Prolactin-induced stimulation of rat renal adenylate cyclase and autoradiographic localization to the distal nephron.

Prolactin was shown to activate adenylate cyclase in broken cellular enzyme preparations from rat renal medulla. Likewise, vasopresin was effective on this enzyme system. Parathyroid hormone was similarly active in the renal cortex. The simultaneous administration of vasopressin and prolactin to medullary kidney slices did not result in an additive effect in stimulating medullary adenyl cyclase. Audioradiographic techniques revealed a selective and prolonged localization of intravenously injected 125I-prolactin to the thick limb of the loop of Henle, the distal tubule and the collecting duct. It is concluded that prolactin activates medullary adenylate cyclase, and may do so by occupying ADH receptors.


Renal failure in malaria: a pathophysiologic study.

A pathophysiologic study was made in 15 patients with acute renal failure due to falciparum malaria. Marked increase in plasma fibrinogen and elevation of serum fibrin degradation products were observed in all cases. The other coagulation parameters including prothrombin time, partial thromboplastin time, factor V and factor VIII were within the normal limits. Plasma hemoglobin was minimal. The blood viscosity was significantly increased. Blood volume study in 5 patients showed initial hypovolemia followed by hypervolemia and normovolemia. Decreased cortical renal blood flow was noted in renal hemodynamic study using 133Xe. Plasma renin activity was increased. Intravenous pyelography during the oliguric phase of renal failure revealed a poor nephrogram which increased in density at 24 and 48 h after the injection of the contrast material. The findings suggest the significance of reduction of renal blood flow in the pathogenesis of renal failure in human malaria. The roles of blood hyperviscosity and hypovolemia are emphasized.


Nephrotic syndrome associated with amyloid-like glomerular deposits.

An Arab patient with a typical nephrotic syndrome associated with the deposition of an amyloid-like material in the glomeruli is described. The deposits consisted of an electron-dense finely granular material which contained immunoglobulins and complement and fibrillar structures which resembled those of amyloid but did not stain with the typical amyloid stains.


Catheterization and superselective angiography of the cerebral vessels.

The technique of catheterization and superselective angiography of the cerebral arteries is described. The balloon can be introduced safely into any of the cerebral arteries including the anterior communicating artery and the peripheral branches of the middle cerebral artery. The superselective angiography seems to be suitable for the study of the regional venous circulation of the brain.


Pituitary abscess.

Three cases of pituitary abscess are presented. The history of recurrent attacks of aseptic meningitis, together with radiological and clinical features suggestive of pituitary tumor, appear to form a fairly typical picture of the condition. Long follow-up was possible in two of the cases. There are no radiological features which distinguish the lesion from pituitary tumor, hence the importance of recognizing the significance of such a clinical presentation with radiological evidence of sellar enlargement. Pituitary abscesses seem to occur in preexisting pituitary tumors. The possible relationship with pituitary infarction is discussed.


A new method of localize the choroid point of the PICA and the venous copular point on the lateral projection of vertebral angiography.

The location of the choroid arterial point as well as of the copular venous point with reference to a line, dealing with the anatomical structure at the level of the cervicooccipital joint, was found to be a quick and accurate method for the diagnosis of tonsillar herniation. The application of this method has the advantage of giving the location of the choroid arterial point, and a control of the venous time of arteriography by the location of the copular point.


Oxygen myelography for cervical spinal cord injuries.

Oxygen myelographies were performed on 15 patients with cervical spinal cord injuries, in seven of whom narrowing of the spinal cord was caused by a fracture-dislocation. In eight the fracture was of bursting type, and the neurological involement in these was more severe than in the former type. The main findings in seven early myelograms were swelling of the cord (3/7) and non-visualization of the spinal canal at the injury level (6/7). The main findings in eight late myelograms were narrowing of the cord (5/8) and anterior stretching of the cord over the obstructing bony ridge.


Positive arthrography of the craniocervical joints.

The configuration of the articular cavities of the cervico-occipital region have been demonstrated by an experimental technic of positive contrast arthrography in postmortem specimens.


The traumatic pneumomyelogram. A previously undescribed entity.

Air within the cervical subarachnoid space secondary to skull trauma (traumatic air myelogram or pneumomyelogram) has not been reported previously. Such a case is presented and the findings are reviewed in the light of existing literature.


The medial tentorium and incisura: normal and pathological anatomy.

There are large variations in the length and breadth of the tentorial incisura, its relationship to the brainstem, and in the exact course and position of the free tentorial margins. On contrast-enhanced CT scans, the obliquely sectioned posterolateral tentorial leaves of the tentorial notch can usually be delineated easily. Lesions intrinsic to the tentorial hiatus are discussed and the CT features of remote mass effects causing transtentorial herniation described.


Angiographic appearance of a huge retrocerebellar arachnoid cyst in an infant.

A detailed analysis of the angiographic findings with a congenital retrocerebellar arachnoid cyst in an infant is reported. The angiographic features are a huge retrocerebellar extra-axial avascular mass compressing and displacing the fourth ventricle anteriorly, dysgenesis of the cerebellum, a tight posterior fossa and transtentorial upward herniation of the monticulus and brainstem.


Diagnosis of empty sella with CT scan.

The diagnosis of empty sella was made correctly by CT scanning in 100% of 19 cases studied.


Pneumoencephalographic changes with intrasellar cisternal herniation (primary empty sella).

In a selected material of 47 cases of primary intrasellar cisternal herniation, analysis of pneumoencephalographic changes demonstrated the long axis of the anterior part of the third ventricle to point towards the center of the herniation. Transmitted CSF pulsations from the third ventricle probably determine the formation and location of intrasellar herniations. The distribution of air in the subarachnoid space indicated a disturbed CSF circulation in the majority of patients. Visual field defects were unrelated to the slight deformity of the optic nerves observed but rather to a high position of the third ventricle.


Skull changes with intrasellar cisternal herniation (empty sella).

Forty-seven cases with intrasellar cisternal herniation (empty sella) examined by plain X-ray of the skull and pneumoencephalography have been reviewed. Although the diagnosis may frequently be anticipated from the plain X-ray findings, further studies are necessary to establish the diagnosis. Also the type of herniation, whether horizontal, anterior or complete, may be anticipated from the appearance of the sella. Signs attributable to increased intracranial pressure, mainly erosion of the dorsum sellae, were found in about half of the cases.


A standardized method for computed tomography of the orbits.

A standardized method for the CT exploration of the orbital region has been searched for. This method makes it possible to visualize the entire orbital region with a minimum of 4 tomographic scans, each section 6 mm thick. The reference line chosen for this exploration is parallel to the optic nerve and joins the projection of the inferior border of the orbit on the lateral view with the upper border of the ear to the scalp. After each tomographic scan the patient is moved so that the new scanning line is still parallel to the reference line but distant by 9 mm from the previous one.


Venous drainage in the craniocervical region.

The venous drainage of the craniocervical junction is made up of jugular veins and particularly the vertebral veins and their anastomoses. The anterior and posterior condylar veins join to form the plexus of the vertebral vein, the supply functions of which can be modified by the presence of the mastoid anastomotic emissary veins which increase the possibilities of drainage at that level.


Menkes' kinky hair disease.

Four new cases of Menkes' kinky hair disease are reported with special attention to the vascular and particularly the cerebral vascular changes.


Myelography for severe thoracolumbar injuries.

Myelography was carried out on 30 patients with severe thoracolumbar injuries. In ten cases the myelography gave specific information which could not have been obtained by any other method. Myelography made within 1 month of trauma gave specific information in only one of 16 cases. Late myelography, in nine of 14 cases, provided valuable specific information about the type of cord atrophy, dorsal scar formation and transsection of the cord.


[Technical variants of median sternotomy].

Various modifications of the technique of median sternotomy are described. Advantages thus obtained with respective to saving time and better haemostasis are explained.


[Surgical technics indicated for spontaneous pneumothorax. Personal experience in 266 operations].

The surgical techniques best suited for timely management of spontaneous pneumothorax are described. Results in 266 cases are discussed and compared with the recent literature. Reference is also made to a little known technique: photothermostimulation, and the results it offers are illustrated. Encouraging results have been obtained from rapid frottage of the parietal pleura and this is described. Emphasis is placed on the advisability of early operation to forestall possible surgical and anatomofunctional complications, to ensure good recovery of respiratory capacity, and to prevent mechanical sequelae involving the cardiorespiratory system.


[Ischemic phlebitis and venous gangrene].

Seventeen cases of ischaemising phlebitis and 5 of venous gangrene are reported. Attention is given to the aetiopathogenetic factors that lead to massive thrombosis and dramatic progression of the disease: depression of vascular heparin, polyglobulia, serious dysproteinaemia, marked involvement of the arterial district, etc. Treatment may be medical or surgical, based on large doses of anticoagulants, low-weight dextrane and thrombolytic drugs, though the results expected are not always obtained. At present, early venous disobstruction with a Fogarty catheter, coupled with prolonged anticoagulant management is the best course. Prognosis is certainly better in ischaemia. When gangrene sets in, prognosis is particularly poor, even as far as survival is concerned, due to serious concomitant shock.


[An unusual case of perforation of Meckel's diverticulum].

An infrequent case of puncture of Meckel's diverticulum whose aetiopathogenesis was attributed to a segmentary intestinal dyskinetic phenomenon is reported. The pneumoperitoneum consequent on the puncture was not associated with peritonitis and histology showed that the diverticulum did not show either inflammatory phenomena or areas of ectopic mucosa, namely none of the causes which are usually at the origin of Meckel's diverticulum puncture.


[Acute hyperparathyroidism. Emergency surgical operation in a case of hypercalcemic coma].

A case of acute hyperparathyroidism complicated by oliguric renal failure successfully resolved only after surgical removal of a parathyroid adenoma is reported. The need for early diagnosis of this rare condition is stressed and the commonest and most recent techniques for investigating primary hyperparathyroidism are discussed. In agreement with other reports, the importance of the earliest possible surgery, without which prognosis is almost always poor, is reiterated.


[A case of simulation of ovarian cyst in volvulus of an ectopic spleen].

A case of volvulus of ectopic spleen mistaken for twisted ovarian cyst is described. Attention is drawn to six points: 1) the rarity of the condition; 2) the persistent uncertainty concerning its aetiopathogenesis, even though over a century has passed since the first case was reported; 3) the mechanism leading to twisting of the spleen stalk; 4) the absence of specific symptoms and the consequent impossibility of preoperative diagnosis in most cases; 5) the ready confusion with ovarian cyst; 6) the reasons for supposing that the reported case was the result of congenital factors.


