Increased permeability to horseradish peroxidase across cerebral vessels, evoked by electrically induced seizures in the rat. Under normal conditions a slight vesicular transfer of intravenously injected horseradish peroxidase (HRP) occurs across the endothelium of cerebral vessels, especially short segments of arterioles. The vesicular transport can be notably increased by chemically induced acute hypertension. In the present investigation 4 groups of animals received HRP, and the permeability of the cerebral endothelium was studied semimacroscopically, light microscopically and electron microscopically. The rats in group 1 were given 10 electroshocks. This caused a significant rise in the blood pressure (BP). Furthermore, a noticeable extravasation of HRP was observed, especially across the endothelium in cerebral arterioles. From the basement membranes of the vessels reaction product could be followed into the extracellular spaces of the neighbouring neuropil. Group 2 comprises rats that were given 10 electroshocks preceded by transection of the cervical part of the spinal cord. The BP remained at normal level and the permeability was unaltered. The animals in group 3 received only 1 electroshock. Usually, the BP was markedly increased and this was accompanied by enhanced permeability across the vessels of the brain. Group 4 consists of control animals, injected with HRP and treated as groups 1 and 3 with the difference that electrical stimulation was not performed. A general feature was that no endothelial damage was observed and that reaction product was not found between neighbouring endothelial cells from the first luminal to the first abluminal tight junction. Based on the observations it seems reasonable to assume that the increased permeability of tracer that occurs after 10 electroshocks or only one is caused by the acute hypertension evoked by the electrical stimulation; furthermore, the transfer is concluded to be vesicular transport.


Chronic relapsing polyradiculoneuritis in a cat. An 18 month old cat had a 6 month history of abnormal high stepping gait, ataxia, muscle twitching and loss of sensory perception. The clinical course was interrupted by several episodes of temporary remission. The essential pathological features were those of a polyradiculoneuritis with segmental demyelination, focal mononuclear cell infiltration and hypertrophic onion-bulb formations. The condition is compared with chronic relapsing polyradiculoneuritis in the dog and in man.


Primary cerebral neuroblastoma: a light and electron microscopic study. A small-cell neoplasm in the left temporal lobe of a 10 and a half year old boy was studied by light and electron microscopy. Routine sections of the mass showed a differentiating neuroblastoma with Homer Wright rosettes, several foci of immature neoplastic neurons (ganglion cells), and many mitoses, areas of necrosis and tumor vessels showing endothelial proliferation. Ultrastructurally, most cells resembled early fetal neuroblasts and also were similar to those in murine and peripheral human neuroblastomas.


Histopathological evaluation of materials implanted in the cerebral cortex. Histopathological changes of the cerebral cortex in response to small, penetrating metal and non-metal implants were analyzed by means of light and electron microscopy. The needle-shaped implants were left in place during all stages of histological preparation and embedded in plastic together with the cortex. Changes of the brain-implant boundary were classified as non-reactive, reactive, or toxic, according to the reactive cellular constituents. Among the non-reactive materials were several plastics and metals such as aluminum, gold, platinum, and tungsten. The boundary of these implants displayed little or no gliosis and normal neuropile with synapses within 5 micron of the implant's surface. The boundary of reactive materials such as tantalum or silicon dioxide was marked by multinucleate giant cells and a thin layer (10 micron)) of connective tissue. Toxic materials such as iron and copper were separated from the cortical neuropile by a capsule of cellular connective tissue and a zone of astrocytosis. Cobalt, a highly toxic material, produced more extensive changes in the zones of connective tissue and astrocytes. These results indicate that a variety of materials are well tolerated by the brain and could be used in the fabrication of neuroprosthetic devices.


An unusual intraspinal connective tissue mass. The fine structure of a surgically excised intradural spinal mass is described. The mass was essentially composed of giant collagent fibers measuring up to 500 nm or more in diameter. In addition, small collections of collagen fibers with unusual cross banding pattern were occasionally observed. The precise nature of this apparently unique lesion simulating an intraspinal tumor remains undetermined.


Ultrastructure of oncocytic adenoma of the human pituitary gland. Two cases of oncocytic adenoma occuring in the pituitary are reported. Both were men aged 40 and 50 years respectively and there was no evidence of endocrine abnormality. In both the tumours many cells showed abundant acidophilic finely granular cytoplasm which had not stained positively with PAS-orange G stain. Electron microscopically the cells contained numerous mitochondria associated with marked reduction of other cytoplasmic organelles including the secretory granules.


Brain monoamines in human cerebral infarcts. A preliminary study. Dopamine (DA), serotonin (5-HT), and 5-hydroxyindole acetic aced (5-HIAA) were assayed spectrofluorometrically in various brain regions of 8 human patients who died after acute and old cerebral infarction. In both recent and older infarct a total depletion of DA and 5-HT was associated with slight reduction of DA and 5-HT levels in remote nonischemic areas and various nuclei of both the injured and contralateral hemispheres. 5-HIAA was significantly reduced in acute ischemic necrosis, while the perifocal edema zone showed considerable accumulation of both 5-HT and 5-HIAA. The degradation zone surrounding old infarcts showed a mild decrease of both 5-HT and 5-HIAA, indicating normalization of K-HT metabolism and turnover after decrease of cerebral edema. These preliminary data which confirm previous findings in experimental cerebral ischemia and infarct indicate that disorders of brain monoamine metabolism are contributing to the development of postischemic brain damage and the complicating cerebral edema.


Peripheral neuropathy in mutant diabetic mouse [C57BL/Ks (db/db)]. A new animal model for the study of diabetic neuropathy is presented. The homozygote (db/db) of the mouse strain C57BL/Ks shows severe diabetes with longstanding hyperglycemia. Electrophysiological studies showed severely decreased motor nerve conduction velocity. Morphometric examination of sensory and motor nerves at different levels revealed absence of large myelinated fibers, with morphological features indicative of axonal atrophy.


Plasma steroids in the foetal and maternal circulation at normal delivery and elective caesarean section. Maternal and foetal plasma collected at normal delivery and at elective caesarean section was assayed for sex steroid levels. Foetal cord plasma concentrations of progesterone, 17-hydroxyprogesterone, oestrone and oestriol were higher than maternal values at normal delivery, whereas oestradiol levels were lower. Oestrone concentrations were higher than oestradiol in the foetal circulation at normal delivery and oestrone values were higher following normal delivery than at elective caesarean section.


Electrical potential difference across the mid-term human placenta. Electrical potential difference across the mid-term human placenta was recorded during hysterotomy. The average value registered was 2.7 mV (S.E. of mean=0.4 mV, n=7), fetus negative. From this value and the concentrations of Na, K, Ca, Cl and inorganic phosphate in maternal and fetal plasma the possible mechanisms of net transport from mother to fetus are inferred. It is concluded that of the above ions only the transport of Na is compatible with simple diffusion.


Maternal mortality in Sweden 1955-1974.

Maternal mortality in Sweden 1955-1974. A survey of the causes of maternal death in Sweden during the years 1955-74 is presented. 296 cases, where autopsy has been performed in 94%, have been reviewed. 219 have been classified as obstetrical deaths and 77 as non-obstetrical. During the period an almost uniform lowering of the maternal death rate occurred. The explanation is a probable improvement in the quality of the medical care given in the hospitals and the antenatal clinics.


The influence of locally administered prostaglandin E2 and F2alpha on uterine motility in the intact non-pregnant human uterus. Clinical studies on the effect of locally administered prostaglandin E2 and F2alpha on the sensitivity and reactivity of the non-pregnant human uterus were performed in 16 volunteers. With the use of the flaccid microballoon technique, uterine recordings were made at frequent intervals throughout the menstrual cycle. As little as 0.25 microgram PGF2 or 1.0 microgram PGF2alpha effected an increase in uterine motility during most of the proliferative and secretory phases of the menstrual cycle. However, a marked decrease in sensitivity and suppression of reactivity to either prostaglandin compound was observed around ovulation. Moreover, an inhibition of uterine contractility in response to PGE2 but not to PGF2alpha was noted during active menstrual bleeding. Circulating levels of estrogen could be correlated generally with these uterine responses. Endogenous prostaglandins normally occur in the secretory endometrium in levels compatible with the amount of exogenously administered prostaglandins which elicited increased, decreased, or unchanged uterine activity in this study. These findings suggest that local prostaglandin E2 and F2alpha in concert with variable levels of circulating estrogen, may play important roles in the cyclic regulation of uterine motility during the menstrual cycle.


Human ovarian tumours heterotransplanted to "nude" mice. 22 different human ovarian tumours were heterotransplanted subcutaneously to female "nude" mice. When small tissue pieces were used 10 out of 16 tumours grew. Subcutaneous injections of suspended tumour cells were made to 11 mice: all failed. Metastatic or infiltrative growth was never seen in the mice observed for up to 25-40 days. Material from each tumour was transplanted to four separate sites in two mice. The successful grafts largely retained the original morphological features. As measured with H3-thymidine incorporation, DNA-synthesis was also similar in the original tumours and the growing grafts. This animal in vivo model might be highly informative for the study of inter alia fundamental biology, chemotherapy, and irradiation of ovarian tumours.


Relaparotomy in advanced ovarian carcinoma. Patients with Stage III ovarian carcinoma were treated either with extensive initial surgery and postoperative radiation therapy (17 patients) or with a less extensive initial laparotomy, postoperative radiation therapy and relaparotomy (19 patients). Better results were obtained among the patients in the latter group.


Acute fatty liver of pregnancy with disseminated intravascular coagulation. A patient with acute fatty liver of pregnancy associated with disseminated intravascular coagulation (DIC) is reported. The case lends support to the hypothesis that DIC may be of pathophysiologic significance in this disorder. Treatment principles are discussed and the importance of prompt Caesarean section as early as possible after the onset of symptoms is emphasized.


Delivery complicated by myasthenia gravis and epilepsy. The literature on the possible risk of myasthenia gravis complicating pregnancy and delivery is sparse and partly contradictory but some of the reports on the number of perinatal and neonatal deaths are alarming. Epilepsy in pregnancy implies on approximately twofold risk of intervention in connection with labour. A pregnant patient with myasthenia gravis and epilepsy has recently been delivered. The case is reported and the considerations with regard to suitable anaesthesia and the two diseases are discussed.


