The surgical treatment of incapacitating constipation associated with idiopathic megacolon. Results of the surgical treatment of idiopathic megacolon with incapacitating constipation in 23 patients are reviewed. The Swenson endorectal pull-through procedure, although it gave satisfactory results, was associated with high morbidity and resulted in the only death in this series. Anterior resection gave good results in six of eight patients. This procedure should give good results when the dilatation as seen on barium enema studies is confined to the rectosigmoid. However, for patients who have more extensive dilatation of the colon, extensive left hemicolectomy or total abdominal colectomy should be strongly considered, for these procedures have been associated with uniformly good results and little morbidity. There is little to recommend bilateral lumbar sympathectomy.


Responses of mitochondrial superoxide dismutase, catalase and glutathione peroxidase activities to aging. The previous observation (Eur. J. Biochem., 82 (1978) 563--567) that age-dependent accumulation of lipid peroxides follows as a consequence of increased radical formation in mitochondria has prompted an examination of the response of a set of protective enzymes to the above situation. Levels of mitochondrial catalase activity as well as selenium-dependent glutathione peroxidase activity were found to be increased with age, while superoxide dismutase activity remained unchanged. No selenium-independent glutathione peroxidase activity could be detected either in preparations from young 3-month-old controls or in preparations from 2-year-old rats. Both the relatively high and unchanged levels of reduced glutathione and kinetic considerations suggest that glutathione peroxidase is preferentially involved in lipid peroxide metabolism, while catalase predominantly metabolizes mitochondrial H2O2.


Analysis of the translational capacity of the male accessory gland during aging in Acheta domesticus. The protein synthesizing capacity of the male cricket accessory gland was inspected for changes associated with aging by analysis of organs from young (2 weeks post-imaginal molt), middle-aged (4 and 6 weeks) and senescent (8 weeks) animals. Total RNA content and the percentage of ribosomes in polysomes show an increase up to 4 weeks and then a steady decline. The rates of protein synthesis by young and old glands incubated in vitro were comparable, although the old glands were significantly less efficient in precursor uptake and therefore showed lower incorporation levels. The overall picture appears to be one of a steady but unspectacular decline in protein synthesizing capacity in aging animals. The quality of the secretory proteins formed by young and old glands was inspected by SDS--polyacrylamide gel electrophoresis and by isoelectric focusing, using both wide and narrow pH-range gels. While some differences in the banding patterns of isoelectric focusing gels were detected, they were eliminated by the inclusion of Triton X-100 in the gels. No other evidence for age-associated qualitative or quantitative changes was detected, strongly suggesting that proteins from young and old glands are identical.


Age changes in the livers of Costa Ricans. Age changes in the livers of Costa Ricans have been compared with those of native and Hawaii Japanese and U.S. caucasians. In the case of the U.S. caucasians and Costa Ricans, the decrease in the number of hepatic cells is similar up to 70 years of age, but after 80 years of age the decrease is more marked in the Costa Ricans. The difference in the process of senile change among these four groups suggests that the environmental, especially nutritional, conditions during their childhood and adolescence play an important role.


Strict relationship between dialyzed serum concentration and cellular life span in vitro. To determine the extent of the contribution of growth factor level on the life span of human diploid fibroblasts in vitro, the growth rate changes of IMR-90 cells under altered dialyzed serum (d-FBS) concentrations were investigated at different population doubling levels (PDL). As the PDL increased, the cells showed an accelerated requirement for d-FBS in order to maintain a constant growth rate, thus indicating a rapid loss of responsiveness of the cells to serum growth factors. A similar relationship was observed when the growth rate was extrapolated to zero and the cellular life span was predicted from this relationship. The cells cultured with 0.3% and 10% d-FBS ceased their growth at 54 and 76 PDL, respectively, while their predicted life span was 58 and 80--85 PDL, respectively. The cells cultured with 0.3% d-FBS responded poorly to an increase in the d-FBS concentration after entering phase III. These results suggest that the serum growth factor level is one of the determinants of cellular life span in vitro.


Cell culture studies in progeria. I. Establishment and partial characterization of a lymphoblastoid cell line. A lymphoblastoid cell line (EKS-L44) with definitive HLA specificities (HLA-Aw24, w30, B14, w35, Cw4-, DRw4, 5) was established from peripheral blood cells of a patient with progeria using Epstein-Barr virus. Cytogenetic study indicated that EKS-L44 was diploid after four months in vitro. The growth pattern of this cell line was not significantly different from a similarly established normal control nor from other lines initiated from patients with various disorders.


On the duration of mitotic stages in senescing human fibroblasts in culture. The duration of three mitotic periods was measured by time-lapse cinemicrography in a line of normal human fibroblasts which displays the phenomenon of limited growth potential in vitro. It was found that the durations of metaphase and anaphase did not change as a function of passage level but that there was a statistically significant increase in the duration of cytokinesis. It was also found that there was no progressive increase in the variance of these periods between early and late passage cells. The data suggest that for those late passage cells which still retain the capacity to divide, the cellular mechanisms responsible for the synthesis of functional proteins, energy regulation and at least some membrane functions appear to be working normally.


Changes in the activity and distribution of the ribosomal dissociation factor of rat liver during growth. In order to assess the relationships between the rate of growth and the activity of the initiation factors of protein synthesis, the activity and intracellular distribution of partially purified preparations of the ribosomal dissociation factor, obtained from the 0.5 M KCl wash of the ribosomes and from the high-speed supernatant (cytosol) of rat liver, were investigated in animals aged 1, 30, 60, 90 and 180 days. During the early phases of growth the activity of the dissociation factor was found mostly in the KCl wash of ribosomes. With advancing age, this activity decreased whereas that of the supernatant was found to increase. The activity of the supernatant was similar to that of ribosomes at 60, 90 and 180 days of age. The older rats showed, however, a decline in the activity of the dissociation factor. These observations suggest an increased rate of protein synthesis initiation in the early phases of growth in rat liver. With advancing age, a progressive reduction of ribosome recycling into subunits might take place, due to the increased accumulation of the dissociation factor in the cytosol. This might suggest a lowering of the initiation reactions of protein synthesis in such conditions.


Substrate specificity of monoamine oxidase in pig liver mitochondria. In pig liver both the A and the B form of monoamine oxidase (MAO) were found to be responsible for the oxidation of 5-hydroxytryptamine (5HT), a substrate oxidised by the A form alone in most other tissues. With increasing concentrations of this substrate, the percentage of the substrate oxidised by the B form increased. The Km value of the A and the B form of MAO for 5HT was 200 microns and 2.2 mM, respectively. It is suggested that the division of the monoamines into A and B form substrates should be done on the basis of the molecular turnover numbers rather than on their activities, and that the substrate specificities of the two forms of MAO should be determined over a large range of substrate concentrations.


Morphological findings in granular reticulum of arcuate nucleus neurons after clomiphene citrate administration. The action of high doses of clomiphene citrate on the rough endoplasmic reticulum of the hypothalamic arcuate neurons of male cat has been studied. Clomiphene (250 mg/kg) produces an accumulation of typical paracrystalline material in the rough endoplasmic reticulum. After the administration of a protein-synthesis inhibitor no such material was observed in clomiphene-treated cats. The possibility exists that the specific ultrastructural changes seen indicate an increased protein synthesis in hypothalamic arcuate neurons.


Acetaldehyde in cerebrospinal fluid: its near-absence in ethanol-intoxicated alcoholics. The cerebrospinal fluid of five ethanol-intoxicated alcoholics was found to contain only barely detectable (0--5 microM) concentrations of acetaldehyde, thus questioning its frequently advocated contribution to intoxication, dependence and other central ethanol effects.


On the analysis of ambulatory utilization: an investigation of the roles of need, access and price as predictors of illness and preventive visits. After separating ambulatory visits into those made in connection with illness or injury and preventive visits, the utilization patterns of a sample of families and individuals are analyzed. Need, in terms of perceived health status and the numbers of acute and chronic conditions, price, and access are found to be the best predictors of visit rates, but their roles in illness and preventive visit rates are different. The methodologically relevant findings indicate that individual self-reports and independent individual observations are required to identify relationships hidden by family member data, such as that between hospital episodes and ambulatory visits. The substantive findings indicate a substitutive relationship between illness and preventive visits, lend further evidence for relatively low price elasticity for illness visits and show that membership in a closed panel health maintenance organization increases preventive visit rate while price has little or no effect on it. The tentative policy implication--that it is not so much price as the characteristics of the usual source of care which appear to determine preventive services utilization--is discussed in the context of potential biases inherent in the sample.


Illness with a high emotional component and the use of medical services. This article investigates the relationship between the use of medical services for illnesses with a high emotional component and the use of medical services for other conditions. The site of the research is the Kaiser-Permanente Medical Care Program (Portland). The study population comprises a sample of 2502 adults for whom up to seven years of utilization data are available. Using a specially developed disease classification system, all doctor office visits (DOVs) are summarized by disease class for the years 1967-73 and converted into annualized rates for each subject. In the analysis, the rates of DOVs for "diseases with a high emotional component," one of the ten classes in the classification system, is the independent variable. The dependent variables are the rates of DOVs for the other disease classes, both singly and in combination. Sex and age are included as control variables. Except for one disease class (chronic nontreatable) and a few sex/age groups in the case of several other classes, there is a highly significant relationship between DOVs for emotion-related illnesses and DOVs for other diseases or conditions. Some implications of these findings are noted.


Selecting a suitable appointment system in an outpatient setting. One of the principal causes of waiting time in outpatient departments is the lack of well-designed appointment systems. A conceptual framework is given for dealing with existing appointment systems and to explain their working. The variables that play a role with respect to the appointment system are discussed. All different appointment systems can be compared according to their effect on the patients' waiting time and the physician's idle time, when the systems are expressed in terms of a new variable called "prepunctuality." Prepunctuality means the difference between the time of a patient's arrival at the clinic and the expected time of treatment, and is caused by the patient's own earliness, physician's lateness and the earliness induced by the appointment system chosen. The relationship between prepunctuality and both waiting and idle time was investigated by means of a computer simulation model. In this way, the consequences of using different appointment systems have been clarified, expressed in mean waiting time for the patient and total idle time for the physician. Given certain standards for waiting and idle time, the calculated results can be used to determine an appropriate appointment system and the corresponding waiting and idle time for the range of most common clinic situations. Examples are given to illustrate how these results can be used.


