Evoked response and kinesthetic measures of augmenting/reducing in schizophrenics: replications and extensions.

This study represents an attempt to replicate the central results of earlier work on stimulus intensity control. It uses a diverse sample of 40 hospitalized schizophrenic subjects, both chronic and acute. Two measures of stimulus intensity control were used: the Petrie kinesthetic figural aftereffects procedure (KFA), and the EEG method of average evoked response (AER). Finding the earlier results generally applicable, it presents a model of the function of stimulus intensity control in schizophrenia, which suggests that acute schizophrenics are particularly vulnerable to being inundated by stimuli, and therefore, that in order to protect themselves, they tend to reduce the perceived intensity of stimuli. Chronic schizophreniics have higher AER amplitudes and reduce less than acutes, suggesting that among chronics, the reducing mechanism either never was present or failed, whereas paranoid schizophrenics tend to be augmenters--a response style consistent with vigilant scanning.


MDA-assisted psychotherapy with neurotic outpatients: a pilot study.

Ten neurotic patients (five males and five females) were treated over a period of 2 to 6 months (mean, 4.1) as outpatients. The study allowed for a maximum of 75 hours of psychotherapy (mean, 51.55 hours). During the course of treatment, two to four (mean, 3.5) administrations of MDA (3,4-methylenedioxyamphetamine) were employed as adjunctive aids in an effort to enhance the psychotherapeutic process. The mean duration of the drug sessions was 8 hours (range, 6 to 14 hours). The first administration of MDA took place when, in the therapist's judgment, sufficient rapport had been established with the patient. All patients received an initial dose of 75 mg of MDA; subsequent dosage was allowed to range up to 200 mg. On these occasions, the drug appeared to be well tolerated with no serious side effects or complications observed. Psychometric assessments were obtained pre- and post-treatment, employing the Minnesota Multiphasic Personality Inventory (MMPI), Wittenborn Psychiatric Rating Scales (WPRS), and Brief Psychiatric Rating Scale (BPRS). In addition, follow-up evaluations were obtained 6 months after the termination of therapy by the use of the MMPI, WPRS, BPRS, and a Social History Questionnaire (SHQ) which had also been administered before treatment was initiated. Clinically, the impression was obtained that psychotherapy and the adjunctive use of MDA appeared to facilitate improvement in these patients. This impression was substantiated by significant reductions in scores on the psychometric assessments measuring depression, anxiety, and obsessive-compulsive traits. The meaures evaluating the sense of well-being and self-actualization also were encouraging. Although some of the patients were not as responsive as others, there were no observations to suggest that the condition of any of these patients had become worse.


The neuropsychological, psychiatric, and physical effects of prolonged and severe stress: 30 years later.

This study investigates the long term or residual effects resulting from severe and extended exposure to stress. The samples were prisoners of war who were intended in Japan (high stress group) or Europe (low stress group) during the Second World War. They were examined in the following three areas: neuropsychological, psychiatric, and physical/neurological. Significant differences were found in all three spheres between the two groups. Second, to examine further the effect of length of internment on these variables, the low stress group was divided into long term and short term internment duration groups, and then the three groups were compared. Significant differences were found among these three groups. These results are discussed in relation to a traditional model of explanation.


A comparative evaluation of two day hospitals. Goal attainment scaling of behavior therapy vs. milieu therapy.

Previous attempts at program evaluation of partial hospitalization programs have consisted largely of descriptive and anecdotal reports of programs and patient characteristics. There have been no comparative or experimental studies of the effectiveness of differing day treatment programs. In the current study, Goal Attainment Scaling, a goal-oriented program evaluation system, was used with 56 randomly selected partial hospitalization patients who attended two day hospitals: one program was based on behavioral-educational methods, and the other was an eclectic program based on the concepts of a therapeutic community. Patients attending the behavioral-educational program showed greater attainment of their therapeutic goals than did the patients involved in the eclectic program. The greater effectiveness of the behavioral-educational day program increased from the 3-month follow-up to the 2-year follow-up.


The effects of cerebral electric therapy (electrosleep) on anxiety, depression, and hostility in psychiatric patients.

The effects of cerebral electric therapy (electrosleep) and placebo on self-ratings of anxiety, depression, and hostility were compared. No difference in the amount of improvement shown by the two groups appeared on any of the five measures employed, although a major placebo effect was evident on all of the criteria. The results argue against the use of electrosleep as a treatment for these symptoms except when it may be employed for its placebo value.


How long does chlorpromazine last?

How long does chlorpromazine last? This question regarding the persistence of chlorpromazine (CPZ) in chronically medicated schizophrenic patients after drug discontinuation led to wide ranging preliminary answers. These varied from a few to several days for blood studies up to many months for urinary and clinical studies. At least two implications of the question need to be considered: a) the pharmacological persistence of active drug and/or metabolites after drug discontinuation; and b) the persistence of the therapeutic effects regardless of whether or not active drug and/or metabolites are pharmacologically present. For example, a patient's behavior may improve while on CPZ and this improvement may persist after the active drug and/or metabolites cease to be present in the patient's body. These two areas of inquiry were examined by looking at blood, urinary, and clinical data. Although blood studies undoubtedly give the most definitive data, they are greatly complicated by the lack of definitive information regarding the active moiety (moieties) and crucial sites of action, the large number of metabolites (up to 150 or so), the minute quantities involved (ng/ml), the wide inter- and intrapatient variations, and the newness and lack of complete comparability of the quantitative methodologies. Within these limitations, there are a number of studies that are fairly consistent in showing a half-life of disappearance from the plasma of CPZ and/or metabolites in the range of a few to several hours. This would usually mean that most of the drug and metabolites are cleared from the plasma in a few days after drug discontinuation. Urinary studies are related less directly than blood studies to desired clinical effects. Under steady-state conditions in various studies, 43 to 63 per cent of a daily therapeutic dose of CPZ can be recovered in the urine in 24 hours. After drug discontinuation, urinary drug and/or metabolites in most studies last from about 3 to 18 days, with sometimes minimal or trace amounts after this. The clinical studies show a continuation of therapeutic benefits for up to 6 months and longer in some studies, but there are a number of studies showing placebo (withdrawn) groups deteriorating significantly more than continued drug groups much before this, even as early as 1 to 2 weeks off drug. This examination of the literature tends toward a duration of substantial pharmacological (therapeutic) action of CPZ of no more than a few days after drug discontinuation. For a small number of patients, clinical deterioration begins about the same time, whereas in many others, clinical improvement lasts weeks or months. Some of this latter continuation of improvement is likely not due to CPZ and/or metabolites currently active. There do remain many unanswered questions regarding the persistence of minute amounts of CPZ and/or metabolites in storage and possibly at active sites, and whether or not in some patients this makes a significant contribution.


A depressive syndrome responsive to lithium. An analysis of 20 cases.

The authors analyze a series of 20 patients seen over the past 4 years who have shown a dramatic improvement following the introduction of lithium carbonate to their therapy. The results indicate that these patients showed a consistent syndrome with the following features: a) anergic endogenous depression; b) positive family history in first degree probands; c) obsessional personality traits and symptoms; d) hypochondriasis and somatic symptoms; e) failure to respond to previous antidepressant therapy with tricyclic and MAOI compounds as well as ECT. A previous study by Gittleson showed that one third of a series of psychotic depressives admitted to the Maudsley Hospital, London, also displayed obsessional symptoms and hypochondriasis. These patients, however, seemed to do as well with standard antidepressant treatment as a control group of psychotic depressives without obsessional features. However, in this series, there was a 7 per cent residue whose obsessional symptoms worsened, even after recovery from their depression. The authors' group of patients represented approximately 3 per cent of all psychotic depressives seen over the 4-year period and could, therefore, coincide with Gittleson's residue. The mean age of onset of illness in the authors' depressive group was 45.5 years, and this finding, coupled with the high incidence of psychotic depression in first degree relatives, indicates that these patients were suffering from a psychotic depression modified by personality traits, rather than an atypical obsessional neurosis. The consistency of clinical features and specificity of response to lithium therapy appear to indicate that this is a clearly definable clinical syndrome worthy of further investigation.


Psychiatric diagnosis and tricyclic plasma levels in 36 hospitalized overdose patients.

Thirty-six hospitalized patients who were considered by emergency room physicians to have ingested medically serious tricyclic overdoses were studied. The purpose of the project was to determine if psychiatric diagnosis and associated psychiatric factors correlated with the severity of the overdose as defined by plasma drug levels. Medically serious overdoses were ingested by patients with alcoholism, primary affective disorder, undiagnosed psychiatric illness, and Briquet's syndrome. Prior psychiatric treatment, prior admissions, prior overdoses, or precipitating events did not correlate with the medical severity of the ingestion. Attempting to predict the individual medical severity of the overdose from psychiatric factors resulted in a dangerous underestimation of the risk of patients with Briquet's syndrome and an overprediction in the case of primary affective disorder.


Microsurgery of Arnold-Chiari malformation in adults with and without hydromyelia.

Microsurgical exploration of 15 adults with Arnold-Chiari malformation with and without hydromyelia using 3 to 20 X magnification has led to the following conclusions. Hydromyelia, associated with Arnold-Chiari malformation, is a progressive mechanical disorder that causes spinal cord deficits by pressure distention of the cord. Arnold-Chiari malformation causes slowly or suddenly progressive bulbar dysfunction by impaction of the malformation in the foramen magnum. Decompression of both can be achieved by a suboccipital carniectomy, upper cervical laminectomy, establishing an outlet from the fourth ventricle, and opening the distended cord in the thinnest exposed area, which is usually along the dorsal root entry zone. If Pantopaque myelography in patients in the supine position shows the Arnold-Chiari malformation, hydromyelia can be established as a cause of central cord deficit even if myelography shows the cord size to be normal. Syringomyelia, traditionally considered a degenerative disease, is a less common cause of a slowly progressive central cord deficit than either hydromyelia or intramedullary tumor.


Proximal occlusion of the dominant anterior cerebral artery for anterior communicating aneurysm.

