Pneumococcal bacteremia associated with gingival lesions in infants.

Five infants with fever, leukocytosis, and a cystic lesion superimposed on a swollen gingiva had pneumococcal bacteremia. Lesions were so characteristic that a presumptive diagnosis of pneumococcal bacteremia was made in the last three patients before confirmation by blood cultures. Infants who initially have these symptoms should be considered at risk for pneumococcal bacteremia.


Osteomyelitis in infants and children. A review of 163 cases.

One hundred sixty-three cases of osteomyelitis in infants and children were seen at our hospital during the past 15 years. There were twice as many boys as girls. Staphylococcus aureus was the major etiologic agent, being identified in 61% of the cases. Gram-negative bacteria were responsible for only 14 cases (9%). The femur, the tibia, or the humerus were affected in 103 of the 152 patients with single bone involvement. Ostoemyelitis of more than one bone was seen in 11 cases (7%). Associated joint infectin was confirmed in 29 patients. There were no deaths. Surgical drainage was carried out in 81 cases (50%). Ten patients had recurrent or persistent drainage and one developed a Brodie abscess. Of the patients with S aureus osteomyelitis, chronic disease occurred in 19% of those receiving parenterally administered antibiotics for three weeks or less, but in only one patient (2%) of those who received parenteral antibiotics longer than three weeks.


Rational diagnostic evaluation of the child with mental deficiency.

Evaluation of a mentally deficient child should be individualized, using findings from an appropriate history and physical examination. Depending on these findings the patient may be assigned to one of four subcategories, as determined by clinical indications and the patient's age at onset of the problem. These categories are (1) prenatal problem of morphogenesis, (2) perinatal insult to brain, (3) postnatal onset of brain dysfunction, and (4) undecided age at onset. This subcategorization has revelance to the type of diagnostic studies that may be indicated. Using this approach, a retrospective study of the diagnostic evaluation of 98 mentally deficient children was performed. Ninety percent of these children were considered to have had "nonrational" laboratory tests, and of these, none contributed to elucidation of the basic diagnosis. The only tests that were valuable had been indicated by a specific historical or physical finding in addition to mental deficiency.


Acute morbidity and physical growth in rural Guatemalan children.

The relationship between morbidity and physical growth increments was investigated in 716 Guatemalan children ranging in age from 15 days to 7 years. The growth variables investigated were semestral and yearly increments in total body length and weight. The number of days ill with diarrhea, fever, and respiratory illnesses per semester or year was used as an indicator of morbidity. The morbidity data were collected through bi-weekly retrospective interviews of mothers. Children less ill with diarrhea had substantially larger increments in length and weight than children who were ill with diarrhea a greater percentage of the time. In contrast, fever and respiratory illnesses did not affect growth rates. These findings highlight the fact that diarrhea is a major public health problem in developing nations.


Giardiasis in childhood.

Giardiasis is still regularly encountered in the United States, both as endemic cases from the local community as well as in patients returning from travel abroad. Giardiasis should be suspected in any child with steatorrhea, unexplained chronic diarrhea (especially if associated with growth failure), weight loss, or abdominal pain and bloating. Duodenal aspiration or small intestinal biopsy may be necessary to make a diagnosis because Giardia lamblia are not found by stool examination in 50% of symptomatic individuals. A diagnosis of giardiasis is important because the disease is curable.


Purtscher retinopathy in the battered child syndrome.

Purtscher retinopathy is a hemorrhagic angiopathy that occurs after sudden compression of the thorax. Virtually all reported cases have been in adults who have decreased visual acuity, retinal hemorrhages and exudates, and no other neurological signs. By contrast, in infants, hemorrhagic retinopathy is rarely benign, and generally is considered to indicate intracranial hemorrhage, usually an acute subdural hematoma. Two battered infants had seizures and associated chest injury. There were retinal hemorrhages and exudates, unaccompanied by clinically important intracranial hemorrhage. At follow-up, the hemorrhagic retinopathy had resolved without sequelae; development was normal, and seizures had not recurred. Purtscher retinopathy thus should be added both to the differential diagnosis of hemorrhagic retinopathy in infancy and to the list of physical signs suggesting child abuse.


Chylous ascites. Manifestation of the battered child syndrome.

A child had chylous ascites and other findings suggestive of child abuse. He had a spontaneous remission, with conservative therapy. A lymphangiogram showed the area of leakage into the peritoneal cavity. The discussion includes a brief review, a literature on chylous ascites.


Horseshoe lung in an infant with recurrent pulmonary infections.

A case of horseshoe lung occurred in a 7-month-old infant, the first, we believe, to be associated with horseshoe kidney. This lesion should be considered in any infant with dextrocardia, recurrent cardio-respiratory distress, and pulmonary infections.


Potter syndrome. Nonrenal features induced by oligoamnios.

A fetus with normal kidneys and the nonrenal features of Potter syndrome is presented. The case is made that these features resulted from uterine compression caused by premature rupture of the gestational membranes and subsequent leakage of amniotic fluid.


The Opitz trigonocephaly syndrome. A case report.

This is the third report, to our knowledge, of a baby with Opitz trigonocephaly syndrome of multiple congenital abnormalities. The unusual facial and palatal abnormalities are diagnostic.


Rubella reinfection during pregnancy. A case of mistaken diagnosis of congenital rubella.

A case of subclinical rubella reinfection during pregnancy with serologic findings in the offspring initially led to an erroneous diagnosis of fetal infection. Laboratory diagnosis of congenital rubella infection, based on finding hemagglutination-inhibition (HI) activity in immunoglobulin M (IgM) fractions of newborn's serum after sucrose gradient fractionation, was questioned when apparent IgM-HI activity was to be probably due to nonspecific inhibitors, which resulted from bacterial action on the beta-lipoprotein in the serum. These findings emphasize some pitfalls encountered in arriving at a diagnosis based soley on serologic data. This case also illustrates the importance of keeping serum samples sterile when performing serologic tests.


Compliance and self-medication in cystic fibrosis.

Sixty-one patients with cystic fibrosis were studied to determine the relationship between degree of compliance with taking antibiotics and severity of the disease. The compliance rate was high in these patients, suggesting that perception of the severity of the disease and the potential consequences of discontinuing medication is a principal factor.


Amino acids and collagen-induced platelet aggregation. Lack of effect of three amino acids that are elevated in homocystinuria.

Arterial thrombosis frequently occurs in homocystinuric children whose plasma levels of homocystine, homocysteine, and methionine are elevated. Since platelet aggregation is important in the pathogenesis of arterial thrombosis, we wondered whether the elevated concentrations of these amino acids might predispose to arterial thrombosis by enhancing platelet aggregation. Addition of the above amino acids to normal platelet-rich plasma to achieve concentrations within or above the range found in homocystinuric children had no effect on collagen-induced platelet aggregation. These data give no support to the hypothesis that the arterial thromboses of homocystinuric children are a result of enhancement of platelet aggregation by homocystine, homocysteine, or methionine.


Neonatal small left colon syndrome. Occurrence in asymptomatic infants of diabetic mothers.

An unusually high incidence (40%) of maternal diabetes was observed in a series of 20 newborn infants who had low colonic obstruction and barium enema findings of a uniformly narrowed colon from the splenic flexure to the anus. This has been termed the "neonatal small left colon syndrome." We investigated the incidence of this colon configuration in gastrointestinally asymptomatic infants of diabetic mothers. Of 12 such infants examined by barium enema, six have shown this same narrowing of the left colon. The relationship of maternal diabetes to the small left colon is not yet clearly understood.


Intravenous metyrapone testing. Evaluation of growth hormone and adrenocorticotrophic hormone in children.

An intravenous metyrapone tartrate test was performed on 26 children to assess growth hormone (GH) reserve and pituitary-adrenal axis. Results were compared to the response evoked by an estrogen-primed arginine-insulin tolerance test (ATT/ITT). Administration of metyrapone intravenously proved to be a reliable means of evaluating pituitary-adrenal function. However, a normal serum GH concentration (greater than or equal to 7 ng/ml) during the test occurred in only nine of 18 children who had an adequate response to the ATT/ITT, and in three of these, the peak GH level occurred at the start of the infusion. Therefore, this procedure does not appear to be a satisfactory test for GH reserve in children. Further, the discrepancy between time of the peak serum concentrations of compound S and GH following intravenous administration of metyrapone does not support the contention that the rise of GH level during stress is secondary to release of adrenocorticotrophic hormone.


Adolescent attitudes in a general pediatric hospital. A survey of 87 inpatient admissions.

A study of 87 adolescent patients hospitalized in a large pediatric hospital was made to define their emotional, social, recreational, and educational needs. Open-ended questionnaires were given to the adolescents, their parents, and medical care personnel. Chronic diseases, prolonged hospitalization, multiple admissions, and severity of illness were prominent in the population surveyed. These characteristics were associated with critical patient attitudes toward the physical facilities and psychological atmosphere of the hospital. Knowledge of these attitudes aids in the recreational, vocational, and educational planning for adolescents.


Pediatric interviewing skills taught by nonphysicians.

We cannot assume that medical students develop, through unstructured educational happenings, the skills of interviewing a mother about her child. Teaching these skills requires extensive one-to-one faculty-student involvement, which is almost prohibitive if pediatricians are expected to do this teaching. This article describes (1) a current pediatric interviewing teaching program that uses nonphysicians as teachers; (2) the selection and training of nonphysicians to teach the skill of pediatric interviewing to third-year medical students; and (3) an assessment of these teachers by comparing their techniques with those of three pediatric faculty members. The nonphysician teachers fared most favorably when their teaching methods were compared with those of three pediatricians. Acceptance of the program by the students, faculty, and administration has been most encouraging.


Acute transplacental ethanol intoxication.

With the use of ethanol in hyperalimentation regimens and for the inhibition of premature labor, there is increased opportunity for exposure of the fetus to this potentially toxic substance. We reviewed the literature regarding the effects of ethanol on the fetus and neonate, and illustrate its potential toxicity by the report of a case of neonatal depression secondary to acute maternal ethanol ingestion.


