English schoolchildren and illegal drugs. II. Changes over one year. Part I of this paper described levels of familiarity with drugs of fifth form pupils in 29 schools in England. In Part II, changes in reported levels of drug use over 1 year are described in two sets of pupils. First, changes in drug use reported between a 1973 forth form group and a matched fifth form group from the same schools 1 year later (follow-up study); and second, differences in reported levels of use between the 1973 fourth form and a matched group of 1974 fourth forms from the same schools (trend study). It is concluded that there was no evidence of any substantial general increase or decrease in familiarity with drugs in the schools studied during the 1-year period of study.


Sib group therapy: a prevention program for siblings from drug-addicted families. To prevent drug abuse among younger siblings of addicted adolescents, weekly group therapy sessions were implemented at a suburban therapeutic drug community. The concept evolved as an outgrowth of family therapy which revealed that intergenerational addictive patterns might impose a high future risk of similar behavior among latency age children. Results after 18 months indicate that although severe group acting-out behavior has diminished, underlying psychodynamics appear somewhat unchanged. Some evidence of experimentation with alcohol has emerged. Conclusions are that superego development is still impoverished but the tenacity of the group's existence provides positive speculations of ultimate success.


Environmental and behavioral aspects of glue sniffing in a population of emotionally disturbed adolescents. The following study used an eight question survey to explore some ecological and behavioral dimensions of glue sniffing in a population of emotionally disturbed adolescents. The results indicated that peer-based pressure was a dominant motivational aspect for engaging initially in glue-sniffing behavior. In addition, a significant number of adolescents in this survey revealed a trend toward experiencing unpleasantness with continual use.


A comparative study of oral and intravenous drug-dependent patients on three dimensions of personality. In an investigation of personality differences between oral and intravenous drug addicts, 59 subjects attending a London clinic were given the Eysenck Personality Questionnaire. Both groups scored highly on the neuroticism and psychoticism dimensions, though oral users were found to have significantly higher scores on both of these scales. High P scorers have been found to be cold, unfriendly, hostile, etc., and it is suggested that the lower P scores of the intravenous users may be partly due to possible hostility-reducing effects of the narcotics used by this group. Other implications of these findings are also discussed.


Relationship between locus of control and drug effects in users of narcotics, stimulants, hypnotic-sedatives, and hallucinogens. A test is made of the hypothesis that the subjective effects of narcotics lead to an internal locus of control orientation. No support is evident. Similar findings are given for users of stimulants. As an aside to the major focus of the study, a test of locus of control differences between users of narcotics, stimulants, hypnotic-sedatives, and hallucinogens is given, with no differences being found.


Correlates and predictors of recidivism among drinking drivers. Follow-up interviews on 47 formal DUI clients of an alcohol treatment program were conducted in an effort to find predictors of success. Predictors included historical factors occurring at the time of arrest, stressful events since treatment, length of treatment, time since treatment, and demographic data. Recidivism was conceptualized as a multidimensional construct through self-report measures and arrest records. Findings indicated that punitive actions fail to account for recidivism. Involvement in an accident, however, is significantly and positively related to future success in treatment. The implications of this observation are discussed.


Interpersonal behavior in group discussion during marijuana intoxication. Four-person groups of moderate and heavy marijuana users were studied in a group discussion situation during marijuana intoxication. Amount of participation and role behavior were compared to nonintoxicated baseline performance and to that of a no-drug control group. During intoxication, moderate users were less task-oriented and participated less in group discussion. These findings were interpreted in terms of cognitive, motivational, and physiological reactions to marijuana. The lack of any social effect on heavy users suggested the existence of behavioral tolerance.


Nutrition, development, and foreign aid: a case study of U.S.-directed health care in Colombian plantation zone. Based on a case study of some aspects of Rockefeller and USAID intervention in the Cauca Valley, Colombia, this article is aimed at drawing attention to the political characteristics and inadequacies of U.S.-sponsored health care planning and research in the Third World, particularly as regards nutrition in rural regions of intensive economic development. By contrasting an historical analysis of the politicoeconomic development of agriculture and nutrition in the southern Cauca Valley with the assumptions guiding U.S. intervention in the health field there, a more complete picture of the causes of malnutrition is obtained, among which should be counted the intervention of the U.S. itself. Inter alia, other approaches to the malnutrition problem are suggested.


Social justice and the demographic transition: lessons from India's Kerala State. Kerala is a small, densely crowded state in South India. It is a poor state, even by Indian standards. Its per capita income of US$80 lies well below the all-India average of US$120, and it suffers from the lowest per capita caloric intake in India. Nevertheless, Kerala has managed to achieve the demographic transition from high (premodern) to low (modern) birth and death rates-something no other Indian state has been able to attain. Indeed, the magnitude of Kerala's fertility decline-the birth rate fell from 39 in 1961 to 26.5 in 1974-has never before been observed in a nation with comparable levels of income and undernutrition. Other indices of Kerala's soical development are equally surprising: levels of literacy, life expectancy, female education, and age at marriage are the highest in India, while mortality rates, including infant and child mortality, are the lowest among Indian states. But Kerala's anomalous and unexpected demographic trends and levels are not the result of the direct interventions designed to influence health and fertility levels elsewhere in India-conventional strategies of population control and health services delivery that thus far are notable for their failure to generate such positive results. Instead, Kerala's demographic levels evidently reflect a broad social response to structural reforms in its political economy.