Twenty-seven patients with ruptured and one with symptomatic unruptured anterior communicating aneurysms were treated by proximal clip occlusion of the dominant anterior cerebral artery. These patients have been followed for 2 to 4 1/2 years and the results evaluated. The operation carried a very low mortality rate (3.5%) and a relatively low morbidity. There was no instance of recurrent hemorrhage during the study period. Clinical and preoperative angiographic criteria for selection of patients and the timing and technique of surgery are discussed.


Microvascular bypass surgery. Part 2: physiological studies.

Intraoperative electromagnetic blood flow measurements were recorded in 15 patients undergoing extracranial-intracranial arterial bypass surgery. The initial average blood flow of 28.2 cc/min supplies 8.4% of the expected flow from one internal carotid artery. Blood flow probably increases postoperatively, as evidenced by angiographic enlargement of the bypass and its recipient cortical arteries.


Endothelial cell damage by temporary arterial occlusion with surgical clips. Study of the clip site by scanning and transmission electron microscopy.

The effects of temporary vascular occlusion with surgical clips on the underlying endothelial lining were studied with scanning (SEM) and transmission (TEM) electron microscopy. Twenty-five rabbits were anesthetized and both common carotid arteries exposed. A Heifetz clip was used to occlude the right carotid artery for 5, 15, and 30 minutes, and 2 hours in five animals each. The clips were removed and the vessels immediately perfused with glutaraldehyde. In five remaining animals, the right carotid arteries were occluded for 30 minutes followed by removal of the clip and resumption of blood flow for 30 minutes prior to fixation. Combined SEM and TEM examination of the endothelium of compressed segments revealed "craters" and "balloons", blebs and vacuoles, swollen mitochondria, dilated granular endoplasmic reticulum, and subendothelial edema. There were also areas of endothelial cell flattening, discontinuity, and desquamation exposing the subendothelial tissues. Following restoration of flow, platelets and fibrin were found adherent to altered endothelial cells and to exposed subendothelial tissues. Endothelial craters and balloons were also found distal and, significantly less frequently, proximal to the site of occlusion. It is suggested that antiplatelet aggregating agents may prove beneficial for the prevention of thrombus formation at the site of the clip as well as craters and balloons distal to the clip following procedures requiring temporary vascular occlusion.


Fluid-percussion model of mechanical brain injury in the cat.

Mechanical brain injury was produced in 36 cats with a fluid-percussion model in which brain damage or dysfunction is produced by a single, brief, hydraulically-induced pressure transient that is conducted through the brain. Fluid-percussion injury induce elastic deformation of the brain resembling the brain deformation known to occur following head impact. Physiological responses and pahtological changes following injury were expressed as a function of peak pressure. Macroscopic central nervous system lesions concentrated at the pontomesencephalic junction, cervicomedullary junction, and in the cerebellar tonsils were consistently observed at and above 2.6 atmospheres (atm). At higher levels of injury (greater than or equal to 3.2 atm) there was extensive basal subarachnoid hemorrhage. At very high levels of injury (greater than 4.0 atm) hemorrhagic contusions were noted at the cerebral hemisphere impact site. A spectrum of neuronal alterations was identified in the damaged areas. Computer analysis showed correlation of electroencephalographic (EEG) changes with the neuropathological changes, since EEG recovery became severely impaired above 2.6 atm. No EEG changes were noted below 1.5 atm. From 1.5 to 2.2 atm there was a physiological response to injury but no significant changes were seen on neuropathological examination. This range of injury should permit further studies of the more subtle changes following mechanical brain injury without intraparenchymal hemorrhage or subarachnoid hemorrhage. The fluid-percussion model relates brain deformation following mechanical loading to a single pressure transient that is easily measured and controlled. Further quantitative investigation into the pathobiology of mechanical brain injury following graded brain deformation is thus made possible.


Effect of increasing the plasma oxygen diffusivity on experimental cryogenic edema.

Mongrel cats with experimental cryogenic brain lesions were treated with the carotenoid compound crocetin. It has been shown that crocetin increases the diffusion speed of oxygen through plasma, and should provide a net increase in available oxygen to the capillary endothelial cell. The treated group of animals showed a significant reduction in edema as compared to a comparable control group. It is suggested that oxygen availability is an important factor in vasogenic edema.


Activation of neurons in the cerebellar nuclei and ascending reticular formation by stimulation of the cerebellar surface.

Electrical stimulation of the cerebellar surface has been used therapeutically for the control of certain epileptic seizure and motor disorders. Recent hypotheses suggest that the therapeutic results in the treatment of epilepsy might be a consequence of the activation of Purkinje cells which subsequently inhibit the epileptic activity in the cerebrocellular loop. These experiments establish that an anatomical substrate exists whereby the effects of stimulating the cerebellar surface might be mediated by the ascending reticular formation and the non-specific thalamic nuclei. Specifically, the stimulation of the cerebellar surface activates not only Purkinje cells but also cerebellar afferent systems, climbing fibers and mossy fibers, and neurons in the cerebellar nuclei and reticular formation. In addition, recordings from neurons in the ascending reticular formation suggest that stimulation of the cerebellar surface can affect processing of ascending sensory information, thus influencing neural integration of non-specific sensory system.


Laminotomy and total reconstruction of the posterior spinal arch for spinal canal surgery in childhood.

Kyphosis, anterior subluxation, and instability of the spine are reported as postoperative complications of multiple level laminectomies in children. The surgical procedure of multiple level laminotomies is proposed as an alternative. Indications in infants and children, the surgical technique, and the postoperative management are presented. The goal is preservation of the normal architecture of the spine in patients who are still developing.


Detection of small trigeminal neurinomas.

Four cases of trigeminal neurinoma are reviewed with particular attention to clinical signs and symptoms, lumbar puncture, electroencephalogram, brain scan, plain skull and tomographic radiographs, and angiographic and pneumoencephalographic findings. Pneumoencephalography, with special tomographic projections to identify various portions of the trigeminal nerve, delineated the tumor in all cases. Tumor removal was complete in three patients and nearly complete in the fourth. There was no operative morbidity or mortality.


Combined isotope ventriculography and lumbar myelocisternography in the diagnosis of communicating syringomyelia. Case report.

Several investigative procedures are currently used to diagnose communicating syringomyelia. The combination of isotope ventriculography and lumbar myelocisternography has never proposed nor carried out to verify this condition. We feel that this is a safe and valuable procedure to identify a patent central canal communicating with the fourth ventricle and is worth considering when diagnosing communicating syringomyelia.


Late pseudotumoral brain necrosis following irradiation of a scalp neoplasm. Case report.

The authors report the case of a 70-year-old man who developed intracranial hypertension and lef-arm paresis 2 years after irradiation for the right preauricular basal cell epithelioma. Angiography disclosed a right temporal lobe mass and the histopathological diagnosis was late postirradiation necrosis of the brain. Postoperatively, dexamethasone was given in increasing doses up to 60 mg/day for control of cerebral edema. The patient died of gastrointestinal bleeding on the 60th postoperative day.


Symptomatic Rathke's cleft cyst. Case report.

A case of a symptomatic Rathke's cleft cyst in a 10-year-old boy is described. The importance of the intraoperative differentiation between this rare tumor and a craniopharyngioma is discussed.


Replacement of a self-adjusting bone flap. Technical note.

Postoperative cerebral edema is often worrisome after intracranial surgery. A self-adjusting bone flap is described that uses sections of Raimondi catheter tubing.


Isospora vulpina Nieschulz and Bos, 1933: description, and transmission from the fox (Vulpes vulpes) to the dog.

Oocysts of Isospora vulpina were found in silver foxes (Vulpes vulpes) on a fox farm in Wisconsin. They were 29.7 (25-38) X 24.3 (21-32) mum. The sporocysts were 17.7 (15-23) X 13 (11-16) mum. Five coccidia-free puppies were inoculated with 22,000-42,000 oocysts each of I. vulpina from the fox: a patent infection resulted after 6-7 days. The infection was then transferred from 1 of these dogs to another coccidia-free puppy. After a 7-day prepatent period the puppy passed oocysts for 7 days.


Fine structure of an unidentified protozoon in the epithelium of rainbow trout exposed to water with Myxosoma cerebralis.

An intracellular protozoon was discovered in the epithelium of young rainbow trout (Salmo gairdneri) exposed for as short a time as 1 hr to water known to contain infective stages of Myxosoma cerebralis. Light- and electron-microscopic examination of this tissue revealed what appeared to be a proliferative stage (presumptive schizont) of a sporozoon; other possible stages in the life cycle were also observed. The relationship of this unidentified protozoon of M. cerebralis remains unresolved.


Myxosoma cerebralis: in vitro sporulation of the myxosporidan of salmonid whirling disease.

Trophozoites and other pre-spore stages of the myxosporidan Myxosoma cerebralis were taken from infected rainbow trout (Salmo gairdneri) and cultured in vitro. Cultures eventually yielded mature spores capable of discharging their polar capsules. This is the first report of culture of a myxosporidan.


Immunologic and electrophoretic characteristics of two species of Crithidia.

Crithidia harmosa and Crithidia fasciculata were compared immunologically by the indirect fluorescent antibody (FA) method and by agglutination. The FA technic yielded more specific results with cellular-debris than with whole-cell antigens. The immune sera collected from chickens 9 days after the last inoculations with whole-cell antigens had higher homologous titers than those collected after 4 days. Major antigenic differences between the 2 species were revealed by both methods. The electrophoretic patterns of C. harmosa and C. fasciculata obtained by polyacrylamide gel slab electrophoresis differed in the numbers and relative mobilities of their component bands.


Specificity of the glucose transport system in Leishmania tropica promastigotes.

The glucose transport system in Leishmania tropica promastigotes was characterized by the use of labeled 2-deoxy-D-glucose (2-DOG), a nonmetabolizable glucose analog. The uptake system has a Q10 of 2 and a heat of activation of 10.2 kcal/mole. The glucose transport system is subject to competitive inhibition by 2-DOG, glucosamine, N-acetyl glucosamine, mannose, galactose, and fructose which suggests that substitutions in the hexose chain at carbons 2 and 4 do not affect carrier specificity. In contrast, changes at carbon 1 (alpha-methyl-D-glucoside, 1,5-anhydroglucitol) and carbon 3 (3-0-methyl glucose) lead to loss of carrier affinity since these sugars do not compete for the glucose carrier. Sugars that compete with the glucose carrier have one common feature--they all exist in the pyranose form in solution. The carrier for D-glucose does not interact with L-glucose or any of the pentose sugars tested. Uptake of 2-DOG is inhibited by glycerol. This inhibition, however, is noncompetitive; it is evident; therefore, that glucose and glycerol do not compete for the same carrier. Glycerol does not repress the glucose carrier since cells grown in presence of glycerol transport the sugar normally.


