The use of ultraviolet light and fluorescence macrophotography in orthopedic morphology and pathology.

The efficiency of ultraviolet light and fluorescence macrophotography in screening various tissues of the locomotor system was tested on 46 human and 43 animal specimens from surgical, experimental and autopsy material, examined as living tissues during operation, or as fresh, frozen or fixed specimens. After visual examination under UV light, the material was photographed in reflected UV light, fluorescence, infra-red, and normal white light, and the results compared. Visual examination under UV light and fluorescence photography appeared to give the most satisfactory results. These methods are superior to white light photography in that they give high resolution and increased contrast between individual locomotor system tissues, even after formalin fixation. The UV methods also revealed certain pathological changes in bone and articular cartilage which could be of diagnostic importance and would normally escape attention.


Observations on eburnated bone.

Eburnated bone in osteoarthritic joints has been examined with the Scanning Electron Microscope to investigate the cause of the bone loss which occurs at the joint surface in this condition. In eburnated bone the lamellae surrounding the Haversian canals can readily be seen. After artificial abrasion the surface is flat and featureless. After treatment with agents which leach out some of the ground substance the lamellae can again be seen. These observations indicate both corrosive wear and abrasive wear play a part in producing eburnation.


Biological apatite vs hydroxyapatite at the atomic level.

Known differences in chemical content of biological apatites, specifically the dense (sp.g. greater than 2.95) portion of human tooth enamel (TE), and of stoichiometric hydroxyapatite (OHAp) imply atomic-scale crystal-structural differences, via major and minor substitutions, which can impart very different characteristics to the two materials. Further, some substitutions are shown to produce important effects not predictable from study of pure materials alone. A number of crystal-detail differences between TE and OHAp, both at room temperature and in response to heating (which occurs to some degree locally in hard tissue in vivo as a result of grinding, laser action, etc.), are tabulated. They include CO3 content and incorporation, lattice parameters, water content, non OHAp phases formed on heating, structural OH deficiency, and hydrogen-bonding of F and Cl "impurities" to OH. The significance of these differences is such that it is clearly misleading to speak of tooth enamel, and by inference other biological apatites, as "hydroxyapatite" without considerable qualification of the statement. The differences between biological apatite and OHAp are, in fact, of greater current interest and probable biological significance than are the similarities.


Tissue pressure measurements as a determinant for the need of fasciotomy.

An experimental and clinical tehcnique of measuring tissue pressures within closed compartments demonstrates a normal tissue pressure is approximately zero mmHg, and increased markedly in compartmental syndromes. There is inadequate perfusion and relative ischemia when the tissue pressure within a closed compartment rises to within 10-30 mm Hg of the patient's diastolic blood pressure. Fasciotomy is usually indicated, therefore, when the tissue pressure rises to 40-45 mm Hg in a patient with a diastolic blood pressure of 70 mm Hg and any of the signs or symptoms of a compartmental syndrome. There is no effective tissue perfusion within a closed compartment when the tissue pressure equals or exceeds the patient's diastolic blood pressure. A fasciotomy is definitely indicated in this circumstance, although distal pulses may be present. The measurement of tissue pressure aids in the early diagnosis and appropriate treatment of compartmental syndromes.


An animal model of the compartmental syndrome.

An animal model of the compartmental syndrome is presented to study the effect of elevated intracompartmental pressure on muscle histology and nutrient blood flow. Latex balloons were inserted into the anterior compartment of rabbits and the pressure within them controlled by an adjustable water column. Nutrient blood flow to the muscles of the compartment was determined by an Rb86 isotope dilution technique and showed a progressive decline with intracompartmental pressures over 50 mm Hg. At 80 mm Hg, flow was but 5 per cent of control values. An inflammatory necrosis was noted when a pressure of 60 mm Hg was exerted for 24 hours. At higher pressures an ischemic necrosis without inflammation was observed.


Volkmann's ischemia. A volar compartment syndrome of the forearm.

In a series of 19 patients with Volkmann's iscemia, 63 per cent had suffered skeletal trauma, whereas 38 per cent had received non-skeletal trauma. Non-specific trauma may trigger an ischemia-edema cycle, producing increased intracompartmental pressure. This cycle, if unrelieved, can involve all of the muscles in the compartment, via cyclic propagation and reinforcement of arterial spasm. The volar compartmental syndrome is not an all or none phenomenon. Localized ischemia may trigger a gradually spreading arterial spasm which results in slowly progressive clinical changes as late as 3-4 months after onset. Decompression not only of the compartment but of each individual muscle which shows evidence of vascular compromise, may reverse this destructive cycle even as late as 3-4 months but it should be performed promptly with the onset of symptoms, when its effect is rapid and dramatic. Induration of the compartment is pathognomonic of the compartmental syndrome. As long as it is present, benefit can be expected from decompression procedures. Regeneration of necrotic ischemic muscle is possible following restoration of circulation.


The anterior and the lateral compartmental syndrome of the leg due to intensive use of muscles.

The anterior and lateral compartmental syndromes of the leg due to intensive use of muscles can be briefly defined as painful circulatory disturbances associated with a pathological increase in total intramuscular pressure. In these syndromes, an acute and a chronic form are distinguished. The acute form takes a progressive course, and the structures within the compartment affected are subject to complete or partial destruction. The chronic form takes an intermittent course. Physical exertion of the lower limbs gives rise to pain in the compartment. Determination of the pressure in the tibialis anteriot muscle and phlebography, both before and after weighted exercise of the muscles of the anterior compartment, were found to be the most valuable diagnostic aids in the chronic syndrome. In the acute syndrome, the compartment affected must be decompressed by fasciotomy as quickly as possible. Since most patients with a chronic syndrome can adequately cope with daily requirements, an operation is not always required. Indications for fasciotomy are presented. The real cause of the increase in total intramuscular pressure is not understood, suggestions concerning the pathogenesis are made, and the mechanism of the circulatory disturbances is discussed.


Sudden infant death syndrome: the role of the emergency room physician.

Prompt recognition by the emergency room attending physician of the occurrence of SIDS provides the opportunity to deal empathetically with parents, thus ameliorating to some degree their profound psychiatric trauma. Among the responsibilities of the emergency room physician are 1) talking with the parents, 2) obtaining postmortem examination permission and making certain that the results of the autopsy are promptly communicated to the parents and to the family physician, and 3) arranging follow-up psychologic support for the parents. Awareness of the frequency of the sudden infant death syndrome and of the potentially preventable psychiatric morbidity among parents by the emergency health care personnel can do much to reduce the tragic toll of SIDS.


Compartmental syndrome. An unified concept.

A compartmental syndrome is defined as a condition in which increased pressure within a space compromises the circulation to the contents of that space. Any cause of increased intracompartmental pressure may result in a compartmental syndrome. The diagnosis should be suspected in any case of pain or neuromuscular deficit in an extremity and may be confirmed by signs of circulatory disturbance of nerve and muscle in association with increased pressure in the compartment. Generous opening of any dressings covering the extremity permits a proper examination and rules out a compartmental syndrome caused by the dressing itself. Immediate decompression is indicated in all cases of compartmental syndrome unless the risk of complications exceeds the possible gains from improvement in circulation. Elevation of an extremity afflicted with a compartmental syndrome is contraindicated. Myoglobinuria and renal failure may complicate severe cases.


The pathophysiology of the anterior tibial compartmental syndrome.

Based on a clinical review of 45 patients with acute anterior tibial ischemia, four different conditions were identified. Three were related to increased pressure within the compartment and were called anterior compartmental syndromes. They followed exercise, trauma, and ischemia. The fourth entity was anterior tibial ischemia due to anterial occlusion. An experimental investigation demonstrated that increased pressure within the anterior compartment slows blood flow to the enclosed tissues.


Compartmental syndromes following trauma.

When an ischemic contracture develops after injury it appears that the ischemia has pursued a middle course between full recovery and gangrene. The mechanism of such a pathology is difficult to understand. There appear to be two distinct types of injury that precipitate such a contracture; one where a major vessel is occluded and the ischemic tissue lies distal to the injury; and a second where the injury is a direct one and the ischemia develops at the site of the injury. The ischemic changes that develop after both types of injury appear to be remarkably similar and they develop, almost exclusively, where the tissues involved lie within unyielding osteofascial compartment. In both types, compartmental syndrome could have been precipitated; on the one hand by the ischemia of arterial interruption and on the other by direct tissue damage. Early fasciotomy is advocated after both types of injury, quite apart from any necessary arterial repair.


Compartmental syndrome and its relation to the crush syndrome: A spectrum of disease. A review of 11 cases of prolonged limb compression.

A review of 11 cases of prolonged limb compression usually following drug overdose, revealed a spectrum of disease from isolated compartmental syndromes to full crush syndromes with renal failure. Residual limb contractures were moderate or severe in 80 per cent of the extremities involved. Five of the 11 patients demonstrated significant, systematic manifestations, Stage II or Stage III crush syndrome by our definition. The severity of the systemic manifestations is related to the amount of muscle tissue being subjected to elevated pressure and the length of time this pressure is maintained. Delay in hospitalization, delay in diagnosis, and delay in treatment prolong this period. The diagnosis should be made on the basis of the histroy of prolonged immobilization and the finding of a swollen extremity. Fasciotomy should be performed immediately, both to minimize residual limb contracture and to prevent the crush syndrome from developing secondary to myonecrosis.


Paradoxical diuresis after vasopressin administration to patients with neurohypophyseal diabetes insipidus treated with chlorpropamide, carbamazepine or clofibrate.

1. Chlorpropamide, carbamazepine and clofibrate have an antidiuretic action in patients with neurohypophyseal diabetes insipidus which is qualitatively similar to that of antidiuretic hormone (ADH). 2. An additive antidiuretic effect is produced by combination of chlorpropamide and carbamazepine with small dosages of ADH. 3. After an immediate and transient antidiuresis, a single intravenous bolus injection of lysine vasopressin given during treatment with chlorpropamide, chlorpropamide with a continuous intravenous infusion of lysine vasopressin, carbamazepine or clofibrate, resulted in increased water diuresis for 12-24 h or longer. 4. This paradoxical diuresis was not observed during treatment with chlorothiazide. 5. It is suggested that the antidiuretic action of chlorpropamide, carbamazepine and clofibrate is localized at the receptor site for ADH in the distal renal tubular cell.


