Effect of glycylglycine on absorption from human jejunum of an amino acid mixture simulating casein and a partial enzymic hydrolysate of casein containing small peptides.

1. A jejunal perfusion technique has been used in normal volunteer subjects to study jejunal absorption of amino acid residues from a partial enzymic hydrolysate of casein in which about 50% of the amino acids existed as small peptides, and also from an equivalent mixture of free amino acids. 2. The effect of a high concentration of the dipeptide glycylglycine on the absorption of amino acid residues from these preparations was studied to quantify the importance of mucosal uptake of intact peptides during absorption of the partial hydrolysate of casein. 3. The results were unexpected. Glycylglycine significantly inhibited absorption of several amino acid residues (aspartic acid + asparagine, serine, glutamic acid + glutamine, proline, alanine, phenylalanine, threonine and isoleucine) from the free amino acid mixture, whereas it significantly inhibited the absorption of only two (serine, glutamin acid + glutamine) from the peptide-containing partial casein hydrolysate. 4. The effect of glycylglycine on absorption of amino acids from the mixture of free amino acids was apparently due to inhibition of amino acid uptake by free glycine liberated from the dipeptide during perfusion. The reason for the failure of glycylglycine to cause extensive inhibition of absorption from the partial hydrolysate is not clear. It may be due to glycylglycine being only a weak inhibitor of peptide uptake, but the possibility that some peptides are taken up by a system unavailable to glycylglycine has to be considered.


Coeliac disease: the abolition of gliadin toxicity by enzymes from Aspergillus niger.

1. Gliadin from which carbohydrate was removed by treatment with carbohydrase from Aspergillus niger was fed to three coeliac patients in remission. 2. Xylose absorption, mucosal morphology and brush-border enzymes were used to assess the toxicity of the carbohydrase-treated gliadin. 3. Gliadin treated with carbohydrases did not damage the intestinal mucosa of the coeliac patients. 4. The primary structure of the gliadin proteins was not altered by the enzyme treatment.


Effects of clonidine on biochemical indices of sympathetic function and plasma renin activity in normotensive man.

1. A single oral dose of clonidine hydrochloride (300 microgram) lowered systolic blood pressure by 20+/-2 mmHg and diastolic blood pressure by 15+/-2 mmHg in seven healthy normotensive subjects. 2. Resting supine plasma noradrenaline concentration fell from 2-42+/-0-47 nmol/l before dosing to a minimum of 0-59+/-0-18 nmol/l at 6 h. The value subsequently rose and was not significantly different from that before the dose at 12 h. There was a significant reduction in urinary free catecholamine excretion in the first 12 h after dosing. 3. Resting supine plasma renin activity before dosing was 0-95+/-0-16 pmol of angiotensin I h-1 ml-1 of plasma and rose significantly after clonidine to 3-50+/-0-39 pmol of angiotensin I h-1 ml-1 of plasma at 6 h. By 12 h plasma renin activity had returned to control values. 4. When the same subjects were studied on a control, drug-free, day under the same conditions, there was no significant change in blood pressure or plasma noradrenaline. Although plasma renin activity rose during this control day, it was significantly lower than after clonidine. 5. In normotensive subjects single doses of clonidine lower blood pressure and are associated with a reduction of sympathetic nervous activity. Delayed elevation of plasma renin activity may be secondary to the fall in blood pressure. There is no evidence for an overshoot of sympathetic activity after a single dose of clonidine.


The assessment of left ventricular ejection fraction in patients with ischaemic heart disease by contrast ventriculography and nuclear angiography.

1. In 18 patients with ischaemic heart disease left ventricular ejection fraction, measured by two different nuclear angiographic methods, has been compared with ejection fraction measured by single-plane contrast angiography. 2. The first nuclear angiographic technique involves detection of variation in the radio-activity from the left ventricle during the initial passage of a bolus of 99Tcm-labelled human serum albumin injected intravenously; the second is our own modification of a "gated" method, which accumulates the radioactivity detected during the continuing recirculation of the plasma bound radioisotope, so presenting an "averaged" ventricular volume curve. 3. Ejection fraction, measured by the "bolus" method, is lower than that measured either by contrast ventriculography or by the "gated" method. This may be due to a damping effect. 4. Ejection fraction measured by the "gated" method is well correlated with that measured by contrast ventriculography (r = 0-89). 5. Our modification of the "gated" method, which presents the changes in ventricular volume throughout the cardiac cycle, without needing computer facilities, is a useful non-invasive means for assessment of left ventricular function.


Effect of anticonvulsants on the uptake of 5-methyltetrahydrofolic acid by the choroid plexus in rabbits.

1. The isolated choroid plexus of the rabbit takes up 5-methyltetrahydrofolate from the incubation medium. 2. Other folate analogues (pteroylglutamic acid, methotrexate, 5-formyltetrahydrofolate = folinic acid) inhibited the uptake of 5-methyltetrahydrofolate. 3. The uptake of 5-methyltetrahydrofolate was inhibited by low temperature, anaerobic conditions and dinitrophenol. 4. The anticonvulsant drugs, diphenylhydantoin and phenobarbital, had no effect on 5-methyltetrahydrofolate uptake. 5. The inhibitory effect of pteroylglutamic acid on the uptake of 5-methyltetrahydrofolate by the choroid plexus may explain the effect of long-term folic acid therapy in aggravating vitamin B12 neuropathy in pernicious anaemia.


A slow component of iodine turnover in athyreotic individuals.

1. Whole-body retention and plasma values of 131I after a test dose were measured for up to 32 days in patients previously rendered athyreotic by surgery, and 131I treatment for thyroid carcinoma, and who were without detectable functioning tissue at the time of study. 2. About 99-8% of the administered 131I was rapidly excreted, consistent with renal iodide excretion. The remainder (about 0-2%) was eliminated slowly, with mean half-life 15 days; we call this the slow-turnover component. 3. By the sixth day after the 131I dose, very little [131I]iodide remained in the plasma. The average protein-bound 131I was only 0-0035% of dose/l, with mean half-life 14-1 days; 90% was non-extractable in butanol. Labelled albumin accounted for about 80% of the non-extractable fraction. 4. The distribution space estimated from the slow-turnover component and protein-bound 131I was 34 l, indicating that most of the slow-turnover component is extravascular. 5. Stable potassium iodide administration, starting 2 days after giving 131I, had no observable effect on the variables measured. 6. Impairment of renal function delayed [131I]iodide excretion and increased both slow-turnover component and plasma protein-bound 131I. 7. A simple model describing iodine kinetics in athyreotic individuals is suggested. It predicts that the slow-turnover component contains only about 4 micrograms of iodine and, since this is distributed widely in body tissues, it is unlikely to be of biological significance.


An investigation into the pathogenesis of hypertension in acromegaly.

1. In 29 patients with acromegaly, plasma renin activity and growth hormone were measured during fasting and recumbency on free diet. Exchangeable sodium was measured in all cases and expressed as a percentage of the expected value on the basis of lean body mass. 2. Twenty-two control subjects without evidence of cardiovascular, renal or endocrine disease were studied in the same way. 3. There was a significant increase in exchangeable sodium and suppression of plasma renin activity in the acromegalic patients in comparison with control subjects. 4. There was a significant positive correlation between exchangeable sodium and plasma growth hormone. 5. Hypertensive acromegalic patients (diastolic blood pressure larger than or equal to 100 mmHg) tend to have a lower (although not significantly so) exchangeable sodium than normotensive subjects. 6. We conclude that (a) suppression of plasma renin activity in acromegaly can be explained by sodium retention, (b) hypersecretion of growth hormone is probably responsible for the increased exchangeable sodium, and (c) sodium overload cannot be directly related to blood pressure but may contribute to the increased occurrence of hypertension in acromegaly.


Renal handling of dibasic amino acids and cystine in cystinuria.

1. The effect of intravenous infusion of L-lysine and L-arginine on the tubular reabsorption of dibasic amino acids and cystine was studied in normal individuals and in homozygous and heterozygous subjects with cystinuria. 2. The control subjects reabsorbed almost all filtered lysine and arginine until the filtered load was elevated about fourfold. With further increased loads the tubular reabsorption began to fall and tended to approach a maximum reabsorption rate. By contrast, the homozygous subjects could not reabsorb the elevated amino acid beyond the endogenous capacity until the filtered load was increased seven- to ten-fold. When the filtered load was further increased, tubular reabsorption proceeded at the normal rate in the cystinuric patients. 3. These findings may be explained by a low-capacity transport system, which acts at low substrate concentrations, being defective in the cystinuric subjects, while a high-capacity transport system, which predominates at high substrate concentrations, remains intact. 4. Lysine and arginine infusion depressed the percentage tubular reabsorption of other dibasic amino acids and cystine both in the control and the cystinuric subjects. In the control subjects the amino acid infusion caused a gradual linear fall in the fractional reabsorption of the dibasic amino acids and cystine, whereas the depressed reabsorption of the dibasic amono acids in the cystinuric patients returned to that observed under the endogenous condition when the filtered load was high. The amino acid load caused only a gradual decrease in cystine reabsorption in the cystinuric patients. 5. In the heterozygous subjects the slope of the titration curves and the depression of the tubular reabsorption were intermediate between those of the control and homozygous subjects.


Effect of thyrotoxicosis on the reflex hypoxic respiratory drive.

1. Oxygen breath tests were performed in seven patients with thyrotoxicosis. The inspired air was replaced by oxygen without their knowledge for 20 s and the fall in ventilation was recorded. 2. Ventilation fell significantly in all the patients within 40 s. The mean fall was 21-1% (se +/-1-7) below the control value. 3. beta-Adrenoreceptor blockade with propranolol had little effect on this reduction in ventilation. The fall observed in five patients receiving propranol was 19-6% (se +/-1-0). 4. After definitive treatment, which rendered the patients euthyroid, the observed reduction in ventilation after breathing oxygen was significantly less at 11-7% (se +/-1-2). 5. It is concluded that patients with thyrotoxicosis have an increased resting reflex hypoxic drive to respiration, when compared with the euthyroid state, and this is unaffected by beta-adrenoreceptor blockade.


Lithium carbonate and methyldopa: apparent interaction in man.

An experimental subject with a stable serum level of lithium experienced symptoms of lithium toxicity when he ingested methyldopa. Physicians prescribing either or both of these drugs should be aware of this apparent interaction between lithium and methyldopa.