Activities of glucose-6-phosphate, 6-phosphogluconate, and isocitrate dehydrogenases from Leishmania donovani cultivated at 25 and 37 C.

The activities of glucose-6-phosphate dehydrogenase (G-6-PD) (EC No. 1.1.1.49), 6-phosphogluconate dehydrogenase (PGD) (EC No. 1.1.1.44), and isocitrate dehydrogenase (ICD) (EC No. 1.1.1.42) from promastigotes of Leishmania donovani strain 3S grown at 25 C in modified Tobie's (mT) medium and from promastigotes of the 37 C-adapted substrain of this strain cultivated in the mT at 37 C were assayed at 25 and 37 C. At 25 C ICD from both the strain and the substrain had the highest, and PGD, the lowest activity; the activity of G-6-PD was intermediate, but much closer to that of ICD. Irrespective of the temperature of the assay, the activities of G-6-PD and ICD from the 37 C substrain were significantly higher than those of these enzymes from the parental strain; however, the activity of PGD from the 25 C strain was slightly higher than that of this dehydrogenase from the 37 C-adapted stock. No significant activity losses of G-6-PD and ICD from either the strain or the substrain were noted after incubation of the extracts in the presence of 0.25 M sucrose at 37 C for 2 hr. PGD was unstable in such extracts, but it could be rendered stable by the addition of 4 mM 6-phosphogluconate, G-6-PD was the least and ICD the most dependent on Mg2+ ions. In the 15-25 C range, the Q10 values of the enzymes from the 25 C strain were 2.83, 2.5 and 2.63 for G-6-PD, PGD, and ICD, respectively. These values for the respective enzymes in the 25-35 C range were 2.06, 1.67, and 1.62. The Q10 values of the enzymes from the 37 C substrain in the 15-25 C range were 2.06 for G-6-PD, 3.25 for PGD, and 2.77 for ICD; in the 25-35 C range, the corresponding values were 1.67, 1.46, and 1.83. Cultivation of the 37 C substrain at 25 C was accompanied by a drop in G-6-PD and ICD activities.


Effect of glucose on glycine requirement of Acanthamoeba castellanii.

Acanthamoeba castellanii grows in a minimal medium (AMLIV) containing only arginine, methionine, leucine, isoleucine, and valine as sole nitrogen sources, other than vitamins, when glucose is the carbon source. With acetate as the carbon source, glycine must be added to AMLIV. Doubling time in AMLIV varies according to the ratio of amino acids concentrations. Several combinations yield Td values of approximately 70 hr.


The socialization of a Medical School faculty.

The research reported here shows the processes which socialize M.D.s and Ph.D.s into academic roles in a medical school and the factors affecting their retention and attrition. Eighty-one percent (350) of the regular faculty of a midwestern university medical school provided career background data and information on their attitudes toward issues within their school and their perceived and preferred organizational goals, characteristics, and managerial styles. Sherlock and Morris' (1) paradigm was the theoretical framework. Principal findings include the greater importance of latent over manifest variables, the M.D.s' late decision to try an academic career, the high colleague acceptance of the new M.D. recruit, the greater adoption of university professoriat norms by the Ph.D.s, and the high goal agreement between basic science and clinical faculty.


An NIH/Columbia University information system interface.

The National Institutes of Health (NIH) and the Health Sciences of Columbia University have developed an information system interface whereby sponsored research information is routinely forwarded, in machine-readable form, from the NIH to Columbia University. For Columbia University the interface system has materially reduced data input costs, made information available on a more timely basis, improved the quality of its system by the adoption of existing standardized data definitions, and allowed flexible access to NIH's broad data base. For NIH the system permits an improvement in its data base through high-quality and fast feedback from the grantee institution. The promotion of future systems development is enhanced through the adoption of standardized data element designations and definitions.


A method for defining competency in Pediatrics.

In 1972 the American Board of Pediatrics (ABP) initiated studies leading to a report which identifies the important components of competency needed in the practice of pediatrics. The development of the report involved a group process engaging ABP board members and examiners. The outcome has been (a) the delineation of a process for establishing definitions of competency in a medical discipline; (b) the development of a framework for specifying the abilities needed to perform the tasks required of pediatricians; (c) an elaboration of samples of pediatric subjects to which these abilities and tasks are relevant; and (d) the development of a basis for choice of methods to use for purposes of certification.


A study of the demand for part-time residency programs.

A survey was conducted at the Medical College of Pennsylvania to measure the magnitude of demand for part-time residency programs and to assess the motivations underlying such interest. Responses from 206 females and 96 males (84 percent of all students) indicated that approximately 39 percent would probably or definitely apply to part-time residencies if they were available. As was expected, interest was greater among women and was greatest among women who were parents. At the same time, however, there was considerable interest which was not related to marital or parental status and which derived from a general dissatisfaction with the time demands of traditional graduate medical training. While there are many other factors to be considered, the demand for part-time residency programs probably far exceeds the supply of such programs and, with the continued expansion of the numbers of women physicians, will probably continue to grow.


A formative and summative evaluation model for special educational programs.

During the past two decades the problems of recruiting minority students into careers in the health fields have been addressed by many educators and various special study groups. Recent efforts by schools of medicine and allied health sciences to find viable solutions to the problem have facilitated implementation of career exploration and study-skills programs. Although the focus and sophistication of evaluation designs vary substantially among educational programs of this type, all share some common problems. The positions taken by the authors is that evaluation, both during and at the end of a program, is an essential aspect of the program and that the use of a systematic evaluation model is central to this effort. Data are presented which illustrate the utility of a systematic evaluation model when applied in a realistic test situation (an operational program for minority students). Several advantages of using this model are discussed.


Designing a curriculum in a clinical setting: an iterative process.

A curriculum for the training of medical students was designed and implemented in a functioning clinical setting. The multidisciplinary, multiprofessional staff of a primary care center participated with professional educators in an iterative process for curriculum development. A three-stage plan was conceived: behaviorally oriented educational objectives were constructed, instructional methodologies to satisfy these objectives were created, and evaluation instruments were designed. Throughout each stage the educators facilitated the process by teaching the staff the necessary techniques for the design and implementation of the curriculum. The curriculum that resulted from this process is focused on those issues that are important to team delivery of primary care. An important outcome of the project is the increased enthusiasm and competence of the professional staff in the teaching of students in the health professions.


[Anti reflux plasty by submucous "advancement" of the ureter. An experience of 384 malformative vesico-renal cases which were operated (author's transl)].

The authors present their experience of 384 ureters which were operated for malformative vesico-renal reflux by the technique of submucous advancement of the ureter. The quality of the results from the standpoints of ureteric function and that of sterility of the urine shows the quality of this technique.


[Stress incontinence: symptoms. Anatomo-radiological and urodynamic exploration by flow-metry (author's transl)].

The authors study stress incontinence, symptom and not disease, an entity which is rarely found in the pure state in the 21 cases presented. After analysis of the physio-pathological factors concerning stress incontinence, they present the results of a dynamic study by flow measurement (flow-metry). This enabled division of the incontinent patients into 3 groups, depending on the amount of flow, on micturition, normal, increased, decreased. Each group has common anatomo-radiological points, perhaps permitting a new dynamic classification of symptomatic stress incontinence.


[Socalled "primary" megaureter in the child and adult. Comparative study of 46 megaureters (author's transl)].

This analysis covering 46 MU in 36 patients, of which 16 were adults, shows the greater gravity in the child, with regards to the renal lesions as well as the degree of ureteric dilatation. The advantage of quantitative renal scintigraphic scanning in the evaluation of renal involvement is stressed. On the other hand, with regards to the results of conservative surgery (21 Leedbetter-Politano antireflux uretero-vesical re-implantations of which 5 were complemented by Hendren type modeling ureteroplasty) there seems to be no difference between the children and adults: 18 good results, 2 of which after reintervention for stenosis and uretero-vesical reimplantation.


[Transperineal prostatography for the diagnosis of cancer of the prostate (author's transl)].

Prostatography by perineal puncture is a remarkable technique for examination of patients with prostatic disorders. The authors prefer transperineal puncture of the prostate for the following reasons: 1) It is carried out under the guidance of the free right index finger in the rectum; 2) Infection has never been observed; 3) Stimultaneous biopsies taken from various regions of the prostate, for histological examination, is possible on changing the position of the needle. Perineal prostatography enabled one to: 1. Precisely see the extent of a cnacer. 2. Discover lesions provoked by the tumor (necrotic zones, opacities). 3. Assert that extracapsular extension has taken place when the contrast medium has diffusep outside of the prostatic capsule. 4. Possibly establish the presence of latent carcinoma within a prostatic adenoma. These being all useful notions for treatment.


Defective interfering passages of Sindbis virus: nature of the defective virion RNA.

Defective interfering particles of Sindbis virus contain 20S RNA identical to that found in BHK cells co-infected with standard and defective virions. We have characterized these RNAs by their oligonucleotide fingerprints. Most of the oligonucleotides were identical to those found in the mRNA (26S RNA) that codes for the virion structural proteins. Three oligonucleotides found in 20S RNA were absent from the 26S RNA pattern and may represent sequences from the 5' end of the virion RNA. Previous difficulties in describing the nature of the defective virion RNA were due to the aggregated state of the RNA. Nucleocapsids obtained from standard and defective virions were essentially the same size and had about the same density, suggesting that defective particles contain more than a single molecule of 20S RNA.


Genome localization of adeno-associated virus RNA.

