser therapy was used in 50 patients, 46 of whom had varying degrees of cervical and vaginal intraepithelial neoplasia. Treatment failures occurred in five patients (10 per cent). The experience of this study suggests that the major value of laser treatment of the lower genital tract will be in the management of vaginal intraepithelial lesions, while similar results in the treatment of cervical neoplasia may be achieved by much simpler methods.


Progestational agents and blood coagulation. VIII. Effect of low-dose, alternate-day, estrogen-progestin combinations on blood coagulation factors in man, with a special note on the effect of freezing of blood samples.

Changes in the blood coagulation system were studied in three groups of 20 patients each. The first group received 0.5 mg. of norethindrone daily, plus 0.06 mg. of ethinyl estradiol on alternate days from cycle Day 5 through 25. The second group, all of whom had been fitted with an intrauterine contraceptive device (IUD), received no hormonal treatment and served as a control group. The third group received 0.5 mg. of norethindrone daily, combined with 0.045 mg. of ethinyl estradiol given on alternate days from cycle Day 5 through 25. Blood samples were drawn prior to the initiation of the study and after three months of treatment. Tests of the following parameters of the blood coagulation system were performed: direct platelet count; platelet adhesiveness; prothrombin time; thrombin time; fibrinogen; factor II assay; activity of factors V, VII, VIII, IX, and X; antithrombin III; and fibrin/fibrinogen degradation products. For a number of these factors, both fresh and frozen blood samples were examined. It was concluded that the two treatment regimens, with the use of alternate-day estrogen administration over a three-month period, had no clinically significant effect on the blood coagulation system.


The effect of time of cord clamping and maternal blood pressure on placental transfusion with cesarean section.

We measured the residual placental blood volume (RPBV) of 20 infants delivered at term by cesarean section of women not in labor. In all cases, the umbilical cord was clamped within 40 seconds of birth. RPBV decreased significantly with increasing age at cord clamping. In addition, RPBV for infants with cords clamped within 20 seconds of birth correlated inversely with maternal systolic blood pressure (mean RPBV = 54.8 ml. per kilogram at 105 torr and 28.4  ml. per kilogram at 148 torr). However, RPBV did not correlate with maternal blood pressure for the whole group of 20 infants or for those with cords clamped later than 20 seconds after birth. These data indicated that in infants delivered by cesarean section placental transfusion is time related during the first 40 seconds of life and that maternal blood pressure also influences the magnitude of placental transfusion during the first 20 seconds after birth. Analysis of data from this study combined with data from a previous study shows that after 40 seconds the net flow between placenta and infant reverses and that cord clamping delayed beyond this point is accompanied by a rise in RPBV back to the level found when the cord was clamped before 20 seconds.


Multiphasic prolactin secretion during parturition in human subjects.

Prolactin (PRL) secretion in the periparturitional period in patients undergoing labor and vaginal delivery follows a remarkable multiphasic pattern not found in patients who underwent elective cesarean section without labor. There is a highly significant decline in PRL levels during active labor which reaches a nadir about two hours prior to delivery. Immediately after delivery, a surge of PRL is noted, reaching peak levels within two hours post partum. Thereafter, PRL levels fall, reaching a second nadir about nine hours post partum, and this low level is maintained for nine to 24 hours after delivery. This multiphasic pattern of PRL secretion is not correlated with changes in serum concentrations of cortisol, progesterone, estradiol, or estrone. PRL levels in all pregnant patients at term were unaffected by the administration of synthetic narcotic analgesic agents, anesthesia, or the stress of operation. It is concluded that PRL secretion in the pregnant patient at term is unresponsive to usual stimuli and that the multiphasic pattern of PRL secretion uniquely found with labor and vaginal delivery may be associated with dopaminergic neuroendocrine processes during human parturition.


Human grief: a model for prediction and intervention.

