Humeral hypertrophy in response to exercise.

We compared roentgenograms of the jumeri of a group of professional tennis players and showed that there was pronounced hypertrophy of bone on the playing side. The cortical thickness on that side was greater by 34.9 per cent in men and 28.4 per cent in women compared with the control side. This represents a highly significant hypertrophy of bone in response to exercise.


The urinary excretion of collagen degradation products by quadriplegic patients and during weightlessness.

Urinary total hydroxyproline, peptide-bound hydroxyproline, hydroxylysine glycosides, and calcium were measured in three healthy individuals subjected to weightlessness for eighty-four days and in three young quadriplegic patients. The former group had significant calciuria but no evidence of collagen degradation. The latter group, however, had conspicuous calciuria and also excreted large amounts of collagen breakdown products. This documented degradation of matrix may be related to the continuous calciuria, osteoporosis, and cutaneous dystrophic changes occurring in quadriplegics.


The effect of biopsy-hole shape and size on bone strength.

Investigation in cadaver femora of the relationship between the shape or size of a hole made in the cortex and the breaking strength of the bone revealed that of the shapes studied, an oblong hole with rounded ends afforded the greatest residual strength. Furthermore, we found that increasing the width of the hole caused a significant reduction in strength, while increasing the length did not.


Joint resurfacing in the rabbit using an autologous osteochondral graft.

In rabbits, joint resurfacing with autologous osteoarticular condylar grafts composed of the articular cartilage and subchondral bone (two to eight millimeters thick) from the lateral femoral condyles was investigated. By means of morphological, histochemical, autoradiographic, and biochemical studies, the grafts were compared with sham and normal controls. When adequately fixed, the grafts remained viable and functionally and structurally intact during the twelve months of the experiment. The subchondral bone underwent rapid replacement in less than six weeks without loss of its supportive function. Resurfacing of a joint using an osteochondral graft is feasible in rabbits.


Vascular injuries associated with dislocation of the knee.

Two hundred and forty-five knee dislocations were analyzed including forty-one new cases. The high incidence of injuries to the popliteal artery that accompanies this lesion (32 per cent) was confirmed, and it was re-emphasized that vascular repair must be completed within six or at the most eight hours from the time of injury to avoid amputation. Of the patients not treated within that time period, 86 per cent had an amputation and two-thirds of the remaining 14 per cent had ischemic changes.


Ipsilateral fracture of the femur and tibia.

Thirty-two cases of simultaneous ipsilateral femoral and tibial fractures in thirty-one patients were treated by rigid internal or pin fixation of both fractures in fourteen cases, by rigid internal or pin fixation of one fracture in three, and by conservative management or non-rigid internal fixation in fifteen. Rigid internal or pin fixation of both fractures resulted in a lower incidence of complications and shorter duration of hospitalization and time to healing. An initially active surgical approach also produced considerably better functional end results: twelve of fourteen patients so treated resumed their former occupations, compared with four of thirteen patients treated conservatively.


Non-union in open tibial fractures.

This is a retrospective study of 104 open fractures of the tibial shaft seen at a civilian teaching center. Seventy-one per cent of the fractures resulted from vehicular accidents. Twenty-seven per cent of the fractures did not unite and half of these non-unions were infected. Virtually all of the ununited tibial fractures were associated with fractures of the fibula and with extensive avulsions of skin and dirty wounds. Although a variety of techniques for care of the wound and treatment of the fracture was used, none was entirely successful. Some failures were attributable to inadequacies of wound care--either premature primary closure or failure to perform secondary skin closure. Other failures of treatment were associated with use of internal fixation. Early weight-bearing without internal fixation, however, did not uniformly result in union.


Reduction of neglected traumatic dislocation of the hip by heavy traction.

Heavy traction treatment was applied to seven patients with old isolated posterior dislocation of the hip. Traction of seven to eighteen kilograms applied under sedation for five to seventeen days allowed over-reduction of the dislocation. Then gradual reduction of the femoral head into the acetabulum was accomplished by reducing the traction and abducting the limb. The results were good to excellent. In six patients there was no evidence of avascular necrosis or osteoarthritis during a follow-up period of from six months to three years. The femoral heads became fully concentric. The method failed in one patient in whom the dislocation was of nine months' duration and in whome a comminuted fracture of the acetabulum and other fractures of the pelvis were also present.


Acute osteomyelitis in children.

A number of problems in the treatment of acute osteomyelitis have remained unresolved in recent years. The clinical experience of ninety-three patients with proven acute haematogenous osteomyelitis is presented to help resolve these problems. Analysis of the clinical features, the operative, bacteriological and haematological findings is made and discussed in detail. Eighteen patients had continuing bone infection and recommendations are made as to how diagnosis and management might have been improved. Surgery is considered to be an essential part of the diagnostic and therapeutic management of this disease. A combination of cloxacillin and fusidic acid is recommended at the antibiotic treatment.


Fractures of the femur during total hip replacement and their management.

Seventeen femoral fractures occurred in 1,751 operations for total hip replacement. They usually occurred during dislocation of the hip, reaming of the shaft, or insertion of the femoral component, and were common in second operations. The short oblique fracture can be controlled by use of the standard implant, and the long oblique fracture by internal fixation. Fractures well below the implant should probably be treated by continous traction. The eventual results were adequate in all cases. The liability to fracture can be reduced by taking special care during operation in particulary susceptible cases.


Late infection after total hip replacement.

Four patients who developed deep infection of six hips, on average three and a half years after total replacement by McKee-Farrar prostheses, are described. In each case there was strong evidence that the source of the infection was a distant focus.


Induction of tendon and ligament formation by carbon implants.

Experiments have been performed on rabbits and sheep which demonstrate that pure carbon, in a flexible and filamentous form of great strength, can be used successfully to induce the formation of new tendons. A concept fundamentally different from that underlying the use of other artificial tendon replacements is involved, in which rapidly developing tendon-like tissue is induced to form around the implant. This gradually takes over the function of the implant. The early results in rabbits and the late results in sheep suggest that filamentous carbon may have a place in the replacement of the calcaneal tendon and the collateral ligaments of the knee.


Osteochondritis dissecans patellae.

Six cases of osteochondritis dissecans patellae have been studied in five patients in an attempt to clarify the aetiology and prognosis. Assessment of the results of treatment was performed using a standard protocol. The thirty-four previous case reports in the literature are reviewed. In four of the five patients symptoms began after flexing the knee under load and three showed patellar subluxation on tangential radiographs. Thus, repetitive shearing stress on the patellar surface is thought to be an important aetiological factor. The indication for operation is a loose osteochondral fragment either wholly or partly detached from the articular surface of the patella. Vertical excision of the affected area of articular cartilage with drilling of the underlying bone gave two "good" and two "excellent" results. Healing of the drilled area and maintenance of the cartilage space was seen in radiographs of all four cases so treated. This simple method of treatment, which probably causes filling of the defect in the surface by fibrocartilage, is recommended.


Replacement of the severely damaged arthritic knee by the ICLH (Freeman-Swanson) arthroplasty.

A multi-centre clinical trial of ICLH (Freeman-Swanson) arthroplasty has been in progress since 1971. In this paper the results up to two years after operation are reported in seventy-one knees displaying at least 30 degrees of fixed flexion, 25 degrees of valgus or 20 degrees of varus, before operation. It has been found that knees displaying 70 degrees of fixed flexion, 70 degrees of valgus, 30 degrees of varus or 50 degrees of valgus/varus instability can be satisfactorily aligned and stabilised with acceptable function. Three knees required revision. The other complications are listed and were unremarkable in nature. These results depend upon the prosthesis and upon the operative technique. The latter avoids damage to healthy bone but does involve the replacement of the tissues in the midline of the knee.


The correction of genu valgum by epiphysial stapling.

Forty-nine patients treated by epiphysial stapling for idiopathic genu valgum are reviewed. The children were aged from eleven to fourteen and a half years. The severity of the condition and subsequent correction were assessed by measuring the inter-malleolar distance. Results show that femoral stapling is the treatment of choice for most patients with inter-malleolar separation of up to 12-5 centimetres. The optimum age for stapling for both boys and girls is eleven and a half years. Stapling of both epiphyses is advised for those patients presenting late, for example, between thirteen and fourteen and a half years, or where the deformity is greater than 12-5 centimetres of separation. Correction rarely takes more than one year, and was cosmetically satisfactory in all cases. The operation is virtually free from complication except for a tendency for the scars to be broad and conspicuous. Stapling has proved to be a safe, effective and predicatable operation for idiopathic genu valgum.


The preformed socket and modular assembly for primary amputees.

A method is described by which an artificial limb can be fitted as soon as an above-knee or below-knee amputation wound is healed, by using preformed sockets which enable the prosthetist to fit the limb within the hour. The method has been found safe, and better than other methods previously described to facilitate the early mobilisation and rehabilitation of the amputee.


Perthes' disease treated by prolonged recumbency and femoral head containment: a long-term appraisal.

The results of a long-term review of 102 hips in eighty-seven patients with Perthes' disease are described, the mean follow-up interval being seventeen years. All had been treated by an extremely rigorous conservative regime in which the patients were kept in hospital for an average period of twenty-six months, during which time they were confined to bed with the legs in wide abduction, first in traction and later in "broomstick" plasters to ensure "containment" of the femoral head. The patients were assessed by the joint clincial and radiological method described by Ratliff (1956). The results were very satisfactory, with only 2 per cent poor results and 10 per cent fair. The remaining 88 per cent were good. The radiological results at the end of treatment have also been compared with control series described by Catterall (1972) and with the osteotomy series of Lloyd-Roberts, Catterall and Salamon (1976). From this it appears that the described regime offers no benefit compared with the natural history in Catterall's Groups I and II, and in Group III the results were only marginally better than those following osteotomy. In Group IV cases, however, where the femoral head was totally involved, the benefit was important, and since these are the cases which carry the worst natural prognosis it is suggested that the use of the method described in such instances must be seriously considered in spite of its social disadvantages. The theoretical implications of the findings are considered, and it is concluded that the benefits of the method cannot be ascribed wholly to the application of the "containment" principle.