Rupture of the spleen during delivery.

Rupture of the spleen during delivery. A case of traumatic rupture of a normal spleen in a complicated delivery is presented. The etiology of splenic rupture and therapeutic aspects of this unusual occurrence are discussed. It is pointed out that a violent expression of the fetus might be dangerous for the mother.


Haemodynamic effects of oxytocin (syntocinon) and methyl ergometrine (methergin) on the systemic and pulmonary circulations of pregnant anaesthetized women. The haemodynamic effects of oxytocin (Syntocinon) and methyl ergometrin (Methergin) were studied in 9 healthy females in the first trimester of pregnancy. The patients were anaesthetized with sodium thiomebumal, pethidine and pancuronium bromide and ventilated on a Manley respirator. 10 i.u. oxytocin given as an i.v. bolus brought about a fall in femoral arterial pressure of 40%, systemic resistance 59% and pulmonary resistance 44% 30 sec after injection. However, the heart rate increased 31% and stroke volume 17%, so that the cardiac output increased by 54%. The pulmonary arterial pressure and wedge pressure were increased by 33% and 35%, respectively 150 sec after injection. No changes were seen in the haemodynamic parameters during infusion of 80 mU oxytocin for 10 min. 0.2 mg Methergin brought about an increase in the femoral arterial pressure of 11%, pulmonary arterial pressure 27% and wedge pressure 31%, with no changes in the other measured parameters. The use of oxytocic drugs in patients with compromised circulation is discussed.


Peripheral vasoconstriction in the rat in response to sound. I. Dependence on stimulus duration. Vasoconstriction in response to sound has been studied in the non-anaesthetized rat. Arterial pulsations in the tail were recorded by a non-invasive technique. Broad-band noise bursts at 80 dB SPL with durations from 1 ms to several hours were presented in a free field in a sound-isolated box. The results show that acoustic energy is integrated with a time constant of about 0.1 s. The responses during continuous stimulation habituated slowly and the time to halfway normalization of arterial pulsation was more than 15 min.


Transtympanic electrocochleography during glycerol dehydration. Thirteen patients with Meniere's disorder were tested using transtympanic electrocochleography during glycerol dehydration. The most common finding was a decrease in the negative summating potential and this appeared to be a more sensitive indicator of changes occurring in the cochlea than pure tone audiometry and speech discrimination. A pathophysiological explanation for this observation is offered and the possibility of using this decrease in the negative summating potential as a pointer to the prognosis of endolymphatic sac surgery is discussed.


Relation between the waveform of the cochlear whole nerve action potential and its intensity function. The whole-nerve action potential (AP) was recorded by intracochlear electrodes in the guinea-pig. As is well known, in normal conditions, the AP elicited by tone bursts displays negative and positive deflections. Inactivation of the central end of the nerve at the internal auditory meatus (IAM), by introduction of a few drops of KC1 solution, or by mechanical pressure, produces a change in the wave shape of AP which is transformed into a single negative deflection. The relation of the amplitude of the monophasic AP to the intensity of the tone burst is monotonic, in contrast to the classical two-slope variation observed in normal conditions. These results are interpreted by the disappearance of a positive component of the response produced at the IAM. The convolution of the monophasic unit AP would explain the monotonic intensity function.


Cochlear frequency sharpening-a new synthesis. Recent evidence indicates a substantial difference in sharpness of tuning between basilar membrane mechanics and primary neuron responses in mammals. This paper describes a new qualitative model for a sharpening mechanism. It is suggested that the inner hair cells are sensitive to d.c. potential changes in scala media that are induced by sound stimuli, and that these d.c. potentials can suppress neuron activity in a frequency-dependent way. The model explains sharpening of both sides of neural tuning curves, the shape of the low-frequency part of the tuning curves and is also compatible with other phenomena such as two-tone inhibition and the effects of electrical polarization of the basilar membrane.


Some experiments on temporary threshold shifts produced by short tones. TTSs produced by short (500-1000 msec) pure frequency (2000, 3000, 4000 c.p.s.) tones on normal young subjects show, under comparable conditions, the same essential characteristics as TTSs which follow longer stimulations. In particular, they show a tendency to a displacement of their maximal values, as soon as the stimulating tone is presented at adequately high (100 dB SPL) intensity levels, towards a frequency about a halfoctave higher than that of the stimulating tone. In our experiments, however, this tendency was more clearly and constantly demonstrable following stimulations with 3000 c.p.s. tones. Significant individual variations in quantitative aspects of the TTSs have been observed. It is suggested that the use of short tones may be easier and more applicable in practice in investigations concerning the after effects of acoustical stimulation and possible also in procedures aimed at obtaining a better understanding of the significance of individual variations in the behaviour of the receptor organ upon exposure to high intensity stimulations.


Cochlear pathology following exposure to mercury. The sensory and secretory epithelia may become morphologically changed following the exposure to mercury chloride. The earliest and most sever change in the sensory epithelium appeared in the apical part of the cochlea, while the basal coils were only seldom damaged (cytocochleogram studies). Acute intoxication mostly affected both afferent and efferent nerve terminals and the hair cells, while chronic poisoning could also damage the stria vascularis.


Clinical findings and diagnostic problems in sensorineural low frequency hearing loss. The otological and audiological findings in 39 patients with sensorineural low frequency hearing loss are reported. This type of perceptive hearing loss is difficult to distinguish from the true conductive hearing losses due to the air conduction audiogram shape and the invalidity of bone conduction determinations showing a false "air-bone gap". This may lead to surgical treatment of a perceptive hearing loss, as reported in the four case histories. By various audiological tests, contradictory information may be obtained. In our material, Bing's test and absent acoustic reflexes indicated a conductive disorder in 25% of the ears. The final differentiation may require cochleography. The hearing loss may be diagnosed as Meniere's disease. In our material only 17% complained of tinnitus and no patients had vertigo. Consequently, we find sensorineural low frequency hearing loss to differ from Meniere's disease. Our material comprises different etiological types of perceptive low frequency hearing loss. On type was inherited as an autosomal dominant trait, another type due to cochlear malformation probably also inherited, and a third group showing diverse audiological results. When the diagnosis is established, the patients may be treated successfully by specially constructed hearing aids.


Auditory function after Haemophilus influenczae meningitis. Eighty-three children, having recovered from Haemophilus influenzae meningitis, were examined with audiometrical tests. Fifteen of the children (18.1%) had significant hearing loss. Bilateral severe hearing loss was found in 3 patients. Three patients had severe hearing loss affecting one ear and slight or moderate hearing loss affecting the contralateral ear. Six children had entirely unilateral severe hearing loss. Bilateral or unilateral slight or moderate hearing loss was found in 3 patients. The remaining 68 patients had normal pure tone average. Half of these patients, however, showed minimal hearing impairment at the low and high frequencies.


Hearing in pop musicians.

Hearing in pop musicians. Comparatively few previous studies have investigated the hearing of pop musicians. On the average, a surprisingly low percentage (5%) of hearing loss was demonstrated in 160 pop musicians. The present material comprises 83 musicians, with an average exposure of 9 years. Group mean hearing thresholds show only a slight deviation from normal. Age, weekly and total exposure time appear to increase the risk of hearing impairment. In the individual analysis 13-30% were found to have a sensorineural hearing loss, depending upon the definition of hearing loss. Subjects with hearing loss show a discrete impairment in the frequency range 3-8 kHz. Considering the sound levels and the length of exposure, the incidence of hearing loss is suprisingly low. Possible reasons for this are discussed.


A note on the so-called Lennert's lymphoma (lympho epithelioid cellular lymphoma) concerning its disease entity. Two cases of so-called Lennert's lymphoma, which is characterized by massive infiltrations of focally aggregated epithelioid cells, are presented. Since this lesion was particularly emphasized by LENNERT and MESTDAGH in 1968, the major conflicting issue has been focussed on its precise disease entity whether this is an independent or already-established lymphoproliferative disorder. Based on our experiences, we are rather inclined to regard this lesion to be "a curious histologic variant of an already-established disease entity". In order to investigate its precise disease entity and also in view of a possible significance of the presence of epithelioid histiocytes in the lymph nodes and of tonsillar involvement in relation to immunocompetence of the patients, further accumulation of similar cases is required.


Sinus histiocytosis with massive lymphadenopathy (Rosai and Dorfman) and significant skin involvement. Clinicopathological features of this female patient described here, showing unusual and extremely marked sinus histiocytosis of lymph nodes with considerable systemic lymphadenopathy, accompanying fever as well as acceleration of erythrocyte sedimentation rate fairly well coincided with the symptoms of "Sinus Histiocytosis With Massive Lymphadenopathy" (Rosai and Dorfman). The onset of the present case was in 1966 when the patient was 10 years of age, and she has been followed-up for over 10 years. While persisting to display active clinical manifestations, immunological abnormality with thymus involution was demonstrated--deterioration of cell-mediated immunity, but with non-remarkable humoral immunological data, except for hypergammaglobulinemia with elevation of IgG. In 1973 lymphadenopathy as well as skin eruption extended over the extremities and abnormalities of hematological and serological nature began to improve and at the present date the patient is uneventful. This is the first recorded case of "Sinus Histiocytosis With Massive Lymphadenopathy" (Rosai and Dorfman) in Japan. Considerable skin involvement in the upper and lower extremities was a significant feature and unique in this case.


Desquamation on taste buds.

Desquamation on taste buds. Taste bud surface cells suffer from a desquamation process that modifies the pores' shape and size and the amount of amorphous substance in the pits region. We have studied this phenomenon-which probably plays an important functional role-by light, electron and scanning microscopy.


Epithelial migration on the tympanic membrane. An experimental study. The existence of an epidermal migration pattern was studied in mice using a whole-mount autoradiographical technique. The mitotic activity appeared to be confined to an area close to the annulus tympanicus. A very slow migratory activity of the labelled cells, was observed, situated in the basal cell layer. Perforation of the tympanic membrane showed no effect on the position of the labelled cells. This slow migration described by several authors. The latter migration was suggested to represent a mechanism for cleaning the tympanic membrane.