Drug-induced extrapyramidal signs in chronic liver disease--a case report.

Extrapyramidal effects of phenothiazines and related compounds are well documented and may be dose related. Impaired drug metabolism can occur in chronic liver disease. A case is reported of extra pyramidal signs occurring in a patient with alcoholic liver disease given the antiemetic Ancoloxin in therapeutic dosage.


Effect of guanidine, germine, and steroids in a case of botulism.

A patient with severe type A botulism demonstrated several interesting features. Characteristic electrophysiologic findings are not necessary for the diagnosis. Guanidine hydrochloride provided mild improvement. High doses of steroids and low dose of germine-monoacetate had no effect.


Propoxyphene-associated deaths: methods, post-mortem levels in blood and liver.

Gas chromatographic methodology for the determination of d-propoxyphene in blood and liver samples is given. The method results in a clean extract and sharp response peaks. Quantitation is based on peak height ratios of propoxyphene and pyrroliphene. Post-mortem levels in blood range from 0.1-0.7 mg/dl; in liver from 1.1-18.9 mg/100 gm. The highest blood level has the lowest blood-liver ratio, the rest being widely variable. The incidence of propoxyphene in accidental and suicidal deaths appears to be increasing steadily.


Locoweed poisoning in sheep: electroencephalographic and brain amine changes.

The effects in sheep of locoweed poisoning on electroencephalograms and on levels of the brain amines serotonin and norepinephrine were measured. Lucoweed-induced EEG changes in sheep were characterized by episodes of high voltage, slow activity (HVSA). There was no effect on brain norephinephrine levels. The mean brain serotonin level of the sheep fed locoweed was approximately 57% higher than the control but was not significant.


Human tissue distribution of cyclodiene pesticides-Hawaii 1964-1973.

Data have been presented covering symptoms of acute exposure to cyclodiene pesticides in adults and infants in Hawaii. Varying concentrations of heptachlor epoxide, dieldrin, DDT, DDE, and DDD were found in human autopsy material, with the highest levels of heptachlor epoxide in bone marrow and liver and those of dieldrin in kidney and gonad. Maximum concentration of dieldrin in human milk was 0.25 ppm on an extracted lipid basis; in fetal tissues, 1.46 ppm; and in maternal tissues, 2.04 ppm. There was correlation between dieldrin concentration in household dust and human blood serum. The general baseline levels of cyclodiene pesticides were lower in Hawaii than the rest of the United States.


Effects of chronic organophosphate pesticide exposure on the central nervous system.

An index of the relative amount of chronic exposure to organophosphate (OP) pesticides was developed to compare individuals with high and low levels of chronic exposure. Results of neuropsychologic tests and computer-analyzed electroencephalographic data indicated an association between higher levels of chronic OP pesticide exposure and frontal lobe impairment.


Association between renal function tests and pentachlorophenol exposure.

Data are presented and renal function tests and Pcp measurements on consecutive blood and urine samples collected from 18 workers at a wood treatment plant before, during, and after a 20-day vacation. Pcp concentrations in blood averaging 5.1 ppm before vacation fell to 2.2 ppm during vacation but with a temporary rise early in this nonexposure period, suggesting a body tissues store of Pcp which was mobilized in response to a negative Pcp balance. Urine Pcp concentrations showed similar but less marked variations. Creatinine clearance and phosphorus reabsorption values were depressed before vacation but showed significant improvement during vacation, suggesting that Pcp exposure reduced both glomerular filtration rate and tubular function, with recovery following a nonexposure period.


Lanolin with reduced sensitizing potential. A preliminary note.

The allergens of lanolin appear to lie in the content of natural free fatty alcohols rather than in the total alcohols as hitherto supposed. The detectable incidence of allergy is increased by the simultaneous presence of detergent. Amongst selected lanolin-sensitive skin patients, removal of both free fatty alcohols and detergent from lanolin reduces the incidence of detectable hypersensitivity by 96%. Methods are described for determining free fatty alcohols and detergent in lanolin, and for removing them.


Immediate reactions to fruits and vegetables.

Common fruits and vegetables were tested as such with the "scratch-chamber" method in 388 patients with various atopic disorders. Of the patients with hypersensitivity to birch pollen, 36% showed immediate positive responses to these natural, fresh materials. Apple, carrot, parsnip and potato elicited reactions more often than, e.g. swede, tomato, onion and parsley. On the basis of clinical data, the relevancy of the results of the skin tests was 80-90%. Both "false positive" and "false negative" responses were seen. Itching and tingling with or without oedema of the lips, mouth and tongue were the most common complaints after eating raw fruits and vegetables. In addition, laryngeal and abdominal disturbances, rhinitis and hand dermatitis were recorded. Among patients without allergy to birch pollen, reactions to fruits and vegetables were rare. The nature of the allergens could not be determined.


Psoralen photoallergy caused by plant contact.

A case of acquired photocontact allergy to furocumarins in plants is reported. Photopatch testing was performed with four psoralens [8-methoxypsoralen (8-MOP), 5-methoxypsoralens (5-MOP), trimethylpsoralen (TMP) and imperatorin (IMP)[. The use of serial dilutions of the test compounds made it possible to differentiate between photoallergic and phototoxic reactions. 8-MOP gave a positive eczematous test reaction down to a concentration of 0.0001%. The reactions to 5-MOP and imp also were positive, while that to TMP awas negative. Histopathological examination of a biopsy specimen from a positive test site showed changes consistent with photoallergic contact dermatitis. The multiple reactions could be explained on the basis of multiple sensitization but cross reactions cannot be ruled out.


Contact dermatitis to PPD rubber in Maleki shoes.

The Persian cloth shoe (Maleki) which has been in use for more than 800 years has a strong cloth sole and a woven cotton upper. In the last 20 years, used car tires have become readily available in Iran and the soles of some shoes are now made from these. A man with the typical picture of rubber dermatitis on the soles of his feet is described. On patch testing he gave a 2+ positive to PPD rubber and this was thought to be due to the fact that he had worn Maleki shoes for several years.


United States cosmetic ingredient labeling.

United States federal regulations require ingredient listing on cosmetics labeled after November 30, 1976. Standardized ingredient nomenclature from a reference text will be utilized to minimize confusion which might arise if various synonyms for chemical names were used. This new information on cosmetics labeling will assist physicians in the diagnosis of cosmetic-related dermatoses. It should facilitate the patch testing procedure by enabling the dermatologist to focus attention on suspect ingredients early in the evaluation. Once the identify of offending ingredients in a cosmetic has been determined for a particular patient, the individual will have the opportunity to avoid those ingredients and related ingredients in future purchases of cosmetics.


Septicemia and meningoencephalitis in pastured cattle caused by a Haemophilus-like organism ("Haemophilus somnus").

Septicemia and meningoencephalitis developed in 10 pastured cattle 7 months to 3 years of age. Two unrelated herds were involved. Necropsy findings were similar to those previously reported in cattle infected with a Haemophilus-like organism, including multifocal hemorrhages in some muscles, suppurative polyarthritis, and multifocal hemorrhagic thrombi in the brain. A Haemophilus-like organism was isolated from one animal. It was characterized by growth on blood agar or tryptose agar plus a feeder streak under raised carbon dioxide tension, and lack of response to Haemophilus growth factors X and V.


Nasal prevalence of Mycoplasma bovis and IHA titers in young dairy animals.

Serologic and cultural observations were made in three herds with and three herds without histories of mycoplasma mastitis. Nasal swabs and sera were collected from dairy animals of various ages over an eight month peiod. The overall prevalence of Myocopalsma bovis in the nares was 34% in diseased herds and 6% in the non-diseased herds without mastitis. Mycoplasma bovis was isolated in the highest prevalence in those young animals fed infected milk. Slight serologic differences were seen in these animals. Nasal prevalence of M. bovis was low but readily detectable in non diseased herds as well as in prepartum heifers in the diseased herds with mycoplasma mastitis.


Pemphigus vegetans in a dog.

Pemphigus vegetans of the Hallopeau type was diagnosed in aged dog. Diagnosis was based on (a) history, (b) physical examination, (c) histopathologic examination of affected skin, and (d) response to therapy. Clinical response to immunosuppressive doses of prednisolone was excellent.


Teat apex microflora: influence of washing and dipping procedures.

Effects of teat washing and dipping were determined on the bacterial populations occurring naturally at the teat apex. Teat washing, using an iodine solution, was ineffective unless that procedure was done carefully and vigorously. Teat dipping using an iodophor solution was able to significantly decrease the staphylococcal population and sustain this lower population for a period up to six weeks.


Paired stimulation of the heart in the treatment of tachycardia and tachyarrhythmia.

Paired electrical stimulation of the heart was applied in the treatment of 82 patients with tachycardia of various origin, refractory to drug treatment. Cardiostimulators and electrodes of the Institute's own original design were used. The stimulation parameters were calculated by a method proposed by the author. The best results were achieved in patients with paroxysmal tachycardia; in 14 out of 17 patients, paired stimulation suppressed the attack. In a majority of patients with tachysystolic form of atrial fibrillation (30 out of 49 patients), stimulation led to normalization of haemodynamics and helped overcome the crisis. In sinus tachycardia the retardative pacing was beneficial in rare cases only, when the tachycardia was losing its compensatory character. Of dangerous complications there occurred ventricular fibrillation (2 patients), removed by electroshock. In the author's opinion, paired stimulation has its advantages over electric defibrillation in patients in a poor condition with paroxysmal tachycardia and the tachysystolic form of atrial fibrillation.


Use of polarized-light microscopy in histological diagnostics of early stages of ischaemic and metabolic myocardial lesions.

Animal experiments have proved that the earliest morphological manifestations of acute lesions of myocardial cells (at the optical microscopic level) are myofibrillar changes detectable by polarized-light microscopy. As basic types of myocardial cell lesions there can be distinguished segmental and subsegmental contractures, intracellular myocytolysis, and primary granular disintegration. These changes persist in animal myocardium for many hours and thus can be recognized at autopsy. The application of polarized-light microscopy makes possible a diagnosis of early stages of myocardial infarction, associated with lesions of myocardial cells appearing at the periphery of the ischaemic zone already within the first minutes, revelation of focal metabolic changes leading to acute heart failure, and diagnosis of ventricular fibrillation, characterized by subsegmental contractures of the subepicardial and subendocardial layers of the myocardium.


Resetting of aortic baroreceptors in experimental hypertension and atherosclerosis.