[Endoscopic retrograde catheterization of Vater's ampulla in the diagnosis of bilio-pancreatic diseases].

The technique, indications and contraindications for endoscopic retrograde cholangiopancreatography are discussed. Some of the most demonstrative cholangiographic and pancreatographic pictures are described and the reasons that have led to a marked reduction in complications immediately after the examination are analysed. Therapeutical aids for limiting any slight disturbances connected with the examination are also presented. Finally, some morphological data useful for differentiating between inflammatory and neoplastic lesions in the juxta- and intrapancreatic biliary excretory way and the pancreas itself are considered.


[Instrumental perforations of the proximal esophagus. Proposal of conservative therapy].

A series of 8 cases of oesophageal perforations observed between 1949 and 1975 is reported. 5 of these cases were located in the oesophagus and did not communicate with the pleural cavity. All the patients were successfully treated with drainage of the lesion through a naso-pharingeal tube. It is then suggested that this method bloodless drainage may be successfully carried out in cases of accidental lesion of the oesophagus without perforation of parietal pleura, caused by peroral endoscopic manoeuvres or dilatation of oesophageal anatomical and functional strictures.


[Repeat operations in thoracic surgery for post-exeresis bronchial fistula. Case studies].

41 cases of bronchial fistula secondary to 458 pulmonary tuberculosis exeresis, and 4 cases of bronchial fistulae secondary to 476 exeresis for non tubercular diseases, observed from 1969 to 1975, are reported. Possible surgical treatment of post-exeresis bronchial fistula is examined and the various reintervention methods and results obtained are described.


[Suppurative disease of the ano-rectal tract].

Suppuration of the anal-rectal tract usually requires nothing more than ordinary surgical management. In many cases, however, particularly when the fistula lies entirely above the anal sphincter, the picture is complicated, with recurrences and exacerbations. In addition, incontinence following unsuitable surgery may constitute a possible risk. Statistical assessment of a personal series is primarily directed to analysis of factors leading to chronic evolution of the disease and its complications. Eclectic management founded on the surgeon's experience, but nevertheless based on well-defined techniques, will be found to offer the best results.


[The cervical approach in surgery of the thymus for myasthenia. Comparison with the trans-sternal route. Considerations on 75 operated patients].

The role played by the surgical route on the immediate post-operative course has been studied on the basis of personal experience of thymectomy for myasthenia gravis (75 operated cases). Time of respiratory assistance, pleuropulmonary complications, operative mortality and recourse to trachetomy were evaluted in two homogenous groups of patients thymectomized cervically (group I: 36 cases) or trans-sternally (group II: 39 cases). It is was found that the average duration of respiratory assistance was significatly less in the first than in the second group (it was often not necessary at all), pleuropulmonary complications were halved, tracheotomy was never indicated and operative mortality was nil. The cervical approach thus offers enormous functional advantages and devers a leading place in surgery of the thymus; it would appear to be contraindicated only in the presence of radiologically evident thymomas and at times in cases where tracheotomy has been performed previously.


[Anatomo-clinical considerations of several cases of pseudocysts of the pancreas].

The aetiology and clinical manifestations most commonly noted in pseudocysts of the pancreas are briefly described. Particular attention is given to the treatments of lesions operated under emergency conditions and the clinical aspects of pancreatic effusions sometimes encountered during the course of the disease.


[Perforations of the small intestine].

Six cases of perforation of the small intestine, one secondary to anaphylactoid purpura and five spontaneous, are reported. Ingestion of an iced drink acted as a trigger in two cases. A vascular genesis is put forward to explain the aetiopathogenesis of two cases and it is noted that perforation of this type is present in the final ileal ansa, at the mesenterial margin. In three cases, histology revealed the presence of double refraction crystal. These came from vegetal residues and are probably capable of penetrating from the lumen into the mucosa causing a foreign body reaction, abscess and subsequent perforation. In these cases, perforation occurred in an ansa located further away than the last ileal ansa (about 3 m) and on the mesenterial margin. Intestinal resection and subsequent end-to-end, single layer anastomosis were performed in all cases.


[Post-traumatic stenosis of the small intestine].

A case of intestinal stenosis in a subject who had received an abdominal injury four weeks earlier is presented. The relevant literature is surveyed and the pathogenesis of this unusual condition is examined. Post-traumatic stenosis of the small intestine is seen as an example of ischaemic stenosis.


[Cystic ureteritis].

A case of cystic ureteritis associated with pyelo-ureteral calculosis is presented. A survey is made of the subject and nephroureterectomy is recommended in unilateral forms.


[Prospects and utilization of xeroradiography in the osteoarticular diagnosis and study of soft parts].

Xeroradiography and its physical phenomena are briefly described and attention is drawn to its offer of marked contrast and hence greater perception of details than conventional radiography. A comparison is made between ordinary and xero pictures of the spine, mediastinum and lungs with regard to the definition and identification of individual parts. The literature dealing with results obtained in areas where xeroradiography is best employed (joints and accompanying soft parts) is reviewed and personal experience in this field, based on a nosographic criterion and specific diagnostic choice, is presented. Cases illustrated cover ligamentous microcalcifications, knee meniscus calcifications, shoulder periarticular calcifications, and partial fractures. A comparison is made between conventional and xero pictures of joint changes in rheumatoid and uraemic arthritis, and bone changes in osteomyelitis and specific forms of arthritis. Diagnosis in osteo-necrosis and prosthesis complications is also examined. The results are such as to encourage further use of the method in the gathering of a fuller series of selected cases.


[Spinal meningioma as a frequently unrecognized cause of neuromotor disorder in the aged].

The clinical history prior to surgery of 18 cases of spinal meningiomas is examined. In most cases, surgical management had been undertaken too late and the reasons for this are discussed. Poor neurological knowledge on the part of general practitioners or mistaken interpretation of the initial symptoms by specialists were the main causes. Persistent prejudices based on the supposed damage caused by myelographical investigation also proved a stumbling-block to timely intervention.


[Respiratory function in uremic patients before and after dialysis].

Respiratory function investigations (spirometry, capillary haemogasanalysis and Xenon 133), before and after dialysis, have been carried out in 10 uraemic patients. Methods of investigation and the results showing a post-dialysis improvement of the lung ventilation and perfusion function, are described.


[Duration of antidepressive treatment. Recurrences and their prevention].

The basic strategy for the pharmacological treatment of depression, with special regard to its continuance following the start of remission, is outlined. The problem of the prevention of recurrences of dysthymic symptomatology is discussed and emphasis laid on the importance of lithium about whose use a fair literature is already available. The results obtained to date demonstrate the undoubted advantages of lithium salts (particularly of carbonate) in the maintenance of good affective balance, above all in the case of those subjects in whom the frequency or gravity of dysthymia seriously handicaps working or social life.


[Fanconi-Zinsser disease].

Fanconi-Zinsser's disease is a serious involutive myelopathy responsible for pancytopenia, hyperpigmentation, oralplakia and onychodystrophy, together with lesser dysmorphisms in many cases. The marrow blood picture is reminiscent of the better-known Fanconi's disease, while the skin and mucosa picture is similar to that of congenital dyskeratosis - hence the combined name. A typical case, but complicated by Lewandowsky's disease for the first time in the literature, is presented. Papova-virus was noted in the typical verrucae. The modern "pathology due to genome instability" is examined. Lewandowsky's disease is regarded as a familial form and precancerous, owing to its possible Bowenoid transformation. The association is seen as particularly significant in stressing the disorder of the immunocompetent syste, this being most evident from the finding of serum anti-red-cell auto-antibodies and a deficiency of T lymphocytes. Fanconi-Zinsser's disease has only been reported 21 times in the literature, mostly in males. Incomplete forms are, however, noted in relatives, suggesting that it originates in a genetic disorder whose transmission modality is not clear, though incomplete dominance is suspected. Genome instability is probably responsible behind the onset of the disease and its neoplastic complications - these being also feature of other forms provoked by such instability, such as Bloom's syndrome and ataxia telengiectasia. Fanconi's disease also has marked neoplastic tendencies. Clinically, Fanconi-Zinsser's disease can be classified as distinct, since it has signs and an evolutive modality that distinguish it from Franconi's disease, Estren-Damesheck's syndrome and amegakaryocytic thrombocytopenia. Genetically, it can be seen that all these diseases are referable to "pathology due to genome instability".


[Use of the M.H.Q. test (Middlesex Hospital Questionnaire) in the diagnosis of neuroses].

A psychological interview and the MHQ, Koch, Rorschach, TAT, Machover and family design psychological tests were conducted in pneumopathic patients. The results obtained with the MHQ were compared with those of the other tests with respect to the diagnosis of psychoneurosis. A perfect fit was observed.


[Usefulness of the M.H.Q. (Middlesex Hospital Questionnaire) in the diagnosis of psychoneuroses].

The M.H.Q. test was carried out on 97 pneumopathic subjects and the data obtained are compared with those deriving from clinical conversation and  the Rorschach, Koch, T.A.T., Machover and family drawing tests. The results obtained with the latter tests made it possible to divide subjects up into two large groups: 48 normal cases and 49 psychoneurotic cases. Perfect agreement was found between this judgment and that based on the M.H.Q. test; the test is therefore considered a useful means for the diagnosis of hospitalized psychoneurotics.


[Leukemic reticuloendotheliosis. Problems in differential diagnosis apropos of our study of 1 case].

A case of leukaemic reticuloendotheliosis is reported. The clinical and histocytological picture of the disease is discussed in relation to the complex problems of differential diagnosis it involves with other forms of systemic involvement of the spleen. The electivity of splenectomy is stressed.


[Various physiopathological aspects of asthma due to effort].

Ten patients with various clinical forms of bronchial asthma were subjected to exercise of increasing intensity on the bicycle ergometer. It was found that effort is not capable of causing a true asthma crisis, though it may lead to the appearance or accentuation of bronchostenosis. Inhalation of acetylcholine during the tests, however, constantly resulted in crises, even in cases where acetylcholine alone had not caused bronchostenosis.


[Study on the relationship between meteorological-seasonal factors and acute vascular accidents].