Aseptic necrosis of bone in a compressed air worker.

This paper reports a detailed examination of three lesions of aseptic necrosis of bone occurring in a man who had worked in compressed air eleven years previously. Although two of the lesions were juxta-articular, in neither had the bone collapsed. Histology of only one similar lesion is reported in the literature (McCallum et al. 1966). Necropsy material is considered, together with radiographs and bone scans of the same lesions taken four years earlier. Similar changes have been shown to occur in commercial divers. On the evidence of this case it becomes clear that radiography is limited in its use and that bone scans as an indicator of repair may be open to misinterpretation. There may be a place for operation before the onset of symptoms in these cases of aseptic bone necrosis.


Irradiation lesions of the growth plate in rabbits.

The effects of gamma irradiation on the growth plate have been studied in nineteen rabbits with a 1,000 rads/skin dose. The rabbits were killed after one to ninety days. The growth plates were studied by microscopic examination, thymidine-H3 autoradiography, and fluorescence with radiographic measurement. Changes were already detected after twenty-four hours at the cell mitosis level, which showed the sensitiveness of the chondrocyte itself. The lesions were clearly seen with the optical microscope after seven days, and they were most advanced between the fourteenth and twenty-first day after irradiation. Regeneration of the cartilage began in the fourth week and the histological appearance became normal after seventy days. Fluorescence with tetracycline showed a temporary retardation of growth, with consequent shortening of the affected limb.


Syphilitic aortic aneurysm with spinal erosion. Treatment by aneurysm replacement and anterior spinal fusion.

Five cases of syphilitic aortic aneurysm with erosion of the spinal column are reviewed. Four patients underwent operation. When erosion of the spine was mild or moderate, the aortic lesion only was treated. Aneurysm associated with extensive vertebral erosion was treated in two cases by anterior spinal fusion combined with replacement of the disc and part of the aorta. In one of these cases the spine was later reinforced by a posterior spinal fusion. One patient so treated died a week after operation. The patient who refused operation later developed a complete paraplegia.


Potentially fatal asphyxia following a minor injury of the cervical spine.

The case is reported of an elderly man with asymptomatic cervical spondylosis who sustained a minor hyperextension injury of the cervical spine when the brakes of a car were applied suddenly to avoid a collision. Within six hours marked swelling of the neck and severe dyspnoea developed, and a lateral radiograph showed the pharyngeal shadow displaced far forwards and a crack fracture of an anterior osteophyte. Tracheostomy and evacuation of a massive prevertebral haematoma were performed, with immediate relief. The case draws attention to the possibility of this serious complication of a "whiplash" type of injury.


Spondylolisthesis of the cervical spine. Report of a case.

Spondylolisthesis of the fourth cervical vertebra is reported in a thirty-four-year-old woman. Only one other case at this level has been found in the literature, but others have been recorded of the sixth cervical vertebra.


Continuous aerosol therapy system using a modified Collison nebulizer.

A Collison nebulizer was incorporated into an exposure system for administering antiviral compounds as continuous aerosols to mice infected with influenza virus. The nebulizer was modified to control aerosol output by varying the liquid feed rate. A multiple regression equation was developed from data obtained with uranine dye to define the aerosol concentration of the dye in the system as a function of the concentration of the dye in the spray fluid and the rate at which it was aerosolized. The rate of change of the concentration of the test solution due to evaporative losses was also ascertained for a 1-ml/min feed rate over a 23.5-h period of operation. Procedures are outlined for using these relationships to determine the concentration of a given drug that will result in a given dose. Performance data for the drug ribavirin are presented.


High-pressure liquid chromatographic studies of TCC and metabolites in experimental animals and man.

A reversed-phase high performance liquid chromatographic (HPLC) procedure for the analyses of 3,4,4'-trichlorocarbanilide (TCC) and its free and/or conjugated metabolic products in plasma/serum in described. A rapid, effective clean-up procedure, prior to chromatographic evaluation, involves a single-step combined protein removal and THF extraction. Detection of the TCC moiety after HPLC separation is by UV absorption at 265 nm; quantitation by peak height measurement. A detection limit of 10 ppb of TCC and/or metabolities has been demonstrated for this method. Verification of this method was by radiotracer counting of the appropriate HPLC peaks from plasma of animals adminstered 14C-TCC/TCC. The utility of this method was demonstrated in both animal pharmacological and toxicological studies and in human bathing studies.


Comparison of thirty-seven strains of Vd-3 bacteria with Agrobacterium radiobacter: morphological and physiological observations.

Thirty-seven cultures of Vd-3 bacteria, isolated from clinical specimens, were characterized morphologically and physiologically. The cultures produced positive reactions when tested for oxidase, urease, nitrate reduction, phenylalanine deaminase, oxidative metabolism of carbohydrate substrates, and 3-ketolactose production. These peritrichously flagellated microorganisms were isolated primarily from the respiratory tract. When compared to authentic strains of Agrobacterium, they appeared to be most similar to A. radiobacter. Gas-liquid chromatography of trimethylsilyl derivatives of whole-cell hydrolysates of some of the Vd-3 strains and A. radiobacter yielded nearly identical elution patterns. The Vd-3 cultures were identified as probable strains of A. radiobacter. A method is presented for differentiating cultures of A. radiobacter from other similar bacteria encountered in clinical specimens. Although these bacteria rarely occur in clinical specimens, the clinical microbiologist should be familiar withe their outstanding characteristics.


Gas chromatographic resolution of  polyunsaturated wax esters based on their degree of unsaturation on Silar 10C.

Wax esters of C28-C44 chain-lengths, and containing 0-7 double bonds, were characterized with equivalent chain lengths [ECL] obtained by GC using a cyanosiloxane, Silar 10C. The ECL of the unsaturated wax esters is significantly dependent upon the column temperature, and selection of an appropriate column temperature permitted adequate resolution of critical pairs differing in the degree of unsaturation or the position of the double bonds.


Physiological differentiation of viridans streptococci.

Twelve hundred and twenty-seven clinical isolates and eighty stock strains of viridans streptococci were tested for serological and physiological characteristics. Because the serological reactions of these strains varied, a differentiation scheme could not be based on these reactions. For the same reason, there could be no correlation of serological characteristics with physiological characteristics. Nearly 97% of the clinical isolates were speciated by differences in physiological characteristics. Ten different physiological species were recognized. The physiological speciation scheme was based on stable enzymatic reactions rather than on results of tolerance tests. The study included air-tolerant anaerobic streptococcal strains as well as viridans streptococcal strains not normally found in humans. The differentiation scheme and nomenclature of the author are related to those of other investigators. Differences in the distribution of species isolated from different clinical sources and human infections were also noted. A key for the differentiation of human isolates of viridans streptococci is proposed.


Electrochemical gas chromatographic detection of hydrogen sulfide at PPM and PPB levels.

An electrochemical detector for gas chromatographic analysis of hydrogen sulfide is described and its operating characteristics are discussed. The detector operation is based upon the measurement of the current when hydrogen sulfide is electrochemically oxidized at a diffusion electrode. The lower detectable limit was 3 X 10(-12) grams H2S, the precision was 0.5% and analysis was achieved within 2 minutes. Accuracy was limited principally by the preparation of calibration samples and the availability of standard reference gas mixtures.


Characterization and identification of gram-negative, nonfermentative bacteria.

The morphological and physiological characteristics of 593 strains of nonfermentative, gram-negative bacteria are described. A battery of 46 tests was used to identify and differentiate strains representing 8 genera and 31 species of named and group-designated bacteria. Seven selected amides and organic salts were closely examined to determine their usefulness, individually or as a battery, in characterizing and identifying the organisms. Of these, allantoin and acetamide showed the most promise in differentiating the more commonly occurring organisms from biochemically similar species. Susceptiblilty patterns to 12 antimicrobics also proved useful in differentiation, especially among atypical strains.


Genetic transformation assays for identification of strains of Moraxella urethralis.

Studies of 31 strains of Moraxella urethralis have shown that 20 of them are competent for genetic transformation. This finding has led to the development of transformation assays for identification of newly isolated strains of this organism. Crude deoxyribonucleic acid (DNA) samples from all strains of M. urethralis readily transform auxotrophic mutants of competent strains to prototrophy, whereas DNA samples from unrelated bacteria such as Acinetobacter, Moraxella, and Neisseria species uniformly fail to elicit positive transformation of mutant tester strains. One of the competent strains of M. urethralis investigated is a naturally occurring mutant defective in its ability to utilize citrate as a carbon and energy source. DNA samples from 29 of the 30 remaining strains of utilization; the one nonreacting strain is citrate negative and probably possesses the same genetic lesion as the citrate-negative mutant. Three organisms originally identified as strains of M. urethralis, because of their phenotypic properties, are probably incorrectly designated, since DNA samples from these strains failed to transform any of the tester mutant strains used in the present study. The transformation assay for M. urethralis is very simple and can be performed readily in a clinical laboratory. The entire procedure can be carried out in less than 24 h.


Isolation of Allescheria boydii from pleural fluid.

Allescheria boydii was repeatedly isolated from thoracentesis fluid from a patient with a right pleural effusion. Histological study of methanamine-stained pleural tissue revealed the presence of septate hyphae. After a thoracotomy and decortication, the patient's symptoms cleared, and he has remained asymptomatic over a postoperative period of 13 months.


Tween 80 medium for differentiating nonpigmented Serratia from other Enterobacteriaceae.

The ability of Serratia to hydrolyze Tween 80 can be utilized to distinguish this genus from other Enterobacteriaceae.


Use of serum stored on filter paper disks in complement fixation tests for adenovirus antibody.

A simple method of storage and retrieval of serum samples for adenovirus serology is described. Complement-fixing antibodies remained stable for at least 5 years when stored at -10 degrees C or below.


Collagen synthesis in normal and osteoarthritic human cartilage.