The anterior tibial compartmental syndrome. A complication of the Hauser procedure.

Six cases with neurovascular complications, previously unreported as a complication of the Hauser procedure, have been presented. The salient features were unrelenting pain during the first 24 hours postoperatively, completely out of proportion to that which might be anticipated, and with concurrent or subsequent numbness. The anatomy involved was presented, and a theory of causation was discussed. A plea is made for early and complete tibial compartment decompression through fasciotomy and/or fibulectomy-fasciotomy.


Plasma catecholamines, plasma renin activity and plasma aldosterone in tetraplegic man, horizontal and tilted.

1. Plasma catecholamines, plasma renin activity, plasma aldosterone and haematocrit were measured in four subjects with physiologically complete cervical spinal cord transections, before, during and after head-up tilt to 45 degrees for 30 min. Plasma catecholamines were measured in five normal male volunteers in the supine position and after head-up tilt to 45 degrees for 10 min. 2. After 10 min of head-up tilt, the plasma noradrenaline rose 14% in the tetraplegic patients and 115% in the control subjects. These findings indicate a failure of sympathetic activity in response to head-up tilt in the tetraplegic patients, probably caused by interruption of pathways by which the brain normally controls sympathetic outflow. 3. In the tetraplegic patients the resting plasma renin activities were above normal, and rose more quickly and greater on head-up tilt than in published studies of normal subjects. It is likely that the renal baroreceptors are important in the control of renin release. 4. In the tetraplegic patients, there was a late rise in plasma aldosterone which was probably due to the elevation in plasma renin activity.


Increased plasma calcitonin in early acute renal failure.

1. High plasma immunoreactive calcitonin concentrations were observed in ten of eleven patients with acute renal failure, particularly in the oliguric phase. 2. Immunoreactive calcitonin decreased progressively with time, independently of recovery of renal function. 3. Radioimmunoassay curves obtained with serial dilutions of plasma from these patients were parallel to or superimposed upon those obtained with calcitonin standards.


Evidence for active transport of tripeptides by hamster jejunum in vitro.

1. This paper describes the uptake by rings of everted hamster jejunum in vitro of three peptides with structural features making them resistant to hydrolysis, glycylsarcosylsarcosine, glycylsarcosylsarcosylsarcosine and beta-alanylglycylglycine. 2. Glycylsarcosylsarcosine was taken up by a saturable mechanism and accumulated intact in the intracellular compartment of the intestinal wall, apparently against an electrochemical gradient. Its uptake was reduced by Na+-replacement, anoxia and metabolic inhibitors. It was concluded that uptake of this peptide was the result of Na+-dependent active transport. 3. Glycylsarcosylsarcosylsarcosine was very poorly taken up and its uptake did not appear to be the result of active transport. 4. Beta-Alanylglycylglycine appeared intact in the intracellular compartment of the intestinal wall on a substantial scale though it was not concentrated. No satisfactory evidence of uptake by a saturable mechanism was obtained. Uptake was, however, inhibited by anoxia, 2,4-dinitrophenol and Na+-replacement. Reasons are given for supposing that uptake of this peptide may be the result of Na+-dependent active transport by the same carrier as that utilized by glycylsarcosylsarcosine. 5. The results suggest that provided that they escape brush-border hydrolysis, tripeptides, like dipeptides, are actively transported into the absorptive cells of the intestinal mucosa, but that the ability of these cells to take up peptides by an active mechanism is unlikely to extend to tetrapeptides.


Body weight and body water in chronic cor pulmonale.

1. Body weight was measured through forty consecutive illnesses in seventeen patients with oedema in association with chronic bronchitis and hypoxia. All patients were taking diuretic drugs at the time. 2. Body weight increased little as peripheral oedema and a raised jugular venous pressure appeared. The subsequent weight-loss during treatment was usually greater than the pre-treatment weight-gain. Body weight increased slowly in convalescence to equal or exceed hospital admission weight without a deterioration of general health or reappearance of oedema. 3. Total body water, exchangeable sodium and exchangeable potassium were measured in patients after treatment of the acute illness and clearance of oedema and again in six patients of the group 2-3 months later in convalescence. Total exchangeable sodium was normal or slightly reduced after treatment of oedema and in convalescence between recurrent acute illnesses. Even when gross oedema was present exchangeable sodium was substantially increased in only one of three patients studied at this stage. Total exchangeable potassium was invariably severely depressed. 4. Large changes of body tissue weight without comparable change in exchangeable sodium support previous evidence that oedema in hypoxic bronchitis is not simply a further form of congestive cardiac failure. 5. It is suggested that at least some of the tissue loss in acute exacerbations is a direct result of hypoxaemia and similar to that observed at high altitude. Part of the oedema fluid is thought to be derived from intracellular water released during dissolution of tissue matrix.


A common mechanism for transport of di- and tri-peptides by hamster jejunum in vitro.

1. This paper describes the results of a survey of the effects of peptides and amino acids on uptake by rings of everted hamster jejunum in vitro of glycylsarcosylsarcosine, a tripeptide which is taken up by an active mechanism but is very resistant to hydrolysis, appearing intact in the rings. The results of a small number of similar experiments with beta-alanylglycylglycine, another tripeptide which is taken up with very little hydrolysis, are also described. 2. Uptake of the two tripeptides was inhibited by other di- and tri-peptides, but not by free amino acids. The results suggest that dipeptides and tripeptides share a common uptake mechanism. The tetrapeptide glycylsarcosylsarcosylsarcosine did not inhibit uptake of glycylsarcosylsarcosine, and appears to be unable to utilize the uptake mechanism. 3. The results add to information about the influence of molecular structure on intestinal uptake of peptides by the system used by glycylsarcosylsarcosine, which is shared by a wide range of other di- and tri-peptides. In conjunction with previous results, they suggest that substitution of the N-terminal amino or C-terminal carboxyl groups reduces affinity for transport, that the presence of a beta-amino acid residue in a peptide is tolerated by the transport system, and that the presence of a D-amino acid residue reduces affinity for transport. Some peptides containing or made up of basic or acidic amino acid residues appear to have a low affinity for the transport system used by glycylsarcosylsarcosine. 4. Of two biologically active peptides, one, cephalexin, a peptide antibiotic, inhibited uptake of glycylsarcosylsarcosine and is probably transported by the same system. The other, prolylleucylglycineamide, which has the action of a hypothalamic regulatory factor, did not, and its structural features may make it unsuitable for carrier-mediated transport by the small intestine.


Cardiac effects of lead in drinking water of rats.

1. There is no known cause for the increased mortality due to ischaemic heart disease in soft water areas. Since the lead concentration of soft water is elevated in houses with lead plumbing, studies have been carried out to determine the effects of lead on the heart of rats. 2. Rats were given drinking water containing lead for 1 year at concentrations similar to those found previously in Glasgow, which has a soft water supply. 3. There was increasing deposition of lead in the heart and a fall in the cardiac levels of the enzymes ferrochelatase and delta-aminolaevulinic acid dehydratase. These changes are maximal after 6 months, when there were marked electron-microscopic changes in the myocardium and myocardial mitochondria. 4. Further studies are needed to determine whether lead is a cause of the increased mortality from ischaemic heart disease in soft water areas.


Effect of intravenous frusemide on plasma renin concentration: suppression of response in hypertension.

1. Intravenous frusemide produced in normal subjects a prompt rise of plasma renin concentration which correlated with urinary sodium. 2. The renin response to frusemide was suppressed in patients with primary hyperaldosteronism. 3. In patients with low-renin hypertension and normal renin essential hypertension, the renin response to frusemide was similarly suppressed. 4. Suppression of the renin response to frusemide is therefore a feature of hypertension not confined to patients with primary hyperaldosteronism and low-renin hypertension. 5. Thus low-renin hypertension does not appear to constitute a distinct diagnostic entity. 6. It is suggested that suppression of the renin response is part of a long-term renal adaptation to high blood pressure.


Epitaxial relationships in urolithiasis: the calcium oxalate monohydrate-hydroxyapatite system.

Chemical kinetic data, complemented with scanning electron-microscope observations of the crystalline phase, show that seed crystals of hydroxyapatite have the ability to induce the growth of calcium oxalate monohydrate crystals epitaxially from a metastable supersaturated solution of calcium oxalate. The rate of growth of calcium oxalate crystals is dependent on the surface area of the seed material and follows a second-order rate law. It is suggested that there may be a causal relationship between the occurrence of apatite crystals in the urinary tract and the formation of both 'pure' and mixed urinary stones containing calcium oxalate. Under similar experimental conditions, however, seed crystals of calcium oxalate monohydrate appeared unable to induce epitaxially the growth of calcium phosphate crystals from a supersaturated calcium phosphate solution, indicating the absence of an epitaxial relationship between calcium oxalate monohydrate and the initially precipitating calcium phosphate phase(s).


The effect of external potassium concentration on leucocyte cation transport in vitro.

1. Sodium and potassium transport rates in human leucocytes were measured in vitro at different external potassium concentrations. 2. At nominally zero external potassium concentrations, the ouabain-sensitive sodium efflux was reduced to less than 20% of its maximum value. There was evidence that under these conditions a ouabain-sensitive sodium-sodium exchange occurs. 3. Both total and ouabain-insensitive potassium influx increased with increasing external potassium concentration. The ouabain-sensitive potassium influx showed saturation. 4. Ouabain-insensitive potassium efflux was also stimulated by increasing the external potassium concentration, suggesting significant potassium-potassium exchange at physiological external potassium concentrations.


A study of relations between the absorption of amino acids, dipeptides, water and electrolytes in the normal human jejunum.

