Reaching the hard-to-reach: illicit drug use among high school absentees.

As part of a large-scale survey of adolescent drug use in the State of New York, two absentee studies were carried out to estimate levels of drug use among school absentees. Students interviewed in households reported very little drug use. By contrast, absentees self-selecting themselves to participate in a group-administered questionnaire reported much higher illicit drug use than regular students from the same schools. However, comparison of students in the absentee sample with the total target absentee population, and the reverse association between drug use and selected background factors among absentees, suggest that most chronic absentees and heavy users, especially blacks and males, did not participate in the self-selected absentee sample. Attempts to identify factors related to higher drug use among absentees were unsuccessful. While poor school performance brings levels of illicit drug use among regular students to levels comparable to those of the absentees, poor school performances per se does not explain the higher rates of illicit drug use among the absentees. It is clear that school absentees who are generally excluded from school surveys are extremely hard to reach for research purposes.


Biomedical applications of vapor phase analysis.

Recent investigations of physiological systems have demonstrated that even minor chemical constituents can play a major role in mediating physiological responses. Recognizing this, the investigator seeks to isolate or selectively quantify the concentration of a specific drug or hormone that is available to target tissue. Today, as drugs are developed which are more and more potent, greater demands are made on analytical methodology for ever more sensitive yet specific techniques of quanification. The techniques of vapor phase analysis such as gas chromatography, especially in combination with mass spectrometry, offer great promise to investigative pharmacology/toxicology. Some of the potentials and limitations of vapor phase analysis will be described. More detailed descriptions of basic gas chromatography (McNair and Bonelli, 1969; Ettre and McFadden, 1969) and combined gas chromatography-mass spectrometry (McFadden, 1973) can be found elsewhere.


Neonatal abstinence syndrome: assessment and management.

A scoring system for the neonatal abstinence syndrome has been devised and implemented as both a clinical and investigative tool. The score monitors the passively addicted infant in a more comprehensive and objective fashion, and facilitates a more precise evaluation of the clinical status of the infant undergoing withdrawal. In addition, the scoring system has been applied in research designed to test the comparative usefulness of various pharmacologic agents currently recommended for the neonatal abstinence syndrome, and has been found useful in following the progression and diminution of withdrawal symptomatology before, during, and after therapy. Furthermore, the scoring system provides a basis ofr developing uniform criteria for the assessment and treatment of the neonate born to the addicted mother.


Disposition of methadone and its relationship to severity of withdrawal in the newborn.

We studied the placental transfer of methadone, the relationship of neonatal plasma methadone concentrations to withdrawal symptomatology, and the relationship between maternal methadone dose and severity of neonatal withdrawal in 31 methadone-maintained mothers and their neonates. Methadone concentrations in maternal, cord and neonatal plasma were measured using a gas chromatographic micromethod. Neonatal plasma was assayed on days 0-5 of life. Urine methadone levels were measured for the first 3 days of neonatal life, using a similar assay. Twenty-five of the neonates experienced mild to severe withdrawal symptoms. There was no consistent relationship between the maternal methadone dose and the severity of neonatal symptoms. However, when neonatal withdrawal did occur, it began after plasma methadone levels fell below .06 mug/ml. The neonatal plasma methadone levels were consistently lower than those of the mother. Maternal methadone is transferred across the placenta and can induce significant withdrawal symptomatology in the newborn.


Phenobarbital disposition in the neonate.

The disposition of phenobarbital in premature infants was assessed by repeated measurement of the serum concentration of unmetabolized drug and the urinary excretion of both phenobarbital and its metabolite, p-hydroxyphenobarbital. Serum elimination rates did not adequately reflect the elimination of total body phenobarbital. A prolonged distributive phase is postulated. The elimination rate of p-hydroxyphenobarbital was constant, suggesting capacity limited kinetics. Slow elimination in serum concentrations which remained in the therapeutic range for several days suggests that short courses of therapy may have prolonged effect in the newborn premature infant.


A study of factors that influence the severity of neonatal narcotic withdrawal.

1. History is unreliable in assessing maternal drug habit. Morphine was detected in significant amounts in maternal and fetal urine regardless of whether the mother was on a methadone program or whether she denied any use of heroin during the last trimester of pregnancy. 2. Infants born to drug-addicted mothers were, in general, of birthweight normal and appropriate for gestational age (i.e., greater that 10th percentile). The infants born to mothers on a methadone clinic program had a higher birthweight compared to those whose mothers were not on any methadone program. 3. In order of frequency, the signs and symptoms of withdrawal were: central nervous system manifestations-fist sucking, irritability, tremors, sneezing, high-pitch cry, hypertonia; vasomotor in the form of stuffy nose; and gastrointestinal in the form of sweating, diarrhea, vomiting and yawning. Convulsions were not noted. No death occurred. 4. The severity of neonatal narcotic withdrawal did not correlate with the infant's gestational age, APGAR, sex or race; nor with maternal age, parity, duration of heroin addiction or duration of methadone intake. Also, it did not correlate with the total morphine level measured either in infant's or mother's urine or in cord blood. The serum levels of calcium and glucose were normal and identical in either mild or severe withdrawal. 5. The severity of neonatal withdrawal correlated significantly with the methadone dose per day of the mother (in initial, final or average dose). A maternal methadone dose of more than 20 mg per day was associated with a higher incidence of moderate to severe withdrawal in their babies. As a corollary, it was also noted that infants whose mothers were on a high methadone dose (i.e., greater than 20 mg per day) had a greater postnatal weight loss despite a significantly higher birthweight initially, and stayed in the hospital longer. 6. Finally, the modification of the environment to reduce external stimuli to the infant born to a drug-dependent mother, does not prevent or diminish the severity of neonatal narcotic withdrawal. Thus, there is no need to manage these infants in a special nursery.


Neurological aspects of perinatal narcotic addiction and methadone treatment.

The semeiology and significance of neonatal "minor withdrawal" are developed. Its treatment and the consequent prevention of rebound, late, or classical withdrawal are proposed. Basic research implications are formulated.


Neonatal addiction: a two-year study. Part I. Clinical and developmental characteristics of infants of mothers on methadone maintenance.

Thirty-five infants born over a two-year period to mothers participating in a methadone-maintenance treatment program were studied The average birthweight was normal (3240 gms) for infants born to mothers who conceived while taking methadone, and 465 gms less (2775 gms) for infants conceived while their mothers were taking heroin (p less than .01). Sixty percent of the infants demonstrated mild or no symptoms and 40% developed moderate or severe symptoms. The infants whose symptoms were most severe were born to mothers who had documented histories of polydrug abuse. Many infants were slow to gain weight in the neonatal period. Thereafter growth and development have remained generally within the normal range.


Part II. Behavioral and electrophysiological characteristics of the addicted neonate.

The neonatal withdrawal period was characterized by heightened auditory responsiveness and orientation, lowered overall alertness and poor attentiveness to and following of visual stimuli. Electroencephalographic recordings revealed high-frequency dysynchronous activity suggestive of cns irritability. Analysis of evoked response data further corroborated the behavioral findings with evidence for low arousal value of visual stimulation in the vertex frequency characteristics and poorly defined occipital responses. Auditory evoked responses appeared better integrated, and a significant correlation was found between auditory orienting ability and latency of the P2 component. The long-range developmental significance of these neonatal characteristics awaits further follow-up investigation.


The assessment of behavioral change in infants undergoing narcotic withdrawal: comparative data from clinical and objective methods.

Studies comparing objective measures of sucking with data from finegrained clinical assessments of the neonate have shown significant correlations between painstaking and time-comsuming clinical methods which may only be reliably applied by highly trained clinician-investigators, and the data generated by a simple technique which can be rapidly and precisely administered in the nursery by nurses or technicians. Within a few minutes the sucking instrument can generate data that explain 50% or more of the variance in certain relevant factors of the Brazelton neonatal neurobehavioral assessment scale, which in our hands requires the participation of two trained clinician-investigators for a period of almost one hour for each test and recording session. There are certain limitations to the information directly available from the sucking measures. Clinical observations must be made in order to correctly interpret some of the findings such as the biphasic relationship between irritability and sucking. For example, an infant may not suck at all because it is obtunded, or it may not suck because it is overexcited. In the case of irritability, sucking performance provides a measure of the magnitude, but not of the polarity of the CNS arousal sucking correlates directly and gives a good estimate of both polarity as well as amount of these behaviors. Objective measures of sucking behavior are a convenient and reliable means for measuring drug effects in the nursery and may be useful in regulating therapy of the newborn.


Some effects of prenatal exposure to d-amphetamine sulfate and phenobarbital on developmental neurochemistry and on behavior.

Amphetamine. Prenatal intraperitoneal injection of d-amphetamine sulfate (5 mg/kg) produces decreases in the levels of catecholamines in the brain the day of birth and increases on day 30. Open-field activity from days 12 to 31 was higher for the group of animals injected with amphetamine or saline if scores were totaled across all test days. At day 75 the offspring of amphetamine-injected mothers exhibited altered open-field behavior. The effects were not observed with subcutaneous injection regardless of the dose used (2.5, 5.0, and 10.0 mg/kg). The lowest subcutaneous dose decreases neonatal viability. Phenobarbital. Prenatal intraperitoneal injection of phenobarbital (80 mg/kg) resulted in decreased litter size, increases mortality, and decreased amounts of nucleic acid and protein in the brains of surviving offspring. Behavioral deficits associated with response perseveration could be demonstrated at 60 days in the mice prenatally exposed to this dosage. Subcutaneous injections of phenobarbital to pregnant mice at 80 and 40 mg/kg, but not 20 mg/kg, doses increased neonatal mortality. Mature animals prenatally exposed to 40 mg/kg phenobarbital have altered open-field behavior and differ from control animals on a passive avoidance task. Mature offspring prenatally exposed to the 20 or 40 mg/kg dose also responded less than controls on an operant task requiring an increasing number of responses per reinforcement. These studies suggest that prenatal exposure to phenobarbital has in some way altered the animals' reactivity to stimualtion.


Somatic growth effects of perinatal addiction.