Effects of a self-administered health history on new-patient visits in a general medical clinic. Self-administered health history questionnaires (SAHHQs) are widely used in ambulatory care settings to save provider time and to assure completeness of the clinical data base. A controlled, prospective study was undertaken in a general medical clinic to evaluate the impact of an extensively pretested, highly reliable, 120-item self-administered health history questionnaire developed for new patient visits. Seventy-seven patients were randomly assigned to the SAHHQ or control groups. Time analyses were performed on audiotapes of the encounters. Patients' charts were scored on explicit criteria for data completeness. Problem recognition was determined by comparison of pre-encounter and postencounter problem lists. SAHHQ and control visits did not differ significantly in total encounter time (44.7 versus 48.3 minutes, respectively). Less time was spent in SAHHQ encounters on data base questions (2.5 versus 3.9 minutes, p = .003). Chart data were more complete for SAHHQ patients (p less than .001). The completeness of senior staff charts was more affected by the presence of the SAHHQ than residents' charts (p = .03). Physicians tended to recognize more new problems in SAHHQ visits. Mutual (physician and patient) recognition of problems occurred more often in the SAHHQ visits (p = .05). Carefully designed SAHHQs increase recorded data base completeness and may increase problem recognition, but do not result in major time savings.


Areawide fluctuations in hospital daily census. The importance of variations in hospital census for planning bed requirements has long been recognized. Traditional models assume Poisson or normal distribution patterns accurately describe such variations in specific hospital units, entire facilities, and groups of hospitals serving the same area. A study of 20 groups of hospitals in five states indicates that these traditional statistical distributions are only occasionally accurate. Different services display different census variation patterns. The standard deviation of the daily census distribution becomes increasingly higher than the square root of the mean estimate as the size of the mean increases. Implications of this finding for regional planning and coordination of hospitals are discussed.


Automated medical screening in an urban county jail. A machine-administered, branch-chain automated medical history (AMH) was evaluated as a medical intake screening tool for inmates of a large metropolitan county jail. The reproducibility, validity, sensitivity and specificity of the AMH were measured and found comparable to other previously reported AMH systems. The AMH did not produce intake screening data comparable to that obtained by trained face to face medical interviewers. This, in addition to the time and personnel effort required for administering the AMH while preventing vandalization of the equipment, made the AMH impractical for use in the county jail setting. Physicians used only 21 per cent of the positive AMH responses when they were asked to formulate problem lists from the AMH data. Physicians who used the AMH in clinical settings complained that "the AMH data seem as often wrong as right." The authors observed that the number of true-positive AMH responses was matched by an almost equal number of false-positve and false-negative responses. This may account for the physician's subjective response. If so, this represents a problem to be addressed by future AMH systems. Physicians used only 55.8 per cent of the intake screening information obtained by nurse practitioners. This was also somewhat lower than expected. For this reason, medical historical information in the county jail setting might be most efficiently obtained by the provider who has clinical responsibility for prescribing treatment.


Microprocessors as intelligent front-end devices for medical-information systems. Computer technology has produced increasingly powerful systems whose miniaturization has spawned the term microprocessor. The role of microcomputers is optimal if they are linked to larger systems in a distributed, hierarchical network with each element performing those functions for which it is best suited. Obstacles to the development of such a network include incompatibilities in operating systems, application languages, file structures, and communication protocols. Some attempts to address these problems are briefly reviewed. Given the availability on an effective distributed hierarchy of computers, the microprocessor can be useful in a number of functions requiring rapid response and limited access to large, central data files. Examples of such activities in the medical-information environment included program development and testing, forms entry, and text-management systems. With adequate attention to the systems support as well as the development of effective application techniques, the role of microprocessor-based intelligent terminals will inevitably expand rapidly in coming years.


Methods of implementation of the MUMPS global data-base. Recent standardization of the MUMPS language (ANSI X11.1-1977) has resulted in increased investigations into its efficient implementation. Of particular concern is the method of implementation of the MUMPS hierarchical data file, or global. Two implementation techniques have found substantial support: a traditional technique utilizing linked physical blocks, and a more recent, self-indexing method based on the theory of balanced trees. Comparison of these methods shows that the balanced-tree implementation offers significant advantages in most MUMPS environments.


Computerized management of a medical bacteriology laboratory using real-time processing. The computer system of the Bacteriology Laboratory at the Hôpital Cardiologique in Lyon is one of the elements in the computer management of patient data. It dovetails in with the various units for admission, patient location, ward surveillance, outpatient appointments. The main objectives are as follows: to improve quality of sample information, to reduce clerical work and accelerate information circulation, to widen the scope of epidemiological research. Computers can register samples, edit laboratory work sheets, entry lists, record results, generate reports, give a visual listing of all analyses performed before a patient leaves hospital, list pending analytical results, make available in the total system all laboratory-validated information, produce automatic billing of analyses and statistical editing. The Bacteriology Laboratory has three visual display units and two printers at its disposal. Computer laboratory management has been operational since May 1977. First results are satisfactory and suggest extension of the system to other laboratories and handling of quality control.


A computerized perinatal data system.

A computerized perinatal data system. A computerized perinatal data system has been proposed and is under implementation at St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. The concept encompasses all phases of perinatal care from pre-natal consultation through transferral of infant care to the family paediatrician. A complete record system was designed and computerized to serve both in-house and regional institutions with an on-line data system. Extensions into labour-delivery and nursery are under way and will provide augmentation of health care delivery as well as serving educational, audit, and research needs.


Clinical use of triaxicardiometry.

Clinical use of triaxicardiometry. A series of analogue and digital derivations from recorded electrocardiograms is analysed. Processing such data by digital computer allows the maximum amount of information to be extracted from the data. The triaxicardiometric method enables the differentiation between normal and abnormal cardiograms to be improved by the extra amount of information available. The analyses of 550 patients are presented.


The long-term quality control and clinical data evaluation of individuals in AMHTS. A new aspect of clinical data evaluation has been revealed by our recent research on the membership of AMHTS--long-term quality control (LTQC). The state of LTQC is evaluated by the distribution of mu, where mu is (mean minus micro 0) square root n minus/sigma 0, n is the number of the samples taken each day, mean is the mean of each day's samples, and sigma 0 and micro 0 are population deviation. Correction methods have been developed to obtain reasonable correction factors against the long-term analytic errors, and they have been implemented as an on-line, real-time subsystem of the AMHTS information system. The correction of LTQC errors has enabled us to observe an individual's health dynamics accurately, which allows us to pursue detection methods of diseases, such as cancer, in terms of a homeostatic disorder.


Identification ability of the first five letters of Christian name and surname. Identifiers must be easy for access and discrimination. Usual identification by surname and christian name is convenient, for these two identifiers are almost always available. Their discrimination ability was studied in terms of the theory of information and the rate of homonymy. In the French language, the first five letters of the surname provide information equal to 12.11 bits and the rate of homonymy is about 0.659%. If one adds the first three letters of the first name, the gain in the quantity of information is 1.68 bits and the rate of homonymy becomes 0.087%. So the first five letters of a surname and the first three letters of a christian name ensure a relatively satisfactory identification and may constitute a significant way of reinforcing the discrimination power of another identification system.


Inflammatory and neoplastic masses of the nose and paranasal sinus in children. This study categorizes the diseases of 376 children with inflammatory or neoplastic masses of the nose and paranasal sinuses treated at the University of Pittsburgh or reviewed at the Armed Forces Institute of Pathology. The presenting symptoms and signs of these masses, patient evaluations, and the outcome of management are reviewed. A plan for therapy of the various masses presenting in this area is suggested based on the outcome of this study.


Early childhood language delay: the otolaryngologist's perspective. Many etiologic factors have been implicated in delayed language development in the preschool child including: low birth weight, perinatal insults to the CNS, and chronic/recurrent middle ear disease with conductive hearing impairment during the first years of life. The results of an in-depth evaluation of 24 children, who manifested preschool language delay significant enough to require remedial intervention, are reported. A suggested early identification model employing High Risk Factors and a Developmental Screening Questionnaire for use by otolaryngologists, pediatricians and audiologists is presented.


The influence of embryology of the mid-face on the spread of epithelial malignancies. A review of 150 cases of mid-face skin cancers treated by the fresh tissue technique of microscopic controlled excision has revealed local epithelial cancer spread to be markedly influenced by embryological fusion planes. Knowledge of facial embryology which is reviewed in this article should allow the surgeon to better predict and treat mid-facial skin cancer.


The surgical anatomy of the spinal accessory nerve and the internal branch of the superior laryngeal nerve. Injury to the spinal accessory nerve may occur during conservation neck dissection. In supraglottic laryngectomy preservation of the internal branch of the superior laryngeal nerve has largely been ignored. Cadaver dissection and diagrams are used to review the surgical anatomy of these two structures. Particularly important are the relationship of the spinal accessory nerve to the sternocleidomastoid muscle, its interaction with the cervical plexus, and its superficial path inferiorly. Landmarks for the identification of the internal branch of the superior laryngeal nerve are indicated, and technique for preservation is described. An intact accessory nerve can be efficiently preserved thereby eliminating the shoulder syndrome. Significant sparing of the internal branch of the superior laryngeal nerve can be routinely accomplished as an aid in minimizing postoperative aspiration.


Hypermobility of the incudostapedial joint: a clinical entity. During exploratory tympanotomy for conductive deafness, the surgeon is occasionally perplexed to find no apparent cause for the air-bone gap. This unexplained deafness has been called "inner ear conductive hearing less" because of the apparent absence of pathology in the middle ear. The incudostapedial joint was studied in 68 vertically sectioned temporal bones and the anatomy is presented. Varying amounts of laxity is observed in the normal joint capsule at the time of surgery. A theory is suggested in which an elongated capsule allows incus motion without energy transmission to the stapes. It is proposed that hypermobility of the incudostapedial joint may exist and explain conductive hearing loss of undetermined etiology.


