Movement disorders as a complication of acute hemiplegia of childhood.

We evaluate three cases of acute hemiplegia in childhood complicated by tremor and/or choreoathetosis. Each patient experienced the abrupt onset of hemiplegia thought to be localized to an insult involving the middle cerebral distribution without associated seizure, trauma, loss of consciousness or demonstrable cardiac, hematological or neoplastic causes. All three patients recovered most, if not all, strength on the affected side, but each was left with a disorder of movement involving the previously hemiplegic upper extremity. These disorders included resting and intention tremors, as well as choreoathetosis. Anticholinergic drugs failed in treating two patients, but biofeedback techniques were quite successful in one of the two patients so treated.


The metabolic effects of excess noradrenaline secretion from a pheochromocytoma.

We report a 14-year-old boy with severe hypertension who was cured by surgical removal of a pheochromocytoma. The tumor was shown biochemically and morphologically to secrete predominantly noradrenaline. The metabolic effects noted in this patient were raised free fatty acid levels and depressed insulin levels, hyperreninemia, hypercalcemia, and hypercalciuria with normal parathyroid function. All these abnormalities returned to normal after removal of the tumor. It is suggested that these effects were mediated via beta-adrenergic stimulation of the excess noradrenaline.


Nine cases of sphingomyelin lipidosis, a new variant in Spanish-American Children. Juvenile variant of Niemann-Pick Disease with foamy and sea-blue histiocytes.

We describe nine Spanish-American children from five families with an unusual hereditary lipid storage disease. The family origins were in two small southern Colorado towns. The clinical course varied, but all of the children were found to bruise easily and to have splenomegaly, while most had hepatomegaly. Post-natal jaundice and hepatitis occurred in four. Impairment of vertical gaze and intellectual and neurologic deterioration occurred in most of the patients, with the onset of the disease, usually in childhood. The bone marrow in all patients examined contained both foamy and sea-blue histiocytes. Sphingomyelinase levels in skin fibroblast cultures were greatly decreased in seven of the eight cases evaluated. It is believed that these patients have a sphingomyelin lipidosis and represent a variant of the Niemann-Pick disease. Clinical and enzymatic findings are compared with those of other cases in the literature.


Abnormal lipid accumulation within the small intestinal mucosa of children with juvenile-onset diabetes mellitus.

The lipid content of the proximal jejunum, as studied by light microscopy with lipid histochemical staining methods, is determined in 14 fasting children with juvenile-onset diabetes mellitus. The results show that four children had greatly increased amounts of lipid, while six others had a mildly to moderately increased amounts of lipid present. The amount of lipid present appears to correlate most closely with the quality of control of the diabetes. These results indicate either that the clearance of exogenous lipid is impaired or that there is an increased endogenous synthesis of lipid within the intestine of the diabetic child, especially in those under poor control.


Reliability of salivary theophylline as a guide to plasma theophylline levels.

Simultaneous saliva and plasma theophylline levels in 12 chronic asthmatic children were measured by high pressure liquid chromatography following administration of a theophylline preparation. In five subjects, simultaneous plasma and salivary theophylline were measured one week later. A strongly positive correlation between plasma and salivary theophylline levels was found at all time periods tested. There was no substantial difference in the plasma-saliva theophylline ratio determined one week later. A predicted plasma level was compared with the observed value. The proportionality of predicted to observed plasma theophylline levels using either the entire study group mean plasma-saliva ratio or each individual's ratio was approximately 1.00 with 9% variability. When a previously reported plasma-saliva theophylline ratio was used for comparison, the predicted plasma theophylline was 15% above the observed plasma level.


The effect of early diagnosis and treatment in cystic fibrosis: a seven-year study of 16 sibling pairs.

Data on 16 sibling pairs with cystic fibrosis were analyzed to test the hypothesis that early treatment of this condition improves prognosis. Younger siblings' conditions were diagnosed before 1 year of age, usually before the onset of pulmonary disease. Older siblings' conditions were diagnosed after 1 year of age and after the onset of pulmonary disease. Although the sibling pairs received similar treatment, comparison at 7 years of age showed that the younger siblings had significantly better chest roentgenogram scores, total clinical scores, residual lung volumes, and ratios of residual volume to total lung volume. Younger siblings also required fewer hospital admissions to control their lung disease. The results suggest that, in general, early initiation of therapy is beneficial for patients with cystic fibrosis.


Premature coronary atherosclerosis in a 5-year-old with corticosteroid-refractory nephrotic syndrome.

We report the case of a 5-year-old girl who died two years after onset of the idiopathic nephrotic syndrome, which failed to respond to treatment with corticosteroid and cyclophosphamide. Severe atherosclerotic changes were noted in both coronary arteries. Prolonged hyperlipidemia in patients with long-standing nephrotic syndrome may represent a major risk factor predisposing to premature coronary atherosclerosis in children who are also destined to develop chronic renal failure.


Dermal and glomerular deposition of IgA in anaphylactoid purpura.

During the period of acute anaphylactoid purpura, skin biopsies were performed on 14 patients with purpuric and nonpurpuric skin. In addition, four patients had renal biopsies. Examination of the tissue by immunofluorescence to anti-human immunoglobulins IgG, IgA, IgM, and IgE, fibrin/fibrinogen, complement Clq, C4, and C3 demonstrated predominant IgA, C3, fibrin/fibrinogen in the purpuric skin and glomerulus, without Clq and C4. These immunohistochemical findings are characteristic of anaphylactoid purpura and suggest that IgA is involved in the pathogenesis of anaphylactoid purpura and may operate through the alternate pathway of the complement system.


Systemic gas embolus: a discussion of its pathogenesis in the neonate, with a review of the literature.

We report, a term newborn infant with congenital vocal cord paralysis and congenital viral myocarditis. In her five days of life she developed a pneumomediastinum, pneumopericardium, subcutaneous emphysema, and terminally a pneumothorax and systemic air embolus. This unusual case is used to develop a concept of the pathogenesis of extraventilatory air, and is also represented in diagrammatic form.


Splenorenal fusion: heterotopia simulating a primary renal neoplasm.

We report an instance of splenic heterotopia arising within the left kidney of an otherwise normal female infant. Embryologic considerations suggest that fusion of nephrogenic mesoderm and splenic anlage in the second month of gestation accounts for the observed findings. Although splenic-mesonephric (splenogonadal) fusion is a well-characterized, although rare, malformation, we were unable to find any previous description of splenic-metanephric fusion.


Renal failure as a presenting sign of diffuse sarcoidosis in an adolescent girl.

We report a renal failure due to sarcoid granulomatous infiltration of the kidney that was documented by renal biopsy in an adolescent black albino girl. Treatment with prednisone was associated with improvement in the clinical disease and the histologic picture on repeat biopsy. With cessation of prednisone there was clinical and histological relapse while reinstitution of prednisone therapy was again associated with improvement. Experience with this child, as well as that reported previously in seven similar adult patients, would indicate that prednisone is an effective drug to control this unusual problem.


Effects of glucagon and secretin on food- or morphine-induced motor activity of the distal colon, rectum, and anal sphincter.

The effects of glucagon and secretin on food- or morphine-induced motor activity of the distal colon, rectum, and internal anal sphincter were investigated in 12 healthy subjects. Intraluminal pressure changes were measured using a triple-lumen polyvinyl tube assembly with 3 side orifices. Glucagon, administered intravenously, caused significant inhibition of food- or morphine-induced motor activity of both the distal colon and rectum. In contrast, secretin did not suppress morphine-induced motor activity but did significantly inhibit food-stimulated motor activity of the distal colon. The inhibitory effect of secretin on motor activity of the rectum was insignificant. Morphine, but not food, elevated the pressure of the anal sphincter which was not effected by glucagon or secretin. Hyperglycemia, produced by the infusion of 5% glucose, had no effect on motor activity. These studies demonstrate that glucagon but not secretin, in the doses employed, inhibits morphine-induced motor wave activity of both the distal colon and rectum and that this inhibitory effect is not secondary to hyperglycemia. Furthermore, the rise in anal sphincter pressure is not affected by glucagon or secretin.


Rabbit ileal mucosa exposed to fatty acids, bile acids, and other secretagogues. Scanning electron microscopic appearances.

Segments of rabbit ileum were examined by scanning electron microscopy (SEM) after exposure to various compounds known to stimulate fluid secretion in the small intestine. After perfusion with ricinoleate (castor oil) at a 10 mM concentration, striking changes were observed at villus tips and on the apicolateral surfaces of villi; erosions at tips were confirmed by light microscopy of the same pieces of tissue examined by SEM. The appearances after ricinoleate were reversed in part during perfusion with control buffer for 2 hr. Statistical comparisons between control perfused, treated, and reversal tissues showed that the "damage" produced by ricinoleate, and its reversal, was significant statistically. Tissues treated with other intestinal secretagogues, oleic acid (10 mM), deoxycholic acid (4 mM), cholic acid (4 mM), dioctyl sodium sulfosuccinate (6 mM), and cholera toxin (1 microgram/ml) also showed surface changes by SEM. Fluid secretion, produced by an osmotic agent (mannitol) was not associated with "damage." Changes in structure of the mucosal surface after exposure to intestinal secretagogues should be considered as one possible mechanism of impaired fluid transport.


Changes in site distribution of colorectal carcinoma in Connecticut, 1940-1973.

The proportion of colorectal cancer occurring above the rectosigmoid junction has been increasing over time. The 40,771 cases of colorectal carcinoma reported to the Connecticut Tumor Registry from 1940 through 1973 were analyzed to determine the incidence in the ascending colon, the transverse, descending, and sigmoid colon, and the rectum. The numbers of cases, the proportion, and incidence rates of cancer in the ascending colon and sigmoid have increased over the 34 years. The increases were greatest among people over 65 years old. Only about half of colorectal cancer can now be identified with the rigid sigmoidoscope. Other tests must be used for early diagnosis of the increased numbers of cancers in the upper parts of the colon.


Doxycycline esophageal ulcers.

Two patients developed acute esophageal ulceration after ingestion of doxycycline hyclate. Despite vigorous investigation no evidence was found to support a viral etiology. The ulcers are postulated to result from close contact between the capsules and the esophageal mucosa.