The prevalent approach to understanding of and clinical intervention in the process of mourning employs a model based on stages of bereavement. This paper suggests a theoretical conception that is not tied to a fixed order of emotional states. Two dimensions--closeness of relationship and mourner's perception of preventability of the death--are identified as prime predictors of the intensity and duration of bereavement.


Birth outcomes in the offspring of mentally disordered women.

The course of pregnancy and birth were studied among schizophrenic, neurotic depressive, and personality-disordered women, compared to a normal control group. The lighter birthweight of schizophrenic women's offspring was found more strongly related to the severity and chronicity of their mental illness than to the diagnosis itself. Children of neurotic depressive women had lower APGAR scores and more fetal deaths.


Initial clinical interaction and premature discontinuance in treatment.

This exploratory study suggests that continuance of the therapeutic relationship is more the responsibility of the clinician than of the patient. Two interactional variables--stimulus-response congruence and content relevance--were operationalized and their effect on patient continuance tested. Results suggest that, as indicators of viability of the treatment relationship, these variables may be purposefully employed to control for patient continuance.


The right to treatment and the right to refuse treatment.

This paper examines the legal status of the questions of right to treatment of institutionalized patients and of the need for patients' consent to treatment. The history of judicial involvement in these questions is outlined, and the directions and implications of current litigation are discussed.


Informal admission of patients to state psychiatric institutions.

Informal hospital admission procedures require no written application by patients and provide that patients must be released upon their demand to leave the hospital. Statistics indicate that informal admission is infrequently used by hospital staff where the more restrictive conditional voluntary procedure is available. Origins of staff reluctance to use informal admission are discussed.


An assessment of accountability areas by psychiatrists, psychologists, and social workers.

Sixty-nine psychiatrists, psychologists, and social workers rated the usefulness of fifteen studies representing seven broad areas of accountability. Although respondents differed in experience, training, and position in the hospital hierarchy, their ratings were highly similar. Results suggest that, in the hospital under study, members of the three professions respond as members of a single profession--clinician.


The development and application of indices of health: general methods and a summary of results.

A multidisciplinary group has developed a health index questionnaire designed to measure the social, emotional, and physical function of free-living populations. The strategy has been found to be generally applicable, capable of application by lay interviewers, acceptable to interviewees, and amenable to index construction. Furthermore, initial evaluations of the resulting health indices suggest that they are biologically and clinically valid. These health indices have been successfully applied in a randomized trial of innovative primary care services. The comceptualization of individual sections of the health index questionnaire for each of these three functional areas, the generation of the instrument, and the evaluation of questionnaire responses for their biologic and clinical validity are summarized here.


Metals in municipal landfill leachate and their health effects.

The leachate from five municipal landfills (containing no industrial waste or sewage sludge) was studied in 1975 by the U. S. Environmental Protection Agency (EPA). Copper was not present in concentrations above EPA standards. Zinc concentrations decreased with age of the site and were below standards. The amounts of cadmium and chromium appear to vary greatly from site to site. Lead, selenium, iron, and mercury were present at each site in concentrations above standards, regardless of site age. Although raw leachate contains concentrations of heavy metals in excess of the drinking water standards, it is not clear how likely it would be for these recorded levels to be found in drinking water supplies or for contamination to reach the human body. Before leachate reaches an aquifer, it is subject to the attenuating effect of the unsaturated zone. If municipal solid waste is placed directly into ground water, or if leachate is allowed to drain directly into surface water, severe damage to water quality can result. Further study of the environmental effects of leachate are being undertaken by the Environmental Protection Agency.


Factors affecting the choice of hospital-based ambulatory care by the urban poor.

