"Tropical pyomyositis." A diagnostic problem in temperate climates.

Pyomyositis is a common disease in tropical countries, but is believed to be rare in temperate climates. Two children who had never left the northeastern part of the United States developed single intramuscular abscesses. Pyomyositis may be more common in temperate climates than has previously been appreciated.


Histidinemia. Classical and atypical form in siblings.

Two brothers, 6 and 13 years old, had histidinemia. On the basis of clinical and biochemical observations, the younger boy was considered to have a classical type of the disease, while the older boy had an atypical form characterized by partial impairment of the skin histidase activity and a moderately prolonged half-life of blood histidine. The mother is a heterozygous carrier, while the father and sister seem to be normal.


Correlation of lower esophageal sphincter pressure and serum gastrin level in man.

Resting lower esophageal sphincter pressures and fasting serum gastrin levels were measured in 35 consecutive patients. 28 of these patients were subdivided into Group I, which consisted of 9 patients with symptomatic gastroesophageal reflux and hiatus hernia, and Group II was further subdivided into Group IIA, 5 patients with hiatus hernias, and Group IIB, 14 patients without hiatus hernia. Mean LES pressures for Groups I, IIA, and IIB were 9.7, 36.8, and 25.6 cm H2O, and serum gastrin levels were 129, 74, and 116 pg/ml, respectively. Examination of these data as a whole or as subgroups failed to demonstrate a correlation between these two variables. The remaining 7 patients had abnormal sphincters (3 patients which scleroderma and 2 with achalasia) or abnormal serum gastrin levels (1 patient with pernicious anemia and 1 patient with antrectomy and Billroth II anastomosis). For these patients as well, no correlation between LES pressure and serum gastrin level was found. These results cast doubt on the hypothesis that endogenous gastrin is a major factor in the maintenance of resting LES pressure.


The mucosal lining of the intramural common bile duct as a determinant of ductal opening pressure.

Microanatomical evidence is presented which shows that the lumen of the intraduodenal portion of the common bile duct is almost completely filled by folds of a highly vascularized mucosa in the dog, cat, rabbit, and human.  These folds are most apparent near the intraduodenal ductal orifice, where they almost completely occlude the lumen.  Physiological data are presented which indicate that changes in systemic arterial blood pressure are associated with changes in the opening pressures of the choledochoduodenal junction of the cat and dog, which vary in the same direction.  Experimental results indicate that bile duct opening pressures of these two species are increased by the intraductal administration of histamine and reduced by the intraductal administration of norepinephrine.  A histological examination of the intraductal mucosal folds in this area, subsequent to the administration of the elevating agent, revealed a marked presence of vascular engorgement.  It is concluded that the most significant determinant of changes in ductal opening pressures in the cat and dog is probably the state of the mucosal vasculature of the terminal portion of the common bile duct.


Selective arteriography in the diagnosis and evaluation of amebic abscess of the liver.

Hepatic selective arteriography was performed in 20 patients with an amebic hepatic abscess.  In most cases, arterial hepatic vascularization showed a characteristic change in the benign space-occupying lesion.  The arteriogram revealed displacement of intrahepatic arteries, with a bare area outlined by curved, narrowed, and stretched vessels.  The hepatogram phase showed a different radiolucency of the liver parenchyma in the area of the amebic abscess.  It is possible to differentiate between an abscess and an hepatic malignant tumor by hepatic arteriography.  This technique is valuable in that it can be used to determine whether the abscess has disappeared  after medical treatment.


Diffuse leiomyomatosis of the esophagus: a case report and review of the literature.

A case of diffuse leiomyomatosis of the esophagus in a 21-year-old woman with a 5-year history of dysphagia is presented.  The radiological appearance was that of achalasia, but at esophagoscopy, a diagnosis of an organic stricture of the lower end of the esophagus was made.  During the operation a diffuse tumor involving the lower end of the esophagus, cardia, upper portion of the stomach, and the tail of the pancreas was found.  The histological diagnosis was diffuse leiomyomatosis of the esophagus.  The individual characteristics of the microscopic picture are described.  Distal esophagectomy and total gastrectomy resulted in complete recovery of the patient.  This is a very rare condition; only a dozen similar cases have been published before.  The data of these patients are presented.


Hemobilia and pancreatitis as complication of a percutaneous transhepatic cholangiogram.

Percutaneous transhepatic cholangiography (PTC) was performed on a 23-year-old male because of an atypical progression of hepatitis B antigen-negative hepatitis.  No bile duct was entered and the procedure was uneventful.  However, celiac angiography the day following PTC revealed abnormal liver vessels in the target area and the patient developed hemobilia and clinical pancreatitis, causing common bile duct obstruction.  Symptomatology persisted until celiotomy 32 days after PTC.  Clots were found obstructing the bile duct.  This case is presented both because of the unusual complications of PTC and the unusual angiographic abnormalities.  It is suggested that when there is a specific indication for the procedure either to differentiate cholestatic jaundice from extrahepatic jaundice or to localize a site of abstruction before surgical intervention.


Combined use of percutaneous transhepatic cholangiography (P.T.C.) and endoscopic ampullary cholangiography in the diagnosis of "difficult" jaundice cases.

When bilirubin levels are elevated, visualization of the biliary ducts is only possible by endoscopic transampullary cholangiography or by P.T.C. Cannulation of the biliary tree is difficult under the best of circumstances and when obstruction exists at the caudal end of the ducts, success is frequently precluded. P.T.C. then becomes the modality of choice, since visualization can be achieved in 98% of cases when obstruction exists. These methods are complementary. Each should be used when the other fails. Their dual application and complementary role in "difficult" jaundice cases is elaborated upon in the 16 cases reported in this current series. Their combined use should help elicit the diagnosis in almost all cases of jaundice.


Cardiovascular lesions in pancreatitis.

Data have been presented correlating changes of blood coagulability, capillary permeability, blood electrolyte content with electrocardiographic abnormalities and symptoms of coronary insufficiency. In acute pancreatitis and in acute exacerbation of chronic pancreatitis, accentuation of these vascular factors may induce symptoms of coronary disease. Data are also presented indicating abnormal blood coagulability and blood electrolyte content in patients with chronic pancreatitis. Minimal augmentation of these abnormalities may account for the "yoke" syndrome.


Simultaneous changes in pancreatic and gastric secretion induced by acute intravenous ethanol infusion. Effect of atropine and reserpine.

The simultaneous effects of acute i.v. ethanol administration (1.3 gm./kg.) on pancreatic and gastric acid secretion was studied on dogs provided with chronic pancreatic and gastric fistulas (Thomas cannula) and subjected to a continuous i.v. injection of GIH secretin (0.5 CU./kg./hr.) and gastrin (Eurorga hog gastrin I-II, 6 gamma/kg./hr.). Acute i.v. ethanol inhibits the pancreatic secretion of protein (concentration and output) and stimulates gastric acid secretion. Experiments were repeated: 1. Superimposing an atropine infusion (1.0 mg./hr.) on the continuous hormonal perfusion. 2. After reserpine administration for 48 hours (0.10 mg./kg./24 hr.) Atropine abolished the ethanol-mediated inhibition of pancreatic protein secretion but did not prevent the alcohol-mediated gastric acid stimulation. Reserpine did not change the ethanol-mediated pancreatic inhibition. It is assumed that in nonalcoholic dogs, i.v. ethanol inhibits pancreatic secretion by an intermediate nervous mechanism and enhances gastric acid secretion by acting directly on the oxyntic cells. Reserpine induces a high plateau level of HCl secretion which obscures the ethanol-mediated excitatory influences on the oxyntic cells.


The effect of diazepam on pentagastrin-stimulated and nocturnal (sleeping) gastric secretion in man.

Intravenous diazepam will not significantly suppress gastric secretion within the first hour after "maximal" stimulation with pentagastrin. In the second and third hours, however, gastric secretion is significantly diminished. Further suppression after pentagastrin and diazepam is possible in each of the three post-stimulation hours by the simultaneous administration of atropine. Diazepam does not suppress the seven-hour basal nocturnal gastric secretion during sleep. This suggests that diazepam acts during wakefulness by inhibition of secretory stimuli arising centrally, thus providing a rationale for use of this drug in patients with peptic ulcer in whom stress may be a factor in the pathogenesis.


Studies of the effects of blockage of intestinal lymphatics. III. Temporary isolation of lymphedematous bowel from intestinal continuity.

Eight dogs underwent intestinal lymphatic block. Once intestinal lymphedema was established, a segment was excluded from continuity for four months and then restored to continuity. The lymphedema decreased during exclusion and reappeared after restoration to continuity. The relationship of the changes seen in the intestine following lymphatic block and to the changes observed in the bowel in regional enteritis suggests a pathogenetic role for lymphatic blockage and explains the pseudobeneficial effects of by-pass as well as the prompt recrudescence of pathology which follows reconstruction procedures.


Barium peritonitis.

A case of generalized peritonitis, secondary to a rupture of the rectosigmoid portion of the colon is presented. The surgical management is discussed, a basic part of which is the use of a Baker tube to splint the small intestine while adhesions form in a pattern along the tube, as a substitute method for a Nobel plication, to prevent chronic small intestinal obstruction. Extensive lavage of the peritoneal cavity should also be carried out. Energetic fluid replacement with careful monitoring of the fluid and electrolyte balance is essential before, during and after the surgical procedure. Adequate broad spectrum antibiotic coverage is important. We believe that the management of these cases should be by surgical intervention and institution of the above mentioned measures and not by expectant therapy and treatment of complications.


Spntaneous perforation of the gastrointestinal tract in patients with cancer.

The mortality of spontaneous gastrointestinal perforation in 36 patients with cancer was 84% (30 patients).  The main factors responsible for this included failure of recognition, perforation through tumor, advanced uncontrolled disease and multiple organ failure.  Six of 19 patients who underwent surgery survived (32%).  Five of these patients did not perforate through tumor and their underlying malignancy was in good control.  Earlier diagnosis is essential.  Prompt surgical intervention and intensive supportive measures are indicated only if additional therapy of the underlying malignancy offers a reasonable chance for continued worthwhile palliation.