I-cell disease. Report of three cases.

Clinical, radiological, histochemical, ultrastructural, and biochemical studies were conducted on three cases of I-cell disease. I-cell disease can be readily distinguished from Hurler syndrome (mucopolysaccharidosis I) by the presence of hypertrophic gums, vacuolated lymphocytes in peripheral blood, and a normal level of urinary mucopolysaccharides. Accumulation of proteoglycans was more prominent in the inclusion bodies of I-cell chondrocytes in comparison to cultured fibroblasts, which contained a large amount of glycolipids and a small amount of proteoglycans. An autosomal recessive mode of inheritance was suggested in two of the cases.


Death rates and causes of death among opioid addicts in community drug treatment programs during 1970-1973.

Death rates and causes of death among opioid addicts in 52 community treatment programs in a national reporting network were compared for 3 consecutive years. The greatest proportion of patients in the base samples were male, 21 to 25 years old, black, and in MM programs. The 275 patients in the deceased sample presented essentially the same profile, with the exception that the older patients were more highly represented among the deceased. Death rates were particularly high during each year for patients over 30 years old. Over the 3 years, death rates increased for whites, addicts 21 to 25 years old, and patients in outpatient DF programs. Consistent decreases in rates each year were found for blacks, patients in the 26 to 30 age range, and patients in MM programs.


Metastatic disease involving the stomach.

Metastatic disease involving the stomach is an unusual and difficult clinical problem. A review of 1010 autopsies of patients with cancer disclosed 17 cases of gastric metastases (an incidence of 1.7%), with breast cancer, lung cancer, and melanoma being the most frequent primaries. The clinical manifestations of epigastric pain, melena, and anemia are nonspecific, necessitating radiographic examination of the gastrointestinal tract. The radiographic findings are usually sufficient to suggest the diagnosis.


The butterfat absorption test in adults.

The usefulness of the butterfat absorption test in assessing fat absorption has been studied in 89 adult patients. In 42 patients who were shown to have steatorrhea by the criteria of the fat balance studies, 33 patients (78.6%) had abnormally low serum optical density values following butterfat ingestion. In 8 patients, steatorrhea could not be clearly explained on the basis of their underlying disease. If these 8 patients are excluded from consideration, then 28 of 34 patients (82.4%) had an abnormal response following butterfat ingestion. A maximum increase of optical density of 0.25 or less is a useful indication of fat malabsorption in adult patients.


Effect of bombesin on extragastric gastrin in man.

The effect of a protein test meal and a bombesin infusion on extragastric gastrin levels was studied in patients with truncal vagotomy, antrectomy, and gastroduodenostomy or gastrojejunostomy and in patients with total gastrectomy. In patients with vagotomy, antrectomy, and gastroduodenostomy and in patients with total gastrectomy the gastrin levels were raised by 33% and 35%, respectively, from basal after test meal, while during BBS infusion gastrin values decreased by 25% and 30%, respectively, from basal. In patients with vagotomy, antrectomy, and gastrojejunostomy, test meal and BBS infusion did not significantly alter basal gastrin values. It is concluded that BBS does not stimulate extragastric gastrin.


Evaluation of endoscopic examination of colon tumors in rats.

This study is an evaluation of the use of endoscopic examination to detect MNNG-induced large-bowel tumors in rats. The smallest human fiberbronchoscope was used as a colonoscope for the rats and the full length of the distal large bowel was visualized. The correct diagnosis rate in all rats with and without large-bowel tumors was 94%. Of rats with colon tumors, 85% were correctly diagnosed endoscopically. Even tumors 1 or 2 mm in diameter were detected. The examination was easy and reliable. This procedure may be an adjunct in experimental work with this and other animal models of colon cancer.


Altered bile acid metabolism in vegetarians.

Bile acid kinetics were studied in a group of healthy vegetarians and a matched group of healthy control subjects. The daily fractional turnover rate of cholic acid was significantly smaller in the vegetarians than in the controls and deoxycholic acid pool size was significantly smaller in the vegetarians than in the controls. The data suggest that enterohepatic conservation of cholic acid is more efficient in vegetarians than in control subjects resulting in decreased deoxycholic acid input in vegetarian subjects. The possible significance of these data to intestinal oncogenesis is discussed.


Etiology of strictures of the colon associated with pancreatitis.

Colonic strictures are an uncommon complication of pancreatitis. Three new cases are described and in each case the histological features strongly resemble those seen in strictures of ischemic origin. It is postulated that ischemia and not encircling pericolic inflammation, is the cause of strictures associated with pancreatitis.


Gastric acid secretory differences in patients with Heineke-Mikulicz and Finney pyloroplasties.

To study gastric emptying and secretion, liquid meals of 10% glucose lasting 15 and 30 min, and physiological saline meals lasting 30 min, all containing phenol red as a gastric nonabsorbable marker, were given to postvagotomy patients with Finney or Heineke-Mikulicz pyloroplasties. No differences in emptying were found. A small but statistically greater amount of acid was found in the stomach with the 15-min glucose meal after Heineke-Mikulicz pyloroplasty. This represented greater acid secretion into glucose meals generally after Heineke-Mikulicz pyloroplasties, because of the larger volume contained in the stomach at 15 min. 15-min glucose meal acid secretion correlated with basal acid concentration but not with insulin-stimulated gastric acid output. The small excess of acid in the Heineke-Mikulicz group's 15-min glucose meals may represent a small, maintained excess of gastric acid in this group detected only in the brief glucose meals due to rapid and erratic gastric emptying of liquids after vagotomy.


Esophageal cancer in Israel: selected clinical and epidemiological aspects.

Records of all patients diagnosed as having carcinoma of the esophagus in Israel between 1960 and 1966 were reviewed. The mean annual incidence was 2.3/100,000, with a male/female ratio of 1.6:1. Incidence was higher among the Asian-born segment of the population below 60 years of age. The most frequent localization was in the middle third of the esophagus, followed by the lower third. More than two thirds of the patients were considered unsuitable for surgery. Overall 5-year survival was 5.8%.


The antidiarrheal action of bismuth subsalicylate in the mouse and the rat.

The antidiarrheal effectiveness of bismuth subsalicylate was determined in two species of laboratory animals. Doses of castor oil were, at first, found to accelerate significantly the movement of a charcoal test meal along the small intestine of the mouse and rat and also to increase both the fecal output (dry or wet weight) and the frequency of diarrhea in mice. Bismuth subsalicylate significantly prevented the enhancement of charcoal-meal transport induced by castor oil in both mice and rats. Increased fecal outut (dry or wet weight) and increased frequency of diarrhea in mice were also significantly reduced by bismuth subsalicylate in a dose-related fashion. The findings in these experiments lead to the definitive conclusion that bismuth subsalicylate exerts antidiarrheal activity in the mouse and in the rat and support its use in therapy of common clinical diarrheal states.


The effect of manometric assembly diameter on intraluminal esophageal pressure recording.

Recent studies indicate that lower esophageal sphincter pressure is influenced by manometric assembly diameter. This study determines the effect of assembly diameter on both esophageal sphincter pressure and peristaltic pressure in the esophageal body. We performed esophageal manometric studies in 6 normal subjects using graded assembly diameters. High-fidelity recording was achieved by using a noncompliant catheter-infusion system. The results indicate that increases in assembly diameter cause significant increases in peristaltic pressure amplitudes and in resting sphincter pressure in both the smooth and striated muscle portions of the esophagus. This phenomenon is best explained by the length-tension characteristics of esophageal muscle, increased stretch causing greater contraction force.


Meal interference with antibiotics administered orally in hospitals.

A study of 132 hospitals in New York City was conducted to determine: (1) The usual drug administration and meal serving time schedules used; (2) if oral antibiotics recommended to be given on an empty stomach are actually administered with or near meals; and (3) who is responsible for establishing drug administration time schedules. A structured-disguised questionnaire was used and administered via telephone. Results revealed a wide variation of drug administration time schedules and meal serving times. Meal interference with oral antibiotic absorption was defined as a meal that is served less than one hour before or two hours after an oral antibiotic is scheduled to be administered. The incidence of meal interference ranged from 35 percent to 64 percent. The pharmacy and therapeutics committee, more often than any other group or individual (19.2 percent), was responsible for establishing drug administration times. A formal dosage schedule for orally administered antibiotics is recommended as an effort to reduce the incidence of meal interference with antibiotic absorption. Such a schedule developed at one hospital is presented.


Drug usage review in a community hospital.

A simple and effective manual drug usage review program in a community hospital is described. Fifteen randomly selected charts are screened each month by a drug information pharmacist. Charts demonstrating questionable drug therapy are forwarded to a physician member of the pharmacy and therapeutics committee; those showing questionable drug administration practices are referred to the nurse member of the committee. These committee members screen the questionable charts and refer to the entire committee those cases which require further follow-up. The committee categorizes the problems and communicates its recommendations to the individual practitioners involved. Recommendations focus on the legal ramifications of FDA-unapproved drug usage. During the first two years of the program, 341 charts were screened for drug usage; 62 of these were referred to the pharmacy and therapeutics committee for further review. In 20 cases, the committee sent a letter to the prescribing physician or his department chairman; in 16 cases, letters were sent to nursing administration.


Economics of institutional pharmacy services under national health insurance in Australia.

The development and effect of the National Health Scheme on institutional Health Scheme on institutional pharmaceutical services in Australia are discussed. Government control over drug costs and the provision of pharmacy services, with its effect on both community and institutional practice, is assessed. Methods of improving the present system of health insurance under the Pharmaceutical Benefits Scheme in Australia are suggested, including their relevance to health care in the United States.


Establishment of a nuclear pharmacy.

The University of Michigan Regional Nuclear Pharmacy is described. The scope of operation of the nuclear pharmacy includes radiopharmaceutical formulation and dispensing, quality control, inventory control, research and development of new radiopharmaceuticals, and consultation. Also discussed are program objectives, pharmacy location, organizational structure, budget and staff, economic considerations, facilities and equipment, and legal considerations.