This study of patients in the outpatient department at an urban hospital revealed that almost all could have reached a neighborhood center in less time and only a small number came to the hospital rather than a neighborhood center out of medical necessity. When the patients were asked about their willingness to obtain treatment at a neighborhood center, 48 per cent were willing, 52 per cent were not. These responses did not vary by demographic or medical characteristics but rather by the patients' stated priorities regarding medical care. Eighty per cent of those willing to change sites stressed convenience of access as a first priority compared with only 17 per ccent of those not willing to change. Emphasis on quality of care (45 per cent) or on familarity with the site (37 per cent) distinguished the group not willing to change. The findings suggest that successful efforts to persuade patients to utilize a neighborhood center must base their appeal on patients' individual priorities.


Peer sex education training and evaluation.

Human sexuality has been recognized as an important developmental, emotional, and medical concern on the college campus. The Peer Sex Education Program at the University of Massachusetts/Amherst has been developed as a model for the use of trained students in an educational, referral, and counseling role. This paper describes the program and outlines the methodology used in the documentation and evaluation of various program aspects. Aspects described include the program's rationale and background, the recruiting process, roles and responsibilities, training and supervision models, community development, and delivery of service. Categories of documentation and evaluation considered include effort, performance, adequacy of performance, efficiency, and process. These are related to consumer acceptance and satisfaction, outcome measures of knowledge, attitude, and behavior, effectiveness of referral and other functions, and effect of program on the peer educators' growth and development. The allocation of energy and resources between program development, service delivery and evaluation needs is highlighted.


The epidemiology of recurrent otitis media.

Nearly one-half of 165 children with episodes of acute otitis media had at least one recurrent acute episode within the year. Males had significantly more recurrences. Most (60 per cent) of the recurrent episodes occurred within four months of the index episode. Hearing loss persisted beyond two weeks in 8 per cent of testable children. This experience suggests that prophylactic antibiotic use within the first few months after an episode of acute otitis media in young children should be evaluated.


[On the monitoring of neuromuscular blockade during anaesthesia (author's transl)].

Objective evaluation of muscle relaxation during surgery is possible only by indirect stimulation of a skeletal muscle by means of a peripheral nerve stimulator. Most frequently the ulnar nerve is electrically stimulated and the resulting contraction of the hand muscles, i.e., twitching of the fingers is observed. This direct observation of the finger twitches induced by a nerve stimulator provides valuable information a) on the actual magnitude of neuromuscular blockade, b) on the development of a dual block following suxamethonium, c) on the need for more muscle relaxant, d) on the reversal of muscle paralysis by a cholinesterase inhibiting agent, and finally e) on the differential diagnosis of prolonged postoperative apnoea. By employing a nerve stimulator, the neuromuscular blocking agents can be titrated according to the surgical requirements and overdosage can be avoided. The clinical judgement of muscle relaxation by the anaesthesiologist should be accompanied by a more quantitative and objective evaluation, making use of the nerve stimulator.


[Long-lasting neuromuscular effects of non-depolarizing muscle relaxants, as measured by tetanic stimulation (author's transl)].

Spontaneous decurarization after single doses of tubocurarine (d-Tc) 0.44+/-0.04 mg/kg, pancuronium (PANC) 0.093+/-0.013 mg/kg, gallamine (GALL) 1.69+/-0.31 mg/kg and alcuronium (ALC) 0.193+/-0.02 mg/kg b.w. was investigated by means of tetanic stimulation of the ulnar nerve in 37 routinely anaesthesized adults of either sex. Tetani of 4-5 s and 30-400 Hz were sustained prior to muscle relaxation during light anaesthesia. After the injection of muscle relaxants the frequency of incomplete myographic black-out revealed slight underestimation of the doses of both GALL and ALC. However, no significant differences could be found between the drugs investigated, as far as latency of recovery is concerned. Recovery time to 30 Hz (=75-80% receptor occlusion) was 110+/-37, 109+/-66, 92+/-25 and 90+/-35 minutes for d-Tc, GALL, PANC and ALC, respectively. Up to 100 Hz (=50% receptor occlusion) it was 328+/-69, 327+/-83, 282+/-88 and 218+/-66 minutes for d-Tc, ALC, GALL and PANC, respectively. Myographic recurarization rather frequently occurred with ALC, GALL and d-Tc. The use of antidotes seems urgently to be indicated whenever non-depolarizing muscle relaxants have been applied in the above mentioned range of dosage.