In previous work, linear duplex molecules of adeno-associated virus, type 2 (AAV2), DNA were cleaved with the restriction endonucleases R-EcoRI, R-HindII, and R-HindIII. The physical order of the specific fragments obtained was deduced and oriented with respect to the DNA strand polarity and the direction of transcription. Stable AAV RNA is transcribed only from 70% of the minus DNA strand. We report here RNA-DNA hybridization experiments using these restriction fragments to obtain a more accurate map of the portion of the AAV genome represented in stable RNA. The data obtained with several sets of restriction fragments annealed to either whole-cell RNA or poly(A)-containing RNA were internally consistent. The AAV RNA annealed with a continuous region of the AAV DNA, beginning at 0.18 map units (18%) from the left end of the molecule and ending at 0.88 map units. In addition, the restriction endonuclease BamHI was found to make one specific cleavage in AAV2 DNA at 0.22 map units, which is 0.04 map units (i.e., 160 nucleotides) to the right (""down stream'') of the point corresponding to the 5' end of the viral mRNA.


Isolation of a transcriptive complex from Newcastle disease virions.

An active transcriptive complex was isolated from purified virions of Newcastle disease virus. After disruption with Triton X-100 and high salt, soluble and particulate fractions were separated by density gradient centrifugation. The transcriptive complex, recovered at a density of 1.275 g/cm3, appeared as a nucleocapsid structure by electron microscopy. When analyzed by polyacryl-amide gel electrophoresis, the nucleocapsids consisted of the nucleocapsid protein, a minor protein of 53,000 molecular weight, and the large L protein. Nucleocapsids possessed less than 1% of the hemagglutinating and neuraminidase activities originally associated with virions. The active complex synthesized predominantly 11 to 20S RNA in vitro and approximately one-fourth of the RNA molecules contained polyadenylic acid segments. In the presence of S-adenosyl-L-methionine, the RNA molecules were capped and methylated at the 5' termini. The transcriptive complex was also capable of methylating exogenous Escherichia coli RNA in the absence of viral RNA synthesis.


Replication of T4 DNA in vitro. II. Assay system for and some properties of gene products required for T4 DNA replication.

[3H]dTTP was not incorporated into T4 DNA in the in vitro system for T4 DNA replication when the system was prepared from cells infected with T4 amber mutants defective in DNA replication. [3H]dTTP incorporation was resumed by adding the missing gene product to the defective system. DNA replication by the reconstituted system proceeded by the discontinuous mode of replication, as observed in the wild-type system. By using this in vitro complementation system, molecular weights of gene 41, 43, 44, 45, and 62 products in the active form were roughly estimated as 60,000, 130,000, 130,000, 60,000, and 130,000, respectively. Complex formation between the products of genes 44 and 62 was detected. Other strong interactions between the gene products tested were not detected by glycerol density gradient sedimentation. Interaction of gene products with denatured DNA was analyzed by using a DNA-agarose column, and the results showed that products of genes 32 and 43 had a strong affinity for DNA.


Characterization of an RNA-a protein complex isolated from the RNA bacteriophage M12.

The properties of an RNA-A protein complex isolated from the RNA bacteriophage M12 are described. The molar ratio of RNA to A protein in the complex is estimated to be 1:1. In sucrose gradients, the complex sediments like free RNA molecules. In contrast to RNA alone, which can only infect spheroplasts, the RNA-A protein complex infects intact Escherichia coli cells and produces infectious progeny particles like the original phage. Evidence is presented that the infection of the host cells by the complex takes place via F pili. All of the infectivity disappears if the ionic bonds of RNA to A protein in the complex are dissociated in 0.5 M sodium chloride buffer at 37 degrees C. Furthermore, the kinetics of complex dissociation and loss of infectivity are the same, implying that the binding of A protein to the RNA is a prerequisite for infectivity on intact host cells.


Thymidine metabolism and DNA synthesis in Newcastle disease virus-infected cells.

The inhibition of thymidine incorporation into DNA in Newcastle disease virus-infected cells has been studied. At 6 h after infection of L-929 cells at high multiplicity, transport of exogenous thymidine across the cell membrane was inhibited. The kinetics of this inhibition, decreased Vmax with no change in Km, suggest that there are fewer sites available for transport in infected cells. The conversion of thymidine to dTTP was not inhibited. Equilibrium of exogenous thymidine with the acid-soluble pool occurred more slowly and at a lower level of radioactivity than in uninfected cells, and there was a reduction in the rate of incorporation of exogenous thymidine into DNA. The reduction of incorporation into the pool and into DNA was proportionate. The size of total cellular dTTP pools was changed very little in infected cells. DNA synthesized in infected cells in the presence of [3H]BrdUrd had reduced incorporation of tritium but similar buoyant density to that from uninfected cells. The results show that Newcastle disease virus inhibits DNA synthesis directly and, in addition, decreases thymidine transport. Together these account for the overall decrease in thymidine incorporation into DNA of infected cells.


Adenovirus transcription. IV. Synthesis of viral-specific RNA in human cells infected with temperature-sensitive mutants of adenovirus 5.

Cytoplasmic RNA sequences produced in HeLa cells infected with the adeno-virus 5 temperature-sensitive mutants ts1, ts2, ts9, ts17, ts18, ts19, ts20, ts22, ts49, ts36, and ts125 were characterized by hybridization to DNA probes generated by strand separation of restriction endonuclease fragments of adenovirus 5 DNA. Two ""early'' mutants defective in DNA synthesis, ts125 and ts36, fail to make wild-type levels of all previously reported classes of late RNA at the nonpermissive temperature. At 40.5 degrees C, both ts125 and ts36 synthesize a wild-type complement of early cytoplasmic RNA 16 h after infection. Under these conditions, no ""late'' cytoplasmic RNA sequences were observed. Similarly, nuclear RNA present in these cells resembled early cytoplasmic RNA rather than late nuclear RNA. All the late adenovirus 5 temperature-sensitive mutants synthesized normal wild-type levels of late cytoplasmic RNA at the nonpermissive temperature, except ts2, which appears to overproduce certain cytoplasmic species.


Single major polypeptide of a calicivirus: characterization by polyacrylamide gel electrophoresis and stabilization of virions by cross-linking with dimethyl suberimidate.

A calicivirus, San Miguel sea lion virus serotype 4, isolate 15FT, externally labelled with 125I, was shown by gel electrophoresis to possess a single major polypeptide. The polypeptide migrated anomalously upon electrophoresis in two sodium dodecyl sulfate (SDS) systems: more slowly than bovine serum albumin in a continuous phosphate-buffered system and more rapidly than bovine serum albumin in a discontinuous system. Estimated molecular weights in the two systems were approximately 71,000 and 64,000, respectively. There was no clear evidence for a minor virion polypeptide. Treatment of purified San Miguel sea lion virions with dimethyl suberimidate, a cross-linking reagent, preserved virion integrity during long-term storage at 4 degrees C. Oligomeric species of the polypeptide were observed upon electrophoresis of products from cross-linked virions. Based upon a preferred polypeptide molecular weight estimate of 71,000 and distribution of oligomeric species, a calicivirion model with 120 monomeric protein units is proposed as an alternative to a 180-unit model.


Structural proteins of La Crosse virus.

Preparations of La Crosse virus, a member of the California encephalitis group of bunyaviruses, were found to possess three major virion proteins. Two of the proteins were glycosylated (G1 and G2) and were located on the surface of the virus particles. These two glycoproteins were present in equimolar amounts and possessed apparent molecular weights of 120 X 10(3) and 34 X 10(3). Virion nucleocapsids, isolated by a nonionic detergent and salt treatment, contained another major protein, N (molecular weight = 23 X 10(3)). A large, but minor, protein species L (molecular weight = 180 X 10(3)) was also found in virus preparations. The approximate number of protein molecules per virion has been determined. Electron microscopy of purified La Crosse virus indicated that the virus particle (mean diameter, 91 nm) is enveloped and possesses irregular surface projections (length, 10 nm).


Methylation pattern of genomic RNA from Moloney murine leukemia virus.

32P- and methyl-3H-labeled 70S Moloney murine leukemia virus RNA was purified from virions produced in Moloney murine leukemia virus-infected mouse embryo cells. Primer-free RNA subunits obtained by heat treatment and zonal centrifugation were digested with RNase T2, and methylated oligonucleotides were chromatographed on DEAE-Sephadex in 7 M urea. Approximately one molecule of RNase T2-stable oligonucleotide (-5 charge) was isolated per subunit. Structural analysis indicated that the sequence of the oligonucleotide is m7GpppGmpCp. Analysis of the mononucleotide fraction isolated by DEAE-Sephadex chromatography of the RNase T2 digest identified 15 to 23 internal N6-methyladenylic acid molecules per subunit.


The influence of ventricular function on the results of aortic valve replacement for aortic stenosis.

Thirty-three patients who had aortic valve replacement (AVR) for isolated aortic stenosis (AS) were retrospectively evaluated to determine the influence of preoperative ventricular function on the results of operation. Patients were arbitrarily divided by ejection fraction (EF) into Group I having EF 0.46 or above and Group II having EF 0.45 or below. Group II had significantly lower mean EF and cardiac index and higher left ventricular end-diastolic volume index and end-diastolic pressure. There were two early and no late deaths in 21 Group I patients. There were no early and five late deaths in 12 Group II patients. All Group I survivors and six of 12 Group II patients were New York Heart Association (NYHA) functional Class I or II at follow-up evaluation. No preoperative hemodynamic index was predictive of which Group II patients would do well. Mortality was substantially higher in patients with severe preoperative disability. Early or late death occurred in five of 12 patients who were NYHA functional Class IV before operation but in only two of 21 patients who were functional Class II or III preoperatively. We conclude that patients with isolated AS and poor left ventricular function have a low hospital mortality but an increased risk of late death or poor functional result following AVR. Excellent functional results can be obtained after AVR in most patients with AS and good left ventricular function and approximately half of the patients with AS and poor left ventricular function.


Role of monovalent ions in the reabsorption of fluid by isolated perfused proximal renal tubules of the rabbit.

