[Rescue helicopters in secondary missions].

During the last five years, we have had to fly 560 primary and 1150 secondary missions with the rescue helicopter of the Ulm Rescue Centre. This relationship of approximately 1 : 2 is distinctly different from the numbers obtained in other helicopter bases. The geographical location and structure of the hospitals within range of the Ulm rescue helicopter account for the large proportion of urgent secondary missions. The evaluation of these secondary missions concurs with the ADAC statistics and shows that the quick transport of the emergency doctor to the scene of the emergency, is only one component in the functions of the rescue helicopter. During primary and secondary missions, the ability to transport emergency patients to the nearest qualified hospital by helicopter, which is a mobile intensive care unit, is of equal importance. In the future, rescue helicopters will have to take these requirements into account by providing the necessary equipment and more especially, by providing sufficient space to carry out emergency diagnostic and therapeutic treatment.


[Quantitative studies on recruitment in objective audiometry with evoked potentials and the relationship to Fowler's loudness test].

Recruitment of loudness in patients with unilateral sensorineural hearing loss--an abnormal subjective sensation-is quantitatively measurable by means of objective audiometry with auditory evoked potentials without patients' help. Recruitment measure subjectively and objectively corresponds quantitatively. The only diminution of the latency of the evoked potential in comparison to the latency of a standard group is not proof of an existing recruitment.


[The hidden intrauterine device].

The hidden intrauterine device (IUD) may result because of disapperance of the tails into the uterus, unobserved loss of the device and perforation. The localization can be estimated by sonography, x-ray and probing of the uterine cavity. In most of the cases the device can be removed without hospitalization, surgical procedures are rarely neccessary. If pregnancy did occur the hidden intrauterine device cannot be removed without termination of the pregnancy in most cases.


[Differential diagnosis and therapy in Adie's syndrome].

In general, Adie's syndrome does not represent a serious diagnostic problem. In cases of cerebrospinal syphilis the Argyll-Robertson phenomenon or even absolute pupillary rigidity will be observed. Positive syphilis reactions will clarify these cases. The erroneous diagnosis of brain tumour may arise because of anisocoria. However, if pupillotonia can be ascertained by means of conjunctival instillation of drugs no further invasive diagnostics will be necessary. In some cases of Adie's syndrome concomitant emotional instability may be present. This dysautonomic reaction type of personality will hardly ever be confounded with the psychological disturbances encountered in brain tumours. Therapy is restricted to symptomatic measures. Pupillotonia can be influenced by strychnine and thymoxamine. Headache and facial neuralgia respond to the usual therapeutic schemes. Sweating disorder cannot be influenced. Neuropharmacological treatment may become necessary in periods of acute emotional disturbance.


[The mouse mutant "Jimpy". Animal model of leukodystrophy].

The Jimpy mouse is an x-linked recessive mutation of the house mouse resulting a myelin deficiency in the central nervous system. It is of interest as an animal model of human leukodystrophy. Clinical symptoms include ataxia  and tremor as initial signs, followed by tonic-clonic convulsions prefinally. The myelin deficiency is probably caused by a developmental disturbance of the oligodendrogial cell line. Clinical and pathological findings in the mouse mutant Jimpy show some remarkable similarities to Pelizaeus-Merzbacher disease.


[Experimental carcinogenesis in the respiratory tract using the European field hamster (Cricetus cricetus L.) as a model].

Subcutaneous treatment of European hamsters with aliphatic (diethyl-, diisopropanol-,dibutylnitrosamine) and cyclic nitroso compounds (nitrosopiperidine, morpholine, and heptamethyleneimine) led to the development of respiratory tract tumors. Most of the neoplasms were seen in the nasal cavity and lungs, although tumors were also found in the larynx and trachea. Histologically, the tumors were diagnosed as papillary polyps, papillomas, adenomas, adenocarcinomas, squamous cell carcinomas and mixed carcinomas. The length and weight of this species permit the performance of routine diagnostic methods such as radiography, bronchography and bronchoscopy. All such methods help towards a particularly early diagnosis of benign and malignant lesions.


[Microsymptoms in leptospirosis].

Leptospirosis is not an exotic disease, still it is  seen more frequent in southern countries. Microsymptoms, such as supraorbital headache, muscle pain in the legs, herpes naso-labialis or axillaris (often symmetrical), pharynxenanthema, fugitive rash, epistaxis, confusion, etc., are very important for early diagnosis. An intradermal test for early diagnosis was developed and is described here.


[Studies on the estimation of the postmortem interval. 1. The temperature of cadaver (author's transl)].

The relationship was investigated between the postmortem intervals and the rectal temperatures of 35 persons who had died at known times and had been subjected to medico-legal autopsies after exposed to changed environments. The influence of air temperature, body size and cause of death upon the cooling rate of cadaver has been found to be complex and not to be analyzed quantitatively. It has been concluded that the time of death cannot be estimated merely by means of the temperature reading of cadaver.


[Studies on the pharmacokinetics and effects of beta-adrenergic blocking agents, sotalol (author's transl)].

Present investigation was undertaken to elucidate what pharmacokinetic parameters in animal experiment could be of more predictable for human clinical trial of beta-blocking agents. Sotalol was administered as a model drug to dogs, rats, and men. Dog experiments disclosed that the apparent volume of distribution of sotalol was about 4 times larger than the space of total body water and the plasma level of sotalol was 1.0-2.0 and 2.3-3.4 microgram/ml when the beta-blocking index showed 50 and 100% to the intravenous bolus injection of isoproterenol (0.1-1.0 microgram/kg). The clearance studies of dogs and men suggested that the elimination of sotalol depended essentially on renal excretion. The regression coefficient of beta-blocking index and plasma level of this agent in dog experiment using 0.1 microgram/kg isoproterenol was nearly equal to that of human study in which maximal exercise test was performed. Rat experiments showed a large apparent volume of distribution as well as in human study and high concentrations of sotalol in various tissues of rats. The plasma level of sotalol was well correlated with the content of the drug in such organs as heart, lung, liver, and kidneys.


Metabolism of labeled fatty ozonides administrated intravenously in rats.

The distribution and metabolism of uniformly labeled fatty ozonides administrated intravenously in rats were studied. More than 90% of radioactivity was recovered in the lung tissue even 4 to 8 hr after injection of labeled ozonides, and approximately 60% of total radioactivity incorporated into the lung tissue remained as fatty ozonides. A slight amount of radioactivity, which was mainly incorporated into phospholipid and triglyceride, was recovered in liver and kidney.


Criminal justice procedures in civil commitment.

The actions of federal district courts and state legislatures in recent years have resulted in the growing application of procedures of the criminal justice system to the civil commitment process. Increasingly patients can be confined only if they are dangerous to others, and increasingly due-process procedures of the criminal law are required, to the detriment of the patient's treatment and his survival in the community. The author says that allegations of patients' being railroaded into hospitals are, with few exceptions, fictitious. Abuses thet do exist should be handled through writs of habeas corpus and malpractice suits, remedies much more available now than in the past. The principal abuse in commitment occurs not when patients are admitted, the author believes, but at discharge, when so many patients are turned out into communities that lack proper services for them.


A study of involuntary patients in Seattle.

The authors describe a study of 224 involuntary patients admitted to, Harborview Medical Center in Seattle in 1974, the first year of the implementation of Washington States Involuntary Treatment Act. The patients, 115 men and 109 women, had a total of 297 episodes of hospitalization, with an average length of stay of 12.7 days. Fifty-one per cent were discharged in less than ten days. The authors compare the findings with studies of similar patient groups in Sacramento, California, and New York City. They concur with others who believe involuntary treatment statues provide a means of dealing with the small group of psychiatric patients whose needs would otherwise go unattended.


A review of criminally insane patients in Ohio: a personal narrative.

In 1974, acting on precedents set in other cases, a federal district court in Ohio ordered the re-evaluation of all patients committed to Lima State Hospital to determine the need for their continuing to be held in a maximum-security facility. The court set a 12 week period for the review of more than 600 patients by three-member teams consisting of a psychiatrist, a psychologist, and a social worker. The author, a psychoanalyst, was one of approximately 30 professionals who volunteered to participate in the project, which was completed three weeks ahead of schedule. He describes the review process and his personal reactions and observations as a participant.


No-red-tape counseling for clients alienated from traditional services. Walk-in counseling center. Minneapolis, Minnesota.

Since 1969 the Walk-In Counseling Center in Minneapolis has offered free, no-red tape counseling to individuals and families alienated from traditional services. All counseling is provided by teams of mental health professionals who volunteer their services. The emphasis is on crisis and short-term counseling with a maximum of ten sessions. The center was established mainly to serve young drug abusers, but the clientele has diversified to include individuals of all ages and socioeconomic groups. The center also conducts an active consultation and education program with more than 200 community groups a year.


The role of diet in renal disease.

Reutilization of endogenous nitrogen makes it possible to manage many chronic uremics for long periods on diets low in protein without dialysis or transplantation, provided that the protein is of high biologic value and is accompanied by enough calories from nonprotein sources to meet energy needs. But while dietary management of uremia is now feasible, its efficacy is limited by gaps in knowledge about nitrogen metabolism.


The changing face of hyperparathyroidism.

Despite its earlier reputation as a relentlessly progressive disease, hyperparathyroidism may actually remain asymptomatic for many year. If its possible presence is signaled by hypercalcemia and supported by other laboratory findings, surgery is often indicated because no medical treatment is effective, and long-term follow-up of this frequently malignant condition is difficult; the surgical cure rate is about 95%.


X-chromosome replication in parthenogenic benign ovarian teratomas.