Gastric polypectomy.

In 138 patients of 215 gastric polyps were removed by electroresection through a fiberscope and the polyps recovered in toto by suction or special grasper-forceps.  Discepancies of histological findings in the biopsy specimens and in the tissue of the whole polyps were often found.  Follow-up examinations of the cases were presented.  Based on our experiences a new histological classification of gastric polyps is neccessary.


Clinical application of amylase isoenzyme analysis.

Amylase isoenzyme analysis of serum, urine and other bodily fluids using dextran gel and ion exchange chromatography provides a new dimension in the identification of pancreatic disease.  Examples are described that illustrate the clinical application of such analysis and the usefulness of the information that may be derived.


Can regional enteritis resolve completely?

The clinical experiences with a few patients diagnosed as regional enteritis by x-ray and histological examination and treated as such during a period of 15-40 years, have furnished some interesting data. It appears that in some instances, regional enteritis may gradually resolve completely or "burn" itself out, while in others it may be asymptomatic for years only to reappear suddenly with marked abdominal symptoms. An asymptomatic course can occur without steroid therapy. Initial surgery may be "curative" in some for many years; in others for only a short time.


Gastroduodenal Crohn's disease presenting as biliary colic.

A 31-year old physician, with a 15-year history of regional enteritis, presented with a gallstone and biliary colic, who on further work-up proved to have Crohn's disease of the stomach and duodenum.  Roentgenographic, endoscopic and biopsy material were all consistent with Crohn's disease of the stomach and duodenum.  Response to steroid treatment indicated that the symptoms were secondary to Crohn's disease and, as such, this is the first report of this rare problem.  Further, to our knowledge this represents only the ninth endoscopy and only the second biopsy via endoscopy to demonstrate a noncaseating granuloma from the stomach in this disease.


"Trench ulcer" of the stomach.

The clinical, endoscopic and histological findings of 14 cases with unusual gigantic ulcers of the stomach were reported. The patients were mainly aged, complicated by cardiovascular diseases. The ulcer was designated as "trench ulcer" from the characteristic endoscopic features, which ran from the cardiac portion to the angle along the lesser curvature.


Effect of glucagon on pure human exocrine pancretic secretion.

In this study the inhibitory effect of glucagon on pure exocrine pancreatic secretion obtained by direct drainage of the duct of Wirsung in man is demonstrated.  In two experiments carried out during stimulation with secretin and CCK-PZ and in one experiment during secretin stimulation an inhibitory effect on pancreatic secretion was found.  This effect was global, affecting both the total volume and the concentration and output of protein and the output of bicarbonate.  The greater inhibition, however, occurred in the case of protein.


Comparison of two lidocaine preparations by in vivo assay methods.

An in vivo study was conducted to determine if there were differences in local anesthetic potency between two commercial brands of lidocaine. The two preparations were evaluated in terms of onset of action, peak effects and duration of action using a double-blink technique. Both products were tested at concentrations of 0.25%, 0.50% and 1%. Each were evaluated for conduction (in rats), topical (in rabbits) and in filtration (in guinea pigs) anesthesia. No clinically significant differences between the two commercial preparations were found.


Training, utilization and motivation of pharmacy technicians--a five-year analysis.

A 600-hour-on-the-job training program for hospital pharmacy technicians is described. Qualified applicants who successfully pass a written examination are admitted to the program. Trainees receive both didactic and practical experience in all service areas of the pharmacy department. Opportunity for advancement through a technician specialist training program is available. Eighty percent of all applicant accepted into the program graduated, and 39% are currently employed by the pharmacy department with an average of 42 months work experience each. It is recommended that national guidelines are established for hospital-based pharmacy technician training program.


Influence on medication therapy of increased patient services by pharmacists in a pediatric hospital.

The effect of decentralized pharmacy services on medication therapy was studied. The records of 200 patients at a 175-bed, nonprofit, pediatric hospital were reviewed to determine the drug therapy received agreed with the indications, contraindications, ages and dosages recommended by the official labeling. Half the patients received treatment before decentralized pharmacy services and half after. For all drug-use variables, a one-way analysis of variance revealed no significant differences between the two groups of patients.


Phenformin-associated lactic acidosis; a review.

A case of lactic acidosis associated with phenformin therapy for diabetes mellitus is reported, and 34 previously reported cases of lactic acidosis associated with phenformin therapy are reviewed to determine if any predisposing factors to lactic acidosis were apparent. Observations of sex, age, duration of diabetes, pathologic conditions, dosage, duration of phenformin therapy and the onset of symptoms preceding lactic acidosis were made. Renal impairment, urinary tract infections, hepatic impairment, ethanol ingestion and poorly controlled congestive heart failure were found to be predisposing factors to lactic acidosis. The appearance of a syndrome of impending lactic acidosis consisted of anorexia, nausea, vomiting with abdominal pain or lethargy.


Use of fructose in the treatment of acute alcoholic intoxication.

The literature concerning the use of fructose to lower ethanol blood levels in acute alcoholic intoxication is reviewed. Studies indicate that 500 ml of a 40% infusion of fructose solution given over a 30-minute period can increase the rate of decline of ethanol blood levels by 25%. The recommended daily dosage is one to three liters of a 10% solution. Lactic acidosis is a potentially serious side effect of large doses of fructose. The lack of controlled clinical studies or other convincing evidence makes the routine use of fructose to treat acute alcoholic intoxication inadvisable.


Quantitative determination of phenol in ointments.

A quantitative method for the assay of phenol in ointments is described. The procedure involves the formation of a blue indophenol by reacting phenol with 2,6-dibromoquinone-4-chloroimide which can be measured spectrophotometrically. The method is accurate, and interference from other active ingredients (hydrocortisone and menthol) does not occur.


Pharmacy-based analytical toxicology service.

An analytical toxicology service, which primarily tests specimens for drugs of abuse but also determines blood levels of therapeutic drugs, is described. Analytical methods discussed are the enzyme multiplied immunoassay technique, hemagglutination-inhibition, the free radical assay technique, radioimmunoassay, thin-layer and gas liquid chromatography, and spectrophotometric analysis. A typical scheme for drug analysis is presented.


Development and implementation of a pharmacy technician training program.

A nine-month on-the-job training program for hospital pharmacy technicians is described. The first three months of the program are devoted to didactic training and the remaining six months to acquiring practical experience. Candidates for the program are provided through state-sponsored public assistance or manpower training programs. A minimum of six individuals are needed to begin a program to ensure that during at least three complete it. Forth technicians have completed the program during the past six years, and eight are currently employed by the hospital. Thirteen others are known to be employed at other institutions or in health-related occupations.


Clinical use of potassium supplements.

The clinical use of potassium supplements is reviewed. Included is a discussion of the measurement of potassium status, oral and intravenous potassium therapy, intraperitoneal potassium administration, and hazards of potassium supplements. It is concluded that the potential hazards of potassium indicate a need for a more rational approach to potassium therapy.


Determination of methadone hydrochloride in a maintenance dosage formulation.

A colorimetric method for direct quantitative assay of methadone hydrochloride in liquid oral dosage forms is presented. The procedure involves the formation of a dye complex with bromothymol blue buffer solution. The resultant complex is extracted with benzene and measured spectrophotometrically. Duplicate tests on the formulation showed 99.2% of the labeled amount of methadone.


Use of bioavailability data by practitioners. I: pitfalls in interpreting the data.

Potential pitfalls in evaluating bioavailibility data are presented.  These pitfalls are involved with interpretation of the therapeutic significance of the data, the methodology of the bioavailibility study and presentation of data.  Specific information which should be requested from manufacturers for proper evaluation of bioavailibility data is given.


Implementation of the medication technician concept.

The implementation of a pharmacy-controlled medication technician program is discussed.  Qualified candidates are selected and trained to administer medications to patients under the supervision of a pharmacist.  A centralized unit dose drug distribution system is employed. The responsibilities of the technicians and the pharmacists are presented.


Unit dose innovations.

Four innovations in a unit dose drug distribution system are described. The innovations involve prefilling oral syringes, distribution of refrigerated doses, pharmacist verification of nurses' transcriptions of medication orders, and pharmacy preparation of dose administration schedules.


Particulate contamination and stability of three additives in 0.9% sodium chloride injection in plastic and glass large-volume containers.

The effect of particulate matter and stability of three parenteral drugs upon addition to glass and flexible polyvinyl chloride containers of 0.9% sodium chloride injection was studied. Aminophylline, lidocaine hydrochloric and metaraminol bitartrate were added to the solution in therapeutic quantities using techniques normally practiced by the hospital pharmacist. Statistical comparisons of the amount of particulate matter present were made for each solution consisting of drug added to plastic and glass bottles, drug filtered through a 0.22-mum filter and then added to the solution in plastic bags, controls for bags and bottles, and solutions with adjusted pH values to simulate the pH attained after addition of the drug to the solution. A correlation appeared to exist between the quantity of particulate matter and the amount of unfiltered drug solution added to the large-volume parenteral containers.  Differences in storage and handling had an influence on the initial quantity of particles found in the plastic bags, no significant change in concentration of the drugs occurred during the 24-hour test period.


Communication techniques for patient instruction.

The techniques of pharmacist-patient communication are discussed.  Ways in which the pharmacist can identify the patient's information needs, control communication timing, define communication objectives, develop methods of communication and evaluate the effectiveness of his instructions are covered.


Pharmacy newsletter evaluation by nurses.

A survey of staff nurses was conducted to determine readership and evaluate the usefullness of a pharmacy newsletter.  Questionnaires were sent to a random sample of 50 nurses.  Of the respondents, 91% claimed to read the newsletter at least occasionally.  Formulary and pharmacy policy information was considered most important.  Interest in drug quizzes and features concerning drug therapy appeared to be high enough to make the newsletter an aid to inservice education.  Readership was felt to be at a sufficient level to justify publication of a regular monthly newsletter for staff nurses.


Pharmacy use of the shared hospital accounting system.

