Balkan (endemic) nephropathy and foodborn ochratoxin A: preliminary results of a survey of foodstuffs.

Ochratoxin A is a nephrotoxic fungal metabolite (mycotoxin) occurring in foodstuffs. The compound is causally associated with mycotoxic porcine nephropathy, a disease comparable with a human kidney disease, Balkan endemic nephropathy. A preliminary survey of home-produced foodstuffs in areas of Yugoslavia revealed that contamination with ochratoxin A is more frequent in an area where Balkan endemic nephropathy is prevalent (endemic area) than in area where this disease is absent. This indicates higher exposure to foodborn ochratoxin A in the endemic area. Thus further evidence is provided supporting the hypothesis that ochratoxin A is a disease determinant of Balkan endemic nephropathyk0


Tail artery response to sound in the unanesthetized rat.

Arterial pulsations have been recorded indirectly from the surface of the rat's tail. Slight heating of restrained unanesthetized rats produces vasodilatation and large amplitude pulsations that are influenced by sensory stimuli, in this case, sound. The surface-recorded pulse volume was found to be proportional to pulse pressure, indicating vasoconstriction as the cause of the decline of the pulse amplitude. A one-second noise burst elicited vasoconstriction, the duration of which was proportional to sound level and occurred as low as at hearing threshold. Under the specified conditions, reproducibility was good with no significant habituation both within session, and between sessions with a one week interval. The warming of the rats was found to be critical for the sound-elicited reactions; responses were obtained only within a narrow, individual temperature-range. The possibilities of using tail vasoconstriction for evaluation of hearing was pointed out, as well as for studies of noise effects on peripheral circulation.


The compliance curve for the flow limiting segments of the airway. II. Experiments with human subjects.

Maximum effort flow-static recoil curves were obtained in 5 healthy subjects breathing air, He/O2, and SF6/O2 mixtures. In 4 of them maximum effort flows corresponded to really maximal flows and their curves were transformed into compliance curves for the flow limiting segments of the airway and analyzed from the point of view of a previously presented lung model (Pedersen and Nielsen 1976). The results showed, that viscosity dependent pressure losses from the alveoli to the flow limiting segments were minimal for air and SF6/O2, but not for He/O2. When viscosity dependent pressure lossess could be negleted, then expiration of gases of different densities gave almost identical compliance curves for the flow limiting segments. This supported the applicability of the model. The calculated compliance curves for the flow limiting segments were compared with data from the literature, and the findings indicated that flow limitation during expirations with just maximal flows throughout began in the extrapulmonary airways and moved upstream during the expiration.


Regional blood flow in the left ventricular wall of dogs with a graded coronary artery stenosis.

Blood flow in the circumflex branch of the left coronary artery was recorded by electromagnetic flowmeter. In the area supplied by this branch vasodilatation was produced by progressive constriction until the diastolic reactive hyperemic response to 10 s occlusion disappeared ("optimum" stenosis). This degree of stenosis was accompanied by a 20% decrease in diastolic circumflex flow, while systolic flow remained unchanged. This distribution of blood flow in the left ventricular free was was evaluated at "optimum" stenosis by counting activity in tissue blocks following bolus injection of Xe-133 into the aortic root. When Xe-133 was injected immediately after occlusion of the left anterior descending branch the Xe-133 concentration of toncentration in the epicardial part. The concentrations in the two parts did not, however, differ significantly when occlusion of the left anterior descending branch was omitted. This indicates that the endocardial blood flow reserve is lower than the epicardial, and that, yet, a preferential fall in blood flow in the endocardial part of a post-stenotic area can be rapidly eliminated when blood supply from a neighbouring artery is available.


Effects of prostaglandins on the isolated human bladder and urethra.

The effects of prostaglandins F2 alpha (PGF2 alpha), E1 (PGE1) and E2 (PGE2) on the human lower urinary tract were studied in vitro in preparations obtained from patients undergoing total cystourethrectomy because of bladder malignancy. Tissue specimens were taken from different parts of the urethra, the urethrovesical junction, and the bladder. From these specimens, smooth muscle preparations were dissected and mounted in organ baths, that were filled with Krebs solution (37 degrees C) and bubbled with carbogen. Isometric tension was recorded. Preparations from the bladder and all parts of the urethra were contracted by PGF2 alpha. This effect was not affected by tetrodotoxin, phenoxybenzamine, or atropine; isoprenaline relaxed the PGF2 alpha  induced contractions. PGE1 and PGE1 both contracted strips from the bladder. However, urethral preparations contracted by PGF2 alpha or noradrenaline were relaxed by these agents. This relaxing effect was at least as pronounced as that produced by isoprenaline; it was not affected by propranolol.


Brain energy metabolism in angiotensin-induced acute hypertension in rats.

In order to study if rapid elevation of blood pressure is associated with cerebral ischemia, anesthetized (70% N2O) and artificially ventilated rats were subjected to angiotensin-induced hypertension. After a 5 min hypertensive period, cerebral cortex tissue was frozen in situ for subsequent measurements of labile glycolytic metabolites, ammonia, and organic phosphates. The degree of hypertension induced, which gave evidence of blood-brain barrier damage in 7 of 8 rats, did not affect the tissue concentrations of labile metabolites. It is concluded that ischemia does not contribute to the barrier damage, nor is it likely to be the cause of the clinical symptoms that may occur in conscious rats in the same experimental model.


Comparative effects of adrenaline and felypressin (octapressin) on consecutive sections of the vascular bed in canine adipose tissue.

Blood flow and tissue volume were recorded in the isolated canine subcutaneous adipose tissue, enclosed in a plethysmography. Adrenaline and felypressin (octapressin) were infused intra-arterially at doses producing a blood flow reduction of approximately 60%. Adrenaline (4.6-23 ng/min) caused an initial reduction in tissue volume, indicating a constriction of capacitance vessels. Octapressin (0.46-9.2 ng/min) had no effect on tissue volume. Neither adrenaline or octapressin caused appreciable filtration or absorption, suggesting that the pre- to postcapillary resistance ration remained unchanged. In contrast to sympathetic stimulation and noradrenaline, adrenaline significantly reduced the capillary filtration coefficient (CFC) by 34%, the change in CFC being related to the flow reductions, while octapressin did not reduce CFC sffect of adrenaline on precapillary sphincter sections and on capacitance vessels is greater than that of octapressin in doses producing similar flow reductions.


Small airway constriction and closure after induced intravascular platelet aggregation.

The aim of this study was to investigate the function of the peripheral airways after intravascular platelet aggregation induced by i.v. infusions of collagen in open chest anesthetized cats, ventilated with constant tidal volume. Lung compliance was examined under static conditions (stat CL) and under dynamic conditions (dyn CL) at ventilation frequencies of 5, 24 and 50/min. In the control situation dyn CL 24 was approximately 90% of stat CL. Collagen infusions resulted in a pronounced frequency-dependence of lung compliance. When dyn CL 24 had decreased by approximately 40% a reduction in stat CL could also be detected. When dyn CL 24 decreased even more a concurrent reduction in stat CL was evident. These findings indicate that the initial event after induced intravascular platelet aggregation is small airway constriction. With more pronounced changes airway closure and reduction in lung volume occurs. We suggest that these functional changes in peripheral airways result in the impaired gas exchange known to occur after intra-vascular platelet aggregation.


Inhibition of gastric and intestinal motor activity in dogs by (Gln4) neurotensin.

The action of (Gln4)-neurotensin was studied on the spontaneous motor activity in isolated canine fundic, antral and intestinal pouches. All pouches had been prepared more than 6 months prior to the experiments. Spontaneous motor activity was recorded for at least 1 h before the Gln4)-neurotensin was infused i.v. for 30 min in doses ranging between 6.3 and 100 ng X kg-1 X min-1. In the vagally denervated fundic pouches (Gln4)-neurotensin inhibted motor activity in doses above 25 ng X kg-1 X min-1. The vagally innervated antral pouches were more sentitive than the vagally denervated fundic pouches to the action of (Gln4)-neurotensin. Thus motor inhibition was induced by doses as low as 6.3 ng X kg-1 X min-1. The effect of (Gln4)-neurotensin on motor activity in intestinal pouches was inconsistent. Inhibition was seen in 1 out of 7 expts. The present results show that the gastric motor activity is the most sensitive function to (Gln4)-neurotensin so far studied.


Blood volume and extravascular water content in the rat lung during acute alveolar hypoxia.

Values for pulmonary blood volume and extravascular lung water (estimated as wet weight of lung tissue) were arrived at in intact, anesthetized rats by labelling of blood constituents with isotopes and rapidly freezing the whole animals in liquid nitrogen. On ventilating the animals with 10% O2 in N2/N2O, a reduction in lung blood content could be demonstrated. The degree of reduction depended on the type of anesthesia and ventilation used. In some animals the volume reduction was so marked that both arterial, venous and capillary blood compartments have most probably been involved. The water content of the lung tissue was also rapidly and markedly reduced during hypoxia. Increased plasma osmolarity in mixed venous blood could partly be responsible for this tissue water reduction.


Changes in motor unit activity and metabolism in human skeletal muscle during and after repeated eccentric and concentric contractions.

This study was designed to investigate electromyographic (EMG), muscle glycogen and blood lactate changes in quadriceps muscle group during repeated 40 maximal eccentric and concentric contractions, and to follow the recovery in EMG, muscle glycogen and serum creatine kinase values during a 4 day period following the work test. The subjects were normal males and test order (eccentric or concentric) was randomly selected. The results indicated first, that the EMG parameters (IEMG, AMUP), muscle glycogen and blood lactate changed in a similar manner during the both fatigue loads. Despite the high tension work no selective depletion of glycogen could be observed in the slow or fast twitch muscle fibres in either type of work. The restoring of muscle glycogen occurred in a similar manner after the both fatigue loads, and no significant differences were present between eccentric and concentric works in the serum creatine kinase levels for a 2 days period. The eccentric work was associated with muscle soreness, which was strongest during the second day after the termination of the work test. The recovery of the EMG parameters were also delayed in eccentric fatigue. After concentric fatigue EMG-activity returned to normal values within 2 days.