Intrauterine growth retardation occurs in a large percentage of infants born to mothers addicted to heroin during pregnancy. This is seen less often in infants of mothers who faithfully attended methadone programs. Postnatally, a decline in linear growth and head circumference is seen during the first year in both heroin- and methadone-exposed infants. The basis for this postnatal growth retardation requires further investigation. The birth weights, lengths and head circumferences were appropriate for gestational age in 28 of 29 infants delivered to mothers participating in methadone-maintenance programs three months or longer during pregnancy. Absence of intrauterine growth retardation seens to reflect the addict's improved lifestyle. Postnatally, growth distrubance occurred in 35% of infants exposed to heroin and 25% of infants exposed to methadone during gestation. Several cases of chronic unsuspected infections in addicts' infants are reported, raising the question of the significance of undiagnosed infection as it affects growth.


Adaptive changes in behavior after repeated administration of various psychoactive drugs.

Evidence has been presented that d-amphetamine interacts with various types of behavior in the context of a conditioning paradigm. Rats exposed simultaneously to a locomotor activity measurement and three dose levels of d-amphetamine on repeated occasions gradually developed dose-related enhancement of drug-stimulated activity, which persisted after discontinuation of the drug. Rats trained in FR-operant chambers with food reinforcement showed a decrease in the rate of lever pressing after administration of d-amphetamine. Tolerance to this effect required varying numbers of daily drug injections, according to the subject's degree of prior drug experience. In both situations the drug administrations were coupled with the behavioral measure to allow for conditioning effects. In a continuous avoidance procedure the initial dose of d-amphetamine did not enhance response rate, although subsequent doses did produce significant stimulation. Even when the initial doses were administered out of temporal phase with the avoidance measurement, the simultaneous administration of the drug and the behavioral procedure on a subsequent day resulted in a significant drug-induced stimulation of response rate. Thus, in this particular instance, the conditioning influence of the earlier doses was apparent whether or not the drug effect occurred in contiguity with the avoidance measurement. Other reports in the literature (16) suggest that hallucinogenic drug action may be characterized by the peculiar "pause" in an FR pattern of responding for food reinforcement. This proposal was substantiated and extended to a number of representative hallucinogenic agents. d-Amphetamine or chlorpormazine reduced the rate of FR responding without provoking an obvious pause. Examination of tolerance and cross-tolerance to the hallucinogenic pause in the FR pattern after LSD, mescaline, psilocybin, DOM, and DMT generally indicated interactions between the drugs, although this was not entirely consistent. It follows that the mechanisms of action of these drugs probably have elements in common, though they are not necessarily identical. In doses as small as 10 mg/kg, cinanserin, a serotonergic receptor-blocking agent, completely reversed the pause in FR pattern induced by the various hallucinogenic drugs.


Studbook of Pan paniscus Schwarz, 1929.

On the basis of information provided by various zoos who have, or used to have, Pan paniscus in their collections, as well as information in the International Zoo Yearbook or in the literature, an approximate outline has been given of our knowledge of this animal since the description given in 1929 by Schwarz. The status of species is preferred to that of subspecies. The question whether the bonobo should be regarded as a true dwarf form is considered. It is, however, emphasized that the majority of researchers - and for different reasons - consider the species to be the primate closest to man.


[Case of mange in zoo buffaloes caused by a new psoroptic acarina].

The authors describe six cases of mange in buffalos of the Zoo, produced by a new species of a mite Choriopsoroptes syncerus n. sp. (Psoroptidae). The lesions were located on the back, extending from the base of the tail to the withers. The lesions were cured with a combinationn of organophosphor derivatives locally and orally.


[New taxa in Psoroptinae. Hypothesis on the origin of the group (Acarina, Sarcoptiformes, Psoroptidae)].

The author describes three new species and one new genus in the family Psoroptidae, subfamily Psoroptinae. A key is given to all the known genera of this subfamily. The fact that amongst the 16 species known from Africa South of the Sahara, 9 are endemic incites the author to believe that this group has a Centro-african origin.


Chemotherapy of helminthiasis among wild mammals. I. Lungworm infection of Felis (lynx) canadensis (Kerr).

Lungworm infection of Canada lynx, Felis (Lynx) canadensis, presumably due to Troglostrongylus wilsoni (Nematoda: Metastrongylidae), was successfully cured with the use of Mebendazole.


Parasitic mites of Surinam. XXX, New observations on the Genera Chirnyssoides and Notoedres from bats (Sarcoptiformes: Sarcoptidae).

The authors describle 5 new species of mites of the family Sarcoptidae. Among these psecies 4 belong to the genus Chirnyssoides and one to the genus Notoedres, subgenus Bakeracarus. They correct and complete their previous observations on these genera of mites.


Sinus node re-entrant tachycardia in man.

Sinus node re-entry (SNR) usually appears as a single beat. Tachycardias (SNRT) consistent with sustained SNR were seen in six patients and were initiated by premature stimulation of the high right atrium (six patients) and coronary sinus (four patients), and after continuous pacing from the high right atrium (four patients) or right ventricle (one patient) at rates of 130 to 200 per minute. During SNRT: (1) atrial beats exhibited a high-to-low atrial activation sequence, (2) the P-waves were similar in morphology to P-waves during sinus rhythm, and (3) re-entry in the A-V node or at the site of stimulation could be excluded. The cycle length of SNRT ranged from 625 to 320 msec. and SNRT either terminated spontaneously (six patients) or after premature atrial capture and/or vagal maneuvers (two patients). The electrophysiologic characteristics of SNRT and differentiation of SNRT from A-V nodal re-entry are discussed.


Sinus node re-entry and sinus node tachycardia.

Five patients are reported with SN echoes which could be produced by the technique of APD. The RA was paced at the basic rate and the SEI was measured repeatedly. SN echoes were diagnosed on the basis of: (1) A1A3 interval shorter than the SEI; (2) upright P-waves in Leads II and III; (3) activation of high RA preceding the activation of low RA; (4) lack relation to critical delay in the A-V node or HPS; (5) definite echo zone. In one of the cases, attacks of reciprocating tachycardia through the SN occurred spontaneously and also could be initiated by an SN echo. These were terminated by a single APD or by atrial pacing.


The natural history of uncomplicated valvular pulmonic stenosis.

Sixty-eight patients with isolated valvular pulmonic stenosis with intact ventricular septum diagnosed by cardiac catheterization underwent a repeat study one to twelve years later which documented the progression of the lesion. These 68 patients were classified into two groups according to age. Group I comprised 37 patients who were less than one year of age at the initial study, and Group II comprised 31 patients who were older than one year of age at the time of the initial study. These 68 patients were divided into three groups according to their systolic right ventricular pressure and classified as mild, moderate, or severe. Increasing severity of the lesion was noted much more frequently in Group I, even with patients who were noted to have mild stenosis at initial cardiac catheterization. This was not as marked in Group II. The incidence of patent foramen ovale was noted to be much higher in Group I as compared with Group II. A much greater number of patients required surgery after repeat cardiac catheterization in Group I as compared with Group II. Our data indicate that mild cases of pulmonic stenosis in Group I can become severe at a later date, whereas this was less likely in Group II. Those with moderate and severe stenosis can remain the same or become more severe as age advances in both groups.


Changes associated with quitting cigarette smoking: the Framingham Study.

During the first 18 years of the Framingham Study there was a substantial decrease (39 per cent ) in the number of men smoking cigarettes and a moderate decrease (22 per cent) in the number of women smoking cigarettes. Except for a greater tendency of diabetic patients to quit smoking, there were no significant differences at baseline between smokers who quit and smokers who continued smoking. After quitting there was a short-term rise in weight for men. This rise led only to trivial changes in blood pressure and serum cholesterol levels. There was a beneficial impact on long-term vital capacity trends from quitting smoking.


The effect of congestive heart failure on quinidine pharmacokinetics.

Quinidine is an effective antiarrhythmic agent whose therapeutic effects and toxicity have been related to its serum concentrations. Many patients with cardiac arrhythmias also suffer from congestive heart failure. It is well documented that congestive heart failure can reduce blood perfusion to many regions of the body, and could conceivably alter drug pharmacokinetics. A pharmacokinetic evaluation of two sets of quinidine data in congestive heart failure patients indicates that congestive heart failure reduced the rate of absorption and volume of distribution following oral or intramuscular administration of quinidine. Furthermore, the amount of quinidine absorbed following oral administration is reduced, but congestive heart failure does not appear to alter the elimination rate of quinidine. The interpretation of the data presented herein strongly suggests that the site of administration, extent of distribution, and rate of absorption must be considered when determining dosage regimens in congestive heart failure patients since normal dosages in these patients result in abnormally high serum quinidine concentrations.


Hemodynamic and metabolic effects of isosorbide dinitrate in chronic congestive heart failure.

To assess the potential beneficial effects of a nonparenteral vasodilator, sublingual isosorbide dinitrate (5 to 15 mg.) was administered in 12 patients with chronic congestive heart failure refractory to conventional therapy. Hemodynamic measurements were performed before and at 15 minute intervals after drug administration for 90 minutes. Venous capacitance was measured at 5 minute intervals. Myocardial metabolism was also studied in five patients before and after drug administration. Hemodynamic effects were characterized by a modest decrease in mean arterial pressure (85 +/- 3 to 78 +/- 2 [S.E.M.] mm. Hg) and substantial decrease in right atrial (10 +/- 1 to 6 +/- 1), pulmonary arterial (39 +/- 4 to 30 +/- 4) and pulmonary capillary wedge pressures (28 +/- 2 to 21 +h- 2). These changes were accompanied by an increase in venous capacitance (2.46 +/- 0.16 to 3.99 +/- 0.24 c.c./100 c.c. of tissue). Along with a decrease in left ventricular filling pressure, cardiac index increased (1.99 +/- 0.13 to 2.37 +/- 0.15 L./min/M.2). No significant effect on heart rate was seen. Delta P/delta t, an index related to left ventricular dp/dt, increased in all but one patient (253 +/- 31 to 298 +/- 39 mm. Hg/sec.) (p less than 0.02 for all changes) in the face of decreased preload and afterload and unchanged heart rate, suggesting improved contractile state. A decrease in coronary blood flow (165 +/- 13 to 131 +/- 15 c.c./min.) and myocardial oxygen consumption (18.1 +/- 1.6 to 14.5 +/- 1.6 c.c./min.) was noted (p less than 0.02). No change in arterial-coronary sinus oxygen difference or lactate extraction was observed. These data demonstrate that the objectives of therapy in congestive heart failure, namely improved forward output and decreased ventricular filling pressures, can be achieved without metabolic deterioration by using sublingual isosorbide. The mechanisms responsible are related to diminished impedence to ventricular ejection and peripheral pooling of blood. Since the duration of action does not usually exceed 90 minutes, frequent drug administration may be a source of patient inconvience.