The dependence of aortic baroreceptor activity on aortic pressure and aortic distension was studied in isolated preparations "aortic arch--aortic nerve", obtained from normal rabbits and from rabbits with experimental hypertension and atherosclerosis varying in duration. It was found that in both atherosclerosis and hypertension the reactivity thresholds of aortic baroreceptors shifted toward higher pressures. In initial stages of hypertension and atherosclerosis this resetting results from changes in the baroreceptive zone itself, and aortic distensibility does not differ from the normal state. In later stages of hypertension and atherosclerosis the aortic distensibility decreases; in consequence of this the shift of baroreceptor reactivity threshold increases. Possible mechanism of baroreceptor resetting and its role in the regulation of arterial pressure in hypertension and atherosclerosis are discussed.


An attempt to prevent spontaneous hypertension in rats by antihypertensive drug treatment.

Experiments were carried out on 10 spontaneously hypertensive rats (SHR) with  the intention to prevent or modify the onset and the course of spontaneous hypertension by application of a long-term antihypertensive drug treatment started during the prehypertensive period of their life. Ten untreated SHR and 10 normotensive Wistar rats (NWR) were used as controls. The results indicate that even very early administration of antihypertensive drug during the prehypertensive stage of genetically determined SH in Okamoto-Aoki rats does not suppress the onset and the development of hypertension in spite of long-term continuation. It only alters its course, suppresses the blood pressure elevation maintaining it at a "subhypertensive" level during the period of treatment, and postpones for a certain period the elevation of BP to an excessive level after medication is discontinued. It is suggested that these results should be kept in mind when prophylaxy of essential hypertension is considered.


Blood flow and vascular resistance in lower limbs in hypertensives at rest and at reactive hyperaemia.

The maximal decrease of vascular resistance during reactive hyperaemia in lower limb was investigated in a group of healthy control persons, in hypertensives (stage II) with blood pressure level over 160/95 mmHg, in hypertensives (stage II) with pressure level below 160/95 mmHg, and in patients with atherosclerotic changes in the lower-limb arteries without signs of obliteration. Insufficient distensibility was found not only in hypertensives with pressure over 160/95 mmHg, but also in those with a normal pressure level at the time of examination (achieved by antihypertensive therapy or bed rest). A similar insufficient distensibility was observed in patients with atherosclerotic changes in the lower-limb arteries without obliteration. The findings support the view that anatomical rebuilding of vascular wall takes place in hypertension, and suggest that the incapacity of maximal dilatation is characteristic not only of resistance vessels but probably of larger arteries as well.


Constipation in childhood: a controlled comparison between lactulose and standardized senna.

Twenty-one children under 15-years' old with chronic constipation were treated in a crossover trial lasting 3 weeks. In the first week they received either lactulose or senna, in the next week no treatment, and in the third week the alternative treatment. Patient diaries were kept by parents on the number and character of stools passed, and of side-effects reported, during the 3 weeks. There was a significant difference, in favour of lactulose, in the number of days on which normal stools were passed during the treatment weeks. The number and frequency of the side-effects reported in the senna treatment week were very much higher (p less than 0.001) than in the lactulose week. Lactulose is recommended as an effective and very well tolerated treatment for the constipated child.


Use of mass spectrometry and infrared CO2 analyzer for bedside measurement of cardiopulmonary function during anesthesia and intensive care.

In response to the increasing abilities to provide continuous and detailed information on the cardiopulmonary status during and after open heart surgery, we measured hemodynamic and pulmonary functions including cardiac index, end-tidal CO2, minute volume, dead space, ventilation/perfusion ratio, O2 consumption, and other derived variables with a mass spectrometer. This was found useful, for example, in evaluating the need for artificial ventilation in postoperative cardiac patients.


Pharmacology of Bay g 2821, a long-acting, high-ceiling diuretic.

Bay g 2821 is a diuretic, from a new class of chemical substances, with both the efficacy of diuretics with a high-ceiling activity, such as furosemide, bumetanide and ethacrynic acid, and the prolonged duration of action of thiazides. Pharmacological investigations showed that Bay g 2821 was more potent than furosemide in dogs but less potent in rats. Bay g 2821 did not differ from furosemide in excretion of electrolytes. Further studies showed that Bay g 2821 had an antihypertensive effect in dogs, spontaneously hpertensive rats, and in rats with artificially-induced renal hypertension. Other pharmacological studies did not reveal any other significant effects.


Pharmacokinetics of Bay g 2821 in the dog and in man.

The pharmacokinetics of Bay g 2821, a new diuretic agent, were studied in dogs, healthy volunteers and in patients with renal insufficiency. The drug was rapidly absorbed after oral administration, peak plasma levels (approx. 0.4 microgram/ml) occurring within 1 hour. Elimination of the unchanged drug from plasma was biphasic - an initial rapid decline with a half-life of about 3 hours, followed by a longer second phase with a half-life of 13 to 17 hours. Results were similar in healthy volunteers and in patients with renal insufficiency. It is assumed that the drug is mainly eliminated in bile, probably after biotransformation, and elimination in the urine is a minor pathway.


Psychiatric complications in a surgical ICU.

Pathological behavior patterns are often observed in patients in the ICU. In a Surgical ICU (SICU), 7% (22/322) of a patient population required psychiatric consultation during a 6-month period. As a group, these patients had more prolonged stays, more frequent requirements for mechanical ventilation, a higher incidence of cardiac arrest and a higher mortality rate than the entire SICU population. The psychiatrist was asked to evaluate multiple behavioral syndromes, some of which were irreversible concomitants of grave illnesses. However, with certain syndromes, psychiatric assistance greatly facilitated the resolution of problems that hampered pre- and postoperative management and the patient's eventual recovery.


Indicators of intensive care in critically ill patients.

To define severity of illness objectively and to justify further the need for intensive care, we have analyzed measurable objective data points (indicators) in 226 consecutive critically ill Class IV patients. The indicators include: (1) Pao2 (Fio2, 1.0), (2) platelet count, (3) cardiac index, (4) BUN, 5) creatinine, (6) acute renal failure, (7) peritoneal or hemodialysis, (8) continuous infusion of antiarrhythmia therapy, (9) base deficit greater than 10mEq/liter, (10) state of consciousness, and (11) unexpected cardiac arrest. Most indicators were significantly worse in patients who ultimately died within one year than in patients who survived with a successful recovery. An indicator profile could be derived for each disease process category, since different indicators applied to different diseases. The indicators were not markedly affected by age. Standard discriminate analysis predicted a group of patients who would not survive and documented that acute renal failure was a primary predictor of death.


Amitriptyline and weight gain: a biochemical and endocrinological study.

A study was carried out in 6 healthy volunteers to test the hypothesis that weight gain associated with amitriptyline treatment may be due to hypoglycaemia caused by increased circulating blood insulin. Subjects were treated with 50 mg amitriptyline b.d. for 28 days. Estimations made of serum levels of amitriptyline and its metabolite nortriptyline showed a steady state by the 10th day. No significant weight-gain was observed in any of the volunteers, although 2 reported an increase in appetite. There were no significant differences in any of the glucose tolerance curves, fasting or peak insulin levels or in the glucose/insulin curves for Days 0, 14 and 28.


Rheological changes in the blood of patients with chronic arterial occlusive disease after the administration of vasoactive drugs.

Patients with chronic arterial occlusive disease were found to have higher blood and plasma viscosity levels than healthy controls. Measurements were taken at high and low shear rates. Blood and plasma viscosity in these patients was significantly reduced following parental administration of pentoxifyline, and this effect was particularly pronounced at low shear rates. The changes recorded after administriation of bencyclane did not follow a consistent pattern. There was no significant correlation between the rheological changes measured and changes in plasma protein fractions.


State or regional critical care societies.

The success of the SCCM has spurred other individuals with similar backgrounds (many of them SCCM members) to start state or regional critical care societies. Such societies provide a forum where local recognition and educational needs are met; state health regulations and economic issues can be discussed with a unifying voice. The experiences and organizational steps taken are described. The intent of this article is to provide information to those individuals contemplating starting similar societies.


Left ventricular function during respiratory failure.

Indirect measures of left ventricular function were studied in seven patients with respiratory failure secondary to chronic obstructive pulmonary disease to determine if there were a relationship between left ventricular function and treatment of the pulmonary disease. All patients were studied during acute episodes while in respiratory failure having arterial Pco2 (Paco2) values greater than 49 torr with no clinical evidence of left ventricular failure. Indirect methods to evaluate left ventricular function included the use of the Swan-Ganz catheter for pulmonary capillary wedge pressure measurement, systolic time intervals, and cardiac output. There was improvement in left ventricular function with treatment of the respiratory failure manifested by decreases in the wedge pressure and pre-ejection period/left ventricular ejection time ratio, and an increase in the dp/dt/pulmonary capillary wedge pressure with treatment of the chronic obstructive pulmonary disease. The improvement in left ventricular function suggests that there is a depression of left ventricular function in respiratory failure. The depressed function improved with therapy of the lung disease without additional medication directed at cardiac function.


Ants and bees: whole body extracts vs venom.

Ants, bees, and other stinging hymenoptera can induce serious anaphylactic reactions in susceptible individuals. Certainly, hymenoptera venom contains potent antigens that have been useful in testing and treating hymenoptera-sensitive patients who fail to acquire protection from whole body extract therapy. However, before whole body extracts are forever abandoned, their antigen content and stability should be re-examined by means of modern immunologic methods.


Cardiac connections: the segmental approach to radiologic diagnosis in congenital heart disease.

The segmental approach to the diagnosis and classification of congenital heart disease, which emphasizes the importance of the connections (proximal-to-distal relationships) of cardiac chambers and great vessels, is presented. The radiologic identification of great vessels and cardiac chambers and their connections is described, considering, in turn, three major segments: the atria together with the systemic and pulmonary veins, the ventricles with their atrioventricular valves and the great arteries with their outflow tracts. Cardiac and great vascular connections can be described with greatest clarity by using the atria as the starting point. The atrial situs is defined as solitus, inversus or ambiguus, the great veins connecting to the atria normally or anomalously. The ventricles may be connected to the atria in concordant or discordant fashion or a double inlet ventricle may be present. The ventriculo-arterial connections can be classified as normal, transposition, double outlet right ventricle or double outlet left ventricle. The angiocardiographic techniques and criteria that differentiate these connection disorders and identify the transitional cases between them are discussed and illustrated. A complete diagnosis must indicate not only the connections of the three major segments but also the malformations and abnormalities of spatial position that may be present. Certain associations are of value in predicting the positions and connections of the cardiac chambers and great vessels, making it possible to formulate helpful rules to aid the progress of a diagnostic study. The fallibility of such rules is discussed, emphasizing the need to define connection disorders in terms of the connections rather than in terms of malformations or of abnormalities in spatial position of the individual parts.