Yttrium-90 citrate colloid for radioisotope synovectomy.

The preparation of an yttrium-90 citrate colloid is described. This formulation localizes in the synovial membrane and thereby eliminates any irradiation received by extra-articular tissues. Yttrium-90 is eluted from Sr-90 bound to a sulphonic acid ion exchange resin. The colloid is prepared using a 3:1 ratio of carrier yttrium and citrate. Contamination with ionic 90Y and ionic 90Sr was less than 1 percent and 0.001 percent, respectively. In the 28 patients studied, all of the injected dose of 90Y remained in the region of the joint. Brief clinical results are presented.


Filling vials aseptically while monitoring for bacterial contamination.

An aseptic system for prefilling radiopharmaceutical kit vials or syringes is described. The system combines ultrafiltration with a method for monitoring for bacterial contamination. It could be used in any vial or syringe prefilling operation and is not restricted to radiopharmaceuticals.


Comparison of the bioavailability of cyanocobalamin from capsule and liquid dosage forms.

Comparative in vivo absorption of cyanocobalamin from two dosage forms, gelatin capsule and liquid, was studied. Forty-two subjects received simultaneous doses of cyanocobalamin in capsule and liquid form, labeled with cobalt-57 and cobalt-60, respectively. Excretion, a measure of absorption, was between 2 percent and 66 percent greater with the liquid form. In vitro dissolution studies showed that the capsules had a tendency to collapse into a stringy mass and to dissolve slowly.


Pharmacy information system for a health maintenance organization.

A computerized pharmacy system developed for a health maintenance organization (HMO) is described. The system has been operational for nearly three years. It is based on a coding scheme for (1) all drugs in the HMO formulary and (2) prescribing information. The information is processed by a computer which generates a variety of usage information. The system produces reports on frequency of drugs dispensed, number and percentage of patients obtaining each drug, and age-sex distribution of patients using a particular drug. The special characteristics of an HMO pharmacy as they relate to computerized systems are discussed. System requirements, maintenance procedures and cost estimates are also presented.


Clindamycin prescribing patterns in a university hospital.

A study was conducted at a university hospital to determine the patterns of clindamycin prescribing, to assess the appropriateness of clindamycin usage and to quantitate the drug's toxic reactions. Three evaluators (two pharmacists and a physician) reviewed clindamycin usage data for 65 patients who received 67 courses of clindamycin therapy during the period January 1, 1975, through March 20, 1975. Forty-eight courses were parenteral, three oral, and 16 a combination of parenteral and oral. Fifty-four courses were intended for therapeutic use rather than prophylactic use. Of these 54 therapeutic courses, 23 were considered rational and 26 irrational; insufficient data existed to make a judgment in five cases. Three adverse reactions (diarrhea in each case) were observed. The time relationship of this study with the changing clinical status of clindamycin is discussed. Identification of clindamycin's toxicity appears to have reduced oral use at the study hospital, but parenteral usage of the drug remains high.


Drug usage review and inventory analysis in promoting rational parenteral cephalosporin therapy.

Drug usage review and inventory analysis data on the cephalosporin antibotics were presented by the pharmacy to a hospital pharmacy and therapeutics committee in an effort to promote rational use of these drugs and decrease drug costs. The committee recommended that cefazolin be the parenteral cephalosporin of choice. Cephalothin was placed on a limited formulary status for ophthamology patients and patients with renal impairment. Efforts by the committee to promote physician compliance with its recommendations are discussed.


Missing medications associated with centralized unit dose dispensing.

The reasons for missing medications in a centralized unit dose system were studied, and means of improving the situation were recommended. Reasons for missing medications included: insufficient or incorrect medications dispensed by the pharmacy, differences in interpretations of orders by pharmacists and nurses, administration of extra medication or incorrect doses, waste of medication, administration of medication to patients other than for whom it was dispensed, delivery to wrong nursing unit, pilferage, and requests by nurses for medication before the orders were received by the pharmacy. A procedure for checking medications in unit dose carts by pharmacy and nursing personnel was implemented. Before this procedure, the rate of missing medications was 0.93% of the doses dispensed; after the procedure, the rate was 0.33%. Other recommendations designed to prevent missing medications in this unit dose system are presented.


Distribution accuracy of a decentralized unit dose system.

Unit dose medication carts in a 500-bed university hospital were monitored for accuracy and completeness after delivery to the nursing station. The contents of the cart were compared with the nurse's patient medication record. Discrepancies were recorded for evaluation. All medication cart distribution errors found were analyzed to identify the source and were tabulated to determine error rate. Three major categories of errors were discovered: pharmacy technician errors not corrected by the pharmacist, errors associated with nurse's patient medication records, and errors resulting from lost orders.


Respiratory therapy unit dose medication distribution.

A unit dose system for distribution of respiratory therapy medication is described. One unit dose cart, containing respiratory therapy medication for each patient and equipment for administration of the medication, is used for each floor. Syringes are prefilled by the pharmacy for unit dose use. Storage and stability data are given for normal saline, isoproterenol, acetylcysteine, and combinations of these drugs. Cost factors of this respiratory therapy medication distribution system are discussed.


Stability of sodium oxacillin in intravenous solutions.

The influence of concentration, vehicle, dextrose and temperature on the stability of sodium oxacillin solutions was determined using a chemical kinetic approach. Sodium oxacillin degraded faster in dextrose solution than in sodium chloride injection. This finding was attributed to the catalytic effect of dextrose on sodium oxacillin hydrolysis. Solutions of 1-50 mg/ml oxacillin in each vehicle were found to be stable for 24 hours at 23 C. The degradation of sodium oxacillin in various dextrose solutions was independent of oxacillin concentration, and followed first order kinetics.


Detection of particles in intravenous fluids using scanning electron microscopy.

A study was conducted to compare the particles in intravenous solutions found in glass and plastic containers, and to investigate the use of scanning electron microscopy in detecting and identifying such particulate contamination. The method used was to filter one liter of each fluid from glass and plastic containers through a membrane filter, attach the membrane to aluminum studs and coat the specimens with a thin layer of gold-palladium in a vacuum evaporator. Scanning electron microscopy was then used to examine the specimens, and photomicrographs were prepared. The results showed that the particles found in glass and in plastic containers have distinctive differences and that scanning electron microscopy is useful in detecting and characterizing these particles.


Vial retention of technetium-99m sulfur colloid in commercial kits.

Vial retention of technetium-99m sulfur colloid in five commercial kits used for the preparation of this radiopharmaceutical was studied. Radiochromatography and microscopic particle sizing were performed on all products; the biologic distribution in rats of two products was tested. Loss of activity attributable to vial retention was evident with only two products. The resulting loss of specific concentration did not affect biologic distribution. The cause of the "plating-out" of the radiopharmaceutical on the interior reaction vial surface was not determined, although the gelatin component of the product was suspected to be a factor.


Etiological factors of the Stevens-Johnson syndrome.

Etiologic factors of the Stevens-Johnson syndrome, both drug-related and nondrug-related, are discussed. A description of the Stevens-Johnson syndrome as a symptom complex is presented. Available literature is reviewed and critiqued as to its contribution in helping to define the role of drugs as specific etiologic factors in the syndrome. A patient case history is presented to demonstrate the difficulty of determining the causative agent for the syndrome, and to emphasize the need for a complete drug history before specific agents are implicated. The need for caution and discretion in reporting and implicating agents without the availability of a complete patient history is discussed.


Comparison of the clinical utility of four drug information services.

The clinical utility of International Pharmaceutical Abstracts, Iowa Drug Information Service, deHaen Drugs in Use, and deHaen Drugs in Research was compared. The number of references obtained for questions in five different clinical areas, and the amount of time for each search, were studied and compared. The Iowa Drug Information Service appeared to have the highest overall relative utility for obtaining clinical information. The two deHaen services offered broad coverage of the primary clinical literature. International Pharmaceutical Abstracts was effective in locating many useful references.


Bioavailability of acetaminophen suppositories.

Urinary excretion of acetaminophen after rectal administration of three suppository formatulations obtained from hospital and commercial sources was compared to that after oral administration of a tablet dosage form. The absorption of acetaminophen from the suppositories was extremely variable and showed relative bioavailabilities of 68.4 to 87.5% when compared to the oral absorption of the drug from the tablet. The rate of bioavailability differed markedly between products and, in one case, the suppository dose of acetaminophen was so slowly absorbed that the clinical effectiveness of the product is doubtful. The study points out the need for in vivo evaluation of hospital pharmacy manufactured products.


Development of a computer-based controlled substances reporting system.

A computer-based system of reporting the disposition of controlled drugs is described. An automated posting system, of which this system is a byproduct, is also described. The primary advantage is that no separate effort is involved in compiling the reports which provide information on the inpatient and emergency-room disposition of controlled substances.


Pharmacy-nursing communications in an intravenous admixture program.

A centralized pharmacy admixture program is discussed, with emphasis on the forms used to communicate between pharmacists and nurses. Aspects of the programs described include the patient intravenous profile folder, preparation and delivery of i.v. solutions, preparation of piggyback solutions and prefilled syringes of reconstituted antibiotics, and emergency intravenous solution stock.


Combined volume control set-piggyback system for intermittent intravenous therapy.

A new method for intermittent administration of i.v. fluids which maintains the advantages of the piggyback system but at a lower cost than the piggyback system is described. The system uses a volume control chamber as a replacement for a minibag or minibottle to deliver doses of different medications. The volume control set, when attached in the prescribed fashion, permits the flow from the primary i.v. solution to resume automatically when the volume control chamber is empty. One large-volume container of i.v. fluid can be used to dilute many doses of different drugs in the volume control chamber rather than one small-volume container per dose. No significant difficulties have been encountered with the mechanics of the system, and nursing response has been favorable.


Quality of care evaluation applied to assessment of clinical pharmacy services.