Three uses of the Shared Hospital Accounting System (SHAS) by pharmacies in two hospitals are described.  Improvements in the inventory control system, more accurate drug usage information and formulary drug lists are benefits derived through the use of this computer system.  It is recommended that pharmacists practicing in hospitals using SHAS implement sismilar programs.


Management challenges to the hospital pharmacist.

The challenges to the management abilities of the hospital pharmacist are identified.  Included is a review of the forces acting to change the hospital management climate and the changes occurring in the field of management itself.


Evaluation of a program of systematic instructional procedures for extremely poor retarded children.

A demonstration program was conducted in which 54 innercity children classified as educable mentally retarded were selected on the basis of age, IQ, family income, race, and achievement scores.  They were then placed into self-contained classrooms with two classes being taught by precision-teaching procedures and two classes being taught by the methods particular to their teachers.  Tesults showed that a high percentage (60 percent) of the children taught by precision-teaching procedured were capable of acquiring the basic skills necessary for regular-class placement.


Cardiac effects of hemodialysis: noninvasive monitoring by systolic time intervals.

The effects of hemodialysis on cardiac performance were evaluated by systolic time intervals measured blindly in 15 chronic renal failure patients maintained free of circulatory congestion.  After a mean dialysis of 8.7 hours, levels of blood urea nitrogen, serum creatinin, and potassium and body weight showed statistically significant decreases and serum calcium and hematocrit values increased; heart rate and both diastolic and systolic blood pressure did not change significantly.  Left ventricular ejection time (LVET) and ejection time index (ETI) were significantly shorter, falling from within normal limits to below normal.  Pre-ejection period (PEP) rose significantly.  These changes are consistent with a two-fold immediate effect of hemodialysis: (1) reduction of stroke volume as reflected by decreased ETI; and (2) reduced Starling effect, with or without decreased contractility, as reflected by increased PEP.


Effects of structural variations in elaboration on learning by EMR and nonretarded children.

The effects of three elaboration structures (compound sentences, complex sentences, and paragraphs) on the paired-associate learning and reversal of 30 8- to 10-year-old nonretarded and 30 8- to 10-year-old EMR children were investigated.  Analyses of trials-to-criterion, first trial errors, and reversal errors did not reveal any differences in the effects of the three elaboration structures.  Results of the present study indicate that given constant meaning and relational factors, some forms of surface structure differneces (compound sentences vs. complex sentence vs. paragraph) are not significant in determining a child's ability to understand an elaboration or to use it in a learning situation.  There was no population difference found in the analysis of first-trial errors, although small significant differences between the nonretarded and EMR children were found in the analyses of trials-to-criterion and reversal performance.


Use of the lactose-ethanol tolerance test in diabetes.

The standard lactose tolerance test involves measuring a patient's blood glucose after the ingestion of lactose. If the patient has lactase deficiency and is unable to hydrolyze lactose and absorb its monosaccharides, glucose and galactose, the blood glucose does not usually increase greater than 20 mg/100 ml. Since factors other than the absorption of glucose can cause an increase in the blood glucose of greater than 20 mg/100 ml in a diabetic, this test could be unreliable when it is performed on a diabetic. The present study was performed to determine whether the lactose-ethanol tolerance test could be used to diagnose lactoase deficiency in diabetics. This test involves measuring the blood galactase level, instead of the blood glucose, and the administration of ethyl alcohol to a subject prior to the test to delay the clearance of galactose from the circulation. The results indicate that the standard lactose tolerance test in which the blood glucose is measured is unreliable when performed on insulin-dependent diabetics, but that it can be reliable when performed on non-insulin-dependent diabetics. The lactose-ethanol tolerance test gave results in each type of diabetic which were qualitatively similar to those of nondiabetics. It was concluded that the latter test is a useful screening test for lactase deficiency in diabetics.


Relationship of Piaget's sensorimotor period to language acquisition of profoundly retarded children.

The relationship of Stage 6 of Piaget's sensorimotor period and the acquisition of meaningful expressive language was investigated.  The sample consisted of eight profoundly retarded children who exhibited some meaningful expressive language and eight profoundly retarded children who exhibited none.  Chronological ages of the children ranged from 47 to 98 months.  A strong relationship was found between meaningful expressive language and Stage 6 functioning as tested by the Uzgiris and Hunt (Note 1) instrument.  The findings were discussed in terms of supporting Piaget's theory that cognitive structures exist which are prerequisites for the development of language.


Training and transfer of clustering and cumulative rehearsal strategies in retarded individuals.

Forty-four retarded adolescents varying in MA, IQ, and etiology were taught one of three active rehearsal strategies or assigned to a control condition. Immediate, short-term (1 day), and long-term (2 weeks) transfer of the strategy was assessed by presenting new 9-item serial lists on each day. Exposure durations, which indicated the rate of subject-pacing, showed that the two highest MA-IQ (mean IQ = 55) groups, one diagnosed as organically impaired and the other as cultural-familially retarded, successfully transferred their strategies over three sessions, while no transfer occurred in the lower MA-IQ group (mean IQ = 40). Greater consistency in the expected pattern of exposure durations of high MA-IQ subjects was found in the cumulative-rehearsal group than in the cumulative-clustering group across sessions. During immediate transfer, the best recall was found for the cumulative group, while on short-term transfer both the cumulative and the cumulative-clustering groups learned more rapidly than the clustering or control groups. No significant recall differences during long-term transfer were apparent for high MA-IQ subjects, probably due to a ceiling effect. For retarded individuals with IQs above 50, the cumulative-rehearsal strategy was the most efficient technique for inducing strategy transfer to a categorized serial list.


Action-concept usage by nonretarded and retarded children on structured tasks with praise for performance.

In equivalence-formation tasks, retarded children have been ovserved to use fewer action concepts than expected on the basis of their MA.  When tasks were structured and praise for performance was introduced, mildly retarded children performed like nonretarded children in most respects, except for total number of responses.  Moderately retarded children of the same MA showed improved performance but still performed more poorly than either of the other two groups.  The implications of these findings were discussed.


Therapy of staphylococcal infections: (a comparative study of cephaloridine and gentamicin).

Two groups of 38 patients have been treated for staphylococcal infection with either cephaloridine (4 gm daily) or gentamicin (320 mg daily) by the intramuscular route. The rate of favorable clinical response was higher among the patients who received cephaloridine (78.8 per cent) than among those who were treated with gentamicin (60.5 per cent). No death related to the infection occurred in the cephaloridine-treated patients. The mean peak and trough antibacterial activity reached in the serum of the patients after injection of the antibiotics was higher in patients receiving cephaloridine (1/64 and 1/16) than in those treated with gentamicin (1/16 and 1/4). Patients who failed to respond to therapy had often a low antibacterial activity of the serum. These studies suggest that the 1/8 level of bactericidal activity should be attained in the serum one hour after the administration of the antibiotics to allow optimal results in staphylococcal infections.


Effects of directive vs. nondirective play therapy with institutionalized mentally retarded children.

Institutionalized retarded children were randomly assigned to 11 sessions of directive play therapy (N = 5), nondirective play therapy (N = 5), or no treatment (N = 4). Student nurses were therapists.  The Denver Developmental Screening Test was administered before and after treatment.  For the Fine Motor and Personal-Social scales, a significant interaction effect (p smaller than .05) was found between treatment group and measurement period (pre vs. post).  The interactions tended to support the hypothesis that play therapy was effective in increasing developmental level but not the hypothesis that directive therapy was more effective than nondirective therapy.


Coma due to hypercalcemia in a patient with Paget's disease and multiple parathyroid adenomata.

A patient with histologically proven coexistent Paget's disease of the bone and parathyroid adenomatosis is described.  She developed coma associated with hypercalcemia and underwent successfully surgical removal of two parathyroid adenomata.  The differential diagnosis of hypercalcemia in patients with this rare association is discussed and the importance of early surgical treatment is stressed.  A review of similar reported case is presented.


Survey of reported sexual behavior and policies characterizing residential facilities for retarded citizens.

The results of a survey directed to administrators of 82 residential facilities for mentally retarded citizens were presented and discussed. The survey concerned sexual behavior among residents and professional attitudes toward these kinds of behavior.


Post-splenetomy spur cell hemolytic anemia.

A patient with post-necrotic cirrhosis is described in whom spur cell hemolytic anemia developed eight years after splenectomy in association with worsening liver function.  The presence of a spleen or splenic function is therefore not essential either for the formation of spur cells or for the hemolysis of such cells.  Splenectomy therefore should be regarded with circumspection in the management of patients with spur cell hemolytic anemia.


Retarded persons as "teachers": retarded adolescents tutoring retarded children.

The present study was concerned with investigating the effect of training mentally retarded adolescents in a residential school to act as tutors for younger retarded children who were deficient in dressing and eating skills.  The effect of a tutorial program on both the adolescents (tutors) and the young children (trainees), in terms of acquisition and retention of self-maintenance skills for the trainees and social and personal adjustment for the tutors, was examined.  Tutors received 30 hours of training in dressing-techniques and 30 hours of training in eating-techniques.  The tutors were able to teach the dressing- and eating-skills to the trainees in 18.5 and 20 hours, respectively.  The statistically significant overall success of the trainees supports the view that retarded persons can successfully instruct other retarded persons.  Educational and economic implications of the findings were discussed.


Role of naming in delayed matching-to-sample.

A delayed matching-to-sample task, with pictures as sample and comparison stimuli, was given to four severely retarded youths.  Although they matched accurately when the sample picture was available for comparison, they performed poorly on the delayed-matching in which the sample was removed a few seconds before the comparison stimuli appeared. When dictated names rather than pictures were presented as samples, three of the four subjects could match pictures to the names even under delay conditions which caused complete breakdown of picture-picture matching.  Further tests indicated that these three subjects could name the pictures.  Apparently, these three subjects were not applying existing skills (naming and remembering names during a delay) to the performances of the visual delayed-matching task.  The second experiment confirmed that when the subjects were instructed to name the pictures during the matching task, they could do delayed picture-picture matching accurately.  These findings suggested that some retarded persons, like some young children, may fail to bring existing language skills to the performance of a new task; instructions may bring out such skills, but the effect of the instructions may be transitory.