Treatment of pyoderma gangrenosum with benzoyl peroxide.

A fifty-three year old woman presented with pyoderma gangrenosum on the right buttock. She had associated intestinal symptoms, but repeated roentgenologic studies revealed no abnormalities. Local treatment with benzoyl peroxide (20 percent) lotion produced clearing of the cutaneous lesion in about six weeks.


A comparative study of the karyotypes of eight Xenopus species and subspecies possessing a 36-chromosome complement.

A comparative study of the karyotypes of eight Xenopus species and subspecies possessing a diploid number of 36 chromosomes (X.l. laevis, X.l. petersi, X.l. victorianus, X. borealis, X. gilli, X. fraseri, and X. clivii) was performed. Karyotypes based on the morphology and size of chromosomes differ only by the type and position of secondary constrictions. Some of these constrictions are nucleolar organizers, recognizable by mitotic chromosomal association. By comparing the chromosomes bearing secondary constrictions, an attempt is made to establish the cytotaxonomic relationships. The close relationship between the subspecies X.l. laevis, X.l. petersi, and X.l. victorianus is confirmed; X. borealis, however, is a separate species much nearer to X. muelleri. The karyotype of X. gilli is interpreted as being intermediate to these two groups. X. clivii could be regarded as a species close to the group of X. muelleri. X. fraseri, having a particular type of secondary constriction, is systematically more distant.+20


Specific chromosome changes associated with rabbit cell lines cultured in vitro.

Thirty-three rabbit cell lines were established from various fetal tissues of the inbred strain III of the New Zealand rabbit (Oryctolagus cuniculus). None of these lines exhibited senescence during a growth period of more than 2 years. Karyologic studies of most cell lines at 10 to 20 cell-passage intervals revealed that the karyotype stability of the rabbit cells in vitro was correlated with the organs from which the cell lines were derived. Thus, lines derived from cornea, spleen, and kidney tissues usually contained high frequencies of polyploidy in their early passages, whereas most of those derived from lung and skin were found to retain the normal diploid karyotype for much longer periods of time. One line derived from fetal lung tissue, designated Lung 16, remained diploid up to 100 passages. In late passages of the majority of all the lines studied, the cells became pseudodiploid, hyperdiploid, or polyploid. Among the pseudodiploid and the hyperdiploid cell lines, the chromosomal changes followed three basic patterns: (1) a gain of one or more telocentric chromosomes; (2) a loss of one telocentric chromosome plus a metacentric marker chromosome (M); or (3) a gain of a long telocentric marker chromosome with or without changes in the number of telocentric D chromosomes. By the G-banding technique, the telocentric chromosome involved in these three patterns was identified as the D-group chromosome 18 and the M marker chromosome as an isochromosome of 18. These results suggest that chromosomal rearrangement in rabbit cells involving trisomy of 18 may be responsible for the longevity of these cell lines cultured in vitro.


A simplified technique for in vivo analysis of sister-chromatid exchanges using 5-bromodeoxyuridine tablets.

A small tablet of 5-bromodeoxyuridine (BrdU), implanted subcutaneously in a mouse, provides sustained release of base analog sufficient to effect substitution of DNA throughout an entire replication period. As illustrated by studies of mouse bone-marrow and spleen cells in the presence or absence of cyclophosphamide, this depot method of BrdU administration greatly simplifies in vivo analysis of sister-chromatid-exchange formation.


Paracoccidioidomycosis (South American Blastomycosis) in the United States.

The findings in a patient with paracoccidiodomycosis (South American blastomycosis) diagnosed by open-lung biopsy and treated successfully with a combination of trimethoprim and sulfamethoxazole are reported, and the clinical spectrum of the disease is reviewed. Although paracoccidioidomycosis is rarely encountered in the United States and is clinicially similar to other deep mycoses, it should be considered in patients who are suspected of having a fungal infection and have had previous exposure in an area endemic for paracoccidiodomycosis.


Fatal pneumonitis and septicemia after fiberoptic bronchoscopy.

This report describes the development of fatal pneumococcal pneumonia and septicemia following fiberoptic bronchoscopic examination and endobronchial biopsy of a patient with severe chronic congestive heart failure. Although a causal relationship has not been proven, the temporal sequence seems to favor this over a coincidental nosocomial infection. This case emphasizes that significant and occasionally fatal infectious complications may occur following fiberoptic bronchoscopic examination.


Hyperpyrexia complicating low fixed cardiac output.

A 41-year-old woman with end-stage mitral and aortic stenosis developed the cycle of low cardiac output, peripheral vasoconstriction, increased core temperature, and cardiac decompensation. This was interrupted by core cooling utilizing iced gastric lavage. We propose that her severe hyperthermia was caused or abetted by her low cardiac output.


Myocardial infarction associated with thyrotoxicosis.

Myocardial infarction occurs rarely with thyrotoxicosis. A 34-year-old woman with thyrotoxicosis sustained a transmural myocardial infarction and subsequently on cardiac catheterization studies had no significant coronary arterial disease but only residual apical wall akinesia. Thyroid hormone may directly influence myocardial oxygen supply and demand and, by some unknown mechanism exclusive of major coronary arterial blood supply, cause a critical imbalance resulting in angina pectoris and myocardial infarction.


Dual atrioventricular conduction during an acute inferior myocardial infarction. Electrocardiographic evidence.

A 49-year-old man had electrocardiographic evidence of a dual atrioventricular conduction system which occurred spontaneously during the course of an inferior myocardial infarction. Retrograde concealed conduction involving both conduction systems is proposed as the mechanism to explain the varying patterns of atrioventricular conduction seen.


Respiratory tract burns after aspiration of hot coffee.

We present the fingings in a patient with acute thermal burn to the upper and lower airway who developed mucosal edema followed by patchy areas of granuloma-like lesions in the trachea and bronchi. A four-month follow-up showed resolution of the gross lesions, but functional alterations remained. This patient illustrates the necessity for repeated direct observation and functional evaluation of the lower airway folllowing thermal injury, which can be a life-threatening disorder.


The use of 201thallium for myocardial perfusion imaging in sarcoid heart disease.

Cardiac dysfunction due to systemic sarcoidosis is most of ten due to severe restrictive pulmonary diseases. Although the diagnosis is frequently missed during life, direct granulomatous infiltration of the myocardium may occur with systemic sarcoidosis and, when present in the heart, is a major cause of death. To explore the possible use of radioactive 201thallium, a new agent for myocardial imaging, for improved clinical recognition of sarcoid heart disease, myocardial perfusion imaging with 201Tl was performed in six normal volunteers and in five patients with documented systemic sarcoidosis and clinically apparent cardiac dysfunction. Two of the patients with sarcoidosis had severe restrictive pulmonary disease. Their myocardial perfusion scans revealed relatively uniform uptake of 201Tl by the left ventricle, similar to that found in the normal volunteers; however, the right ventricular uptake of 201Tl and right ventricular thickness in these two patients with sarcoidosis was greater than normal. The other three patients with sarcoidosis had unexplained congestive heart failure, mitral regurgitation, or arrhythmias. Myocardial perfusion imaging in these patients revealed normal right ventricular uptake of radioactivity but segmental defects in the left ventricle compatible with an infiltrative disease of the myocardium. Segmental myocardial infiltration by sarcoid was confirmed by autopsy in one of these patients and at operation in another. Thus, myocardial imaging with 201Tl may provide a noninvasive technique for the improved clinical recognition of primary myocardial sarcoid and for distinguishing it from cardiac dysfunction secondary to pulmonary disease.


Carboxyhemoglobin levels in primary and secondary cigar and pipe smokers.

This study of 130 subjects was performed to obtain more data about the smoking habits and levels of carboxyhemoglobin in various types of pipe and cigar smokers. These smokers may be divided by history into primary or secondary smokers and also into current inhalers and noninhalers. Prior studies of carboxyhemoglobin levels have yielded conflicting results, presumably due to differences in current habits of inhalation, which were often not taken into account. Cigarette, primary pipe, and secondary pipe inhalers had similar carboxyhemoglobin levels that were significantly higher than nonsmokers (5.6, 5.0, 5.4, and 1.0 percent, respectively). Cigar inhalers had markedly elevated concentrations of carboxyhemoglobin (13.8 and 11.8 percent in primary and secondary inhalers, respectively). Most secondary cigar and pipe smokers inhaled, whereas most primary smokers did not. Intentional inhalation, rather than past smoking history, is the most important factor in determining the carboxyhemoglobin level for each type of smoke.


A one-year trial of triamcinolone acetonide aerosol in severe steroid-dependent asthma.

Twenty-three steroid-dependent severely asthmatic patients, ranging in age from 20 to 67 years, tolerated reduction in their oral dosage of steroids during a one-year trial of triamcinolone acetonide aerosol. Sixteen patients maintained their initial one-second forced expiratory volume without oral therapy with steroids, two required resumption of daily steroid dosage because of lethargy and arthralgia, and four required 2.5 to 20 mg of prednisone every other day to control their asthma. Five-day oral courses of steroids were occasionally required because of episodes of asthma from a variety of external causes. One patient failed to benefit within two months and withdrew from the study. One patient had precipitins to Candida albicans prior to the study, and he developed transient oropharyngeal culture-positive thrush, which subsided with use of a gargle containing nystatin. None of the other patients had oral candidiasis, and laryngoscopic examination revealed no lesions attributed to the aerosol. The mean fasting cortisol level did not increase throughout the one-year trial. Thus, the use of triamcinolone acetonide aerosol (2,000 microgram or less daily) can eliminate or greatly reduce oral requirements for steroids in patients with severe steroid-dependent asthma. Side effects are mild, but adrenal recovery may be exceedingly slow.


Pulmonary function in former alcoholics.