Drug information supplied in a clinical setting was evaluated to determine the quality of care provided by a group of clinical pharmacists. Both process and outcome were assessed to determine the pharmacists' effectiveness in supplying clinical pharmacy services as well as to determine the relationship between these services and patient outcomes. Evaluation was conducted by a group of five physicians and the coordinator of the clinical pharmacy program. The method of evaluation seemed to contain a very high degree of interviewer reliability. Results indicate a moderate correlation, significant beyond the 0.01 level, between intermediate outcomes and the clinical pharmacy care process. The review group judged approximately three-fourths of the drug information communications as having at least a "significant" potential for benefiting the patient. Outcome measurement indicated, however, that only 14.5% of these communications were judged as actually benefiting the patient while 25% were judged as probably benefiting the patient.


Judgmental questions processed by a drug information center.

The number of judgmental questions handled by a pharmacy-operated, university-based drug information center was studied. Judgmental questions were defined as those requiring the integration of data or knowledge and experience in the process of making a decision regarding a specific therapeutic problem. Less than 5% of 720 questions handled by the drug information center during a three-month period were of the judgmental type. Based on this result, and because of the need to use resources most efficiently, it is suggested that it may be advisable to develop more regional (and fewer hospital) drug information centers.


Pharmaceutical services for skilled nursing facilities in compliance with federal regulations.

A program of providing dispensing, clinical and administrative pharmaceutical services to three skilled nursing facilities is described. Medications are provided to patients from a community pharmacy through a centralized unit dose drug distribution system. Features of the system include pharmacy review of the physician's original order, medication histories obtained by a pharmacist, patient medication profiles, and a 24-hour exchange of drug cabinets containing individual patient drawers. The time requirements for administrative and clinical functions, and the calculation of a fee for these services, are described. Over a four-year period, the average number of medications per patient was reduced from 7.7 to 6.1. Two factors believed to be related to this reduction are an effective automatic stop order policy and careful review of patient medication profiles by the pharmacist.


Evaluation of preparations of patent blue (Alphazurine 2G) dye for parenteral use.

The stability and the behavior of patent blue (Alphazurine 2G) dye in a vehicle such as lidocaine hydrochloride injection were studied with regard to medication orders which may be prepared by hospital pharmacists. The patent blue family of dyes are sulfonated diaminotriphenylmethane, vital, acid dyes which have been used as diagnostic aids in both lymphography and burn debridement. A literature review, including some toxicological information, is presented. The occurrence of the sodium salt form and the equilibrium solubility of the patent blue sample studied are reported. Some implications of patent blue injections include: Clinical literature reports of toxicities, the unapproved status of patent blue by the Food and Drug Administration, results of stability studies, and the formation of viscid, water-insoluble precipitates of patent blue in combination with lidocaine hydrochloride. The extemporaneous preparation and subsequent use of parenteral prescriptions of patent blue dye in vehicles containing lidocaine hydrochloride and methylparaben are not recommended.


Chemical structure and purity of dyes used in lymphograms.

Because of confusion in the literature, studies were performed on several samples of patent blue violet and Alphazurine 2G to determine their chemical structure and purity. Nuclear magnetic resonance studies revealed that three distinct compounds and one mixture had all been labeled as the same compound. The purity of the dyes varied from batch to batch, as shown by thin-layer chromatography. Caution should be exercised in the use of these dyes for lymphograms.


Prevention of post-transfusion hepatitis. Role of sensitive hepatitis B antigen screening tests, source of blood and volume of transfusion.

Aliquots from units of blood were screened by radioimmunoassay (RIA) and reverse passive hemagglutination (RPHA) shortly after transfusion. Recipients of positive units, as well as control subjects, were followed prospectively for evidence of either post-transfusion hepatitis (PTH) or exposure to hepatitis B (HB). There was a significant correlation between receipt of either an RPHA-positive or RIA-confirmed positive unit and the subsequent development of PTH or HB exposure. Recipients of all volunteer units had a lower incidence of PTH than did recipients of all commercial units. The frequency of PTH and HB exposure was not statistically different in groups receiving 1 to 5, 6 to 10, 11 to 20 and greater or less than 21 units of blood. The PTH seen in the study presented over a wide clinical spectrum, but it was usually anicteric and frequently asymptomatic.


Impaired cell-mediated immunity in systemic lupus erythematosus (SLE). A controlled study of 23 untreated patients.

Cell-mediated immunity was evaluated in 23 patients with systemic lupus erythematosus (SLE) prior to therapy and in 23 control subjects. The patients with SLE who had moderate to severe disease activity had significantly fewer positive delayed skin tests to streptokinase-streptodornase (SK-SD) and Candida than the control subjects, and a higher frequency of anergy than either the control subjects or the patients with mild SLE. Significant impairment of lymphocyte transformation to all common antigens tested was found in patients with SLE as compared to both normal subjects and control subjects with disease. Phytohemagglutinin response was reduced in patients with SLE as compared to normal subjects but not to the control subjects with disease. Lymphocyte transformation responses to SK-SD and Candida were also significantly lower in patients with moderate to severe SLE as compared to patients with mildly active SLE. Primary immune response to keyhole limpet hemocyanin (KLH) was impaired in patients with SLE as measured by lymphocyte transformation and total KLH antibody, but not 2-mercaptoethanol resistant antibody. The data indicate defective T-cell function in SLE, and suggest that the impairment relates in part to disease activity.


Angio-immunoblastic lymphadenopathy. Diagnosis and clinical course.

The clinical and pathologic findings in 24 patients with "angio-immunoblastic lymphadenopathy with dysproteinemia" (AILD) are presented. The patients' ages ranged from 44 to 80 years, with a median age of 68 years. The disease has an acute onset. In many respects, the clinical presentation is suggestive of malignant lymphoma. Generalized lymphadenopathy was always present. Hepatomegaly was found in 20 patients, splenomegaly in 17, constitutional symptoms in 20 and skin rashes in nine. Twenty patients had anemia, with positive Coombs' test in eight of 14 tested. Polyclonal hypergammaglobulinemia was found in 17 of 22 patients. Two patterns of evolution were recognizable: (1) long survival (24 to 67 months) without treatment or after the administration of intensive combination chemotherapy; and (2) rapid progression (one to 19 months) regardless of the treatment given. Sixteen patients died; postmortem examination in 10 cases showed the cause of death to be attributable to severe infection in eight patients, to renal disease in one and to cardiovascular disease in one. No evidence of malignant lymphoma was seen in any of these autopsies. Histologically, the disease is systemic, with specific lesions in the lymph nodes. The spleen, liver, bone marrow, skin and lung are also involved, but the changes are less characteristic than in the lymph nodes. In the patients in whom sequential biopsies were performed, a trend toward restoration of the nodal architecture was observed. AILD is a clinical-pathologic entity in a spectrum of yet to be defined immune reactions. The clinical, laboratory and pathologic manifestations of AILD are consistent with an autoimmune disorder, in which a deficiency of the T-cell regulatory functions probably predisposes to an abnormal proliferative and autoaggressive reaction of the B-cell system. Surgical staging procedures do not appear to be indicated. Intensive cytotoxic treatment may be hazardous in some patients, precipitating their death, but long survival after such therapy has been observed in others. Supportive therapy and small doses of steroids appear to be a safer therapeutic approach.


The Jeune syndrome (asphyxiating thoracic dystrophy) in an adult.

A 32 year old American Indian man with the Jeune syndrome (asphyxiating thoracic dystrophy), a condition previously reported only in children, is described. The patient exhibited a cardiomyopathy of unknown etiology and evidence of hepatic and renal disease in addition to characteristic osseous malformations of the thorax, pelvis and extremities. The identification of an established syndrome in this patient permits one to view the combination of abnormalities present in a more coherent manner.


Platelet hypersensitivity and intravascular coagulation in paroxysmal nocturnal hemoglobinuria.

The patient described had paroxysmal nocturnal hemoglobinuria associated with recurrent arterial as well as venous thrombosis. Study of platelet function revealed hypersensitivity to epinephrine, adenosine 5'phosphate (ADP) and collagen as judged by their ability to aggregate platelets as well as to release 14C serotonin. The release of total nucleotides was also markedly increased over normal with all aggregating agents. The abnormality was localized to the platelet since aggregation occurred when the patient's platelets were resuspended in normal plasma but not when normal platelets were incubated in the patient's plasma. Presumptive evidence for ongoing intravascular coagulation was an increase in fibrinogen derivatives of heavier molecular weight than the native protein presumably a result of thrombin action. However, factor XII was not activated and fibrinolysis was not increased. Complement component levels and antithrombin concentrations were also normal. The findings in this case suggest that hypersensitive platelets may contribute to the intravascular coagulation that is manifested by the increased incidence of thrombosis in patients with paroxysmal nocturnal hemoglobinuria.


Primary empty sella, galactorrhea, hyperprolactinemia and renal tubular acidosis.

Discussed here is a 41 year old woman with galactorrhea associated with the empty sella syndrome and mild renal tubular acidosis. Basal serum prolactin (PRL) levels were normal, but a 24 hour serum PRL secretory profile demonstrated an increased mean PRL concentration. Serum PRL was appropriately suppressed by the administration of L-dopa; however, chlorpromazine stimulation resulted in a blunted serum PRL response. Pituitary luteinizing hormone, follicle stimulating hormone, ACTH and thyroid stimulating hormone levels were normal. Thus, galactorrhea associated with an enlarged sella does not establish the diagnosis of a pituitary tumor, and pneumoencephalography must be performed to exclude the empty sella syndrome.


Hypomagnesemia due to renal disease of unknown etiology.

A young man, investigated because of tetanic convulsions and arthritic pains, was shown to have hypomagnesemia, hypermagnesuria, hypokalemia, hypercalciuria, progressive nephrocalcinosis and chondrocalcinosis. In this syndrome, renal function was normal except for the abnormal excretion of electrolytes. Renal sodium conservation was normal. Light and electron microscopic studies of renal biopsy specimens showed the presence of several abnormal tubules. Immunofluorescent staining showed deposits of immunoglobulins in the glomeruli and tubules. Magnesium therapy was started under balance study conditions and resulted in decreased calciuria and complete remission of subjective symptoms. The progression of nephrocalcinosis was halted, and there was some decrease in the intra-articular calcium deposits after two years of continuous oral magnesium therapy. The administration of spironolactone decreased urinary magnesium but did not normalize it, whereas triamterene administration was without effect in this respect. The results of the morphologic and electrolyte balance studies are discussed. The patient was found to exhibit several features which have not been described before in connection with hypomagnesemia of unknown origin.