Anterior table frontal sinus fractures.

Anterior table frontal sinus fractures. Frontal sinus fractures cover a spectrum of injury. A series of 52 primarily treated patients from the University of Cincinnati Medical Center is presented. Initial systematic management was applied to these patients and consisted of complete radiographic evaluation supplemented by wound care and cosmetic restoration when needed. All patients were followed on a long-term basis; both clinically and radiographically. Results to date are that 49 patients have had an uneventful post-traumatic course with re-establishment of normal sinus aeration. From the cosmetic standpoint no contour revisions have been needed and only two patients required elective scar revision. Three patients developed chronic suppurative sinus disease within the first post-traumatic year which was readily diagnosed and managed without complication by osteoplastic frontal sinusotomy and adipose obliteration.


Clinical accuracy of tuning fork tests.

Clinical accuracy of tuning fork tests. A review of the literature reveals a surprisingly sparse amount of true documentation concerning the validity of using tuning forks as an adjunctive measure in the diagnosis of hearing impairment. Most reports are historical or anecdotal. With this in mind, a protocol was set up to identify the value of three standard tuning fork tests--the Rinne, the Weber, the Bing Occlusion--at frequencies of 256, 512 and 1024 Hz. The data were compared to otologic examination, audiometry and acoustic impedance. Results indicate the Rinne, Weber and Bing Occlusion tests do not accurately predict the type of hearing impairment as frequently as the literature suggests.


Development of laryngeal function: etiologic significance in the sudden infant death syndrome. Recent clinical evidence implicates transient upper airway obstruction as a cause of potentially fatal cardiorespiratory disturbances. This investigation identifies age-related neurologic mechanisms which may be pertinent to the production of abnormal laryngeal closure as a possible cause of unexpected infant death. A period of transient laryngeal hyper-excitability is identified in pups 50--75 days post-natally. The mechanism of the hyper-excitable state resulting in increased risk of laryngeal spasm, appears related to: 1. the completion of central synaptic maturation: 2. transient reduction in central latency; and 3. a reduction in central inhibition. Such observations provide clues to neurologic vulnerability occurring not immediately after birth, but during a discrete time period thereafter, prior to complete neurologic maturation. As such, these observations fulfill a criterion of utmost importance in the search for etiologic significance in the Sudden Infant Death Syndrome, and, in a broad sense, support the concept of selective maturational failure as a possible cause for age-dependent, unexpected infant death.


The treatment of subglottic stenosis in children by prolonged dilatation. Laryngeal stenosis can present with recurrent lower respiratory tract infections, hoarseness, stridor or decreased exercise tolerance. Asphyxia and death may follow. One accepted method of treatment is to perform a tracheostomy, dilate the stricture and insert an obturator for 6 to 9 mo. Ten children with a subglottic stenosis were treated by this technique and 7 completed the treatment. Results in 5 of these children were good, 1 was improved and 1 restenosed. These results compare favorably with those reported by others. This form of treatment is indicated for unyielding but dilatable strictures which have failed to respond to other approaches. The choice, therefore, lies between resection and plastic repair or prolonged dilatation. Results are generally quite good for strictures near the vocal cords, but are variable for those well below the cords. The manufacture and insertion of a prosthesis used in the above cases are described.


Bronchial adenoma: a malignant misnomer. Bronchial adenomas are a histologically and clinically diverse group of respiratory tract neoplasms arising from mucous glands and ducts of the tracheobronchial tree. They represent 1% of pulmonary malignancies. The traditional concept of a single, histologically benign form is challenged and the malignant potential of these tumors is stressed. Three main cell types with their characteristic histopathologic and clinical features are discussed: carcinoid, adenoid cystic carcinoma, and mucoepidermoid carcinoma. A case of bronchial carcinoid with hepatic metastases is reported, emphasizing the malignant potential of this controversial group of tumors. The appropriate diagnostic evaluation is outlined and aggressive surgical management is stressed. Chemotherapy and radiation therapy which are reserved mainly for palliation do not add to overall five year survival rates.


Spastic dysphonia: treatment by selective section of the recurrent laryngeal nerve. Selective section of the adductor branch of the recurrent laryngeal nerve appears to result in phonatory results similar to complete nerve section without the inherent morbidity. The abductor branch to the posterior cricoid-arytenoid muscle remains intact for glottic opening during inspiration. We emphasize the importance of careful preoperative patient evaluation as described by Dedo. All patients should be seen by a speech therapist and undergo a trial of speech therapy prior to surgical evaluation. A test block of the recurrent nerve with 1% xylocaine is imperative to allow the patient to hear the postoperative speech characteristics and give him a realistic expectation of the surgical result. We find that patients and referring professionals more readily accept the concept of selective nerve section.


Serum lipids in suckling and post-weanling iron-deficient rats. Serum lipids were studied in iron-deficient and control rats during suckling and after weaning at 21, 30, and 60 days of age. Diets providing 5 or 307 ppm iron were fed to dams and their offspring during gestation, lactation, and after weaning. Rats on the deficient diet throughout the experimental period developed a hyperlipidemia characterized by elevated triglycerides, cholesterol, and phospholipids which was present at 21, 30, and 60 days. Control pups weaned to the deficient diet developed anemia at 30 days of age and hypertriglyceridemia at 60 days of age. Repletion of deficient rats with iron after weaning caused a rapid decline in serum lipid levels after only 9 days on the control diet. The hyperlipidemia of iron deficiency thus appears to be reversible with iron supplementation. The time required to develop hypertriglyceridemia in iron deficiency is longer postweaning than during suckling.


End product specificity of triacylglycerol lipases from intestine, fat body, muscle and haemolymph of the American cockroach, Periplaneta americana L. The triacylglycerol-hydrolyzing capacity of tissue homogenates has been investigate for midgut, fat body, thoracic musculature and haemolymph of the American cockroach, Periplaneta americana. The greatest lipolytic activity was demonstrated in midgut homogenates with decreasing levels of activity present in fat body, muscle and haemolymph. Comparison of the lipolytic products resulting from triacylglycerol hydrolysis indicates that midgut homogenates effect the production of sn-2-monoacylglycerols and free fatty acids, whereas the other tissues that were examined favor the accumulation of diacylglycerols. Stereospecific analysis of the diacylglycerol products of triacylglycerol hydrolysis demonstrated that the lipolytic activities of midgut and muscle homogenates result in the production of a racemic mixture of the sn-1,2- and sn-2,3-enantiomers, but the fat body and haemolymph show a preference for the accumulation of the sn-1,2-isomer.


Reaction between peroxidized phospholipid and protein: II. Molecular weight and phosphorus content of albumin after reaction with peroxidized cardiolipin. Peroxidized cardiolipin (diphosphatidylglycerol) reacts covalently with albumin. Incubation of albumin with increasing amounts of peroxidized cardiolipin produces a gradual increase in molecular size. Incubation with a small amount of peroxidized cardiolipin (molar ratio of cardiolipin/albumin 21) produces a mixture of complexes that differs considerably with respect to the number of cardiolipin molecules bound per molecule of albumin. With larger amounts of peroxidized cardiolipin (molar ratios of cardiolipin/albumin 54 and 114), the complexes formed seem to be of a more uniform type since the numbers of cardiolipin molecules bound per molecule of albumin are similar. No polymerization occurs for reactions in which up to at least 15 moles of cardiolipin have become bound per mole of albumin, and 20--25 moles may be found with only very little polymerization. Only when the ratio of peroxidized cardiolipin to albumin was increased to a high value of 314 did polymerization occur. The present findings show that extensive covalent binding of peroxidized cardiolipin to albumin can occur without intermolecular crosslinking of the protein.


Inhibition of cholesterol synthesis in mammary tissue, lung, and kidney following cholesterol feeding in the lactating rat. Pregnant rats were randomly allocated to one of 3 experimental dietary groups: Group 1 -- 15.5% butter, 2% cholesterol, 0.78% sodium cholate purified diet; Group 2 -- standard rat diet with the addition of 10% lard and 2% cholesterol, and Group 3 -- standard rat diet. Plasma and milk cholesterol at 10 days postpartum were significantly elevated in dams fed exogenous cholesterol. The rat of incorporation of [1-14C] acetate into digitonin-precipitable sterols of mammary tissue slices from dams in Group 1 and Group 2 was eight-fold and two-fold, respectively, less than controls. Mammary tissue cholesterol was greater in dams fed detary cholesterol. Thus, our data, for the first time, demonstrate that cholesterol synthesis in lactating rat mammary tissue is suppressed following cholesterol feeding. In a second experiment, the rate of incorporation of [1-14C] acetate into digitonin-precipitable sterols in kidney and lung tissue of Group 1 rats was suppressed; however, this response was not as marked as that observed in lactating mammary tissue. The concentration of cholesterol in kidney and lung was greater than controls. These results suggest that extrahepatic inhibition of cholesterol synthesis exists in the rat with a concomitant increase in tissue cholesterol.


Synthesis of phosphatidylcholine and phosphatidylethanolamine at different ages in the rat brain in vitro. The de novo synthesis of choline and ethanolamine phosphoglycerides in brain microsomes from 18 month-old male rats was investigated in vitro by using labeled cytidine-5'-diphosphate choline and cytidine-5'-diphosphate ethanolamine as lipid precursors. The rate of synthesis of the two phospholipid classes was found to be noticeably decreased, as compared to that of adult animals. The addition of exogenous diacyl glycerols to microsomes from ageing rat brain brings the rate of synthesis nearly to the adult levels. The synthesis of choline and ethanolamine phosphoglycerides is not affected in the liver microsomes of ageing rats. The molar distribution of fatty acids in brain microsomal diacyl glycerols of ageing rats is noticeably different from that of adult animals. The content of monoenoic and dienoic species is increased, whereas that of the tetraenoic species is decreased. Base exchange reaction for choline and ethanolamine incorporation into respective phospholipids is not affected in the brain microsomes of the aged rats.


Metabolism of linoleic acid in the cat.