1. A double-lumen perfusion technique was used to study the effect of a wide range of concentrations of the dipeptide glycyl-L-alanine and its constituent amino acids on water and electrolyte absorption from iso-osmotic solutions in the upper jejunum of normal human subjects. 2. There was no significant absorption of water and electrolytes from sodium chloride solution (150 mmol/l) but the presence of the dipeptide or its constituent amino acids stimulated water and electrolyte absorption. 3. Water absorption reached a peak at increasing amino acid and dipeptide concentrations and then tailed off. Our data suggest that the tailing off is not solely due to the diminished sodium content of the solutions. 4. During perfusion of the dipeptide-sodium chloride and amino acid-sodium chloride solutions solute and water were absorbed as an iso-osmotic solution. Analysis of the results indicates that this could occur at high dipeptide concentrations only if the majority of the dipeptide enters the cell intact.


Effects of pent-4-enoic acid on renal free water, bicarbonate and phosphate excretion in the dog.

1. The effects of pent-4-enoic acid, an inhibitor of fatty acid oxidation, were studied in dogs undergoing water diuresis and acetazolamide diuresis. Free water excretion and distal solute delivery were increased when infusion of pent-4-enoic acid was superimposed on an increasing mannitol diuresis. 2. Bicarbonate excretion increased significantly when infusion of pent-4-enoic acid was superimposed on maximum acetazolamide diuresis. 3. Phosphate excretion exceeded 90% of filtered load when pent-4-enoic acid was administered under stable free water conditions and increased significantly when pent-4-enoic acid was superimposed on stable acetazolamide diuresis. 4. The results are interpreted as indicating inhibition of proximal tubular reabsorption by pent-4-enoic acid, emphasizing the importance of fatty acids as a major fuel for proximal tubular metabolism.


Respiratory responses to simultaneous static and rhythmic exercises in humans.

1. Six male subjects performed simulataneous static (hand-grip) and rhythmic (bicycle ergometer) exercises while their respiratory responses were measured. 2. Oxygen consumption increased with the intensity of rhythmic work load, with a modest additional oxygen consumption accompanying the addition of static effort during the rhythmic exercise. 3. Minute ventilation (VE) increased directly with rhythmic exercise, but increased disproportionately to the metabolic need when static effort was added. The mean increment of VE elicited by the static exercise influence was nearly constant at 20 l/min, regardless of the rhythmic load present. 4. Possible reflex mechanisms which result in disruption of the normally well-matched ventilation and metabolic oxygen demands whenever static effort is present are discussed.


A comparison on natriuresis after oral and intravenous sodium loading in sodium-depleted rabbits: evidence for a gastrointestinal or portal monitor of sodium intake.

1. Rabbits in balance on a low sodium diet were given doses of sodium chloride either orally or intravenously. 2. Those receiving oral doses responded with a much greater natriuresis than those receiving intravenous ones. 3. This could be explained by the existence of a sodium input monitor somewhere in the gut or portal circulation.


A comparison of natriuresis after oral and intravenous sodium loading in sodium-depleted man: evidence for a gastrointestinal or portal monitor of sodium intake.

1. Dietary sodium reduction in man is followed by rapid conservation of sodium by the kidneys. The rapidity of this response suggests that the gastrointestinal tract is involved in early recognition of changes in sodium intake or in mediation of the compensatory response. 2. In order to test the hypothesis, 100 mmol of sodium was given to normal volunteers in balance on a low-sodium diet (5 mmol/24 h): the dose was given either orally or intravenously. 3. Those who received their sodium orally excreted it more rapidly than those who received it intravenously and the difference was most marked in the first 8 h after the dose. 4. This finding is consistent with the presence of an input receptor for sodium in the gastrointestinal tract.


Urinary excretion of 17-oxosteroids in hereditary coproporphyria.

1. Urinary 17-oxosteroid conjugates were measured by gas-liquid chromatography in five patients with hereditary coproporphyria. 2. Three patients were in an acute attack and showed significantly increased excretion of sulphate or glucuronide conjugates of aetiocholanolone. There was increased excretion of several other related steroids but no consistent pattern was apparent. 3. In the two patients in remission, excretion of urinary 17-oxosteroids was not increased. 4. The ratio of total urinary aetiocholanolone to androsterone (5beta:5alpha) was found to be significantly elevated for the three patients in an acute attack. Serial measurements were made in two of these patients and showed a highly significant linear correaltion between this ratio and the urinary content of delta-aminolaevulic acid and porphobilinogen. 5. These observations suggest the involvement of the 17-oxosteroids, espically aetiocholanolone, in the pathogenesis of hereditary coproporphyria.


The release of renal prostaglandins during saline infusion in normal and hypertensive subjects.

1. Renal venous prostaglandin concentrations (PGA, PGE and PGF) were determined, together with renal plasma flow, urinary output and blood pressure changes, before and after infusion of sodium chloride solution (saline) in four normotensive and three hypertensive subjects. 2. No changes in blood pressure and in glomerular filtration rate were observed. 3. Saline infusion induced a significant increase in renal venous PGA and PGE, and also in total and non-cortical renal plasma flow and urinary output. There was an insignificant increase in renal venous PGF. 4. These findings show that prostaglandin release after saline infusion is associated with changes in renal blood flow and suggest that the natriuretic and diuretic effect of saline could be the result of prostaglandin release.


The role of baroreceptors and chemoreceptors in the regulation of the cerebral circulation.

1. Ten experiments, each using two dogs, were performed to evaluate the effect of chemoreceptor and baroreceptor activity on the cerebral circulation. 2. The carotid bifurcation areas were vascularly isolated bilaterally and perfused with arterial blood from a second animal. 3. Bilateral vagotomy interrupted stimuli from the aortic group of receptors. 4. Administration of 5% carbon dioxide to the donor animal resulted in an increase in cerebral (cortical) blood flow in the recipient. 5. A change in the arterial perfusion pressure from the donor resulted in a reciprocal change in the cerebral blood flow of the recipient. These changes were abolished by sectioning the sinus nerves.


Disturbances in glucose metabolism in patients with liver damage due to paracetamol overdose.

1. Intravenous glucose tolerance test were performed in fourteen patients with mild or moderate liver damage due to paracetamol overdose. 2. In patients managed conservatively there was glucose intolerance associated with a diminished early insulin response to glucose, suggesting inadequate nutrition in the period between the overdose and the glucose tolerance test. 3. Patients given intravenous glucose supplements to maintain nutrition were also glucose intolerant and, in these, insulin responses to glucose were normal. The decreased fractional disappearance rate was partly due to an increase in glucose distribution space and partly due to a decrease in absolute glucose disappearance rate. 4. Impaired gluconeogenesis was suggested by mild fasting hypoglycaemia in four patients and raised fasting blood lactate concentrations. Serum growth hormone concentrations showed a paradoxical increase after glucose. 5. All these variables had returned to normal in four patients re-tested after recovery.


The direct effect of calcium on the hyperparathyroidism of chronic renal failure.

1. The direct effect of calcium on the hyperparathyroidism of chronic renal failure was studied in rats with induced chronic renal failure, who were fed on a diet low in phosphate and who received supplemental phosphate by injection. They were given a normal (0-8%), or (0-1%) or high (1-7%) calcium diet. 2. The animals on the low calcium diet had larger parathyroids and more severe bone disease at the end of 4 weeks, indicating the importance of calcium intake in directly influencing the degree of hyperparathyroidism. 3. Increasing the calcium content of the diet from 0-8% to 1-7% produced no additional benefits.


Urinary noradrenaline excretion and renal function in normal and hypertensive 50-year-old men.

1. Sympathetic nervous system activity, measured by urinary noradrenaline excretion, was determined in a group of untreated hypertensive subjects (n = 35), a reference group (n = 80) and a normotensive group (n = 51), all derived from a random population sample of 50-year-old men. It was compared with casual and resting blood pressure, urinary sodium excretion, urinary cretinine concentration and glomerular filtration rate. Hypertension was defined as systolic pressure greater than 175 or diastolic greater than 115 mmHg on two separate occasions. Normotension was defined as systolic pressure less than 160 and diastolic pressure less than 95 mmHg. 2. There was no difference in the average excretion of noradrenaline during the day or night between the reference, normotensive and hypertensive groups. None of the hypertensive patients had values for urinary noradrenaline excretion during the day above the range found in normotensive subjects, indicating that hypertension with increased sympathetic nervous system activity is uncommon when hypertension in defined as above. 3. No correlation between urinary noradrenaline excretion during the day and blood pressure was found in the reference group or in the normotensive group. In the hypertensive group, there was a negative correlation between urinary noradrenaline excretion and blood pressure after rest. This finding might indicate that factors other than sympathetic nervous system activity determine the level of blood pressure in hypertensive subjects. 4. In the hypertensive group, urinary noradrenaline excretion during the day was positively correlated with both urinary sidium excretion during the day and glomerular filtration rate. Urinary noradrenaline excretion per 24 h was positively correlated with urinary sodium excretion during the same time. High resting blood pressure, low urinary sodium excretion, low glomerular filtration rate and a reversed diurnal rhythm of urinary excretion characterized hypertensive patients with low urinary noradrenaline excretion, indicating more severe hypertension in these hypertensive patients with reduced sympathetic nervous system activity.


Hepatic glutathione depletion and impaired bromosulphthalein clearance early after paracetamol overdose in man and the rat.

1. Plasma clearance of bromosulphthalein was impaired in patients within 8 h, and in rats within 2 h , of paracetamol overdose, before biochemical signs of liver damage had appeared. 2. Paracetamol and bromosulphthalein competed for uptake into the liver and excretion into the bile. Impaired hepatic uptake of bromosulphthalein could also be demonstrated in man at doses of the drug within the therapeutic range. 3. In patients studied a smaller proportion of bromosulphthalein was retained in the plasma as the glutathione conjugate after an overdose than after therapeutic doses. This effect could be reproduced in the rat and shown to be due to depletion of hepatic glutathione and to impairment in the activity of the enzyme glutathione-S-aryl transferase. 4. These studies provide further evidence that depletion of hepatic glutathione occurs after paracetamol overdose in man, as in the experimental animal, allowing the subsequent accumulation and binding of a toxic metabolite of the drug within liver cells. Impaired enzymic conjugation of the toxic metabolite with hepatic reduced glutathione may also be important in this situation.


The effect of indomethacin and prostaglandin (PGE2) on renal failure due to glycerol in saline-loaded rats.