Enflurane metabolism and postoperative renal function.

Inorganic fluoride concentrations in blood and urine were measured in 22 gynaecological patients during and after anaesthesia with enflurane and post-operative renal function was investigated. Ten patients (group I) were given 0.6 vol.% enflurane, and 12 patients (group II) a mixture of 0.6 and 0.8 vol.% enflurane. The serum fluoride concentration of arterial blood reached, in group I, after 120 min 18,99 micronmol/1 whereas in group II the concentration was 21 micronmol/1. One hour after the end of anaesthesia the fluoride concentration in venous blood were nearly identical in both groups and decreased in the following 12 h evenly. In all patients relatively high postoperative fluoride concentrations were observed in the urines. No evidence of renal dysfunction was found after anaesthesia.


Appraisal of the dislocation of central venous catheter tips using subclavian and arm veins.

The most dramatic of the complications resulting from central venous catheterization is perforation of the heart. We studied the complications reported in the literature and undertook an original investigation of the dislocations of peripherally and infraclavicularly inserted catheters while moving the arm and shoulder in patients during autopsy. In a postmortem examination of three patients it was found that the greatest displacement, up to eight centimetres, of the tips of the catheters occurred when they were inserted through the basilic vein. The tips of infraclavicular inserted catheters did not move at all during movements of the arm. Only by extreme movements of the shoulder we were able to show a maximal displacement of two centimetres. Advancement of the catheter tip occurred during adduction and flexion of the elbow joint and not during abduction. Our experimental evidence suggests that the best site for a catheter tip is the upper part of the right atrium. We therefore recommend the subclavian route for in-dwelling central venous catheters rather than insertion through an arm vein, as this minimizes the risk of cardiac perforation due to its great stability.


Alteration of protein-binding during storage of human plasma preparations.

The influence of the storage of plasma preparations on binding was studied in different drugs. No alteration on only a slight alteration of binding was found if the plasma preparations were kept deep-frozen, or at temperatures between +3 degrees and +4 degrees C, for up to 12 months. More marked changes were found for some drugs if the plasma preparations were lyophilized or stored at +32 degrees C, for 6 and 12 months.


Morpho-histology of the alimentary canal of an Indian fresh-water perch, Colisa fasciata (Bloch) in relation to food and feeding habits.

The morpho-histology of the alimentary canal in an Indian freshwater perch, Colisa fasciata (Bloch) in relation to food and feeding habits has been described. C. fasciata is an omnivorous, mid-feeder. The mouth is protractile. The alimentary canal comprises the lip, buccal cavity, pharynx, oesophagus, stomach, pyloric caeca, a long and coiled intestine and the rectum. The teeth on the roof and floor of the buccal cavity, jaw teeth, pharyngeal teeth and horny pad teeth are all adapted to the nature of the food ingested. The nature and disposition of taste-buds and mucous cells on the lips suggests that the fish is a taste-feeder. The presence of taste-buds in the anterior oesophagus indicates that the gustatory sense extends upto the oesophagus. The stomach is divided into the cardiac and pyloric regions. The surface epithelium of the cardiac stomach secretes mucous and the glandular epithelium contains numerous gastric glands. The pyloric caeca are paired. The intestine is divided into anterior, middle and posterior regions. The R.L.G. (relative length of the gut) varies from 4--5. Mucosal folds are simple.


Paranasal sinuses of the adult buffalo (bubalus bubalis).