Pulmonary function was evaluated in 44 former alcoholics (abstinence, 0.5 to 32 years) without cardiac or specific pulmonary disease. All were members of Alcoholics Anonymous. Fourteen subjects (32 percent) were non-smokers, ex-smokers, and cigar or pipe smokers, yet 28 subjects (64 percent) had abnormal expiratory flow rates, and 17 (39 percent) had an elevated value for the ratio of the residual volume to the total lung capacity. Single-breath diffusing capacity was abnormal in seven subjects (16 percent). Of interest was the high incidence (77 percent) of obstructive phenomena among the women. This high incidence of abnormalities among both the men and women could not be attributed to previous pulmonary infection or smoking. Comparison of these patients with chronic alcoholics suggests that the obstructive component in these patients is, in part, a result of their past alcoholic intake and that it is not reversed by abstinence. On the other hand, the impairment in diffusion, which was so common in alcoholics, appears to be reversible with sobriety.


Monitoring of pulmonary fluid volume and stroke volume by impedance cardiography in patients on hemodialysis.

Changes of intrathoracic fludi volume during maintenance therapy with hemodialysis were studied in ten patients with the aid of impedance cardiography. It was found that there was a statistically significant correlation between the decrease in body weight and the increase in basic thoracic impedance in the individual patients, but the values differed considerably from one patient to another. Therefore, comparison of sequential measurements is feasible only in one and the same patient. Out of 16 patients with overhydration undergoing dialysis, the stroke volume could not be determined by impedance cardiographic studies in eight, owing to the abnormal morphology of the dZ/dt curve. Moreover, because the basic thoracic impedance was not constant during treatment, the calculated changes in stroke volume did not appear to be reliable. This has to be taken into account when repeated measurements are made under clinical conditions. In some of the patients, the dZ/dt curve displayed interesting anomalies, probably resulting from hemodynamic alterations. The diagnostic meaning of these features is not yet known.


Major airway injury in closed chest trauma.

Major fracture of the intrathoracic airway following closed chest trauma is a potentially lethal injury which can be repaired successfully if the diagnosis is made early, Cough, dyspnea cyanosis, hemoptysis, mediastinal emphysema, or pneumothorax not responding to drainage via intercostal tube and a deterioration of the patient's clinical condition out of proportion to the apparent closed chest injury, should alert the clinician to the possiblity of this entity. This report describes the findings in a patient with a longitudinal disruption of the entire intrathoracic trachea and the findings in a second patient with complete transection of the right main bronchus. Each was repaired primarily, with eventual recovery, The principles of management of this difficult group of injuries are reviewed.


Aberrant left pulmonary artery. Clinical and embryologic factors.

The case of an infant with a pulmonary arterial sling (or aberrant left pulmonary artery) is presented. Associated congenital anomalies found in the original patient and in each of four other patients with this lesion, identified from postmortem files, are noted. The importance of associated anomalies of the respiratory tract is emphasized, since if present, they may affect the outcome after sucessful surgical correction of the vascular lesion. Previous theories of the embryologic origin of the anomalous artery are discussed, and a new theory is presented.


Coronary circulatory effects of increased intrathoracic pressure in intact dogs.

The effect of increased intrathoracic pressure on coronary hemodynamics and coronary venous oxygen tension was evaluated in surgically instrumented dogs. Following abrupt increase in intrathoracic pressure, as systolic pressure decrease, the tension time index (TTI) fell 83 percent (P less than 0.001) compared to control. The diastolic pressure time index (DPTI) decline proportionately less, effecting an increase in the ratio of DPTI/TTI from 1.19 +/- 0.08 to 1.78 +/- 0.16 (P LESS THAN 0.05). The mean circumflex coronary blood flow declined only minimally toward the end of the test (5.1 +/- 9.0 ml/min; P less than 0.05), and stroke systolic circumflex coronary blood flow increased 116 percent (P less than 0.01) as late diastolic coronary resistance decreased 31 percent (P less than 0.01). The mean coronary venous oxygen pressure increased transiently above control values from 21 +/- 1 to 24 +/- 2 mm Hg (P less than 0.05). These data suggest that in anesthetized dogs, brief periods of high intrathoracic pressure abruptly reduce determinants of myocardial demand for oxygen, while myocardial perfusion decreases to a lesser degree.


The First Second Timed vital capacity and the course of obstructive lung diseases.

Previous work has shown that with increasing airway obstruction in chronic obstructive pulmonary disease, the decrement in the maximum midexpiratory flow (MMEF) is exponential. Therefore, with severe obstructive disease the decrease in the MMEF as the disease progresses is difficult to discern. This work points out that the fall in first second timed vital capacity (FEV1/FVC x 100) is linear through the course of the disease and, therefore, the decrement, in absolute terms, continues unaltered regardless of how severe the obstruction becomes. It is suggested that the FEV1/FVC x 100 might be more useful in monitoring the course of severe disease than the MMEF. However, it is stressed that both measurements are useful for large groups, but may not be useful in individual cases.


Pulmonary mucormycosis: another cure.

Pulmonary mucormycosis in an ill patient with poorly controlled chronic lymphocytic leukemia was diagnosed with open lung biopsy without excision. He improved on medical management and became ambulatory. At autopsy one year later, no residual mucormycosis was present. Better control of leukemia and more specific antimicrobial therapy are discussed as potentially important factors in patient management.


Cardiac tamponade with nonhemorrhagic pericardial fluid complicating Dressler's syndrome.

A 39-year-old man developed cardiac tamponade with Dressler's syndrome four weeks after an inferior myocardial infarction. Treatment of the tamponade by pericardiocentesis on two occasions produced serous fluid. The pericardial effusion cleared with short-term therapy with corticosteroids and the prolonged use of indomethacin.


Acute supine respiratory failure due to bilateral diaphragmatic paralysis.

This report documents the first known case of bilateral diaphragmatic paralysis following blunt trauma to the chest. The important role of diaphragmatic function in maintaining ventilation, particularly with the patient in the supine position, is illustrated by the reduced total lung capacity, functional residual capacity, and vital capacity. Severe hypoxemia with the patient in the supine position, was markedly improved by elevation of the patient to 30 degree and was further improved by sitting the patient upright. Following an initial period of acute respiratory failure, the patient was managed acceptably by maintaining an elevated position for sleeping until diaphragmatic function returned, about nine months after the injury.


Removal of a fragment of catheter entrapped in a Bjork-Shiley aortic valvular prosthesis. Transarterial approach using a modified loop-snare technique.

Fracture of a left atrial catheter made of polyethylene and its subsequent embolization and entrapment in a Bjork-Shiley aortic valvular prosthesis is reported in a 62-year-old woman. The entrapped fragment of the catheter was retrieved by a transarterial approach using a homemade modified snare-loop device. Measures to prevent such a complication should be directed towards avoidance of force when removing such catheters. In addition, their length should be determined prior to insertion and again after removal, in order to detect their possible fracture and loss at once.


Juvenile delinquency, adult criminality, and adult psychiatric treatment: an epidemiological study.

This report explores some associations among juvenile-delinquency, subsequent criminality, and subsequent psychiatric treatment. A sample of 255 males known to the juvenile court 25 years prior to the study is examined in terms of subsequent documented psychiatric treatment and/or criminal activity. Of the 255 former delinquents, 6% were known later to both criminal justice and psychiatric systems, 6% to psychiatric systems only, 28% to the criminal justice system only, and 60% to neither. Delinquents with later psychiatric histories were twice as likely to be known to the criminal justice system than were those without psychiatric histories. Those with adult psychiatric histories were also significantly younger at the time of their first delinquent offense and committed more juvenile offenses than the nonpsychiatric group. Only 2 of the 16 individuals later known to both systems were diagnosed sociopathic. The findings are discussed.


Hyperactivity among white middle-class children. Psychogenic and other causes.

This paper investigates the problem of hyperactivity in school children and draws on the literature in the field, data collected from comprehensive examinations of 37 hyperactive children, and extensive field interviews with Chicago-area school nurses, social workers, psychologists, teachers, and principals. The research indicates that although constitutional factors are at times responsible for this problem, hyperactivity is due to psychogenic factors much more frequently than is often recognized. It also was found that school teachers seem overly inclined to identify hyperactivity in their students and to recomment that it be counteracted with prescribed drugs. The suggestion is offered that any child thought to be hyperactive undergo a comprehensive examination before such drugs as Ritalin and Dexedrine are prescribed.


The management aspect of psychotherapy with aggressive children.

Psychotherapy with an aggressive child may require the imposition of rather firm limitations over aspects of the patient's aggressive behavior. The nature of this management strategy is determined by the individual child's psychopathology. The management aspects of the psychotherapy with two aggressive boys are illustrated in detail. In one case, stringent limitations were imposed when it was discovered that the boy's behavior was regressive and represented an effort to sadistically control people in his environment. In the other case, the behavior was initially left almost unchallenged; this boy's aggressive and delinquent behavior reflected an effort to achieve a sense of order in an inconsistent external and potentially chaotic internal environment.


Innovative programming in school mental health. Search for a methodology.

Entering a system it often regarded as the most difficult aspect of consultation, especially when entry is initiated by the consultant. Issues involved in seeking entry into a school system are considered from the perspective of a university-based consultant interested in developing, delivering, and evaluating innovative approaches to school mental health problems. Experience with a number of school systems leads to several conclusions about the entry process. Foremost is the existence of a difficult, time-consuming period of negotiations involving various school personnel; because of their varying perspectives and different interests, problems emerge and must be resolved successfully in the course of negotiations if a consultation project is to develop. Often this is not possible, and it is therefore suggested that the consultant seeking a school setting approach several systems concurrently.


The organization of DNA sequences in the mouse genome.

Analysis of the organization of nucleotide sequences in mouse genome is carried out on total DNA at different fragment size, reannealed to intermediate value of Cot, by Ag+--Cs2SO4 density gradient centrifugation.--According to nuclease S-1 resistance and kinetic renaturation curves mouse genome appears to be made up of non-repetitive DNA (76% of total DNA), middle repetitive DNA (average repetition frequency 2X10(4) copies, 15% of total DNA), highly repetitive DNA (8% of total DNA) and fold-back DNA (renatured density 1.701 g/ml, 1% of total DNA).--Non-repetitive sequences are intercalated with short middle repetitive sequences. One third of non-repetitive sequences is longer than 4500 nucleotides, another third is long between 1800 and 4500 nucleotides, and the remainder is shorter than 1800 nucleotides.--Middle repetitive sequences are transcribed in vivo. The majority of the transcribed repeated sequences appears to be not linked to the bulk of non-repeated sequences at a DNA size of 1800 nucleotides.--The organization of mouse genome analyzed by Ag+--Cs2SO4 density gradient of reannealed DNA appears to be substantially different than that previously observed in human genome using the same technique.