Somatic cells from human females undergo X-differentiation, which curtails expression of most, if not all, of the genes on one X-chromosome. According to the Lyon hypothesis, the designation of whick X will be inactive in eutherian females is random. However, in spite of the obvious biologic importance of X chromosome differentiation, little is known about either the mechanism of this process or the role played by fertilization. Benign ovarian teratomas provide a system for assessing the importance of fertilization in X chromosome differentiation. Biochemical and cytologic data indicate that these teratomas are of germ-cell origin. They are comprised entirely of one of the products of the first meiotic division and are thus parthenogens. In the absence of appropriate recombinational events, ovarian teratomas are consistently homozygous at autosomal loci, even when the host is heterozygous. Analysis of X chromosome replication kinetics provides one additional approach for investigating X-differentiation in individual teratoma cells. We utilized BrdU-dye techniques to study terminal replication patterns in ovarian teratomas and in normal fibroblasts and peripheral lymphocytes from the same individuals. The results confirm that human ovarian teratomas possess a single late-replicating X chromosome. Moreover, the pattern of replication in this X is identical to that in normal fibroblasts, but different from that usually observed in peripheral lymphocytes. Thus, if late replication is an accurate gauge of X-inactivation, the data confirm that X-inactivation can occur without fertilization.


The frequency and distribution of sister chromatid exchanges in human chromosomes.

The distribution of sister chromatid exchanges (SCEs) both between and within chromosomes was studied in cultured human lymphocytes using the BRDU-Giemsa technique. In general, the distribution of SCEs between chromosomes was a function of chromosome length. However, chromosomes of the B group had more exchanges than expected on this basis, while the E, F, and G groups had less than expected. Analysis of cells showing both G-banding and sister chromatid differential staining indicates that the distribution of exchanges within the chromosomes is non-random and possible reasons for the observed distribution pattern are discussed.


Evidence for postmeiotic expression of ribosomal RNA genes during male gametogenesis.

Pre- and postmeiotic stages of male gametogenesis of 10 different vertebrate species belonging to mammals, birds, amphibians, and fishes were subjected to the Ag-AS staining technique (Goodpasture and Bloom, 1975). A uniform pattern of silver-staining is observable during spermatogenesis of the different vertebrate species. Silver-staining is present in spermatogonia and during the whole period of meiotic prophase, but totally absent during diakinesis and metaphase II of meiosis. In early spermatids silver-staining reappears and only disappears around the beginning of elongation of the spermatid nucleus. Since the Ag-AS technique is believed to stain only transcriptionally active nucleolus organizer regions, our findings indicate that ribosomal RNA genes become reactivated in the haploid spermatid.


Intellectual level (IQ) in heterozygotes for phenylketonuria (PKU). Is the PKU gene also acting by means other than phenylalanine-blood level elevation?

There is a statistically significant difference in the IQ's of PKU and histidinemia parents. The difference is due entirely to the verbal part of the Hamburg-Wechsler test. There is no significant difference in performance. The heterozygous state of histidinemia does not seem to bear an intellectual (evolutionary) advantage, since the IQ's of histidinemia parents show the same distribution as a normal population. In early and mostly well-treated PKU patients, the same slight deficit in verbal IQ appears with increasing age (changing test methods). These patients, simultaneously tested at 4 years of age with the Bühler-Hetzer and Kramer tests, exhibit a statistically significant difference between the results in favor of the less verbal Bühler-Hetzer. Since heterozygots for PKU never have elevated phenylalanine blood levels, and because tryosine deficiency as argued by others seems highly improbable, we believe that the PKU gene has a more direct action on (or in) at least certain ganglion cells, lowering the verbal IQ slightly but significantly. This action is not reflected by phenylalanine increase in the extracellular space in heterozygots and is not abolished by dietary treatment in homozygous PKU patients. The major damage in PKU patients must be due to chronic phenylalanine poisoning, which deteriorates cells and/or functions on a much larger scale, because it can be easily prevented by decreasing the phenylalanine blood level with correct dietary treatment.


Bloom's syndrome: DNA replication in cultured fibroblasts and lymphocytes.

Analysis of DNA fiber autoradiograms from Bloom's syndrome skin fibroblasts and blood lymphocytes shows a retarded rate of replication fork movement compared to normal adult controls. Other measurements from the autoradiograms--replication unit length, incidence of bidirectional replication, and degree of initiation synchrony--are normal in Bloom's syndrome cells. These results suggest that a slow rate of fork movement is a specific manifestation of defective DNA synthesis in all Bloom's syndrome cells.


LBA technique in the detection of chromosome variants. II. Chromosomes except for those with Q variants.

In Part I of this communication, a technique (LBA) was described which used DNA replication in the evaluation of chromosome variants in man. It was shown that the method was very useful in the detection of variants in D- and G-group chromosomes. Results on pars 3 and 4 were also presented. In Part II, the rest of chromosomes were examined. In the evaluation of qh variants in 1, 9 and 16, the LBA technique proved itself to be a very effective implement. It was practically free of technical variables coherent with C-band technique and, therefore, it was possible to use the size of an euchromatic segment of a chromosome as a reference standard. LBA variants were observed in about 50% of the members of the remaining 12 pairs of chromosomes, i.e., 2, 5, 6, 7, 8, 10, 11, 12, 17, 18, 19, and 20.


A case of (13q;18q) translocation with proximal 13q monosomy.

A case of partial monosomy of the 13p terminal to 13q12, associated with a de novo 13/18 translocation, is reported. The symptoms appeared to be derived from both 18q- and partial monosomy 13, the latter giving rise to: high arched palate, epicanthus, antimongolian slant, small eye fissure, flat nasal bridge, hypoplastic helix, and large clitoris. Serum Ig-A and Ig-M levels were normal in our case.


Partial monosomy of the long arm of chromosome 16 in a malformed newborn: karyotype 46,XX,del(16))q21).

A polymalformed newborn with partial monosomy for the long arm of chromosome 16 is presented. Karyotype 46,XX,del(16)(q21).


Partial trisomy 16q-.

A 5-month-old female was found with a 16q- trisomy; her mother was the carrier of a balanced translocation 46,XX,t(15p+;16q-)(15p12;16q11). This is the first report in the literature of a liveborn with this chromosome abnormality.


Nonmosaic 46,X,r(Y) karyotype with female phenotype.

A nonmosaic case of ring Y chromosome is described. The patient is phenotypically female and has streak gonads. The histologic examination revealed dysgenetic seminiferous tubules in the streaks and epididymislike tubules besides them. The possibilities of the development of the phenotype and the streaks are discussed.


A casuistic report on the Gruber or Meckel syndrome.

A case of Meckel or Gruber syndrome is reported, together with a survey of the relevant literature of recent years (1971-1977), in reference to a probably autosomal recessive inheritance of this malformation.


[Nosocomial infections of the urinary tract by Proteus rettgeri (author's transl)].

Out of urine samples from 170 male patients strains of the genus Proteus with atypical biochemical characteristics and extensive corresponding multiresistance were isolated. Their significance as causative agents in urinary tract infection looks to be established as well as their ability of transfer by cross infection. Because of this we are concerned with the epidemiological occurrence of a special biotype of Proteus rettgeri as a causative agent in urinary tract infections.


Medical implications of macrolide resistance and its relationship to the use of tylosin in animal feeds.

Staphylococcus aureus strains isolated from human patients were tested for susceptibility to erythromycin and certain related antibiotics by the disc method. The incidence of resistance to erythromycin has remained relatively constant at less thatn 20 percent. Only four percent of erythromycin-resistant human clinical isolates were cross-resistant to tylosin. Oral administration to humans of tylosin or erythromycin did not cause an imbalance in the gram-negative Enterobacteriaceae nor did it cause the selection of resistance factors. It is concluded that, from the human medical standpoint, the use of tylosin in animal feeds does not present any threat to human health.


[Occurence, significance and clinical consequences of lipid A antibody titers in patients with urinary tract infection (author's transl)].

Lipid A antibody titers were measured by the passive hemolysis test in 349 humans. In two out of 20 healthy adults and 16 out of 18 children with recurrent urinary tract infection (UTI) in the presence of anomalies anti-lipid A antibodies were present. In contrast, no titers were found in 23 newborn babies. In a group of 156 patients with acute UTI, 28% revealed positive titers, whereas in a group of 132 patients with recurrent UTI titers occurred in 81%. In a selected group of 132 patients with recurrent infections of the upper tract 59 (=96%) showed definite titers. There was no difference in the development of anti-lipid A antibodies between men and women and the height of the titers did not correlate with the clinical picture of the disease (acute or chronic). The combination of proteinuria and anti-lipid A antibodies indicates the presence of recurrent UTI or chronic pyelonephritis with about 90% accuracy. The titers are caused by immunogenically active lipid A in the body. Since lipid A has the ability to remain in the renal tissue for a long period of time and thereby to maintain the inflamatory response, long-term antimicrobial prophylaxis (six months) should be given to patients with a high risk of recurrent UTI.


The changing subtypes of hepatitis B surface antigen in Hungary and the lack of correlation with severity and chronicity of the disease.

Two hundred and twenty sera from asymptomatic carriers and 129 sera from acute hepatitis patients were subtyped. Subtype adw was found in a significantly higher percentage of asymptomatic carriers. The indices of disease severity and chronicity were compared in adw and ayw cases. Now significnat difference was found. The incidence of subtype ayw in acute hepatitis patient was seen to be increasing. The difference between the two patient groups was thus explained by epidemiological factors with reference to current data.


[Detection of meningococci in the sputum of bronchitis patients (author's transl)].

Within a period of only three months meningococci, Sero B, C and also Y, were detected among the patients of a hospital. The meningococci were isolated as sole pathogen, or in association with other bronchopathogens in five cases of purulent respiratory tract infection, most of whom were suffering from acute or chronic bronchitis. The pathogens were initially identified falsely as "facultative" Neisseria subflava. It is stressed that meningococci must be considered as possible pathogens in such infections if large numbers of the socalled facultative Neisseria have been detected with corresponding culture findings. Reference is made to the possible epidemiological significance of such findings.


Chronic active hepatitis in patients with and without hepatitis B surface antigenemia.