Four autopsy cases of neonatal giant cell hepatitis died suddenly and unexpectedly from intracranial hemorrhage. The authors present four cases of neonatal giant cell hepatitis who died suddenly and unexpectedly from intracranial hemorrhage, autopsied recently at the Tokyo-to Medical Examiner Office. This series consisted of one male and 3 female infants ranging from 37 to 52 days of age. The cause of death of all cases was thought to be massive intracranial hemorrhage. Referring to the connection between intracranial hemorrhage and neonatal giant cell hepatitis, it was assumed that the former must have occurred due to the hemorrhagic tendencies of the latter, superimposing to the hemorrhage at birth trauma of the head. As to the formation of multinucleated giant cell, it is considered to be of degenerative nature of hepatocytes, i.e. the giant cell is formed by fusion of hepatocytes as a result of the disappearance of bile canaliculi, although the etiology of this hepatitis is still unknown.


Neural discharge of medial geniculate body units and single semicircular canal stimulation. In curarized guinea pigs, 68 neurons of the medical geniculate body (MGB) were tested with vestibular and acoustic stimulations. Single semicircular canals were stimulated thermally. Convergence of acoustic and vestibular afferences on the same MGB unit was observed. Following stimulation of the semicircular canals, activation and inhibition of urinary discharge were recorded, inhibition being predominant, while, when clicks were delivered, bursts of activity occurred. The implications of MGB in vestibular and acoustic integration are postulated.


A simple device measuring differences in level in the oesophagus. A device for measuring the difference in level between the pressure transducer and a point of measurment is described. It can be used in oesophageal manometry with waterfilled catheters to measure and compensate for superimposed hydrostatic pressure. The practical application of the method is illustrated.


Various epithelial and non-epithelial tumors spontaneously occurring in long-lived mice of A/St, CBA, C57BL/6 and their hybrid mice. Various kinds of epithelial and non-epithelial tumors, and tumor-like lesions spontaneously developed in long-lived mice of strains A/St, C57BL/6 and CBA, and of (C57BL/6 X CBA) F1 hybrids, all of which had been fed in the 2nd Department of Pathology, Gifu University School of Medicine. Some tumors were successfully transplanted into the same strain of mice. An interesting tumor line showing phagocytic activity and growing only in the liver even when inoculated subcutaneously, which was obtained from a reticulum cell neoplasm, Type A by Dunn, originated in the liver of a (C57BL/6 X CBA) F1 hybrid male mouse.


Cystic fibrosis of the pancreas in a human fetus. Postmortem examination of a 26 week old (postmenstrual) human fetus delivered by Cesarean section revealed meconium ileus and many swollen mucus-secreting cells in the gastro-intestinal mucosa. The pancreas showed extensive fibrosis, acinar destruction and dilatation of ducts containing eosinophilic casts. Mucous glands of the lungs also revealed mucous cells swollen and distended with their secretory products. The patient is believed to have cystic fibrosis of the pancreas, suggesting that the pathologic manifestations of the disease may begin early in fetal life.


Focal "spontaneous" alterations and loss of endothelial cells in rabbit aorta. Rabbit aortas were examined by light, scanning, and transmission electron microscopy to observe the morphological steps in focal endothelial cell desquamation. The aortas were not subjected to any instrumentation prior to fixation by either immersion alone or combined perfusion and immersion. In areas where boundary layers separation of flow with eddy formation is known to occur, many elongated protruding cells were observed, some obviously partly loosened from the basement membrane. Some of the latter cells appeared to be attached by two ends and to be twisted longitudinally. Single cells, or even sheets of cells, were completely detached. The breaks seemed to have taken place close to, and parallel with, intercellular junctions, but not within these structures. Platelets had reacted both with injured cells and the denuded intimal surface. Thus, the sequence appears to be protrusion of cell body, partial loosening of cells from the basement membrane, breaks near the intercellular junctions, twisting of cells, and complete detachment.


Histological and fine structural studies on pigmented neuroectodermal tumor of infancy. Pigmented neuroectodermal tumor of infancy originating from the anterior maxilla in a two-month-old male has been studied by light and electron microscopy. The tumor is characterized histologically by two types of neoplastic cells embedded in considerable amounts of fibrous stromal tissue. The first type of cell is cuboidal to columnar in shape with an epithelial appearance having abundant cytoplasm; either scanty or a heavy accumulation of melanin pigment is observed in the cytoplasm. These cells are aligned along the cleft-like space or arranged in small ductal structures. Electron microscopy shows the characteristic features of melanocytic cells having a varying degree of asynchronous maturation of melanosomes. The second type of cells is small and round in shape and has a hyperchromatic nucleus and scanty cytoplasm, resembling neuroblastic cells or lymphocytes. Electron microscopy reveals cytoplasmic processes resembling immature neuritis which protrude into the intracellular space; a small number of secretory granules having a central core surrounded by a single limiting membrane are observed in the cytoplasm and cytoplasmic processes.


Ultrastructural observations on the parotitis autoimmunica in the NZB/NZW hybrid mice. The lesions of the spontaneously occurring sialoadenitis in the parotid gland of New Zealand Black/New Zealand White (NZB/NZW) hybrid mice were studied with the light microscope and the electron microscope. The inflammatory mononuclear cell infiltrates of the glands observed adjacent to glandular vessels and ducts were found to consist of several different cell types. Lymphoid cells (large, medium sized and small lymphocytes) were the most common, but plasma cells, histiocytes and macrophages were also encountered. Furthermore lymphoid cells were frequently observed inside the basement membrane of acini as well as INTERcalated ducts. Evidence of cell damage of the epithelium invaded by lymphoid elements included loss of cytoplasmic density, vesiculation of the endoplasmic reticulum, the appearance of cytoplasmic vacuoles, and cellular lysis. All the animals studied displayed moderate to advanced glomerular, wire-loop lesions in the kidneys. The light and electron microscopic findings indicate that the parotitis in NZB/NZW mice is basically a vasculitis. Duct cell proliferation and epimyo-epithelial island formation, which are common features in Sjögren's syndrome, are totally lacking in the material studied.


Tumour cell death: the probable cause of increased polyamine levels in physiological fluids. The occurrence of extracellular polyamines in Ehrlich ascites tumour-bearing mice was studied in relation to tumour growth. The concentration of putrescine and spermidine in cell-free ascites fluid and serum was found to increase significantly with increasing tumour mass. Data is presented which suggest that the observed accumulation of extracellular polyamines is a result of a continuous release from dead or dying tumour cells. This observation is consistent with the notion that extracellular polyamines accumulate during tumour growth and following radio- and chemotherapy as a result of tumour cell death, and emphasizes the potential clinical usefulness of the polyamine analysis for evaluating tumor cell kill.


Solitary dural plasmacytoma.

Solitary dural plasmacytoma. Only four of the nine published cases of solitary, extraskeletal, intracranial plasmacytoma are considered authentic. In this report we describe an accidentally discovered dural plasmacytoma and draw the attention to this rare lesion which might have a different prognosis from the rather benign course of meningioma with which it is confused.


Carcinoma of the uterine cervix and dysplasia in Greenland. A preliminary study, based on officially recorded cases of cervical carcinoma, dysplasia and carcinoma in situ in Greenlandic women over the period 1955-1975 revealed a total of 117 cases of carcinoma and 119 cases of dysplasia and carcinoma in situ. The incidence of invasive carcinoma, age-adjusted to "European standard population" (Doll 1976), exhibited a rise from 20.9 per 100,000 in 1955-1959 to 84.8 in 1970-1975. The latter incidence rate is one of the highest in the world, and about 2.5 times as high as the most recently recorded incidence in Denmark. Age-specific incidence rates for cervical carcinoma in Greenland for 1970-1975 showed significantly higher values in the age groups 15-49 and 60-64 years as compared with the most recent Danish rates. The crude incidence of dysplasia and carcinoma in situ per 100,000 women over 15 years of age rose from 10.5 for 1955-1959 to 137.5 for 1970-1975. The corresponding incidence for severe dysplasia and carcinoma in situ was 93.7 for 1970-1975. There has most likely been a more complete registration of these initial stages during recent years, although organized detection work has not been initiated.


Plasma membrane motility and proliferation of human glioma cells in agarose and monolayer cultures. Human glioma cells, growing as spherical colonies in agarose gel, or as monolayers on glass or plastic, were studied with time-lapse cinematography and electron microscopy. The cells in the agarose cultured colonies often had ruffling-like membrane structures which were similar in for, although smaller in size, than those observed on monolayer cultured cells. The ruffling-like structures were more frequent at the periphery than in the central regions of the colonies which was in parallel to the proliferative pattern. In time-lapse cinematography it was seen that pinocytotic vacuoles were formed from ruffling membranes in the monolayer cultures. In the transmission electron microscope, such vacuoles were also found near the ruffling-like structures in the agarose cultured cells. In dense monolayer cultures, ruffling and associated pinocytosis were to a large extent transferred from the margin to the upper surface of the cells. This capacity may be an important property for the ability of the malignant cells to attain extreme high cell densities in monolayer cultures and to grow as colonies in agarose cultures. As has been previously shown, the normal counterpart of the gliomas, the glia cells, cannot grow to high densities; they do not ruffle on their upper cell surface and are unable to grow in suspension or agarose culture.


Morphometric and dynamic studies of bone changes in hypothyroidism. Bone biopsies were performed after tetracycline double-labelling by transfixing the right iliac crest in fourteen hypothyroid patients. The bone changes in cortical and trabecular bone were determined by simple measurement and point counting on decalcified and undecalcified stained sections and compared to normal controls and to sex and age matched hyperthyroid patients. The amount of trabecular bone and the cortical porosity were unchanged in the hypothyroid patients compared to normal controls, whereas the mean cortical thickness was increased. The amount of osteoid and the length of the osteoid seams were normal, whereas the mean width of the osteoid seams was decreased. The linear calcification rate in cancellous bone was decreased, as were the active calcification surfaces (tetracycline-labelled) and the percentage of osteoid covered surfaces active in mineralization. The osteoclastic resorption surfaces were unchanged in trabecular bone, whereas the osteoclastic activity in cortical bone was decreased. The osteocytic osteolysis was normal. The bone changes in hypothyroidism were opposite to the changes in hyperthyroidism characterized by a very low bone turn-over with a reduced osteoid apposition and bone mineralization rate, an inactive osteoclastic resorption in trabecular bone and a decreased osteoclastic resorption in cortical bone.