The economic and political determinants of human (including health) rights. This paper presents an analysis and critique of the U.S. government's current emphasis on human rights; and (a) its limited focus on only some civil and political components of the original U.N. Declaration of Human Rights, and (b) its disregard for economic and social rights such as the rights to work, fair wages, health, education, and social security. The paper discusses the reasons for that limited focus and argues that, contrary to what is widely presented in the media and academe: (1) civil and political rights are highly restricted in the U.S.; (2) those rights are further restricted in the U.S. when analyzed in their social and economic dimensions; (3) civil and political rights are not independent of but rather intrinsically related to and dependent on the existence of socioeconomic rights; (4) the definition of the nature and extension of human rights in their civil, political, social, and economic dimensions is not universal, but rather depends on the pattern of economic and political power relations particular to each society; and (5) the pattern of power relations in the U.S. society and the western system of power, based on the right to individual property and its concomitant class structure and relations, is incompatible with the full realization of human rights in their economic, social, political, and civil dimensions. This paper further indicates that U.S. financial and corporate capital, through its overwhelming influence over the organs of political power in the U.S. and over international bodies and agencies, is primarily responsible for the denial of the human rights of the U.S. population and many populations throughout the world as well.


Theories of the welfare state: a critique. The article considers three major non-Marxist explanations of the modern welfare state: functionalist sociological theories, economic theories of government policy, and pluralist theories of democracy. Each is subjected to a critique and all are found wanting, in that none can satisfactorily explain the observable similarities and differences in state welfare intervention within advanced capitalist countries. Functionalist theories can explain the dominant trends at work within all countries, but not the immense diversity in state policies which still persists. Economic and pluralist theories can explain the diversity but not the determinant trends. This failing is related to the separation objective and subjective aspects in historical explanation: the first school objectifies history, the second subjectifies it. The article concludes by asserting, but not arguing, that a Marxist approach offers a more fruitful way of understanding the welfare state, insofar as it rejects this separation.


Health education: can the reformers be reformed? Health educators have created a new professional role that emphasizes the changing of individuals rather than their social conditions. The article shows how historical roots, ideological perspectives, and structural constraints have combined to create an ambiguous, generally conservative role for the health education profession. Epidemiological evidence is presented that contradicts many implicit notions of disease etiology that underlie health education approaches. Finally, the authors suggest an "ecological" model of health education that takes account of the multiple causes of disease and is committed to progressive social change.


Comparative study of the antidiuretic effects of Adiuretin-SD (DDAVP) and Pitressin Tannate in diabetes insipidus. An account is given of experience acquired with the prolonged administration of a new vasopressin analogue, 1-deamino-8-D-arginine vasopressin (DDAVP), to patients with diabetes insipidus. The antidiuretic effect of this compound was compared with that of the long-acting Pitressin Tannate, containing a pituitary extract. It was found that DDAVP induces a far more significant antidiuretic effect than does Pitressin Tannate. Its application is not accompanied by any side effects, nor is its effectiveness decreassed after repeated administration. Similar conclusions were reached with the outpatient treatment of diabetes insipidus patients. The results indicate that nasally-administered Adiuretein-SD can be well utilized in the prolonged treatment of diabetes insipidus.


Pharmacologic studies in Bartter's syndrome: opposite effects of treatment with antikaliuretic and antiprostaglandin drugs. Part I. The effect of antikaliuretic agents (spironolactone, amiloride) and antiprostaglandin agents (indomethacin, ibuprofen) on plasma renin activity and potassium metabolism was studied in a patient with familial Bartter's syndrome. The decrease in renal potassium clearance in response to antikaliuretic treatment was only of a temporary nature, in contrast to the marked potassium retention seen after indomethacin therapy. Plasma renin activity showed a consistent increase after kaliuretics and a marked decrease in response to antiprostaglandin agents. The opposite effect of the drugs on plasma renin activity, due to their different sites of action on the pathophysiologic chain of events in Bartter's syndrome, given an explanation for the contrasting therapeutic results.


Comparative effects of placebo and plain and slow-release tablets of xanthinol nicotinate on exercise tolerance in normal human subjects. The effects of placebo and plain and slow-release xanthinol nicotinate on exercise tolerance were studied in 6 normal human subjects. Placebo administration had no significant effect on exercise tolerance. Administration of plain and slow-release xanthinol nicotinate significantly increased exercise tolerance at 1 hour and 1--9 hours respectively from ingestion of the drug. The intensity and duration of action correlated well with the blood levels of nicotinic acid reported earlier. Four subjects experienced moderate to severe side-effects with plain xanthinol nicotinate. Only 1 subject experienced mild side-effects with slow-release xanthinol nicotinate. Slow-release tablets of xanthinol nicotinate may prove useful in the treatment of angina pectoris.