Complications of selective coronary arteriography by the Judkins technique and their prevention.

Complications encountered during 351 selective coronary artery and coronary artery bypass examinations performed by the Judkins technique are reviewed. The over-all incidence of cardiac and peripheral vascular complications was 3.13 per cent. The cardiac complications included four ventricular fibrillations and one acute myocardial infarction. Peripheral vascular complications included three femoral artery thromboses, two peripheral emboli, and one probable cerebral embolus. There was one death. The incidence of cardiac complications was not significantly different from that reported in the literature with the Sones technique and local arterial complications were significantly lower than those reported with the Sones technique. The causes of individual complications are analyzed and measures to minimize these complications are described. The Judkins technique is a simple, reliable, quick, and safe method of selective coronary arteriography. The incidence of complications can be kept at an acceptably low level by stringent observation of every minor detail of the technique.


Minoxidil in severe hypertension: value when conventional drugs have failed.

Twenty-six patients were selected for treatment with minoxidil on the basis of hypertension which could not be controlled either because of (1) drug failures and/or (2) side effects of drugs. Sixteen out of the 26 had had one or more previous episodes of malignant hypertension. Reduced renal function was present in the majority; eight patients were on dialysis. Average preminoxidil blood pressure was 202/127 mm. Hg supine and 162/106 upright which fell to 154/87 supine and 143/86 upright after minoxidil. Propranolol or methyldopa was given to control the reflex increase in heart rate. Edema and congestive heart failure refractory to large doses of potent diuretics necessitated discontinuation of the drug in two patients. Minoxidil proved highly efficacious regardless of initial level of blood pressure, etiology, or supine or upright posture.


Flow murmur associated with partial occlusion of the right pulmonary artery.

An 18-year-old male student presented with a brief history of syncope followed by shortness of breath with exertion, and the development of murmur over the right chest. The symptoms and murmurs were related to a pulmonary embolus which partially occluded the right pulmonary artery and its major branches. The murmur gradually diminished and disappeared when right pulmonary perfusion had almost returned to normal as determined by lung scan. The association of pulmonic flow murmurs and pulmonary emboli is reviewed.


Heart disease mortality among black migrants: a study of Ohio residents (1960-1967).

In a demographic study, the black Ohio residents were characterized by those born in Ohio and those born in other regions of the United States, and comparisons were made of rates for all deaths (1960-1967) for coronary heart disease (420), endocarditis and myocardial degeneration (421-422), hypertensive cardiovascular diseases (440-447), cerebrovascular diseases (300-334), cardiovascular diseases (400-468), and total diseases of the cardiovascular system (300-334) (400-468). The division of the total United States-born Ohio residents by region of birth provided marked differences in the age-adjusted rates in the relative comparisons. The black males and females born in the South had a markedly higher age-adjusted death rate (ages 45 to 64) than those born in Ohio in each of the categories of cardiovascular diseases studied. For coronary heart disease, the age-adjusted death rate for the black males showed a marked excess over the black females, for each region of birth, whereas for hypertensive cardiovascular diseases the black males and females had similar age-adjusted rates for each region of birth. The findings indicate a carry-over among the black of a higher cardiovascular risk among those born in the South and lend support to the concept of the influence of the endemic factors in the early years of life. In the prospective study of black steelworkers, it was observed that migrant and nonmigrant workers had approximately the same mortality for cardiovascular disease overall, and when specific work areas were considered. Selective factors of employment, of medical screening, and capability of continued employment in strenuous environments, were considered the most likely basis for the similar mortality experience.


Wenckebach A-V block: a frequent feature following heavy physical training.

Among 126 top Israeli athletes, in whom an ECG was obtained during a random survey, 11 had first-degree heart block (P-R greater than or equal 0.21 sec.) and in three of them Wenckebach's phenomenon was found. The latter could be demonstrated only after 15 minutes' rest in a recumbent position and was abolished by sitting, standing, and the administration of atropine. This subjects with Wenckebach's phenomenon were followed for 6 years. The heart block was found to be present only during seasons of intensive training and could not be demonstrated a few weeks after the training was reduced in intensity or stopped. No heart disease or diminution of performance developed during 6 years of follow-up. Transient second-degree heart block in top athletes is probably much more frequent than hitherto suspected, but it can be demonstrated only if the athlete is examined during rest and in the recumbent position. It is assumed to be a physiological phenomenon related to heavy physical training.


ST-segment isolation and quantification as a means of improving diagnostic accuracy in treadmill stress testing.

A new method of ST-segment analysis utilizing computer-analytic techniques has been employed in treadmill exercise testing, with the aim of enhancing diagnostic sensitivity and specificity. One hundred thirty-three individuals were studied, including 62 normal subjects (Group I), 29 patients with coronary disease and clear, "ischemic" ST-segment responses to exercise testing (Group II), and 42 patients with coronary disease but normal or nondiagnostic exercise tests (Group III). The techniques used included: computer averaging, to minimize motion artifact and baseline drift; a means of isolating the ST-segment from the T-wave and quantifying ST-amplitude and slope (the isolated ST integral, IST); and the relating of the IST to a given heart rate, thus taking cognizance of the dependency of ST-depression on heart rate and level of exercise. These methods resulted in a test specificity exceeding 90 per cent and a sensitivity of over 85 per cent. Further evidence of the improved sensitivity achieved using these techniques included a 79 per cent (33 of 42) recognition of abnormalities in Group III, patients having normal or nondiagnostic visually interpreted treadmill stress tests (i.e., no flat or downsloping ST-segments of 1 mm. or greater). Moreover, 15 of 29 patients in Group II (52 per cent) manifested abnormal IST's before development of a typical "ischemic" ST, and in 17 patients (59 per cent), the IST continued to remain positive after disappearance of the characteristic flat or downsloping ST-segment. It is concluded that this type of computation analysis adds appreciable diagnostic sensitivity and specificity to treadmill stress testing.


The significance of bundle branch block during acute myocardial infarction.

Analysis of the course of 71 patients with acute myocardial infarction complicated by bundle branch block (BBB) confirms a high incidence of atrioventricular (A-V) block (42 per cent) and severe pump failure (35 per cent) in these patients. Hospital mortality was not correlated with BBB per se, but rather with the associated development of second or third degree A-V block (57 per cent with A-V block vs. 12 per cent without A-V block; p less than .0005) or severe pump failure (35 per cent with vs. 11 per cent without severe pump failure; p less than .001). However, late mortality was high and not significantly different among those surviving hospitalization whether transient A-V block was present or absent. Eight of 11 late deaths were sudden. Temporary pacing could not be shown to alter hospital survival statistically, but made the onset of complete heart block a hemodynamically smooth and clinically undetectable event in several patients who later survived. The place of permanent pacing in these patients cannot be clearly determined on the basis of this study or in the available literature. More data obtained either by pooling the experience of several centers or from a prospective randomized study are needed to determine the indications for permanent pacemakers.


Influence of variations in blood flow on renal A-V oxygen difference and renal oxygen consumption in heart failure. A clinical study.

In the present study, renal A-V oxygen difference and renal blood flow were measured in 18 patients with mitral valvular disease. The renal sodium reabsorption and oxygen consumption have also been measured. The renal A-V oxygen difference was small and remained within the normal range despite large reductions in renal blood flow. Only when flow fell to between 400 and 500 ml. per minute there was a rise in A-V oxygen difference. The renal oxygen consumption was in general reduced compared with normal subjects, but tended to increase in those patients who also had the greatest values for A-V oxygen difference. The renal oxygen consumption was found to vary independently of the sodium reabsorption. Our results indicate a shift to a more aerobic renal metabolism in advanced heart failure when renal blood flow is drastically reduced. It is possible that the variations in oxygen demand may reflect changes in substrate requirements for transport of sodium in different circulatory situations. Redistribution of flow within the kidney at low renal blood flow as well as the possibility of passive transport of sodium in the proximal tubules might also account for the changing relationship between A-V difference and renal blood flow.


Correlation of abnormal Q waves, coronary pathology, and ventricular contractility.

Four hundred and ninety-two patients with coronary artery disease underwent analysis of their electrocardiograms, coronary arteriograms, and ventriculograms. Significant Q-waves were correlated with critical coronary occlusions (greater than or equal 75 per cent obstruction) and ventricular contractility. It was found that Q-waves correlate equally well with ventriculographic abnormalities and critical coronary occlusions. The Q-wave correlation varied from 77 to 87 per cent, depending on the area of myocardium under consideration, except for true posterior myocardial infarction, which correlated 55 per cent with ventriculographic abnormalities and 55 per cent with critical coronary occlusions. Significant Q-waves in Leads II, III, and aVF are better indicators of ventriculographic abnormality than in Leads III and aVF alone, whereas Q-waves in the latter two leads are more definitive than in Lead III alone. Patients who have critical coronary occlusions and normal electrocardiograms have normal ventriculograms in 71 to 78 per cent of the cases, again depending on the area of the myocardium under consideration. Thus, the normal electrocardiogram correlates better with the ventriculogram than with coronary pathology. The abnormal electrocardiogram correlates equally well with both.


Effects of dobutamine on atrioventricular conduction.

Dobutamine, a new beta-stimulating catecholamine, has been investigated in terms of its effect upon atrioventricular conduction. Bundle of His recordings were obtained on six patients in basal conditions and with right atrial pacing at rates of 100, 120, and 140 per minute. Recordings were repeated following intravenous administration of Dobutamine in doses of 5, 10, and 15 mug per kilogram per minute. Dose-response curves were thus obtained for A-H and H-V intervals. Heart rate increased only moderately with progressive concentrations of the drug. Very significant facilitation of A-H conduction was demonstrated with doses of 10 and 15 mug per kilogram per minute, with no effect upon H-V times. Dobutamine may be a clinically useful inotropic agent in conditions associated with A-V conduction disturbances.


