WAIS performance in brain-damaged left- and right-handers. WAIS performance was compared in 35 pairs of left- and right-handed subjects who had been individually matched for lateralization, cause of brain damage, age, education, and gender. WAIS results were similar in the two groups as well as in two subgroups of subjects with unilateral brain damage. No differences between the unilateral groups were found to support the hypothesis advanced by Levy and Nagylaki in 1972 that left-handers have inferior visual-spatial abilities.


"Release hallucinations" as the major symptom of posterior cerebral artery occlusion: a report of 2 cases. Visual hallucinations were the presenting symptoms in 2 patients with probable infarcts in the territory of a posterior cerebral artery. They occurred in areas of paracentral scotomas, right in Patient 1 and left in Patient 2. In Patient 1 they were formed, prolonged, and not apparently related to past experience. In Patient 2 they were at first paroxysmal and unformed, with more prolonged metamorphopsia; later there appeared to be palinoptic formed images, possibly postictal in nature. Such hallucinations appear to be of a "release" type, and may be more common than is generally appreciated in patients with posterior cerebral artery occlusion.


Phenytoin-related cerebellar degeneration without seizures. Cerebellar changes have been reported in relationship to epilepsy alone as well as to phenytoin therapy for the control of seizures. The cliniconeuropathological correlation between these changes and epilepsy or the anticonvulsant is usually complicated by the presence of both variables. Experimental evidence suggests that phenytoin alone may be sufficient to cause cerebellar changes following intoxication. We report a case of cerebellar degeneration in a patient treated with isoniazid and prophylactically treated wtih phenytoin who never had a seizure.


Persistent cerebellar ataxia after exposure to toluene. An optometrist and a glue sniffer exposed independently to toluene vapors developed cerebellar, pyramidal, and cognitive dysfunction. All deficits cleared completely in the former but persisted in the latter. The findings confirm a previous report of a toluene-induced neurological syndrome that is exclusively central, sparing peripheral nerves.


Congenital arachnoid cyst with unusual clinical, radiological, and pathological findings. Choroid plexus-like structures were found in the wall of a congenital frontotemporal arachnoid cyst in a 14-year-old girl who presented with temporal lobe seizures since the age of 6. The temporal cortex beneath the cyst was maldeveloped. The clinical, radiological, and pathological aspects of congenital arachnoid cysts are reviewed.


Paroxysmal choreoathetosis following head injury. A 33-year-old man developed paroxysmal choreoathetosis following a severe head injury. Phenobarbital therapy was promptly effective. The family history as well as physical examinations and laboratory studies were unremarkable.


The influence of route of delivery and hyaline membranes on the risk of neonatal intracranial hemorrhages. The relationship of route of delivery and hyaline membranes to eight sites of intracranial hemorrhage was evaluated in 513 autopsied newborn infants. Those delivered by cesarian section appeared to be at less risk for most hemorrhages compared with newborns delivered vaginally. However, the reductions in risk were small and did not achieve nominal levels of statistical significance. Thus, "birth trauma" probably contributes little to the risk of most neonatal intracranial hemorrhages. Newborns who developed hyaline membranes appeared to be at greater risk for most hemorrhages than those who did not, particularly if the infant had been delivered by cesarian section. This was especially marked for subarachnoid and germinal matrix hemorrhage.


Globoid cells, glial nodules, and peculiar fibrillary changes in the cerebro-hepato-renal syndrome of Zellweger. In addition to a distinct malformation (pachymicrogyria, heterotaxic lamination of the cerebellar cortex, olivary dysplasia), unusual degenerative changes were found in the nervous system of 2 unrelated babies with the Zellweger syndrome. Cerebral clefts were present in 1 case. In both infants there was neuron loss and accumulation of glial nodules and globoid cells in the gray matter as well as degeneration of the white matter. There was fatty change in astrocytes and diffuse gliosis. Neurons in the column of Clarke and the lateral cuneate nucleus showed peculiar fibrillary changes. Cytoplasmic inclusion bodies were seen in the spinal ganglia. Swelling of cortical astrocytes was remarkable in the older infant. The combination of a rare malformation with the cell changes described here gives the syndrome a unique neuropathological profile.


Emotional sequelae of head injury.

Emotional sequelae of head injury. The emotional after-effects of head injury in relation to acuteness versus chronicity of the injury and neuropsychological deficits were studied. The results indicate that there is a decline in emotional distress over time after the injury and show that patients with significant initial and residual neuropsychological deficits experience greater emotional distress than those with negligible difficulties.


Rabies: recent advances in pathogenesis and control. Current knowledge of rabies is reviewed, with emphasis on recent developments in virology, immunology, pathogenesis, treatment, and prophylaxis. Although only a few cases of human rabies occur annually in the United States, the infection is enzootic in wildlife, and an estimated 30,000 possible exposures requiring treatment occur each year. Rabies belongs to the family rhabdovirus, and its molecular anatomy and biochemistry of replication have been described in some detail. There have been advances in measurement of antirabies antibodies, and techniques for measuring cellular immune response have recently been developed. Early stages of infection are more fully understood, with a hypothesis to explain peripheral sequestration of virus during prolonged incubation periods. Rabies was once thought to be uniformly f fatal, but a few patients have survived with aggressive supportive measures. A newly developed vaccine (soon to be licensed in the United States) has been shown highly potent for preexposure immunization and promises to be very effective for postexposure prophylaxis. Current Public Health Service recommendations for postexposure treatment are summarized. Recent research has suggested a novel approach to control of wildlife rabies through oral immunization.


Calcification of axons in experimental spinal cord trauma. Selective discrete intraaxoplasmic deposits of hydroxyapatite crystallites were observed in adult male rats subjected to experimental trauma to the lumbosacral spinal cord. Although previously unreported in spinal cord trauma, the presence of these deposits in minimally altered axons and during the early posttrauma period suggests that such selective calcification may be of more than secondary significance. In view of the current emphasis on cytotoxicity of calcium, especially in relation to axonal degeneration, an evaluation of the role of calcium in augmenting traumatic spinal cord necrosis is warranted.


Lower motor neuron disease with spinocerebellar degeneration. A patient with polymyositis responded initially to steroid therapy. A muscle biopsy disclosed features of primary myopathy and group atrophy. The patient became refractory to therapy and died with relentlessly progressive weakness. The autopsy disclosed lower motor neuron involvement and degeneration of the spinocerebellar tracts. There was loss of Purkinje cells, which may have occurred secondary to an anoxic episode prior to death. The case is unique because of the limited involvement of the lower motor and spinocerebellar systems.


Chronic neurogenic quadriceps amyotrophy. Two patients with chronic neurogenic quadriceps amyotrophy are reported. A 61-year-old woman had symmetrical wasting and weakness of the quadriceps femoris of eight years' duration. A biopsy revealed neuropathic changes, and electromyograms showed neurogenic as well as myopathic patterns in the quadriceps and other muscles. A 29-year-old woman had long-standing wasting limited to the quadriceps and hip muscles. EMG and biopsy were compatible with neurogenic atrophy. She had a brother suffering from a more widespread and severe form of the disease. These cases suggest that chronic neurogenic quadriceps amyotrophy is a forme fruste of Kugelberg-Welander disease.


Supraclavicular and carotid bruits in hemodialysis patients. Auscultation of the neck vessels in patients receiving chronic hemodialysis reveals a high incidence of subclavian and carotid bruits as well as the expected precordial hemic murmurs. These bruits are associated with the high-output hyperdynamic circulatory state. In older patients the finding could be misinterpreted as evidence of extracranial cerebrovascular disease, but clinical considerations should obviate unnecessary neuroradiological diagnostic procedures.


Temporal lobe oligodendroglioma developing from infancy into adulthood. Clinical, radiological, surgical, and histological features are reported for a patient with a temporal lobe oligodendroglioma that had developed in infancy and was diagnosed and partially resected at age 10. The patient is presently 24 years old and still well. To the best of our knowledge this is the first report of an oligodendroglioma with probable onset at 5 months of life and satisfactory course over 24 years.


Computed tomographic arteriography.

Computed tomographic arteriography. Computed tomographic arteriography is the technique of contrast enhancement by arterial perfusion during computed tomography. This technique appears to have significant advantages over conventional intravenous contrast enhancement in selected cases.


Hemispheric specialization of language: an EEG study of bilingual Hopi indian children. Electroencephalographic (EEG) recordings were obtained from electrode placements over the left and right frontal and parietal lobes of the brain in sixteen Hopi Indian children listening to tape recorded children's stories in the Hopi and English languages. Spectral analysis of the EEG data revealed that, for the parietal leads, alpha desynchronization was relatively greater over the right hemisphere for listening to Hopi than for listening to English, which indicates a greater right hemisphere participation in the processing of the Hopi speech. The results of the experiment are directionally consistent with our hypothesis, and imply that linguistic relativity may exist on a neurolinguistic level, such that languages can differ in the relative degree to which they serve as instruments of thought in a propositional, left hemisphere mode, or in an appositional, right hemisphere mode.


Suggestion as an aid to self-regulation of hand temperature. Five subjects were instructed to alter the temperature of the dominant hand (two increase, three decrease) with the aid of an augmented feedback display. On baseline days and on alternate training days, subjects were presented with slide projections and heard a tape-recorded sentence during every other intertrial interval during a 15-minute discrete trial period. On baseline days, the imagery and suggestions were neutral in nature; on training days they suggested thermal conditions appropriate to the subject's task. Subjects displayed a significantly larger temperature change in the instructed direction on suggestion than on nonsuggestion training days.