Mortality from acute cardiovascular accidents has been studied in relation to the seasons in Naples, Milan and the rest of Italy. A constant parallel was noted between such deaths and the winter season. It is concluded that the meteoric-seasonal factor most responsible consists of the drop in temperature which could cause vascular spasm followed by an increase in systemic arterial pressure. It is personally considered that this is the most important pathogenetic mechanism in the majority of cases of acute cardiovascular accidents.


[Gastric mesenteric transverse volvulus. Report of a case].

A case of intermittent transverse mesenteric volvulus with elevation of the left hemidiaphragm and peptic oesophagitis complicated by numerous ulcers, some of them bleeding, is described. Diagnosis was clinched radiologically. Endoscopy make clear the nature of the haematemesis. In the light of the pathogenetic hypotheses applicable to gastro-cardiac syndromes, combined endoscopic and radiological examination may be considered as mandatory.


Postoperative use of radioactive phosphorus in stage I ovarian carcinoma.

The addition of intraperitoneal colloidal radioactive chromic phosphorus following total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy in women with Stage I ovarian cancer does not cause significant morbidity. Moreover, our preliminary results suggest that this regimen appears to increase the rate of local control of disease. In 21 unselected patients, there was 1 incident of small bowel obstruction. Fourteen of these patients have been followed for at least 1 1/2 years; all are alive without evidence of disease. These facts suggest that a national prospective study to investigate the efficacy of this treatment for Stage I ovarian cancer is warranted.


Colposcopic evaluation of patients with abnormal cervical cytology.

A total of 1580 new patients underwent colposcopic evalution in the Dysplasia Clinic at Nassau County Medical Center. Of these patients, 186 had abnormal Papanicolaou smears associated with pregnancy, 150 were referred because of in utero exposure to diethylstilbestrol, and 1244 were referred because of abnormal cervical cytologic smear or suspicious cervical or vaginal lesion. Further analysis of this latter group revealed that 1184 (95%) patients had satisfactory colposcopic evaluation, and directed biopsy showed the following: 10 cases of invasive cervical carcinoma, 9 of carcinoma in situ with microinvasion, 118 of cervical carcinoma in situ, 110 of severe dysplasia, and 424 cases of mild to moderate cervical dysplasia. All of these patients subsequently were treated accordingly. Evaluation of final histologic specimen revealed a very high correlation with colposcopically guided biopsies. In 54 patients, where colposcopic evaluation was unsatisfactory, diagnostic cold knife conization was performed. Final histologic diagnosis disclosed a more advanced lesion in 30 patients (or 56%) of this group. The result of this study shows that satisfactory colposcopic evaluation is a highly accurate method of evaluation of abnormal cervical and vaginal cytologic smear.


The management of severe preeclampsia and eclampsia with intravenous diazoxide.

Twelve patients with either severe preeclampsia (9) or eclampsia (3) were treated with intravenous diazoxide, 300-mg bolus, for the reduction of diastolic blood pressure (less than or equal 110 torr) after the usual and customary measures had been initiated to include parenteral MgSO4 and diazepam. Diazoxide precipitously decreased both systolic and diastolic blood pressure proportionately (35-50%); the nadir was invariably reached in 5-15 minutes. Diastolic pressure never fell below 50 torr, and mean arterial pressure always exceeded 70 torr. Oliguria was not apparent. The vasodepressor response was fairly persistent for 4 hours in all but 3 patients; 2 of these received a second 300-mg dose. Significant changes in fetal heart activity (bradycardia, dysrhythmia) were observed in only 1 patient. Labor was immediately ablated in all patients, but could be restimulated with oxytocin. All pregnancies were terminated within 7 hours (mean, 3.7 hours), seven of them by cesarean section. Eleven newborns did well. We conclude that the immediate reduction in maternal arterial blood pressure is without apparent hazard to the mother as well as the fetus.


Effects of magnesium sulfate on toxemic patients in labor.

One hundred forty-four toxemic patients were studied by continuous electronic maternal and fetal monitoring. Ninety-seven were treated by intravenous bolus of 2 g MgSO4 every 1-2 hours, and 47 by intravenous drip MgSO4 at a rate of 1 g/hour. Clinical doses of MgSO4 do not affect maternal ECG, temperature, uterine contractions, or fetal heart rate. Intravenous bolus administration is frequently associated with slowing of maternal respirations and hypotension and occasionally with transient apnea.


Risk factors associated with post cesarean section febrile morbidity.

A high incidence of post cesarean section febrile morbidity has caused a number of investigators to recommend using prophylatic antibiotics for patients undergoing this procedure. Recent data suggest that such prophylactic antibiotics should be reserved for high-risk patients. Since previous studies have not adequately defined the high-risk patient, we analyzed 129 patients undergoing cesarean section to identify the factors which predispose to postoperative febrile morbidity. Two different statistical programs identified four factors (general anesthesia, obesity, hematocrit less than or equal to 30%, and labor prior to delivery) which were significantly associated with post cesarean section febrile morbidity (P less than 0.025). Patients with 2 or more of these risk factors were highly likely to experience this postoperative complication (P less than 0.001).


Direct evidence of luteal insufficiency in women with habitual abortion.

Plasma levels of progesterone were measured during the luteal phase in 10 of 15 women with clinical histories of at least three spontaneous abortions in the last three gestations, and in 15 healthy nonpregnant women during the same phase of the ovarian cycle. Progesterone values found in the women with habitual abortion were lower (P less than 0.05-0.005) than in the nonpregnant group almost throughout the period of observation. The habitually aborting women who became pregnant again aborted between the seventh and 12th weeks. Their progesterone concentrations were less than 6 ng/ml, 48-72 hours before vaginal bleeding or abortion. These values were compared with those found during the first 12 weeks in normal pregnancy (P less than 0.001). The results suggest a useful method of evaluating the treatment of habitual abortion.


The origin of androgen and estrogen in a virilized postmenopausal woman with bilateral benign cystic teratomas.

Clitoromegaly was observed in a 73-year-old woman who had bilateral ovarian benign cystic teratomas that contained only epithelial derivatives. Scattered in the stroma of these ovaries were clusters of hyperplastic cells. The plasma testosterone production rate was 2.4 mg/day, a value that is ten times greater than that of normal postmenopausal women. The elevated plasma concentrations of testosterone and androstenedione decreased to normal by the second day after bilateral oophorectomy. Ovarian venous concentrations of testosterone and androstenedione were also increased and were considerably greater than those in peripheral blood. Estrone production was 68 microng/day, most of which could be accounted fo by the extraglandular formation from androstenedione. Estradiol production was 71 microng/day, of which 75% was computed to arise from extraglandular formation and the remainder likely arose by ovarian secretion. The modest increase in estrogen production was associated with slight cystic hyperplasia of the endometrium. From this study we conclude that the hyperplastic ovarian stroma was the source of the excessive androgen production.


Obstetrics in Cuba, 1974.

In the past 17 years, Cuba has established a system of governmental medical care, and undergraduate and graduate medical education  have also been revised and expanded. Special attention has been directed to maternal and pediatric care, but no description of this has been published outside Cuba. Standards of care have been formulated by national committees, with emphasis placed on the training of specialists in obstetrics and neonatology. Prenatal care and identification of high-risk patients has produced an institutional delivery rate of over 97% with much antenatal hospitalization and referral of high-risk gravidas to tertiary care facilities. New laws providing benefits for working women encourage prenatal care, rest, and breastfeeding. In 1974 the maternal mortality rate was 55.6 per 100,000 live births, and perinatal mortality was 28.5 per 1000 live births.


Amniotic fluid cortisol concentrations in normal labor, premature labor, and postmature pregnancy.

Amniotic fluid cortisol concentration was measured in 61 gravidas during the third trimester prior to onset of labor. These patients had had normal prenatal courses and served as controls. Cortisol values obtained were compared with those of 1) gravidas with prolonged pregnancy (greater than 42 weeks) who delivered post-mature neonates (N=6), 2) gravidas in spontaneous term labor (N = 10), and 3) gravidas in premature labor (N=10). The mean level of amniotic fluid cortisol (+/-SD) found in those women with premature labor was significantly elevated compared to control values (P less than 0.05). Levels recorded in premature labor patients were in the same range as in the term spontaneous labor group (3.7+/-2.5 vs. 2.7+/-1.5; P greater than 0.3). No difference was found between the spontaneous labor group or the postmature group and their respective controls.


Relative birthweights of twins.

In a series of 182 twin gestations second-born twins were more often heavier than first-born twins (55%), but overall they weighed less by an average of 21 g. This paradox was shown to be due to the skewed distribution of weight differences favoring the first-born twin, most apparent among pairs in which one or both weighed at least 3000 g. The larger the difference between birthweights, the greater the likelihood that the heavier twin would be delivered first.


Choice of analgesia or anesthesia for pain relief in suction curettage.

One  hundred and fifteen patients admitted to Duke University Medical Center from January 1, 1973, to December 31, 1974 inclusive, with the diagnosis of uncomplicated spontaneous incomplete or inevitable abortion were included in a randomized prospective study. All patients underwent suction curettage under either analgesia or general inhalation anesthesia. Patient response was adjudged regarding comfort and cooperativeness in the group receiving analgesia and postprocedure rehabilitation and discharge times in both groups. Fifteen of 59 patients receiving analgesia only were recorded unanimously as failures. Post-operative ambulation was no more rapid in patients receiving analgesia. Procedure-to-discharge intervals were unrelated to medication modality. There appears to be no advantage to analgesia as far as rehabilitation time, procedure-to-discharge time, and medical complications are concerned.


Phytohemagglutinin stimulation of lymphocytes in lung cancer patients.

Peripheral blood lymphocytes obtained from controls and patients with lung cancer treated by radiotherapy were cultured with phytohemagglutinin (PHA). Patient lymphocyte response to PHA was depressed before therapy and even declined further after theapy. There was no prognostic significance associated with pre-therapy PHA responsiveness in this study.


Length of in vivo exposure to a carcinogenic dose of dimethylnitrosamine necessary for subsequent expression of morphological transformation by rat kidney cells in vitro.