Studies on cell proliferation in the mesencephalon of chick embryos by short-term labelling method.

The proliferative activity of the mesencephalon was studied from stage 8- to stage 30 in chick embryos by the short-term labelling method. Recorded values of DNA synthesis, estimated as cp 10 m/DNA, were plotted against the stage of development. The high proliferative activity in young stages decreased gradually to stage 20. It then rose rapidly, reaching a peak at stage 22, before decreasing again towards stage 30. This result supports data previously obtained by mitotic figures counting by Källén (1961) but differs from the results obtained by Cowan et al. (1968) who found the peak of activity at stage 28 in a study of the optic tectum. Possible reasons for this discrepancy are discussed.


[Development of mouse intestines].

The development of the intestine was investigated in 8-16 1/2 days' mouse embryos. Graphical and three-dimensional reconstructions were made. Special attention was paid to the appearance and the regression of the umbilical hernia. In representative stages (10, 10 1/2, 11 1/2, 12 1/2, and 14 1/2 days) the distribution of mitotic epithelial cells was studied. 1. In adult mice a total of eight intestinal loops is observed. Their development occurred before the age of 16 1/2 foetal days. 2. A correlation between the numbers and locations of mitoses on the one hand and the intestinal configurations on the other was established. 3. The presence of an umbilical hernia could not be confirmed after the age of 16 1/2 foetal days. 4. Both the differentiating and the adult intestinal tract, except the duodenum, do not show a regular pattern of intrinsic of extrinsic topographic relations.


Metabolic studies in muscular dystrophy: a role for insulin.

Insulin is important in maintaining carbohydrate tolerance and normal muscle mass. Cabohydrate intolerance and muscle wasting are frequent in the neuromuscular disorders associated with endocrinopathy and in myotonic dystrophy. Studies of the systemic factors that regulate insulin release in myotonic dystrophy have shown that excessive insulin release occurs on oral glucose tolerance testing with diminished peripheral effectiveness. Study of the peripheral action of insulin by forearm investigations of myotonic dystrophy patients and disease controls has suggested that the peripheral skeletal muscle insulin receptor may be relatively insensitive im myotonic dystrophy. It is possible that an evaluation of insulin regulation and action in myotonic dystrophy or many neuromuscular disorders may have eventual therapeutic implications. If neuromuscular disorders other than myotonic dystrophy have evidence of peripheral insulin ineffectiveness, reasonable causes could be an excessive level of an antagonistic hormone, a faulty insulin receptor, or inadequate pancreatic insulin release.


Orthopedic correction of musculoskeletal deformity in muscular dystrophy.

Correction of deformity and maintenance of the upright posture have increased self-reliant skills, thus significantly enhancing the quality of life for the child with muscular dystrophy. In addition, such techniques offer a method of prolonging independent ambulation and, in so doing, forestall confinement to a wheelchair or bed with its inevitable downhill course. Surgery and bracing, accurately indicated and properly timed, play an important role in the total rehabilitation of the patient with muscular dystrophy.


A comparison of fat absorption in young and old subjects.

Using an oral fat load, it is demonstrated that the pattern of absorption in elderly subjects is significantly different from that found in younger controls. This change may be due to the slower gastric emptying or reduced pancreatic function observed in this study. The possibility of impaired small bowel absorption has not been excluded.


Thyroid function tests in the elderly in the community.

A study of the well elderly living at home has demonstrated that the ranges for serum thyroxine (T4), triiodothyronine (T3) uptake and free-thyroxine index (FTI) are much narrower than those for the sick elderly in-patient. The prevalence of thyroid disease appears similar in both types of elderly population.


Unusual presentation of myxoedema coma in the elderly.

Seven patients were found to be suffering from myxoedema coma over a two-year period in this geriatric department. The majority presented with unusual clinical features. Generalized convulsions were particularly common, occuring in five patients. Four patients were previously diagnosed as suffering from myxoedema, but thyroxine therapy had been discontinued. These findings would suggest that this condition is not unusual in the elderly; but it could easily be missed on account of its atypical presentation.


A quantitative histological assessment of cellular death, in relation to mitosis, in rat thymus during growth and age involution.

The rates of cellular proliferation and cellular death were investigated in the rat thymus during growth and involution. It was found that the percentage of dead cells gradually increased with age, whilst the rate of cell proliferation declined, indicating that a substantial proportion of lymphocytes that divide in the thymus also die there. It was also found that there exists a density-dependent distribution pattern of mitotic and dead cells and that this distribution pattern changed with age. It is suggested that this mechanism of density-dependent control of the thymus may be an important factor in the age involution of the thymus.


The value of blood cultures in geriatric practice.

Forty-nine of 498 (10%) blood cultures taken in a 14-month period in a geriatric department were positive. These cultures were taken from 295 patients. Respiratory infections, recent onset of confusion, non-specific malaise and suspected sub-acute bacterial endocarditis were the most common clinical indications for the test. Twenty-seven of the 49 positive cultures were considered significant, the remainder being regarded as due to skin contaminants. This yield was found to be of clinical value, particularly in chest infection when the responsible organism often could not be cultured from the sputum.


Plasma paroxonase activity in old age.

Genetic factors are known to be of importance in determining the rate of biotransformation of foreign compounds in the liver. Adverse reactions to drugs are increased and pharmacokinetic parameters altered with age. In the present study, the effect of age on plasma paroxonase activity is studied. Paroxonase is a hepatically synthesized enzyme whose activity is almost entirely determined by genetic factors. It therefore serves as a model to determine whether changes in the frequency or expression of genes could explain the altered responses to drugs observed with age. The frequency distribution for paroxonase activity for 186 elderly people is closely similar to that obtained from 190 blood transfusion volunteers and 189 family members. Paroxonase activity, as with all other previously investigated pharmacogenetic polymorphisms, is unchanged with age. The hypothesis is put forward that genetic determinants of drug metabolism remain unchanged with age.


Who needs speech therapy?

Assessment of communication by a patient with a speech disorder by clinicians is often dependent on whether the patient makes an appropriate response to an instruction. The speech therapist concerned with language usage and the over-all ability to communicate has developed skills and investigational techniques to identify subgroups within the broad categories of speech pathology appreciated by the clinicians. This prospective study of 100 patients with neurological disease referred for speech therapy, examined in detail in good working conditions and with ample therapy time, is intended to clarify for the clinician a method of assessment, and to illustrate the value of therapy, and establish a prognosis for the variety of speech and language disorders encountered.


Renal carcinoma: diagnostic and therapeutic aspects.

Angiographic diagnosis of renal cell carcinoma depends primarily upon the demonstration of abnormal vasculature within the tumor. Unless the renal vein is well visualized on the arteriogram, a venacavogram and renal venogram should be performed to detect tumor in these vessels. At present, the only effective treatment for renal carcinoma is radical nephrectomy.


Scuba diving accidents.

The principal scuba diving medical problems of barotrauma, air embolism and decompression sickness have as their pathophysiologic basis the Ideal Gas Law and Boyle's Law. Hyperbaric chamber recompression therapy is the only definitive treatment of air embolism and decompression sickness. However, with a basic knowledge of diving medicine, the family physician can provide effective supportive care to the patient prior to initiation of hyperbaric therapy.


Diabetic control and the late complications of diabetes.

Considerable evidence points to a metabolic cause for the long-term complications of diabetes--neuropathy, retinopathy, nephropathy and atherosclerosis. Recent studies suggest potential benefits from controlling hyperglycemia as well as possible. However, the individual physician must analyze the evidence for himself and then decide on which principles to base the treatment of his patients.


An abnormal early diastolic impedance waveform: a predictor of poor prognosis in the cardiac patient?

The first derivative of the thoracic impedance (dZ/dt) was recorded in 81 patients entering the Cardiac Care Unit with diverse acute cardiovascular illnesses. An abnormal diastolic impedance waveform was identified in 30 of the patients. These were compared with the other 51 patients admitted under similar circumstances who did not show this abnormal waveform. Retrospective analysis of these 81 patients reveals that the ones showing the abnormal wave eventually had a poorer prognosis (66 per cent were eventually classified as Class III and IV) versus 90 per cent of the patients without the abnormality who were eventually classified under Class I and II (X2 = 28.6; p less than .001). More than 50 per cent of the 30 patients who showed the abnormality died, and 16 out of the 18 who died belonged to the group who showed the abnormal waveform (X2 = 26.7; P less than .001). From this analysis it appears that the presence of this abnormal early diastolic waveform of the dZ/dt tracing can be used as a predictor of outcome in patients with several myocardial insults, both in terms of functional disability and death.


Results of valve replacement with the Lillehei-Kaster disc prosthesis.

The results of valve replacement in 150 patients with Lillehei-Kaster aortic and mitral prostheses followed for 20 to 40 months are reviewed. Actuarial analysis showed 78 per cent cummulative thromboembolic-free rate three years following mitral valve replacement and 89 per cent following aortic valve replacement. Five patients had a total of six episodes of mitral valve thrombosis despite anticoagulant therapy. Early detection of mitral valve obstruction was difficult because a mid-diastolic murmur and absence of an opening sound was frequently encountered in normally functioning prostheses. Hemodynamic results assessed clinically in patients with nonthrombosed prostheses were satisfactory.


Systolic time intervals in chronic anemia.

Systolic time intervals were measured noninvasively in 12 healthy control subjects (hemoglobin 12 to 15 Gm. per cent) and 32 cases of chronic anemia without underlying cardiovascular disease. It was found that in mild anemia (hemoglobin above 7 Gm. per cent), where cardiac output is known to be normal, the systolic time intervals were also normal. In severe anemia (hemoglobin below 7 Gm. per cent), where cardiac output is known to be high, the systolic time intervals showed the pattern usually associated with high cardiac output, i.e., increased left ventricular ejection time (LVET) and decreased pre-ejection period (PEP) and PEP/LVET ratio, only when congestive failure was absent. In severe anemia with congestive failure, the LVET was decreased, and PEP and PEP/LVET ratio were increased--the pattern associated with impaired myocardial performance, even though cardiac output is known to be high in such cases also.


