Cowden disease.

Cowden disease represents an unusual, but unique syndrome which can be recognized most consistently by the development of characteristic verrucous, keratotic, papular, and nodular lesions about facial orifices, on the oral mucosa, and over the dorsal surfaces of the forearms and hands. The cause of these diverse hyperplastic changes is not known. Recognition of these lesions as signs of more extensive disease should alert the physician to examine the thyroid gland, breasts, female reproductive tract, GI tract, and skeleton for evidence of the associated changes we have enumerated. Because of the tendency for lesions of the thyroid, breast, and intestines to undergo malignant change, these patients require close observation and evaluation.


The syndromes of isolated gonadotropin deficiency.

Six theoretically possible syndromes of IGD are shown in Table 1. 1) IBGD is well-substantiated both in males and in females, and appears to be either of pituitary or more frequently of nonpituitary origin. 2) An example of isolated FSH deficiency has been described. The defect appears to reside at the pituitary level and may be localized to the FSH beta subunit. Recently a male patient has been studied with isolated FSH deficiency and a concordant testicular picture viz germinal cell aplasia. However, the syndrome is complicated by an associated chromosomal abnormality (XO/XXY/XY) whose significance is unclear. 3) Several examples of isolated hLH deficiency have been described. Several questions remain about the exact nature of the defect in some of the published reports of this syndrome.


Family planning services in the United States.

In recent years the United States has made considerable progress in providing family planning services for those in need.  This does not mean, however, that the problems posed by unwanted pregnancies and unwanted births have been completely overcome.  Estimates of the number of low-income women needing and receiving family planning services indicate that roughly 3.6 million women at risk of an unwanted pregnancy were receiving family planning services in 1973.  This represented almost two-thirds of those in need at the time.  Many programs are also seeking to meet the teenage need demonstrated by very high rates of out-of-wedlock births, premarital conceptions, obstetric problems, and legal abortion demands of women 15 to 19 years of age.  As of 1973, it appeared that between 1.3 and 2.2 million never-married teenagers were in need of organized family planning services, and that of these, services were being received by between 25 and 42 per cent.


A rooming-in program for mothers and newborns.

This report describes a rooming-in program based on allocation of resources to patients in accord with their health needs.  It outlines the advantages of having the healthy infant kept with the mother continually during the puerperium.  This promotes easier psychological adaptation of mother and infant, reduces the incidence of cross-infection in the hospital, encourages breast-feeding, and paves the way for providing the newborn with regular checkups at peripheral health centers.  The report also points out the need to instill a strong instructional component into the roomin-in program.  The basic elements of the overall program are maternal training based on indivisual instruction, group discussion sessions accompanied with instructional slides, and participation by the mother in the care of her infant under supervision of the midwifery team.  The adoption of a program of this nature does not imply an increase in existing human and material resources, but rather a rationalization of the distribution of present resources and the added contribution of the mother's active participation in helping to care for her child.


The prevalence of hepatitis B antigen among hepatitis patients and residents of Peru.

Single radial immune diffusion and counterelectrophoresis tests were used to examine 2,593 serum speciments from apparently healthy men, women, and children of Peru for the presence of hepatitis B antigen (Australia antigen).  The object was to estimate the prevalence of the antigen in two contrasting geographic regions and to investigate the relationship between presence of the antigen and jungle hepatitis in eastern Peru.  In connection with the latter goal, both single and serial serum samples collected from hepatitis cases during an epidemic in the northeast were also examined.  Of the 2,593 apparently healthy subjects, the tests showed 1.4 per cent were carrying the antigen.  However, when the data were broken down by geographic region it was found that 1.8 per cent of the subjects from eastern Peru were carriers, as compared to only 0.5 per cent of those from the northern coast.  Moreover, incidences as high as 5 and 6.4 per cent were found in selected eastern areas, and a peak figure of 14.3 per cent was found in sera from children living in some of these areas.  Comparison of the proportions of male and female sera positive for the antigen indicated that the proportion of males with HB Ag was nearly twice as high.  However, sera collected from Indians of 20 different eastern tribes and from mestizos in the eastern region showed roughly the same proportion of samples positive for HB Ag in each ethnic group.  The study also showed a close correlation between presence of the antigen and hepatitis infection during a 1972-1973 epidemic in eastern Peru.  Testing of sera taken from hepatitis patients at that time showed many patients to be carrying HB Ag, specially in cases where serial blood samples were available.  In all, positive test results were obtained for 81.2 per cent of the patients from whom two or more samples had been obtained.


Enviromental sanitation in urban and rural areas: its importance in the control of enteric infections.

In Central and South America, enteric infections constitute one of the leading causes of disease and death.  The terrible toll is exacted by a host of different microorganisms, virtually all of which are transmitted via contact with human excreta.  To change this picture we need many more water supply and sewerage systems, better food preparation and handling, and public comprehension of how elementary good hygiene promotes good health.  Attaining these objectives will be difficult, but less costly than one might suppose, and there is little to be gained by delay.  The basic enviromental causes of enteric disease are clear, current conditions have been aggravated by rapid population growth and urbanization, and basic corrective measures have already been postponed long enough.


Motivating the masses for family planning in the People's Republic of China.

China's family planning efforts give the appearance of being substantial and effective, though in terms of hard data the precise degree of success achieved is hard to gauge.  The author's five-week tour of China, upon which this article is based, showed a country that seemed capable of controlling its rate of population growth, but it was unclear whether the desired level of growth had in fact been attained.  What was clear is that several unusual ingredients are primarily responsible for the marked progress made to date.  Foremost among them is a public attitude of strict adherence to a moral code which effectively limits sexual relations to married couples and which encourages delay of marriage well beyond the teenage years.  Enhancing this, a wide-ranging State publicity campaign promotes birth control through public address systems, brochures given newlyweds, classes and information provided to expectant parents, discussion groups designed to elicit "voluntary" adoption of birth control methods, and other means.  To complement this, the Government provides a nationwide network of free or nearly free family planning services organized down to the local level and fully equipped to assist with contraception, sterilization, or termination of pregnancy upon request.  Although general statistics have not been made available, it seems obvious that a substantial reduction in China's potential rate of population growth has been achieved.


[Comparison of three exercise tests in a group of patients with chronic broncho-pulmonary disease (author's transl)].

In a group of 26 patients with various broncho-pulmonary diseases, the results of three types of exercise were compared : maximum supported power (PMS), maximum supported power + 20 W, and maximum tolerated power (PMT). The two first ones were made at constant power, the last one at increasing power (by 30 W, during three minutes). The comparison of the results indicates that there was no significant difference between the variables measured during PMT and PMS +20 W (power, oxygen uptake, cardiac frequency, oxygen pulse, ventilation). The changes in oxygen uptake, cardiac frequency, and ventilation, as the power increased, were not significantly different in the three types of exercise. In this group of patients, mean PMT was 121 W, mean PMS was 98 W, and the ratio PMS/PMT was thus 81%. To determine PMT first reduced the number of exercise-tests necessary to measure PMS (two or three tests depending on the patient).


Malignant melanoma in the Igbos of Nigeria.

Twenty-one cases of malignant melanoma occurring in the Igbos of Nigeria have been analysed. The site of predilection is the sole of the foot. This result supports the conclusion that Negroes tend to have the disease in the non-pigmented parts. Since preventive surgery has been advocated in Caucasians in whom sole melanomas are not common, it merits consideration and, if possible, implementation in the African Negro. The challenge implicit in this form of preventive oncology should be accepted by plastic surgeons, including Africans who specialized in this field abroad.


Pulmonary mechanics in diffuse fibrosing alveolitis.

The mechanical and the diffusing lung properties have been measured in 19 cases of diffuse fibrosing alveolitis of unknown etiology (proved by histology in 17 cases). The characteristic findings are: a) a striking reduction of DLCO in all the cases; b) a marked reduction of the static and dynamic compliance, in correlation with the reduction of vital capacity; c) an increase in P1max in correlation with the decrease of FRC; d) an increase of the elastic recoil when it is considered at various percentages of the predicted lung volume, but in some cases a normal shape of the V-P curve if the measured lung volume is taken into account; e) a reduction of the maximum expiratory flows suggesting bronchiolar stenosis; f) alterations of DL more marked than those of CL suggesting that DL is a more sensitive test.


Chemosensitive neurons on the ventral medullary surface.

Central chemosensitivity is ascribed to three areas on the ventral medullary surface. The discharge frequency of neurons observed in these areas depends upon pH. Other neurons within the  same areas do not change their frequency during acidosis or alkalosis. Histologically the areas are characterized by superficial nerve cells.


An experimental study of microvascular technique, patency rates and related factors.

Microvascular repairs of 50 rabbits' femoral arteries averaging 0.9 mm in diameter gave an immediate patency rate of 100 per cent and a follow-up patency rate of 98 per cent after 3-41 days. The patency rate of 50 veins averaging 1.1 mm in diameter was 98 per cent immediately after surgery and 80 per cent after 3-41 days. No anticoagulants or antispasmodics were used. An additional 25 vein repairs with sufficient additional sutures to ensure more accurate apposition of the vein edges resulted in 100 per cent immediate patency and 92 per cent patency when examined during the 2nd week, the period which reveals the truest patency rate. Technical adequacy of the microvascular repair is the most important factor in ensuring final patency.


Suicide in Dublin: I. The under-reporting of suicide and the consequences for national statistics.

This study of suicide in Dublin during 1964-1968 from coroners' records was undertaken to estimate the discrepancy between coroners' verdicts, the national suicide statistics compiled from them and the clinical assessment of probability of suicide by psychiatrists examining the same records. The large difference in numbers of suicides deriving from the two approaches has considerable implications for national suicide statistics, and these have been briefly considered. From the findings presented we believe that we are justified in concluding that: (a) there are real differences in national suicide rates, at least between Ireland, England and Wales, and Scotland, and (b) the Irish suicide rate is low, though not as low as official statistics suggest, and (c) the discrepancy between official and "true" suicide rates in Ireland is greater than in England and Wales and in Scotland.