This study was designed to compare the clinical and immunological characteristics of the hepatitis B surface antigen (HBsAg)-positive and HBsAg-negative (cryptogenic) forms of chronic active hepatitis. The data of 48 patients with chronic active hepatitis, 24 with persistent HBs antigenemia and 24 without HBsAg, were analysed. HBsAg was detected by counter-immunoelectrophoresis and radioimmunoassay. The clinical features, biochemical liver function tests, immunoglobulins, complement C3, antoantibodies, and cell-mediated immunoreactivity of the two forms of the disease were compared. Cirrhosis was found to occur more frequently at the time of diagnosis in the HBsAg-negative group, and the serum alkaline phosphatase level was raised significantly compared to the HBsAg-positive form. The elevation of the IgG level was greater in the cryptogenic form, but the difference was not statistically significant compared to the HBsAg-positive patients. There was a marked difference in the frequency of the mitochondrial antibodies, but not of the antinuclear factor and other autoantibody-like serum factors. Lymphoblastic transformation revealed a similar diminution in response to phytohaemagglutinin stimulation in both groups of patients compared to the normal controls. An increase of the 3H-thymidine incorporation was seen after stimulation with human liver mitochondrial antigen, and leukocyte migration inhibition could be observed with this antigen in both forms of chronic active hepatitis.


[Fall in serum complement prior to manifestation of hepatitis B in patients on chronic haemodialysis (author's transl)].

Haemolytic complement activity was measured in a long-term study in patients on haemodialysis. Four of the patients studied developed hepatitis B while under investigation. In all four patients a fall in haemolytic complement activity was observed one to three months before hepatitis B surface antigen was detected in the serum. The fall in complement activity also occurred prior to a rise in transaminase. The maximum fall averaged 27%.


Cerebral edema.

Great strides have been made in understanding the pathogenesis of cerebral edema. Treatment is usually successful, particularly with the newer modes of management (mannitol, steroids, hyperventilation); however, cerebral edema is occasionally resistant to all modes of therapy. At that point, no treatment is effective; even if the patient does survive, he is left with a major severe neurological deficit. Future research must be directed toward methods of reversing this presently untreatable state.


Lymphocyte cytotoxicity against autologous tumour biopsy cells in humans.

By the application of separation techniques in a stepwise manner to mechanically prepared cell suspensions from human tumour biopsies it has been possible to isolate tumour cells having high viability and low contamination with host cells. These tumour cells have been used as targets in 51Cr release cytotoxicity assays using autologous lymphocytes from blood or lymph node as effectors. It has been possible to investigate this reactivity in 30 patients with malignant and four patients with benign tumours. Significant autologous cytotoxicity in the blood lymphocytes was detectable in two of 12 lung tumours, nine of 18 other carcinomas and sarcomas but in none of the benign cases. Cytotoxicity was not limited by the presence of obvious residual disease at the time of operation although reactivity was less frequently detectable in patients with secondary involvement. Reactivity in the tumour-draining lymph nodes largely paralleled that in the blood in the limited number of patients examined. The technical problems encountered during this study and the role of natural cytotoxicity in the interpretation of these data are discussed.


The metabolism and DNA binding of 3-methyl-cholanthrene.

Tritiated 3-methylcholanthrene (3MC) was administered to mouse embryo cells in culture from which DNA was later isolated and hydrolysed to deoxyribonucleosides. The hydrolysate was analysed by LH20 chromatography, HPLC and fluorescence spectroscopy. The 3MC-nucleoside products were compared with the nucleoside derivatives obtained from 3MC-11,12-oxide-treated DNA and found to differ in both fluorescence spectra and chromatographic behaviour. Microsome-catalyzed DNA binding of primary metabolites of 3MC identified two metabolites for which DNA reaction was extensive. These metabolites were characterized by their chromatographic and spectrophotometric properties. The products of their microsome-induced DNA binding were isolated, and comparison with the products derived from cell-mediate 3MC-DNA reaction suggested that these metabolites might be precursors of this latter reaction. The chemical nature of the metabolites and of their DNA reaction products is discussed in relation to the "bay region" and carbonium ion concepts of the ultimate carcinogen of polycyclic hydrocarbons.


Two-step chromosomal control of tumorigenicity of Chinese hamster cells in nude mice.

A simple method for microinjecting isolated chromosomes into a single living cell under an inverted microscope has been developed. Of the 368 injected cells, 85 were able to form a colony and could be cloned. Clones of Chinese hamster V79 cells microinjected with chromosomes isolated from murine D56 cells [V79 (D56) cells] were tested for tumorigenicity in immunodeficient nude mice and for colony-forming ability in soft agar. Untreated recipient V79 cells were highly tumorigenic and had a high colony-forming ability in soft agar. In contrast, two out of the 21 microinjected clones tested were non-tumorigenic in nude mice and had only weak colony-forming ability in soft agar. The chromosome banding pattern was analyzed in microinjected clones and tumors derived from cells of these clones. In cells of the two non-tumorigenic clones, a telocentric chhromosome 1 (t1) was specifically involved in translocations with other chromosomes or chromosome fragments. In all tumor cells obtained from nude mice, a supernumerary piece or a whole biarmed chromosome 14 (b14) was specifically found. The results suggest that the t1 chromosome bears the gene which controls in vitro transformation and that the additional genetic change, i.e. the extra piece of b14 chromosome, was required for tumor formation in vivo.


Enhancement of anti-tumor activity of 1-beta-D-arabinofuranosylcytosine by encapsulation in liposomes.

1-beta-D-Arabinofuranosylcytosine (ara-C) was encapsulated in four different types of unsonicated artificial vesicles of phospholipid (liposomes) to compare the anti-tumor effect on mouse leukemia L1210 inoculated in CD2F, mice with that of free ara-C. The anti-tumor activity of ara-C was markedly enhanced by encapsulation in liposomes when given in a single IP injection. Among the four types of liposomes, a physically stable and positively charged liposome consisting of sphingomyelin, stearylamine and cholesterol (20:2:15 molar ratio) most effectively enhanced the effect of ara-C. A single IP dose of 50 mg/kg of ara-C, encapsulated in this kind of liposome exhibited high activity, producing a survival rate of 60% of the treated mice at 60 days. This enhanced effect of ara-C encapsulated in liposomes was also demonstrated when the drug was administered either IV or SC, and the range between the minimum effective and the maximum tolerable doses was wide enough to allow the safe use of the encapsulated ara-C. Intraperitoneal administration of encapsulated ara-C induced a more prolonged survival of mice inocualted with L1210 than did free ara-C, regardless of whether it was given in single or multiple doses.


Neoplastic transformation induced by furylfuramide and nitromethylfuran of embryonic hamster cells in tissue culture.

Secondary cultures of Syrian hamster embryonic fibroblasts were tested for transformation and neoplastic properties after exposure in vitro to furylfuramine (AF-2) and other nitrofurans. Typical morphological transformation was seen in five of six cultures between 30 and 186 days following treatment with 5-10X10(6) M AF-2 for 24 h. Transformation was seen in only one of four cultures 145 days after treatment for 6 h with AF-2. Treatment with 5-10X10(6) M NMF (5-nitro-2-methylfuran) for 24 h also induced transformation after 50 and 118 days in two cultures. In contrast, untreated cultures and cultures treated with 5-10X10(-6) M NFT [4-(5-nitro-2-furyl)thiazole] for 24 h were not transformed within 200 days. Three of the six lines transformed by AF-2 and both lines transformed by NMF also became tumorigenic 7-24 days after morphologic transformation. The other three transformed lines produced nodules which regressed within a few weeks of transplantation. Untreated and treated non-transformed lines did not produce tumors during an observation period of 6 months. The tumors were classified as fibrosarcomas. The ability to form colonies in soft agar was acquired by only one tumorigenic line.


Cell-mediated immunity against particulate and solubilized tumor-associated antigens of murine plasmacytomas detected by macrophage migration inhibition assays.

Cell-mediated immunity (CMI), as detected by the agarose microdroplet macrophage migration inhibition (MMI) assay, was investigated using peritoneal exudate cells (PEC) of BALB/c mice and several crude membrane (CM) and solubilized preparations of murine plasmacytomas. The MMI assay was quite sensitive and detected inhibition of macrophage migration as low as picogram quantities of CM, NP40 detergent- and papainsolubilized preparations (CS) of ADJ-PC5 and LPC-1 plasmacytomas. The data were highly reproducible from one experiment to the next with the same or different lots of the CM or solubilized extracts. Specificity studies demonstrated that ADJ-PC5 and LPC-1 plasmacytomas expressed cross-reactive tumor-associated antigens (TAA) as detected by MMI and confirmed by tumor challenge and Winn neutralization experiments. No cross-reactivity was observed with similar extracts prepared from an unrelated syngeneic simian virus 40 (SV40)-induced sarcoma. The inhibition of macrophage migration observed was mediated by culture supernatants generated from the mixture of plasmacytoma-immune spleen cells with antigens and then assayed in an indirect MMI assay on normal PEC. The agarose microdroplet MMI assay appeared to be a rapid and sensitive method to measure TAA recognition and to monitor TAA isolation and solubilization with minimum numbers of immune cells.


Does unemployment cause the death rate peak in each business cycle? A multifactor model of death rate change.

Natural time series and prospective studies are combined to determine the contribution of many causal factors to the business cycle variation of the death rate. The variation of housing and nutrition together accounts for roughly a tenth of the death rate fluctuation. Drug consumption accounts for about one-sixth, with 11 percent of the total variation due to alcohol and 6 percent due to cigarette smoking. Social relationship changes, both as sources of stress and as means of relief, account for the greatest part (72 percent) of the business cycle variation of the death rate.


Principles of justice as a basis for conceptualizing a health care system.

This paper opens with a concern for the causes of the maldistribution of health care throughout most of the world. It then explores briefly the question of entitlement to health care, focusing on the appropriateness of expressing that entitlement in terms of social justice. Some principles of justice as related to health care are formulated, drawing on the thinking of John Rawls and his Theory of Justice, and the ideas of distributive justice that have been set forth by Nicholas Rescher. These principles are then used as a basis for planning a theoretical health care system in the setting of a less-developed country. This theoretical health care system is intended to reflect a just distribution of health care under conditions of varying limitations of resources, including those in which resources are not adequate to provide care for all of the people. Some of the technical, social, and political implications of such a system are discussed.


Experience with a clinical pharmacological service in a teaching hospital.