Performance and attributions to ability, effort, task, and luck of retarded adults after success or failure feedback.

Performance and causal ascriptions to the four factors effort, ability, luck, and task difficulty as a function of success for failure feedback were investigated.  A total of 40 male, educable mentally retarded adults served as subjects.  Although performance was unaffected by feedback, results, indicated that (a) success was ascribed to ability more than failure was attributed to lack of ability, (b) failure was attributed to lack of effort more than success was ascribed effort, and (c) failure was ascribed more to bad luck than than success was attributed to good luck.  No effects were found on task attributions.  Research implications for the attribution theory interpretation of the mentally retarded adults' motivation in achievement-related situations were discussed.


Acquisition of simple motor imitative behavior in mentally retarded and nonretarded children.

The effects of social reinforcement and population on two simple motor tasks which were embedded within a contingently reinforced imitation task were explored.  A  Social Reinforcement Type x Population interaction was observed, where the nonretarded children performed at higher levels under informative social reinforcement (right-correct) and at lower levels under affective social reinforcement (good-fine); the opposite was observed for the retarded children.  In addition, one motor response was imitated to a higher degree than the other response.


Bear meat trichinosis with a concomitant serologic response to Toxoplasma gondii.

A severe case of trichinosis occurred following the ingestion of raw meat from a common black bear, Ursus americanus, that was shot in Butte County, California. Examination of steaks cut from the bear revealed heavy infection with T. spiralis. A good clinical response was obtained following treatment with prednisone (1 mg/kg body weight per day) and thiabendazole (50 mg/kg body weight per day); no toxic effects were observed. In comparison with the pre-treatment biopsy, a more intense inflammatory response was seen following the administration of thiabendazole. Nevertheless, a muscle biopsy taken several months after discharge still showed well-encapsulated, morphologically intact larvae. In addition to the expected immunological responses to T spiralis, a marked rise in titer of antibodies to Toxoplasms gondii was observed by the fluorescent antibody and Sabin-Feldman dye test methods. Since toxoplasma infection of muscle is widespread in man, it is possible that an unrelated disease of muscle could result in stimulation of anti-toxoplasma antibodies similar to the findings in polymyositis and dermatomyositis. Alternatively, the possibility that a dual infection was acquired from the bear meat cannot be excluded.


Contribution of visual perceptual maturation to the ability to conserve.

The extent to which visual perceptual maturity contributes to intellectual efficiency, as measured by the ability to conserve, was investigated in educable mentally retarded and nonretarded children.  Hypotheses that visual perceptual ability and conservational ability would be positively correlated and that children with more mature visual perceptual processes would be better able to conserve were supported.  Relationships among visual perception, conservation, CA, MA, and IQ were discussed.


Predictors of parent involvement with institutionalized retarded children.

A multivariate discriminant function analysis was used to explore 22 biographical and psychological variables which were thought to have some possible bearing on frequency of family visits to the institution and attendance at parent conferences.  The analysis identified 6 of the variables as significant predictors, although the factors related to the 2 measures of parental involvement were not identical.  The 6 major predictors of lack of involvement were: presence of physical anomalies, high disparity between CA and social maturity, greater distance from the institution, low occupational level of the father, maintenance payments not being required, and the parent having custody being divorced and remarried.


Teaching a simple reading vocabulary to retarded children: effectiveness of fading and nonfading procedures.

Four equated groups of moderately retarded children were trained on a simple eight-word vocabulary, each under a different experimental condition.  In the standard condition a printed work was repeatedly paired with a pictured representation.  In the faded condition the same procedure was used except that the picture was gradually faded-out over trials.  A mixed condition had, on alternate trials, either work-and-picture or word alone, while on alternate trials a control condition had either picture alone or word alone.  On immediate and delayed tests of vocabulary learning, subject showed large differences in reading performance with these methods. The order of efficiency of conditions was faded, mixed, standard, and control.  Several theoretical interpretations of the superiority of fading were considered.  The conclusion favored was that the fading procedure was best because it increased the attention-value of the words in relation to the faded pictures, without sacrificing the superior associative effects of noncontingent pairings of words and pictures.


Provision of a language index for severely and profoundly retarded individuals.

The development of habilitative language programming for severely and profoundly retarded individuals requires detailed knowledge of their current levels of competence.  Specific information is needed regarding the particular language skills characteristically displayed, the frequency with which such skills are used, and the proportion of severely retarded individuals who evidence linguistic abilities at the various levels.  An index of language proficiency has been developed utilizing a standardized system of direct observation of subjects in their usual, familiar environment.  Data on a group of ambulant, institutionalized, severely and profoundly retarded individuals were described.  Some type of vocal or gestural communication was observed for about 75 percent of the subjects; almost 60 percent evidenced some vocal or verbal expression.  One in four subjects demonstrated meaningful, articulate speech.  Associations between language and factors such as sex, chronological and mental age, diagnosis, and biosocial history were investigated.  Implications of these findings were discussed in relation to programs for language development.


Performance of epileptic patients in continuous reaction-time situations.

Through the use of a 4-choice continuous reaction-time paradigm, the hypothesis that epiliptic patients have frequent lapses of attention was tested. Control subjects were nonepileptic mentally retarded subjects matched for IQ and CA.  Experimental variables were: paced and self-paced work, massed and spaced work periods, and short or long stimulus exposition.  The epileptic patients performed well as compared to the control group or to nonretarded persons with respect to reaction time, accuracy, and the occurrence of mental blocks.  No abnormal disturbance of attention was clearly detected.  This conclusion leads to the possibility that even for patients with severe epilepsy, some tasks can be defined that they can perform successfully.


Institutional tour effects on attitudes related to mental retardation.

The effects of an institutional tour on college students' attitudes toward the mentally retarded child, mentally retarded adult, state school for mentally retarded persons, and ward attendant at a state school for mentally retarded persons were investigated. Four separate Semantic Differential Scales were administered to 179 subjects prior to being given the alternative of touring a state school for mentally retarded persons (72 subjects took the tour).  Pretest responses were used to divide subjects into initially positive or negative attitude groups.  Posttest scores for each concept were then analyzed by a two-way classification mixed-models analysis of variance for unequal Ns. Results indicated significant positive effects on attitudes toward mental retardation as a function of the institutional tour.


Hypothesis-testing from a limited set: an example of mentally retarded subjects outperforming college subjects.

By making a discrimination problem's solution equivalent to an hypothesis (response alternation) known to be more dominant in retarded subjects than college students, superior performance by retarded subjects can be accurately predicted.


Epilepsy and abnormal calcium metabolism in institutionalized mentally retarded patients.

A group of epileptic and nonepileptic patients from an institution for mentally retarded persons was surveyed for roentgenographic and biochemical abnormalities of calcium metabolism. Osteoporosis, hypocalcemia, and increased alkaline phosphatase were found to be significantly increased in incidence in the epileptic group. The only significant difference among the osteoporotic and nonosteoportic epileptic patients was the increase fo the alkaline phosphatase in the former. Ambulation did not appear to influence the significance of the above parameters.


Colposcopic evaluation of the abnormal Papanicolaou test in pregnancy.

Colposcopy, including colposcopically directed biopsies in selected cases, was employed to evaluate over 300 pregnant patients with abnormal Papanicolaou tests suggestive of mild dysplasia or worse (Class III to V). Over half of the patients had benign disorders determined by colposcopic examination. All cases of invasive disease were diagnosed by colposcopy and biopsy, and the patients were treated accordingly. Only 3 diagnostic conizations were necessary in the antepartum period. The majority of patients with cervical intraepithelial neoplasia were seen post partum, and appropriate therapy was instituted. In the pregnant patient with an abnormal Papanicolaou test, colposcopy has proved to be a reliable and safe method of evaluation and has virtually eliminated the need for conization.


The incidence of fetal asphyxia in six hundred high-risk monitored pregnancies.

Six hundred high-risk monitored obstetric patients were reviewed for evidence of fetal asphyxia at delivery. The over-all incidence was 20 per cent, i.e., 8 times the incidence in a normal obstetric population. Highly significant indicators of risk for asphyxia were severe toxemia (79 per cent), prematurity with further medical or obstetric complications (36 per cent), and clinical fetal distress, particularly meconium staining with fetal heart rate abnormality (33 per cent). All obstetric, medical, or gestational complications in this review were associated with an increased risk for fetal asphyxia when compared to that in a normal obstetric population.


The elderly primigravida.

A five-year review of 127 elderly patients (35 years of age and over), in their first pregnancies, defines the risk to the fetus in terms of perinatal death and neonatal morbidity. With the equivalent of a perinatal mortality rate of 94/1,000, an 11 per cent incidence of small-for-dates infants, and a neonatal morbidity rate of 18 per cent, there would still appear to be a need for an increased awareness of the fetal risks in this group and an increased emphasia on their prevention. Areas of management in prenatal care and labor which might reduce these figures are defined.


Spectral analysis as a diagnostic aid in the management of high-risk pregnancy.

Spectral analysis of the fetal heart rate and intrauterine pressure was done with data obtained during labor for 24 patients delivered of their infants in an obstetric intensive care unit. The patients were grouped according to clinical assessment of labor and neonatal outcome as normal (11), abnormal/premature (4), and prolonged labor/cesarean section (9). A comparison among groups of spectral density functions and of coherence functions and phase angles failed to reveal consistent features that could be used to distinguish between groups. However, an analysis of the variance (integrated spectrum) and the mean of the base-line component of the fetal heart rate showed that the values for the normal and abnormal/premature groups could be distinguished from the background population. It is suggested that a study of the joint statistics of the variance and the mean may lead to the development of a diagnostic aid to the early detection of incipient fetal distress.


The use of the oxytocin challenge test for antepartum clinical evaluation of uteroplacental respiratory function.