Rat kidney cells isolated in vitro at intervals from one to 24 hours after the administration of a single, carcinogenic dose of dimethylnitrosamine (DMN) were characterized by the expression of morphological transformation and a prolonged life span. In cultures isolated four hours or more following the dose of DMN, morphological transformation was expressed at subculture five, but this effect was progressively delayed with earlier times of isolation. Relative to control kidney cell cultures, transformed cells exhibited enhanced proliferative properties evident from assays for plating efficiency and DNA synthesis. The capacity for increased cloning efficiency by the test cultures was acquired several subcultures after the expression of morphological transformation, while ability for colony formation in semi-solid media evolved later still. The results suggest that target cells permanently altered by the carcinogen are present one hour after the administration of DMN, but the effect is more significant by four hours.


Methyl-CCNU in malignant melanoma--a divided dose schedule of administration.

Methyl-CCNU (NSC-95441) was administered to patients with malignant melanoma in a split dose schedule. Nausea and vomiting were eliminated as clinical problems during therapy. Response rate to the drug seemed somewhat lower than the average of three previously reported disease-oriented phase II trials, though the difference was not significant statistically. The time course of myelosuppression seemed comparable to that seen with a single dose schedule of administration.


Repair of marginal furrow perforation.

Limbus base lamellar scleral flap and fornix base conjunctival flap have been combined for repair of perforation secondary to Terrien's marginal furrow degeneration of the cornea. Postoperative thinning of the flaps, pseudopterygium extension, and other complications have not occurred.


Trabeculectomy with cautery.

Trabeculectomy with cautery was performed on 31 eyes of of 25 glaucoma patients uncontrolled on maximal medical therapy. The procedure was designed to combine the effectiveness of Scheie's thermal sclerostomy with the low incidence of complications associated with trabeculectomy. There was an 81 percent success rate overall and an 83 percent success rate in blacks. Average follow-up was 25 months. The average preoperative pressure was 29 mm Hg and the average postoperative pressure was 11 mm Hg. Immediate postoperative complications were minimal. The most serious long-term problem was the acceleration of lenticular changes. The procedure is technically simple with a majority of cases being performed by house staff at a relatively early stage of training. It is believed that trabeculectomy with cautery is indicated in blacks, in far-advanced glaucoma cases, and in patients in whom a conventional trabeculectomy has failed.


Anterior chamber after intrascleral filtering surgery.

Intrascleral filtering surgery was performed in 58 eyes and the anterior chamber (AC) depth was estimated postoperatively by recording the equivalent number of corneal thicknesses (CT) of central AC depth (lens-cornea distance). Lens-cornea touch occurred in 3 of 28 eyes with chronic simple glaucoma and was highly correlated with cataract formation. Lens-cornea touch did not develop in any of 11 eyes with other types of phakic glaucoma. Lens-cornea touch did not occur in any eye if the postoperative AC depth was ever 2 CT or greater and all three instances of lens-cornea touch occurred on or by the fifth postoperative day. Nineteen aphakic eyes were operated and all had normal AC depth from the first postoperative day. The data do not support the common belief that filtering procedures done beneath a scleral flap result in faster AC depth reformation than filtering procedures not done beneath a scleral flap.


A fiber-optics pig-tail probe.

A pig-tail probe with a fiber-optics bundle incorporated within its thickness is described. The instrument is used as is commonly done at present with the standard pig-tail probe. In addition, the fiber-optics bundle delivers cold light to the tip of the probe which has been found very useful for locating the torn ends of a canaliculus, as well as delineating the anatomy of the lacrimal sac.


Experience with donor sclera for extruding orbital implants.

Accumulated clinical evidence has confirmed the suitability of eye bank sclera as a structural and reconstructive material for lid and orbital surgery. Since 1970 we have been using fresh donor sclera. In our series of sixty-four cases, seventeen were for extruding or extruded orbital implants. Of these seventeen only two had any sort of complication, and these were easily corrected. This technique has permitted a successful prosthetic fitting within six weeks following surgery, with good cosmesis in all cases.


Plugs and stiletto: entry incisions for a 20-gauge instrument system.

A specialized stiletto shaped knife (Stiletto) and self-retaining incision plugs (Sclera Plugs) have been made. They are very useful for creating and temporarily occluding entry incisions for 20-gauge instruments suitable for closed eye intraocular surgery such as vitrectomy, lensectomy, removal of retina and vitreous membranes. The choice of material, configuration and dimensions of these new devices enable one to create incisions in the pars plana which do not leak liquid, gas, or tissue at IOP up to 80 mm Hg, when occupied by 20-gauge cylindrical instruments or Sclera Plugs. The plugs free one or both of the surgeon's hands for use outside the eye for indirect ophthalmoscopy, external surgery, and reduce considerably the time and skill formerly required for proper incision management.


Persistent hyaloid with retinal detachment.

An 11-year-old female with acquired traction retinal detachment associated with persistent hyaloid responded with retinal reattachment by intravitreous surgical technique and scleral buckling.


[Larvogenesis of the diplocyst of Aploparaksis furcigera (Rud., 1819) Fuhrmann, 1926 (Cestoda, Hymenolepididae)].

Data are given on the larvogenesis of the diplocyst of Aploparaksis furcigera. The invagination process of the metamere is described. The external layer of duplicature (exocyst) of the diplocyst has been shown to be a derivate of typical cerecomere. Due to this the larvogenesis of the diplocyst of A. furcigera is regarded as a cystocercoid larvogevesis changed by the adaptation to parasitism in polymyarian intermediate hosts (Oligochaeta). The origin of protective cenogeneses of diplocyst is a response to mechanical effects of the cutaneous-muscular sac of Oligochaeta upon the developing larvocyst.


[Rodents trichomonads: morphology, life cycle and several ecologic features (Polymastigina)].

Some morphological and cytochemical methods were applied to the study of the life cycle of Trichomonas parasitizing the intestine of various rodents. The comparative study of trophonts morphology showed that the only species of the genus Trichomonas--T. muris inhabits the intestine of mice, rats, field-voles, hamsters and susliks. The life cycle of T. muris includes three morphologically different stages: trophonts, pseudocysts and cysts. The pseudocysts and cysts are the infectious stages of T. muris. All rodents ingest them together with their food. The cysts of T. muris can survive for a long time (6 months and more) in the environment under the conditions of various temperature and humidity.


[Heat resistance of the cercariae of serveral species of trematodes].

Cercariae of Echinostoma sp., Cotylurus cornutus, Cercaria C Szidat, marites of which parasitize homeothermic hosts (birds), were found to have a high heat resistance at the effect of lethal temperature. There were established specific differences in the temperature level and its stability during a long period at a relatively constant environmental temperature. Thé heat resistance of cercariae of the same species does not change during their parasitism in different species of mollusks, hosts (e. g. C. C Szidat). Thermoresistance of mature cercariae of C. C Szidat and Cotylurus cornutus having entered the water is in agreement with the environmental temperature and changes with a temperature regime of the environment. Even an acclimation within 3 hours at 29 degrees results in a rise of the heat resistance of cercariae. Their stay at 4 degrees within 3 hours decreases two times the heat resistance.


[Electrophoretic study of the proteins of the hemolymph, intestine, excrement (and ova) of active and dispausal Dermacentor marginatus Sulz (Ixodidae) females].

The polyacrylamide-gel electrophoresis was used to separate the negative charged proteins from adult females of the tick Dermacentor marginatus Sulz. There were separated up to 25 protein bands from haemolymph and up to 19 bands from midgut extracts of the engorged females. The number of protein bands in excreta and eggs was 15 and 18 respectively. Haemoproteins from haemolymph, midgut and eggs were different in their electrophoretic mobility. Active and diapausing ticks showed essential differences in protein spectra and content of haemolymph (the enrichment of them was characteristic of diapausing ticks). The presence or absence of reproductive diapause affects the digestive functions and has no influence on the excretory functions of the midgut.


[Morpho-physiologic criteria for the taxonomic independence of the species Trichinella pseudospiralis Garkavi, 1972].

A taxonomic status of a new species of Trichinella from Procyon lotor L. described by V. L. Garkavi in 1972 as T. pseudospiralis is discussed. Two-month invasional larvae resemble in their size and structure 19-20-day larvae of typical T. spiralis. However, the ratio between their organs points not only to the delay in development but also to significant structural morphological differences. Luminiscent microscopic analysis of muscular and intestinal forms of both species confirms this. Impossibility of crossing between both species is noted. Results of investigations show that T. pseudospiralis Garkavi can be accepted as a valid species.


[Life cycle and nucleic acid distribution in the endogenous development stages of coccidia (Coccidiida, Eimeriidae) of the Vinogradov gerbil].

Studies were undertaken of the life cycles of three intestinal coccidia: Eimeria arabiana, E. bistratum and E. poljanski, parasites of meriones vinogradovi. The number of the asexual generations, the period of appearance of the endogenous stages and the first oocysts, localization were determined. The successive phases of the growth and development of schizonts of different generations, macrogametes and microgametocytes were described. The distribution of DNA and RNA in different endogenous stages of three kinds of coccidia were studied by methods of cytochemistry.


[Comparative characteristics of cestode parenchyma].

A comparative description is given of different connective tissue cells and the character of intercellular substance in the parenchyma of two species of cestodes of the order Pseudophyllidea and 4 species of the order Cyclophyllidea. The parenchyma of the cestodes has been shown to be a complex specialized tissue system evolving divergently. The first distinct morphological differences arise at the family level. The direction of the divergent evolution of the parenchyma depends on the development of certain components of intercellular substance, frequencies of individual types of cells and appearance of specific cellular element in it.


[Ultrafine structure of the intestinal region of hungry nymphs of Ornithodoros papillipes (Acarina, Argasidae)].

Studies were carried out of the ultrafine structure of the midgut epithelium of hungry nymphs of O. papillipes. The intestinal epithelium has been shown to consist of both reserve and digestive cells which are at different stages of blood digestion. The former are characterized by a poor development of surface structures and by the absence of inclusions. On the contrary, the digestive cells abound in inclusions most of which are associated with intracellular blood digestion. On the surface of such cells there are specialized pinocytosis structures: coated kesicles and tubular invaginations. A number of cells possess vacuoles which are, apparently, secretory in their nature.


[Description of the imago of the little known species of mosquito Aedes (Ochlerotatus) rempeli (Culicidae)].

A little-known species of mosquito, Aedes (O.), rempeli Vockeroth is described. According to its structure and ecology the species belongs to the group A. communis and by the complex of its characters (according to the key for identification of females, Gutsevich, Monchadsky, Stakelberg, 1970) the species corresponds to the diagnosis of A. communis. The females of A. rempeli differ from this species by light bands at the bases of tergites narrow to the middle.