Effects of intravenous verapamil on cardiac arrhythmias and on the electrocardiogram.

The effects of intravenous verapamil on the electrocardiogram in 15 patients with heart disease in sinus rhythm and in 44 patients with supraventricular and ventricular tachyarrhythmias were evaluated. Verapamil prolonged the P-R interval without effect on the QRS duration or the Q-Tc interval. In patients with atrial flutter and fibrillation, A-V block was increased, with slowing of the ventricular rate, in almost all cases but sinus rhythm was restored in only 1 of 12 patients in atrial fibrillation and in 2 of the 11 patients with flutter. Verapamil had no effect in 3 patients with atrial fibrillation complicating WPW syndrome; in 1 of 5 patients with ventricular tachycardia it caused reversion to sinus rhythm. Sinus rhythm was restored promptly by verapamil in 13 of 17 patients with paroxysmal supraventricular tachycardias; in 2 others, sinus rhythm became established 1 to 2 hours after administration of the drug. Transient hypotension, not requiring treatment, was the only side effect noted but not in the patients with supraventricular tachycardias, in whom blood pressure generally increased after reversion to sinus rhythm by verapamil.


Systolic prolapse of the mitral valve in Noonan's syndrome.

A thirty-five-year-old woman with Noonan's syndrome (Turner phenotype with normal chromosome pattern) had mitral valve prolapse and mitral insufficiency associated with the auscultatory findings of a midsystolic click and late systolic murmur. Selective left-ventricular angiocardiography also showed eccentric hypertrophy of the left ventricle. To our knowledge, this is the first reported instance of mitral valve prolapse occurring in association with Noonan's syndrome.


Idiopathic calcified apical aneurysm of the left ventricle in an asymptomatic child.

To our knowledge, this is the eighth reported case of isolated, idiopathic, noncontractile apical left-ventricular aneurysm in the child. Referral to the physician is likely to be made because of a systolic murmur, unusual cardiac contour, cardiomegaly, or apical calcification on chest x-ray or, rarely, a systemic embolus. Heart failure is uncommon. The electrocardiogram shows abnormal Q-waves and/or inferior and lateral ST-T changes. Careful image intensification fluoroscopy will demonstrate apical calcification in one-half of the cases.


Comparison of the nutritional status of pregnant adolescents with adult pregnant women. I. Biochemical findings.

Biochemical findings on blood samples from 102 pregnant women in four age groups, 12-17, 18-19, 20-24, and 25-32, are reported. Samples represent 8 antepartum periods of 4 weeks each and 3 postpartum periods over 6 weeks. Blood analyses were carried out for hemoglobin, plasma iron, plasma total protein, glucose, plasma alkaline phosphatase, plasma ascorbic acid, plasma vitamin A and carotene, erythrocyte transketolase as a measure of thiamine status, plasma cholesterol, plasma lipid phosphorus, plasma total fatty acids, and triglyceride fatty acids. For the most part, means of these nutrients were in acceptable ranges for all age groups. Although adolescents had better levels than anticipated, the two younger groups on several occasions had means significantly lower than those of the two older groups, indicating that they needed greater nutritional support during pregnancy than older women.


Comparative bioavailability of folate and vitamin C from a synthetic and a natural source.

Intraluminal perfusion of the human small intestine has not been used extensively to study comparative bioavailability of vitamins. In this study a triple lumen tube with a 30-cm study segment was used to measure absorption of water-soluble vitamins from the human proximal jejunum. Fifteen normal subjects served as their own controls to quantitate absorption of folic acid and vitamin C from an orange juice solution and from a solution of synthetic vitamins. Despite a predictably greater water absorption from the glucose containing orange juice solution, the absorption of the two water-soluble vitamins did not differ significantly from the two solutions. Natural and synthetic ascorbate and folate were avidly absorbed in the first 30 cm of jejunum and with the exception of synthetic folate correlated positively with water absorption. This method, previously applied to the absorption of sugars, amino acids, and electrolytes, can be reliably applied to the study of comparative bioavailability of nutrients from food sources. The advantages of triple lumen perfusion over previous methods are: 1) it overcomes the necessity for urine collections in metabolic studies, 2) it can be used to study sites and mechanism of absorption, and 3) it is a direct measurement of absorption capacity.


Studies in calcium metabolism. II. Effects of low calcium and variable protein intake on human calcium metabolism.

Six healthy males consumed diets containing about 0.1 g calcium/day at three levels of protein intake: 0.9, 12, and 24 g nitrogen/day. Daily urinary calcium excretion on the 0.9 nitrogen diet was 51 mg, 99 mg on the 12 g nitrogen diet, and 161 mg on the 24 g nitrogen diet. A calcium supplement of 0.9 g for four subjects on the 12 g nitrogen diet caused an increase in urinary calcium from 68 to 160 mg/day. Varying the calcium and protein intake had no effect on dermal calcium loss or serum calcium. Five subjects had the least negative calcium balance on the 12 g nitrogen diet. Increase in urinary calcium is not likely to result solely from enhancement of intestinal calcium absorption. Our data suggest that increased glomerular filtration with possible inhibition of renal tubular reabsorption of calcium may be an additional mechanism responsible for the calciuretic effect during high-protein intake.


Hypertriglyceridemia in patients with chronic renal insufficiency.

The development of hypertiglyceridemia was studied in 38 patients who were at different deteriorative stages of chronic renal insufficiency, as measured by corrected creatinine clearance. Patients in the mild stages of chronic renal insufficiency showed a 53% decrease in postheparin lipolytic activity, and no change in plasma triglyceride levels. In the moderate and severe stages, plasmia triglycerides were significantly elevated but there was no further decrease in PHLA. Those patients undergoing chronic hemodialysis showed a further increase in plasma triglycerides and postheparin lipolytic activity decreased to near zero. Serum electrophoretic studies indicated that in the moderate and severe stages of chronic renal insufficiency, prior to initiating hemodialysis, the chylomicron and very low density lipoprotein fraction were elevated. In those patients receiving chronic hemodialysis hyperchylomicronemia was the predominant finding.


Effect of mild infectious illness on nitrogen metabolism in patients on a modified fast.

To assess the catabolic effects of mild infectious illness on protein metabolism, the metabolic responses to incidental infections were studied in four obese patients undergoing a modified fast consisting of a low calorie diet essentially free of carbohydrate but meeting protein needs. In six infectious episodes investigated, there was no change in urinary nitrogen excretion. Nitrogen balance was positive when protein intake was maintained at 0.8-1 g/kg body weight in four of five episodes, despite intakes of less than 700 kcal. These preliminary data from patients experiencing infections under these conditions suggest possibilities for significant reduction in catabolic losses in other stress situations.


A dietary method for an epidemiologic study of gastrointestinal cancer.

The validity of a dietary recall questionnaire was tested among 50 men of Japanese ancestry, participating in a prospective epidemiologic study of gastrointestinal cancer in Honolulu. The questionnaire included 33 food items consumed in Hawaii and suggested as possibly carcinogenic or possibly protective. Estimated intakes of frequencies and amounts during the previous day and previous 7 days were obtained. The validity study consisted of a comparison of a 7 day diary of the frequencies and amounts of the 33 items with a subsequent recall of the same items. The sensitivity (proportion of men recording an item who subsequently recalled it) was better for 24 of the 33 items during the 7-day period than the 1-day period. The overall agreement between the two methods on whether the item was eaten or not was only marginally less for the 7 days than for the 1 day. Estimated intakes tended to be higher for the diary than the recall method. The Spearman rank correlation coefficients among persons recording the items generally were good (greater than 0.7) for items eaten habitually and for those associated with specific events. Further, rank order correlations for quantitative recell of particular food items has considerable validity and is a reasonable choice of method for studies of large groups concerning the role of particular food items in the etiology of cancer.


Head and chest circumferences in rural Guatemalan Ladino children, birth to seven years of age.

Growth patterns in head and chest circumferences are reported for a mixed-longitudinal sample of rural Guatemalan Ladino children from birth to 7 years of age. The sample is representative of a population with suboptimal nutrition. Both circumferences show similar rapid growth from birth through 9 months, after which chest circumference continues to increase more rapidly, while head circumference increases at a slower rate. Chest circumference provides nutritional information apparently not contained in length and weight. Compared to a sample of well-nourished children from Denver, the head circumferences of Guatemalan children are consistently smaller. Differences are relatively small at birth, are well established by 6 months, and become progressively greater through 24 months. After 2 years the mean smaller head circumference of the Guatemalan children also reflects stunted growth during the first 2 years of life. Similarly, among 5-year-old Guatemalan children of similar stature, head circumference at 5 years of age indicates which of these children were more stunted in stature at 2 years of age.


Addition of leucine precursors to the diet of leucine-starved mice.

Leucine-starved mice placed on a diet supplemented with the immediate precursor of leucine, alpha-ketoisocaproic acid, regain lost weight. This weight gain is similar to that observed when the leucine-starved mice are provided with leucine in their diet. Mice on a leucine-free diet supplemented with alpha-ketoisovaleric acid, the first compound in the leucine biosynthetic pathway, continued to lose weight as quickly as mice on leucine-deficient diets.


Vitamin B6 deficiency in uremia.

Significant decreases in plasma pyridoxal-5-phosphate (PLP), plasma glutamic-oxaloacetic transaminase (PGOT) and erythrocyte glutamic-oxaloacetic transaminase (EGOT) were found in 29 uremic patients including 14 who had been on hemodialysis an average of 15.8 months. The mean PLP values of the uremic patients (5.39 +/- 0.37 ng/ml) were clearly lower than the values obtained for the normal group (9.30 +/- 0.80 mg/ml). The mean PGOT values of the uremic patients (dialyzed 4.07 +/- 0.29 U/liter, undialyzed 5.31 +/- 0.49 U/liter) were significantly lower than the normal group (6.57 +/- 0.39 U/liter). The mean EGOT value of the uremic patients (325 +/- 17 U/liter) was also lower than normal subjects (416 +/-21 U/liter). Stimulation of the EGOT by exogenous PLP (EGOT index) was less in dialyzed patients (1.60) than normal subjects (1.80) while the undialyzed uremic subjects had a greater than normal stimulation (2.12). All of these results indicate that uremic patients are vitamin B6 deficient and that those undergoing hemodialysis may have decreased amounts of the EGOT apoenzyme.