The clinical functions of our Pharmacology department involves teaching, research and patient service. Patient service is rendered at two levels. 1. Clinical Pharmacologists: These are medically trained people and one of them is available for 24 hours a day for therapeutic and toxicological consultation, for channeling requests for laboratory aid and for interpretation and distribution of laboratory results. At the time of preparing this report we received an average of 34 consultations per day (1/3 therapeutic, 2/3 toxicological) of which about 38% are personally seen. 2. Laboratory based Pharmacologists: These people have basic training in Pharmacology, Chemistry and Biochemistry and are involved in qualitative and quantitative investigation of body fluids in cases of poisoning and therapeutic problems. A laboratory-based pharmacologist is available for 24 hours per day but clinicians do not have direct access to him but have to channel their requests through the clinical pharmacologist on call. The laboratory handled 2302 specimens of body fluids during 1975 of which about 75% were of a therapeutic and 25% of a toxicological nature.


Digitalis effect and blood concentration.

Comparing cardial and extracardial effects of digitalis with corresponding digoxin blood concentrations, we determine the therapeutic range of glycosides. These studies are based on 1109 determinations in 317 patients with heart failure. The clear intoxication limit is above 2.0 ng/ml.


Opposite changes in blood histamine and force expiratory volume during bronchial inhalation challenge.

Lack of in vivo data on blood histamine changes in subjects during induced attacks of asthma prompted serial determinations of blood histamine levels and of the forced expiratory volume of the first second (FEV1) in 2 asthmatic undergoing antigen (house dust) inhalation challenge and in 3 subjected to methacholine inhalation. In 1 of 2 dust-sensitive asthmatics inhaling house dust (10(4) pnu), a prominent histamine spike occurred 5 minutes after challenge termination, coinciding with a fall in FEV1 by about 15%. In the other, blood histamine had risen steeply at 7 minutes, FEV1 not falling, due presumably to increased bronchial tolerance acquired by hyposensitization therapy. In 1 of 3 asthmatics inhaling methacholine, 0.75 cumulative units/5 breaths (c.u.) entailed a blood histamine spike coinciding with a fall in FEV1 by 26%; after return of both variables to control levels, a second histamine rise preceded a second FEV1 fall. In another, a blood histamine spike coinciding with a fall in FEV1 by 19% occurred 6 1/2 minutes after the methacholine increment affording 99.15 c.u. In the third, FEV1 from the outset fell progressively before blood histamine rose steeply, reaching its lowest value (-26%) likewise with 99.15 c.u. The mechanisms and the source(s) of the histamine accounting for its short-lived increases in blood remain to be determined.


Methodology of kinetic interaction studies in clinical pharmacology: an experimental contribution on diftalone and acetylsalicylic acid.

The possible interaction of acetylsalicylic acid (ASA) and diftalone (DIF), a new anti-inflammatory drug, was studied in 6 volunteers. All subjects received each of the following three treatments: ASA 1 g, DIF 0.5 g, ASA 1 g plus DIF 0.5 g at 4-day intervals (stage 1 of the study). In stage II of the same study, each subject received ASA 1 g plus DIF 0.5 g in three different occasions 1 week apart; after a 7-day pre-treatment with either DIF 0.25 g b.i.d., or ASA 0.5 g b.i.d., or DIF 0.25 g b.i.d. plus ASA 0.5 g b.i.d. A total of four different comparisons were made. After pre-treatment with DIF, but not after pre-treatment with DIF plus ASA, the peak level of salicylate was significantly reduced by about 15%. No other evidence of interaction was found.


Scabies in a Semiurban area of India: an epidemiologic study.

An epidemiologic survey was conducted in a population of 1,727 persons living in 253 households in a semiurban area of Goa, India. The prevalence of scabies was 9.7% by persons, 22.5% by households and 22.8% by families. Prevalence of scabies was highly associated with age. The highest prevalence (23.7%) was in school-age children. Prevalence was higher for females than males age 25 or older, but there was no significant difference in prevalence by sex for all ages. Prevalence rate by persons was approximately the same in Hindus and Christians but prevalence rate between families was higher for Hindus, although prevalence within families was higher for Crhistians. First to contact scabies in the family was generally a school child.


Pachyonychia congenita (Jadassohn-Lewandowsky) and Kyrle's disease in the same patient.

An 11-year-old boy with typical lesions of pachyonychia congenita (Jadassohn-Lewandowsky) type II and with keratotic lesions histologically characteristic of Kyrle's Disease is described.


Investigation on the reaction of molybdenum with collagen in vivo.

Male Wistar rats were treated with Mo in a single dose or over a period of 84 days. The course of molybdenum excretion after a single dose was expressed mathematically. It was shown that various tissues produced different excretion curves and a high retention was observed only in skin. In long-term treatment it was possible to ascribe this retention to direct binding of molybdenum to collagen. In contrast to some other heavy metals molybdenum causes a decrease of collagen stability. The mechanism of this effect is discussed.


Cylic peptides. I. Synthesis of AM-toxin analog containing O-methyl-l-tyrosine.

An AM-toxin analog, cyclotetradepsipeptide, containing an O-methyl-L-tyrosine residue in place of an L-2-amino-5-arylpentanoic acid residue in AM-toxins has been prepared by a conventional method. The synthesis was attempted through six different routes and the desired analog was obtained by one such procedure. This compound showed extremely weak activity in causing necrosis on apple leaves.


Cyclic peptides. II. Synthesis of a cyclodepsipeptide, rotodestruxin.

Synthesis of a cyclohexadepsipeptide corresponding to the sequence of protodestruxin from linear hexapeptides was attempted through five different routes in a conventional method, and three routes afforded the same cyclopeptide. Biological and physiocochemical properties of the synthetic peptide were identical to those of natural protodestruxin. Differences in the yields of the cyclization were explained through the assumed conformations of the linear hexapeptides.


Short- and long-range spectral perturbants: dependence on solvent concentration and chromophore structure.

Some perturbing solvents appear to be short-range perturbants at 20% concentration, but long-range at 40%, based on delta epsilon/epsilon for phenols and their ethers. The apparent long- or short-range character of a solvent also depends on the chromophore. It is possible that perturbants, which are apparently of long-range character at 20% concentration, are really of short-range character because they interact rather similarly with phenols and their ethers. For ethers delta epsilon/epsilon increases faster than for phenols with increasing concentrations of some perturbants.


Chemical studies on a hamster sublingual glycoprotein.

A secretory glycoprotein was isolated from the hamster sublingual gland. It contains 65% carbohydrates, the remainder being protein. The principal type of sialic acid was identified as N-acetylneuraminic acid with about 1/4 of the molecules O-acetylated. The hexosamine occurs mainly as N-acetylgalactosamine; other sugars present are galactose and fucose. The carbohydrate side chains are linked to the protein core by an O-glycosyl linkage between seryl and threonyl residues and N-acetylgalactosamine. The glycoprotein has an apparent molecular weight of 330,000. The sialogly coprotein may act as a biological antifreeze. Relevant differences in the chemical composition of the secretory glycoproteins of the sublingual and submaxillary salivary glands of this species are briefly discussed.


Conformational analysis of cyclo (L-cystine).

Conformational analysis of cyclo(L-cystine) shows that the diketopiperazine ring has to exist only in the boat form. With this geometry, the molecule can adopt two distinct forms differing mainly in the chirality of the disulphide bridge. In both the P- and M-models, corresponding to dihedral angles of nearly +90 degrees and -90 degrees respectively about the S-S- bond, the molecule displays an approximate two-fold symmetry. According to our semi-empirical energy calculations, the minimum energy of the M-model is --9.2 kcal/mol, only 0.3 kcal/mol lower than that of the P-model. Because the difference between the two minima is so small, neither form is clearly superior to the other. However, the number of low energy conformations of the M-model in the allowed conformational space is significantly larger than that of the P-model by a ratio of 3 to 1, and therefore the former is likely to be thermodynamically favoured.


Solid phase synthesis and some hormonal activities of 1-deamino-4-L-valine-8-D-homolysine-and 1-deamino-4-L-valine-8-D-homoarginine-vasopressin.

1-Deamino-4-L-valine-8-DL-homolysine-vasopressin and protected 1-deamino-4-l-valine-8-D-lysine-vasopressin were synthesized by the solid phase method and were then converted into the title compounds (dVDHLVP and dVDHAVP) by tryptic digestion and epsilon-guanidination, respectively. The new hormone analogues exhibit only moderate antidiuretic potency, dVDHLVP 21 units/mg and dVDHAVP 31 units/mg, but since they are essentially devoid of pressor activity (o.o1 units/mg/ the A/P ratios are very high. In fact, dVDHLVP is the most specific antidiuretic agent in the lysine series known so far.


Predicted secondary structure of snake venom toxins from their primary structures.

We have predicted the secondary structure of 38 snake venom toxins using the  method of Chou and Fasman. Our predictions indicate that beta-chain and random coil structures predominate in these proteins. The conformations of long neurotoxins, short neurotoxins and cytotoxins are less similar than previously believed. Cytotoxins contain 40--50% of beta-structure and they form a notably homogeneous group. Short neurotoxins contain less beta-structure (13--30%) and more random coil than cytotoxins, and they also form a more heterogeneous group in terms of secondary structure. The characteristics of long neurotoxins are intermediate to the above mentioned groups. Experimental evidence supporting these propositions is discussed.


The therapist's use of metaphor.

A linguistic perspective is applied to the therapist's use of original metaphors in psychoanalytically oriented psychotherapy. I present a review of the literature along with a view of psychotherapy and metaphor from a linguistic perspective. Three examples from psychotherapy are used to illustrate properties of metaphorical interpretations. An examination of the portion of the hour that precedes the therapist's metaphor suggests the importance of context in reducing the dangers of misunderstanding inherent in the use of metaphor.


Symbiotic block with psychotic patients.

An impasse, which I term symbiotic block, occurs commonly in psychoanalytic psychotherapy with psychotic patients. Three cases, representing  different levels of psychotic transference relatedness, are chosen to exemplify this phenomenon. This impasse is defined in terms of undifferentiated symbiotic transference-countertransference phenomena which interfere with the separation-individuation process. The resolution process is defined in terms of concretizing issues of self-object differentiation and causality. A brief review of the literature is presented, along with discussion of the nature of the phenomenon and some key technical points.