In addition to sinus conchalis, four paranasal sinuses; sinus frontalis, sinus lacrimalis, sinus maxillaris and sinus palatinus have been found to occur in adult buffalo. The sinus sphenoidalis was not noticeable, whereas all other paranasal sinuses were well developed. The sinus frontalis in buffalo differs from that in ox, in that, in buffalo it does not involve any part of os-temporale; its sinus frontalis caudolateralis subdivided by the septum sinuum frontalium transversus rostralis; another transverse septum, the septum frontalium transversus caudalis separates the sinus frontalis from its diverticulum nuchale; the diverticulum nuchale is much more extensive due to well developed os parietale in this species than in ox and is further subdivisible into four subcompartments. The sinus lacrimalis, sinus maxillaris and sinus palatinus do not present much appreciable differences from those in ox. The topographic description of all the compartments, diverticulae, septae and communication of the paranasal sinuses in buffalo has been presented. The most suitable site of trephining the sinuses has been suggested.


The different types of neuronal cells in the retina of the owl as revealed by phase contrast microscopy.

Observations on the retina of the owl by employing phase contrast microscopy revealed the presence of double cones, single cones and rods. Horizontal cells, bipolar cells (two types), muller cells, amacrine cells (two types) and ganglion cells were distinguished.


Terminal innervation ratios and fiber type grouping in normal porcine skeletal muscle.

Terminal innervation ratios were determined in normal porcine semiendinosus to test the hypothesis that intramuscular collateral branching of subterminal axons gives rise to fiber type grouping. Innervation ratios were near 1.00 in both the lateral pale portion which exhibits type II predominance and in the medial red portion which exhibits extensive grouping of type I fibers. Type grouping observed in porcine skeletal muscle is not the result of multi-fiber innervation by subterminal axons, but, rather, may be the manifestation of a unique motor unit topography.


[The stress of the human hip joint. VI. A functional analysis of the cartilage thickness in the human femoral head (author's transl)].

The distribution of cartilage thickness was ascertained in 11 femoral heads. The greatest thickness of cartilage was always found lateral of the fovea capitis at the medial margin of the pressure area ("Druckbündelzone") of the cancellous bone, whereas the dorsomedial part of the head showed a zone of thinning, extending to the medial margin of the fovea capitis. The decrease in cartilage thickness occurred less rapidly in the lateral part of the joint than in the medial part. In the case of coxa vara, a changed pattern of cartilage thickness was observed, with a maximum thickness located more towards the lateral edge of the cartilage and a reduction in cartilage at the lateral margin of the fovea. The results are put in relation to the stress of the hip joint and are explained according to Pauwels' conceptions of the causal histogenesis and preservation of the mesenchymal supporting tissues. Differences in cartilage thickness are discussed as being a functional adaptation to local stress.


Electron microscopic detection of calcium binding to the duodenal absorptive cell plasma membranes.

Electron dense structures (EDS) were observed on the plasma membranes of duodenal absorptive cells of chicks of various physiological states regarding the calcium binding protein (CaBP). EDS were seen only when calcium was added to formal-glutaraldehyde fixative in cacodylate buffer and the material was post-osmicated in phosphate buffer. Microvillar, lateral and basal plasma membranes showed the EDS and these were seen always in the inner dark layer of the three-layered unit membrane. No EDS were seen in the embryonic material and some were present in material from chicks two days after hatching. There were more in that of 6-week-old normal and vitamin D replete animals. The absorptive cells from chicks, fed on a diet supplemented with cestrum powder, known to mimic the effects of 1,25-dihydroxycholecalciferol, showed the highest number of EDS. On the basis of this distinct correlation of EDS frequency with amounts of CaBP known to be present in chick duodenum, it seems that EDS, precipitated calcium phosphate, strongly suggest the sites of CaBP.


Experimental analysis of the origin of the wing musculature in avian embryos.