Higher cortical dysfunction associated with long term alcoholism. A number of studies during the past decade have described deficits associated with chronic alcoholism. Although several of these studies have used neuropsychological tests, no study has comprehensively surveyed all recognized neuropsychological skills in a single population. The present study compared 41 chronic alcoholics to 41 matched controls during a two-day battery of neuropsychological tests, including the Halstead-Reitan, Wechsler Memory Scale, and other major tests. It was hypothesized that tests reflecting right and anterior brain function would differentiate between the groups. A factor analysis of the tests which differentiated between the groups indicated five primary deficits in chronic alcoholism: spatial conceptual skills, associative conceptual skills, flexibility, spatial-motor integration, and serial integration. The last factor demonstrated a small but significant verbal loss in the alcoholics. The implications of these factors for understanding and treating chronic alcoholism were discussed.


Ocular-motor function and information processing: implications for the reading process. This paper discusses the dichotomy between continually moving eyes and the lack of blurred visual experience. A discontinuous model of visual perception is proposed, with the discontinuities being phase and temporally related to saccadic eye movements. It is further proposed that deviant duration and angular velocity characteristics of saccades in patients with hypertonic motor impairment relate to information processing defects. Stabilized retinal image procedures, which control for the effects of eye movements, significantly increase the ability of these patients actively to recall information presented for periods of less than three sec. A model of the reading process is presented based on these findings that addresses itself to the specific components of an interactions between eye movement, information transmission and information processing.


An interpretation of implicit judgments in chart review. The effects of methods that are commonly employed to summarize implicit judgments about quality-of-care assessments, based on medical records, are examined. A sample of 250 medical records, from three outpatient clinics in a municipal hospital, was studied. Two, or three, reviewers judged the quality of both the process of care and the outcome of care, as reflected in each medical record; the reviewers were medical school faculty members. Thirty-seven combinations of the data were used to summarize the judgments made on each medical record. These combinations resulted in significant differences in interpretation within each clinic, but there were only insignificant differences in interpretation across the three clinics. Hence, the use of a single method to summarize data may distort the conclusions. These results demonstrate that data often should be summarized by several methods and that measures of association should be used to supplement tests of significance so as to develop a comprehensive understanding of a set of data.


The content of care provided by family nurse practitioners. The content of care provided by 30 graduates of the UCLA Primex (Family Nurse Practitioner) program was examined. An encounter form similar to that used in the National Ambulatory Medical Care Survey was employed to code patients' complaints. These practitioners had been specifically trained to provide care for ambulatory patients. Data were collected one year after the completion of the university didactic phase of the program. We found that Primex practitioners spent more time with patients, more often employed traditional nursing functions, and more often used medical investigative procedures, such as x-rays and laboratory tests than did the physicians in the NAMC survey. Although the types of problems seen varied according to the organizational setting, these nurse practitioners were more often assigned routine health examinations and less often saw certain kinds of acute health care problems than had been anticipated in their training; 116 different types of symptoms or problems were presented, with a total of 1,170 encounters.


Rating the lecturer: a study of how different disciplines used comparative criteria. Faculty members from medicine, nursing, social work, and law, as well as a group of medical students, tested their own criteria for a good lecturer; each group focused on different aspects of the behaviors sought in the good lecture. The "Dr. Fox" paradigm was the lecture chosen; all groups failed to identify the deliberately incorporated failings. These results were then compared with the results obtained by using a standardized rating form in current use within a major university.


Quality assurance and the continuing education of physicians. The rising impetus for mandatory continuing medical education (CME) is based on the assumption that CME presents an effective means of assuring physician competence. The relationship between competence and CME, as it currently exists, is unclear, however. The passage of legislation requiring mandatory CME credits will only serve to obscure this further by emphasizing quantity in credits rather than quality of educational experience.


Physician competence and compulsory continuing education: are they compatible? Continuing medical education (CME) should be broadly defined as any intervention into the activities of a physician that produces behavioral change. Under this definition, it is unquestionable that CME influences quality of care. However, the current CME-accreditation system, with its narrow emphasis on course work, serves to inhibit the development of individualized educational activities geared to identified needs.


Patient adherence to antihypertensive medical regimens. The initial findings from a long-term study of patient adherence to antihypertensive medical regimens are reported; the research was designed to identify factors related to adherence. Data were collected by means of personal interviews and from medication records for a sample of 132 hypertensive patients of private physicians. Patient beliefs about their susceptibility to the effects of hypertension, about the severity of the condition, and about the efficacy of the regimen prescribed were all associated with compliance, when the self-report and pharmacy records were analyzed. A lesser degree of adherence was found to be related to the patient's feelings of dependence on the physician and to a lesser sense of personal control; those patients who found it difficult, for personal reasons, to comply with the regimen also exhibited a lesser degree of adherence. Although a patient's understanding about the disease was not related to adherence, his awareness of the purpose of the regimen was. Less educated and older patients showed less compliance. The compliance of patients in following dietary advice was less marked than was compliance in taking medication. Although preliminary, the results emphasize the importance of a patient's beliefs and his social situation in decisions to follow medical advice.


Reducing the risk of cardiovascular disease: effects of a community-based campaign on knowledge and behavior. In 1972 the Stanford Heart Disease Prevention Program launched a three-community field study. A multimedia campaign was conducted for two years in two California communities (Watsonville and Gilroy), in one of which (Watsonville) it was supplemented by an intensive-instruction program with high-risk subjects. A third community (Tracy) was used as a control. The campaigns were designed to increase participants' knowledge of the risk factors for cardiovascular disease, to change such risk-producing behavior as cigarette smoking, and to decrease the participants' dietary intake of calories, salt, sugar, saturated fat, and cholesterol. Results of a sample survey indicate that substantial gains in knowledge, in behavioral modification, and in the estimated risk of cardiovascular disease can be produced by both methods of intervention. The intensive-instruction program, when combined with the mass-medica campaign, emerged as the most effective for those participants who were initially evaluated to be at high risk. The results after two years of intervention are reported for effects on knowledge and behavioral change for the total participant samples and for the high-risk subsamples in each of the three communities.


Car crashes: perceived vulnerability and willingness to pay for crash protection. A national random sample of 1,017 new-car buyers was surveyed. The respondents indicated a clear preference for more, automatic crash protection rather than for protection that must be activated by those to be protected. Respondents were willing to add an average of $12 to their monthly car payments, if the added cost would save 6,000 lives a year--three times the amount that the currently available technology would actually cost to save 8,800 lives per year. Buyer preferences for crash protection and their willingness to pay were unrelated to their feelings of personal vulnerability to death or injury in car crashes.


Sex roles as variables in preventive health behavior. Preventive health behavior is broadly defined to encompass a spectrum of actions that range from voluntary exposure to the risk of disease, injury, or death to active efforts at prevention or detection of disease. Data are presented to show that men, in our culture engage in more risk-taking behavior and take preventive measures less frequently than women, while women avoid risks and take preventive action, particularly when this action requires medical intervention. The literature review supports the hypothesis that these differences in behavior arise out of the socialization and adult role patterns that our society defines as appropriate for each sex. Women, in particular, are encouraged to define their problems in medical terms and to seek help for them within the medical care system.


Neighborhood health centers: a decade of experience. The first neighborhood health center was funded in 1965 by the Office of Economic Opportunity. Now, 12 years later, 127 federally funded centers are serving over a million people. The centers have offered a high quality of service, delivered comprehensive care that includes preventive services and health supervision, developed a workable team approach in such care, and shown that this can be done at reasonable cost. Evaluative studies made on center effectiveness in disease prevention, in reduction of hospitalization and emergency room usage, and in improving the quality of care show that the centers compare favorably with other methods of providing similar care. Problems of financing are discussed, as well as possible directions for the future.


New roles for health care consumers: a study of role transformation. The increased emphasis on citizen participation in health planning has caused changes in the traditional roles of health professionals and their clients. Interaction patterns between health care providers and health care consumers as members of planning boards are examined in two health-related organizations: a comprehensive health planning council and a low-income neighborhood health center. Eighteen months of observation, supplemented with an analysis of official records and interviews, provide the basis for the discussion.


Visual bottle inspection performance in highly paced belt-conveyor systems. The relation between visual work performance and a few variables with immediate effects, i.e,  lighting, work speed, work spell, etc. was studied. At the same time, some physiological and behavioral variations obtained in the study were also discussed. Through experiments and surveys, the optimum conditions were found for each variable. Work performance, however, is affected in such a subtle, interactive and dynamic manner that the working conditions are to be adjusted by taking into account not only these variables having immediate effects but also those indirectly relating ones meeting real needs in the practical working fields. Improvement of some physical working conditions, such as lighting, produces only a transitory increase of performance which is very unstable unless other determinants of performance are simultaneously managed in a proper manner. The same applied to arrangement of the optimum work speed and work spell for highly paced visual inspection, variations in rejection rate and in physiological functions interacting with individual and other determinants. In order to maximize understanding of the integrated and synthesized manner of determinants, it is emphasized that work performance must be pursued in a considerably comprehensive framework from a long-term perspective.


Effects of environmental heart on performance and some physiological responses of a man during a psychomotor task. In climatic chamber experiments some physiological responses of a young healthy man were studied. He was able to perform a pursuitmeter task in a fairly wide range of warm climates without decrement of performance. The highly trained and heat-acclimatized subject was exposed nearly undressed to various ambient temperatures (28--55 degrees C) and air humidities (10--92%) which were combined in such a way that the conditions were tolerable up to 4 h. In 18 experiments the man was sitting quietly all the time, and in a parallel series of 19 experiments (up to 50 degrees C) he performed the pursuitmeter task during the last 2 hours of each exposure. Under equal climatic conditions work caused a slight increase in oxygen uptake corresponding to an increase in metabolic heat generation by about 70 kj/h (17kcal/h) on the average. Rectal temperature and temperature next to the eardrum were 0.1--0.2 degrees C higher at work as compared with rest. Weight loss at work exceeded weight loss at rest, the difference ocrresponding to an increase in evaporative heat loss by about 110 kj/h (26 kcal/h) which resulted in a decrease of mean skin temperature of 0.5 to 0.9 degrees C. Superelevation of heart rate due to work reached about 10 beats/min in a thermally neutral environment, but up to 30 beats/min in hot dry and warm humid surrounding, reflecting the additional effort for maintaining performance under conditions of increasing heat stress.