Colonic mucosal atrophy induced by a liquid elemental diet in rats.

The weight, the total crypt cell population, and the proliferation parameters of the colon were estimated in rats during a 4-week administration of a liquid elemental diet (Vivonex standard). Both mitotic and DNA synthesis activity were decreased (P less than 0.01) in the colonic mucosa during the administration of the diet. The weight of the colon was electively decreased (P less than 0.01) from the first week of the treatment. After four weeks, a 75% decrease in the cell population of mucosal glands was observed. This showed that considerable atrophy of the colonic mucosa occurred under the effect of feeding the elemental diet. This atrophy was probably mediated by a reduction in the proliferative activity of the stem cells in the mucosal glands.


Effect of synthetic motilin on gastric motor activity in conscious dogs.

The effect of intravenous infusion of synthetic motilin on gastric motor activity was investigated by means of chronically implanted force transducers in 4 conscious dogs. Since the gastric motor pattern consisted of two major subpatterns, digestive and interdigestive motor activity, motilin was tested for its motor stimulating activity in both states. It was found that motilin had no influence upon gastric motor activity in the digestive state. However, during the interdigestive state, intravenous infusion of motilin in doses of 0.3-2.7 microgram/kg/hr induced motor activity similar to the naturally occurring interdigestive contractions in a dose-related fashion. Since motilin is released by duodenal alkalinization in the dog, it may be postulated that motilin is a substance to control the interdigestive contractions in the dog, although other reports describe motilin release by duodenal acidification and inhibition of gastric emptying in man. Endogenous stimuli leading to motilin release may be different among species. The present study clearly indicates that motilin induces a contractile pattern similar to that seen during the interdigestive state in conscious dogs.


Evaluation of biliary tract disease by diagnostic ultrasound.

Diagnostic ultrasound is useful in evaluation in biliary tract disease because it is independent of function, rapidly performed, and noninvasive. In most cases the presence or absence of obstruction as well as the etiology of the obstruction can be made.


Duplication of the pylorus found concomitantly with achalasia: congenital or peptic etiology?

A patient is presented with true duplication of the pylorus and concomitant achalasia of the esophagus. This patient has never had peptic ulcer disease and is suspected to have a double pyloric anomaly as a congenital abnormality rather than the result of peptic disease and scarring.


Acute pancreatitis secondary to furosemide with associated hyperlipidemia.

A patient is described with acute pancreatitis which was probably caused by furosemide. Administration of furosemide on two separate occasions was associated with increases in serum amylase concentrations and recurrence of abdominal pain. This case is of further interest because of the presence of hyperlipemia in the absence of an underlying lipid abnormality. Following recovery from pancreatitis, the lipoprotein pattern evolved from type V to type III, type IIA, and finally to normal.


Azathioprine-associated acute pancreatitis.

Azathioprine therapy in a patient with granulomatous ileocolitis was associated with an attack of acute pancreatitis, which was confirmed by laparotomy. Recurrence of pancreatitis occurred after rechallenge with a single dose of azathioprine.


The development of carcinoma of the colon.

Carcinoma of the colon usually starts as a small nidus of malignant cells on the tip of adenomatous/villous polyps. The term "early cancer of the colon" is introduced as part of the concept that there are stages in the development of colon cancer and that it can and should be treated at an early stage. Removal of polyps at any point in their development up to the stage of early invasiveness represents the most favorable time for resection and cure.


Colonoscopic excision of large sessile polyps.

Experience with 80 consecutively-encountered large sessile colon polypoid lesions is reviewed in order to document the salient principles involved with safe and total endoscopic excision of certain of these lesions. The endoscopic physical characteristics of the polypoid lesion is the single most important factor in determining the method of removal of sessile polypoid lesions. Considerable experience with diagnostic colonoscopy and endoscopic removal of pedunculated and small sessile lesions is most important before considering the technic of piece-meal polypectomy for large sessile benign lesions.


Use of biliary drainage in diagnosis of biliary tract disease.

Thirty-five patients with biliary-type symptoms and normal oral cholecystograms were found to have either cholesterol crystals, calcium bilirubinate pigment or leucocytes in gallbladder bile collected through duodenal drainage. All underwent cholecystectomy. The gallbladders all showed histological evidence of chronic cholecystitis and/or cholesterolosis. In addition, four gallbladders contained calculi. Cholecystectomy is recommended as treatment for a selected group of patients with duodenal bile crystals or pigment.


Incidence of HBsAg, anti-HBs and subtypes ad and ay in a general hospital: correlation with clinical data and its significance as a public health problem.

During a period of four months, 9,418 individuals, comprising new hospital admissions, new employees and blood donors, were tested for HbsAg and 1,212 for anti-HBs. A high incidence of positivity for both was found in the different groups under investigation. Subtyping was carried out on acutely ill patients and carriers. Sbtype ay was common in acutely ill patients and among addicts and subtype ad in nonhepatitis patients and healthy carriers. The significance of these findings and possible measures for prevention of spread of the infection are discussed.


The influence of biliary infection on the postoperative course after biliary tract surgery.

A prospective clinicobacteriological study was undertaken in 167 patients undergoing biliary surgery so as to assess the possible influence of the endogenous preoperative biliary infection on postoperative morbidity. Bile cultures were positive in 33% (55 patients); in those undergoing cholecystectomy alone this finding was present in 23% while in those in whom a choledochotomy was also performed cultures were positive in 65%. The incidence of wound infection was found to be twice as high in those undergoin choledochotomy as in those undergoing cholecystectomy alone--37.8% vs. 18.5%. There was no appreciable difference in the rate of wound infection when a routine appendectomy was performed during biliary tract surgery. Among the 38 patients with wound infection, bile cultures were positive in 16. In 13 cases the offending organism in the wound was identical with that recovered from the bile coulture. This finding suggests an endogenous source for the wound infection. This study further indicated that wound infection is most likely to be encountered in patients with pathogenic organisms in the bile, in the aged and in those whose resistance to infection has been lowered by concomitant disease.


Touch smear cytology for endoscopic diagnosis of gastric carcinoma.

A retrospective study was made on the accuracy of histology and touch smear cytology of the specimens obtained by endoscopic target biopsy. Sixty-five cases of small size excavated-type gastric carcinoma, including 27 cases of early carcinoma were studied. By histology alone, 89% of cases (58 cases) were diagnosed accurately, 85% (55 cases) by touch smear cytology alone and 95% (62 cases) by combined examination. By touch smear cytology, 10 out of 16 specimens were diagnosed as positive, although extensive necrosis of the specimens prevented histologic study. The study demonstrated that the floor as well as the edge and margin of the excavated lesion is an important target site for biopsy. Touch smear cytologic technic is an aid to the diagnosis of gastric malignancy.


Blocking of protein pancreatic secretion by maximal secretion infusion in the dog.

In conscious chronic gastric and pancreatic fistula dogs (Thomas cannula), secretin was perfused for three hours with a submaximal (GIH, 1.0 C.U./kg.) and a maximal dose (GIH, 8.0 c.u./kg.), according to the following schedule: 1. First hour submaximal stimulus; 2. second hour maximal stimulus; 3. third hour submaximal stimulus. The alkaline and protein components of pancreatic secretion were analyzed in 20-minute sample collections thoughout the three hours. The same protocol was followed in anesthetized dogs subjected to a mind line laparotomy. A biopsy of the pancreatic gland was taken before (control) and at the end of each perfused dose. The secretion showed a significant increase of protein concentration and output when passing from the maximal to the last submaximal secretin perfusion dose. These findings correlated well with the piling up of zymogen and prozymogen granules in the apical zone of the acinar cells during maximal secretin perfusion, with their subsequent discharge into the acinar lumen upon abrupt reversal to the initial secretin submaximal dose. The study confirms that secretin influences pancreatic protein secretion and indicates in addition, that pharmacologic doses of the hormone, have the capacity to block acinar cell zymogen granule release.


Assay of amylase and isoamylase activities in serum and urine. Modifications in methods and range of normal values.

Certain modifications are described in assay methods previously reported from this laboratory for total amylase and isoamylase activities. These modifications provided more consistent results and achieve superior separation of pancreatic and salivary type (P- and S-type) isoamylases. The estimated range of values in the serum and urine of normal subjects using the modified assay procedures is presented for total amylase as well as for P- and S-type isoamylases.


Variability of splenomegaly in Crohn's disease.

Splenomegaly is an unusual finding in Crohn's disease and can be persistent or transient. In three febrile patients it was so prominent that the diagnosis of lymphoma was considered. In two additional patients the splenomegaly was an incidental finding. It is probably a nonspecific response to the basic disease in most cases, or occasionally a response to the chronic liver disease that can occur in inflammatory bowel disease.


Assessing depressive symptoms in five psychiatric populations: a validation study.

Data from five psychiatric populations and a community sample are presented on the CES-D, 20-item self-report depression symptom scale developed by the Center for Epidemiologic Studies. Results show that the scale is a sensitive tool for detecting depressive symptoms and change in symptoms over time in psychiatric populations, and that it agrees quite well with more lengthy self-report scales used in clinical studies and with clinician interview ratings. Although a symptom scale cannot differentiate between diagnositc groups, the CES-D has demonstrated its validity as a screening tool for detecting depressive symptoms in psychiatric populations.


Epidemiology of mycobacterial lymphadenitis in an Idaho swine herd.

A study of Mycobacterium avium infected swine in an Idaho herd was made to obtain information on morbidity and to evaluate some control measures. Of 867 pigs slaughtered during a 30-day period in May and June, 1974, 100 carcasses were condemned or passed for cooking and 406 carcasses had lesions in one lymph node and were passed without restriction. Mycobacteriologic examinations were made on 33 pigs which were tuberculin tested. Mycobacterium avium was isolated from 21 of 26 tuberculin positive pigs and from 4 to 7 tuberculin negative pigs. Lymphocyte stimulation tests were completed for 12 pigs. Positive results were observed in 11 and M. avium was isolated from 7. Mycobacterium avium serotypes 1,2,4,8, and 9 were identified.


Two more "private" polymorphisms of Amerindian tribes: LDHb GUA-1 and ACP1 B GUA-1 in the Guaymi in Panama.