A novel, convenient, multiple test system for detection of bacteriuria.

A novel, convenient, multiple test system for the detection of bacteriuria is described and evaluated. The system consists of a small plastic strip with three dry reagent areas. One rapidly detects the presence of nitrite in urine and the remaining two quantitate total and gram-negative bacterial urine population after 18 to 24 hours of incubation. Quantitative accuracy was evaluated in two blind studies. In the first, known concentrations of 18 different organisms were compared and in the second, unknown concentrations of 218 randomly collected urine specimens were quantitated by both the calibrated loop streak method the new system. Overall correlation was 96 per cent for growth reagent areas. The nitrite area detected 84 per cent of the urines positive for bacteriuria. The advantages of the system over conventional bacteriuria detection systems are described.


Comparison of three methods for determining oxygen saturation in arterial blood.

Oxygen saturation was determined by direct measurement with the Van Slyke method, an oximeter, and by indirect measurement with a pO2 electrode with conversion of oxygen tension to oxygen saturation. All three methods correlated well when the oxygen saturation was above 94 per cent. Below this value both the oximeter measurement and the saturation value calculated from the oxygen tension significantly overestimated the oxygen saturation as determined by the Van Slyke method. It appears from our data that when the saturation is less than 94 per cent, the absolute values for O2 saturation continue to be accurately determined with a Van Slyke, but the other two methods in this range are, at best, only useful in detecting gross changes in oxygen saturation.


Chromatographic differences in serum amylase among species.

Chromatographic analysis of amylase in human, dog, rabbit, rat and chicken sera were performed and species differences recorded. Iodide, rather than chloride, requirement for optimal activity was demonstrated for one amylase fraction separated from rabbit sera.


A multi-purpose laboratory light box.

A multi-purpose, inexpensive laboratory light box is described which can be used for observing and photographing results of a diversity of laboratory tests using either white or ultraviolet light.


Development of cooperative and competitive play responses in developmentally disabled children.

A behavior management procedure for training cooperative and competitive social play was investigated. Subjects were 5 EMR children who had marked behavior and communication disorders. Baseline data indicated that the subjects exhibited no competitive responses and low levels of cooperative play. Upon instituting a token-praise-feedback procedure, the experimenters observed increases in cooperative play as well as small increases in competitive play. Reinstating the token-feedback procedure after reversal resulted in high levels of competitive play with no change in cooperative play. Several explanations were offered to account for these results.


Effects of auditory and pictorial-auditory stimulus enrichment on the verbal abstracting abilities of low-SES children.

Sixty-four low-SES Caucasian children, mean age 8.3 years, with high- and lowintellectual ability, were given a verbal similarities task. One-half of the subjects (the control group) received nonenriched items (2 exemplars of each concept on Presentation 1, which were repeated on Presentation 2), and half (the experimental group) received enriched items (2 exemplars of each concept on Presentation 1 and 4 exemplars on Presentation 2). Stimuli were presented in either the auditory or pictorial-auditory mode. The low-ability experimental group achieved abstracting gain scores greater than those of the lol-ability control group and greater than those of the high-ability experimental group. The low-ability experimental group achieved scores equivalent to those of the high-ability group under the pictorial-auditory enriched condition. Implications of these findings were discussed relative to academic performance of EMR children.


Action-concept learning in retarded children using photographic slides, motion pictures, sequences, and live demonstrations.

The inadequate use of action concepts by mentally retarded children has been reported in several recent studies, but little is yet known concerning the level of performance that might be expected to result from direct instruction designed to remedy this deficit. In the present study, it was found that three different instructional approaches yielded higher adjusted posttest scores. The highest adjusted posttest score was yielded by an instructional program in which motion picture sequences were used. This program was significantly more effective than two paralled programs, one using photographic slides, and the other using live demonstration by a teacher. An explanation for these findings was suggested.


Response-stimulus interval performance of moderately retarded institutionalized subjects.

Based on previous dual reaction-time research with nonretarded and mildly retarded subjects, the expectancy- and capacity-limit hypotheses for the psychological refractory period effect were tested with moderately retarded subjects. The design included regular-irregular procedure, response-stimulus interval, signal, and hand-preference variable levels. The finding of a psychological refractory period effect at the 250-msec response-stimulus interval was consistent with past related research. The moderately retarded subjects indicated a capacity limitation, resulting in the psychological refractory period effect at the rapid response-stimulus interval. Previous researchers working with nonretarded and mildly retarded subjects have suggested an expectancy explanation for the psychological refractory period. This inconsistency in study findings was interpreted on the basis of an organismic confound. Methodological issues were also presented.


Extinction by retarded children following discrimination learning with and without errors.

Four groups of retarded children (N = 4 in each group) were trained to respond to a triangle with apex up (S+) and not to a triangle with apex down (S-), with and without errors. A free-operant procedure in which responding to S+ was intermittently reinforced and a trial procedure in which all responses to S+ were reinforced were compared. An extinction procedure in which responses were no longer reinforced was then introduced. Extinction resulted in substantial responding during S- for all groups, except the free-operant errorless group. S- responding during extinction did not differ between the errorless and error-trial groups and was maximum for the free-operant error group.


Comparison of two sets of Piagetian scales with severely and profoundly retarded children.

Corman and Excalona's (1969) scales for Object Permanence and Spatial Relationships and the corresponding scales of Uzgiris and Hunt (1975) were administered to 64 severely and prfoundly retarded children. Most of the findings applied equally to both sets of scales: the scoring reliability was very high; the total scores did not vary as a function of subject characteristics (except IQ) or testing conditions; differences in the difficulty of the items did not correspond closely to those reported for nonretarded infants, and the scalability of the items was much lower. Less time was required to administer the two scales constructed by Uzgiris and Hunt, but their Object Permanence scale showed a pronounced ceiling effect and the internal consistency of their Spatial Relationships scale was unacceptably low.


Stimulus persistence in retarded and nonretarded children: a signal detection analysis.

Nine institutionalized EMR and 9 equal-CA nonretarded children were tested on a visual backward masking task. Signal detection analysis was used to separate the sensory and nonsensory aspects of behavior, and the presentation of stimuli was randomized to minimize the formation of effective strategies. Two sets of instructions, strict and lenient, and two stimulus durations, 10 and 30 msec, were used in a repeated measure design. No differences were found between the intelligence groups on interstimulus interval threshold or measures of stimulus sensitivity, criterion placement, and false positive rate. Retarded subjects showed significantly greater intersubject variability in criterion placement but failed to raise their criterion in response to strict instructions. The results suggest that (a) stimulus-trace concepts of retardation have been confounded by retarded subjects' inability to compete effectively with nonretarded subjects in the experimental situation, and (b) signal detection procedures are a useful alternative to traditional psychophysical techniques in such comparative research.


Role-taking ability and the interpersonal competencies of retarded children.

The relationship between social role-taking ability and competencies of 46 retarded children in dyadic interaction was examined. Subjects were rank ordered on Feffer's (Note 1) Role-Taking Task and assigned to dyads according to rank-order position. A specially designed two-person game, involving the delivery of differential reinforcements (pennies) to self or other, was used to operationalize the competencies of dyads in maximizing joint profit and in establishing a reciprocal exchange strategy. Analyses revealed discrepancies in performance over the course of the game for high and low role-taking ability dyads.


Long-term transfer of a mediational strategy by moderately retarded children.

Moderately retarded children were instructed to produce prepositional mediatros by physically manipulating PA objects in learning three nine-term PA lists. Mediational training, distributed across days or weeks, consisted of one or three different prepositions supplied for two-thirds or for all of the items. It was found that mediation subjects performed significantly better than control subjects on an unaided test list administered 2 weeks after training, regardless of distribution of training, degree of aid or number of prepositions provided during training sessions. The degress of transfer, which was larger than in previously reported studies, was attributed to the instructional procedures requiring active production of prepositional mediators, coupled with an emphasis on their value. It was suggested that individual variability in mediational transfer should be considered in future research on mediational transfer.


Effects of stimulus familiarity on the rehearsal strategies transfer mechanism in retarded and nonretarded individuals.

The possibility that the familiarity value of stimuli might be a component of the rehearsal strategies mechanism in Ellis' (1970) multiprocess theory of short-term memory was investigated. Retarded and nonretarded subjects of equal CA were given either PA pretraining of nonsense pictures with colors or were presented with nonsense pictures alone. They were then compared in their performance on either an experimenter- or subject-paced serial memory task in which the nonsense pictures were employed as stimuli. It was expected that pretraining would increase the familiarity value of nonsense stimuli for nonretarded and, to a lesser extent, retarded subjects, facilitating transfer of information from primary to secondary memory in both groups. Although predictions about the effects of pretraining on retention were not substantiated, the results of the experiment did support the hypothesis that a production deficiency in active encoding can account for the poor secondary memory of mentally retarded subjects.


Influence of reinforcement on the paired-associate learning of retarded and nonretarded children.

The effect of presence and types of reinforcement (tangible, social, control) on PA-learning performance was investigated using 24 retarded and 24 nonretarded public-school subjects. A pictorial PA list (pictures used as stimulus and response items) was used. Stastical analysis of the data indicated that the influence of reinforcement on task performance was highly significant. Post hoc comparisons of cell means showed that the use of tangible reinforcement did significantly increase the performance of both retarded and nonretarded subjects. The results also indicated that the nonretarded subjects performed significantly higher than their retarded counterparts.


The efficacy and safety of intramuscularly administered 15(S) 15 methyl prostaglandin E2 methyl ester for induction of artificial abortion.