Prediction chart of thermal sensation levels derived from a sweat pore system model. Because of the half-way wet-and-dry skin surface, it is very difficult to analyze and predict the heat loss by sweat evaporation It is significant that neither wetness nor wet area ratio can be a universal index under the influences of different air current, the state of being clothed making them less useful. Therefore, in an attempt to predict the dynamic thermal sensation levels by means of the simulation method, a sub-skin wet layer and a sweat pore system regulating sweat evaporation were assumed. It was shown that it is possible to indicate the probable values of moisture permeability through the skin or clothing. On the basis of such a thermal systems approach, conditions of the environment, including radiant and ambient air temperature, humidity, and air movement and those of the human bodyworking and wearing clothes could be related to each other as shown by several examples. Then the scaling method of thermal sensation levels were proposed. Finally, the sub-skin heat capacities were discussed according to the step response simulation using the results of cold shock tests.


Environmental factors and work performance of foundry workers. Environmental factors such as atmospheric conditions, lighting, noise, and dust in foundry factories of different sizes were evaluated by direct physical measurements and a subjective rating method using an ergonomic checklist. Working postures and subjective feelings of fatigue of the workers were analyzed in various types of foundry shops. The results showed that work load was highly connected with poor working postures and unfavorable arrangement of work space as well as with poor workplace environment, particularly in terms of dust and noise. Forward bending and squatting positions, which were attributable to the manual working height on or just above the floor level, occupied 70--90% of the actual working time handling large-sized casts, while the work using a table allowed workers more frequent erect standing postures. It seemed essential to redesign the fundamental working processes and to improve the work surface height. A comparison was then made as to performance patterns and electromyographic activities of main muscles between the traditional molding work on the floor and the work at a newly developed hydraulic lift-table operated by foot pedals. The new table assured the worker of an optimal standing position and proved to be an effective means of redesigning the work space.


The physiological costs of box lifting.

The physiological costs of box lifting. Thirteen male subjects lifted boxes of three different weights for 20 min periods each. Ventilation, oxygen uptake and heart rates were measured. Each subject made subjective estimates of the degree of difficulty of the work he was doing. Oxygen uptake and ventilation were found to reach steady state after about four minutes and remain there for the rest of the work session. Heart rate for the two lighter boxes reached steady state after about thirteen minutes while the heart rate continued to rise when lifting was done with the heaviest box. The relationships between oxygen uptake, heart rate and work load tended to be curvilinear, whereas the ventilation was linear when compared to work load. The heart rate and oxygen uptake relationship was also curvilinear, while ventilation and oxygen uptake had a linear relationship. The subjective ratings were expected to be about one-tenth of the heart rate. Only the ratings made while lifting the lightest box reflected this. The heavier boxes were rated as being more difficult to lift than 10 times the heart rate per minute. The mechanical efficiencies were found to range between 4.4% and 6.2%.


Muscle load and fatigue of film rolling workers. Effects of locally concentrated loading by repetitive upper limb operations on the musculature were studied in female workers of ages 19--33 rolling photographic film. They repeated rolling and capping of a 35 mm film every 2.5--5 sec during the whole day shift which had a 60 min lunch recess and two 10 min rests. Increase of dull-drowsy symptoms and shoulder complaints was dominant after work, stiff shoulders complaints being divided into 41.6% for prework and 78.7% for postwork. It was characteristic for these workers to have the trapezius muscle showed continuous electromyographic activities in sustaining arms. The average level of the contraction was estimated at about 10--30% of the maximum contraction. Eighty-four per cent of those studied had tenderness at the ascending part of the trapezius, while the same tenderness was found in only 48% of female office workers of the same firm. The operators having low tenderness threshold of 0.6 kg/cm2 or less had stiff shoulders more frequently as well as lower levels of back muscle and upper arm abduction forces than those having no tenderness. It is thus likely that habitual shoulder muscle fatigue is due to repetitive tasks that results in localized tenderness and possibly in occupational hazards.


Lifting capacity of workers.

Lifting capacity of workers. In order to establish a valid criteria on which to establish lifting guidelines, lifting capacity determination must be made. This has been attempted using several approaches mainly psychophysical, physiological, and biomechanical methodologies. Although the data obtained from these approaches yield information about lifting capacity, some conflict in these data can be found. The purpose of this paper is to discuss the three different approaches, the data obtained from these approaches, and some data on the lifting capacity for males and females in the industrial workforce. In addition, the conflicts in these data are also presented.


Occupational cervicobrachial disorder and its causative factors. Occupational cervicobrachial disorder often diagnosed as cervicobrachial syndrome, cervical syndrome, or thoracic outlet syndrome has been frequently noticed among workers of the offices and factories in Japan since about 1955. Based on the data of case reports and mass examinations, the prevalence and the causative factors of the disease are described. The factors provoking the disorder can be divided into two categories, i.e, the ways how the workers use the musculature and strain the nerous system and the conditions in which the job is organized into the work system and is controlled. Studies on bank note counting, copying-slips writing, machine sewing, and amplifier assembling work reveal that not only the high density of the task but also time factors such as long work spells and lack of voluntary rests are important in causation of the disorder. Results of health examinations of 117 female workers on a cigarette assembly line confirm a close relation between the clinical severity of the occupational disorder and the subjective complaints at work and at home. The manifestation of clinical symptoms depends on what kinds of the first category factors predominate, but the progress to severer cases is relevant to the work system hampering the recovery from chronic muscular and central fatigue.


Model for clinical social work practice in a health care facility. A model of clinical social work practice for direct patient service in a health care setting, providing clarity of role and function, was a side benefit of social service department's addressing the accountability issue. This document has provided the structure for a recording and reporting scheme to demonstrate what social service performs, what it accomplishes, and in what quantity. The model has secondary usages for staff education, student training, and definition of programs for administrative purposes.


The social worker's role in a behavioral management approach to chronic pain. The pain treatment program described in this paper teaches chronic pain patients and their families to manage pain in a constructive manner, increasing activity, eliminating pain medications, and reducing use of the health care system. The social worker carries a crucial role in this behavior modification program: working with the patient, family, and rehabilitation team in evaluation for the program, in treatment of the patient and family, and in the transition from hospital to home and the community. Chronic pain is a costly disability, economically and socially. For many patients traditional medical and surgical approaches have failed to bring relief. By attending to and treating the total family system, at least 75% of the patients treated are enabled to lead normally active lives again.


Attitudes of adolescent males toward abortion, contraception, and sexuality. Younger males appear to be reassessing their roles in preventing unwanted conception. This article reports the findings of a study of the attitudes of 1,017 younger men toward pregnancy, family planning, and sexuality. A questionnaire was used over a 2-year period, administered before educational sessions conducted by the Planned Parenthood Association of the Chicago Area.


Adolescent pregnancy: an interpersonal skill training approach to prevention. The research literature reports numerous negative consequences of adolescent pregnancy. Unfortunately, contemporary approaches to preventing teenage pregnancies have been largely unsuccessful. Recent evidence, however, suggests that interpersonal communication skill training may represent an important step in helping adolescents deal with their sexual and contraceptive behavior. This describes a pilot study of an interpersonal skill training model for sexually active inner-city teenagers. Results show that this training model is a feasible and attractive approach to modifying the youths' communication patterns. Findings indicate that such training is a fruitful direction for future pregnancy prevention research with the adolescent target population.


Can private hospitals afford to provide social services? This article describes a fee-for-service charging system for social work services in a "private" hospital. This system was developed because the financial pressures of the day appear to be causing a trend to decrease the level of social services provided in hospitals. The system has provided the Department of Clinical Social Work the opportunity to demonstrate the marketability of social work and to assure the department's financial viability.


Myofibre abnormalities of orbicular muscle in malposition of the eyelid. Fifty-five cases of senile entropion and ectropion have been studied electron microscopically. In both senile entropion and ectropion significant ultrastructural abnormalities were found in the orbicular muscle fibres, such as a disruption of fibres, Z line streaming, rod formation, Z line duplication and cytoplasmic body formation. These alterations have been described only in neuromuscular disorders and systemic diseases affecting the skeletal muscles. Our observations have confirmed that these abnormalities are not specific signs of any given disease, they rather represent the ultrastructural background of impaired muscle function independently of the aetiology of the disease.


Influence of the intestinal epithelium to the plasma cell differentiation injected into the thymus. Physiological saline solution of enzyme-isolated small intestinal epithelium of rat embryos was injected into the thymus of adult rats, thus increasing the number of epithelial cells in the parenchyma. The effect of the cellular composition of the thymus parenchyma was studied with special regard to plasma cells. Considering the functional importance of epithelial elements in the lymphoepithelial organs, the intervention rendered the thymus similar to the lymphoid organs of the intestinal tract; Plasma cells failed to appear in the thymus, but their number in the lymph nodes surrounding the thymus was considerably increased. It is supposed that under normal circumstances the thymus contains an inhibitory factor, which would make it possible to induce plasma cell transformation, but would inhibit maturation during the presence of the cells in the thymus.


Cytoplasmic aggregates in D-galactosamine induced liver injury. D-galactosamine treatment leads to the formation of PAS-positive granules or aggregates in the cytoplasm of mouse liver cells. Ultrastructural observations show that the granules consist of particles surrounded by membranes of rough endoplasmic reticulum. Cytochemical results reveal that part of the particles is pronase-sensitive and amylase resistant, staining positively by the Thiéry silver proteinate method. The other part is stained positively by EDTA preferentional staining. According to the cyto-and histochemical results the granules consist of ribosomes and abnormal basic glycogen. The aggregates are removed from the cytoplasm mostly by lysosomal degradation.