Fatty acid composition of the plasma lipids in Greenland Eskimos.

Gas-liquid chromatography analyses have been carried out to investigate the composition of esterified fatty acids in the plasma lipids in 130 Greenland Eskimos, compared with those of 32 Greenland Eskimos living in Denmark and of 31 Caucasian Danes in Denmark. While the Eskimos living in Denmark did not differ substantially from other persons living in Denmark and, from what is found in other studies in Western communities, the Greenland Eskimos showed a completely different pattern. They demonstrated a much higher proportion of palmitic, palmitoleic, and timnodonic acids, while they had a markedly lower concentration of linoleic acid. The total concentration of polyunsaturated fatty acids was lower in Greenland Eskimos than in the other groups. These findings are discussed in the light of the generally accepted opinion of the beneficial effect on plasma lipid levels and on the morbidity of coronary atherosclerosis of a high dietary intake of polyunsaturated fatty acids. As plasma lipid and lipoprotein levels in Greenland Eskimos in a previous study were found markedly lower than those found in Western populations, and as coronary atherosclerosis seems to occur far less commonly among Eskimos in Greenland than among peoples in industrialized countries, it was found difficult to combine these observations with the results from the present study. If dietary differences are the main reason for the differences in plasma lipid concentrations, the results from the present study point more toward qualitative than toward quantitative differences in respect of fatty acid composition of the food.


Protein deprivation in primates. V. Fetal mortality and neonatal status of infant monkeys born of deprived mothers.

Seventy-four pregnancies were followed in 45 rhesus monkeys. While pregnant the mothers were fed a semisynthetic diet affording 1, 2, or 4 g protein/kg per day. The poorer diets tended to produce excess fetal mortality, but liveborn infants born to 1-g and 2-g mothers averaged as large as those in the 4-g group. No differences existed in total protein concentration and albumin-globulin ratios in the sera of newborn infants.


Barbital overdose and abuse.

Bailey, David N., and Jatlow, Peter I.: Barbital overdose and abuse. A new problem. Am J Clin Pathol 64:291-296, 1975. The unusual epidemiology and toxicology of barbital overdose and abuse are demonstrated by eight recent cases. Since barbital is used primarily in laboratory buffers and is not available as a prescription or over-the-counter drug in the United States, barbital overdose and abuse have until recently been rare. In several instances the barbital was stolen from a clinical or research laboratory. Serum concentrations were often "astronomically" high compared with those of other barbiturates, including phenobarbital. Concentrations severalfold greater than would be considered lethal for other barbiturates were consistent with survival, and all patients, including one with a serum concentration of 120.2 mg per dl. (higher than any previously reported), recovered with only conservative therapy (no peritoneal or hemodialysis). Patients could be awakened when the concentration was less than 16.0 mg per dl. Serum barbiturate concentrations greater than 20.0 mg. per dl. in a living patient should warrant serious consideration of barbital ingestion. In addition to the eight overdoses, 16 abusers of barbital were detected during 1974 by drug-abuse screening of urine.


The effect of sodium bisulfite on the removal of drugs and their metabolites interfering with the Porter-Silber reaction in the determination of urinary 17-hydroxycorticosteroids.

In the determination of urinary 17-hydroxycorticosteroids, the urine is saturated with NaHSO3 after hydrolysis with beta-glucuronidase and then extracted with methylene chloride. Sodium bisfulfite removes almost all non-steroidal impurities in the urines from patients medicated with acetylspiramycin, leucomycin, erythromycin, triacetylolenadomycin, rifampicin and tranquilizers such as chlorpromazine, which interfere with the absorption at 410 nm. in the subsquent Porter-Silber reaction. In order to increase the specificity of a routine method, a procedure conducted by Allen has been often employed: The sum of 370- and 450-nm. absorbances is subtracted from twice absorbance at 410 nm. However, the procedure could not be used in the medicated urines mentioned above, because the spectral absorption curve of these drugs and their metabolites in the Porter-Silber reaction was not a straight but a strongly convex or concave line in the 370-450-nm. range. Using the present method, interference with the Porter-Silber reaction was not found in the urines from patients medicated with chloramphenicol, minocycline, chlordiazepoxide, meprobamate, methyprylon, nitrazepam, synthetic penicillins such as hetacillin, oxacillin and cloxacillin, or cephalosporins such as cephalexin and cephalothin. However, to obtain correct values in urines from patients medicated with spironolactone, it was necessary to subject the urines to treatment with methylene chloride before enzyme hydrolysis.


An algorithm for the selection of proper group intervals for histograms representing clinical laboratory data.

Although numerous statistical methods are available, proper definitive technics to deal with the determination of normal values or ranges in clinical chemistry are unresolved and ill-defined. Initially, the ability to the analyst to define a mathematical function that can be used to best fit the random distribution of generated laboratory values still depends on proper grouping of the data. Herein is proposed a method for grouping data, in order to select the proper class interval to be used. Arbitrariness is removed and maximum information about the population being tested can be achieved. The concepts of "regrouping" and "sign reversal" are utilized, and the validity of this technic for constructing the "best" frequency histogram is verified by a general computer algorithm.


The pathologic findings in rickettsial pneumonia.

A fatal case of Q fever pneumonia with demonstration of the organisms in the lungs is presented. The disease clinically simulates bacterial lobar pneumonia. Neutrophils were conspicuously absent in the inflammatory process. Histiocytes predominated in the alveolar septal spaces and produced both radiologically and pathologically an alevolar infiltrate. Histiocytic hyperplasia and focal necrosis were present. Histiocytes similar to those seen in the alveolar spaces of the lungs distorted the normal architecture of the lymph nodes. In scattered areas necrosis with histiocytes palisading in the periphery simulating the lesions of cat-scratch disease and tularemia were seen.


Granulomatous synovitis and osteitis caused by Sporothrix schenckii.

Sporotrichosis must be considered in the differential diagnosis of granulomatous inflammation involving bones and joints. The organisms are difficult to demonstrate in direct smears and in histiologic sections, but they grow readily on routine fungal culture media. The cases of two patients, one with sporothrix arthritis and one with sporothrix arthritis and osteitis, are presented. The latter patient underwent ten surgical procedures over a period of 6 1/2 years and was treated for tuberculous arthritis without a definite diagnosis before fungal cultures were obtained and Sporothrix schenckii isolated.


Frequency and some properties of clinical isolates of methicillin-resistant Staphylococcus aureus.

Of 420 Staphylococcus aureus isolates, 3.1% were methicillin resistant. Most of the 13 isolates were from the flora of hospitalized patients. The organisms were also resistant to nafcillin and cephalothin. They shared many of the properties with methicillin-resistant staphylococci accumulated from other sources except for the lack of lysozyme-like activity.


Respiratory colonization with Pseudomonas putrefaciens after near-drowning in salt water.

Pseudomonas putrefaciens, a marine organism infrequently found in human culture material, was repeatedly isolated from the sputum of a patient with pneumonia during a three-week period following a salt-water drowning accident. Similar organisms were found in the water at the site of the accident in Boston, and at ocean bathing beaches on nearby Martha's Vineyard.


Primary osteomyelitis due to an anaerobic microorganism.

Primary osteomyelitis in a teen-aged boy that mimicked Ewing's tumor radiologically showed small Gram-negative rods on the original smear. The organism isolated was an obligately anaerobic bacterium, finally identified as Clostridium sphenoides. This finding underlines the need for microbiologic analysis of orthopedic lesions.


Comparative evaluation of desoxycholate citrate medium and xylose lysine desoxycholate medium in the isolation of shigellae.

Studies of the relative efficacies of different modes of transport of fecal specimens intended for culture for the isolation of Shigellae have been carried out. When the delay between collection and culture was long, transportation in liquid nitrogen was slightly but not significantly better than transportation on ice. When the delay was short (10 hours or less) transportation at ambient temperature was as satisfactory as that on ice. A comparative study of the efficacies of three media for the isolation of Shigellae was also carried out. A total of 75 stool specimens containing Shigellae was studied. Isolation rates were highest with xylose lysine desoxycholate medium (XLD) and desoxycholate citrate medium (DCA). XLD was superior to DCA in that the Shigella colonies were clearly visible after overnight incubation, whereas use of DCA necessitated 48 hours of incubation. Also, colonial morphology on XLD was more specific. It is recommended that both XLD and DCA be employed, but if only one medium is to be used, XLD is the medium of choice.


Hyposplenic, coagulopathic, cryptogenetic pneumococcemia.

An unusual case of sudden, fulminant pneumococcemia and disseminated intravascular coagulation occurred in a woman who had had incidental splenectomy 8 months previously, at the time of gastrectomy for duodenal ulcer. Similar cases in which there is constant relationship of splenectomy, pneumococcal sepsis, and Waterhouse-Friderichsen syndrome have been documented. Other similarities which are notable are a tendency for the disease to occur in women, lack of a nidus of infection, and proliferation of diplococci to numbers great enough to be seen easily on the peripheral blood smear.


A double heterozygous hemoglobin. Hemoglobin OIndonesia and hemoglobin DPunjab in an individual.

During surveys for abnormal hemoglobins in Iran, an individual was found to have four electrophoretically distinct hemoglobins. The abnormality was found only in the father of the propositus, in two of the father's sisters, and in three brothers and sisters of the propositus. Investigations revealed that the four hemoglobin components are the result of a double heterozygosity between an alpha-chain variant (Hb OIndonesia) and a beta-chain variant (Hb DPunjab). The presence of the abnormal hemoglobins was not associated with hemolytic disorders or obvious clinical symptoms.


Consultee-centered consultation with a teacher as a technique in behavior management.