A check on hypothetical personality structures and their theoretical interpretation at 14-16 years in T-data.

Basing hypotheses on interpretations of 12 personality factors most replicated in 10 past researches with children, this experiment sets up about eight subtests as specific markers for each. Ninety-five tests, taking eight hours in all, were administered to 394 14-16-year olds. A majority of the personality pattern hypotheses were sustained factor analytically by evidence on number of factors, significance of unique simple structure reached, and goodness of identifying match (chi-square test). Concept validities can be obtained for some six of the factors rivalling those for intelligence tests. A brief discussion is given of the bearing of the present results upon theoretical explanations of the given source traits, including extraversion, and it is pointed out that the psychological meaning of most, for personality research, is as important, in variance terms, as for the one or two, such as anxiety and extraversion, which have tended to monopolize discussion.


The effects of different modes of supervision on vigilance behaviour.

Experiment I was run to determine if a closed-circuit television and a one-way window mode of supervision were as effective as the direct physical presence of an experimenter in inducing enhanced levels of signal detection in a Mackworth-type vigilance task. A control condition of complete subject privacy was also examined. The results indicated that both the television and the window conditions had a positive effect on overall performance which was similar to that observed in the experimenter-presence condition; however, the performance decrement over the 90 min vigil was equivalent for the four modes. A second experiment involving the variable of camera position with an addition of a fourth 30 min. period yielded no significant differences between the camera positions, but overall performance in the television condition was again better than in the control condition. This study suggested that performance can be enhanced even without the physical presence of the experimenter.


Uric acid and divergent thinking: a possible relationship.

An exploratory investigation of the relationship between serum uric acid levels in male university students and their scores on tests of convergent and divergent thinking was carried out. The data suggested that uric acid levels are lower in highly divergent thinkers than in less divergent. This led to the speculation that uric acid may be an important biochemical precursor of intellectual functioning. If it does affect intellectual functioning, this may result from the action of uric acid as an endogenous cortical stimulant, or possibly from its action as a facilitator of learning.


Effects of tactual and phonological similarity on the recall of Braille letters by blind children.

Forty-eight severly blind children, able to cope with set-sizes of two and three, four, five or six serial items were tested on probed recall of Braille letters they could either name or discriminate, when the letters were (1) dissimilar in tactual characteristics and name sounds, (2) similar in feel, but different in name sound, and (3) dissimilar in feel but similar in name sound. Results showed that tactual similarity produced recall decrements by subjects able to be tested under set-sizes of up to five items, while phonological similarity produced recall decrements by subjects testable under set-sizes of five and six items. It was argued that tactual information survives perception and affects recall, and that blind children can encode tactual inputs either tactually or verbally, but that this probably depends upon different processes.


The recall of digits by normal, deaf and autistic children.

Normal, autistic and deaf children were tested for their immediate memory of visually presented digits. The digits were exposed either with or without a left to right spatial display arrangement, and had to be recalled forewards as well as backwards. Normal and deaf children tended to be sensitive to both display conditions and recall requirements whereas autistic children were mainly affected by direction of recall. Serial position effects in the normal and deaf groups were more dependent on order of retrieval than on input order.


Stimulus generalization following extra-dimensional training in educationally subnormal (severely) children.

The use of discrimination learning paradigms in the study of attentional transfer is discussed. The technique of go/no-go discrimination learning followed by stimulus generalization testing is contrasted with the more familiar simultaneous learning paradigm followed by a shift in the relevant cues. In the former paradigm the effect of training a discrimination on one dimension on the slope of the stimulus generalization gradient on an independent gradient dimension (extra-dimensional training) is assessed. A steepening of the gradient relative to appropriate control procedures is taken as evidence of positive attentional transfer. The relevance of the technique to the detailed study of attentional transfer in educationally subnormal (severely) (ESN(S)) children is considered. In Expt. I nine ESN(S) children were trained in a go/no-go discrimination involving stimuli differing in orientation, and were generalization tested on a dimension that was orthogonal, namely hue. Of the six subjects who learnt the discrimination five showed clear decremental gradients on the hue dimension. In contrast a Pseudo-Discrimination group (PD) of eight subjects matched to those in the TD group showed no gradients. These subjects were not trained in the orientation discrimination, but were reinforced for responding on 50 per cent of each of the S+ and S- stimulus presentations. They thus received equal exposure to, but no differential training on, the orientation dimension. An S+ only group of four subjects who received no exposure to the orientation stimuli showed no gradients when stimulus generalization testing on the hue continuum was carried out. The result is discussed in terms of transfer deriving from stimulus control by relational aspects of the stimuli; in terms of control by constant irrelevant stimuli; and in terms of the study of stimulus control in ESN(S) children. In Expt. II the influence of the codability of the colours on the location of the peak of the stimulus generalization gradients in the TD group is investigated.


Psychiatric morbidity and the menopause; screening of general population sample.

A survey of 539 women from the general population indicated a high prevalence of minor psychiatric illness in women aged 40-55 years. There was evidence of an increase in psychiatric morbidity occurring before the menopause and lasting until about one year after menstrual periods had ended. Vasomotor symptoms increased dramatically when periods stopped and persisted up to five years after the menopause. Both these features seemed to have a clear relation to the menopause but not the same relation. The findings suggested that further investigation of the relation between perimenopausal hormonal changes and psychiatric morbidity should be directed towards premenopausal women. Environmental factors, particularly in relation to children, seemed to be associated with increased psychiatric morbidity at this time of life.


Sleep and blood pressure.

Direct arterial pressure was recorded continuously over 24 hours in 18 totally unrestricted people (six normotensives, four untreated hypertensives, and eight treated hypertensives). There was an almost equal fall of about 20% in both systolic and diastolic blood pressure during sleep in the three groups when compared with their waking pressures. This fall in pressure was greater than that observed previously in patients sleeping in a laboratory or hospital. Furthermore, it suggests that hypertensive subjects do not have a higher centrally-induced vasoactive component and that hypotensive drugs do not alter the pattern of blood pressure behaviour induced by sleep.


Detection of cannabis products in urine by radioimmunoassay.

A radioimmunoassay specific for the closed, three-ringed cannabinoid nucleus was used to detect and measure caname from hospital inpatients not suspected of taking drugs. None of these contained tetrahydro-cannabinol cross-reacting cannabinoids (THC-CRC). The other 393 specimens were from patients known or suspected to be taking various drugs. Of these 51 out of 162 from one hospital treatment clinic and 19 out of 50 from another were positive for THC-CRC. Out of 107 urine specimens from an independent drug treatment clinic 71 were positive for THC-CRC, as were 13 out of 74 specimens from patients in whom drug misuse was suspected or thought possible.


A strategy for thyroid function tests.

The concept of decision-aiding ranges were introduced to improve diagnostic efficiency. The clinical uncertainty in distinguishing borderline cases of hyperthyroidism and hypothyroidism among 1559 consecutive requests for thyroid function tests was 47%. This was reduced to 22% by using the free thyroxine index and to under 2% by using specific tests determined by the decision-aiding ranges.


Alternative means of access to circulation for chronic haemodialysis.

Various standard techniques of access to the circulation for haemodialysis are ideal for most patients. Another type of internal fistual of large vessels, between the saphenous vein and the femoral artery, has been found useful in patients whose peripheral vessels are unsuitable for the standard means of access.


Colonoscopy in management of colonic strictures.

A total of 160 strictures were examined in 154 patients with the fibreoptic colonoscope. When it was possible to make a pre-examination diagnosis colonoscopy proved it wrong in 52% of cases. Unnecessary laparotomy was probably avoided in over half this series. All strictures of the large bowel should be examined colonoscopially whenever possible before considering surgery.


Why sports injuries clinics?

Sport for all" means sports injuries for all. Facilities for their treatment are inadequate in the United Kingdom. An analysis of 1750 cases indicated that many injuries are specific to sporting activity and that the problem of their treatment cannot effectively be solved by the organization of special clinics for sportsmen based on existing services. There is a case for establishing regional or area clinics manned by appropriately trained, recognized, and committed specialists.


Revenue allocation in the reorganized Health Service.

This paper recommends that the secrecy long associated with the allocation of Health Service revenue should be replaced by an objective formula applied to areas and districts. In this way the allocations should be "fairer" and the different tiers of management within the reorganized N.H.S. would have a greater incentive for the better use of their resources. The Department of Health and Social Security has demonstrated its desire to be frank and objective in revenue resource allocation and it new remains for the other tiers to follow suit.


Urinary N-acetyl- beta-D-glucosaminidase activities in patients with renal disease.

Urinary N-acetyl-beta-D-glucosaminidase (NAG) activities were assayed in every urine void throughout 24 hours in 17 normal people and in four patients with renal disease. The variation in NAG activity due to changing rates of urine flow was almost eliminated by factoring enzyme activity by the urinary creatinine concentration. Random samples of urine may thus be used for assay. The results of NAG assay in 36 patients with acute and chronic renal diseases showed that NAG was a sensitive indicator of renal damage. This simple test may be valuable in detecting or monitoring renal disease.


Pigs susceptible to energy metabolism in the fulminant hyperthermia stress syndrome.

Pigs susceptible to the fulminant hyperthermia-stress syndrome spontaneously developed the hyperthermia syndrome. Basal metabolic rates 10-fold higher than normal were observed in these animals. The metabolic rate exceeded a 17-fold increase over normal with a total heat production of over 28.25 J (6;76 kcal) h-1 kg-1. Heat loss by radiation ceased early in the syndrome, possibly owing to intense peripheral vasoconstriction--a finding which suggests that in man vasodilators might have an important therapeutic role.


Prevention of tetanus in the wounded.

Recommendations for the prevention of tetanus in the wounded have been revised to incorporate the use of human tetanus immunoglobulin, which is now available in the United Kingdom. Surgical toilet is of prime importance for all wounds, and is usually sufficient for tetanus prophylaxis in patients with wounds that are less than six hours old, clean, non-penetrating, and with negligible tissue damage. Human tetanus immunoglobulin should be given to patients with more serious wounds sho have had toxoid injections over 10 years earlier, had an incomplete course, or do not know their immunity status. The importance of active immunization is emphasized. The recommendations should be regarded as guidelines as the circumstances in individual cases will differ.