[Deutonymphs of the genus Hirstionyssus of the fauna of the USSR (Acarina, Hirstionyssidae)].

Described and figured are deutonymphs of 18 species of the genus Hirstionyssus Fonseca, 1948, parasites of small mammals (H. carnifex (L. C. Koch) Oudemans, 1913; H. blanchardi (Trouessart, 1904); H. ellobii Bregetova, 1956; H. myospalacis Zemskaja et Piontkovskaja, 1957; H. transiliensis Bregetova, 1956; H. georgicus Bregetova, 1956; H. sciurinus (Hirst, 1921); H. confucianus (Hirst, 1921); H. bregetovae Razumova, 1953; H. macedonicus (Hirst, 1921); H. pauli Willmann, 1952; H. criceti (Sulzer, 1774); H. latiscutatus (Meillon et Lavoipierre, 1944); H. apodemi Zuevsky, 1970; H. pavlovskii Zemskaja, 1959; H. soricis (Turk, 1945); H. meridianus Zemskaja, 1955; H. isabellinus Oudemans, 1913); Keys to deutonymphs of the genus Hirstionyssus are given for the first time.


[Cloning leishmania at the promastigote stage using the Vonbrun micromanipulator].

A method was worked out for cloning Leishmania strains at the promastigote stage from cultures reared on two-phase nutrient medium by means of Vonbrün micromanipulator. By this method cultures of Leishmania can be obtained from one cell of these protozoans. During the cloning of Leishmania strains isolated from experimentally and naturally infected Phlebotomus papatasi and Ph. caucasicus the per cent of obtaining the clones from isolated promastigotes cultivated on a nutrient medium depends on the absolute and relative age of culture and on the growth intensity of the strain on a nutrient medium.


[Influence of temperature on the duration of the developmental cycle of Ixodes persulcatus (Ixodidae) ticks].

Experiments were conducted with ticks of I. persulcatus collected in the vicinity of Khabarovsk. The females were fed at the beginning of June, hatched larvae and nymphs--after the completion of postlarval development. The ticks were maintained in testglasses at constant humidity, at temperatures of 6, 12, 15, 28 and 33C in darkness. Minimum developmental periods of the ticks from egg to imago are 211 days at 28C, 732 days at 15C and 869 days at 12C. The development without diapause was not observed in the experiment.


[Synonyms among the species names for mosquitoes of the genus Aedes (subspecies Finlaya and Neomelaniconion) of the Far East fauna].

The name Aedes (Finlaya) kobayashii Nakata, 1956 for the mosquitoes from Japan and South Korea is a synonym of A. (F.) alektorovi Stackelberg, 1943 from the south of the Soviet Far East as well as A. (F.) bunanoki Sasa et Ishimura, 1951 from Japan is a synonym of A. (F.) oreophilus Edwards, 1916 spread in Pakistan, India, China and related to Chinese--Himalayan subregion of the Palaearctic Region; therefore it may be spread also in Nepal, North Burma and in the south of the Soviet Far East. It is proposed to consider A. (Neomelaniconion) aureus Gutvsevich, 1955 from the Primorye Territory of the USSR as a subspecies of A. (N.) lineatopennis Ludlow, 1905 widely spread in the tropics of the Old World, i. e. A. (N.) lineatopennis aureus Gutsevich, 1955, stat. nov.


[Fauna and ecology of small mammal lice in Priamur'e].

Lice occurring on small mammals of Priamurje are represented by six species. Of 6501 insects collected 91.2% fall on H. acanthopus. 99.8% of lice were collected from rodents of which the main hosts are Clethrionomys rufocanus and Microtus fortis. The active reproduction of insects takes place in a warm period. High abundance indices were registered from April to July: abundance indices were from 0.6 to 3.0; occurrence indices--from 10.1 to 24.9%.


[Local population of helminths].

A local population of any species of helminths is considered to be an assemblage of its individuals pressentas i the organisms of all categories of hosts from corresponding demes so in the environment within the limits of the latter. Its borders coinside with the limits of the activity zone of the definitive host (hosts) which contains a spreading phase of helminths, mature individuals, and is represented by a local population. The borders of the population area are affected by daily and seasonal fluctuations but at the same time rather constant within a long time. The number of the population in different parts of its area can be dissimilar. It is also characterized by many-year fluctuations (pulsation in the number) having a specific character for each species. It is supposed that control of helminths of a given population will be effective mainly in the period of natural recession and depression of its number. Birds-migrants do not cause great changes in the population number though the birds can play a significant part in the formation of new populations in new biotopes.


[One classification of the monogeneans of the Microcotylidae family].

The division of the family Microcotylidae suggested by Unnithan, 1971 into subordinate taxons is quite unsatisfactory. A detailed analysis has shown that all the subfamilies erected by Unnithan due to some reasons or others are invalid. Of 13 new genera six are synonyms of other earlier known genera, one is nomen preoccupatum, one genus is doubtful and only five genera are valid. However, three genera of these five need a serious revision since they represent a conglomerate of non-allied species and one genus requires some emmendations.


Diagnostic evaluation of hypertensive children.

The approach to the diagnosis of established hypertension in childhood can be systematized and focused. The investigation of affected children evolves in an orderly fashion based on data collected from a thorough history and physical examination. Laboratory tests, in the majority of children, can then be selected on the basis of the highest index of suspicion. The cause is often not obscure, and the need to order tests related to several organ systems is avoidable. In a small percentage of patients, however, usually younger children, the cause of hypertension remains obscure until detailed investigations have been performed.


Management of hypertensive crisis in children.

The availability and rapidity of onset of pharmacologic agents for the treatment of hypertensive crisis allow the pediatrician to treat nearly every case effectively. Diazoxide seems to be the agent of choice as a first drug for the patient with encephalopathy. Failure of the blood pressure to respond to this agent should lead to consideration of the use of sodium nitroprusside. The possibility of the presence of a cathecholamine-secreting tumor should also be considered in these rare patients. In less severe cases, reserpine and hydralazine--alone or in combination--offer sufficiently rapid and prolonged action to prevent the development of encephalopathy in patients with acute elevations of blood pressure.


RNA synthesizing activities and glucocorticoid binding capacities in thymus cells during rat development.

This investigation was designed to study specific glucocorticoid binding to cytoplasmic fraction and nuclei of thymus cells during rat development and to find out whether these data can be correlated to changes of RNA synthesizing activity of nuclei and cytoplasm. The dexamethasone binding capacity of cytoplasm rose rapidly in rats weighing up to 125 g and decreased significantly in animals weighing more than 160 g. Hormone binding to nuclei revealed similar but less pronounced changes. RNA synthesizing activity of nuclei measured by [3H]uridine incorporation in vitro decreased from 57 +/- 4.6 dpm/microng DNA in young to 23 +/- 2.2 dpm/microng DNA in adult rats. RNA synthesizing activity of the cytoplasmic fraction fell 21.6% and that of purified polymerase IIIB fell 27.8% during development. Inhibition of RNA synthesis by dexamethasone applied in vivo and in vitro showed age-dependent differences. The RNA synthesizing capacity of nuclei was inhibited up to 39% in animals weighing 130 g and only 9% in aging rats. Similar changes were observed by incubation of intact thymocytes with and without hormone. The observed inhibitory effect of dexamethasone on RNA synthesis is well correlated to changes of cytoplasmic hormone receptor capacities during development.


Early postnatal metabolism of amino acids in rat.

The production of 14CO2 from glutamate and alanine studied in the newborn rat after injection of labeled precursors was intense and revealed an important catabolism from 130 nmol/hr in a 0-hr neonate to 2000 nmol/hr in 3-week-old rat. The degradative metabolism of leucine was low at birth (10 nmol/hr), but increased up to 500 nmol/hr in 3-week-old rat. Phenylalanine was practically not metabolized into CO2, but its incorporation into protein was higher than leucine, alanine, and glutamate incorporation. Glucose is the major fuel utilized by newborn rat for its energy supply (300-560 nmol/hr). However, the relative part of amino acids in energy production is important in the early neonate (0 and 1 hr after birth).


Effect of maternal malnutrition on matrix cell proliferation in the cerebrum of mouse embryo: an autoradiographic study.

Thirty pregnant mice were undernourished by providing low protein diets (PM) or providing approximately one-third their normal diets (PCM) for 9 days from the 8th to the 16th day of gestation. Another 15 pregnant mice, which were fed a normal diet, served as the control. On the 16th day of gestation, all animals were injected with a single does of [3H]thymidine and were killed one by one at 1- or 2-hr intervals. Mean litter size was statistically insignificant between the control group and two malnourished groups. There was, however, a significant difference in mean body weight between the control group and two malnourished groups (P less than 0.005). The cerebral cortex at this stage of development consisted of three different layers, i.e., the cortical plate, the migratory zone, and the matrix layer. The width of the cortical plate of the malnourished embryos was significantly smaller (P less than 0.001). There was, however, no significant difference in width of the migratory zone between the control and the malnourished groups. The width of the matrix layer in PM was significantly smaller (P less than 0.001), but that of PCM showed no significant difference from the control (P greater than 0.1). Coronal section of the brains of the embryos were processed for autoradiography. Labeled cells were found almost exclusively at the matrix layer surrounding the lateral ventricels. Labeling index counted in the matrix layer after 1 or 2 hr of [3H]thymidine injection indicated that more than 30% of the cells in this layer were always synthesizing DNA in each group of embryos. The generation times of the matrix cell, precursor of the neurons, in the matrix layer were approximately 18.5 hr in the control and 21.5 hr and 21.8 hr in the malnourished embryos, thus indicating about 3 hr of prolongation in the latter. DNA synthetic time was about 6.5 hr in the control and 7.0 hr and 7.0 hr in the two malnourished groups. The postduplication time was about 2.5 hr in the control and 3.0 hr and 3.5 hr in the malnourished. The preduplication time was about 8.8 hr in the control and 10.6 hr and 10.3 hr in the malnourished.


A familial defect of neutrophil chemotaxis with asthma, eczema, and recurrent skin infections.

A defect in chemotaxis of peripheral blood polymorphonuclear leukocytes (PMN's) was demonstrated in both parents and three of four children in a single family afflicted with varying degrees of respiratory allergy, unusual onset of severe eczema in the first month of life, and recurrent bacterial skin infections. Of great interest was the identification of HLA-B12 at the B locus in all affected members but not in the unaffected child. The two children known since infancy to be most severely affected with eczema and recurrent infections are HLA identical and homozygous for HLA-B12. The child without eczema and infections had an intermediate cellular chemotactic defect most apparent on kinetic studies.