1. Acute renal failure was induced in conscious rate by subcutaneous injection of glycerol. 2. Expansion of the extracellular space by infusion of 150 mmol/l sodium chloride (saline) partly protected the animals against acute renal failure. 3. This protective effect of saline infusion disappeared when the animals were treated with indomethacin. This effect could be reversed by the addition of prostaglandin (PGE2) to the saline infusion. 4. We suggest that prostaglandins may be involved in mediating the protection afforded by saline infusion against acute renal failure due to glycerol.


Plasma catecholamines and renin activity in response to exercise in patients with essential hypertension.

1. The effect of physical exercise on blood pressure, plasma catecholamines and plasma renin activity was studied in fourteen patients with essential hypertension and in eight healthy subjects. 2. Resting plasma noradrenaline and adrenaline and plasma renin activity of the hypertensive patients did not differ from those of the control subjects. 3. In response to graded exercise producing successive heart rates of 120, 140 and 160 beats/min, significantly greater increases of blood pressure were found in the patients than in the control subjects. 4. Plasma noradrenaline increased significantly in both groups at all levels of exercise, the responses being significantly greater in the hypertensive patients. 5. The mean arterial blood pressure was significantly correlated with plasma noradrenaline concentration in the control subjects but not in the hypertensive patients. 6. In the hypertensive group plasma adrenaline increased significantly after exercise at all work loads whereas, in the control group, significant increase occurred only at the highest work load. The differences in the response of the two groups were significant at each work load. 7. Plasma renin activity increased significantly after exercise at the heart rate of 120 beats/min, both in the hypertensive patients and in the control subjects. The magnitude of the response was similar in the two groups.


The effect of reduction in blood volume on plasma renin activity in man.

1. The blood volume was reduced by approximately 10% in nine adult humans. 2. Plasma renin activity was measured before and at intervals after the venesection. In seven subjects there was no significant change. In two subjects there was a slight but significant increase in plasma renin activity. 3. It is concluded that reduction in blood volume is not a major short-term factor in regulating renin production in humans.


The effect of frusemide on water and electrolyte absorption from the human jejunum.

1. Frusemide, in a dose of 120 nmol (40 mg) administered intravenously, significantly reduced the absorption of water and electrolytes from the human jejunum, a double-lumen perfusion system with proixmal occluding balloons being used. Net secretion of water and electrolytes occurred in some subjects. 2. No significant change in water and electrolyte absorption was observed with 60 nmol (20 mg) of frusemide. 3. These findings may explain the diarrhoea which may be induced by fursemide in some patients.


A study of intraluminal peptide hydrolase activity in the rat.

1. Uncentrifuged and centrifuged rat intestinal contents were assayed for peptide hydrolase activity with glycyl-L-phenylalanine (Gly-Phe) and L-phenylalanyl-glycine (Phe-Gly) as substrates in the absence and presence of the intestinal cytosol peptide hydrolase inhibitor p-hydroxymercuribenzoate. 2. Jejunal contents hydrolysed Gly-Phe faster than Phe-Gly. Conversely, ileal contents hydrolysed Phe-Gly faster than Gly-Phe. 3. p-Hydroxymercuribenzoate markedly inhibited jejunal peptide hydrolase activity. There was ten times as much PHMB-resistant activity towards both dipeptides in ileal contents as in jejunal contents. 4. Most of the luminal enzyme activity was present in the supernatants after centrifugation, indicating the luminal enzymes exist in the soluble form. Although the presence of soluble bacterial enzymes cannot be excluded, peptide hydrolase enzymes in jejunal contents have the characteristics of mucosal cytosol enzymes whereas enzymes in ileal contents have the characteristics of mucosal bruch border as well as cytosol enzymes.


[Typological studies of psychotics' personality before their illness, with special reference to manic-depressives].

This article deals with the following problem: to what extent is it possible to draw conclusions about the type of psychosis involved--in a case of endogenous psychosis--when one only has indications about the family background and the development of the personality before the illness, excluding all data about cases in the family, former pathological episodes and the present illness of the patient? Only pure forms of endogenous psychoses have been taken into consideration. Our hypothesis was that schizophrenics show before their illness schizoid features, subjects with an endogenous depression show features of the melancholic type, whilst manic depressives do not correspond to any of these types. After having studied most of the literature on this subject, we have attempted to draw from case histories the most marked features of personality and to obtain an overall picture of the primary personality of schizophrenic, depressive and manic depressive patients. This material was used for a "blind diagnosis" from 40 case histories (20 schizophrenics, 10 depressives and 10 manic depressive patients treated at the Max Planck Institute of Psychiatry, Munich). The results of this evaluation were significantly superior to those of a random distribution. Furthermore, we have attempted to outline the principal elements of the personality of future manic depressives from three examples out of the ten case histories studied. We came to the conclusion that although it is impossible to clearly oppose the primary personality of manic depressives to that of depressive patients, we have found a series of differences that prevent us from outlining a real common denominator for patients with "affective psychoses'.


[The phenomenon of possession. Conception and experiences of possession in youth].

In the last few years, a trend to the multiplication of experiences of possession has been observed in young people. On the basis of four typical examples, the author examines this phenomenon in the light of the psychiatric, psychoanalytic and theological understanding of possession. It involves mostly young people, who do not have hysterical fits or psychotic episodes during spiritualist practices but who specially tend to take a strong interest in occultism, who very often consume drugs and have contacts with groups in which the interest for demonology plays an important part.


[Speech behavior and neurotic personality structure. Is there a neuroses-specific communication behavior in the psychoanalytic situation].

Speech behaviour of the patient and the analyst is considered with regard to the psychoanalytic situation and its regulating factors such as transference and countertransference. It appears that the scientific viewpoint of the researching analyst determines the conception as well as the interpretation of a possible connection between verbal behaviour and neurotic personality structure. If the psychoanalytic situation is regarded as a means to investigate the patient and his symptoms, his verbal behaviour seems to depend on the unconscious motives forming his neurotic structure of personality. On the contrary, if the psychoanalytic situation is regarded as a communicative situation, the verbal behaviour of the patient as well as of the analyst depends rather on their 'here-and-now' transference relationship in a certain phase of the psychoanalytic process.


[Ritualized suffering as a factor of recovery].

Ritualised suffering as a possible factor in convalescence is discussed and a phenomenalistic analysis has been carried out. Most of the examples are derived from the religious sciences and social anthropology. The different modes of behaviour, e.g. the individual and collective suffering pattern, are compared. Furthermore the analogous behaviour, i.e. the overcoming of suffering through suffering, is contrasted to the antithetical behaviour, i.e. the overcoming of suffering through cheerfulness.


[Hallucinations and experience of fear].

Hallucinations, which are experienced in fear-evoking situations of helplessness and (external) danger, are attempts of defence and the realisation of elementary needs of self-preservation and security. The reality-denying self-deception is accompanied by the mobilisation of own protective potencies. Hallucinations are experienced fearfully, so that there is a situation of helplessness and danger. They are--as neurotic symptoms--an attempt to realise libidinous and/or aggressive desires with the manifestation of (condemning and punishing) defence in the projective perception. The self-deception here concerns the denial of own internal conflicts.


A cerebellar abiotrophy of calves.

A postnatal cerebellar atazia of a type not previously reported in calves is described. Atazia was first noticed in affected animals when they were three to eight months of age, and was often accompanied by loss of the menace response in an animal which was not blind. The disorder was progressive. At postmortem cerebellar size was normal. Microscopic lesions consisted of primarily an apparent degeneration of cerebellar neurons without obvious evidence of inflammation. History, clinical signs, laboratory examination, gross pathology, histopathology, differential diagnosis, search for an etiologic agent and genetic histories are reported. It is concluded that this disorder may represent an hereditary cerebellar abiotrophy in Holstein cattle.


Collection of cerebrospinal fluid from the horse.

Methods for atlanto-occipital and lumbosacral collection of cerebrospinal fluid from the horse are described in detail, and the techniques and complications discussed.


Radiographic method for anatomic study of the teat canal: characteristics related to resistance to new intramammary infection during lactation and the early dry period.

An in vivo radiographic method to determine teat canal anatomy has shown that resistant quarters had teat canals with a smaller diameter than that of susceptible quarters. The length of the teat canal did not appear to be related to resistance to new intramammary infections. These findings relate to new infection caused by Aerobacter aerogenes, Streptococcus agalactiae, and Staphylococcus aureus. Quarters guarded by teat canals with larger diameter were less resistent to new infection during both lactation and the early dry period compared with quarters guarded by teat canals with small diameter.


Cestrum diurnum poisoning in Florida cattle.

Cestrum diurnum poisoning was described in a Florida bull. Clinical signs included chronic wasting and progressive lameness. Plasma calcium was elevated for long periods of time but decreased toward low normal values. There was pronounced C-cell hyperplasia. Osteopetrosis was very severe and reflected retarded osteocytic osteolysis and chondrolysis. Further negative effects on the osteocytes eventually lead to osteonecrosis. Soft tissue calcinosis involved tendons and ligaments, major arteries and veins but kidneys and lungs were spared. Whereas the osteopetrosis could be explained by hypercalcitoninism, the osteonecrosis was believed to result from direct action by the Cestrum diurnum factor, previously shown to have an action similar to that of 1,25-dihydroxy-cholecalciferol, which is the biologically active metabolite of vitamin D3.


Short term abstinence from smoking: its place in preoperative preparation.

Newer pulmonary function instruments make measurement of small airway function possible as a routine, inexpensive part of preoperative preparation of patients with obstructive lung disease. Patients with early stages of chronic obstructive lung disease have maldistribution of ventilation and perfusion producing an increased A-a oxygen gradient. If the disease is at a reversible stage, early diagnosis and treatment should be helpful in preventing postoperative complications. Five volunteer heavy smokers stopped smoking for one week without any improvement in small airway function. A longer period of abstinence and other therapeutic modalities for these patients is needed prior to surgery to reduce the postoperative impact of this pathology.


Studies of temperature balance after open-heart surgery.