Fibrinogen uptake scanning for diagnosis of deep vein thrombosis: a plea for standardization.

From an examination of the factors affecting the diagnostic accuracy of the 125I-fibrinogen test for detecting deep vein thrombosis it is concluded that there is a greater possibility of error if postoperative counts are referred to the preoperative baseline rather than counts made immediately after operation. A method is proposed for reducing other errors caused by instrument mishandling.


Carrier solutions for low-level intravenous insulin infusion.

In the use of low-level intravenous insulin infusion for treating diabetic hyperglycaemia and ketoacidosis adsorption of insulin to containers or plastic infusion apparatus results in significant losses of 60-80% of insulin in dilute physiological saline solution (40 U/l). It is therefore necessary to add protein to the carrier solution to minimize losses and maintain a constant delivery rate. Recovery studies showed that 3.5% w/v polygeline solution (polymer of degraded gelatin) was a suitable medium for this purpose, offering some advantages over human serum albumin. A minimum concentration of 0.5% polygeline was required to ensure adequate delivery of insulin to the patient.


Immobilization hypercalcaemia in patients on regular haemodialysis.

Immobilization of normal people causes reabsorption of calcium from bone, a small rise in serum ionized calcium, and, rarely, frank hypercalcaemia. The hazard is increased when patients with renal osteodystrophy are immobilized because of pathological fractures.


Attitudes to the psychiatric outpatient clinic.

Fifty patients were interviewed before their first ever appointment at a psychiatric outpatient clinic about their attitude to the forthcoming visit. Many did not know that it was a psychiatrist they were to see at the hospital. Widespread misconceptions about the nature of a psychiatric consultation were uncovered. Many felt the referral carried an implicit threat of social stigma. Patient's misconceptions were relieved, and only 13% subsequently failed to attend the clinic compared with 30% of a control group.


Tolerance of debility in elderly dependants by supporters at home: its significance for hospital practice.

Some 12% of all geriatric admissions to University College Hospital and Whittington Hospital are for patients whose relatives or friends can no longer cope with them at home. The person principally involved with home support was interviewed in 50 such cases. The causes of inability to cope were identified on a quantitative and qualitative basis. The supporters were asked to assess which of the problems identified would have to be alleviated to restore a tolerable situation at home; 46 (92%) were able to do so. Identification of the "alleviation factors" forms a therapeutic and prognostic guideline in this type of admission and may have far-reaching social and economic implications.


Epidemiology of rheumatic heart disease in black shcoolchildren of Soweto, Johannesburg.

A survey to determine the prevalence of rheumatic heart disease (R.H.D.) in Black children was conducted in the creeches and primary schools of the South Western Townships of Johannesburg (Soweto). A total of 12 050 Black children were examined by 10 cardiologists in May to October 1972. The overal prevalence rate of R.H.D. was 6.9 per 1000, with a peak rate of 19.2 per 1000 in children of the seventh school grade. The maximal age incidence was 15-18 years and there was a female preponderance of 1 6:1. A rise in prevalence occurred with increasing family size. Most children (92%) were asymptomatic, and in 82.5% R.H.D. was diagnosed for the first time during the school survey. The commonest valve lesion was mitral regurgitation, which was present in 93% and occurred as an isolated lesion in 47.5%. Lancefield's group A beta-haemolytic streptococcus was isolated from the throats of 52 per 1000 Soweto children. The auscultatory features of a non-ejection systolic click and late systolic murmur were prevalent (13.9 per 1000) and had several epidemiological factors in common with R.H.D. A comprehensive preventative campaign is urgently needed in South Africa, directed at both primary and secondary prophylaxis of R.H.D. The socioeconomic status of the community must be improved if optimal prevention is to be achieved.


Comparison of results of treatment of hydrocele and epididymal cysts by surgery and injection.

A comparison has been made between a series of hydroceles and cysts of epididymis treated by surgery with a complication rate of at least 17% haematoma and 10% sepsis, an average hospital stay of five days, and a much longer time off work, and a series treated by tapping and injection (described in detail) requiring one to three visits to outpatients, an almost negligible complication rate, and no failures in those completing treatment.


Cell response in rabbits infected with T. pallidum as measured by the leucocyte migration inhibition test.

Leucocyte migration in agarose was used to examine cell response in 48 rabbits infected with the Nichols strain of T. pallidum for 1 week to 16 months. The response of the peripheral leucocytes to T. pallidum antigen (TpAg), 3 and 15 mug/ml., Reiter antigen (RAg) 6 mug./ml., and VDRL reagent 1:500 was examined. The cells in the presence of RAg, TpAg--3 mug./ml.--and the VDRL reagent demonstrated a biphasic response; in the early stage of infection (until the 4th week) stimulation of leucocyte migration and in the later stage of disease inhibition of leucocyte migration was observed. The higher concentration of TpAg--15 mug./ml.--caused only inhibition of leucocyte migration. The leucocyte response in vitro could not be confirmed by intradermal skin tests with 5 x 10(7) heat-killed T. pallidum. No correlation between the cell response and the treponemal antibodies was observed.


Herpes genitalis and circumcision.

214 patients with genital herpes infection proven by culture and a control group of 410 other patients were included in a retrospective study devised to investigate the relationship of circumcision to genital HSV infection in the male. The percentage of patients circumicised in the control group was significantly larger than in the herpes group (P less than 0-01). The was not found to be the case for other sexually-transmitted diseases apart from monilial balanitis. There was also a significant difference in contraceptive methods in the two groups, barrier methods being used less ofter than other methods in the herpes group and the reverse in the control group. It is concluded that there is a positive relationship between absence of circumicision and genital HSV infection, but that a prospective study should be undertaken to confirm these results.


An electron microscope study of synaptic organization in the lateral reticular nucleus of the medulla oblongata in the cat.

Synaptic organization in the lateral reticular nucleus (LRN) was investigated electron microscopically in the cat. The number of synaptic knobs encountered in a survey of 69 somatic profiles cut through the nucleolar plane varied from 0 to 20 per profile. In 5564 mum of cell perimeters analyzed the number of synaptic knobs per 100 mu was 5.2, ranging from 0 to 22 in each somatic profile. About 46% of the axosomatic synaptic knobs were filled with round vesicles, and 54% with pleomorphic ones. Out of 1424 axodendritic synaptic knobs, about 63% were filled with round vesicles, and 37% with pleomorphic ones. After placing lesions in the spinal cord, frontal cortices or red nuclear areas, electron-dense degenerated synaptic knobs were observed in the LRN. In the cats with spinal lesions degenerated knobs with the active zones of the synapses were found both on somatic and dendritic profiles. On the other hand, in the cats with cortical or rubral lesions degenerated knobs with the active zones were encountered only upon dendritic profiles. These degenerated knobs found in the present study never exceeded more than 3% of the total synaptic population in the areas examined. Thus, the axon terminals of fibers arising from the spinal cord, frontal cortices and red nuclear areas  constituted only a small fraction of the total axonal endings in the LRN.


The reticulovestibular projection in the cat. An experimental study with silver impregnation methods.

The distribution of degeneration in the vestibular nuclei (VN) has been studied in transversely cut sections from 9 cats with stereotaxically performed lesions in the main reticular formation (RF) of the brain stem (Nauta of Fink and Heimer method). No projection was found from the mesencephalic reticular formation (R.mes.) and nucleus reticularis ventralis (R.v.). However, the reticular nuclei gigantocellularis (R.gc.), parvocellularis (R.p.c.) and pontis oralis (R.p.o.) were found to project bilaterally onto the 4 main vestibular nuclei with an ipsilateral overweight. By far the greates contribution comes from the R.gc. and R.p.c. In cases with R.gc. lesions some degeneration was found in the small cell groups x and f. The latter is also supplied from the R.p.c. The distribution of degeneration within the vestibular complex is rather diffuse, but a certain pattern can be discovered. After R.p.c. lesions the maximal terminal field in the VN is found within the superior nucleus, while the lateral and medial nuclei are preferred sites of termination of fibers from R.gc. and R.p.c. The projections of the R.gc. and the R.p.c. may be more different than appears from our findings since lesions of one of them will most likely have affected some ascending or descending fibers emanating from the other. Since the areas of RF projecting to VN receive afferents from many sources, these sources have possibilities to act on the VN even if they do not possess direct connections with this nuclear complex. These possibilities should be remembered in physiological studies of responses in the VN following stimulation of many parts of the CNS.


Receptive fields of single cells in the visual cortex of the hooded rat.

The receptive fields of 107 single cells in area 17 of the hooded rat were examined. About half the cells responded to stationary as well as moving stimuli and about half only to movement. A variety of receptive field types were observed. Some of the cells responding to stationary stimuli had circular receptive fields, some with and some without annuli, some had elongated receptive fields, some had irregular receptive fields. Of the cells that responded only to movement, some were orientation or direction specific and some were not. Only two cells were found that responded to stimulation of the ipsilateral eye. Columnar organization of the cortex was not observed.


Organization of the cat trapezoid body and the discharge characteristics of its fibers.

The laminae of the midline cat trapezoid body (TB) are delimited and named on the basis of their characteristic fiber diameters. Proceeding ventrally from the dorsal boundary of the TB are found the medium, mixed, large, and small diameter populations (the MDP, XDP, LDP, and SDP respectively). Specific cell types of the cochlear nuclear complex give rise to the fibers of the TB. Medium diameter fibers originate from spherical cells while globular cells are the source of the large diameter fibers. Bilateral cochlear nuclei ablations demonstrate that, withe the possible exception of a few thin fibers, all midline TB fibers are second order. The discharge characteristics of single units recorded near the midline in the MDP, XDP, and LDP are presented. The MDP displays a dorso-ventral progression of best frequencies, from low to high. Very high best frequencies (greater than 12 kHz) do not seem to be represented in the MDP but are found in the XDP and LDP. Except for latent periods, the properties of units in the MDP are the same as those of spherical cells and eight nerve fibers for all parameters where comparisons are available. The excitatory response characteristics of units in the XDP and LDP are similar to those of the MDP. They differ from MDP fibers in having tuning curves with inhibitory sidebands as well as a lower mean spontaneous rate of discharge. The results confirm previous observations on the spherical cells and define the discharge characteristics of the globular cells.