A survey of Guaymi Indians of Panama for the occurrence of genetic variants of 25 proteins of the erythrocytes and sera have revealed, in addition to seven well-known genetic polymorphisms, four rare variants and two "private polymorphisms," the latter involving erythrocyte acid phosphatase and lactate dehydrogenase. The significance of such private polymorphisms in tribal populations to the interpretation of rare variants in civilized populations is emphasized.


Maternal influence on plasma cholesterol variation.

Evidence for maternal effects on plasma cholesterol was found by comparing the variance between maternal and paternal half siblings obtained from 83 families of monozygotic twin pairs (424 children). Maternal effects accounted for about one-fifth of the total variance.


Sizes of deciduous teeth in 47,XYY males.

Deciduous teeth of six 47,XYY males have been examined, and the tooth sizes were found to be larger than those of controls. We concluded that a factor or factors which influence excess dental growth in 47,XYY males are probably in effect before the age of a few months. The time needed for the achievement of final tooth growth excess seems to be limited to a 9--18 month period. It also became evident that excess dental growth of 47,XYY individuals is a developmentally stable process, and the Y chromosome apparently regulates quantitative variation of the teeth in normal males [2]. These observations on tooth sizes in 47,XYY males suggest a chromosomal influence on dental determination.


A study of fluctuating dermatoglyphic asymmetry in the sibs and parents of cleft lip propositi.

Fluctuating asymmetry was studied in cleft lip propositi and their normal sibs and parents. The traits examined were a-b ridge counts and fingerprint patterns. Propositi with a family history of this congenital malformation and their normal sibs and parents were significantly different from the controls for this type of asymmetry. Propositi without a family history and their normal sibs and parents were similar to the controls. These results support the hypothesis that familial and sporadic cases of congenital cleft lip are different entities and give evidence for a genetic mechanism in the parents and sibs of the familial cases that may account for this congenital disorder and, concomitantly, increased fluctuating asymmetry.


Recombination, mutation, or constitutive expression at a Gm locus and familial hypergammaglobulinemia.

In a hypercholesterolemic Lebanese family, an uncommon Gm haplotype carrying an unexpected C gamma 1 gene was inherited by only one of 10 siblings. A new recombination during the maternal or paternal meiosis could explain its formation. According to this hypothesis, our data would be informative for the linkage relationship between the gamma-cistrons and the alpha 2-cistron. The latter might be located near the N-terminal side of the gamma-cistron linkage group, and the sequence of genes would be alpha 2, gamma 4, gamma 3, and gamma 1. A mutation could also effect the change from G1m(17) (codons AAA and AAG) TO G1m(3) (codons AGA and AGG). Another alternative is to postulate a constitutive expression of a C gamma 1 structural gene which, normally, would not be expressed. The uncommon derepression could be the consequence of uncommon cellular response to environmental, pathological or metabolic perturbation of a regulatory mechanism.


Third-party reimbursement for clinical pharmacy services: philosophy and practice.

A step-by-step approach is outlined for obtaining third-party reimbursement for clinical pharmacy services separate from dispensing fees. The program is based on a patient-care philosophy rather than a cost-conscious philosophy. The steps in implementation of the program were: (1) a total commitment to the patient's health, (2) identification of patient needs that require clinical pharmacy expertise, (3) development of a patient training program, (4) presentation of a written proposal to the hospital administration, (5) presentation of the proposal to third-party agencies, (6) initiation of charges for the services, and (7) preparation of reports on the progress of the program. Third-party reimbursement covers pharmacist instruction of home therapy patients receiving antihemophilic factor, cytarabine, parenteral nutrition, calcitonin-salmon and injectable analgesics. Financial data based on one year's experience with the program show that savings far outweight the charges.


Third-party reimbursement for pharmacist instruction about antihemophilic factor.

The trial and evaluation of pharmacy education program to teach a 14-year-old hemophiliac to self-administer Factor VIII at home is described. The home therapy program realized a cost saving of $20,230 for this patient for the first year; school attendance increased 15%. The results of the trial were used to justify a professional fee from Blue Cross of Central Ohio for the pharmacist's educational services.


Antimicrobial drug use monitoring by a hospital pharmacy.

An antimicrobial drug use monitoring program which also provides clinical pharmacy services in a 635-bed hospital is described. The program includes culture sensitivity monitoring, antimicrobial use monitoring, aminoglycoside monitoring, physician consultation and reporting of results to the medical staff. It requires 34 hours of pharmacist time per month, at an estimated annual cost of #4,100.


Information on antineoplastic drugs for nononcologist physicians.

A postcard questionnaire was used to evaluate drug information letters that were sent to physicians who administered injectable chemotherapy to a hospital's outpatients. During the eight-month study period, 282 questionnaires were sent out with patients and 86 (30%) were returned. Three drugs (doxorubicin, fluorouracil and cyclophosphamide) accounted for over 50% of all the drugs listed on the returned surveys. Responses indicating prior knowledge of side effects, route of administration and stability ranged from a low of 66% (stability information) to a high of 86% (route of administration). All of the responses for investigational drugs indicated that the physician thought the drug information received was helpful. More than 90% of the responses indicated that the information was helpful for commercially available drugs. Two-thirds of all responses from oncologists indicated that the information in the letters was helpful; a much higher percentage (98%) of nononcologists found the information helpful. Because of the positive response to the letters, the drug information service plans to expand and continue the program.


The clinical pharmacist in emergency medicine.

The function of a pharmacist in emergency medicine, encompasing clinical practice, education and research, are described, and an evaluation of physicians' and nurses' attitudes toward pharmacist involvement in these areas is presented. In July 1974, a pharmacist joined the staff of a department of emergency health services in a medical center. In June 1976, a 14-item questionnaire was administered to physicians and nurses associated with the department. Seventy-two percent of the questionnaires were completed and returned. All respondents felt the pharmacist was an important component of the department and a benefit to its patient care and educational programs. Eighty-seven percent of the physicians stated that the pharmacist is capable of offering primary care to certain patients once the diagnosis has been made by a physician; 95% felt the role of the pharmacist is transferrable to other emergency room facilities and 83% were willing to have their patients charged for his services.


Amphetamine psychosis.

A case report of amphetamine psychosis in a 16-year-old female that closely resembled paranoid schizophrenia following the possible ingestion of a large quantity of amphetamine tablets is presented. The symptoms associated with amphetamine psychoses, the criteria used for differentiating amphetamine psychoses from schizophrenia, and the treatment of this drug-induced reaction are discussed. Treatment recommendation include the use of a dopamine antagonist such as haloperidol and the use of ascorbic acid to accelerate the renal elimination of amphetamines.


Chronic renal vein thrombosis.

Twenty-eight patients with demonstrated chronic renal vein thrombosis were studied. In seven, only small venous channels were involved; in 21, both small and large veins were thrombosed. A constellation of findings occurred with such frequency in these patients that we believe it virtually diagnostic of renal venous obstruction. These findings include the nephrotic syndrome, great variability in proteinuria and glomerular filtration rate, pulmonary embolization, sterile pyuria, hematuria, hyperchloremic acidosis, decreased renal tubular threshold for glucose and increased fibrin degradation products. These findings are an indication for definitive angiographic and biopsy procedures. Prolonged anticoagulant therapy was generally very effective.


Resolution of renal amyloidosis.

A patient with renal amyloidosis and the nephrotic syndrome consequent to extensive infected burns demonstrated both clinical resolution of the nephrotic syndrome and morphologic regression of the renal amyloid deposits over a six year period. The regression of the amyloid deposits was associated with several changes in the glomerular capillary wall resulting in a double capillary wall contour. This case indicates that deposits of amyloid in the kidney may regress and suggests a sequence of events in this resolution.


The effect of hepatitis B on plasma cholesterol and sterol balance.

A patient with hepatitis B was studied by cholesterol balance technics throughout 29 days of the incubation period, the entire preicteric phase (49 days) and 15 days into the icteric phase. As hepatic inflammation developed, the plasma cholesterol concentration declined, reaching 56 per cent of its base line level before the onset of jaundice. Fecal bile acids diminished slightly whereas fecal neutral steroids were unchanged. As jaundice developed, the plasma cholesterol level rose abruptly and fecal bile acid excretion decreased markedly. This report suggests that plasma cholesterol is diminished by hepatitis prior to the development of icterus. Cholesterol synthesis is probably decreased.


The pathogenesis of Bartter's syndrome. Functional and histologic studies.

We describe a patient with Bartter's snyndrome. In addition to the well-known characteristic findings by light microscopy, electron micrograms confirmed the presence of juxtaglomerular cell hyperplasia with polymorphous renin secretory granules and dense multivesicular bodies. Volume expansion by albumin infusion decreased plasma renin activity and aldosterone excretion, and improved the pressor response to exogenous angiotensin, suggesting that the renin-angiotensin-aldosterone system was not autonomous but that a decreased extracellular volume might be a major defect in this patient. During hypotonic saline diuresis, moreover, fractional free water clearance per fractional distal sodium delivery, CH2O/CH2O + CNa, was markedly depressed in the patient when compared with the value in the controls. Evidence presented suggests that chronic extracellular volume depletion exists as a consequence of an impaired sodium transport in the ascending limb of Henle's loop.


Severe pulmonary involvement in adult Gaucher's disease. Report of three cases and review of the literature.

Three patients with "adult" Gaucher's disease with severe pulmonary involvement are described. The clinical course of these patients was characterized by hepatosplenomegaly in infancy, followed by the juvenile onset of dyspnea culminating in pulmonary failure and death. Pathologic examination of the lungs in these patients revealed not only massive infiltration of alveolar walls by Gaucher's cells but also clumps of these cells filling alveolar spaces and obliterating functional air exchanging tissue. The lack of neurologic involvement in these cases delineates them from the "juvenile" forms of Gaucher's disease whereas the malignant course and pulmonary involvement were atypical of the "adult" form. The severity of this type of Gaucher's disease makes it a good candidate for prenatal enzymatic diagnosis.


Rickets in adult cystic fibrosis with myopathy, pancreatic insufficiency and proximal renal tubular dysfunction.

