Diabetic glomerulosclerosis without glucose intolerance.

The pathophysiology of the microangiopathy of diabetes mellitus is poorly understood, and the relevance of carbohydrate intolerance remains uncertain. Four patients are presented with renal abnormalities suggestive of diffuse diabetic glomeruloscierosis. These patients have no evidence of carbohydrate intolerance by standard clinical technics. A familial incidence of diabetes mellitus and delayed insulin response to an oral glucose load support a classification of prediabetes or suspected diabetes mellitus for these patients. Early intercapillary nodule formation was seen in only two of the four patients. In the absence of this infrequent pathognomonic finding, an alternate approach to the diagnosis of diabetic glomerulosclerosis is suggested. Diffuse glomerular capillary basement membrane thickening, consistently present with diabetic glomerulosclerosis, is demonstrated by measurements utilizing the latex microsphere technic. The mean glomerular capillary basement membrane thickness of these patients was 4,403 A, compared with the control value of 3.098 A (P less than 0.001). Other pathologic findings suggestive of diabetic nephropathy include efferent arteriolosclerosis and linear immunofluorescence without electron dense deposits or inflammation. Skeletal muscle capillary basement membranes of all four patients also demonstrated significant thickening. The mean value for the patients was 1,510 A, as compared with a control value of 961 A (P less than 0.001). The importance of this muscle capillary basement membrane thickening to the diagnosis of diabetic microangiopathy is discussed. The pathologic alterations in the renal biopsy specimens and the demonstration of muscle capillary basement membrane thickening strongly suggest that diabetic glomerulosclerosis may occur in the absence of overt clinical carbohydrate intolerance.


Penetration of antimicrobial agents into bronchial secretions.

The entry of ampicillin, cephalothin and gentamicin into traceobronchopulmonary secretions/exudates was assessed in 22 patients during 28, episodes of pneumonia or bronchitis. Specimens were collected from the lower respiratory tract via tracheostomies or endotracheal tubes using either the flexible fiberoptic bronchoscope (50 specimens) or an intratracheal catheter (59 specimens). Venous blood was obtained at the same time. The concentrations in the bronchial specimens were less than those in the corresponding serums, amounting to about 10 per cent with ampicillin, 25 per cent with cephalothin and equal to or greater than 40 per cent with gentamicin.


Lysinuric protein intolerance.

Lysinuric protein intolerance (LPI), an autosomal recessive defect of diamino acid transport, is characterized chemically by renal hyperdiaminoaciduria, especially lysinuria, and by impaired formation of urea with hyperammonemia after protein ingestion. Our 20 patients thrived during breast-feeding, but ingestion of cow's milk caused diarrhea and vomiting. When able to select their diet, they rejected all protein-rich foods. They were short staturated and had weak atrophic muscles, osteoporosis, hepatomegaly and often splenomegaly. Four patients were mentally retarded. Fifteen patients had leukocyte counts below 4,000/mm3, and 17 patients had platelet counts below 150,000/mm3. Serum lactate dehydrogenase activity was constantly increased, and transaminase and aldolase activities were often increased. In the infants' livers, changes were only revealed by electron microscopy: increased and vesicular smooth endoplasmic reticulum, and abundance of glycogen particles in the hepatocytes. In the older patients, light microscopy demonstrated clearly limited areas where hepatocytes had large pale cytoplasm and small pyknotic nuclei. The diamino acids lysine, arginine and ornithine had plasma concentrations only one-third to one-half the normal mean; the renal clearances were clearly increased. Oral diamino acid loading tests suggested impaired intestinal absorption. Urea is built in the liver through transformation of ornithine to arginine, and cleavage of arginine to ornithine and urea. The addition of ornithine to an intravenous I-alanine loading prevented the hyperammonemia and normalized the urea production. Therefore, the diet has been supplemented with arginine, and more protein has been added. This therapy has lead to a remarkable catch-up growth in some patients. The pathophysiology of LPI is explained. Because of defective intestinal absorption and incrased renal loss, the diamino acids have a low plasma concentration. Their transport from plasma to hepatocytes is also impaired, and the liver becomes deficient in ornithine. This retards the urea cycle, and leads to postprandial hyperammonemia and protein aversion. The presence of the transport defect in the hepatocytes distinguishes LPI from other hyperdibasicaminoacidurias.


Carcinoma complicating Crohn's disease. Report of seven cases and review of the literature.

Seven cases of adenocarcinoma complicating Crohn's disease are reviewed. In three of the patients, small bowel cancers developed in association with reginal enteritis. In four patients, carcinoma of the colon was superimposed on Crohn's colitis. In two of these, the adenocarcinoma infiltrated chronic colocutaneous fistulas. Review of the literature shows an increasing number of reports of carcinoma complicating Crohn's disease, with a total of 36 cases of small bowel cancer and 30 cases of colon cancer previously reported. The significane of these and our own cases is discussed. The possibility of carcinoma must be kept in mind by clinicians following patients with Crohn's disease. Adenocarcinoma complicating Crohn's disease occurs at a younger age, on the average, and in areas similar to the distribution of Crohn's disease rather than the usual distribution of the cancer. Preoperative diagnosis is difficult, but changes in the nature of chronic fistulas should be investigated.


Thoracic outlet syndrome with tetany of the hands.

A patient presenting with tetany was found to have thoracic outlet obstruction. This was treated by transaxillary first rib resection, and good relief of the carpal spasm was obtained. The mechanism whereby neurovascular compression may produce tetany is discussed.


Symptomatic sinus node abnormalities following lithium carbonate therapy.

Symptomatic sinus node abnormalities occurred in a woman receiving lithium carbonate. Stimulation studies of the heart revealed that only the sinus node was affected. The abnormalities disappeared completely following cessation of lithium therapy.


Pneumococcal Erysipelas. A unique case in an adult.

The clinical features of a patient with macroglobulinemia and pneumococcal erysipelas are presented. The cellular and humoral factors generated by the host to contain acute pneumococcal tissue invasion are described, and their activities in patients with plasma cell dyscrasias are discussed.


Eosinophilic leukemia. Remission with vincristine and hydroxyurea.

A 40 year old man with eosinophilic leukemia was treated with a variety of chemotherapeutic agents. A long-term remission, unusual for eosinophilic leukemia, was maintained with chronic hydroxyurea therapy after induction with vincristine. Hydroxyurea and vincristine may offer an effective mode of therapy for this disease.


Fermentation reactions of Actinobacillus and Pasteurella in commercial media.

The applicability, reliability and accuracy of various carbohydrate media in the determination of fermentation reactions of 16 Pasteurella and Actinobacillus isolates were investigated. Laboratory prepared and commercially prepared carbohydrate media were inoculated with known test organisms and results were compared with those obtained at the Center for Disease Control (CDC). Only two of the 15 media tested reproduced more than 90 per cent of the reactions obtained at CDC. Significant differences in performance were noted depending on source and type of dehydrated media, manufacturer, type of carbohydrate and isolate studied. Considerations for media selection are summarized.


Biochemical screening of hospitalized geriatric patients.

Blood specimens were collected from 50 hospitalized geriatric patients with a range of chronic diseases. Analyses were conducted for 12 plasma components. Additional tests were performed on patients with abnormal results in the first tests. Of the 50 patients, 21 (42 per cent) had biochemical abnormalities, often unexpected on the basis of current diagnoses. It is suggested that routine biochemical screening should be conducted on geriatric patients at regular intervals.


Measurement of fat absorption utilizing 131iodine-triolein and nonabsorbable radioactive markers.

To eliminate many of the practical problems inherent in the collection of feces and in the chemical determination of fecal fat, a radioactive marker (131Ba) was combined with a labeled fat (131l-triolein) to measure fat absorption in man. The ratios of radioactivity of 131Ba/131l in a prepared capsule and that found in a random "grab" stool specimen after oral administration of the capsule were compared to determine the amount of fat absorbed. In an initial 36 patients, this double-label technique accurately separated normal from abnormal fat absorption as determined by the usual methods of quantitative fecal fat measurement. Results in an additional 102 patients and in 26 normals accurately reflected their clinical states. In addition, in vitro studies demonstrated more complete recovery of added lipid (99 percent) by radioactive techniques than by chemical analysis (86 per cent). The double-label technique not only seems more accurate than usual quantitative fecal fat determinations, but also greatly simplifies the measurement of fat absorption in man by eliminating the need for special diets, quantitative stool collections, and chemical analysis of stool.


Amniotic fluid glucose: a maternal, fetal, and neonatal correlation.

While it  has been noted that amniotic fluid glucose is increased in patients withdiabetes mellitus, the exact significance of this finding is not known.  Our study of amniotic fluid glucose in 53 amniotic fluid samples from 41 patients shows a high correlation of amniotic fluid glucose levels of 30 mg. per 100 ml. or greater with neonatal hypoglycemia.  We have also found elevated amniotic fluid glucose levels in patients whose onlyother indication of abnormal glucose metabolism was recurrent glycosuria.  Thepossible significance of these findings is discussed.


The light and electron microscopic changes in the skeletal muscles during paralysis in thyrotoxic periodic paralysis.

Light microscopy of the biopsied quadriceps muscles during paralysis in 17 patients with thyrotoxic periodic paralysis (TPP) showed no abnormalities in 23.5 per cent, sarcolemmal nuclear proliferation in 35.5 per cent, atrophy of muscle fibers in 29.4 per cent, central nuclei in 23.5 per cent, fatty infiltration in 17.6 per cent, vacuolation in 11.8 per cent, and sarcoplasmic masses in 11.8 per cent. The muscle specimens were also examined by electron microscopy in ten of these patients; the main changes observed were vacuolation (90 per cent), mitochondrial abnormalities (100 per cent), glycogen granules accumulation (100 per cent), disruption of the myofibers (50 per cent), and changes in the T-system (40 per cent). The light and electron microscopic changes in the skeletal muscles during paralysis were not well correlated with the severity of the muscle weakness of hypokalemia.


The effect of medroxyprogesterone acetate on gonadotropin secretion in girls with precocious puberty.