Over the last 4 years at Los Angeles County-University of Southern California Medical Center, Women's Hospital, clinical interest in antepartum fetal monitoring has increased considerably. As a result of approximately 1,500 tests in some 600 patients at high risk for placental insufficiency, we have reached several conclusions regarding the methods for antepartum fetal monitoring, criteria for interpretation of the results obtained, and the role of antepartum monitoring information in clinical management. In this paper, the results of "stress" monitoring (monitoring in the presence of uterine contractions) are presented. The term "oxytocin challenge test" is used in reference to "stressed" monitoring even though sometimes the contractions were spontaneous, or without oxytocin stimulation.


Menstrual extraction.

This report documents the clinical outcome of 137 consecutive menstrual extractions. The pre- and postprocedural pregnancy testing is correlated with histologic examination of tissue obtained. This report reviews the management of the unsuccessful cases.


Ovarian cystadenofibroma: a consideration of the role of estrogen in its pathogenesis.

A review of 35 cystadenofibromas of the ovary has revealed certain morphological features which implicate the role of estrogenic hormones in the pathogenesis of these neoplasms. The epithelium was tubal in type and at the ultrastructural level was found to be comparable with that of the normal Fallopian tube during estrogenic stimulation. The appearance of the stromal fibroblasts in the connective tissue component of the tumor was also consistent with an estrogenic influence. It is suggested that the source of estrogen responsible for both the epithelial differentiation and the fibrous proliferation may be found in functional steroidogenic cells present in the stroma of the neoplasm.


Preliminary experience with 15 (S) 15-methyl prostaglandin F2 alpha for midtrimester abortion.

Twenty-six women received intramuscular or intra-amniotic 15 (S) 15-methyl prostaglandin F2 alpha to induce midtrimester abortion. The median initial injection-abortion interval was 10 hours and 25 minutes. The advantages of intramuscular analogue are somnolence and reduced discomfort during labor. Disadvantages include severe gastrointestinal toxicity in the majority of patients and symptoms of acute respiratory distress in two patients.


Effect of prostaglandin F2 alpha and hypertonic saline on the placental function during midtrimester abortion.

Changes in placental function during the induction of midtrimester abortion by prostaglandin F2 alpha and hypertonic saline were investigated. Serial estimations of human placental lactogen (HPL) and cystine aminopeptidase (CAP) were carried out in 17 subjects. There was a significant (P smaller than 0.01) reduction in the plasma CAP and HPL levels 4 hours after PGF2 alpha administration. In the case of hypertonic saline abortions only HPL levels showed a reduction at 8 and 12 hours after induction.


Serum alpha-fetoprotein in hydatidiform mole, choriocarcinoma, and twin pregnancy.

Serum alpha-fetoprotein (AFP) levels in patients with hydatidiform mole, choriocarcinoma, and twin pregnancy were studied by radioimmunoassay. Serum AFP was absent in seven of seven patients (100 per cent) with choriocarcinoma and 10 of 13 (76.9 per cent) with hydatidiform mole. However, low concentrations (below 8 ng. per milliliter) of AFP were detected in two patients (15.4 per cent) and 105 ng. per milliliter in one (7.7 per cent) with hydatidiform mole. In 10 of 14 patients (71.4 per cent) with twin pregnancy serum AFP levels were significantly above the normal range for single pregnancy and approximately twice as high as the average value in pregnancy. It was concluded from these findings that abnormal levels of serum AFP during pregnancy suggest the presence of various complications such as hydatidiform mole, choriocarcinoma, or twin pregnancy and that the determination of serum AFP is valuable for prenatal diagnosis. The origin and significance of elevated AFP in patients with hydatidiform mole are now being investigated.


Spontaneous lymphocyte transformation in pregnancies complicated by pre-eclampsia.

There was no significant difference between the mean spontaneous transformation rates of maternal lymphocytes from normal pregnant women and patients with pre-eclampsia.


A six-year prospective study of term breech deliveries utilizing the Zatuchni-Andros Prognostic Scoring Index.

Utilizing the Zatuchni-Andros Breech Scoring Index a prospective study of 290 consecutive term breech deliveries occurring at Evanston Hospital from Jan. 1, 1968, to Jan. 1, 1974, is reported. This paper represents a direct continuation of a retrospective study of 500 consecutive term breech deliveries reported by the authorsin 1970. The results indicate that this breech assessment method is a valid method and it is recommended that patients whose breech score is 3 or less be submitted to immediate cesarean section and, conversely, those with a breech score of 4 or more be allowed to labor with meticulous observation with a high confidence level that successful vaginal delivery will result. Also, cautious stimulation with intravenous oxytocin can be safely undertaken when necessary in patients with a breech score of 4 or more. By employment of the Zatuchni-Andros Breech Scoring Index, the authors submit, fetal mortality and morbidity rates are markedly diminished.


Plasma renin activity in maternal and umbilical cord blood during parturition.

Plasma renin activity (PRA) in umbilical cord blood exceeded that of maternal blood in 14 out of 20 cases. Fetal PRA was not significantly correlated to maternal PRA. Significantly higher fetal renin values than the corresponding maternal ones were restricted to shorter labor (N equals 10). In cases with uterine inertia (N equals 8) higher values than in normals (N equals 7) were observed, whereas suppressed maternal and cord blood levels were found in maternal fluid retention with edema (N equals 3). The data suggest that fetal production of renin may be largely independent of maternal renin secretion.


Hysterectomy in a community hospital.

The liberalization of indications for hysterectomy by hospital tissue committees, partly encouraged by sterilization by hysterectomy instead of tubal ligation, has led to an increased frequency of this procedure. To evaluate the debate about tubal ligation vs. hysterectomy and hysterectomy in general, statistics from community hospitals should be reviewed, analyzed, and compared with those from large medical centers where statistics favoring a procedure generally originate. A total of 235 abdominal and vaginal hysterectomies covering a 1 year period in a community hospital of 400 beds are reviewed for indications, complications, morbidity, and death.


Biparietal diameter of the skull and fetal weight in the second trimester: an allometric relationship.

Ultrasonic cephalometry was performed prior to therapeutic abortion in 323 women during the second trimester of pregnancy. In 101 instances satisfactory paired measurements of intrauterine biparietal diameter and extrauterine fetal weight were obtained and these formed the basis for mathematical analysis. In midpregnancy increase in size of the fetal head and increase in body weight seem to proceed at different rates but the ratio of the rates appears to be constant--an allometric relationship of relative growth. The data were used to calculate a standard curve and a graphic method is proposed for estimating gestational age when reliable menstrual history is not available in the second trimester.


A clinical appraisal of patients following long-term contraception.

This study presents a clinical evaluation of private patients between the ages of 16 and 40 who have used contraceptive measures from January 1, 1961, through December 31, 1973. The clinical evaluation involves 3,746 private patients. The contraceptive methods of 641 patients (17 per cent) who have been bollowed for a total of 99,996 months (13 years each) are presented and analyzed. The patients are evaluated as to weight, blood pressure, pregnancy, pap smears. laboratory changes, pelvic surgery, breast surgery, incidence of cancer, contraceptive failures and changes in contraceptive practices over this span of time. This paper evaluates the role of such sociologic factors as education, religion, economic level, occupation, working status, changing marital status, age at the time of contraceptive choice, and the attitude of the husband with regard to long-term contraceptive therapy. Side effects have been well publicized. Safety has been questioned but essentially proved for the vast majority of the patients. Collected data enable some insight into the life style and motivation of the long-term contraceptive users.


Pelvic endometriosis and ureteral obstruction.

Pelvic endometriosis may completely obstruct the ureters and destroy the kidneys with little or no gynecologic symptoms. Five cases are discussed, all causing ureteral obstruction. Two patients suffered the complete loss of a kidney and in each case the remaining kidney was in jeopardy because of partial obstruction due to endometriosis. All these patients were treated by complete removal of all ovarian tissue, dissection of the ureter, and dissection of the scar tissue. In severe cases, retroperitoneal clamping of the infundibular pelvic ligament with clear exposure of the ureter is mandatory to avoid leaving small remnants of ovary in the infundibular ligament clamp. With complete removal of all ovarian tissue, postoperative estrogen therapy will not cause recurrence of the disease.


The role of ovarian conservation in the treatment of carcinoma of the cervix with radical surgery.

This paper is an analysis of 95 cases treated surgically at the University of California Hospitals and at Children's Hospital between 1949 and 1971; 92 had abdominal radical surgery and three were done vaginally. Figures are analyzed by age, cell type, pregnancy status, and survival data. The numbers surviving for 5 years were 27 in the control group (26 living five years and over) and 50 in the study group.


Review of menstrual disorders in which a secretory endometrium was found.

The 310 cases of abnormal uterine bleeding in which secretory endometrium was found are reviewed by age group, presenting symptoms, duration of symptoms, severity of bleeding, continued ovulation, medical treatment, parity, and results. Two unusual endometrial histologic patterns were identified: (1) abnormal stromal and/or glandular response to progesterone and (2) secretory hyperplasia. Twenty-eight per cent of all patients with an adequate follow-up eventually received a hysterectomy--14.8 per cent for bleeding alone. Hypermenorrhea was most likely to result in a hysterectomy, with metrorrhea least likely. Dating the endometrium placed approximately 50 per cent at the time of menses. Those patients with an abnormal response to progesterone were most likely to have a hysterectomy.


Changing patterns in endometrial adenocarcinoma: a study of 291 consecutive cases at a large private hospital, 1960-1973.

The experience with endometrial adenocarcinoma in postmennpausal women in a private hospital is reviewed for the time period from 1960 to 1973. By dividing the investigation into time periods from 1960 to 1966 and from 1967 to 1973 a real increase in the incidence of this lesion in the latter is demonstrated. The data suggest that the increase may be due in part to the increased use of exogenous estrogen in postmenopausal women. A treatment regimen to circumvent this increase is offered.


Plasma renin and aldosterone in an abdominal pregnancy with toxemia.

The first reported measurement of plasma renin and aldosterone in toxemia with an abdominal pregnancy is presented. In contrast to toxemia where plasma renin and aldosterone are either normal or low, extraordinarily high levels of both were found in this patient which returned to normal after delivery. The role of extrarenal renin in the hypertension of toxemia is discussed and the possibility raised that the elevated renin in this case was of placental origin.