Pulmonary excretion of carbon black injected into the cerebral ventricles of the rat. After injection of a mixture of carbon black and a iodinated X-ray contrast medium into the cerebral ventricles of rats carbon black loaded macrophages were found in the alveolar septa in the lungs. It is concluded that contrast media used in cerebral ventriculography are eliminated at least partly by discharge of pulmonary macrophages.


Accident and its correlates in a psychiatric hospital. The literature on accidental and violetn minor injuries in hospitals is reviewed. From it hypotheses about the causes and correlates of such accidents are derived. These theories are tested on a 2-year sample of accidents in a 2,400-patient mental hospital, using standard multivariate statistical procedures. Age, psychiatric disability, and sex prove to be correlates of rates of injury. Social disorganization is shown to be the intervening variable in the common theory that crowding leads to violent injury.


The Marke-Nyman temperament scale. Evaluation of transferability using the Rasch item analysis. The purpose of this study was to test the transferability of the Marke-Nymann Temperament Scale (MNTS) using the Rasch item analysis. The results showed that the three Sjöbring personality dimensions Validity, Stability, and Solidity measured by the MNTS were without transferability. However, the item analysis demonstrated a subscale for each of the three Sjöbring dimensions having adequate transferability, i.e. the subscales continued to test the same dimension in different groups of patients. These subscales still cover much of the range of the original descriptions by Sjöbring.


Intellectual functioning in a 70-year-old urban population. A subsample of 229 persons from the population study "70-year-olds in Gothenburg" was studied with different intelligence tests. The non-response was 15%, and another 4% refused to take part in the psychological examination or had handicaps which made the performance of all or some of the tests impossible. Measurements were made of verbal meaning (SRB1), reasoning (SRB2), spatial ability (SRB3), perceptual speed (Ps-if) and logical thinking and observation (Raven's Coloured Progressive Matrices). There were no differences in the tests between men and women except with Raven's Coloured Progressive Matrices, where the men had a better score. Amongst the women, those who had received a longer education had a better score compared with those who had had less education. Norm-tables for the different tests are presented. As far as could be judged from cross-sectional comparisons the average general cognitive capability was good, even though the 70-year-olds to a higher degree were suffering from mental disorders than younger individuals and more often were living in social situations that could have influenced basic physical and mental functions. The perceptual speed was the only ability that showed a marked change at the age of 70.


Effect of lithium on hypothalamic-pituitary dopaminergic function. The effect of lithium on apomorphine-induced growth hormone secretion and haloperidol-induced prolactin secretion was examined in eight male subjects without history of manic-depressive illness. Lithium had no effect on baseline or drug-induced changes in serum growth hormone or prolactin concentrations. These data suggest that lithium does not alter hypothalamic-pituitary dopamine receptor function.


Calcium metabolism in lithium-treated patients. Relation to uni-bipolar dichotomy. The bone mineral content (BMC) together with biochemical indices of calcium metabolism were measured in 83 manic-depressive patients on long-term lithium therapy. The patients were diagnosed and divided into a unipolar and a bipolar group according to strict symptomatic course criteria. The patients with bipolar course had a significantly decreased BMC (88% of normal, P is less than 0.001), while the unipolar patients had normal BMC. Both groups had biochemical changes consistent with primary hyperparathyroidism.


Fifteen years later. A comparison of patients in Danish psychiatric institutions in 1957, 1962, 1967, and 1972. The census study in 1972, including all Danish psychiatric institutions, was the fourth in a series, the first being performed in 1957. In the 15-year period from 1957 to 1972 the total number of hospitalized psychiatric patients, including day-patients, has been almost unchanged, about 240-260 per 100,000 population. There have, however, been marked changes within the resident population. The hospital prevalence of schizophrenia has gradually decreased from 132 to 97 per 100,000 males and from 140 to 86 per 100,000 females. The decrease concerns all age groups over 35 years and is especially pronounced in females aged 35-54. In young males there has been a remarkable increase during the last 5-year period. In 1957 the schizophrenic patients constituted 62% of the male and 57% of the female patients, compared with 43% and 30%, respectively, of the patients in 1972. The downward trend which was practically linear during the first two 5-year periods slowed down during the third period but was still quite marked for the middle-aged and old groups. The patients with organic disorders (especially senile and cerebrovascular psychoses) and with reactive conditions have increased in absolute numbers as well as in rates per 100,000 population.


Motivation for cross-dressing in heterosexual transvestism. The literature concerning the motivation for cross-dressing in heterosexual transvestism is briefly reviewed. Thirty-three members of a club established for heterosexual transvestites were interviewed. The sensations they derived from cross-dressing and the importance of compulsive and narcissistic aspects in their transvestite behaviour were assessed and compared with those reported by 24 transsexual subjects. While cross-dressed, transvestite and transsexual subjects frequently reported feeling relaxed, comfortable and relieved of masculine demands. Transvestite subjects showed significantly more compulsive and narcissistic aspects in their transvestite behaviour than transsexual subjects. Fetishistic pleasure was infrequently given as a motivation for cross-dressing.


Endorphins in human cerebrospinal fluid: clinical correlations to some psychotic states. The significance of endorphins, endogenous morphine-like agents, in some psychiatric disorders was investigated. Samples of cerebrospinal fluid were taken by lumbar puncture from healthy volunteers and from patients with schizophrenic, manic-depressive and puerperal psychosis and analyzed for two major fractions of endorphins (Fractions I and II). In 19 healthy volunteers the levels of the two fractions fell within a fairly narrow range. In contrast, six out of nine drug-free and symptom-rich schizophrenics showed elevated levels of Fraction I, which returned to normal or slightly supranormal values after treatment with neuroleptics or propranolol. This decrement was paralleled by a clinical improvement in four of six responding patients. In four manic-depressive patients, serial samples of cerebrospinal fluid revealed elevated endorphin levels, particularly Fraction I during the manic stage. In three out of four patients with puerperal psychosis, the levels of endorphins (either Fraction I or II) were elevated in the acute drug-free stage. During a later symptom-free stage, after treatment with ECT and/or neuroleptics, the endorphin levels were within the normal range. The present data lend credit to the hypothesis that endorphins are involved in some psychotic states in the human.


Diagnostic value for acute myocardial infarction of creatine kinase and lactate dehydrogenase isoenzymes compared with total enzymes. Creatine kinase isoenzyme specificity for myocardial damage. The diagnostic value of creatine kinase (CK) and lactate dehydrogenase isoenzymes was investigated in a prospective study of 201 patients with suspected acute myocardial infarction (AMI). The isoenzymes were analyzed with a column chromatographic method. The patients' final diagnoses were made according to the WHO criteria without knowledge of the isoenzyme results. The prevalence of AMI was 50%. The diagnoses were predicted with significantly greater reliability with the isoenzyme than with the total enzyme determinations in most of the patients. However, the greater diagnostic reliability had sufficient therapeutic consequence to justify the extra analytical cost only in patients for whom the diagnosis must be based mainly on the enzyme results. The CK isoenzyme specificity for myocardial damage was studied in populations with low prevalence of heart disease. In a group of 39 patients who had elevated total CK due to noncardiac disease there were five with elevated isoenzyme values, but since among 69 young healthy persons none had elevated isoenzymes, this was taken to indicate that the isoenzymes may be leaked into the blood from other organs than the heart.


Aortic insufficiency in chronic renal failure. A diastolic decrescendo murmur was heard along the left sternal border in 21 patients with advanced renal failure. Eight patients had organic aortic insufficiency. Among the remaining 13 patients, angiocardiography was carried out in 6; aortic regurgitation was demonstrated in 4, while 2 had stenosis of a coronary artery. Two of the 5 patients with positive angiography have died. At autopsy the aortic ostium was normal. The diastolic murmur in these patients is thought to be functional. It disappears during treatment with hemodialysis and renal transplantation.


Long-term effect of clofibrate on albumin turnover and distribution in man. The long-term effect of clofibrate (at least 6 months' treatment) on albumin metabolism was investigated in 7 subjects and the results were compared with those from 15 control subjects. Human albumin labelled with 131I was used as a tracer. A significant difference between the groups was found in the following parameters: The clofibrate-treated group had a prolonged rapid component (t1 1/2) of the disappearance curve (p less than 0.05), relatively increased albumin in the extravascular space (i.e. decreased distribution ratio, p less than 0.01) and increased extravascular albumin space when corrected for body size by calculating it as per cent of the extravascular bromide space (p less than 0.01). There was no significant difference between the groups in albumin synthesis, fractional catabolic rate or the slow component (t2 1/2) of the disappearance curve. The results suggest that long-term treatment with clofibrate causes changes in the intercellular matrix.


Neuropsychological findings with pseudoxanthoma elasticum. It has been reported that the disease pseudoxanthoma elasticum (PXE) is associated with a high incidence of neurologic and psychiatric symptoms, which are possibly due to cerebrovascular ischemia. These reports are based mainly upon clinical observations made without reference to control group data. We have compared the results of 27 PXE patients with results of a control group on a battery of objective neuropsychological and personality tests. The PXE group showed only very mild deficits on extensive neuropsychological testing, a finding which argues against any marked involvement of cerebral vessels in these patients. Similarly, the personality test results did not reveal significant psychiatric disturbances which could be attributed to PXE. Possible reasons for the descrepancy with previous reports include the subjective data and much older PXE patients on which those reports are based. The need for systematic neuropsychological research with older PXE patients and control groups is suggested.


