Family counselors in a pediatric specialty clinic setting.

Numerous studies point up the psychosocial needs of chronically ill children, as well as the fragmentation or lack of services to meet these needs. Following an earlier study demonstrating the effectiveness of nonprofessional family counselors in improving the self-concept of children with chronic illness, this project placed five counselors in the pediatric specialty clinics of a teaching hospital. They were well accepted by all professional staff, and they provided a variety of services for families, improved communication among and coordination of care givers, and felt satisfaction in this role. This program provided an important expansion of social work services at low cost.


Initiation of a quality assurance program for social work practice in a teaching hospital.

This first-stage paper describes the steps taken in implementing a quality assurance program. The rationale for writing social work protocols based on medical diagnosis or tasks rather than on psychosocial diagnosis is explained in detail. Protocols for adult rheumatoid arthritis, pediatric cancer, adult discharge planning, and adult nursing home placement are included to demonstrate the result of the medical diagnosis/task approach.


Interdisciplinary education for health professionals: issues and directions.

With the increasing use of the team approach in health care delivery, many patterns of team practice have evolved. There is cumulating concern about how comprehensive care can be delivered and how to train health professionals for this model. Educators and practitioners and examining and experimenting with approaches to holistic training. This paper summarizes some of the issues in interdisciplinary training of health professionals and makes a number of recommendations.


Interprofessional education and social work: a survey.

In 1974, the author surveyed all graduate schools of social work to determine how team concepts were being introduced to master's degree level students. A 76% response rate was achieved; 31% of the schools offered joint courses with other professional schools, 17%  offered courses on teamwork itself within the school of social work, 10% had virtually no content on interprofessional collaboration, and the majority attempted to introduce this content through the practicum and the overall curriculum, especially health courses. These modalities are further described along with advantages and disadvantages of various approaches.


Evidence of reservior hosts of Brucella mellitensis.

Serological reactors to Brucella melitensis were found among goats and eland in Chilanga. The only clinical evidence of disease were abortion among the goats, and circumstances did not allow for isolation of the organism in the laboratory. No gross pathological lesions were observed on post mortem examination of the goats. The public health significance relates to the ease of Br. melitensis transmission between reservoir hosts and human beings.


The treatment of trichomonal vaginitis using single dose tinidazole (Fasigyn-Pfizer).

A total of twenty eight patients living in a around the City of Lusaka, Zambia were subjected to a drug trial to determine the effect of a single oral dose of Tinidazole (Fasigyn Pfizer) in the treatment of Trichomonal Vaginitis. All the twenty eight patients were proven cases of Trichomonal Vaginitis from microscopy of cervical smears. Two grammes of Fasigyn were used as a single oral dose with yeast as Placebo. Twenty patients were originally treated with Fasigyn and eight received yeast. However two patients in the Fasigyn group absconded, but one later reported satisfactory results. The husbands of two others were untreated. Four patients had other vaginal infections. A microscopic cure rate of 100% and a corrected clinical cure rate of 93.3% was obtained using fasigyn. The side effects were minimal and the patients themselves regarded them as mild.


Bancroftian filariasis. An autochthonous case in Zambia.

The first report of an autochthonous case of Wuchereira bancrofti in Zambia is presented. Observations are made on the diagnostic features of the microfilatiae particularly in relation to their periodicity and aggulutination in sequestrinated blood. The criteria used to identify the worms in section and the problems in diagnosis are outlined. Though imported cases have also been diagnosed it is considered that bancroftian filariasis is probably endemic. Further comprehensive investigations are recommended in ecologically transmissable areas.


Rabies in Zambian children.

Human rabies encephalitis is of particular interest of the doctors working in developing countries. When a person has been exposed to a suspect or rabid animal or human being specific antirabid treatment should be given. Ten of the twelve rabid children seen at Arthur Davison Hospital for Children over a 6 year period are described and the literature on treatment reviewed.


Singleton breach presentation planned for vaginal delivery.

A retrospective study of 156 consecutive cases of singleton breach presentation planned for vaginal delivery is presented. The incidence of caesarean section was not increased when compared with that for all Hospital and Clinic confinements. The perinatal mortality and prematurity rates were high. The incidence of cord prolapse was increased especially with the footling breech. The need for an experienced Obstetrician and Anaesthetist to conduct all deliveries was demonstrated. Factors influencing the assessment of feto-pelvic proportion and the occurrence of trauma and asphyxia in the management of breech labour and delivery are discussed. The continued place of external cephalic version is justified by the perinatal mortality rate.


The risk of birth defects: Jacobs v. Theimer and parents' right to know.

This Article discusses the Texas Supreme Court's holding in Jacobs v. Theimer that the parents of a defective child had a cause of action for damages against a physician for alleged negligent failure to inform the mother during pregnancy that she had contracted rubella and therefore might have a defective child, thereby causing her to lose the opportunity to have an abortion. The Article raises a number of questions that post-Jacobs courts probably will confront concerning the duty of physicians and genetic counselors to keep their clients informed; describes some social and medical developments--including recent progress in medical genetics and prenatal diagnosis--which are likely to make Jacobs a significant precedent; evaluates the court's decision to allow a damage suit only for the costs of treating and caring for the child's defects; and briefly addresses the question of whether the Jacobs case comes within the sphere of suits for what has come to be known as "wrongful birth" and "wrongful life."


Comment: litigation involving manufacturers' liability for defective medical products: judicial perspectives.

In this Comment, Judge Rosenn discusses, from a judicial perspective, the development of manufacturer's liability for defective medical products, with particular attention to the evolution of the strict liability doctrine, the courts' willingness to apply that doctrine to medical manufacturers, and recent suggestions for seriated trials as a means of more effective resolution of the complex litigation that arises in cases of alleged faculty design of medical products.


Liability of manufacturers and providers of health related goods and services: confronting the dilemma.

In this Article, Theodore Cooper, M.D., Assistant Secretary for Health at HEW, contends that the crush of lawsuits brought by aggrieved health care consumers against medical professionals and institutions, and drug and medical equipment manufacturers, may be the result, in large part, of a widely held impression--often encouraged by members of the health professions and industries themselves--that medicine has unlimited powers to heal. Dr. Cooper suggests that those involved in providing health care services and products--and members of the legal profession-have a responsibility to inform the public that this expectation is unrealistic and that everyone suffers when the number of such lawsuits and the size of damage awards are excessive.


A social episode model of human sexual behavior.

A social episode model of sexual behavior is proposed with emphasis placed on arousal as a crucial variable. This model argues against a disease or deficiency concept of homosexuality. However, the authors also hold that it may be coercive to push clients to accept their homosexuality, and that a therapist should adequately respond to a valid sexual orientation request. The social-sexual episode is divided into two relatively independent stages, preparatory and consummatory. A mathematical analysis is included, and the model is related to Freeman and Meyer (1975) wherein changes in sexual preferences were successfully made. Other validation sources for the model are presented.


Analysis of public attitudes toward homosexual behavior.

Data from a 1974 representative survey of the white American adult population indicate that most white Americans (75%) disapprove of homosexual relations. Those persons who tend to hold more favorable attitudes toward homosexual relations are those under 30 years of age, those living in larger urban centers, and those with college experience.


On the validity of typologies of gay males.

The classical dichotomization of male homosexuals into passive and active or insertee and inserter types is tested against empirical evidence. Data on the sexual preferences of 243 male homosexuals are analyzed to determine the extent to which they fit the insertee-inserter dichotomy. The fit between the dichotomy and the data is found to be very poor. The most popular set of sexual preferences is for all roles combined, both active and passive anal and oral. It is suggested that the concepts of oral and anal may better characterize the sexual preferences of male homosexuals than those of insertee and inserter. A variety of complex interaction effects among sexual preferences are also reported.


A psychiatrist's experience in a primary health care setting.

Psychiatrists have, for years, offered consultation to their nonpsychiatrist colleagues in many settings and have worked with them in a variety of ways. The development of new programs in primary medical care offers new challenges and opportunities to the liaison psychiatrist. This paper describes the experience of a full-time psychiatrist in a hospital-based primary health care setting. Special problems are encountered in developing working relationships with patients, physicians, nurses, social workers, administrators, and other members of the health care team. Effective resolution of these problems makes it possible to offer comprehensive mental health services as an integral part of primary health care. This psychiatrist's role differs from other consultation-liaison functions by virtue of full-time economic, patient care, academic, geographic and administrative assimilation into the primary health care setting itself. It is suggested that this role is an effective way to bring supportive and educational psychiatric services to patients and providers of all levels of sophistication and need.


The so-called "inappropriate" psychiatric consultation request on a medical or surgical ward.

Seven cases of psychiatric consultations on medical and surgical wards are reviewed to show how intrapsychic conflicts in the staff may make the consultation request appear inappropriate. On deeper examination, such requests may signify staff dysfunction caused by arousal of conflictual feelings about the behavior of illness of the patient. Mutilated, mute patients appear to arouse fear of agression in their caregivers, who in turn reject such patients, see them as alien and violent, and become illogical in their management. Patients who publicly display sexual behaviors appear to arouse shame over exhibitionism, voyeurism, and masturbation; their caregivers become too passive to effect common-sense measures appropriate to the situation. Very sick and dying patients and ungrateful, demanding patients can arouse anger and despair. Their caregivers may become depressed about failure, feeling helpless and out of control; using projection, they can see such patients as evil or suicidal, and may eventually turn against themselves. The psychiatric consultant, recognizing the conflicts that make the requests seem inappropriate, seeks to substitute higher-level cognitive operations and coping behaviors in the staff (distancing, rationalization, intellectualization, undoing, and altruism) for distortion projection, over-identification, reaction formation, and turning against the self.


A case of chronic factitious illness.