Proximal convoluted tubules were dissected from rabbit kidneys and perfused in vitro in order to determine the effect of monovalent ions on fluid absorption and transepithelial voltage. Replacement of sodium in the perfusate and bath by lithium, tetramethyl ammonium or choline caused the rate of fluid absorption and voltage to fall to near zero. Replacement of potassium in the bath by sodium had the identical effect. Replacement of chloride by nitrate or perchlorate had comparatively little effect. The results are consistent with the generally held view that active sodium transport (mediated by a Na- and K- activated adenosine triphosphatase) is the primary process responsible for the absorption of the fluid and the voltage. Replacement of bicarbonate in the perfusate and bath by chloride caused the rate of fluid absorption to decrease by 33%. The possible relation between sodium transport and bicarbonate is discussed.


Influence of volume expansion on NaC1 reabsorption in the diluting segments of the nephron: a study using clearance methods.

Whether volume expansion influences NaC1 reabsorption by the diluting segment of the nephron remains a matter of controversy. In the present studies this question has been examined in normal unanesthetized dogs, undergoing maximal water diuresis. Free water clearance (CH2O/GFR) has been used as the index of NaC1 reabsorption in the diluting segment. Three expressions have been employed for "distal delivery" of NaC1: a) V/GFR, designated as the "volume term"; b) (CNa/GFR + CH2O/GFR), the "sodium term;" and c) (CC1/GFR + CH2O/GFR), the "chloride term". The validity of these terms is discussed. Three techniques were used to increase distal delivery: 1) the administration of acetazolamide to dogs in which extracellular fluid (ECF) volume was not expanded (grop 1); 2) "moderate" volume expansion (group 2); and 3) "marked" volume expansion (group 3). CH2O/GFR increased progressively with rising values for "distal delivery" regardless of which term was used to calculate the latter. With all three delivery terms, differences in distal NaC1 reabsorption emerged between the two volume-expanded groups, though only with the "chloride" term did substantial differences also emerge between the nonexpanded group 1 dogs and both volume-expanded groups. In group 1, values for CH2O/GFR increased in close to a linear fashion up to distal delivery values equal to 24% of the volume of glomerular filtrate. However, at high rates of distal delivery the rate of rise of CH2O/GFR was less in group 2 than in group 1 and the depression of values was even greater in group 3. Within the limits of the techniques used, the data suggest that volume expansion inhibits fractional NaC1 reabsorption in the diluting segment of the nephron in a dose-related fashion. The "chloride" term was found to be superior to the "volume" and "sodium" terms in revealing these changes.


Variations in muscle cell protein of severely uremic children.

Alkali-solution protein (ASP) was determined in the muscle of 17 controls and 32 uremic children including 9 patients receiving intermittent hemodialysis. With regard to fat-free solids content (FFS), ASP values were found to be lower in uremic children than in normal subjects (59.2 +/- 1.6 vs. 76.4 +/- 1.9 g/100 g of FFS). This decrease was greater in hemodialyzed children (53.8 +/- 1.6 g/100 g of FFS). ASP depletion was found also when the results were expressed in relation to muscle potassium and phosphorus and therefore appeared to be due to an actual decrease in the amount of proteins per cell. ASP values were especially low (52.2 +/- 2.8 g/100 g of FFS) in seven nondialyzed children receiving a low protein diet (less than 0.165 g of N/kg of body wt/day) and in patients with a height below 2 SD (56.3 +/- 3.1 g/100 g of FFS). In the nine cases of glomerulonephritis, loss of muscle protein sfollowed plasma protein depletion. A relationship was found between plasma transferrin concentration and ASP. ASP depletion seemed to be related to the level of renal insufficiency. However, the most important factor in ASP depletion was probably an inadequate protein intake associated with the possible metabolic effects of uremix toxins which are currently unknown.


Effect of dialysate calcium concentration on bone disease in patients on hemodialysis.

Plasma biochemistry, bone radiology and morphometry were studied in a group of 20 patients receiving maintenance hemodialysis. The aim was to determine if increasing the dialysate calcium concentration would decrease plasma parathyroid hormone and improve the radiologic appearances of bone in patients without producing serious side effects. Dialysate calcium concentration was increased stepwise from 4.5 to 6.0 and then to 7.0 mg/100 ml. Mean predialysis plasma calcium concentration increased from 9.4 to 9.7 and then to 10.0 mg/100 ml and mean predialysis phosphate concentration increased from 5.3 to 5.6 mg/100 ml. Parathyroid hormone concentration was elevated in all patients but the mean concentration did not change significantly although in seven patients a decrease occurred. Six patients had radiologic signs of renal bone disease, two patients showed improvement and three patients developed bone disease during the study. The patients with radiologic bone disease had the highest parathyroid hormone concentrations and the majority were female. Morphometric bone measurements showed that bone loss during the study occurred mainly in the male patients. Soft tissue calcification continued to appear during the study. Although the response to some patients to an increased dialysate calcium concentration was favorable, it was impossible to predict which types of patient would benefit from the use of a dialysate calcium concentration of 7.0 mg/100 ml.


Some factors affecting the likelihood of moderate drinking by treated alcoholics.

The 1-year outcome in alcoholics who participated in an outpatient alcoholism treatment program which stressed moderate drinking as the ultimate treatment goal was investigated. The results suggest that such an approach, in an otherwise conventional treatment program, is likely to result in a higher rate of moderate drinking and a lower rate of abstinence but not in a higher over-all recovery rate than a total-abstinence orientation.


Assessing alcoholism treatment effectiveness. A comparison of three evaluative measures.

The success rates of patients in an alcoholism treatment unit were evaluated according to three criteria: vocational rehabilitation, abstinence and a behavioral rating scale. The three measures yielded success rates of 70, 34 and 62%, respectively.


Prognostic indicators for black and white alcoholics in the U.S. Navy.

Among 132 Black and 1384 White Navy enlisted men, about the same proportion of each group (76 and 77%) returned to effective duty after treatment for alcoholism. The best predictors of the sailors' effective recovery after treatment were favorable prognoses by treatment personnel, and their being promoted above the lowest grades of pay.


Referral to alcoholism programs in industry. Coercion, confrontation and choice.

Employees highly coerced into entering industrial alcoholism programs because of affected job performance reported a higher proportion of work improvement than those in treatment for other reasons.


Locus of control among alcoholics. Some empirical and conceptual issues.

Research on locus of control of reinforcement of alcoholics is reviewed. The results are unclear, and a need for the further study of the construct validity of Rotter's Locus of Control Scale, as applied to alcoholics, is demonstrated.


Aggressive behavior of intoxicated subjects. The effect of third-party intervention.

Intoxicated and nonintoxicated subjects competed in a reaction-time situation in the presence of either a pressuring observer or a silent observer. The intoxicated subjects initiated a higher level of attack than the nonintoxicated subjects. The social pressure manipulation was effective in reducing the aggressive behavior of both groups.


Impressions of Jewish alcoholics.

Jews, constituting 6% of the adult population in Toronto, contributed 0.5% of all admissions to one private and one public clinic for alcoholism during a 10-year period. Their demographic, sociocultural and psychological characteristics, and several modes of adjustment to being Jewish alcoholics, are described.


Shifts in the water and alcohol solution intake by rats under conditions of schedule induction.

Choice between a 5% alcohol solution and water by rats was labile when both were drunk to excess under conditions of schedule induction. Selection of the two fluids could be stabilized by sweetening the alcohol solution with saccharin.


Alcohol consumption by rat and mouse strains. Functions of taste and alcohol deprivation.

Three groups of animals (two of rats and one of mice) were tested to determine the effects of alcohol deprivation and the addition of sweetener to an alcohol solution on the animals' intake of alcohol.


Effects of ethanol intake on the immune system of guinea pigs.

Groups of guinea pigs were maintained with alcohol solutions not sufficient to result in liver dysfunction prior to and during investigations designed to determine whether ethanol would nonetheless impair cell-mediated or humoral immunity. No impairment of either was observed in any of the experimental groups.


Alcohol education for alcoholics. Relation to attitude changes and posttreatment abstinence.

Test results of 98 inpatient alcoholics revealed that improvements in attitudes toward treatment were positively related to gains in some areas of knowledge of alcoholism, but a gain in knowledge was not related to posthospital abstinence.


Induction of alcohol selection in laboratory rats by ultraviolet light.

Rats exposed to ultraviolet light with maximum emission at 350 nm showed a stable intake of alcohol over water. A control group of animals exposed to white fluorescence light did not drink more alcohol than water.


Disulfiram-induced convulsions without challenge by alcohol.

A patient who had several grand-mal seizures while taking disulfiram in the absence of a challenge with alcohol is described and some of the possible mechanisms for this occurrence are discussed.


Alcoholism, cigarette smoking, coffee drinking and extraversion.

Alcoholic patients smoked significantly more cigarettes and drank more cups of coffee than nonalcoholic psychiatric patients even when the higher extraversion scores of the alcoholics, as measured by the Eysenck Personality Inventory, were statistically controlled.


Drinking outcome of specific alcoholic subgroups.

Alcoholic's scores on the Eysenck Personality Inventory, the Drinking Behavior Inventory, the MacAndre Alcoholism Scale and Rohan's classification system for alcoholics were not related to drinking behavior during or after a treatment program that permitted drinking.


Self-esteem in alcoholics and nonalcoholics.

Alcoholics scored lower on a test of self-esteem than did nonalcoholics, Alcoholics with lower self-esteem were found to be more willing to seek treatment than those with higher self-esteem.


Compliance techniques to increase mailed questionnaire return rates from alcoholics.

The effects of three compliance techniques were examined. None elicited more returns than did a conventional mailed questionnaire.


A geographical analysis of drunken drivers.

The "nearest-neighbor" spatial approach proved a useful tool in defining the geographic distribution pattern of persons arrested for drunken driving.


Studying the impact of patient drug profiles in an HMO.

The objectives of the study were to determine if a drug profile quantitatively and qualitatively influenced various aspects of drug utilization. A group of 1,632 medically indigent persons enrolled in the Kaiser Health Plan constituted the study population. This population received completely prepaid medical care including drug services from the Kaiser Medical Care Program. A computer-based chronological and monthly updated listing of drugs ordered and prescriptions received was provided as the front page of the centralized outpatient medical chart for a randomly selected half of the study population for a full year. Duplicate and bound copies of these patient drug profiles were also provided each outpatient pharmacy. The findings indicated the presence of the drug profile did not quantitatively or qualitatively affect prescription receipt of the group with the profile. Although the findings must be viewed in the contexts of the population served and the medical care setting, the findings strongly indicate the need for additional research to assess additional forms of drug profiles and under conditions not addressed by this study.