Transitional phenomena in the treatment of a psychotic adolescent.

The clinical history and the initial phase of the psychotherapy of a hospitalized psychotic adolescent are presented to demonstrate the loss of "transitional capabilities" coinciding with the onset of a psychotic regression and their subsequent restoration as the patient reemerged from overt psychosis. Winnicott's concept of transitional phenomena is reexamined, highlighting its function in the capacity for illusion, its internalization as psychic structure, and its interpersonal dimension in the establishment of a "transitional mode of relatedness" within the psychotherapeutic situation.


Countertransference aspects of pharmacotherapy in the treatment of schizophrenia.

Emphasis is placed on largely unconscious aspects of the therapeutic relationship which determine the inappropriate or untimely use of psychotropic drugs, particularly on the therapist's response to the regressive modes of relating and sharing emotional experience which characterize therapeutic work with schizophrenic patients. Case examples illustrate the use of drugs to establish interpersonal boundaries, to disavow frightening feelings within the self, and to renounce forbidden regressive pleasures-thus defending against the regressive pull of the developing symbiotic relationship. The effect of postpsychotic depression on the therapeutic relationship is explored with regard to the dynamics of psychotropic drug usage in treatment.


The treatment of a narcissistic disturbance in childhood.

This paper surveys four years of psychotherapy, beginning at age eight and a half, of a boy whose psychopathology appears to be a precursor of the narcissitic charater disorder described by Kernberg (1975). The vicissitudes of the transference related chiefly to the patient's underlying narcissistic vulnerability. Interventions were generally aimed at demonstrating the relation of the patient's naricissistic (grandiose) defense to his underlying concern about devaluation by the therapist. The advantages of focuisng on such a patient's current needs and reactions are emphasized. The speed and success of the treatment of this child vis-a-vis adults with similar psychopathology is attributed to the relative ease with which his underlying needs (and related pathological envy, rage, and fear of retaliation) could be mobilized within the therapeutic relationship. This probably reflects the fact that his character defense was not yet fully entrenched. The contribution of normal development to the therapeutic process is also identified, as is the importance of both the real relationship and times of direct gratification of the patient by the therapist.


Depersonalization in a female adolescent.

This paper demonstrates the relationship between the onset and persistent manifestation of the depersonalization phenomenon in a femal adolescent. On the basis of a case report it is postulated that certain external stimuli coinciding with anxiety lead to a physiologically induced altered state of consciousness which defends against the maintenance or repetition of these events. If the state functions effectively, as in the presented case, a symptom pattern develops which resembles very closely that altered state of consciousness. The particular form of the altered state is postulated to depend upon the personality configuration of the individual patient.


Impotence, frigidity and depersonalization.

A review of important psychoanalytic literature in the perplexing area of depersonalization focuses primarily on its phenomenology and genesis. Case material from two patients elucidates a relatively neglected, specific substate. These two analyses center about prominent complaints of impotence and frigidity which are seen as equivalents of, or screens for, underlying depersonalization. Only by understanding and working through the genesis of the masked depersonalization could these sexual dysfunctions be adequately treated. Depersonalization was also manifest outside the sexual sphere, but its presence there led to a more thorough elucidation of its etiology, in which actual childhood observations of the primal scene were of paramount importance. A comprehensive description of depersonalization phenomenology is offered which considers this state as a compromise formulation with contributions from each structure of the mental apparatus. Normal and pathological determinants of the sesation of a split within the self into observing and participating aspects are described, as is the genesis of feelings of alienation and estrangement.


Adverse response to neuroleptics in schizophrenia.

Negative therapeutic reactions to neuroleptics in schizophrenic patients are examined from the psychoanalytic perspective through case examples. Intrapsychic changes resulting from this medication, ordinarily considered beneficial, are shown, in some cases, to be disruptive of schizophrenic functioning and organization and potentially to endanger the continuation of medication itself. Changes are described which effect defenses, object relations, psychotic restitution, use of external reality, body image and cognition, and the symbolic significance of medication. Alterations in narcissistic ego states and disruption in preconscious processes, superimposed upon defective ego functioning, are used as explanatory concepts. These interact with transference based responses; in some cases, important psychodynamic issues emerge amenable to transference interpretations. Further study of intrapsychic changes may be useful in delineating a previously inexplicable response, understanding symptom formation, recognizing shifts in the patient-psychotherapist relationship, and forestalling premature cessation of medication.


The psychotic character.

A warp in the childhood emotional pattern may involve the ego and superego enough to cause psychotic elements or coloring, which may evolve into the psychotic character or into the potential for it or for psychosis. A brief review of relevant literature and a series of clinical vignettes are presented from the perspective of Alexander's model of the neurotic character. The psychotic is seen as showing: the dynamics of the neuroses acted out as in the neurotic character; narcissistic egocentricity and a failure of emphathetic, sympathetic identification and loving object relations; id impulses rationalized by a distortion of reality (manifested not in specific delusions, but rather, more diffusely throughout the ego); minimal or no insight into illness, as in criminality; and a failure of defenses against id impulse although the ego organization is intact. The clinical material reveals that these elements are encountered in all combinations and gradations; several types of psychotic character are discussed.


The alcohol induced hypnoid state and its analytic corollary.

Alcohol can be ingested to achieve a hypnoid state. This altered awareness is actively sought by the alcoholic as part of an ongoing attempt at mastery. By this symptomatic resort to a change in consciousness, the painful affects connected with earlier assaults and seductions carried out by severely disturbed parents, are maintained in repression. At the same time this self-induced hypnoid state facilitates the gratification of both conscious and unconscious fantasies. The case history of a patient is reported who while in analysis, and on the analytic couch, evoked a hypnoid state. For this patient the analysis of this hypnoid state led to the recall and verbalization of early traumatic experiences. The similarity of early life circumstances, in regard to disturbed and inadequate parenting, in both the carefully studied analytic patient and the less frequently available data on patients treated by psychotherapy in an alcohol clinic is discussed.


Frightened men: a wish for intimacy and a fear of closeness.

Men who failed to achieve an adequate separation from their mothers are particularly prone to experience serious distress with their marriages during their middle years, when the wish for intimacy, coupled with a fear of closeness never resolved during infancy, is retriggered. An onslaught of biological, social, and psychological stresses force acknowledgement of previously denied needs for succor, plunging them into battle with their wife-surrogate mother. The resulting counterphobic, hypersexual, ofter self-destructive behaviors are usually falsely interpreted as oedipal. Clinical material in this report strongly suggests this distress is not primarily related to genital sexual issues or fears of castration, but more often concerns issues of autonomy and independence which typically involve the mother and which arose in the toddler or anal phase. Supportive evidence for this thesis from cross-cultural observations, child developmental studies, and primatology is presented, and the usefulness of this view in facilitating clinical work with such men is described.


Alienation: character neuroses and narcissistic disorders.

Various defensive adaptations are described that patients with structural defects involving the self-representation (character neurotics) use to adapt to the external world, often achieving an organization sufficiently stable to lead to considerable success. Externalization rather than projection is used. The differences between these two psychic processes are important for our understanding of character neurotics. Projection signifies placing impulses or parts of the self into external objects whereas externalization involves creating or finding a reality to support the defences, including projecting. The patient externalizes his infantile traumatic environment to construct a current world after his early environment which he finds both threatening and familar. Clinical material illustrates how the process of externalization operating within the transference context may lead to special technical problems. One type of character neurotic demonstrates a special type of externalization which supports overcompensatory feelings of self-aggrandizement, which are in effect, narcissistic defenses. To varying degrees, all character neurotics have some narcissistic defenses. Countertransference problems are also discussed.


Transference phenomena in initial interviews.

Transference phenomena can be used effectively in pursuing diagnostic and therapeutic aims in initial interviews. Theorectical and clinical aspects of transference phenomena are discussed with special reference to preformed transference expectations, the dynamic and genetic aspects of transference, the differentiation of transference phenomena from transference and the transference neurosis, and their relevance to other analytic data. A case is presented, and two transference phenomena is the initial interviews are traced through later stages of the analysis; their origins and multiple determinants are demonstrated.


Countertransference.

Countertransference can be used as an instrument in understanding the patient's projective identification. An analogy for the patient/therapist interaction is found in Bion's model of the infant's communicating by projection to the breast and the mother as containing and modifying such projections. The particular countertransference problems created by patients who have been objects of massive parental projections are examined. In such cases the patient's projections induce in the analyst diverse experience of past helplessness in relation to projections.


The evolution of a shoe fetish.

This paper deals with clinical material gathered from the long-term, psychoanalytically-oriented treatment of a patient with a shoe fetish. Genetic and dynamic aspects of this problem are emphasized. The combination of a dominating mother and a passive and absent father, the sharing of a bed with an older sister until age eleven, and the receipt of frequent enemas contributed directly to the development of the fetish, the most crucial determinant being the commulative traumatic effect of the enemas. During adolescence, the patient also resorted to transvestism to deal with the intensification of castration fears. Becoming a husband and father threatened to disrupt his tenuous defenses and forced him to seek therapy for two years, during which he was able to gain sufficient insight to forego the fetish and to engage in heterosexual activity in reasonably conflict-free manner. Previous theorectical contributions on the subject are included and theorectical issues are dealt with, particularly the role of the core fantasy of the phallic woman in the perversions.


Prevention, infant therapy, and the treatment of adults. 1. Toward understanding mutuality.

This is the first in a series of papers about the relevance of infant therapy to the treatment of adults. A description of maternal and infantile movement patterns is used to substantiate our thesis that not only does the mother hold the child, but the child holds the mother. A good-enough holding environment is maintained when the mother's adult patterns of effort and shaping dovetail with the infant's inborn reflexes to make mutual holding possible. Mutual support enables mother and child attune in tension-flow rhythms (used for need satisfaction) and to adjust in shape-flow rhythms (used for intake and output). Attunement is the physical core of empathy, and adjustment is the cradle of trust. Empathy and trust between therapist and patient develop in a good-enough holding environment which is derived from mutual holding in early infancy. Not only does the therapist provide a holding environment for the patient, but the patient does his share to support the therapist in his aims.