An analysis of postoperative records over a two-year period has shown that a mean rise in central body temperature greater than 2 degrees occurs in patients within 12 hours of return from the operating room following open-heart surgery. In some patients the central body temperature may rise to greater than 41 degrees C. despite an adequately warm peripheral temperature, and this is associated with a high mortality rate. An apparatus has been developed which enables the immediate enviroment of the patient to be controlled. A comparison of two groups of patients, in one of which the apparatus was used, demonstrated that it was possible to attenuate significantly the usual postoperative temperature rise seen in the control group. In a third group further cooling was employed: these patients were successfully held at subnormal temperatures. Using multiple temperature probes and heat balance formulas, it was shown that the rise in central body heat was due mainly to elevation of total body heat rather than the result of redistribution of heat from the surface.


The Spirostat: comparison with water-sealed spirometer.

Performance of four Spirostat units in measuring forced expiratory volume, 1 sec (FEV1) and forced vital capacity (FVC) were examined against that of a Collins spirometer using 10 volunteers. One Spirostat was discarded because of gross inaccuracy. The other three were evaluated for accuracy, repeatability and comparability among Spirostats. For FEV1 it reads high over the low ranges and low over the upper ranges. For the FVC, it reads high for all values up to 5.0 liters where it becomes quite accurate. The repeatability was considered only fair, since one spirostat differed from the other two; the comparability was acceptable.


Experience with an intensive care unit in a developing country.

In September 1963 an intensive care unit was established at the Lagos University Teaching Hospital in Nigeria. The incidence of mortality was significantly high (38%). This was attributed to several factors: (1) severity of illnesses, types of illness and antecedent period of neglect; (2) lack of a critical care medicine program; (3) limited numbers of skilled, full-time intensive care unit personnel, including physicians, nurses, inhalation therapists and paramedics, and (4) the high incidence of sepsis in the intensive care unit.


Changes in urea clearance after a single dose of diuretics during water diuresis.

The action of various diuretics on the excretion fraction of urea (Curea/Ccr) was studied in 91 healthy volunteers under conditions of maintained maximal water diuresis. On the basis of previous data on transtubular transport or urea it should be expected that with an increase in the excretion fraction of water (V/Ccr) under the given experimental conditions we should find an increase in Curea/Ccr. After administration of polythiazide, which has a predominantly distal localisation of action in the nephron, Curea/Ccr did not change. After administration of chlorothiazide, furosemide and after i.v. administration of ethacrynic acid there was a marked increase in V/Ccr, ranging from 5.4 to 18%. Despite this there was no significant increase in Curea/Ccr. After i.v. administration of acetazolamide or oral administration of ethacrynic acid Curea/Ccr even showed a statistically significant decrease. These findings suggest that a decrease in proximal tubular reabsorption of water after administration of diuretics during maximal water diuresis is not a decisive factor for the renal excretion of urea. The data suggest that the diuretics affected the permeability of the distal segment of the nephron for urea in the sense of an increase of tubular reabsorption.


Reevaluation of micropuncture techniques: some of the factors which affect the rate of fluid absorption by the proximal tubule.

The present study has shown: (1) Hydrostatic pressure from the lumen is not an effective driving force ofr fluid absorption (Jv). (2) Hydrostatic pressure from the contraluminal side can strongly inhibit Jv. (3) Colloid in the capillary perfusate can effectively minimize the artifact of capillary perfusion. (4) HCO3 free serum as capillary perfusate inhibited Jv approximately to 50% of control. (5) 5 mM NaCN in capillary perfusate (dialyzed serum) inhibited Jv by 90% after two min and almost totally after 4 min. The presence or absence of exogenous substrate in capillary perfusate had no effect on NC-induced inhibition. The data indicate that glycolysis alone can not sustain fluid absorption.


Error calculation in the study of renal metabolism.

1) By the aid of error calculation various formula structures of method in the renal metabolism have been investigated in regards to their intermediary information contents. 2) The effects of the formations of the means and the error calculation on correlation and significance test are shown. 3) The calculation was carried out for a mean relative error of the means which were 1 respectively 5% of the determinants. It showed how dangerous it can be to calculate with means without taking into account the errors induced.


Changes in blood serotonin during hemodialysis.

Authors studied serotonin (5-hydroxytryptamin) in blood in patients with severe renal failure. Changes of serotonin in platelets and plasma in renal failure possibly play a part in clotting disorders of uremia. The authors found increased levels of serotonin in the patients, who suffered from acute and chronic renal failure. 15 patients were dialysed in regular dialysis treatment. Serotonin increased in blood after each dialysis. Platelets remained unchanged during hemodialysis. The authors discuss these new findings and correlate the above mentioned changes with electrolytes and some other laboratory findings.


Gluconeogenesis in isolated nephron segments of the rabbit.

Glucose production rates from lactate and pyruvate in individually isolated segments of the rabbit nephron were measured using the enzymatic cycling method. Glucose production per mm length was uniformly high in the whole proximal tubule including the straight descending portion. Lower values were observed in the thin descending limb and in the thick ascending limb of Henle's loop. We believe that this study demonstrates two advantages of the approach suggested by Burg and Orloff to study renal metabolism in different parts of the nephron: first, specific differences in the metabolism of indivudual nephron segments can be detected directly, second, metabolic rates are easily to be compared with physiological data obtained by micropuncture and microperfusion since the common point of reference is the length of the nephron segments.


Stimulation of renal gluconeogenesis by L-alanine and AIB.

L-alanine as well as AIB have been shown to stimulate gluconeogenesis in isolated kidney cortex tubules in a catalytic way. The data reported are consistent with the view, that the stimulation of renal gluconeogenesis by L-alanine and AIB is due to an inhibition of glycolysis at the level of the pyruvate kinase reaction. In the light of results of Carminatti et al. [8], showing that in kidney cortex 70-80% of total pyruvate kinase activity is represented by a type which is insensitive to inhibition by ATP but sensitive to inhibition by alanine, it appears conceivable also from our results, that alanine counteracted by FDP might contribute to the regulation of pyruvate kinase acti-ity and consequently thereby gluconeogenesis in kidney cortex.


Triploidy and haploid-triploid mosaicism among chick embryos (Gallus domesticus).

Homomorphic, chromosomally abnormal roosters were mated to normal hens. The 23 hens produced 67 embryos, including two triploids and a haploid-triploid mosaic at about 26 hours of incubation. Both of the triploid embryos were conceived within a 5-day period. The presence of a single genome of paternal origin with marker chromosomes in each triploid led to the conclusion that these embryos were derived from diploid, ZW-type ova fertilized by haploid, Z-type spermatozoa. The inheritance pattern of the mosaic embryo was clearly due to a spermatozoal origin for the haploid cell line; and one genome of the three in the triploid cell line was paternal. The sec chromosomes were Z/ZZZ, with one Z of each cell line being a translocation product of paternal derivation.


A simple statistical analysis of Indian muntjac Giemsa band patterns.

Indian Muntiacus muntjac G-banded chromosomes were used for computerized analysis for standardized karyotype generation. Individual chromosomes on high-contrast photographic negatives were scanned densitometrically. Alignment of each chromosome for analysis was achieved by locating predominant peaks as well as the centromere. This provided better alignment that the use of the chromosome-end locations. The standardized set was obtained by determing the root-mean-square average density along 10-20 homologous chromosomes. The resulting standard karyotype differs from those published earlier. Prophase chromosomes exhibited greater detail than more condensed metaphase chromosomes. Although Indian muntjac chromosomes were used as a model, the method of analysis should be readily adaptable for examining chromosomes of any origin. The analytic technique should be within the capabilities of the smallest cytogenetic laboratories.


Comparative cytochemical measurements in the diploid-tetraploid species pair of hylid frogs Hyla chrysoscelis and H. versicolor.

Hyla versicolor (2n = 48) is a tetraploid counterpart to H. chrysoscelis (2n = 24). Cytochemical measurements revealed that no cytological parameter of the two species conformed to the expected 2:1 ratio. Every cytological factor of the tetraploid appeared to have been regulated toward the diploid level. H. veriscolor-to-H. chrysoscelis mean ratios and their standard errors were: DNA 1.90 +/- 0.03; nuclear histone, 1.70 +/- 0.18; nuclear RNA, 1.63 +/- 0.19; total nuclear protein, 1.46 +/- 0.05; nuclear sizes, 1.42 +/- 0.08.


Incidence of serum precipitins against organic-dust antigens in different populations by counterimmunoelectrophoresis.

The incidence of serum antidust and antifungal precipitins was determined by counterimmunoelectrophoresis in 317 atopic and nonatopic subjects of three geographic areas (north central, southern, and western United States). The selected lyophilized crude antigens employed were from house dust, Micropolyspora faeni, Candida albicans, Alternaria tenuis, Aspergillus fumigatus, Puccinia coronata, Cantharellus cibarius, and Amborsia trifida. Antidust precipitins were detected with high frequency in atopic and nonatopic subjects of each geographic area (48 to 71 percent of different population subgroups). Precipitin reactions were generally intense and often multiple, in keeping with the marked heterogeneity of the crude dust antigen employed. Antidust precipitins were also present in serum fractions precipitated with ammonium sulfate and in IgG-rich fractions obtained by gel filtration (Sephadex G-200) and diethylaminoethyl-cellulose chromatography. Precipitins against crude somatic fungal and actinomycetic antigens were detected with considerably less frequency in all populations surveyed, considerably less frequency in all populations surveyed, and antiragweed precipitins were not detected. Our results suggest that prolonged environmental exposure to diverse, ubiquitous organic dusts results in a "normal" serum precipitating-antibody response. They also extend our previous finding of a high precipitin response against organic dusts in residents of the Gulf south area compared to other geographic areas.


Treatment of asthma with triamcinolone acetonide aerosol.

Thirty-five steroid-dependent asthmatic patients have been treated with an aerosol of triamcinolone acetonide for periods ranging from 8 to 26 months. Fourteen patients discontinued the oral use of steroids for the first time in from 2 to 19 years and throughout the period of treatment with aerosol, have not required any other steroid medication. Fifteen patients were able to discontinue oral use of steroids but have required one or more short supplemental courses of oral steroid treatment for exacerbations of asthma. Six patients have either continued to require oral steroid therapy, or their symptoms have been incompletely controlled by the aerosol. Steroid aerosols represent an important advance for the treatment of asthma. Small doses which do not suppress adrenal function and do not produce hyperadrenocorticism make it possible for most patients to eliminate or substantially reduce their requirement for oral steroid therapy.