The practicability of an intramuscular dose schedule of 10 mug of 15(S) 15 methyl prostaglandin E2 methyl ester [15(S) Me PGE2] administered every 4 hours was evaluated in 42 subjects from 7 to 20 menstrual weeks' gestation. Half of the subjects served as controls (Group I) and half of the subjects (Group II) were treated with a medication regimen of prochlorperazine, acetylsalicylic acid, diphenoxylate hydrochloride, and atropine sulfate to evaluate the regimen's effects. Although the 15(S) Me PGE2 dose schedule appeared to be effective (74 per cent aborted in 24 hours and 95 per cent aborted within 48 hours in a mean time of 18.9 hours), Group I (control) subjects frequently had side effects: 62 per cent had emesis, 86 per cent had diarrhea, 76 per cent had shivering, and 76 per cent had fever (greater than 100 degrees F.). Fewer Group II (medicated) subjects had side effects: 43 per cent had emesis, 19 per cent had diarrhea, 52 per cent had shivering, and 43 per cent had fever. The medication regimen did not appear to interfere with the abortifacient or oxytocic effects of the 15(S) Me PGE2 dose schedule, since Group I and Group II subjects had similar cumulative abortion rates, mean abortion times, and uterine activity. Although this 15(S) Me PGE2 dose schedule is effective in first-trimester patients, it is probably less satisfactory than the conventional method of vacuum aspiration. While intramuscularly administered 15(S) Me PGE2 with medications to attenuate side effects may be practicable for inducing midtrimester abortion, especially between 12 and 16 weeks' gestation, large controlled comparative studies of the intramuscular 15(S) Me PGE2 method and other experimental and conventional methods will be necessary to determine the most satisfactory method of performing midtrimester abortions.


Inadvertent injection of corticosteroid into the choroidal vasculature.

A 21-year-old woman with pars planitis was treated with a subtenon's depot corticosteroid injection that was complicated by the appearance of the corticosteroid suspension within the choroidal vasculature. White, flocculent material was observed in the anterior chamber and 24 hours later this settled on the iris surface. Similar material was located in the major choroidal vessels. Two months after the incident, the choroid was normal appearing but the pars planitis was unchanged.


Surgical removal of nonmagnetic foreign bodies.

A microsurgical technique for the removal of nonmagnetic foreign bodies in eyes with opaque media incorporated the simultaneous use of the foreign body forcepts with a vitrectomy machine equipped with fiberoptics. The superb viewing system provided by the operating microscope combined with the excellent illumination from intraocular fiberoptics offered precise surgical control. Nonencapsulated nonmagnetic foreign bodies in eyes with clear vitreous cavities were removed by using the operating microscope, corneal contact lens, and foreign body forceps introduced through a pars plana location. Vitrectomy was not performed. The surgical techniques allowed early removal of the foreign body and, in a preliminary series of cases, improved visual results in what is usually a devastating ocular injury.


The reproducibility of the intraocular pressure response to dexamethasone.

The reproducibility of the intraocular pressure response to topical dexamethasone was investigated in 162 persons previously classified as low (NN), intermediate (NG), or high (GG) responders. The concordance of first and second test results was 71% for NN, 74% for NG, and 79% for GG responders, exceeding chance significantly for the NG and GG categories. Quantitative assessment revealed significant correlation of final pressure achieved on first and second tests (r equals .747, P LESS THAN .001). In the course of the study applications of dexamethasone to one eye were noted to have no effect on the intraocular pressure in the contralateral untreated eye, nor did testing of one eye influence the response of the contralateral eye in simultaneous bilateral testing. Using our data to estimate the reproducibility of topical testing in a general population, a value of 73% was obtained. That value was similar to the 65% concordance reported in an identical twin study, suggesting that the limited precision of topical testing accounts for the relatively low concordance found in that study.


The histopathology of pigmentary dispersion syndrome with glaucoma.

Iris tissue and trabecular meshwork, obtained at time of trabeculectomy, was studied using the light and electron microscope in a 54-year-old woman with pigmentary dispersion syndrome with glaucoma. The specific defect was a loss of the outer epithelial cells of the iris with marked thinning of the remaining outer layers so that the two-cell architecture of the iris epithelium was maintained. In addition, the radial muscle layer was increased in both number and size of muscle fiber. It would appear that the pigmentary dispersion syndrome may represent a congenital or developmental abnormality of the iris epithelium, or both, and that the glaucoma which occasionally occurs in conjunction with this syndrome is of the usual open-angle type.


Spontaneous regression (autoinfarction) of proliferative sickle retinopathy.

Of 45 patients with proliferative sickle retinopathy in stages III, IV, and V, nine patients (eight with hemoglobin SC disease, one with sickle cell thalassemia) showed spontaneous regression (autoinfarction) of retinal sea fans. One mechanism involved in autoinfarction of neovascular tissue is progressive, centripetal retraction of the anterior vascular arcade of the peripheral retina. In addition, vitreous traction on feeder vessels may result in sluggish blood flow and occlusion of these vessels, or may tear the sea fan completely away from its feeder vessels. In view of the many incidences of vitreous hemorrhages that occur in patients with proliferative retinopathy, however, we recommend treatment of neovascularization rather than prolonged observation.


Amblyopia screening with random-dot stereograms.

A stereoscopic test was developed for the visual screening of preschool children. The TNO test for stereoscopic vision utilized the same principle as the Julesz random-dot stereogram, and provided a simple and unequivocal test criterion understood even by young children. The results of a comprative evaluation of the TNO and Titmus stereoscopic tests proved the TNO test to be the more reliable of the two, particularly in the 2- to 4-year-old age range. Failure to pass this test at the 240 seconds of arc disparity level yielded an excellent screening criterion, as attested by the results of a validation experiment employing 81 patients (2 to 7 years old) with known visual health records. Furthermore, the screening results obtained from 129 preschool children (2 to 5 years old) tested in the classroom by a nonprofessional examiner, suggest that, under these more realistic conditions, the TNO test yields at least 60% less overreferrals than the Titmus test.


Horizontal saccadic velocities in Duane's syndrome.

Horizontal ocular saccadic velocities were measured by electro-oculography in 33 patients with Duane's syndrome. In 28 patients with limited abduction associated with retraction on adduction (Type 1), abduction saccadic velocity was markedly reduced while adduct-on saccades were moderately slow. In three patients with exotropia and good abduction but associated limited adduction and retraction on adduction (Type 2), abduction velocity was good, while adduction saccadic speed was slow. In two patients with limited abduction and adduction with retraction on adduction (Type 3), abduction and adduction saccadic velocity was appreciably slow. Ocular electromyographic testing selected patients indicated that slow abduction saccades could be explained by absence of lateral rectus muscle recruitment, while slow adduction saccadic speed could be explained by paradoxical innervation of the lateral rectus muscle.


Ring scotomata in fundus flavimaculatus.

Ring scotomata were associated with fundus flavimaculatus in six patients. The demonstration of ring scotomata in patients with fundus flavimaculatus helps to explain persistent visual complaints that may exist in the presence of normal central visual acuity. In many instances, ring scotomata cannot be predicted on the basis of the ophthalmoscopic findings. The presence of ring scotomata appears to be an ominous finding, even when associated with normal central visual acuity, for in three of our patients it preceded loss of central vision by 1 1/2 to four years.


Cystic retinoblastoma.

A grossly cystic retinoblastoma, presumably a form of the diffuse infiltrating type, mimicked uveitis in an 81/2-year-old boy. A review of 44 cases indicated that grossly (clinically) detectably cysts are rare in this neoplasm, although microcysts are relatively common. Lesions of this nature, especially if presenting with a history of trauma, as in our patient, may lead the ophthalmologist to diagnose uveitis. The diagnosis of retinoblastoma may thus be unduly delayed.


Retinal fat emboli as sequela to acute pancreatitis.

A clinical picture of Purtscher's retinopathy was observed in three patients with acute pancreatitis. In two patients, fluorescein angiography revealed arteriolar obstruction. Since fat emboli occur in pancreatitis, and since fat emboli may produce the picture of Purtscher's retinopathy, we proposed that fat emboli caused the retinal findings in these patients.


Posterior vortex vein and congenital glaucoma in a patient with trisomy 13 syndrome.

A 4-month-old infant boy presented with a mild manifestation of trisomy 13 syndrome. The severe ocular findings usually associated with this syndrome were not seen. Rather, the patient had bilateral congenital glaucoma with glaucomatous optic disk cupping and, in one eye, a posterior vortex vein. Such findings are unusual in the trisomy 13 syndrome. The posterior vortex vein is a particularly unusual finding previously occurring in myopic eyes.


Paranasal sinus carcinoma causing orbital mucocele.

Three patients presented with typical orbital mucoceles. However, subsequent histopathologic study revealed paranasal sinus concomitant squamous cell carcinoma in all three cases. Careful histologic investigation is necessary before considering orbital mucocele a benign process.


Metastatic carcinoma of the iris.

Of three women and one man with metastatic carcinoma of the iris, the average age of the four was 50.2 years. Two of the tumors originated in the breast and two in the lungs. The average survival from time of diagnosis of the iris lesion was less than six months. Each patient presented with characteristic grayish-white translucent nodules on the iris or in the anterior chamber angle. The patients displayed other features of iris metastases such as secondary glaucoma, rubeosis iridis, iris atrophy, anterior uveitis, hypopyon, and hyphema. As an aid in the clinical evaluation, anterior segment fluorescein angiography was performed, revealing vascular details not seen clinically. Leakage of dye was a constant feature of the angiogram.


Visual effects of peripheral and sector iridectomy.

Twenty-five patients had bilateral cataract extractions: one eye with peripheral iridectomy and the fellow eye with sector iridectomy. They were followed from four months to two years. No significant differences in visual acuity between the two eyes were found. No patient reported any subjective difference between the right or left eye.


Surface epithelium of the developing ovary. Possible correlation with ovarian neoplasia.