Serial measurements of serum calcium, magnesium, parathyroid hormone, calcitonin, and 25-hydroxy-vitamin D in premature and term infants during the first week of life.

The mean +/- SEM of the cord, 48-hr, and 7-day values for serum calcium, magnesium, human calcitonin (HCT), parathyroid hormone (PTH), and 25-hydroxy-vitamin D (25-OHD) for premature and term infants can be seen in Table 1. Mean cord calcium concentrations were similar for term and premature infants. Serum calcium concentrations fell in both term and premature infants at 48 hr, but decreased more in the premature infants (from 10.23 +/- 0.30 to 8.74 +/- 0.19 mg/dl) than in the term infants (from 10.5 +/- 0.26 to 9.6 +/- 0.23 mg/dl). Serum calcium values increased from 48 hr to 7 days in both groups, and there was no significant difference between term and premature infants' serum calcium concentrations (10.6 +/- 0.28 and 10.12 +/- 0.3 mg/dl, respectively) at that time. There was no significant difference between term and premature cord serum magnesium concentrations. Serum magnesium concentrations increased similarly by 48 hr in both groups and remained at these concentrations at 7 days of life. Serum HCT concentrations were elevated above normal adult levels (71.9 +/- 6.6 pg/ml, 81% less than 100 pg/ml, n = 63) in both premature and term cord sera, but premature cord concentrations (146 +/- 24 pg/ml) were significantly higher than term cord concentration (91 +/- 21 pg/ml). Both term and premature infants displayed a 2-3-fold increase in serum HCT by 48 hr and a partial fall by 7 days to concentrations still above those seen in cord sera (Fig. 1). Nine of 10 premature and 9 of 10 term infants had undetectable PTH concentrations in cord sera. In two premature infants, PTH serum concenttration remained undetectable at 48 hr. However, the majority of both premature and term infants had elevated levels of PTH at 48 hr. The mean PTH concentrations were lower but still elevated at 7 days with the suggestion of higher concentrations in premature infants (Fig 2). There were no significant differences in serum 25-OHD concentrations between term and premature sera at birth or at 7 days. There was a weakly positive correlation between 25-OHD and cord calcium (r = 0.45, P less than 0.05), and a negative correlation between cord calcium and 48-hr PTH (r = -0.53, P less than 0.01). Calcium and magnesium were significantly positively correlated in 48-hr (r = 0.83) and 7-day (r = 0.84) sera in premature infants but not in term infants. Cord 25-OHD and cord HCT levels were significantly positively correlated (r = 0.80, P less than 0.01) in the term infants but not the premature infants.


Magnesium deficiency anemia in the rat fetus.

Magnesium-deficient fetuses exhibited malformations (44%), anemia, and edema. Maternal plasma magnesium levels at day 21 of pregnancy reflected the level of dietary magnesium (2.43 +/- 0.09 mg Mg/100 ml, control; 0.74 +/- 0.02 mg Mg/100 ml, deficient). Plasma magnesium levels of deficient fetuses showed similar decreases although all fetal magnesium values at term were hihger than maternal values from the same group (3.29 +/- 0.22 mg Mg/100 ml, control; 1.78 +/- 0.07 mg Mg/100 ml, deficient). Magnesium deficiency did not appear to affect the maternal blood parameters. However, when fetal blood was examined, all of the parameters measured were altered in magnesum-deficient fetuses (Table 2). No abnormalities in hemoglobin bands or plasma proteins were seen between any groups by electrophoresis. Measurement of total protein contents showed no differences between maternal blood protein contents, but total plasma protein from magnesium-deficient fetuses was significantly lower than controls (2.00 +/- 0.14 versus 2.62 +/- 0.13 g/100 ml), thus establishing a factor in fetal edema production. Morphologic data showed that in magnesium-deficient fetuses, fetal erythropoiesis was significantly greater in liver, adrenal glands, and spleen than in controls and that maturation was normoblastic. Stained and unstained peripheral blood smears of magnesium-deficient fetuses showed and obvious macrocytosis and at least 50% of the red cells stained abnormally, exhibiting pale areas. Erythrocytic morphology seen in fetal magnesium deficiency is consistent with inadequate filling of the cell by hemoglobin as suggested by Cohlan et al. (5), a probable cause of membrane collapse. The inadequate filling of magnesium-deficient red blood cells (RBC) with hemoglobin might be explained by a reduction in hemoglobin synthesis which is consistent with the reduced mean corpuscular hemoglobin (MCH) and MCH concentration (MCHC) of the deficient fetal red cells. The role of magnesium in protein synthesis is also compatible with a reduction in hemoglobin synthesis, yet may not completely explain the abnormalities and resultant shortened lifespan of the red cells.


An electron microscopic cytochemical study on concanavalin A binding sites and their mobility in normal and cystic fibrosis fibroblasts in vitro.

Concanavalin A (Con A) binding sites were visualized ultrastructurally in the cultured fibroblasts from cystic fibrosis patients, obligatory heterozygotes, and normal individuals by peroxidase labeling technique. Con A binding sites were localized as a continuous layer on the external side of the plasma membrane in fixed fibroblasts of the three genotypes. In living cells, Con A induces both lateral and vertical movements of binding sites as expressed by cap formation and internalization of the plasma membrane. Fibroblasts of the three genotypes responded similarly to Con A treatment and failed to show significant detectable differences.


Effect of the level of dietary protein intake on fat absorption in children.

The quantity and quality of protein in the diet affect both nitrogen balance and energy utilization in man. One possible mechanism is by a direct effect on the process of fat digestion and absorption. The effect on fat absorption of feeding diets providing 0%, 6.4%, or 12.5% of energy as protein was assessed in nine children. Liquid diets were prepared by high speed blending of calcium caseinate, a soy-cottonsed oil blend (80:20), sucrose, water, vitamins, and a mineral mixture and fed by bottle five times per day. Diets varied in the amount of protein and were fed to maintain constant the intakes of fat and carbohydrate. All children began by consuming the diet providing 6.4% of energy as protein for a period of 6 days: 3 days of adaptation, 3-day dietary periods and metabolic collections followed in one of two sequences: 12.5%, 0%, 6.4% energy as protein in five children; 0%, 12.5%, 6.4% energy as protein in four. Mean fat excretion during the two 6.4% periods did not differ significantly (initial 14.5 +/- 6% of intake; final, 11.7 +/- 5.0% of intake). Fat excretion was significantly greater during the period when no protein was consumed (23.9 +/- 7.7% of intake) than during either the period in which protein provided 6.4% of energy (P less than 0.01) or during that in which protein provided 12.5% of energy (10.0 +/- 2.6% of intake, P less than 0.001). The difference between the 6.4% and 12.5% periods did not attain significance (P = 0.10). Fecal fat expressed as a percentage of fecal dry weight was significantly greater during periods when the diet contained no protein than during periods in which protein provided either 6.4% (P less than 0.05) or 12.5% (P less than 0.01) of energy. Additional studies were carried out in a similar fashion in six children consuming diets in which protein provided 5%, 9.6%, and 15% of energy. All six possible dietary sequences were used. At these intakes fat excretion did not vary significantly with protein intake.


Toxicity and tissue distribution of aminophyline in neonatal and adult mice and rats.

The LD50 of aminophylline in adult mice differed from young mice and rats of both ages, in which the values were remarkably similar (Table 1). With the exception of fat, which had lower concentrations in all groups, tissue concentrations after a 4 mg/kg rectal dose of aminophylline in the 10-day-old animals ranged from 10-20 microng/g as compared to 4-10 microng/g in the adults (Table 2). To evaluate preferential distribution, an analysis of tissue to blood concentration ratios was made. All ratios approximated 1.0 except fat which had a ratio of 0.1-06. The neonates of each species had significantly higher tissue to blood ratios for brain, heart, small intestine, skeletal muscle, and fat (P less than 0.05). Brain to plasma and brain to blood ratios were very similar ranging from 0.4-1.3 in adults versus 0.8-1.7 in neonates. Consideration of the time course indicated a trend toward unit, with the overall ratio in both groups being 1.15 at 2 hr. However, at all earlier time periods the ratios were clearly higher in neonates. Administration of aminophylline intraperitoneally to produce serum concentrations of theophylline far in excess of the 10-20 microng/ml considered to be safe and effective in clinical use did not decrease bilirubin levels in young or old Gunn rats (Fig. 1).


Changes in tonsillectomy rates associated with feedback and review.

Among 13 Vermont Hospital Service Areas, tonsillectomy rates decreased over a five-year period. In 1969, the rates in seven areas exceeded the estimated United States national rate; by 1973, the average rate for all areas had declined 46% and only one area remained above the U.S. rate. Much of the change occurred after feedback of data to the Vermont State Medical Society demonstrating 1969 variations. In 12 of the 13 areas, the relationship between feedback and change in clinical practices could not be documented; however, physicians in the area with the highest rate reviewed the indications for tonsillectomy and adopted a second opinion procedure for reviewing candidates for the surgery. The experience suggests that feedback of population-based data on incidence of procedures may be a valuable tool for the peer review process.


Vertigo in children: differential diagnosis and treatment.

A study of vertigo in 50 children showed that a careful neurological examination should be performed for all patients. A detailed family and personal history to find possible episodes of loss of consciousness or seizures should be obtained; 13 children with vertiginous seizures had a positive family history for seizures and 5 had febrile seizures in infancy. Electroencephalograms should be obtained in all instances of vertigo occurrence.


Twelve years' experience with bronchopulmonary dysplasia.

A retrospective study of 299 successive infants who were ventilated for respiratory distress syndrome (RDS) showed that 62 (21%) developed radiographic stage VI bronchopulmonary dysplasia (BPD). The largest, most mature, and least ill infants tended to survive without developing BPD; the smallest, least mature, and most ill infants tended to die without developing BPD. The patients who developed BPD  tended to be intermediate in terms of weight, maturity, and severity of disease; they required longer exposures to elevated oxygen and assisted ventilation than patients who did not develop BPD. The data suggest that in addition to varying individual susceptibility (primarily degree of immaturity and initial severity of disease), elevated oxygen is more important than mechanical ventilation in the pathogenesis of BPD.


Persistent interstitial pulmonary emphysema: another complication of the respiratory distress syndrome.