Interspecific grafts of somites, as well as parts of the somatic plate mesoderm, have been made between quail and chick embryos (stages 12--14 H. H.)  at the level of the prospective wing bud in order to examine the relationship between somites and wing bud myogenesis. The stability of the natural quail nuclear labelling makes it possible to follow the developmental fate of grafted mesodermal cells in the host embryo. Embryos examined after subsequent incubation periods of 3--7 days show the following distribution of somatic and somitic cells within the wing bud: as soon as the three zones of different cell density within the mesoderm can be distinguished, cells of somitic origin are limited to the prospective myogenic area which is made up of mixed population of somatic and somitic cells, whereas the prospective chondrogenic area as well as the subectodermal zone only consists of cells originated from the somatic plate mesoderm. After further incubation, single muscle blastema are present which were also seen to be a mixture of somatic and somitic cells. The cells of muscular bundles are of somitic origin, while the muscle connective tissue cells are derived from the somatic plate mesoderm. After grafting into the coelomic cavity or on the chorio-allantoic membrane, fragments of the somatic plate mesoderm previously isolated from quail embryos (stage 14 H.H.) at the level of the prospective wing bud exhibit well developed skeletal elements, but fail to differentiate any musculature. These experimental investigations support previous evidence for a somitic origin of wing bud myogenic cells. Histological and scanning electron microscopic studies of the brachial somites and the adjacent somatic plate mesoderm of chick embryo (stages 13--15 H.H.) reveal that migration of still undifferentiated somitic cells into the brachial somatic plate mesoderm begins to take place in embryos at stage 14.


Do oculomotor neuroblasts migrate across the midline in the retal rat brain?

Toluidine blue-stained semithin sections and Cajal-Castro preparations are used to study in rat fetuses whether oculomotor neuroblasts migrate across the midline at a certain period of development. In confirmation of previous studies, a group of oculomotor neuroblasts was detected which first grow cytoplasmic processes into the mesencephalic midline, and afterwards translocate their somata towards the midline, between the 12th and the 15th days of gestation. At this moment a midline mass of neuroblasts characterizes the meeting at this landmark of both left and right migrating neuroblastic groups. No crossing oculomotor axons yet are demonstrable with reduced silver techniques. In further stages of development the neuroblasts continue their migration until they arrive at the contralateral nucleus at the 16th and 17th day of gestation. At the midline the mass of neuroblasts disappears gradually and crossed oculomotor axons become visible. The electron microscope was then used to study ultrastructurally the migrating motoneurons. It was discovered that no preexisting structure guides their movement by contact. Their leading processes show no filopodial activity, and contain abundant microtubules and thick bundles of neurofilaments in eccentric position. The neuroblasts carry their axon across the midline as a trailing process.


The pigment architecture of the human occipital lobe.

With the aid of steromicroscopical examination of pigment preparations uo to 1,000 micronm thick the various areas of the occipital lobe of the human brain are described. In the occipital lobe there are three main cortical types, forming the striate, the parastriate area, and the peristriate zone. The parastriate area is a horseshoe-shaped fringe area adjacent to the primary visual field. It is conspicuously marked by a relatively dark stripe of pigmented granule cells dividing the fourth layer into a light upper, a  pigmented middle, and a light lower zone, a unique feature of the parastriate area, which is not to be found in any other isocortical area. This three-fold layer disappears abruptly as one passes from the parastriate to a peristriate area, permitting the definitive determination of this boundary. The peristriate zone is quite large in the inferior and the lateral parts of the occipital lobe and comparatively small in the superior parts. Its peripheral boundaries do not coincide with the limits of the occipital lobe. Parts of the cuneus on the one side are covered by parietal and temporal areas, whereas peristriate areas on the other side penetrate widely into the temporal lobe along the medial occipitotemporal and to a lesser extent the parahippocampal gyrus. As regards pigment architecture, the peristriate zone is divisble into ten areas. A relatively simply organized area accompaines the parastriate area. The structure of the cortex changes gradually until one reaches the various fringe areas adjacent to the parietal and temporal areas. The limit adjoining the temporal areas is sharply traceable, since the lower of two light cortical stripes vanishes abruptly when passing from a peristriate to a temporal area. The most highly developed field, the area peristriata magnopyramidalis, occupies part of the inferolateral margin of the occipital lobe. It displays a wealth of large pyramids in the lower reaches of the third layer, which contain tightly packed and densely stained pigment granules forming large rounded aggregates in the basal cytoplasm. Pyramids of this type give the field a close resemblance to association fields such as the posterior speech area, where they are commonly encountered as the predominant neurons of the third layer.