A twenty-four-year-old woman is presented with multiple previous hospitalizations for joint and muscle pains. Guarded in her description of symptoms, she reports that "lupus" has been diagnosed at several hospitals over the past few years, unable to recall the name of any other than on previous hospital. The medical work-up failed to show any abnormality except that compatible with previously diagnosed von Willebrand's disease. In the discussion of the case, the patient's desire to be taken care of is seen as a major dynamic, causing her to fabricate illness. The diagnoses of Munchausen Syndrome, malingering, conversion reaction and hypochondriasis are discussed and differentiated from each other, and the treatment of Munchausen Syndrome is discussed.


Some experiences through family-psychotherapy for psychotics in Japan.

My experiences of family-psychotherapy for psychotics in Japan, are discussed. The emphasis is put on the emotional problems which had been elicited among the hospital staffs; nurses, psychologists, and social workers. Applying a new type of the therapy, such as family-psychotherapy, has important factors beside the theoretical effect of them. We divided the course of family therapy into four clinical stages, from fragmented way of communication in the family to integrated one. My experiences which I have had in Japan, where the psychiatry itself has had a organic orientation, seem to be very helpful for those countries where the family-psychotherapy is not popular yet.


Michael and Christine confront their elders.

This article is an account of an incident at a special school, involving a pupil, a young teacher, and two senior members of staff. The article offers some reflections and conclusions on the special challenges to be faced when making relationships with the young. Reference is made to Winnicott, Lomas, Bridgeland et al, in suggesting connections between the insights and skills of both therapy and of teaching.


Psychological factors in the etiology of ulcerative colitis: objectlessness and rage.

In this second investigation of psychological factors in the etiology of ulcerative colitis, the author again utilizes unusual cases characterized by limited variables preceding illness. The first investigation involved several patients whose partial deafness antedated their illness. A significant point was that prior to developing their illness, all these patients had arrived at a state of objectlessness which was abetted by the deafness. This report presents four ulcerative colitis patients with pre-existing organic problems affecting their mental status. Two of the patients are severely mentally retarded. A third patient has rapidly advancing multiple sclerosis, and a fourth--actually an addition to the earlier study--has long-standing partial deafness. Aside from the objectlessness which was also prominent in the earlier group, all four patients demonstrate a consistent pattern of vicious self-directed rage. This paper takes into account the interaction between the rage and the state of objectlessness in the production of illness.


Pediatric referrals to psychiatry: I. Comparison of referrals and nonreferrals.

Age, sex and duration of hospital stay of 220 patients consecutively referred to psychiatry (Group I) and of their fellow 2065 nonreferred patients (Group II) were compared. Overall, Group I was significantly older, remained in hospital longer, and included more girls than boys, whereas Group II included slightly more boys than girls. Separation of Group II into those whose primary discharge diagnosis was psychiatric or nonpsychiatric revealed that mean age and duration of hospital stay of the former were almost identical, and the sex distribution was similar, to those of Group I. These findings suggest that children referred for psychiatric evaluation differ from their nonreferred fellows discharged with a nonpsychiatric diagnosis but not from nonreferred fellows discharged with a psychiatric diagnosis.


Pediatric referrals to psychiatry: II. Factors relating to delays in referral.

Delays in  requesting psychiatric consultation were examined, in relation to 220 referrals from a medical ward in a pediatric hospital, to determine why children referred for psychiatric evaluation remained in hospital longer than the non-referred. Request delays did not correlate with age, sex, or length of hospitalization, but were likely to be shorter for acutely ill patients and those whose admission diagnosis evidenced the pediatrician's awareness of the possibility of significant emotional factors. The onus may be on the psychiatrist to increase the medical staff's awareness of the possibility that emotional factors often contribute to their patient's ills. This increased awareness may result in prompt referrals to psychiatry, and shorter, less costly hospitalization.


A phase in the psychotherapy of a juvenile onset diabetic patient.

The psychotherapy of a juvenile onset diabetic patient, who initially presented with problems of poor diabetic management and depression, is discussed. Pertinent details of the first two years of treatment are presented to show the interrelationship between the medical and psychiatric problems. The patient severely mismanaged her illness around the tenth anniversary of her father's death. The patient's behavior and attitude toward her own illness were associated with guilt relating to the death of her father, also diabetic. During the anniversary period the patient was able to gain insight into the dynamics of her behavior, and from then on, succeeded in adequate management of her diabetes. The events in this case are linked to relevant literature.


Psychiatric problems of the 1970's.

This paper describes some of the social trends of the 1970's that may be affecting patterns of psychiatric needs and presents data showing their impact. It suggests possible psychiatric and sociopolitical responses to meet these needs. Patients were studied in the outpatient and inpatient services of the Shands Teaching Hospital and Student Mental Health Services at the University of Florida. The main findings were that single youth, both females and especially males, were requiring less help since the winding down of American participation in the Vietnam War, perhaps indicating that youth are feeling less alienated from the national effort. Black women are seeking help more than ever before, probably because the black liberation movement has offered them hope that psychiatry can help them. Despite the women's liberation movement, white women still remain the largest group of psychiatric outpatients, as they were in the 1950's and 1960's.


The effect of pentoxifylline ('Trental') on cerebral blood flow: a double-blind study.

A double-blind, placebo controlled crossover study was carried out in 20 geriatric patients with cerebrovascular insufficiency ot asses the effect of pentoxifylline on cerebral blood flow. Using 99m Tc cerebral scinitigraphy and a gamma comera/computer system, the pattern of blood flow in 5 brain areas was manitored after a single intravenous infusion of 200 mg pentoxifylline (10 ml) and after 10 ml saline solution. The results showed that, with the exception of one brain area, there was a statistically significant increase both in regional and hemispheric cerebral blood flow after pentoxifylline. It is of particular interst that global hemispheric blood flow, which gives an indication of total blood supply to the brain, showed approximately the same percentage increase on both sides with pentoxifylline.


Pre-clinical toxicological studies with muzolimine.

Toxicological studies were carried out to assess the acute, sub-chronic and embryotoxicity of muzolimine, administered orally to a number of animal species. The results showed that muzolimine had only slight acute toxicity, of the same degree in the mouse, rat, rabbit and dog. In the sub-chronic toxicity studies over 90 days, the presenting symptom in rats and dogs was a pronounced diuresis and, apart from the kidney, no other organ or organ systems were impaired. Macroscopic and microscopic changes in the kidney were the pharmacological result of overdosage, i.e. excessive diuresis, and not due to typical toxic renal damage. Embryotoxicity studies on pregnant rats and rabbits showed that toxic (rat) or lethal doses (rabbits) had no embryotoxic or teratogenic effects.


Human studies on the bioavailability of a quaternary ammonium compounds, tiemonium iodide and tiemonium methosulphate.

Five volunteers were administered capsules containing 14C-labelled tiemonium iodide and 4 volunteers received capsules of 14C-labelled tiemonium methosulphate. Serum, urine and faecal levels of tiemonium were measured. The percentage of the dose absorbed was determined after a further labelled intravenous injection into 3 of the volunteers. The drug appeared to be poorly absorved, as expected for quaternary ammonium compounds, but there was no difference in the bioavailability of these two tiemonium salts.


Control of hypertension with single daily doses of sotalol hydrochloride.

A study was carried out in 12 previously untreated hypertensive patients to assess the efficacy of sotalol given in a once-daily dosage regimen. After an initial dosage titration period (mean 3 weeks) during which diastolic pressure was stabilized at less than 100 mmHg, all patients were satisfactorily maintained on a constant once-daily dose of sotalol for 3 months. Eight of the 12 patients required 320 mg or less daily (mean dose 190 mg). Whilst blood pressure remained controlled for at least 26 hours after daily doses the pulse rate, counted at the same time, showed escape from beta-blockade. Side-effects (vivid dreams) were reported in only 1 patient.


Reactivity of the beta-93 SH groups in Hb Köln.

The beta-93 SH groups were found to be present in freshly purified Hb Köln, but over a period of several days storage they gradually oxidized to form inter-beta chain disulfide bonds. It is suggested that this gradual oxidation accounts for the low SH values which have been reported. The SH groups of Hb Köln were also found to react more readily than normal with H2O2 and O2-.


Homozygous cases for hemoglobin J Mexico (alpha54 (E3)Gln replaced by Glu) evidence for a duplicated alpha gene with unequal expression.

Hemoglobin J Mexico has been found in five generations of a large Algerian family. Nine subjects have 55% Hb J although their parents, siblings and offspring may have 31%, the usual quantity found in heterozygotes. Those with 55% Hb J are considered to be homozygous for a chromosome carrying both a normal alpha chain locus and a locus for alphaJ. The proportion of the abnormal hemoglobin in all the subjects is in favor of an unequal expression of both loci, the amount of protein synthesis directed by the alpha J gene being greater than that directed by the alpha A. In two heterozygotes a slightly higher proportion of the Hb J (38%) suggests the presence of a single normal alpha chain locus in trans. An associated alpha-thalassemia was excluded by biosynthetic studies in this family.


Separation of human hemoglobins by DEAE-cellulose chromatography using glycine-KCN-NaC1 developers.

This chromatographic procedure uses DEAE-cellulose as ion exchanger and glycine-KCN-NaC1 solutions as developers. Blood samples from several adults and newborn infants with alpha, beta, delta, or gamma chains variants have been analysed. The hemoglobins are eluted as compact and symmetrical zones, and the separation of many hemoglobin types is greatly improved. The procedure is relatively fast, simple, and inexpensive.


Hemoglobin Riyadh--alpha2beta2 (120(GH3)Lys replaced by Asn). A new variant found in association with alpha-thalassemia and iron deficiency.

On a field trip toSaudi Arabia (M.A.F.E.H.) in which the relationship between alpha-thalassemia and iron deficiency was studied, a fast moving hemoglobin variant was noted in a 30 year old Saudi Arabian woman. Analysis of the hemoglobin variant showed that the amino acid substitution was beta120 Lys replaced by Asn. This variant had not been described previously and has been named Hb Riyadh. There was also present an alpha-thalassemia and details are given of the imbalance of globin chain synthesis. It was possible to improve considerably the balance in vitro by the addition of hemin.


beta+-Thalassemia trait: hematologic and hemoglobin synthesis studies.