Depressant effect of marihuana smoke on antibactericidal activity of pulmonary alveolar macrophages.

Other than the potentially therapeutic bronchodilatory influences of marihuana, very little is known of its biologic effects on the lung. To evaluate this problem, alveolar macrophages were harvested from rats by bronchopulmonary lavage and incubated in vitro with Staphylococcus albus and marihuana smoke of standardized 2.2-percent tetrahydrocannabinol content in graded amounts. After three hours, control alveolar macrophages inactivated 78.0 +/- 5.0 percent of the staphylococcal challenge. There was a dose-dependent depression of alveolar macrophage bactericidal activity, with 66.7 +/- 7.1 percent, 23.7 +/- 7.0 percent, 20.5 +/- 7.0 percent, and 11.4 +/- 7.6 percent of the bacteria killed following exposures to 2 ml, 4 ml, 6 ml, or 8 ml of marihuana smoke, respectively. Differential filtration of marihuana smoke revealed that the alveolar macrophage cytotoxin was present in the gas phase of the smoke and was water-soluble. Studies on purified tetrahydrocannabinol and on tetrahydrocannoabinol-extracted marihuana revealed that the impairment in alveolar macrophage function was not related to the psychomimetic or bronchodilatory components of marihuana.


Effect of cuffed endotracheal tubes on tracheal mucous velocity.

The inflated cuffed endotracheal tube produces a significant depression of tracheal mucous velocity in anesthetized dogs after one hour. This effect occurs with bot low and high compliance cuffs but is not observed with an uncuffed tube. This phenomenon is another factor that must be considered in establishing criteria for the frequency of cuff deflation in patients supported by mechanical ventilators.


Echocardiographic manifestations of postinfarction ventricular septal rupture.

The echocardiographic features of three patients with postinfarction ventricular spectal rupture are described. All patients showed a decreased or paradoxical motion on the ventricular septum, and two of the patients demonstrated an unusual motion of the tricuspid valve. There were no abnormalities in mitral valve motion. The echocardiogram can be helpful in the diagnosis of postinfarction ventricular septal rupture and can assist in distinguishing this condition from acute disruption of the mitral valve complex.


Varied manifestations of left atrial myxoma and the relationship of echocardiographic patterns of tumor size.

Four cases of left atrial myxoma with varied clinical manifestations were diagnosed with echocardiographic studies prior to cardiac catheterization and surgery. The unusual clinical features include Raynaud's phenomenon and intermittent claudication. The echocardiographic features of the atrial myxoma appear to be related to tumor size. Systematic echocardiographic evaluation of patients with mitral valvular disease and systemic and cerebral vascular insufficiency will undoubtedly increase the positive diagnostic results in patients with atrial myxomas. Removal of these tumors results in normalization of the echocardiographic pattern.


Symptomatic and puomonary response to acute phlebotomy in secondary polycythemia.

A double-blind study of the effects of phlebotomy was carried out in 18 patients with polycythemia secondary to severe hypoxemic lung disease. Eleven subjects underwent a single phlebotomy of 10 percent of their blood volume, and eight patients serving as controls underwent a sham procedure. Eight of the phlebotomized subjects, but none of the controls, reported subjective clinical improvement (P less than 0.005). Subjects who noted improvement after venesection had higher hematocrit readings than those who did not (P less than 0.02). Symptomatic relief seemed to be most dramatic in those with clinical evidence of congestive heart failure. In contrast to this clear-cut subjective improvement, phlebotomy did not alter objective indices of airway obstruction, lung elastic recoil, pulmonary gas exchange, or exercise tolerance in either the phlebotomized or the control group. Thus, although phlebotomy produced subjective benefit in the majority of patients studied, it was not associated with objective improvement in lung function or exercise tolerance.


The Chanute histoplasmosis epidemic. New variations of urban histoplasmosis.

An epidemic of acute histoplasmosis occurred in a long-established residential neighborhood in central Illinois. Ten of the 28 individuals living in the five duplex buildings comprising the housing project had evidence of acute infection. The epidemic was unusual in that the infections apparently occurred as the result of adults tending their gardens and children playing under and about the tress of the area. No specific event, such as a construction project or the demolishing of an old building, was involved as a point source, as has usually been observed in past epidemics. The infections occurred sporadically over a summer and probably resulted from exposure to any one of several sites where the fungal organisms were shown to exist in the housing area.


Diagnosis of upper airway obstruction by pulmonary function testing.

We compared 11 patients with upper airway obstruction (obstruction at or proximal to the carina) to 22 patients with chronic obstructive pulmonary disease and to 15 normal subjects utilizing spirometry, lung volumes, airway resistance, maximal voluntary ventilation, single-breath diffusion capacity, and maximal inspiratory and expiratory flow-volume loops. Four values usually distinguished patients with upper airway obstruction: (1) forced inspiratory flow at 50 percent of the vital capacity (FIF50%) less than or equal to 100 L/min; (2) ratio of forced expiratory flow at 50 percent of the vital capacity of the FIR50% (FEF50%/FIF50%) larger than or equal to 1; (3) ratio of the forced expiratory volume in one second measured in milliliters to the peak expiratory flow rate in liters per minute (FEV1/PEFR) larger than or equal to 10 ml/L/min; and (4) ratio of the forced expired volume in one second to the forced expired volume in 0.5 second (FEV1/FEV0.5) larger than or equal to 1.5. The last ratio can be determined with a simple spirometer.


Tuberculosis and pregnancy. Five- to ten-year review of 215 patients in their fertile age.

This study evaluated the influence of pregnancy as a relapse factor in pulmonary tuberculosis in 215 patients who recieved adequate chemotherapy. A comparison was made between the evolution of patients who had pregnancies and those who did not. On ending the period of observation (details are lacking with respect to only of observation (details are lacking with respect to only seven patients), 203 patients continued to be well without active pulmonary lesions, and no relapses had been seen. Of these patients, 100 had 149 pregnancies, giving birth to 135 children; 108 had no pregnancies. Fifteen pregnancies took place while patients were in the active phase of their tuberculosis, and 134 occurred once chemotherapy had ended; seven patients gave birth to nine children while their postchemotherapy cavity remained inactive. From the extended period of observation, it can be concluded that pregnancy, birth, puerperium, and lactation do not presuppose any risk of relapse of pulmonary tuberculosis when it is adequately treated even in patients in whom an inactive postchemotherapy cavity persisted.


Acute pulmonary artery hypertension produced by distention of the main pulmonary artery in the conscious dog.

In order to delineate further the function of the main pulmonary artery as a receptor site, a specially designed Laks triple-lumen balloon catheter was inserted transvenously and positioned in the main pulmonary artery. In six conscious nonsedated dogs, inflation of a balloon in the main pulmonary artery produced acute reversible pulmonary arterial hypertension; the pressure beyond the balloon increased from a mean of 21/6 mm Hg to 43/14 mm Hg (P less than 0,001). This observed pulmonary hypertension occurred at an amount of balloon inflation which produced an increase in right ventricular systolic pressure (P less than 0.001), but no significant change occurred in cardiac output (P greater than 0.05) or right ventricular end-diastolic pressure (P greater than 0.1). Left atrial and pulmonary artery wedge pressures did not change or decreased slightly (P greater than 0.1 and P greater than 0.1, respectively). The calculated pulmonary vascular resistance increased (P less than 0.001), while the calculated systemic vascular resistance did not chang (P greater than 0.04). Therefore, we postulate that distention of the main pulmonary artery in the conscious dog reflexly produces constriction of pulmonary arterioles, and possibly venules, due to excitation of receptors probably located in the wall of the pulmonary artery or possibly the right side of the heart, or both.


Pulmonary talc embolization.

A young woman with a history of drug abuse rapidly developed cor pulmonale, restrictive pulmonary defect, low diffusion capacity, and a suggestion of left ventricular dysfunction. She died from complications after a lung biopsy. Microscopic examination showed talc granulomas and arteritis. Some form of closed biopsy is probably safer, and trial of corticosteroid therapy seems warranted for this diagnosis. Talc ia a dangerous ingredient for any oral preparation that is likely to be used parenterally.


An unusual precordial pulse and sound assoicated with large pericardial effusion.

An unusual, high-pitched, early diastolic sound coinciding with a prominent, sharp precordial pulse was observed in a patient with a large chronic pericardial effusion. The pulse and sound coincided exactly with the anterior excursion of the heart within the fluid-filled pericardial sac, suggesting that the sound and pulse result from the ballistic effect of the heart striking the anterior pericardium and chest wall. This finding may be specific for large pericardial effusion with a "swinging heart."


Intraventricular dissociation due to complete intraventricular block.

Intraventricular dissociation due to intraventricular block occurred in a patient with cardiac arrest due to massive cerebral hemorrhage. The electrocardiogram showed complete atrioventricular block with three different types of accelerated ventricular rhythm. The ectopic beats did not interfere with each other because of the existence of an area of complete block surrounding the areas in which impulse formation occurred. Hence, the corresponding QRS complexes did not result from depolarization of all the ventricular muscle mass but only of certain regions. The latter were large enough to produce ventricular complexes of enough size to be recorded at the body surface. This phenomenon is the clinical counterpart of the multiple isolated focal contractions which may be seen directly in the ventricules of dying hearts.


Postinfarction ventricular septal defect with posterior ventricular aneurysm. Result of a single distal right coronary artery obstruction.

A patient with postinfarction ventricular septal defect, posterior aneurysm, severe congestive heart failure, and significant atherosclerosis in the distal right coronary artery only is reported. Closure of the defect resulted in quich recovery of the patient. We demonstrated that a single significant lesion in one coronary artery can cause rupture of the interventricular septum.


Myocardial embolus to coronary artery: result of rupture of papillary muscle during acute myocardial infarction.

A patient is described with acute myocardial infarction complicated by rupture of a papillary muscle. A surprise finding at necropsy was a fragment of necrotic myocardium, similar to that at the site of papillary muscle rupture, in one coronary artery. Myocardial embolism to a coronary artery has not been described previously to our knowledge.