The electrocardiographic response to maximal treadmill exercise of asymptomatic men with left bundle branch block.

This study presents the results of maximal treadmill testing and coronary angiography in 31 asymptomatic USAF aircrewmen with acquired left bundle branch block. There were two subgroups: 26 men with normal coronary angiography and five men with significant angiographic coronary angiography and five men with significant angiographic coronary artery disease. The mean amount of maximal ST-segment depression induced by treadmill exercise was --0.5 mv. for both groups and the range in the normal subgroup was --0.3 to --1.0 mv. No significant differences were found between the groups. We concluded that apparently healthy, asymptomatic men with acquired left bundle branch block can have considerable ST-segment depression in response to maximal treadmill testing and that their ST-segment response cannot be used to make diagnostic decisions about them.


A clinicopathologic study of prosthetic valve endocarditis in 22 patients: morphologic basis for diagnosis and therapy.

Although endocarditis is a frequently lethal complication of prosthetic valve replacement, there is little pathological information on which to base diagnosis and treatment. We have studied the clinical and pathological features of 22 patients with prosthetic valve endocarditis seen at The Johns Hopkins Hospital over the past 17 years. Five patients developed endocarditis within two months of operation and 17 between two and 48 months (average 12) after operation. Patients dying early had a more fulminant course and their endocarditis was less often recognized during life. Late deaths, tending to present with fever and bacteremia unmasked by postoperative problems, were more readily recognized. Mitral and aortic prosthetic endocarditis generally led to a different type of prosthetic valve dysfunction: nine of 14 aortic valve prostheses with endocarditis developed incompetence and one other stenosis; five of seven patients with mitral valve prostheses developed stenosis and one, a homograft, developed incompetence. Prosthetic valve dysfunction led to death in 10 patients (45 per cent) and embolic events in five (23 per cent), including four cerebrovascular accidents. Ring infection, often believed to be universally present, and a contraindication to surgery, was found only in 50 per cent of these patients. In four patients (18 per cent) the endocarditis was sterilized by antibiotics but death occurred from valve dysfunction or emboli. These findings suggest that early surgical intervention combined with antibiotics has a chance of providing effective therapy for prosthetic valve endocarditis.


Retrograde left atrial catheterization in children with congenital heart disease.

Entry into the left atrium during cardiac catheterization may be essential for full assessment of the hemodynamic situation, particularly for the accurate calculation of pulmonary blood flow and pulmonary arteriolar resistance. The retrograde transaortic transmitral technique of left atrial catheterization has been described in adults but no detailed reports are available for the pediatric age group. Experience of this technique in 43 children with congenital heart disease is now presented, with a success rate of 67 per cent and a low incidence of complications. This method compares favorably with other methods of left atrial catheterization when the interatrial septum is intact.


Time course of ventricular fibrillation threshold in infarcted and non-infacted myocardium after acute coronary ligation.

The time course of the ventricular fibrillation threshold (VFT) was studied in 10 open-chest mongrel dogs following acute occlusion of the left anterior descanding coronary artery (LAD). The VFT in the infarcted area was compared to a non-infarcted area of the left ventricle supplied by the circumflex coronary artery. Prior to coronary occlusion the mean VFT for the entire group of 10 animals was 14 ma. for the area supplied by the LAD and 17.6 ma. for the area of the left circumflex. Immediately after coronary ligation the VFT decreased in both areas. Within 90 to 120 minutes the VFT in the infarcted area was 27 ma. and after 6 hours of occlusion the VFT was 3 times the pre-ligation value. The VFT in the non-infarcted area remained near the pre-ligation values. The excitability of the infarcted area was markedly decreased after coronary occlusion and this accounted for the increase in the VFT in the infarcted area. In the non-ischemic area the excitability was unchanged during the entire six hour period following occlusion. The study stresses the importance of the location of the electrodes used for fibrillation and the natural course of the VFT in evaluating VFT's within the ischemic myocardium.


Granulomatous myocarditis secondary to cornstarch.

A 44-year-old white female with chronic rheumatic heart disease and mitral insufficiency was admitted to the hospital for cardiac catheterization and mitral valve replacement. On the ninth postoperative day the patient experienced a sudden onset of chest pain, hypotension, and died shortly therafter. Autopsy revealed multiple mural thrombi of the left atrium, one of which occluded the mitral orifice. Histologic examination showed a granulomatous and non-specific interstitial myocarditis involving all chambers of the heart. In the granulomas, both inside and outside giant cells, rounded foreign bodies were noted which stained light blue with hematoxylin and eosin, red with the periodic acid Schiff reagent, dark bluish-black with Gram's iodine, and showed Maltese cross birefringence under polarized light. These particles were identical with starch granules from surgical glove powder. The cause of death was acute mitral occlusion form a flapping mural thrombus.


Platelet functions in patients with aortic ball valves.

Platelet functions were studied in normal subjects and patients with single Staff-Edwards aortic ball valves of series 1200 and 2300. The most pronounced changes were found in platelet adhesiveness, measured with Hellem's modified method. The mean percentage of adhesive platelets was reduced from 71.8 in normal subjects to 50.9 in patients with valve type 1200 and to 27.2 in those with type 2300. An inverse correlation was found between platelet adhesiveness and the degree of intravascular hemolysis, as reflected by serum LDH levels. The mean bleeding time was significantly prolonged in patients with valve 2300, and the individual values correlated inversely to the adhesiveness. The mean values of platelet counts, or irreversible aggregation induced by collagen or epinephrine, and of platelet survival were all moderately-but significantly-reduced as compared to normal. The most important mechanism behind the disturbed platelet reactivity is probably mechanical damage of the platelets by the valve, whereas refractoriness of platelets toward ADP liberated from red cells as well as consumption of adhesive platelets by thrombus formation is thought to have limited influence on platelet behavior. Platelet function was altered to the same extent in patients with a history of arterial thromboembolic complications as in those without. The disturbed platelet reactivity may predispose to bleeding, but may also offer some protection against arterial thromboembolism.


The consequences of fever.

Although recent studies in lizards show that induced fever reduces mortality during an experimental infection, the question of the biological value of a fever response remains an open one. Although both the fever response and muscular work during a shaking chill have a measurable metabolic cost, body temperatures cannot be related directly to heat production. Heat loss must also be considered, for heat losses vary according to body size, amounts of subcutaneous fat, and the insulating effects of clothing or blankets and environmental temperatures. The nutritional costs of fever vary in patients of differing age and size, differing nutritional status, and differing environmental and cultural conditions. More information about these factors is required to help assess the metabolic needs of individual patients during a febrile illness.


Effect of infection on food intake and the nutritional state: perspectives as viewed from the village.

Data from a prospective study of a Guatemalan village population revealed an exceedingly high force of infection which may effect nutrition and growth from gestation onward. Maternal morbidity was higher and fetal antigenic stimulation was more frequent than in industrial societies. Infection of the young child was a common occurrence and although a great many infections were silent, morbidity rates were extremely high, particularly during the protracted weaning period (6 to 24 months). Infectious disease was found to be an important cause of weight loss, arrest in height, and impaired physical growth. Also, it was a common precipitating factor of severe malnutrition and death. Analysis of the dietary data of fully weaned children did not reveal a deficit in protein intake. Most children, however, had very low calorie intakes. Infectious disease was a common cause of anorexia and of marked reduction in calorie intake, followed by weight loss and impaired physical growth. A strong inverse correlation was detected between infectious disease and calorie intake in the 2nd year of life, when children were being weaned. Infection is the most important isolated factor in the causation of malnutrition in the village. A reorientation of health and nutrition policies seems in line in view of failures of food supplementation programs, particularly with protein, in many parts of the world.


Malabsorption associated with diarrhea and intestinal infections.

An episode of diarrhea causes weight loss and a temporary cessation of growth in infants and children. Diarrhea is accompained by malabsorption of sugars, nitrogen, fats, and micronutrients. The mechanisms by which acute diarrheal disease produce malabsorption have not been studied carefully. The nutritional costs of malabsorption may pose a major threat if diarrhea becomes chronic or recurrent. The hydrogen breath test for carbohydrate malabsorption does not require intubation or blood drawing and can be used in children to help clarify the importance of carbohydrate intolerance in the duration and perpetuation of acute diarrhea and intestinal bacterial overgrowth.


Energy balance and carbohydrate metabolism in infection and sepsis.

Indirect calorimetry and nitrogen measurements suggest that uncomplicated abdominal surgery produces no significnat change in resting metabolic expenditure and only a slight loss of urinary nitrogen. More severe injury and infections produce larger increases in resting metabolic expenditure and nitrogen loss. Severe injuries can result in a 15 to 30% loss of body weight, but the protein contribution to caloric expenditure does not exceed 20% and is less than expected. The provision of calories and nitrogen can change the course of the septic patient. A continual conversion of alanine carbon to glucose occurs in septic patients, including those who are receiving exogenous glucose at the normal hepatic production rate. In sepsis, the release of glucogenic substrates from peripheral tissues may determine the rate of hepatic gluconeogenesis.


Fat metabolism in normal and abnormal states.

Various aspects of the use of fatty acids as fuel in normal and abnormal states in mammals are described. The discussion includes use of dietary lipid as fuel, the functioning of adipose tissue as a fuel reservoir, the use of free fatty acids mobilized from adipose tissue as fuel, the liver as a source of lipid fuel, and the use of intracellular lipids as fuel sources. In addition, the responses of lipid metabolism to fasting and exercise are reviewed. Finally, selected data on the effects of infections on the use of lipids as fuels are considered in relation to our current knowledge metabolism.


Whole body protein synthesis and catabolism in septic man.