Rickets is reported in a 19 year old white man with cystic fibrosis in whom pancreatic and hepatic involvement was advanced. There was evidence of secondary hyperparathyroidism with proximal renal tubular acidosis, aminoaciduria, phosphaturia and hypophosphatemia. Treatment with oral pancreatic and parenteral vitamin D supplements led to full recovery of the rachitic syndrome and the proximal renal tubular dysfunction.


The hazard of persistent cigarette smoking in later life.

Data derived from four major prospective epidemiological studies in the U.S. and Britain indicate that persistent cigarette smoking in later life carries an appreciable hazard. In two of these studies men aged over 65 years who smoked cigarettes had a significantly higher mortality from coronary heart disease than men who had ceased to smoke cigarettes, and in all four studies their overall mortality was significantly higher than that of ex-smokers. At 65-74 years the overall mortality of men still smoking cigarettes was higher by 24 percent or more than that of ex-smokers, and at 75-84 years it was higher by 12 to 18 percent. The absolute difference in overall mortality was 9 to 13/1000 per person-years in both age-groups. A comparison of data on men who had given up smoking at different ages suggests that while the benefit is greater if smoking is stopped earlier in life, men in their sixties and (especially in the case of heavy smokers) their early seventies may still increase their longevity by giving up smoking cigarettes.


Duration of hospitalization for acute bacterial meningitis at Boston City Hospital during 12 selected years, 1935-1972.

An analysis is presented of the duration of hospitalization of the patients with acute bacterial (purulent) meningitis which occurred at Boston City Hospital during 12 selected years between 1935 and 1972. Considerable differences in the length of stay in the hospital were noted depending on the bacterial etiology, whether the infection was present on admission or acquired within the hospital, and, of course, whether the patient survived or died. Most of the deaths occurred within the first few days after admission or after the diagnosis was first established, but even among fatal cases, the survival time differed depending on the etiology and site of acquisition of the infection. During the years after effective antibiotics became available the hospital stay of patients who survived after admission for meningococcal, influenzal, or pneumococcal meningitis was shorter than before. The same has not been true for meningitis caused by other gram-positive cocci, gram-negative rods, or mixed infections, probably reflecting the relative ineffectiveness of antimicrobial therapy in such patients.


Myo-inositol clearance in renal failure and in patients with normal kidney function.

In order to determine the mechanism of elevated serum inositol in renal failure, the clearance values of inositol and of creatinine were measured in patients with normal kidney function and in those whose renal function was impaired due to varying causes. Mean serum inositol level in controls was 5.6 microgram/ml, and in patients with renal failure 28.6 microgram/ml. In control patients, inositol clearance was 2.8 ml/min, and tubular reabsorption of inositol was found to be over 97 percent. The inositol clearance of patients in renal failure varied from 0.62 to 17 ml/min. The ratio inositol clearance/creatinine clearance was elevated in uremic patients. Total amounts of inositol excreted in the urine of uremic patients were consistently higher than those excreted by control patients. The elevated serum inositol levels seen in renal failure were therefore not primarily caused by inability of the diseased kidney to excrete inositol.


The presence of hepatic intramitochondrial crystalline inclusions in routine liver biopsies.

Electron microscope examination of the liver biopsies of 33 patients revealed the presence of intramitochondrial crystalline inclusions (IMCI) in ten of them. Three patients suffered from iron deficiency anemia, porphyria, and malignant melanoma, conditions not reported to be associated with IMCI. Comparison of the clinical and laboratory findings of patients with and without IMCI did not show significant difference, or a clue for clarifying the nature of this phenomenon. Although these inclusions were reported in normal individuals, the possibility that they are the result of liver damage is not excluded.


The effect of near-maximal isometric stress on the presence and amplitude of fourth heart sounds.

Near-maximal isometric exercise (IHG) was employed to provoke new, or alter pre-existing fourth heart sounds (S4s) in ambulatory middle-aged normal subjects (N), hypertensive patients (HHD), and patients with coronary disease (CAD). S4 amplitudes and systolic time intervals (STIs) were measured blindly. No subjects without a resting S4 developed a new S4 during IHG. Increases and decreases of pre-existing S4 provoked by IHG were not statistically different among all groups. Among subjects matched for presence of S4, STIs during IHG showed significant shortening of the ejection time index and prolongation of Q-Im in the HHD group only. When the subjects who increased a resting S4 during IHG were compared with the subjects who decreased their resting S4 during IHG there were no significant differences in the responses of STIs. Thus, in these ambulatory, hypertensive patients, coronary patients, and normal subjects, near-maximal IHG did not induce new S4s and had variable effects on pre-existing S4s. Neither type of S4-response could be associated with corresponding changes in systolic time intervals.


Case report: chronic disseminated intravascular coagulation due to occult carcinoma.

A patient with a relatively localized occult carcinoma of the lung and hemorrhage secondary to chronic disseminated intravascular coagulation (DIC) which continued for eight months is described. Despite continuing DIC two major operations were performed without excessive blood loss. Preoperative heparinization, in vitro clotting of the arterial graft, and temporary postoperative reversal of systemic heparin were utilized for abdominal aortic aneurysm resection. Blood product replacement therapy facilitated an emergency laparotomy. The patient was also managed successfully for several months without anticoagulant therapy. A hypothesis that vascular thrombi are not a necessary prerequisite for DIC is proposed. This hypothesis is based on the absence of thrombi or evidence of ischemia in this patient and in others and is supported by experimental observations made by other investigators.


Studies of the renin-renin substrate reaction in man; kinetic evidence for inhibition by serum.

Increasing evidence suggests that the renin-renin substrate reaction is regulated by factors other than the concentrations of enzyme and substrate. Partially purified human renin and renin substrate extracted from the plasma of each of eight human subjects were used to construct substrate-velocity curves comparing the rate of substrate cleavage in the whole serum of each individual with the rate in a corresponding system containing purified autologous substrate, or purified substrate plus a small amount of autologous serum. Linear regression analysis of the double reciprocal plots were used to compare the kinetic constants in paired experiments. Maximal reaction velocity (Vmax) was significantly lower (p greater than .05) when the reaction rate was measured in whole serum, in seven of the eight patients, while Km did not differ significantly, suggesting the presence of noncompetitive inhibition by human serum. The mean Michaelis constant in serum was 449 ng/ml while the average native substrate concentration of the five normal subjects was 629 ng/ml, an excess of less than twofold. The data suggest that plasma renin activity in man depends upon the concentrations of inhibitor and substrate, as well as upon the concentration of renin.


Case report: splenectomy in patients with Hodgkin's disease and marrow hypoplasia.

Two patients with Hodgkin's disease and hypoplastic bone marrow underwent splenectomy in an attempt to reverse pancytopenia and to improve chemotherapeutic tolerance. Although the peripheral blood counts were improved, the clinical course was not significantly affected. Infectious complications occurred. This suggests that the peripheral hematologic improvement following splenectomy may not reflect a true improvement in marrow tolerance.


Use of a beta 2-sympathomimetic drug as a temporizing measure in the treatment of acute fetal distress.

Severe fetal distress in labor is an obstetric emergency which may result in the delivery of a severely asphyxiated baby or even death of the fetus. This problem may be compounded by a hurried mechanical vaginal delivery or by delay before a cesarean section can be performed. The rationale for using a beta sympathomimetric drug as a temporizing measure in the treatment of fetal distress to prevent deterioration in and even to improve the condition of the fetus before delivery is discussed. Six cases are described in which hexoprenaline (Ipradol), a beta2-selective sympathomimetic drug, has been administered as a 10 microgram intravenous bolus in the treatment of acute fetal distress in labor.


Testosterone and dihydrotestosterone in maternal and cord blood and in amniotic fluid.

Maternal and umbillical arterial and venous plasma and amniotic fluid testosterone (T) and dihydrotestosterone (DHT) were measured by radioimmunoassay. Maternal plasma T was 690 +/- 80 pg. per milliliter (mean +/- S.E.) in early pregnancy (less than 20 weeks) and increased significantly (p = 0.0002) to 1,095 +/- 177 pg. per milliliter in late pregnancy (greater than 20 weeks). DHT was 113.0 +/- 18.8 pg. per milliliter in early pregnancy and 179.8 +/- 30.5 pg. per milliliter in late pregnancy. Both umbilical arterial (UA) and umbilical venous (UV) plasma T were significantly higher in 11 male infants (UA T = 135.6 +/- 16.5 pg. per milliliter; UV T = 227.5 +/- 40.8 pg. per milliliter) than in 12 female infants (UA T = 92.1 +/- 9.7 pg. per milliliter; UV T = 89.6 +/- 12.6 pg. per milliliter) (p = less than 0.05 and less than 0.005, respectively). UV DHT and UA DHT showed no significant difference between male and female neonates. In midtrimester pregnancy, amniotic fluid T (AFT) was 165.2 +/- 15.4 pg. per millitier in pregnancies with a male fetus and was significantly higher (p = less than 0.001) than in pregnancies with a female fetus (mean +/- S.E. = 27.6 +/- 2.6 pg. per millitier). In late pregnancy, AFT levels were similar to those of early pregnancy, but a considerable overlap in AFT between fetuses of both sexes was observed. DHT was not detectable in amniotic fluid. The results suggest the potential value of AFT for determining fetal sex in midtrimester pregnancy and confirm that maternal T and DHT increase during pregnancy and that cord T levels reflect fetal gonadal androgen synthesis.


Prolonged rupture of fetal membranes and decreased frequency of respiratory distress syndrome and patent ductus arteriosus in preterm infants.

Observations were made on 153 preterm infants (25 to 34 weeks' gestation) in an attempt to answer the following questions: dose prolonged rupture of the fetal membranes (ROM) correlate with a decreased frequency of respiratory distress syndrome (RDS) and patent ductus arteriosus, and, if so, what is the duration of ROM required? An analysis of the data indicates that as the duration of ROM is lengthened the incidence of RDS and patent ductus arteriosus decreases. In fact, after 48 hours of prolonged ROM (PROM), there is a virtual absence of RDS. In addition, after 72 hours of PROM, the frequency of patient ductus arteriosus was markedly reduced to only 12 per cent (three of 25 infants). PROM beyond 24 hours was also associated with a significant decrease in deaths (p less than 0.05). Amnionitis occurred in 33 per cent of pregnancies with PROM greater than 48 hours; however, only one infant died of sepsis. These findings support the hypothesis put forth by the others 1-5 that PROM is indeed associated with a decreased frequenct of RDS in preterm infants. Moreover, our findings suggest that PROM greater than 72 hours is associated with a relatively low frequency of patent ductus arteriosus. The question is then raised that perhaps pregnancies less than or equal to 34 weeks' gestation with PROM should be allowed to continue for 72 hours in the absence of amnionitis.