Lung tumor in a patient with congenital unilateral hypoplasia of the pulmonary artery.

The occurrence of an undifferentiated carcinoma in the affected lung of a cigarette smoker with asymptomatic congenital hypoplasia of the right pulmonary artery is reported.


Psychological factors in maternal grandparents of asthmatic children.

The presently perceived past family interactions between mothers and maternal grandparents of asthmatic children and nonasthmatic children were compared. All the children included in this study had a common factor in that they suffered from early infantile eczema in the 1st year of life, and in their families there were many cases of asthma, hay fever, and eczema. With the use of two different test instruments for the measurement of family relationships, it was found that maternal grandmothers of asthmatic boys had a highly positive relationship with the mothers of the boys and that the maternal grandfathers were perceived by the mothers as rejecting figures. Even though the correlation between the two tests was rather high, they showed differences in their sensitivity. There was a striking difference between the mothers of asthmatic boys and the mothers of asthmatic girls in both tests. This fact together with the established greater vulnerability of boys to asthma seem to justify studying the sexes separately. It could be assumed that the asthmatic and nonasthmatic children in  this study had a similar constitutional-familial allergic predisposition and that the differences between these groups of children were mainly influenced by environmental factors. The mothers' perception of the family relationship with their parents was considered to be minimally influenced by the asthma of their children.


Two cases of children of homosexuals.

The literautre is reviewed with reference to parental attitudes related to homosexuality, sex role typing, and object choice. Two cases of children of opposite-sexed homosexual parents are presented with projective testing indicating difficulties with gender role identity. It is our impression that the manifestation of sexual conflict in these homosexual parents expressed in attitudes and behavior toward the child is not unique and does not differ significantly from that of the heterosexual parent who has sexual conflicts. More long-term data are necessary to help us to understand the influences of parental homosexuality on the growing child.


Behavior modification as a therapeutic technique for use with parents of emotionally disturbed children in residential treatment.

This paper is based on the experience of the author in establishing and directing a program of behavior modification for children and their parents at the New Hampshire Hospital. The focus is on the operant conditioning procedures used with the parents to foster improved relationships with their children and between spouses. Attention was given to the promotion of awareness and praise for productive behaviors and extinction of hostility. Modeling, prompting, shaping, ignoring, and reinforcement principles were followed in parent activities such as TV viewing, individual and group counseling, and controlled visits with children.


An approach to working with the "placed child".

This paper presents an approach to working with the diagnostic and therapeutic challenges posed by the "placed child". A thorough knowledge of child development, combined with awareness of the basic tenets of crisis intervention, offers the child mental health professional guidelines to assist placed children in coping with their uncertain environment. Parents and agencies are guided toward stabilizing the child's environment, while the child is maintained in play therapy to assist him in coping with the confused and frightening emotions that attend the experience of placement separation. Three clinical cases are presented that illustrate an active short-term therapy, a form of primary prevention attempting to forestall the potential damage of unresolved placement separation crises.


The stress of parenting.

The ongoing process of parenting is examined with respect to the following: the dyadic versus triadic relationship; change in familial structure; cultural trends; problems of individuation; and other environmental influences.


Autism and attention: theoretical considerations and a pilot study using set reaction time.

We have presented an attentional model that may have value in the pathophysiology of autism. We have presented data that suggest attentional dysfunction and an attentional hypothesis that may explain autism's multisensory clinical appearance and natural history. Only further studies will be able to evaluate this hypothesis and hopefully provide us with something more promising to offer parent and child in the way of therapy.


Emotionally disturbed children in special schools: an analysis of ratings of disturbed behavior and perceptual handicaps.

The relationship between perceptual handicaps and adjustment was studied among 573 emotionally disturbed children from Massachusetts. Little relationship was found between perceptual handicaps and overall adjustment. Antisocial behavior was the most prominent factor related to removal from regular classrooms and placement in special residential and day schools.


A mother instruction program: behavior changes with and without therapeutic intervention.

Mother-child behavior changes over therapeutic intervention and no-contact periods were compared. Fifteen dyads had 8 weeks of instruction followed by no contact; 15 followed a reversed schedule. Overall change was about the same in both groups, and both changed more during instruction than during no-contact periods. Mothers receiving immediate instruction showed greater and more systematic immediate changes following instruction. Children in the group with later follow-up exhibited a greater proportion of behavior change during that no-contact period than during instruction. Thus, no-contact periods cannot be considered no-change periods, though immediate intervention probably ensures more systematic change than intervention preceded by waiting-list experience.


Latency-group art therapy: teaching socialization skills through art.

An art therapy experiment involving 10 weekly sessions for six latency-age emotionally disturbed boys produced marked improvements in peer relationships and socialization skills.


Home visiting with family day care providers.

The benefits and problems of home visiting with agency-sponsored family day care providers are illuminated in a study of the perceptions of both agency visitors and the providers.


Family life education: a treatment modality.

Family life education is a long-established form of help that continually ramifies into new areas. It aims at healthier family living, and reduction of family breakdown and child placement. Most child welfare personnel know about family life education, and some are practitioners in it. Many, however, may not be familiar with its present extensiveness or method of organization and operation. This personalized account of one agency's program, presented at the CWLA Central Regional Conference in Detroit, 1975, provides useful information.


Optical studies of the interaction of 33258 Hoechst with DNA, chromatin, and metaphase chromosomes.

The interaction of the bisbenzimidazole dye 33258 Hoechst with DNA and chromatin is characterized by changes in absorption, fluorescence, and circular dichroism measurements. At low dye/phosphate ratios, dye binding is accompanied by intense fluorescence and circular dichroism and exhibits little sensitivity to ionic strength. At higher dye/phosphate ratios, additional dye binding can be detected by further changes in absorptivity. This secondary binding is suppressed by increasing the ionic strength. A-T rich DNA sequences enhance both dye binding and fluorescence quantum yield, while chromosomal proteins apparently exclude the dye from approximately half of the sites available with DNA. Fluorescence of the free dye is sensitive to pH and, below pH 8, to quenching by iodide ion. Substitution of 5-bromodeoxyuridine (BrdU) for thymidine in synthetic polynucleotides, DNA, or unfixed chromatin quenches the fluorescence of bound dye. This suppression of dye fluorescence permits optical detection of BrdU incorporation associated with DNA synthesis in cytological chromosome preparations. Quenching of 33258 Hoechst fluorescence by BrdU can be abolished by appropriate alterations in solvent conditions, thereby revealing changes in dye fluorescence of microscopic specimens specifically due to BrdU incorporation.


Electron microscopy of whole mount metaphase chromosomes.

Whole mount metaphase chromosomes, from cultured L cells, have been centrifuged onto grids and examined by electron microscopy. Compact and dispersed chromosome forms provide extensive ultrastructural information. Condensed chromosome arms appear as packed fibers with centromeric heterochromatin identifiable because it stains more intensely than the rest of the chromosome. Kinetochores are readily visible in these preparations. Under appropriate isolation conditions, it is possible to obtain mitotic spindles in which bundles of microtubules remain attached to kinetochores, suggesting that the kinetochores retain basic structural integrity throughout the isolation procedure. Dispersal of metaphase chromosomes by treatment with formalin and distilled water shows that these chromosomes are composed of a basic fiber that is normally highly condensed. This fiber is made up of regularly repeating 70-90 A diameter nucleoprotein granules separated from neighboring granules by a 20-40 A diameter fiber whose continuity is maintained by DNA. This structural arrangement is totally analagous to that reported for interphase chromatin from a variety of sources.


Biological rhythm experimentation: a longitudinal design and analysis.

Certain experiments exploring the relationship between biological rhythms and external factors such as pharmacologic agents are typified by the particular importance of interaction and conditional effect parameters. The category of biological rhythm experiments presented here also necessarily involves a deliberate confounding of periodicity rooms and biological rhythm stages (time points). These features, together with the longitudinal nature of the observations, require special precautions in the experimental design and analysis.


Behavior of calf blood flow in normal subjects and in patients with intermittent claudication during a 24-h time span.

Calf basal resting and reactive hypercemia blood flow were measured at 4-h intervals during a day in fifteen healthy subjects and in fifteen patients with intermittent claudication by means of a venous occlusion plethysmograph. Mathematical-statistical analysis of the data failed to demonstrate circadian periodicity of calf blood flow in healthy subjects, but proved the existence of a 24-h rhythm of calf basal resting and reactive hyperemia blood flow in patients with intermittent claudication. This different behavior of calf blood flow can be understood if one considers that in healthy subjects the voluntary muscles in the extremities have a blood supply which can be instantaneously adjusted over a large area. In patients with peripheral arterial disease, on the other hand, the vascular responses in voluntary muscles of the limbs to various endogenous or exogenous stimuli are impaired and reduced. The circadian rhythm observed in patients with intermittent claudication has early evening peaks and a nocturnal trough with a nadir occurring after midnight and before 0400. This rhythm displays marked similarities with those of all other circulatory values. As to the mechanism of rhythm, it is hard to decide whether or not it has an independent endogenous origin. It is known that many of the circulatory variables are interrelated and that some are clearly related to other circadian rhythms. Perhaps the rhythmic reduction of limb blood flow which occurs during the night is the mechanism underlying the nocturnal pain of subjects with limb ischemia by peripheral arterial disease.


Re-entrainment of circadian rhythms after phase-shifts of the Zeitgeber.

To describe anabrupt shift of the Zeitgeber sufficiently, it is necessary to indicate whether the phase has been advanced or delayed, for how many hours it has been shifted, and what part of the Zeitgeber has been lengthened or shortened respectively. The entrained circadian system usually follows a shift of the Zeitgeber in the same direction and by an equal amount. However, there can be exceptions to both of these rules: a) an instantaneous 12-h shift of a (symmertric) Zeitgeber always represents a delya (= doubling of one-half of its period). In contrast to this, the gradual re-entrainment of the circadian system can be accompalished by either advances or by delays (Fig. 2), it can occur in both dirctions simultaneously by splitting the rhythmic variable (Fig. 1),or it can represent an apparent advance not distinghushable from a delay ( Fig. 6); b) after complietion of re-entraiment, the phase-angle difference psi between organism and Zeitgeber an differ systematically from the pre-shift psi-value...