Two types of depolarizing after-potentials in hippocampal pyramidal cells of rabbits.

(1) Depolarizing after-potentials (DAPs) of hippocampal pyramidal cells were studied with intracellular microelectrodes in rabbits anesthetized with Nembutal and, in addition, curaized. (2) DAPs were classifiedl into two types. One was linearly related in magnitude to the spike and the membrane potential of the cell body while the other was not. Therefore, the former was tentatively called the true DAP and the latter the pseudo-DAP. (3) In accordance with reduction in the membrane potential, the magnitude of the true DAP diminished and at a membrane of--60 to--50 mV, the true DAP disappeared. On further reduction in the membrane potential, a hyperpolarization-going dip appeared in place of the true DAP. (4) The pseudo-DAP usually appeared when the membrane potential of the cell body was reduced beyond--60 to--50 mV. But the pseudo-DAP was not quantitatively related to the membrane potential. It was shown that the pseudo-DAP was a nonsynaptic process, and its possible relation to the dendritic spike was discussed. (5) It was demonstrated that it was the pseudo-DAP that led to the genesis of the so-called inactivation response, i.e. a large and prolonged depolarization of the cell membrane with a strong tendency to spike inactivation.


Cortical responses to electrical and gustatory stimuli in the rabbit.

The distribution of surface positive cortical potentials evoked by electrical stimulation of the chorda tympani, glossopharyngeal and lingual nerves which innervate the tongue was mapped in rabbits. All projections were bilateral. Judging from the extent of the cortical response area and the amplitude and latency of the responses, the major projection of the chorda tympani was ipsilateral, whereas that of the lingual and the glossopharyngeal nerves was contralateral. Both the chorda tympani and the glossopharyngeal nerve project to a confined area in the insular cortex and the lingual nerve projects to the appropriate part of the somatotopic pattern of somatic sensory area I. Further, a single unit study was undertaken to characterize the response of units in the cerebral cortex which was induced by gustatory stimulation of the anterior tongue, Twenty-four gustatory units were found in the insular cortex and the claustrum. The gustatory units were divided into an early response type (21 units) and a late response type (3 units) based on latency measurements. Gustatory units were also classified according to discharge patterns into excitation type (21 units) and inhibition type (4 units). Eleven units responded to 1 or 2 kinds of conventional taste stimuli, and 13 units responded to more than 3 different taste stimuli. Sensitivities of cortical units to the 4 conventional taste stimuli were found to be mutually independent and randomly distributed among cortical units. The frequency of discharges increased in the excitation type units and decreased in the inhibition type units monotonically with the excitation type units and decreased in the inhibition type units monotonically with an increse of NaCl concentration exfept at the highest concentrations.


Changes in vesical function produced by cutaneous stimulation in rats.

(1) The effect of stimulation of various skin areas on the function of the bladder was examined in anesthetized rats with the CNS intact, in decerebrated non-anesthetized rats and in spinal rats. The tone and contraction of the bladder was measured by the intravesical ballon method. (2) When the volume of the intravesical ballon was expanded so that the resting vesical pressure was increased from O to approximately 40 mm H2O level, the bladder revealed small spontaneous contractions in all experiments. Under these conditions intravesical pressure was increased approximately 40 mm H2O by application of tactile or nociceptive stimulation of the skin in the perineal area. This excitatory perneal-bladder response existed befor and after spinal transection and was shown to be a propriospinal reflex for which reflexly increased nerve discharges of vesical branches of the pelvic nerves were responsible. (3) When the volume of the intravesical ballon was further expanded so that the resting vesical pressure was kept about 200 mm H2O, the bladder had the usual large rhythmic contractions (micturition contractions) with amplitudes of about 610 mm H2O, and rhythms of 1--3/min in the CNS intact or decrebrated rats. These large contractions were driven by the rhythmic bust discharges of the vesical nerve branches of the pelvic nerves. The occurrence of the large contractions of the bladder could be inhibited by nociceptive stimulation which was localized in the perineal area. This inhibition of the large contractions was caused by disappearance of the rhythmic burst discharges in the vesical branches of the pelvic nerves. (4) On some occasions in the CNS intact anesthetized and in the decerebrated non-anesthetized rats the large contractions of the bladder disappeared during experiments even when the bladder was expanded enough for producing normal large contractions and kept at high intravesical pressure. Regardless of whether the large contractions existed or not at the high intravesical pressure, the vesical pressure was increased by perineal stimulation due to the same neural mechanism mentioned in (2) above.


Is calcium deficiency related to thiamine-dependent neuropathy in pigeon?

In convulsive pigeons on a diet of polished rice, a significant decrease of thiamine and calcium in the central nervous system rather than in peripheral nervous system was observed. In subcellular fractions of telencephalon in these same pigeons, thiamine and calcium levels decreased in the myelin-membrane and synaptosomal fractions. When radioactive thiamine was injected into the pieon during a convulsion, radio-activity was most prominent in the telencephalon and in subcellular fractions, in the myelin-membrane and synaptosomal fractions of telencephalon immediately after recovery from the convulsion. When calsium was added to the polished rice, the pigeons never had such convulsions. Thiamine and calsium concentrations in myelin-membrane and synaptosomal fractions of telencephalon of calcium-rice fed pigeons were significantly higher than in convulsive pigeons. It is suggested that calsium plays a role in binding the protein and thiamine which is related to the sodium transport system of excitable membranes.


Energy metabolism and nerve function in cockroaches (Periplaneta americana).

Levels of ATP are near normal in the cockroach nerve cord when hypoxia is sufficient to cause coma as determined by behavioral observations and nerve cord electrical activity. During anoxia the major change in ATP occurs after loss of measurable nerve activity. High glycogen levels and reduced energy demands due to coma may contribute to the resistance to anoxic death.


Impairment of thermoregulation, food and water intakes in the rat after hypothalamic injections of 5,6-dihydroxytryptamine.

A bilateral microinjection into the anterior hypothalamus of 5,6-dihydroxytryptamin (5,6-DHT), a substance that lesions serotonin (5-HT)-containing neurons, caused a rise in the body temperature of the rat. The anatomical sites were the same as those at which 5-HT given in the same dose range (1.25-2.5 mug) evoked a similar hyperthermia. When exposed for one hour to a temperature of either 35 degrees C or 8 degrees C, the rats were not able to defend against the heat or cold, respectively. The magnitude of this thermoregulatory deficit depended upon the dose of 5,6-DHT given as well as the site of injection. A partial recovery from the warmth deficit was evident 13-17 days following the 5,6-DHT microinjection. Food and water intakes were also suppressed significantly and body weights declined concomitantly. These results provide additional evidence to support the view that a serotonergic mechanism in the hypothalamus is involved in both thermoregulation and the control of ingestive behavior.


Some connections of the entorhinal (area 28) and perirhinal (area 35) cortices of the rhesus monkey. I. Temporal lobe afferents.

In this investigation the efferent projections from ventral temporal neocortical and limbic cortical areas to the entorhinal and perirhinal cortices have been investigated in the rhesus monkey using silver impregnation methods. It was observed that virtually all ventral temporal neocortical areas contribute some afferents to the transitional zones of periallocortex (perirhinal and prorhinal cortices) forming the walls of the rhinal sulcus. These areas in turn project medially to the entorhinal cortex and hippocampus. Additional direct sources of afferent input to the entorhinal cortex were found to originate in Brodmann's areas 51, 49 and 27, and Bonin and Bailey's areas TF and TH. These connections have been characterized as final relays in multisynaptic cortico-cortical pathways linking the entorhinal cortex and, ultimately, hippocampus to the association areas of the frontal, parietal, temporal, and occipital lobes.


Some connections of the entorhinal (area 28) and perirhinal (area 35) cortices of the rhesus monkey. II. Frontal lobe afferents.

In this investigation, the efferent cortico-cortical projections of the orbitofrontal cortex in the rhesus monkey have been investigated using silver impregnation methods. Projections from this area were observed to terminate in the rostral portions of the temporal lobe (areas TA, TE and TG) and cingulate gyrus (area 24), the insular cortex, and some dorsolateral prefrontal areas. Although these connections characterized all areas, with the exception of Walker's area 14 and Bonin and Bailey's area FL, the caudal levels of the orbitofrontal area were found to give rise to an additional projection which terminated in the entorhinal cortex and the transitional cortices bordering the rhinal sulcus. The source of this projection correlated closely with an area labeled FF by Bonin and Bailey. This connection may provide a much more direct means for the frontal lobe to influence the hippocampus than those involving the cingulate gyrus.


Some connections of the entorhinal (area 28) and perirhinal (area 35) cortices of the rhesus monkey. III. Efferent connections.

In this investigation the efferent projections of the entorhinal and prorhinal cortices relative to their sites of termination in the hippocampus and fascia dentata were investigated in the rhesus monkey using experimental silver impregnation methods. Contrary to the often cited observations of Lorente de No, all entorhinal areas, including the laterally lying prorhinal cortex, were found to give rise to the perforant pathway, and furthermore, each cytoarchitectonically defined subarea was found to contribute a unique component. These perforant pathway components terminate in distinct regions of the dendritic zones of the fascia dentata granule cell and the hippocampal pyramidal cell. A previously undescribed projection to the prosubiculum and hippocampus has been found to originate from the prorhinal cortex which forms the medial wall of the rhinal sulcus along the lateral-most portion of the entorhinal cortex in the rhesus monkey. These results, in conjunction with our previous observations regarding differential afferents to the entorhinal cortex, indicate that specific afferent and efferent connections characterize each cytoarchitectonically definable subareas of this periallocortical region. Additionally, they indicate that the perforant pathway might be conceptualized as the final link in a multisynaptic series of connections instrumental in providing the hippocampus with potential modality specific and multimodal input.