Collagen metabolism in osteoarthritic human articular cartilage was compared to that in normal cartilage and was also correlated with the degree of severity of the osteoarthritic lesion as determined by a histological-histochemical grading system. No correlation was apparent between the concentrations of DNA, hydroxyproline, and hydroxylysine and the degree of severity of the osteoarthritic lesion (except in far-advanced lesions). Similarly, there was no correlation in levels of these components in tissues from the normal vs. osteoarthritic group. The similarity of the values of the ratio hydroxylysine/hydroxyproline in osteoarthritic tissue compared with normal, and the lack of variation in these with increasing severity of the disease process argues against the possibility that osteoarthritis is associated with a major shift in the synthesis of type II collagen to type I. [3H]Proline incorporation into osteoarthritic cartilage was increased fourfold as compared to normal cartilage and varied with advancing histological-histochemical grade. Measurement of the specific activity of insolubilized hydroxyproline-containing material of the cartilage matrix, as an index of the turnover of collagen, showed a sixfold increase in osteoarthritic cartilage which also varied with grade. These data suggest that collagen synthesis in these tissues is substantially greater than in nonosteoarthritic tissues and varies directly with the severity of the disease process up to a point and then varies inversely as the lesion becomes more severe.


Effect of estrogen on post-heparin lipolytic activity. Selective decline in hepatic triglyceride lipase.

The rise in plasma triglyceride (TG) levels associated with estrogen administration has been thought to arise from impaired clearance because of the uniform suppression of post-heparin lipolytic activity (PHLA). Recently PHLA has been shown to consist of two activities: hepatic TG lipase and extrahepatic lipoprotein lipase (LPL). To determine whether estrogen might induce a selective decline in one of these activities, both hepatic TG lipase and extrahepatic LPL were measured in post-heparin plasma from 13 normal women before and after 2 wk of treatment with ethinyl estradiol (1 mug/kg per day). Hepatic TG lipase and extrahepatic LPL were determined by two techniques: (a) separation by heparin-Sepharose column chromatography, and (b) selective inhibition with specific antibodies to post-heparin hepatic TG lipase and milk LPL. Estrogen uniformly depressed hepatic TG lipase as measured by affinity column (-68 +/- 12%, mean +/- SD, P less than 0.001) or antibody inhibition (-63 +/- 11%, P less than 0.001). Extrahepatic LPL was not significantly changed by affinity column (-22 +/- 40%) or antibody inhibition (-3 +/- 42%). Direct measurement of adipose tissue LPL from buttock fat biopsies also showed no systematic change in the activated form of LPL measured as heparin-elutable LPL (+64 +/- 164%) or in the tissue form of LPL measured in extracts of acetone-ether powders (+21 +/- 77%). The change in hepatic TG lipase correlated with the change in PHLA (r = 0.969, P less than 0.01). However, neither the change in PHLA nor hepatic TG lipase correlated with the increase in TG during estrogen. The decrease in PHLA during estrogen thus results from a selective decline in hepatic TG lipase.


Studies of the mechanism of contralateral polyuria after renal artery stenosis.

Acute renal artery stenosis in hydropenic dogs caused a contralateral increase in urine volume and free water clearance without change in glomerular filtration, renal blood flow, or osmolar clearance. The increase in urine volume was not dependent on the development of hypertension since it occurred in animals pretreated with trimethaphan but was dependent upon angiotensin since it was presented with angiotensin blockade with Saralasin. The effect was not caused by angiotensin inhibiting antidiuretic hormone release since the polyuria occurred in hypophysectomized animals receiving a constant infusion of 10 muU/kg per min of aqueous Pitressin. Since the rise in urine volume was associated with an increase in renal vein prostaglandin E concentration and was prevented by pretreatment with indomethacin (5 mg/kg) the results suggest that the rise in plasma angiotensin after renal artery stenosis causes an increase in contralateral prostaglandin E synthesis with resultant antagonism to antidiuretic hormone at the collecting tubule.


Denatured hemoglobin in sickle erythrocytes.

To study the nature of numerous inclusion bodies seen in red cells from patients with sickle cell disease (Hb SS), we have prepared red cell ghosts free of oxyhemoglobin and analyzed them by spectrophotometric and heme extraction methods. The absorption spectrum in the visible region of the ghost suspensions was typical of hemichromes. The spectrum was similar to that of denatured hemoglobin repared by treatment of oxyhemoglobin S with mechanical shaking or heat. Similar treatment of cells containing only normal hemoglobin (Hb AA) showed a very small amount of denatured hemoglobin, approximately one-fifth of the amount in Hb SS cells. The amount of denatured hemoglobin determined after solution of membrane with 2.5% sodium dodecyl sulfate was 0.158+/-0.070% (1 SD) of the total cellular heme in Hb SS patients. In controls, the amount was 0.030+/-0.016%. Persons with Hb AA and reticulocytosis did not have an elevated amount of membrane-associated heme. In patients with hereditary spherocytosis and autoimmune hemolytic anemia, denatured stromal hemoglobin was normal or slightly elevated before and after splenectomy. The increased amount of denatured hemoglobin in Hb SS red cells may be related to the instability of sickle oxyhemoglobin.


Liver collagen synthesis in murine schistosomiasis.

Collagen synthesis was measured in liver slices obtained from mice with hepatosplenic schistosomiasis. Enlarged fibrotic livers from these mice contained 20 times more collagen than normal. This model of hepatic fibrosis results from an inflammatory granulomatous host response to Schistosoma mansoni ova in portal tracts, rather than from direct lover cell injury as with carbon tetrachloride-induced liver fibrosis. Collagen synthesis, as measured by the formation of labeled protein-bound hydroxyproline, occurred in granulomas isolated from fibrotic livers. Labeled collagen that cochromatographed with type I collagen was extracted with neutral salt solution from liver slices incubated with labeled proline. The free proline pool of the liver was doubled in infected mice; coordinately, liver slices from these animals showed maximal collagen production when the concentration of free proline in the medium was raised to 0.4 mM, the same level measured in the fibrotic livers. Under such conditions, collagen synthesis was at a rate equivalent to the formation of 5.4 nmol of protein-bound hydroxyproline per g liver in 6 h. In comparative incubations in medium containing 0.2 mM proline, fibrotic liver slices produced 16-fold more collagen than normal slices. The proline analogue, L-azetidine 2-carboxylic acid, effectively inhibited synthesis of labeled collagen by fibrotic liver slices. These studies show the synthesis of collagen in a reproducible animal model of the most prevalent form of human liver fibrosis. Difinitition of the controlling factors in this system is of interest for the general problem of fibrosis produced by immunological responses.


Relative contributions of large and small airways to flow limitation in normal subjects before and after atropine and isoproterenol.

Bronchodilatation was produced in normal subjects by the inhalation of atropine, a parasympatholytic agent, and isoproterenol, a beta adrenergic stimulator. Density dependence of maximal expiratory flow (Vmax), expressed as a ratio of Vmax with an 80% helium-20% oxygen gas mixture to Vmax with air at isolung volumes, indicated that the predominant flow regimes across upstream airways changed differently after each agent was given separately. After atropine Vmax increased, elastic recoil pressure did not change, and density dependence decreased. Utilizing the equal pressure points analysis which defines upstream and downstream segments of the intrathoracic airways at flow limitation, these results suggest a greater relative dilatation of the larger upstream airways such that more of the driving pressure is dissipated across the smaller airways in which flow is less  dependent upon gas density. After isoproterenol Vmax increased, elastic recoil pressure did not change, and density dependence increased. This suggests a preferential dilatation of the smaller and more peripheral airways with less density-dependent flow regimes such that more of the driving pressure would be dissipated in the larger airways in which flow is more dependent upon gas density. Systematic decreases after isoproterenol lead independently to the same conclusion. After both agents together, Vmax increased and density dependence and critical alveolar pressures did not change from control, suggesting a relatively uniform dilatation of all the airways comprising the upstream segment.


Metabolism of the fifth component of complement, and its relation to metabolism of the third component, in patients with complement activation.

The metabolism of the fifth component of complement (C5), and its relatonship to metabolism of the third component of complement (C3), has been studied in normal subjects and patients by simultaneous administration of radioiodine labeled C5 and C3. In seven normal subjects the fractional catabolic rate of C5 ranged from 1.5 to 2.1% of the plasma pool/h and extravascular/intravascular distribution ratio from 0.22 to 0.78, these values being similar to those obtained for C3, and synthesis rate from 71 to 134 mug/kg per h, In patients with complement activation the increase in fractional catabolic rate of C5 was nearly always less than that of C3. The data also showed that there was increased extravascular distribution of C3 and C5 in most patients and considerable extravascular catabolism of both proteins in some. However, there were differences in metabolic parameters between patients with different types of complement activation. In patients with systemic lupus erythematosus, fractional catabolism and extravascular distribution of C3 and C5 were both increased, and there was marked extravascular catabolism of both proteins. There was increased fractional catabolism and extravascular distribution of C3 in patients with mesangiocapillary nephritis and (or) partial lipodystrophy, and fractional catabolism of C5 was also increased in three of six studies although distribution of C5 was always within the normal range; however, in two patients with nephritic factor in their serum fractional catabolism of C5 was normal despite markedly increased C3 turnover, suggesting that in patients with alternative pathway activation by nephritic factor little or no C5 convertase is generated.


Factors controlling gastric-glucagon release.

A system consisting of an isolated dog stomach perfused with whole blood has been designed to study gastric glucagon secretion. Under basal conditions, gastric glucagon release was 0.0-3.1 ng glucagon/100g of stomach per min. Arginine, at an arterial plasma concentration averaging 10 mM, elicited a rapid glucagon release. This gastric glucagon release was almost completely abolished by somatostatin (100 ng/ml). The release of gastric glucagon was not affected by hyperglycemia alone but was reduced by about 40% when hyperglycemia was concomitant with an hyperinsulinemia within the physiological range. These observations support the concept that adequate concentrations of insulin are necessary in order for hyperglycemia to inhibit gastric glucagon secretion. Furthermore, it is suggested that the isolated perfused dog stomach might provide a unique tool permitting investigation of alpha-cell function in the absence of endogenously released insulin.