Polymorphism of the X-chromosome, Y-chromosome and autosomes in the Australian hopping mice, Notomys alexis, N. cervinus and N. fuscus (rodentia, muridae).

All three species of Notomys so far studied possess a diploid number of 48. Many elements in the karyotype of N. alexis are polymorphic due to variation in heterochromatin, but the variation is most marked in autosomal pair 1, which occurs in at least four forms, the X-chromosome, which occurs in three forms, and the Y-chromosome which occurs in many forms. N. cervinus is unique in the genus in possessing an entirely biarmed karyotype due mainly to the addition of heterochromatic short arms. The X-chromosome of N. cervinus occurs in three forms and the Y-chromosome in two forms. The karyotype of N. fuscus is mainly telocentric although two autosomal pairs are polymorphic due to pericentric inversions. The X- and Y-chromosomes both occur in two forms in N. fuscus. Chromosome measurements and C-banding show that most of the variation in the size and morphology of the sex-pair both within and between species is due to variation in constitutive heterochromatin.


The insensitivity of Vinca rosea to vinblastine.

Root tip mitosis in both Vinca rosea and the chosen control Lepidium sativum is susceptible to the effects of colchicine at and above 5X10(-4)M.--Root tip mitosis in L. sativum is susceptible to the effects of vinblastine at concentrations equal to and greater than 10(-4)M, while root tip mitosis in V. rosea, the plant which is the source of vinblastine, is unaffected by exogenously-applied VBL at concentrations up to and including 10(-2)M.--The possible mechanisms by which the resistance of V. rosea to vinblastine might be conferred are discussed.


The dilemma of Crohn's disease: long-term follow-up of Crohn's disease of the small intestine.

Seventy-four patients having primary Crohn's disease of the small intestine have had follow-up studies for at least 10 years after initial resection, and the results of treatment are presented. The commonest indication for operative treatment was obstruction, followed by fistula formation, intractability, abscess formation, and free perforation. Disease recurred in 69 per cent of patients in this series, and 55 per cent of this group required fruther operative treatment. It is necessary to have a lengthy follow-up period if we are to appreciate fully the serious nature of the recurrence problems of Crohn's disease of the small intestine.


Lithium and aggressive behavior in patients with early total deafness.

Patients with early total deafness frequently present with impulsive, aggressive behavior. Nine such inpatients were treated with Lithium. Two acting out adolescents showed a response to medication and a third personality disorder was dropped for side reactions. Of six schizophrenics, five responded in terms of aggressive behavior, while requiring continued medication with phenothiazines at notably lowered doses for their schizophrenic pathology.


Small-intestinal involvement in familial polyposis diagnosed by operative intestinal fiberscopy: report of four cases.

Operative intestinal fiberscopy, in which the duodenal fiberscope was introduced during laparotomy for colectomy in familial polyposis via the enterotomy opening, permitted the demonstration of small intestinal polyps in six of seven consecutive cases. Four of the six patients had adenomatous polyps in the proximal jejunum, including one patient with the concomitant presence of ileal adenomas. Polyposis due to lymphoid hyperplasia in the terminal ileum was found in three patients. Preoperative upper gastrointestinal surveys revealed adenomas in the duodenums of all seven patients, adenomas in the gastric antrum in three, and multiple hamartomas in the gastric corpus in two. Thus, in familial polyposis or Gardner's syndrome, more or less the entire gastrointestinal tract seems to be involved and the term "gastrointestinal polyposis" seems to describe these conditions.


Occupation characteristics in affective disorders.

One hundred and fifty-four consecutively evaluated new and return psychiatric outpatients were examined by the same interviewer using a detailed, precoded questionnaire based on the diagnostic criteria for psychiatric research proposed by Feighner et al. Affective disorders were present for 75% of the patients and were associated with a history of past employment at a declared occupation, inactive occupation status, and recent occupation status change. Sixty patients with diagnoses of primary affective disorders and 56 patients with diagnoses of secondary affective disorders were identified and studied. The primary affective disorder was associated with higher level and longer held occupations with fewer changes of occupation activity status than was the secondary affective disorder. Forty-one patients with diagnoses of unipolar primary affective disorders and 19 patients with diagnoses of bipolar primary affective disorders were examined. The unipolar illness was associated with a shorter duration of occupation type and less permanent unemployment than was the bipolar illness.


Blue rubber bleb nevus syndrome: report of a case.

A 21-year-old man had blue rubber bleb nevus syndrome: 1) hemangiomas of the skin all over the body; 2) hemangiomas of the digestive system; 3) iron-deficiency anemia. A giant mass of hemangiomas in the tranverse colon was resected surgically.


The dilemma of Crohn's disease: ileosigmoidal fistula complicating Crohn's disease.

Between 1965 and 1975, 27 patients underwent surgical treatment for ileosigmoidal fistulas complicating Crohn's disease at the Cleveland Clinic. There was no death and no anastomotic leak. The preferred procedure is resection of the ileocecal area involved by Crohn's disease with ileocolic anastomosis and a separate segmental resection of the sigmoid colon with colocolic anastomosis. A covering temporary loop ileostomy is used when there is associated pelvic sepsis or small-bowel obstruction.


The dilemma of Crohn's disease: ileoduodenal fistula complicating Crohn's disease.

Nine cases of duodenal fistula complicating Crohn's disease are reported. All nine patients were male. Four patients had Crohn's disease of the ileum and five had ileocolitis. No patient had primary duodenal Crohn's disease. Because attempt at primary closure of the duodenal defect may fail, our treatment of choice has been formal cross cut two-layered duodenojejunal anastomostis with extensive drainage of the area postoperatively. This treatment has been associated with no mortality and little morbidity, and no late recurrence of duodenal fistula.


Transsacral removal of rectal leiomyomas from the same patient on two occasions: report of a case.

An unusually large rectal leiomyoma was excised by the transsacral approach. It recurred six years later and was removed once again in similar fashion. Reoperation was found to be not difficult, though added care is necessary to identify the sphincters, which have a paler appearance. Nerve damage can be kept to a minimum if the same incision is employed. Despite the palliative nature of the operation, the patient was spared total rectal excision and colostomy.


Smooth-muscle rectal tumors: a therapeutic dilemma.

Five cases of smooth-muscle rectal tumors seen in the Lexington, Kentucky, area over a 25-year period are reported. These unusual tumors cause symptoms similar to those of more common anorectal diseases, namely, painful defecation and rectal bleeding. Often these tumors are initially asymptomatic due to their submucosal origin. Clinical diagnosis depends on awareness of these lesions, digital rectal examination, endoscopic examination, and tissue biopsy. Microscopic diagnosis and differentiation of malignant from benign features require a pathologist with special interest and expertise with these lesions. Smooth-muscle rectal tumors should be considered more dangerous than those in other locations in the gastrointestinal tract, as half are malignant and only a fifth of patients who have sarcomas survive five years. Treatment of malignant rectal myomas should be very aggressive from the outset, with abdominoperineal resection being advocated by most investigators due to almost uniform local recurrence with lesser procedures. When the lesion recurs, it is likely to be more virulent histologically and clinically than the initial lesion. Benign myomas are cured by local excision alone.


[C-peptide: secretion and metabolism in different functional states and with abnormal B-cell function (author's transl)].

Fasting C-peptide levels and those after tolbutamide or glucose stimulation were measured in normal subjects. In patients with various hypo- or hyper-functions of the endocrine pancreas, C-peptide levels were compared with the corresponding insulin levels. In insulin-dependent maturity-onset diabetics there were both normal and elevated serum C-peptide levels. In juvenile diabetics and patients with total duodenopancreatectomy there was no measureable C-peptide. It is concluded that the half-life of C-peptide is three times that of insulin.


[Surgical treatment of ischaemic cerebro-vascular accidents (author's transl)].

23 patients were operated on between 3 and 24 hours (group 1) and between 2 and 14 days (group 2) after a stroke with a diagnosis of carotid obstruction. A retrospective study for patients of stage IIIa and IIIb showed that clinical and functional results of both groups correspond. The mortality of group 1 was slightly less than that of group 2. Group 1 showed the largest number of successful vascular reconstructions. Thus an early operation of stage IIIa and possibly IIIb seems indicated. In view of the high mortality (5 out of 6 patients) surgery cannot be recommended in stage IV.


[Two-stage surgical treatment of acute complicated ulcerative colitis: indications, observations and results (author's transl)].

Among 195 patients with ulcerative colitis 30 had acute complications--toxic megacolon with or without perforations. In 16 primary treatment consisted of proctocolectomy in one stage: all patients died. Since 1971, 14 were treated by primary multiple enterostomies, with only three deaths. Indications for the latter procedure are given if after 48-72 hours of conservative treatment there is no response. Definitive treatment consists, almost without exception, of secondary proctocolectomy during the period of remission. Indications for the two-stage procedure should be extended to all acute cases requiring operation.


[Haemodialysis of acute renal poisoning (author's transl)].

A 16-year-old laboratory technician ingested 30 g of sodium nitrite (NaNO2) in a suicidal attempt. Within a short time severe cyanosis and distressing dyspnoea developed. The conservative therapeutic approach with redox substances showed little success. However, haemodialysis resulted in rapid improvement of all signs. After three hours of dialysis the patient was symptom-free and could be discharged after two days without damage due to the intoxication. Additional experimental investigations showed NaNO2 to be easily dialysable. There is, however, no binding to active charcoal.


[Tonography of the eye in the diagnosis of myasthenia gravis (author's transl)].

Tonography of the eye was performed in 15 patients with proven myasthenia gravis and ten control subjects, before and after administration of edrophonium (Tensilon). In nine myasthenics there was definite intra-ocular pressure rise after an average of 20 seconds. In control subjects a comparable pressure rise did not occur. Tonography was superior to results obtained with serial stimulation of the ulnar nerve. The results confirm that tonography of the eye is a valuable and reliable diagnostic test of myasthenia gravis.


[Endogenous plasma histamine and "hepatogenic" peptic ulcer in liver cirrhosis (author's transl)].