Client-centered consultation was effective in helping a teacher to decrease one child's disruptive classroom behavior, and consultee-centered consultation helped the teacher improve her control of the class as a whole. Initially, a client-centered reinforcement program effectively decreased the disruptive behavior of one target child. Later, attention to the teacher's feelings about being the authority figure in the classroom was used in an attempt to modify the behavior of the entire class. The data describing the behavior of a second child in the classroom suggested that this consultee-centered consultation was followed by less classroom disruption. In addition, anecdotal observations indicated that consultee-centered consultation was effective in modifying the behavior of both the teacher and the rest of the class.


The training of telephone crisis intervention volunteers.

Telephone crisis intervention services are growing at a very rapid rate. A review of the literature reveals that there are very few references to this new phenomenon and even fewer that deal with evaluating the effectiveness of telephone crisis training. Herein 7 articles are reviewed which deal with volunteer selection and training. These articles demonstrate that no consistent rationale for volunteer selection or training exists. Selection of volunteers typically consists of a gross screening to eliminate any obviously unsuitable persons, with training serving as a further sorting procedure where volunteers who are uncomfortable with the role of a crisis interventionist can be encouraged to drop out. The authors suggest that a training model be built around crisis intervention theory using principles of social learning as the methodology for training.


A conceptual overview of selected consultation models.

Because of their current popularity and utility 4 consultation models have been selected for analysis: consultee centered, group process, social action, and ecological (exemplified by Gerald Caplan, Ronald Lippitt, Saul Alinsky, and James Kelly, respectively). The process of consultation as outlined by these models is described along the following dimensions: definitions of consultation, self-perceptions of the consultant, target populations, motivation of the client system, entry, goals, diagnosis, techniques, termination, and evaluation. The discussion focuses on criteria for selecting an appropriate consultation model.


Strens, traumas, and trauma resolution.

With both primary and early secondary prevention in mind, this investigation sought to answer several basic questions regarding the resolution of traumas and their conversion into strens - growth-potentiating experiences. College volunteers (N = 40) described in detail their significant positive and negative experiences. The results indicate that many people did experience a trauma that was converted into a stren, and the resolution appeared to be primarily a cognitive process, usually done by the subject himself, and it most frequently occurred between 2 weeks and 4 months after the precipitating event.


The Papago psychology service: a community mental health program on an American Indian reservation.

A community psychology service run by the Papago Indian tribe and staffed largely by Papago Indians who have been trained as mental health workers is described. This service is unique among mental health services for Indians in that the tribe has complete control of the funds for the service and sets its own policies. It was developed for a rather traditional Indian group, and the culture, the traditions, and the wishes of the Papago community were respected. Consultation with medicine men was built into the program from the start, and adaptation of mental health techniques to fit the culture is stressed. Before this clinic was established, few mental health resources were directly available to the reservation. Similar to other Indian tribes, the Papagos are economically disadvantaged, with an unemployment rate of over 50%, low educational attainment, and very high rates of alcoholism, suicide, and vehicular accidents. The topics covered are the tribe's view of health programs for its people, the present Papago community and traditional means of treatment, traditional psychotherapy adapted to Papago culture, the indigenous Papago mental health worker, and the non-Indian professional consultant.


Assessing nonprofessional mental health workers with the GAIT. An evaluation of peer ratings.

Coed groups of undergraduates took the Group Assessment of Interpersonal Traits (GAIT) twice with either a 3-week or a 9-week interval. Peer ratings of the nine GAIT scales were unrelated to sex. Test-retest correlations were significantly positive for the short-interim Ss (N = 41) but were generally low for the long-interim Ss (N = 29). Peer-rated GAIT Therapeutic Talent variables (Understand, Accepting-Warm, Open) were significantly correlated with the self-reported Comrey Personality Scale of Empathy, and GAIT Open was significantly correlated with Comrey Activity. GAIT Open, Accepting-Warm, and Best Counselor ratings were significantly correlated with total verbal responses (as counted from audiotapes of the GAIT interactions). The highly intercorrelated GAIT Therapeutic Talent variables may not be discriminated by peer raters. It is suggested that peer GAIT Therapeutic Talent ratings may be tapping an underlying global dimension, Help-Oriented Activity. Attention is called to the need for standardizing Gait ratings and for retaining the economy and ease of the GAIT.


Electroencephalographic findings in children with phenylketonuria.

The electroencephalographic findings of 90 patients with phenylketonuria (PKU) who were observed in one clinic were critically reviewed. Seventy-three percent of patients with classical PKU that was diagnosed and treated early (group 1) were found to have normal EEGs, 23% had mild background abnormalities, and 4% had paroxysmal discharges. Only 31% of the patients in whom PKU was diagnosed after 6 months of age (group 2) had normal EEGs, while 24% had background abnormalities and 45% had paroxysmal discharges. Of the patients with atypical PKU (group 3), 62% had normal EEGs and 38% showed background abnormalities. No major changes in EEG patterns were noted with initiation or termination of the low phenylalanine diet. There was no correlation between the degree of dietary control, EEG findings, and intellectual performance in group 1.


Pubertal gynecomastia and transient elevation of serum estradiol level.

Serum levels of testosterone, estradiol, progesterone, 17alpha-hydroxyprogesterone, follicle-stimulating hormone, and luteinizing hormone were measured in 16 boys with pubertal gynecomastia. Six patients had elevated serum estradiol concentrations, and four of these six also had elevated progesterone levels. Serum estradiol/testosterone ratios were high for the stage of puberty in 11 of the 16 patients. In five patients who had two or more determinations, the steroid concentrations returned toward or into the normal range. Transient increases in serum estradiol concentration or an abnormally high estradiol/testosterone ratio may be causally related to the development of  gynecomastia in adolescent boys.


Increased circulating basophils in juvenile rheumatoid arthritis. A preliminary report.

Basophil counts were done in children with rheumatoid arthritis, using a special staining method. Basophils were increased in absolute number and in percentage in 11 of 16 patients with juvenile rheumatoid arthritis. This increase was particularly significant in children with active polyarticular arthritis.


Are 1974-1975 automotive belt systems hazardous to children?

The 1974 and early-1975 model automobiles are equipped with belt interlock systems that require front outboard seat occupants who weigh more than 21.5 kg (47.3 lb) to wear threepoint lap and diagonal upper-torso belts (or wear the lap belt and position upper-torso belt behind them), assuming that the interlock has not been circumvented. Recent legislation has eliminated the interlock requirement, but new models are still likely to be fitted with three-point restraints for the front outboard seating positions. These restraint systems were designed and tested for adult use. Thus, based on the different structure of a younger child and the fact that there is a wide variation of belt orientation, child size, and seating environments, there is legitimate concern that the upper diagonal belt might contribute to injury of the child under certain impact conditions.


Born in a caul. Remarkable survival.

An infant born in a complete caul survived 25 minutes of extrauterine life inside the intract sac of membranes. Up to three years later, no ill effects from this unusual birth have been demonstrated.


Mediastinitis in a child caused by perforation of pharynx.

Mediastinitis in infants and children secondary to trauma is rarely reported as evidenced by a literature search. A case of mediastinitis occurred following perforation of the pharynx by a pencil. In neonates, traumatic perforation may mimic esophageal atresia. In older children with a history of trauma to the mouth or pharynx by a sharp object, the possibility of secondary mediastinitis exists.


Vitamin D deficiency rickets. Two cases with faulty infant feeding practices.

Two cases of vitamin D deficiency rickets verify the occurrence of deficiency rickets in the United States in 1973. The two cases demonstrate the need for periodic reviews of feeding practices, especically when the possibility of so-called milk allergy is postulated. This may lead to avoidance of milk products. Fortification of various kinds of food with vitamin D does not ensure the protection from nutritional rickets of all children with peculiar feeding habits.


Complete spondylolisthesis in an infant. Treatment with decompression and fusion.

A grade 4 spondylolisthesis at the level of L-4 and L-5 was detected in a 3-year-old girl who had a spastic gait and focal sensory deficit. There was no history or objective evidence of substantial spinal trauma. A deformity over the lower part of the spine had been noted at 1 year of age and the radiological lesion was more extensive than that found in classical spondylolysis. Consquently, a diagnosis of congenital spondylolisthesis is most acceptable. Treatment via combined posterior and posterolateral fusion following anterior decompression has yielded gratifying results.


An unusual case of Peutz-Jeghers syndrome in an infant.

An 11-month-old girl had an unusual history of colocolonic intussusception associated with polyps that prolapsed through the rectum. Several months thereafter, characteristic brownish-black pigment spots of the lips were noted. The histologic appearance of the polyps was consistent with that of the Peutz-Jeghers syndrome. To our knowledge, this is the youngest reported case of symptomatic Peutz-Jeghers syndrome.


Pneumococcal endocarditis in a 7-week-old infant. A case complicated by congenital heart malformation with mitral valve perforation.

A 7-week-old girl had pneumococcal endocarditis and perforation of the mitral valve. Pneumococcal endocarditis in children under 2 years of age is extremely rare, and is a prototype for endocarditis in general in infants less than 2 years of age. To our knowledge, this is the youngest reported patients with pneumococcal endocarditis in the penicillin era.


Familial pseudomembranous colitis and its relation to lincomycin therapy.

Severe pseudomembranous colitis was observed in 3 members of a single family: the father and 2 of his children. 2 of the affected family members received the antibiotic lincomycin prior to the onset of their symptoms. The findings in this family raise the possibility that antibiotic-induced pseudomembranous colitis in some patients may be the result of a pharmacogenetic interaction.


Experimental chronic gastric ulcer due to ischemia in rats.

Ligation of the left gastric and right gastroepiploic arteries and veins resulted in chronic gastric ulcer formation in the rat. Linear mucosal corpus hemorrhages appeared within 8 hr of ligation. By 2 days large corpus hemorrhagic erosions were present. A single, large ulcer involving nearly the entire corpus was present at 3-5 days. In the ulcerated area the mucosa and muscularis mucosae were destroyed, thick granulation tissue filled the submucosa and the muscularis propria was severely damaged. Progressive healing occurred thereafter and 75% of the ulcers healed completely grossly in 2-8 weeks. Histologic studies showed that healing and mucosal regeneration occurred by the outgrowth of a layer of cells from the adjacent intact epithelium extending over the surface of the ulcer. Invaginations from this covering layer of cells formed a glandular mucosa composed of mucous cells. Later parietal and chief cells appeared, and eventually (6 months) a normal corpus-type mucosa covered the entire corpus. With time smooth-muscle fibers appeared in the outer half of the dense submucosal granulation tissue and eventually a normal muscularis mucosae, submucosa, and muscularis propria were present (6-12 months). These studies show that: (1) ischemia can give rise to chronic gastric ulcer, and (2) all elements of the gastric wall, including the mucosa, the muscularis mucosae, and the muscularis propria can fully regenerate.