The effect of a synthetic progestine on the fine structure of the epididymal head (stereological analysis).

The alterations induced in principal cells of the epididymal head tissue of the rat by administration of a synthetic progestine (R2323, ethinyl-norgestrienone) were studied by electron microscopy. A total of 3 male, sex mature rats was applicated ethinyl-norgestrienone during a 3 months period in low dosage (60 mug) per day and was studied with 5 control animals. Stereological methods devised by Weibel (1969) and Rohr et al. (1976) were applied to light and electron micrographs. The calculated values are related to 1 cm3 of epididymal tissue, 1 cm3 of epididymal cell and 1 cm3 of epididymal cell cytoplasm. The Golgi apparatus was further subdivided; the values for the Golgi compartments are therefore  refered to 1 cm3 of Golgi apparatus was further subdivided; the values for the Golgi compartments are therefore refered to 1 cm3 of Golgi apparatus. In the treated animals there was, related to the unit of epididymal tissue, a significant decrease in the volume density of the interductular tissue, whereas that for the lumina was significantly higher. The volume density of the glandular epithelium remains unchanged. Refered to the unit volume of principal cell cytoplasm the rough endoplasmic reticulum shows a signficant decrease by 6.5%, whereas the smooth endoplasmic retiuclum is increased by 6.3%. The volume density of the lysosomes was calculated to be 4.3% (Control 2.5%). The stereological data of the Golgi apparatus indicate a vacuolar transformation: Increased volume of vacuoles, decreased volume fraction of saccules and vesicles. However, the volume density of the whole Golgi apparatus remains unchanged. An impaired secretory activity of the principal cells could be assumed.


Structure of northern elephant seal population breeding on San Nicholas Island, California, in 1971.

The structure of the population of northern elephant seals, Mirounga angustirostris, on San Nicolas Island, California, was studied during the 1970 and 1971 breeding season. At the population peak on 31 January 1971, there were 77 males, 306 females, 315 pups, and 6 yearlings on shore. The breeding population was subdivided into 15 groups, containing from 3 to 75 breeding animals. Fourteen of the groups were considered territories defended by individual males, and one group, the largest, was controlled by three males in a social hierarchy. The relatively small size of the San Nicolas population and the large amount of available beach space allowed the existence of numerous small breeding groups. Female elephant seals, although gregarious, apparently prefer to be in small groups when conditions permit it. It is likely that the same males that were territorial would have formed the nucleus of a social hierarchy if space had been limited enough to cause all of the females in the population to congregate in one large group.


An ethology-based catalogue of facial/vocal behaviour in infancy.

The ethological approach is suggested as a fruitful research strategy in the study of how infants express emotions. This approach led to the development of a large catalogue of facial/vocal behaviour which was used in the systematic observation of 75 girl and boy infants, who in the last quarter of the first year of life were placed in a series of standardized laboratory situations. Each of the 42 facial expressions contained in the catalogue is precisely defined according to the expressive elements of the brow, eyes, mouth and other facial regions. The vocalizations are also operationally defined. The possible ways that the facial expressions and vocalizations could be combined in the expression of emotional behaviour in infants are discussed.


A new simple spirometric index for use with bronchial provocation tests.

