Diaphragm pacing. Evaluation of current waveforms for effective ventilation.

To evaluate the effectiveness of the configuration of the stimulating waveform on diaphragm pacing, we evaluated several different current forms: UDC-bipolar, UDC-monopolar cathodal, UDC-monopolar anodal, and ABDC. During stimulation with a pulse interval of 37 msec., a decrease in tidal volume was observed during the initial 30 hours with UDC-bipolar and UDC-monopolar anodal waveforms. Both UDC-monopolar cathodal and ABDC stimulation maintained the initial effectiveness for 6 hours. The decrease in tidal volume of UDC-monopolar anodal closely paralleled that of UDC-bipolar stimulation. Decreasing the pulse interval to 20 msec. caused a decrease in tidal volume with both UDC-monopolar cathodal and ABDC waveforms. Arterial oxygen tension (PaO2) in these experiments decreased to about 60 mm. Hg soon after the onset of unilateral diaphragm pacing. The concomitant decrease in tidal volume seen with UDC-bipolar stimulation could be avoided through the administration of oxygen to keep the animal's PaO2 about 100 mm. Hg. The amplitude of the evoked diaphragmatic action potentials decreased significantly under hypoxemia and returned to normal with hyperoxygenation. From these short-term experiments, our findings indicate that waveform configuration does influence the time of onset of diaphragm fatigue due to either an neuromuscular junction. Further, hypoxemia accelerates the occurrence of fatigue.


A hitherto undescribed cause of prosthetic mitral valve obstruction.

A case is described in which severe prosthetic mitral valve obstruction was produced by entanglement of sutures across the central axis of the prosthesis on its ventricular side. The entangled sutures prevented the tilting disc occluder from falling into the left ventricular cavity during ventricular diastole.


The role of carbon dioxide in the development of pulmonary insufficiency.

The effects of carbon dioxide (PCO2 = 40 versus PCO2 = 20) on pulmonary function changes during 2 hours of hemorrhagic hypotension followed by resuscitation are evaluated in 21 dogs. Pulmonary hemodynamics, mechanics, gas exchange, functional residual capacity, and morphology are studied. In the preshock period, hypocapnia is associated with a decreased cardiac output, increased dead space, and increased alveolar-arterial (A-a) gradiant (room air). During the period of hypotension, all parameters in both groups changed similarly. After resuscitation, the A-a gradients in the two groups further widened. Following the return to control levels of normocapnia in all animals, the group which had been hypocapnic during the hypotensive episode continued to show increased shunting (20 versus 13 percent, p less than 0.05). These results correlated well with cinemicroscopic findings, which showed the normocapnic group to have less interstitial edema and better capillary flow.


Congenital lobar emphysema resulting from bronchial sling around a normal right main pulmonary artery.

A 5-month-old female infant was transferred to our institution for evaluation of recurrent upper respiratory tract symptoms and chest x-ray films showing hyperaeration of the right upper lobe. Preoperative studies including chest fluoroscopy, lung scan, and bronchoscopy suggested congenital lobar emphysema. At thoracotomy, an anomalous right upper lobe bronchus which bifurcated around the main pulmonary artery in a sling fashion was found. This anatomic abnormality has not been described previously and is a unique cause of congenital lobar emphysema.


Implantable artificial lung. Preliminary report.

The ultimate treatment of chronic respiratory insufficiency is pulmonary replacement by an artificial organ, homologous lung transplantation, or chronic paracorporeal respiratory supplementation. The woven capillary membrane oxygenator appears to be a major development toward implantable artificial organs. The four units tested are made up of screens 3.5 by 4.0 cm. of capillary tubing 0.3 mm. I.D. by 0.64 mm. O.D. assembled into rectangular blocks. Units made up by five, ten, twenty, and forty screens have been assembled and tested according to the protocol suggested by Galletti. The maximum oxygen transfer rate with blood was 48 ml. per minute per square meter. Water carbon dioxide transfer rate was 23.1 ml. per minute per square meter. The pressure drops in the liquid phase were 8.5, 15.3, 13.8, 17.6 mm. Hg at 1 L. per minute flow. These results indicate that the woven capillary membrane lung is an acceptably efficient oxygenator. The characteristics of design and performance suggest that this oxygenator can be made to be implanted into the chest or used as a paracorporeal respiratory assistance device.


Sclerosing mediastinitis with occlusion of pulmonary veins. Manifestations and management.

A case of mediastinal fibrosis with occlusion of the right inferior and middle lobe pulmonary veins is described. The patient had severe hemoptysis, and the diagnosis was established with thoracotomy. Review of the literature emphasizes the lethal nature of this syndrome if untreated. Resection of the involved bronchopulmonary tissue, when feasible, offers good palliation, although the long-term prognosis is unpredictable.


Accidental pneumatic rupture of the esophagus.

A case of accidental pneumatic rupture of the thoracic esophagus in a 6-year-old boy is reported. Early operation with transthoracic esophageal repair resulted in survival of the patient, and follow-up at 18 months has demonstrated normal esophageal function and anatomy. A search of the literature has yielded 11 similar cases.


Inhalation of foreign bodies in children. Report of 500 cases.

Inhalation of foreign bodies is a major cause of accidental death during childhood. Aspiration of foreign bodies is common in children aged 1 to 3 years, especially in boys. A past history of foreign body aspiration is itself an indication for bronchoscopic examination of the airways, because some children with aspirated foreign bodies are without symptoms and chest x-ray films may not show abnormalities. Bronchoscopic removal of the foreign bodies requires close communication between the anesthesiologist and the endoscopist. Forgotten foreign bodies in the airways cause chronic pulmonary infections, allergic asthma, bronchiectatic changes, and lung abscess. Foreign bodies that cannot be grasped by bronchoscopic forceps should be removed by thoracotomy and bronchotomy. This report describes our experience in 500 children with suspected foreign body inhalation. We routinely use prednisolone, 1 to 2 mg. per kilogram, and nebulization just after bronchoscopic examination of the airways. This medication greatly diminishes the rate of postbronchoscopic complications such as laryngeal edema, which require tracheostomy. In our series of 500 case, the incidence of postbronchoscopic tracheostomy is 1.4 per cent and the total mortality rate is 1.8 per cent.


Traumatic perforation of the hypopharynx in infants.

Three cases of traumatic perforation and pseudodiverticulum of the hypopharynx in newborn infants are presented. This lesion may be encountered with increasing frequency as a result of the more aggressive management of newborn infants with respiratory distress. Early recognition of this complication is essential to successful therapy. Appropriate management includes local drainage, treatment with antibiotics, and use of a nasogastric tube or gastrostomy to provide a safe route for intestinal alimentation.


His bundle electrograms in 51 patients requiring permanent transvenous pacemakers.

Fifty-one patients required the implantation of a Cordis Omnis-Stanicor permanent pacemaker. His bundle electrograms studies, which included right atrial pacing and sinoatrial (SA) node postsuppression recovery times, were performed prior to the implantations. Pacing and sensing thresholds were obtained in all patients. Syncope or episodes of dizziness were the presenting symptoms in virtually every patient. Twenty-eight of the 51 patients had the sick sinus syndrome. Only nine patients were in complete heart block, and an additional nine were in second-degree heart block. The His bundle electrogram technique was not particularly helpful in selecting the potential pacemaker candidate. The symptomatic patient with second- or third-degree heart block requires a pacemaker. In the sick sinus syndrome, the His bundle electrogram was a disappointing tool in detecting abnormalities. In chronic bundle branch block, the His bundle electrogram appears to play a major role. A prolonged H-V interval in a symptomatic patient, in whom a specific noncardiac cause cannot be identified, signifies that a pacemaker is required.


Tissue uptake of 3H-methylprednisolone in acute myocardial ischemia.

The tissue uptake of 3H-methylprednisolone (3H-MP) was studied in anesthetized cats during acute myocardial ischemia 1 and 2 hours after injection of 3H-MP. There was a rapid uptake of 3H-MP by many tissues. Liver, kidney, and pancreas exhibited tissue/perfusion ratios of 3 to 7, heart, lungs, and intestine about 2, spleen, adrenal, and aorta 1 to 2, and skeletal muscle and omentum less than 1. Very similar tissue uptakes occurred in cats subjected to myocardial ischemia and sham myocardial ischemia at 1 and 2 hours. Plasma clearances of 3H-MP was not significantly altered either 1 or 2 hours after the onset of myocardial ischemia. Although ischemic myocardial tissue took up less than nonischemic myocardial tissue, this region accumulated significant amounts of 3H-MP. Myocardial tissue metabolized only about 15 to 20 per cent of the 3H-MP taken up after 2 hours. These data indicate that in acute myocardial ischemia, myocardial tissue takes up large amounts of exogenously administered glucocorticoid, most of which remains in the native form during the early phase of acute myocardial infarction.


Pseudoaneurysm of atrioventricular groove. A late complication of mitral valve replacement.

This report describes an unusual late complication of mitral valve replacement in which a false aneurysm of the atrioventricular groove produced compression on the circumflex coronary artery and myocardial infarction. The cause of this condition is not well explained, but its potential is present whenever there is early separation of the mitral anulus from the fibrous skeleton of the heart. Early hematoma formation resulting in frank perforation and hemorrhage has been reported, but late pseudoaneurysm formation after initial mitral valve replacement appears to be a rare occurrence.


Pericardial tamponade due to perforation with a permanent endocardial pacing catheter.

A case is presented in which shock developed suddenly during implantation of a permanent pacemaker. The cause proved to be pericardial tamponade secondary to catheter perforation. Analysis of this case and the 6 similar cases reported in the literature reveals that although perforation occurs not infrequently from immediately to many months after implantation, tamponade is quite rare and is invariably closely related temporally to catheter manipulation. Tamponade has occurred with different catheter sizes and makes. It is more likely related to local myocardial factors than to faulty technique. Closed pericardiocentesis is generally unsuccessful in relieving the tamponade, and prompt open drainage through the subxiphoid approach is recommended.


Double-outlet right ventricle (S,D,D), VSD related to pulmonary artery, and pulmonic stenosis absent. Correction with an intraventricular conduit in infancy.