Plasma luteinizing hormone (LH) and follicle stimulating hormone (FSH) as detected by radioimmunoassay have been found to be present in prepubertal children and show a gradual rise until the onset of puberty. Children with idiopathic true precocious puberty have plasma gonadotropin levels which are appropriate for their advanced degree of sexual development. A potent progestational agent, 6-methyl-17-hydroxyprogesterone acetate or medroxyprogesterone has been used in the treatment of precocious puberty and will suppress its physical manifestations. In this study the effect of medroxyprogesterone on gonadotropin levels was investigated in seven girls with true precocious puberty. Plasma LH values were found to be significant lower in patients receiving this agent than in a group of normal prepubertal girls. FSH values did not differ from the control group. One patient was evaluated prior to treatment and showed decreasing levels of LH after therapy was begun. These data suggest that medroxyprogesterone may act on the pituitary-hypothalamic axis to suppress the pubertal levels of LH.


Smoking and coronary heart disease in the elderly.

This paper is concerned with the question of whether elderly people (ages 65-84) are more likely to develop coronary heart disease (CHD) if they continue or stop cigarette smoking. Age-standardized CHD rates and mortality ratios have been computed from data available in four major prospective cohort investigations of smoking and health. The data examined gave consistent results. For elderly men, there were no appreciable excess risks of CHD mortality or morbidity among cigarette smokers compared to ex-cigarette smokers and non-cigarette smokers. For elderly women, the CHD rates seemed lower in continuing cigarette smokers than in ex-cigarette smokers. These results obtained from cohort data are concordant with previous analyses of secular data. Among elderly people, the risk of CHD is essentially the same with persistence of cigarette smoking than with its cessation.


Squamous neoplasia of vagina related to DES syndrome.

The emphasis to date in the DES syndrome has been confined to the presence of adenosis in the vagina and the occassional adenocarcinoma which may arise from this ectopic glandular epithelium (less than 250 to date).  As these patients mature, however, the glandular epithelium in the vagina is replaced by squamous metaplastic epithelium.  Forty-six patients with benign vaginal adenois were observed colposcopically for up to 2 years. Atypical squamous epithelium (white epithelium, punctation, or mosiac pattern) was observed in 40 of the 46 patients.  Colposcopically directed biopsy revealed six cases ofdysplasia (mild to severe) and one unequivocal case of in situ squamous carcinoma.  These squamous lesions in the vagina were identical, both colposcopically and histologically,to similiar lesions on the cervix.  These data suggest that squamous neoplasia may be more frequent in the future of the DES-exposed patient than adenocarcinoma.


Subacute consumption coagulopathy--an unusual complication of angiography.

A 20-year-old female with congenital venous malformations in her left lower extremity had a self-limited, moderate consumption coagulopathy following angiographic studies. This episode was documented by both conventional coagulation studies and by 125l fibrinogen survival studies. It seems likely that venography triggered a local inflammation in the vascular malformations, which resulted in a localized consumption coagulopathy which abated as did the phlebitis in three weeks. We are aware of no prior reports of this complication of venography. Patients with venous malformations who undergo venography should have appropriate coagulation screening performed before and after the procedure so that any similar episode can be promptly diagnosed and treated, if treatment is deemed necessary.


Tobramycin in renal impairment.

Calculated elimination rate constants of tobramycin were correlated with endogenous creatinine clearances in 128 normal subjects or patients with various degrees of renal impairment. A similar correlation was made with serum creatinine concentration in 85 subjects. Superimposition of these regression lines permitted calculation of daily maintenance dosage ranges for tobramycin in patients with all degrees of impairment of renal function as determined by either creatinine clearances or serum creatinine concentrations. These maintenance dosage ranges are presented in a simplified figure.


Subcostal loculated pleural effusion in congestive heart failure: an unusual case of vanishing tumor.

Localized collection of fluid in an interlobar fissure as a consequence of congestive heart failure is a well-known entity. It has been termed vanishing tumor because of its appearance as a mass lesion in the lung and its propensity to resolve with diuretic therapy. We report a case of loculated pleural effusion in the subcostal pleural space without interlobar fluid collection. This was initially thought to represent an occult metastatic malignancy; however, the cause of the density became obvious when it disappeared with therapy of heart failure and recurred concurrent with cardiac decompensation. Loculated pleural effusion must be included in the differential diagnosis of roentgenographic densities in the chest when seen in subcostal as well as in interlobar locations.


Calcitonin effects in primate pregnancy.

The acute effects of calcitonin (CT), a hypocalcemic hormone to act by inhibiting bone resorption, were studied in rhesus monkeys in late pregnancy.  Salmon CT was injected intravenously into either mother or fetus and the concentration of total calcium and inorganic phosphorus in maternal plasma, fetal plasma, and amniotic fluid measured.  Maternal CT administration produced a gradual fall in maternal plasma calcium levels and, to a lesser extent, in maternal plasma phosphorus levels.  Both depth and duration of maternal hypocalcemia were related to dose.  In addition, the dbree of hypocalcemic response was greater in pregnant than in nonpregnant animals at equivalent dosage levels.  Hypocalcemia induced in the mother by CT injection was not reflected in fetal hypocalcemia.  Fetal CT administration produced a triphasic response in fetal plasma calcium, consisting of a prompt initial drop followed by a return to or above the baselineand then a more gradual decline.  Bth the initial and the secondary hypocalcemic responses in the fetus were dose-related in terms of depth and duration.  These observations suggest that CT MAY BE AN IMPORTANT HORMONE IN BOTH MATERNAL AND FETAL PHYSIOLOGY.


Herpes zoster induced urinary retention in Hodgkin's disease.

A patient with Hodgkin's disease with acute urinary retention caused by herpes zoster is presented. Two other similar cases previously reported in the literature are reviewed  along with a review of English literature on herpes zoster causing urinary retention and on other genitourinary problems in Hodgkin's disease. Because of increased incidence of herpes zoster in Hodgkin's disease, recognition of this complication is stressed since other causes of actue urinary retention in Hodgkin's disease have serious implications.


Hypoglycemia and ventricular tachycardia due to adenocarcinoma of the stomach.

We report the first case of adenocarcinoma of the stomach associated with severe hypoglycemia. Accompanying the profound hypoglycemia, as low as 5 mg per cent by the orthotoluidine method, were multiple episodes of ventricular tachycardia which were abolished by glucose infusion. Following surgical excision of a hemorrhagic portion of the tumor, normoglycemia levels were achieved and ventricular irritability was no longer present. The possible mechanisms of hypoglycemia in extrapancreatic tumors are discussed as well as a mechanism for hypoglycemic-induced ventricular tachycardia. It is postulated that hemorrhage of a necrotic tumor may release large amounts of an insulin-like substance and cause hypoglycemic coma.


Adenocarcinoma of the uterine cervix.

From January 1, 1947, through December 31, 1971, 219 patients with primary adenocarcinoma of the intact uterine cervix were treated at the M.D. Anderson Hospital and Tumor Institute.  Two modes of therapy were primarily used, namely, irradiationtherapy alone and irradiation therapy plus operation.  The 5 year survival resultsare 83.7 per cent for patients with Stage i disease, 48.0 per cent for patients with Stage ii disease, 29.2 per cent for patients with Stage iii disease, and 0.0 per cent for patients with Stage iv disease.  The group with irradiation plus operation had a better over-all survival rate.  In addition, the incidence of central and pelvic recurrent disease was remarkably lower (fourfold difference).  The urologic and bowel complications are discussed.  This review lends support for our practice of preoperative irradiation followed by simple (constructive) hysterectomy for selected patients eith adenocarcinoma of the uterine cervix.


Legal guidelines for the performance of abortions.

Abortion is a nationwide problem. This paper summarizes the original decisions of the Supreme Court and interprets those decisions and subsequent decisions of the various federal and state cases as they apply to physicians and hospitals. The legal duties, obligations, and responsibilities as well as the rights of health care providers in providing abortions to women are reviewed. The present status of the legal rights of parents, husbands, and fathers is discussed. The problems of payment for abortion services by third parties, welfare agencies, and insurance carriers are presented. The social impact of legalized abortion, the present status of abortion, and the legal guidelines for the performance of abortion are noted.


Bacterial flora of the cervix from 100 prehysterectomy patients.

Although anaerobic bacteria are being reported more frequently as causes of pelvic infections, few investigators have carefully studied these organisms in the normal female genital flora. This study describes the aerobic and anaerobic flora of 100 women prior to their undergoing hysterectomy. Anaerobic organisms were isolated from 86 per cent of the cultures in combination with aerobic organisms. Of the anaerobes the gram-positive cocci were the most common isolates (154 isolates in 74 cultures). The anerobic gram-positive rods (41 isolates in 38 cultures) were second, followed by the anerobic gram-negative rods (32 isolates in 29 cultures) and the anerobic gram-negative cocci (16 isolates in 15 cultures). The gram-positive cocci were most prevalent aerobic organisms isolated (149 isolates in 85 cultures).


Female sterilization. III. vaginal hysterectomy.

One hundred and eleven cases of vaginal hysterectomy for sterilization, performed over a period of five and a half years, were analyzed and compared with alternative methods of female sterilization. The mean operating time for vaginal hysterectomy was 98 minutes, and the mean length of hospitalization was 9.5 days. Immediate morbidity of one sort or another occurred in 89 cases (90.0 per cent), while the incidence of standard morbidity was 40.9 percent (35 cases). These data compare most unfavorably with findings for interval tubal ligation by either the vaginal or laparoscopic approach. Our data indicate that vaginal hysterectomy for sterilization should be used only in selected patients where there is a clear indication for hysterectomy above and beyond the desire for sterilization.


Cystine animopeptidase and leucine aminopeptidase of choriocarcinoma cells grown in culture.

Cystine animopeptidase (CAP) and leucine aminopeptidase (LAP) in choriocarcinoma cells grown in culture were assayed and characterized electrophoretically. The specific activity of CAP in choriocarcinoma was about 1.5-fold greater than the specific activity of term placenta. The extract of choriocarcinoma contained an enzyme which is similar to one of the pregnancy-specific serum aminopeptidases in electrophoretic mobility and in resistance to inhibition by 0.1M methionine. The CAP activity was not increased in either the cells or the medium by growing the cells in the presence of oxytocin, estrogen, progesterone, or prostaglandin F-2alpha. It was tentatively concluded that choriocarcinoma cells produce CAP and that it is not regulated by any of these hormones.


Colpocystography in cases of genital prolapse and urinary stress incontinence in women.