Blood supply of the rat hypothalamus. V. The medial hypothalamus (nucleus ventromedialis, nucleus dorsomedialis, nucleus perifornicalis). Using the India ink double-perfusion technique, the blood vessels of the rat's medial hypothalamus were reconstructed from serial sections. The area studied comprised the ventromedial, dorsomedial and perifornical nuclei. The arterial supply of this territory comes from the middle hypothalamic and the anterior, middle and posterior tuberal arteries. The drainage is strictly undirectional: ventralward by the anterior, middle and posterior ventromedial, the posteromedial and posterolateral hypothalamic veins, all ending in the basal vein. The arteries of the ventromedial and dorsomedial nuclei are distinct from those of the arcuate nucleus and median eminence, and their drainage is not connected with the portal vessels. The nuclei studied, even at the levels of their subdivisions, possess own arteries whose territories of supply can well be distinguished with a minimum of overlap. The topography of these arteries is described in detail. The medial hypothalamus has no vascular connections with other regions of the diencephalon including the thalamus.


Intermittent hypoxic loading: a model system to study the early stages of myocardial lesions. Authors applied the model system of intermittent hypoxic loading to study the development of early myocardial alterations. It was found that a primary role is played by the deficiency of high-energy phosphate synthesis and by the disturbance of energetic and transport processes. The change of Ca2+-control, activation of anaerobic glycolysis and intracellular acidosis were found to be instrumental in decreasing contractility, impairing membranes and finally in a diffuse destruction of myofilaments.


Post mortem detection of early myocardial infarction by determination of the tissue K+/Na+ ratio. The K+/Na+ ratio was determined in myocardial specimens obtained post mortem from a total of 90 patients. The ratio was 1.0 or higher 25 cases in which there was firm evidence against myocardial infarction, and 0.7, or less in 30 cases with grossly visible signs of myocardial narcosis. The remaining 35 cases were suspect of myocardial infarction on the grounds of either clinical observation or sudden death, without gross change. Out of these the K+/Na+ ratio was above 0.7 histological evidence of myocardial infarction was absent, but other changes accounting for death were present in 17 cases. In another 16 cases a K+/Na+ ratio of 0.7 or less was the sole indication of myocardial infarction, and any other change likely to be responsible for death was absent. In two further cases a false negative result was obtained for the K+/Na+ ratio, owing in all probability to some technical error. The findings suggest that determination of the myocardial K+/Na+ ratio is a great aid in detecting early myocardial infarction. The technique is not affected by post mortem autolysis, and is simple enough for routine use.


Some properties of autoprothrombin II-A anticoagulant. Autoprothrombin II-A anticoagulant was isolated from bovine prothrombin. Purified prothrombin was applied to DEAE-cellulose chromatography after incubation with thrombin. Four protein peaks were obtained where the third peak corresponded to the anti-coagulant effect. The fractions under the third peak were pooled together and the anticoagulant effect was evaluated with different methods. From 25,470 +/- 2,800 U of prothrombin, 5,800 +/- 1,400 U of inhibitor were obtained. The inhibitor was found to be most effective at pH 7.2--7.8. In vitro, the inhibitor inhibited the thrombin time and the plasma clotting time highly significantly but had no effect on euglobulin lysis time and fibrin plates. In vivo, when injected into rabbits, the inhibitor effect was also significant on the same tests. The autoprothombin II-A anticoagulant had a protective effect on DIC formation with rabbit brain thromboplastin administration. This protective effect was found to be statistically significant.


The ethanol gelation test and thrombosis. Intravascular fibrin formation takes place during thrombus formation or by activation of coagulation in circulating blood. Incorporation of fibrin in thrombi may be detected by usine 125I-labelled fibrinogen. Soluble fibrin may be present during thrombophilic states or during thromboembolic complications and diseminated intravascular coagulation (DIC) and may be detected and quantitated by various techniques such as N-terminal amino acid analysi, chromatographic procedures and so-called paracoagulation test, using ethanol or protamine sulfate. Finally, transformation of fibrinogen to fibrin may be indirectly assayed by quantitation of fibrinopeptide A released, by immunological technique. For routine purposes and especially in emergency situation, rapid and simple tests are required. In these circumstances, only the paracoagulation tests are at hand. Below, the present situation with regard to the ethanol gelation test (EGT) is outlined.


Detection of thrombin-induced fibrinogen derivatives in thrombotic states. Affinity chromatographic studies using insolubilized fibrinogen (fibrinogen-agarose) revealed that fibrin monomer present in plasma is selectively adsorbed to fibrinogen-agarose and may be quantitatively estimated following desorption. Analysis of plasma samples from patients with myocardial infarction, cirrhosis of the liver malignant diseases and DIC confirmed the presence of considerable amounts of fibrin monomer revealing concentrations between 3 and 15 mg/100 m1 plasma as compared to normal plasma (1.96 +/- 0.37 mg/100 m1,  = 27). The method is suitable for the assessment of hypercoagulable states. Standard conditions for the procedure were evaluated using 3H-labelled fibrinogen and fibrin monomer.


Induced chronic intravascular coagulation in dogs. When an emulsion of dog brain thromboplastin was infused continuously into dogs for 1--4 weeks only platelets and factor XI were consistently depressed. The remaining clotting factors fell in a dose-dependent fashion but there was a tendency toward recovery despite continued infusion of thromboplastin. Fibrinogen and factor V were unique in that with weaker emulsions of thromboplastin, they often rose without a preliminary fall.


Autoprothrombin ii-a, thrombin, and epinephrine: interrelated effects on platelet aggregation. Platelets aggregate with thrombin-free autoprothrombin II-A. Aggregation was dependent on an intact release mechanism since inhibition of aggregation occurred with adenosine, colchicine, or EDTA. Autoprothrombin II-A reduced the sensitivity of platelets to aggregate with thrombin, but enhanced epinephrine-mediated aggregation. Autoprothrombin II-A directly competes for membrane sites sensitive to thrombin. It allows complexes to from with epinephrine. There was no absolute requirement for autoprothrombin II-A since epinephrine aggregated dog platelets at the identical optimum concentration following Coumadin treatment.


Usefulness of new analytical reagents demonstrated with coumadin-modified plasma. Prothrombin, factor X or factor IX were removed specifically from bovine plasma by immunological techniques. Each depleted plasma is responsive to the respective purified component, and was used to follow the blood changes produced in a steer's blood by Coumadin administration. A factor IX-VII reagent was also used to follow changes in factor IX and factor VII activity. It is suggested that the new reagents may have practical value for qualitative and quantitative work in blood coagulation studies.


Isolation and characterization of factor IX Chapel Hill: comparison to normal human factor IX. A classification scheme for patients with hemophilia B has been devised. Assessment of factor IX antigen and factor IX coagulant activity has confirmed the genetic heterogeneity of hemophilia B and has shown that some affected patients have normal amounts of factor IX-like protein. An abnormal factor IX, factor IX Chapel Hill, has been isolated from one of these variants and compared structurally and functionally to the purified normal human factor IX molecule. The major difference between factor IX Chapel Hill and normal human factor IX appears to be defective activation of the abnormal molecule by factor XIa and calcium.


Comparative aspects of prothrombin activation. The activation of the purified prothrombins from human, bovine, and chicken species have been studied. Chicken prothrombin activation, similar to bovine prothrombin, resulted in the formation of a 161 residue prothrombin fragment 1, a 113 residue prothrombin fragment 2, and chicken thrombin with a 49 residue A chain and a B chain of approximately 260 residues. When human prothrombin is converted to thrombin, the resulting thrombin is shorter from the amino-terminus of the A chain by 13 residues (human prothrombin fragment 3). The vitamin K-dependent regions of all three species are very similar in sequence (33 of 46 residues identical for all three species). The regions of internal homology observed within the human and bovine fragments are apparently also  present within the chicken fragments, indicating that the partial gene duplication which resulted in the evolution of a prothrombin molecule of greater size than the other vitamin K-dependent coagulation proteins occurred prior to the divergence of birds and mammals over 300 million years ago.


Prothrombin complex concentrates.

Prothrombin complex concentrates. The use of the prothrombin complex products for the treatment of inhibitor patients is discussed in relation to our difficulty in identifying the effective therapeutic principle, as well as the factors responsible for thrombogenicity. It would appear that combination of factors is responsible for either or both therapeutic and thrombogenic phenomena. Possible intermediate or aggregate forms of the procoagulants are present in the products, protected from the neutralizing effects of antithrombin III.


Characteristics and thrombogenicity of factor IX concentrate. Thrombogenicity of the factor IX concentrate and its clinical use for stoppage of the bleeding in the case of hemophilia A with inhibitor were reported. (1) Factor IX concentrate contained the coagulation factors as prothrombin complex (factors II, VII, IX and X); Thrombin and factor Xa. (2) Prothrombin in the factor IX concentrate could be converted to thrombin without any additional procoagulant such as thromboplastin or factor V, but in just 2.5M glycine solution by the effect of factor Xa. (3) The infusion of factor IX concentrate into a rabbit induced DIC promptly which was proved by autopsy and coagulation-fibrinolytic studies. (4) Factor IX concentrate showed a great efficacy in stopping the bleeding in the case of hemophilia A with inhibitor.


The rehabilitation of adults with acquired hearing loss. The problems of adults with acquired hearing loss, together with aspects in the development of the rehabilitative skills of speechreading and auditory training are considered. An investigation carried out over a period of two years demonstrated how these skills may be acquired using single sensory and bisensory modes of instruction. The combined modes of speechreading and auditory training was found to produce the most effective communication. It was concluded that the combination of visual and auditory channels reduced sensory confusions.