The case history of a 5-month-old infant with double-outlet right ventricle (S,D,D) ventricular septal defect (VSD) related to the pulmonary artery, and absence of pulmonic stenosis is reported. The anomaly was repaired with an internal intraventricular conduit. This is the youngest infant with this subset of DORV to survive complete repair and the youngest in whom an intraventricular conduit was used. The diagnosis was not suspected preoperatively, and it is fortunate that the intracardiac anatomy permitted this type of repair at this age. The optimal management program for this subset of DORV should be initial pulmonary artery banding with later complete repair.


Serum and urinary amylase levels following pulsatile and continuous cardiopulmonary bypass.

The incidence of elevated serum and urine amylase values was examined in a prospective clinical study of patients subjected to either continuous or pulsatile extracorporeal perfusion. Mean postoperative values for urine and serum amylase were higher in the continuous group, and the incidence of abnormal values was also greater in the continuous group (70 percent versus 32 percent, p less than 0.01). Clinical pancreatitis was absent in both groups. This study documents a high incidence of elevated amylase values following bypass with either modality and provides evidence for possible improved visceral circulation with pulsatile extracorporeal bypass during routine cardiac operations.


Primary liposarcoma of the mediastinum. Report of a case and review of the literature.

Primary liposarcomas of the mediastinum are very rare tumors. We record herein the fiftieth documented case, and the sixth in which there was evidence of superior vena caval obstruction. All previously reported cases have been studied; their salient clinical and pathological features have been tabulated. Review of these case reports reveals that the majority of patients have complaints of respiratory distress or chest pain. Other common presenting complaints include cough and weight loss. These tumors grow to an enormous size, and symptoms are referable to compression of contiguous intrathoracic structures. Radiotherapy or chemotherapy or both are ineffective theraputic modalities. The treatment of choice is surgical in all cases. Such an approach serves to establish a tissue diagnosis, to relieve the patient's symptoms, and may at times result in a cure.


The role of preoperative mesenteric arteriography in colon interposition.

In a series of mesenteric arteriograms, the marginal artery in the right colon was present in six of 20 studies (30 percent); in the left colon it was present in all of the 20 cases studied (100 percent). Such preoperative knowledge of the vascular pattern permits the surgeon to choose a suitable segment of bowel for successful colon interposition and assists him in shortening the operative time. When this information was applied in 19 consecutive left colon interpositions, only one major suture line dehiscence in the neck was encountered (5.3 percent).


The ophthalmologic manifestations of Wilson's disease.

Fifty-three patients with Wilson's disease were studied with regard to ophthalmologic abnormalities. Of the 35 symptomatic patients initially seen and treated at the Mayo Clinic, 34 (97%) had Kayser-Fleischer rings and 6 (17%) had sunflower cataracts at the time of diagnosis. In patients followed for a year or more, penicillamine therapy resulted in improvement of the Kayser-Fleischer rings in 18 of 20 (90%) patients and total clearing of the sunflower cataracts in 4 of 5 patients. The specific pattern of copper deposition in Kayser-Fleischer rings and the improvement with treatment occurred along four reproducible stages. None of five asymptomatic siblings of patients with known Wilson's disease had Kayer-Fleischer rings at the time of initial study. In one (untreated) of the five, Kayser-Fleischer rings developed 20 months after the initial normal slit-lamp examination. The presence of Kayser-Fleischer rings, and the absence of other ophthalmologic signs (such as nystagmus, cranial nerve palsies, and other movement disorders), can be of great assistance in the diagnosis of Wilson's disease. Once the condition has been diagnosed, specific medical therapy with penicillamine and low-copper diet dramatically improves what would otherwise be an inevitably fatal course.


Half-life of circulating renin under different experimental conditions.

The half-life of circulating renin was studied in normal rats and in rats with a single kidney that was ischemic. The resulting disappearance curve represented the sum of two exponentials. The average half-life of the fast component was 11.5 minutes for normal rats, 11 minutes for rats with mild renal ischemia, and 8 minutes for rats with severe renal ischemia. The mean half-life of the slow component was 67 minutes in normality, 84 minutes in mild ischemia, and 121 minutes in severe ischemia. Also, the calculated proportion of the slower component was different for each group--60.3% in normality, 68.2% in mild ischemia, and 82.2% in severe iischemia. The results suggest that more than one kind of renin may be produced and released by the kidney, and also that renal ischemia may modify the normal metabolism of renin.


The role of calcium in the response of rabbit aorta to angiotensin.

The role of Ca++ in the stimulus-contraction coupling of the response of the isolated rabbit aorta to angiotensin II was investigated. Angiotensin was found to have lower intrinsic activity than epinephrine and to be more sensitive to acute exposure of the organ to Ca++-free medium. Two minutes after removal of Ca++, the maximal responses to angiotensin and epinephrine were reduced by 40% +/- 8% and 7% +/- 5%, respectively. Further loss of response for the two agonists followed parallel time courses. In another series of experiments, angiotensin tachyphylaxis was obtained in the rabbit aorta by administration of either [1-sarcosine]angiotensin or betainyl-angiotensin. The intrinsic activity of [1-sarcosine]angiotensin was lower than that of angiotensin and was not affected by removal of Ca++. It is concluded that the low intrinsic activity and the tachyphylaxis may be dependent on a strong binding of the molecule's positively charged N-terminus to sites responsible for release of Ca++ into the cell.


Physiologic mechanisms of bupicomide- and hydralazine-induced increase in plasma renin activity in hypertensive patients.

A study was made of the possible mechanisms underlying bupicomide- and hydralazine-induced increase of plasma renin activity. Six patients with mild to moderate hypertension were treated with both bupicomide and hydralazine on separate occasions in random order. Bupicomide lowered mean arterial pressure from 124.2 +/- 3.7 mm Hg (mean +/- SE) to 107.2 +/- 3.9 mm Hg (P less than 0.001). The associated increase in plasma renin activity was 1.27 ng/ml per hour and the increase in heart rate was 16.5 beats/min. Hydralazine reduced mean arterial pressure from 124.2 +/- 3.7 mm Hg to 107.0 +/- 2.0 mm Hg (P less than 0.01). The associated increase in plasma renin activity was 2.20 ng/ml per hour and the increase in heart rate was 22.4 beats/min. Plasma renin activity during bupicomide and hydralazine administration correlated positively with control plasma renin activity (r = 0.98, P less than 0.001). The log of plasma renin activity correlated positively with heart rate (r = 0.51, P less than 0.02) and negatively with mean arterial pressure (r = -0.62, P less than 0.005). We conclude that control plasma renin activity is a major determinant of change in plasma renin activity during administration of bupicomide or hydralazine. Both an increase in sympathetic activity and a decrease in perfusion pressure may contribute to the bupicomide- and hydralazine-induced increase in plasma renin activity, possibly by a baroreceptor-mediated increase in adrenergic tone.


Continuous measurement of aortic caliber in conscious rats. Effect of acute hypertension.

For continuously measuring the circumference of the aorta in conscious rats for up to 20 days, a new electrolytic strain gauge of high sensitivity and stability was constructed of silicone tubing filled with copper nitrate. The mean systolic and diastolic circumferences measured in 11 nonanesthetized undisturbed rats were 6.557 +/- 0.128 mm and 6.533 +/- 0.128 mm, respectively--the pulse pressure (51 mm Hg) producing an increase of 0.024 mm in aortic size (0.37% increase of the diastolic circumference). The calculated dynamic elastic modulus was 13,908 dynes/cm2. Infusions of blood, angiotensin, and noradrenaline to increase mean aortic pressure acutely by 50 mm Hg caused aortic circumference to increase by 0.59, 0.58, and 0.53%, respectively. Seven rats were subjected to acute hypertension produced by subdiaphragmatic aortic constriction after recording the control measurements. Over the period of study (6 hours) after aortic constriction, mean aortic blood pressure was increased 50 mm Hg from the control of 101 mm Hg. A mean maximal increase of 6% in aortic circumference was seen at 3 hours and a mean minimum of 0.9% at 4 hours, with an average increase of 3% for the entire 6-hour period. These changes in aortic circumference coincide with an upward displacement of about 30% in the range of activation of the aortic baroreceptors.


Vascular renin-like activity and blood pressure.

Plasma renin activity, reninlike activity present at the artery wall, pressor response to exogenous hog renin, renin half-life time, and renin-like activity present at the artery wall 1 hour after injection of renin were measured in conscious rats 1 month after inducing hypertension by renal artery constriction and contralateral nephrectomy (one-kidney hypertension). Plasma renin activity was higher but without statistical significance in one-kidney hypertensive rats when compared with normotensive or sham-operated animals. Renin-like activity present at the artery wall was significantly increased in hypertensive animals only when compared with one-kidney normotensive rats. Pressor responses to renin in one-kidney hypertensive and normotensive rats were of significantly longer duration than in sham-operated animals. The inactivation rate of exogenous renin followed a first-order reaction with a half-life of 6 minutes in sham-operated rats and of 12 minutes in one-kidney hypertensive and normotensive animals. Decreased inactivation of circulating renin could explain the protraction of the pressor response; however, the slope of the regression equation describing the inactivation of renin in all of the rats was steeper than the slope of the pressor response, indicating a dissociation between blood pressure and plasma renin activity. The renin-like activity present at the artery wall 1 hour after injection of renin was determined in the three groups; the arterial tissue of one-kidney hypertensive rats bound more circulating renin than that of normotensive rats and the latter more than that of sham-operated animals, suggesting the participation of this binding capacity in the protraction of the pressor response and in the maintenance of hypertension.


Altitude and hypertension.