In Thailand, two types of high Hb A2-beta-thalassemia genes: beta0-thalassemia (beta0-thal) or classical beta-thalassemia and beta+-thalassemia (beta+-thal) or mild beta-thalassemia exist. This study presents hematologic data and globin chain synthesis in peripheral blood of the genuine beta+-thal heterozygotes in comparison with those of the beta0-thal heterozygotes. Thirty individuals of Thai and Chinese extraction with the beta+-thal heterozygosity were hematologically examined. The hematologic means of hemoglobin concentration, MCV, MCH, MCHC, Hb A2 and alkali denaturation hemoglobin of the beta+-thal traits were, 11.7 g%, 67.8 mu3, 21.5 gammagamma, 32.1%, 4.94% and 1.20% respectively. These were not statistically different from those of the beta0-thal traits of our previous study(1). The globin chain synthesis in reticulocytes were performed by incorporation of 3H-Leucine for 3 hours. The mean of total radioactivity alpha/beta ratio in 11 normal controls was 1.07 +/- SD 0.03. The mean of alpha/beta ratio in 9 beta+-thal traits was 2.03 +/- SD 0.10 which was significantly different from that in 7 beta0-thal traits of 2.28 +/- SD 0.07. Our globin chain synthesis thus appears to be helpful of discriminating the beta+-thal trait from the beta0-thal trait.


Hemoglobin Willamette (alpha2beta2 51Pro replaced by Apg (D2)) a new abnormal human hemoglobin.

A hemoglobin variant with the same electrophoretic mobility as hemoglobin S was found in three generations of a black family. No clinical symptoms or findings were present in subjects heterozygous for this mutant. Except for target forms of mature erythrocytes, they have no abnormal hematologic findings. Structural studies demonstrated a previously undescribed substitution, beta51 Pro replaced by Arg, in the abnormal fraction which accounts for about one-third of the total hemoglobin. This fraction is more unstable in vitro at 65 degrees than normal A hemoglobin. Both whole blood and purified abnormal hemoglobin have increased oxygen affinity and a slightly decreased Bohr effect.


Hemoglobin Baylor (alpha2beta281(EF5) leu replaced by Arg)--an unstable mutant with high oxygen affinity.

The amino acid substitution in a new hemoglobin variant, Hb Baylor (alpha2beta281 (EF5) Leu replaced by Arg), has been determined by application of column chromatography and amino acid analysis of the tryptic peptides. The hemoglobin is somewhat unstable and it has a high oxygen affinity. The propositus shows the opposing hematologic effects of these two properties--the instability being associated with increased destruction, and the high O2 affinity with increased production, of erythrocytes.


Altered erythropoiesis and increased hemolysis in hemoglobin M Akita (M Hyde Park beta92 His replaced by Tyr) disease.

Hb M Akita disease is a cyanotic hemoglobinopathy found in Akita Prefecture, Japan. The abnormal hemoglobin was found to be the same as Hb M Hyde Park (beta92 His replaced by Tyr) by chemical analysis in 1967. In this disease signs of accelerated hemolysis (serum bilirubin, 2.4 mg/dl; splenomegaly, 2 finger breadths; Hb, 10.7 g/dl; reticulocyte index, 2.7) were noted, but the causes of its slight anemia were revealed to be fairly complex by ferrokinetic study, RBC life-span measurement, and 99mTc myeloscintigram. The anemia in this disease is caused not only by shortened erythrocyte survival (T 1/2 = 11.5 days by 51Cr-tagging method) and sequestration of red cells in the spleen (Spleen: liver ratio = 2.5 approximately 3.0 by 51Cr-surface counting), but also by slow supply of erythrocytes to the peripheral blood from the bone marrow, presumably, related to the existence of unstable Hb M Akita and its derivative (Hb Akita) in the erythroid cells. Both Carrell's isopropanol test and Heinz body formation test were positive. In spite of maximally increased total erythropoiesis (8 times as high as the normal level; M:E ratio = 0.22:1.0), supply of red cells from the bone marrow to the peripheral blood was significantly decreased. The distribution of hematopoietic sites throughout the body was reasonably uniform.


Another form of the hereditary persistence of fetal hemoglobin (the Atlanta type)?

The propositus in a Black family has elevated Hb-F and approximately equal amounts of Hb-A and Hb-S. Hematological and chemical studies of the propositus and his family show elevated Hb-F in the father and a sibling and sickle cell trait in the mother and another sibling. This family is believed to have a form of the hereditary persistence of fetal hemoglobin in which beta chains are produced in cis to the determinant.


Gamma chain variants in Jamaican newborns.

15,661 cord bloods from Jamaican infants were examined for abnormal hemoglobins using alkaline cellulose acetate electrophoresis for the initial screening, supplemented by acid agar gel electrophoresis for samples exhibiting abnormal hemoglobin bands. Of the 16 electrophoretic variants which were detected, six were fully characterized and found to be: four Hb F Port Royal (alpha2 Ggamma2 125 Glu replaced by Ala) and two Hb F Victoria Jubilee (alpha2Agamma2 80 Asp replaced by Tyr). The Hb F Port Royal samples each constituted about one eighth of the total Hb F as did seven additional samples presumed to be Hb F Port Royal. The infants with this variant exhibited no special hematological characteristics or other consistent associations. Both Hb F Victoria Jubilee samples occurred in somewhat lower proportions of the total Hb F compared with Hb F Port Royal and exhibited an apparent increase of free alpha chains in the whole hemolysate. The data available on detectable gamma chain variants suggest that a specific point mutation may occur in either a HbGgamma or a HbAgamma locus.


Globin synthesis during erythroid cell maturation in alpha thalassemia.

Globin chain synthesis was examined in erythroid cells of increasing maturity, fractionated from bone marrow of two patients with hemoglobin H disease and in one alpha thalassemia 1 heterozygote. In contrast to beta thalassemia where a gradient of alpha/beta chain ratios increasing with erythroid cell maturation is observed, in alpha thalassemia the alpha/beta chain ratio remains constant throughout maturation. This finding suggests that in alpha thalassemia there is no modification of the imbalance in globin chain synthesis either by increased alpha chain production or decreased beta chain synthesis in erythroid precursors. Furthermore, the constant alpha/beta ratio reflects a limited degree of beta chain destruction, indicating that the ability of the excess beta chains to associate into tetramers protects them from proteolytic digestion.


Hemoglobin British Columbia (alpha2beta2 101(G3)Glu replaced by Lys). A new variant with high oxygen affinity.

Hemoglobin British Columbia was found in an East Indian living in Vancouver, British Columbia, Canada. Its structure was demonstrated to be alpha2beta2 101(G3)Glu replaced by Lys. It has a significant increase in oxygen affinity, decrease in heme-heme interaction, but normal Bohr effect. Unlike Hb Rush (beta101 Glu replaced by Glu), it is as stable as Hb A to heat and alcohol denaturation. By both cellulose acetate electrophoresis and chromatography the undissociated Hb British Columbia moves between Hb S and Hb A rather than behaving like Hb C. However, the dissociated abnormal beta chain behaves like beta C. The substitution is at the alpha2beta2 contact region. Except for a mild erythrocytosis, the propositus has normal hematological findings.


Hb-Alberta or alpha2beta2 (101(G3) Glu replaced by Gly), a new high-oxygen-affinity hemoglobin variant causing erythrocytosis.

Hb-Alberta has been found in a 51 year old Caucasian male with erythrocytosis. The substitution in this variant involves the glutamyl residue in position 101(G3) of the beta chain which is replaced by a glycyl residue. Hb-Alberta accounts for about 45% in the heterozygote, and readily forms hybrid tetramers with other hemoglobins. The oxygen affinity of Hb-Alberta is greatly increased, its Bohr effect reduced, and its subunit interaction greatly diminished.


Asymetric tetramer in a second occurrence of hemoglobin Porto Alegre alpha A2betaAbeta9Ser replaced by Cys.

Hemoglobin Porto Alegre is an abnormal human hemoglobin which polymerizes by formation of intermolecular disulfide bonds between the mutant cysteinyl residues at the beta9 position. Biochemical studies of this abnormal hemoglobin from a heterozygous carrier of a second family of carriers indicates that an asymmetric tetramer alphaA2betaAbeta9 Ser replaces Cys is formed after polymerization. Functional studies of the polymer indicate that its oxygen binding properties are unaffected by the polymerization and that its oxygen affinity is somewhat higher than that of normal hemoglobin; it has a slightly reduced heme-heme interaction and a normal Bohr effect.


The significance of certain catastrophic dreams.

Four examples of catastrophic dreams in which the dream action progressed to include the total destruction of the dreamer's body image are presented. This feature of total destruction of the body image possesses a special heuristic significance because it is a variance with Freund's clinical experience which helped to shape his view of the factors responsible for the creation of traumatic neurosis. He felt that nothing resembling death can ever have been experienced and therefore he dismissed the idea that the traumatic neurosis could arise a direct result of the fear of death. Each of the dreams revived a real life traumatic event which had caused a registration in the mind of a shattering experience without causing the destruction of the actual body at the same time. When the same traumatic event was revived in the dream the ego functions available at that time were evidently insufficient either to modify the traumatic event or to awaken the dreamer prior to its denouement. The powerless ego of the dreamer seemed to have been derived from the powerless ego of the patient at the traumatic moment in waking life which was carried over into the dream as a part of the representation of the traumatic event. The destruction of the body image in these dreams apparently played a role in the production of symptoms characteristic of the dissociative syndromes. On the morning following the dream three of the patients awakened in a depersonalized state and the fourth in a catatonic state.


Indications for psychotherapy in a psychiatric clinic population. Reliability and validity of evaluations.

A half-year survey was made on an in-patient clinic population as to a specific kind of short-term dynamic psychotherapy. The reliability and validity of the evaluations are discussed. It was found that a moderate accordance in evaluations could be found between the evaluators, with a high degree of reliability.