Resuscitation of the monkey brain after one hour complete ischemia. III. Indications of metabolic recovery.

Adult rhesus monkeys were subjected to complete cerebral ischemia for one hour and subsequent recirculation for up to 24 h. Animals with signs of functional recovery (e.g. spontaneous EEG activity) exhibited a partial replenishment of cellular energy sources (ATP, phosphocreatine) and a progressive normalization of cerebral lactate levels. Glucose and pyruvate concentrations showed a transient increase over control values during the early stages of postischemic recirculation. Monkeys without functional recovery lacked a significant resynthesis of energy-rich compounds; adenine nucleotides continued to decrease and lactate concentrations were higher than in animals subjected to ischemia without recirculation. Cerebral polysome profiles remained unaltered during the ischemic period but in all animals a marked disaggregation of polyribosomes with a concomitant increase in ribosomal subunits occurred after the onset of recirculation. In monkeys with indications of functional recovery these changes were reversible but a normal polysome profile was only observed after 24 h of recirculation. The results obtained indicate a postischemic depression of protein synthesis due to an inhibition of peptide chain initiation. After recirculation of the brain for 3-6 h there was evidence for an induction of enzymes involved in polyamine synthesis (ornithine decarboxylase and S-adenosylmethionine decarboxylase). No changes in the activity of these enzymes were observed at the end of the ischemic period, indicating that during complete cerebral ischemia not only the synthesis but also the catabolism of proteins is inhibited.


Alpha motoneuron responses to natural stimuli in decerebellate cats.

The responses of single alpha motoneurons to various "natural' stimuli were recorded from dissected ventral root filaments in lightly anesthetized control and recently decerebellate cats. The identity of the motoneurons was established by recording the unitary responses to orthodromic stimulation of nerves innervating the triceps surae muscles in the hindlimb. We recorded only the activity of units which responded to electrical stimulation of the medial or lateral gastrocnemius nerves, though some units responded to stimulation of both these nerves, and some also responded to stimulation of the posterior tibial nerve. The distributions of unit latencies and amplitudes did not differ between the two groups of animals. Baseline firing rates were also similar. However, unit firing rates in response to neck extension, ipsilateral hindfoot dorsi- or ventral-flexion were significantly higher in decerebellate than in control cats. The discharge rates in response to other stimuli, including neck flexion, pinna stimulation, and noxious stimulation in the hindlimb, were not significantly different between the two groups. Since the alpha motoneurons showed an increase in responsiveness only to some stimuli, specific mechanisms probably explain this release. The most important mechanism seems to be a loss of inhibition normally exerted by the cerebellum on vestibular and joint proprioceptive reflexes. The pathways to the ventral horn cells are thought to involve the vestibulo-spinal and reticulo-spinal tracts.


Diversity of mossy fibres in the cerebellar cortex in relation to different afferent systems: an experimental electron microscopic study in the cat.

The evolution of the terminal degeneration has been compared in two systems of mossy fibres: the spinocerebellar and the pontocerebellar projections. The two systems exhibit both dense and clear types of terminal degeneration. However, there are important differences between the evolutive processes of terminal degeneration in the two systems: (i) the time course of the degenerating process is much faster for spinocerebellar than for pontocerebellar rosettes, and (ii) the glial phagocytic process accompanying the dense type of degeneration is different for the two systems. Spinocerebellar rosettes are generally removed from their glomerular central position by reactive glia, leaving fragments of the presynaptic membrane attached to their postsynaptic partner. This feature is exceptional for pontocerebellar rosettes which, in the course of their glial engulfment, leave free the postsynaptic differentiation of their former target granule cell dendrites. These differences of terminal degenerative processes have been reconciled with optical microscope observations by Brodal and Drablos1 of morphological differences between the rosettes of two different fibre systems.


Diencephalic projections from the midbrain reticular formation.

(1) Physiologically guided stereotaxic coagulation was placed so as to avoid major through pathways in the midbrain reticular formation of 7 cats. Diencephalic degeneration resulting from this was traced by the Nauta method. (2) Preterminal degeneration was found in: the intralaminar nuclei and the posterior group (PO); the ventral group of thalamic nuclei; the ventral thalamus, including the zona incerta, subthalamus and fields of Forel; and the lateral hypothalamus. (3) The results are discussed in relation to somatomotor reactions, reticular influences on the electroencephalogram and telencephalic representation of pain.


Demonstration of a somatotopically organized projection onto the paramedian lobule and the anterior lobe from the lateral reticular nucleus: an experimental study with the horseradish peroxidase method.

Using the retrograde axonal transport of horseradish peroxidase, the projection from the lateral reticular nucleus (NRL) to the cerebellar anterior lobe and paramedian lobule has been studied in 13 cats. Both the anterior lobe and the paramedian lobule receive a somatotopically organized projection from the NRL. The projection to the paramedian lobule is nearly exclusively ipsilateral and originates mainly in the dorsal part of NRL, while the projection to the anterior lobe is bilateral (with ipsilateral predominance) and takes origin from all parts of the NRL. The lateral part of the NRL (closely coinciding with the parvocellular nucleus) projects to the rostral part of the anterior lobe and caudal parts of the paramedian lobule (both representing the hindlimb), while the medial part of the NRL (magnocellular nucleus) projects to the caudal parts of the anterior lobe and rostral parts of the paramedian lobule (representing the forelimb). The small subtrigeminal nucleus projects onto the anterior lobe as well as the paramedian lobule, but apparently mainly to their forelimb areas.


Distribution of olivocerebellar fibers demonstrated by a radioautographic tracing method.

The method of injecting radioactive amino acids for the marking of neurons and the demonstration of their terminals by means of radioautography has been applied to the olivocerebellar projection. After injections in the olive, labeled fibers were observed in the molecular layer of the cerebellar cortex. The projections were distributed in specific regions of the cerebellum, depending on the position of the injections within the nucleus. A comparison of that topographical arrangement with Brodal's chart of olivocerebellar distribution indicates a close correspondence. In addition, the olivocerebellar climbing fibers terminate as a series of strips oriented perpendicularly to the long axes of the folia. In all regions observed so far, the strips of the projection alternate with empty spaces of the same width. It is postulated that another group of climbing fibers originating outside the olive interdigitate with the olivocerebellar fibers.


Transganglionic degeneration in trigeminal primary sensory neurons.

In 16 kittens either the frontal or the inferior alveolar nerve was transected and in 17 adult rats either the supraorbital, the infraorbital or the mental nerve was divided. The postoperative survival periods were kept at 3-28 days for the kittens and 15-26 days for the rats. Sections from the caudal brain stem and the upper part of the cervical cord were impregnated according to the Fink-Heimer method, procedure II. In the kittens degeneration was found after the 8th postoperative day ipsilaterally in both the spinal and main sensory trigeminal nuclei and the spinal trigeminal tract. In the rats degeneration was found in all cases in the same ipsilateral structures as in the kittens. The amount of degeneration was relatively great in the rats, whereas it was very modest in the kittens. A somatotopical pattern was found for the degeneration both within the spinal and the main sensory nuclei. It was in agreement with what has been found in earlier studies, where other techniques have been used. By a comparison with the results of a previous study on the trigeminal nerve in the rat, where partial lesions of the ganglia had been made, it was found that the degeneration in the present study did not cover the whole area receiving primary trigeminal afferents. Possible explanations for this are discussed.


The pontocerebellar projection onto the paramedian lobule in the cat: an experimental study with the use of horseradish peroxidase as a tracer.

Horseradish peroxidase (HRP) was injected into cerebellar cortex of the paramedian lobule in 12 cats, and the ensuing distribution of labeled cells in the pontine nuclei was mapped in some detail. The cells in the pontine gray which give origin to fibers to the paramedian lobule lie together, in part in groups, and in part in columns. The columns are situated both medial and ventrolateral to the peduncle, as well as in the dorsolateral pontine nucleus. The projection is bilateral with a clearcut contralateral preponderance, except in the lateralmost region in the dorsolateral nucleus, which projects mainly ipsilaterally. The column medial to the peduncle projects in a topographical pattern to the paramedian lobule. The dorsal part of this column projects to the rostral folia of the paramedian lobule, while successively more ventral parts in the column project to more caudal paramedian lobules. Within the other columns only a faint sign of a topographical organization is found. The location of the pontine columns projecting onto the paramedian lobule largely corresponds to the pontine terminal areas of fibers from the sensory cerebral cortex (SmI and SmII). The corresponding topography in these parts of the corticopontine and pontocerebellar pathways is suitable for a somatotopical impulse transmission from the sensory cortex to the paramedian lobule, in agreement with the results of physiological investigations. Furthermore, a correlation of the pontine areas projecting onto the paramedian lobule with the terminal areas of pontine afferents shows that the pons may be a relay station in mediating influences from other parts of the cortex (MsI, visual and acoustic), the cerebellar nuclei and the colliculi to the paramedian lobule.


The pontine projection from the inferior colliculus in the cat. An experimental anatomical study.

The present study was carried out in order to clarify the organization of the pontine projection from the inferior colliculus in the cat with the methods of Nauta27 and Fink and Heimer16 following lesions of different sizes and locations in the inferior colliculus. The inferior colliculus projects exclusively to the anterior two-thirds of the ipsilateral dorsolateral pontine nucleus. The majority of fibers originates from cells in the central nucleus and a small amount from cells in the external and the pericentral nuclei as well. Areas of the present projection largely overlap with areas of projection from the auditory cortex, and also fairly well with those from the superior colliculus. Possible pathways of the acoustic inputs to the cerebellum involving the pontine nuclei are discussed based upon the current findings, as well as upon those obtained by preliminary experimental studies of anterograde and retrograde axonal flow.


On the pathology of experimental hydrocephalus.