Prevention, infant therapy, and the treatment of adults: 2. Mutual holding and holding-oneself-up.

This is the second paper in a series of papers concerned with the relevance of infant therapy to the treatment of adults. The detailed presentation of a case of infant therapy illustrates our thesis that (1) early failures in mutual holding lead to a distortion of the body image, to an insufficient development of trust and empathy, and to a difficulty in holding-oneself-up and becoming self-reliant; (2) movement retraining of mother and infant is a method of choice to prevent the sequelae of holding failures; (3) insight gained from infant-therapy through movement retraining helps us understand adult patients whose body attitudes reveal their attempts to hold themselves up by putting strain on their neck, back, or shoulders; (4) the analysis of the defensive use of certain parts of the body for self-support reveals the underlying fear of falling, collapsing or falling apart.


On neutrality.

The various meanings of neutrality are traditionally assigned either to the psychoanalytic model, which developed within psychoanalysis, or to the natural science model whose meanings and methods were imported from the observational methods of natural science. The rules of abstinence and anonymity and the analyt's respect for the patient's autonomy are the principal distinctly psychoanalytic meanings of neutrality. These are discussed and illustrated by case examples. Psychoanalytic neutrality is founded upon and regulated by ethical principles of truthfulness, personal freedom, and the analyst's caring commitment to the patient. The natural science model includes the inhibition of the analyst's affective reactions, the attitude of impersonal detachment, and the requirement that the analyst's evaluations and interpretations be value-free. It is nether possible nor desirable for analysis to adopt the neutral attitudes and techniques of the natural science observer.


On lying fallow: an aspect of leisure.

The capacity for lying fallow is discussed as a nonconflictual affective state and as a function of the process of personalization and growth. The qualities and achievements of the fallow mood are indicated, as are the factors on which this state is dependent.


Notes on Ibsen's Peer Gynt.

A short account of the verse drama Peer Gynt is given, showing its setting in Ibsen's life and work, and its content. The paper relates what the poem tells us about Ibsen to what I know of him from elsewhere, specifically to certain conflicts and the search for his "true self." It also relates the poem to the experience of psychoanalysts and psychiatrists (illustrating this with clinical material), and finally, to aspects of the world today.


Psychoanalytic notes on suicide.

The typology of and theories on suicidal behavior are reviewed to integrate various points of view in terms of the paranoid process. Freud's theory of internalized aggression, the relation of suicide impulses to depression, the operation of narcissistic components in the complex motivation of suicide are related to the concept of the victim-introject as central to the pathology of suicide. Suicidal patterns play out the dynamics inherent in the victim-introject and its correlative component the aggressor-introject. The victim-introject serves as the core internalization around which a false-self system is organized; the suicide represents the attempt to destroy the false-self as a means of realizing the dynamic purposes of the victim-introject. The concept of the victim-introject integrates previous psychoanalytic formulations of suicide and provides a template  for the development of a therapeutic rationale. Implications for therapeutic response are considered, particularly in terms of the need to undermine the patient's attempts to maintain and reinforce his victimization.


Obsessional phenomena and the concept of intentionality.

Obsessional phenomena exist in a variety of character types. The particular phenomena may be of limited value in total personality assessment. Some speculative links are made between obsessional phenomena and preanal developmental steps. It is suggested that the concept of intentionality of thought and action be examined in these patients to distinguish obsessionals with core conflicts that are primarily neurotic and triadic, from those with more significant, earlier difficulty in the oral period. The concept of intentionality is related to self-object distinction, the use of projections, the sense of self, pathologic ego-superego condensation, and the existence of the ability to tolerate and recognize aggressiveness within. More accurate and rapid diagnostic distinction among obsessionals has implications for different treatment approaches.


The eroding concept of intrapsychic conflict.

With the increased interest in borderline and psychotic patients, concepts are being introduced which erode the concept of intrapsychic conflict between the ego and the other macrostructures. In particular, the drive derivative as source of danger is being lost sight of as expressions such as fear of the loss of ego boundaries and struggles against identification are introduced. Some authors who use these expressions, judging from their clinical material, do uncover their patients' fantasies and the drive derivatives and defenses they reflect. Nonetheless, they contribute to the problem by introducing inaccurate new terms. Other authors, having embraced recent innovations in theory, seem to disregard intrapsychic conflict.


Monologue, dialogue, and soliloquy.

Psychoanalytical therapy can be seen along developmental lines of three phases, the phases correlating with the early mother/child relationship which is reenacted in the transference relationship. At times one or the other of the phases can be totally permanent, but there can be alternation of the various phases both within a session and between sessions. Techniques implied for therapy are outlined and discussed, as the phases are explicated and related to Rickman's one-, two-, and three-or-more-body relationships.


On Guntrip's analysis with Fairbairn and Winnicott.

Guntrip's paper is an account of his ananlytic experience, first with Fairbairn and then with Winnicott. Although attempting to be objective, he cannot disguise the fact that he is frustrated and dissatisfied. He raises this question: "How complete a result does psychoanalytic therapy achieve?" The question Guntrip is, in effect, asking himself, is: "What went wrong?" We suggest the following points: The failure of both analysts to recognize a very specific form of resistance and to deal with an unusual transference situation. Fiarbairn's insistence on giving oedipal interpretation to a patient who, as Winnicott recognized, did not have an oedipus complex. The failure of both analysts to recognize Guntrip's infantile megalomania; to expose his insistence that the blame for his neurosis must be attached to a "totally" bad mother; and the failure to recognize the intensity of his sibling rivalry. Psychoanalytic therapy is not merely "correct" interpretation and "correct" technique. It involves the interaction of two human beings. The countertransference of Fairbain and Winnicott prevented their perceiving and dealing with the essential problem of this exceptionally gifted patient.


Visual imagery and defensive processes.

The ideas and feelings that a patient usually avoids gain expression in therapy as words, images, or acts. The model presented of these representational systems conceptualizes defensive processes as information processing decisions at the boundaries of particular systems and describes in detail the cognitive maneuvers that regulate image formation. Specification of these operations allows for acute observation and selective wording of the interpretation and direction on the part of the therapist that may help a patient override unconscious defenses by conscious choice.


Nutritional evaluation of B groups of vitamins in institutionalised aged.

The nutritional consequences of institutionalisation of the aged are poorly defined apart from hospital admissions. Food intake has been measured and correlated with biochemical assessment of B group vitamin function. Results reveal the dietary intake of thiamine and riboflavin were barely adequate while pyridoxine was deficient in 90%. Enzyme function tests revealed deficiencies at cellular level in up to 60% of subjects. In view of the increasing numbers in the ageing population these trends in nutrition require further study.


The effect of ascorbic acid supplementation on some parameters of the human immunological defence system.

We have investigated the effect of ascorbic acid (vitamin C) supplementation on some parameters of the human immune defence system in a group of 25 healthy, male university students. The subjects ingested 1 g ascorbic acid per day for a period of 75 days. Serum levels of IgA, IgG, IgM, C-3 complement component, cortisol and transcortin were measured before and after the ascorbic acid course. Corresponding measurements were performed on a control group of 20 healthy, male university students receiving no extra-dietary vitamin C. Our results showed that ascorbic acid supplementation caused a statistically significant increase in the serum levels of IgA, IgM and C-3 complement. Our study does not permit of conclusions regarding the mechanisms of action of ascorbic acid.


Iron and hemoglobin status of the offspring of guinea pigs whose mother received large doses of vitamin C during pregnancy and lactation.

1. Lower level of serum and liver iron were noted in the offspring of experimental group quinea pigs who received 1, 2 and 3 mg ascorbic acid per 100 g body weight per day. 2. Similar results were obtained in the hemoglobin content of same animals. 3. Normal values were observed for hemoglobin and the content of iron in serum and liver in the same group of offsprings when they were fed 4 mg ascorbic acid per 100 g body weight per day.


Dietary vitamin E and levels of reduced glutathione, glutathione peroxidase, catalase and superoxide dismutase in rat blood.

The effects of dietary vitamin E on the important cellular antioxidant defense systems were studied in rat blood. One-month-old male Sprague-Dawley rats were fed a basal vitamin E-deficient diet and supplemented with either none or 45 ppm vitamin E for 4 months. The activity of glutathione (GSH) peroxidase was decreased significantly (p less than 0.05) in the red blood cells and plasma of vitamin E-deficient rats. The level of GSH in the red cells of vitamin E-deficient rats was also significantly decreased. No detectable GSH was found in the plasma of both groups of animals. The activities of catalase and superoxide dismutase were not significantly altered by the status of dietary vitamin E. Similar results were obtained when 2-month-old male rats were fed the respective diets for 3 months. The results suggest that the decreased levels of GSH and GSH peroxidase in the red cells of animals fed a vitamine E-deficient diet may in part contribute to their increased susceptibility to hemolytic agents.


[Alkaline and acid phosphatase activity in the liver and serum during Ni versus Fe deficiency].

In previous studies on the essentiality of nickel, a reduced iron absorption causing anemia was observed. Since Ni deficiency also affects Zn metabolism, the different phosphatase activities were determined. Ni deficiency, however, resulted in an increased activity of the alkaline phosphatase in liver. On the other hand, the activity of the alkaline phosphatase was deduced by 59% during Fe deficiency. Similarly, the alkaline and acid phosphatases in serum were reduced during Fe deficiency. Consequently, determination of the activity of the alkaline phosphatase in serum, besides that of various liver enzymes, is suited well to differentiate between Fe and Ni deficiency.


[Influence of zinc deficiency on lipid metabolism].

Thirty-five male weanling Sprague-Dawley rats with an average live weight of 32 g were divided into three groups. The Zn-deficient group of 14 animals was given 1.3 mg Zn/kg of diet for 23 days, while the pair-fed control group with 14 animals and the ad libitum fed control group with 7 animals were both fed 100 mg Zn/kg of diet. Serum was assayed for triglycerides, total lipids, cholesterol, cholintesterase, free fatty acids and beta-lipoproteins, and duodenal juice for trypsin. While the serum concentrations of beta-lipoprotein, total lipids and total cholesterol were not different in response to Zn deficiency, the activity of the cholinesterase activity was reduced, the triglyceride concentrations and trypsin activity increased. Similarly, the serum free fatty acids were elevated compared to the ad libitum fed controls. This disturbances in Zn-deficient rats are discussed in connection with the lipid metabolism.