Management of carcinoma in situ of the cervix.

Sixty-eight patients with in situ and seven patients with microinvasive cervical carcinoma were reviewed. Thirty per cent of the patients with carcinoma in situ were 30 years old and under. The mean age for carcinoma in situ was 37.8 years; for microinvasion, 42.6 years; and for postconization residual carcinoma, 48.5 years. Forty per cent of the patients were para 0 or 1. There was a 13 per cent incidence of postconization complications. The incidence of residual carcinoma in 58 patients who underwent conization and subsequent hysterectomy was only 10.3 per cent. The residual carcinoma was present high in the endocervical canal of the hysterectomy specimen. None of the patients with microinvasion had residual carcinoma. A positive correlation was found between the anatomic extent of the lesion on the conization specimen and the incidence of residual carcinoma. We conclude that conization and careful follow-up frequently are effective therapy for treating cervical carcinoma in situ, thereby reducing the incidence of hysterectomy.


Endogenous plasma epinephrine and norepinephrine in last-trimester pregnancy and labor.

Plasma epinephrine and norepinephrine concentrations during labor and immediately after delivery were compared to those of the third trimester in 21 uncomplicated pregnancies of married primigravid women, 20 to 32 years old. Third-trimester catecholamine concentrations were similar to those of normal, nonpregnant subjects; samples were obtained under identical conditions. Compared to third-trimester levels, significant elevations of plasma epinephrine and norepinephrine were found in three phases of labor (at 3 to 5 cm. and 9 to 10 cm. of cervical dilatation and immediately after delivery). Epinephrine values returned to normal within three to 21 minutes after delivery; norepinephrine values remained high or continued to rise in this time interval. Maternal analgesia and anesthesia influenced plasma catecholamine levels.


Xeromammography: five years and 559 carcinomas.

This study encompasses five years and includes 559 cancers, diagnosed at the Kaiser-Permanente Medical Center, Los Angeles, California. With current low-dose techniques, we have shown the efficacy of xeromammography, even in younger women. One third of the breast cancers, one third of the occult breast cancers, occurred in women under 50 years of age. Most important are the 161 occult cancers which were detected radiographically in these five years.


Correlation between climacteric symptoms and serum levels of estradiol, progesterone, follicle-stimulating hormone, and luteinizing hormone.

Correlation between the climacteric symptoms and serum levels of estradiol. progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) was studied in 191 premenopausal and postmenopausal women. Significant correlation was obtained between the climacteric symptoms represented by the menopausal index of Kupperman and associates and serum levels of estradiol as well as LH in a subgroup of the premenopausal women, ages 35 to 39 years. The symptoms were shown to be significantly related in serum levels of LH and inversely related to estradiol. These results confirmed that climacteric symptoms, at least in premenopausal women 35 to 39 years of age, could result from a low output of ovarian estrogen and a high production of pituitary gonadotropin.


Initial pelvic examination instruction: the effectiveness of three contemporary approaches.

Initial pelvic examination skills were taught to 38 second-year medical students who were assigned to one of three study groups. The cognitive posttest scores of all groups were nearly identical, but the students who had received training from professional simulated patients rated significantly better in psychomotor and interpersonal skills than did those who received simulated outpatient instruction by a gynecologist. Thirty-five per cent of the psychomotor and interpersonal ratings attained by the latter and 5 per cent of those attained by the former were marginal or inadequate. It was concluded that a program involving professional simulated patients is an effective method of teaching pelvic examination skills to beginning students.


Serum levels of d-norgestrel, luteinizing hormone, follicle-stimulating hormone, estradiol, and progesterone in women during and following ingestion of combination oral contraceptives containing dl-norgestrel.

Three formulations of dl-norgestrel were administered daily to groups of three women for five consecutive days. The serum levels of d-norgestrel were related to the dosage of dl-norgestrel ingested. Peak concentrations in the circulation of synthetic gestagen were attained a half hour to three hours after oral administration, followed by a rapid and sharp decline in levels until the next dose. Three women received 500 micrograms of dl-norgestrel and 50 micrograms of ethinyl estradiol for 21 days followed by six to seven days of no medication for two consecutive cycles. The gonadotropins remained suppressed for four to six days when therapy was discontinued. The daily concentrations of estradiol varied from less than 5 to 81 pg. per milliliter, and there was no difference in estrogen values during the nontreatment and treatment days. Due to the long half life of norgestrel, the one-week pill-free interval is not long enough for the complete recovery of the reproductive axis from the inhibition of oral contraceptives.


False positive cervical cytology: an important reason for colposcopy.

Over an 18 month period, 352 patients with a report of abnormal cervical cytology ranging from mild dysplasia to invasive carcinoma were evaluated with colposcopy and, if indicated, directed biopsies. From the group, there were 26 women in which a lesion consistent with the cytologic diagnosis was not found in each of these cases, an error in the interpretation of the Papanicolaou smear, resulting in a false positive report, was suspected. The cytology was reviewed and the results were compared to the original reports. Twelve cases were reinterpreted as negative for cervical neoplasia. A similar review of the histology failed to reveal a previously missed lesion. Cervical conization in four patients and repeat cytology and colposcopy in 22 patients confirmed the false positive interpretations of the original cervical cytology. The importance of colposcopy as a means of recognizing false positive cytology and avoiding an unnecessary cervical conization is emphasized.


Plasma prolactin changes during the administration of human menopausal gonadotropins in nonovulatory women.

Plasma prolactin concentrations were determined in 16 nonovulatory women during treatment with human meonpausal gonadotropins (hMG). In eight patients with initially normal prolactin levels of less than 20 ng. per milliliter, a significant rise was noted at the end of hMG administration, this is thought to be a response to increased endogenous estrogen concentrations. A similar rise in plasma prolactin levels was seen in some but not all of the eight patients with initially elevated "basal" prolactin concentrations. Three of these hyperprolactinemic patients had radiographic evidence of a pituitary lesion--either a pituitary adenoma or a "microadenoma"--but the variance in prolactin response could not be explained on this basis. The two groups of normo- and hyper-prolactinemic patients showed no significant difference in the required dosage and duration or hMG treatment, plasma estradiol-17 beta response, and ovulatory and pregnancy outcome.


Microbiological investigation of Bartholin's gland abscesses and cysts.

Percutaneous aspirates from intact Bartholin's gland cysts (12) and abscesses (34) were examined for bacteria and genital mycoplasmas. Aspirates from 10 of the 12 patients with Bartholin's gland cysts were sterile. Aspirates from the other two cysts contained organisms that are part of the vaginal microbial flora. Of the 34 abscesses, 24 (70.6 per cent) contained bacteria. Eight abscesses contained gram-negative rods in pure culture and four contained gonococci in pure culture. Twelve abscesses contained one or more vaginal organisms including anaerobic gram-negative rods (eight isolates), anaerobic gram-positive cocci (eight), Staphylococcus epidermidis (four), and microaerophilic streptococci (three). Although most of the patients had genital mycoplasmas isolated from vaginal cultures, Mycoplasma hominis was isolated from only one and Ureaplasma urealyticum from none of the aspirates.


Mechanism of crystallization of purified human midcycle cervical mucus.

The crystallization phenomenon of human midcycle cervical mucus was studied with purified mucin and sodium chloride. The drying of the purified mucin in saline was subjected to stress by the use of an air curtain, and crystallization (fern pattern) was found to follow the stress. Lithium chloride and calcium chloride were not compatible with the mucin for the formation of fernlike crystals. When a dilute solution of mucin dissolved in saline was dried, a radial crystallization pattern was observed to emanate from a single crystal in the center. Upon closer examination, the pattern was observed to emanate from the corners of the crystal.


Effect of pregnancy hormones on herpesvirus and other deoxyribonucleic acid viruses.

Clinical impressions and observations of genital herpesvirus infections indicate that lesions are more persistent and more severe during pregnancy. Several explanations are possible: an altered immune state, increased vascularity and blood flow, and/or increased viral infectivity due to increase in one or more hormones during pregnancy. Studies presented here were directed toward investigating the latter possibility. Herpesvirus, type 2, isolated from a genital lesion was titrated in WI-38 cells in the absence and presence of estriol, progesterone, human chorionic gonadotropin (hCG) and human placental lactogen. Two other deoxyribonucleic acid (DNA) viruses, adenovirus type 7 and vaccinia virus, were included for control purposes. Although estriol significantly inhibited and hCG significantly enhanced the single-cycle production of herpesvirus, there was little or no effect on these hormones on adenovirus. Progesterone, after 48 hours but not after two hours of preincubation, inhibited production of herpesvirus and vaccinia virus but had no effect on aderiovirus. When end-point titers were measured after multiple cycles of viral growth, there were no differences in viral titers with any of the hormones, except for a slight reduction with estriol. Except for the uniform effect of progesterone on DNA viruses, hormonal effects on viral production cannot be generalized from experiments with one virus.


d-Norgestrel concentrations in maternal plasma, milk, and child plasma during administration of oral contraceptives to nursing women.

In order to correlate plasma and milk concentrations of d-norgestrel (d-Ng) in lactating women, three oral contraceptives, containing different amounts of this synthetic gestagen, were given to 15 fully lactating women, starting two months post partum. Plasma and milk samples were collected according to a special schedule. d-Ng concentrations in plasma and milk were measured by radioimmunoassay. When d-Ng was measured in milk, extraction was performed with petroleum ether and in the radioimmunoassay an internal standard was used. This method is evaluated in the present paper. The plasma: milk ratio of d-Ng was found to be about 100:15 and the amounts of d-Ng transferred with 600 ml. of milk per day were calculated to be 0.3 an 0.15 microgram with daily intakes of 250 and 150 microgram of d-Ng, respectively, corresponding to about 0.1 per cent of the given dose. When the women received 30 microgram of d-Ng daily, no d-Ng could be detected in the milk. In three of the breast-fed children the d-Ng concentration in plasma was measured. This concentration was found to be in the same range as would be expected after oral d-Ng medication to adults, allowing for body weight differences, indicating that d-Ng is metabolized and is not accumulated in the baby.