In order to study the prevalence of hypertension and some of the factors relevant to its natural history, cross-sectional surveys were performed during the period 1967 to 1973 in five small Peruvian communities, two located at sea level and three above 13,000 feet of altitude. In total, 4,359 persons were studied at sea level (1,970 males and 2,389 females) and 3,055 at high altitude 2,189 males and 866 females). At high altitude, the age-adjusted prevalence of hypertension (particularly systolic) was definitely low; diastolic hypertension was more frequent in men than in women, and it was commoner than systolic hypertension. The reverse was observed in communities at sea level. Long-term blood pressure changes observed in natives accustomed to high altitudes but living at sea level, as well as in white persons usually living at sea level but residing at high altitude, appear to indicate that environmental forces are more important than genetic predispositions in determing the rarity of hypertension in the highlands. Among the environmental forces, chronic hypoxia seems to play an important causal role.


New approaches to the study of angiotensin tachyphylaxis.

Of the various mechanisms proposed to explain the development of tachyphylaxis, the initial step of drug-receptor interaction has received the most attention. The present study suggests that the affinity of angiotensin II itself or an angiotensin analogue for the angiotensin receptor is a determing factor in the development of tachyphylaxis. The concept of negative cooperativity is introduced as a consequence of the observed correlation in the present study between slopes of less than unity as determined in Hill plots and the development of tachyphylaxis.


Renal kallikrein system, volemia, and renal hypertension.

Plasma, blood, and urine volumes, renal kallikrein, and arterial pressure were measured in control and renal hypertensive rats in order to study the role of the renal kallikrein system in regulating arterial pressure and its relation with the alterations in water handling observed in hypertension. A decrease in kallikrein content of the kidney (157 +/- 17 versus 236 +/- 16 ng bradykinin equivalents per gram of tissue in control rats) was associated with an increase in plasma volume (38.0 "/- 1.6 versus 32.0 +/- 0.9 ml/kg body weight in control rats) and an increase in urine volume (45.5 +/- 4.9 versus 20.3 +/- 1.6 ml/kg body weight per 24 hours in control rats). No linear correlation was found between these factors and the arterial pressure of hypertensive animals. These findings support the hypothesis that changes in renal kallikrein are more directly related to water and electrolyte metabolism than to the arterial pressure regulation. Our results also suggest an interaction between the kallikrein-kinin and the renin-angiotensin-aldosterone systems. The possible relations of both enzymatic systems to the regulation of arterial pressure and of water-electrolyte handling are summarized schematically.


Hypertension and the interrelated renal circulatory effects of prostaglandins and the renin-angiotensin system.

Blockade of prostaglandin synthesis with indomethacin (1) did not induce significant changes in blood pressure or in renal circulation in renovascular hypertensive rabbits with normal renal blood flow; (2) induced renal insufficiency and aggravated hypertension in hypertensive rabbits whose renal blood flow was below normal levels; (3) did not alter the reversal of renovascular hypertension produced by the release of the renal arterial constriction; and (4) induced a decrease in plasma renin activity by decreasing renin release. These findings indicate that the vasodilator and natriuretic actions of prostaglandins may play an important role in protecting the kidney against ischemia; the facilitating role of renal prostaglandins on renin release raises the possibility that a primary hypersecretion of renal prostaglandins is responsible for Bartter's syndrome, whereas a primary deficiency may be responsible for "low-renin hypertension."


Urinary kallikrein in rats bred for susceptibility and resistance to the hypertensive effect of salt and in New Zealand genetically hypertensive rats.

Urinary kallikrein excretion was studied in rats bred for susceptibility and resistance to the hypertensive effect of salt. The rats were on a regular rat chow diet (0.45% sodium content) and tap water and were not hypertensive at the time of the study. Urinary kallikrein excretion, measured by kinin radioimmunoassay, was 10 to 20 times lower in the susceptible rats than in the resistant rats (4.39 +/- 1.61 microgram/24 hours and 56.4 +/- 5.8 microgram/24 hours, respectively; P less than 0.001). Urinary kallikrein excretion was also measured in New Zealand genetically hypertensive rats and in normotensive Wistar-Otago rats (controls). Kallikrein was found to be significantly lower in the genetically hypertensive rats than in the controls (49.1 +/- 6.2 microgram/24 hours and 76.8 +/- 6.9 microgram/24 hours, respectively); however, when expressed per 100 g of body weight, there was no significant difference. In conclusion, although urinary kallikrein excretion per rat was decreased in the genetically hypertensive rats when compared with the controls, this difference could be caused by the lower body weight of the genetically hypertensive rats. Urinary kallikrein excretion, when expressed per 100 g of body weight, is significantly lower in susceptible than in resistant rats. This could be a consequence of a genetic defect that may play a role in the development of hypertension, perhaps through alteration of renal function.


A population-based assessment of the continuity of ambulatory care.

A strategy is described in which explicit patient care criteria are used to measure the continuity of the health problem solving process. Prevalent diseases are selected to represent the work load of the health system. Continuity is defined in terms of rates of transition between the major clinical elements: screening, the definitive diagnostic evaluation, treatment, and follow-up evaluation. Results define critical dropout patterns and promote constructive assessment of the health care system. Sample data from the Indian Health Service are presented and discussed.


Interdiagnosis relationships of physican recording in ambulatory child health care.

The joint Committee on Quality Assurance developed and validated by expert opinion a list of criteria for each of seven areas of ambulatory child health care: well-child supervision in four age ranges: bith to 1 year, 1 through 5 years, 6 through 12 years, and 13 through 18 years; and three diseases: bronchial asthma, tonsillopharyngitis, and urinary tract infection in the female. Each physician was scored on a list of criteria for each of the seven areas. The relationship among the areas was studied by correlating the scores on these criteria. The degrees of the relationships among the seven areas of care, and the reliability of each list of criteria are reported. All relationships were positive. Various age ranges of health supervision were more strongly related to one another than to any of the diseases. Individual diseases were more strongly related to one another than to health supervision. Reliabilities of each list ranged from .74 to .95. All correlations between areas were positive and, except for health supervision (birth to one year) with the three diseases, significant (p less than.01). These high correlations would imply a great deal of homogeneity among health care areas of ambulatory child health care.


Respiratory activities of hepatocytes isolated from rats of various ages. A brief note.

The ratio between the oxygen consumption of isolated hepatocytes in the presence of an inhibitor of oxidative phosphorylation (oligomycin, atractyloside) and in the presence of an uncoupler (dinitrophenol) is used as an estimation of the respiratory control ratio of mitochondria inside the isolated liver parenchymal cell. No significant age-related decline in the functional integrity of the mitochondria could be detected.


Colony size distribution as a measure of age in cultured human cells. A brief note.

Individual human diploid cells from the same culture differ greatly in the number of doublings they can achieve and consequently the size of colony they can initiate. Computer simulations suggested that the life-span of a culture could be determined from the distribution of colony sizes. Colony size distributions of cultures of a human diploid fibroblast, WI-38, were determined experimentally and found to be a sensitive measure of in vitro age. In particular, there is a highly significant linear correlation between the percentage of colonies of sixteen or more cells and the number of population doublings remaining in the in vitro life-span. Thus, the colony size distribution can be used to predict the number of population doublings remaining in the vitro life-span of a human diploid fibroblast cell culture without knowledge of its prior history.


Interdiagnosis relationships of physician performance measures in hospitals.

Correlations among ten diagnostic categories of hospital care physican performance measures are reported. Using measures of conformance to predetermined criteria for optimal performance, mean scores of individual physican performances within diagnostic categories were calculated and correlated. Measurement reliability estimates were computed and it was suggested that a minimum of four cases in each diagnostic category be used for measurement of performance on the individual physician level of analysis. There appeared to be homogeneity of performance measures among some but not all diagnoses studied. This finding reinforces the need to examine interdiagnostic correlations before attempting to measure overall individual physican performance by combining measures from separate diagnostic categories.


Variation among physicians in use of laboratory tests. II. Relation to clinical productivity and outcomes of care.

Previous studies from this institution have shown extreme variation in laboratory and x-ray use among comparably trained physicians caring for similar patients. In addition, essentially no correlation (r = --.13) existed between a physician's lab use profile and subjective estimates of clinical competence. This study compares variations in lab use with both clinical productivity and outcome of care. Costs of lab tests of 149 long-term ambulatory hypertensive patients cared for by 13 faculty internists during one year were computed. Variation in mean annual lab costs per patient among the internists was great (range, $8-$161; standard deviation, $42). Outcomes of care were estimated using hypertension as an indicator condition. The physicians were scored according to percentage of hypertensive patients with systolic and diastolic pressures below specified levels. Correlation between lab use profiles and outcomes was negative (r = --.42) but not significant. Clinical productivity was estimated by two methods: adjusted panel size and subjective estimates of efficiency by the clinic administrator. Correlations between lab use behavior and each estimate of productivity were negligible (.13 and --.16 respectively). These data indicate that in this setting there is no positive association between a physician's frequency of lab use and either clinical productivity or outcomes of care.


Accuracy of physicans' predictions of cholecystography results.

In the decision theory model of medical diagnosis and treatment, optimal choice of diagnostic tests requires accurate estimation of the probability that a given test will be positive. We assessed the ability of physicians to estimate the probability that a specific test (cholecystography) would be positive. For 102 patients, the predicted number of gallstone cases, 35.8, was significantly greater than the observed number, 15 (p less than 0.001), even though 13 of the 15 observed cases were patients with previous radiographic evidence of gallstones. The overestimation of probability of positive tests casts doubt on the correctness of decisions regarding selection of diagnostic tests when these decisions are derived from probability estimates based on intuition or expert opinion.


The effect of age on protein synthesis by isolated liver parenchymal cells.

The protein synthesizing capacity of liver parenchymal cells isolated from 3-, 12-, 24-, 31- and 36-month-old rats was determined by the incorporation of 14C-leucine. Conditions for optimum protein synthesis included the use of an enriched medium (modified Waymouth's MB 752/1) and cell suspension concentrations ranging from 0.25 to 4 X 10(6) cells/ml medium. The cells were incubated with a dose of 6 micronmol leucine/ml medium for 2 h at 37 degrees C under an atmosphere of 95% O2 and 5% CO2. With parenchymal cells isolated from 3-month-old rats, a leucine incorporation rate of 14.4 nmol leucine/h/10(6) cells was found. The capacity of the parenchymal cells to synthesize protein decreased between 3 and 12 months, remained constant between 12 and 24 months and increased between 24 and 26 months. Degradation of newly synthesized proteins or reutilization of 14C-leucine did not occur during the incubation period. The ratio between albumin and total protein synthesis as a function of age was determined. This ratio did not change between 3 and 24 months but there was a significant increase between 24 and 36 months. The increase in total protein synthesis in late age may be due to a compensation by the liver for a more pronounced proteinuria, increased proteolysis or an accumulation of "altered" proteins.