The protein catabolic response to sepsis has been measured in three patients and in two normal subjects using a pulse injections of L-[15N]alanine. In addition, the urea kinetics were measured using a pulse administration of [15N]urea. Several nitrogen models which simulated the metabolic pathways of nitrogen-labeled compounds were tried. Best curve fits and acceptable confidence limits were obtained with a four-pool model containing two metabolic pools and two urea pools. Using this model, synthesis and catabolism rates were calculated for a fast and slow protein turnover pool. The mean daily total protein synthesis rate in the normal was 3.695 g/kg compared to 4.479 g/kg in sepsis. Because all subjects were in negative nitrogen balance, the mean total protein catabolic rate in the normal was 4.379 g/kg, compared to 5.298 g/kg in sepsis. These data suggest an increase in both protein synthesis and catabolism during sepsis.


Muscle protein catabolism in the septic patient as measured by 3-methylhistidine excretion.

Muscle protein catabolism has been evaluated using the excretion of urinary 3-methylhistidine (3-MEH) is six normal male and six normal female subjects and in four surgical patients, two of whom developed febrile episodes during the course of their study. In addition, their nutritional status was also evaluated using percentage body weight losses before hospital admittance, creatinine-height ratios, and, in two patients, serum alkaline ribonuclease levels. The results indicate that: 1) prolonged starvation may produced decreased 3-MEH excretion because of an adaptive diminution of muscle breakdown in sustained starvation, decreased 3-MEH excretion also may simply reflect diminished lean body mass, 3-MEH excretion may be increased above basal levels because of superimposed stresses such as fever, and the acute phases of starvation produce increased levels of 3-MEH excretion until adaptive mechanisms occur; 2) creatinine-height ratios are low in starvation, and increase not only with improved nutrition but in response to fever and stress of operation, even when these are superimposed on malnutrition; and 3) alkaline RNAase levels are elevated in malnutrition and decrease with improved nutrition but in response to fever and stress of operation, even when these are superimposed on malnutrition; and 3) alkaline RNAase levels are elevated in malnutrition and decrease with improved nutrition. The enzyme may also be elevated by the stress  of operations.


The in vivo measurement of protein synthesis.

Methods of measuring in vivo protein synthesis are briefly reviewed. Methods involving incorporation of label into protein are more appropriate for mixed proteins. The major difficulty is the definition of the precursor pool for protein synthesis. The only data available on the effect of infection on protein synthesis are open to criticism on the grounds that the precursor pool was not sampled.


Impaired gluconeogenesis in extensively injured patients with gram-negative bacteremia.

Glucose kinetics and gluconeogenic precursors were studied in burned patients with or without gram-negative bacteremia. Gram-negative sepsis in burned patients impairs the increased rate of hepatic glucose production which characteristically occurs after thermal injury.


Effect of inflammatory and noninflammatory stress on ketone bodies and free fatty acids in rats.

Both bacterial and viral infections prevented or reversed the expected ketogenic response induced in rats by starvation. In contrast, ketogenesis was not inhibited by stresses such as aseptic femoral fracture or immobilization by screen restraint. Infection had no effect on mitochondrial enzymes of terminal respiration and fatty acid oxidation.


Graduate training in community psychology.

The results of a 1975 survey of graduate training programs in community psychology and community mental health are presented. For 62 programs offering master's or doctoral training, formal curriculum components in each of five content areas (community systems and behavior, prevention or promotion of effectiveness, practice of community mental health, research and evaluation, and administration) are reported. Availability of training in six sites (community mental health centers, state hospitals, schools, legal, public health, and social service systems) is also indicated for each program. The number of faculty primarily involved in community psychology or community mental health training and principal sources of financial support for graduate students are described. A list of the 62 programs is provided.


Significant life experiences in an adult sample.

This study sought to focus on the significant life experiences of an adult sample (n = 45, ages 30-60); in particular, stress, traumas, and trauma-resolved experiences were examined and compared to like experiences of an undergraduate sample. The results for the adults revealed that two-thirds of the sample were able to convert traumas into strens, and the ability seemed to be dependent more on the person than the specific event. Success at converting, if it occurred at all, usually occurred while in subjects were in their 20s; once it occurred, subsequent events were more likely to be coped with in a more positive manner. The implications for primary and early secondary prevention are discussed.


A method for the study of lay conceptions of psychopathology: a free-response approach.

A free-response approach for identifying a lay group's conception of psycopathology is described in this paper and is illustrated with a college student population. An initial sample of individuals from the population is asked to give "reasons why someone might need to be examined by a professional person in the field of mental health." A second sample of individuals sort the problem statements on the basis of their judgements of the similarity among the statements. A measure of psychological distance for each pair of statements, based on the proportion of times the two statements are sorted together, is used as input for clustering and multidimensional scaling. A third sample contributes to the interpretation of the resulting structures by rating each problem on several psychological properties. The most relevant properties found for college students are: (a) degree of abnormality; (b) referral source--self versus others. Also disc1ssed are possible applications of the method to other lay groups in the interest of providing improved community mental health services to such groups.


Roles and expectations for mental health professionals in law enforcement agencies.

To assess consumer needs for and attitudes toward mental health services within law enforcement agencies, a questionnaire composed of a comprehensive list of mental health services potentially available to police departments was administered to populations of police officers and mental health workers. Respondents rated the services according to perceived utility of the service for law enforcement needs. Generally, police officers seemed receptive to several kinds of mental health  service, although they were less enthusiastic about the value of the services than professionals. The implication of these data for the community mental health worker are discussed in terms of establishing and maintaining effective, mutually satisfying relationships with law enforcement agencies.


Money and mental disorder: toward behavioral cost accounting for primary prevention.

This paper reviews recent retrospective sociological research suggesting that rises as well as falls in the economy are associated with such indicators of mental disorder as suicide and mental hospitalization. The review emphasizes that a lag exists between economic change and the changes in associated mental indicators. It is suggested that these findings hold promise both for early warning for practitioners and for primary prevention. Also described is a survey in four centers of 93 community mental health workers, indicating that such workers are receptive to the use of such economic indicators but not well-informed about them. Suggestions are made for prospective research to relate economic change to mental disorder through such intervening constructs as life change and stress. Such research, it is hoped, would expand the capacities of community psychologists to account for the behavioral costs of economic policy alternatives.


Job design and staff satisfaction in human service settings.

It was hypothesized that job design is systematically related to employee satisfaction. The job design variables included were: variety, task-identity, feedback, autonomy participation, learning, and information. Subjects were 137 professional and nonprofessional employees of 22 agencies providing services to children. Agencies included mental health facilities, visiting nurse associations, residential care settings, and foster placement and adoption agencies. The hypothesis was supported. The correlations between specific jog design variables and work satisfaction were examined.


Client evaluation of community mental health services: relation to demographic and treatment variables.

Community mental health center (CMHC) outpatient clients' satisfaction and perceived problem improvement were assessed by telephoning 108 clients, representing 40% of clients discharged during the period under investigation. The CMHC's services were perceived positively, and most clients were satisfied with their therapy experience, found it helpful, and felt more able to handle future problems. Data on reasons for termination, expected future behavior, and extratherapeutic factors were also gathered. Of particular interest were the findings that satisfaction and improvement were unrelated to client age, sex, marital status, or social class, but significantly more positive outcome responses were found for those clients who terminated therapy with a mutual client--therapist decision as compared to those who terminated unilaterally.


Pneumococcal meningitis in children.

We review the clinical and laboratory features of 79 children with 83 episodes of pneumococcal meningitis over a 26-year period. The onset of illness was often severe, with convulsions occurring in 31% of the patients. The mortality was 10.8% and all deaths occurred in patients younger than 1 year of age; the death rate has dropped from 19% in the 1948 to 1962 era to 3% from 1963 to 1973. The association of pneumonia with meningitis, the presence of hypoglycorrhachia, and an increased CSF protein concentration were associated with a poor prognosis; bacteremia and convulsions were also more common in the fetal cases. Neurologic sequelae including recurrent meningitis, deafness, hydrocephalus, convulsions, and retardation were present in 56% of the patients observed. Findings from EEGs did not correlate well with the clinical picture during the acute or convalescent stage of the illness. Despite accurate diagnosis, prompt therapy, and a decrease in the mortality in the past decade, pneumococcal meningitis in children is still often associated with a serious outcome.


Botulism in infancy. Report of a case.

A 22-day-old infant developed infant botulism characterized by profound weakness, hypotonia, respiratory arrest, areflexia, ptosis, pupils that responded poorly to light, and absent gag reflex. Stool examination yielded Clostridium botulinum type B organisms and type B toxin. Electromyography provided rapid diagnostic assistance. With supportive care, reovery was complete. This "new" disease probably is more common than now appreciated.


Home follow-up of urinary tract infection. Comparison of two nonculture techniques.

Thirty children with recurrent urinary tract infection were followed up at home by their parents, using urine nitrite and urine glucose bacteruria detection methods. Their results were compared with traditional clinic culture techniques. The home testing chemical methods proved to be more effective than office cultures in detecting children with recurrent infections with a considerable saving in cost and inconvenience.


Supravalvular mitral stenosis associated with ventricular septal defect.

We describe three patients with supravalvular mitral stenosis caused by a diaphragm located just above the mitral valve and associated with a ventricular septal defect. Two of our three patients also had an associated coarctation of the aorta. The physical signs, ECGs, chest roentgenograms, and cardiac catheterization data are described. Points helpful in the differential diagnosis of this malformation are emphasized. All three patients were treated successfully by surgery.


Kentucky Appalachian goiter without iodine deficiency. Evidence for evanescent thyroiditis.

In Breathitt County, Kentucky, an Appalachian Mountain community, 1,267 children were examined to determine goiter prevalence. Matched pairs of 82 goitrous and nongoitrous children were reexamined six months later for family history, urinary iodine excretion, serum thyroxine, triiodothyronine, protein-bound iodine, thyrotropin, and thyroid autoantibodies. Goiter prevalence was 8.4%. Iodine deficiency was not found. Thyroid stimulating hormone levels were higher in the goitrous group. Microsomal autoantibody titers were elevated in 20% of the children with goiters vs 6% of controls (P less than .05). Fluorescent antibodies were associated with positive microsomal (P less than .01) but not with positive tanned RBC autoantibodies. Unexpectedly, on repeat examination, goiter was absent in 17 (21%) of the originally goitrous group, but was now present in 22 (25%) of the controls. We concluded that while evolving thyroiditis is common in Appalachian children, it does not explain all goiters in an area of abundant iodine intake and known familial goiter.