Antenatal investigation of human fetal systolic time intervals.

A noninvasive method for measuring the antenatal human fetal systolic time intervals with the use of the transabdominal fetal electrocardiogram and Doppler cardiogram is described. Unique interactive computer routines were developed for rapid and accurate determination of the pre-ejection period (PEP), ventricular ejection time (VET), PEP/VET ratio, and fetal heart rate (FHR). Thirty normal patients were monitored between 20 and 40 weeks of gestation. A regression analysis of the fetal systolic time intervals and FHR against gestational age was done. PEP and PEP/VET ratio were significantly correlated to the gestational age, while VET and FHR were not.


Presence of immunoassayable beta-endorphin in human amniotic fluid: elevation in cases of fetal distress.

Immunoassayable beta-endorphin is present in samples of amniotic fluid obtained in the last two weeks of pregnancy. Average concentration is approximately 300 pg. per milliliter. In all cases of suspected or recognized fetal distress, striking elevations of the beta-endorphin concentrations (twofold to 20-fold) were observed. The degree of elevation correlated with the degree of fetal distress.


Quantitative analysis in the oxytocin challenge test.

A quantitative analysis of the oxytocin challenge test (OCT) was carried out in 305 women to evaluate: (1) the intrauterine pressures evoked during the oxytocin infusion, (2) when fetal heart rate (FHR) decelerations are likely to occur, (3) the type and amount of decelerations which are significant, and (4) what clinical events and laboratory parameters correlate with the OCT. If contractions are evoked at a rate of three per 10 minutes, the pressure profile mimics normal labor. The first FHR deceleration is likely to occur between the second and third effective contraction. A deceleration/contraction ratio greater than or equal to 10% significantly forecasts an abnormal FHR during parturition and an increased chance of a cesarean section.


Endometriosis in 1,000 consecutive celiotomies: incidence and management.

A prospective study of the incidence of endometriosis encountered in consecutive pelvic explorations was carried out. When study cards were filled out immediately after operation, it was found that one half of the patients had endometriosis. The symptoms, indications for operation, and pelvic findings in patients with endometriosis were compared with those in patients not having endometriosis but with similar operative procedures. The location of the condition and the results of the operation were evaluated. Further comparisons were made as to subsequent symptoms, pregnancy, operations, and hormone requirements, and conclusions were drawn as to risks and benefits referable to the type of operation performed.


The residual adnexa--asset or liability?

Nine hundred and twenty-two patients who had one or both adnexa conserved at the time of abdominal hysterectomy for benign diseases are presented. Thirteen patients (1.4%) have required subsequent re-exploration for adnexal pathology. Corpus luteum cysts were found in 10 (77%) of these patients. The primary pathology was found in the Fallopian tube in five patients (38%). No patient was found to have an ovarian malignancy in the short period of follow-up. Conservation of ovarian function is recommended in patients who have not undergone menopause.


Conservative management of pre-eclamptic and eclamptic patients: a re-evaluation.

A philosophy of conservatism in regard to termination of gestations complicated by pregnancy-induced hypertension has been practiced at the University of Virginia Hospital for many years. The advent of improved methods to evaluate the intrauterine fetal status prompted retrospective review of 246 pre-eclamptic and 13 eclamptic patients managed during the antepartum period. Continuous magnesium sulfate infusion for periods up to 144 hours (265 grams) was the therapeutic measure used for prevention or control of convulsions. Average duration of predelivery hospitalization increased 8.7 days, and the incidence of neonates requiring intensive care increased 10.9% with the use of tests to evaluate intrauterine fetal status. Frequency of spontaneous onset of labor and vaginal delivery decreased 18.6%. The uncorrected perinatal mortality rate for all antepartum patients was 7.0%. The mortality rate for infants of mothers with superimposed, severe or convulsive disease was significantly less in pregnancies in which tests of fetoplacental status were employed (8.2%) compared to pregnancies in which they were not (15.2%). The only maternal death was a 41-year-old patient with severe pre-eclampus who suffered a cerebral vascular accident on the fifth hospital day. These data reiterate the value of conservative management with meticulous individualized care.


Infertility and uterine contour.

Presented is a series of 190 primary infertility patients with patent Fallopian tubes and no obvious cause for infertility. Uterine contour was demonstrated by hysterosalpingogram and subsequently classified by Jarcho's classification of uterine abnormalities. An analysis of the results revealed a 74.21% incidence of uterine anomalies.


Differential reactivity of the gravid uterine vasculatures: effects of norepinephrine.

Norepinephrine dose-conductance-response relationships were determined for the placental and nonplacental vasculatures of ewes between 95 and 130 days of gestation with the use of radioactive-labeled microspheres injected under flow meter guidance. The regression line for the placental circulation differed significantly from that for the nonplacental circulation (P less than 0.01). The decrease in nonplacental conductance was 30 to 45% of control greater than the decrease in placental conductance. These responses are consistent with the hypothesis that the site of placental vascular resistance is in vessels of larger caliber than those which are usually the primary site of resistance to blood flow.


Adenocarcinoma of the cervix: histopathologic and clinical features.

Primary adenocarcinoma of the cervix and endocervix is an unusual lesion. It is cytologically evasive, diagnostically challenging, histologically variable, and therapeutically perplexing. During the period 1954 through 1971, 53 cases were diagnosed at the Medical College of Virginia, representing 3% of all invasive cervical carcinomas. Clinical material, therapy, and five-year survival statistics have been complied for each histologic type of adenocarcinoma. The average age of the patients was 53.8 years, and the most frequent complaint was abnormal uterine bleeding. Histologically, the majority had adenocarcinomas of the endocervical type. Others, in order of descending frequency, had endometrioid, clear cell, colloid, and adenoid cystic carcinomas. Patients treated for endometrioid carcinomas had the best five-year survival rates. Standardization of the diagnostic process and the use of modern radiation therapy have significantly improved survival. All patients having radiation plus operation or operation alone lived five years or more.


Epidural analgesia and its effects on the "normal" progress of labor.

The effects of epidural analgesia on the duration of labor have been a controversal subject since its increased use in recent years. A total of 598 patients receiving this form of analgesia were studied as to progress in labor and eventual outcome. The mean cervical changes during epidural analgesia with a single drug, bupivacaine, 0.125%, with epinephrine, 1:200,000, have been calculated. The labor curves are characterized by constant acceleration in dilatation without deceleration at approximately the same rate for nulliparous and multiparous patients after dilatation of 5 cm. has been reached. Examination of maternal and fetal profiles failed to demonstrate any consistent variables that produce abnormal labor.


A histopathologic review of 168 cases of preretinal membrane.

In 168 eyes with preretinal membranes studied histopathologically, five major distinct types of membranes were categorized: 61 glial, 28 fibrous, 22 cortical vitreous, 16 retinal pigment epithelium, 15 fibroinflammatory, 24 combinations, and one endothelial and melanomatous membrane each. The overall prevalence of preretinal membranes was 5.5% in 2,000 cases studied. Selected cases examined by electron microscopy were supportive of the origin of the cells in the preretinal membranes in the glial, fibrous, and retinal pigment epithelial types. Glial preretinal membranes occurred as the result of defects in the internal limiting membrane, such as retinal pits or holes, and from the optic nerve head in association with posterior vitreous detachment. Fibrous preretinal membranes were associated with proliferative retinopathy and long-standing retinal detachment. Studies of the cellular origin of these membranes were inconclusive. The cortical vitreous type of preretinal membrane was hypocellular and occurred in the absence of associated ocular abnormalities. Pigment epithelial preretinal membranes occurred in eyes with rhegmatogenous retinal detachment.


The replica technique used to study superficial corneal epithelium in vivo.

We used 2.15 to 2.3% collodion in amyl acetate to form a replica of the corneal surface epithelium in vivo in seven rabbit eyes and ten human eyes. When it was peeled off the replica removed superficial epithelial cells in patches. The corneal epithelium regenerated within one week. Repeated applications at weekly intervals for three months produced no harmful long-term effects in five rabbit corneas as evaluated with slit-lamp biomicroscopy, histological methods, and vital staining of the endothelium. In ten human eyes, the technique was harmless and chemically cauterized the dendritic herpetic ulcers. We studied the replicas and cells by conventional histological methods and electron microscopy. The preservation of cells was fairly good even for ultrastructural study.


Late iris abscess after cataract extraction.

A 73-year-old woman underwent an uneventful intracapsular lens extraction. Two years later, an iris abscess, hypopyon, strong flare, corneal edema, and elevated intraocular pressure developed. Visual acuity diminished from 6/6 (20/20) with aphakic correction to hand movements. Gram-positive cocci sensitive to erythromycin and chloramphenicol were cultured from the anterior chamber. The hypopyon and the iris abscess reabsorbed because we administrated erythromycin at the beginning of the illness. Final visual acuity was 6/6 (20/20) and only a small hole remained in the iris at the site of the abscess. She was in good health four years later.


A portable system for external photography.

A portable system for external photography combines a focusing lamp and movable flash unit with a wide focusing range. The system is arranged to operate from a single two-position trigger and may be hand-held or mounted on a slitlamp stand. It is designed for use in general ophthalmology in a multilaned office practice or bedside use in a hospital situation.


Immune complexes in the aqueous humor and serum.

The aqueous humor and serum of patients with various ocular diseases were analyzed for the occurrence of rheumatoid factor or immune complexes. Rheumatoid factor was detected by its direct agglutinating activity on IgG-coated particles (latex) and immune complexes were detected by their ability to inhibit exogenous rheumatoid factor or the subunit q of the first component of complement (Clq). Rheumatoid factor or inhibitory activity were found in the aqueous humor of nine of 11 patients with Fuchs' syndrome. In some patients who were examined two or three times, agglutination alternated with inhibition. Among 13 patients with endogeous uveitis, five had either agglutinating or inhibitory activities in their aqueous humor. The tests were also positive in the aqueous humor of three of seven patients with choroidal melanoma. A high titer of rheumatoid factor was found in the aqueous humor in an accidentally perforated eye that resulted in sympathetic ophthalmitis. No inhibitory or agglutinating activity was detected in the aqueous humor of 20 patients with senile immature cataract.