Experience with colpocystography used routinely in 586 cases of genital prolapse and urinary stress incontinence is described. Radiologic aspects are discussed and related to clinical findings by means of an original classification. The technique is described in detail. Systematic opacification of the urethra permits the study of changes in the urethrovaginal region. Contrary to prevailing opinion, the lower urinary system and the anterior vaginal wall do not participate concomitantly in the process of prolapse but sliding bladder prolapse, which may cause urinary stress incontinence, is often seen. Colpocystography is simple, easy, inexpensive, and safe. Its use in surgical gynecology assits in evaluation the tactical and technical indications, assessing the effectiveness of the operation, and studying recurrences and postoperative complications.


The use-effectiveness of two contraceptive methods in a Navajo population: the problem of program dropouts.

Navajo Indian intrauterine contraceptive device (IUD) and oral contraceptive users between 1966 and 1971 were followed up to estimate life table rates of complications and continuation. Because of high rates of dropping out, 41.6 per cent of 291 oral contraceptive users and 18.2 per cent of 534 IUD users, a 26 per cent sample survey of the dropout population was used to collate the dropout population data into the life table analysis. Estimates of the IUD continuation rates for one, two, and three years are similar to rates published elsewhere; however, continuation rates for the oral contraceptive are clearly lower than those for other populations, which only 33 per cent continuing after one year, 23 per cent after two years, and 12 per cent after three years. The IUD user is two to three times more successful than the oral contraceptive user in this population.


Recognition of meconium staining of the liquor aminii at amnioscopy.

The results of a prospective investigation into the reliability of amnioscopy in the detection of meconium staining of the liquor amnii is presented. Under the conditions which prevail in most obstetric units, amnioscopy was found to be an unreliable method of detecting meconium staining of the liquor amnii. False-positive findings are infrequent but false-negative findings are common.


Metabolic control in diabetic pregnancy. Variations in plasma concentrations of glucose, free fatty acids, glycerol, ketone bodies, insulin, and human chorionic somatomammotropin during the last trimester.

Metabolic control was evaluated under standard conditions in pregnant gestational and insulin-dependent diabetic patients and control subjects from: (1) changes during an 8 hour period in blood glucose, free fatty acids (FFA), glycerol, ketone bodies, chorionic somatomammotropin (HCS), and insulin during the last trimester and (2) changes from weeks 32 to 40 in fasting blood glucose, FFA, glycerol, and ketone bodies. Mean glucose levels calculated from five daily analysis 28 days before delivery were determined in insulin-dependent and gestational diabetic patients (pregnancy glucose level). Group mean 8 hour glucose levels were similar in diabetic patients and control subjects, but glucose swings were greater in diabetic patients. Gestational diabetic patients had delayed insulin response following meals. FFA, glycerol, and ketone bodies varied in parallel with a simmilar pattern in diabetic patients and control subjects. Insulin-dependent diabetic patients had suppressed lipid mobilization in the afternoon when glucose levels were almost normal. In control subjects, FFA, glycerol, and ketone bodies were not above normal nonpregnant values. Diabetic patients showed great individual variations in all parameters measured. FFA and ketone bodies were significantly above normal; glycerol and glucose were normal. Pregnancy glucose levels were significantly correlated to a mean amplitude of glycemic swings (MAGE) determined from the 8 hour glucose profiles. The glucose value 2 hours after breakfast correlated best to the MAGE value.


Crohn's disease and pregnancy.

Crohn's disease is occasionally associated with pregnancy, but only rarely does the firth manifestation of Crohn's disease appear during pregnancy. Two cases of Crohn's disease commencing during pregnancy are reported. The English-language literature reveals eight others-a total of 10. Review of these 10 cases indicates that surgery was required during pregnancy or shortly afterward in six. The 10 pregnancies yielded 11 infants, six of whom died. In this unusual situation there is an increased risk to both mother and infant. Progress of the intestinal disease may make surgical treatment during pregnancy urgently necessary.


Fetal monitoring: its effect on the perinatal mortality and cesarean section rates and its complications.

Direct fetal monitoring was employed in 608 patients, 96 per cent of whom were though to be at "high risk". A definite rise in the primary cesarean section rate occurred, but 107 cesarean sections were averted. Fetal deaths after admission as well as the total perinatal mortality rates were reduced. Apgar scores were recorded, and low Apgar scores correlated with fetal distress patterns. Complications consisted of only one uterine perforation and two cephalohematomas; no evidence of puerperal pyrexia was noted secondary to intrauterine catheter placement.


The use of amniotic fluid bubble stability, L/S ratio, and creatinine concentration in the assessment of fetal maturity.

Amniotic fluid bubble stability and creatinine concentration are analyzed in relation to the L/S ratio and clinical outcome. Bubble stability by the standard method showed 20.5 per cent (31/151) initial disagreement between two laboratories, 53.6 per cent (81/151) correlation with L/S ratio, and did not correlate well with patient outcome. However, a "foamy" test, i.e., foam noticeable at a distance, in both 1:1 and 1:2 dilutions, indicated an elevated L/S ratio and mature pulmonary outcome. Amniotic fluid creatinine levels showed an estimated 5 to 6 per cent risk for RDS at levels we formerly thought to be safe (greater than or equal to 2.0 mg. per 100 ml. with maternal serum less than or equal to 0.9 mg. per 100 ml.), and has many false-negative values. Fetal maturity can be estimated with clinical data and amniotic fluid analysis. Amniotic fluid sampling is necessary in all instances where the clinical data leave a reasonable doubt of actual gestational age and in all cases for elective preterm delivery. We recommend a sequential approach to amniotic fluid analysis. First a bubble stability test (a "foamy" at both 1:1 and 1:2 dilutions indicates pulmonary maturity). If the bubble stability test is not "foamy", an L/S ratio. The risk of RDS associated with creatinine concentration makes this test unacceptable in any case of elective delivery; however, it may be useful as a weighing factor in emergency situations where phospholipid analysis is unavailable.


Tracheal suction in meconium aspiration.

We performed a retrospective study of the morbidity and mortality rates of 125 infants, born through meconium-stained amniotic fluid, and admitted to the newborn intensive-care unit for observation. A comparison was made of maternal age, history of toxemia, type of anesthesia, duration of analgesia, presence of cord complications, abnormalities of fetal heart rate, duration of meconium staining, birth weight, gestational age, 1 and 5 minute Apgar scores, and type of resuscitation between infants who were symptomatic or asymptomatic in the unit. Forty-three developed respiratory distress (symptomatic) and eight died; 82 were asymptomatic. The only difference between the two groups was a history of immediate tracheal suction in the delivery room. Of 97 infants receiving immediate tracheal suction, 27 became symptomatic and one died--an infant with Down's syndrome and endocardial cushion defect. On the other hand, of 28 infants who did not receive immediate tracheal suction, 16 became symptomatic and seven died of massive meconium aspiration pneumonitis (P less than 0.001). We concluded that in infants born through meconium-stained amniotic fluid, immediate tracheal suction is a safe procedure that significantly lowers the morbidity and mortality rates and produces no further respiratory depression of the infant.


Amniotic fluid lecithin/sphingomyelin ratio in complicated pregnancies.

Amniotic fluid (AF) lecithin/sphingomyelin (L/S) rations were obtained in 223 pregnancies. Gestations complicated by maternal diabetes (71), vascular disease (50), and fetal growth retardation (47) were included. Elevated L/S ratios at 34 to 36 weeks' gestation were observed to accompany maternal vascular disease; higher rat;os were also related to fetal sex (female) and race (black). Declining L/S rations were observed in 14 of 35 diabetic patients studied serially (40 per cent) and were accompanied by increased perinatal morbidity and deaths. These data suggest an urgent need for further studies concerning the clinical usefulness of a serial decline in the L/S ration as a predictor of fetal compromise.


Human endometrial fluid kinetics as observed by scanning electron microscopy.

Segments of human endometrium, obtained during different stages of the menstrual cycle, were fixed in glutaraldehyde, processed by critical point drying, coated with carbon and gold, than observed with a scanning electron microscope under magnifications varying from 20 to 200,000. The endometrium was basically made of two different types of cells: secretory nonciliated cells and ciliated cells. Different types of secretory cells at different stages of secretory cycles were observed. The endometrial secretion is apocrine: the apical cell membrane of the endometrial cell ruptures, releasing secretory material. The rupture of cells within a given segment of the endometrium is asynchronous. Development of aptical microvilli, synthesis, storage, and release of endometrial secretory granules, and ciliogenesis are hormone dependent. The response of the ciliated and secretory cells of the endometrium varies throughout the menstrual cycle. This is particularly noted in cell specialization, the development of apical microcilli, and ciliogenesis.


Influence of the size of cone specimens on postoperative hemorrhage.

To investigate whether the amount of the tissue removed at conization could influence the frequency of postoperative hemorrhage, the size of 221 cone specimens was measured in two different series. The 119 patients in the first series were operated upon mainly during 1972 and the second series of 102 patients mainly during 1973. The cones in Series II were empirically reduced following the technique proposed by Crisp and associates. Actual measurements demonstrated that the specimens in Series II were smaller than in Series I. The frequency of bleeding following conization was 4 per cent in the second series but as high as 21 per cent in the first series. Postconization hemorrhages, however, were unrelated to the size of the individual cone specimens in the different series. The operative technique used in Series II appears to be responsible for the decrease in the amount of postconization hemorrhages.


The correlation between colposcopic grading, directed punch biopsy, and conization.

In a study group of 102 patients in whom colposcopy examinations were done, a series of 67 selected biopsies and 47 cold-knife conizations were performed. All patients had suspicious or positive Papanicolaou smears. There was a 96 to 98 per cent correlation between the colposcopic findings, biopsies, and cone specimens.


Mid-trimester abortion induced by intravaginal administration of prostaglandin E2 suppositories.