Acinar cell neoplasms of the exocrine pancreas.

The pathological features of 12 acinar cell neoplasms of the pancreas are described; these comprise 11 carcinomas, of which seven were pure acinar cell growths and four were mixed acinar and ductal carcinomas, and one adenoma. These tumors occurred in a series of 105 during the period 162-75. Thrombotic endocarditis developed in three out the 11 carcinoma cases. The distinctive histological features of these neoplasms and the means of differentiating them from anaplastic carcinomas and certain other carcinomas, for example, islet cell carcinoma, oat cell carcinomas, and carcinoid tumours, are discussed. The poor prognosis of pancreatic cancers is emphasized, and reasons are put forward for believing that future epidemiological studies may need to take account of the histological types of pancreatic carcinoma.


Malignant histiocytosis (histiocytic medullary reticulosis) with spindle cell differentiation and tumour formation.

Malignant histiocytosis (histiocytic medullary reticulosis) in a 45-year-old white man is described. Unusual features were presentation as a surgical emergency with signs of obstruction and peritonitis due to an ileal tumour and extensive spindle cell differentiation. Problems in the differential diagnosis of malignant histiocytosis are briefly discussed.


Rectal biopsy as a prognostic guide in Crohn's colitis.

In a retrospective study, 64 rectal biopsies from 27 patients with Crohn's disease limited to the large bowel have been reviewed using a semiquantitative grading of histological abnormality. The subsequent clinical course was assessed independently, and patients were included in one of four categories: (1) remaining asymptomatic; (2) showing continued moderate inflammatory activity; (3) requiring colectomy; and (4) dying as a direct result of colonic disease. Biopsies from group (4) showed a greater degree of histological abnormality than those in the other three groups. This difference was statistically significant for first biopsies ((4)-(1) p less than 0-05; (4)-(2) p less than 0-05). In any one patient the histological appearances were relatively constant from one biopsy to the next. The presence of either fissuring or ulceration suggested a poor prognosis.


Frequency of renal impairment in paracetamol overdose compared with other causes of acute liver damage.

In an analysis of 160 patients with fulminant hepatic failure, the frequency of renal failure in the patiens who had taken an overdose of paracetamol was not significantly higher than in those with hepatic failure due to other causes. The same was found in another group of patients with less severe hepatic damage. In both the latter group and the patients with fulminant hepatic failure, the development of renal failure was closely related to the occurrence of endotoxaemia as detected by the Limulus lysate assay. These findings do not support the concept that an overdose of paracetamol has a specific nephrotoxic effect.


Use of umbelliferone derivatives in the study of enzyme activities of mycobacteria.

A spectrophotometric method using umbelliferone derivatives has been developed for the study of enzymic activites of mycobacteria. Arylsulphatase activity can be estimated in six hours rather than in 10 days as in the conventional method. The technique may be applied to a study of whole cells or to cell-free extracts.


An outbreak of infection caused by a gentamicin-resistant Staphylococcus aureus.

An outbreak of infection caused by a strain of Staphylococcus aureus resistant to gentamicin and tobramycin and other antibiotics occurred in two wards in a hospital. Eight patients were colonized, of whom six had clinical infections. Previous administration of gentamicin appeared to predispose the patients to infection with the strain. Restriction of the use of gentamicin and tobramycin is essential to preserve their value in serious infections.


Red cell indices and serum ferritin levels in children.

The blood counts of 187 non-anaemic children who attended hospital with minor illnesses and who were between the ages of 12 months and 6 years were studied retrospectively. As many as 76-8% of these children were found to have MCVs below the normal adult range. A prospective study of a further 28 non-anaemic children in the same age group showed that the majority of children with low MCVs have normal haemoglobin A2 and F levels and have serum ferritin levels within the normal adult range. These findings indicate that microcytosis is an intrinsic feature of erythropoiesis in early childhood and that in most instances this feature cannot be attributed to iron deficiency or beta-thalassaemia syndromes.


Congenital dyserythropoietic anaemia: response to splenectomy and quantitation of ineffective erythropoiesis.

The clinical and haematological features of an unusual case of congenital dyserythropoietic anaemia are described. There was a pronounced haemolytic component to the anaemia, with a mean cell life of five days, and a remarkable response to splenectomy. Measurement of the incorporation of 15N glycine into the haem of circulating red cells and into bilirubin showed that haem turnover due to ineffective erythropoiesis was increased 45 times compared with a control group (11.63 mg/kg/day, NR = 0.26 + 0-10) and represented 51% of total erythroid haem turnover.


Does preoperative iodide treatment for thyrotoxicosis bring about involution?

It is generally believed that preoperative iodide decreases the hyperplasia of the toxic thyroid gland. Histometric studies of glands from thyrotoxic patients pretreated with propranolol alone compared with those from patients pretreated with propranolol and iodide failed to confirm this. Although histological appearances and volume percentage measurement of component tissues suggested that the glandular epithelium had involuted after iodine treatment, measurement of their absolute mass indicated that the mean mass of epithelium was the same in both groups and that involution had not occurred. We conclude that considerable confusion in the thyroid literature has arisen through incorrect use of the term involution.


Adrenocortical hyperactivity with disseminated malacoplakia.

A case is described of an ectopic ACTH syndrome associated with malacoplakia.


Pre-eclampsia presenting with deep jaundice.

Pre-eclampsia complicated by deep jaundice occurred in a previously healthy primigravida. The main aetiological factor was disseminated intravascular coagulation; this caused both haemolysis and liver cell necrosis. Liver biopsy showed fibrin thrombi in the capillaries with microhaemorrhages and loss of periportal liver cells. The jaundice was attributed to both haemolytic and hepatocellular processes. Organs other than the liver were relatively unaffected.


Myeloproliferative disorders: a paradox of in-vivo and in-vitro platelet function.

A patient with features of a myeloproliferative disorder developed an acute multisystems illness and died. In-vitro platelet aggregation was imparied, but necropsy revealed widespread platelet-rich thromboemboli and multiple organ infarctions. It is suggested that platelets are damaged during disseminated intravascular platelet aggregation (DIPA) and that disaggregation of platelet thrombi and recirculation of platelets give rise to their subsequent hypofunction when tested in vitro.


Polymorphonuclear leucocyte function in Behçet's disease.

Polymorphonuclear leucocyte function was investigated in 19 patients with active Behçet's disease. Spontaneous free leucocyte migration was found to be significantly reduced, yet after stimulation the leucocyte's chemotactic activity was considerably increase (p less than 0-05) when compared to control leucocytes. Control leucocytes migrated more rapidly when incubated in serum taken from patients with Behçet's disease (p less than 0-005). The enhanced chemotactic activity in Bechçet's disease appears to be due to both serum and intrinsic leucocyte factors. Spontaneous nitroblue tetrazolium reduction was found to be normal, although after stimulation leucocyte nitroblue tetrazolium reduction was lower than in the control group (P less than 0-025), as was leucocyte oxygen utilisation. It is suggested that the hyperreactive cellular inflammatory response that characterises Behçet's disease may be due to increased chemotactic activity and minor alterations in functional metabolic activity of leucocytes.


Cryptococcal meningitis complicating systemic lupus erythematosus: two patients treated with flucytosine and amphotericin B.

Two fatal cases of cryptococcal meningitis complicating adrenocorticosteroid-treated systemic lupus erythermatosus are reported. In one patient who was treated with flucytosine alone, after an initial period of improvement cryptococci resistant to flucytosine were isolated, and subsequent amphotericine B treatment silated, and subsequent amphotericin B treatment did not alter the progress of the disease. In the second patient, who received both drugs concurrently, resistant cryptococci did not appear and the patient recovered sufficiently to return home. Flucytosine-resistant mutants could be demonstrated in vitro in the original cryptococcal isolated from both patients. The use of flucytosine and amphotericin B in combination is discussed.


Infection of the foot with Peptococcus magnus.

Peptococcus magnus was the predominant organism in severe infections of the feet in three diabetic patients. In one patient the organism was found also in blood culture, and in two it was repeatedly recovered from the feet, usually in pure culture.


API ZYM: a simple rapid system for the detection of bacterial enzymes.

The API ZYM system of detection of enzymes has been applied to 81 bacteria belonging to several species. It was found to be easy to use and has produced results that may be useful in the identification of a variety of bacteria.


Fucosidosis in a native-born Briton.

This investigation reports the biochemical findings in a native-born Briton suffering from the adult form of fucosidosis. Alpha-L-fucosidase, alpha-L-iduronidase, and beta-D-galactosidase were studied in cultured fibroblast and leucocytes from the patient with fucosidosis, her maternal grandfather, and several normal controls. A complete lack of alpha-L-fucosidase activity was found in the patient's fibroblasts and leucocytes while the grandfather exhibited a heterozygous level of alpha-L-fucosidase activity in his leucocytes. Excessive excretion of what is very likely to be a fucose-containing sphingolipid was demonstrated in the patient's urine by thin-layer chromatography. Compared with five isoenzyme forms of alpha-L-fucosidase activity in normal leucocytes, cellulose acetate electrophoresis of the patient's leucocytes produced evidence of a single band of slight activity associated with one of the isoenzymes. This residual activity probably accounts for the survival of such patients into adolescence and beyond.


Formation of hemi-desmosomes during regeneration of crayfish nerve root sheath as studied with freeze-fracture.