Pattern dystrophy of the pigment epithelium.

Three generations of a family showed alterations in the retinal pigment epithelium along with mild visual disturbance. Younger members had granular pigment dispersed beneath the fovea while older members showed a reticular pigment pattern. The electro-oculogram was subnormal in most affected individuals, but visual fields, color vision, dark adaptation, and the electroretinogram were normal. The pigmentary changes in these patients are similar to those seen in other pigment epithelial dystrophies such as reticular dystrophy and butterfly-shaped dystrophy. Until these disorders can be separated pathophysiologically, we suggest the definition of a more inclusive clinical term, "pattern dystrophies of the pigment epithelium.


Cerebrospinal fluid abnormalities in acute posterior multifocal placoid pigment epithelialopathy.

Two patients with acute posterior multifocal placoid pigment epithelialopathy also had cerebrospinal fluid pleocytosis and elevated protein levels. A 24-year-old white women had visual acuity of counting fingers in each eye. The cerebrospinal fluid contained 56 lymphocytes per cubic millimeter and a protein level of 48 mg/100 ml. When the retinopathy resolved, visual acuity returned to R.E.: 6/60 (20/200), AND L.E.: 6/9 (20/30). A 22-year-old white man had visual acuity of counting fingers bilaterally. The initial lumbar puncture showed 70 lymphocytes and a protein level of 76 mg/100 ml. A second cerebrospinal tab showed 64 lymphocytes and a protein level of 86 mg/100 ml. Final visual acuity was R.E.: 6/15 (20/50), and L.E.: 6/6 (20/20). Neither patient received treatment for this disorder. The findings of cerebrospinal fluid cells and elevated protein levels in acute posterior multifocal placoid pigment epithelialopathy probably represent a mild viral meningitis as part of a systemic viral infection that also involves the retinal pigment epithelium or choriocapillaris.


Isolated retinal hemorrhages associated with oral contraceptives.

Seven patients had isolated retinal hemorrhages without other systemic or ocular disease in a six-year period. Six patients were females, of whom five were taking oral contraceptives. The number of patients taking contraceptives and the fact that one patient had a similar episode earlier during pregnancy suggested a hormonal etiology. In the two patients we examined, we concluded that direct hormonal action causing vascular wall lesions was probably responsible for the pathology.


Cilioretinal artery occlusion associated with oral contraceptives.

Visual acuity in a 17-year-old girl who took norethindrone with mestranol (Ortho-Novum) for eight months decreased to 6/9 (20/30) in the left eye. Ophthalmoscopically, retinal edema was temporal to the disk and white plaques were in each of two branches of cilioretinal artery. A superior centrocecal scotoma corresponding to the area of edema was present. After the patient discontinued use of the drug, visual acuity improved to 6/6 (20/20).


Anterior tarsectomy reoperation for upper eyelid blepharoptosis or contour abnormalities.

In five cases, a simplified anterior tarsal resection corrected complicated upper eyelid blepharoptosis and contour abnormalities. One case of residual blepharoptosis after levator muscle resection was corrected by resecting an amount of tarsus equal to the desired amount of correction. Two cases of upper eyelid blepharoptosis resulting from overcorrected levator muscle recession were corrected in the same manner. In one case of residual segmental blepharoptosis of the upper eyelid causing a contour abnormality, we resected a segment of tarsus corresponding to the amount of blepharoptosis in the affected segment of the eyelid. In one patient who developed a contour abnormality after a Fasanella procedure with segmental blepharoptosis nasally and overcorrection temporally, a segment of tarsus resected nasally and inserted temporally created an even contour. Anterior tarsal resection is a simple method of revising the upper eyelid level of contour in situations where the upper eyelid anatomy has been distorted by previous surgery.


Sclerocornea associated with the Smith-Lemli-Opitz syndrome.

A 2,000-g infant boy had many features of the Smith-Lemli-Opitz syndrome (prenatal growth deficiency and developmental retardation, microcephaly with unusual facies, hypospadias, and feeding difficulties) as well as sclerocornea. The association of this rare eye finding with this rare congenital syndrome is unique. Successful penetrating keratoplasty was performed in one eye at 8 months of age.


Reversibility of corticosteroid-associated cataracts in children with the nephrotic syndrome.

We reexamined the eyes of 39 nephrotic children to investigate further the relationship between oral corticosteroid therapy and posterior subcapsular cataract formation. The corticosteroid dosage was proportional to each patient's weight. Six children had posterior subcapsular cataracts an average of 16 months after the first examination. Nine patients had complete regression of their posterior subcapsular cataracts. We found no correlation between the age at onset of the nephrotic syndrome, the dosage or duration of corticosteroid therapy, or the renal biopsy findings and posterior subcapsular cataract formation. Cushingoid manifestations were significantly more common in the patients with posterior subcapsular cataracts. These patients may be more sensitive to the effects of corticosteroids than those who never had cataracts and those whose cataracts regressed.


Treatment of total hyphemas with urokinase.

Total hyphemas were created by aspirating the aqueous humor from the anterior chambers of rabbit eyes and then injecting human blood. Thirty-six of these eyes were then treated with urokinase. A control group of 26 eyes was treated with normal saline. Nine eyes with total hyphemas were left untreated. The untreated eyes had uniformly bad results with prolonged elevation of intraocular pressures, marked ciliary injection, and corneal vascularization. The normal saline control eyes cleared faster than the untreated eyes, probably because of the mechanical dissolution of the clot with irrigation or injection. However, these control eyes showed significantly poorer results than the enzyme-treated eyes. The eyes treated with urokinase, whether injected or irrigated, had a marked increase in the rate of absorption of clot and less fibrin formation in the anterior chamber. Intraocular pressures returned to normal much sooner in these eyes than in untreated eyes, and most corneas cleared completely.


Coloboma in progressive hemifacial atrophy.

Over a seven-year period, a 22-year-old woman developed clinical linear scleroderma with associated ipsilateral coloboma of the upper eyelid, blepharoptosis, enophthalmos, and impairment of extraocular motility. Reconstructive surgery included correction of the enophthalmos by Silastic block implant, closure of the coloboma, and resection of the levator palpebrae superioris muscle for correction of the blepharoptosis.


Optic cupping caused by an intracranial aneurysm.

A 51-year-old woman had optic disk cupping from optic nerve compression by an intracranial aneurysm. Slit-lamp stereoscopic examination of the living eye immediately post mortem revealed an optic cup vertically oral, elongated superiorly, and indistinguishable from disk changes seen early in glaucoma. The histopathological changes differed from those in glaucoma by showing no glial atrophy. Instead, the cupping was caused by loss of axons in the prelaminar region of the nerve head and collapse of glial columns.


Histoplasma capsulatum in the presumed ocular histoplasmosis syndrome.

I demonstrated Histoplasma capsulatum organisms in disciform macular lesions, as well as a peripapillary lesion and peripheral atrophic scars in both eyes and in the lung of a patient with no history of active histoplasmosis. Autopsy findings were compatible with those of the presumed ocular histoplasmosis syndrome.


The inhibition of corneal vascularization in rabbits.

A single subconjunctival injection of 250 microgram of a partially purified extract of bovine aorta, administered immediately before or after silver nitrate injury to the cornea, markedly inhibited corneal vascularization in the rabbit eye. We believe the active molecule is a protease inhibitor that prevents the potential source of new vessels from proliferating and invading the diseased cornea.


Central areolar choroidal dystrophy.

Three members of a family with central areolar choroidal dystrophy showed the early and late stages of this disorder. The youngest affected was a 12-year-old girl who exhibited decreased vision, a red-green dyschromatopsia, and mild granularity of the macula with a diffuse foveal reflex. A discrete focal loss of choriocapillaris in the macula was seen on fluorescein angiography. This indicates that choriocapillaris atrophy is an early finding in this disease.


Inhibition of neovascularization by an extract derived from vitreous.

An extract of the vitreous body, inhibited the growth of new blood vessels induced by tumors in the rabbit cornea. This extract was delivered by an inert, continuously releasing polymer. The average vessel growth rate in the region surrounding the polymer was 32% less in corneas containing the inhibitory substance than in control corneas.


Cutaneous leishmaniasis (oriental sore) of the eyelid.

A 45-year-old American residing along the basin of the Mediterranean Sea developed a cutaneous lesion involving his right lower eyelid. He returned to the United States several months after it first appeared and sought treatment. On clinical examination the lesion was regarded as either a tumor or a cyst. It was excised, and on pathological examination a chronic granulomatous inflammatory lesion, containing innumerable Leishman-Donovan bodies, was found.


The pathogenesis of reversible cupping in congenital glaucoma.

The pathogenesis of reversible cupping of the optic disk in congenital glaucoma was examined by two approaches. Human fetal, neonatal, and adult eyes were examined by histochemistry and electron microscopy to delineate the embryologic development of the optic nerve head. While the neural, glial, and vascular elements of the nerve head attain their adult configuration by midgestation, the connective tissues of the lamina cribrosa are incompletely developed at birth. The response of the optic disk cup to elevated intraocular pressure (IOP) was observed in enucleated infant and adult eyes. While no disk changes were seen in adult eyes subjected to an IOP up to 90 mm Hg for 24 hours, enlargement of the disk cup in infant eyes was documented photographically and histologically after eight to 24 hours of IOP elevations to 50 mg Hg. Reversible cupping in congenital glaucoma can be best explained by compression or posterior movement of optic disk tissues--a result of the incomplete collagenous structural framework of the lamina cribrosa during late gestation and early neonatal life.


Fusobacterium in presumed Actinomyces canaliculitis.

Based on stained smears of material obtained from the canaliculus, three cases of canaliculitis were presumed to be caused by Actinomyces. Cultures of these cases showed Fusobacterium to be the probable infectious agent producing the disease.


Computed tomographic scanning in the management of retinoblastoma.

We used the computed tomographic scanner in the assessment of ten cases of retinoblastoma in children. With each patient the stage of the disease before operation could be more accurately defined and therefore more definite treatment could be undertaken.