Effect of abnormal glucose tolerance in pregnancy on infant mortality rate and morbidity. A prospective study.

Ninety-five pregnant women, not previously known to have diabetes but suspected of being at risk for the disease because of obesity, glycosuria, family history, or obstetric history, underwent oral and intravenous glucose tolerance tests in the last trimester of pregnancy. Several methods were used to categorize the degree of abnormality, but none was of value in predicting pregnancy outcome. Perinatal mortality and malformation rates in the offspring of these women were no greater than those of the over-all infant population at this Center and were much lower than those in infants born to women with overt diabetes. Causes of infant morbidity were not increased, with the exception of overweight babies, hypoglycemia, and hypocalcemia. Umbilical vein glucose level correlated significantly with the mothers' blood glucose at the time of delivery. Cord insulin level correlated with infant birth weight and with University Group Diabetes Program number. Birth weight correlated with the degree of the mothers' obesity. It was concluded the documentation of the degree of glucose intolerance in the mother is of little value in predicting fetal outcome but may indicate infants at risk for hypoglycemia and hypocalcemia.


Ovarian surgery in pregnancy.

A series of 57 cases of ovarian disease during pregnancy is presented; 10 of the patients were referred to the Mayo Clinic for treatment. During the 17 year period under investigation (1955 through 1971), there were 25,189 deliveries in Rochester, Minnesota. Thus, the corrected incidence of operable ovarian disease in pregnancy was one case in every 536 deliveries. Simple ovarian cysts were the most common lesions found (38 of 57 cases). The over-all abortion rate was about 25 per cent (14 of 57 patients); six of the patients were threatening to abort prior to surgery. Therefore, the incidence of spontaneous abortion after surgery was 16 per cent (eight of 51 patients). Progestational agents given before and after operation did not affect the abortion rate.


Clomiphene citrate in suppression of puerperal lactation.

Demand for inhibiting puerperal lactation has brought about a plethora of methods, none entirely satisfactory, in achieving successful and comfortable ablactation. In addition some were associated with untoward side effects. In this study administration of 100 mg. of clomiphene citrate daily for 5 days was effective in suppressing puerperal lactation. Response to the treatment was particularly pronounced, when this was started within the first 12 hours post partum.


Opportunistic mycotic infections in pregnant women.

Immunosuppression was the major factor associated with the deaths of 44 women who died from opportunistic mycotic infections. The patients were immunosuppressed by malignancies, irradiation, cytotoxic drugs, and metabolic diseases. An additional four patients may have developed candidiasis as a result of antibiotic therapy. Coccidoidomycosis was the only mycosis solely associated with pregnancies not altered by exogenous immunosuppression.


Prostaglandins in the human endometrium. Gas chromatographic-mass spectrometric quantitation before and after IUD insertion.

Prostaglandin F2alpha and its major metabolite in plasma, 15-keto-13, 14-dihydro-PGF2alpha were quantitated in biopsies from human endometrium using gas-liquid chromatography-mass spectrometry. In four of the five cases studied, the levels of both compounds were higher in the secretory phase than in the proliferative phase regardless of whether the IUD was present or not. Before insertion of an IUD the levels of PGF2alpha ranged from 65 to 8,280 pg. per milligram of tissue and those of 15-keto-13,14-dihydro-PGF2alpha ranged from less than 4 to 1,940 pg. per milligram. After insertion of an IUD the levels of the compounds ranged from 260 to 2,100 and from 5 to 109 pg. per milligram, respectively. In four of the five individual cases the IUD caused a decrease rather than an increase of the prostaglandin content of the tissue. These data do not indicate an increased biosynthesis of prostaglandins in the human endometrium after insertion of an IUD.


Comparative studies of the ethynyl estrogens used in oral contraceptives. II. Antiovulatory potency.

The occurrence or inhibition or ovulation was inferred from the plasma progestin level measured in the last week of 430 control cycles and of 4,638 cycles from fertile women receiving various antiovulatory steroids, singly and in combination. The substances tested included: mestranol and ethynylestradiol (EE) of homogeneous bioavailability, used alone in a range from 50 to 100 mug per day; these same dose levels combined with various progestins; and finally various proprietary combination and sequential low-dose regimens undergoing clincial trials. Statistical analysis showed ethynylestradiol and mestranol alone to be equipotent over the tested range, although at 50 mug per day superiority of mestranol over EE was suggested. Two preparations of EE at 50 mug per day, one of them a sequential with dimethisterone, showed different potency. At 50 mug per day no estrogen, alone or with a sequential progestin, reached a satisfactory level of effectiveness. However, very small amount in the range of 20 to 40 mug per day were highly effective when combined with quantities of various 19-nor progestins which by themselves are well below the antiovulatory level. This indicated that a synergism exists between these two classes of compounds insofar as their antiovulatory effect is concerned, thus explaining the high contraceptive effectiveness observed with very-low-dose combination regimens.


Comparative studies of the ethynyl estrogens used in oral contraceptives. I. Endometrial response.

Reproductive-age women were given identically prepared mestranol or ethynylestradiol orally for two consecutive 21 day cycles in doses ranging from 50 to 100 mug per day. Endometrial biopsies were obtained at the end of the second cycle and assessed for estrogenic effect. At these dose levels and with this treatment regimen, no differences could be detected between doses or between drugs, indicating that a plateau in endometrial response was reached.


Comparative studies of the ethynyl estrogens used in oral contraceptives. III. Effect on plasma gonadotropins.

Twenty-one-day treatment cycles of ethynylestradiol or mestranol at dosages of 50 to 100 mug per day were administered to 191 normal volunteer women from six cycles, followed by six cycles of this estrogen treatment combined with 2.5 mg. of norethindrone acetate, 2 mg. of megestrol acetate, or 0.5 mg. of norgestrel. The drugs were prepared to insure uniform bioavailabiltiy. Plasma FSH and LH were determined by radioimmunoasay during the last week of medication intake in each cycle. In another study, a large number of blood samples were obtained at various times during the menstrual cycle from women using IUD's (as a control population) and from women who had been taking oral contraceptives regularly for 5 to 12 years. With the various estrogen treatments, the median FSH level showed no change at any estrogen dose at the end of the first cycle. From the second cycle on, a stable, dose-related fall was obtained with the 80 or 100 mug per day doses. The addition of any of the three progestins caused a prompt, stable, further fall in FSH level. By contrast, the median LH level rose in the first cycle with all estrogen regimens, and then fell progressively in a dose-related fashion in cycles 2 to 6. The addition of a progestational agent also caused a further prompt and stable fall in LH during cycles 7 to 12. Except for a minimal indication of greater LH suppression by ethynylestradiol as compared to mestranol at 50 mug per day, all other indices and dosages showed ethynylestradiol and mestranol to be essentially equipoten under these experimental conditions. Long-term administration of oral contraceptives produced a comparable degree of gonadotropin suppression. There was a suggestion of slightly less FSH suppression with agents using 50 to 75 mug per day of estrogen than from those with 100 mug per day. Both in normal controls (IUD cycles) and in cycles under chronic treatment with oral contraceptives, pulses of both FSH and LH were seen with some frequency, at times distant from the "periovulatory" period. The significance and origin of these random FSH and LH pulses is unknown.


Effects of 0.5 mg. of lynestrenol daily on hypothalamic-pituitary-ovarian function.

This study was undertaken to investigate the effect of daily ingestion of 0.5 mg. of lynestrenol on some parameters of the hypothalamic-pituitary-ovarian axis. Daily plasma concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol-17-beta (estradiol; E2-17beta), and progesterone (P) were determined by specific radioimmunoassays during one control and one treatment cycle of seven normally ovulating women. One of the volunteers was followed throughout 84 days of treatment. The  following changes were observed during medication: (1) the midcycle FSH/LH peak was abolished, with a trend toward reduced LH values during the second half of the treatment cycles; (2) progesterone was significantly, though variably, reduced whereas estradiol showed little difference between control and treatment cycles; (3) during prolonged treatment two difference cyclic response patterns were observed in the same individual. It is concluded that daily administration of 0.5 mg. of lynestrenol exerts a profound effect at the central level, which contributes to the satisfactory contraceptive efficacy of this compound. A hypothetic blockade of estradiol receptors at the pituitary and/or hypothalamic level is discussed.


Structural aspects of human cervical mucus.

Two types of fibrous structures  can be demonstrated in midcycle cervical mucus: (1) long, thick fibers that vary in diameter from 0.5 to 5 mum and run parallel to each other, and (2) microfibrils that vary in diameter from 500 to 1,500 A and form bundles or networks. The spaces in such networks usually measure from 800 to 4,0000 A. The fibers are made up of the microfibrils and most likely represent the micelles that give spermatozoa their directional transport through the cervix.


The psychological sequelae of abortion performed for a genetic indication.

Psychometric testing and psychiatric interviews were conducted on 13 families in which the women had undergone amniocentesis for the prenatal detection of a genetic defect in the fetus and, upon receiving positive results, elected to have a therapeutic abortion. The indication for amniocentesis was maternal age in two families, a previous child with Down's syndrome in one family, a previous child with a recessively inherited inborn error of metabolism in four families, and the mother being a carrier for an X-linked disease in six families. The incidence of depression following selective abortion may be as high as 92 per cent among the women and as high as 82 per cent among the men studied, and was greater than that usually associated with elective abortion for psychosocial indications or with delivery of a stillborn. Four families experienced separations during the pregnancy-abortion period. Despite the emotional trauma of the procedure, most of the families studied would repeat their course of action and consider selective abortion preferable to the alternative birth of a defective child. Several modifications in the amniocentesis and selective abortion procedure which might diminish the concomitant emotional trauma are suggested.


Spontaneous motility and distribution of prostaglandins in different segments of human Fallopian tubes.