The role of group practice in the distribution of physicians in nonmetropolitan areas.

The geographic maldistribution of physicians persists as a major obstacle to improving the availability of health services in rural areas. This study looks at group practice as a potential factor in the location of physicians in nonmetropolitan areas. The basic assumptions are 1) the expected conditions of practice are critical to a physician's decision about where to locate, and 2) a group practice form of organization alleviates many of the deterrents to rural practice. The sample for the study is 287 nonmetropolitan trade areas in eight geographic regions of the U.S. Stepwise multiple regression is used to evaluate the relationship of demographic and health system variables, including group practice, to the physician/population ratio. Analyses are done for 1960 and 1970 and then for the change over the ten-year time period. The regression outcomes show that income, population over age 64, and urbanization are most helpful in explaining physician distribution in 1960. In 1970, hospital facilities also contribute. However, the percentage change in the physician/population ratio between 1960 and 1970 is explained by the 1960 physician/population ratio and the per cent of physicians in group practice in 1960. The findings suggest that attractive practice arrangements may be one way to alter the geographic maldistribution of physicians.


Time utilization of a population of general surgeons in a prepaid group practice.

Seven general surgeons in a prepaid group practice previously shown to have a mean operative work load of 9.2 hernia equivalents (HE) per week were found to have a standardized mean daytime working week of 56.2 hours, exclusive of evening activities of which 50.7 hours were devoted to professional activities. The surgeons also devoted a mean of 6.7 evening hours per week to professional activities for a mean net professional week of 57.4 hours. Comparisons with a population of previously studied community surgeons revealed that the prepaid group surgeons were able to produce a surgical output more than double that of the community surgeons while devoting only one and a half as much time to professional activities. Economies in the utilization of surgical manpower in the prepaid group appear to stem from: 1) restriction of practice setting to a single geographic location, 2) restriction of patients to surgical patients, 3) reduced surgeon waiting time in the office, and 4) the utilization of paraprofessional personnel for selected operative assisting. These economies were achieved while the prepaid group surgeons were observed to average more time per patient visit both on rounds and in the office than the community surgeons.


Analyzing the start-up effects of new patients on an ambulatory care program.

Holmes County, Mississippi was the site of a pilot study to develop a community-based program to combat hypertension, the primary health problem in the rural black community. Using experience gained during the pilot program, a model was developed that computes, over a sequence of planning periods, the personnel utilization and the treatment status of the patients as functions of treatment protocols, allocations of procedures to personnel, and the additions of new patients. The model can be used to study the impact of new patients on any ambulatory care program or any health maintenance organization in which there is unusually high personnel resource utilization during a patients first visit.


Satisfaction with health services: some policy implications.

Although consumer satisfaction with health services is a frequently measured variable in health services research, the relevance of this variable for health policy is not always clear. The present paper suggests two criteria for specifying the relevance of satisfaction with health services for policy at the organizational level. First, it should be shown that consumer satisfaction is the result of organizational behaviors that are manipulable by policy. second, where he has a choice, it should be shown that satisfaction affects the organizationally relevant behavior of the consumer. Data are presented that support both criteria. Several suggestions are made for maximizing the policy relevance of future studies of satisfaction.


Nursing homes and the Roemer-Feldstein hypothesis.

The theory of certification-of-need is based in large part on the Roemer-Feldstein hypothesis, which holds that demand for services is proportional to bed supply. Athough developed solely from hospital data, this hypothesis is commonly assumed to hold for nursing homes as well. In fact, a high correlation between nursing home bed supply and bed utilization does exist. However, the rate of utilization should not be judged without reference to the appropriateness of use. Analysis of nursing home placement data revealed that overplacement of patients in skilled nursing facilities decreased as bed supply increased. These results suggest that the Roemer-Feldstein hypothesis may provide an inadequate rationale for regulation of nursing home bed supply. Further developments should be based on more sophisticated notions of bed supply, should make reference to the appropriateness of services, and should be subjected to empirical verification.


Inpatient hospital utilization in three prepaid comprehensive health care plans compared with a regular Blue Cross plan.

The evidence is substantial that comprehensive, HMO-type prepayment plans can significiantly reduce hospitalization rates. Yet it remains unclear which factors contribute to this phenomenon. This study focuses on organizational characteristics of four plans with different hospitalization experiences. Regular medical staff review and frequent use of second opinions and economies of scale achieved by providing care at one well-equipped, large health center appear to have the largest impact. However, such organizational advantages can easily be wiped out by adverse self-selection of patients during open-enrollment periods. Evidence of selection based on predictable high obstetrical and newborn care costs is presented.


Factors determining the quality of physician performance in patient care.

The study determined the separate and joint effects of 1) physician specialty, 2) type of medical school attended, 3) time in practice, 4) type of ambulatory care setting, and 5) type of hospital on the quality of physician performance in patient care. The sample consisted of 454 physicians in 18 specialty categories. Multiple Classification Analysis was used to determine the effects of these predictors on the quality of physician performance. The study found that the organization of hospital care had a large independent effect, but that the other four predictors had relatively small effects on the quality of physician performance. The findings imply that the organization of the setting in which care is provided has more influence than the education and training that physicians had attained. All five predictors together explained 20 per cent of the variance. Methodological suggestions were made to improve the explanatory power of the variables, and various pragmatic for medical care administrators were presented.


Correlates of outcomes in patients with congestive heart failure.

This study relates components of care, including patient characteristics, degree of initial morbidity, and process of care, to patient outcomes. One hundred twenty-two adults who were being treated for congestive heart failure by a sample of physicians in Fort Wayne, Indiana were studied. Data were obtained on the patients' personal characteristics; degree of illness at the beginning of the six-month study period; process measures (physician awareness, communication, medication use, therapeutic management, patient satisfaction, and utilization of services); and level of activity and symptoms at the end of the study period. These components were quantified and subjected to correlation and regression analysis. The largest and most significant predictors of outcome status were measures of initial disease status. Process variables were strongly and significantly associated with outcome only in a group of patients who were minimally symptomatic initially. The lack of an overall association between process of medical care and patient outcome cannot be generalized beyond these patients with congestive heart failure. A similar approach of dissection, quantification, and analysis of components of care, however, can be used to explore a possible relationship in other conditions and care delivery settings.


[Catheterization of the umbilical vein, diagnostic and therapeutic relevance (author's transl)].

Catheterization of the umbilical vein does allow direct access to the portal system, thus yielding information about the pathophysiology of the hepatic and splanchnic vessel system. Mesurement of the portal vein pressure in conditions of portal hypertension can be performed in the portal vein. A special, three-compartment ballon catheter is available for mesurement of intrahepatic wedge pressure. Angiography of the umbilical vein allows earlier diagnosis of metastases within the liver than other diagnostic procedures. Intraportal application of cytostatic drugs using a long term indwelling umbilical vein catheter is feasible as well. Own experiences are as yet rather limited. Three patients have been treated up to now this way; evaluation of the therapeutic results is not yet possible, because of the short duration of therapy and because of the low number of patients. The technique of umbilical vein catheterization does not seem to present any problems. Complications are rare and did not occur in our series.


[The diameter of the pancreatic duct in relation to the size of the organ in chronic pancreatitis (author's transl)].

In 108 cases a postmortal pancreatography followed by histological examination was performed. The size of the pancreas could be measured on X-ray films after complete acinar filling. In normal cases organ size was proportional to the diameter of the duct, the diameter ranging between 2 and 4 mm (average 3,7 mm). In subjects with chronic pancreatitis, the diameter varied from 4 to 8 mm (average 5.7 mm). From these results it could be concluded, that the S/D-quotient (pancreatic surface seen on X-ray in cm2 divided by the greatest diameter of the main duct in mm) might be an aid in establishing the diagnosis of chronic pancreatitis in doubtful cases. In chronic pancreatitis the width of the duct generally increases while the size of the organ decreases due to scar formation, thereby clearly reducing the S/D-quotient. The average quotient of our normal cases was 24,2 and that for cases of chronic pancreatitis was 12,0.


[Unusual lethal outcome of percutaneous needle biopsy of the liver (author's transl)].

In a 71 year old patient liver needle biopsy caused death 18 days after biopsy was done, resulting from hemorrhage into the intra- and extrahepatic bile ducts. The biopsy had caused an acute exacerbation of a clinically latent cholangitis, followed by acute purulent pylephlebitis of intrahepatic branches with vascular arrosion. Data in the literature concerning complications after percutaneous or peritoneoscopic biopsy of the liver are quoted. The causes leading to the lethal outcome are discussed.


[Perforation of the esophagus by gastric tubes (author's transl)].

Esophageal lesions caused by gastric tubes are not rare nowadays. Perforation at the physiologically narrow sites of the esophagus is a wellknown mechanism as is the use of inflexible polyethylen tubes containing a mandrin. Within 12 months perforation of the esophagus caused by gastric probes occurred in four patients of our intensive care unit. Clinical symptoms, diagnostic procedures and therapy of this complication are discussed, especially emphysizing the need of early diagnosis. The extent of complications arising from and the process of healing of this iatrogenic lesions depend upon the localization of the lesion and ypon early diagnosis.


[Selection of patients with gallstones for litholysis (author's transl)].

Drug therapy of cholelithiasis with chenodeoxycloic acid (CDC) will yield better results, if patients with new cholesterol stones are selected for therapy, since these stones dissolve quickly and completely. X-ray diagnosis of the different types of stones is discussed; radiolucent bilirubin stones with or without cholesterol covering and with low calcium content do present the most difficult diagnostic problems. Old cholesterol stones do not disolve completely. If litholysis is supposed to be succesful, the diameter of a solitary cholesterol stone should not be greater than 20 mm and the total volume of cholesterol stones should not occupy more than 50% of the gallbladder volume in order to allow sufficient contact of the stones with the bile. Litholysis may be stopped if calcium salts or pigments cover the surgace of the stone. At the present stage only 24% of all patients with gallstones are suited for CDC-therapy. Early diagnosis of cholelithiasis is essential, if CDC-therapy is to be applied more frequently and if this form of therapy is to have better effects.