Anorexia nervosa: a case study.

D.R., a single 19-year-old female experiencing anorexia nervosa, was admitted to a mental health center inpatient unit weighing 64 lb, approximately 54 lb underweight, with liver, kidney, and pancreas damage. D.R. was hospitalized for 59 days. Treatment consisted of utilizing a hierarchy of reinforcements in the form of privileges mutually agreed upon between patient and therapist, psychodynamic and supportive psychotherapy, and involvement in the ward milieu therapeutic program. All privileges had to be earned. Access to food was controlled by the staff. For pounds gained privileges were granted, for pounds lost privileges were curtailed. Dynamically, D.R.'s eating behavior was viewed as an unconscious spite and revenge reaction toward her parents as well as an attempt to elicit attention. At the time of discharge D.R. weighed 104.5 lb. Prior to discharge D.R. agreed that if her weight dropped below 100 lb she would return for readmission. Five months later D.R.'s weight stabilized between 102 and 104 lb. Two years later, D.R.'s weight remains at that level. The study cautions against using solely a behavior modification approach in the treatment of anorexia nervosa.


Anxiety and rehabilitation after myocardial infarction.

General and specific anxiety, connected with the fact of myocardial infarction (MI), were investigated in 105 patients before and at the end of posthospitalization rehabilitation. Results as regards general anxiety were compared with data of 63 employed men free of coronary disease and with 34 comparable rheumatic patients. The patients with MI, before the comprehensive rehabilitation, compared with both control groups, have had higher levels of general anxiety in a statistically significant way. At the end of rehabilitation there were no significant differences. There was a significant positive correlation between general and specific anxiety, connected with the fact of MI. During the organized comprehensive posthospitalization rehabilitation, we see that there is a statisticallysignificant decrease of general and specific anxiety.


A longitudinal study of some physiological parameters and autogenic training.

Physiological parameters were studied over 4.5 months in normal high-school girls. One group frequently practised autogenic training (AT) whereas the other (control) did not. After 4.5 months the physiology of the AT, but not the control group had changed to some extent. The mean increase in finger skin temperature in the final session was significantly greater in the AT group than in the control group, especially in subjects who experienced hand warmth during AT. No significant differenced between groups were apparent for finger blood flow, but within the AT group the girls who experienced hand warmth showed a significantly greater blood flow than those who did not experience hand warmth. The electroencephalogram (EEG) of the AT group showed significantly more 'slow' (delta and theta) and less fast (alpha and beta) activity than at the beginning of the project. Microvibration (MV) of the thumb did not differ significantly in any comparisons. Both in the AT and control group means there were no significant differences between the periods before, during and after AT although significant changes did occur in some individuals of the AT group in the final session. In particular, in 3 of 14 AT subjects respiration rate decreases markedly even though weekly training had not included any breathing exercies. The results suggest that the effects of AT are predominantly long-term, resulting in gradual physiological changes that are maintained to some extent between practice periods.


Attention and intrinsic rewards in the control of psychophysiologic states.

Attention is a process which regulates the information obtained from a stimulus. In this paper I view selective attention as a means of arriving at different psychophysiologic states. Special consideration is given to the self-regulation of enjoyment by selective attention to intrinsically rewarding activities.


Large bowel disorders. II. Psychopathology and alexithymia.

Psychopathology and alexithymia were investigated in a consecutive series of 60 patients suffering from large bowel disorders (ulcerative colitis, irritable bowel syndrome and appendicitis). Patients with irritable bowel syndrome reported the highest percentage of psychiatric illness and the lowest alexithymic score. Conversely, patients with ulcerative colitis showed very pronounced alexithymic traits with limited psychopathology. Implications for psychosomatic research and treatment are discussed.


Sensory perceptual limitation in schizophrenia.

Sensory perception and selective attention capacity of schizophrenic patients have drawn particular interest. Schizophrenic patients show a peculiar deficit in screening and processing of incoming sensory data. Review of the literature suggests a breakdown in the selective-inhibitory function of attention in schizophrenic patients facing multiple sensory modalities. Although disorganization of attention is a focal point in schizophrenic perception, the influence of memory on the perceptual process deserves further investigation. Distracting sensory stimuli particularly of an auditory nature seem to interfere with visual perception and motor performance in these patients. Avoidance of sensory overload and improving selective attention through psychotherapy though of some therapeutic value, requires further exploration. A case of a young schizophrenic patient exposed to distractible environmental stimuli was presented and discussed.


Dysthymia: an atypical protracted depression. A preliminary report.

The author reports on 86 cases of protracted disorders - without significant changed consciousness - which he named dysthymia. The clinical manifestations were characterized by peculiar emotional disorders, polymorphous autonomic and vascular shifts. These states occurred in the majority of cases after some somatic diseases in conjunction with other physical or psychological stresses in individuals with anxiety traits and 'neurocirculatory asthenia'. The first phase of the disease was accompanied by anxiety, restlessness, autonomic and vascular paroxysms, anorexia, insomnia and disturbances of other physiological functions. Subsequently dysphoric mood, somatic concerns, pseudoneurotic and neurotic syndromes appeared. The outcome of the disorders was either with slow practical recovery or with a relatively stable personality change in the form of weakened volition, a reduction of energy, and a narrowing of the 'zone of comfort' due to the impairment of homeostatic functions. Often hypochondriasis could develop on the background of such features. Dysthymia is viewed as a special entity which must not be included either in the group of neuroses or in the group of typical organic brain syndromes, or in the group of endogenous psychoses.


Large bowel disorders. I. Illness configuration and life events.

Stressful life events preceding disease onset were investigated in a consecutive series of 60 patients with large bowel disorders (ulcerative colitis, irritable bowel syndrome and appendicitis), using Paykel's methodology. Ulcerative colitis and irritable bowel syndrome were frequently preceded by events generally regarded as undesirable and involving losses or exits from the social field, which would be specific of a depressed population, while appendicitis seemed to reflect more generic psychosocial difficulties.


A family systems approach to home dialysis.

Dramatic increases in the cost of the end stage renal disease program are producing an emphasis on home dialysis with the patient and his family carrying the responsibility for this treatment. This requires an adjustment of the family's emotional system and role assignment to sustain members through the continued stress of chronic catastrophic illness. We are suggesting a model of intervention in which family members are encouraged to recognize stress caused by one member's illness and to make necessary changes in the family functioning.


Use of artificial circulation in resuscitation of drowned dogs.

The effectiveness of artificial circulation by the method of Bryukhonenko and his colleagues in the resuscitation of dogs that had died from drowning in fresh- or salt-water was studied. Eight out of ten dogs were revived after freshwater drowning 'death' lasting from 10.5 to 21 min, when a variant of the artificial circulation method, dog donor with a venous pump of the artificial heart, was used. Resuscitated dogs remained alive from 3 to 72 h and died from pulmonary oedema. Artificial circulation appeared to be more effective in resuscitation of dogs drowned in saltwater. Their clinical 'death' lasted up to 31.5 min; clinically signs of pulmonary oedema were not observed in any of them, though some signs of oedema were revealed by histological studies. Of the 42 dogs in this series, all the main functions of the central nervous system were restored in 18 with clinical 'death' for up to 25 min. Resuscitation was performed by one of two methods, either the dog donor plus venous pump of the artificial heart, or the method of Bryukhonenko. The effectiveness of artificial circulation for resuscitation of dogs from drowning was demonstrated.


Programmed management of acute cervical cord trauma.

Results in ten patients admitted with the diagnosis of complete traumatic quadriplegia and with fracture-dislocation of the cervical spine are reviewed. Emphasis is placed on aggressive emergency surgical treatment of these lesions such as tracheostomy, laminectomy and cord cooling, incorporated into a detailed protocol of overall management.


An evaluation of basilic vein catheterization.

Percutaneous 'blind' catheterization of the basilic vein with a 14 gauge Intramedicut resulted in an intrathoracic placement in 85.4% of cases. The advantages and disadvantages of the technique are discussed. Accurate localization can only be confirmed by a chest radiograph.


Plasma cortisol monitoring acute myocardial infarction.

A study of the concentration of unconjugated plasma cortisol in nine patients with acute myocardial infarction has been made. The effectiveness of monitoring this factor in assessment of the clinical course and establishing early treatment in this condition is also reported.


Changes in blood viscosity and plasma proteins in myocardial infarction.

A clinical study of some biological and biochemical factors was carried out on patients with acute myocardial infarction. It was shown that: (i) the plasma viscosity was highly correlated to the clinical evolution of myocardial infarction; (ii) the variations of plasma viscosity were related to changes in the connection of fibrinogen and globulin; (iii) the highest correlation was between the plasma viscosity and alpha2-globulin concentration. The monitoring of these may be useful in the clinical evaluation of myocardial infarction.


Plasma cortisol in open-heart surgery.

In view of disagreements about changes in plasma cortisol, during and after open-heart surgery, a group of patients was studied with both unconjugated plasma cortisol, and anaesthetic, surgical and pharmacological factors that could interfere with the response, being analysed.


The role of shock in the pathogenesis of fat embolism after trauma.

Experimental studies and pathological investigations indicate that intrusion of fat into the circulation is common after trauma. This may not have any effect unless frank hypovolaemia supervenes upon changes in the blood vessels, manifested by a deficient vasomotility in shock. After fat embolism disseminated intravascular coagulopathy may occur as a consequence of the haematological changes and disturbances of capillaries. The morphological appearance of massive post-traumatic fat embolism evolves from the compensatory effect of accumulated synergistic factors that primarily induced the changes. From this point of view fat embolism should be recognized in the additional important role of an epiphenomenon of post-traumatic shock.


The application of competency-based education to consultation-liaison psychiatry: I. Data gathering and case formulation.