Mid-trimester abortion was successfully induced in 70 of 71 patients by administration of vaginal PGE2 suppositories. The one patient who failed to abort with this method was pregnant in the blind horn of a duplex uterus. The mean abortion time for the successful inductions was 11.88 hours. Multiparous patients aborted somewhat faster than nulliparous patients, but the difference was not significant. Among the 70 successful inductions 42 patients aborted in 12 hours or less and only one patient had an abortion time of more than 24 hours. The drug appeared effective throughout the stages of gestation included in this series--from 8 to 27 weeks. Eight patients were monitored throughout the abortion procedure and uterine activity was calculated and analyzed. The development of uterine activity was gradual without the sudden rise in frequency of contractions and intrauterine baseline tonus that characterized prostaglandin administered by other methods. The most frequently encountered side effect of vaginal PGE2 suppositories was a temperature elevation, which returned to normal within a few hours of the last dose of the drug. Gastrointestinal disturbances--vomiting and diarrhea--were also common, despite a low initial dose of PGE2 and premedication with antiemetic and antidiarrheal agents. These side effects were in general well tolerated by the patients and never required termination of therapy. The cardiovascular effects of PGE2 in this series could be considered minimal. In a single patient surgical intervention was required to remove the placenta. In seven patients the placenta was removed by sponge forceps and in five patients the placenta was removed manually. There was an estimated blood loss exceeding 250 ml. in 10 patients, but transfusion was not required. Although white blood cell count rose significantly during the abortion period there were no significant changes in hematocrit or platelet count. Mid-trimester abortion with intravaginal administration of PGE2 suppositories appears to offer a valid alternative to the presently available techniques, with a rapid abortion time, high success rate, and low incidence of complications.


The relationship of a newly described acute-phase protein to human gestation.

Rho is a newly described acute-phase serum protein which increases in titer in response to a variety of inflammatory and infectious diseases. It is present in 100 per cent of sera from pregnant women by the twentieth week of gestation, rises in titer until term, and then falls slowly during the postpartum period. It was barely detectable in some fetal sera and in some amniotic fluid samples near the end of the first half of gestation, and it could not be demonstrated in fetal tissue obtained at that time. Fetal serum titers increase with gestational age, but fetal levels remain below those of maternal sera. Undifferentiated placental tissue and estrogen/progestin do not appear to evoke rho antigen production. The stimulating mechanism during gestation remains unknown.


Multiple births in drug-addicted women.

Two sets of twins and two sets of triplets were delivered in a group of 126 pregnant drug addicts. The over-all multiple-birth incidence of 1:32 is three times more prevalent than that found in the general population. Three of the four multiple births were dizygotic. The mothers with the dizygotic multiple births were on moderate to elevated levels of heroin or methadone at the time of conception. Mechanisms are presented to help explain why narcotics may cause supraovulation and multiple births.


Depression of blast transformation of peripheral leukocytes by plasma from pregnant women.

The blast transformation of peripheral leukocytes from pregnant and nonpregnant women has been studied at different time intervals with graded concentrations of phytohemagglutinin. The transformation is markedly depressed during pregnancy. Leukocytes from nonpregnant women and men show diminished transformation when cultured in a medium containing plasma from pregnant women.


Possible adrenocortical insufficiency in postmature neonates.

Total plasma cortisol in cord and neonatal blood was measured by a radioassay method in neonates resulting from (1) term vaginal delivery following uncomplicated labor (control group), (2) term vaginal delivery following fetal distress during labor, (3) postterm, postmature vaginal delivery following fetal distress during labor, and (4) postterm, postmature emergency cesarean section performed because of signs of severe fetal distress during labor. Comparison of the mean peripheral plasma cortisol values showed that whereas the mean level (plus or minus S.E.) of the distressed term neonates (22.2 plus or minus 5.3 mug per 100 ml.) use 180 per cent of that of the control group (12.3 plus or minus 1.1 mug per 100 ml.; P smaller than 0.01) the mean level for the vaginally delivered postmature group (7.5 plus or minus 1.8 mug per 100 ml.) was only 61 per cent of that of the control group (P smaller than 0.05). Furthermore, in the postmature group with sufficient intrapartum distress to warrant emergency cesarean section the mean level (4.6 plus or minus 1.5 mug per 100 ml.) was found to be only 37 per cent of that of the control group. No differences were observed among the cord plasma cortisol values. These results are strongly suggestive of a relative adrenocortical insufficiency in postmature neonates. Such insufficiency could result from a defect in any portion of the adrenal-pituitary-hypothalamic axis. Effort is under way to further define such a defect.


Perinatal factors and neonatal morbidity in twin pregnancy.

There were 177 pairs of twins reviewed. The incidence of twin pregnancy was 1:112.2 deliveries in a population consisting of 76.8 per cent Mexican-Americans. The incidence of breech, cesarean section, and assisted deliveries was higher in twins than singleton deliveries, and the incidence was higher in twin 2 than twin 1. Mortality rates, fetal and neonatal, were lower than those previously reported. Neonatal findings and complications include low Apgar scores, small-for-dates infants, hyaline membrane disease, hypoglycemia, hypocalcemia, hyperbilirubinemia, and congenital malformation. The increased incidence of deaths and morbidity in twin pregnancy, as compared to singleton pregnancy, was attributed to prematurity, and to complications and diseases pertaining to prematurity, rather than to twinning per se.


Complications of Mohs' chemosurgical excision of eyelid and canthal tumors.

Seven patients with basal cell epithelioma of the eyelids, canthi, or periorbital skin who were initially treated by Mohs' chemosurgery or by fresh-staged excisions developed complications directly referable to the initial method of excision. Five patients achieved excellent results. Methods of one-staged complete excision and plastic reconstruction were used when tumor excision was incomplete. When excision was complete, secondary reconstructive surgery was sometimes necessary to assuage the effects of healing by granulation.


Immunoglobulins in the human cornea.

We examined 20 corneas of ten subjects to determine the amounts and distribution of immunoglobulins and albumin. Immunoglobulins IgG and IgA were found in all corneas, were at the same level centrally and peripherally, and were at one-half and one-fifth the serum levels respectively. The amount of cornea IgG correlated with serum IgG, but not with IgA. Immunoglobulin IgM was present in five of the ten sets of eyes. No IgM was detected in the central buttons of four of the five sets where IgM occurred in the corneal periphery. Albumin was present in all corneas, but less centrally than peripherally. The cornea contains high levels of antibody proteins.


Effects of drug vehicles on ocular uptake of tetracycline.

Varying concentrations of tetracycline hydrochloride were topically applied to the rabbit eye in several ophthalmic vehicles. The antibiotic levels in the corneal epithelium, aqueous humor, and lens were markedly elevated by increasing the drug concentration and the drug contact time with the eye. The ocular levels of tetracycline were increased by the vehicle in this ascending order: isotonic saline, 1.4% polyvinyl alcohol, 1% alpha-methylcellulose, and a 6:4 mixture of white petrolatum-mineral oil ointment. Tetracycline hydrochloride as a 2.0% suspension in ointment produced anterior chamber and corneal concentrations for several hours in the range of bacteriostasis for many gram-negative bacteria that occasionally invade the eye.


Biochmical aspects of contact lens wear.

Glycogen, adenosine triphosphate, and hydration were measured in rabbit corneal epithelium to determine whether the corneal epithelium glycogen decrease, increase in epithelial hydration, and decrease in epithelial adenosine triphosphate stores, seen as a result of contact lens wear, were secondary only to anoxia or may also have resulted from mild trauma, with no interference to oxygenation. Conventional contact lens wear, trauma, and oxygen-permeable contact lens wear caused metabolic changes, showing trauma as well as anoxia may play an important role in the corneal epithelial response to contact lens wear.


A chin-operated switch for motorized three-axis microscopic movement.

A chin-operated switch was developed to permit control of motorized operating microscope movement simultaneously along three axes. It permits use of both feet to operate surgical modalities, decreases microscope positioning time, and decreases needless hand movements.


Prolonged vertical nystagmus after pentobarbital sodium administration.

Of 17 healthy adults without nystagmus who ingested 100 mg of pentobarbital sodium, six had up-beating, gaze-evoked vertical nystagmus 12 hours later. Three of them had nystgmus 36 hours later, but none of them had it 60 hours later. Therefore, one should be reluctant to ascribe this type of nystagmus to a disease of the central nervous system in patients who received a barbiturate within several days of examination.


Corneal forceps.

A pair of corneal forceps combining a large overall size with delicate features-13,5 cm long, 1.5-cm wide handles, and 0.15-cm teeth on the branches--is fenestrated and finely corrugated for easy grip.


Retrobulbar hemorrhage occurring after placement of a superior rectus muscle suture.

A retrobulbar hemorrhage occurred in a 25-year-old woman after placement of a superior rectus muscle traction suture. In evaluating the causes of a retrobulbar hemorrhage, one must consider the possibility of a needle injury to an extraocular muscle.


Management of cataract in patients undergoing vitrectomy.

We developed two techniques to combine vitrectomy with cataract extraction. In technique 1, we used the lens fragmenter to break up cataractous lenses with 1+ to 2+ nuclear sclerosis. The vitrophage removed the lens and opaque vitreous body through a single pars plana incision. In technique 2, if the knife did not penetrate the nucleus (in the presence of 3+ or more nuclear sclerosis), we removed the lens through a corneal incision and immediately performed a vitrectomy with a vitrophage through a corneal incision and immediately performed a vitrectomy with a vitrophage through the pars plana. In ten consecutive patients, we used these techniques successfully to remove ca((taractous lenses in patients undergoing vitrectomy for vitreous hemorrhage.


Results and complications of 100 consecutive cases of pars plana vitrectomy.

We employed pars plana vitrectomy for several different indications in 100 eyes. In 51 eyes, the operation was performed for complications of pholiferative diabetic retinopathy. Improved visual acuity was our only criterion of success, and this varied widely depending on the specific indication forsurgery. Vision improved in all eight eyes undergoing anterior segment reconstruction and in none of three eyes with preoperative retinal detachment complicated by massive vitreous retraction. There was a high incidence of retinal tears complicating the operations in the series (37%). These retinal breaks could usually be closed at the time of the initial operation, and retinal detachment that could not be successfully managed developed in only four eyes.


Intravitreal hemorrhage associated with rapid increase in intracranial pressure (Terson's syndrome).

Four patients manifested Terson's syndrome in association with increased intracranial pressure. Three patients had subarachnoid hemorrhages, while the fourth suffered strangulation. Vitreous hemorrhage probably is related to the rapid increase in intracranial pressure with compression of the central retinal vein and its choroidal anastamotic channels.


Complications of acute posterior vitreous detachment.