Clinical observations in 101 consecutive patients with Duane's retraction syndrome.

We retrospectively studied 101 consecutive patients with Duane's retraction syndrome. Eighty-five percent were unilaterally affected and 15% were bilaterally affected. More patients had straight eyes in primary position than esotropia or exotropia. On lateral version reflex testing the amount of underaction of the lateral and medial rectus muscles could be determined, and could be used to predict whether the patients' eyes were esotropic, exotropic, or straight in primary position. Almost all the patients showed an esotropia when looking to one side and either an exotropia or no deviation to the other side. The degree of the exotropia and the esotropia on opposite sides determined whether a head turn would be present and in what direction. On adduction, the palpebral fissure in the affected eye narrowed in one half the patients because of motion of both upper and lower eyelids, and in 40% because of motion of only one eyelid. When the lower eyelid elevated, it usually assumed a straight horizontal contour with peaking of the punctum lacrimalis (appearing as a small pyramid). The statistical predominance of females and left eyes was more significant among patients whose eyes were straight in primary position. All patients tested demonstrated stereopsis. Most of the amblyopic patients had anisometropia.


Anterior segment ischemia after cyclocryotherapy.

The syndrome of anterior segment ischemia occurred in three patients as a complication of cyclocryotherapy for hemorrhagic glaucoma. Cryotherapy was applied with a retinal probe (2.5 mm in diameter) for 12 one-minute applications (-60 degrees or -80 degrees C) over the entire 360-degree circumference at the globe. The pathogenesis for this complication may be related, and unique, to chronic ocular ischemia associated with rubeosis iridis.


Implementing an Occupational Therapy Assistant training course for the Eastern Caribbean.

The Eastern Caribbean region is working toward providing rehabilitation services for all handicapped persons. With the realization that there will not be enough trained therapists in the West Indies for many years, it is hoped that the training of occupational therapy assistants will help fill the gap in rehabilitation services. Many compromises and adaptations needed to be made to make this program a reality. However, the lively enthusiasm and commitment of the first group of students in the OTA program helped to compensate for the lack of material wealth and resources.


Success in ambylopia therapy as a function of age: a literature survey.

It is frequently stated that amblyopia is not correctable after the age of 6 years. Many practitioners report marked success for older patients. To evaluate these conflicting reports, we analyzed the results from 23 published amblyopia studies. Our analysis indicates that substantial numbers of patients over age 6 were successfully treated. Success rates under age 6 were not significantly better than those in older patients when the criterion for success was achievement of 20/30 acuity or better. When a criterion of 4 lines improvement was used, success rates at all ages under 16 were quite similar; in patients 16 and over, success by this criterion was significantly less frequent, but even in this group success was achieved by 42% of the patients.


Effects of topical anesthetics on phenylephrine-induced mydriasis.

Pupil responses to phenylephrine alone and to phenylephrine preceded by a topical anesthetic were recorded by means of an infrared pupillometer. In response to phenylephrine, pupils dilated more in eyes with pale irides. Dilation was greater if a topical anesthetic was applied before the mydriatic. Benoxinate, proparacaine, and tetracaine produced approximately equal degrees of enhancement of the mydriasis. One drop of 1% phenylephrine had only a small dilating effect on an eye when the fellow eye received the phenylephrine preceded by 0.5% proparacaine.


Displaying distortion in ophthalmic lenses.

A procedure is outlined for generating and displaying information about distortion in an ophthalmic lens. It involves a direct comparison of an object and its image as viewed at the entrance pupil of the eye. The same procedure may also be used to assess chromatic dispersion produced by the chromatic differences in magnification.


In-office measurement of soft contact lenses.

The dimensions of soft contact lenses cannot be measured by methods used for hard lenses, so new techniques have had to be devised. This paper introduces standards and tolerances for the measurement of soft contact lenses. Previous methods of measuring these lenses are reviewed, and 2 new methods are described for measuring thickness and diameter. Instrument errors and the reliability of these methods are assessed.


Assessment of stimulus field size for strabismic amblyopes.

Recently, small-screen measurements have suggested different types of visual loss in strabismic amblyopia. The present experiment examined the influence of field size on this conclusion for low- and high-frequency measurements. The original findings are believed to be independent of the grating field size, because (1) in the present study of 4 amblyopes, normal and amblyopic eyes were affected equally by increasing the number of cycles, and (2) the amblyopes' foveas did not have high-frequency discrimination superior to that of the eccentric area used for fixation.


Effect of scattered light on extent of border enhancement.

A contrast border, formed where 2 uniform fields of differing luminance meet, was viewed through filters containing a scattering agent. The filters resembled the cornea and crystalline lens in that the amount of light scattered increased exponentially toward the direction of the indicent light. The perceptually enhanced regions on both sides of the border were measured for various concentrations of the scattering agent. Measurements were obtained for several luminances of the brighter field, the darker field remaining constant. It was found that the width of the enhanced region, both on the bright and on the dark side of the border, increased approximately linearly with the logarithm of the amount of light scattered. The increase was of approximately the same order for all of the luminances tested.


Training and practice effects in performance with low-vision aids: a preliminary study.

Reading speed and duration were measured for 24 low vision subjects, 12 learning to use closed circuit television and 12 learning to use optical aids. Reading speed and duration increased for both groups during 10 days of training and practice. Improvement occurred by steplike increases and plateaus. Visual acuity was not correlated with either performance measure; reading speed on the initial day of training was correlated with reading speed on the last day. The results have implications for both the prescription of aids and the training of low-vision patients.


Comparison of "near retinoscopy" and subjective refraction in adults.

Static retinoscopy can yield contaminated results because the central rays of the retinoscope beam are oblique with respect to the line of sight of the eye being examined. Additionally, it is difficult to obtain steady distant fixation by children and infants. A near-retinoscopy technique is described, and refractive errors obtained by subjective refraction and near retinoscopy on adults are compared to show that the latter technique yields reliable and valid measures of refraction.


Monocular central-field occlusion for intractable diplopia.

This report describes several methods of degrading imagery through the central portion of a spectacle lens to provide a cosmetically acceptable means of obtaining single vision in the central field of patients with intractable diplopia. For 2 strabismic patients with annoying diplopia, we applied to 1 spectacle lens a centrally placed disc (about 1 inch diameter) consisting of (1) translucent tap,a (2) a +7 D Fresnel lens,b or (3) stippled, clear lacquer. For 1 patient, the lacquer was the most acceptable; for the other, the tape was best. We present here the case reports for these 2 patients, showing why they preferred different image-degrading methods and how these and other methods of central-field image degrading can be advantageous even when diplopia is present across most of the visual field.


A study of vision in cerebral palsy.

One hundred twenty-eight patients (most less than 13 years old) with various types of cerebral palsy were examined to assess visual acuity, refractive state, oculomotor functions, sensory fusion, and ocular health. Special procedures for examining these patients are described. Vision or ocular defects were found to be present in 86% of these cerebral palsy patients. Significant refractive errors and strabismus were the most common defects, being present in 50% or more of the patients. Ocular disease was relatively uncommon.


The successful professional woman: on being married to one.

Feminity and professionalism traditionally have been regarded as incompatible. From their own experience and that of colleagues and patients, the authors argue that female personhood is enriched by professional committment. In consequence, the woman with a career becomes a more stimulating spouse and parent. Problems of role differentiation and of time allocation stress the dual-career marriage, but coping with those stresses enhances personal growth and leads to a more rewarding marital relationship. The authors consider themselves the most fortunate of men.


Asylums revisited.

The authors revisited Erving Goffman's Asylum (Saint Elizabeths Hospital) and found both the "institutionalization" and "secondary adjustment" phenomena he described 20 years ago. However, they question whether secondary adjustments necessarily follows institutionalization. They also express doubt that institutionalization should be condemned automatically and suggest that it may in fact be the approach of choice for some patients.


Outpatient treatment of schizophrenia.

The authors discuss the treatment of 575 schizophrenic patients over the past 15 years. They describe a shift the patients have experiences from reliance on inpatient treatment to heavy use of outpatient services. The have found that effective outpatient treatment for these patients involves a program of nearly continuous administration of neuroleptic medication combined with counseling and social and crisis services. A major component of the outpatient management of these schizophrenic patients is the education of the patients in how to regulate their own medication within a prescribed range. This educational component appears to add a measure of precision that enhances the safety and reliability of the treatment program.


The medical basis of psychiatry.

The authors state that the medical model represents the most useful and appropriate model available for the practice of psychiatry. They discuss the implications for psychiatry of the three essential features of the medical model: the concept of disease and diagnosis, the concept of etiology and treatment, and the nature of the doctor-patient relationship. They conclude that the adoption of the medical model for psychiatry would have profound implications for residency training, continuing education, delivery of care, standards of ethical and professional practice, dealings with third-party payers, and conflicts with other professions.


A comparison of videotaped and live patient interview examinations and written examination in psychiatry.

The authors scored the examination performance of 28 psychiatrists who were tested after conducting an interview with a real patient and after seeing a videotaped interview with an actor playing the role of either a psychotic or a neurotic patient. The also scored the performance of 15 of the same examinees who completed a written examination. Eighty-five percent of the examinees reported that the videotaped interview examination was a useful learning experience, and 81% said that it was a useful testing experience. The examiners' feelings varied regarding the use of the standardized videotaped format for certification and recertification of psychiatrists.


Platelet MAO activity in schizophrenia and other psychiatric illnesses.

Previous reports have indicated that platelet MAO activity is low in some schizophrenic and other psychiatric patients. However, other studies have not been able to replicate this phenomenon. This study supportsthe previous observations of low enzyme activity in some chronic schizophrenic patients. The authors discuss the thesis that low platelet MAO activity may be a biochemical marker for vulnerability to psychiatric illness.


A psychodynamically oriented group training program for early childhood care givers.

A training program for enhancing the care-giving qualities of child-care workers was developed and implemented through semistructured groups for family day-care mothers. The authors describe the theoretical orientation, program goals, and the outcome for trainees and trainers. Most impressive was the group process and content, which indicated the effectiveness of psychodynamically oriented program for care givers--people who ordinarly would not be expected to integrate such an experience successfully.