Developmental patterns of plasma TSH, T4 and T3 in rats deprived of light from birth.

Plasma levels of TSH, T4 and T3 in the rat show characteristic developmental patterns within the first postnatal month, with TSH reaching a peak on day 13, T4 on day 16 and T3 on day 20. In dark-reared rats, a significant reduction in plasma T3 associated with low plasma T4 as well as high plasma TSH suggest that light-deprivation from birth impairs and/or delays maturation of pituitary-thyroid axis.


Factors affecting nursing home medical review Implications for program and facility planning.

A system for the Medical Review of nursing home patients has been fully operational in the state of Rhode Island since 1973. This study examines recommendations as to the appropriate level of care required by each of 1,309 skilled nursing patients reviewed during the system's first full year of operation and relates these recommendations to a number of other factors, including patient and facility characteristics. Variables measuring patient medical condition and need for skilled nursing care correlated strongly with level of care recommendations made by the team of professional reviewers. In addition, facility licensing status emerged as a significant influence in the decision-making process concerning appropriate level of care assignments. Skilled nursing patients in multi-level (SN/ICF) facilities were much more likely to be recommended for less intensive, intermediate levels of nursing care than were patients residing in single-level (SN) facilities. This relationship persisted after controlling for variations in patient characteristics, but was strongest among those patients for whom the need for continued SN care seemed most dubious. The authors conclude that 1) the relationship can be attributed to a reluctance on the part of the review team to physically relocate aged patients, and 2) long-term care patients with complexly intertwining medical and social needs might be most appropriately placed in facilities which offer a spectrum of services and multiple levels of care.


Clinical engineering: an in-depth review of its economic potential.

Clinical Engineers are currently employed in hospitals to see that the more complex instrumentation is electrically safe and well maintained. Such an objective fails to capitalize on the economic advantages which can be derived from specialist management. This paper proposes that the objective be broadened to cover the application of engineering technology for lower cost-higher quality health care. The functions involved and the staff needed to attain this objective are analyzed, together with the modus operandi for selecting and integrating cost-effective equipment, designing practical maintenance programs, and training the staff to avoid equipment abuse. Details of recent equipment-oriented malpractice suits are reviewed to identify already proven vulnerable areas. The results achieved from this approach at a 450-bed University Hospital show an estimated reduction of from $144 to $59 for the average cost of a repair, and an overall 60 per cent cost saving in the handling of the biomedical electronic equipment.


U. S. medical graduates versus foreign medical graduates. Are there performance differences in practice?

This study has attempted to determine the relationship between physicians' medical education and their performances (technical quality and utilization of medical care resources) in offices and hospitals. The sample consisted of 506 physicians of Hawaii, involving 18 specialty categories. The study finds little evidence of the influence of the type of medical schools on physicians' technical quality and utilization of medical resources in practice. The mean differences between the categories of medical schools were not statistically significant (except for the quality when specialists practiced within their own areas of specialization). There is no evidence that all categories of U.S. medical graduates provided a higher quality care and better utilization than all categories of foreign medical graduates. There was no consistent pattern of performances within the categories of U.S. medical schools and of foreign medical schools in these dimensions of performances.


Physicians' knowledge of and response to patients' problems.

The purposes of the study were: 1) to describe the extent of the physician's knowledge and his response; 2) to measure the degree of correlation among four indicators of knowledge and among four indicators of response; and 3) to measure the association between physician's knowledge and his response. There were five physicians and 299 patients in the study. All the patients had at least one chronic condition and one current complaint. The four indicators referred to the four kinds of problems considered: discomfort, worry, disturbance of daily living, and social problems. The physicians had high percentages of perfect scores on knowledge of discomfort, worry, and disturbance of daily living, but a low percentage on knowledge of social problems. Scores on response to discomfort were high but were low on response to other aspects. The correlations between knowledge and response, although statistically significant, were low for all four types of problems. It is possible that these correlations were underestimated because the physician's responses were recorded only for the three-month period of the study.


Treated adverse effects of drugs in an ambulatory population.

Adverse drug reactions represent an area of concern in the delivery of medical care. Current data available indicating the nature and extent of the problem of adverse drug reactions are recognized as inadequate for policy making. This study contributes new information about the adverse effects of drugs treated in an outpatient population. The findings showed that the adverse effects of oral contraceptives accounted for a large share of medical care contacts, procedures rendered, and estimated dollars expended. The incidence and prevalence rates indicated relatively few persons among the population were treated for adverse effects of drugs. Annual costs to the medical care system of treating adverse drug effects were estimated to be $.83 per person. Additional information is needed about adverse drug reactions if strategies and approaches to deal with adverse effects of drugs are to be efficient and effective.


Common neurologic syndromes in medical practice.

The cases presented here are intended to illustrate an approach to the patient with complaints which may be vague, evanescent, or related to emotional factors. A scheme to analyze only five factors, mood, movement, sensation, cognition, and consciousness is presented to simplify the complexity of human behavior in order to arrive at correct diagnoses. The importance of a complete medical evaluation is stressed. Psychosis and other major psychiatric illness have been alluded to, but space does not permit discussion of the very important issues of the genetics, the neurochemistry, and the differential diagnosis of schizophrenia, mood disorders, and the organic brain syndromes. Some of the many manifestations of epilepsy have been presented, and the importance of electroencephalography and computed axial tomography is stressed. The references have been chosen for their general utility to practicing clinicians, especially the works of Pincus, Glaser and Tumulty.


Psychological aspects of oncology.

The patient with cancer presents the physician with challenging psychological issues: maintenance of an effective and understanding physician-patient relationship, in the context of optimal medical care, and alertness to signs of significant psychologic symptoms that may occur more commonly in the course of cancer. The closest relative, also under great emotional stress, must be considered in communications about the patient's clinical state and treatment. Psychological aspects of oncology are a demanding component of total care of the cancer patient, yet an integral part of optimal cancer care.


Pain: the most common psychosomatic problem.

The individual who complains of pain often has a combined emotional and organic experience. Pain is the resultant symptom of organic factors, personal and developmental phenomena, as well as social and cultural characteristics of the individual. The individuals who complain of pain often have chronic histories of difficulty and disability thus creating a difficult treatment problem. The physician who faces such individuals must attend the psychological, social, and organic entities in order to adequately manage and help rehabilitate these distressed individuals.


Basic considerations in the treatment of obesity.

The recognition and treatment of obesity has undergone marked changes in the past two decades. Along with the abandoning of the concept of exogenous obesity, the physician has discovered a variety of developmental, psychological, pharmacologic, socioeconomic, neurological, and genetic roots for the syndrome. The clinician has also found medical treatment modalities (fasting and behavior modification) that hold much more promise than traditional supportive relationships with dietary consultation and anorexogenic medications. Surgical treatment also, ileojejunal bypass, is gradually emerging as a treatment of choice for certain well-motivated, super-obese people for whom all other treatment modalities have failed. Future research into central serotonergic mechanisms offers hope that we can begin to know what it is that turns on hunger, turns off appetite, and regulates weight in such a stable manner over such a long period of time.


Rhabdomyoma of the pharyngeal wall.

Rhabdomyoma is a rare benign tumor of skeletal muscle, and the head and neck region is the most common extracardiac area for these tumors to occur. Twenty-one cases have previously been reported, and this report, "A Rhabdomyoma of the Pharyngeal Wall," brings the total to 22. Pathologically, these tumors show abundant polygonal skeletal muscle cells with demonstrable cross striations. Differential diagnosis of these tumors has included granular cell myoblastoma and rhabdomyoscarcoma. Treatment is usually complete excision.


Assessment by audiotympanometric testing: three case reports.

Tympanometric measurements are versatile and accurate when more than one type of ear disease is present. Three cases are presented where information from tympanometry beyond that derived from otological and routine audiological testing yielded accurate diagnoses. A patient with a history of middle-ear disease presented with a sensori-neural loss. Measures of static conductance correctly identified the problem as stiffness of the ossicular chain. An infant with unilateral congenital atresia and questionable hearing in her normal-appearing ear was determined to have serous otitis media by tympanometry and reflex testing. The course of the disease was monitored and reversed. A 17-year-old female suffered a basal skull fracture with a sudden conductive hearing loss. Low conductance and high impedance correctly identified loss of mobility of the ossicular chain which was confirmed surgically. These three cases illustrate the advantages of tympanometry in making rapid, accurate, objective measurements involving complex diagnoses of middle-ear function.


Nystagmus responses to water and air caloric stimulation in clinical populations.

The nystagmus responses of two groups of patients referred for electronystagraphy were compared to test for differences between air and water caloric stimulation. Responses from patients with spontaneous or positional nystagmus or who showed greater than 30% directional preponderance or excitability of labyrinth were removed from the data. The 30 degree C and 44 degree C water and the 24 degree C air produced equivalent responses. The 50 degree C air produced responses with slow component velocities greater than expected; however, the distributions of computed directional preponderance and excitability of labyrinth showed no differences between the air and water caloric stimulation.


Sequenced scintigraphy: a morphological and functional study of the salivary glands.

The use of scintigraphy in sequenced registration shows that there are three fundamental stages in the intraglandular turnover of the radionuclide: 1. At very early stage (between 3 min. and 15 min.), the major salivary glands could be clearly distinguished; 2. At the stage immediately following (between 20 min. and 35 min.), both the parotid and submaxillary glands were already less well defined; while in the mouth projection zone, quite intense radioactivity, connected with a progressive accumulation of the radionuclide in the minor salivary glands, was seen; 3. Within an hour after injection, maximum captation took place in the minor salivary glands, while both the parotid and the submaxillary glands were hardly distinct. These three stages are strictly related to the three phases of behavior of the radionuclide in each salivary gland; arrival, accumulation, dismissal. Then, each documented variation from the normal pattern will indicate a determined functional anomaly related to defined disease of the salivary glands. The sequenced scintigrraphy offers a functional study of the salivary glands from which it is possible to obtain many elements of practical clinical utility.