The multilamellate glial sheath of mixed nerve roots of the sixth abdominal ganglion of crayfish contains numerous hemi-desmosomes which appear to attach glial lamellae to material in adjacent extracellular clefts. These junctions, which have been described in detail in an earlier report (Shivers and Brightman, '76), are irregular in shape, punctuate and may be as large as 1 mum in diameter. Surgical interruption of sixth ganglion nerve roots results in regeneration of motor axons and their multilamellate glial sheaths. As the glial processes grow and re-establish a highly organized axon sheath, hemi-desmosomes appear. These junctions are present at the advancing edge of glial processes as well as on their lateral margins. Developing hemi-desmosomes are characterized as a diffuse aggregation of 120-130 A intramembrane particles which are present three weeks following nerve section. As growth and reorganization of the sheath proceeds, the intramembrane particles appear to aggregate and form irregular clusters of varying dimensions. Regenerating nerves freeze-cleaved 8 to 16 weeks following surgery exhibit junctional particle aggregates similar to those in normal unoperated nerve roots. Origin of the intramembrane particles which comprise the junctional aggregated in unknown. Perhaps they are synthesized de novo by the regenerating glial cells or, they may be remnants of complexes which became dispersed following surgery. This is the first report of a freeze-fracture study of hemi-desmosome plasticity in an invertebrate nervous system.


Afferent connections of the habenular nuclei in the rat. A horseradish peroxidase study, with a note on the fiber-of-passage problem.

The afferent connections of the habenular complex in the rat were examined by injecting horseradish peroxidase (HRP) into discrete portions of the habenular nuclei by microelectrophoresis. 1. HRP deposits confined to the lateral half of the lateral habenular nucleus labeled a multitude of cells in the entopeduncular nucleus. Numerous labeled cells also appeared in such cases in the lateral hypothalamus, indicating that the lateral habenular nucleus is a major convergence point of projections from these otherwise apparently quite separate cell regions. Moderate-to-small numbers of labeled cells were also found in the nuclei of the diagonal band, substantia innominata, lateral preoptic area and more caudally, in the ventral tegmental area, the region of the mesencephalic raphe, and the central gray substance. 2. HRP injected into the medial part of the lateral habenular nucleus labeled cells in the same regions, but more in the diagonal band and fewer in the entopeduncular nucleus than were labeled by more lateral injections. The contrast suggests that the projections from the basal forebrain and entopeduncular nucleus to the lateral habenular nucleus are somewhat topographically organized. 3. Injections of the medial habenular nucleus labeled an abundance of cells in the posterior parts of the supracommissural septum, but also a small number of cells in the diagonal band and mesencephalic raphe. 4. HRP injected into the stria medullaris labeled cells in all of the afore-mentioned areas and, in addition, cells in several olfactory structures, confirming that HRP may be taken up by fibers of passage and label their cells of origin, and suggesting that olfactory structures contribute fibers to the stria medullaris that do not terminate in the habenula.


Normal nerve fibers in the barrel region of developing and adult mouse cortex.

The pattern of normal nerve fibers associated with barrel-shaped structures in the somatosensory cortex of both young and adult mice, has been studied using a reduced silver method. In adult animals, the "barrel" sides and septa can be seen to contain densely packed bundles of nerve fibers running vertically between layers III and V. In parasagittal sections, these fibers appear as very dark bands between adjacent barrels, while in tangenital sections the fibers, cut in cross-section, appear as rings of dark spots concentrated around the barrel edges. In contrast to this, barrels in immature animals have dark, evenly stained centers and pale, cell dense sides. This immature pattern can first be distinguished in 2-day-old animals and persists until 18 to 19 days. Between 18 and 24 days a change from the immature to the adult pattern occurs with the appearance of darkly stained, fine fibers within layer IV, particularly within the barrel sides. It is suggested that the immature pattern is due, primarily, to the staining of thalamic afferents while the adult pattern appears with the development of intracortical and association fibers. Electron microscopy, on tissue previously treated by the silver method, shows that the silver deposits are mainly attached to longitudinal elements of the axoplasm and not associated with myelin. This may explain the success of this method in showing fibers in young, unmyelinated brains.


Unmyelinated and small myelinated axons in rat ventral roots.

The present study is an analysis of the ventral roots in the rat. The smallest myelinated fibers are found in segments T1-L2 and L6-S1. These fibers are regarded as preganglionic efferents and the L6-S1 outflow is more cranial than the sacral parasympathetic outflow in other animals. Large numbers of unmyelinated axons are seen in segments T1-L2 and L6-S1, the same segments that contain the smallest myelinated fibers. This data will be used as a baseline for determining the functional categories of the unmyelinated axons.


The prenatal development of some of the visual pathways in the cat.

Lesions were made in the visual system in a series of cat fetuses of known gestational age, and fiber and terminal degeneration were stained by the Eager method. The times of development of the retinal projection, of the thalamcortical and corticothalamic projections of area 17 of the visual cortex, and of the intrinsic fibers in the visual cortex were examined. Enucleation of one eye resulted in degeneration being detected bilaterally in the lateral geniculate nuclei (LGN), superior colliculi (SC) and optic tracts. The optic nerves reached the optic chiasm by the thirtieth embryonic day (E30) and the optic tract connections with the LGN and SC were made by E37. The projection always appeared stronger in the contralateral LGN and SC, and the amount of degeneration increased in both sides with increasing age. A parasagittal knife cut was made in the dorsomedial crest of the visual cortex. Where the lesion passed through the cellular layers of the cortex, intrinsic fibers were cut when these were present. The deeper part of the incision through the white matter undercut the medial wall of the visual cortex, interrupting thalamocortical and corticothalamic fibers when these were present. The longer horizontal fibers that were intrinsic to the visual cortex began to develop during the last two weeks of gestation but were not fully developed at birth. In the undercut visual cortex distant from the place of entry of the lesion, and before the intrinsic fibers of the cortex had developed, degeneration was found in layers 1 and 4, demonstrating the presence of a thalamocortical pathway. The youngest fetus to show this degeneration was operated at E48. This degeneration was not present three days earlier at E45. Fiber plexuses that have been described earlier in development (Marin-Padilla, '71; Cragg, '75) do not appear to degenerate after undercutting the cortex. The corticothalamic pathway to the lateral posterior nucleus medial to the LGN was developed at E45. The descending pathways to the ipsilateral LGN and SC were developed by E48, but it is not known whether they are present before this. Thus degeneration has been used to detect the development of axonal pathways in the fetus for the first time; the major afferent and efferent pathways are developed at an earlier stage than has previously been described.


Cerebellar histogenesis in the lurcher (Lc) mutant mouse.

The postnatal development of the cerebellar cortex of normal and lurcher (Lc) mutant mice was studied by neurohistological and autoradiographic techniques at ages ranging from 2 days through 18 days after birth. Lurcher shows severe defects in the granule cells and Purkinje cells soon after birth. A decrease in the generative layers of the external granular layer is seen as early as two days in the lobulus simplex and by six days of age in the uvula. Granule cell death is common before and during granule cell migration, from 2 to 18 days of age. Loss of granule cells is reflected in reduced growth of the molecular and granular layers. Purkinje cell abnormalities appear at three to four days after birth in the form of crowding failure of nuclear growth, and condensed or lessened cytoplasm; Purkinje cell death is apparent at four to six days of age depending on the region of the cerebellum.


The commissural projection of the superior colliculus in the cat.

The origin, course, and termination of the commissural projection of the superior colliculus were studied using the orthograde and autoradiographic tracing method and the retrograde method utilizing horseradish peroxidase. The complementary and mutually confirming sets of data showed that the commissural fibers interconnect a restricted region of the colliculi. This region includes the strata grisea intermedium and profundum and to a lesser degree the stratum opticum. It extends throughout only the rostral part of the colliculus where it ends abruptly at a level slightly less than half the distance from the anterior border of the deep gray layers. By using the needle used for isotope injection to record multiunit responses to somatic and visual stimuli, direct evidence was obtained that this region falls within that functional area of the colliculus devoted to face representation and central vision. The results also suggested that more commissural fibers arise from lateral than medial parts of this region and that many fibers interconnect corresponding points in the colliculi. In addition to intertectal connections, the commissural projection contains decussating axons which terminate in tegmental structures and within a restricted zone of the central gray matter directly overlying the oculomotor complex. The results are discussed in relation to the possible role the commissural projection plays in the regulation of eye and head movement.


Genetically-associated variations in the development of hippocampal pyramidal neurons may produce differences in mossy fiber connectivity.

The neuronal generation patterns of hippocampal pyramids were analyzed in two inbred strains of house mice (SM/J and BALB/cJ) using triated thymidine radioautography. These two strains of mice possess markedly different patterns of mossy fiber synapses upon pyramidal neurons within a specific segment of regio inferior. The results of this study show that this same segment of regio inferior also displays markedly different patterns of pyramidal neuron generation in the two strains. Specifically, the pyramids of this segment of regio inferior are generated according to the typical "inside-out" sequence in SM/J mice, but this pattern is reversed into an "outside-in" sequence in BALB/cJ mice. Remaining segment of regio inferior, and all of regio superior, is formed in an inside-out sequence in both strains. These results strongly suggest that altered temporal patterns of pyramidal neuron generation may play a major role in determining mossy fiber connectivity patterns.


Catecholamine-induced release of [3H]-Gpp(NH)p from turkey erythrocyte adenylate cyclase.

Incubation of Gpp(NH)p-activated adenylate cyclase in the presence of isoproterenol caused the release of bound [3H]-Gpp(NH)p, and the decline of activity to the basal state. The isoproterenol-induced release of the nucleotide was proportional to the decrease in adenylate cyclase activity. Since there is a large excess of Gpp(NH)p binding sites in the membrane, the isoproterenol induced release of Gpp(NH)p, rather than binding of the nucleotide, was used to measure the amount of guanyl nucleotide binding sites coupled to the activated adenylate cyclase. This amount, 1.5-2.0 pmoles/mg membrane protein, is only approximately 1% of the total Gpp(NH)p binding sites, and is about equal to the number of beta-adrenergic receptors in the membrane. Chromatographic analysis revealed that Gpp(NH)p was released from the membrane as an intact molecule. The findings suggest that persistent activation of the adenylate cyclase is due to persistent binding of Gpp(NH)p to the regulatory site, and that this GTP analog is a better activator of the adenylate cyclase than GTP because of its resistance to hydrolysis.


Membranes of mammary gland. XII. Loosely associated proteins and compositional heterogeneity of bovine milk fat globule membrane.