In the first of three papers, the authors present a competency-based model for training in consultation-liasison psychiatry which addresses the issues of how residents are taught to collect and formulate patient data. This model emphasizes the use of behavioral statements to describe the process of how a consultation is done. By comparing the resident's performance with prestated behavioral objectives, a method for residency supervision is offered. The second paper carries this one step further with the application of the model to clinical intervention strategies. The final paper discusses the implications of this approach to some of the issues that surround residency training in this field.


The application of competency-based education to consultation-liaison psychiatry: II. intervention knowledge and skills.

Although psychological and pharmacological intervention is an important aspect of the treatment of patients seen in consultation on medical and surgical wards, little attention has been directed to the method of training psychiatric residents in these areas. In this paper, the authors continue the application of the competency-based model of training to the problems of clinical intervention. Behavioral objectives are presented as a focus for residency supervision and their application to a clinical situation is illustrated. The objectives are designed to consider the activities of the consulting psychiatrists as he relates to the patient as well as other members of the treatment milieu.


Grief-related facsimile illness.

One aspect of the grief process which is frequently mentioned in the literature on mourning but has not yet received adequate clinical attention is the tendency for the bereaved to assume symptoms and behavior of the deceased. This paper presents evidence that pathologic identificantion 1) is an important clinical syndrome that is frequently misdiagnosed and mistreated, 2) defines a population at high medical and surgical risk, 3) can be diagnosed by history alone, and 4) carries a good prognosis when identified and properly managed. Four of a series of ten clinical cases are presented and discussed. Analysis of the cases reveals a number of common features, including 1) an arrest of the normal grief process; 2) a presentation of symptoms identical or nearly identical to those experienced by the deceased; 3) previous ineffective and inappropriate treatment endeavors; 4) referral for reasons other than a recognition of an abnormal grief state; and 5) improvement or recovery during treatment aimed at facilitating the grief response. Based on a survey of the literature and the clinical material analyzed, the authors conclude that patients who present with psychologic identification with the deceased have a distinct clinical syndrome (grief-related facsimile illness) for which recognition is important to institute proper management. Contrary to the reports in the literature, it frequently presents as other than hypochondriasis. When identified, this syndrome carries a good prognosis.


The application of competency-based education to consultation-liaison psychiatry: III. Implications.

In this paper the authors consider the implications of a competency-based model of education in relation to issues that affect the training of consultation-liaison psychiatrists. These issues include program design, the integration of consultation-liaison psychiatry to psychiatry in general, and the relationship of consultation-liaison psychiatry to medicine. Training programs in consultation-liaison psychiatry need to respond to the issues that derive from each of these areas. The authors argue that the competency-based model provides a framework which offers guidelines for designing a program that addresses these concerns.


Possible sequelae of trauma and somatic disorder in early life.

All children experience trauma. The age, state of development and constitutional factors will determine whether some children will have a traumatic effect. Trauma occurring before the age of three, at a time when the ego has not developed its synthetic and integrative functions, may be reproduced in later life as an isolated symptom, by selected sensations involved in a sensory imprint or screen sensation of the trauma as a simple recording. After the age of three, under the influence of a more mature ego, excessive traumatic stimuli will be integrated and elaborated in symptom formations as phobias or other conditions and extended as part of the total personality. Recurrence in later life is triggered by events related not only to the original experience, but also to the content of its elaboration. The earlier in life the trauma occurs, the more likely that somatic imprints of primitive physiological symptoms would result as an archaic, biological defense or screen sensations. Recurrent sensory imprints or screens may appear as organic illness or functional somatic symptoms. Diagnostically, a detailed early life history is necessary to uncover the presence of a sensory screen memory of a trauma and so avoid diagnostic medical search for organic causation. Case material illustrating the two groups are presented. Indications for psychoanalysis and for supportive psychotherapy are discussed from our theoretical framework as well as from the literature.


Health practice at the technologic/folk interface: witchcraft as a culture-specific diagnosis.

"Witchcraft illness" is a widespread belief among many people, even after acculturation to technological concepts of illness etiology. Two cases are presented to show that such beliefs can complicate physical or psychological dysfunctions, or themselves can be the primary origin of physical or psychological dysfunctions. In both instances, witchcraft beliefs take on a dynamic of their own and must be resolved both in terms of the patient's culture as well as the clinician's treatment plan. Considering such phenomena from the vantage point of family systems provides useful insights into etiology as well as amelioration. The latter requires engaging all parties in the health care system-clinician, patient, family, and indigenous health caretakers.


Discrepant cortisol values: comparison of radioimmunoassay and competitive protein binding technics.

Radioimmunoassays are expected to yield values representing the antigen, i.e., insulin, growth, cortisol, etc. employed in producing the antibody. However, in a recent study of a synthetic ACTH which involved the measurement of cortisol levels (1), we found that above 20gamma%, the radioimmunoassay (RIA) yields cortisol values distinctly above those obtained with the competitive protein binding (CPB) technic. We now suggest a possible explanation for this discrepancy and have calculated a correction factor.


Civil background variables significant to the development of psychiatric disorders during military service.

The author served as a military psychiatrist for one year. In this article, he presents material from a personally conducted examination of soldiers with psychiatric disorders. He has also collected material on two control groups of soldiers. He has also processed patient material collected by other military psychiatrists. Both patient groups are compared with the two control groups concerning various civilian background factors. The study shows that the patients differ from the controls regarding a number of negative factors in their civilian background. These factors can be seen as predisposing to the development of psychiatric disorders while in the Military. The author concludes that these factors  ought to be identified at the conscription examination, which is a present in adequate from a psychiatric viewpoint. An effort should be made at conscription to construct a profile of the individual's adaptability. The possibility of the development of a psychiatric disorder could thus be better evaluated.


Psychiatry on the prevention of crime.

The main endeavor of Forensic Psychiatry is to find out the causes, to investigate the psychodynamics of crime, hence based on them, to try to prevent or to treat them. In this connection, I will not enter into details today about the position of delinquency into psychodynamics, as they have elsewhere been described; I only would emphasize some cases which take place during the state so-called "hystero-epilepsy" of Charcot.


Etiology and the prevention of wars. (Preliminary thoughts).

There is a suggestion in the previous paper that a way out to convey the overwhelming progress and "heavy" civilization of humanity may be to explore the Space, the Universe, and it, indeeed, results in an excellent job what American and Soviets together are these days endeavoring toward new exploration in Space. Let us see now, is this way out going to give the solution of our problem, hence avoid wars in the world?


Obesity related to the use of psychotropic drugs, considered in its organic aspect.

The purpose of this brief work is to study and make a general survey of the problem of obesity as related in whatever way, to the use of psychotropic drugs. It is a fact learned through clinical experience and knowledge by clinics and researchers working in the field of psychotropic drugs that patients subjected to extended therapy with such drugs show, in a considerable number of cases, an increase in body weight. We consider that this obesity, the pathogenetic cause of which is attributed to the action of psychotropic drugs, constitutes a serious disadvantageous side-effect of those drugs, since a large number of mental patients discontinue their drug therapy for the reasons that it is responsible for the increase in their body weight. It is a known fact discontinuation of the psychotropic drug treatment generally results in a relapse of their mental disorder.


Inappropriate counter-regulatory hormone levels in insulin treated diabetes.

The data herein presented describe, identify, and quantitate interrelationships among blood glucose and serum insulin, growth hormone, cortisol, and glucagon levels of hospitalized insulin-treated diabetic patients. The findings indicate that conventional diet and insulin therapy of diabetes mellitus is almost always accompanied by inappropriate counter-regulation by growth hormone, cortisol, and glucagon. The data are consonant with the hypothesis that a shortage of insulin is only one of the multihormonal defects of diabetes.


Obesity related to the use of psychotropic drugs, considered in its psychodynamic aspect.

It is a well known fact that one of the side-effects of the psychotropic drugs is a disturbance of body weight in the form of obesity. We believe this to be a serious side-effect because obesity is often the main reason why the patient discontinues his psychopharmaaceutical therapy, thereby causing a recrudescence of his mental illness. We have proposed that this type of obesity be designated by the diagnostic term "psychopharmacotherapeutic obesity". This paper contains a formulation and discussion of views and concepts related to a consideration of the psychodynamic aspect of the subject. Special emphasis has been given to commenting on the problem of psychopharmacotherapeutic obesity from the standpoint of etiogenesis, psychological effects, and its importance in relation and conjunction with the development and formation of the individuals' psychosomatic identity.


Relationship between parental attitude towards the emotionally disturbed child and nocturnal enuresis.

In a study of children with nocturnal enuresis a close relationship was found between disturbed family environment and the frequency of enuresis. It will appear that negative parental attitudes in contrast to positive ones, as defined in this paper, are predisposing factors for the appearance of nocturnal enuresis. It is well known that nocturnal enuresis is one of the most serious problems encountered in children. It is estimated that over 25 percent of the children examined in Child Guidance Clinics suffer from nocturnal enuresis. In fact enuresis is considered the most common reason for referral of children to such Clinics. Much has been said about the etiology of nocturnal enuresis, and the organic factor was considered to be of primary importance by physicians of past generations. Spina bifida, local infections, small cyst, adenoids, epilepsy and mental retardation were at times considered as the main causes. Today the organic factor is accepted as an important one in a percentage not exceeding that of five percent. As a psychological psychosomatic phenomenon, nocturnal enuresis is considered to be the result of many interacting factors. One of the psychological factors is known to be the child-parent relationship and the influence of the family environment as a whole. The purpose of this paper is the study of the influence of the family environment on the frequency of nocturnal enuresis regardless of the parents' reactions to the enuresis itself.


Visual and auditory cognitive processing affected by epilepsy.

Neuropsychological studies on epileptic patients may be expected to reveal specific cognitive dysfunction even in patients with normal general intellectual ability. Difficulties in cognitive processing by visual-spatial and auditory-verbal modes are indicated by this investigation employing the Wisconsin Card Sorting Test and the Token Test, with epileptics of normal intelligence. Impairment in capacity for sustained, focused attention significantly affects performance of epileptic patients on these clinical measures, and others as well which require vigilance and attention and sensory-perceptual discrimination.