Hypocalcaemia with zonular cataract due to idiopathic hypoparathyroidism. With a note on the prevalence of severe hypocalcaemia in a health screening. A 59-year-old woman with idiopathic hypoparathyroidism who had tetany and zonular cataract is described. Twelve years ago she had had a period with cramps and convulsions, followed by an absence of symptoms for several years. Judging from the distance between the opacity of cataract and the surface of the lens, the onset of the cataract was estimated to have occurred 11 years ago and the apparent cessation of cataract development 10 years ago. It is suggested that the absence of hypocalcaemic symptoms during the last 10 years was associated with an increase in serum calcium levels, possibly connected with the onset of menopause. The occurrence of hypocalcaemia was analyzed in a health-screened population of 15 903 persons. Nine of the subjects were found to have a serum calcium level of less than 2.10 mmol/l, giving a prevalence of 0.6%0. None had primary hypoparathyroidism, which illustrates the rarity of this condition.


Acute interstitial nephritis during treatment with penicillin and cephalothin. A case of non-oliguric acute interstitial nephritis during treatment with ampicillin, benzylpenicillin and cephalothin is reported. There were symptoms of drug hypersensitivity, including fever, exanthema, eosinophilia and elevated serum IgE. Renal biopsy showed marked interstitial edema and infiltration with numerous eosinophils, some mononuclear cells and giant cells, and scattered tubular damage, but normal glomeruli and vessels. There was no pathological deposition of immunoglobulins or complement in the renal tissue. Renal function recovered after withdrawal of antibiotics and treatment with steroids. The findings suggest a drug-induced, hypersensitivity-mediated pathogenesis of the renal lesions, with participation of both humoral and cell-mediated immunological reactions.


Persistent hypothalamic-pituitary insufficiency following acute meningoencephalitis. A report of two cases. This report concerns two patients, a 43-year-old woman and a 53-year-old man, who developed clinical as well as laboratory signs of permanent gonodal and thyroid failure following an acute intracranial infection--in the woman a meningoencephalitis of unknown origin, and in the man an encephalitis caused by Coxsackie B5. Endocrine investigations were compatible with hypothalamic-pituitary dysfunction, with some of the results favoring a hypothalamic lesion. Perhaps hormone deficiency of hypothalamic and/or pituitary origin is a more common sequel of acute meningoencephalitis than has hitherto been reported.


Hemodynamic evaluation in acute myocardial infarction. Bedside right heart catheterization in patients with acute myocardial infarction and hemodynamic dysfunction provides a rational basis for therapy aimed at maximizing cardiac performance and limiting infarct size. Readily performed and associated with minimal risk, this diagnostic approach is primarily indicated when myocardial infarction is associated with evidence of hemodynamic dysfunction. It affords precise information on cardiac performance and prognosis, allows identification of specific complications such as ventricular septal defect and acute mitral regurgitation, and is of critical importance in selection of therapy. Hemodynamic monitoring is also essential for safe, effective application of certain forms of treatment such as vasodilator therapy for the failing ventricle.


Progesterone receptors of chick oviduct. The chick oviduct progesterone receptor has been purified to homogeneity by affinity chromatography and its molecular action studied in vitro. The native receptor is a 200,000 MW dimer of two dissimilar 4S subunits with different intranuclear function. The receptors directly regulate RNA chain initiation sites in oviduct chromatin by interactions involving target tissue nuclear acceptor sites. There is a 1:1 correspondence between receptor "acceptor" sites and RNA sites. Only the dimer form of the receptor is active in vitro on chromatin templates. The study suggests a novel model for hormone action which can be tested directly in this system.


Vitamin C and osteoporosis in old age.

Vitamin C and osteoporosis in old age. In a study of 80 reasonably healthy geriatric day hospital attenders, a progressive decline with age in bone mass and ascorbic acid level was noted; however, they were not simultaneous in each individual and there was no statistically significant correlation. Ascorbic acid depletion is not a cause of osteoporosis in old age.


Fracture of the femur in old age: A two-centre study of associated clinical factors and the cause of the fall. All patients with fractured neck of the femur admitted to hospitals in two areas (North London and Manchester) in a period of one year have been examined--a total of 384 patients. Compared to control groups of similar age, the older fracture patients showed a higher prevalence of chronic brain syndrome, they were in poorer physical state and their skinfold thickness was less. They also had more unrecognized visual disorders. Those who were younger had a higher prevalence of stroke than comparable controls. The type of fall leading to the fracture varied with age--tripping was the commonest cause in the younger patients the 'drop attacks' in the older. Both stroke and partial sightedness were associated with falls due to loss of balance. The older patients had a very high prevalence of pyramidal tract abnormality associated with chronic brain syndrome--and it appears that these demented patients fall not because of mental confusion but because of associated motor abnormalities. Extra-capsular fractures occur in older patients. They are more likely to have a history of falls but previous fracture is equally common at this age in the fracture and control series.


A study of religious attitudes of the elderly. A study is reported of the religious beliefs, attitudes, and practice of old people in the West of Scotland, based on a questionnaire given to 501 people aged 65 years and over randomly selected from those living at home. Almost all had had a full range of religious instruction, and regarded their parents as religious. Weekly church attendance was commoner among Catholics (70%) than Protestants (40%), among women than men, among those whose beliefs were those of organized religion, and among those with unrestricted mobility. The pattern of participation in church organizations and social activities was similar. A firm belief in an after-life was expressed by 80% of Catholics and 60% of Protestants, and higher proportions derived comfort from religion, especially in bereavement. Over 70% expressed no fear of their own death. In this elderly population, religious beliefs and attitudes remain important considerations, which should therefore be of concern to all those involved in the care of the elderly.


A survey of the haematological, nutritional and biochemical state of the rural elderly with particular reference to vitamin C. A survey of the rural elderly has been carried out to determine basic haematological and biochemical data, and to establish a pattern of living for this 'well' population. The blood parameters related to diet, such as haemoglobin, folate, cholesterol, vitamin C etc., show considerable changes with increasing age in the male but little significant change in the female. The vitamin C status for both sexes compares favourably with that reported by other workers studying the urban elderly. The biochemical and haematological data derived provide a normal range with which the 'sick' elderly can be compared. The subjects were generally active and independent in spite of (or because of) a somewhat Spartan existence.


Career plans of student physical therapists regarding geriatric medicine. Questionnaires designed to evaluate experience in geriatric medicine and attitudes towards a career with a geriatric service were set to final-year students of eight schools of physical therapy. An analysis of replies indicates that many students are not sufficiently involved in the care of the elderly or with the practice of modern geriatric medicine. The majority of students preferred a career which involved both elderly and younger patients and work in geriatric rehabilitation wards and day hospitals.


Changes in rectal temperature of the rabbit by intracerebroventricular injection of bradykinin and related kinins. The effects of intracerebrovascular injections of bradykinin (BK), lysyl-bradykinin (L-BK), methionyl-lysyl-bradykinin (ML-BK) and des-arginyl-bradykinin (Des-Arg9-BK) on the rectal temperature of rabbits were investigated. A linear dose-response curve could be obtained with bradykinin. Equimolar doses to BK of L-BK and ML-BK gave responses of the rectal temperature undistinguishable from those of BK. In contrast, the smaller polypeptide Des-Arg9-BK did not show any hyperthermic properties. Since prostaglandins (PG) are known to potentiate (facilitate) the peripheral effects of BK and display a hyperthermic action, their synthesis being inhibited by antipyretics, we studied the effect of indomethacin and paracetamol on the BK-induced rise in rectal temperature in rabbits. It could be shown that these drugs inhibited partially the response to BK. The possible participation of BK in thermoregulation will be discussed.


Mechanism of the pulmonary edema induced by intravenous injection of scorpion toxin in the rat. The intravenous injection of purified scorpion toxin (tityustoxin, TsTX) into unanesthetized rats induces a severe systemic hypertension followed by a hemorrhagic edema of the lungs. The edema is focal or diffuse, whereas the hemorrhage is always focal and less prominent than the edema. Anesthesia of the rats prevents the appearance of pulmonary edema. It seems likely that this protective action of the anesthesia is due, at least in part, to an interference with the hypertension induced by TsTX. The pulmonary edema is prevented by bilateral adrenalectomy, guanethidine or phenoxybenzamine. It is suggested that the edema depends on a sympathetic-adrenal discharge and that catecholamines released by TsTX act on alpha adrenergic receptors. The mean kininogen content of the rat plasma, 1 h after TsTX injection, is not significantly different from that found in the control animals. The possible role played by kinins and other mediators in the early phases of the pulmonary edema induced by TsTX is under investigation.


Effect of scorpion toxin (tityustoxin, TsTx) on the salivary gland of the rat, in vivo and in vitro. Intravenous injection of purified scorpion toxin (tityustoxin, TsTX) brings about the appearance of salivary flow and of kallikrein and amylase secretion in the saliva of rats. In experiments performed in vitro, using slices of parotid gland, a dose-response curve correlating tityustoxin concentration with kallikrein and amylase activities was obtained. The secretion of kallikrein is slower and smaller than that of amylase after up to 60 min of incubation. Experiments in which propranolol, phenoxybenzamine or atropine were injected into rats or added to parotid gland slices showed that the release of kallikrein is more dependent on cholinergic mechanisms, whereas the release of amylase is mainly related to adrenergic effects. Pre-treatment of the animals with reserpine confirms these results. The actions of tityustoxin on the kallikrein and amylase secretions, per min, are more effective than those by pilocarpine and isoproterenol, respectively.


Naturally occurring low molecular weight inhibitors of neutral proteinases from PMN-granulocytes and of kallikreins. Human mucous secretions contain low molecular weight (Mr approximately 11,000) acid-stable inhibitors directed against elastase and cathepsin G from PMN-granulocytes. Important biochemical properties of these inhibitors are presented and their possible biological function is discussed. An inhibitor of glandular and plasma kallikreins preventing kinin-liberation from kininogen but not ester hydrolysis was obtained from rat kidney tubules. A molecular weight of about 4700 was estimated for this kallikrein-specific inhibitor (trypsin-induced kinin-liberation is not prevented).