Ribonucleic acid labelling perfused livers of protein-fed and protein-deprived rats. Several observations suggest an increased RNA synthesis in livers of protein-deprived rats, though the RNA/DNA ratio is decreased. A number of hormones may be involved in these changes. Therefore, we studied in RNA metabolism in isolated perfused livers taken from protein-fed and protein-deprived rats. (3H)-orotic acid was given to the rats 2 h before liver explantation, and (14C)-orotic acid was added to the perfusate. Other rats, called controls in vivo, whose livers were not transplanted were also given (3H)-orotic acid followed by (14C)-orotic acid. The livers of these rats, which were not hormone supplemented, were labelled for the same length of times as the livers in vitro. The ratio specific RNA radioactivity/specific nucleotide radioactivity x RNA/DNA was determined and taken as a measure of the RNA synthesis per liver cell. In the controls in vivo, this ratio was significantly higher for protein-deprived than for protein-fed rats. In livers from the protein-fed rats, labelling in vitro increased significantly when growth hormone, hydrocortisone, insulin and tri-iodothyronine were added to the perfusate. Labelling was also significantly higher in these livers than in the controls in vivo. In livers from protein-deprived rats, the ratio in question was the same whether the hormones were added to the perfusate or not, and was significantly lower than in the controls in vivo. Differences in RNA labelling are thus obtained in our in vitro system. Gel electrophoresis of RNA demonstrated normal RNA labelling, showing that the system is suitable for studying liver RNA synthesis. Further refinement can be made by studying the labelling of UTP and CTP. The results might suggest that the liver from a protein-fed rat, explanted in vitro, may increase its RNA synthesis under the influence of the four hormones in question, and that the RNA synthesis of the liver of a protein-deprived rat is high in-vivo and that it might decrease, when it is explanted to in vitro conditions.


The aggregation of rabbit polymorphonuclear leukocytes (PMN's): effects of agents which affect the acute inflammatory response and correlation with secretory activity. Rabbit peritoneal exudate polymorphonuclear leukocytes (PMN's) aggregate in shaken suspensions and their adhesiveness, as judged by the extent of aggregation, can be modified by various agents. Vasoactive amines, nonsteroidal antiinflammatory drugs, autonomic agonists, cholinergic agents, and adenine nucleotides have only minor inhibitory effects. Cytochalasin B, ionophore A23187, bacterial endotoxin, and the phagocytosis of bacteria all markedly increase adhesiveness. Enhanced aggregation correlates positively with increased secretion of lysosomal enzymes, although the contents of the secretory granules are mild inhibitors of aggregation. The implications of the linkage between the process of secretion and the increased adhesiveness of the cells are discussed.


Ultrastructural characteristics of developing eosinophil leukocytes in human bone marrow during acute leukemia: evidence for extracellular granule release from human eosinophils. Developing eosinophils from the bone marrow of a patient with acute "eosinophilic" leukemia were characterized by electron microscopy. It was suggested that the first sequential step in granule formation occurred at the level of the endoplasmic reticulum without actual participation of the Golgi complex. Progressive densification of the former profiles, presumably mediated by Golgi vesicles, resulted in the formation of dense immature granules. Ultrastructural observations of the "leukemic" eosinophils which were generally arrested at an intermediate stage of maturation revealed also large vacuoles containing sequestered immature granules, without any indication of phagocytic activity. Morphological evidence that has been accumulated indicates that the membrane of these vacuoles fused with the cell membrane, thus being in contact with the extracellular space. These profiles strongly suggested that granules and/or granule-associated material were secreted by developing bone marrow eosinophils.


Neutrophilic leukocytes in immunologic reactions in vitro: IV. The effect of trypsin. Prior trypsinization of rabbit PMN prevented the normal selective release of lysosomal constituents induced by contact with zymosan-C3 and abolished the adherence of these cells to sheep RBC sensitized with IgM antibody and complement (PMN rosettes). The effect of trypsin could be completely reversed by exposure of the cells to soybean trypsin inhibitor after trypsinization. Trypsin did not inhibit the lysosomal release provoked by contact with immune complexes of interfere with rosette formation between PMN and sheep RBC sensitized with IgG antibody. The action of trypsin on the PMN C3b receptor may not be enzymatic.


An overview of nonsteroidal antiinflammatory agents (NSAIA). Since the rediscovery of willow bark extract (salicin) in 1763, there has been a continuing effort to improve efficacy and reduce the side effects of antiinflammatory agents through chemical modification and innovation. The second-generation NSAIA's, phenylbutazone and indomethacin, provided clear support for the idea that these objectives were obtainable. The success of steroid programs in enhancing potency and modifying side effects, coupled with the development of effective screening techniques for identifying antiinflammatory activity, stimulated an enormous effort to develop new NSAIA's. The products of this effort are now coming to the clinic. Although less successful than the steroid program in enhancing potency, the effort has succeeded in changing and reducing side effects. As a result, the clinician has a greater choice of agents for dealing with individual patient variability and achieving greater patient acceptance.


Honey bee venom melittin: correlation of nonspecific inflammatory activities with amino acid sequences. The nonspecific (nonallergic) inflammatory activity of melittin, a protein toxin from honeybees, was correlated with specific amino acid sequences. Two different amino acid sequences of melittin were found to contribute to nonspecific inflammatory activities in guinea pig skin. Carboxy terminal peptide sequences of 7--10 amino acids induced immediate inflammatory reactions that reached maximum intensities by 15--30 min, then rapidly dissipated. The amino (N) terminal hydrophobic sequence, although not directly inflammatory, intensified the immediate reaction, causing a severe lesion evident by 2 h and characterized by massive polymorphonuclear leukocyte infiltration. A conceptual model of bee venom-induced inflammation in nonallergic individuals is suggested.


Leukocyte chemotaxis: a new in vivo testing technique. A new and sensitive technique is introduced for evaluating in vivo leukocyte chemotaxis. A small, disposable plastic chamber is used for holding the test solution, and an electric ink eraser for controlled abrasion of the skin test site. Another innovation is the use of capturing micropore membranes that, when placed between the test solution and the skin, collect cells for a permanent record. The small size of the chamber, the ease of application and immobilization, and the short time needed for cell collection permit experimentation with laboratory animals as well as with human volunteers. The accumulation of leukocytes in the chambers containing previously frozen or complement-activated autologous serum was 20 to 40-fold greater than in buffer controls after 3 h. Cell counts of approximately (1--2) x 10(3) leukocytes per mm3 were obtained in 3 h when serum diluted 1:1 with Hank's solution was applied to human or rabbit skin. Although predominantly polymorphonuclear leukocytes were detected in the chambers after just 3 h, prolonged incubations of 6--12 h found mononuclear cells also invading the chambers. These results clearly simulate the sequences of cellular emigration commonly observed in local inflammation.


The purification and characterization of a lymphokine chemotactic for lymphocytes--lymphotactin. Aqueous extracts of the thymus from vaccinated calves contain a protein specifically chemotactic for lymphocytes (lymphotactin). Lymphotactin has been isolated and purified by ethanol fractionation, ultrafiltration, isoelectric focusing, and preparative acrylamide gel electrophoresis. Its isoelectric point is 5.9, and the molecular weight by both SDS electrophoresis and exclusion chromatography is about 10,500. The purified sialoprotein is homogeneous at three different pH's in acrylamide gel electrophoresis. As little as 1 microgram of this material intraperitoneally wlll produce massive lymphocyte infiltration within 4 h in vivo.


Casein-mediated neutrophil chemotaxis: a parallel between surface binding and chemotaxis. This study was directed toward demonstrating an interaction between human polymorphonuclear leukocytes (PMNs) and the chemotactic factor,casein. Experiments conducted using fluorescein-labeled casein indicated that PMNs have a membrane receptor for this chemotactic factor. This receptor was specific for casein and was not found on lymphocytes. A direct parallel was shown between the binding of FITC--casein and the PMN chemotactic response to this protein. Binding to the receptor was optimal at 25 degrees C, unaffected by sodium azide, and partially reduced by iodoacetate. Enzymatic treatment of PMNs with pronase and trypsin resulted in a loss of both FITC--casein-mediated PMN fluorescence and chemotaxis. Our data indicate that human PMNs have a membrane receptor for casein and that interaction with this receptor results in a chemotactic response.


Antiinflammatory activity: evaluation of a new screening procedure. Acetaminophen, ascorbic acid, aspirin, dexamethasone, indomethacin, and phenylbutazone were tested to evaluate a new antiinflammatory screen. The basic methodology of Rassaert (1) was employed with slight modifications. The technique employs a 50-mm length of cotton twine instead of a cotton pellet. The data confirm the ability of this technique to rapidly screen activity of a variety of chemicals having antiinflammatory activity. It appears that statistically significant reductions in granuloma weight range between 10% and 50%, depending on the test compound and dose employed. This technique demonstrates activity for compounds such as aspirin and acetaminophen only at extremely high doses. However, more potent agents are detectable at more reasonable dose levels. Ascorbic acid, which has been shown to have activity in other models, was inactive in this assay. Dexamethasone was the most active agent, followed by indomethacin and phenylbutazone. Duplicate assays of selected agents showed a satisfactory degree of reproducibility.


Partial purification of human leukocytic pyrogen. Human leukocytes stimulated in vitro release leukocytic pyrogen (LP), a protein which is the mediator of fever. In order to study human leukocytic pyrogen, we attempted to purify this molecule from the large quantity and variety of proteins which are present in leukocyte supernates. Human peripheral leukocytes were stimulated in vitro by phagocytosis of killed staphylococci, and several methods were used to isolate the pyrogen protein. First, using isoelectric focusing, it was found that crude leukocyte supernates contained two molecular species of LP which were separable by precipitation in cold alcohol. Isoelectric focusing, although used for confirmation of the molecular homogeneity of LP, could not be employed as a preparative purification technique. Following alcohol precipitation, human LP was chromatographed on ion-exchange materials at various pH with modest recovery of initial activity but marked increase in specific activity. Gel-filtration was also employed and yielded partially purified LP. When alcohol precipitation was combined with ion exchange at alkaline pH and followed by gel-filtration, resulting LP preparations contained 5 or 6 contaminating proteins. These results demonstrate that human LP can be partially purified from the large quantity and variety of proteins present in crude leukocyte supernates and during purification procedures, the pyrogen did not change in either molecular weight or isoelectric point. This work provides reliable techniques for initial purification of human LP.