Achalasia of the esophagus. A reappraisal of esophagomyotomy vs forceful pneumatic dilation.

56 patients with achalasia of the esophagus were reviewed in a retrospective study to compare the results of a forceful pneumatic dilation with those of a Heller esophagomyotomy. 22 of 33 patients treated with forceful dilation (67%), showed relief of dysphagia and reduction in the average esophageal diameter by barium swallow during the follow-up period (mean = 6.5 years). In 2 patients (6%), forceful dilation was complicated by esophageal perforation, promptly diagnosed, and successfully treated at surgery in both patients. 21 out of 23 patients who underwent esophagomyotomy (91%) showed permanent relief of symptoms and improvement by endoscopic and radiographic criteria. There were no significant postoperative complications during the follow-up period ranging between 1.5 and 10.0 years. The results of this study indicate that esophagomyotomy constitutes a more effective therapeutic modality than forceful dilation (P less than 0.05). Although esophageal dilation has a place in the treatment of early achalasia, esophagomyotomy appears to be a safer and a more successful form of treatment, of particular value in advanced esophageal disease and in those instances where pneumatic dilation fails to result in immediate clinical improvement.


Inhibitory action of antidiuretic hormone on canine pancreatic exocrine flow.

A direct relationship was observed between the percentage inhibition of secretin-stimulated pancreatic exocrine flow and the dose of antidiuretic hormone administered with the minimal effective concentration being 0.75 m units/kg or 0.012 m units/ml. An alteration in the molecular configuration of the antidiuretic hormone modified its ability to inhibit secretin-stimulated pancreatic exocrine secretion.


The effect of fasting on the rate of intestinal drug absorption in rats: preliminary studies.

The absorption rates of two model drugs, salicylate and antipyrine, from the small intestines of rats deprived of food for various periods of time were compared with rats fed ad libitum. Fasting reduced the absorption rate constants for both drugs with the salicylate rates being depressed more severely than the rates for antipyrine. Intestinal mass studies showed that the weight/length ratio of the rat intestine is progressively decreased as fasting is prolonged up to 96 hr. The intestinal weight loss was much more pronounced than the total body weight loss. The loss in intestinal weight and the observed decrease in drug absorption rate are believed to be related to the inhibition of intestinal cell proliferation due to fasting, resulting in a decreased absorptive surface and reduced mucosal cell viability.


Surfactants and bioelectric properties of rat jejunum.

The effects of surfactants on bioelectric properties of rat jejunum were determined. Tween 80 (nonionic) and sodium dodecylsulfate (anionic) increased transmural potential differences 20-34% over values in Krebs-Ringer bicarbonate buffer. Short-circuit currents increased 66-112% and net tissue resistance decreased 19-30%. The cationic surfactant cetrimide decreased transmural potential 23%; short-circuit current decreased 32%, and resistance increased 22%. When sulfate replaced chloride in buffer, surfactant effects were minimized or reversed suggesting a role of Cl- flux in the bioelectric effects. Cationic surfactant effects on current and resistance were in the same direction as, but of greater and lesser magnitude, respectively, than alterations observed with bile salts. The current increase was of greater magnitude and resistance decrease less marked. Surfactant molecules may interact specifically with membranes in a more complex manner than simple "detergency".


Rhabdomyosarcoma of the duodenum with sinus tract formation into the gastric wall, visualized by gastroduodenoscopy.

Fiberoptic instruments have improved the accuracy of diagnosis of lesions of the upper digestive tract, particularly since the capability to perform biopsy under direct vision has been developed. Primary rhabdomyosarcoma of the upper gastrointestinal tract is an extremely rare entity. A literature search has revealed only 10 instances of rhabdomyosarcoma involving the esophagus, stomach, or duodenum (1-5). In this report, we describe the use of fiberoptic diagnosis and gastroduodenoscopic biopsy in a patient with rhabdomyosarcoma of the stomach and duodenum.


Thrombosis with low-estrogen oral contraceptives.

A retrospective study of the relationship of oral contraception to thrombosis was made in 104 idiopathic cases, 357 other thrombotic cases (exclusive of cerebrovascular thrombosis), and 1302 matched controls. The relative risk for idiopathic case users was 7.2 times that for non-users; for the whole series it was 1.9. The apparent low risk for non-idiopathic cases is considered to be due to selective prescription of this method of contraception. The risk for women using formulations containing 100 mug or more of estrogen was higher than that for users of lower doses. Among the controls, the risk of gallbladder surgery was twice as high for users as non-users. Several theoretical sources of bias were searched for and shown not to be present. Histories of oral contraceptive use were found to be accurate. A definite risk of thrombosis exists even with the low-estrogen dosage currently employed in oral contraceptive steroids.


Characteristics of menopausal women: a survey of King and Pierce counties in Washington, 1973-2974.

Age-specific menopause rates, frequency and duration of menopausal estrogen use, and characteristics of users and non-users of menopausal estrogen therapy are presented for the population of King and Pierce counties in the state of Washington from 1973-1974 survey data. Age-specific menopause rates do not differ substantially from rates derived from data from the 1960-1962 US Health Examination Survey, although women over 50 years of age were more likely to report operative menopause in the present study than in the Health Examination Survey. The estimated frequency of menopausal estrogen use of over 3 months' duration in the population was 51%; this is in contrast to an estimated 26% rate of severe menopausal symptoms. Median use of menopausal estrogen therapy was over 10 years. Estrogen users were younger than non-users and reported more formal education. More users had had difficulty with severe menopausal symptoms and more had had a hysterectomy.


Late sequelae of induced abortion: complications and outcome of pregnancy and labor.

The effects of previous induced abortion on pregnancy, labor and outcome of pregnancy were measured in a prospective study of 11,057 pregnancies to West Jerusalem mothers who were interviewed during pregnancy and who subsequently delivered a single live or stillborn infant. The 752 mothers who reported one or more induced abortions in the past were more likely, at the same interview, to report bleeding in each of the first 3 months of the present pregnancy. They were subsequently less likely to have a normal delivery and more of them needed a manual removal of the placenta or other intervention in the third stage of labor. In births following induced abortions, the relative risk of early neonatal death was doubled, while late neonatal deaths showed a 3- to 4-fold increase. There was a significant increase in the frequency of low birthweight, compared to births in which there was no history of previous abortion. There were increases in major and minor congenital malformations, but no significant changes in stillbirth or post-neonatal death rates, nor in mean birthweight or sex ratio. When the effects of other variables were taken into account, there were no significant changes in frequency following an induced abortion as to: ABO and rhesus isoimmunization, toxemia, hydramnios, premature rupture of membranes, induction of labor, breech or vacuum delivery, cesarean section, breech presentation, placenta previa, placental abruption, cord prolapse, cord anomalies, fetal distress or asphyxia, post-partum hemorrhage.


Influenza surveillance in the United States 1972-1974.

Individual cases of influenza are not reported nationally to the Center for Disease Control (CDC). Other methods of surveillance, therefore, must be used to estimate the extent and impact of influenza in the country. In the past, CDC has performed telephone surveys during the respiratory season and tabulated mortality due to pneumonia and influenza from 121 cities. The telephone data vary considerably from state to state and are only a general assessment of influenza activity. Tabulation of influenza-pneumonia deaths reflects more accurately the extent and impact of influenza but suffers from a 3-4 week-lag behind the actual clinical events. To improve influenza surveillance over the past 2 years, CDC obtained weekly numbers of emergency room visits to large community hospitals, school and industrial absenteeism, numbers of specimens submitted and numbers positive for influenza isolation from laboratories throughout the United States. Surveillance was most effective in large urban areas of the US where community hospital emergency rooms function as private physicians. Where people are more likely to consult a private physician than utilize a hospital emergency room, the correlation between private physician visits and influenza was good. Furthermore, school and industrial absenteeism are not very sensitive indicators of influenza-A activity; however, school absenteeism was a good index of influenza-B activity.


Laboratory studies of a lymphocytic choriomeningitis virus outbreak in man and laboratory animals.

Investigation of an outbreak of prolonged febrile illness in medical center personnel at the University of Rochester School of Medicine and Dentistry revealed lymphocytic choriomeningitis (LCM) virus to be the causative agent. Syrian or golden hamsters (Mesocricetus auratus) were found to be the only animals involved in maintaining the virus and were the source of human infections. Isolations of LCM virus were made from autopsy specimens of 13 of 46 (28%) golden hamsters. Virus isolations were made from 22 of 28 (79%) frozen specimens of 11 tumor lines transplanted repeatedly in golden hamster cheek pouches. No virus isolations were made from 86 autopsied laboratory mice, laboratory rats, Chinese hamsters (Cricetulus griseus), or laboratory rabbits or from 10 tumor cell lines transplanted in laboratory mice. Complement-fixation testing of 301 animal sera from the vivarium also revealed involvement primarily of golden hamsters. The probable source of virus introduction into the Rochester facilities was found to be two LCM-contaminated tumor lines sent from a biological supplier to Rochester in 1969.


Epidemic acute infectious nonbacterial gastroenteritis at the Children's Asthma Research Institute and Hospital.

During the period from September 8 to October 2, 1970, 44 of the 120 children and 78 of 141 adults questioned at the Children's Asthma Research Institute and Hospital experienced gastroenteritis characterized by nausea, vomiting, and fever and/or chills. Diarrhea was rare in children (4.5%) and common in adults (74%). The median duration of illness for children, 18 hours, was significantly shorter than the 48 hours for adults. All viral and bacterial cultures of 30 stool specimens were negative for viruses and bacterial pathogens. A retrospective survey of 28 ill employees revealed a secondary attach rate of 46% of 76 family contacts. A bacteria-free filtrate prepared from stool swab specimens of 2 ill adults by a team at the National Institute of Allergy and Infectious Diseases was administered orally to 3 adult volunteers. One of the 3 vomited and had 4 watery diarrheal stools on the third post-inoculation day. Diarrheal stool filtrates from this person were then given orally to 8 others; 1 became ill. Although the epidemiologic features point to the respiratory route of infection, the probably successful serial transmission of disease via bacteria-free stool filtrates through 2 generations of volunteers also suggests that the "Denver agent" is a virus-sized particle that replicates in the gastrointestinal tract.