Fulminant hepatitis. A presentation of Wilson's disease.

A boy, 10 years of age, was admitted to the hospital with rapid onset of hepatic failure and died within three weeks. Laboratory and pathological data were consistent with Wilson's disease. We discuss the importance of Wilson's disease in the differential diagnosis of acute liver failure.


Chronic overtreatment with insulin in children and adolescents.

We have recorded clues to the clinical recognition of chronic insulin overdosage in 101 pediatric patients with diabetes mellitus, identified predisposing circumstances, and reconsidered the traditional strategy of slow reduction in insulin dose. Overtreatment occurred in 70%, overall, and in 90% of those referred for instability; mean overdose was 38% of the readjusted dose. The most common findings were frank hypoglycemic episodes, polyuria/nocturia/enuresis despite increasing insulin dosage, excessive appetite, hepatomegaly, weight gain, headaches, exercise intolerance, marked variation in glucosuria, mood swings, and frequence bouts of rapidly developing ketoacidosis. Overtreatment usually developed because of attempts to achieve metabolic control using glucosuria as principal criterion. One fourth of those observed became overtreated during periods of emotional turmoil when need for increased insulin to counter stress-induced hyperglycemia and ketosis led to chronic increase in dosage. Persistent glucosuria/ketonuria and exacerbation of hypoglycemic symptoms were more frequent with slow than with rapid reduction in insulin dosage.


Systemic amyloidosis in cystic fibrosis.

We report two siblings with cystic fibrosis and systemic amyloidosis. The major clinical problem in both cases was recurrent respiratory infection with pulmonary fibrosis and bronchiectasis prior to death at ages 20 and 22 years. Findings from postmortem examinations disclosed diffuse amyloidosis. In addition, amyloid infiltration developed in both patients, with enlargement of the thyroid gland, and one required thyroidectomy. An autopsy review of 17 additional cases of cystic fibrosis failed to disclose any other instances of systemic amyloidosis.


Transillumination detection of a growing skull fracture.

Transillumination is shown to be an effective device in the early diagnosis of enlarging skull fractures in children.


Cat eye syndrome. Partial trisomy 22 due to translocation in the mother.

We describe a case of cat eye syndrome with 47,XX, +22q--. A balanced translocation, 46,XX,t(11;22), was found by banding studies in the mother. The clinical and cytogenetic correlations disclosed by a review of sporadic and familial cases illustrate the heterogeneity of the syndrome and the challenge to genetic counseling.


Influence of gestational age and clinical status on bilirubin-binding capacity in newborn infants. Sephadex G-25 gel filtration technique.

Total bilirubin-binding capacity was measured by Sephadex G-25 gel filtration in 43 clinically well and 45 clinically ill newborn infants between 26 and 41 weeks' gestation. In the well patients, bilirubin-binding capacity, serum albumin concentration, and the molar-binding ratio of bilirubin to albumin were directly related to gestational age. In the sick patients, serum bilirubin-binding capacity and albumin concentration also correlated with gestational age; however, from 32 to 41 weeks' gestation, the mean values for the sick infants were significantly lower than for the well infants. In the sick infants, the molar binding ratio of bilirubin to albumin was also lower than in the well patients and did not correlate with gestational age. The data are in agreement with previous clinical findings indicating an increased risk for low-bilirubin kernicterus among immature infants and suggest that some critically ill term infants may be at risk for kernicterus at serum bilirubin levels below 20 mg/100 ml.


Body height and body mass as determinants of basal blood pressure in children--The Bogalusa Heart Study. Am J Epidemiol 106:101-108, 1977. Risk factor variables for coronary artery disease were measured in a total biracial community study of 3524 children, ages 5-14 years. Anthropometric variables, serum lipids, and blood pressure (BP) were measured in a rigid randomized design. Blood pressure data were obtained with an automatic recording instrument that avoids excessive pressure readings in obese children by the use of an over-sized arm cuff bladder with a built-in infrasonic transducer. By reducing the anxiety of the child and by taking multiple readings, pressures were obtained that approached published basal levels. A multiple regression analysis showed that all measured variables could account for 39% of the systolic BP variation. Major determinants were based on weight (W) and height (H). The BP levels, when related to H and to a weight-height index (W/H3), suggest a strong influence of H and an additional influence of W/H3 on BP, both consistent and proportionate over the entire ranges of H and W/H3. The total spectrum of observed correlates of BP, resulting from the multiple regression analysis, suggests that the BP measured under basallike conditions increases as the child grows and is proportional to lean body mass and total body mass. Practical criteria for evaluating abnormal blood pressure levels in children should be based on normative values derived from body weight and body height rather than from age.


Mortality and industrial employment. III. Industries with high standard mortality ratios for persons with social security coverage in 1960 and 1965.

Data are available on a 1% sample of social security covered employees by industry, age, sex and race for years 1960 and 1965 and their mortality through 1972. Previous papers have reported on overall rates by age, sex and race and on industries in which mortality appears to be increased among younger workers. In this paper mortality ratios, compared to the expected overall race-sex-age specific rates for this population, are shown for the Standard Industrial Classification two-digit-industry classes for the 1960 and the 1965 cohorts. Among women employed in four industries involving chemical exposures, an abrupt increase in mortality occurred around 1965. Possible reasons for this are discussed. The epidemiologic usefulness of social security mortality data for occupational and preventive purposes and for surveillance is emphasized.


Tests for homogeneity of effect in an epidemiologic investigation.

A test for homogeneity of the effect of a factor in inducing disease in the various strata of a population should relate to the scaling in which homogeneity is anticipated. Popularity, it is the multiplicative effect on the odds ratio in which homogeneity is anticipated. An asymptotic test by M. Zelen (Biometrika 58:129-137, 1971) for homogeneity in this scaling is indicated to be invalid. Further, a test by J. L. Fleiss (Statistical Methods for Rates and Proportions. NY, Wiley, 1973) for homogeneity of the standardized difference is shown to be the same as the Zelen test, to be invalid in any case, and not to correspond to any scaling. The examples given include one in which results of two studies are apparently inhomogeneous by the test even though they give effectively identical results. It is advised that tests for homogeneity be conducted with care, and that thought be given to how effects might be made homogeneous rather than to trying to demonstrate the existence of heterogeneity.


The families of patients with acute rheumatic fever or glomerulonephritis in Trinidad.

The families of 21 patients with acute rheumatic fever (ARF) and 44 patients with acute glomerulonephritis (AGN) in Trinidad were examined in their homes. The ARF and AGN families were equally large and crowded and they lived in the same largely rural areas. However, only 22% of the ARF family members had skin infections in contrast to 61% of the AGN family members. Sixty-eight per cent of skin infections in ARF families and 69% of skin infections in Agn families yielded group A streptococci. Throat cultures were positive in 19% of ARF family members and 25% of AGN family members. Thirty-two per cent of 51 group A strains isolated from ARF family members (29 from throat, 22 from skin) were M11 or "M41" strains which were associated with ARF during the study, while only 8% were M1, T4 (MNT or 60) or M55 strains which were associated with AGN. In contrast, 49% of 171 group A strains isolated from Agn family members (64 from throat, 107 from skin) were M1, T4 (MNT or 60) or M55 while only 10% were M11 or "M41." Serum antibody titers were similar in both groups: antistreptolysin-0 titers were not markedly increased in either while anti-hyaluronidase and/or antideoxyribonuclease-B titers were increased in both. Evidence of subclinical AGN was found equally often in both groups: 6% of each had abnormal urine and 4% of each had decreased serum complement while 2% of the ARF and 3% of the AGN family members had both abnormal urine and decreased serum complement.


An evaluation of penicillin prophylaxis during an outbreak of foodborne streptococcal pharyngitis.

Between August 16 and 21, 1974, an outbreak of beta-hemolytic group A M-9 T-9 streptococcal pharyngitis affected 49% of a randomly selected group of inmates at a jail in southern Florida. Food-specific attack rates incriminated improperly stored egg salad served at lunch on August 16 as the vehicle of transmission. By August 20, 290 symptomatic inmates had been placed on penicillin or erythromycin; on that day fewer than 5% of throat cultures from 400 allegedly non-penicillin-allergic largely asymptomatic inmates, cultured just before penicillin prophylaxis, were positive for the epidemic strain. At the time prophylaxis was given, secondary transmission had accounted for only 3% of cases. No non-suppurative sequelae were observed but 5% of inmates who received penicillin prophylaxis experienced an adverse reaction to the drug. Although widespread penicillin prophylaxis during outbreaks of group A beta-hemolytic streptococcal pharyngitis will likely prevent transmission of these organisms, prompt treatment of all symptomatic cases may be equally as effective in controlling adult institutional foodborne outbreaks of streptococcal pharyngitis and will likely minimize the number of adverse reactions to penicillin which may be seen.


Fatal parathion poisoning caused by contamination of flour in international commerce.

In January 1976, 79 persons in Jamaica were acutely poisoned by the organophosphorus insecticide parathion. Seventeen died. Cases occurred in three episodes at separate locations, but all patients had consumed wheat flour from a single lot consisting of 5264 cotton bags. Parathion in concentrations of less than 1 to 9900 ppm was identified in flour from six bags in this lot; three had splash marks. The flour had been milled in Western Europe from European wheat, carried in trucks to a dockside warehouse, and loaded aboard ship after 2-5 days' storage. In Jamaica, the flour had moved from quayside to outbreak locations along separate routes through two import houses. Site inspections and review of shipping records suggested that the likely point of contamination was the European port, where foodstuffs and insecticides were stored in the same warehouse.


Pseudobacteremia: false-positive blood cultures from mist tent contamination.