Effects of level of dietary sulfur on the growth performance and blood mineral profile of sheep fed urea-supplemented corn silage.

Several blood constituents were measured in whether receiving a basal diet of corn silage, urea and a mineral-vitamin supplement to which various levels of sulfur (S) were added. The amounts of S in the total diets were: .16, .26, .38, .47 and .57% of dry matter. After a six-month experimental period, the levels of copper and iron in the plasma and of urea and manganese in the blood had been effected, lower levels being associated with higher levels of dietary S. Plasma zinc and magnesium levels showed a quadratic response to dietary S levels. However , plasma calcium levels and blood selenium levels were not significantly affected. Plasma sulfate-S content was higher in those animals receiving higher levels of S in the diet. The quantity of S ingested did not significantly affect voluntary feed intake, growth rate, or diet digestibility; however, nitrogen retention was lowered. The higher dietary S levels resulted in higher urinary excretion of the element, while fecal S remained unchanged.


Effect of dietary carbohydrates on intestinal transport and accumulation of 59Fe++ in iron deficients rats.

Laboratory rats were fed several types of carbohydrates incorporated into iron-deficient diets. The lowest active transport of 59Fe++ across the intestinal wall as well as the lowest intestinal accumulation of radioiron occurred in rats fed either dextrin or fructose, while rats fed cornstarch, sucrose, or sucrose plus lactose exhibited the highest active transport and the highest accumulation of radioiron in the intestinal tissue. Animals which received dextrin as the dietary carbohydrate also maintained the highest hematocrit and hemoglobin levels during the iron depletion period.


Research of international suicide.

Twenty two variables of social, economic, geographic and psychological significance, including  suicide rate, were factor analysed for forty world nations. Five factors achieved eigenvalues of 1.00 or more, which were the Modern Technological State (France, Germany, Sweden), the Affluent State (the U.S.A.), the City-State (Israel, Singapore), the Horizontal Society (Chile, Guatamala), and the Developing Nation (Guyana, Costa Rica). A high national suicide rate was found to be significantly related to the Modern Technological State (P less than .001), and a low national suicide rate was found to be significantly associated with the Horizontal Nation (P less than .05). Results were interpreted in view of frustration theory and Durkheim's theory of suicide.


Report on a three-year follow-up of 100 cases of suicidal attempts in Shiraz, Iran.

One hundred cases of attempted suicide were followed up after three years. Only 50 records were recovered and of these 26 subjects were personally contacted. There had been only one subsequent suicide and three suicide attempts after three years. The possible relationship between psychiatric intervention and the low incidence of subsequent suicide attempts was discussed. The psychological adaptation after a suicidal attempt was also discussed.


The problem of cultural specificity of mental illness: a survey of comparative psychiatry.

The question posed in the present paper arises from the relationship of psychiatric disorder to culture. This question is: Are mental diseases the same all over the world, or do certain mental diseases exist only in one country or cultural setting and therefore are the specific product of that given culture? After a careful review of the literature supplemented by his own anthropological observations and psychiatric reports, the author was able to conclude that most of the allegedly "specific" mental sickness, which reflect in their behaviour the specific cultural content of the victim's society, are simply local varieties of a common disease process to which human beings, as such, are vulnerable.


Circadian rhythm of circulatory functions in depressives and on sleep deprivation.

Continuous examinations of circulatory functions in three 24-hour periods, before, during and after sleep deprivation, were carried out on 26 endogenous depressives and 10 neurotic depressives. The blood pressure recordings scarcely revealed relevant findings. The diurnal rhythm of heart rate in endogenous depressives is less pronounced than in healthy subjects, a phasal shift not being noted. A correlation between diurnal variation of depression symptomatology and the circadian rhythm of hear rate could be presumed on the basis of these findings. The heart rate curve is further flattened, almost levelling off, on sleep deprivation. The extent of this change is related to the therapeutic effect of sleep deprivation. A less pronounced diurnal rhythm of heart rate was also noted in neurotic depressives; however, there was no relationship between the therapeutic effect of sleep deprivation and its influence on heart rate.


Noncontact detection of ocular pulse--correlation with carotid stenosis.

Differences in ocular pulses from both eyes are well known to be associated with pathology; correlation of ocular pulse amplitude with the degree of carotid stenosis is made by a new method. Detection of ocular pulse is done by noncontact air-propagated ultrasound. Experimental results with dogs show detection of 10 to 15% carotid stenosis. By this method, one can screen for potential stroke in its incipient stages.


Minimizing corneal endothelial damage due to intraocular lens contact.

Previous studies have shown that momentary contact between a methylmethacrylate intraocular lens and the corneal endothelial cells results in extensive cell damage. This contact damage is reduced by coating the pseudophake with various solutions prior to contact with the endothelium.


Enzyme-synthetic approach to demonstration of phosphorylase activity in the living rabbit cornea.

An enzyme-synthetic method of demonstrating phosphorylase was applied to the living rabbit cornea, and polyglucose particles synthesized from glucose-1-phosphate in vivo were studied electron microscopically. In the corneas in which the medium for phosphorylase was applied from the anterior chamber or the bulbar subconjunctiva, synthesized polyglucose particles were found in the cytoplasmic matrices of the epithelium. When the medium was deposited in the conjunctival sac, a few synthesized polyglucose particles were found in the cytoplasmic matrices of only the superficial layer of the corneal epithelium. These findings suggest that metabolites for glycogen metabolism come mainly from the aqueous humor in the anterior chamber. The polyglucose particles synthesized by the enzyme-synthetic method in vivo resemble native glycogen particles. In addition, these particles were not overproduced because the synthesis of polyglucose is probably regulated in vivo.


Choroid tension and facility of aqueous outflow.

Tension of the choroid of enucleated eyes was adjusted by incising the sclera and lengthening the eye. The facility of outflow increased in direct proportion to choroid stretch. The present results are compared with reported results of anterior chamber deepening and lens depression in vitro and with accommodation and goniospasis in vivo. Choroid stretch in the enucleated eye is less efficient in increasing outflow facility than is equivalent choroid movement in accommodation. Anterior chamber deepening and lens depression also appear to be relatively inefficient means of enhancing outflow facility, although goniospasis appears to be relatively efficient. The suggestion is made that traction of the ciliary body on the trabecular mesh in an axipetal direction is more efficient in enhancing outflow facility than is traction in the meridional direction.


Photosensitization of the lens by 8-methoxypsoralen.

During the past decade, ambient ultraviolet radiation has been implicated in the age-related increase in fluorescence and pigmentation of the human lens nucleus. 8-Methoxypsoralen (8-MOP) (currently in vogue for the treatment of psoriasis) is a well-known photosensitizing agent. This drug lar fluorescence (360/440 nm.) and a change in receiving a single intraperitoneal dose (4 to 8 mg./kg.) of 8-MOP. When such rats are subjected to ambient light or ultraviolet (UV) radiation in vivo, there is an enhancement of lenticular fluorescence (360/440 nm.) and a change in their phosphorescence spectra. In vitro studies on lenses derived from rats given 8-MOP and exposed to monochromatic UV radiation show effects similar to those of the in vivo experiments. The foregoing studies demonstrate that 8-methoxypsoralen enters the lens and can be affected by ambient light as well as UV radiation, resulting in a photosensitized enhancement of lenticular fluorescence and a binding of this photosensitizing agent to macromolecules within the lens.


Binocular interactions in the human visual evoked potential after short-term occlusion and anisometropia.

The human visual evoked potential was recorded during 9 hr. of monocular occlusion or deprivation of fine detail by anisometropia. Some decrement in the response from the occluded eye was evident, but the major result was a sustained increase in the response from the nonoccluded eye. The anisometropic condition produced no decrement for stimulation of the deprived eye, but again there was an increase in the response from the nondeprived eye. Under some conditions the changes became apparent after only 6 hr. of deprivation. The data may be interpreted in terms of binocular competition or reciprocal inhibition at the level of the visual cortex or lateral geniculate nucleus.


Objective determination of human visual acuity: pattern evoked potentials.

The natural visual acuities of 15 adult persons were predicted on the basis of changes in visual evoked potentials (VEP's) to flashed patterns of various sized dots. An objective method was used to quantify the VEP's, based on the minimum-sized stimulus that would elicit a pattern VEP- the VEP pattern threshold. This measure was highly correlated with recognition and resolution measures of perceptual visual acuity (r's as high as 0.89). The regression equation between the VEP measures and predicted perceptual measures of acuity enabled the objective estimation of perceptual acuity to within +/- 0.29 decimal units.


Acidosis, alkalosis, and aqueous humor dynamics in rabbits.

Systemic acidosis induced by intravenous administration of hydrochloric acid lowered intraocular pressure in unanesthetized rabbits. Aqueous humor flow was reduced by approximately 50%, as measured by the iodide method and as calculated from tonographic data. Outflow facility, episcleral venous pressure, plasma osmolality, blood pressure, pulse, and body temperature were not altered by systemic acidosis. Systemic alkalosis induced by intravenously administered sodium bicarbonate was associated with an increased intraocular pressure. Aqueous humor flow following systemic alkalosis was increased by approximately 100%, as measured by the iodide method and as calculated from tonographic data. Alkalosis was not associated with alterations in outflow facility, episcleral venous pressure, plasma osmality, blood pressure, pulse, or rectal temperature.


Dangers of left main coronary artery lesions: angiographic technique and evaluation.