Spirometric indices such as the forced expiratory volume in one second (FEV1), the maximal expiratory flow rate (MEFR) and the maximal midexpiratory flow rate (MMFR) can be criticized for use with bronchial provocation tests since they are either partly effort-dependent or dependent on the forced vital capacity (FVC). These criticisms can be avoided by the use of a new index corresponding to the volume of air expired in one second starting at 75% of the control FVC, called the (FEV1)-25. This study was performed to evaluate the relative sensitivity of the (FEV1)-25 and the classical FEV1 in detecting airway obstruction caused by an inhaled carbachol aerosol in 20 asthmatic subjects. The mean fall in (FEV1)-25 of 46% following carbachol inhalation compared with a mean fall in FEV1 of 35% indicates that, in addition to its theoretical advantages, the (FEV1)-25 is a sensitive index for use with bronchial provocation tests.


Enrichment of human X- and Y-chromosome bearing spermatozoa by density gradient centrifugation.

Human spermatozoa (120--180 Mill/0.6 ml Tyrode solution) were laid on the top of a continous density gradient column consisting of 4--16% bovine serum albumin. The columns were then centifuged at 1500--1600 rpm (200-240 g) at 20 degrees C or 4 degrees C for 15 min. By this procedure the spermatozoa sedimented within the tubes of normal distribution curves. The mean percentages of y-spermatozoa gradually decreased from 62,3 +/- 6,1% (max. 70%) in the upper fractions to 42,4 +/- 3,8% (min. 37%) in the bottom fractions. These results could be verified by inseminations of rabbit does with spermatozoa separated by the same technique.


Sperm motile efficiency.

To provide an alternative to presently available subjective ways of measuring sperm motility which often yield inconsistent data, we devised a method for determining sperm motile efficiency with it one can express objectively the amount of active sperm movement. Using a melangeur for counting white cell, semen is diluted 20-fold in normal saline solution. With the diluted semen on Thoma's hemocytometer, spermatozoa passing its small quarter line in one minute are counted, and the value is divided by the estimated number of spermatozoa per ml. The quotient is multiplied by 100 and expressed by %/min. This shows the active movement of a spermatozoon per minute. In the present study, we measured sperm motile efficiency in 162 male sterility patients, 64 cases showed values of 49%/min or less, with a mean of 20.3%/min, 46, between 50%/min and 99%/min, with a mean of 70.1%/min; and the remaining 52 over 100%/min, with a mean of 195.9%/min. Among these there were 10 cases of successful pregnancy with a mean sperm motile efficiency of 152.7%/min, and 69.0%/min at the lowest. Our new method requiring no special equipment can easily identify active sperm movement and is easily reproducible,


Controlled trial of 6-month and 9-month regimens of daily and intermittent streptomycin plus isoniazid plus pyrazinamide for pulmonary tuberculosis in Hong Kong. The results up to 30 months.

A comparison was made between 6-month and 9-month regimens of streptomycin plus isoniazid plus pyrazinamide given daily, 3 times a week, or twice a week in the treatment of newly diagnosed, smear-positive pulmonary tuberculosis in Chinese patients. At 6 months, the twice-weekly regimen was marginally inferior; treatment failed for 5 (4 per cent) of 126 patients with drug-susceptible strains before treatment compared with 2 (1 per cent) of 141 on the 3-times-weekly regimen and none of 137 on the daily regimen. The results for patients with pretreatment strains resistant to isoniazid, to streptomycin, or to both drugs were not as good, treatment failing for 10 (30 per cent) of 33 on the daily regimen, 15 (37 per cent) of 41 on the 3-times-weekly regimen, and 14 (39 per cent) of 36 on the twice-weekly regimen. In contrast, the relapse rates after chemotherapy were similar for patients with drug-susceptible and drug-resistance strains before treatment and for patients on the daily and intermittent regimens. By 30 months, 35 (21 per cent) of 167 patients with susceptible strains who were treated for 6 months and 10 (6 per cent) of 179 treated for 9 months had relapsed, all with strains still susceptible to isoniazid and streptomycin. The relapse rates for patients with resistant strains were 7 (24 per cent) of 29 and 1 (4 per cent) of 26, respectively. Drug toxicity was not a special problem.