The "in vitro" spontaneous magnitude and stability with time of the isometric developed tension (IDT) and frequency of contractions of ampullar longitudinal and ampullar circular as well as isthmic longitudinal and isthmic circular muscle, from human Fallopian tubes, were explored. The effects of polyphloretin-phosphate (PPP), an inhibitor of prostaglandins (PG), upon the IDT and frequency of different tubal segments, were also explored. We looked for PGE, and F2alpha in extracts of ampullar and isthmic tubal segments. The initial IDT and frequency (recorded at 10 minutes following equilibration) as well as the stability with time (explored afterward during 40 minutes) were comparable among all the preparations, with the exception of the isthmic longitudinal muscle, which suffered a progressive decrement of IDT. PPP inhibited significantly the IDT of the isthmic circular muscle but had no effect upon the ampullar circular muscle. Whereas PGF2alpha was frequently detected in extracts from the isthmic region, those from the tubal ampullar region showed the consistent presence of PGE1. The results suggested a possible relationship between isthmic PGF2alpha and its spontaneous motility. Also, the peculiar distribution of PGE1 and PGF2alpha could have some bearing on the regulation of the different functions of isthmic and ampullar regions of human Fallopian tubes.


Scanning electron microscopy of human placental villi from early and late in gestation.

Human placental villi from term placentas and from 10 to 14 week placentas were examined in the scanning electron microscope (SEM) after critical point drying. When prepared by this method, the syncytial surface appears covered with slender microvilli similar to those seen in transmission electron micrographs. We find no support in our observations for the suggestion that the trophoblastic surface is a mosaic of microvillous and nonmicrovillous areas or that substantial areas lack microvilli. In addition, the villi often show circumferentially oriented furrows. SEM's of the early placentas showed numerous syncytial sprouts, most of which represent stages in the formation of new free or terminal villi.


Influence of pregnancy on the kinetics of insulin.

The disappearance rate of intravenously injected insulin was investigated in the serum of 30 women during the third trimester of pregnancy and 6 to 8 weeks post partum, in order to determine whether pregnancy has an influence on insulin kinetics in human subjects. Both women with unimpaired glucose tolerance and those with latent diabetes were included in this study. The disappearance rate of exogenous serum insulin in pregnancy was characterized by a two-compartment model. Multivariate analyses of variance were used to determine whether the estimated parameters of this model during pregnancy differ from those obtained after the puerperium and whether the insulin kinetics are altered when carbohydrate metabolism is disturbed. The kinetics of insulin during pregnancy did not differ from those after pregnancy. Thus, hyperinsulinemia observed in pregnancy cannot be explained by a change in the insulin kinetics. It appears improbable that the insulin-degrading enzyme activities of the placenta participate in degradation of insulin circulating in the maternal blood. A connection between the decline of glucose tolerance during pregnancy and the kinetics of exogenous insulin could not be found.


Immunoreactive gastrin and gestation.

Serum concentration of radioimmunoreactive gastrin reflects closely the known physiology of gastric acid secretion during pregnancy. In particular, marked rises of immunoreactive gastrin occur in late pregnancy, at parturition, and in the early puerperium.


Effect of alcohol on fetal cerebral function and metabolism.

The effect of maternal alcohol infusions on fetal cerebral function in terms of the electroencephalogram (EEG) and fetal brain metabolism was studied in 10 fetal sheep experiments. A 9.75 per cent alcohol-dextrose solution was infused at the rate of 15 c.c. per kilogram of maternal weight for 1 or 2 hours. Fetal cerebral uptake of oxygen was unaffected. Blood flow was significantly increased as a result of a greater decrease in resistance than decrease in blood pressure. The cerebral uptake of glucose and the glucose-oxygen utilization ratio were significantly increased. The EEG showed a decrease in amplitude and slowing of the dominant rhythm as the blood alcohol concentration increased and became isoelectric on occasion during the postinfusion period associated with a severe fetal acidosis.


Perfusion of human ovaries in vitro with artificial medium: metabolism and steroidogenesis.

A study was made of ovaries perfused in vitro with a liquid fluorocarbon that was stabilized in emulsion by a nonionic detergent to which tissue culture medium was added. A pulsatile flow was used in an organ preservation system under aseptic conditions. Glucose was utilized and lactate produced at a fairly constant rate for as long as 20 hours of perfusion. 14-C-progesterone and 14-C-17alphaOH-progesterone were synthesized from 14-C-acetate and estradiol was secreted. The production of these steroids by the perfused ovary appears to be responsive to gonadotropins.


Abdominal hysterectomy for surgical sterilization in the mentally retarded: a review of parental opinion.

Between the years 1950 and 1973, 152 abdominal hysterectomies were performed for surgical sterilization in patients who were mentally retarded. A retrospective follow-up study was performed to ascertain the opinions of parents, guardians, and institutional care workers charged with the care and responsibility of these patients since the time of the original operation. In the categories evaluated, over 90 per cent of those charged with the care of the patient were enthusiastic for the benefits achieved by hysterectomy rather than tubal ligation for the purpose of surgical sterilization.


Cell-mediated immunity to melanoma-associated antigens in patients with ocular malignant melanoma.

We tested 11 patients with choroidal melanomas and 32 control subjects for cell-mediated immunity to melanoma-associated antigens by an in vitro leukocyte migration inhibition assay. Five of seven patients with choroidal melanomas, who received two melanoma extracts used in this series of experiments, had significant leukocyte migration inhibition as compared with none of 17 normal subjects. Four of five melanoma patients who received a third melanoma extract had significant leukocyte migration inhibition as did three of four normal controls, indicating that the extract showed nonspecific inhibition. These data agreed with the concept that patients with choroidal melanomas have cell-mediated immunity to common melanoma-associated antigens.


Bilateral microphthalmos without microcornea associated with unusual papillomacular retinal folds and high hyperopia.

A 23-year-old man had bilateral microphthalmos without microcornea. The eyes measured about 15 mm in length by ultrasound while the corneas were 11 mm in diameter. A distinctive, elevated, funnel-shaped retinal fold stretching between the disk and the macula was present bilaterally. Other unusual aspects were the deep anterior chambers and uncompromised chamber angles. This combination of anomalies is believed to be the result of a failure of growth of the posterior outer coats of the eye. These were of insufficient size to accommodate the excess sensory retina which folded to conform to its outer structural shell. Other cases of high hyperopia may in some instances be cases of microphthalmos, unrecognized because of normal-sized corneas.


Childhood blindness in Lebanon.

A survey in the Lebanese schools for the blind revealed that 77% of childhood blindness in the country was genetically determined. Two thirds of the hereditary blindness cases were due to autosomal recessive conditions; the high frequency of consanguineous marriages in Lebanon was the underlying cause of this finding. There is marked similarity in the etiology of childhood blindness in Cyprus and Lebanon, for both countries are somewhere between the highly developed countries.


Effectiveness of trabeculectomy in glaucoma.

A follow-up study of 90 eyes in 60 patients subjected to trabeculectomy between 1967 and 1972 showed that intraocular pressure was controlled at the onset in 84% of the eyes, and eventually controlled in over 97%. Only 11% of the eyes required further medication and 5.5% further surgery. Subconjunctival drainage was established by means of a bleb in 91%. Trabeculectomy produced a high significant fall in intraocular pressure (P less than .001) and a parallel rise in aqueous outflow facility. The absolute fall in intraocular pressure was constant whether the preoperative pressure was high or low and whether or not the postoperative pressure remained above 20 mm Hg. This method was virtually free of major operative and postoperative complications when used appropriately; and it can be modified during the operation to deal with peripheral anterior synechiae. The anterior chamber remained formed or, if lost, was speedily re-formed. The anterior chamber rarely flattened postoperatively.


Giant retinal tears.

Of 94 patients (100 eyes) with giant retinal tears, 71.4% of eyes with nontraumatic breaks were myopic and severe retinal pathologic findings were present in 57.3% of fellow eyes. Fifty-five (58%) of 95 treated eyes were successfully reattached; retinal incarceration, attempted in 19 cases, was successful in five. Serious surgical complications were responsible for failure in nine cases (22.5%). The worst prognostic factor were extension of the tear for over two quadrants, myopia of -10 diopters or more, and the presence of aphakia.


Spontaneous remodeling of the peripheral retinal vasculature in sickling disorders.

Periodic photographic and angiographic surveys of patients with the earliest stages of sickle retinopathy showed a number of fundus findings. In seven cases (sickle cell anemia, four; sickle cell hemoglobin C, three), these findings included: (1) a variety of vascular abnormalities in the equatorial and post-equatorial retina such as segmented dilations of the vessel walls, hairpin-shaped vascular loops, hypertrophic, tortuous A-V anastomoses, intraluminal plugs, closure and loss of capillary bed, and terminal budding of capillaries; and (2) a continuous, spontaneous remodeling of the peripheral retinal vasculature due to successive closures and reopenings of equatorial retinal vessels. A centripetal recession of the peripheral retinal vasculature usually resulted. No correlation between the ophthalmoscopic and the systemic condition of the patients could be made.


Anterior segment ischemia after segmental episcleral buckling and cryopexy.

A 63-year-old man with a one-quadrant retinal detachment developed anterior segment ischemia after an operation that included the use of cryopexy, release of subretinal fluid, and segmental episcleral buckling without detachment of the extraocular muscles. A compromised cardiovascular condition of long duration and an episode of transient hypotension immediately preceding operation were factors in the pathogenesis of the ischemia. Although the anterior segment changes were moderately severe, recovery of vision ultimately was excellent.


Diabetic vacuolation of the iris pigment epithelium.

In a postmortem study of 57 diabetic patients, 19 of 23 patients with blood glucose levels greater than 200 mg/100 ml in the 72-hour period before death showed the characteristic histologic findings of "lacy" vacuolation of the iris pigment epithelium as well as vacuolation of the renal tubules (Armanni-Ebstein nephropathy). Conversely, 33 of the remaining 34 patients with blood glucose levels below 200 mg/100 ml in the 72-hour period prior to death showed no vacuolation in the iris or kidney.


Refractive change as the initial sign of progressive facial hemiatrophy.

Unilateral arrested myopia preceded other signs of progressive facial hemiatrophy in a 13-year-old girl. Facial signs including soft tissue atrophy, enophthalmos, pupillary dialation with decreased pupillary reaction, and extraocular muscle involvement later appeared on the same side as the eye with the arrested myopia.