Metabolism of arachidonic acid in rabbit alveolar macrophages. Rabbit alveolar macrophages incorporated radioactive arachidonic acid primarily into phosphatidylcholine, phosphatidylethanolamine, sphingomyelin, and triglycerides. When these cells, so labelled, were washed and treated with polystyrene beads, there was a distinct and reproducible decrease in the radioactivity of phosphatidylcholine, phosphatidylethanolamine, and triglycerides. This decrease was accounted for by the appearance of two major prostaglandins, PGE2 and PGF2alpha, and uncharacterized hydroxy fatty acids, which may be 12-hydroxy-5,8,10,14-eicosatetraenoic acid, 5-hydroxy-6,8,11,14-eicosatetraenoic acid, and/or 8-hydroxy-9,11,14-eicosatrienoic acid.


Mast cell-mediated reactions of host defense and tissue injury: the regulatory role of eosinophil polymorphonuclear leukocytes. Immunological stimulation of mast cells, by way of either IgE- or IgG-directed reactions, initiates the rapid release of an array of chemical mediators. The predominant local tissue effects of these mediators collectively constitute a defensive response of the host. The early humoral phase of defense is exemplified by the alterations in microvascular permeability induced by histamine which provide a local concentration of immunoglobulins and complement components. The later cellular phase of defense is composed of the PMN leukocytes that accumulate in response to mast cell-derived chemotactic principles and which phagocytose and degrade opsonized foreign material, thus eliminating the inciting stimulus. Of the several endogenous regulatory mechanisms which act to contain the immediate hypersensitivity reaction, the eosinophil has a special role since it is specifically attracted to sites of mast cell activation and has selective concentrations of several enzymes which degrade the mast cell-derived chemical mediators. Failure of the local regulatory processes can permit the mast cell responses of host defense to become pathological reactions leading to tissue injury by virtue of persistence of high levels of humoral mediators and/or increasing infiltration with PMN leukocytes.


A method for producing synchronized audio signals. An examination of the work dealing with dichotic listening reveals that technical problems prevent clear interpretation of the data. One of the most crucial problems is that of achieving simultaneity of output so that dichotic (simultaneous but different) material is introduced into the auditory system. A simple method for achieving such synchrony on stereotape is described together with a method for testing for degree of simultaneity, if possible.


On the cross hearing of spondaic words.

On the cross hearing of spondaic words. Twelve adults with unilateral hearing losses were tested to determine interaural attenuation for spondaic words. Low-pass and band-pass filters were used to simulate hearing loss at the normal ear. Results suggest that in deciding on the possibility of cross hearing, the spondee threshold at the test ear should be compared to the most sensitive bone-conduction threshold at the nontest ear, excluding .25 kc/s.


Annoyance response to spectrally modified recorded aircraft noise during television-viewing. Magnitude estimations of the annoyance of 27 individual noise stimuli were made by 24 Ss while viewing television; 8 different spectrum modifications of a basic aircraft noise were introduced at 3 overall intensities. The basic spectrum was that of an untreated commercial jet aircraft takeoff noise; the other 8 were created by removal of one of two amounts of energy from an octave band centerered at either .315, .8, 1.6, or 4 kc/s. An ANOVA showed significant annoyance differences for spectrum modification, overall noise intensity and their interaction. Annoyance reduction was greatest when  energy was removed at the octave band centered at 1.6 kc/s, next at .8, and .315, and least at 4 kc/s. Although greater overall intensity reduction yielded progressively less annoyance with various spectrally-modified noises as well as unmodified noise, the spectrum modification was apparently most effective in reducing annoyance when the overall maximum noise intensity ranged from 88.0 to 89.1 dbA, and was least effective from 83.9 to 85.3 dbA. Annoyance reduction resulting from spectrum modification at a single octave band (centered at either .8 or 1.6 kc/s) was equivalent to that resulting from a 2.7 dbA overall intensity reduction. The results are discussed in terms of speech interference as well as intermodal effects of noise during television viewing.


Stapedial reflexes in normal versus recruiting ears. The latency and magnitude of the stapedial reflex was examined in a group of normal-hearing Ss (N: 15) and in 15 Ss with unilateral sensorineural impairment exhibiting abnormal loudness growth in the impaired ear. Reflexes were determined at successive 2-db steps from threshold to 16 db above using a 2-kc/s stimulus tone. Latency and magnitude measurements were not statistically different between groups nor between ears within the pathological group. These results substantiate dependence of the stapedial reflex on loudness. Furthermore, there appears to be a dependence of the reflex magnitude on age, in that the magnitude tends to be less in older Ss.


Validation norms for speech discrimination scores of normal-hearing subjects in wide-band and in speech-spectrum noise at S/N 0 DB. W-22 lists were given at 40 db re SRT with a Maico MA-24B audiometer and attachments to 20 normal-hearing adults in quiet and in combination with either wide-band or speech-spectrum noise at S/N = 0, monaurally by earphone and binaurally by loudspeaker(s). No systematic L-R differences were observed. DS in quiet by any condition was at or near 100%. Mean DS in noise by monaural earphone was 79.80 +/- 13.3 for wide-band noise and 54.7 +/- 12.7 for speech-spectrum noise. When speech and noise were from two different loudspeakers placed +/- 45 degrees from midline, DS was 90.8 +/- 9.5 for wide-band noise and 88.1 +/- 7.8 for speech-spectrum noise. When both speech and noise came from the same loudspeaker, DS was 79.10 +/- 10.3 for wide-band noise and 57.0 +/- 21.8 for speech-spectrum noise. These values are proposed as provisional norms for clinical facilities using these conditions and employing similar instrumentation.


Normal-hearing subjects' perception of speech through one-third octave bands. Perceptual features of consonants were investigated from normally-hearing Ss' confusions of stimuli perceived through one-third-octave bands; 12 Ss were paid to respond to CVs consisting of 17 consonants, each paired with the vowels /i, a, u/ and filtered through one-third-octave bands centered at  0.5, 1, 2, 3.15 and 4 kc/s and one critical band (500 c/s wide) centered at 3.15 kc/s. An earlier cursory analysis of distinctive features in these data (Chari, N.C.A., Herman, G. and Danhauer, J.L. "Perception of one-third octave-band filtered speech." J. Acoust. Soc. Am., 1977, 61, 576-580) showed that while place features were severely affected by the filtering, manner and voicing features were not. The data were submitted in the present study to INDSCAL for a more a-posteriori investigation of the features and their weights by the Ss. Results showed some differences in the features and their weights across the various filter bands, but that they were similar to those found earlier for hearing-impaired Ss having losses corresponding to frequency cut-offs in this study.


Glucose uptake and lactic acid production of adenovirus type 5-infected HEp-2 cells cultured under exponential growth and stationary phase conditions. Exponentially growing HEp-2 cells have a higher rate of glucose uptake and lactic acid production than stationary phase cells. Infection of cells with adenovirus type 5 stimulates glycolysis irrespective of the original rate of the host cells. Therefore, infected cells cultured under exponential growth conditions have a higher rate of glycolysis than infected stationary phase cells. The rate of host cell glycolysis does not influence the time required for virus replication, the yield of infectious virus particles produced, or the time of appearance and progression of virus-induced cytopathology.


Regulation of cellvibriocin activity.

Regulation of cellvibriocin activity. Attempts were made to enhance the production of cellvibriocin, the bacteriocin produced by Cellvibrio sp. NCIB 9916, by a study of cultural conditions in agar (solid) media. In such media cellvibriocin was unstable: within 24 h all activity disappeared at 45 degrees C, 70% at 37 degrees C and more than 50% within 5 days at 5 degrees C. The temperature at which the producer strain was grown was critical, 25 degrees C being optimal. Cellvibriocin activity was markedly affected by the composition of the medium. Small amounts of metallic salts (Cu2+, Mn2+, Sr2+, Zn2+) and carboxylic acids of the citric acid cycle, especially citrate and tartrate, promoted its activity. Protease inhibitors, p-chloromercuribenzoic acid, N-ethyl maleimide and iodoacetate, enhanced cellvibriocin activity whereas a promoter of protease activity, casein hydrolysate, decreased activity.


Effect of single stimulation of the posterior hypothalamus on visual evoked potentials in anesthetized rabbits. During single stimulation of the posterior hypothalamic nuclei an evoked hypothalamo-cortical response with a short latent period, well-marked primary positive and negative components, and a secondary positive wave of high amplitude was recorded in the visual cortex of rabbits anesthetized with pentobarbital. It is postulated that pathways from the posterior hypothalamus to the cortex are numerous, pass through various subcortical structures, and terminate in different synaptic organizations. Single stimulation of the posterior hypothalamic nuclei at intervals of between 700 and 100 msec facilitate the visual evoked potential on account of an increase in its negative component. Besides facilitation of the visual response, during single stimulation of the posterior hypothalamic nuclei the zone of recording of the visual evoked potential is widened.


Method of estimating preference of the female rat for various sound stimuli while searching for pups. A rat was placed without her pups in an open T-shaped maze and maternal behavior stimulated by the presentation of pups. The pups were then removed and tone pulses (7 kHz, 14 kHz) and a tape recording of the pup's pain signal were simultaneously presented from different alleys of the maze. Preference was estimated by the predominate direction of sorties during random alternation of the sound sources. Preference for the pup's pain signal was found in eight rats.