Of 201 patients whose presenting symptoms were acute entoptic phenomena or photopsia, or both, 150 patients had posterior vitreous detachment; 69 patients (46%) had retinal breaks; 18 (12%) had a vitreous hemorrhage without detectable retinal breaks; and two (1.3%) had peripheral retinal hemorrhages without retinal breaks or vitreous hemorrhage. Retinal breaks that occur in eyes in conjunction with acute posterior vitreous detachment are potentially dangerous and there is a possibility of delayed break formation.


Photogrammetric analysis of volume asymmetry of the optic nerve head cup in normal, hypertensive, and glaucomatous eyes.

Recent studies of optic cup volume, depth, and orifice area demonstrated a large overlap of the range of these factors for normal and glaucomatous eyes, suggesting that it is usually not possible to distinguish abnormal disks on the basis of a particualr set of geometric quantifiers. Because of the knowledge that qualitative asymmetry of a person's optic cups may be a sign of glaucoma, calculation of the quantity of cup asymmetry using the aforementioned geometric parameters was undertaken in 90 patients. Results indicated that 90% of the bilaterally normal subjects who were studied and 80% of the ocular hypertensives had less than 0.20 mm3 cup volume asymmetry. In contrast, however, all of the unilateral glaucoma patients in this sample exceeded that value. It therefore appears that measurement of the amount of, volume asymmetry between a person's optic cups may be a useful tool in the diagnosis of glaucoma.


Gonioscopic differences between primary open-angle glaucoma and normal subjects over 40 years of age.

Gonioscopy was performed on 110 patients with primary open-angle glaucoma over 40 years of age and an equal number of normal sugjects, matched by race and age. The frequency distribution of various angle features differed in the two groups: in the glaucoma group, there were more iris processes at all levels of insertion, a higher insertion of the iris root and more trabecular pigmentation. A congenital angle anomaly is one important factor in the pathogenesis of the elevated pressure.


Blindness from glaucoma.

We observed an overall ratio of 8:1 for nonwhite to white primary glaucoma blindness. Our fragmentary evidence suggested that the ratio of underlying disease, that is, nonblinding glaucoma or intraocular pressure differentials, may be closer to 2:1 than 8:1 as between nonwhites and whites. The remaining four fold differential can be explained by a combination of the following: more complete reporting for nonwhites, reporting for medical care later in the disease than whites, and poorer response to treatment for nonwhites compared to whites. The trend of new blindness from glaucoma for recent years was stationary in the United States, England, and Wales.


Ceroid lipofuscinosis.

Seven of ten patients with ceroid lipofuscinosis, including infantile, late infantile, juvenile, and atypical variants, presented with visual acuity loss. In the infantile case visual acuity loss was early and severe. Two patients with atypical variants did not develop ocular abnormalities. Children presenting with macular degeneration may have more extensive retinal involvement on electrophysiologic testing; neurologic evaluation may rule out the prodromal stages of lipofuscinosis.


Sudden onset of bilateral symmetrical proptosis in acute intracranial hypertension.

A 32-year-old man had the clinical features of progressive increase in intracranial pressure due to a chronic subdural hematoma except for papilledema. Lumbar puncture, however, precipitated acute tentorial coning and severe neurologic signs. The tentorial coning resulted in an acute aggravation of intracranial hypertension and precipitated an increase in the intracranial venous pressure that was transmitted to the orbital veins, causing orbital venous stasis, symmetrical increase in the intraorbital contents, and symmetrical bilateral proptosis.


Retinal cryoprobe in orbital tumor management.

We used the retinal cryoprobe in the surgical management (biopsy and excision) of orbital and ocular adnexal tumors in four patients. The strong bond between the cryoprobe tip and the tumor allowed application of moderate traction to the tumors, facilitating their removal. The amount of traction on the tumor or cyst appeared to be much greater than that caused by forceps or clamps. In one case, however, marked traction with the cryoprobe caused rupture of the tumor capsule. In another case, in which a cyst wall was entered during dissection, we applied the cryoprobe to the opening, sealing the hole with an ice ball, to keep the cyst from collapsing. Histopathologic structure was not altered by cryoprobe applications.


Polycythemia vera associated with Ushers's symdrome.

A 50-year-old man with Usher's syndrome, progressive retinitis pigmentosa, and congenital sensoneural deafness developed polycythemia vera. Usher's syndrome was associated with a variety of congenital herediatry disorders but there was no evidence to support more than a chance association between Usher's syndrome and polycythemia vera.


Pathogenesis of aphakic macular edema.

Six months after cataract extraction, a 71-year-old man had cystoid macular edema confirmed by fluorescein angiography. Microscopic examination revealed cystoid spaces in the outer plexiform and outer nuclear layer of the neurosensory retina. Chronic inflammatory cells were scattered throughout the ciliary body. Inflammatory cells were also present in a section of iris that had an adherent strand of vitreous leading to the pars plana. Comparison of these findings with other related clinical entities supported the hypothesis that ciliary body inflammation may play a significant role in postcataract extraction macular edema.


Cholesterosis bulbi: the ocular abnormality known as synchysis scintillans.

Review of inpatient records at the Massachusetts Eye and Ear Infirmary for ten years and the inpatient and outpatient records at the Children's Hospital Medical Center for eight years revealed no diagnosed cases of synchysis scintillans. The pathology reports from the Ophthalmic Pathology Laboratory at the Massachusetts Eye and Ear Infirmary for the last ten years revealed 12 eyes with cholesterol crystals in the vitreous cavities or subretinal spaces, or both. All were blind, long-term damaged eyes; there were no vitreous cholesterol crystals observable clinically. This study corroborates previous reports and suggests that synchysis scintillans occurs only in severely damaged, blind eyes not visible to observation. Both the current concept and terminology of synchysis scintillans are inaccurate. Cholesterosis bulbi is a more appropriate term. Cholesterol crystals are clinically different from asteroid bodies since the former occurs only in a damaged, functionless eye.


Intracranial ophthalmic artery aneurysm.

A 45-year old black man with a carotid-ophthalmic artery aneurysm developed sudden loss of vision in his left eye, a mid-dilated pupil, and pain on movement of the left eye. A temporal island of vision was present in the left eye and the right visual field was normal. There were no other neurologic abnormalities. The aneurysm spontaneously ruptured, resulting in the death of the patient.


Vitreous hemorrhage after intracranial hemorrhage.

Eight patients, aged 2 months to 55 years, developed vitreous hemorrhages as a result of subarachnoid or subdural bleeding. Subhyaloid hemorrhages were associated with, or preceded, hemorrhage into the vitreous cavity in four cases. Most vitreous hemorrhages cleared spontaneously, several months later, without major visual sequelae. In one patient, intravitreal blood persisted after 28 months. Vitreous hemorrhage can be a serious complication in patients surviving subarachnoid or subdural hemorrhages and, though uncommon, probably occurs with greater frequency than previously acknowledged. While vitrectomy may be a reasonable therapeutic approach in selected cases, in most instances vitreous hemorrhage following intracranial hemorrhage should be treated conservatively.


Bright-flash electroretinography for the evaluation of eyes with opaque vitreous.

Standard retinal function tests are of limited value in assessing retinal function in eyes with opaque vitreous. We developed a method for obtaining an electroretinogram (ERG) from eyes with significant vitreous opacity by utilizing a much brighter than normal stimulating light. Of 115 eyes with vitreous opacities and good ERG responses to this bright-flash photostimulator, 47% would have been nonrecordable with a conventional ERG light source. Bright-flash ERG was often helpful in evaluating eyes with vitreous opacities for vitrectomy and was sometimes the only source of information regarding potential retinal function.


Temporal aspects of electroretinography in patients with myotonic dystrophy.

Electroretinographic records of eight patients with myotonic dystrophy (Steinert's) in ganzfeld and single-flash stimulation showed a decrease of the b-wave amplitude and a delayed scotopic implicit time.


A family study of fundus flavimaculatus.

Three sisters, aged 14 to 25 years, showed ophthalmoscopic findings typical for fundus flavimaculatus with atrophic macular disturbances. Examination of all surviving family members did not disclose any additional affected persons. This four-generation pedigree indicated an autosomal recessive inheritance pattern.


Retinal microangiopathy in systemic lupus erythematosus.

We performed complete ocular examination, including fluorescein angiography of the fundus, in 50 ambulatory patients with moderately active or inactive systemic lupus erythematosus; none had ocular symptoms. One patient had drusen and two patients had increased intraocular pressures with disk cupping attributable to orally administered corticosteroids. No patient had detectable abnormalities by ophthalmoscopic examination. Despite this apparently normal condition, fluorescein angiography revealed single or multiple microaneurysms in nine patients (13 eyes) and retinal capillary dilatations with leakage of fluorescein in six patients (six eyes). Both abnormalities occurred in two patients. These capillary changes in moderately ill patients with lupus erythematosus are probably the residue of previous acute vasculitis, perhaps due to immune-complex deposition.


Rhegmatogenous retinal detachment after tributary retinal vein occlusion.

Two patients had rhegmatogenous retinal detachment after tributary retinal vein occlusion. Neovascularization adherent to the posterior hyaloid was avulsed, along with a plug of retinal tissue, as the vitreous body collapsed. Localized retinal detachments resulted. Photocoagulation successfully obliterated the retinal holes and prevented extension of the retinal detachments in both cases.


The incidence of retinoblastoma.

Data from the Third National Cancer Survey indicate that the annual incidence of retinoblastoma in the United States is 11.0 new cases per million children under the age of 5 years. In response to a reported excess of mortality among blacks, rates were computed by race. There was a rate of 10.8 cases per million children for the whites compared to 9.8 cases per million for the blacks. Among the total of 61 newly diagnosed cases reported among residents of the survey area, the 50 unilateral cases occurred in 24 boys and 26 girls, whereas the 11 bilateral cases occurred in nine girls and only two boys. The reasons for a female preponderance among the bilateral cases remain unclear.


Comparative intraocular pressure measurements with the pneumatonograph and Goldmann tonometer.

Comparative intraocular pressure measurements made with the pneumatonograph and the Goldmann tonometer showed close agreement with a statistically higher mean pressure when using the pneumatonograph. Significant changes in mean pressure differences between the two instruments were seen upon changing the pneumatonograph calibration and with change in the order of testing (which instrument was used initially). However, transient biologic changes in an individual eye producing minute-to-minute fluctuations in intraocular pressure may be equal to or larger than differences in measurement between instruments.