Mechanical syringe drive for vitreous surgery.

A mechanical syringe drive permits one-handed, precise control of the suction force at the time of vitrectomy, is autoclavable, utilizes disposable syringes, and can be operated by surgeon or assistant.


The diagnosis of Adie's pupil using 0.0625% pilocarpine solution.

In five patients a 0.0625% concentration of pilocarpine provided the marked difference in miosis between Adie's and normal pupils. Other concentrations did not produce as much as a difference.


Colloidal lanthanum as a marker for impaired plasma membrane permeability in ischemic dog myocardium.

Colloidal lanthanum salts have an average particle size of 40 degrees A; consequently, this electron-opaque marker remains extracellular and does not cross the intact plasma membrane. The affinity of lanthanum for calcium-binding sites on mitochondrial membranes makes it possible to demonstrate loss of plasma membrane integrity at the cellular level in ischemic myocardium. Biopsies were obtained from infarcted, marginal and normal areas 3 1/2 hours after ischemia was produced in 9 anesthetized closed-chest dogs by electrically induced thrombosis of the left anterior descending coronary artery. The tissue was immediately fixed in 4% glutaraldehyde and 0.1 M cacodylate buffer containing 1.3% La(NO3)3, pH 7.4, for 2 hours. In normal control tissue prepared this way the lanthanum tracer, as expected, was confirmed to the extracellular spaces, including, basement membranes, gap junctions and portions of the intercalated discs. Specimens taken near the center of frank infarctions all contained intracellular as well as extracellular lanthanum. Intracellular lanthanum could be seen evenly distributed around lipid droplets and in focal deposits around mitochondria. Only when mitochondria were disrupted did lanthanum gain access to internal sites on mitochondrial membranes. Areas marginal to the infarct contained cells in varying stages of degeneration including many that appeared normal by morphologic criteria alone. Intracellular lanthanum was present in many but not all of the marginal cells in which degenerative changes could be seen. Similarly a few of the cells that appeared morphologically normal contained intracellular lanthanum. The entry of lanthanum into some of these marginal cells and its exclusion from adjacent cells demonstrated that ischemic injury affects the permeability properties of the plasma membrane and independently of other intracellular morphologic changes and that lanthanum can be a sensitive indicator of such alteration in membrane permeability.


Calcification of rachitic rat cartilage in vitro by extracellular matrix vesicles.

Growth plate cartilage from rachitic rats was studied to assess the role in calcification of extracellular matrix vesicles, which are thought to participate in the initial stage of mineralization of connective tissue. The concentration of matrix vesicles and their distribution within the longitudinal septa was found to be normal in rats made rachitic by feeding by a diet low in vitamin D and phosphate for 3 weeks after weaning. Rachitic cartilage matrix did not contain circumvesicular clusters of apatite as does normal cartilage; however, occasional vesicles did enclose one or a few apatite needles. When slices of rachitic cartilage were incubated at 37 C in a metastable calcium phosphate solution ([Ca++] times [PO SEE ARTICLE] equals 3.5 mM identical to 2), apatite formation was initiated in association with matrix vesicles. Under these conditions, mineralization was prominent in the upper hypertrophic cartilage, where matrix vesicles became encrusted with apatite after only 2 to 3 hours of incubation. Vesicular apatite accumulation was inhibited by preheating the cartilage to 60 C for 30 minutes. Measurements of 45Ca uptake by rachitic cartilage slices from metastable calcium phosphates solution also indicated inhibition of calcification by heat. Light microscopic autoradiographs showed 45Ca localization primarily in the matrix of longitudinal septa and substantiated the inhibition site of mineralization in healing rachitic cartilage. The presence of apatite within rachitic vesicles prior to heating and the inhibition of vesicle calcification by heat suggests an active, enzymatically and mediated mechanism of vesicular calcification.


The proliferative response to epidermis of hairless mice to full thickness wounds.

The healing of full thickness surgical wounds from 0 to 14 days has been studied in hairless mice. Within 2 days after wounding the surrounding epidermis is thickened and primarily composed of enlarged basophilic cells. The remnants of the hair follicles attached to the epidermis are converted into cords of enlarged basophilic cells. Epidermal thickening is maximum at 7 days. Associated with the epidermal thickening surrounding the wound edge is an increase in the total number of cells in the stratum granulosum and in the stratum spinosum. The number of basal cells does not change. Mitotic activity and mitotic rate increase within 1 day after wounding. Both reach their peaks by approximately 5 to 7 days and then begin to return to control levels. Mitotic duration does not change.


The effect of chronic hypoxia on the number and nuclear diameter of type I cells in the carotid bodies of rats.

We measured the number and nuclear diameter of type I cells in the carotid bodies of 10 normal rats and in 10 rats living in a hypobaric chamber at a pressure of 460 mm Hg for 25 to 96 days. In normal rats, the number of type I rats, the number ranged from 15.92 to 30.77 times 10-3 with a mean of 40.79 times 10-3 which differed significantly from that in the control group. In 5 hypoxic rats the number of type I cells was less than the highest figure in the control group. The mean diameter of the nuclei of type I cells of hypoxic rats (5.5 mu) was greater than that of the controls (5.0 mu). The largest type I nuclei were seen in those rats which had been subjected to hypoxia for the shortest time.


A measurement of attitudes about an activity program.

Staff and patient attitudes about an activity program were measured to highlight problems that existed in a paritcular milieu. Statements concerning the rationale for this activity program were compared to determine the similarities and differences between staff and patient perceptions of the program. To create a more therapeutic milieu, suggestions for openness and sharing were made based on the results of the attitude study. Their implementation would require staff and patients to interact on a more nearly equal basis. Such an approach is a bias toward the Maxwell Jones philosophy of therapeutic milieu, the direction in which the ward staff of this study wanted to go. This paper offers a way for the staff to reach their goal and suggests several paths they might take. The attitude questionnaire method used in this study might be a useful tool for those who are studying the therapeutic aspects of ward milieu.


Competition as a motivational incentive.

Since motivation is a key concern in rehabilitation, methods of encouraging clients to active participation in therapy are frequently sought. The motivational level of the client is an indicator of the success that can be anticipated in occupational therapy activities. This article identifies the phenomenon of competition as a potential motivator for promoting competent performance by clients receiving occupational therapy services.


Formation of myocardial zonal lesions.

Right ventricular papillary muscles from control cats and from cats subjected to hemorrhagic shock were studied by electron microscopy. Half of the muscles were fixed at the apex of their active length-tension curves following stimulation in a papillary muscle bath. The other half were also fixed under tension. The ultrastructure of each muscle was examined in detail. A series of stages in the formation of myocardial zonal lesions, ranging from minimal changes in the intercalated discs to severe lesions, were identified and interpreted as representing the sequential stages in the formation of zonal lesions. One of the earliest (least severe) changes in the formation of zonal lesions, the separations of actin filaments from the intercalated disc, may be critical to the subsequent development of cardiac failure in hypovolemic shock. Mitochondrial displacement was a late event in the formation of the lesions, occurring only after major alterations had taken place in the sarcomeres and intercalated discs. It was noted that the ultrastructure of mitochondria remained essentially normal, and that there was no cell swelling associated with zonal lesions. This serves as confirmatory evidence that myocardial zonal lesions are a unique form of myocyte injury, are potentially reversible, and are not caused by ischemia.


Pulmonary lymphangiomyomatosis. A review.

Anatomic and clinical observations of 28 cases, including 23 previously unpublished, of pulmonary lymphangiomyomatosis are recorded and discussed. This brings the total reported to 57. All patients were women in the reproductive age group with the major complaint of breathlessness. This was usually progressive, and death from pulmonary insufficiency resulted within 10 years. Functional changes were obstructive or restrictive, or both. Pneumothorax, chylous effusions and hemoptysis were frequent complications. Radiographically the lesions initially appear as fine, linear and nodular, predominantly basal densities, and progress to a pattern of bullous change, or honeycombing, involving all portions of the lungs not sparing the region of the costophrenic sinuses as is typical of eosinophilic granuloma. There may be associated pleural effusions. A progressively increasing lung volume is characteristic. The lesions consist of an irregular, nodular or laminar "irrational" proliferation of smooth muscle within all portions of the lung, with loss of parenchyma leading to honeycombing. Proliferated muscle can obstruct bronchioles (with air trapping and formation of bullae often complicated by pneumothorax), venules (with pulmonary hemorrhage and hemosiderosis accompanied clinically by hemoptysis) and lymphatics (with chylothorax or chyloperitoneum). Both thoracic and abdominal lymph nodes and the thoracic duct can also be involved in the myoproliferative process with formation of subsidiary minute channels and obstruction. Renal or perirenal angiomyolipomas can also occur, as exemplified by 2 patients in the present series. Identical pulmonary lesions occasionally occur in tuberous sclerosis. Especially since these patients usually have no neurologic disturbances and are almost women, the possibility of a relationship between tuberous sclerosis and lymphangiomyomatosis must be considered. One feature of note in pulmonary lesions of tuberous sclerosis is the presence of adenomatoid proliferations of epithelium. Such changes were also observed in 2 patients of the present series, and it is remarkable that both of these women had "retarded"children. At present the question of whether by lymphangiomyomatosis is a forme fruste of tuberous sclerosis must be considered as unresolved. It may yield to further investigation, possibility including chromosomal studies.


Unraveling child abuse.

This paper attempts to clarify the dynamics of child abuse, and to suggest approaches to primary prevention. Child abuse is redefined, within egalitarian value premises, as inflicted gaps in children's circumstances that prevent actualization of inherent potential. Levels of manifestation and causal dimensions of child abuse are identified, and their multiple interactions are traced. Primary prevention is shown to be essentially a political, rather than a purely technical or professional, issue.


Professional abuse of children: Responsibility for the delivery of services.

Determination of which children will receive or be excluded from services, as well as the nature and extent of those services is largely the province of professionals. This paper examines the responsibility of professionals and social service agencies for the delivery - and denial-of services to children,discusses children's rights, and examines the role and oligation of professionals in the resolution of larger social issues.