Surface activation of factor XII (Hageman factor)--critical role of high molecular weight kininogen and another potentiator). When factor XII was adsorbed to kaolin it slowly became activated and converted prekallikrein to kallikrein. In the presence of HMW-kininogen the rate of activation of factor XII and consequently that of prekallikrein was markedly enhanced. The enhancing effect of HMW-kininogen was a dose-dependent phenomenon. In order to enhance the activation of factor XII on a surface the HMW-kininogen molecule had to be intact. Cleavage of HMW-kininogen by kallikrein decreased the enhancing effect of HMW-kininogen, there being an inverse relation between the bradykinin-generated and the capacity to enhance factor XII activation. Another 'potentiator' of factor XII activation was isolated from proteins adsorbed to aluminum hydroxide. This potentiator further increased the activation of factor XII, also in a dose-dependent fashion. It was postulated that factor XII is slowly converted into its active form by exposure to negatively charged surfaces; that this process is enhanced by kallikrein and further accelerated by HMW-kininogen and the 'potentiator'; and that these enhancing substances probably act by opening active sites on the factor XII molecule.


An aminopeptidase of human neutrophil leucocytes--its possible role in enhanced vascular permeability. An aminopeptidase of human leukocyte lysosomes was partially purified by chromatography on SP-Sephadex, Sephadex G-200 and QAE-Sephadex. By QAE-Sephadex and isolelectric focusing it showed microheterogeneity, focusing at pH 3.7 and 4.1. By gel filtration its molecular weight was estimated to be approx. 200,000. The enzyme had leucine amino peptidase activity and pharmacological assays indicated that it converted lysyl- or methionyl-lysyl-bradykinin to bradykinin. Conversion of lysyl-bradykinin to bradykinin could be confirmed also by chromatography on CM-cellulose. When the neutrophil-derived enzyme acted on methionyl-lysyl-bradykinin it increased its effect of enhancing vascular permeability, when injected intradermally into guinea pits. Thus the enzyme may play a role in neutrophil leukocyte-mediated vascular phenomena of the inflammatory reaction.


The biochemistry of lymphocyte-derived mediators of immunological inflammation. Evidence is presented to indicate that there exists in lymphoid tissue, as a result of transforming lymphocytes, a new lymphokine which is chemotactically specific for lymphocytes, called 'lymphotactin'. Lymphotactin has been purified to electrophoretic homogeneity; has a molecular weight of 10,500 D and an isoelectric point of 5.9. Its role in amplifying the immune defense system by recruitment of naive lymphocytes into propinquity with the challenging antigens is suggested. Purification of macrophage migration inhibitory factor from thymus extracts to electrophoretic homogeneity leads to a compound of molecular weight of 36,500 D and an IEP of 6.9. Chemically it contains sialic acid and o-methyl glucopyranoside as its only carbohydrates. Purified MIF activates the macrophage phagocytically. Skin reactive factor and lymph node permeability factor have been isolated and purified and are found to be inhibited by pepstatin and antihistamine and to have an isoelectric point of pH 4.2 and a molecular weight of 50,000--100,000 D. It is believed that this anionic permeability increasing agent actually arises from the lysosomes of macrophages and lymphoblasts (the normal small lymphocyte having essentially no lysosomal organelles). The mononuclear cell infiltration characteristic of crude SRF and LNPF may proceed from their being contaminated with lymphotactin.


Inflammatory models in rats depleted of endogenous precursors of prostaglandins. Inflammatory models in rats, depleted of prostaglandin precursors, are discussed as a novel approach to investigate anti-inflammatory drug mechanisms independent of interaction with the production of prostaglandins and to study the ambivalent (pro- or anti-inflammatory) role of endogenous prostaglandins.


Biofeedback treatment of orofacial dysfunction: a preliminary study. One quadriparetic patient and three hemiparetic patients, who were two-months, one-year, and three-year's post-stroke, respectively, were involved in a study to compare the effectivess of electromyographic biofeedback versus mirror feedback in correcting orofacial dysfunction. The results of this study support the use of electromyographic biofeedback as an adjunctive tool in muscle reeducation, demonstrate the value of its application by trained allied health professionals, and raise questions for further research.


Olfaction in health & disease.

Olfaction in health & disease. The significance of olfaction is frequently overlooked by health professionals. The purpose of this presentation is to briefly review the neurophysiology of olfaction, survey the relevant research, and present specific implications for occupational therapists working in both physical disabilities and psychiatric settings.


Learning style preferences of occupational therapy students. Fifty-five undergraduate and 22 graduate students in occupational therapy were surveyed by using the Canfield-Lafferty Learning Styles Inventory. The results of the study indicate that their learning style preferences favor the learning conditions that permit knowing and liking the instructor personally, setting one's own objectives, and working alone and independently. The highest content and mode preferences for learning were working with people and engaging in direct experience, respectively. The lowest content and mode preferences were for working with numbers and for reading. Achievement expectations for grades were A and B. The findings are discussed.


The effect of restricted manipulative experience on problem solving. The literature has described restricted active movement as a contributing factor to a general state of distress, behavioral disruption, and cognitive disturbance under experimental conditions and suggests similar effects may result from chronic illness or physical disability. In this study, an attempt was made to investigate the effect of short-term restructed active movement in the upper extremities, specifically with regard to object manipulation, on problem-solving ability. A two-factor design was employed involving 60 male college students ranging in age from 18 to 24. The variables were: restricted versus free manipulation, and easy versus difficult arrangements of a Dunker-type candle problem. An analysis of the variance revealed no significant interaction between problem difficulty and manipulative condition. The restricted manipulation condition produced significantly lower solution times than the free manipulation condition. Observations on the significance of sensory experience arising from active movement and relevant implications for the health care professions are discussed.


Technology transfer: from space exploration to occupational therapy. The technologies developed for the United States space exploration program are frequently adapted for use in other fields, including occupational therapy. For example, technologies transferred from the space program to occupational therapy include a special foam material, developed for space vehicle seating, that is now used as a padding for orthopedic and prosthetic devices; and a control switch, developed for astronauts immobilized by the force of gravity, that has been adapted for use by paralyzed patients. These and similar space technology spinoffs and the several technology utilization programs that help provide new aerospace solutions to health-care problems are discussed in this article.


Traction splint for maximum interphalangeal joint flexion. Several splints are being used, both dynamic and static, for the purpose of increasing finger flexion. The joints affected by the splint as well as the maximum degree of motion feasible vary with the splint design. This paper suggests a splint design for which the specific goal is maximum flexion of the distal and proximal interphalangeal joints (DIP and PIP) while maintaining metacarpophalangeal joint (MCP) flexion.


A seating position for a cerebral-palsied child. An alternate seating position for the cerebral-palsied child who is less impaired in the lower extremities than in the upper extremities is discussed in this article. A straightback wooden chair adapted with armrests, a hip restrainer, and a lapboard with a removable midsection panel, plus an elevated slantboard, provided versatility and was functional as well. This adapted seat not only permits the child greater selfmobility but offers a basic, proper position for activities such as reading, self-feeding--with some assistance, typing, writing, or playing--in other words, proper posture, self-propulsion, eye-foot and eye-hand skills are facilitated.


"Silent" myocardial ischemia during and after exercise testing in patients with coronary artery disease. Although many patients with coronary artery disease (CAD) have a positive exercise test without pain, the frequency and significance of this "silent" ischemia is unclear. Therefore, we studied 122 consecutive clinically stable patients with angiographically defined CAD (greater than 75 per cent luminal stenosis) and a positive exercise test. Seventy-eight patients had pain or anginal equivalent during or after a positive exercise test; 44 did not, including 32 (26 per cent) with no symptoms at all. Patients were evaluated as to age, sex, prior myocardial infarction, congestive failure, hypertension, diabetes mellitus, and digoxin or propranolol therapy--in addition to anginal symptoms before, during, or after the exercise itself. Extent of CAD, presence of collaterals, and left ventricular ejection fraction were also determined. All exercise tests were evaluated for evidence of ST-T abnormalities or prior infarction on the control ECG as well as peak heart rate during exercise and post-exercise degree of ST segment depression. There were no significant differences between patients with and without exercise-induced pain in regard to any of the clinical and angiographic features noted above, demonstrating that "silent" myocardial ischemia during or after exercise testing is not uncommon and is not readily attributable to any obvious clinical or catheterization findings. Further studies are necessary to determine if patients with evidence of "silent" myocardial ischemia are especially prone to sudden death.


Bacterial endocarditis: an analysis of factors affecting long-term survival. The records of 108 patients treated for bacterial endocarditis were reviewed. Six were diagnosed at autopsy and had not been treated for endocarditis. Of the 102 treated patients, 32 died during the first 30 days and 32 more were dead by 365 days. Although some reports indicate a much greater survival rate, our findings are more in keeping with those reports giving a rather poor long-term outlook for patients with endocarditis.


Influence of etiology on the functional result of aortic valve replacement. The functional result of aortic valve replacement has been assessed in patients treated for isolated aortic incompetence. Using maximal oxygen uptake as an index of myocardial function, a significant difference (p less than .05) exists between the patients who had Q fever endocarditis on the one hand and those who had bacterial endocarditis or rheumatic fever on the other hand. We believe that permanent myocardial damage occurs as a result of bacterial endocarditis and rheumatic fever but because of the biological properties of Coxiella burnetii the myocardium is spared in Q fever endocarditis.


Coronary artery spasm and mitral valve prolapse. Ten patients, representing 1.34 per cent of those patients undergoing selective coronary arteriography, were found to have unequivocal evidence of coronary artery spasm. This involved the proximal right coronary artery in eight patients, the mid-left anterior descending branch in one, and the left main coronary artery in one. Eight of these 10 patients had otherwise normal coronary arteries. Of these 10 patients with coronary artery spasm, nine had evidence of mitral valve prolapse. This involved the posteromedial scallop in six patients; the anterolateral and posteromedial scallops in one; the middle and posteromedial scallops in one; and the anterolateral, middle, and posteromedial scallops in one. These data suggest an association between coronary artery spasm and mitral valve prolapse. Coronary artery spasm may thus be an important factor in the pathogenesis of the chest pain, arrhythmias, electrocardiographic abnormalities, and sudden death, that have already been described in some patients with mitral valve prolapse.