Because of its anatomical relationship to the gastrointestinal tract, the normal liver is able to act as a controlling "filter" against the influx of plasma histamine chiefly by uptake and breakdown. This prevents unwanted effects on the systemic circulation. The ability to eliminate histamine from plasma is decreased in cirrhosis. Plasma histamine levels in peripheral venous blood of ten patients with liver cirrhosis and gastric ulcer, proven radiologically and by endoscopy, indicated a significantly higher concentration (1.3 +/- 0.4 micron/1) than in a control group of 16 patients without such disease (0.7 +/- 0.2 micron/1). In a group of patients with fatty liver (stages I-II) there were normal histamine levels (0.7 +/- 0.3 micron/1).


[Research in maternal and child health and in human reproduction].

This article stresses the importance of research in the field of maternal and child health because it can provide knowledge on which to base activities designed to change conditions, as required by the specific needs of the population. The authors review the characteristics of such research in Latin America and put forward a number of suggestions for promoting studies on maternal and child health, including priority areas, methodologies and analytical models, and specific research projects based on an overall approach to the situation concerned. Finally, they emphasize that research must focus on the priority problems of each country in the area of maternal and child health.


Prostaglandin F2alpha and E1 in plasma and amniotic fluid during human pregnancy and labor.

In order to elucidate the significance of PGs in human labor, PGE1 and F2alpha in biological fluid during human pregnancy and labor were measured by RIA newly developed. Analytical studies demonstrated that the levels of PGF2alpha in maternal plasma were 3.7 +/- 2.5 ng/ml a few days before parturition, 2.0 +/- 0.9 ng/ml in the first stage of labor and 1.9 +/- 1.4 ng/ml at delivery. Thus the concentrations of PGF2alpha in maternal plasma showed no significant changes around parturition. On the otherhand, the level of PGF2alpha in amniotic fluid represented a significant increase up to 44.27 +/- 32.81 ng/ml at delivery from 1.45 +/- 0.76 ng/ml before labor at 38-40 weeks of pregnancy (p less than 0.05), although it was uncertain whether this elevation was the cause or effect of uterine contraction. The concentration of PGE1 ranged from 2 to 14 ng/ml around parturition. This indicates that there was little remarkable difference between the levels of PGE1 in plasma and amniotic fluid during the last month of pregnancy and labor. Possible involvement of prostaglandins (PGs) in human labor has been discussed.


Effect of hypolipidemia on testosterone-stimulated prostatic growth in castrated rats.

Hypolipidemia caused by Simfibrate feeding for 3 weeks reduced responses of weight and nucleic acid contents to testosterone administration in the ventral and dorsolateral prostates of castrated rats. However, the effect of testosterone on the contents of citrate, fructose, zinc and the activity of testosterone 5alpha-reductase in the glands of castrated animals was not modified by Simfibrate feeding.


Effect of methallibure (ICI compound, 33, 828) on ovarian activity in the catfish, Heteropneustes fossilis (Bloch).

The effect of methallibure on ovary of H. fossilis was studied. Intraperitoneal administration of methalibure (100 microgram/g body weight) once a week for 4 weeks was very effective in suppressing the gametogenic and endocrine activities of ovary. The regressed condition of ovary was also apparent in GSI (2.84 to 1.09) readings. This decreased state of activity was further confirmed by reduced ovarian 32P uptake (28.00 to 18.10). The results obtained after the administration of the above compound on ovary were similar to those of surgical hypophysectomy.


Growth hormone release by gamma-aminobutyric acid (GABA) and gamma-amino-beta-hydroxybutyric acid (GABOB) in the rat.

Effects of gamma-aminobutyric acid (GABA) and gamma-amino-beta-hydroxybutyric acid (GABOB) on growth hormone (GH) release were investigated in the urethaneanesthetized male rat. An intraventricular injection of GABA and L-GABOB but not D-GABOB caused a significant increase in plasma GH. An intravenous injection of L-GABOB, at the dose which had no significant effect on basal plasma GH, remarkably enhanced plasma GH response to pentobarbital. These results suggest that GABA and L-GABOB stimulate GH release possibly via the central nervous system in the rat.


A comprehensive, interdisciplinary approach to the care of the institutionalized person with epilepsy.

This report summarizes the experience of a comprehensive, interdisciplinary pilot program for improved care of institutionalized persons with epilepsy. From a hospital population of nearly 3,000 persons with diseases of the nervous system, virtually all having varying degrees of retardation, 892 persons were identified as epileptic and classified by seizure frequency: 13% uncontrolled, 24% partially controlled, and 63% controlled. These three categories were similar in respect to levels of retardation and functional disability. The project personnel consisted of a full-time nurse specialist in epilepsy, a part-time health resource analyst, and neurological consultants. Effects on health status were identified by comparing demographic and health data collected during the project. The typical patient was an adult epileptic, functioning at a severely to profoundly retarded level and institutionalized for over 15 years. A significant reduction in anticonvulsant toxicity was observed. A 48% decrease in episodes of status epilepticus and a 73% decrease in the number of seizure-related deaths were demonstrated. During the second year, 23% of the uncontrolled group, representing all retardation levels, became seizure free. In addition to improved care, an effective model for dealing with institutionalized epileptics is proposed.


Gas chromatographic on-column methylation technique for the simulataneous determination of antiepileptic drugs in blood.

An on-column methylation technique (OCMT) is described for the simultaneous, gas chromatographic determination in blood of ethosuximide (ES), phenobarbital (PB), primidone (PD), phenytoin (DPH), and 5-ethyl-5-phenylhydantoin (EPH). Multiple internal standards are employed in the OCMT, in order to eliminate or to minimize greatly error sources common to the technology of gas chromatography and to compensate for the different chemical dispositions of the antiepileptic drugs in an OCMT. The internal standards used in the OCMT were as follows: alpha,alpha,beta-trimethylsuccinimide (TMS) was used for the determination of ES; 5-ethyl-5-para-tolylbarbituric acid (MPB), for PB; 5-ethyl-5-(para-tolyl) hexahydropyrimidine-4,6-dione (MPD), for PD; and 5-(para-tolyl)-5-phenylhydantoin (MPPH), for EPH and DPH. The use of ether, the buffering of the plasma sample at pH 7.6, and the use of dilute (0.30-0.35 M) trimethyl-phenylammonium hydroxide (TMPAH) contributed to the specificity of the extraction scheme of the OCMT. The precision and accuracy of the OCMT was attributed to the use of appropriate, multiple internal standards. A method is described for the preparation of standard solutions of drugs in blank plasma (biological matrix) and for the use of the standards in calibration and daily intra-laboratory control of the OCMT.


Total hydroxyproline in urine of 4 to 6 year-old children--an investigation on its relationship to growth and nutrition.

We analysed over a period of 30-32 days the daily total hydroxyproline and creatinine excretine in urine from 9 healthy, normally fed 4 to 6 year-old children (2 girls, 7 boys). The average urinary hydroxyproline excretion was 45.6 mg/24 hr, with a coefficient of variation of 25.6%. Urinary hydroxyproline for individual children showed distinct differences from day to day, which were independent of urine volume. There were significant differences between the mean values for urine hydroxyproline in individual children, which were independent of age. The average creatinine in urine was 346/24 hr with a coefficient of variation of 17.7%. The hydroxyproline-index did not define the nutritional state of these normally developed children on a normal diet. Dietary hydroxyproline contributed 7.4% to the total urinary hydroxyproline in our investigation. There was a close correlation between urine hydroxyproline excretion and growth velocity in each child.


The SC phocomelia and the Roberts syndrome: nosologic aspects.

We reviewed the SC phocomelia syndrome (SCS) and the Roberts syndrome (RS) to demonstrate techniques of nosologic analysis based primarily on the phenotype analysis. We considered type, localization, severity, and variability of the manifestations. In this patient sample these techniques are not sensitive enough to rule out any one of the three most likely etiologic hypotheses, namely whether the SCS and the RS are due to different recessive genes, different alleles, or the same recessive gene. However, this study does suggest certain implications for each of these possibilities.


Plasma volume estimation in severely ill infants and children using a simplified Evans blue method.

Plasma volume was measured using Evans blue dye and 125iodinated human serum albumin (RIHSA) simultaneously in order to evaluate the accuracy of a simplified Evans blue method recommended by Nielsen and Nielsen (1962). 9 studies were performed in 8 newborn infants weighing 1.07 to 2.85 kg and 16 studies in 14 patients aged 6 months to 14 years suffering from severe circulatory disturbances. In 20 studies, plasma volumes measured by Evans blue and by RIHSA agreed within +/-5%, and in all the studies within +/-10%. The Evans blue method yielded higher plasma volumes than the RIHSA method in 19 instances. The mean difference (paired t-test) was only significant in newborn infants (+4.0+/-3.6%; P less than 0.05). The disappearance rates of Evans blue exceeded that of RIHSA in 16 studies, but this was only significant in the patients older than 6 months (+2.3+/-4.2%/h; P less than 0.05).


IgG-subclass concentrations in cord sera from premature, full term and small-for-dates babies.

IgG-subclass concentrations were determined in cord sera from 47 premature, 59 full-term, and 29 small-for-dates babies of varying gestational age. In permature and full term babies the relative percentages of all four subclasses were in the range for normal adult values. However, in small-for-dates babies significantly lowered IgG1-levels were found.


Logorrhea syndrome with hyperkinesia.

The present paper reports on 13 cases of logorrhea syndrome with or without hyperkinesia, or hyperkinesia without logorrhea, with lesions at various levels of the nervous system. Lesions of the ascending reticular inhibitory system are incriminated. The mechanism producing this syndrome is discussed.


Polygraphic study of periodic breathing and hypersomnolence in a patient with severe hypothyroidism.

A 67-year-old woman with primary hypothyroidism, who had Pickwickian syndrome as well, was studied electrophysiologically. A polygraphic study with simultaneous recordings of electroencephalography, actograms of the abdominal walls, the mentum and the anterior neck, and electromyogram of the intercostal muscles revealed a cyclic appearance of apnea in the sleep phase and gasping preceding arousal, which, together with macroglossia and sleep in the sitting position, suggested a cyclic obstruction of the upper airway. The obstruction appeared responsible for both alveolar hypoventilation and disturbance of consciousness.


Intention and action myoclonus from thalamic angioma. Report of a case.