In the seven-month period from July 1975 through January 1976, 11 pediatric patients had Acinetobacter calcoaceticus var. anitratus cultured from blood; this organism had not been isolated from pediatric patients in the previous six months. In 10 of 11 patients, only the first of two cultures was positive. All patients recovered uneventfully, although only two were treated with appropriate antibiotics. Nine of 11 had been in mist tents at the time of the culture. Mist cultured from one tent contained the same organism found in the patient's blood culture. Eight of 10 patients, however, had blood for culture drawn from the same needle as samples for other blood work, compared with only three of 13 controls (p = .013); this represented a deviation from proper blood culture technique, and a mock trial confirmed contamination of blood cultures when technique was broken. Contamination by this organism occurred in the tent water reservoir and mist, and the nose and skin of the children were colonized. The hands of respiratory therapy technicians and blood-drawing personnel became contaminated while handling the mist tents. Thorough attention to hand-washing, tent sterilization, and technique in drawing blood cultures stopped the pseudo-epidemic.


Salmonella typhi infections in the United States, 1967-1972: increasing importance of international travelers.

Isolates of Salmonella typhi from 3661 persons in the United States were reported to the Center for Disease Control from 1967 to 1972. Available case reports and carrier lists for the patients from whom the isolates were recovered were reviewed. During this period the yearly number of travel-associated cases rose 270% and, in contrast to indigenous cases, the number of travel-associated ones increased each year. This increase was largely due to cases associated in some way with Mexico. Furthermore, residents of the United States with Hispanic surnames were at higher risk of contracting typhoid in this country than was the rest of the population. Most indigenous cases were in children or young adults and were not linked to recognized outbreaks. Most known typhoid carriers in the United States are elderly women.


Rickettsia tsutsugamushi infection and scrub typhus incidence among Chinese military personnel in the Pescadores Islands.

Personnel assigned to infantry units of the army of the Republic of China (Taiwan) stationed in the Pescadores Islands experienced the highest incidence rate of scrub typhus (4%) and the highest rate of Rickettsia tsutsugamushi infection (12%) of the units studied during 1976. The ratio of scrub typhus to infection with R. tsutsugamushi was 30%. Non-immune personnel, when infected, were more likely to develop scrub typhus than were those who had previously been infected. There was a correlation between clinical illness and high antibody titers developed in response to the infection.


The anemia of vitamin E deficiency in swine: an experimental model of the human congenital dyserythropoietic anemias.

The ultrastructural and erythrokinetic characteristics of vitamin E deficiency in swine were investigated in an effort to evaluate the suitability of the swine disorder as a model of the human congenital dyserythropoietic anemias. The dominant erythrokinetic abnormality in vitamin E deficient pigs, as in the CDAs, is ineffective erythropoiesis. As in some patients with CDA, the activity of a number of erythrocyte enzymes was increased. Distinctive ultrastructual changes previously described in patients with CDA were found in normoblasts from vitamin E deficient pigs. The morphologic, erythrokinetic, biochemical and ultrastructural similarities between vitamin E deficiency in swine and the CDAs in man appear to justify the study of the animal disorder as a model of the human disease. A complete hematologic response was elicited by the administration not only of vitamin E, but also, as in the previous studies of vitamin E deficiency in monkeys, by hexahydrocoenzyme Q4. The partial hematologic response occurring after deletion of tocopherol stripped corn oil from the diet indicates that factors other than the dietary lack of vitamin E are important in the pathogenesis of this disorder.


Borate and glycerol inhibition of the aggregation of guinea pig platelets by bovine factor VIII and ristocetin.

To demonstrate the importance of the carbohydrate portions of bovine factor VIII and ristocetin for the induction of platelet aggregation, guinea pig platelets were treated with either borate or glycerol before and after addition of ristocetin or bovine factor VIII. Both borate and glycerol were capable of inhibiting the aggregation of blood platelets induced by adding bovine factor VIII or ristocetin to platelet-rich plasma. Furthermore, aggregates formed after treatment with either agent could be dispersed by high concentrations of either borate or glycerol. These effects did not appear to be solely the result of high ionic strength or of irreversible damage to the platelets. The results obtained support the hypothesis that the binding of the carbohydrate groups of factor VIII plays an important role in the induction of platelet aggregation and in the maintenance of aggregates formed in response to the treatment of platelet-rich plasma with bovine factor VIII or ristocetin.


A chlorpromazine-induced inhibitor of blood coagulation.

An inhibitor of blood coagulation was detected in the plasma of four schizophrenic patients receiving long-term chlorpromazine therapy. The partial thromboplastin time (PTT) was prolonged in all four patients and the prothrombin time (tpt) was prolonged in one. The inhibitor which resembled in many respects that seen in patients with systemic lupus erythematosus (SLE), was shown to be associated with the tigM-rich fractions of the serum. None of the patients manifested a clinical bleeding tendency and in two, discontinuation of the chlorpromazine was followed by a decrease in the activity of the anticoagulant. While three of the patients had a positive antinuclear antibody test (ANA) and the fourth a false positive serology for syphilis, no further evidence for SLE was found.


Pharmacy-based infusion pump program.

A pharmacy-based program for the procurement, allocation and maintenance of infusion pumps is presented. Policies and procedures for various facets of the program, job descriptions for personnel, and training programs for pharmacy and nursing personnel are discussed. A plan for quality assurance, including in-use accuracy testing, preventive maintenance, repairs, and complete record keeping and documentation is outlined. Various aspects of equipment selection, economic justification of equipment, and revenue generation potential are addressed. It is concluded that an infusion pump program can be operated successfully by the hospital pharmacy department.


Foreign bodies in contrast media for angiography.

Commercially available soluble contrast media for angiography were investigated for particulate contamination by a technique involving scanning electron microscopy and energy dispersive x-ray analysis (EDAX). The investigation revealed a number of particles (up to 3 x 10(5)) in 20 ml of contrast medium in many different shapes, in the size range from 0.5 micrometer to 50 micrometer and, in some instances, up to 450 micrometer. The EDAX analysis disclosed elements such as silicon, iodine, chromium, cobalt, iron, manganese, aluminum, calcium, chlorine, sodium, potassium and zinc in the particles.


Community-hospital pharmacist detection of drug-related problems upon patient admission to small hospitals.

A method was developed to increase community-hospital pharmacist consultation on patient drug use in order to detect drug-related problems upon patient admission to the hospital. A medication history was takenon criteria-selected patients admitted to two hospitals in distant, but similar, geographically small and isolated areas. Tho total number of patients selected was 392. Information about prior drug use was obtained from participating community pharmacists and their patient prescription records and medication profiles. It was found by pharmacist-acquired drug histories that one of five criteria-selected patients had a preexisting drug-related problem that the admitting physician acknowledged probably contributed to the admission and necessitated professional and patient communication. These problems included: adverse response to prescribed therapy, misuse of medication or noncompliance, effect of diet on therapy, patient treatment by more than one prescriber, and therapeutic ineffectiveness or inappropriateness of prescribed therapy. Drug histories were not obtainable in 25.6% of the patients.


Behavioral objectives for a hospital pharmacy residency program.

The purpose and design of behavioral objectives in educational programs are reviewed, and the behavioral objectives of a pharmacy residency program are listed. The behavioral objectives for the program follow, as a guide, the ASHP Accreditation Standard for Pharmacy Residency in a Hospital.


Administrative case study: the patient care area pharmacist.

The development and implementation of a patient area pharmacist position is described. Difficulties which led to the creation of this position are discussed. Primary duties of the position include improving communications with personnel in the patient care areas, reducing the work load and pressure within the pharmacy, and providing nonproduct and clinical services to health care personnel. The advantages and disadvantages of the position are discussed.


Skilled nursing facilities--a clinical opportunity for pharmacists.

It is suggested that nursing homes, as opposed to hospitals, provide the pharmacist with one of the best opportunities to practice clinical pharmacy. Restraining forces to clinical pharmacy include the reluctance of other health professionals to accept the pharmacist in clinical roles, and inadequate reimbursement for monitoring services. These restraining forces are less prevalent in nursing homes. Further, the great reliance on drug therapy in nursing homes, coupled with regulations requiring the pharmacist to assume a drug monitoring role, create a favorable atmosphere for clinical pharmacy practice. The importance of documenting the benefits of clinical pharmacy service is discussed.


Interpretation of studies on adverse drug reactions.

The findings of the Boston Collaborative Drug Surveillance Program on the toxicity of drugs are summarized, and the methodologies of this and other epidemiological drug monitoring programs are defended. It is concluded that the currently available data on adverse drug reactions provide a reasonably complete and clear picture of the "ADR problem".


Nitrofurantoin polyneuropathy: report of two cases.

Two case reports of patients who developed a toxic neuropathy associated with nitrofurantoin are presented. In each case the patient had normal renal function and the symptoms abated upon withdrawal of the drug. Although the specific mechanism by which nitrofurantoin causes the neuropathy is still not known, various hypotheses are discussed and the literature is reviewed. The danger of nitrofurantoin administration in patients with impaired renal function is emphasized, and it is stress that early signs and symptoms of peripheral neuropathy be reported and the drug immediately discontinued. Even in the presence of normal renal function, the recommended dosage and duration of therapy should not be exceeded.


Conjunctival microangiopathy. An early sign of degenerative vascular disease?

Biomicroscopic examination of the bulbar conjunctival vessels regularly discloses degenerative microangiopathy in patients with overt arteriosclerotic cerebral vascular disease. Examination of a group of normotensive nondiabetic adults aged 21 to 39 years disclosed similar but less severe changes in 56 per cent of the men and 26 per cent of the women. The incidence was higher (88 per cent of the men and 45 per cent of the women) in those with a strong family history of early death from arteriosclerotic disease. There was no consistent correlation between the severity of the microangiopathy and the values for hematocrit, cholesterol, triglycerides or blood pressure. Conjunctival microangiopathy, like atherosclerosis of larger vessels, starts in the second and third decades and advances with age. We suggest that microangiopathic changes in the conjunctival vessels may provide the first readily detectable evidence of degenerative vascular disease.


Familial proximal renal tubular acidosis. A distinct clinical entity.