Comparative distribution of pilocarpine in ocular tissues of the rabbit during administration by eyedrop or by membrane-controlled delivery systems.

We compared the patterns of pilocarpine distribution in the rabbit eye during two regimens that were comparably efficacious in human clinical use: an administration of 2% pilocarpine nitrate eyedrops, every six hours, for four and eight days, and a continuous delivery of pilocarpine for as long as eight days, at 20 mug/hr, from a membrane-controlled delivery system in the inferior cul-de-sac. Pilocarpine labeled with radioactive carbon (14C) was used as a tracer. With administration of eyedrops, 14C levels in ocular tissues rose and fell within each six-hour interval between eyedrops, but with the delivery system, 14C levels remained constant over the two- to eight-day period. In each tissue, the 14C level within the first hour after the most recently administered eyedrop always exceeded the constant level maintained by the delivery system. Three to six hours after eyedrop administration, the 14C levels in cornea, iris, and sclera were approximately equal to those maintained by the delivery system. However, in lens, vitreous humor, and conjunctiva, the 14C levels were always two to five times higher with eyedrop administration than with the delivery system. Only aqueous humor showed a significantly lower 14C level with eyedrops than with the delivery system, occurring late in the interval between eyedrops. Compared to eyedrop administration, the membrane-controlled delivery system produced drug levels in ocular tissues that were constant rather than variable with time, and appreciably lower in tissues where the drug made no known contribution to the reduction of pressure.


Optic disk topography and visual field defects in patients with increased intraocular pressure.

One hundred one eyes of 54 ocular hypertensive patients were studied to determine the value of optic disk evaluation in predicting the presence or absence and the location and type of visual field defects by means of binocular slit-lamp examination and projected 35-mm monocular color slides. We suspected visual field loss erroneously in only one patient, and failed to detect ten (16%) of 61 eyes with field defects. An examiner experienced in slit-lamp evaluation of the optic disk can accurately predict the presence, absence, and location of field defects in most cases by stereoscopic evaluation of disk topography.


Ion exchange tempering of glass ophthalmic lenses.

We performed low velocity drop-ball tests using 5/8-, 7/8-, and 1-inch diameter steel balls on ophthalmic crown glass lenses chemically tempered by the ion exchange process. Four representative dioptric strengths (+ 2.50 spherical, - 2.50 spherical, -2.50 cylindrical, and plano) were studied with the isolated lenses mounted, convex side up, on the American National Standards Institute Z80 test block. New ion exchange lenses exhibited a 100 to 350% greater capacity for attenuation of energy from low velocity, large size missiles than matched lenses of similar strength prepared by the conventional heat-treating and air-quenching process.


A Ganzfeld contact lens electrode.

A small piece of Ping-Pong ball material fitted to a Burian-Allen contact lens electrode provided a large field of evenly distributed light on the retina that resulted in larger electroretinographic amplitudes and more accurate measurement of b-wave latencies.


A dual viewing attachment with the hand-held ophthalmoscope.

A flexible dual viewing attachment for a hand-held ophthalmoscope permits rapid and effective instruction of undergraduate medical students in the ophthalmoscopic technique.


Cataract associated with long-term facial paralysis.

Of 29 patients with postoperative acoustic neuroma, five patients with facial paralysis developed unilateral lens opacities of unknown etiology on the paralyzed side, one to six years after surgery. The corneas were well maintained in all patients by means of either eyelid surgery or flush-fitting scleral contact shells. Four patients had anterior subcapsular opacities and in one patient a mature cataract developed. Thus, cataracts may be associated with long-term facial paralysis.


Tactile function of educable mentally retarded children.

The tactile perception ability of 29 seven-and eight-year-old educable mentally retarded children was evaluated by using the tactile perception portions of the Southern California Sensory Integration Tests. The children were also observed for tactile defensive behavior. Compared to normal children of the same age (as reported in normative data), this sample of children was significantly inferior in manual form, finger identification, graphesthesia, and perception of simultaneous stimuli, but not in the localization of single stimuli. During the testing, 62 percent showed tactile defensive behavior. The role of tactile perception in the development of symbolic communications is reviewed.


Occupational therapy for chronic obstructive lung disease.

The role of occupational therapy in a multi-disciplinary approach to treatment of chronic obstructive pulmonary disease is described in this paper in terms of the evaluation and implementation of the role in the general hospital settings of two neighboring Cleveland institutions. Cleveland is a heavily industrialized urban region with a high concentration of patients suffering from chronic obstructive pulmonary disease. Motivated by this fact and by the knowledge of the increasing incidence of chronic obstructive pulmonary disease in the United States, therapists at the two facilities wanted occupational therapy to become an intrinsic part of both the Lutheran Medical Center's outpatient demonstration program and St. John's Hospital's pulmonary rehabilitation team. Although of differing natures, these programs were similar in purpose, complementing one another and therefore enhancing the quality of rehabilitative care of the patient with a chronic lung disease within this geographic area.


Occupational therapy and child abuse.

This report describes the part occupational therapy played in a community-based research and demonstration project instituted to treat abusive parents and their children. The development of the project, designed to define characteristics of abusive parents and their children and to experiment with various forms of treatment, is discussed first. The psychosocial and psychological dynamics of abusive parents are reviewed next. Through an occupational therapy evaluation process, these dynamics were found to be isolation, poor group and socialization skills, inability to set priorities or to develop order in most situations, a weak internalized ego structure as a basis for determining their needs and identity, the inability to perceive one's abilities and limitations accurately, and a great need for clear external structure. Finally, occupational therapy as a viable, evaluative tool and treatment mode in child abuse is discussed wherein the parents learned and understood cause and effect and developed some measure of control of a situation.


Introducing a stroke service in a general hospital setting.

A stroke service was begun at a private general hospital in Florida that consisted of a weekly spouse group meeting, and included treatment services already in existence, that is, occupational therapy, physical therapy, speech therapy, and social work. The five major objectives of this program were early identification of stroke patients who had rehabilitation potential, support for families of stroke patients, coordinated discharge planning as well as better communication among the professional services, and increased discharge of patients to the home setting. This project demonstrates a means of introducing change in a general hospital setting.


AOTA human resources project. 4. The member data survey--demographic characteristics of occupational therapy personnel.

This article is the fourth in a series describing the American Occupational Therapy Association's Human Resources Project. The Project consists of several interrelated studies aimed at identifying the supply of occupational therapists and assistants in the United States as of December 1973, and at projecting requirements for their services. The present report is the second of several that will describe the results of the Member Data Survey, the objective of which is to define the geographic, demographic, educational, and employment characteristics of the AOTA membership.


Viral carcinogenesis in a pronephric cell line.  An ultrastructural study.

Herpesvirus recovered from cell fractions of the spontaneous Lucké renal tumor of adult Rana pipiens were used to infect a cell line derived from pronephroi of the same species. Viruses and virus-associated structures previously found in the primary renal tumor were observed, including nuclear inclusions of capsids with single or double membranes and capsids with nucleoids often within nuclear sacs. Embedded within the clumped and marginated chromatin were 55-nm tubular elements and associated unit membrane structures. Virus-associated, 35-nm tubular elements were also  seen. The cytoplasm contained single, enveloped nucleoid virus and clusters of virus within cytoplasmic vesicles. Other cytoplasmic inclusions were dense, virus-associated, 25-nm filaments, virus particles within myeloid bodies, and possible viral budding from tubular organelles.


Iron metabolism and cell membranes. III. Iron-induced alterations in HeLa cells.

The morphologic characteristics of acute iron loading were studied in HeLa cells incubated in an iron-enriched Eagle's medium containing 500 mug/ml of iron. Chemical studies showed that ferritin synthesis was rapidly induced and the concentration of intracellular ferritin increased up to 72 hours. Closely coupled with an increase in HeLa cell ferritin was a marked decrease in the rate of cell multiplication. The significant ultrastructural findings of iron-induced HeLa cell injury are characterized by the appearance of both autophagic multivesicular and residual bodies over the first 72 hours of iron incubation. The prominence of multivesicular bodies was noted after only 4 hours' incubation, with iron and myelin figures first appearing after 6 hours. Thus, the partial arrest of cell multiplication was associated with an increase in cytoplasmic residual bodies containing iron and other debris. The distribution of intracellular ferritin within HeLa cells differs significantly from the distribution described previously in hepatic parenchymal cells. In HeLa cells, ferritin particles were confined to lysosomal vesicles and were not identified in cell sap, endoplasmic reticulum, or Golgi apparatus.


Interface unit for on-line measurements of motor unit properties with a small laboratory computer.

Some simple circuitry is described which has been successfully used in conjunction with a small laboratory computer for "on-line" measurements of the force of contraction of single motor units in cat gastrocnemius and soleus muscles. Our approach emphasizes use of a sample and hold device to allow high amplification of small forces developed during single motor unit contractions which are often superimposed on relatively large whole muscle passive forces. Two digitally controlled selectable gain amplifiers are used to ensure proper modulation of the computer's ADC and to enable automatic scaling of the measured variables. An analog peak detector is incorporated into the unit such that peak force measurements can be made with the minimum of computer software. The principles governing the present design are directly applicable to the measurement of intracellularly recorded postsynaptic potentials and a variety of other physiological variables which require accurate measurement of a small transient signal superimposed on a large "control" or "resting" signal.


Assessment of an audio-visual feedback device used in motor training,.

A miniature biofeedback device, the Basmajian-Emory Muscle Trainer, has been developed at the Emory University School of Medicine. A training and testing protocol was designed for using this device in the training of precise voluntary control of individual skeletal muscles. Thirteen normal subjects were trained to abduct the big toe of the right foot, eleven of whom displayed increases in maximum motion. Use of a biofeedback device to improve a subject's ROM capabilities requires consideration of four factors: (1) initial emphasis must be on making the subject aware of his muscle activity, (2) the muscle activity must be increased, (3) the positive re-enforcement of feedback must be continual, and (4) the newly acquired muscle activity must be used to perform a greattting.


The functional morphology of the cercopithecoid wrist and inferior radioulnar joints, and their bearing on some problems in the evolution of the Hominoidea.