Metabolism of linoleic acid in the cat. Cats fed a diet containing linoleate as the only polyunsaturated fatty acid showed extremely low levels of arachidonate in the plasma lipids, as well as an increase in linoleate, eicosadienoate and an unknown fatty acid. Administration of [1-14C]linoleic acid and [2-14C]eicosa-8,11,14-trienoic acid to cats showed that in the liver there was no conversion of the [1-14C] 18:2 to arachidonate, whereas there was significant metabolism of [2-14C] 20:3 to arachidonate. It was found when methyl-gamma-linolenate was fed to cats that the level of 20:3 omega 6 and 20:4 omega 6 in the erythrocytes increased significantly. These results show that there is no significant delta 6 desaturase activity in the cat, whereas chain elongation and delta 5 desaturase enzymes are operative. The unknown fatty acid was isolated from the liver lipids and shown to be a 20-carbon fatty acid with 3 double bonds and which by gas liquid chromatography could be separated from 20:3 omega 9 and 20:3 omega 6. The presence of the delta 5-desaturase activity and the results of the ozonolysis studies indicated that this unknown fatty acid was eicosa-5,11,14-trienoic acid.


Comparison of lipid composition of Candida guilliermondii grown on glucose, ethanol and methanol as the sole carbon source. The carbon and energy source for aerobically grown cultures of Candida guilliermondii profoundly influenced the neutral lipid content and the fatty acid composition of the individual lipid components. Methanol (0.80%, w/v) grown cells cultivated at 30 C in presence of 0.025% ammonium sulfate contained 12% total lipids, 67% of which was neutral lipids. Glucose (0.74%), w/v) or ethanol (0.53%, w/v) grown cells contained 21--22% total lipids, 80% of which was neutral lipids, under the same conditions. Methanol-grown cells contained a decreased 18:1 acid (52--54% of total fatty acids) and an increased 18:2 acid (23--25%), as compared with glucose- or ethanol-grown cells which contained 57--66% 18:1 acid and 8--14% 18:2 acid, in both neutral and polar lipid fractions. The relationship between methanol metabolism and desaturation of fatty acid in yeast was discussed.


Isomerization of the double bonds of a conjugated fatty acid during beta-oxidation. The beta-oxidation of an unsaturated fatty acid containing conjugated double bonds at odd-numbered carbon atoms has not previously been studied. It is, therefore, not clear whether, during the beta-oxidation of such an acid, the double bonds will be isomerized by enoyl-CoA isomerase (delta 3 - delta 2-enoyl-CoA isomerase) with the loss or retention of its conjugated nature. To investigate the problem, (E,E)-3,5-octadienoyl-CoA was synthesized for use as a model substrate, and enoyl-CoA isomerase was partially purified from bovine liver. The isomerization was followed by spectrophotometric and gas liquid chromatographic methods, and the results suggested that the isomerization of the model substrate proceeded with retention of a conjugated double bond system. It is, therefore, proposed that the beta-oxidation intermediate of alpha-eleostearic acid (delta 9,11,13 fatty acid) will also isomerize with retention of the conjugated double bond system.


[Polarization method of examining the fundus and anterior chamber of the eye]. The method using polarization light proved to be efficient for examining eye tissues. It provides better contrast of some ocular elements, and thus, more reliable detection of pathological changes, more complete extinction (relaxation) of reflexes which hamper the observation and photograph of different eye parts. To interprete the patterns observed on the fundus in crossed polaroids, a matrix method is recommended for calculation of intensity of light passing through the optically-anisotropic layers of the eye ball. Data of clinical examinations carried out on pilot models of ophthalmological instruments confirmed diagnostic value of the polarization method for the eye study.


[Statistical analysis of data from glaucoma examinations]. Early detection of glaucoma can be achieved through prophylactic screening of population. This leads to a sharp increase in the patients' flow and deprives the physician of a possibility to examine them by routine methods. Such examinations will be feasible if to reduce the procedure time by automation, or to cut the examination program after the analysis of the existing medical programs by mathematical methods. The authors have used the method of linear discriminant functions which permits one on the basis of the medical data statistical analysis to learn the informativeness of diagnostic symptoms and decisive rules to form risk-groups of the patients who need more thorough medical examination. The analysis accomplished has indicated that there is no closely interlaced symptoms. Among most informative there are signs considerably differing in their statistical characteristics. The diagnostic rules proposed in this article provide adequately high accuracy in selection of healthy people groups and, as well, the patients with suspected glaucoma or suffering this disease.


[Automation of mass screening for glaucoma]. An experimental model (mock-up) of automated complex "Glaucoma" has been produced for mass population screening. It comprises five ophthalmologic instruments: for history data collection; for visual acuity examining; for examining the visual fields limits (perimeter); for determination of paracentral sites within visual field (campimeter), and finally a device for intraocular tension measurement. A special computer serves to control the operation of these instruments, collection, processing and display of information. A set including magnetic recorder, projector and synchronizer provides instructions for patients. The latter were examined following special lecture explaining the purpose of investigation, operation rules for these instruments and sequence of procedures.


[Improving the quality of glass ocular prostheses]. A critical analysis has been attempted of the current state-of-the-art in studying seleno-cadmium ruby glasses applicable for glass ocular prosthesis production. Better quality of these prostheses can be achieved by both the refinement of the ruby glass composition and by its strengthening (hardening) through proper methods.


[Medical digital thermometer].

[Medical digital thermometer]. For rapid measurement of the human body temperature, three modifications of medical digital thermometer are recommended for clinics: a thermometer with compensation of the body's local cooling by a transducer, thermometer for cardiosurgery, and adaptive thermometer. The article describes the basic structural scheme of the medical digital thermometer, ways of accelerated temperature measurement and main technical characteristics of the above models.


[SFON-01 Watchall stethophonendoscope].

[SFON-01 Watchall stethophonendoscope]. The Watchall-type stethophonendoscope CphiOH-01 for auscultation of adult patients, which most completely meets the current medical requirements, has been recommended for medical practice.


[Use of fiber-optic elements in ophthalmological instruments and light sources]. Application of flexible light guides in ophthalmological devices and light sources permits to develop the tools for illumination of surgical field, transilluminators for eyes, combinations of instruments with tools for intraocular manipulations. An eye transilluminator has been produced and tested with a set of attachments comprising fiver-optic light-guiding elements. This instrument allows to reveal foreign particles in the eye's vitreous body and in the surrounding tissues, and to diagnose some pathological changes.


[Ocular microforceps with fiber lightguides]. Application of fiber-optic elements for intraocular illumination facilitates the search, capture and holding of foreign particles at their removal from the human eye's vitrecus body.


Common bile duct stenosis from chronic pancreatitis: a clinical and pathologic spectrum. The chronic pancreatitis population of Wadsworth VA Hospital over the past five years was screened for two-fold or greater alkaline phosphatase elevation at any time during their course, as a marker for either distal common bile duct stenosis or other hepatobiliary disease. Forty-seven of 207 patients screened met this criterion and are reviewed in detail. Of the 16 patients with persistent alkaline phosphatase elevation (group B), 15 had proven common bile duct stenosis, demonstrating a clear pathophysiologic role of partial bile duct obstruction in their liver disease. Three had developed secondary biliary cirrhosis, marking this entity the commonest cause of secondary biliary cirrhosis at our hospital. Of the remaining 31 patients with transient alkaline phosphatase elevation (group A), only 4 had proven duct abnormalities which may resolve during recovery. Alcoholic liver disease was demonstrated with normal extrahepatic ducts in the remainder in group A adequately studies. Persistent greater than two-fold alkaline phosphatase elevation in pancreatitis thus represents a reliable marker of distal common bile duct stenosis, whose sequelae may include cholangitis and secondary biliary cirrhosis and which requires operative intervention in these cases. When a persistent alkaline phosphatase elevation greater than two-fold is encountered in a chronic pancreatitis patient, adequate cholangiography and liver histology are both necessary to confirm and grade this frequent and treatable complication.


Factor XIII.

Factor XIII. 1. Activated factor XIII is the enzyme that covalently cross-links fibrin monomers into fibrin polymers and results in increased clot strength and resistance of the clot to fibrinolysis. 2. Small amounts (greater than 1% of normal) of factor XIII are necessary for normal in vitro and in vivo activity. 3. Factor XIII deficiency is a rare autosomal recessive illness in which a hemorrhagic diathesis is caused by the virtual absence of the active a subunit of factor XIII. Approximately 100 cases have been described. 4. The disease in homozygotes is characterized by umbilical stump bleeding, a high incidence of fetal wastage, delayed soft tissue hemorrhage, and a high incidence of intracranial bleeding. The heterozygote is asymptomatic. 5. This paper calls attention to the apparent high incidence of oligospermia and small testes seen in homozygote males. Otherwise secondary sex characterics are normal. 6. Because there is no abnormality in thrombin generation and conversion of fibrinogen to fibrin, route coagulation tests (prothrombin time, partial thromboplastin time, thrombin time, etc.) are normal. Platelet function tests are normal. 7. Clots made from recalcified plasma severely deficient in factor XIII are soluble in 5 M urea or 1% monochloroacetic acid. These screening tests are simple and nearly pathognomonic of the illness. 8. More sophisticated and quantitative tests (e.g., dansylcadaverine incorporation) are available for definitive diagnosis and heterozygote detection. 9. Replacement treatment of the illness is simple, effective, and relatively inexpensive. Due to the long half-life of infused factor XIII and the small amounts necessary for normal hemostasis, prophylaxis is feasible and encouraged.


[Determination of benzidine in the air using the colorimetry and liquid chromatography methods]. The paper presents selection of analytical methods for determination of airborne benzidine, whose maximum admissible concentration (MAC) comes to zero. Colorimetric method with T chloroamine, allowing to determine 3 microgram of benzidine in m3 of the air, was evaluated. Such advantages of the method as specificity and availability of reagents and measuring apparatus were stressed. Another method presented in the paper is based on liquid chromatography, and its main features are: much better determinability of--0.7 microgram benzidine in m3 of the air and better precision than that of the colorimetric method. Its usefulness is however limited due to the necessity to have a very expensive liquid chromatograph.