We have studied a family in which nine members present hyperchloremic acidosis with normal plasma creatinine and good ability to acidify urine. Renal functions, other than bicarbonate wasting, are normal, which identifies the condition as a pure form of proximal renal tubular acidosis. The acidosis persists into adult life and appears to be inherited as an autosomal dominant trait. All affected members are asymptomatic and the only peculiar finding is a decrease in stature. No hypercalciuria was detected, and no evidence of rickets or osteomalacia was found by x-ray studies. We consider these findings characteristic of a familial trait different from that in previously reported cases of renal tubular acidosis.


Staphylococcus aureus bacteremia and endocarditis associated with a removable infected intravenous device.

Records of 21 patients with Staphylococcus aureus bacteremia associated with a removable infected intravenous device were reviewed. Sixteen patients had a peripheral intravenous catheter, four had a central venous catheter and one had a transvenous cardiac pacer. The duration of the indwelling intravenous device in situ prior to the detection of infection ranged from two to 11 (mean 5.2) days. The infected intravenous device was promptly removed as soon as bacteremia was suspected. Endocarditis was diagnosed in eight patients: in two patients an aortic murmur developed; in two the diagnosis was made clinically and was confirmed at necropsy (one mitral and one aortic); in four the diagnosis was made at necropsy (two tricuspid and two atrial wall). In patients with Staph. aureus bacteremia associated with a removable infected intravenous device, the risk of endocarditis developing was significant.


Primary sarcoma of the pulmonary trunk and/or right or left main pulmonary artery--a rare cause of obstruction to right ventricular outflow. Report on two patients and analysis of 35 previously described patients.

Clinical and morphologic observations are described in two women with primary sarcoma of the pulmonary trunk, and observations in 35 previously described patients with primary sarcoma involving a major extrapulmonary pulmonary artery are summarized. The neoplasm produces symptoms by causing obstruction to right ventricular outflow or by dislodging tumor fragments to the smaller intrapulmonary pulmonary arteries with or without pulmonary infarction. The sarcoma nearly always arises from the pulmonary trunk to which it is firmly attached. Although it grows to a large size within the lumen, it infrequently, despite its highly malignant histologic pattern, extends through the wall of the pulmonary trunk or metastasizes outside the pulmonary circulation. It may mimic a variety of more common disorders. Diagnosis can be achieved by angiography and treatment starts with total excision.


Exertion-induced rhabdomyolysis with acute renal failure and disseminated intravascular coagulation in sickle cell trait.

From 1970 to 1974, among thousands of trainees seen at two large military installations who were subjected to the same physical and environmental stresses, only four recruits were hospitalized because of acute exertional rhabdomyolysis, renal failure and coagulopathy. The illness followed the performance of vigorous exercise. These four patients had sickle cell trait. In an attempt to explain this association, the data in these four cases are summarized. The hypothesis is then developed that rhabdomyolysis and endothelial damage, terminating in severe coagulopathy, may more likely occur in patients with sickle cell trait who are subjected to virorous physical exertion.


Nephritis associated with a diphtheroid-infected cerebrospinal fluid shunt.

Hypocomplementemic proliferative glomerulonephritis occurred during diphtheroid infection of a ventricular decompression shunt for cerebrospinal fluid diversion (cerebrospinal fluid shunt) in a young man. Granular deposits of immunoglobulin M (IgM) and the third component of complement (C3) were found along the glomerular basement membrane. This report provides supportive evidence for immune complex-mediated glomerular injury due to diphtheroid infection in a cerebrospinal fluid shunt.


Individual need satisfaction, organizational practices, and job satisfaction among laboratory professionals.

This study examines the role of 1) personal job-related needs and 2) certain organizational characteristics in affecting overall job satisfaction for a sample of 259 laboratory professionals, primarily medical technologists. Specific individual needs and specific organizational characteristics were found to be related to three measures of overall job satisfaction. Additional comparisons were made for administrators versus non-administrators and for differences associated with different sized organizations. Implications for the managers of medical technologists and other laboratory professionals are discussed.


Gas-liquid chromatographic micromethod for the determination of theophylline.

A micromethod for the determination of theophylline using gas-liquid chromatography is described. The volatile ethylated derivative is prepared by the flash-heater derivatization technique. Substances that interfere in the classical determination of theophylline such as caffeine and phenobarbital did not interfere in this procedure. The coefficient of variation was 2.1 percent for 5 microgram/ml and 5.4 percent for 40 microgram/ml. This determination is useful for assessing patient compliance and adjusting dosage schedules.


Normal hemostatic mechanisms: a review.

A review of the normal hemostatic mechanism is presented. The controversy surrounding the complicated nomenclature for the coagulation system is discussed as well as the complex chain reaction or multiplier effect involving the extrinsic and intrinsic systems. Attention is also given to the role of thrombin and the role of the liver in the clotting mechanisms.


Student evaluation of instruction: a challenge to medical technology educators.

Through ever increasing political and economic pressures, accountability is in the foreground of higher education today. Demands are increasing for formal evaluation of instructor effectiveness in classrooms and laboratories. The general concept of teacher evaluation by students is discussed and a form which can be used for evaluation is presented.


The large scale use of frozen blood by the hospital blood bank.

The large scale use of frozen blood has become practical and economical. Inventory control can be mastered. Components are derived as a by-product. An autologous blood transfusion program can be successfully developed. Frozen blood is available for transplantation patients. tover 25,000 units of frozen-thawed erythrocytes have been given without an allergic, anaphylactoid, or febrile reaction. In the future the majority of red blood cell transfusions may be given as frozen-thawed erythrocytes supplemented by washed refrigerated blood with optimal 2,3 DPG levels.


Men's reactions to their partners' elective abortions.

Sixty men who accompanied their wives or girlfriends when the latter came for elective abortions were surveyed to explore, broadly, men's experience of abortion. Portions of the survey relevant to health care revealed that most men felt involved in the abortion experience. They initially wished to play an active, but circumscribed, role in matters related to abortion; they wanted to accompany their partners in order to be supportive and considered themselves responsible, along with their partners, for preventing unwanted pregnancies and choosing abortion. In contrast, there was initially a lack of interest in participation in clinic functions or learning about abortion and contraception despite inadequate knowledge. However, as information and comfort with the setting were gained, it became apparent that greater responsiveness was there to be tapped. Permitting men increased participation in abortion services, both educational and psychological, is discussed as advantageous.


Free testosterone concentration in serum: elevation is the hallmark of hirsutism.

A simple, reliable procedure for quantitating the concentration of free (not protein bound and thus biologically active) testosterone in serum has been applied to normal and hirsute patients. Each of 32 hirsute women studied had a significantly elevated level of free testosterone (that is, more than two standard deviations above the mean of that found in normal women), although half of them had a total serum testosterone level within normal limits. Suppression of free testosterone to within normal limits could be accomplished by dexamethasone alone in 47 per cent of the hirsute group. In the remainder of the hirsute group, suppression of free testosterone to within normal limits could be accomplished by addition of Enovid-E. Use of free serum testosterone concentration is clearly superior to the use of total serum testosterone concentration for the identification and rational therapy of simple hirsutism.


Hysterosalpingographic follow-up of the partial salpingectomy type of sterilization.

Two hundred and eleven of 743 patients with salpingectomy-type sterilization had hysterosalpingographic (HSG) follow-up. This type of sterilization was performed post partum, electively suprapubic, vaginally (including fimbriectomies), or at the time of cesarean section. A Foley catheter technique was used for hysterosalpingography. Of these, 1.895 per cent had fistula on hysterosalpingography. Mechanism of fistula formations and recanalization is discussed. A modification of the Pomeroy sterilization procedure is described and discussed.


The effect of amniotic fluid on bacterial growth in three population groups.

Eighty-five amniotic fluid from women of three racial groups in the third trimester of pregnancy were each tested for antibacterial activity against Escherichia coli, Staphylococcus aureus, Proteus mirabilis, Streptococcus faecalis, and Candida albicans. Seventy-six per cent of fluid samples from white patients were inhibitory, while the corresponding figures for Africans and Indians were 33 and 52, respectively. Of 19 African fluid samples tested against E. coli only, one proved inhibitory.


Prospective study of angiotensin II response to positional change in pregnancy-induced hypertension.

The response of endogenous angiotensin II levels to positional change, lateral to supine recumbency, was investigated in a prospective study of 55 primigravid patients during the last half of pregnancy. Blood samples were obtained in the lateral and supine recumbent positions. The mean supine angiotensin II level was significantly higher between 29 and 34 weeks' gestation in those patients destined to develop pregnancy-induced hypertension than in those who remained normotensive (P less than 0.05). As gestation advanced, the mean per cent relative change of angiotensin II from the lateral to the supine position altered from negative to positive in those patients destined to develop pregnancy-induced hypertension, whereas it remained negative in those patients who remained normotensive. These findings are discussed in relation to pathophysiologic alterations in the development of pregnancy-induced hypertension.


The prognostic value of serum human placental lactogen determinations in early pregnancy.

Serial serum human placental lactogen (S-HPL) determinations were done in early pregnancy on 85 high-risk cases. Normal S-HPL values with a normal ultrasonogram had a 94.8 per cent successful outcome of pregnancy. Low S-HPL values were often accompanied by an abnormal or equivocal ultrasonogram (29.6 per cent). The fetal loss in patients with low S-HPL values and a normal ultrasonogram was 36.8 per cent.


The estimation of fetal weight by computer-assisted analysis.

The need for a quick and easy method for estimating fetal weight in utero has been clearly established. Estimates by abdominal palpation and fetal hormone production have proved to be of limited value. Eight-five patients, ranging from 17 to 41 weeks' gestation, were ultrasonically scanned within 48 hours of delivery. Statistical analysis and multiple multivariant linear regressions were performed employing the BMD statistical packages. Our results show that birth weight is a logarithmic function of fetal body parameters and that the abdominal circumference has the single best correlation with the log10 birth weight. Our best linear regression with the use of two fetal dimensions (abdominal circumference and biparietal diameter) had a standard deviation of 106 grams per kilogram fetal weight. Since this derived formula is very cumbersome to manipulate, tables have been prepared with computer assistance to read the estimated fetal weight directly. Prospective estimates in 32 cases of both normal and pathologic gestations have proved to be within our expected accuracy.