Five hundred consecutive coronary arteriograms were reviewed to evaluate left main coronary artery lesions. This entity has been associated with a high incidence of angiographic deaths. Clinical signs claimed to be diagnostic were analyzed together with the value of various projections for making the diagnosis. Pressure damping was a vital sign, and when persistent, it required 3-5 mm to be cut from the catheter's tip for a safe study to be performed. Shallow 10-15 degrees oblique and AP projections were found to be essential for a complete evaluation of the left main trunk. Marked ST depression or hypotension during treadmill exercise testing, as well as the presence of coronary calcification were not statistically significant in anticipating this lesion. The incidence of left main lesions nearly 15% (74/500) in this series is higher than previously reported (2.4-5.9%); however, in 8% (40/500), the stenosis was 75% or greater in degree which more closely approximates to the incidence previously reported in the literature. This may be the result of the additional projections recommended, but is probably also related to the population studied. No complications occurred in this series.


Renal renin and hemodynamic responses to selective renal artery catheterization and angiography.

Selective renal artery catheterization and renal angiography are commonly performed diagnostic procedures; however, the effects of these procedures on renal blood flow (RBF) and renin release have only been partially described. A biphasic RBF response has been well documented furing selective angiography in dogs. The renal autoregulatory mechanisms governing the responses are uncertain. The renin-angiotensin system and the major parameters of contrast media, hypertonicity and viscosity, have been suggested as important factors. In the canine model, we examined the acute changes in renal venous renin activity along with the renal hemodynamic effects of hypertonicity and viscosity. Our results do not support a primary effect mediated by the renin-angiotensin system. Hypertonicity and the contrast medium per se are significant in active and passive autoregulatory responses at the smooth muscle cellular level.


Grid versus non-grid techniques for the detection of pulmonary nodules in a chest phantom.

A partial chest phantom was constructed to compare two commonly employed radiographic techniques, 70 kVp without a grid and 120 kVp with a grid, for the detection of pulmonary nodules. The phantom consisted of human ribs embedded in paraffin, the lungs of a dog injected with silicone rubber, a tissue equivalent wax heart and beeswax nodules. The nodules ranged in size from 3-7 mm. A series of 120 films was exposed, half with each technique, and the films were interpreted by three senior residents and seven staff radiologists. More nodules of all sizes except 3 mm were detected with the 120 kVp technique. The 3 mm nodules were rarely detected with either technique. The disadvantages of the 120 kVp technique were an approximate 50 percent increase in patient exposures and almost twice as many false-positive nodule detections.


Renal vein renin activity in primary hypertension: variability and influence of contrast material.

Despite recognized limitations, the renal vein renin ratio (RVRR) remains the most commonly used index of surgical curability in hypertensive patients with renal artery stenosis. It is generally held that a ratio exceeding 1.5 forecasts a favorable response to surgery. Measurement of this ratio in 40 patients with essential hypertension (no arteriographically demonstrated stenosis) showed 8 (20%) with RVRR over 1.5, confirming an overlap of this ratio between patients with essential and renovascular hypertension. Intra-arterial injection of contrast material influenced renal vein renin activity (RVRA) in some individuals, but we were unable to demonstrate significant alterations in the group as a whole. Since the influence of intra-arterial contrast material on RVRA is variable and unpredictable, it appears unwise to collect renal venous blood for renin measurements soon after angiography.


A new in vivo method of quantitating the rate of magnitude of mineralization of an experimental osseous defect.

An in vivo, quantitative, non-destructive method of measuring bone mineral deposition in a repairing osseous defect has been developed. A circular osteotomy, used as a controlled fracture, was found to be extremely reproducible, and could be introduced with a minimum of trauma. The rate and magnitude of mineralization of the osteotomy was directly related to the attenuation of a highly collimated photon beam produced by Iodine-125. Changes in bone mineral content of 4% can be detected using this system.


Dose reduction in mammography.

Two mammographic imaging systems (Xerox and Kodak Min-R) were evaluated. Three hundred consecutive mammographic examinations were performed utilizing both imaging systems. Results of these studies indicated equivalency of image detail at identical source-to-image receptor distance (SID). Patient exposure as measured by the thermoluminescent dose meter for Kodak Min-R system was approximately 25% that of Xeromammography system. Due to reduced power requirement, it is possible to increase the SID when Min-R system is employed for imaging. Improved geometric arrangement provided superior diagnostic images in 5.5% of 200 comparison cases.


Relationships between base-exchange reaction and synaptosomal phospholipid pool in the rabbit brain in vitro.

The calcium-stimulated incorporation of ethanolamine, L-serine and choline into rabbit synaptosomal phospholipids in vitro has been investigated. The synaptosomal membranes were prelabelled in vitro in their choline-, ethanolamine- or serine-phosphoglycerides by base-exchange and then chasing experiments were performed by displacing the lipid-bound base by ethanolamine, choline of L-serine labelled with a different isotope. The results indicate that membrane phosphatidylcholine, phosphatidylethanolamine and phosphatidylserine are substrates for the exchange with all the three mentioned bases. A very small phospholipid pool (0.5-2% of the total available pool) is active in the calcium-dependent exchange between membrane phosphatidylcholine or phosphatidylethanolamine and free bases, whereas the pool of exchanging phosphatidylserine molecules is sensibly larger (2-9%). The possible physiological importance of these small phospholipid pools, involved in base-exchange reaction at brain membrane level, is discussed.


Some characteristics of the residue obtained after pronase treatment of sheep erythrocyte membranes. II. Carbohydrate patterns.

The composition of single carbohydrate classes of intact and pronase treated sheep erythrocyte membranes has been studied. In comparison with the data obtained from untreated stromata after proteolytic digestion the amount of each class of sugars is decreased. A high disappearance of sialic acids and hexosamines can be observed. Nevertheless if the total sugar content is referred to the residual protein content (16% of the native proteins, an enrichment in carbohydrates, specially neutral hexoses, can be observed. The results indicate that most of the carbohydrate fractions solubilized by pronase treatment are sialic acids and hexosamines. Different molar ratios obtained for the single carbohydrate classes in comparison with NANA before and after pronase treatment suggest a microheterogeneity of the glycoprotein structure of sheep erythrocyte membranes. By the use of several analytical methods the residue obtained after pronase treatment shows two major fractions containing proteins, lipids and carbohydrates. The data are discussed in view of the possible arrangement of lipo-glycoproteins in sheep erythrocyte membrane.


Some characteristics of the residue obtained after pronase treatment of sheep erythrocyte membranes. I. Protein and phospholipid patterns.

In this note some data regarding analysis of sheep erythrocyte stromata after pronase treatment are reported. The membrane material obtained after pronase treatment was analyzed by density gradient ultracentrifugation, gel filtration, acrylamide gel electrophoresis and for phospholipid content. With all techniques employed two major lipo or glycolipopeptides can be observed. The whole body of phospholipids is not lost after pronase treatment, therefore lipid-lipid interactions are maintained after pronase treatment, moreover sodium dodecyl sulphate is not efficient in the breakdown of some protein-lipid interactions. The results are discussed in view of the correspondence of the two fractions obtained with portions of the major glycoproteins of the erythrocyte membranes.


[Diffuse melanosis in malignant melanoma].

A patient with widely metastasized malignant melanoma assocaited with diffuse melanosis is presented. The widespread metastases in liver; skin and tonsilla are remarkable. The cutaneous melanosis in the form of the slate-blue colour caused by the increased dermal melanin deposits can arise in two different ways. One possibility is that melanin or precursors can be released from liver or other metastases and reach the dermis via the circulation. On the other hand a diffuse direct haematogenic single cell metastatic formation in the dermis with melanin formation and release can occur. In the case of the described patient the first etiopathology is dominating as it is shown by the light and electron microscopical results presented here.


[Contact thermographic studies on primary cutaneous melanomas].

Contact thermography in diagnosis of cutaneous melanomas is only a complementary method of investigation. Positive thermograms should lead to a diagnosis of malignancy without being pathonomic of malignancy.


[Treatment of oligozoospermia with HMG and HCG in normogonadotropic men].

The treatment of subfertile men with HCG and HMG over 20 days does not produce statistically significant increase of sperm count, their motility and their mophology.


[Determination of IgE using PRIST].

In 160 allergic patients the total IgE level was determined by PRIST, a paper sandwich technic, and compared with the corresponding RAST values. Judging the IgE levels in positive RAST as pathologic and in negative RAST as normal we found IgE levels up to 20 U/ml as normal and IgE levels higher than 100 U/ml as pathologic. When used alone the PRIST gives a reliability of 73% as a screening test in allergic patients.


[Swimming-pool granuloma].

The swimming pool granuloma is a chronic granulomatous skin disease, caused by atypical quick growing mycobacteria in areas of minor injuries with high self-healing rate.


Viral hepatitis B: aspects of environmental control.

In recent years it has become increasingly evident that viral hepatitis type B is a major disease problem among patients and/or health professionals associated with environments such as hemodialysis centers, dental operatories, clinical laboratories, and institutions for the mentally retarded. Studies have incriminated the intramural environment as well as specialized equipment and procedures as important factors in disease transmission. With hepatitis B surface antigen (HBsAg) as a marker of potentially infectious blood or body fluids such as saliva, it is possible to assess the environmental role in transmission of hepatitis B by use of a swab-rinse technique coupled with radioimmune assay. Assay procedures have been developed and utilized for detecting HBsAg on surfaces and in air and for quantitating of HBsAg in thermal and chemical inactivation studies. Specific decontamination strategies and recommendations for sterilization or disinfection procedures are described.


Qualitative evaluation of macroscopic flocculation tests for syphilis.

Five thousand two hundred and two sera were tested in parallel using the Rapid Plasma Reagin (RPR) Card Test, the Reagin Screen Test (RST), and the Venereal Disease Research Laboratory (VDRL) Slide Test. The fluorescent treponemal antibody absorption (FTA-ABS) test was then used to confirm the reactive specimens. This comparison study was to evaluate the RPR and the RST when used in a screening program. Of the total 5,202 samples, 199 (3.8%) were VDRL reactive, 187 (3.6%) were RPR reactive, and 183 (3.5%) were RST reactive. Of the 199 VDRL reactive, 116 (58.2%) were confirmed by the FTA-ABS, 137 (73.3%) of the 187 RPR reactives were confirmed by the FTA-ABS and of the 183 RST reactives, 115 (62.8%) were confirmed by the FTA-ABS. Included in this discussion are some testing and procedural problems encountered during the study.