The cercopithecoid wrist joint differs from the wrist joints of hominoids in several ways. The distal ulna, the distal radius, the pisiform, the triquetrum, the hamate, and the base of the fifth metacarpal are on the one hand remarkably alike among cercopithecoid genera, and on the other remarkably distinct from homologous bones in the Hominoidea. Functionally, the triquetrum and the pisiform, in conjuction with the ulnar styloid process, check the proximal carpal row during ulnar deviation, and are possibly important in stabilizing the wrist during dorsiflexion as well. The head of the ulna almost certainly betokens a range of radioulnar supination in cercopithecoids that is substantially less than is to be found in any of the hominoid genera. The articulation between the hamate bone and the base of the fifth metacarpal allows for considerable dorsiflexion in the Cercopithecoidea; this potential was not evidenct in any of the hominoids examined. Behaviorally, the cercopithecoid wrist can most profitably be viewed as an adaptation for a quadrupedal life style involving dorsiflexion of the wrist and palmigrade/digitigrade substrate contact. The hominoid wrist joint is not adapted for such a behavioral potential.


Demography and evolution of an urban ethnic community: Polish Hill, Pittsburgh.

Polish Hill is an urban, ethnic enclave of approximately 3000 residents residing in a 25-block area of Pittsburgh. This paper documents changes in the fertility, morbidity, and mortality patterns in the community from the turn of the century to the present. The demographic reconstruction is based upon baptismal and marriage records, the administration of demographic proformae and population censuses. The high mortality, morbidity, and fertility variance suggest that the immigrant population has experienced a period of high opportunity for selection in the early 1900's and that Crow's index was gradually reduced to its present level.


The sex difference in dimensional communalities in Macaca nemestrina.

Intr-individual correlations for cranial, mandibular and dental measurements made on lateral skull radiographs of Macaca nemestrina were systematically higher in 30 adult females than in 31 adult males by an average of 0.11 to 0.15, depending upon method of computation. Clearly, for the adult pig-tailed monkey as in Homo during both prenatal and postnatal life, developmental and dimensional communalities are systematically higher in the female indicating a general principle or trend.


Thickness of the normal skull in the American Blacks and Whites.

Normal skull thickness has been measured in a general hospital population of 300 blacks and 200 whites in America. In both groups, there is a rapid increase in skull thickness during the first two decades of life, followed by a small uniform increase reaching a peak in the fifth and sixth decades. The sex differences are variable, but in certain age groups the females in both races have significatly thicker parietal and occipital bones than their male counterpart. The frontal bone is thicker in the white male than in the black, and the parietooccipital thicker in the blacks than in the whites. Some suggestions are offered to explain the sex and racial difference noted.


Mineral metabolism and microstructural defects in primate teeth.

There are numerous structural defects that occur in primate teeth due to variable calcification during certain growth stages. These interruptions are usually areas of hypomineralization in enamel and dentin which are referred to as Striae of Retzius and Hunter Shreger bands in the enamel or Incremental Lines of von Ebner and Contour Lines of Owen in the case of the dentin. The frequency of occurrence of these variations in mineralization can be related to such factors as growth tempo, dietary quality, state of health, and past disease episodes. Another structure that appears in the dentin is a region that fails to calcify and is referred to as Inter-globular Dentin. Our studies have shown that the microstructural quality of different species' dentition varies widely. Samples obtained from certain fre-ranging cercopithcoids show that these species have the least hypomineralizations while man has the most. Other primate species range between these two extremems with the pongids nearer to man in these characteristics, as previously noted by Sognnaes. Additionally, out initial study shows a great deal of diversity between prehistoric human populations in the microstructural quality of their teeth. We offer the tentative explanation that this variation is due to differences in the calcitying properties of the diet and hence a difference in the general state of their health.


Genetic microdifferentiation in the Semai Senoi of Malaysia.

Blood samples, demographic and cultural data were collected from seven settlements of Semai Senoi, a swidden farming ethnic group of Malaysia. Three genetic loci (ABO blood group, hereditary ovalcytosis, and hemoglobin) were analyzed in a total sample of 546 individuals. These data indicate a considerable degree of genetic microdifferentiation in this area of the Semai distribution. Parent-offspring birthplace data (analyzed by means of a migration matrix) and settlement histories show that settlements are not strongly isolated. Genetic differences in the study area demonstrate a reasonable correspondence with migration and the history of the settlements. Genetic convergence also occurs through the addition of migrant groups to established populations leading to new patterns of marriage between donor and recipient groups. The genetic structure of the total Semai population through time thus comprises a mosaic of shifiting allele frequencies in a series of semi-isolated local populations.


Anatomical differences in the femur and tibia between Negroids and Caucasoids antheir effects upon locomotion.

Nine variables of length, width and circumference of the femur and tibia were measured on post-cranial remains of 28 Caucasoids and 45 Negroids. The distance from the point of tibial attachment of the patellar ligament to the head of the tibia (PLID) was also determined. It was found that the Negroid has a significantly longer and narrower femur and tibia than the Caucasoid, although PLID did not vary between the two groups. Thus PLID, relative to the length of the tibia, was less in Negroids than Caucasoids. A factor analysis was carried out in order to examine the relation between PLID and the other variables. It appeared that the same three factors governed the ten variables in both races. In Caucasoids, PLID did not load on either the "length" or "width" factors and appeared unique. In Negroids, PLID loaded on Factor III with two width measures, and this factor correlated positively with the "width" factor. It is suggested that in Caucasoids PLID does not relate to length or width dimensions of the leg but in Negroids it is related to width rather than length.


The Griqua of Campbell, Cape Provice, South Africa.

The Griqua of Campbell in the Cape Province of South Africa are reputed to be descended from an amalgam of Khoi ("Hottentots") with various Caucasoid, Negroid and East Asian elements at the Cape of Good Hope. A stormy history of migration and deprivation has left this small residuum on the edge of the Kalahari Desert. It was hoped that a sero-genetic study of these people, who proudly preserve their identity, might provide further insights into the genetic consitution of their Khoi forebears. Despite the retention of the language of their own, an social mores distinct from of other Mixed populations, they have been shown, however, to have received an appreciable inflow of non-Khoisan genes. This has probably resulted from social factors such as the prestige attaching to Griqua membership and the willingness of the Griqua to assimilate outsiders, combined with the tendency of Campbell Griqua to migrate elsewhere. There are no significant differences between "Griqua" members of the population and those who are not recognized as "Griqua."


Sequential changes in weight of the skeleton and in length of long limb bones of Macaca mulatta.

In a collection of 274 monkeys (Macaca mulatta) the relative weight of the dry, fat-free skeleton, expressed as a proportion of total body weight, increases significantly throughout the gestational period to approximately 6% with only random variation after birth. The weight of the fetal skeleton increases exponentially with age. In the postnatal period the skeletal weight increases asymptotically to adulthood, which is considered to be 6.5 years of age. Equations for estimating skeletal weight are presented. Of four subdivisions of the skeleton, the skul contributes the greatest proportion of total skeletal weight in the fetal stage with the proportion decreasing to adulthood. The contributions of the other subdivisions, postcranial axial, superior limb, and inferior limb, and inferior limb, are nearly equal in the fetal stage, with that of only the inferior limb increasing to adulthood, when it makes up the greatest proportion of total skeletal weight. Until the last third of the gestational period, the humerus is longer than the femur and the radius longer than the tibia. Thereafter, the inferior limbs grow at a faster rate than the superior limbs, resulting in an intermembral index of approximately 95% by birth and less than 90% by adulthood.


Effect of glucagon on plasma alanine and glutamine metabolism and hepatic gluconeogenesis in sheep.

Net hepatic uptakes of plasma alanine (Ala), glutamate (Glu), and glutamine (Gln) were measured before and during intraportal glucagon infusions in five normaland four insulin-and alloxan-treated (ITA), conscious, fed sheep.  Since hyperinsulinemia is associated with glucagon administration, ITA sheep were used so that constant plasma insulin levels could be maintained.  Glucose turnover was determined by a vena caval infusion of glucose-6-'3H.  In addition, in ITA sheep, Ala-'14C wasinfused for measurement of plasma Ala turnover, its unidirectional organ metabolism, and contribution to glucose synthesis.  During infusion of glucagon, the net hepatic uptake of Ala increased significantly (P is less than 0.01) from control values of 3.8  plus or minus 0.5 and 2.7 plus or minus 0.6 mmol/h to 5.9 plus or minus 1.0 and 5.5 plus or minus 0.8 mmol/h in normal and ITA sheep, respectively.  Similarly, Gin uptake increased from 4.3 plus or minus 1.4 and 1.6 plus or minus 0.5 to 5.5 plus or minus1.6 and 3.7 plus or minus 1.0 mmol/h, respectively.  The conversion of Ala to glucose increased from control values of 1.7 plus or minus 0.5 to 3.0 plus or minus 0.5 mmol/h. Arterial plasma Ala and Gin concentrations decreased about 25% during glucagon administration, presumably as a result of their increased hepatic uptakes.  A decreasein utilization of plasma Ala, but no change in production was calculated for the nonhepatic tissues, indicating that glucagon increased gluconeogenesis from Ala at the expense of muscle protein synthesis.  Glucagon thus has a direct effect on the liver butonly an indirect effect on other tissues.


Z protein in hepatic uptake and esterification of long-chain fatty acids.

Fatty acids radioactivity was bound to Z protein in liver after administration of['3H]oleate to rats or to a perfused rat liver preparation.  Pretreatment withflavaspidic acid (340 mumol/kg), a potent inhibitor of fatty acid binding to hepatic Zprotein in vitri, effectively reduced oleate radioactivity bound to Z by 90.2 plusor minus 4.3% and 85.0 plus or minus 6.2% in the intact rat and perfused liver, respectively.  In spite of this effect, pretreatment of rats with flavaspidic acid did notalter plasma clearance, hepatic uptake, and esterification of ['3H]oleate.  In contrast, in the perfused liver preparation, infusion of flavaspidic acid (340 mumol/kg)or bromosulphalein (360 mumol/kg) increased uptake of ['3H]oleate at least twofold,and oleate esterification was decreased by 15-30%.  These results suggest that the binding of long-chain fatty acids to Z protein is not an obligatory step in their uptakeby the liver and that Z protein may be involved in fatty acid esterification.


Myocardial substrate utilization in perfused hearts isolated from adrenalectomizedcats.