Persistent interstitial pulmonary emphysema (PIPE) was observed in 22 infants during the neonatal period. All of the infants experienced respiratory distress during the first few days of life, and 21 of them were treated for the respiratory distress syndrome with artificial ventilation or oxygen or both. Ten infants developed a localized form of PIPE, with air-filled interstitial cysts measuring up to 3.0 cm in diameter confined to one or more lobes of lung. The involved segment of lung was resected in seven of these infants, all of whom survived. The remaining three died and autopsies were performed. A diffuse form of PIPE was observed in the other 12 infants. Numerous cysts that were predominantly small (less than 0.3 cm) were seen in all lobes of both lungs. These infants received high concentrations of oxygen for prolonged periods, resulting in bronchopulmonary dysplasia in 11 of the infants. All 12 infants died. PIPE is characterized histologically by air-filled interstitial cysts partially lined by multi-nucleated giant cells.


Hypoventilation during sleep in children who have lymphoid airway obstruction treated by nasopharyngeal tube and T and A.

Three children with sleep apnea, alveolar hypoventilation, apparent mental retardation, and poor growth associated with chronically enlarged tonsils and adenoids were treated with the use of a nasopharyngeal tube followed by tonsillectomy and adenoidectomy. The effectiveness of this therapy was documented by polygraphic recording of sleep stages and respirations, and by correlation with serial arterial blood gases and pH. The nasopharyngeal tube was well tolerated, easy to use, and effective in diagnosis and treatment. We suggest that its use be further evaluated in patients with obstructive apnea.


Noninvasive evaluation of the pediatric airway: a recent advance.

Visualization of the pediatric airway is now possible by new noninvasive radiologic methodology--the magnification high kilovoltage (Mag-high KV) technique. Clinical expamles of airway diseases are presented to show the ease and utility by which precise diagnoses can be made. The dynamic aspect of airway evaluation is discussed. The Mag-high KV technique is also valuable for the number of invasive procedures it prevents.


Effect of exchange transfusion on bilirubin binding.

The bilirubin titration point--the lowest bilirubin concentration at which loosely bound bilirubin could be demonstrated by Sephadex gel filtration--was determined in samples collected before, during, and on completion of 17 exchange transfusions as well as in the discarded and donor blood. The bilirubin titration point expressed either as bilirubin concentration or as bilirubin/albumin molar ratio failed to be increased by the exchange transfusion and, in each case at the end of the procedure, the titration point was below the expected level, assuming that the donor albumin was going to retain its binding properties in the infant's circulation. The bilirubin titration point was also depressed in the discarded blood, and the depression was inversely related to the amount of bilirubin removed by the exchange transfusion (expressed as mg/kg of body weight/mg of initial bilirubin concentration). These results are interpreted as an indication that interfering substances are responsible for the decreased binding of bilirubin in newborn, particularly preterm, infants. In practical terms the criteria for a repeat exchange transfusion should be the same as for the initial one, as no change in the bilirubin binding properties of the serum is likely to occur following exchange transfusion.


Children with cystic fibrosis: I. Psychological test findings of patients, siblings, and parents.

Psychological evaluation of 43 families, each with a child with cystic fibrosis, is reported. Personality testing of the parents showed that 32% of the fathers and 22% of the mothers obtained scores in the range suggestive of emotional disturbance. The Family-Concept O Sort assessment of family interaction indicated that the primary effect of having a child with cystic fibrosis was in terms of decreased family satisfaction and family adjustment. The results do not support previous estimates of an increased incidence of emotional disturbance in children with cystic fibrosis. Evidence for negative psychological impact of chronic illness on sibling development was also lacking. Future research would benefit from a focus on the strengths and resilience of children with cystic fibrosis and their families.


Fibromuscular dysplasia as a cause of stroke in infancy and childhood.

Two children had abrupt onset of hemiplegia due to childhood fibromuscular dysplasia (FMD). Although FMD is a recognized cause of strokes in adults, the disorder has not, to our knowledge, been reported previously in children. Our report reviews the pathology and diagnosis of FMD and discusses the complexities of its treatment.


Serum concentration and serum half-life of digoxin in premature and mature newborns.

Serum concentrations and half-life times of digoxin were determined in ten mature and nine premature newborns. Median serum digoxin concentration was 2.3 ng/ml (1.2 to 3.5 ng/ml) in mature newborns and 2.4 ng/ml (1.5 to 4.5 ng/ml) in premature newborns. Median serum digoxin half-life was 35 hours (17 to 52 hours) in mature newborns and 57 hours (38 to 88 hours) in premature newborns. The difference in serum digoxin half-life between the two groups is statistically significant. The relatively long serum digoxin half-life in premature newborns is probably due to immature renal function in this group. The data emphasize the need for cautious digoxin administration, especially in premature infants.


Kerion caused by Trichophyton verrucosum.

A 12-year-old girl developed a severe inflammatory fungal infection of the scalp caused by Trichophyton verrucosm. The infection resulted in scarring alopecia. The natural history, differential diagnosis, pathogenesis, and treatment of this infection of the skin are reviewed.


Hemoglobin-oxygen equilibrium in cystic fibrosis.

A study of 35 patients with cystic fibrosis demonstrated that increasing severity of pulmonary involvement was associated with a mild but definite increase in erythrocyte 2,3-diphosphoglycerate (2,3-DPG) and a decrease in hemoglobin affinity for oxygen. The predominant regulators of 2,3-DPG were blood pH, cardiac output, and systemic oxygen transport. No significant relationship was observed between erythrocyte 2,3-DPG content and arterial oxygen tension. Hypophosphatemia may have prevented a greater increase in erythrocyte 2,3-DPG content. The inadequate increase in 2,3-DPG and consequent insufficient change in hemoglobin-oxygen affinity, coupled with an insufficient compensatory erythrocytic response, may adversely affect tissue oxygenation in patients with severe cystic fibrosis.


The lacrimo-auriculo-dento-digital syndrome.

A mother and son had an autosomal-dominant malformation syndrome that included absence of the lacrimal puncta, obstruction of the nasolacrimal ducts, hearing loss, poor dentition, and abnormal thumbs. The son also had severe hypertension with renal anomalies and absence of several salivary glands. Affected members of the only other reported family also had cup-shaped ears and synostosis of the radius and ulna. Early recognition of this disorder is important because of the possibility that the affected infant may have hearing loss and kidney malformations.


Sjögren's syndrome in children.

Sjögren's syndrome is a relatively uncommon condition in the pediatric age group. The clinical and immunological features of this disease in childhood have not been adequately described in the literature. Herein, we present details of the clinical features and results of laboratory investigations including minor salivary gland biopsy, parotid scintigraphy, and renal biopsy on two children with Sjögren's syndrome associated with systemic lupus erythematosus.


Juvenile dermatitis herpetiformis: an immunologically proven case.

Subepidermal blistering diseases of childhood have, in the past, been thought to represent cases of juvenile dermatitis herpetiformis, bullous pemphigoid, or benign chronic bullous dermatosis of childhood. While the small-blister variety closely resembles adult-type dermatitis herpetiformis, the large-blister, or bullous, variety has clinical and histologic resemblances to bullous pemphigoid. The patient presented in this report clearly fits previous descriptions of the large-blister type of juvenile dermatitis herpetiformis, bullous pemphigoid, or benign chronic bullous dermatosis of childhood both clinically and histologically, while his therapeutic response to dapsone and the presence of in vivo bound IgA at the basement membrane of normal and perilesional skin are highly characteristic of the adult type of dermatitis herpetiformis. Immunofluorescent studies of similar cases reported in the literature, however, have shown variable results, thus obscuring their classification. Though the proper place of all such cases in the nosology of blistering diseases is not yet clear, at least some of them closely resemble adult-type dermatitis herpetiformis by two important criteria--immunologic and therapeutic.


Traumatic perforation of the pharynx in the newborn.

Two newborn, low-birth-weight infants with traumatic perforation of the pharynx and an additional 18 previously reported cases are presented. Injury produced by pharyngeal suction catheters and nasogastric and endotracheal tubes is generally unrecognized until the baby develops signs of esophageal obstruction or radiographic evidence of pharyngeal perforation, usually in the posterior mediastinum. The catheter may enter the pericardial space. Conservative management with intravenous antibiotics and a feeding gastrostomy is favored, except in instances that require mediastinal decompression. The key to prevention is the use of soft-tipped suction catheters and nasogastric tubes and careful visualization of the cords during endotracheal intubation. The use of metal stylets to direct the endotracheal tube is condemned. Pediatrics, 56:1019-1022, 1977, PHARYNX, PERFORATION, SUCTION CATHETER, NASOGASTRIC TUBE, ENDOTRACHEAL TUBE, METAL STYLET.


The lack of effects of phototherapy on neonatal oxygen dissociation curves and hemoglobin concentration in vivo.

Phototherapy has been shown to cause hemolysis of fetal red cells and a shift to the right in the neonatal oxygen dissociation curve (deltaP50) in vitro. To determine if these parameters act similarly in vivo, we have studied 16 icteric infants before and after phototherapy and compared them with eight control infants studied at birth and at 3 days of age, measuring the change in P50, 2,3-diphosphoglycerate (2,3-DPG), serum bilirubin, the percent of bilirubin/albumin saturation, and the hemoglobin concentration in the two groups. Following phototherapy, in the icteric infants there was a shift to the right in the O2 dissociation curve of + 1.7 mm Hg, a rise in 2,3-DPG of 2.26 micronmol/gm Hb, a fall in serum bilirubin of 4.3 mg/100 ml, a decrease in percent bilirubin/albumin saturation of 12.4%, and a drop in hemoglobin of 1.1 gm/100 ml. The control group showed a deltaP50 of + 2.0 mm Hg, a rise in 2,3-DPG of 3.67 micronmol/gm Hb, an increase in serum bilirubin of 3.2 mg/100 ml, an increase in percent bilirubin/albumin saturation of 9.3%, and a fall in hemoglobin of 0.3 gm/100 ml. Significant differences between the groups were seen only in the changes in bilirubin concentration and percent bilirubin/albumin satruation. The magnitude of changes in P50, 2,3-DPG, and hemoglobin concentration was similar in the phototherapy and control groups and was related to the expected changes with reference to postnatal age. These results suggest that phototherapy in vivo neither affects (fetal erythrocytic affinity for oxygen nor causes hemolysis. Pediatrics, 59:1027-1031, 1977 PHOTOTHERAPY, 2,3-DIPHOSPHOGLYCERATE, HEMOLYSIS, NEWBORN INFANT.