Electrode position effects on Frank lead electrocardiograms. Frank lead electrocardiograms were recorded from 149 normal and abnormal adult males using four different electrode placements. All chest electrodes were placed at: (1) the fourth intercostal space level, (2) the fifth intercostal space level, (3) the fourth intercostal space level with V4 substituted for C, and (4) the fifth intercostal space level with V4 substituted for C. Differences in mean values of many commonly used amplitudes and orientations were not statistically significant among the four recording methods, but amplitude differences for individual subjects were often large and difficult to predict. When V4 is substituted for C, as commonly done in some laboratories, Rx decreased and Rz increased by more than 10 per cent in about 40 per cent of the cases. In about 70 per cent of the cases, Rx and Rz changed significantly when electrode level was shifted from the fifth to the fourth intercostal space. For these 70 per cent, it does not appear possible to accurately predict increase or decrease of Rx, Rz, or QRSm. Analysis programs which depend on individual amplitude measurements are likely to be significantly affected by electrode placement. It is suggested that criteria for analysis programs developed using a specified version of the Frank system should ideally be applied only to electrocardiograms recorded in the same manner.


Lidocaine-induced cardiac rate changes in atrial fibrillation and atrial flutter. To assess atrial and ventricular rate changes after lidocaine injection, 18 atrial flutter patients and 35 atrial fibrillation patients were given intravenous lidocaine, mean dose 100 mg. Continuous electrocardiographic recording for 5 minutes before and at least 10 minutes after lidocaine injection was used to determine rate changes. The atrial flutter rate decreased after lidocaine in 17 of 18 patients (94 per cent), mean maximal decrease 27 beats/minute. The ventricular rate response in atrial flutter was variable but in three patients increased 21, 27, and 47 beats/minute respectively (P less than 0.001). In atrial fibrillation, the mean ventricular rate after rapid lidocaine injection increased six beats/minute (P less than 0.01). In three of 35 atrial fibrillation patients (9 per cent), the ventricular rate increase was greater than 20 beats/minute (P less than 0.001), and in two patients (6 per cent), the ventricular rate increase was associated with potentially serious clinical events. Lidocaine-induced ventricular rate increases are common in atrial flutter and fibrillation, particularly in patients who are also receiving quinidine.


Cholelithiasis: a frequent complication of artificial heart valve replacement. The results of this investigation reveal that 39 per cent of patients in a study group of 46 patients with heart valve prostheses had gallstones if they survived 18 months or longer following valve replacement. In contrast, the prevalence of gallstones in a general population of autopsied rheumatic heart disease patients, including those who had been operated for severe valvular heart disease and had not survived for more than one month, was only 12 per cent. These findings suggest that gallstones are a frequent late complication of heart valve replacement.


The influence of atrial systole on ventricular capture by failing artificial pacemakers. II. Experimental observations. The mechanism by which atrial systeole influences the efficacy of ventricular capture by a failing pacemaker was investigated in 12 dogs with atrioventricular heart block. Atrial systole caused facilitation of ventricular capture in eight dogs, and inhibition of capture in 10 dogs. Interpolating atrial extrasystoles caused an enhancement or depression of the hemodynamic performance of the atrial systole that affected the efficacy of the pacemaker stimulus. These interpolation experiments showed that atrial systole influenced the efficacy of capture by a mechanical mechanism and not by an electrotonic mechanism. Atrial systole probably caused motion of the endocardial pacing catheter and/or ventricular myocardium. This motion increased or decreased the contact between the pacing electrode and the endocardium with subsequent changes in the efficacy of capture. In three dogs with pacing through epicardial electrodes, atrial systole had no effect on the efficacy of capture.


Systemic hypertension after surgical treatment of a congenital arteriovenous malformation. The development of systemic hypertension, in an eight-year-old girl, after resection of a large arteriovenous malformation, is described. The hypertension was related to an elevated plasma renin activity and was controlled with propranolol. A possible mechanism for the rise in plasma renin activity is postulated.


Angina pectoris, myocardial infarction and sudden cardiac death with normal coronary arteries: a clinicopathologic study of 9 patients with progressive systemic sclerosis. The syndrome of angina pectoris or acute myocardial infarction without obstructive coronary artery disease has been the subject of much interest. We studied nine autopsied patients with progressive systemic sclerosis and evidence of ischemic heart disease but morphologically normal coronary arteries. Three patients had angina pectoris and three others chest pains of unknown etiology, six had ventricular arrhythmias, four had clinically suspected acute myocardial infarction, and eight had sudden cardiac death. At autopsy extensive focal myocardial necrosis was present in seven patients and myocardial scarring in all nine, but all patients had widely patent intramural and extramural coronary arteries. The finding of contraction band myocardial necrosis in seven of the eight patients who experienced sudden death suggests that the myocardial damage was a consequence of reperfusion of focally nonperfused myocardium, and thus due to a myocardial Raynaud's phenomenon. Patients with PSS may provide a model of spasm of intramyocardial vessels causing angina pectoris or myocardial infarction with morphologically normal coronary arteries.


Hemodynamic evaluation of the Ionescu-Shiley pericardial xenograft in the mitral position. Hemodynamic studies were performed in 27 patients at a mean interval of 40.3 (range 24 to 59) months following mitral valve replacement with pericardial xenografts. Six patients had sequential studies, one before operation and two separate investigations at mean intervals of 11.2 and 42.8 months following valve replacement. The results showed significant increase in cardiac index, reduction in mean pulmonary artery and wedge pressures, and decrease in pulmonary vascular resistance both at rest and during exercise, when compared with the preoperative values. The mean diastolic gradient across the pericardial xenografts was 6.4 mm. Hg at rest and 15.3 mm. Hg during exercise. The calculated xenograft surface area was 2.0 and 2.3 cm.2, respectively. The sequential studies established that the maximum hemodynamic improvement was achieved within the first year following valve replacement and that the functional performance of the xenografts was maintained, unaltered, with the passage of time.


Mechanism of antihypertensive effect of thiazide diuretics. Hemodynamic studies were carried out before and during 8 weeks of treatment with hydrochlorothiazide 50 mg. twice daily in 11 hypertensive patients. Forty-eight hours after beginning treatment there was a significant reduction in blood pressure, cardiac output, plasma volume, and extracellular fluid volume (thiocyanate space) while total peripheral resistance increased. After 6 and 8 weeks of treatment, the blood pressure and the plasma and extracellular volumes remained reduced. However, total peripheral resistance fell while cardiac output rose to control levels. These results were consistent with the "reverse autoregulation" theory of the action of the thiazides as proposed by Tobian. The present evidence discussed below makes it appear unlikely that the thiazides have an important direct vasodilator effect.


Chlamydia trachomatis endocarditis.

Chlamydia trachomatis endocarditis. A case of infective endocarditis due to Chlamydia trachomatis immunotype F is reported. Multiple negative blood cultures were a major deterrant from the initial clinical diagnosis of infective endocarditis. Postmortem ultrastructural identification of Chlamydia in the aortic valve vegetation led to an intensive retrospective study of retrieved serum samples utilizing microimmunofluorescent tests. Likewise an unusual echocardiographic finding was discovered to be the ultrasonic visualization of an aortic ring abscess. No similar case could be found in the literature. Clinicopathologic correlations are presented.


Tellurium and tellurium dioxide: single endotracheal injection to rats. Single endotracheal injections of tellurium and tellurium dioxide, at dosage levels sufficient to cause observable stress in rats, did not result in a progressive fibrotic tissue response after 180 days. The observation period of 180 days is insufficient to assess the lack of tumorigenic potential of these compounds and, therefore, no conclusions on this point are to be inferred.


Quest for a gasoline TLV.

Quest for a gasoline TLV. The major components in gasoline vapor generated during tank truck loading operations are identified. By analyzing 95 separate gasoline vapor samples, a mean Threshold Limit Value (TLV) for mixtures of about 300 ppm is calculated using 1976 TLV's for the individual hydrocarbons, if available. For compounds without an assigned TLV, a safe exposure value is estimated. Maximum levels of leaded gasoline additives tetraethyl/tetramethyllead, ethylene dibromide and ethylene dichloride are also estimated.


Gasoline vapor exposure during bulk handling operations. The survey evaluated gasoline vapor concentrations in the employees, breathing zone at five bulk handling facilities. Charcoal tube samples were analyzed by a special GLC/flame ionization/flasher technique which coupled with a computer program identified up to 142 constituents. A time-weighted limit of 240 ppm/10-hour day was only exceeded for five percent of the time at one location.


Occupational exposure to synthetic estrogens--the need to establish safety standards. An environmental survey of a plant formulating oral contraceptives demonstrated considerable variation in possible synthetic estrogen exposure to the plant personnel. Clinical epidemiological studies showed evidence of increased absorption of estrogens in some employees at the plant. In view of the company's considerable efforts to suppress dust from work areas, new approaches to containment may be necessary with biologically active dusts--including the establishment of a dust standard.


Tandem HEPA filter tests.

Tandem HEPA filter tests. Current methods for evaluating the performance and reliability of high-efficiency air cleaning systems use forward light-scattering photometers and DOP aerosol. This method is limited to measuring protection factors of 10(4) or 10(5) and has poor sensitivity to particles less than .3 micron. More accurate determination of system performance could be made by measuring two filter stages with a single test. Because of the large protection factors of a two-stage system, it is necessary to use high challenge aerosol concentrations and long downstream sampling times. Concentrations were measured using an intra-cavity laser light-scattering aerosol spectrometer which is capable of detection of single particles ranging in size from 0.07 to 3.00 micron diameter. The results of several tests with challenge aerosols of both NaCl and DOP yielded protection factors ranging from 1.4 x 10(7) to 3.0 x 10(9) for two HEPA filters in series.


Analysis of formic acid in air samples.

Analysis of formic acid in air samples. The method reported here is for formic acid in air. Air containing formic acid is drawn through a midget impinger containing 15 ml of 0.1 N NaOH at a rate of one liter per minute for 42 minutes. An aliquot from the impinger is treated with an equal volume of ethanol-sulfuric acid mixture in a gastight reaction vial to produce ethyl formate. Because ethyl formate is volatile, an analysis of its vapor contained in the vial (headspace analysis) can be performed. The ethyl formate is analyzed by gas chromatography and its quantity is proportional to the quantity of formic acid contained in the reaction vial. With a relative standard deviation of 11 percent the method is precise enough for evaluating airborne formic acid at 0.1 of Threshold Limit Value of 9 mg/m3.