[Effects of chronic inhalation intoxication with carbon disulfide on the content of various lipid metabolism indices in the serum, aorta and cardiac muscle in rabbits. II. Lipid phosphorus and phospholipid fractions in the serum, aorta and cardiac muscle]. Lipid phosphorus and single phospholipids content was checked in serum, aorta and cardiac muscle of rabbits exposed in toxicological chamber for 3 and 6 months, to carbon disulfide of low concentration (0.44 mg/l) and higher concentration (0.8 mg/l). Phospholipids were separated using thin--layer chromatography. Lipid phosphorus content in each fraction was determined colorimetrically. Statistical analysis of obtained results was done based on the Student "t" test. Lipid phosphorus content in serum, aorta and cardiac muscle was found to increase in animals exposed to CS2 in lower concentration. A decrease in lipid phosphorus content (statistically significant) was noted in the serum of rabbits intoxicated with CS2 in high concentration for 3 months. Changes in the percentage of phosphatidylcholine and sphingomyelins in cardiac muscle were found.


[Effect of vibration on the functioning of the lymphatic system in the small intestine in rat]. The production rate and flow of the lymph in mesenteric lymph vessels under normal conditions and after horizontal vibration of 5 Hz frequency and 20 mm amplitude were measured by means of intravital, intravenous injection of trypan blue water solution. The investigations were carried out on 66 Wistar rats of both sexes. It was found, that 3 and 7-hour vibration and everyday 7-hour vibration applied during a week result in the acceleration of lymph flow, whereas 3- and 4-week vibrations result in reduction of production and flow of the lymph. In all cases the lymph flow speed becomes normal after one day break. The results obtained show that low frequency vibration causes reversible functional changes in small intestine lymphatic system. These changes more probably result from hemodynamic disturbances. The applied vibration parameters did not cause any perceptible morphological changes in the lymphatic system.


[Cytochemical and immunological examinations of workers exposed to the effects of organic solvents of paints and varnishes. I. Activity of beta-glucuronidase and N-acetyl-beta-glucosaminidase. Glycogen content in lymphocytes]. In workers, aged 26--55, occupationally exposed for 80--118 months to organic solvents of paints and varnishes containing benzene, toluene and xylene, beta-glucuronidase (GR) and N-acetyl-beta-glucosaminidase (GZ activities were determined and glycogen content in peripheral blood lymphocytes was evaluated. In addition to lymphocytopenia, the number of lymphocytes with cytoplasmic localization of GR and GZ and a decrease in glycogen content in those cells were found. The authors suppose these changes are due to toxic effects of aromatic hydrocarbons, present in organic solvents of paints and varnishes, upon lymphocytes.


[Butylglycol toxicity].

[Butylglycol toxicity]. Basing on literature, the authors evaluate the toxicity of butylglycol, especially its narcotic effects and action inducing parenchymatous organs lesions, symptoms of inhalant, oral and percutaneous intoxications and their treatment.


[Respiratory tract diseases in coal miners. I. Pneumoconiosis]. In two mines, "A"--in Lower Silesia with low, inclined coal seam and lesser degree of output mechanization and "B"--in the Silesia-Dabrowa Basin with high coal seams and a great degree of output mechanization), work conditions were examined (dust concentration, chemical composition of dust, and microclimate) and medical examinations of underground miners were done. The examinations involved: mine "A"--2094 miners, mine "B"--1846 miners. The two examined populations were almost identical as regards age and length of employment. The number of miners working in bad conditions in the "A" mine was twice as great as that of miners working in bad conditions in the "B" mine. In dust collected on work--stands in the "A" mine the amount of copper, chromium and vanadium was 3 times that in the "B" mine and in the "A" mine approximately 40% more nickel was found in the dust than in the "B" mine. Average dust concentration on work stands was 10 times greater in the "B" mine than in the "A" mine. The rate of pneumoconiosis was on average 3.7% in both populations, in the "A" mine--6.2% and in the "B" mine--0.8%. In currently working miners no nodular changes, like PMF, were found. The rate of pneumoconiosis significantly varied with the length of employment. In 71.7% miners changes in EKG were found, in the "B" mine the number of those with changes being about 10% greater than in those in the "A" mine. In miners from the "A" mine, mostly changes in conduction (17.1%) were found; in the "B" mine these changes were twice less frequent.


[Respiratory tract diseases in coal miners. II. Chronic non-specific respiratory tract diseases in coal miners]. Miners of two coal mines were examined: mine "A"--2094 miners and mine "B"--1846 miners working underground. Both the examined population and work environment were thoroughly described in part I. Medical examinations involved disease history and occupational inquiry on a special questionnaire form, a part of this questionnaire being based on the BMRC questionnaire. In addition, spirometric examinations were conducted, VC, FEV1 was determined, and chest was X-rayed. Average PNChUO rate in both populations under examinations came to 16.5%; in the "A" mine it was significantly higher (19.1%), compared to the "B" mine--(13.5%). Obturative PNChUO constituted, on average, 1.7% of the total PNChUO rate in both mines and occurred more frequently in the "B" mine (2.1%), where work was more mechanized than in the "A" mine (1.3%). The highest PNChUO percentage was found in those working at most dusted work--stands. The PNChUO rate in its obturative form was found to be directly proportional to age and length of employment. No effect of PNChUO on the quality and rate of changes in EKG in those suffering from this disease was found.


[Respiratory tract in subjects occupationally exposed to asbestos dust]. Health status of 145 "isolators", in this 50 women, engaged in ship building and repair, inhalating asbestos dust for 2 to 24 years of occupation (10.7 and 1.7 years on average) was examined. High percentage (63.6) of chronic bronchitis was found, especially in those working more than 10 years, and more frequently in women. 13.3% of asbestos cases were diagnosed, in this in the group working longer than 15 years in 47.4%. In 20.6% of those examined, respiratory disfunction was noted, mainly obturative, with no changes in blood gases. Chronic bronchitis was found to have developed earlier and more frequently in women than in men, under the same exposure. This should be a contraindication to employ women on those work--stands where the air is considerably dusted by highly aggressive dusts.


[Improper posture adopted by workers in 2 different groups: weavers and seamstresses]. 50 weavers working in a standing-walking position and 50 seamstresses working in a sitting position have been examined. During the research it has been shown that frequent occurrence of posture defects is different in various occupational groups and it increases with the age and duration of work. Posture defects prophylaxis in the examined two occupational groups has been presented as well.


[Occupational exposure to x-rays in Poland in 1977]. The paper presents results of measurements of individual doses received by people occupationally exposed to X-rays in Poland. At the end of 1977 measurements covered over 18 thous persons. The group of those who did not exceed 1/10 permissible annual dose came to 99.24%. Average dose for the whole monitored population amounted to 74.6 mrem. Only 28 cases of exceeded permissible quarterly doses and 7 cases of exceeded permissible annual doses have been noted.


Effect of endurance exercise training on plasma pancreatic polypeptide concentration during exercise. The effect of exercise on human pancreatic polypeptide (hPP) levels was evaluated in five subjects preceding and following a conditioning program. During 90 min of exercise, the plasma concentration of hPP rose to a peak value five times higher than the resting level. After 2 mo of endurance exercise training, exercising at the same absolute work load resulted in only a twofold increase in hPP levels. Even at a higher work load, plasma hPP levels were significantly lower than the values observed prior to conditioning. These results show that plasma hPP concentrations rise during exercise and the magnitude of this response is significantly lower after 2 mo of endurance exercise training.


Insulin secretory dynamics after two consecutive intravenous stimulations with glucose and/or tolbutamide. Intravenous glucose and/or tolbutamide administered in two consecutive pulses 30 and 60 min apart to the same subjects using identical doses showed that insulin secretory responses was altered during a subsequent stimulation and that this was modulated by the time factor. Insulin response was more sustained after the second glucose pulses and the insulin peak response was delayed and diminished if the second glucose dose was given 30 min after the first, but not if given 60 min later. It is suggested that the beta-cell membrane might remain partially depolarized above a certain glucose level or that a postulated signal relay mechanism might become saturated. Responses to two tolbutamide pulses did not show these characteristics; however, the second insulin response was smaller than the first. When the first pulse was glucose and the second tolbutamide, or vice versa, the second responses were altogether different from those elicited by the double doses of either tolbutamide or glucose. To explain these characteristic patterns of insulin secretory dynamics, the existence of occult glucose receptors on the beta-cell that are opened up by tolbutamide was postulated. These studies do not support the two-pool theory, or at least restrict it to glucose-stimulated insulin response. The positive correlations between the first and the second insulin responses in all tests argue strongly against the existence of an insulin feedback mechanism in man.


Biochemical abnormalities of the human diabetic glomerular basement membrane. Since the biochemical composition of the diabetic glomerular basement membrane is still a controversial area, a study was carried out using kidneys from seven diabetic and seven nondiabetic subjects. In diabetic membranes, the glycine, hydroxylysine, glucose, galactose, and hydroxylysine-linked disaccharide unit content was increased together with a decrease in the half-cystine and sialic acid content. These findings support the view of a biochemical alteration in the human diabetic glomerular basement membrane.


Racial differences of parameters associated with blood pressure levels in children--the Bogalusa heart study. Racial differences in prevalence of essential hypertension are well known. In order to explore these differences at an early age in terms of etiology, we investigated schoolchildren in an entire, biracial community. A sample of 278 children, stratified by diastolic (fourth-phase) blood pressure and specific for age, race, and sex, was reexamined 1--2 yr after initial observation for the following: (1) a physical examination and urinalysis to exclude secondary hypertension; (2) 24-hr urine sodium, potassium, plasma renin activity, and serum dopamine beta-hydroxylase; (3) 1-hr oral glucose tolerance test; and (4) heart rate and blood pressure at rest and under standarized physical stress. We found that 24-hr urine sodium was positively associated with blood pressure level as measured on the same day for the high blood pressure strata of black children. Urine potassium excretion was lower in blacks than in whites, although their intakes seemed equal. In the high blood pressure strata especially, black boys had lower renin activity than whites, and the resting-supine and stressed systolic blood pressures were higher in black boys than in any other group. In these black boys, resting and stressed systolic pressures were negatively related to plasma renin activity. On the other hand, dopamine beta-hydroxylase levels in white children were higher than in blacks for all blood pressure strata, and in the high blood pressure strata white children had higher 1-hr glucose levels and faster resting heart rates than black children. Different mechanisms may play a role in and contribute to the early stage of essential hypertension.