Percutaneous arterial sampling using transillumination.

Percutaneous arterial sampling was performed using transillumination. A success rate of 96% was obtained when sampling the radial, ulnar, posterior tibial, and dorsalis pedis arteries. Although small hematomas were produced despite pressure, no serious complications of infection, thrombotic obstruction, or thermal injury occurred. We conclude that the use of transillumination for arterial sampling is a safe technique that permits rapid sampling of very superficial peripheral arteries, allows visual confirmation of the Allen test for estimation of collateral flow, and would perhaps aid in arterial cannulation. Pediatrics, 59:1032-1035, 1977, TRANSILLUMINATION, ARTERIAL SAMPLING.


Umbilical artery catheterization by a cutdown procedure.

In severely ill newborns conventional methods of umbilical artery catheterization sometimes fail to achieve a functioning intravascular line. In 18 of 19 such newborns requiring umbilical artery catheters for optimal management, successful catheterization was attained using a cutdown procedure on the umbilical arteries. Vascular perforation within the anulus umbilicalis, tunica intima invagination ahead of an advancing catheter, and subintimal cannulation were defined as the causes of initial catheterization failure in all 19 newborns.


Language development in 2-year-old normal and risk infants.

A variety of language measures was obtained on two groups of 2-year-old infants matched for social class but differing in terms of birth conditions. One group, a high risk group, contained infants who suffered from RDS, birth asphyxia, hypercalcemia, and hyperglycemia while another group consisted of normal infants. The results of the language tests revealed that the high risk group showed poorer performance than the normal subjects. Other tests of perceptual-cognitive development revealed little difference between the groups. The data suggest that the assessment of early trauma needs to employ a variety of measures, especially those which are related to the unfolding skills appropriate for the particular age group studied. Pediatrics, 59:982-986, 1977, LANGUAGE DEVELOPMENT HIGH RISK, BIRTH ASPHYXIA, RESPIRATORY DISTRESS SYNDROME (RDS).


Renal failure during the first year of life.

All cases of persistent renal failure in infants less than 1 year of age were reviewed to determine whether the prognosis has improved equally for infants as for adults. During a ten-year period, 52 infants were treated by applying uniform therapy; 28, more than half, were less than 4 weeks old. All cases were separated into two groups; 19 infants without and 33 infants with congenital renal or urinary tract anomalies. In 20 patients of the latter group, additional serious anomalies of other organs were present. The age distribution was strikingly different: in 18 of 21 infants, renal anomalies were present, as diagnosed on the first day of life. In contrast, only 3 of 11 infants, 4 to 12 months old, had urinary tract anomalies. In infants without renal anomalies, renal failure was caused by hypotension or shock in 10 of 19 cases, by pyelonephritis or sepsis un 6 of 19. Of this group, eight infants (42%) recovered completely, nine (47%) died. Death occurred within one to two days of hospitalization in all but three cases, caused by shock or sepsis. In this group medical problems that are amenable to therapy have caused either renal failure or contributed to the infant's death. In infants with renal or urinary tract anomalies, renal failure was caused by renal dysplasia or agenesis in 16 of 33 infants, by urinary tract obstruction in 12 of 33. Only three patients (9%) recovered, all older than 4 months, 20 (61%) died, and 10 are living with signs of chronic renal failure. Death usually occurred within one week of hospitalization and, in 16 of 20, it was caused by renal failure and multiple additional anomalies. The multiplicity and complexity of the congenital anomalies in most instances precluded effective, lifesaving therapy. Renal failure in infants is still a serious disease accompained by a high mortality rate in which therapeutic possibilities are limited. No improvement in prognosis can be expected in the near future. Pediatrics, 59:987-994, 1977, RENAL FAILURE, CONGENITAL RENAL ANOMALIES, INFANT, ISCHEMIC RENAL DAMAGE.


Paced auditory serial-addition task: a measure of recovery from concussion.

The need for a measure of severity of concussion apart from duration of post-traumatic amnesia is examined. The paced auditory serial-addition test, a measure of rate of information processing, is presented as a convenient test for estimating individual performance during recovery. Procedures for administration and control data are given, and the programme used for managing the rehabilitation of concussion patients described.


Self-esteem of prisoners committing directly versus indirectly destructive crimes.

62 prisoners from a county jail and a state forensic hospital, having committed 12 types of crimes, were administered the Coopersmith Self-esteem Questionnaire and a biographical form. Self-esteem scores were compared across three classifications of destructiveness of criminal acts. A significant difference was found between self-esteem scores for those prisoners who were indirectly destructive to others and those prisoners who were directly destructive to others or to themselves. Also, prisoners who were on work release and/or in psychology classes tended to have higher self-esteem. No causality was inferred between the instruction in psychology and work-release programs and higher levels of prisoners' self-esteem.


Several variables of importance in the use of the cold pressor as a noxious stimulus in behavioral research.

To examine the effects of subject's sex, hand dominance, and spatial summation on cold pressor tolerance and discomfort, 80 subjects were randomly assigned to one of eight conditions using a 2 x 2 x 2 design. Analysis showed that females immersing the hand tolerated the stimulus significantly less time than males immersing the hand, females immersing the finger, or males immersing the finger. Female subjects reported significantly more pain than males, and subjects who immersed the hand reported significantly more pain than subjects who immersed the finger only. Implications are discussed.


Cross-cultural investigation of conservation of weight in Zambian adolescents and young adults.

The effect of cross-cultural factors in the acquisition of conservation of weight in adolescents and young adults was assessed. No significant differences were found between 25 Zambian female subjects and two control groups of U. S. high school (n = 52) and university female subjects (n = 34).


Vividness of visual imagery and movement percepts on the Rorschach.

To determine whether individuals showing vivid imagery would produce more Movement responses on the Rorschach, subjects high and low in visual imagery (ns = 14) were compared. Contary to previous reports, no positive relationships were found between visual imagery and Rorschach M.


Threshold and reaction time to noxious stimulation: their relations with scores on Manifest Anxiety Scale and Maudsley Personality Inventory.

With 20 male Japanese undergraduates relationships between electric shock threshold and reaction time to electric shock with 10 v and personality factors were investigated. Significnat product-moment correlations of --.79 and --.69 between response to noxious stimulation and Manifest Anxiety and Maudsley Neuroticism scores were found.


Time perception and schizophrenia.

Time perception of 10 schizophrenic patients, 10 nonschizophrenic patients, and 10 normal subjects was compared. The method of estimation was used for four intervals ranging from 5 sec. to 120 sec.; the subject was required to perform a certain task until the experimenter stopped the subject and then to estimate the length of time spent working on the particular task. The results show significant differences between schizophrenics and other subjects in the judgment of 5-sec. intervals. The results partially confirm previous findings and suggest other possible trends not previously reported.


Cognitive set influences on Witkin's Rod-and-Frame Test.

Witkin's field-dependence theory is embroiled in conflict as research shows its primary assessment method, the Rod-and-frame Test, is influenced by situational events. This study explored the impact of an additional situational variable, locus of problem-solving data search, a cognitive set modified from Rotter's (1966) work. Two experimental groups of hospitalized alcoholics received standard Witkin instructions plus instructions emphasizing either an internal or external search for problem-solving cues. A control group received only Witkin's instructions. Aanlysis of variance showed the special instructions affected rod-and-frame scores in the predicted directions. The results were interpreted as indicating a need for a multi-factor approach to analyzing the complex relationships of the Rod-and-frame Test.


Effects of Syosset's developmental learning program on self-concept: some preliminary data.

This study investigated the effects of a Developmental Learning Program upon self-concept of 40 children having trouble in school. While preliminary in nature, the results suggest that such a program may have a beneficial effect.


Sensory feedback does not cause selective adaptation of human "command neurons".

It has been proposed that body movements are partly controlled by a neural hierarchy, with cells at successively higher levels controlling increasing numbers of muscles engaged in functionally equivalent responses. In addition to physiological support for the hypothesis, obtained from infrahuman species, evidence from human subjects has been obtained in the form of negative transfer between successive similar responses. This negative transfer has been attributed to selective adaptation of "command neurons" in the human motor system. The present experiment found no evidence for negative (or positive) transfer between passive and active movements, suggesting that selective adaptation of human command neurons is caused by efference rather than afference.


Stuttering, speech rate, and the metronome effect.

Methodological inadequacies cast doubt on previous investigations of the hypothesis that metronome-paced speech reduces stuttering by slowing the rate of speech. In the present study, 6 stutterers' fluent speech rates were calculated by excluding the time occupied by stutters and pauses. The fluency-enhancing effect of metronome pacing was independent of speech rate.


Relative effect of father's education and "psychoticism" on some measures of aptitude in Iran.

This paper compares differences in mean test scores of contrasting groups formed in terms of parental education and psychoticism. Subjects were 747 male and 239 female Iranian university applicants. Psychoticism was measured by a Persian adaptation of Eysenck's test. Mean differences between groups with very high and very low psychoticism scores on tests of general intelligence and Persian language are larger than those between groups with college-educated versus illiterate or semiliterate fathers. The reverse is found on a test of English language.


Read-out times from iconic memory in normal and retarded adolescents.

The method limits was used to obtain an estimate of read-out times for a sample of 12 normal and 12 retarded subjects matched on chronological age. The procedure required tachistoscopic presentation of a stimulus array (2, 4, or 6 digits) for a variable duration, followed by a post-stimulus. The subject's task was to recall the digit indicated by the cue. The results indicated that read-out time (a) increased as the number of digits increased, (b) was longer for retardates relative to normals, and (c) decreased with practice for both intelligence groups. The implications of a read-out deficit in retarded individuals were discussed.


Physiognomic form perception: mature or immature?

The hypothesis that physiognomic perception, rather than being an immature mode, characterizing, in particular, children, primitives, and schizophrenics, is, instead, a basic mode, was tested. Children of both Eastern and Western parentage in Grades 3, 5, 6, and 11 were given the Physiognomic Form Perception Test, an instrument specially developed for testing physiognimic perception. No decrease with age in such perception was noted. Although there was a tendency for scores to increase with age for girls of Eastern origin, in general the scores do not increase with age. Physiognomic perception is apparently not acquired. Sex differences were not significant.