The surface epithelium of the fetal ovary undergoes diffuse proliferation during the fourth and fifth months of gestation, after which it reverts to a single layer separated from the developing cortex by a tunica albuginea. The proliferation is associated with marked nuclear irregularity and pleomorphism similar to that seen in surface epithelial neoplasms. The epithelial changes occur during the same time period that interstitial cells with ultrastructural and histochemical properties of steroid-secreting tissue appear in the ovarian stroma. The possible role of steroid hormones in stimulating surface epithelial proliferation is discussed.


The resistance of certain tissues to invasion. III. Cartilage extracts inhibit the growth of fibroblasts and endothelial cells in culture.

Extracts of bovine dermis and cartilage inhibit the growth of bovine endothelial cells more than that of most of the fibroblast types tested. Extracts of cartilage, a tissue rather resistant to invasion, inhibit the growth of endothelial cells more than extracts of dermis do. Since such extracts contain antiproteolytic activity, it is suggested that the inhibition of cell growth they induce is effected by protease inhibitors native to connective tissues.


Congophilic angiopathy complicated by surgery and massive hemorrhage. A light and electron microscopic study.

Three autopsied cases of congophilic angiopathy have been studied by means of polarized light microscopy and in 2 of these, biopsy material is available for electron microscopic study. All 3 patients had a surgical procedure and a subsequent massive hemorrhagic episode. Two of these patients had clinical evidence of dementing syndrome, for which shunts were performed. Ultrastructural studies have confirmed the amyloid nature of the congophilic material in the 2 biopsied cases. The deposition of amyloid in these cases is believed to be a primary event and is related to a generalized body disorder. The distinction of congophilic angiopathy from Alzheimer's disease is discussed.


Acute hyperuricemic nephropathy in rats. An electron microscopic study.

Hyperuricemia and uricosuria were induced in rats fed uric acid and oxonic acid. Kidneys then were studied by light and electron microscopy. After 1 day of hyperuricemia, animals had deposits of uric acid and urate crystals within collecting tubules of the renal papillae, and tubular cells were altered. By 10 days, there was an exudative response with further injury to epithelium. Clear spaces within lumens, epithelium, and neutrophils suggested the presence of crystals; however, there was no direct ultrastructural evidence that neutrophils or epithelial cells ingested crystals and suffered injury. Presumably, crystals readily seen in frozen, unfixed tissue were lost during preparation for electron microscopy. Nonetheless, the ultrastructural findings indicated that hyperuricemic nephropathy was initiated in a fashion analogous to urate arthropathy. Urate crystals formed within collecting tubules, epithelial cells were altered, and most likely there was chemotaxis of neutrophils which underwent degranulation and vacuolation followed by lysis freeing any ingested urate. Release of ingested crystals plus precipitation of new crystals both might serve to sustain the nephritis.


Clonal characteristics of fibrous plaques and fatty streaks from human aortas.

Using isoenzymes of glucose-6-phosphate dehydrogenase (G-6-PD) as cellular markers, a study was made of atherosclerotic fibrous plaques and fatty streaks in aortas of black women heterozygous for G-6-PD. Of 29 fibrous plaques, 26 (89.7%) contained only one isoenzyme (17, A; 9, B), the other three containing both A and B. Of 28 fatty streaks, five (17.8%) contained only one isoenzyme (2, A; 3, B), the remaining 23 containing both A and B. Normal uninvolved aorta contained both A and B isoenzymes in 99 of 101 samples. These results confirm the monoclonal character of atherosclerotic fibrous plaques; this strands in contrast to the fatty streaks which most commonly contain the two isoenzymes. The studies on the fatty streaks are inconclusive at this stage in determining whether the streak is the forerunner of the fibrous plaque.


Situation/transition groups: a conceptualization and review.

Small discussion-education groups moderated by a trained leader have been used in a variety of settings for the mutual assistance of individuals who share some stressful life situation. This paper reviews the literature on a broad range of such groups, and finds they have common characteristics, modes of function, and problems of leadership. The situation group is seen as being an important primary preventive approach for both mental and physical health problems.


The use of self-help groups as supportive reference communities.

Self-help groups such as Recovery Inc., Parents without Partners, and Alcoholics Anonymous have a unique role in relation to the professional system of human services. From the professional's standpoint, such groups may be viewed as self-sufficient programs, concurrent treatment programs, and as sources of information and users of consultation. Patterns of influence operative in self-help groups are examined, and suggestions made for professional cooperation with such groups to the greater benefit of clients.


Children in a warring world.

This essay considers the psychological effects on children of growing up in a society that expresses violence while it professes peace and order. Even those children not directly affected by social upheaval or instability are seen at serious risk of inadequate ego development when the social reality they perceive diverges sharply from the values they are taught. Action and education by adults congruent with the values they espouse are suggested as a first step toward facilitating the integration of ego functioning in their children.


Maternal employment reconsidered: effects on infants.

Studies of the effects of variations in infant care are reviewed in relation to maternal employment. The research suggests that maternal employment may be a contributory factor in hindering the development of an optimal caretaker-infant relationship. Suggestions for further research, particularly in areas related to the formulation of social policy, are presented.


Child custody consultation.

The limited influence of the needs of the child upon the decision-making process in child custody disputes is discussed, with particular attention to the consultant's role and unique aspects of this type of consultation. A case is described in which a multitude of consultants presented the court with a morass of parent-oriented conflicting testimony. It is concluded that clinicians can better serve children by seeking to consult not for one of the competing adult parties, but only for the court.


Children, privacy, and nontherapeutic experimentation.

Experimentation not for the direct benefit of the child-participant raises serious legal problems. Strict adherence to the law indicates that neither the child, parent or guardian, nor the state has the power to grant legally binding consent. A possible solution to this dilemma is suggested.


Follow-up of adolescents treated in a psychiatric hospital: operational solutions to some methodological problems of clinical research.

Procedural problems inhibiting follow-up research on psychiatric patients are discussed, and solutions offered, in the areas of ethical concerns, study design, selection of variables, collection of data, and researcher-clinician relationship. Early communication with patients about methods and goals, and maintenance of rapport and feedback between research and treatment staffs may overcome many difficulties of long-term research, and even aid treatment.


Preparation during pregnancy and ability to cope with labor and delivery.

Within nine weeks following childbirth, 279 new mothers were interviewed to determine effects of preparation for labor and delivery on their perceptions of childbirth and their babies. The more preparation a woman had, the more aware she was at delivery, and that awareness was strongly associated with positive reactions to the birth and the baby. These findings are interpreted in terms of theory on coping with stress.


Teacher ratings of children vulnerable to psychopathology.

Teacher behavior ratings were collected on children of schizophrenic, depressed, and normal mothers. Children of schizophrenic and depressed mothers were rated higher than were children of normal mothers on classroom disturbance, impatience, disrespect-defiance, and inattentiveness-withdrawal; they were rated lower on comprehension, creative initiative, and relatedness to teacher.


Family lunch session: an introduction to family therapy in anorexia nervosa.

Family lunch sessions have proved a useful diagnostic and therapeutic technique in the treatment of anorexia nervosa. This paper describes the goals of these sessions and the strategies employed in the restructuring of family relationships. Data are presented illustrating changes in eating behavior of eight identified patients.


The married manic.

In group psychotherapy and follow-up studies, the interpersonal relationships and psychodynamics of the married manic depressive patient and spouse were studied. Prominent among these subjects were massive denial of grief, rage, and dependency in the context of symbiotic relationships; and the absence of a father during early development. Clinical expressions of these factors are presented, and therapeutic implications are discussed.


Reaching emotionally disturbed children: 'judo' principles in remedial education.

The importance of the interpersonal meanings of symptomatology, especially as they relate to issues of control in therapy, is explored across a wide variety of treatment approaches. It is concluded that the often destructive behavior of distrubed adolescents may be viewed not simply as pathology to be altered, but as potential strength to be channeled. Implications for therapeutic technique are discussed, and examples are offered.


Corrective social interaction therapy: role modeling.

This paper describes an experimental clinical approach to the problem child and his family, in which parents are trained to provide corrective social interaction experiences for the child. Negative interaction patterns are modified by teaching specific techniques of expressing warmth. Results of a pilot study indicate the technique is effective in working with immature and antisocial children who are hospitalized.


Drinking and feeding induced by jugular and portal infusions of 2-deoxy-D-glucose.

Intravenous infusions of three levels of 2-deoxy-D-glucose (2DG) were made through chronically implanted jugular and portal cannulas in rats. Food and water intakes were unaffected by 100 mg/kg 2DG, enhanced by 200 and 400 mg/kg 2DG, and unrelated to the route of administration. Drug-induced drinking occurred as readily when food was present as in its absence. Infusions of 2DG also produced stupor and ataxia whose severity was proportional, as was feeding and drinking, to the dose administered. Drinking induced by 2DG is inconsistent with the glucoprivic theory of feeding, and it was proposed that the consummatory and aberrant behaviors elicited by 2DG may result from hypoglycemia-induced seizures in limbic structures of the brain.


Rapid insulin release after ingestion of a meal in the unanesthetized rat.

Blood glucose and insulin levels were measured in undisturbed and free-moving rats. The insulin level rises already in the 1st min after the start of food ingestion, whereas the glucose level begins to increase only in the 3rd min if carbohydrate-rich food is eaten. This early rise in insulin level is observed also under conditions in which either carbohydrate-free food or even "food" without any caloric value is offered. The smell of food cannot produce this early insulin response. It is concluded that in the rat other factors besides a rise in nutrient content in the blood produce insulin release in the first minutes after food ingestion.


Glutamine transport by mitochondria isolated from normal and acidotic rats.

The transport of L-glutamine by isolated rat renal mitochondria was studied by means of a rapid-filtration (Millipore Filter Corp.) technique. The movement of glutamine from the incubation medium into the inner mitochondrial compartment (matrix) was inhibited by structural analogues (6-diazo-5-oxo-L-norleucine and glutamic acid), sulghydryl-binding agents (p-chloromercuri-benzoate and mersalyl), and inhibitors of mitochondrial oxidative metabolism (azide, antimycin A, and uncouplers of oxidative phosphorylation). These results suggest that glutamine is transported across the inner membrane of renal mitochondria by a carrier-mediated system that is linked to the processes of oxidative metabolism. The transport of glutamine by isolated renal mitochondria was increased two- to threefold by chronic (5-7 days) metabolic acidosis. However, short-term metabolic acidosis did not increase the glutamine transport capacity of isolated mitochondria. A hypothesis is presented for the regulation of mitochondrial glutamine transport, in vivo, during short-term and chronic acidosis.