Differential sensitivity to somatostatin of pancreatic polypeptide, glucagon and insulin secretion from the isolated perfused canine pancreas. This dose-response study deals with the relative inhibitory effect of somatostatin on the acetylcholine-stimulated release of pancreatic polypeptide (PP), glucagon, and insulin from the isolated canine pancrease. Somatostatin in picomolar doses potently inhibited insulin and glucagon secretion, whereas PP secretion was relatively insensitive. Also, in the absence of acetylcholine, somatostatin exerted a preferential inhibition of the release insulin and glucagon compared with PP. These findings point to a physiologically important role of somatostatin for the secretion of insulin and glucagon, but probably not for PP.


Increased dietary calcium lowers blood pressure in the spontaneously hypertensive rat. The effect of increased dietary calcium on the development of hypertension in spontaneously hypertensive (SH) rats was investigated by feeding lab chow fortified with calcium carbonate (2.5% calcium, hCa) beginning at 4 wk of age. A control SH group was fed regular lab chow (1.2% calcium, rCa). Two groups of age-matched Wistar-Kyoto (WKY) rats were treated in parallel. Systolic blood pressure (BP) was measured weekly until the age of 18 wk using a tail cuff method. The hCa diet significantly attenuated the time course of hypertension in SH rats even though both SH groups eventually developed hypertension. The hCa also lowered BP in WKYs, but to a lesser extent. Urine output (24-hr volumes) was not affected by hCa, but in both SH and WKY groups fed the hCa diet, the excretion of Na+, K+ and Ca++ was markedly elevated at 11, 15, and 19 wk of age. Urine osmolality was also elevated. Plasma Na+, Ca++ and osmolality were not significantly altered by the diet in either SH or WKY rats; plasma potassium was significantly lower in the SH group fed the hCa diet than in the group given rCa. The hCa diet did not significantly affect the body or heart, kidney, adrenal, or thymus weights. The results suggest that hCa diet may attenuate genetic hypertension by inducing an osmotic diuresis.


Effect of growth hormone on lymphocyte respiration and growth rate of children. Oxygen consumption by circulating lymphocytes of children with isolated growth hormone deficiency was studied before and 6 mo after the start of growth hormone therapy. A plot of percent change in respiration (oxygen consumed per mg protein or microgram DNA) against height gain during the therapy showed a linear association (correlation coefficient 0.667--0.756).


Serum cholesterol and triglycerides in children with growth hormone deficiency. To test the hypothesis that hyperlipidemia is characteristic of growth hormone deficiency in childhood, we have measured serum cholesterol and triglyceride concentrations in 24 euthyroid children with growth hormone deficiency. Although modest elevations of cholesterol and/or triglyceride above the 95th percentile for age, race, and sex were present in 46% of the children studied, the mean (+/- 1 SD) cholesterol of 173 +/- 36 mg/dl and the mean triglyceride of 80 +/- 42 mg/dl were not significantly different from published normal mean values. Administration of human growth hormone for 4 mo to 15 of these subjects did not alter these mean cholesterol and triglyceride values, but did result in a marked improvement in the growth rate. Some individuals (n = 6) with a subnormal growth response to therapy and/or a low serum thyroxine and high serum cholesterol were treated for an additional 4 mo with growth hormone and thyroid hormone together. There was a statistically significant decrement in serum cholesterol in this group. We conclude that modest hyperlipidemia does exist in some children with growth hormone deficiency. Subclinical hypothyroidism may play a role in the hypercholesterolemia of some children, as may growth hormone deficiency itself. Any association of growth hormone and lipid metabolism remains to be clarified.


Anion transport in red blood cells. III. Sites and sidedness of inhibition by high-affinity reversible binding probes. Studies of binding of the reversible inhibitor DNDS (for abbreviations, see Nomenclature) and red blood cell membranes revealed 8.6 +/- 0.7 x 10(5) high-affinity binding sites per cell (KD = 0.8 +/- 0.4 muM). Under conditions of "mutual depletion," inhibition studies of anion exchange revealed 8.0 +/- 0.7 x 10(5) DNDS inhibitory sites per cell (KD = 0.87 +/- 0.04 muM). Binding and kinetics studies with DNDS indicate that there are 0.8 -- 0.9 x 10(6) functional anion transport sites per blood cell. The transport of DNDS displayed high temperature and concentration dependencies, chemical specificity, susceptibility to inhibition by DIDS, and differences between egress and ingress properties. Under conditions of no DNDS penetration (e.g., 0 degrees C), inhibition of anion exchange by DNDS showed marked sidedness from the outside inhibitions and were demonstrable at micromolar concentrations, whereas from the inside no inhibition occurred even at millimolar concentrations. The asymmetry of DNDS transport properties and the sidedness of binding and inhibition suggest that anion transport sites have a very low affinity for or are inaccessible to DNDS at the inner membrane face. The site of DNDS permeation, although susceptible to DIDS, is apparently not the site of anion exchange.


Solute transport process in intestinal epithelial cells. In rat small intestine, the active transport of organic solutes results in significant depolarization of the membrane potential measured in an epithelial cell with respect to a grounded mucosal solution and in an increase in the transepithelial potential difference. According to the analysis with an equivalent circuit model for the epithelium, the changes in emf's of mucosal and serosal membranes induced by active solute transport were calculated using the measured conductive parameters. The result indicates that the mucosal cell membrane depolarizes while the serosal cell membrane remarkably hyperpolarizes on the active solute transport. Corresponding results are derived from the calculations of emf's in a variety of intestines, using the data that have hitherto been reported. The hyperpolarization of serosal membrane induced by the active solute transport might be ascribed to activation of the serosal electrogenic sodium pump. In an attempt to determine the causative factors in mucosal membrane depolarization during active solute transport, cell water contents and ion concentrations were measured. The cell water content remarkably increased and, at the same time, intracellular monovalent ion concentrations significantly decreased with glucose transport. Net gain of glucose within the cell was estimated from the restraint of osmotic balance between intracellular and extracellular fluids. In contrast to the apparent decreases in intracellular Na+ and K+ concentrations, significant gains of Na+ and K+ occurred with glucose transport. The quantitative relationships among net gains of Na+, K+ and glucose during active glucose transport suggest that the coupling ratio between glucose and Na+ entry by the carrier mechanism on the mucosal membrane is approximately 1:1 and the coupling ratio between Na+-efflux and K+-influx of the serosal electrogenic sodium pump is approximately 4:3 in rat small intestine. In addition to the electrogenic ternary complex inflow across the mucosal cell membrane, the decreases in intracellular monovalent ion concentrations, the temporary formation of an osmotic pressure gradient across the cell membrane and the streaming potential induced by water inflow through negatively charged pores of the cell membrane in the course of an active solute transport in intestinal epithelial cells are apparently all possible causes of mucosal membrane depolarization.


Characterization of an 11,000-dalton beta-bungarotoxin: binding and enzyme activity on rat brain synaptosomal membranes. The binding and phospholipase A2 activity of an 11,000-dalton beta-bungarotoxin, isolated from Bungarus multicincutus venom, have been characterized using rat brain subcellular fractions as substrates. 125I-labeled beta-bungarotoxin binds rapidly (k = 0.14 min-1 and 0.11 min-1), saturably (Vmax = 130.1 +/- 5.0 fmoles/mg and 128.2 +/- 7.1) fmoles/mg), and with high affinity (apparent Kd = 0.8 +/- 0.1 nM and 0.7 +/- 0.1 nM) to rat brain mitochondria and synaptosomal membranes, respectively, but not to myelin. The binding to synaptosomal membranes is inhibited by divalent cations and by pretreatment with trypsin. The binding results suggest that the toxin binds to specific protein receptor sites on presynpatic membranes. The 11,000-dalton toxin rapidly hydrolyzes synaptosomal membrane phospholipids to lysophosphatides and manifests relative substrate specificity in the order phosphatidyl ethanolamine greater than phosphatidyl choline greater than phosphatidyl serine. These results indicate that the 11,000-dalton beta-bungarotoxin is a phospholipase A2 and can use presynaptic membrane phospholipids as substrates. The binding, phospholipase activity and other biological properties of the 11,000-dalton toxin are contrasted with those of the beta-bungarotoxin found in highest concentration in the venom (the 22,000-dalton beta-bungarotoxin), and the two toxins are shown to have qualitatively similar properties. Finally the results are shown to support the hypothesis that beta-bungarotoxins act in a two-step fashion to inhibit transmitter release: first, by binding to a protein receptor site on the presynatic membrane associated with Ca2+ entry, and second, by perturbing through enzymatic hydrolyses the phospholipid matrix of the membrane and thereby causing an increase in passive Ca2+ permeability.


Electrogenic absorption of sugars and amino acids in the small intestine of the human fetus. Some characteristics and the degree of intestinal absorption in the developing human fetus were examined by measuring solute evoked potentials and 14C-D-glucose uptake into the everted jejunal segments. In all segments, the Michaelis-Menten relationship was observed between D-glucose concentrations and the evoked potentials or D-glucose uptake. Increase of Na-ion concentrations enhanced both D-glucose evoked potentials and uptake. Both D-glucose and L-alpha-alanine evoked potentials increased in a significant correlation to the fetal age; however, the apparent Michaelis constants did not show any signficant change. The structural specificity of sugar for generating evoked potentials was the same as that reported for adult mammals. Among amino acids, only the L-form of neutral and acidic amino acids generated markedly high evoked potentials, but the basic ones hardly at all. Oligopeptides such as glycyl-glycine and glycyl-glycyl-glycine also generated high evoked potentials. Our results have indicated that the active transport system of sugars and amino acids in the human fetus have already developed by as early as the sixth month of gestation.


Control of renal bicarbonate transport.