The psilocybin-induced "state of drunkenness" in normal volunteers and schizophrenics.

The effects of the psilocybin, a psychomimetic substance, on mental junctioning were investigated in normal volunteers as well as in schizophrenics. The disturbances induced constitute a psychoneurotoxic syndrome--"a state of drunkenness"--of about four hours duration which develops in three distinct phases. The basic mental symptoms of this syndrome consist of disturbances of the apperception, sensory perception and emotion. A moderate impairment of egofunctioning or reality appraisal and an inability to integrate different mental processes are observed. The psychomotor behavior is mainly harmonized to the prevailing emotional state and to the experiences caused by perceptual alterations, in a lesser degree. These changes, according to our observations, are more severe and more "psychotic-like" in schizophrenics rather than in normals. Psychopathological analysis of these changes proves that the whole syndrome cannot be considered as related to the spontaneously triggered functional psychoses or to the organic ones and, therefore, the term "model-psychosis" according to our opinion, is unsatisfactory.


"Short and long-term therapies in psychosomatic disorders".

Narcoanalysis (narcosynthesis) as well as psychoanalytically oriented psychotherapy (psychoanalytic psychotherapy) are both, in my opinion, practical and useful short-term methods of therapy in psychosomatic disorders. Psychoanalytic psychoterapy may also be used as an alternative to narcoanalysis when the latter method decisively fails the therapist. In selecting candidates for psychotherapy in psychosomatic practice, 3 essential factors should be taken into consideration, viz. the time of onset of the illness, the patient's personality structure and his intellectual capacities.


Functional cerebral asymmetry and performance. I. Reaction time to words and dot patterns as a function of EEG alpha asymmetry.

Alpha activity in left and right hemispheres was recorded while subjects performed in verbal and nonverbal target detection/reaction time tasks. Alpha in the right hemisphere was paradoxically enhanced during the nonverbal task, but RT varied as a function of differential hemispheric arousal in the expected manner--e.g., RT to words was fastest in the performance set showing greatest relative left hemisphere arousal.


Functional cerebral asymmetry and performance II. Individual differences in reaction time to word and pattern stimuli triggered by asymmetric alpha bursts.

The difference in mean square values of EEG alpha in left and right hemispheres recorded from parietal scalp regions of 5 female and 6 male human Ss was used to trigger 50 msec presentations of words or random dot patterns, and reaction times to correctly detected target stimuli were obtained. In 9 of 11 Ss the effect of left and right triggering was opposite for word and pattern stimuli, although in only 4 Ss were results consistent with a simple interpretation of alpha as an "idling" rhythm. The results support the hypothesis of complementary hempheric specialization and indicate that overt performance depends on the state of functional cerebral asymmetry.


War Sailor syndrome.

One third of the Norwegian sailors in the merchant navy, who survived World War II, are today disabled and on invalid pension. The majority suffer from a syndrome which is very similar to that present in the concentration camp survivors. The syndrome falls into two parts, the one consisting of non-neurotic anxiety repeating the terrors of war time, the other being a brain-organic one. This last part has in a few cases been confirmed by neuroradiology and neuropsychology. This is taken as an indicator that prolonged stress, as constant fear of death, may cause brain damage without physical trauma.


Management of pain through cerebral activation. An experimental analogue of alexithymia.

The present experiment was designed to explore the relationship between pain, language and cerebral functioning in normal subjects, as an analogue to alexithymia. Left hemisphere cerebral activation, as measured by an EEG-alpha ratio score, was found to be associated with a reported increase in painful sensation during painful stimulation. Right hemisphere activation was found to be associated with a decrease in reported pain. The results were interpreted in terms of the mobilization of fantasy processes, following experimental instructions, which seem to be mediated by right hemisphere activation. Uninstructed subjects, lacking a stable visualization, utilize a left-hemisphere, verbal mode to cope with the pain. It is suggested that left-hemisphere mobilization, and a lack of right-hemisphere processing of painful stimulation may be in part responsible for the alexithymic patients' psychosomatic symptoms.


Gestosis and the psychosomatic phenomenon--an empirical investigation.

Patients suffering from psychosomatic diseases in the strict sense of the term (asthma, ulcers, colitis etc.) have characteristic object relations which we call the 'relation blanche'. The present investigation aims at finding out whether similar features can be observed in patients suffering from early and late gestosis. The results indicate that there is a definite connection between gestosis and the group of strictly psychosomatic diseases, thus confirming our hypothesis that gestosis does not primarily represent a neurotic conflict situation nor a psychotic breakdown.


Psychometric investigation in 48 Dutch patients suffering from psoriasis.

48 psoriasis were compared with patients suffering from a variety of psychosomatic diseases, with regard to neuroticism, extraversion and self-defensive attitude. In addition, a Social Anxiety Scale was administered to the psoriasis patients to evaluate the patient's concern of his appearance in social situations. Finally, some psychometric data, which differentiated between the males and the females of the psoriasis group, are discussed.


Borderline hypertensives volunteering for follow-up and biofeedback. A preliminary study: locus of control characteristics.

We compared the locus of control scores of the following groups: (1) 19 male borderline hypertensives volunteering for biofeedback treatment; (2) 100 consecutive males who were screened for hypertension; (3) 30 male cancer patients receiving radiation therapy, and (4) the normative data from college students. The biofeedback volunteer group was significantly more internal in locus of control as compared to all other groups. The locus of control of the borderline hypertensives within the screened population did not differ from the normotensives, but the screened population as a whole had a relatively internal locus of control. Our findings imply that the 'internals' may be more attracted to self-control treatments like biofeedback, and data generated from this particular population may have limited generalizability, especially in regard to 'externals'.


A 4-year follow-up study of in-patient psychosomatic patients.

The subjects of the inquiry were 13 psychosomatic patients who had all undergone psychotherapy in the special research unit of the University Clinic for Psychosomatics in Giessen (FRG) in 1971. Data collection took place at the beginning (time a) and end (time b) of in-patient treatment, and then again 4 years later (time c). The same test battery was administered each time. The results indicate that a significant change in the patients' self-image came about during in-patient treatment and the catamnesis carried out 4 years later attests to the stability of this development. The question of whether this change reflects the patient's adjustment to the ideals of his therapist--conformity with the 'norm'--or can be interpreted as a criterium for true ego development in the sense of an expansion of his psychic possibilities, is discussed.


Disability, psychosomatic disease, and psychoneurosis. The problem of differential vulnerability.

A pattern of cognitive and of affective development characterizing three classes of psychiatric patients is presented: (1) disabled persons, usually unskilled laborers showing a 'somatization reaction', are unable to form abstract categories and, as well, to describe the physiological correlates of 'inner' feelings; (2) psychosomatic patients may show highly developed cognitive skills, although they may not; but they uniformly show a similar inability to 'know' and describe inner feelings; (3) 'neurotic' patients, most dramatically in the phobic category, often show both well-developed cognitive skills and a high degree of sensitivity to, and ability to describe, the symptom complex of anxiety in physiologically relevant forms, with maintenance of meaningful relations with supportive (often 'overprotectively' supportive) family members. These three different states can be diagrammed as follows: (1) -, -; (2) +/-, -; (3) +, +. The suggestion appears that these differences have to do with vulnerability, and that there may be in the general population three separable populations at risk for the development of these three categories of psychiatric disorder. The vulnerability so identified seems to be inversely proportional to 'suitability for interpretative psychotherapy'.


Borderlines: problems of self and object separation.

The borderline has deficiencies in the capacity to maintain stable self and object representations and in establishing 'emotional separateness' from others. In order to create and maintain a 'propitious treatment situation' and a 'therapeutic alliance' the therapist must work with unusual sensitivity and repetitiveness on the ground rules of the therapeutic environment. Explicit clarifications of the therapist's usual constructive attitudes, as a caring, responsive, neutral and real person must be continuously emphasized. The intense psychotic transference potential that leads to therapeutic complications and disruptions can be worked through, if recognized early, through countertransference clues, acceptance of positive aspects of the countertransference and technical moves that enhance the patient's capacity for individuation and separation, all this within the framework of a structured and consistent therapeutic situation. These assertions are illustrated by specific instances from treatment processes.


Psychotherapy and sociology: flirtation, marriage or divorce?

Psychotherapy and sociology are themselves products of mixed marriages; each experiences problems of identity and their children face problems of legitimacy. This paper considers the relevance of some sociological perspectives to the psychotherapeutic process, using the following analogies; (1) Flirtation: Why the attraction? 'going steady' or 'femme fatale'? (2) Marriage: Mutual enrichment, cross-fertilisation and new life? Examples of shared perspectives in the work of E. Becker, Erikson, Goffman etc. Influence of psychosocial contexts on psychotherapeutic processes. (3) Divorce: Too little shared life or too much destructive criticism? If the world within man and the world between men are interrelated, psychotherapy and sociology--although at times uneasy bedfellows--have much to give each other.


A context study of psychological conditions prior to shifts in blood pressure.

Shifts in intra-arterially registered blood pressure during an initial interview were studied in 4 young patients with essential hypertension by means of the Symptom Context Method. The relationships found between both formal variables and thematic categories of speech anteceding blood pressure shifts were in terms of patient and interviewer. All patients showed an increased rate of speech before blood pressure elevations, and in 3 of them the thematic content of 'personal failing, personal failure', 'loss of status of being useful and needed', and 'failure of others to meet the standards of the patient' was more often present before pressure elevations than decreases.


Psychological and physiopathological study on coronary patients.