A quantitative histochemical approach to renal transport. I. Aspartate and glutamate.

Renal transport was studied by direct analysis of specific segments of the nephron for the substance transported. Rats were given inulin plus loads of glutamate or aspartate. Glomeruli, six different identified segments, and patches from thin-limb and papillary areas were dissected from individual nephrons in freeze-dried sections. Large amounts of the amino acid (up to 35 mmol/kg) accumulated in segments in which transport is believed to occur. With subthreshold loads, large amino acid increments were confined to earlier proximal segments. With loads above threshold, increases occurred throughout the proximal tubule. The early convoluted tubule probably has less transport activity than the rest of the proximal tubule. Both dicarboxylic amino acids accumulate in large amount when one is given. Aspartate is probably formed within the tubule after a glutamate load. This new histochemical approach may have general applicability for more precise localization of transport cells, for assessing changes in those cells during transport, and for study of structures inaccessible to micropuncture.


Oxygen transport of colloidal fluorocarbon suspensions in asanguineous rabbits.

In anesthetized, oxygen-breathing rabbits, the entire blood volume was exchanged with a 20% colloidal fluorocarbon fluid suspension of high gas solubility. In contrast to the control animals with acute isovolemic and hypervolemic hemodilution, the fluorocarbon suspension prevented the decrease in arterial oxygen content below a hematocrit of 13%. However, the more pronounced effect of the fluorocarbon suspension on oxygen delivery occurred at higher hematocrits and was due to its efficiency as a plasma expander, since it increased the cardiac output even above the level of the hypervolemic hemodilution group. The fluorocarbon suspension also raised arterial blood pressure and total peripheral resistance due to its increased viscosity. Thus, in mild hemodilution, the fluorocarbon suspension kept oxygen utilization in the normal range by increasing cardiac output, and in extreme hemodilution it improved oxygen utilization by also raising the arterial oxygen content and arterial blood pressure. The survival time of the isovolemic control animals was 31.6 min, it was extended to 57.8 min in the hypervolemic control animals, and the rabbits with the fluorocarbon suspension lived for 124.8 min.


In vivo toxic effects of halothane on canine cerebral metabolic pathways.

The effects of high concentrations of halothane on cerebral metabolism were examined in dogs with the aid of an extracorporeal circuit to support the systemic circulation. At blood levels exceeding those representing equilibration with 2.3% halothane, a dose-related decrease in cerebral oxygen consumption (CMR02) occurred that was unrelated to the presence or absence of an active electroencephalogram. In this circumstance, despite adequate oxygen delivery, a dose-related alteration in oxidative phosphorylation also occurred as evidenced by progressive decreases in cerebral concentrations of ATP and phosphocreatine and concomitant increases in cerebral lactate and lactate/pyruvate ratio. These effects were totally reversible, except for persistence of increased of increased CMR02, after return to low halothane concentrations. It is concluded that the mechanisms of the cerebral metabolic effects of halothane differ from those of thiopental and, at high concentrations, are at least in part related to interference with oxidative phosphorylation. These in vivo studies confirm the potentially detrimental effects of high halothane concentrations on cerebral metabolic pathways as demonstrated by others in vitro.


Secretion of K and fluid by rat submaxillary during sympathetic nerve stimulation.

Stimulation of the sympathetic innervation to rat submaxillary gland is known to evoke saliva which contains high concentrations of potassium (130-160 meq/liter). Relationships were examined between salivary [K] and several parameters of the stimulation, including pulse frequency and duration of the stimulus train and rate of flow of the evoked saliva. Secretion of sympathetically evoked saliva was found to occur in two phases. After stimulation was started, flow rate was relatively high initially, and then decreased to a lower, relatively steady value. Initial and steady flow rates were maximal when stimulus frequency was 10 Hz. Salivary [K] was lowest initially, and, at that time, was inversely related to flow rate. At steady flow, [K] was flow independent. While salivary [K] was lower during initial than during steady secretion, the rate of K secretion was initially higher. During the initial phase, K decreased in the gland, and this decrease was sufficient to account for the increased amount of K secreted in initial saliva and for the increased initial flow.


Nitrogen utilization within equine large intestine.

The distribution of nitrogen in ligated segments of the stomach and intestine of two groups of ponies has been examined at sacrifice 2, 4, 8, and 12 h following the final 12-h scheduled feeding of diets designed to provide either 1) ample protein, or 2) limited protein plus supplemental urea as the major nitrogen source. Concentrations and total quantities of total N, NH3, urea plus NH3, and alpha-amino N were determined, and protein N was calculated by difference. Liquid marker (PEG) distribution rate constants and N concentrations were used to calculate rates of entry and exit by digesta flow for the large intestinal compartments. These values, together with measured accumulations of each constituent, allowed assessment of transitory net appearance and net disappearance within each compartment due to processes other than flow along the tract. The data suggested cyclic fluctuations of microbial populations within the large intestine, particularly the dorsal and ventral colon. These segments also were implicated as major sites of microbial protein synthesis and degradation. the former process appeared more evident in animals consuming the urea-supplemented diet.


Separate roles of sodium ion concentration and fluid volumes in salt-loading hypertension in sheep.

The goal of these studies was to determine whether the hypertension caused by excessive salt loading results from sodium-induced expansion of the extracellular fluid volume or whether the salt increases the pressure in some other way, such as by causing vascular constriction. In one group of sheep, a combination of total nephrectomy and hemodialysis was used to produce and maintain step increases in extracellular fluid volume for 1 wk without a significant change in sodium ion concentration. In a 2nd group, unilateral nephrectomy, dialysis, and DOCA administration were used to cause step increases in sodium ion concentration while the extracellular fluid volume was held as close to normal as possible. The results showed a 41% increase in arterial pressure in the high-volume sheep and only a 4% increase in pressure in the high-sodium sheep. In both instances the total exchangeable sodium increased almost equally--a 21% increase in the high-sodium sheep. The data support the concept that sodium retention causes hypertension almost entirely because of sodium-induced expansion of the extracellular fluid volume.


Characteristics of sodium and potassium transport in the lung.

Freshly prepared lung slices were incubated in an oxygenated Krebs-Ringer bicarbonate medium for 90 min at 0.5 degrees C (chilling) followed by 60 min at 38 degrees C (rewarming). Fresh tissue cation contents (mean +/- SE) in mmol/kg dry wt were: sodium, 431 +/- 7; potassium, 416 +/- 10. After chilling, tissue sodium increased to 757 +/- 11 and potassium decreased to 113 +/- 6. Upon rewarming there was a net increase in tissue potassium of about 150 (mmol/kg dry wt) and a net decrease in tissue sodium of about 130. Tissue extrusion of sodium and reaccumulation of potassium observed at 37 degrees C were abolished when 1 mM ouabain, dinitrophenol, or iodoacetamide was added to the incubation medium. Similar results were obtained when the medium contained no potassium or when medium Na was replaced by choline. The data indicate the presence of active Na+-K+ transport in lung cells somewhat similar to that found in other mammalian tissue.


Control of tissue manganese: initial absence and sudden emergence of excretion in the neonatal mouse.

All adult animals and humans tested up to this time have controlled their tissue manganese concentrations by controlling primarily the rate of the metal's excretion. In sharp contrast, neonatal mice did not excrete manganese for the first 17-18 days of life, although absorption of the natural 55Mn as well as distribution, tissue accumulation, and mitochondrial accumulation of the radioactive 54Mn were vigorous. This suggested as initially avid accumulation of this essential micronutrient, supplied in scarce traces in mouse milk (54 ng/ml) by mothers consuming very much higher dietary concentrations (55,000 ng/g). The tissue accumulation was demonstrated analytically and was particularly impressive in the brain, which can be susceptible to both manganese poisoning and deficiency.


Effects of testosterone and prolactin on rat prostatic weight, 5alpha-reductase, and arginase.

Prostatic weights, 5alpha-reductase, and arginase activities were utilized as indexes for the effects of prolactin in short-term experiments in intact, hypophysectomized or castrated rats. Experiments were performed in which a dose-related response in the above parameters was obtained with testosterone administration in castrated mature and immature rats in order to evaluate the effects of simultaneously administered prolactin. This approach was necessitated by the failure of prolactin alone to affect the parameters listed in intact, castrated or hypophysectomized rats. It was shown that ovine prolactin may have an enhancing effect on the prostatic weight, 5alpha-reductase, and arginase activities, but that this effect is neither consistent nor striking when compared to that of testosterone.. Nevertheless, it is still possible that the long-term effects of prolactin, even if they are only of an enhancing quality, may play an important role in normal prostatic physiology and in abnormal states.


Analysis of brain uptake and loss or radiotracers after intracarotid injection.

The amount of radioactivity in brain was estimated at different times after intracarotid injection in the pentobarbital-anesthetized rat. Fifteen seconds after injection, six radiolabeled solutes minimally metabolized by brain, 3H2O , isopropanol, nicotine, antipyrine, 3-O-methyglucose, and codeine, left the brain according to first-order kinetics. Two solutes metabolized by brain, lactic acid, and heroin, behaved in a more complex fashion. The behavior of the six nonmetabolized solutes was interpreted satisfactorily by a simple model in which the brain is treated as a single compartment. From the model, uptake at 15 s as a percentage of the dose is linearly related to the permeability when the uptake is low, i.e., 30% or less. In higher uptakes blood flow becomes increasingly important. The efflux rate is similarly related to permeability and blood flow, but additionally it depends inversely on brain space. The exchanges of 3H2O, isopropanol, and nicotine were determined almost solely by blood flow and brain space. Movements of codeine and 3-O-methylglucose depended primarily on permeability and those of antipyrine on both factors.