Clinical electrophysiological and neuroradiological examination of a case of unilateral intention and action myoclonus is reported. Brachial arteriography revealed an angioma located mainly in the lateral portion of the right posterior thalamus. Clinical and electrophysiological findings suggesting involvement of nonthalamic structures were absent. Our case, together with some cases previously described, raises the possibility that volitional myoclonus may be related to a relatively circumscribed damage of some diencephalic and/or mesencephalic structures. The rare occurrence of a hyperkinetic syndrome as principal symptom of a cerebral vascular malformation should be borne in mind in view of the potential risk of a stereotactic surgical procedure designated to alleviate the involuntary movements.


Clinical, social and biochemical studies on Batten's syndrome, alias Spielmeyer-Vogot or Stengel's Syndrome.

The clinical and biochemical data on 13 patients with Batten's syndrome are described. Clinically the disease was characterized by progressive maental and somatic deterioration. Initially, vision loss was found between the ages 4 and 8 years. This was associated with 1 or 2 years of normal school attendance followed by attendance at a school for mentally retarded from the age of 8 to 11; then warding was established at a school for blind children and later on a hospital for epileptic patients when seizures and mental retardation made hospitalization necessary. Biochemically, an increased peroxidation rate was revealed in peripheral thrombocytes. This abnormality was associated with a significant decrease in peroxidase activity of leucocytes assayable with p-phenylenediamine, but not with Guajacol. The peroxidase defect seemed to concern an azide-resistant peroxidase. However, in serum the glutathione peroxidase was only found insignificantly decreased.


A progressive congenital myopathy. Initial involvement of the diaphragm with type I muscle fiber atrophy.

An uncommon case of initial respiratory distress during the first months of life as the result of bilateral diaphragmatic weakness is presented. The biopsy and necropsy findings show a progressive congenital myopathy with type I muscle fiber atrophy and predominant involvement of the respiratory muscles. The lesions, observed in the central nervous system are due to the severe hypoxia. The morphological findings are discussed in relation to the etiology and the clinical picture of the disease.


Ophthalmoplegic migraine with persistent abducens nerve palsy.

A 27-year-old woman had been suffering from recurring episodes of left-sided migraine since the age of 5. When 14 years old, a diplopia on looking to the left followed each episode; its length progressed with time and eventually became permanent. On examination a left abducens palsy was found. Arteriography failed to reveal the presence of aneurysm or other vascular anomalies.


The transfer of IgG from serum to CSF, evaluated by means of a naturally occurring antibody.

Titres in CSF of natural IgG antibodies (AB) to rabbit erythrocytes (RRBC) correlated well with titres in serum in normal individuals, indication a passive transfer of the Ab. The ratio of CSF Ab to serum Ab mostly found was 1:400. The ratios of total IgG were slightly lower than the ratios of Ab to RRBC in normal individuals and in the majority of the diseases, except in multiple sclerosis and in subacute sclerosing panencephalitis (SSPE) where the ratios of total IgG were markedly elevated, indicating production of IgG in the central nervous system. In SSPE the ratio of measles Ab was even more elevated, suggesting that these antibodies contribute to the local IgG production. The ratios of Ab to RRBC in the two diseases were not elevated, or only slightly elevated. In normal and pathological CSF and in the Ab to RRBC all subclasses of IgG were found. In conclusion, the Ab to RRBC are considered convenient markers of serum IgG in the CSF.


Imagery in the aged.

Two studies were conducted to investigate the use of imagery by subjects of different ages. Experiment 1 was designed to test the effectiveness of "peg-word" system as a memory aid for the elderly. Variables believed to be important in the effectiveness of mnemonic devices were manipulated. The results showed that the mnemonic and imagery instructions were of benefit to the young subjects but not to the older subjects. Age was also found to interact with the concreteness variable, item concreteness having a smaller effect on the oldest subjects. These results suggest that the older subjects were not using imagery mediation effectively. Under the conditions of the second experiment, however, item concreteness had a similar effect across age groups. Tye of instruction was also manipulated in Experiment 2 and only the middle age group improved with imagery instructions. The older age group was not benefited by such instruction.


Active and passive avoidance in rats as a function of age.

Rats of four age groups: young (30 days of age), adolescent (180 days of age), adult (365 days of age), and old (547 days of age) were trained on active and passive avoidance tasks. There was impaired acquisition and 30-day rentention of passive-avoidance learning in both young and old rats, compared to the intermediate age groups, and marked impairment of acquisition and retention of active-avoidance learning in the old rats. Learning impairment is thus associated with immaturity as well as senescence.


Age and sex differences in cerebral asymmetry as a function of competition for "time" and "space" in a successive auditory matching task.

Subjects in three age groups identified verbally encoded (VE) and nonverbally encoded (NVE) stimuli as "same" or "different". Matching times increased with age, but differentially for men and women and VE and NVE stimuli. Evidence for asymmetry effects occurred for middle age and older men, but only when a secondary memory task produced competion for "time" and "space" in the left hemisphere.


Central/incidental recall and selective attention in young and elderly adults.

Central and incidental recall of young (Mean age=28.4) and elderly (Mean age=70.9) men and women was examined. As expected, statistically significant age differences were found for both central and incidental recall. For the eight items mean central recall (5.72) was significantly higher than mean incidental recall (2.56) at both age levels; mean incidental recall was significantly greater than chance for both age groups. Lack of an age X central/incidental interaction was interpreted as supporting a general recall deficit. No evidence was found to suggest an attentional focusing difference between young and elderly adults. Verbal labeling of the central stimuli had no effect on recall scores. Differential recall for each of eight positions of stimuli was also examined. Both age groups exhibited a spatial primacy-recency effect for central but not incidental recall. No support was obtained for an attentional interpretation of age-associated differences in learning.


Biochemical changes in the central nervous system with age in the rat.

Studies dealing with biochemistry of the central nervous system of rats have been reviewed. Data on the effects of age on enzyme activity and cellular substrates have been summarized in tabular form. In general, it can be concluded that biochemical functions dealing with anabolism decrease whereas those dealing with catabolism increase as aging progresses.


Decidual extracts suppress antibody response in vitro.

Extracts of decidual tissue produced in pseudopregnant rats were found to suppress in vitro antibody response to alpha-2,4-dinitrophenyl-polylysine. The peak levels of both the total antibody response and the 2-mercaptoethanol-resistant fraction were reduced. Extracts prepared in a similar manner from uteri of normal untreated or pseudopregnant rats did not exert such an effect.


The immune response to allogeneic rat platelets; Ag-B antigens in matrix form lacking Ia.

Allogeneic rat platelets fail to induce either primary antibody or cell-mediated immune responses despite repeated injections. Platelets bear Ag-B epitopes which are capable of being recognized by antigen-reactive T and B cells since primed rats develop secondary responses after challenge with allogeneic platelets. The secondary responses induced decrease rather than increase on repeated injection of platelets. Repeated injection of allogeneic platelets into nonprimed rats leads to a state of specific, partial non-reactivity; recipients given such treatment show marked depression of cytotoxic antibody responses, but normal cellular immunity after challenge with viable lymphoid cells taken from the platelet-donor strain. Injection of normal rats with allogeneic platelets mixed with 3rd party, viable lymphoid cells, does not provoke an anti-platelet Ag-B antibody response.


Interaction between IgE complexes and macrophages in the rat: a new mechanism of macrophage activation.

In earlier studies we found that normal rat macrophages, preincubated at 37 degrees C with the serum of syngeneic rats immune to Schistosoma mansoni, strongly adhered to S. mansoni schistosomules whereas no significant adherence was induced with serum from normal rat. Using 51 chromium release assay, it now proved that immune serum-incubated macrophages lysed the schistosomules in 18 h. Absorption experiments and ultracentrifugation of the immune serum showed that immune complexes containing specific IgE antibody against S. mansoni and soluble parasite antigens induced macrophage adherence and cytotoxicity. Using various labeling techniques, the binding of aggregated rat IgE to the macrophage surface at 37 degrees C is evident in conditions where endocytosis is neglible. The binding of immune complexes containing IgE antibody to S. mansoni elicits dramatic ultrastructural changes in the macrophage and an increase of its lysosomal enzymes together with specific lytic activity for the schistosomules. The parallel development of immune serum-induced macrophage adherence or cytotoxicity with the level of circulating IgE antibody to the parasite in correlation with the development of immunity in the rat, suggests that this new mechanism of macrophage activation could play a role in immune effector mechanisms against S. mansoni. Therefore, IgE acts as a humoral mediator of cellular immunity.


Role of brain monoamines in the anorectic activity of mazindol and d-amphetamine in the rat.

The interaction of mazindol and d-amphetamine with brain monoamines was studied in rats. At each dose used, both compounds markedly counteracted the decrease of brain noradrenaline induced by 6-hydroxydopamine while only at high doses they did significantly reduce the effect of 6-hydroxydopamine on brain dopamine. Unlike d-amphetamine, mazindol significantly counteracted the decrease of brain serotonin induced by fenfluramine. The anorectic effect of mazindol and of d-amphetamine was markedly reduced by an electrolytic lesion at the level of the ventral noradrenergic bundle but not by an electrolytic lesion of the nucleus raphe medianus. An intrastriatal injection of 6-hydroxydopamine significantly reduced the effect of mazindol but not that of d-amphetamine. The results indicate that both compounds may block noradrenaline uptake in the brain while their effect on dopamine uptake is less evident. Ulike d-amphetamine, mazindol appears to inhibit serotonin uptake also. In addition, the integrity of the noradrenergic neurons in the brain appears to be an important condition for these drugs to exert their anorectic effect.


Modulation by histamine of the efflux of radiolabeled catecholamines from rat brain slices.

Histamine induced a dose-dependent stimulation of 3H-catecholamine(CA) efflux (superfusion procedure) from hypothalamic, striatal, hippocampal and cortical slices. The extra-hypothalamic regions were the most sensitive to histamine. Efflux of 14C-GABA and 14C-(acetyl)choline was not affected. The effect of histamine on 3H-CA efflux developed slowly, reaching its maximum after 15-20 min. Histamine was inefffective with tissue from reserpinized animals. The major part of the radioactivity released by histamine consisted of CA metabolites. Histamine apparently does not enter catecholaminergic neurons, since tyramine and the CA had no effect on the efflux of 3H-histamine previously taken up by brain slices. After incubation of slices with 3H-CA in the presence of histamine and subsequent superfusion, tyramine or K+ -depolarization induced much less 3H-CA release than from control slices not incubated with histamine. It is suggested that histamine may act as a modulator of presynaptic catecholaminergic processes in the central nervous system by causing a depletion of the transmitter stores in the nerve terminals.