Placental transfer of a large angiotensin fragment in the guinea pig.

Angiotensin II (AII) levels are usually higher in the fetal than in the maternal circulations. Radioiodinated AII has been used to establish whether or not this hormone crosses the placenta from the fetus to the mother in the pregnant guinea pig. No intact radioiodinated AII was found to have crossed in any of 13 experiments. A single radioiodinated AII fragment was found in 10 of these experiments. This ran as (des-(Asp1 Arg2 Val3)) in one solvent, but this could not be confirmed when a different solvent was used. The results support the hypothesis, previously based on indirect evidence, that AII does not cross the placenta.


Trabeculectomy and postoperative ocular hypertension in secondary angle-closure glaucoma.

I performed trabeculectomies to reduce the introacular pressure to 20 mm Hg or lower, in 56 eyes with medically uncontrollable primary open-angle glaucoma or secondary angle-closure glaucoma. In the former group, I achieved success in 85% of cases, 65% without further antiglaucomatous therapy. In the latter group, 59% obtained a successful result, 41% without additional treatment. The readings of applanation tonometry on the first postsurgical day were compared to those obtained after one year. Although approximately 50% of eyes in both glaucoma categories had an initially elevated pressure after trabeculectomy, it decreased steadily in most of those with primary open-angle glaucoma. In the secondary angle closure glaucoma population, this immediate postoperative ocular hypertension was significantly correlated with eventual failure of the operation.


Pars plana lens removal with vitrectomy.

We used a modification of lens removal by phacofragmentation in conjunction with posterior vitrectomy without any serious complications in over 200 procedures. This modification allowed removal of hardened nuclear sclerotic lenses and reduced the time required for lens removal.


Detection, removal, and effect of unpolymerized methylmethacrylate in intraocular lenses.

Gas-liquid chromatography, infrared spectroscopy, or Raman spectroscopy were used to determine the level of monomer in intraocular lenses and in the preforms used in each step of the manufacturing process. Heating, lathing, molding, and grinding caused an increase in monomer content, presumably the result of depolymerization. The tendency of methylmethacrylate to volatilize, repolymerize, or dissolve precludes high monomer contents from persisting in intraocular lenses. Vacuum ovens or water baths significantly reduced the monomer content to levels of 0.5% or less. Lenses with a monomer content higher than that found in currently available commercial lenses had no effect on rabbit kidney cell cultures. Lens fragments with a similarly elevated monomer content were indistinguishable from lenses with a low monomer content in rabbit eyes. According to these data, monomer does not appear to be a toxic agent in currently available intraocular lenses.


Hemorrhagic peripapillary lesions in presumed ocular histoplasmosis.

Eight eyes of five patients with hemorrhagic peripapillary histoplasmosis demonstrated prolonged symptomatic periods and recurrent bleeding episodes, although final visual acuity was equal to or better than 6/12 (20/40) in five eyes (63%). Fluorescein angiography demonstrated new subretinal neovascular growth at the margins of atrophic scars. In the late stages additional retinal pigment epithelium was lost and a white subretinal mass developed adjacent to the atrophic zone. Argon laser photocoagulation was used in two cases to destroy this neovascular tissue, but caused a permanent arcuate defect in one.


Benzalkonium chloride toxicity to the human cornea.

A 36-year-old woman fitted with a soft contact lens after an uneventful extracapsular cataract extraction was wearing her aphakic lens successfully until she switched her lens-soaking solution to an isotonic solution of boric acid, potassium chloride, and sodium carbonate preserved with benzalkonium chloride and edetic acid. After three days her eye became inflamed and vision decreased. No endothelial damage was apparent and the anterior chamber showed 2+ cell and flare reaction. Three weeks after removal of the lens and fitting with an aphakic lens visual acuity was 6/9 (20/30). Study of the preservative by a semiquantitative dilution method together with the clinical evidence in this case proved the cytotoxic effect of benzolkonium chloride when used to sterilize soft contact lenses.


Early argon laser photocoagulation of presumed histoplasma maculopathy.

In this study, 66 patients with presumed ocular histplasmic maculopathy and in whom the edge of the neovascular membrane was at least 200 micron from the center of the fovea were selected for treatment with argon laser photocoagulation. They were divided into three groups depending on the time elapsed between the beginning of symptoms and treatment with argon laser photocoagulation. The size of the neovascular membrane, the distance from the center of the fovea, and the presence of hemorrhage in the foveal area were also noted. We found that the most important prognostic factor for best final visual acuity was the interval of time between onset of symptoms and treatment. The study showed that 73.3% (22 of 30) of patients with symptoms of short duration (four weeks or less) compared with 17.6% of those with symptoms of long duration (16 weeks or more) retained 6/15 (20/50) or better final visual acuity following argon laser photocoagulation treatment.


Retinal breaks secondary to vascular accidents.

Seven retinal breaks occuring after occlusion of a major retinal arterial or venous branch were found in the eyes of six patients. Five holes were in the midretina, in a nonperfused avascular area corresponding to the sector affected by the vascular accident. One was a macular hole, and one a horseshoe tear outside the area involved in the vascular occlusion caused by traction of vitreous on a tuft of neovascular tissue. Five of the holes may have been caused by a kind of sequestration of the retina secondary to vascular insufficiency.


Malignant melanoma of the choroid associated with spontaneous expulsive choroidal hemorrhage.

A 79-year-old man initially had a perforated corneal ulcer of his blind right eye. The next day a spontaneous expulsive choroidal hemorrhage occurred just before scheduled enucleation. Histopathologic examination of the enucleated eye revealed a severe necrosis of several posterior ciliary arteries in the expulsive choroidal hemorrhage, as well as a large occult spindle B malignant melanoma of the choroid. The necrosis of the posterior ciliary arteries may have been the cause of the choroidal hemorrhage. The finding of an occult malignant melanoma may be more than a chance occurrence of two unrelated events, inasmuch as both are associated with necrosis of the posterior ciliary arteries.


Necrotizing vaso-occlusive retinitis.

We studied two adult patients with fulminating, necrotizing vaso-occlusive retinitis, and documented the progressive course of retinal necrosis, vitreoretinal interface contraction, and consequent retinal detachment. The systemic criteria for Behçet's disease were present in one patient, and partially fulfilled in the second.


Congenital retinal arterial loops and vitreous hemorrhage.

In two adolescents, mild vitreous hemorrhage occurred from the area of retinal arterial loops near the optic nerve. In both cases the hemorrhage cleared without further complications. This vascular malformation may be associated with secondary complications more frequently than has previously been reported.


The eye in the partial trisomy 2q syndrome.

Mandibulofacial dysostosis, mental retardation, skeletal, genital, and ocular malformations occurred in a family with partial trisomy of the long arm of chromosome 2. Translocations of chromatin material from the long arm of chromosome 2 to the short arm of chromosome 9 was balanced in the female carriers of the pedigree but was unbalanced among the males. Ocular signs in the males included uveal coloboma, anterior chamber angle anomalies as in Ringer's syndrome, congenital glaucoma with dislocated lens, exotropia, and blepharoconjunctivitis. These findings were related to an inherited malformation syndrome.


The retinal manifestations of Rocky Mountain spotted fever.

The prominent ophthalmoscopic features in a 9-year-old white girl with Rocky Mountain spotted fever consisted of papilledema, cotton-wool spots, and dilated, tortuous retinal veins. Fluorescein angigography showed focal areas of capillary nonperfusion with blocked retinal and choroidal fluorescence at the cotton-wool spots. We observed perivascular staining adjacent to the infarcted areas. In addition to hyperfluorescence of the optic disks, late phase photographs demonstrated prolonged retention of intravascular fluorescein indicating obstruction to venous outflow.


Mydriasis from Datura wrightii.

A 4-year-old girl had painless, uniocular mydriasis after picking flowers. Pharmacologic testing with 1% pilocarpine confirmed the probability that an atropine-like agent had been instilled in the affected eye. The flowers were identified as Datura wrightii and contained scopolamine, hyoscyamine, and atropine on thin-layer chromatography.


Subconjunctival dislocation of intraocular lens implant.

Eight weeks after intracapsular cataract extraction with implantation of a Binkhorst iris-clip lens joined with a suture to a peripheral iridectomy at the 12 o'clock position, a 52-year-old woman struck the right side of her head. The corneoscleral wound ruptured for three fourths of its length and the artificial lens was located in the subconjunctiva in the superior-nasal quadrant of the eye. The lens was removed, the iris reposited, and the anterior chamber reformed, and the wound resutured. Her vision was 6/12 (20/40) at the time of discharge.


A visual tracking machine.

The Visual Tracking Machine is an easily constructed device used for perceptual training with adults and children-with the following diagnoses: cerebral vascular accident, traumatic head injury, cerebral palsy, mental retardation, and spina bifida. It offers activities for the following purpose: development of visual attention and eyemotility, stimulation to cross the midline, compensation iraining for homonymous hemianopsia, one-side neglect, eye-hand coordination, and motor planning. The machine features control over smoothness, speed, and direction of movement of a visual stimulus, eliminates a potentially distracting background, spans the whole visual field, motivates the patient by offering the opportunity for many challenging games, and offers variability in task difficulty. It is sturdily built, relies only on manual power, and is not prone to mechanical breakdown. Used successfully during a one-year trial period, it appears to be a potentially useful adjunct to perceptual training programs. A description of its construction and materials needed are included. Other devices promoting tracking are reviewed in terms of function, source, and availability.


Training the deaf-blind child.

The literature pertaining to deaf-blind persons was reviewed to acquaint occupational therapists with the needs of this population and to delineate their role in the habilitation of these persons. Two examples of the occupational therapy role in programming for deaf-blind children were described. In the late 1960s, occupational therapists were needed in small numbers, therapists who could work intensively in specific programs for deaf-blind children; in the late 1970s, a much greater number will be needed to provide services to small numbers of deaf-blind persons of all ages who will be attending the same schools, clinics, sheltered workshops, and group living facilities as will other handicapped persons.