Ototoxicity and the olivocochlear bundle.

Cochlear hair cell damage due to kanamycin sulfate was studied in chinchillas receiving 200 mg/kg kanamycin for nine days. The drug was given to a group of animals with lesions of the crossed olivocochlear bundle, a group that had received a sham operative procedure, and a group of normal animals. The animals were sacrificed 14 days after the last drug injection and the cochleae removed for examination by surface preparation. The lesioned animals showed markedly less hair cell loss than the control groups, and this was attributed to the fact that the loss of the efferent endings rendered these animals less susceptible to the ototoxic effects of kanamycin.


Liposarcoma of the larynx: a multicentric or a metastatic malignancy.

The third case of liposarcoma of the larynx, this one arising from the preepiglottic space, is presented. The report is unique in so far as the patient previously had been treated for a liposarcoma in another anatomic region. The diagnosis in this case was in doubt until electron microscopic studies were done. Since the histopathology of the laryngeal and the previous liposarcoma were different, the question of metastasis versus multicentricity was raised. Other discussions of liposarcomas over the past three decades have not resolved this aspect of their behavior completely. In this instance, after considering avenues of metastatic spread in conjuction with the histopathology, it would appear that the laryngeal lesion was a second primary and not a metastasis.


Otoadmittance in normal subjects.

Otoadmittance audiometry was performed on a group of young subjects (18-30 years old) with normal hearing. Mean values and standard deviations for static admittance, conductance and susceptance were computed on the basis of the point of maximum compliance, as well as the point of zero cross (drum-free position). In addition, the values of curve width for conductance and susceptance, middle ear pressure and the threshold of the acoustic reflex for pure tones and interrupted tones were evaluated. Subjects presenting an abnormality of the tympanic membrane were studied as a separate group. The results obtained in this study were compared with those reported in the literature.


Traumatic carotid-cavernous sinus fistula.

Seventy-five percent of carotid-cavernous sinus fistulae result from high velocity head trauma. The most common symptom is a pulse synchronous bruit which usually becomes apparent when the patient regains his sensorium. The objective manifestations of such an arteriovenous fistula are characteristically localized to the ipsilateral orbit. A periorbital bruit and venous engorgement of the palpebral and bulbar conjunctivae are pathognomonic features. Bilateral carotid angiography confirms the diagnosis and determines which of several techniques might be used to obliterate the fistula. Occasionally the classic signs and symptoms may be delayed for days or weeks. Thus, the maxillofacial surgeon must be aware of this clinical entity to avoid untimely repair of facial fractures with potentially disastrous consequences.


Squamous cell carcinoma of the soft palate.

Thirty-eight patients with squamous cell carcinoma of the soft palate treated between 1960 and 1975 were reviewed. Males in the seventh decade predominated. All symptomatic patients complained of sore throat and/or odynophagia. Seventy-eight percent were symptomatic less than three months. Approximately equal numbers of patients presented with T1, T2, and T3 tumors. Twenty-seven percent had cervical metastases when initially seen. The majority (89%) of patients were treated with radiation initially and the remainder (11%) received radiation therapy at the time of postsurgical recurrence with an absolute five year survival of 33%. Patients less than 60 years of age and those with small primary tumors and no neck metastases demonstrated better survival. Radiation therapy to the primary tumor and neck appears to be the preferred modality of initial treatment.


Partial horizontal supraglottic laryngectomy. A method of reconstruction.

Despite the low occurrence of early laryngeal lesions amenable to Partial Supraglottic Laryngectomy, they form a very interesting and important group of lesions. Timing is important in their recognition, since adequate treatment can then be secured and important functions of the larynx preserved. The draw back in the treatment of these lesions by partial laryngectomy lies in the difficulty in restoring the patient to his preoperative pattern of life. Repeated aspiration pneumonitis becomes a life threatening problem in a good number of such patients. A new method of reconstruction is described here by which the aspiration problem is obviated with the aid of a pedicle flap to line the raw surface of the transected base of the tongue allowing the organ to remain in a position capable of occluding the glottis during deglutition, and at the same time guiding the food along the posterior pharyngeal wall and into the esophagus.


Clinical evaluation of TMJ arthroplasties with insertion of articular eminence prosthesis on ninety patients (an eight year study).

This paper represents an analysis, accomplished over an eight-year period, of 90 individuals who have been operated on for various arthritic diseases of their temporomandibular joints (TMJ). In arthritic changes of the joint, several changes may occur: perforation of the disc, flattening of the articular eminence, asymmetrical condylar movement, and chronic synovitis. This may result in increased synovial pressure on nerve fibers within the capsule of the joint, and a variety of referred pain symptoms. Prior to operation, a careful differential diagnosis was made by an otolaryngologist and, frequently, by a neurologist/neurosurgeon and a psychologist. The prosthesis inserted during surgery was a metallic device which fits over the articular eminence in the upper portion of the joint. This prosthesis accomplished primarily three functions: elimination of the crepitus; restoration of the contour of the eminence; separation of the articular surface of the joint.


Recording projection of nasal landmarks in rhinoplasty.

Because of difficulties in making accurate measurements from before and after photographs, we have devised measuring techniques not dependent upon exact reduplication of photographic circumstances before, during, and after surgery. Measuring devices contacting the head of the patient in specified ways are described. They allow simple and exact reduplication so that measurements made at different times can be compared. Lengths of nose and of columella and actual projection of brow, nasofrontal angle, rhinion, supratip region, the tip itself, and of the columella-labial junction can be measured. Tip rotation, cephalic or caudal, can be determined and quantitated. The devices and techniques for using them are described. We believe that employment of the suggested measuring techniques will allow better reporting of rhinoplastic methods and results should significantly increase our understanding of this complex surgical procedure.


Studies on the total synthesis of bisindole alkaloids in the vinblastine-vincristine series.

A series of investigations involving the total syntheses of a variety of indole and dihydroindole alkaloids in the Aspidosperma, Iboga and Vinca families are discussed. In this lecture particular emphasis is placed on studies relating to the synthesis of the clinically important bisindole or "dimeric" alkaloids of the vinblastine-vincristine family. Apart from the activity demonstrated by the natural alkaloids, it is shown that closely related synthetic derivatives can possess interesting anti-tumor activity as well.


A comparison of the mechanisms of action of VP-16-213 and podophyllotoxin.

A comparison of the mechanism of action of VP 16-213 and podophyllotoxin has revealed that although both drugs inhibit nucleoside uptake in HeLa cells, they exhibit other biological properties which are quite distinct. Podophyllotoxin inhibits microtubule assembly in vitro while VP-16-213 has no effect in this system. VP-16-213 induces single-stranded breaks in DNA in HeLa cells, an effect which may explain the cytoxicity of VP-16-213. In contrast to VP-16-213-treated cells, cells treated with podophyllotoxin maintain DNA integrity and show no evidence of single-stranded breaks.


Purification and properties of anthranilate synthetase from the ergot fungus, Claviceps spec., strain SD 58.

A three-enzyme complex containing anthranilate synthetase, phosphoribosyl anthranilate isomerase and indole-3-glycerol phosphate synthetase was partially purified from Claviceps spec., strain SD 58. The anthranilate synthetase activity of the enzyme complex was quite unstable unless glutamine, MgCl2, TRIS and, most importantly, glycerol were included in the extraction buffer. The three-enzyme complex showed a molecular weight of 400,000 when estimated using Sephadex gel filtration, and a molecular weight of 200,000 when using sucrose density gradient centrifugation. At least two bands of anthranilate synthetase were detected on disc gel electrophoresis. An enzyme complex containing phosphoribosyl anthranilate synthetase and indoleglycerol phosphate synthetase, but no anthranilate synthetase, was isolated from Claviceps. This enzyme complex had an apparent molecular weight of 165,000 as estimated by sucrose gradient centrifugation. Anthranilate synthetase is inhibited by L-tryptophan and elymoclavine, the terminal ergot alkaloid produced by this strain of Claviceps. No differences could be detected between the enzyme complexes isolated from 2-day-old growing mycelia and from 6-day-old alkaloid-producing mycelia of the organism.


Two metabolites from Aspergillus flavipes.

Two novel fungal metabolites, N-benzoyl-L-phenylalaninol (1a) and asperphenamate (2) were isolated from the culture filtrate and mycelium of Aspergillus flavipes ATCC 11013. N-benzoyl-L-phenylalaninol was identified by direct comparison with an authentic sample. The structure of asperphenamate is proposed as (S)-N-benzoyl-phenylalanine-(S)-2-benzamido-3-phenyl propyl ester, based on chemical and spectroscopic evidence.


Toxic principles of hippomane mancinella. II. Structure of Hippomanin A.

Hippomanin A is a pale yellow crystalline toxic principle isolated from the water-soluble portion of the ethanolic extract of Hippomane mancinella. Acid hydrolysis gave glucose, gallic acid and ellagic acid, thus showing that it belonged to the class of "crystalline tannins" and was isomeric with corilagin. The presence of free anomeric hydroxyl was shown by methylation and by reduction with sodium borohydride. Mass spectral and chemical evidence showed that the structure was 2-galloyl-4,6-hexahydroxydiphenoyl-D-glucose.


Potential anticancer agents. IV. Constituents of Jacaranda caucana Pittier (Bignoniaceae).

An aqueous ethanol extract of Jacaranda caucana Pittier (Bignoniaceae) showed in vivo antitumor activity against the P-388 lymphocytic leukemia system. Fractionation, accompanied by monitoring for biological activity, afforded a novel phytoquinoid derivative jacaranone, which exhibited both in vivo antitumor and in vitro cytotoxic activity. beta-Sitosterol, betulinic acid, ursolic acid, 2alpha-hydroxyursolic acid, 2alpha,3alpha-dihydroxyurs-12-en-28-oic acid and a new triterpene acid, jacarandic acid, were also isolated. The structure elucidation of jacarandic acid is described.