Dimensions of the hippocampus, memory, and learning in the ontogenesis of rats. Damage to the hippocampus in 20-, 50-, and 110-day-old rats impairs the processes of learning and short-term memory in them. In 50-day-old rats, hippocampectomy has less of an influence on the process of learning and memory than for 20- and 110-day-old animals. The anatomic and physiological characteristics of the hippocampus in 20-day-old rats may be evidence of a special importance of this formation at the early stages of ontogenesis, when the cerebral cortex is still insufficiently mature and its associations with other structures have not been entirely formed. The nonlinear nature of the dependence of the disruption of learning in rats of different ages after hippocampectomy suggests that the function of the rat hippocampus undergoes changes during the process of individual development of the animal.


Effects of electrical stimulation of vagal nuclei in anesthetized and unanesthetized cats. Changes in the heart rate were studied during stimulation of the effector nuclei of the vagus nerves--the dorsal vagal nucleus and the nucleus ambiguus--in anesthetized and unanesthetized cats. If groups of neurons, stimulation of which in anesthetized cats causes slowing of the heart, were stimulated in unanesthetized cats under conditions of free behavior, the heart rate was increased. Pharmacological beta-adrenergic receptor blockade by injection of Obsidan or Inderal (propranolol) demonstrated the parasympathetic nature of these effects. The fact that they are parasympathetic in nature was also confirmed by the character of the response: its short latent period and rapid disappearance of the effect after removal of the stimulation.


Evoked responses of the superior olive to amplitude-modulated signals. Evoked potentials of some auditory centers of Rhinolophidae bats to amplitude-modulated signals were studied. A synchronization response was found in the cochlear nuclei (with respect to the fast component of the response) and in the superior olivary complex (with respect to both fast and slow components of the response) within the range of frequency modulation from 50 to 2000 Hz. In the inferior colliculus a synchronized response was recorded at modulation frequencies below 150 Hz, but in the medial geniculate bodies no such response was found. Evoked responses of the superior olivary complex were investigated in detail. The lowest frequencies of synchronization were recorded within the carrier frequency range of 15-30 and 80-86 kHz. The amplitude of the synchronized response is a function of the frequency and coefficient of modulation and also of the angle of stimulus presentation.


Invariability of auditory perception with respect to frequency--time signal transformations in the dolphin Tursiops truncatus. The characteristic of hearing in the dolphin Tursiops truncatus were investigated by the method of motor-feeding conditioned reflexes under conditions of frequency--time signal indeterminancy with background noise. It was shown that the effectiveness of auditory detection of tone--pulse signals is invariant with respect to Doppler and shift signal transformations, while the number of waves is a characteristic parameter of the auditory system.


Outcome of infants of very low birthweight treated in neonatal intensive care unit. The neonatal survival rate of 500 VLBW (less than or equal to 1 500 g) treated in the neonatal unit of the Departement of Paediatrics in Lausanne (C.H.U.V.) was studied according to changing patterns of nursing and medical care occurring in four successive periods (1961 IX-1963, X-1963 - 1965, 1966-1968, IV-1971-1973). The survival rate at 28 days increased from 35.5% to 47.7% between 1961 and 1965. Earlier start of feeding, intravenous fluid therapy, better control of ambient temperature and better oxygenotherapy are the main changes during this period. Further improvement in neonatal care did not affect the 28-day survival rate. 213 VLBW out of 500 (42.6%) survived at 28 days, 13 (6.1%) out of these died within the first two years of life, 36 (16.9%) were lost for the follow-up. The remaining 164 VLBW were followed until ages between 18 months and 8 years. The improvement in neonatal care was associated with a decrease in the incidence of major neurological sequels from 21.1% to 12.2% between 1961 and 1973. Cerebral palsy and epilepsy are responsible for this decrease. The incidence of mental retardation (DQ or IQ less than 80) also decreased from 17.5% to 4.9% during the same period. However, the incidence of retrolental fibroplasia remained stable. The outlook for VLBW infants is now much more encouraging. Further improvement in perinatal care is likely to further reduce the incidence of major handicaps. but it is not clear whether they will affect the incidence of minor problems such as learning difficulties or poor school performances. More prospective studies are necessary to clarify these points and to ensure early detection of these developmental problems.


[Distribution of birth weights and influenza epidemics (author's transl)]. The possible consequences of influenza during pregnancy on the weight of the new born were studied. It was shown that the major 1969-70 winter influenza epidemic in Alsace was followed by a decrease in the mean birth weight registered in Haguenau's maternity hospital. This study confirms previous work on the subject and shows that birth weight can be used as a valuable tool at the epidemiologic scale.


[Functional bucco-dental restoration cost for adolescents aged 16 to 20 in the Geneva resident population (survey 1970-72). I. -- Description of estimates (author's transl)]. In 1970/72, a random sample of 1392 adolescents of the population irrespective of nationality and sex has been drawn, using computer equipment, from the Geneva (Switzerland) resident population, ages 16 to 20 years. The sampling fraction was 13%. These adolescents were interviewed for case history, and then underwent clinical, radiological and photographic examination by a medically trained team including a dentist and a dental hygienist. The sampling had been designed so as to avoid selection regarding the adolescents' sex and occupation (student/apprentice/young labourer) or the parents' socio-professional category. Comprehensive epidemiological data concerning the main dental and periodontal diseases are thus recorded to allow estimation of the individual cost for a complete functional restoration of the dentition and the periodontium (orthodontic treatments not included). The estimating arithmetic is performed on the computer by means of an original program worked out especially for cost estimation referring to an approved list of fees for medico-dental treatments. The first part of the article, as published below, reports the relative frequency distributions of estimated cost depending on age, sex and occupation separately as well as jointly. Moreover, these distributions are summarized by their basic descriptive statistics (medians, quartiles, ranges, extreme values, etc.). At first sight, it seems that by and large the median cost is higher for boys than for girls, and that there is evidence for an increasing trend with respect to age; young labourers rank somehow between students and apprentices. The data seem to exhibit a decreasing trend of median cost as regards ascending socio-professional category. Besides this trend is maintained when duration of caries prophylaxy by means of fluorine tablets intake is accounted for. Average number of daily tooth brushings also positively correlates with median cost, whereas the latter does not seem to depend very closely on time elapsed since the latest appointment with the adolescent's dentist. In another connection, the present paper indicates the overall cost (as well as cost for certain treatment subgroups) estimated for the sample on the one hand, for the whole population on the other hand.


[The difficulty of choosing a good control group in a retrospective study (author's transl)]. The choice of either hospital or population controls in retrospective studies is guided by rules implying underlying hypotheses. In a study on aesophageal cancer in relation to alcohol and tobacco consumption, two such control groups were available and were compared. It was found that some of the currently accepted assumptions relating to representativeness of cases or controls were verified but many others were not, particularly in hospital controls. These were found to give less correct estimates of drinking and smoking habits than those obtained from population controls. The limitations in the use of either type of controls is discussed, in relation to the purpose of the study concerned.


[The decline of fertility in Western Europe. II. Which fertility rate would be desirable in France? (author's transl)]. A way to try and assess the significance of such or such level in long term fertility is to work out population projections based on a variety of assumptions and to compare their different implications. The age pyramids of France until 2100 that derive from four contrasted evolutions of fertility are studied in the present article: completed fertility in birth cohorts ranging from 1.4 to 2.6 children per woman. While some demographic parameters are not much sensitive to the assumption made for the fertility level (e.g. percent of economically active people in total population), others are closely related to fertility (such as total number of inhabitants, percent of younger people or of older people in total population, annual rate of entry into economically active population). In France, where population density is much lower than in most neighbouring countries, a fertility level that would lay at -- or a little higher than -- replacement (i.e. 2.1 children per woman) can be considered as a desirable target.


Radical cystectomy with or without prior irradiation in the treatment of bladder cancer. This is a summary presentation on certain aspects of an experience with the use of radical cystectomy with or without prior irradiation in the treatment of selected patients with bladder cancer at the Memorial Sloan-Kettering Cancer Center.


Evidence for a new mammalian organ. II. Calcium kinetics. The calcium content and calcium kinetics of the fatty tissue complex comprising the renal sinus organ of the rat kidney are reported. A comparison is made to control brown and white fat in the same animal. The calcium content of the renal sinus tissue is significantly greater than controls. Calcium localization in the mitochondria of the sinus tissue complex is demonstrated. Radioactive iostope studies (45Ca, 85Sr and 99mTc) indicate a dynamic exchange of calcium between the systemic pool and the sinus organ. Active accumulation appears to be operative. Supporting evidence for the existence of a portal vascular system joining the renal sinus complex and the renal parenchyma is presented. The significance of a calcium sink in the renal sinus tissue of the rat kidney is discussed.


Intrarenal nephrolithotomy and reconstruction of the solitary kidney. There were 30 patients with solitary kidneys containing staghorn claculi who have been subjected to nephrolithotomy with extensive plastic revision of strictured calices using local renal hypothermia. These patients have been followed for 8 months to 16 years and all have had a recent in-hospital evaluation of renal function and recurrent stone formation. No surgical mortality occurred (death within 3 months of operation). Seven patients have died postoperatively, only 1 of whom had associated progressive deterioration of renal function as a contributory cause of death. It is concluded that surgical removal of calculi from a solitary kidney is a relatively safe procedure that results in significant improvement in the patient's well being. The degree of improvement is of such a nature that it may be equated to "cure of the disease" in 63 per cent of the patients.


Urodynamic patterns in children with dysfunctional voiding problems. Simultaneous measurements of the intravesical pressure, electromyographic activity of the anal sphincter and the urinary flow rate in 17 children with dysfunctional voiding problems have shown a variety of unusual patterns, each distinct for the particular child but all with the common denominator of failure to coordinate detrusor and sphincter activity. We postulate that these patterns represent persistence of the transitional phase in the development of micturitional control whereby the child learns to prevent involuntary wetting by forceful contraction of the external urethral sphincter.