[Antegrade visualization of the billiary duct system by percutaneous transjugular cholangiography (author's transl)].

Percutaneous transjugular cholangiography (PTJC) is a new technique for visualization of the biliary duct system and for diagnosis of obstructive jaundice. First experiences of the authors in 22 patients are described. The advantages and disadvantages of this procedure, which at the present time is used rather rarely, are discussed and compared to various other cholangiographic methods. The endoscopic retrograde cholangiography (ERC) was used for patients with obstructive jaundice of unknown origine in the first place. If the biliary duct system could not be visualized by ERC (failure of complete obstruction of the common bile duct), the antegrade technique (PTJC) was performed. The peritoneoscopic and the transjugular cholangiography yield about the same percentage of positive results (90%), as far as visualization of the biliary tree is concerned. However in contrast to the peritoneoscopic methods PTJC seems to bear a smaller risk of complications. Some further diagnostic and therapeutical advantages, which might result from the use of PTJC are pointed out.


Identification of plant sterols in plasma and red blood cells of man and experimental animals.

Direct gas liquid chromatography (GLC) of total plasma lipids showed small peaks (0.5-1.5% of total free sterol area) corresponding to free C28 and C29 sterols in ca. 50% of some 3,000 normal subjects and patients with hyperlipemia. Comparable proportions of similar peaks were present in the sterol fraction isolated from the red blood cells of many of these subjects. The maximum levels of these components in the plasma and red blood cells of domestic and laboratory animals were up to 10 times higher than those seen in man. Detailed gas chromatography/mass spectrometry analyses of the plasma lipids from a much more limited number of subjects and animals showed that the GLC peaks corresponding to the free C28 and C29 sterols were largely due to the plant sterols campesterol, stigmasterol, and beta-sitosterol. In all instances, variable amounts (0.05-0.2% of the total free sterol area) of 7-dehydrocholesterol, desmosterol, lanosterol, and cholesterol alpha-oxide were also detected. While the total content and composition of the plasma plant sterols appeared to vary greatly among the subjects, it never exceeded 2% of total sterol in the normal subjects and patients examined. There was no evidence for a significant increase in the plant sterol content of the plasma of patients with hypercholesterolemia or hypertriglyceridemia.


Plasma transport forms of ingested fatty alcohols in the rat.

Previous studies have shown that ingested fatty alcohols are absorbed as fatty acids and fatty acid esters, particularly triglycerides. The present study was carried out to determine whether fatty alcohols are also transported as 0-alkyl glyceryl ethers, alk-1-enyl glyceryl ethers, and as wax esters. Oxidation of fatty alcohols to other lipids was assessed by using a mixture of [1-3H] hexadecanol and [1-14C] hexadecanol of predetermined ratio. The results indicate that the absorption of fatty alcohol, and of its transport forms, parallels the absorption of labeled fatty acids. Six to 25% of plasma radioactivity was present as 1-0-alkyl diacylglyceryl ethers with a smaller proportion of ether lipids in the phospholipid fraction. In addition, 4-13% of the ingested hexadecanol appeared in the plasma as a material having the chromatographic properties of wax ester. Fatty alcohols were not detected in the plasma as alk-1-enyl lipids.


Syntheses of tetra- and hexadeuterated octadecenoates.

A study of the metabolism in man of cis and trans monoenoic acids required the synthesis of tetra- and hexadeutero-9-octadecenoates. Preparation of methyl 9-octadecenoate-8,8,11,11-d4 (90 mol % deuterium) by the Wittig reaction was accompanied by deuterium scattering with sodium methoxide as the base but not with alkylithium. Scattering occurred in both the aldehyde and phosphorane moieties only when the aldehyde contained deuterium on the alpha carbon. Methyl 9-octadecenoate-8,8,13,13,14-14-d6 (98 mol % deuterium) was also prepared by the Wittig reaction. The deuterated octadecenoates were formed principally as cis isomers. The trans isomers were produced by nitrogen oxide isomerization and separation on a silver ion column.


Mass spectra of acetylenic fatty acid methyl esters and derivatives.

A series of isomeric methyl octadecynoates was analyzed by mass spectrometry; each isomer gave a unique spectrum. The characteristic ions were those resulting from a McLafferty rearrangement of the allenic sites or of the already-rearranged allenic sites. The acetylenic esters were also subjected to oxymercuration whereupon a carbonyl group was formed at either of the original actylenic carbon atoms providing two oxostearates. Further reaction with NaBH4 formed hydroxy esters which, after silylation, gave diagnostic mass spectra indicative of the triple bond location. Applied to esters with both double and triple bonds, this procedure permitted differentiation between the two types of unsaturation. Methoxyl groups marked the original double bond locations and hydroxyls did so for triple bonds.


Kinetics of absorption, equilibration (or distribution), and excretion of orally and intraperitoneally administered cholesterol in the rat.

Resorption and metabolism of cholesterol administered intraperitoneally and per os have been described in the rat utilizing a technique of double isotopic labeling. Depending upon the route of administration, these parameter vary to a large degree. Alimentary cholesterol is progressively resorbed over a period of 10 hr, while the maximal blood level of cholesterol is attained after the 6th hr following intraperitoneal injection. On the other hand, cholesterol administered per os is more rapidly utilized in biliary acid synthesis than cholesterol administered intraperitoneally. In the range of concentrations utilized in this work (10-300 mug and 0.2-300 mug, respectively, administered to the rat, orally and intraperitoneally), the rate of cholesterol resorption remained constant.


Age-related changes in the lipid metabolism of Fisher 344 rats.

Lipid metabolism of male Fisher 344 rats aged 2-24 months was studied. Serum and liver cholesterol levels did not display the age-related gradual increase seen in other rat strains. An increase in the serum plus liver cholesterol pool from 2 to 6 months was followed by a plateau through 18 months and then another increase at 24 months of age. The triglyceride pool increased from 2 to 6 months and then remained unchanged through 24 months of age. Cholesterol synthesis from acetate decreased 50% between 2 and 9 months and fell only slightly through 24 months of age. Assay of 3-hydroxy-3-methyl glutaryl Coenzyme A (HMG-CoA) reductase showed a similar pattern but did not decrease further after 9 months of age. Cholesterol 7alpha hydroxylase activity was not significantly altered by age. These age- and strain-related differences present an opportunity for a comparative study of the aging process using the parameters of lipid metabolism as indicators.


Fecal long chain fatty acids and colon cancer risk.

To determine whether excretion of high concentrations of long chain fatty acids might be associated with high colon cancer risk, we compared concentrations of major long chain fatty acids in the feces of four populations at different risk for colon cancer. Concentrations of C18:1 were found to be significantly higher (P less than 0.05) in the feces of the two high risk populations than in the feces of the two low risk populations.


Object analysis of the Stilling tables.

The CIE space that is occupied by the Stilling tables was found to be similar to that occupied by the Ishihara plates [LAKOWSKI, 1965] with the notable exceptions of a single table that extends into the blue area and two others that extend further into the green (fig. 4). Spectrophotometric curves show that the inks used are similar to those in other PIC plates, i.e. they have reflectance curves with broad-band characteristics. All tables are of the vanishing type and there is an attempt to differentiate between protan and deutan defects. Colorimetrically, tables I, II, VII and VIII have figure and background colours aligned mainly along the deutan isochromatic lines and only table III is a clear protan plate. Tables V, VI, IX, X and XI are ambiguous in design, i.e. they would be confused by most colour-deficient persons. Of the tables designed to detect blue-yellow deficiencies (tables V, VI, XI and XII), only the colours in table XII are aligned along tetartan confusion lines, while the other three tables are indefinite in their design. Thus the usefulness of these plates for detecting acquired dyschromatopsias is limited.


Examination of chromatic adaptation.

The author describes a simple self-constructed apparatus which is suitable to perform investigations on adaptation in four domain of the spectrum. He considers the apparatus as appropriate to examine acquired colour vision deficiencies.


Color vision and visually evoked response (VECP) in the recovery period of optic neuritis.

Color vision and visually evoked cortical potentials (VECPs) are compared in a group of patients with optic neuritis. In the early recovery period, both were disturbed in a similar degree, whereas in the late recovery period, the VECPs remained more affected than color vision.


Chromosome aberrations in oocytes of NMRI mice and bone marrow cells of Chinese hamsters induced with 3,4-benzpyrene.

This paper deals with mutagenicity tests with 3,4-benzpyrene in mice oocytes of the strain NMRI and Chinese hamster bone-marrow cells. The mutagenic effect of this hydrocarbon was observed in both test systems. Investigations of bone-marrow chromosomes clearly show dose-response curves.


Injuries to research subjects A survey of investigators.

A task force of the Department of Health, Education, and Welfare conducted a survey aimed at estimating the incidence of research-related injuries, with a view to determining the feasibility of compensating subjects injured during research. The data were obtained by telephone from 331 investigators conducting research on nearly 133,000 human subjects over the past three years. Eighty-five investigators reported at least one injury. Of the 4957 reported injuries, 3926 were classified as trivial, and 974 as temporarily disabling; of 57 injuries resulting in death or permanent disability, one disabling stroke, not clearly related to the research, occurred three days after a non-therapeutic procedure; the rest resulted from treatments expected to benefit the patients directly, usually cancer chemotherapy. The data suggest that the risks of participation in nontherapeutic research may be of no greater than those of everyday life, and in therapeutic research, no greater than those of treatment in other settings.


Predictors of epilepsy in children who have experienced febrile seizures.

We examined the frequency of development of afebrile seizures in 1706 children who had experienced at least one febrile seizure and were followed to the age of seven years. Epilepsy developed by seven years of age in 20 per 1000 (2 per cent), and another 10 per 1000 had at least one afebrile seizure that did not meet our definition of epilepsy. In children whose neurologic or developmental status was suspect or abnormal before any seizure and whose first seizure was complex (longer than 15 minutes, multiple or focal) epilepsy developed at a rate 18 times higher than in children with no febrile seizures (92 vs. 5 per 1000; P less than 0.001). In the largest group with febrile seizures, those previously normal with noncomplex first febrile seizures, epilepsy developed in 11 per 1000; this rate, although moderate, was greater than that for children with no febrile seizures (P = 0.027). Prior neurologic and developmental status and characteristics of the first febrile seizure are important predictors of epilepsy after febrile seizures.