Evaluation of the barium-enema examination and colonoscopy in diagnosis of colonic cancer.

The diagnostic value of colonoscopy was investigated in 123 patients with certain or questionable cancer of the colon as demonstrated by an ordinary barium-enema examination. The diagnosis was revised by laparotomy or clinical follow-up studies in cases of patients having no operation. The following conclusions were deduced: 1) The number of unnecessary laparotomies may be reduced by doing colonoscopy in patients with certain or questionable cancer of the colon as demonstrated by ordinary barium-enema studies. 2) The gain in diagnostic value of adding a colonoscopy to a barium-enema examination is more pronounced in patients with questionable than in those with certain cancer as visualized by the barium-enema studies. 3) The risk of missing a cancer of the colon during colonoscopy is very small if an experienced examiner looking for cancer performs the colonoscopy. 4) Colonoscopy is of little diagnostic value in cases of patients who have radiologic evidence of stenosis of the sigmoid colon. 5) The number of patients selected for colonoscopy on the basis of radiologic evidence suggesting cancer probably can be reduced by refinement of the barium-enema examination.


Intestinal and peritoneal tuberculosis: report of two cases.

One hundred and seven cases of abdominal tuberculosis were analyzed. There were no specific laboratory or x-ray findings pathognomonic of abdominal tuberculosis. Leukopenia was often found, but was nonspecific. An abdominal tumor was often palpable.  A great rarity in our series was profuse hemorrhage from a jejunal tuberculous ulcer; the patient had to be subjected to an emergency operation. In another case tuberculosis appeared in a side-to-side small intestinal anastomosis and in its blind ends, which had developed as a late complication. The diagnosis of abdominal tuberculosis must be confirmed by histologic examination of biopsy specimens; if the results are inconclusive, acid-fast bacilli must be seen or culture should be positive. Guinea-pig inoculation is rarely positive, probably owing to the low virulence of the tuberculous bacteria in abdominal tuberculosis. Good results are obtained with chemotherapy in both intestinal and peritoneal tuberculosis. The complications, obstruction being most usual, must be surgically treated. Resection of the affected segment is the best surgical procedure. For ileocecal tuberculosis, right hemicolectomy was performed. According to the authors, roentgenographic evidence of tuberculosis in the abdomen must always be confirmed by operation, because differentiation from carcinoma and other inflammatory lesions is impossible. For good results after operation, anti-tuberculosis chemotherapy is mandatory.


Sexual behavior and affective disorders.

One hundred and fifty four consecutively evaluated new and return psychiatric outpatients were examined by the same interviewer using a detailed, precoded questionaire based on the diagnostic criteria for psychiatric research proposed by Feighner, et al. Sexual behavior manifested as prostitution involvement, promiscuity and extramarital sexual experiences was studied for groups of patients with unipolar and bipolar primary affective disorders, secondary affective disorders and non affective disorders. Results and conclusions are reported.


The effect of modified ECT on serum creatine phophokinase, I. With intravenous atropine.

Interpretation of serum creatine phosphokinase (CPK) levels is frequently difficult because of complicating circumstances known themselves to raise CPK; for instance, intramuscular injections. One such circumstance among psychiatric patients is said to be administration of electroconvulsive therapy (ECT). In a series of 22 patients who received drug modified ECT, four had CPK elevations beyond the normal range. These findings indicate that CPK elevations among patients receiving ECT should be interpreted cautiously.


The effect of modified ECT on serum creatine phosphokinase. II. With subcutaneous atropine.

In the previous study, the effect of modified ECT on serum CPK was investigated. In that study, atropine was administered intravenously two minutes prior to ECT being given. In this study, the more usual clinical procedure in which atropine is administered subcutaneously is investigated. In a series of nineteen patients, four had CPK elevations beyond the normal range. These findings resemble the findings of the previous study closely, and indicate again that elevations of CPK in patients receiving ECT should be interpreted with caution.


Inflammatory colorectal disease and pregnancy: report of a case.

A retrospective study of women in the child-bearing age with inflammatory disease of the bowel seems to suggest that these women become pregnant as often as other women in the general population. In this small study it was 100 per cent. The incidence of subjective difficulty with conception is likewise small. Patients with Crohn's disease appear to feel better in pregnancy with regard to their intestinal problems, while more than 60 per cent of the patients with ulcerative colitis appear to do poorly. The live-birth rates for both conditions in our series were approximately 80 per cent. An unusual complication in two of our patients with Crohn's disease was a postpartum, postepisiotomy rectovaginal fistula. This may indicate a possible danger of episiotomy in patients who have Crohn's disease.


Evaluation of the electrosleep machine.

Seven dogs were intensively studied to determine the clinical, physiological, biochemical, and pathological effects of the electrosleep machine. Both the normal dose and a high dose of current was studied. The most notable finding was an increasing number of histologic findings with increasing current dose. There is some question regarding the true nature of these findings. Other changes which were less definite included: EEG slowing and depression of the amplitude of the B-wave in the ERG. Suggestive changes included a chronic increase in pulse rate. Because of the small number of subjects, further studies are indicated to investigate further the findings of this study.


The psychoanalyst and the state hospital.

The experience of a psychoanalyst functioning as a consultant to a state hospital has been reported. Some reference was made to other such projects. The objectives and goals of this affiliation were then delineated. Next a description was given of the setting in which the work took place, of the process, of the reactions of the staff to the consultant, and of the consultant to the staff. Finally there was a description of the results and the conclusions.


Socioathy and drug use in a young psychiatric population.

Recent studies have consistently demonstrated a higher-than-expected proportion of heavy drug users among young psychiatric patients. Careful reading of these reports fails to adduce what might account for this constant finding. In order to examine this question more closely, one hundred young psychiatric inpatients (aged 15 to 25 years) were studied in detail. The following extensive data were obtained for each patient: demography (sex, age, race, marital status occupation), clinical characteristics (prior psychiatric care, presenting complaint, duration of hospitalization, diagnosis, treatment, disposition), prior social problems (truancy, runaway, pregnancy out of wedlock, divorce or separation, vehicular accident while intoxicated, felony), and social resources on admission (employment, friends, family-of-origin). An extensive drug history consisted of types of drugs, duration and frequency of usage, and pattern of use over the previous twelve months. Based on specific criteria patients were divided into abstainers, occasional users, regular users, and heavy users. Forty-nine of the patients were tabulated as heavy users. Compared to the other patients, heavy users were found to have more unemployment, more divorce and separation, more characterological and fewer neurotic diagnoses, more problematic prior social events, and fewer social resources at the time of admission. Unexpectedly, the two groups did not differ significantly for all other demographic and clinical parameters. The implications of these findings for our psychopathologic categorization and for our management of young in-patients are noted.


Progressive spinal muscular atrophy in a case of hypokalamic periodic paralysis.

A 47-year-old man with well-documented hypokalemic periodic paralysis demons-rated permanent myopathy as shown by biopsy. In addition there was clinical and biopsy evidence of progressive spinal muscular atrophy. The feature of the combination of these diseases is reported in a case and discussed.


Hospitalization rates for alcoholism in the Navy and Marine Corps.

Hospitalization rates for alcoholism were determined for Navy and Marine Corps male enlisted personnel during the period Fiscal Year 1966-Fiscal Year 1969. Overall rates were 74 and 44 per 100,000 for the Navy and Marine Corps, respectively. These rates were high compared with male civilian populations of the same age range; the high incidence may be secondary to such factors as separation from families, a social milieu that encourages drinking and close sjrveillance by superiors and associates. The rate of first hospital admissions is a gross under-estimate of the total alcoholism problem. Alcoholic cases probably are often given other diagnoses early in the course of their illness. Actual prevalence of alcoholism cannot be determined directly at the present time, but reasonable estimates would be in the range of 2-3% of all naval personnell. Admissions for alcoholism show wide seasonal variations, suggesting the importance of administrative factors such as bed space, staff availability, and possibly diagnostic inexperience and inaccuracy.


[The significance of endoscopic retrograde cholangiography (ERC) in biliary stasis and the postcholecystectomy syndrome (author's transl)].

In a group of 103 patients with biliary tract disease only 27% had findings of ERC which were concordant with the operative observations. False-negative results were present in 20%, while in 55% conventional cholangiography did not provide enough opacification for exact diagnosis. The size of the common bile-duct lumen correlated with the degree of biliary stasis. It can, therefore, be used as a good diagnostic indicator. The normal lumen diameter as measured by ERC was 6.29 +/- 1.29 mm in the suprapancreatic part of the common bile-duct. All cholecystectomised patients had a dilated lumen, the borderline value for biliary stasis being at 13-14 mm.


[Transcutaneous measurement of partial pressure of oxygen in paediatric intensive care (author's transl)].

The method of measuring oxygen partial pressure transcutaneously has provided an opportunity for continuous monitoring of patients on long-term resporator treatment. It has been convincingly demonstrated that serial samples obtained by arterial puncture are inadequate for controlling oxygen supply. An ideal correlation between arterial and transcutaneous pO2 was obtained when the control arterial sample was taken via an indwelling arterial catheter and artefacts, e.g. reaction to the needle puncture, had been eliminated. The necessary percentage of oxygen in the inspiratory mixture can be accurately gauged by continously measuring arterial pO2, as can changes brought about by the application of positive end-expiratory pressure in children on long-term ventilation. The transcutaneous measurement makes it possible to improve continuous monitoring of critically ill patients, and to carry out sparingly and safely long-term ventilation in them.


[Angiographic diagnosis of paraduodenal hernia (author's transl)].

The case is reported of a 26-year-old man who had several episodes of subileus which responded to spasmolytics. Mesenteric angiography revealed a paraduodenal hernia, with displacement of several jejunal arteries towards the mesenteric root and compression of intestinal vessels at about the level of Treitz' ligament. The angiographic findings were confirmed at operation, which consisted of repositioning the jejunal loop and closing the hernial orifice. The patient has since been free of complaints.