Electrophoretic patterns of polypeptides of milk fat globule differed quantitatively depending on extent of washing during membrane preparation. This was due to selective loss of loosely associated, extrinsic membrane proteins. Major polypeptides with apparent molecular weights of 155,000 and 43,500 and membrane glycoproteins were released selectively during preparation of milk fat globule membranes. Evidence suggested that xanthine oxidase was a constituent of the selectively removed polypeptide fraction of apparent molecular weight 155,000. A major class of polypeptide with an apparent molecular weight of 62,500 was not extracted from milk fat globule membrane by treatment with dilute salts, ethylenediaminetetraacetic acid, or by nonionic and ionic detergent solutions. Milk fat globule membranes were separated into seven subfractions on isopycnic centrifugation in sucrose density gradients. Specific activities of the enzymes 5'-nucleotidase, xanthine oxidase, acid and alkaline phosphatases were similar or identical in all fractions. Electrophoretic analysis showed these seven subfractions had similar polypeptide profiles. Both phospholipid and total lipid content of subfractions were correlated inversely with fraction density. The results show that milk fat globule membrane is nearly homogenous in content of intrinsic membrane proteins and certain membrane-bound enzyme activities but is markedly heterogeneous with respect to buoyant density and lipid content.


Changes in portal blood metabolites and insulin with feeding steers twice daily.

Four Holstein steers surgically prepared with a device for sampling from the portal vein were used to examine changes in concentrations of metabolites and insulin in portal blood with scheduled meals. The animals were fed a complete mixed ration (3.4 kcal/g digestible energy) twice daily at three intakes. Blood was sampled at 30, 15, 10, and 5 min before feeding and at 1, 3, 5, 10, 15, 30, 45, 60, and 120 min after feeding began. Average intakes of food at 30 min for the three intakes were 0 (control), 889 g (restricted), and 1425 g (fed). Packed cell volume increased rapidly within 15 min of initiation of the meal in fed steers, but the maximum change from pre-feeding was 6.6%. Insulin increased within 5 min with the restricted intake and at 15 min in fed steers. Portal volatile fatty acids and beta-hydroxybutyrate also increased within 15 min of initiation of the meal in fed steers, and glucose tended to decrease after feeding. Certain metabolites and insulin of portal bood changed rapidly with feeding. Additional studies are required to establish any role of these blood components in the short-term control of feed intake in steers consuming concentrate feeds.


Portal blood insulin and metabolite changes with spontaneous feeding in steers.

Four Holstein steers surgically prepared with a device for sampling blood from the portal vein were used to study changes in metabolites and insulin of portal blood associated with spontaneous meal feeding. The animals were fed a complete mixed ration (3.4 kcal/g digestible energy) in individual, electronically controlled feeding units. Blood was sampled before, during, and after meals. During the meal, blood samples were at 2-min intervals. Blood was sampled at 50 individual meals. Average meal length was 15.0 min and average consumption per meal was 631.7 g. Portal insulin increased within 2 min of meal initiation and remained elevated for the first 14 min of meals. Free fatty acids also increased at 8, 10, 12, 16, and 18 min after meal initiation. There were no consistent changes in packed cell volume, glucose, beta-hydroxybutyrate, or volatile fatty acids during this time. On control days when no feed was consumed, there were no significant changes in concentrations of metabolites or insulin. The increase in insulin of portal blood, which occurs upon meal initiation, preceded changes in metabolites. Therefore, the rapid change in insulin may be the result of a reflex neural stimulation rather than the result of a metabolite stimulating release of insulin.


Comparison of two methods for analysis of aflatoxin M1 in milk.

The cellulose chromatography method of the Association of Official Analytical Chemists for determination of Aflatoxin M1 was compared with a two-dimensional thin layer chromatography procedure. The minimum detectable Aflatoxin M1 by the Official procedure was approximately .01 mug/kg while the thin layer chromatography procedure has a claimed sensitivity of .004 mug/kg. Analyses of milk samples by thin layer chromatography agreed with results of the Official procedure in the range of .01 to .25 mug/liter. Each method consistently yielded recoveries greater than 87% and there was no significant difference between means or variances of each method. The thin layer chromatography method took less time than the Official method and showed a reproducible lower threshold sensitivity of .005 mug/liter.


Chromosomal analysis of fertile female heterosexual twins in cattle.

Metaphase chromosomes derived from leukocyte cultures of peripheral blood were examined in 15 fertile, female, heterosexual bovine twins. Of the 15 animals, 14 contained only XX cells in cultured leukocytes while the remaining female was chimeric containing 26% XY cells. The fertile, female, bovine, heterosexual twin demonstrating XX/XY sex chromosome chimerism in cultured leukocytes supplies evidence that chorionic fusion and vascular anastomosis may occur between male and female cattle twins without production of a freemartin. Although one fertile, female, bovine, heterosexual twin expressed XX/XY chimerism, we believe the leukocyte culture technique is a valuable tool for early diagnosis of the freemartin condition. In comparison with other diagnostic aids including clinical observations, erythrocyte typing, and homograft tolerance, chromosome analysis of leukocytes is equally efficient, less expensive, and more practical for routine early diagnosis of the bovine freemartin. Blood can be sampled soon after birth for karyotyping. From leukocyte culture technique, in 3 days after initiation of the cultures the reproductive capacity of the female twin can be decided.


Selective attention in children with reading problems: a developmental study of incidental learning.

The performance of poor readers and control children at three grade levels, first, third, and fifth grades, was compared on an incidental learning task adapted by Hagen (1967). A significant group by task interaction in a repeated measures ANOVA indicated that reading ability was differentially related to performance on the tasks. Relative to control children at all grade levels, poor readers obtained lower scores on the central task and higher scores on the incidental task. The absence of a grade X task X reading ability interaction indicated that selective attention follows the same developmental course in poor readers as in control children. The data suggest that the development of selective attention as reflected in performance on this task is delayed from 2 to 4 years in poor readers.


Behavior modification in the home: siblings as behavior modifiers, parents as observers.

It was hypothesized that siblings could function as effective behavior change agent for their behaviorally disturbed brother and sisters within the home environment. Further, it was predicted that parents could be trained to be reliable observers of their children's performance under these circumstances. The results of the study supported both predictions with siblings in two separate families demonstrating their ability to work with their brother or sister within the context of an ABAB reversal design. Parents were also shown to obtain consistently high reliability ratings when compared to outside observers. The judicious use of siblings as behavior modification aides is recommended as a treatment procedure.


The effect of adult influence on children's preferences: compliance versus opposition.

The present study examined the effects of adult influence on the choice preferences of first and fifth grade girls and boys. It was found that when the adult directed the children as to which choice alternative to choose, all children (both grades and both sexes) preferred that alternative advocated by the adult. When however, the adult's influence attempt was followed by another adult's stating that the child should choose whatever he/she wanted, first graders displayed oppositional behavior (preferring the alternative not urged by the first adult), while fifth graders continued to comply with the first adult's influence. These results suggested that oppositional behavior in first grade children may occur as a function of conflict between adults regarding adult control over the child.


An investigation of relationships between teachers' ratings of behavior and children's personality traits.

This study examined the relationships between teachers' ratings of children's behavior on the Behavior Problem Checklist and children's self-reported personality source traits on age-appropriate Personality Questionnaires. The sample consisted of 254 children from first through eighth grades and 13 teachers in a rural Maine elementary school. Analysis of the data revealed that teachers' ratings and children's self-reports in grades four through six agreed more frequently about problematic behavior than did children's self-reports and teachers self-ratings in grades one through three and seven and eight. In general, the study (1) supported the validity of teacher judgments made with the Behavior Problem Checklist, (2) demonstrated the critical need for more than one perspective when identifying and defining maladaptive behavior potentially indicative of emotional disturbance, and (3) suggested the need to increase the accuracy of teachers' perceptions and evaluations of children's behavior.


Drug use and deviation from self-concept norms.

The more the deviation from a sex-and-grade, self-concept score norm (as indexed on a pair-comparisons, adjectival inventory), the greater the incidence of reported drug use. This assertion applies (a) to both sexes (teen-agers) for beer and wine, cigarettes, hard liquor, and marijuana, and (b) to males alone for speed and LSD.


A matched-subject comparison of underachievers with normals on intellectual, behavioral, and emotional variables.

Children labeled as underachievers are compared to a matched group functioning normally within the classroom. Factor analyses of the data from several tests reveal that the "normal" children not only have achieved higher academic performance but also have better learning aptitude. The inference may be made that many "underachievers" actually have a low general aptitude when carefully measured.


Child abuse and neglect: effect on Bayley Scale scores.

Compared to controls, children who were diagnosed as victims of Nonaccidental Trauma or Failure to Thrive had depressed Bayley Scale Mental Index scores, p less than .002 and p less than .0001, respectively. Failure-to-Thrive children also had depressed Bayley Scale Motor Index scores, p less than .0001. Nonaccidental-Trauma children had Mental and Motor Scale range scores, as determined by differences between basal and ceiling items on the Mental and Motor scales, that were a function of measured Mental and Motor Index Scores. Specifically, Nonaccidental-Trauma children with lower Mental Index scores had higher Mental Scale range scores than Nonaccidental-Trauma children with higher Mental Index scores, p less than .003. Control children had Mental Scale range scores that did not differ between the high-low Mental Index score conditions. On the Motor Scale, range scores of Nonaccidental-Trauma children in the high-low Motor Index score conditions did not differ. However, children with higher Motor Index scores had higher Motor Scale range scores than control children with lower Motor Index scores, p less than .02. In addition, the Infant Behavior Record of the Bayley Scales revealed behavior ratings of Nonaccidental-Trauma and Failure-to-Thrive children that differed from Mental and Motor Scale scores on several dimensions. These differences may reflect differential effects of the Nonaccidental-Trauma and Failure-to-Thrive conditions.


Empathy and socialization in first and repeat juvenile offenders and normals.