In this paper the AA have tried to define the relationship between psychopathological characteristics or symptoms and angina attacks in coronary patients. The research plan was agreed upon and carried out as a collaborative program between psychiatrists and internists with the goal of reaching a more comprehensive approach to the psychosomatic patient. In 20 patients suffering from nocturnal angina attacks the polygraphic sleep recording was performed; 10 of them received psychodiagnostic examination (MMPI). In 8 cases during sleep recordings hemodynamic monitoring was also performed. The MMPI data were compared with 82 other individuals who had myocardial infarction (56 ss) and diurnal angina (26 ss) and 34 control subjects without cardiac disease. The results show that the sleep patterns were strongly affected and the most relevant alterations were recorded during the nights with ischemic episodes. No significant correlations were found between ischemic episodes and sleep stages. In no instance did the hemodynamic monitoring show an increase in the parameters related to myocardial oxygen consumption. The psychological data showed that the most severe symptomatology was observed in the nocturnal angina patients where the disease seems to be mostly related to a functional pathogenic mechanism.


Area in the rat brain producing rhythmical slow activity after chemical stimulation.

Serotonin, carbamylcholine, norephinephrine, and various control substances were implanted stereotaxically into various areas of the rat brain, and the effects of the compounds in altering the hippocampal rhythmical slow activity (RSA) were noted. Both carbamylcholine and serotonin implanted into the tip of the diagonal bands of Broca were observed to produce a regular rhythm of 7 Hz in both dorsal and ventral hippocampal recording sites. Carbamylcholine implanted into the medial parolfactory area consistently elicited RSA only in the ventral hippocampus recording area, while carbamylcholine implanted into the lower limb of the diagonal bands elicited the rhythm only in dorsal hippocampal recording sites. In rats in which the rhythm was elicited by serotonin, no effect was seen upon further implantation of carbamylcholine, whereas the converse was not true. These results are interpreted as suggesting a serotonergic influence upon hippocampal RSA separate from the usual cholinergic system which seemed to be inhibitory in nature.


No specific thalamic influence on cell composition, sugar or electrolytes of peripheral blood.

Cellular components, blood sugar, and serum electrolyte concentrations of chloride, sodium and potassium were analyzed serially in 20 patients who underwent either stereotactic thalamotomy, frontal internal capsulotomy or subcaudate tractotomy. No significant changes were seen during the interventions either after electrical stimulation or coagulation of the target area, but 3 h after the operation the neutrophile granulocyte count was significantly raised. This reaction reached a peak by the morning of the first posoperative day. Other cellular elements, blood sugar, and serum electrolytes remained unchanged. We believe that the leukocytosis is not a specific effect of the thalamic lesions, but a nonspecific stress reaction, similar to that seen after air encephalography.


A therapeutic approach and objective test in the treatment of tremor.

Medical treatment of tremor is deceptive. The biochemical disturbance causing its appearance is not known, so that no specific treatment can be applied. Many substances have been proposed for their antitremulant properties, but clinical results must be interpreted with caution as tremor is a labile symptom which is under many influences. The authors have analysed the clinical effect of an interesting antitremulant drug and have reported an original method for measuring tremor.


Electrophysiologic principles of radiofrequency lesion making.

Understanding of the electrophysiologic principles of radiofrequency lesion making is necessary to ensure reliable results in surgical procedures using this technique. A radiofrequency lesion is produced by tissue electrocoagulation. Its method of formation and factors affecting heat generation and loss are discussed. Guidelines for making radiofrequency lesions, based on electrophysiologic principles are outlined.


RF lesion generation.

Although the technique of RF lesion generation is a well-established medical technique, most professionals using it do not understand the basic principles of electronics by which the phenomenon occurs. A review of this with special attention to the 'indifferent' or 'dispersive' electrode would lead to better practice and less adverse effects, such as patient skin burns.


Field trial of compact travel dialysis system.

To increase mobility for home hemodialysis patients, a portable, light weight hemodialysis system has been bench and field tested. The combination of a 21 L dialysate reservoir and small, high speed blood and dialysate pumps has permitted the entire system to be contained in a twenty two pound, 22 X 13 X 6 inch aluminum suitcase. Initial evaluation in hospitalized patients has shown the system to be safe and efficient. Acceptable clearances of creatinine and urea are maintained throughout a five hour dialysis by changing the bath at 120 and 210 minutes. Successful application of the system in travel by 3 patients, who perfomed a total of 12 dialyses in their hotel rooms while on vacation, indicates the broad potential of the new system.


Theoretical considerations on molecular transport in dialysis and sorbent therapy for uremia.

The technology of uremic blood purification has grown rapidly over the past decade and has provided the clinician with a wide range of therapeutic options. These options involve mass transfer processes which may be primarily due to diffusion or convection, or a combination of both mechanisms. However, regardless of the mechanism of molecular transport, evaluation of the clinical utility of these therapies requires studies which provide sufficient data to solve the appropriate rate equations and to close mass balances. Data from the recent hemodialysis, peritoneal dialysis and sorbent literature are analyzed to show the magnitude of variability in both patient and therapy-related mass balance paramters for urea nitrogen (U) and middle molecules (MM) and to provide unambiguous comparisons for some of these therapies. A theoretical model is developed to describe sorbent-mediated gut elimination of solute as a first-order clearance limited by sorbent saturation. The model is used to analyze data in the literature on AL (OH)3 facilitated gut clearance of phosphate and indicates a gut P clearance of approximately 20 ml/min with maximum removal of approximately 800 mg P/24 hrs. Similar analysis of oxystarch indicated a gut U clearance of 2.5 ml/min and maximum removal of 1.5 gm/24 hrs.


Sorbent regeneration of peritoneal dialysate: an approach to ambulatory dialysis.

Sorbent regeneration of peritoneal dialysate has been shown to be feasible in experimental and preliminary clinical studies and provides a realistic basis for the optimization of dialysis therapy and the potential development of an ambulatory dialysis system. Peritoneal dialysis efficiency can be significantly enhanced by continuous dialysate flow techniques and the mass transfer of uremic solutes can be theoretically augmented by the increased dialysis time made possible by a wearable design. Further optimization of end stage renal failure therapy may be achieved by the combined use of various methods for blood purification.


Cold carbon apparatus for hemodialysis.

A prototype of artificial kidney with regeneration of the dialysis fluid in active carbon at low temperature is presented. The data obtained through a series of simulated dialysis show that carbon adsorbs, besides creatinine and other compounds, urea in satisfactory quantities. Furthermore, the possibility of completely regenerating carbon with tap water washing makes the routine use of an artificial kidney based on a cold operating carbon depurator extremely practical.


Current nursing practice in dialysis care: a summary.

The provision of comprehensive care to patients requiring maintenance hemodialysis has developed into a complex multidisciplinary effort involving nurses at all levels. Nephrology nursing has evolved over 15 years into a model of so-called "expanded practice," i.e., one in which technical expertise and broad scientific and professional education are necessary as well as significant commitment to quality of care. This practice includes unusual responsibility for management of many aspects of patient care. Described in this paper are the specific responsibilities expected of nurses in hemodialysis, including the response to clinical problems during dialysis. Also reviewed are the more independent contributions of nurses to home and self-care dialysis. An outline of recommended educational content for nephrology nurses is included.


Distribution of evoked potentials on stimulation of the human pulvinar.

The distribution of the evoked cortical potentials recorded during stereotactic pulvinectomy is analyzed. The evoked cortical potential shows maximal amplitude in the precentral area, with decreasing amplitude in the parietal and anterior temporal area, and minimal amplitude in the occipital area. The pulvinar has been histologically considered to have dense connections with the parietal lobe and no connection with the frontal lobe. However, our results suggest that the pulvinar has a dense functional connection with the frontal cortex, through which the pulvinar plays a role in motor function.


Several clinical aspects of thalamic pulvinotomy.

Several clinical aspects of thalamic pulvinotomy were investigated. Influence of electrical stimulation of pulvinar on consciousness, speech, memory, evoked response, emotion, intelligence, character, ophthalmic and auditory examinations were studied during operation and compared between pre-, post, and during operation.


Vascular lesions of the thalamus on the dominant and nondominant side.

A clinicopathological study was done on 87 subjects with VPL lesions due to vascular pathology, with special reference to the difference of clinical manifestations between the right and left sides. Thalamic pain was far more common in VPL lesions on the right side. The responsible lesions for thalamic pain were observed in lesions of VPL and VPL extending to the internal capsule, while in the lesions of the VPL extending to the centrum medianum, central pain was rare. 2 cases with aphasia due to thalamic hemorrhage were found in this series, both in the dominant hemisphere. It is suggested that the thalamus in the dominant hemisphere may be related to speech and in the nondominant to a central pain mechanism.


Role of computerized transverse axial tomography on stereotactic surgery of the diencephalon. A preliminary report of 67 cases.

67 cases of various functional disorders of the diencephalon were examined by EMI scanner. The patients were composed of 38 cases of parkinsonism, 7 cases of thalamic syndrome, 6 cases of choreoathetoid movement, 2 cases of dystonia, 11 cases of involuntary movement of unknown etiology and 1 case of torticollis, tic, and ballismus, respectively. In parkinsonism, 79% showed diffuse cerebral atrophy, 5% had focal low density in the substantia nigra and the thalamus, whereas 16% remained normal. Pre- and postoperative assessment with CT scan was briefly discussed with reference to stereotactic surgery of the diencephalon.


Correlation between the neural noise in the thalamus after cerebrovascular disease and computerized tomography. A case report.

The case is presented of a 45-year-old man who suffered from a sudden attack of unconsciousness with right hemiplegia and later developed a spastic hemiparesis accompanied by involuntary movement of the right upper limb. CT scan revealed an old putaminal hemorrhage and almost intact thalamus, but neural noise recordings during the stereotactic thalamotomy of this case showed marked decrease of the neural activity in the thalamus suggesting some functional changes.


The thalamus in the motor system.