Acute hydrocephalus was produced in newborn rabbits by injection of kaolin into the cisterna magna. The light microscopic changes which occurred in the ependyma and periventricular brain tissue were studied. Some animals also received intraventricular injection of Evans blue albumin (EBA) at various times after the kaolin injection to study the permeability of the ependyma. There was a progressive dilatation of the lateral ventricles from the second day after the kaolin injection. Marked hydrocephalus was seen after 2 weeks. The white matter of the cerebral hemispheres showed increasing reduction in volume with the degree of hydrocephalus. Neither destruction of brain tissue nor macrophage response or inflammation were seen. The ependyma adapted remarkably well to the increased intraventricular pressure by extensive flattening and stretching. No convincing breaks or ruptures were seen. There was a patchy spongy zone beneath the ependyma, probably indicating oedema of the periventricular white matter due to transventricular absorption of the cerebrospinal fluid (CSF). Denudement of the ependymal lining is not necessary for the concept of transventricular flow of CSF. No difference was seen in the penetration of EBA into the periventricular tissue between hydrocephalic and control animals. The reduction of the cerebral mantle thickness was probably caused by simple pressure atrophy. This indicates that the morphological changes may to a large extent be reversible if the hydrocephalus is properly treated within reasonable time. The role of morphological changes in the pathophysiology of hydrocephalus if briefly commented upon in relation to certain aspects of human hydrocephalus.


Macular input to neurons of the spinoreticulocerebellar pathway.

The present report summarizes the results obtained in previous experiments in which the responses to lateral tilt of both reticulocerebellar neurons located in the lateral reticular nucleus (NRL) and ascending spinoreticular tract axons, located in the lateral funiculi of the cervical segments C2-C3, had been recorded in precollicular decerebrate cats. Steady changes in unit activity were evoked by 15-20 degrees tilts which lasted as long as the position of the cat was maintained. Most of the units responsive to tilting showed an increase in discharge rate during tilt in one direction and a decrease in discharge rate during tilt in the opposite direction. Moreover the magnitude of the unitary responses was clearly related to the degree of tilt. The responses of the NRL neurons to tilt were attributed in part to direct efferent vestibuloreticular projections from the Deiters' nucleus, in part to some indirect influence of the lateral vestibulospinal tract on neurons of the cervical ascending spinoreticular pathway. Since most of these ascending units affected by tilt were influenced by stimulation of both ipsilateral and contralateral forelimb nerves, and some of them also by stimulation of high threshold neck muscle afferents, it was postulated that these neurons projected to the forelimb and the neck region of the cerebellar cortex of the anterior lobe. This corticocerebellar region may therefore integrate from time to time not only the signal input originating from macular receptors but also the somatosensory input which originates from neck receptors as a result of the actual displacement in head position induced by the vestibulospinal reflex.


Considerations on the principles of surgical treatment of partial epilepsy.

Some considerations on the principles of surgical treatment of partial epilepsy are prompted by the still relatively high number of unsatisfactory surgical results. The fundamental principle of surgical treatment, based on the view that partial epilepsy is due to the hyperactivity of given neuronal aggregates consequent to a cerebral lesion (the lesional-functional epileptogenic complex), is still regarded as satisfactory. The present concept of the lesional-functional epileptogenic complex and the means to topographically locate and delimit it are illustrated and discussed. Surgical failures are ascribed mainly to the difficulty in reaching a complete and detailed spatial definition, and then a complete removal, of the epileptogenic complex.


Dendrite bundles, central programs and the olfactory bulb.

The long secondary dendrites of mitral cells in the olfactory bulb are well developed in the mammalian neonate and show a considerable degree of interweaving and coiling characteristic of dendrite bundles. In a number of other areas throughout the central nervous system, we have made a provisional correlation between the appearance of these bundles and the development of specific items of output performance characteristic of the aras involved. On this basis we have suggested that the dendrite bundles may serve as a repository for the central program shaping the response. This hypothesis is explored further in the case of the olfactory bulb. Mechanisms are suggested whereby rudimentary appetitive programs already encoded along facing dendrite membrane pairs within the specialized intrafascicular milieu, may trigger and control nipple search and suckling in the still blind and only primitively mobile neonate.


Histological findings after hemicerebellectomy in man: anterograde, retrograde and transneuronal degeneration.

Histological changes are described in the brain of a patient in whom a hemicerebellectomy had been performed 14 years before death. There is cell and fibre loss, partial or total, in nuclei known to have direct connections with the cerebellum. In some nuclei the sequel to cell loss is marked fibrillary gliosis. In other nuclei the cells have disappeared without trace. The degeneration of these tracts with a direct connection with the cerebellum has also led to degeneration of other tracts in synaptic relationship with them. This transneuronal degeneration has occurred in the corticopontine tracts and in the central tegmental tract, in the former definitely, and in the latter probably, retrogradely. It is probable that transneuronal degeneration has also occurred in other tracts. The extent of the degeneration and, in particular, the occurrence of overt transneuronal degeneration, suggest that the examination of material after a very long term of survival might be of value in experimental work concerned with mapping neuroanatomical networks.


Histogenesis of the deep cerebellar nuclei in the mouse: an autoradiographic study.

In order to tag cells when they arise, pregnant mice were injected usually once or in some cases multiple times at a known time of gestation with tritiated thymidine. The offspring were killed and their brains prepared for autoradiography. Distribution of labeled cells was plotted using a drawing apparatus. Neurons of the deep cerebellar nuclei arise on gestation days 10-17. (Later periods were not studied.) Most neurons arise on gestation day 11. Many medium and small sized neurons arise after gestation day 11 with a limited number of small neurons observed to arise through the 17th day. Neurons for all parts of the complex arise at the same time, thus no gradients could be established.


The perineuronal glial reaction after axotomy.

The perineuronal glial reaction after axotomy of the facial nerve was examined in adult mice and rats and in newborn rabbits. The facial nerve was damaged in two ways: by crush lesions, which were followed by complete neuronal regeneration, and by transection (in mice) or evulsion (in rats and rabbits), which caused extensive nerve cell disintegration. After nerve lesions which caused irreversible damage the microglial cells encircled the degenerating neurons and ultimately phagocytosed them. After crush lesions there were great species variations in the glial reaction: the neurons of rats and rabbits showed considerable and reversible separation of the synaptic terminals by glial cells, while mice showed no significant synaptic separation. It is suggested that the main function of the microglial cells may be to serve as potential phagocytes for disintegrating neurons, and that the reversible glial changes around regenerating neurons possibly represent abortive glial reactions.


The vestibular nuclei in the domestic hen (Gallus domesticus). II. Primary afferents.

Lesions of the vestibular ganglion in the domestic hen have been made by mechanical damage and thermocoagulation, and the resulting degeneration of the proximal vestibular nerve fibers has been studied in Fink-Heimer9, Nauta18 and Eager8 sections of the brain stem. The vestibular nerve fibers were found to terminate within central regions of the superior nucleus, in the cell group A, the nucleus Deiters ventralis, the nucleus tangentialis, the cell group B, the dorsomedial part of the medial nucleus and the descending nucleus. The nucleus Deiter dorsalis does not receive vestibular nerve afferents. The findings are discussed in the light of the structural organization and physiology of the vestibular nuclear complex in birds and compared with the organization of the nuclear complex in mammals.


The pancreatic insulin content and its relationship to plasma glucose and free fatty acid concentrations in the embryo and neonatal chick.

1. An inverse relationship was found between the plasma glucose and FFA concentrations of embryos aged between 14 and 20 d. 2. Both the plasma glucose and FFA concentrations were constant during hatching. 3. The insulin content of the pancreas increased between 14 and 20 d but fell during hatching.


The adrenal cortico-medullary ratio in the fowl.

1. A new integrating method of assessing the proportions of cortical and medullary tissue in the avian adrenal gland is described and statistically evaluated. 2. It is shown that a single "central" section of the adrenal gland will suffice to obtain accurate results. 3. Each section was projected on to a grid of about 2500 intersection points and the ratio of points falling on cortical or medullary tissue was determined. 4. Applications of this method to normal fowls showed that there were significant breed, sex and, particularly, age differences in the cortico-medullary ratio of the fowl's adrenal glands.


Effects of strain of chickens and vaccination with turkey herpesvirus on Marek's disease and lymphoid leukosis in breeding stocks.

1. A total of 3236 females from eight meat-type strains, half of which were vaccinated for Marek's disease (MD), and 11,193 Leghorn females from ten strains, all vaccinated for MD, were adventitiously exposed to MD and lymphoid leukosis (LL) viruses and observed to 392 and 497 d of age, respectively. 2. In the meat-type birds, vaccination reduced total mortality from 43-4% to 27-1% and mortality due to MD from 16-4% to 5-4% but did not affect mortality and LL (2-9% and 3-4%). 3. In the vaccinated Leghorns total mortality was 11%, including 2-1% from MD and 1-2% from LL. 4. Significant differences between strains of chickens were found in total mortality, as well as in MD and LL mortality. 5. Strain by vaccination interaction was observed in total rearing and adult mortality, as well as in the MD mortality of adult meat-type females. 6. Leghorn strains with higher rate of egg production and meat-type strains with lower growth rate to have better viability.


The fate of recycled urate in hens fed on a diet containing dried poultry manure.

1. Seven colostomised hens were fed on a control diet free of dried poultry manure (DPM) or one including 20% DPM. 2. Urate excretion was greater during DPM feeding by approximately the amount consumed: little urate was present in faeces. 3. Doses of 10-6 muCi of 14C-urate introduced into the crop were quantitatively excreted in the urine within 24 h. 4. The results show that none of the urate present in DPM is utilised by the laying hen.


Effects of growth hormone on tissue metabolism in broiler chicks.

1. The effect of bovine growth hormone (GH) on cartilage, liver, muscle, pancreas and spleen has been investigated. 2. Tissue RNA was elevated in the liver, muscle and spleen of the GH-treated chicks while uptake of radioactive phosphate into RNA was stimulated for both liver and spleen. 3. The GH-treated chicks had an increased cartilage protein content together with a higher rate of incorporation of 14C-methionine pancreatic protein.