The present study examined empathy and socialization in delinquent and nondelinquent juveniles. From 32 first offenders, 16 repeat offenders, and 19 normals who were administered Hogan's empathy scale and the socialization scale of the California Psychological Inventory, groups of 16 subjects matched on age and race were compared. Results indicated that the three groups did not differ on empathy but that each of the three groups differed on socialization. Results are discussed in terms of potentially identifying recidivists and the efficacy of therapist-trained empathy.


Legal issues facing dietetic practice.

Malpractice is today's sword of Damocles threatening not only physicians but the entire health care community. For dietitians--clinical and administrative alike--there are a number of areas which could be sources of litigation involving negligence or lack of competency. Is the right therapeutic diet served to the right patient at the right time? A word to the wise would be: Always have records to substantiate professional judgments and actions, even though this means increased paper work. Another potential pitfall--which could result in revocation of licensure or accreditation--involves the standards of the Joint Commission on Accreditation of Hospitals (JCAH). Is scrupulous attention being paid to the JCAH's principles and four standards for dietetic practice? Violation of, for instance, Standard II relating to sanitation practices could bring about sanctions by the local or state health agency. Labor laws, too, have implications for dietitians. The recent change in the Taft-Hartley law brings hospitals under the jurisdiction of the National Labor Relations Board. Care must be taken not to violate its regulations. The federal Occupational Safety and Health Act is also concerned with sanitary and working conditions of employees. In contrast to such restrictive legislation, however, is the Health Professions Educational Assistance Act of 1976 which opens up new educational opportunities from which dietitians could benefit.


Taste acuity and food attitudes of selected patients with cancer.

Patients with cancer may display taste abnormalities. In this study, abnormalities observed before treatment involved decreased salt and sweet sensitivity. For some thresholds, greater abnormalities were observed among men and women, among patients with colon cancer than among those with breast cancer, and among those with a greater extent of disease. Observations of slight increases in thresholds for sour detection and bitter recognition during the early treatment period and normalization of high sweet recognition thresholds after two weeks of treatment suggest that additional changes in taste acuity may accompany short-term treatment with 5'fluorouracil. However, absence of a correlation of taste changes with changes in food preferences points to the role of other factors in determining patients' food preferences during such treatment. Consideration of the incidence of taste abnormalities in these groups of patients with cancer and observation of altered food attitudes among patients receiving 5-fluorouracil does provide a basis for general recommendations for serving foods which will appeal to these patients.


Body weight-gain equivalents of selected foods.

A table of body weight-gain equivalents of selected foods has been developed to illustrate the weight gain to expect when eating single protions of a food above daily maintenance requirements for varying periods. The data were designed to discourage overeating habits, which result in obesity, and may be utilized to reinforce proper dietary habits in counseling of all individuals.


Impact of fast food meals on nutrient intake of two groups.

Two groups in different population centers were studied to determine how often consumers frequented fast food restaurants, and consequently, how heavily they relied on this type of food for nutrients. A questionnaire was answered by 280 customers of two fast food restaurants of the same chain. They were asked how often they patronized fast food restaurants, their specific food choices, and other pertinent questions. Food choices were evaluated for energy and seven nutrients on the basis of published analyses of the menu items of the particular fast food chain. Fifty-two per cent of the subjects in the two groups considered their purchases to be meals. Seventy-seven per cent of these consumed one-third or more of the recommended dietary allowance for protein, but no more than 30 per cent received that amount of the other nutrients examined, including food energy. Calcium and particularly vitamin A were least often consumed in amounts equal to one-third of the recommended allowances. Consumer choices were responsible for low consumption of calcium, but no good sources of vitamin A were included on the menus. Fast food items were purchased so infrequently by the majority of our respondents that nutrient composition of the fast food meals or snacks would be of concern in only a small number of cases. This study indicates that any attempts to improve nutritive value of fast food snacks or meals must include efforts to lead consumers to make wiser food choices, as well as encourage the fast food industry to provide rich sources of all the nutrients in their menus.


Cost of using permanent vs. disposable ware. Studies in two school systems.

In this study, the cost of using permanent ware and disposable ware in selected schools was compared. Included in the permanent ware study were the costs of: The ware, machine washing of the ware (including labor time and consumption of utilities, detergents, and chemicals), and refuse removal. Data collected in the disposable ware study were: Meal count; number of items of ware used; labor time; and cost of equipment, supplies, and refuse removal. The cost per student was 4 cents for permanent ware and 10 cents for disposable ware. Although the findings in the schools studied point to an economic advantage in using permanent ware, other considerations might prompt a decision in favor of disposable ware.


The electroencephalogram in the middle-aged and the elderly.

A survey was made of the electroencephalographic (EEG) changes during the human lifespan. It was found that the EEG changes during childhood and adolescent maturation continue even between the ages of 30 and 60 years. There is a decrease in the abundance of alpha activity, with a reduction in the fast part and a relative increase in the slow part of the alpha band. In the span of life between 60 and 90, there is an increase of slow waves with a progressive slowing during the aging process and a shift in the dominant frequency from 9 cps to 7 cps. Computerization of results in the beta band (above 13 cps) enables differentiation of the waves of the lower part (13-25 cps) from those of the upper part (above 25-30 cps). The lower part of the beta band decreases parallel to the alpha activity but the upper part of the beta band increases in amount during the aging process. The meaning of the divergent behavior of these sub-groups of beta activity in the aged is discussed. The EEG seems to be an important factor in the study of aged persons.


Measuring dementia.

Maudsley Tests of the Sensorium (used by clinicians to assess verbal memory and orientation) and Kendal's Memory for Design (used by psychologist to assess visual memory) were employed to differentiate between elderly patients with organic brain damage (neurologic disease, chiefly stroke) and those with functional psychiatric disorders which had been present in youth. There were 25 patients in each group. Both test differentiated organic from functional disorders. There was no statistically significant difference in the effectiveness of the two tests.


A device for expressing the serum insulin glucose relationship in diabetes, hyper- or hypothyroidsm, and chronic hepatitis.

When the serum insulin valves during a 50-gm oral glucose tolerance test were expressed as the function of glucose concentrations, a good linear relationship was found in normal subjects and in patients with diabetes, hyperthroidism, hypothroidism or chronic hepatitis. The insulin index calculated from the line representing this relationship was less than 100 in all 19 diabetic patients and most of the 13 hyperthyroid patients with oxyhyperglycemia, whereas it was more than 100 in the 14 normal subjects, the 4 hypothyroid patients, and the 8 patients with oxyhyperglycemia due to chronic hepatitis. The insulin index decreased with increasing maximal blood glucose concentration during the glucose tolerance test in diabetic patients. Furthermore, improvement in the insulin index was correlated with the effectiveness of sulfornylurea drugs in the diabetic group.


Mental status questionnaire for organic brain syndrome, with a new visual counting test.

Ninety aged patients at the Philadelphia Geriatric Center were asked to give answers to a 35-item mental status questionnaire which included a new visual counting test. By this mean it was found that 20 of the 90 subjects were not mentally impaired, but 34 had mild dementia, 17 moderate dementia, and 19 servere dementia. These results proved to be well correlated with the clinical findings. The test records showed that as dementia develops, the first thing to be forgotten is the awareness of time, place and recognition (in that order). Then the ability to count disappears. As mental oblivion intervenes, the last thing the patient forgets is his/her own name. It was also noted that patients with mild senile dementia fared better when kept with a similar group than with patients who have moderate or severe dementia.


Age-associated statural loss and socioeconomic status.

Association between socioeconomic score (SES) and age-related statural loss were investigated in a cross-sectional sample of 718 adults from rural Colombia. Estimates of statural aging were calculated by estimating the maximum statural attainment of each subject from statural relationships with subischial length. Statural loss was correlated with SES, r=-0.06 (not significant) for men, and r=-0.14 (p less than 0.01) for women. Subjects with a high SES tended to lose stature at a slower rate than those with a low SES. For women, the difference in rates of statural loss between the low SES groups was significant (p less than 0.05).


The renal lesion associated with total lipodystrophy.

This report concerns a 41-year-old man with total lipodystrophy associated with a specific renal disorder. He had massive proteinuria, mild azotemia and a normal level of serum complement in addition to the generalized loss of subcutaneous fatty tissue. Results of 1 50-gm glucose tolerance test indicated a high fasting insulin level with an exaggerated response to glucose. Hypoglycemic responses to exogenous insulin were reduced. Renal biopsy revealed changes consistent with glomerular lipidosis. This case is unique in that the renal lesion was not the Kimmelstiel-Wilson pathologic change atributable to abnormal glucose metabolism.


Metabolic behavior of alpha-ray activity in large human arteries: relationship to atherosclerosis.

The paradoxic biologic behavior of tissue calcium metabolism is emphasized. Although calcium salts are essential for the development of bones, they also contribute to aging of the large human arteries. The heavy elements providing alpha-ray activity tend to be metabolized like calcium. The concept of an osteoporosis-atherosclerosis relationship led to a series of investigations in which ash content and alpha-ray activity were examined in abdominal aortas, coronary arteries, pulmonary arteries and, for comparison, in bones and ventral costal cartilages. Both ash content and alpha-ray activity rise with age in the aorta and in the coronary arteries, but there is no such increase in the pulmonary arteries. A statistically significant correlation between ash content and alpha-ray activity has been found only in aortas and coronary arteries. This correlation is even closer in the coronary arteries of subjects who die of coronary artery disease and in the aortas of the elderly. Wet tissue alpha-ray activity in an aorta with severe atherosclerosis may be 220 times higher than in an aorta without significant atherosclerosis. Alpha-activity in bones and in ventral costal cartilages tends to decline in advancing years, though in the cartilages the calcium deposits increase with age. Our studies reveal a close relationship between atherogenesis and the unique metabolic behavior of alpha-ray radiation in the large human arteries.


Ear lobe creases and heart disease.

In 50 patients with coronary heart disease (CHD) and 38 controls, comparative data on age, sex, serum cholesterol level, hypertension, obesity, diabetes, smoking habits, and ear-lobe creases were analyzed statistically. After adjustment for age differences, the factors which chiefly distinguished the two groups were the incidences of smoking, obesity, diabetes, and ear-lobe creases. Of these, the ear-lobe crease seemed to be correlated best with CHD, and may prove to be a useful diagnostic sign.