Malignant hypertension in children secondary to chronic pyelonephritis: laboratory and radiologic indications for partial or total nephrectomy. Severe renin-mediated hypertension was noted in 2 children as a result of selective renal damage from vesicoureteral reflux during the early years of life. In each case the reflux had been corrected successfully long before hypertension developed. In 1 case the late damage involved only 1 kidney and nephrectomy resulted in immediate relief of the hypertension. In the second case, even though both kidneys showed segmental scarring from calicectasis and chronic pyelonephritis, removal of the atrophied lower pole of 1 kidney made hypertension amenable to medical treatment and reduced excessive renin output to a fraction of the original high levels. The mechanism of renin-mediated hypertension in kidneys with segmental scars of chronic pyelonephritis is believed to be ischemia of the relatively normal renal cortex in proximity to areas of interstitial fibrosis, within which are tortuous interlobular and smaller arterioles with severe intimal thickening. Hypertrophy of normal renal segment occurs in young patients with segmental chronic pyelonephritis. To accommodate this enlargement the original calix develops an extension or elongation readily distinguishable from other dilated calices.


Splenorenal bypass in the treatment of renal artery stenosis. A retrospective study is presented of our experience from 1962 to 1976 with the splenorenal bypass procedure in the treatment of 32 patients with renovascular hypertension. The over-all results were 53 per cent of the patients cured, 28 per cent improved and 19 per cent failures. Improved results were noted when the splenorenal bypass was performed in relation to specific operative indications. The results were somewhat better in men than in women and poor results were obtained in children. Intraoperative and early postoperative complications were minimal. There were 2 postoperative deaths, for a hospital mortality rate of 6.3 per cent. Late complications were limited to splenic artery graft stenoses, which developed in 3 patients (9.4 per cent). When performed in relation to specific clinical and operative indications the splenorenal  bypass is believed to represent an excellent means to achieve safe and effective renal revascularization.


Pyelometry: an objective evaluation of obstruction in the upper urinary tract. Constant infusion pressure monitoring is proving to be valuable in the clinical evaluation of patients with dilated upper urinary tracts. A sound physiological basis has been established for the method and good results can be achieved with a simple, easily available apparatus.


Technical considerations in distal tunnel ureteral reimplantation. The advantages of a distal tunnel ureteral reimplantation have been elaborated upon previously. This method offers simplicity of transvesical exposure, rapidity of execution, excellent visibility of the terminal ureteral segments, minimal dissection and trauma in the paravesical space, the opportunity to advance the ureteral orifices to a physiologic position on the trigone and minimal risk of angulation, kinking or obstruction of the terminal ureter. It is now recognized that this method, with the modifications discussed herein, has wide applicability in the management of vesicoureteral reflux of all varieties and etiologies.


Priapism cured by creation of fistulas between glans penis and corpora cavernosa. A simplified method to drain the corpora cavernosa into the spongiosum in cases of priapism is discussed and the advantages are listed.


Urological and behavioral approach to the treatment of secondary impotence. Psychogenic impotence is far more common than organic impotence and may co-exist with or be a result of it. Psychological principles of therapy may be needed for all impotent patients treated by the urologist. These principles include 1) re-education in sexual function, 2) removal of pressure for male performance, 3) bringing existing performance fears to the surface for therapy, 4) teaching patients techniques to deal with the fears, 5) teaching the partner proper cooperation and 6) improving the communications between the 2 partners.


Motion picture: routine perineal urethrotomy for transurethral surgery. The concept that perineal urethrotomy is a prodigious time-consuming procedure is no longer tenable. The procedure need not require the use of holding sutures to evert the urethra, a gorget or similar device to aid the manipulation of the instrument into the bladder nor sutures to close the urethra. The procedure can be done smoothly and quickly without any indecision as to its consequences.


Preoperative evaluation of patients with bladder outlet obstruction with particular regard to excretory urography. During the last 15 years excretory urography has been a routine preoperative diagnostic procedure for patients with bladder outlet obstruction in our department and, perhaps, for many more years in other urological centers. There are 2 reasons that this investigation should be done: 1) to detect abnormalities of the upper urinary tract that can be important indicators to operate or for the postoperative course and 2) to detect abnormalities in the bladder that should be corrected simultaneously with the prostatectomy or that can interfere with the procedure.


Experience with an animal model for the study of prostatic carcinoma. We report on the development of the Dunning R3327 prostatic adenocarcinoma of the Copenhagen rat as a suitable model for human prostatic cancer. Tumors produced by the subcutaneous or intraprostatic injections of viable cells had the macroscopic and microscopic characteristics of human disease. Histologically, these tumors were well differentiated adenocarcinomas with the human disease. Histologically, these tumors were well differentiated adenocarcinomas with the formation of glands and acid secretions within the acini. The intraprostatic tumor, although initially confined to the injected lobe, grew to involve the surrounding tissues and eventually metastasized to the lymph nodes and lungs. Occasional metastatic lesions were found in other organs as well. Acid phosphatase could be demonstrated by histochemical staining of frozen tumor sections and elevated levels of the enzyme were seen in the serum of rats bearing long-term subcutaneous tumors. During investigation of the tumor a fast growing line arose that grew equally as well in female as in male rats. The histology of this tumor was of an undifferentiated anaplastic tumor. Treatment by cryosurgery completely destroyed the prostatic tumor within 2 weeks. A tissue culture line derived from R3327 was capable of producing tumors in recipient rats with characteristics similar to the original Dunning tumor.


Micturition urodynamic flow studies in children. Voiding abnormalities are encountered frequently in pediatric patients. Symptoms of daytime incontinence, frequency and nocturnal enuresis in any combination may indicate underlying neurophysiologic detrusor imbalance. Incomplete evaluation of these symptoms can result in inappropriate medical therapy or even ineffective operations. Within the preceding 7 months 34 children with hard-core voiding abnormalities were evaluated with urodynamic techniques. Several categories of abnormal voiding patterns were identified, including the hyperactive external sphincter, uninhibited pediatric neurogenic bladder, detrusor hyperreflexia secondary to chronic cystitis, hyperactive external sphincter with hypotonic bladder and the hyperactive external sphincter with detrusor irritability. All patients received specific pharmacotherapy based on presenting signs and symptoms, and voiding pattern abnormality. Of the 24 patients who have been treated in this manner and were evaluated 83.5 per cent have had complete remission of symptoms while on therapy, the remainder being improved but still having occasional symptoms. The technique and data demonstrate that children with hard-core voiding abnormalities can achieve rehabilitation with urodynamic assessment.


Eight years of experience with preoperative angiographic and lymphographic staging of bladder cancer. Our experience with the preoperative staging of bladder cancer by bilateral selective hypogastric arteriography has been accumulated since 1968. More than 150 patients have been studied by selective angiography before radical cystectomy. Our latest series of 52 patients (1972 to 1976) compares to our previous experience demonstrating angiographic staging accuracy to detect bladder invasion and occult metastases at a rate exceeding that of clinical staging alone. Arteriographic staging of D lesions, when supplemented with lymphography, approaches 100 per cent accuracy. Falsely negative lymphograms currently are extremely uncommon (1.9 per cent). In several illustrated instances angiographic staging was proved to be even more accurate than the pathologic staging of a limited cystectomy specimen. The over-all angiographic and lymphangiographic staging accuracy in our most recent series of cystectomy patients was 78.8 per cent. The techniques and reliability of the data are discussed in detail, including the factors that interfere with the exact arteriographic staging of bladder cancer. However, these factors are more troublesome in early stage lesions. These studies demonstrate the role and value as well as areas of limitation of preoperative arteriography and lymphography in the evaluation of invasive bladder cancer.


Partial cystectomy in the treatment of transitional cell carcinoma of the bladder. Between 1950 and 1974, 35 men and 10 women underwent partial cystectomy for transitional cell carcinoma of the bladder. Indications, contraindications and the principles of technique for partial cystectomy as therapy for transitional cell tumors of the bladder are discussed. All patients were evaluated postoperatively, with cystoscopic examination every 3 months for 1 year, every 6 months for 3 years and then at yearly intervals if no tumors had been detected. None of the patients received preoperative irradiation. Eight ureters were re-implanted and 6 prostate glands were enucleated at the time of partial cystectomy. There was 1 death in the immediate postoperative period. Complications developed in 12 patients, in 3 of whom they were considered major. When recurrences were noted appropriate therapy was performed as indicated. Irradiation was the most commonly used method to treat distant metastases. The over-all 5-year survival rate is 57.7 per cent (26 patients). Thirty-four patients were followed for 10 years. The survival rate for this group of patients was 32.4 per cent (11 patients). The results of this study correlate well with other published reports.


Secondary polycythaemia.

Secondary polycythaemia. The secondary polycythaemias are classified on an aetio-pathological basis and the main pathological and clinical features of the individual types are presented in the light of data in the literature and own observations in 138 cases seen during 15 years. The general lines and possibilities of therapy are discussed.


In vitro effect of immune complex positive human sera on antibody dependent cellular cytotoxicity. The effect of immune complex positive and negative (control) sera on the antibody dependent cytotoxicity of normal human lymphocytes was studied in a xenogeneic assay in vitro. Significant inhibitions were obtained with the sera of immune complex positive patients as compared with age and sex matched controls. The possible significance of these findings in autoimmune diseases and malignancies is discussed.


Antibody dependent and spontaneous lymphocyte mediated cytotoxicity in normal subjects, patients with SLE, and malignancies. Antibody dependent and spontaneous lymphocyte mediated cytotoxicity was studied in healthy subjects and patients with systemic lupus erythematosus and metastatic tumours. The purified peripheral blood lymphocytes of healthy subjects exerted a similar cytotoxic activity on allogeneic K-562 and xenogeneic chicken erythrocyte targets in the antibody dependent and spontaneous lymphocyte mediated cytotoxicity tests. There was a stronger correlation between the cytotoxicity measured in the two allogeneic assays than between allogeneic and xenogeneic tests. Allogeneic systems using K-562 targets were more sensitive to changes in cytotoxic activity in systemic lupus erythematosus and metastatic tumours than was the xenogeneic chicken erythrocyte assay.