Cactus alkaloids. XXXI. beta-Phenethylamines and tetrahydroisoquinolines from the Mexican cactus dolichothele uberiformis.

A total of ten alkaloids have been identified in extracts of a Mexican cactus, Dolichothele uberiformis (Zucc.) Br. and R. The data provide documentation for the presence of (--)-synephrine, (--)-longimammine, N-methyl-3,4-dimethoxy-beta-phenethylamine, N-methyl-4-methoxy-beta-phenethylamine, (--y-normacromerine, N-methyltryramine, hordenine, longimammatine, and the first reported isolation of (--)-N,N-dimethyl-beta-hydroxy-beta-phenethylamine (ubine) from a natural source. Spectral data support the identification of another new alkaloid (uberine) as 5-methoxy-7-hydroxy-2-methyl-1,2,3,4-tetrahydroisoquinoline.


Mannosidosis in three brothers--a review of the literature.

Three brothers with mannosidosis were studied, and their clinical and biochemical manifestations are compared with those of 41 cases in the literature. All three boys have psychomotor and growth retardation, characteristic facies, recurrent respiratory infections, sensorineural deafness, craniosynostosis, protuberant abdomens, and thin limbs. Roentgenographic findings of mild dysostosis multiplex, thick calvaria, abnormally contoured vertebrae, coarse trabeculi and thin cortices are consistent with those of reported cases. The lymphocytes of peripheral blood and bone marrow are vacuolated. Alpha-mannosidase deficiency in leukocytes and cultured skin fibroblasts and glycoproteinuria have been documented. The biochemistry  of this glycoproteinosis and the pitfalls in diagnosis, such as improper assay conditions of pH and substrate concentration, are discussed. Extrapolation of in vitro and animal model studies suggest that trace metal therapy may be more effective than attempts at enzyme replacement to treat this hereditary storage disease.


Carbohydrate metabolism in hypothyroid myopathy.

The carbohydrate metabolism in hypothyroid patients was investigated. After an overnight fast, the blood glucose level was 24% lower and the blood lactate level was 35% lower in the untreated hypothyroid patients than that observed in the treated hypothyroid patients or in the normal subjects. There was no difference in the blood alanine or plasma free fatty acid values between the subject groups. Skeletal muscle biopsied from two hypothyroid patients with marked myopathy showed normal glycogen content, 0.83%-0.86% (normal 1.06%), but reduced activity of acid maltase, 32-50 nmoles/min/g (normal 97). Forearm ischemic stimulation applied to hypothyroid patients failed to elevate the level of lactate. The results are compatible with impaired glycogenolysis from the skeletal muscle, which may be a contributory factor in the myopathy in hypothyroidism.


Glucocorticoid control of hepatic proline oxidase.

Since adrenal corticosteroids are known to affect amino acid metabolism and gluconeogenesis, we examined the relationship of these hormones to hepatic proline oxidase, the mitochondrial enzyme degrading L-proline. In adrenalectomized rats hepatic proline oxidase activity decreased to about 50% of control levels within 5-6 days. This depressed activity can be restored to normal by 4 days of corticosteroid repletion. Treatment of intact rats with supraphysiologic doses of corticosteroid further elevated proline oxidase activity. The level in treated intact rats was three-fold that of adrenalectomized rats. Kinetic analysis revealed that corticosteroid increased the amount of enzyme without altering enzyme affinity for proline. Administration of a single dose of corticosteroid to either adrenalectomized or intact animals increased enzyme activities, with a lag time of less than 2 hr. The maximum effect occurred 5-6 hr following injection. Since proline degraded by this pathway can contribute carbon skeletons directly to carbohydrate, corticosteroid induction of proline oxidase may play an important role in hepatic gluconeogenesis occurring with corticosteroid action.


Amino acid modulation of glucose-induced insulin and glucagon release in diabetic patients.

In order to determine whether amino acids have a beneficial effect on glucose tolerance in diabetes, the effect of intravenous infusion of mixed amino acids on plasma insulin, glucagon, and blood glucose responses to oral glucose loading was studied in patients with mild to moderate diabetes. Intravenous infusion of mixed amino acids over a period of 30 min which was started 30 min or immediately before oral glucose loading significantly augmented the insulin response but did not improve the blood glucose curve, probably due to excessive glucagon response. However, amino acid infusion over a period of 60 min started immediately before oral glucose loading evoked a sustained rise of plasma insulin associated with a lesser degree of glucagon secretion, thus causing significant improvement of the blood glucose curve.


The effect of glycerol and other intermediates on the incorporation of 14C-fructose and 14C-glucose to hepatic triglyceride.

Mature male rats were given, orally, 14C-fructose either alone or in conjunction with dihydroxyacetone, glyceraldehyde, or glycerol. Glycerol was also administered with 14C-glucose in a dose equimolar with fructose. After 2 hr the rats were killed and the liver triglyceride fraction was separated. Estimations of the degree of incorporation of 14C from the radioactive labeled carbohydrate into the glycerol and fatty acid moieties were carried out. Dihydroxyacetone and glyceraldehyde reduced the incorporation of 14C-fructose into hepatic triglyceride to approximately equal extents, suggesting that both trioses contribute equally to alpha-glycerophosphate formation. Glycerol, however, brought about a profound increase in the amount of fructose converted to triglyceride. This effect of glycerol was not apparent to any measurable extent on glucose incorporation into triglyceride and none of the intermediates affected the proportional distribution of radioactive counts between the fatty acid and glycerol moieties of the triglyceride after 14C-fructose administration.


Suppression of human growth hormone secretion by cyproheptadine.

In order to determine whether or not a serotoninergic mechanism is involved in the secretion of the growth hormone (GH), a study was made of the effect of cyproheptadine, an antiserotonin agent, on plasma GH levels in normal children. The oral administration of cyproheptadine (12 mg daily) reduced GH responses to both L-dopa and glucagon; similarly, the mean GH response to oral glucose administration was significantly reduced after cyproheptadine administration. Plasma glucose values during the tests were not altered by cyproheptadine therapy. These results suggest that the serotoninergic mechanism might be involved in L-dopa-, glucagon-, and glucose-induced GH release.


Isolation and biological characterization of a measles virus-like agent from the brain of an autopsied case of subacute sclerosing panencephalitis (SSPE).

Isolation of a cytopathic agent causing formation of syncytial giant cells in co-cultivated Vero cells from the brain of an autopsied case of subacute sclerosing panencephalitis (SSPE) is reported. The syncytia usually autolyzed from the center after growing to 1 to 2 mm in diameter and then detached from the culture vessels, and finally made macroscopically recognizable round plaques on the monolayer under liquid overlay. The agent was identified serologically as an agent related to measles virus, by both immunofluorescent tests and plaque reduction tests using anti-measles sera. However, the infected cells did not produce either virions or hemagglutinin, and failed to show hemadsorption and hemolysis of African green monkey red cells even after the 55th passage through Vero cells. Newborn mice, adult mice and hamsters showed neurologic signs after intracerebral inoculations of the infected cells, and most of them died from acute encephalitis. Guinea pigs were unsusceptible. From the brain of the animals with neurologic signs, a similar agent to the inoculated one was recovered. The new isolate appears to be a strain closely related to measles virus on the basis of serology, and was designated as SSPE-"Kitaken-1" strain.


Properties of virus isolated from an epidemic of hand-foot-and-mouth disease in 1973 in the city of Matsue. Comparison with Coxsackievirus group A type 16 prototype.

The virus strains isolated from clinical cases in an epidemic of hand-foot-and-mouth disease in Matsue in 1973 were characterized and its properties were compared with those of the Coxsackievirus group A type 16 (CA 16) prototype strain. The virus isolated in 1973 was similar to CA16 prototype virus with respect to morphology in electron microscopy, resistance to ether and capability to replicate in meidum containing fluorodeoxyuridine. Cross neutralization tests using guinea-pig and horse antisera revealed that there was little or no detectable common antigen between the two viruses. The two viruses also differed in heat stability of virion infectivity: the 1973-viruses were much more resistant to heat than the prototype virus. Under one-step growth conditions in Vero cell cultures, growth rate and virus yield of the 1973-viruses were lower than those of CA16, but this property was independent of incubation temperatures, pH of culture medium and other culture conditions. Several other differences in property between the 2 strains are also described. It is concluded that the epidemic in 1973 was caused by a virus whose properties differed greatly from those of the CA16 prototype.


Measurement of flow dynamics in the microcirculation.

The measurement of flow in the microcirculation is based on the processing of optical signals derived from photometers onto which is projected the image of the microvessel under study. Reliable flow records can be obtained from capillaries up to vessels 100 micrometer in diameter. Television recordings of microvascular scenes provide additional data since flow in many capillaries can be determined simultaneously. A specialized correlator provides a dynamic response sufficient to quantify pulsatile flow, vasomotion, and the effects of physiological maneuvers. The methodology is presently being applied to studies in the human skin.


Noninvasive numerical vivisection of anatomic structure and function of the intact circulatory system using high temporal resolution cylindrical scanning computerized tomography.

A high temporal resolution cylindrical scanning computerized tomographic system (DSR) is being built for study of anatomic structural/functional relationships of heart, lungs, vascular anatomy, and circulatory dynamics in any region of the body. Unlike current commercial CT scanners which scan only one or, at most, a few cross sections at a time, cylindrical scanners such as the current Mayo SSDSR and upcoming DSR scan nearly 250 cross sections simultaneously. Twenty-eight or more multiplanar images over a range of 160 or more degrees of an entire rapidly moving structure such as the heart or a segment of the circulation will be recorded in periods as short as 10 msec by the DSR at 60/sec rates and stored in computer memory. The scanned volumes can then be sectioned mathematically in any direction at will, including zooming in on regions of interest to problems at hand (e.g., clinical diagnoses). Progression from biomedical investigation to practical clinical and health care uses requires development of special-purpose, readily replicable, economical (but very high speed and volume) data handling and computational devices. The ultimates overall objective is to quantitatively characterize the performance of the human cardiopulmonary and circulatory systems utilizing pertubations associated with various types of physiologic stress and congenital or acquired disease processes including neoplasia.