Inheritance of very low serum dopamine-beta-hydroxylase activity.

Serum dopamine-beta-hydroxylas (DBH) activity was measured in blood samples obtained from 841 children ages 6-12, 277 adults subjects, and 114 relatives of children with serum DBH activity of less than 50 units. Approximately 4% of the children and 3% of the adult subjects tested had very low sweum DBH activity (50 units or less). Because these subjects appeared to make up a separate subgroup within the population and because of a striking familial aggregation of subjects with very low enzyme activity, serum DBH activity was measured in blood obtained from members of 22 families of probands with very low serum enzyme activity. The results of sibship and pedigree analyses of the data were compatible with autosomal recessive inheritance of very low serum DBH activity. Unaffected parents of probands had serum DBH activity intermediate between that found in affected individuals and in control population. No significant correlation of serum DBH activity with either systolic or diastolic blood pressure was found in this randomly selected population of children.


Localization of spherocytosis to chromosome 8 or 12 and report of a family with spherocytosis and a reciprocal translocation.

Significant linkage was found between spherocytosis and a translocation involving the short arms of chromosomes 8 and 12. The gene for spherocytosis, therefore, is likely either very close to the centromere of chromosome 8 or on 12p. The unusually high frequency of spontaneous abortion in this family was probably due to this translocation and was unrelated to the spherocytosis.


X-linked recessive inheritance of sensorineural hearing loss expressed during adolescence.

Eight males in 4 generations with hearing impairment were observed in a kindred; family transmission suggested X-linked recessive inheritance. In previously reported cases of X-linked sensorineural hearing loss, hearing impairment was usually severe to profound and was either present at birth or manifested by 5 years of age. In the present cases, rapid onset of a bilateral sensorineural hearing loss occurred during adolescence and did not generally progress beyond moderate impairment. Significant deterioration in seech production did not usually result.


Effects of various medical and social pracitices on the frequency of genetic disorders.

The effects of a number of new medical and social practices on the incidence of genetic diseases and gene frequency have been studied. The results deal with short-term effects, since these are of most practical importance, and with the combined effects of several factors acting together. The size of any effects depends on the feasibility of the different practices and on the extent to which they are adopted by the population. Most of the practices reduce the incidence of the diseases in the next generation, but some may be dysgenic. For example, improved treatment of affected individuals in dominant and X-linked diseases could lead to improved reproductive fitness, higher gene frequencies, and to an increased incidence in future generations. However, such deleterious effects may be avoided by genetic counseling or offset by other preventive practices. In recessive disorders, a small reduction in the average fitness of carfiers detected by population screening would outweigh any deleterious effects of other practices. In general there seems to be little cause for alarm about the deleteious effects of the new medical and social practices being adopted.


Polymorphism of human alpha fucosidase.

A common polymorphism of human alpha fucosidase has been detected by the technique of isoelectric focusing on thin layer acrylamide gel. Family studies have shown that the three common phenotypes Fu 1, Fu 2, and Fu 2-1 represent homozygosity or heterozygosity for two autosomal codominat alleles, Fu1 and Fu2. Frequencies of the Fu1 and Fu2 alleles in the New York populations studied were .753 and .247 among whites and .926 and .074 among blacks, respectively.


Recessive inheritance of the adult type of intestinal lactase deficiency.

In order to investigate the genetic control of the adult type of intestinal lactase deficiency, 61 families with 177 children over 6 years of age were investigated. The results strongly suggest that this deficiency is inherited as a simple Mendelian recessive trait.


Genetics of acheiropodia (the handless and footless families of Brazil). VII. Population dynamics.

Since carriers of the acheiropodia gene cannot be distinguished from noncarriers, parents and normal sibs of affected individuals have been used to estimate the fitness of heterozygotes. No significant difference in biologic fitness (viability and fertility) between normal sibs and the general population could be detected. A comparison between acheiropods and their normal sibs showed the following: (1) a nonsignificant difference in stillbirth rate; (2) a higher mortality rate of acheiropods in the first 5 years of life; (3) a relative viability not larger than .7; (4) a relative fertility no greater than .14, due to "cosmetic effects"; and (5) a fitness of .10 or lower. The total number of acheiropodia genes in Brazil has been calculated as 25,000 in the 1970s. The data are compatible with an extremely low mutation rate and a very stable locus. It is suggested that all Brazilian acheiropods can be traced to a single mutation. A conservative estimate of the number of acheiropods to appear in the future in Brazil is 14,000 with an extinction time of no less than 2,300 generations or almost 70,000 years. A variety of other parameters have been calculated.


Acute eosinophilic interstitial nephritis and renal failure with bone marrow-lymph node granulomas and anterior uveitis. A new syndrome.

We describe two patients with a unique granulomatous syndrome who presented with renal failure secondary to diffuse eosinophilic interstitial nephritis. Both had bilateral anterior uveitis, bone marrow granulomas, hypergammaglobulinemia and an increased sedimentation rate. One patient had lymph node granulomas and an immunoglobulin G (IgG) rheumatoid factor. An extensive investigation for an etiologic agent was unrewarding, and neither patient could be placed into any existing diagnostic category. Over a period of 2 years both patients have experienced improved renal function and dissolution of their bone marrow granulomas.


Decreased hypoxic ventilatory drive in the obesity-hypoventilation syndrome.

Most patients with extreme obesity do not exhibit alveolar hypoventilation, but an intriguing minority do. The mechanism(s) of this phenomenon remain unknown. A disorder in ventilatory control has been suggested as a major factor in the pathogenesis of the obesity-hypoventilation syndrome. Accordingly, hypoxic and hypercapnic ventilatory drives were measured in 10 patients with the typical symptoms of the syndrome: obesity, hypersomnolence, hypercapnia, hypoxemia, polycythemia and cor pulmonale. Hypoxic ventilatory drive, measured as the shape parameter A, averaged 21.9 +/- 5.35, approximately one-sixth that in normal controls, A = 126 +/- 8.6 (P less than 0.01). The ventilatory response to hypercapnia also was markedly reduced, the slope of the response averaging 0.51 +/- 0.005, or about one-third the normal value of 1.83 +/- 0.13 (P less than 0.01). This decreased responsiveness in hypoxic and hypercapnic ventilatory drive was consistent throughout the group. The depression in ventilatory drive found in the obesity-hypoventilation syndrome may be causally related to the alveolar hypoventilation manifested by these patients.


Defects of taste and smell in patients with hypothyroidism.

Taste and smell functions were measured in 18 unselected patients with untreated primary hypothyroidism, and in 15 of the 18 patients after treatment with thyroid hormones. Before treatment, 9 of the 18 patients (50 per cent) were aware of some alteration in their sense of taste, and 7 of the 18 patients (39 per cent) were aware of some alteration in their sense of smell. Distoritions of tase (dysgeusia) and smell (dysosmia) were frequent complaints among the untreated patients; dysgeusia was observed by 7 patients (39 per cent) and dysosmia by 3 patients (17 per cent). Median detection and recognition thresholds for four taste stimuli salt (sodium chloride), sweet (sucrose), sour (hydrochloric acid) and bitter (urea), and for two smell stimuli (pyridine and nitrobenzene), were determined in each patient before and after treatment with thyroid hormones. Before treatment, decreased taste acuity (hypogeusia) for at least one stimulus was observed in 14 of the patients (83 per cent); the most common abnormalities were in the detection and recognition of bitter stimuli. Median detection thresholds for both smell stimuli were also markedly elevated (hyposmia) before therapy. Treatment with throid hormones largely reversed both the taste and smell defects. In one patient, taste and smell abnormalities were completely corrected after 16 days of treatment with thyroxine. This study indicates that taste and smell defects are common clinical abnormalities in primary hypothyroidism, and suggests that these defects may contribute to the anorexia and lack of interest in eating which are frequently observed.


Chronic intrahepatic cholestasis of sarcoidosis.

The development of the syndrome of chronic intrahepatic cholestasis in five young, black men who had systemic granulomatous disease and clinical features consistent with those of sarcoidosis is described. Clinical and biochemical aspects, similar to those of primary biliary cirrhosis, included pruritus, jaundice, hepatomegaly and striking elevations of serum levels of alkaline phosphatase and cholesterol. (One patient had skin xanthomas.) Mitochondrial antibodies were not found; and survival of the patients (7 to 18 years) exceeded the usual survival of patients with primary biliary cirrhosis. The histologic abnormalities included noncaseating granulomas, chronic intrahepatic cholestasis, increased copper in hepatocytes, progressive diminution in number of interiobular bile ducts, periportal fibrosis and the eventual development of a micronodular "biliary" cirrhosis. The histologic evolution of the disease suggests a slow, progressive destruction of the bile ducts by granulomas. Although the end stage of this syndrome resembles primary biliary cirrhosis, the characteristic nonsuppurative, destructive cholangitis of primary biliary cirrhosis was not present.


Effect of procainamide and lidocaine on total electrical systole of ventricular premature depolarizations.

The effect of lidocaine and procainamide on the electrocardiogram of a patient with coupled ventricular premature depolarizations was observed after continuous electrocardiographic monitoring during a control period and drug therapy. First lidocaine, 100 mug/kg/min, and 3 1/2 hours later procainamide, 200 mug/kg/min, were infused until the arrhythmia was completely suppressed. In each drug study, blood samples were taken every 5 minutes for determining plasma drug concentration. In addition to important differences between the two drugs on the standard electrocardiographic intervals, a new electrocardiographic phenomenon was recognized: a change in the total electrical systole of the ventricular premature depolarization (ventricular premature depolarization-Q-T interval). These observations are discussed and related to the electrophysiologic properties reported for each of these agents.