The feeding of copper sulphate to ducklings.

1. Aylesbury ducklings, from 8 to 63 d of age, were fed on diets with or without supplemental copper (100 mg/kg). 2. Copper resulted in significant increases in growth rate and significantly smaller caeca both as a proportion of body weight and as the weight of unit length.


Transfer of 125I to eggs in hens fed on diets containing rapeseed meal.

1. Transfer of 125I into the egg in hens fed on diets containing rapeseed meal and a source of myrosinase, to liberate the antithyroid compounds from the glucosinolates, was studied. 2. It was found that less 125I was transferred if the diet contained a myrosinase source and rapeseed meal.


Influence of hormonal extracts on hens producing eggs with non-calcified or partially calcified shells and factors associated with this condition.

1. Daily injection of hypothalameal extract (HE) and adenohypophyseal extract (AE) into hens aged 56 or 67 weeks for 14 d did not significantly influence the production of shell-less (SL) or ultra-thin-shell (UTS) eggs. 2. The injection of HE significantly increased hard-shell (HS) egg production in the younger hens. 3. Neither AE nor HE affected egg weight, serum calcium, gain in body weight or food consumption. 4. In a third experiment hens selected for poor egg production laid at a rate of 58% of which 36% were SL, 29% UTS and 35% HS eggs. Whereas the production rate of the good layers was 65% of which 1-4% were SL and 1-4% were UTS eggs. 5. Specific gravity of HS eggs, serum calcium, weight of ovary, oviduct, or adenohypophysis did not differ between good and poor layers. 6. Since SL and UTS eggs are easily overlooked the decrease in egg production with age may be as great as indicated by normal production records; the problem may be concerned more with the mechanism of shell formation.


Feather pecking and cannibalism in a caged layer flock.

1. The progress of feather pecking and cannibalism was recorded from hatching to end of lay in a flock of caged layers and the influence of group size, floor area allowance and cage tier upon the incidence of these activities during lay assessed. 2. The largest group suffered more cannibalism and feather pecking than smaller groups, floor area allowance and tier being less important factors. 3. A significant trend was found for one death from cannibalism to be followed by more in the same cage.4. It was concluded that feather pecking and cannibalism are separate phenomena, although the same cage conditions increased the incidence of both. 5. Cannibalism may be divided into vent pecking and cannibalism affecting other parts of the body, the former is independent of feather pecking and the latter, though usually preceded by feather pecking, is only indirectly associated with it.


Seasonal variations in the food intake of captive red grouse.

1. The daily food intake of captive red grouse was measured throughout the year. It was positively related to body weight and to daylength, and negatively to air temperature. Grouse ate more during their main summer moult, and the hens ate most while producing eggs. 2. The total weight of eggs laid was positively related to daily food intake during the 5 weeks before laying, but not to daily intake during laying. The rate at which eggs were laid was related to daily intake during laying as well as before laying. The possible significance of these results for poultry management is discussed.


The utilisation of various fats by turkeys of different ages.

1. The utilisation of fat and fatty acids supplied as maize oil, tallow or lard in the diet of 2-, 4- and 8-week old turkeys has been investigated: a mixture of 10% fat and 15% cellulose replaced glucose monohydrate in a low-fat basal diet. 2. At 2 weeks of age the absorbabilities of the fats were 96, 57 and 91% for maize oil, tallow and lard respectively; at 4 and 8 weekds of age the corresponding figures were 97, 70 and 92% and 98, 74 and 90%. 3. The unsaturated fatty acids (18:1, 18:2) were highly absorbed from all fats; this was true also of the saturated acids (16:0, 18:0) in the maize oil, but in lard and, especially, tallow the absorbability of these fatty acids was lower. 4. The effect of age on the utilisation of tallow could be explained by the improvement in the absorption of these fatty acids. 5. The determined and calculated ME values of the fats are given.


Obesity induced by force-feeding and accompanying changes in body temperature and fertility in the male domestic fowl.

1. Excessive amounts of food (two-fold more than the ad libitum intake) introduced into the gastro-intestinal tract of three adult male fowls, for 5 weeks, caused a marked increase in body weight resulting mainly from fat deposition. 2. The induced obesity was accompanied by an increase of the rectal temperature (0-2 to 0-3 degrees C) and a decrease of the skin and comb temperatures, a cessation in the growth of the comb, a reduction in the blood packed cell volume, an eight-fold reduction in the number of spermatozoa in the vasa deferentia and a concomitant depression in their motility. 3. A decrease of the testosterone and an increase of luteinising hormone concentrations in the blood plasma was obtained in two of the three treated birds.


Designation of the cellular component of the peritubular boundary tissue of the seminiferous tubule in the testis of the fowl (Gallus domesticus).

1. The boundary tissue surrounding the testis has a mechanical function in sperm transport as well as being a significant element in the blood-testis barrier. 2. The designation of the cellular component is suggested to be myofibroblast thus indicating fibroblastic and contractile myoid cell features and suggests their dual functional role.


A new method of determining metabolisability of energy and digestibility of fatty acids in broiler diets.

1. A new method of determining dietary metabolisability of energy and digestibility of fatty acids is described. 2. The method requires the digestion of the faecal sample with 4N NC1 and ashing the residue. 3. Comparisons with the "total collection" method that the 4N HC1-insoluble method has similar accuracy.


A comparison of one and fifteen minutes' equilibration in the technique of preserving fowl spermatozoa at subzero temperatures.

1. There was no difference in the fertilising potential of thawed fowl semen whether equilibrated for 1 min or 15 min in a glycerolised medium prior to freezing.


Effect of colchicine on the secretion of matrices of dentine and enamel in the rat incisor: an autoradiographic study using [3H]-proline.

Effects of colchicine on the incorporation of [3H]-proline into odontoblasts and ameloblasts at various development stages and on the secretion of the radioactive materials from these cells into dentinal and enamel matrices were studied autoradiographically, at 2,4,8 and 24 h after the injection of colchicine.  In young functional and functional odontoblasts and ameloblasts, the number of autoradiographic silver grains over the cells increased while those over the matrices decreased 2,4, and 8 h after the injection of colchicine.  However, the total number of grains over the cells and matrices were fairly uniform in all stages of cell development at all times after the injection of the drug.  It is suggested that the drug does not appreciably affect the incorporation of [3H]-proline or the successive synthesis of the dentinal and enamel matrices but affects the secretion of the matrices in both functional odontoblasts and ameloblasts by interfering with the structure and function of microtubules in these cells.


A sudden death associated with the use of sodium nitroprusside for induction of hypotension during anaesthesia.

A death from cyanide poisoning during operation was attributable to the use of approximately 400 mg (10 mg per Kg) sodium nitroprusside as an hypotensive agent. Autopsy cyanide levels of 0.5 mg per cent in blood and 0.3 mg per cent in urine and thiocyanate levels too low to measure in either, suggest an abnormality of cyanide metabolism. The lethal dose of sodium nitroprusside appears to be 7 mg per Kg. A safe regimen would be 3.5 mg per Kg as the anticipated total dose for the period of hypotension. Patients resistant to the full hypotensive effects of sodium nitroprusside, or unable to maintain the level of hypotension, or requiring more than 3.5 mg per Kg to achieve the required effect for the anticipated time, may accumulate toxic levels of cyanide in the blood. Patients with Leber's optic atrophy, tobacco amblyopia and possibly those with other nerve atrophies should not receive sodium nitroprusside or any other cyanide precursor.


Sodium nitroprusside in children: Observations on metabolism during normal and abnormal responses.

Three different responses to sodium nitroprusside as a hypotensive agent during anaesthesia in children are described. A constant high dose (greater than 3 mg/Kg) response to, abnormal resistance to and tachyphylaxis to the drug are recognised and are dangerous and potentially lethal. They are probably related to abnormalities of cyanide-thiocyanate metabolism resulting in cyanide accumulation. The abnormal responses produce metabolic acidosis, an increase in mixed venous oxygen tension and a decrease in arterial mixed venous oxygen content difference. Tachyphylaxis may be due to depletion of endogenous thiosulphate and was reversible by sodium thiosulphate therapy (150 mgm/Kg) in two cases in which it was used.


Transoesophageal aortic velography in man.

An ultrasonic probe placed in the oesophagus of anaesthetized patients was used to observe the velocity of the blood flow down the descending aorta. The operating principle of the technique was the Doppler shift of the reflection of a continuously emitted MHz beam of ultrasound. The human oesophagus took up to 15 minutes to accommodate to the presence of the probe in the oesophagus. Changes in the diastolic portion of the flow pattern were seen with small changes in peripheral resistance (produced by transiently obstructing a femoral popliteal by-pass graft) (Figure 1). Surgical stimuli also produced marked changes in the flow pattern (Figure 3) before arrhythmias occurred. Following a prolonged period of cardiac arrest the flow pattern was observed to return to normal very quickly (Figure 4). It is suggested that the ultrasonic trans-oesophageal probe could play a useful role in patient monitoring in anaesthesia.


Some pharmacological properties of althesin (CT1341) in man.

Althesin in dose ranges of 40, 60 and 80 mul/Kg was administered to six healthy unpremedicated volunteers according to a balanced incomplete block design. Both subjective and objective changes resulting from the administration of the agent were studied and analyzed. In the dose ranges used, Althesin was found to have no deleterious effects on heart rate, respiratory rate or blood pressure and apnoea only occurred in one patient who had an end-expiratory CO2 level lower than normal, due to preanaesthetic hyperventilation. The onset of sleep is prolonged with Althesin at the injection rate of 1 ml/10 secs. The onset of anaesthesia is not influenced by the total dose, but the sleep time is directly proportional to the dose injected. Auditory evoked responses tended to lie on a curve which might indicate that with increasing dose the time to reappearance of these responses is not correspondingly prolonged. However, this last observation must be confirmed by studies on a larger scale.


Anaesthetic complications in surgical out-patients.