Control of renal bicarbonate transport. Single rabbit renal tubules were perfused in vitro to elucidate the factors that control bicarbonate transport. One factor studied was the preexisting acid-base status of the rabbits. Cortical collecting ducts from acidotic rabbits (given ammonium chloride) transported bicarbonate from lumen to bath. Collecting ducts from alkalotic rabbits (given sodium bicarbonate) transported bicarbonate in the opposite direction. Thus, bicarbonate transport by collecting ducts in vitro was conditioned by the preexisting state of the rabbit in vivo. In contrast, bicarbonate transport by proximal straight tubules and cortical thick ascending limbs was not affected by ammonium chloride or sodium bicarbonate given to the rabbits. Parathyroid hormone, the second factor studied, strongly inhibited bicarbonate absorption by proximal straight tubules.


The activation mechanism of human complement system by immune precipitate formed with rabbit IgG antibody. Immune precipitate (Ippt) formed between egg albumin and rabbit IgG antibody activated both pathways of the human complement system. On incubation with diluted serum, Ippt combined with several factors in the serum to form a complex which acquired C3- and C5-cleaving activities. In serum chelated with ethyleneglycol tetraacetic acid (EGTA), C3- and C5-cleaving activities of properdin system enzymes were formed on Ippt. Kinetic studies on the formation and the decay of C3- and C5-cleaving enzymes on Ippt revealed that C3- and C5-cleaving activites were almost dependent on the properdin system enzymes. The experiments in which C3-cleaving activity formed on Ippt was inhibited by anti-properdin or anti-B but not by anti-C4 supported the above results. The participation of the classical pathway was considered to accelerate the assembly of the properdin system enzymes.


Complement proteins and macrophages. 1. Quantitative estimation of factor B produced by mouse peritoneal macrophages. Cobra venom factor was used for the detection of factor B synthesized by mouse peritoneal macrophages. This method was shown to be specific for factor B assay by neutralization by antimouse factor B antibody. The amount of factor B in the culture supernatant, assessed by this method, was found to be dependent on the medium used for cultivation of macrophages. The addition of 25% L cell-conditioned medium to minimal essential medium (LCM-MEM) enhanced the production of factor B and also of lysozyme. Kinetic analysis in LCM-MEM showed that factor B produced by 6 x 10(4) cells/cm2 increased up to 72 hr and reached a plateau at 96 hr. The amounts of factor B and lysozyme produced in LCM-MEM depended upon the number of macrophages. Production of factor B was completely inhibited by 1 microgram of cycloheximide per ml and was restored by its removal.


The role of zinc in anorexia nervosa: etiology and treatment. Zinc deficiency may play a role in the etiology of anorexia nervosa. The symptoms of anorexia nervosa and zinc deficiency are similar in a number of respects, e.g., weight loss, loss of appetite, amenorrhea in females, impotence in males, nausea and skin lesions. In both conditions females under 25 are most at risk. Stress, estrogen and dietary habits may also be involved in the complex of factors which create or exacerbate a zinc deficiency and result in anorexia nervosa. It is proposed that effectiveness in the treatment of anorexia nervosa.


The varieties of chance in scientific research. Four kinds of luck can be defined --- one that is pure "blind" luck, and three others that are influenced to some degree by certain behavioral characteristics. The term, altamirage is introduced to call attention to that special personal quality by which good luck is prompted as a result of personally distinctive actions (Chance IV). In contrast, serendipity involves finding valuable things as a result of happy accidents (Chance I), general exploratory behaviour (Chance II), or saga-city (Chance III). The most novel scientific discoveries occur when several varities of chance coincide.


The conceptually-oriented physician.

The conceptually-oriented physician. This article is based on the authors' book "Physician or Magician: The Myths and Realities of Patient Care" (McGraw Hill and Hemisphere, 1978). In this paper, the authors contend that the main problem confronting medical practice and medical education today is that there is no consensus on what physicians should be doing. Should they be technologists or should they be conceptually-oriented? The authors further state that these two types of physicians are trained in different approaches to problem solving. They conclude by saying that both types of physicians are needed if the quality of patient care is to improve while containing cost, but that the conceptually-oriented physician--the primary physician--should be in charge of all treatment patients receive. This is because the primary physicians as well as the Cartesian approach. Therefore, they would be better able to determine the risks and benefits to each patient of various technological regimens.


On the role of tortuous coronary arteries in billowing mitral leaflet syndrome. A hypothesis. Sixty three male patients with billowing mitral leaflet syndrome (BML) and forty one age and sex match controls were studied with emphasis on the cineangiographic features of coronary arteries. In the BML group, the coronary arteries were considered normal in five and abnormal in fifty eight. In fifty eight with abnormal coronary arteries, twelve showed atherosclerotic occlusive lesions, fifteen showed combined occlusive lesions and nonocclusive abnormalities and thirty one showed nonocclusive abnormalities alone. The non-atherosclerotic abnormalities consisted of redundancy of the coronary arteries manifested by bizarre changes in configuration and motion. These abnormalities were present in only five patients in the Control Group. On the basis of our observations and corroborative evdience in the literature, a hypothesis is presented; the salient features of which are that: (1) the spectrum of BML may be considerably more complex than  hitherto suspected, (2) a combination of BML and tortuous coronary arteries may form a distinct subset of this spectrum and (3) the increased tortuousity may result in impaired coronary perfusion causing myocardial ischemia thus offering a possible explanation for some of the symptoms - such as chest pain, arrhythmias and even sudden death seen in this syndrome.


Is idiopathic dementia a regional vitamin deficiency state? We hypothesize that some cases of idiopathic dementia are due to a gradual undernourishment of the brain with water-soluble vitamins. This occurs because the choroid plexus and possibly other transport loci in the central nervous system become unable to transport water-soluble vitamins from blood into the central nervous system in adequate amounts. If this testable hypothesis is correct, direct injections of vitamins into the ventricular cerebrospinal fluid should ameliorate the development of dementia.


Does exposure to elevated levels of lead enhance sodium induced hypertension? Numerous community drinking water sources have elevated levels of both sodium and lead. Recently reported studies have indicated that elevated levels of sodium in drinking water may be a facter in the development of elevated blood pressure. The question of how elevated levels of lead may affect sodium induced elevated blood pressure is addressed. The hypothesis is developed which states that elevated levels of lead exposure will not interact with sodium to enhance the development of renin angiotensin aldosterone related hypertension but in fact may even diminish the effects of exposure to elevated amounts of sodium on blood pressure through a depression of plasma renin activity.


Some thoughts on the epidemiology of cardiovascular disease, (with special reference to women "on the pill"). Role of ascorbic acid. Consideration of nine major factors predisposing to cerebral thrombosis, coronary thrombosis or thrombosis in the deep veins of the calf, reveals that these factors all have one thing in common. Estrogen administration, pregnancy, ageing, smoking, infection, trauma, surgery, soft water and winter season are all associated with a tendency towards decreased plasma ascorbic acid levels. Normally, ascorbic acid deficiency is thought of as causing a tendency towards hemorrhage rather than thrombosis, but it is here suggested that petechial hemorrhages under the endothelium of the blood vessels may precipitate thrombosis on the damaged endothelium. Is not blood coagulation the normal mechanism for the arrest of hemorrhage?


Cellular control of heparin in blood.

Cellular control of heparin in blood. Many investigators have observed the uptake of exogenous heparin by cells of the reticuloendothelial system (R.E.S.). When heparin is administered by the intravenous, intramuscular, subcutaneous, intraperitoneal and intratracheal routes the anticoagulant response observed is of varying magnitude. This has led us to examine the literature for evidence of a distribution of heparin between the cellular and blood compartments. A re-evaluation of such evidence has provided a new perspective on the pharmacokinetics of heparin. This is presented here in the cellular pool concept which is based on the premise that there exists in the body a pool of cells which takes up a portion of the administered heparin, stores it and later releases it to the circulation. This concept provides a rational explanation for the different types of anticoagulant response obtained with different modes of administration.


Repeated abortions and histocompatibility antigens. Can HLA antigen restricted gene dose effects influence the feto-maternal relationship? It is suggested that the induction of cytotoxic reactions in the mother by allogeneic fetal cells is HLA antigen restricted and influenced, in certain haplotype combinations, by gene dose effects of specific HLA antigens (locus A and B), shared by the fetus and by the mother. The possibility that alloimmunization of maternal cells to fetal transplantation antigens may have beneficial or adverse effects on the fetal target cells dependent upon feto-maternal histocompatibility antigen interrelationship would provide a new approach for interpreting functional disturbances in certain cases of human pregnancy.


Pulmonary disease caused by Mycobacterium xenopi in an Australian man. A 63-year-old man with a history of increasing cough with sputum, weight loss, and lethargy was found to have pulmonary disease caused by Mycobacterium xenopi, a species rarely seen in Australia. Chemotherapy was successful. Apart from war service in Papua New Guinea, the patient had not travelled outside Australia.


Fatal thioridazine cardiotoxicity.

Fatal thioridazine cardiotoxicity. A case of fatal cardiotoxicity after a deliberate ingestion of 5000 mg thioridazine (Melleril) is reported. The serum thioridazine level is documented for the first time at the time of arrhythmia. Correct treatment of similar cases should often include insertion of a transvenous pacing wire, as the arrhythmias are generally resistant to drug therapy.


The Canberra mental health survey: further analysis of the adult sample. Secondary analysis of the Canberra Mental Health Survey (adult sample) extends the results of earlier analysis. New relationships between independent and dependent variables are revealed. Marital status previously not associated with mental health proves important when sex and socioeconomic status are controlled. Participation in organizations is strongly associated with social variables and mental health adjustment, suggesting explanations of mental health in relation to social support.


Ear disease in rural Australia.

Ear disease in rural Australia. Aboriginals in rural Australia have a higher over-all prevalence of otitis media and tympanic scarring than non-Aboriginals. Over-all, 11% of 60273 Aboriginals had otitis media and 29.1% had scarring in one or both ears, although the rates varied widely in different regions. Of 37713 non-Aboriginals, 1.1% had otitis media and 13.5% had scarring in one or both ears. Children less than 10 years of age had the highest prevalence of otitis media in both racial groups. A lower proportion of the otitis media was "glue ear" in Aboriginals than in non-Aboriginals. The pattern of prevalence of otitis media and scarring suggests that otitis media occurs more frequently and lasts longer in Aboriginals. Scarring rates suggest that otitis media is less frequent now than in the past in non-Aboriginals, but is more frequent in Aboriginals.