When to measure flow and when to hold it constant.

There is a time to measure blood flow and a time to hold it constant. Natural pressure/natural flow (pressure and flow measured), controlled pressure (flow measured), and controlled flow (pressure measured) are the possibilities, and there are definite indications for the use of each. For example, when the aim is to determine the natural hemodynamics of vascular beds, we operate in the natural pressure/natural flow mode. When the objective is to study autoregulation of blood flow, the controlled pressure mode is used. When the aim is to determine the activity of a substance on an in situ vascular bed, it is convenient to set flow constant and measure perfusion pressure, because in this mode blood concentrations can be predetermined and repeated as often as desired. In this review, the virtues and indications for each of these three possible modes of study are considered.


Blood flow measurement: future applications and prospects.

Blood flow measurements have great potential value for evaluating ventricular performance in humans in terms of dynamic properties--peak velocity, acceleration, and instantaneous power development. Transcutaneous ultrasonic Doppler flow sensors provide new and exciting opportunities as simple, noninvasive techniques for ready access to this kind of information under many different circumstances. Recent developments in laser-Doppler technology provide promise of new methods for measuring blood flow in superficial vessels (i.e., skin or retina) without even contact with the surface of the body.


A hospital-based community paediatric unit.

Children with multiple handicaps often require the services of a team of professionals to ensure that they receive a comprehensive assessment. It is essential that the information derived from this assessment is conveyed accurately to the child's parents in language that they understand. It is also important that a member of the assessment team is made responsible for seeing that the recommendations made for the child's future are actually carried out. On hundred and twenty-nine children referred for assessment of developmental delay were found to have multiple intellectual, physical and social problems needing a team approach to their assessment, and the mobilization of a variety of community resources to provide their ongoing care.


Immediate sterility after vasectomy.

Phenyl mercuric nitrate as an injection, in a dilution of 0-02% and buffered to pH 7, is a potent spermicidal agent which has been demonstrated to have no harmful side effects. It produces rapid death of all spermatozoa on contact. The injection of 2-5 ml of the solution into the lumen of each vas at the time of vasectomy is a simple procedure and adds no significant time and no complications to the operation. Studies have shown that no viable spermatozoa were present at seminal counts carried out one or two weeks after operation.


A case of non-agglutinable vibrio gastroenteritis with anuria.

A case of non-agglutinable vibrio (Heiberg Group II) gastroenteritis is presented. The patient, an alcoholic, acquired this infection in Australia and recovered fully. The need to use selective vibrio media when diarrhoeal stools are cultured is emphasized.


Appendicitis presenting as a swollen thigh.

A case of acute appendicitis presenting as an abscess in the thigh with associated gas is described. The tracking of the pus down the psoas muscle is stressed, and its association with the psoas sign is noted.


Cardiac failure in infancy and childhood.

Cardiac failure in infants and children frequently results from pathophysiological mechanisms different from those of cardiac failure in adults. An age-based approach to aetiology is presented and attention drawn to details of management which should allow a high rate of salvage of patients who have reversible or correctable underlying conditions.


Evaluation of the new Gravigard IUCD inserter.

Incorporation of a flexible plastic rod into the new Gravigard plastic inserter assembly has, in our opinion, allowed for easier insertion and positioning of the device in the uterus compared with the previously available metal rod.


Detection and follow-up of moderate and severe hypertensive subjects in the Australia community.

A national screening project has detected 989 subjects aged 30 to 69 years with untreated moderate or severe hypertension. The 1-2% incidence of this condition indicates a total of about 100,000 people in the Australian community potentially requiring therapy. The sample showed that half the subjects were previously unaware of a blood pressure problem. Those so detected showed a very high rate (90-7%) of acceptance of advice to see their own doctor. The local doctors confirmed the elevated pressure level in nearly two-thirds of the patients referred, and initiated treatment in a similar proportion.


A sequential trial of viloxazine (Vivalan) and imipramine in moderately depressed patients.

Patients with moderately severe depressive illness were matched for age, sex, severity of symptoms and number of previous episodes of affective illness. Eleven pairs of patients were randomly assigned to four weeks' treatment with either viloxazine (100 mg three times a day) or imipramine (50 mg three times a day). Both treatments were associated with significant reductions in the scores on depression rating scales. With a sequential testing plan based on repeated significance tests and formed into a skewed restricted plan, no difference in the two treatments was shown. Significantly fewer side effects were reported by patients receiving viloxazine.


Meningeal cysticercosis diagnosed in Western Australia.

Two cases of the relatively unusual meningeal form of intracranial cysticercosis are described in adult Italian immigrants to Western Australia. Each presented solely with raised intracranial pressure caused by communicating hydrocephalus in association with chronic meningitis, characterized by a very low cerebrospinal fluid glucose level. The diagnosis was confirmed histologically on tissue obtained fortuitously at lumbar puncture. These cases draw attention to the epidemiological implications of cysticercosis in the Australian scene. As well, they demonstrate that repeated cerebrospinal fluid analysis may result in diagnostic confirmation of intracerebral cysticercosis of the racemose type.


The prevalence of cysticerci of Taenia saginata in cattle reared on sewage-irrigated pasture.

The hearts, masseter muscles, tongues and laryngeal muscles from 200 cattle aged 10 to 11 months, and 100 cattle aged 20 to 21 months, which had been reared on sewage-irrigated pastures at the Melbourne and Metropolitan Board of Works Farm, Werribee, Victoria, were examined for infection with cysticerci of Taenia saginata by slicing in the laboratory and the result obtained were compared with those recorded during normal meat inspection procedures at the abattoir. Of the 10 to 11-month-old cattle 51-5% were found to be infected and 8% of the total animals harboured viable cysticerci. Of the 20 to 21-month-old animals 33% were infected, and, even at this age, 8% of the animals still carried viable cysticerci. On-line meat inspection at the abattoir detected significantly fewer infections than did laboratory slicing.


Contraceptive practice by women presenting to a free-standing abortion clinic.

A study was made of the contraceptive methods practised by the first 1,007 women who presented to the Preterm Sydney Clinic regarding pregnancy termination, after the clinic opened in June, 1974. The women's use of contraception at the time of the conception in particular, and also the women's general contraceptive history are described. These factors are related to social and demographic variables of age, marital status, educational level, occupation, country of birth, and religion. Additional discussion is included on the types of contraception used, the sources of contraceptive knowledge, and the methods chosen to use after the abortion.


Neonatal tachycardia.

This paper presents two cases of neonatal paroxysmal atrial tachycardia originating in the same country area, and in fact, presenting to the same general practitioner within a month of each other. Both cases were complicated by cardiac failure, and various forms of treatment were employed with variable success.


The long and the short.

The diagnostic problems posed by unusually great height at various ages are discussed, together with the principles governing treatment to curtail height by exhibition of oestrogens or androgens. Short stature is then discussed in terms of an initial approach to assessment and diagnosis, followed by a systematic one. The main agents used in treatment are briefly mentioned, together with some details concerning the use of human growth hormone (hGH).


Carriage by air of the seriously ill.

Almost any patient may be carried by air, but air transport introduces possible problems associated with the effects of altitude, noise levels, turbulence, and the special environment. Because of these factors it is important, when considering a patient for air transport, to know the type of aircraft to be used, and the flight profile--its duration and expected cabin altitudes. It is essential to carry all equipment (as simple and as portable as possible), drugs, and diets that may be needed and to be sure that all the skills and nursing help needed to deal with any possible problems are available.


Drugs and the law.

Legal control of drugs available in Australia varies according to the nature of the drug. This article considers the question whether the different degrees of legal control can be justified on the basis of the pharmacological effects of the drugs or on the basis of their correlation with violent behaviour.


The urinary excretion of cortisol and cortisone glucosiduronates in pregnancy.

The urinary excretions of cortisol and cortisone glucosiduronates were measured at monthly intervals in three normal pregnancies by a double isotope dilution derivative method. The excretions were mostly within the normal range, but some were above the normal range suggesting that these excretions may increase in some pregnancies.


Australian multicentre trial of streptokinase in acute myocardial infarction.

The Australian multicentre trial of streptokinase in acute myocardial infarction has now been concluded. In all, 376 patients were treated with streptokinase followed by heparin and warfarin, and 371 received anticoagulants only. All patients were followed for 12 months. There was no significant difference in mortality (13-6% v. 17-0%; chi2 = 1-69).


The surgical treatment of chronic interstitial cystitis.

Satisfactory relief of the symptoms of intolerable frequency and painful voiding due to interstitial cystitis has been attained by ileocystoplasty and colocystoplasty in eight patients.


A hospital study of a new absorbent bed pad for incontinent patients.

The benefits of a unique washable and reusable absorbent bed pad (Kylie) present significant advantages over drawsheets. In a crossover study on incontinent geriatric patients, those on the new bed pads required less than half the bed changes needed by patients who were lying on drawsheets. The patients benefited by having longer periods when their skin was dry, so that the incidence of erythema was reduced. The new bed pads also demonstrated other advantages, such as less wrinkling and creasing and a reduction in the level of odour, which resulted in patients being more restful. The subsequent need for less linen meant a reduced workload for nurses and cost savings to hospitals and laundries. This bed pad represents a significant advance in the management of incontinent patients.


Ewing's tumour: uncommon presentation of an uncommon tumour.

A case of Ewing's sarcoma presenting with high cervical cord compression is described and disseminated disease was present at the time of diagnosis. A combination of radiotherapy and chemotherapy did not result in a cure. The current treatment of Ewing's sarcoma is briefly reviewed.


Prevention of childhood drowning accidents.