Isolated hearts form chronically adrenalectomized cats were perfused with Krebs-Henseleit buffer plus either glucose (10mM) or palmitate (0.4 mM) under various conditions of constant pressure and constant flow.  Glucose uptake in adrenalectomizedhearts was not diminished from control values under conditions of constant pressure, constant flow, anoxia, or insulin stimulation.  Palmatic acid uptake and oxygen consumption were significantly reduced (P less than 0.02) in adrenalectomized hearts.  This diminished fatty acid utilization was also reflected in a significantly lower CO'2 production and incorporation of the palmitate into myocardial triglycerides.  The decreased fatty acid uptake by adrenalectomized cat hearts may represent aserious defect in myocardial metabolism since lipids are the major energy substrate forthe heart.  Whether the defect occurs in fatty acid transport or activation cannot beelucidated by this study.  However, it is unlikely that this defect has a major contributory effect on the dysfunction of adrenalectomized hearts since the myocardium iscabable of using other energy substrates readily.


Sequential changes in intrarenal hemodynamics during saline infusion in the dog.

Intrarenal blood flow and volume (indicator-dilution technique), kidney volume (mercury-in-rubber resistance gage), intr-renal venous pressure, filtration fraction, and sodium excretion were determined dequentially before and during a l-h infusion of isotonicsaline 80 ml/kg in anesthetized dogs.  The cortical fraction of renal blood flow roseduring the first 20 min of infusion from an average of 70 to 77%, butreturned nearly to control levels during the last 20 min of infusion because ofa low rise in noncortical flow.  During the first 20 min a 23% increase in cortical blood volume accounted for one-third of the 8.5% increase in kidney volume, whereasin the last 20 min cortical blood volume had fallen nearly to control values and kidneyvolume was increased by 17.2%.  Intrarenal resistances calculated from intrarenalpressure and flow indicated persistent cortical prevenous dilatation, progressive cortical venous constriction, and only a slight late reduction in noncortical resistance. These data indicate that hemodynamics are shanging continuously during saline infusion and the natriuresis probably is multifactorial.


Acetylcholine and norepinephrine interactions on cardiac lipids and hemodynamics.

In open-chest dogs anesthized with sodium pentobarbital, acetylcholine (ACh, 5 times 10'-5M) infused into the left circumflex coronary artery caused an increase in coronary flow and a decrease in myocardial O'2 extraction ratio (P less than .01) anduptake (P less than .05).  Heart rate and mean arterial pressure were not altered,although left  ventricular dP/dt declined from 2,037 plus or minus 205 to 1,873 plus or minus 194 mmHg/s (P less than .02).  Intracoronary administration of norepinephrine (NE, 2.4 times 10'-6M) caused an increase in myocardial O'2 uptake (P less than .02); simultaneous infusion of both NE and ACh caused a decline in O'2 extraction ratio (P less than .01) and uptake (P less than 0.5).  Myocardial adenylatecyclase activity in response to ACh was not altered significantly from a control levelof 188 plus or minus 22 pmol of '14C-labeled cyclic AMP/mg protein per 10 min.  Norepinephrine alone elevated adenylate cyclase activity to 401 plus or minus 45 pmol ['14C]cyclic AMP/mg protein per 10 min (P less than .01).  However, with simultaneous infusion of both NE and ACh, adenylate cyclase returned to control levels.  Although ACh alone did not alter myocardial hormone-sensitive lipaseactivity, NE elevated lipolytic activity from 8.1 plus or minus .7 to 13.2 plus or minus 1.8 mueq free fatty acid (FTA)/g per 30 min (P less than .05).  The administration of both ACh and NE returned lipase activity to nearly control levels.  Myocardial uptake of FFA increased significantly during ACh infusion alone (P less than 0.5) and during NE infusion alone (P less than 905).  However, when NE and AChwere administered together, a decline in FFA uptake was observed (P less than .02). These data indicate that the effects of ACh  on cardiac metabolism are minimal, withthe decline in myocardial O'2 uptake of ACh primarily reflecting the decrease in contractility.  On the other hand, antagonism of ACh on NE-stimulated myocardial lipid metabolism appears to involve activity of the adenylate cyclase system.


Factors influencing neurohumoral control of the heart in the newborn dog.

Several investigators have documented immaturity of cardiac autonomic innervation in neonates.  To evaluate the integrity of afferent and efferent responses and to determine the role of circulating catecholamines in newborns, 50 puppies and 24 adult dogswere studied with the use of chloralose anesthesia.  Interventions were: bilateralvagotomy, bilateral carotid occlusion, central vagus stimulation, stellate stimulation, bilateral adrenalectomy, infusion of norepinephrine or isoproterenol, and intravenoustyramine.  Newborns exhibited supersensitivity to exogenous norepinephrine, isoproterenol, and stellate stimulation; responses to carotid occlusion and central vagal stimulation were comparable in both groups.  Newborns had less resting vagal tone.  After adrenalectomy, newborns exhibited a more marked decline in systemic pressureand heart compared to adults.  Myocardial catecholamine content in newborns was 1/10 that in adults, whereas plasma catecholamine concentration in newborns was 30-fold greater than in adults.  These data demonstrate functional integrity of afferent and efferent cardiac autonomic pathways in the newborn, define in vivo supersensitivity to the sympathetic neurotransmitter, and suggest a dominant role of circulating catecholamines in modulation of cardiovascular events in neonates.


Mechanism of methylxanthine sensitization of norepinephrine responses in a coronaryartery.

Beta-adrenergic receptor-mediated relazation to norepinephrine was enhanced by caffeine amd aminophylline in a coronary artery preparation of the beef in vitro. Augmented responses were not obtainable in the presence of known inhibitors of the extraneuronal uptake and metabolism of norepinephrine, estradiol-17beta, and the haloalkylamine GD-131, which themselves potentiate responses.  In addition, the effect on the norepinephrine dose-response curve of the combination of a methyixanthine and U-0521,the latter a potent inhibitor of catechol O-methyltransferase, the major enzyme of catecholamine inactivation in vascular tissue, did not differ from that of U-0521 alone. Studies of the extraneuronal accumulation of '3H-labeled norepinephrine revealed that caffeine and aminophylline, along with the known inhibitors, materially reduced theaccumulation of label in coronary tissue.  It is concluded that the methylxanthinesenhance beta-adrenergic receptor-mediated responses via a blockade of catecholamine uptake, giving rise to an increased concentration of agonist at receptors, and not by an action linked to cyclic AMP accumulation, consequent to receptor activation.


Enhanced contractility during relaxation of cat papillary muscle.

Contractility during relaxation of isometric tension was studied in isolated, electrically driven cat papillary muscle by interpolation of test extrasystoles, all of whichpartially fused with their antecedent (control) contractions, were separated by computer from the fused contractions and then analyzed.  The time course of the restitutionof contractility during relaxation was defined by plotting maximal positive dT/dt andtime-to-peak tension of the computer-separated extrasystole versus delay preceding the extrasystole.  The dT/dt and time-to-peak tension, which steadily decline with progressive prematurity between contractions, both increase again during late relaxation, become progressively greater still earlier in relaxation, peak shortly after peak isometric tension, and then again decline.  This phase of an apparently enhanced contractilityduring relaxation is depressed in low Ca'++ and is transmitted into the postextrasystolic period (in which it is superimposed on the usual postextrasystolic potentiation).  The possible contributions of variations in series-elastic component and contractile-element lengths, actionpotential characteristics, and other factors on contractility during relaxation are discussed.  It is suggested that enhanced contractility during relaxation may also be related in part to the decay of the intracellular free Ca'++ transient.


Effect of chronic preoptic lesions on the renal excretion of sodium in rats.

Rats with bilateral lesions in the preoptic area showed a normal pattern of urineand electrolyte excretion under resting conditions but complete absence of a natriuretic response to unilateral carotid baroreceptor stimulation and also a significant reduction in the rate of sodium excretion after saline loading and after a high-sodium intake.  Measurements of renal clearance did not show any significant differences in glomerular filtration rate, renal plasma flow, or filtration fraction between normal and preoptic-lesion rats.  Apart from the test situations used above, rats with preoptic lesions were apparently able to regulate their sodium metabolism normally because after 3 wk on a high-sodium intake their plasma and extracellular fluid volumes, plasma electrolytes, osmolaity, and mean arterial pressures were indistinguishable from normal rats. It is suggested that the preoptic component of the baroreceptor reflex pathway mighthave an input into a hypothalamic area controlling sodium excretion.


Ca++ and pancreatic amylase release.

The effects of Ca'++ on release of amylase by mouse pancreas in vitri was studied. The cholinergic agonist bethanechol was depressed about 50% in O Ca'++ medium. When pancreatic fragments were superfused with O Ca'++ medium, bethanechol still produced a normal stimulation of amylase release after half of the total tissue Ca'++ was washed out.  This Ca'++ loss included both extracellular and some intracellularCa'++.  Uptake and equilibration of '45Ca'++ into pancreatic fragments was multiphasic, with total equilibration with stable Ca'++ still not reached after 3 h.  Addition of bethanechol had no effect on the rate of '45Ca uptake and equilibration.  '45Ca'++ efflux was not influenced by superfision in O Ca'++ medium, while thestimulation of '45Ca'++ efflux by bethanechol was enhanced.  It is concluded that extracellular Ca'++ and/or Ca'++ influx is not of major importance in triggering pancreatic enzyme release, but that extracellular Ca'++ may regulate the release process thus accounting for the parallel changes in unstimulated and stimulated amylase release.


In vivo and in vitro miniature end-plate potentials at various external K concentrations.

In order to obtain a nore reliable picture of transmitter release, spontaneous synaptic activity was studied in vivo in the rat soleus neuromuscular junction.  The in vivo miniature end-plate potential (MEPP) recordings were compared with those obtained in vitro and, in both circumstances, MEPP frequency was measured at external potassiumconcentrations ranging from 5 to 15 mM.  The influence of external potassium loading on intra- and extracellular potassium concentration also estimated by measuring the muscle ionic composition and water distribution at normal and high plasma potassium concentrations.  The MEPP frequencies recorded in vivo were consistently lower than those observed in vitro for all external potassium concentrations studied (P less than0.01).  These data suggest that better experimental conditions are maintained in thein vivo preparations, since the intracellular potassium increase that follows the external potassium loading can only partially justify the observed differnce and other factors, such as anesthetic effects, etc, may be ruled out.