The use of infrared analyzers for monitoring acrylonitrile. The selectivity, sensitivity, and accuracy obtained with the infrared analyzers discussed here make them well suited for acrylonitrile measurement. The instruments are helping industry solve the many difficulties encountered in protecting its workers from acrylonitrile; and they are of great benefit to the industrial hygienist who previously had at his disposal only techniques which are cumbersome and time consuming.


Air pollution control in kraft pulp mills. A patented gas scrubbing process, whereby the emissions of malodorous reduced sulphur compounds are effectively and economically reduced, is described. Stack gases are scrubbed with an alkaline suspension of activated carbon. Reduced sulphur compounds as well as sulphur oxides are converted to sodium salts which are subsequently recovered and utilized for pulping. The process also reduces particulate emissions. It does not produce subsequent waste disposal problems and has little or, in some cases, zero net cost, on account of the simultaneous recovery of heat and chemicals. Furthermore, the paper also reviews some innovations made in gas chromatography techniques, for the measurement of trace quantities of sulphur compounds present in kraft mill emissions.


The effect of 2-hexanone and 2-hexanone metabolites on pupillomotor activity and growth. Neurotoxic agents such as MBK (2-hexanone) and MBK metabolites were fed in drinking water to guinea pigs. Effects of these solvents on locomotor activity were studied. Dynamic pupillometry indicated that MBK, 2,5-hexanedione and 2-hexanol decreased pupillary response throughout the first five weeks; by the 24th week, all treatment groups showed a greatly impaired pupillary response. From biotransformation studies, it is possible that the 2-hexanol effect on pupillary response may be attributed to its conversion to MBK and/or 2,5-hexanedione. Each of the solvents increased body weight, but decreased locomotor activity. The pupillary changes reported here may serve as an index of solvent exposure in the work environment, if such measurements were to be conducted on workers.


Comparative bioavailability of elemental iron powders for repair of iron deficiency anemia in rats. Studies of efficacy and toxicity of carbonyl iron. The rate of hemoglobin repletion in iron-deficient rats was used to measure the bioavailability of several elemental iron powders added to an iron-free nutritionally balanced chow. We used ferrous sulfate as a standard, highly bioavailable control. Of the several powders, carbonyl iron demonstrated the highest bioavailability. Testing elemental iron powders in human diets seems appropriate.


Diet therapy in adult lactose malabsorption: present practices. Three hundred twenty-three of 473 questionnaires sent to hospital dietitians in 50 states and Puerto Rico concerning diet therapy for adult lactose malabsorption were returned and analyzed. Only 42% of the responding dietitians stated that their hospital diet manuals contained a diet for adult lactose malabsorption, with less than 1% having a diet specific for patients with peptic ulcer disease and lactose malabsorption. Physicians in almost half of these hospitals rarely considered lactose malabsorption when prescribing a diet for patients with peptic ulcer disease or rarely modified diets for suspected lactose malabsorption. The responding dietitians supplied pertinent portions of their diet manuals in 99 instances, which was 72% of those having such diets. Many of the submitted diets were too rigid, frequently restricting foods that did not contain lactose. On the basis of the survey and a review of the literature, a more reasonable approach to the therapy of adult lactose malabsorption is suggested.


Ethanol-induced hypertriglyceridemia. Prevalence and contributing factors. Seventy-seven chronic alcoholic subjects admitted to two alcoholic detoxification centers were evaluated for lipid abnormalities. Nineteen (26%) of these male patients had serum triglyceride levels greater than 150 mg/100 ml and six (9%) had serum cholesterol levels greater than 250 mg/100 ml. Compared to 33 age-matched, nonalcoholic control subjects, there was a significantly greater incidence of hypertriglyceridemia in the alcoholic subjects. All patients with triglyceride abnormalities had type IV electrophoretic patterns. The triglyceride elevations were not related to serum amylase, lipase, liver function, obesity, and abnormal fasting glucose. We conclude that there is a significant increase in hypertriglyceridemia in chronic alcoholic patients.


Nutritional assessment of senior rural Utahns by biochemical and physical measurements. Biochemical composition of blood and urine was used to evaluate the nutritional status of 187 ambulatory, older residents of five rural Utah communities. Measurements were also taken of height, weight, and blood pressure. The sample included 58 men and 129 women, with a mean age of 69 years. No deficiencies were observed for hemoglobin, hematocrit, and serum iron levels, although approximately 15% of the men had low levels for the first two indices. Serum mineral status for zinc, copper, sodium, potassium, magnesium, and calcium was adequate for most of the participants. Of the women 40% and of the men 21% had low serum total protein levels. No low serum levels of vitamin A and carotene were observed. Urinary excretion of riboflavin and thiamine was high for approximately 90% of the participants. Of the women 46% and of the men 37% had serum cholesterol values above 249 mg/100 ml of serum. One half of the women and 30% of the men were determined to be obese. Approximately one-fourth of both sexes had systolic pressures above 160 mm Hg.


A nomogram to predict lean body mass in men. A simple three scale nomogram is presented to predict lean body mass in men from two anthropometric measurements: height and the circumference of the flexed biceps. The prediction equation used in constructing the nomogram was established from data collected on 198 USAF aircrewmen. Lean body mass was determined on these men by a standard tritium dilution technique. The equation was validated on a total of 65 additional flyers, comparing measurements obtained by tritium dilution (r = 0.91), 40K wholebody counter techniques (r = 0.90), and water-displacement techniques (r = 0.86). A second nomogram demonstrates the flexibility in using this anthropometric-type prediction of body composition to arrive at personalized weight standards.


Preventive and therapeutic benefits in relation to cost: performance over 10 years of Mothercraft Centers in Haiti. Evaluation of the effectiveness of Mothercraft Centers operating in Haiti over the period 1964 to 1975 as a public health measure in private and public health services is reported. For the most part, the data are derived from centers operating routinely in the health services rather than from pilot demonstrations. Their impact in both therapy and prevention of severe malnutrition in preschool children is considered, and it is found that numerically the greater benefit is in prevention. At a total annual cost of $4034 a typical center accomplishes successful therapy and prevents relapse in 105 children. In addition, it provides protection against severe malnutrition to their 306 younger siblings. It is thus estimated that, considering only these 411 children demonstrably benefited from a year's operation, the cost of providing essentially lifetime protection from severe malnutrition is approximately $10 per child.


Strumal carcinoid of the ovary: ultrastructural observations and long-term follow-up study. Herein is reported an ovarian strumal carcinoid in a mature tetratoma from a 54-year-old women. Ultrastructural examination revealed numerous electron-dense intracellular granules, which were intrepreted as neurosecretory granules. They corresponded to argyrophil granules observed by light microscopy and were identified within neoplastic cells arranged in both follicular and trabecular patterns. These findings corroborate the contention that the strumal carcinoid itself is a pure neuroendocrine tumor devoid of thyroid follicular epithelium, but do not disprove its possible origin from parafollicular cells of adjacent teratomatous thyroid tissue. There was no recurrence of tumor during the 20 1/2 years the patient was followed.


Karyotypic abnormalities in precursor lesions of human cancer of the breast. Aneuploidy and structurally aberrant chromsomes were identified in most cultures of ductal epithelial cells from proliferative lesions of human fibrocystic disease. These were qualitatively similar to those observed in cells comprising overt invasive mammary cancers. This represents some evidence in support of views indicating that proliferative fibrocystic disease may represent a precursor lesion of cancer of the breast, if not indeed its earliest morphologic expression.


Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases. Thirty-four cases of microcystic adenoma of the pancreas were studied. These benign tumors have traditionally been classified as cystadenomas, but have not been clearly distinguished from those cystic neoplasms of the pancreas that have a significant malignant potential. Microcystic adenomas are benign, usually large (mean diameter 10.8 cm), and are composed of many tiny cysts lined by small cuboidal cells containing glycogen but little or no mucin. The tumor may be found incidentally at autopsy or, more commonly, may manifest as an abdominal mass with some associated local pain or discomfort. There is no sex predilection. The patients are usually elderly, both mean and median ages being 68. A microcystic pattern is apparent both grossly and microscopically. Electron microscopy confirms the presence of intracytoplasmic glycogen and the epithelial character of the cells. Follow-up data (mean 6.4 years), available in all cases, indicate that when these tumors occur in the head of the pancreas, fatalities may result either from complications of radical surgery or from gastrointestinal or biliary obstruction. When the tumors occur in the body or tail of the pancreas, biopsy alone may be sufficient.


Disseminated visceral giant cell arteritis: histopathologic description and differentiation from other granulomatous vasculitides. Disseminated visceral giant cell arteristic, a previously unknown entity, was observed in four autopsied patients, all men, aged 33, 67, 59 and 45 years. None of the patients had temporal arteritis, collagen disease, sarcoidosis, hepatitis or other infections, and vasculitis was diagnosed only after death. All had giant cell arteritis of extracranial arteries and arterioles in at least three of the following organs: the heart, lungs, kidneys, liver, pancreas, and stomach in various combinations. Despite some histopathologic similarities, disseminated visceral giant cell arteritis can be distinguished from other necrotizing and granulomatous vasculitides by the type of vessels principally affected and the presence or absence of giant cells, vascular fibrinoid necrosis and eosinophilic infiltrates. The observations suggest that it is a distinctive type of systemic vasculitis.


Phytohemagglutinin activation of lymphocytes: quantitative comparison of different preparations. Lymphocytes from 12 normal subjects were stimulated in vitro with several concentrations of six commercial preparations of phytohemagglutinin and one column-purified preparation. All preparations produced activation profiles that were highly concentration dependent, with diminished activation at concentrations greater than the optimal concentration. The preparations differed markedly in their mitogenic capacities. Several concentrations of phytohemagglutinin should be employed when lymphocyte activation in vitro is studied as an index of cell-mediated immunity.