The data from the Brisban Drowning Study have been analysed in this article to provide guidelines for preventive strategies. The separate causal links comprising the drowning chain have been identified, and quantitative scores have been assigned to the three identifiable groups of causative factors--environmental, parent-related and victim-related. The identifiable causes of child drowning are absence of a safety barrier or fence around the water hazard, non-supervision of a child, a parental "vulnerable period", an inadequate safety barrier, and tempting objects in or on the water. Effective environmental control  can be achieved only through legislation. The complementary role of a public educational thrust in discussed. Increasing the tempo of "drownproofing* and of teaching children to swim will help, but the expected reduction in deaths and near-deaths from this strategy alone cannot yet be assessed. Compulsory first aid training for pool owners is required. Costs of implementing a total drowning preventive programme are presented.


Pseudomonas pneumonia with bacteraemia.

A previously healthy man developed fulminating pneumonia and bacteraemia due to Pseudomonas aeruginosa. This organism was isolated from sputum and blood before death, and from the lung, liver and spleen at autopsy. Bacteraemic psuedomonas pneumonia is rare, carries a high mortality, and is usually associated with serious underlying disease.


Foot lesions in diabetic patients: pathogenesis and management.

Vascular disease is the major factor in the development of many lesions in diabetics, although the independent role of neuropathy has been increasingly recognized. The major problem in assessment is to decide the severity of ischaemia and neuropathy present in a particular patient. Healing after local surgery can be expected in those lesions which are painless, and peripheral (that is, are situated on the toes or forefoot), especially if the ankle pulses are present. Operation must provide adequate drainage and wound care must be meticulous. The problem of prevention of recurrences remains unsolved, but recurrences can probably be delayed or prevented by a careful follow-up.


The work load and distribution of obstetricians and gynaecologists.

A questionnaire to members of the College was returned, completed, by over half the members. It appears that very heavy work loads are carried by many members, and 44% of those in private practice consider themselves overworked. The opinion of 18% of the respondents is that too few specialists are being trained, and 61% of them said that too few general practitioner obstetricians are being trained. Eighty per cent believe that specialists and trained practitioners should practise obstetrics. Recertification is thought desirable by 79%, and continuing education by every respondent.


A survey of epidemic polyarthritis in the Riverland area, 1976.

In a survey of 93 cases of epidemic polyarthritis which occurred in South Australia in 1976, 77 patients suffered from a rash, and 87 patients had joint pains. Forty-five patients had positive serological results. In a control group, only eight of 34 controls had positive serological results. The distributions of rash and joint pains, together with those of other symptoms, are presented. Forty-five patients were unable to work during their illness. The incidence of doctor contact and the drugs taken are given.


Dopamine hydrochloride (Intropin) and open-heart surgery: results of a clinical trial.

Dopamine hydrochloride (Intropin) has been used in the postoperative management of open-heart surgical patients, both children and adults. It has been associated with a very low incidence of undesirable responses and a high frequency of circulatory improvement associated with diuresis. Its administration requires careful control of infusion rate and measurement of response. In the dosages employed, it has been free of most of the undesirable side effects of other commonly used catecholamines.


Hypnosis in a treatment programme for alcoholism.

This is a report on a pilot study of the use of hypnosis in the treatment of alcoholism at an outpatient clinic. It describes the characteristic features of the sample of patients who seem to have responded to treatment and gives an account of the therapeutic programme.


Family response to loss of a child by sudden infant death syndrome.

Nineteen families were interviewed after their loss of an infant by sudden infant death syndrome. Their bereavement responses are described. The outcome after 13 months is studied in terms of resumption of normal living, and health changes. The parents' perceptions of intervention are discussed, and recommendations are made about how best to help such families.


Rebound hypertension after sudden discontinuation of methyldopa therapy.

A case of "rebound hypertension" resulting from the sudden cessation of methyldopa (Aldomet) therapy is described. The importance of educating patients about the possible outcome of abruptly withdrawing antihypertensive medication is emphasized.


Do support systems prevent psychiatric disorders?

"Support" is a concept which is widely used by clinicians and laymen. What it consists of, though, is quite unclear. The proposition is examined, that just as certain components of the psychosocial environment are noxious, so other parts may cushion or protect the individual against adversity. Such an hypothesis would go some way towards understanding the sex distribution of neurosis, the active ingredient in Caplan's "psychosocial supplies", the presence for most adults of a principal attachment figure, the cohesion of the social network and the affectional function of the medical consultation. The development of this concept provides a new dimension for research in social psychiatry.


Neonatal necrotizing enterocolitis: 1. Clinical aspects.

Forty-infants were diagnosed as having necrotizing enterocolitis (NEC) during a 33 months' period; these represented 4% of all neonatal admissions. Pathological confirmation was obtained at surgery in 12 cases and at autopsy in 11, In the case of 21 infants who recovered without operation, the diagnosis was based on clinical and radiological criteria inculding the presence of intramural gas. NEC occurred primarily, though not exclusively , in low-birth-weight infants. Two-thirds of the infants developed NEC in the first week of life. Clinical features attributable to gastrointestinal malfunction as well as a systemic illness could be defined. Complications included pneumoperitoneum (34%), localized peritonitis as suggested by the development of an abdominal mass (11%) and intestinal obstruction (25%). Fourteen of the 15 cases of pneumoperitoneum were diagnosed within 24 hours after the onset of NEC. The 5 infants were localized peritonitis, who were managed conservatively initially, developed intestinal obstruction during recovery. Intestinal obstruction presented between 2 and 7 weeks after the onset of NEC. The overally mortality was 25%, infants with intestinal perforation or obstruction having and increased mortality of 38%.


Artificial insemination with donor semen.

Fifty-three consecutive couples requesting artificial insemination with donor semen are presented. Insemination was carried out with fresh semen. Forty-three proven pregnancies were achieved with a mean of 3-4 treatment cycles per pregnancy. Psychological and legal aspects relating to this method of treatment are discussed.


Present prognosis in neonatal meningitis.

A retrospective study of neonatal meningitis for a period of 6 years (1970 to 1975) is described. It was found that though the survival rate had increased since the introduction of the aminoglycosides, it was at the expense of major neurological sequelae in the survivors. It is suggested that breast feeding of all infants in the first few days of life will reduce the incidence of neonatatl meningitis. It is recommended that pooled human breast milk should not be heat-sterilized as this destroys anti-Escherichia coli immunoglobulin A.


Some atypical features of Still's disease.

Still's disease can no longer be considered a rare disorder. Although the onset usually follows one of several definable patterns, some patients may present with features at variance with classical descriptions of the disease. Four such patients are described to illustrate some of the diagnostic problems which may arise.


Aboriginal versus non-aboriginal alcoholics in an alcohol withdrawal unit.

Fifty-five Aboriginal alcoholic males were compared with ninety non-Aboriginal alcoholic males, presenting voluntarily for treatment at an alcohol withdrawal unit. Although the chronological development of excessive drinking habits was similar, significant differences in drinking patterns and social backgrounds were found. Aboriginal patients consumed more alcohol, had lower levels of education and vocational achievement and were more often homeless. However, physical condition was similar in both groups. It was suggested that treatment of both groups should be similar in the acute withdrawal phase and that there was need for more rehabilitation and after-care facilities for Aboriginal alcoholics rather than for more medical units.


Human artificial insemination: some social and legal issues.

The demand for human artificial insemination (AI) is increasing as a function of declining numbers of babies available for adoption and greater community awareness. This paper reviews some of the social and legal issues associated with the practice of AI: prevalence of marital infertility; demand for AI; moral objections; effect on marriage; legality of practice; legal position of all the parties to the practice; legislation proposed to regulate the practice; and payment of medical benefits.


The control of hydatid disease and ovine cysticercoses in the Australian Capital Territory and southern New South Wales.

A survey of human hydatid disease in New South Wales and the Australian Capital Territory over the period 1968 to 1973 was made from hospital records in Sydney and Canberra. The 162 new cases found represent an incidence, of 0-57 per 100,000 per annum, but the 20 patients living in the Central West Statistical Division of New South Wales at the time of admission to hospital represent an incidence of 12-6 per 100,000 per annum in that area. A survey of A.C.T. farms revealed dogs carrying the causative parasite Echinococcus granulosus on five out of 44 properties (11-4%). Community attitudes favoured control measures but displayed a misplaced faith in anthelmintic drugs. The high regional prevalence on the Australian mainland reveals a need to restrict availability of anthelmintics and extend the vigorous control measures employed successfully in Tasmania.


Neonates at risk. Screening for deafness--practical or not?

Over a six-year period, 3,507 neonates in King George V Memorial Hospital, classified as being at risk for deafness, were screened for hearing. Although 144 failed to respond in the nurseries, 88 of them were cleared at a later test. The remainder, whether suspect, untraceable or still to return, would all be outside the neonatal period by now. No sensorineural impairment of hearing was detected in all neonates in the programme.


Varihesive sealed dressing for indolent leg ulcers.

Forty-three patients with indolent leg ulcers that were resistant to a wide variety of treatment methods for an average period of 353 weeks, were treated by the application of sealed dressings with Varihesive (a compound of gelatin, pectin, sodium carboxymethyl-cellulose and polyisobutylene) a non-allergenic wafer which sticks to a moist surface. Varihesive dressings proved to be effective both in affording pain relief, and in allowing healing of 36 out of 43 ulcers (84%) in a mean time of 10 weeks. It is concluded that such a non-allergenic seal provides optimum conditions for reepithelialization of chronic ulcers and that Varihesive dressings are a valuable adjunct in the local treatment of skin ulceration.


Pregnancy after jejunoileal shunt.

This report describes an unsuccessful pregnancy after a jejunoileal bypass operation that produced a severe secondary malabsorption syndrome with superimposed mechanical and metabolic effects of pregnancy to which the patient nearly succumbed.


[Relapsing polychondritis (author's transl)].

Report about a case of relapsing polychondritis in a woman aged 60 years, which was proofed through autopsy. There was involvement of the trachea, the bronchial system and the cartilages of the ribs. The cartilages of nose and ear did not show any typical changes; therefore the diagnosis could not be established during life. The pecularities of the clinical picture and the pathohistological findings are reported in detail. It seems that the polychondritis is related in it's pathogenesis to the rheumatic disorders. tthe etiology, however, remains obscure.