This study reports retrospectively the post-anaesthetic complications in surgical out-patients. We have studied the incidence and severity of these complications during the first five post-operative days in 500 female patients who underwent tubal ligation by laparoscopy. The report shows that post-anaesthetic complications in surgical out-patients are frequent but of mild severity. Although they produced some discomfort for the patients most of them were of the opinion that the advantages of having the operation as out-patients made up for the discomfort.


A rapid and sensitive auxin binding system for detecting N6-substituted adenines, and some urea and thiourea derivatives, that show cytokinin activity in cell division tests.

A selective, sensitive and rapid (2 min or less) method for detecting compounds with potential for cytokinin activity is described. The method does not measure cytokinesis; instead, it determines the ability of cytokinin-active agents to (i) activate the intake of either L-tryptophan or indoleacetic acid by germinated spores of the water-mould Achlya, while inhibiting the energy-dependent transport of all L-amino acids usually found in proteins; (ii) inhibit the energy-dependent transport of nucleosides and sugars by the same organism. The compounds with cytokinin activity generally activate auxin (tryptophan) intake at 10(-8) M or greater and inhibit at 10(-6) M or greater. The most effective activating compounds were N6-(delta2-isopentenyl)adenine, N6-benzyladenine. N6-furfuryladenine, and N6-(trans-hydroxy-3-methyl-but-2-enyl)adenine. These compounds are classed generally as cytokinins in plant growth studies. A cell membrane - localized glycopeptide of molecular weight 6000 was isolated from this organism and shown to be the site at which cytokinins, auxin, and tryptophan bind. An earlier study had also established that calcium ions bind to this entity as well. Tryptophan binding to the glycopeptide was enhanced by cytokinins, suggesting that this may be the way in which whole cells display enhanced tryptophan binding in the bioassay. On the other hand, calcium binding was antagonized by cytokinin. The results suggest that this may be an important experimental system for use in studying one possible way in which cytokinin may regulate plant growth.


Partial characterization of a histone acetyltransferase from trout testis.

Histone acetyltransferase activity of trout testis was studied both in intact nuclei, and in high salt nuclear extracts. With intact nuclei, the distribution of incorporated [14C]acetate in the various histones was similar to that observed in vivo; the arginine-rich histones H3 and H4 showed the highest specific activities, and lower amounts of label were detected in histones H2a and H2b. Histone H1 incorporated little or no label. Acetyltransferase activity could be detected in purified, sheared chromatin after the addition of MgCl2 or KCl, suggesting that the enzyme is bound to chromatin. Treatment of nuclei with 0.4 M NaCl caused the dissociation of acetyltransferase activity. Most of this solubilized activity failed to bind to DEAE Sephadex and behaved as a high molecular weight heterogeneous complex on Sephadex G-100, suggesting that the enzyme is present as an aggregate with other proteins in the extract. The pH optimum of this preparation was approximately 8.5, and the enzyme showed a preference for histones H3 and H4 as substrates.


Studies on the fatty acid binding proteins in cytosol of rat liver.

Gel filtration on Sephadex G-75 of crude rat liver supernatant preincubated with [1-14C]oleic acid yields three peaks of radioactivity which are attributed to the presence in these fractions of fatty acid binding proteins. We have confirmed these observations with binding assays by phase partition, polyacrylamide gel electrophoresis, and thin layer electrofocusing. Peak I (mol. wt. 60,000 pI 5.01 was shown to be albumin, which mainly arises from a contamination of the liver preparation by blood. Peak II (mol. wt. 10,000, pI 5.9) is a fatty acid binding protein. Finally peak III (mol. wt. 1500, pI 5.7) is a fatty acid binding component, the chemical nature of which was not elucidated. These fatty acid binding fractions have no effect on the reaction of acyl-CoA synthetase whereas the crude liver supernatant does stimulate the activation of fatty acid as shown earlier. In consequence, the physiological role of these fatty acid binding fractions is not yet elucidated.


Epidemiologic features of cerebrovascular disease in Manitoba: incidence by age, sex and residence, with etiologic implications.

To determine the incidence of and risk factors in cerebrovascular disease in Manitoba, all 1367 new cases in defined areas (population, 660 391) in an 18-month period were studied. Pertinent data were collected from hospital records, death certificates and autopsy reports. The annual incidence of cerebrovascular disease in these areas was 138/100 000 and the incidence was generally higher in men than in women. The incidence of cerebral infarction (INF) and that of hemorrhage (HGE) were similar in men and women less than 50 years old; thereafter the incidence of INF increased faster with age than did that of HGE, the disparity being greater in men than in women, whereas the incidence of HGE increased at similar rates in the two sexes. The incidence of INF was significantly greater in men than in women in urban areas, and in men it was greater in urban than in rural areas. Elevated concentrations of serum lipids and smoking are implicated as risk factors in INF, and hypertension as a risk factor in HGE.


An Ontario solution to medically underserviced areas: evaluation of an ongoing program.

In 1969 a program was established to place physicians in area of Ontario deemed to be medically underserviced. The main features of the program are area designation, physician subsidies, student bursaries, community participation and physician recruitment. From 1969 to March 1973, 162 communities were designated as underserviced and 196 physicians placed. As the program became active the rate of increase of numbers of  physicians practising in northern rural areas (population, less than 15 000) increased sharply, exceeding that for the entire province. Fifty-three percent of bursaried students have honoured their commitment. Seventy-five communities have built modern medical centres that have been an important factor in attracting physicians. Still unanswered are whether the physicians will stay and whether the health of the population will be improved.


Poisoning and poison control centres in Canada.

Poisoning is a major and increasing health problem in the Western world. In 1972 the 310 poison control centres in Canada reported 53 531 enquiries about poisoning, 40% in adults. In 1964 the numbers of hospital admissions and deaths due to poisoning in this country were 2446 and 38, respectively, but in 1972 the figures were 6263 and 319, respectively. Most of the hospitalizations and deaths were among adults. Of 100 Canadian poison control centres two thirds were staffed by "any nurse in the emergency room", most of whom had received no training to answer the phone enquiries. However, two thirds agreed a training program is needed. Only 6.7% of 223 parents surveyed stated they would call a poison control centre if their child had accidentally swallowed a large amount of a  poisonous substance. Regionalization of centres, a training program for personnel answering telephone enquiries, the need for crisis intervention as part of poison control programs, and public education about poisoning and poison control centres are the new challenges facing those providing health services.


Correction of severe facial deformity.

A craniofacial team has been developed to corrdinate the treatment of patients with severe facial deformity and to minimize the surgical risks. Two hundred patients have been evaluated in the last 4 years and more than 100 treated by this team to correct orbital hypertelorism, oxycephaly and plagiocephaly with exophthalmos, features of Crouzon's disease and Apert's and Treacher Collins syndromes, hemifacial microsomia, and severe lower facial deformity and malocclusion. Surgical principles include extensive subperiosteal stripping of bone, osteotomy as necessary, and repositioning maintained by bone grafts. Postoperative evaluation is being maintained for 5 years or to maturity in younger children. Although many of the results are less than perfect, there has been sufficient improvement, especially psychologic and functional, to warrant continuation of the surgical program under closely controlled conditions.


Experience with Yersinia enterocolitica at The Hospital for Sick Children, 1972-74.

Thirty-six cases of Yersinia enterocolitica infection were detected in the years 1972-74. The form of the illness in young children was acute gastroenteritis and in older children "appendicular syndrome". Improved isolation and identification techniques have increased the laboratory recognition of this enteric pathogen.


Cranial computed tomography in infants and children.

Cranial computed tomography has been performed in adults for the past 2 years but relatively few children have undergone this procedure. The specific uses in children are in detecting intracranial mass lesions and identifying the character of the lesion, and evaluating congenital cranial diseases such as cerebral dysplasia, tuberous sclerosis and leukodystrophies. This safe, rapid, noninvasive technique will soon replace or supplement standard neuroradiologic techniques in infants and children.


Cystic fibrosis: present status and future prospects in detection of patients and carriers.

Development of a sensitive, easily performed, reliable test would be an important advance in detecting cystic fibrosis, improving genetic counselling and providing early effective treatment. The sweat chloride test, which is reliable in diagnosis, is technically too difficult for a screening program, and only reliably detects homozygotes. In contrast, the meconium test for detecting homozygote newborns is simple, inexpensive, reasonably specific but its general application has yet to be evaluated. Detection of serum components is the basis of two new tests to distinguish patients with cystic fibrosis and carriers. The effect of these serum components on ciliary activity is the principle of one test, an extremely difficult procedure that is subjective and lacks sufficient specificity for routine use. The second test, in which serum components are separated by isoelectric focusing, may provide an objective biochemical means of detecting both homozygotes and heterozygotes.


Breast cancer report.

The recent increased public awareness of the necessity for early diagnosis of breast cancer has been accentuated by an intense exposure by the news media centering about the disease. This publicity includes the unfortunate but timely clinical sources of the wives of the President and the Vice President of the United States, Mrs. G.F. Ford and Mrs. N.A. Rockefeller. This paper attempts to quantitate in a subjective manner the impact of the events on the American public by comparing the incidence of operative procedures in similar populations in the Nashville community during October through December, 1973, and October through December, 1974, the latter period following the operative procedures upon Mrs. Ford and Mrs. Rockefeller. A statistically significant increase was noted in patients seen, biopsies performed, and cancers detected.


Combination chemotherapy in metastatic carcinoma of the breast. Results with a three-drug combination.

Forty-two patients with Stage IV carcinoma of the breast were treated with an oral program of combination chemotherapy consisting of three drugs: methotrexate, 5-fluorouracil, and cyclophosphamide (substituting 1, 3-bis (2-chloroethyl)-1-nitrosourea in cases with central nervous system involvement). Sixty-four percent of the patients responded to the therapy, with a mean and a median duration of remission of 10.7 and 10.0 months, and a mean and median survival of 12.3 and 13 months. This therapeutic program is equally effective for pre- and postmenopausal patients and does not appear to be influenced by prior response to hormonal manipulation, single or combination drug therapy, or duration of disease. The results are comparable to those shown by previous authors. Toxicity in this group, however, was minimal, and patient acceptance excellent.