Anterior segment photography.

Anterior segment eye photography is rapidly becoming a valuable part of vision care. A simple 35 mm SLR camera set-up that can be easily operated without an extensive photographic background has been designed from readily available equipment. This arrangement produces high resolution color and fluorescein photographs for documenting existing conditions. The system is reasonably priced and can be disassembled for general photographic use.


Vision tests as predictors of learning disabilities.

Three relatively new screeening tests for visual problems are described. They are color matching, visual language field development, and the speed of the visual language field development, and the speed of the visual scan. The visual problems so measured were found to be associated with poor school achievement. In color matching, only blue was involved, not red or green, and proficiency was relatively undeveloped before age 10. Throughout, blue matching difficulty was associated with poor visual language field development, but not with slow scanning. Early screening with these tests offers possibilities for early detection of students with potential learning problems.


An optometric clinic in a state institution for the severely retarded.

A report of the establishment of an optometric clinic in a state hospital for the severely retarded. A discussion of problems, techniques, equipment involved, and an analysis of the first fourteen months of operation. A somewhat detailed report of the results of re-evaluating sixty-three patients in an attempt to establish the worth of the project.


The technician in optometric practice.

With the increasing numbers of optometric technicians graduating throughout the country, more and more optometrists are considering employing a technician. Optometrists and technicians must evaluate certain factors in determining the feasibility of utilizing a technician within an optometric practice. The role of the technician as part of the supportive staff is discussed, as well as the physical layout of the office and the attitude of the staff, the doctor and the patients toward delegation of duties. This paper is presented from the standpoint of a practicing optometric technician, with examples of technician utilization in actual practice situations.


Psychological factors in pediatric optometry.

There are many special considerations and unique approaches applicable in the optometric care of children. In pursuing diagnostic procedures, the behavioral adjustment and responsiveness of the child during the examination proceedings may be optimally managed through an appropriate atmosphere and demeanor. Malingering and other interrelationships of behavioral anomalies and visual disorders may be understood and analyzed in relevant contexts. In pursuing procedures in treatment, approaches in prescribing lenses may be associated with resistance on the part of the child or parent, and may relate to personality characteristics and changes. The application of thoughtful techniques may facilitate maximal progress in a therapy program of visual training. Furthermore, complex psychological problems may coexist with visual disorders in learning disabilities, where broad aspects of development are of concern. Finally, the effective care of routine cases or of learning disabled children requires careful communication and counseling with parents.


The diagnosis of factitious ulcer of the hand: a case report.

Factitious of the hand frequently is difficult to diagnose due to the cunning nature of patients with self-inflicted disease. A typical case of factitious ulcer is described in which the diagnosis was made with tetracycline fluorescence to demonstrate wound manipulation. Protective immobilization allowed healing of the ulcer and institution of appropriate psychiatric care and avoided more costly diagnostic studies and hospitalization.


Abduction-pronation and recession of second (index) metacarpal in thumb agenesis.

Thumb dysplasia imposes a proportionately greater functional deficit than does dysplasia of any other digit. To simulate an opposable unit, the child with but four normal fingers naturally will turn to the next most radial (index) digit and by abducting and pronating will widen his first cleft. When the thumb is absent bilaterally, formal neurovascular pollicization of at least one index digit is the logical choice. The inherent deficiencies in formal pollicization, however, may detract from its use in certain instances, for example, unilateral thumb aplasia or thumb aplasia associated with radial club hand. A simpler procedure performed at age 3 or 4 years avoids many of these deficiencies while still creating a more functional pinch and grasp. Through a small web incision, the index metacarpal is separated from the adjacent metacarpal. The base of the index metacarpal is sectioned and shortened 1.5 cm. The digit is recessed, rotated and abducted radially and palmarly, then immobilized by a K-wire fixation to its base. Since 1960, 17 procedures have been performed with good functional results and acceptable appearance.


A simplified technique for treating mallet fingers: tenodermodesis.

Tenodermodesis is a useful surgical procedure in cases of mallet fingers where conservative treatment has failed. The results have been satisfactory in 22 of 26 patients. These results all have been achieved within 60 days and with no more than 35 days of permanent splinting of the distal part of the digit. The final range of motion depends on the patient and on the patient's age; this procedure should not be proposed for elderly patients. The operation is not performed until 3 months after the initial trauma and until formal request from a patient who cannot tolerate this small disability. We recommend local anesthesia for this procedure. Thus with a small incision, without hospitalization, and with minimal splinting and immobilization, this procedure provides a simple treatment for a minor lesion, a principle which never should be forgotten.


Tendon healing: an experimental model in the dog.

Based upon the studies of the healing process in dogs in which profundus tendons were severed partially by a method in which the cut surfaces remained in contact and the area of division was in an undamaged area of the sheath, it was shown that healing of the tendon took place without evidence of vascular contribution from the sheath. Vascular loop patterns, similar to those seen in synovial lining of joints or on either side of the growth plate of growing bone, were found on the surface of the tendons in the area of mesotenon reflection, the osseotendinous junctions, where the vinculum joined the tendon, and in various areas of the tendon sheath. No other vessels were found. A theory for nutrition of the tendon is proposed analagous to that postulated for maintenance of cartilage, first with the formation of synovial fluid by the vascular loop system and then a diffusion phase dependent upon the repetitive loading and unloading of the tissue to force the fluid into the system of canaliculi in the tendon.


The Krukenberg operation: a modified technique avoiding skin grafts.

The Krukenberg operation involves surgical separation of the radius and ulna in a hand or forearm amputee. Thus the forearm is converted into two rays with good grasp and tactile sensation. Prerequisites for this surgery include an adequate forearm stump; indications include bilateral loss or congenital absence of the hands, loss of the hands in a blind person, or necessity for tactile sensation in an affected limb. Sixteen cases are described in which skin grafting was not required.


Detecting occult fractures of the metacarpal head: the Brewerton view.

A tangential view of the metacarpal heads which previously was described as being useful for diagnosis of arthritic changes also can be a valuable aid in detecting fractures or avulsions of ligamentous insertions in this area of the hand. The technique of Brewerton is described and illustrative cases are reported.


Endoprosthetic replacement of the trapezium for arthrosis in the carpometacarpal joint of the thumb.

One hundred silicone endoprosthetic replacements of the trapezium for arthrosis of the carpometacarpal joint of the thumb (CMC-1 joint) were reviewed in 79 patients with a follow-up time from one to 5 years in 67 women and 12 men. Pre- and postoperatively, pain, range of abduction of the CMC-1 joint, grip and pinch strength were recorded. Pain was relieved in 95 hands and abduction was improved in 85 hands. Dislocation of the endoprosthesis was found in the 15 hands with unimproved abduction. Grip strength was improved in 82 hands and pinch strength in 72 hands. Hyperextension of the metacarpophalangeal joint treated by fusion when more than 20 degrees before operation gave better function than when not fused. Complications were dislocation of the endoprosthesis in 19 hands, one infection, and two fractures of the metacarpal shaft. No fracture of the endoprosthesis itself was observed.


Anatomy of the flexor tendon sheath and pulleys of the thumb.

Studies of the pulley systems of the flexor tendon of the thumb demonstrate one oblique and two annular pulleys. Significant decrease in angular motion of the distal joint resulted when both the proximal annular pulley and the oblique pulley were removed, but isolated loss of either did not affect the motion appreciably. If the oblique pulley was intact, then loss of the distal annular pulley did not result in significant loss of motion.


Bacterial colonization of mutilating hand injuries and its treatment.

A total of 120 hand injuries were reviewed. Sixty-seven occurred between 1965 and 1972 and were analyzed retrospectively, and 53 occurred between 1972 and 1974 and were analyzed prospectively. The bacterial colonization was determined in 86 injuries. Injuries sustained while handling farm implements tended to be colonized by mixed gram-negative and gram-positive isolates. The gram-negative isolates usually were resistant to all antibiotics, with the exception of gentamicin. However, nine bacterial isolates were resistant to all agents tested. Injuries sustained in the home or industry were colonized by gram-positive organisms. Most were susceptible to semisynthetic penicillinase-resistant penicillins such as methicillin and its congeners. The use of parenteral prophylactic antimicrobial agents in the treatment of mutilating hand injuries was not significant in preventing infection, and their use does not seem to be indicated in farm implement-related injuries. Antimicrobials are of value in home- and industrial-related injuries only when the status of the wound so indicates.


Experience with atypical mycobacterial infection in the deep structures of the hand.

Two new cases of atypical mycobacterium infections of the deep structures are reported. With two reported previously by the authors and a review of 24 others recorded by others, the symptoms and signs are reviewed. Typically it occurs in the middle-aged person, some of whom give a history of a puncture wound within 6 weeks of onset of symptoms. Synovium in the finger is involved commonly and a carpal tunnel syndrome may be the result of involvement of the bursae. Fever does not occur and no systemic signs are present. Biopsy and cultures are essential for diagnosis, but a presumptive diagnosis indicates that, after synovectomy, treatment should be started with antituberculous drugs, isoniazid with ethambutol, Rifampin, or both and continued for 18 to 24 months, unless in vitro sensitivity tests indicate a change of medication. The usual organisms are M. kansasii, M. marinum, M. intracellulare, and M. avium.


Human bites of the hand: twenty years of experience.

A retrospective study of the records of 20 years of experience with injuries from human bites reviewed the results of treatment of 42 patients during the first 10 years and 94 in the second 10 years. In the later series there was less delay in the treatment due to better education of primary physicians as well as of patients. There were fewer complications also. A prospective study of 38 patients, whose treatment consisted of soap and water cleansing, thorough exploration and debridement, hospitalization for at least 48 hours, and administration of antibiotics, showed this treatment resulted in a reduction of the incidence of amputation and stiff fingers despite the fact that 61% of the patients still delayed seeking treatment.