Decreased bioavailability of digoxin due to antacids and kaolin-pectin.

Employing a Latin-square design and single-dose studies of bioavailability in 10 normal human volunteers, we tested the hypothesis that antacids and kaolin-pectin might interfere with the bioavailability of orally administered digoxin. Cumulative six-day urinary digoxin excretion (expressed as the percentage of a 0.75-mg dose recovered) was: control, 40.1+/-3.0 (S.E.); aluminum hydroxide, 30.7+/-2.9; magnesium hydroxide, 27.1+/-2.4; magnesium trisilicate, 29.1+/-1.7; and kaolin-pectin 23.4+/-2.0. The differences in means were highly significant (F = 10.47, P less than 0.005). Further analysis (multiple comparison test) revealed that control differed significantly from each of the other treatments (alpha = 0.05), but there was no such difference between any of the other treatment groups. The decreased cumulative excretion produced by antacids and kaolin-pectin reflected a striking reduction in digoxin absorption associated with these compounds that was not related to alteration of gut transit time or to adsorption of digoxin to these gastrointestinal medications.


Enzyme evolution in a microbial community growing on the herbicide Dalapon.

A seven-membered microbial community capable of utilising the herbicide Dalapon has been isolated by continuous-flow enrichment culture. The composition of this community has remained remarkably stable over thousands of hours in a Dalapon-limited chemostat. During this period, however, one member of the community, Pseudomonas putida, acquired the ability to grow on Dalapon through the evolution of an extant dehalogenase.


Partial purification of rabbit aorta contracting substance-releasing factor and inhibition of its activity by anti-inflammatory steroids.

Rabbit aorta contracting substance-releasing factor (RCS-RF) is found in perfusates from guinea pig lungs during anaphylaxis. It has been identified as a small peptide which releases arachidonic acid from lung tissue, thus generating prostaglandin endoperoxides and tbromboxanes and causing bronchocconstriction. Anti-inflammatory steroids block the release of arachidonate by RCS-RF. In this activity their relative potency is very similar to their relative anti-inflammatory potency, suggesting that the two actions may be related.


The renin-angiotensin-aldosterone system in mother and fetus at term.

Plasma renin activity, renin substrate, angiotensin II, aldosterone and cortisol were measured concurrently and renin concentration calculated in plasma from mothers during labor and delivery, from cord and from newborn infants. The renin-angiotensin-aldosterone system was found strongly stimulated in both mother and fetus. The high values of plasma renin activity in fetus were due exclusively to the high renin concentrations the substrate concentration being normal. In the mother, however, the markedly elevated renin substrate resulted in a doubling of relative values of renin activity compared to renin concentration. Therefore gradients of renin and renin substrate across the placenta are established, but the resulting renin activity is similar on both sides and the levels of generated angiotensin II are also nearly indentical with a good correlation between these last parameters. Aldosterone is as elevated in mother as in fetus whereas cortisol, due to its binding to transcortin, is twice as high in mother as in fetus. No correlation was found between renin activity or concentration of angiotensin II and aldosterone or cortisol indicating that other factors controlling aldosterone are involved.


Ultrafiltrable uric acid in serum of healthy humans and patients with renal calcium lithiasis.

Ultrafiltrable serum uric acid (u.a.) was determined by ultrafiltration under in vivo conditions in humans using a reliable technique described in detail. It could be demonstrated that u.a. binding to macromolecules occurs in healthy humans (controls) and in patients with renal calcium stones. The percentage of free u.a. in controls (n=60) averages 86.2 +/- 0.9 SEM. With increasing age, bound u.a. rises slightly. On the other hand, younger (less than 40 years) stone patients have significantly more bound u.a. than matched controls (80.7 +/- 1.0 SEM; p less than 0.001), whereas this is not found in elderly patients. The degree of binding is not related to concentration of plasma proteins but inversely related to free fatty acid concentration in healthy controls (r= -0.52; p less than 0.01). It is suggested that no augmentation of tubular u.a. filtered by the glomeruli could have occurred. The origin of fasting hyperuricosuria shown earlier to be a prominent feature of young renal calcium stone formers is yet unknown.


Prevention of hepatitis type B with specific immune serum globulin.

In order to evaluate the preventive value of specific immune serum globulin against hepatitis type B, we have used this immune globulin in required doses in 12 patients (10 with AU antigen negative and 2 with AU antigen positive) with chronic renal failure who required maintenance hemodialysis for a period of 15 months, and we were able to prevent hepatitis type B in our dialysis patients.


Alterations in the H-reflex in the paraplegic induced by bladder distention.

This study has evaluated the changes in the characteristics of the H-reflex induced by distention of the urinary bladder in patients with complete lesions of the spinal cord. These findings were compared to induced changes in the systolic blood pressure and some degree of correlation was noted. It is well recognised that distention of the urinary bladder can exert a significant influence on the state of both somatic and autonomic reflex activity in spinal man. Although the mode of action of this stimulus has not been fully delineated, it is of some clinical importance since it may intensify muscular spasticity and autonomic hyperreflexia. This study was undertaken to further explore this relationship utilising the H-wave as a measure of segmental reflex activity. When appropriate, the effect of bladder distention on arterial blood pressure was also measured and an attempt made to correlate these observations with the H-wave findings.


Upper and lower motor neuron lesions in the upper extremity muscles of tetraplegics.

Paralysed upper extremity muscles of 24 tetraplegic patients were examined to determine whether their lower motor neuron was intact. Primary emphasis was placed on the forearm finger flexor muscles (Flexor Digitorum Superficialis and Flexor Digitorum Profundus) and finger extensor muscles (Extensor Digitorum Communis and Extensor Indicis). It was found that the vast majority of these muscles in C4, C5 and C6 subjects retained some or all of their lower motor neurons intact. In C5 subjects, examination was performed on additional muscles that were potentially most useful in an orthosis utilising functional stimulation. Similar to the results of the finger flexor and extensor muscles, the muscles of the wrist and thumb generally had the lower motor neuron at least partially intact. A muscle that often was an exception was M. Flexor Carpi Radialis. These studies indicate that most of the forearm muscles of the upper extremity in high level spinal cord injury patients which are paralysed have the lower motor neuron totally or partially intact. With electrically induced exercise, such muscles are strengthened to functional levels of contraction. Subsequent electrical activation enables the quadriplegic patients to use the muscle functionally.


Silent hydronephrosis, a hazard revisited.

Six patients with neurogenic bladder secondary to spinal cord injury were seen in our Centre for routine follow-up. All of these individuals had attained the catheter-free state by various means and were, by their standards, functioning very well. They had gone from 6 months to 2 1/2 years without genito-urinary re-evaluations. One individual had a normal urogram 1 year after catheter removal and then 2 years later was noted to have bilateral hydronephrosis. Development of silent hydronephrosis in the catheter-free state, its treatment, and a regimen for following patients are discussed.


Long-term follow-up of paraplegic patients with vesico-ureteric reflux.

A long-term survey (mean follow-up greater than 12 years) is presented of cord injury patients with reflux up to the kidney (grades 2 and 3). Of 39 patients 17 developed renal damage. There is no evidence that permanent urethral catheters protect kidneys from subsequent damage.


Percutaneous cystostomy in paraplegia--a follow-up of 41 patients.

Percutaneous cystostomy using a fine calibre (9 Charriere) plastic trocar and cannula has been used in 51 male patients in the early weeks following spinal cord injury. The results are satisfactory. Of the last ten patients none has been catheterised per urethram; eight of these patients are now passing urine satisfactorily using a condom urinal.


Hydroelectrolytic determination in paraplegics (total body water; exchangeable sodium and total body potassium).

Measurements of total body water and total exchangeable sodium, by isotopic dilution, and of total body potassium by whole body counting of the naturally occurring 40K isotope, were performed on stabilised paraplegic or tetraplegic subjects. Nineteen patients were investigated by the complete set of tests, six by only body counting. The results of total body potassium are expressed, following a uniform scale, as "relative values", which were established by the processing of reference values, from numberous paired healthy subjects.


Long-term studies about orthostatic training after high spinal cord injury.

Results of long-term observations of paraplegics with upper lesions are presented. The circulatory behaviour of patients, completely bedridden for several months, was observed during orthostatic tilt-table exercise over a period of at least 7 weeks. It is not possible to achieve a decisive circulatory stabilisation in paraplegics with upper lesions. For the most part, there was no improvement in the process of adaptation to varying orthostatic intensity. Much more marked are fluctuations in the ability to adapt to orthostasis, whereby the maximum circulatory lability may not occur until several weeks after the start of therapeutic repositioning to sitting. In practice, these observations point to the need for a sufficiently long period of orthostatic observation of these patients' circulatory system.


New interpretations of lipoproteins and arterial lesions of cholesterol-fed rabbits.

The serum of cholesterol-fed rabbits contains lipoproteins rich in cholesterol, in contrast to those in thoracic duct lymph, which are rich in triglyceride. This study suggests that the serum lipoproteins may be "remnant" chylomicrons which have been stripped of their triglyceride, but which have not been removed from circulation by the liver, as usually occurs rapidly in other animal species. Electrophoresis of rabbit serum showed a broad beta band corresponding to the very low density lipoprotein fraction separated by ultracentritrifugation. This broad beta band may represent the "remnant particles". This proposed "remnant particle" hyperlipidaemia in rabbits may have its parallel in Type III human hyperlipidaemia, which also has a broad beta band on electrophoresis and may be a "remnant particle" disease. It was also found that early arterial lesions in rabbits are similar to some human fatty streaks, which if allowed to age for a further two years while the rabbits eat normal food, do not regress but mature to resemble calcified fibrous plaques.


Methicillin-sensitive variants in ageing broth cultures of methicillin-resistant Staphylococcus aureus.

Methicillin-sensitive variants have been isolated from ageing broth cultures of the methicillin-resistant strain of Staphylococcus aureus NCTC 10442 and also from numerous other strains. There were wide variations and fluctuations in the incidence of sensitive variants from cultures incubated under uniform conditions.