The ventrolateral (VL) and anterior (VA) are the main thalamic relay for cerebellar and pallidal efferents going to the motor cortex. Four aspects of the function of these nuclei are briefly considered. (1) It is well known that these thalamic structures are not a simple relay on the way to the motor cortex, but that they have a gating function for the cerebellar afferents. The gating mechanism is active during slow-wave sleep, with deafferentation and with the use of various anesthetics. Possibly, it might play a role in the central organization of movement. (2) The organization at the unitary level of the projections between VL and motor cortex is examined and their role in the command of motor synergies through the motor cortex is strongly suggested. (3). It appears that unitary activity of VL neurons is not only related to movement but also to postural changes associated with movement. (4) The sensory input to VL nucleus is briefly analyzed. The inefficacy of exteroceptive stimulation in awake animals, in contrast with the effect of the same stimulation in anesthetized preparations, is discussed.


Long-term follow-up results of bilateral thalamotomy for parkinsonism.

27 patients who underwent bilateral thalamotomy for parkinsonism over the past 10 years have been clinically evaluated. Mean follow-up period was 6.2 years after second surgery. In these cases, 8 returned to full social life without any medication, 4 were capable of social life with medical treatment, 6 were self-sufficient and 3 were semi-self-sufficient in ADL, respectively. Therapeutic drug doses were reduced in all cases. L-Dopa-induced dyskinesia was not observed after second surgery. Speech disturbance, which was not severe, was recognized in 12 cases as a complication.


Emotional slow negative potential shift (CNV) in the thalamus.

In order to know the functional relationship between CNV recorded at the vertex and activity of the thalamic nucleus, the CNV at the vertex and the intrathalamic slow potentials responding to an S1-S2-R paradigm were recorded during thalamotomy under local anesthesia. It might be concluded that the activity of the medial thalamus and medial parts of the subthalamic area not only generate slow potential shifts corresponding to S1-S2-R, but also play an important role in controlling the CNV at the vertex.


Readiness potentials recorded from the scalp and depth leads.

Readiness potentials on voluntary hand movements were recorded from the scalp (C3, C4), premotor cortex, subcortical white matter and VL nucleus of the thalamus. Subjects were healthy right-handed men and patients with involuntary movement disorders. We obtained a slow negative shift of brain electrical potentials from the scalp and cortex preceding voluntary hand movements. The mean time interval between the onset of the readiness potential and the onset of motor activity (mean T) was 0.8 sec on right hand movements and 1.0 sec on left hand movements in healthy men. In cases with parkinsonism, the mean T value was 1.4 sec in patients with akinesia, 1.1 sec in those without akinesia. The amplitude of readiness potentials was higher in the scalp contralateral to the hand movement. The readiness potentials recorded from the VL nucleus and white matter were reversed in polarity from those of scalp and cortex. Simultaneous recordings from cortex and VL nucleus showed early onset of readiness potentials from the cortex by approximately 0.1 sec compared with the VL nucleus.


Physiologically defined VIM nucleus. Its special reference to control of tremor.

In the course of stereotactic surgery for some 100 parkinsonian patients, correlative study of recording and stimulation has been done in and around the thalamic nucleus ventralis intermedius (VIM) under local anesthesia. The VIM nucleus is roughly identified either by the increase of neural noise level or radiological measurement. More accurately, in the thus identified VIM, sensory neurons related to kinesthetic sense of the contralateral extremity were found in about half of the cases. Electrical stimulation of this point at threshold intensity produced paresthesia on the contralateral area around its receptive field. With increased stimulus intensity, increment of grouping discharge in EMG of that part was pertinent in the majority of cases. A small localized lesion at such a thalamic point was shown to be quite effective for alleviation of tremor without any neurological, especially sensory, deficit.


Influence of subcortical stimulation on amygdaloid kindled cats.

Amygdaloid kindling seizures with threshold stimulation was modified by electrical stimulation of certain subcortical structures such as the VL, the CGM and the MRF. Low frequency stimulations of the VL and the CGM (10 Hz) were effective for seizure inhibition. On the contrary, high frequency stimulation of the MRF (300 Hz) tended to facilitate the generalization of the seizure.


Some physiological aspects of the basal ganglia. Excitation of the neurons of the globus pallidus by the brain stem structures.

The caudate efferent fibers to the globus pallidus are inhibitory in nature. The pallidothalamic fibers are also inhibitory, exerting monosynaptic IPSPs on the thalamic cells located anteroventrally to the ventrolateral nucleus. Therefore, these two inhibitory neuronal circuits make a double inhibitory chain. To operate the inhibitory circuit, excitatory input to the pallidum is necessary. Stimulation of the ipsilateral brain stem including lemniscus medialis, mesencephalic reticular formation and some other structures, produces short latency excitation of the pallidal cells.


Postural dependence of reaction time in normal subjects and patients with focal brain lesions.

EMG reaction times (EMG-RTs) of triceps brachii muscle of normal subjects and patients with focal brain lesions were measured at two different positions of the shoulder joint. The difference of EMG-RTs between the two positions was smaller in patients with VL-thalamotomy, cerebellar or frontal premotor lesions than in normal subjects and patients with hemiplegia. It is assumed that cerebellum, VL-nucleus and the premotor area are related to the proprioceptive control of RTs.


Analysis of tremulous movements after thalamotomy correlated to intrathalamic therapeutic lesions.

Residual tremulous movements after thalamotomy were examined using an accelerometer and EMG. Various types of tremor-provoking procedures were performed and the tremulous movements were classified according to the pattern of modificiation by these procedures. Four types of postoperative tremulous movements were noted, and a correlation was made to the intrathalamic therapeutic lesions.


Generation in vitro of deletions in the broad host range plasmid RK2 using phage Mu insertions and a restriction endonuclease.

Several non-lethal deletions of the broad host range plasmid RK2 (molecular weight of 37.6 . 10(6) have been produced in vitro. The method employed relied on the single HindIII restriction nuclease site in RK2 and the ability of phage Mu to insert and thereby add new HindIII restriction sites at various positions in the plasmid. The deleted plasmids have in each case lost kanamycin (Km) resistance, and in two cases are defective in self-transmissibility. The method used to reduce the size of the RK2 plasmid also results in the cloning of each of the two ends of the Mu phage DNA on the plasmid derivatives.


In vitro site-directed mutagenesis: generation and properties of an infectious extracistronic mutant of bacteriophage Qbeta.

An infectious extracistronic mutant of phage Qbeta has been prepared by site-directed mutagenesis. Qbeta RNA minus strands containing the mutagenic base analog N4-hydroxy-CMP instead of UMP at position 39 from the 5' end were synthesized in vitro and used as template for Qbeta replicase to synthesize one generation of plus strands. E. coli spheroplasts were infected with the newly synthesized plus strands and phage recovered from single plaques. RNA sequence analysis revealed that four out of the eighteen phage clones analyzed contained RNA with an A leads to G transition at position 40 from the 3' end (which corresponds to position 39 of the minus strand). Thus, the viability of phage Qbeta does not depend on a unique nucleotide sequence in the 3'-extracistronic RNA segment. Upon in vivo propagation of mutant 40, spontaneous true revertants arose with high frequency and overgrew the parental clone within about 10 passages, indicating a selective disadvantage of the extracistronic mutant. Replication of mixtures of wild type and mutant RNA in vitro resulted in a decrease of the proportion of mutated RNA in the progeny plus strands. The fact that Qbeta RNA containing an A leads to G transition in nucleotide--40 of Qbeta RNA is less efficiently replicated in vitro may explain the selective disadvantage of the mutant phage in vivo. The preparation of an infectious mutated RNA by site-directed mutagenesis shows that the method is suitable to produce specific nucleotide exchanges without impairing the biological competence of the RNA.


A general method for inserting specific DNA sequences into cloning vehicles.

A general method has been developed to introduce any double-stranded DNA molecule into cloning vehicles at different restriction endonuclease sites. In this method a chemically synthesized decadeoxyribonucleotide duplex, containing a specific restriction endonuclease sequence, is joinlex DNA is cut by the same restriction endonuclease to generate the cohesive ends. It is then inserted into the restriction endonuclease cleavage site of the cloning vehicle. To demonstrate the feasibility of this new method, we have inserted separately the synthetic lac operator DNA at the Bam I and HindIII cleavage sites of the plasmid pMB9 DNA.


[Growth and reproduction of mitochondria in loach oocytes].

The size and number of mitochondria markedly increase at the early stages of oogenesis in the loach (Misgurnus fossilis). The growth of mitochondrial membranes in the oocytes is characterized by the contact with the rough endoplasmic reticulum. In the period of slow growth of oocytes, the number of mitochondria increases 82 times and by the beginning of vitellogenesis 240 times. Two fractions of mitochondria were noted in the early oocytes: dividing mitochondria localized in the perinuclear zone and non-dividing ones in the periphery of the oocyte. In the period of slow growth of oocytes, 1--2% of dumb-bell-like mitochondria were found. It was calculated that the doubling of the number of mitochondria in the early oocytes proceeded during 1.5 months.


[Characteristics of the mammalian capacity of regeneration].

In spite of certain limitations of the regenerative ability in mammals, they are characterized by four types of regenerative processes: regeneration of parenchymatous organs, regeneration of parts of organs, intraorganic regeneration, intracellular regeneration. These types of regenerative processes may be called forth both by surgery and pathological factors: infection, irradiation, effect of toxic agents etc. The restoration following the destruction caused by pathological factors is an extremely widespread process and it should be paid more attention when analyzing the regenerative ability in mammals. The characteristics of the latter is complicated by the insufficient progress of comparative-evolutionary studies concerning all types of restoration, especially that caused by pathological factors.


[Liver growth fraction, its composition with regard to cell ploidy and changes with aging].

All the hepatocytes incorporating 3H-thymidine under the continuous labeling during the liver regeneration were classed with the fraction of liver growth (proliferative pool). The continuous labeling of proliferating cells was ensured by the injection of a high dose of 3H-thymidine prior to the operation. It was shown that after partial hepatectomy in young mice the label is incorporated by practically all parenchyma whereas in old ones its significant part does not proliferate. Highly ploid cell types predominated among hepatocytes which lost their ability of reproduction.