Petrol-inhalation in aboriginal towns. Its remedy: the homelands movement. Regular petrol-inhaling involves 50 children ("sniffers"), aged nine to 14 years, at the Aboriginal town of Maningrida--over one-third of resident children of this age. Children of two closely related clan-language groups comprise the majority of inhalers. Similarly, at the town of Galiwinku the children of two deprived clans are involved almost exclusively. These are the only clans in eastern Arnhem Land without outstations on their homelands. Revitalization of these clans appears the only effective method of containing the practice. Petrol-inhaling is associated with delinquency, low body weight, venereal disease, and elevated levels of blood lead. The effectiveness of past remedial action is in doubt.


Drowning: community aspects.

Drowning: community aspects. One hundred and ninety-six fatal immersion accidents occurred in Geelong and district during the 20-year period, 1959 to 1978. Of 54 drownings in children aged 16 years and younger, 43 (80%) occurred in males and 33 (61%) in fresh water. All 14 drownings in children under four years of age occurred in fresh-water sites, 12 of which were about the home. Immediate and optimal resuscitative measures in such children are extremely important.


Bee-sting anaphylaxis in childhood.

Bee-sting anaphylaxis in childhood. The syndrome of bee-sting anaphylaxis is described. Children who have suffered crescendo reactions to previous bee stings, especially children with a history of asthma, are significantly at risk. Desensitization is required in such cases; adrenaline should be kept in the home, and parents should be trained in its emergency use. The immunological mechanisms of bee-sting anaphylaxis are described. The striking seasonal incidence of anaphylaxis suggests that pollen or plant products which are incorporated in the venom may also be important in its genesis; it suggests also that antigens prepared from either whole-body or pure-venom extracts should be prepared from bees which are collected in late spring.


The 1977 Busselton children's survey.

The 1977 Busselton children's survey. A health survey of 551 high school students in the coastal town of Busselton, Western Australia, was undertaken in November, 1977. Physical measurements showed that approximately 17% of the boys and 24% of the girls were overweight (115% or more of their standard weight for height and age). Blood pressures ranged from 108/64 mmHg at 13 years to 129/70 mmHg at 17 years for boys, and 109/63 mmHg to 116/66 mmHg for girls of the same age group. Fasting plasma glucose, cholesterol and triglyceride values were also obtained. Twenty-seven per cent of the girls and 17% of the boys were regular smokers, a habit often acquired by the age of 12 years. Most of the children watched television from two to four hours daily during the week, and for longer periods at weekends. Although most had satisfactory levels of physical fitness, there was a trend towards poor performance in overweight children, and there was a significant decrease in participation in regular sports by the older teenagers.


Bicycle accidents in childhood.

Bicycle accidents in childhood. From a total of 4589 accident cases reported from nine Sydney hospitals during 1978, 312 children, 50% of whom were five to nine years old, were injured while riding bicycles. An in-depth investigation of 139 cases showed that motor vehicles were involved on only three occasions; the children were injured as a result of inexperience and misuse. These results indicate the value of developing and implementing bicycle education programmes for younger children, especially those aged five to nine years. Equal emphasis should be given both to traffic safety instruction and to basic riding skills.


Swimming ability of children: a survey of 4000 Queensland children in a high drowning region. The swimming ability of 4128 Queensland school children was studied. The median age for swimming 10 metres is 6.5 years. Ninety-five percent of children are able to swim by 11 years of age. Cumulative frequency curves, by age, are presented for the ability to swim 10 and 50 metres: the latter distance is of relevance in boating accidents. Twenty percent fewer children from lower socioeconomic levels are able to swim. Water safety training is as important as swimming lessons.


Genetic screening of the newborn in Australia. Results for 1978. Since screening of newborn infants for phenylketonuria (PKU) by Guthrie bacterial inhibition assay was established in the 1960s. 2 334 679 infants have been tested in Australia, and 208 cases of PKU detected (an incidence of 1/11 224). In 1978, 21 infants with PKU were detected. Screening for hypothyroidism was carried out in three States, and 29 cases of congenital hypothyroidism were detected in 1978 (an incidence of 1/5894).


An Australia-wide outbreak of gastroenteritis from oysters caused by Norwalk virus. At least 2000 persons were involved in an Australia-wide outbreak of oyster-associated food poisoning in June and July, 1978. At the time, this episode presented a major health risk to the community as a whole and has subsequently posed a serious economic problem for the oyster farming and distributing industry. Although bacteriological investigations indicated some batches of oysters were contaminated by sewage, no bacterial cause could be established. The causative organism was shown to be Norwalk virus, a known cause of acute non-bacterial gastroenteritis. This virus was found in 39% of faecal specimens examined by electron microscopy and an antibody response was demonstrated by immune electron microscopy in 75% of paired sera tested. Norwalk virus has not been identified previously outside the United States of America and has not been linked to food-borne gastroenteritis before. Purification of oysters and other measures have been instituted to prevent a recurrence of the outbreak.


Acute hepatitis B in a metropolitan population. One hundred and fifty-three patients with acute hepatitis B infection over a four-year period have been reviewed. They were predominantly young males (60%) with a mild illness. There was no indication of the source of the infection in 56 patients (36%), while 52 patients (34%) had a history of intravenous narcotic abuse. Twenty-five patients were hospital staff members, while the remainder had known environmental associations with the hepatitis B virus. Eight of the 80 patients who were followed up for longer than six months had persistent hepatitis B surface antigenaemia, and evidence of progression to chronic hepatitis.


Coeliac disease. Haematological features, and delay in diagnosis. Seventy patients consecutively diagnosed as having coeliac disease were studied with regard to the clinical and laboratory features of related blood disorders and the delays that occurred in making the eventual correct diagnosis. Eighty-four percent of these patients had some readily demonstrable haematological abnormality. Thrombocytosis was present in 44% of the patients appropriately studied and hyposplenism was diagnosed in 21% of the total group. The importance of associating these conditions with coeliac disease has been stressed. The average delay from the time of initial presentation with relevant symptoms to correct diagnosis was 73 months.


Intestinal pseudo-obstruction.

Intestinal pseudo-obstruction. Intestinal pseudo-obstruction is a fairly common clinical condition. It is often asosociated with the taking of phenothiazines, tricyclic antidepressants and anti-Parkinsonian drugs, or with another disease. Treatment is conservative, unless gross colonic distension cannot be relieved or perforation is suspected. Vasopressin (Pitressin) may be a useful adjunct in management.


Injuries in Rugby League football.

Injuries in Rugby League football. All injuries occurring in the top three grades of a New South Wales club were documented over a one-year period (1978). Two hundred and four injuries were recorded and over half of these injuries (51%) occurred in the lower limbs. The injury rate was calculated at one injury per 3.6 man hours of play. There was a significant difference in the type of injury sustained by forwards and backs, the forwards receiving more cuts, bruises and haematomas, and fewer joint injuries. This difference is probably because of the nature of the game played by these subgroups.


Children born after elective induction of labour. A comparison was made between the performance at eight years of age of 63 children who were born after elective induction of labour, and 29 spontaneously born children. The children had been tested previously at five years of age. Tests of reading and arithmetic achievement, visuomotor coordination, aural-visual coordination, auditory discrimination, and behavioural rating scales were administered. On two of the 12 measures (reading comprehension and euroticism) the induced children performed better than the spontaneously born. On all other measures there were no significant differences. There appeared to be no evidence of specific learning disabilities or behavioural problems among the induced children.


Epidemics of procedures: growth in admissions to hospital in Western Australia, 1972 to 1977. Admissions to hospital, associated with procedures, increased by 20% in Western Australia between 1972 and 1977. This increase in hospital-based procedures appeared to be widespread, both in terms of types of procedures and in terms of age groups of patients. For some procedures the increase was so large as to imitate an "epidemic". Manpower data indicate a parallel growth in practising clinical specialists and the increase in admissions to hospitals. Some suggestions are made about this association and possible causal factors.


Five-year review of spinal cord injuries in motorcyclists. One hundred and twenty motorcyclists with significant spinal cord injuries, who were admitted to hospital over a five-year period, have been reviewed. Fifty-one per cent of them suffered direct injuries to the vertebral column and spinal cord, the majority remaining permanently paraplegic. Thirteen of the 25 riders who became tetraplegic were wearing open-face helmets, and 11 of these remained permanently paralysed. The survey suggests that the open-face helmet offers less protection to the cervical spinal cord than the full-face helmet. There is an urgent need to review standards for the design of helmets worn by motorcyclists.


Effect of radiographic positioning on the heart shadow in dogs. Dorsoventral thoracic radiographs of 9 dogs were taken from 0 degree to 20 degrees to the right and to the left of a vertical line from mid-sternum to the mid-thoracic vertebrae. Certain measurements indicated that angles greater than 5 degrees from the vertical introduced significant distortions of the heart shadow and thoracic wall in some instances. A method is proposed for determining from a DV thoracic radiograph when improper positioning has produced an angulation greater than 5 degrees.


Necrotizing lymphadenitis as a cause of acute abdominal distress in a dog. An unusual case of acute abdominal distress caused by necrotizing lymphadenitis of the retroperitoneal lymph nodes in a 10-year-old Springer Spaniel is presented. The retroperitoneal lymph nodes were severely distended, but no other abnormalities were found in the abdominal cavity or elsewhere. Biopsy revealed acute necrotizing lymphadenitis, which should be considered in the differential diagnosis of acute abdominal disorders in the dog.


The presence of minor histone components in the chromatin of Pisum sativum L. seedlings. Two minor basic protein components (M1 and M2) were found in the histone extract from chromatin of pea seedlings. In the histone extract of pea cotyledons only one minor component (M1) was detected. These minor components show a high affinity for chromatin, have a molecular weight of 20.200 and 17.800 respectively and a basic amino acid composition. They are not contaminants of cytoplasmatic origin. Two similar minor components were found in the chromatin of Pisum arvense and Lens culinaris-seedlings, one component was present in the chromatin from cotyledons of these species.