Pharmacologic studies in Bartter's syndrome: effect of DDAVP and indomethacin on renal concentrating operation. Part II. We have investigated the effect of indomethacin and DDAVP on water excretion in a patient with familial Bartter's syndrome in whom urinary concentration was impaired during ad libitum fluid intake without any decrease in maximal concentrating ability. In response to indomethacin urine osmolality and free water reabsorption increased, simultaneously with the decrease in the excretion of prostaglandin E2. The indomethacin induced improvement was however less than that obtained after DDAVP with or without indomethacin. The results can be interpreted on the basis of either a direct "vasopressin-like" action of indomethacin or abolishment of the peripheral vasopressin--prostaglandin interaction. The clinical implication is that the theoretical possibility of indomethacin-induced inappropriate ADH syndrome should be borne in mind when a patient is treated with this drug on a long term basis.


The pharmacokinetic aspects of therapy with psychotropic agents. This contribution is concerned with a critical appraisal of the concept that plasma levels of psychotropic agents govern their pharmacodynamic action. In this regard, there are at least three problems: 1. identification of the chemical course of reaction between the introduced pharmacon and its resultant metabolites in reference to the totality of the organism and its biochemical reaction pattern; 2. the course of this reaction relative to intra- and interindividual differences; and 3. the influence of the kinetics as a result of concentration diversities, conditioned by different distributing patterns within the organism. Decisive factors here are: mode of application, blood distribution volume, reaction and/or elimination rate, and, finally, interaction of combined drugs.


Comparison of soft gelatin capsule vs. sustained release formulation of papaverine HCl: vasodilation and plasma levels. The vasodilatory action, plasma papaverine levels achieved, and the incidence of side effects after oral administration of papaverine hydrochloride as a soft gelatin capsule, were compared to those of a sustained release formulation. The incidence of side effects observed after 150 mg, two or three times per day, of the soft gelatin capsule was similar to that observed after 150 mg, twice per day, of the sustained release form in 15 patients with arteriosclerosis obliterans. A relatively higher plasma papaverine concentration was achieved, 120 minutes after 150 mg administration of the soft gelatin form, compared to an equivalent dose of the sustained release form. The degree of vasodilation obtained after four doses (150 mg X 4) of soft gelatin within 24 hrs., was significantly superior than that induced after four doses (150 mg X 4) of the sustained release form in 6 patients with a severe degree of arteriosclerosis obliterans.


Comparative bioavailability: influence of various diets on the bioavailability of indomethacin. After oral application of 100 mg indomethacin to eight healthy male volunteers, the concentrations in plasma and their time course were determined when the drug was given to fasting individuals or after a high-protein, a high-lipid or a high-carbohydrate meal. The study was designed as a fourfold-crossover experiement with intermissions of at least one week between applications. Indomethacin in plasma was determined by fluorimetry after a double extraction procedure. Indomethacin plasma concentrations and the truncated areas under the curves (AUC) were evaluated. Administration to fasting subjects provides higher plasma levels and a smaller tmax value than after either one of the three diets. Also the absorption rate was higher in fasting individuals. However, the absorbed amount of indomethacin after 24 hr was practically equal in all four groups. Attempts to distinguish between the effects of the various diets revealed significant differences in the time period necessary to reach the peak values. After high-protein and high-lipid diets they were reached in the 90 min sample while after high-carbohydrate 120 min were required. These values are significantly different from fasting controls (45 min) and from each other. There is no great influence of food on the other aspect of bioavailability, amount of unchanged drug reaching the systemic circulation.


Pharmacokinetics and clinical studies of ioglicinate, a new contrast medium for intravenous urography. The new amino acid-bound contrast medium ioglicinate was first of all studied in respect of its pharmacokinetics in comparison to iothalamate and amidotrizoate in groups of 4 patients. The distribution volume was very similar for all 3 substances. Ioglicinate was found to have the shortest half-life. The elimination of the contrast media studied was mainly via the kidneys. The plasma protein binding of ioglicinate was again lower than that of amidotrizoate and iothalamate. These good experimental results were confirmed for ioglicinate in respect of the tolerance and opacification in a subsequently conducted clinical double-blind study in groups of 50 patients in comparison with iothalamate.


Pharmacokinetic and clinical studies with carfecillin. The pharmacokinetics of carfecillin (Carbenicillin-phenyl-ester) were studied in 10 healthy subjects, in 5 patients with hepatic cirrhosis and in 5 cases of renal insufficiency. In healthy subjects maximal carbenicillin serum levels attained by therapeutic doses were about 20 microgram/ml; concentrations in the urine surpassed 1000 mu/ml. The phenol moiety was detectable as free phenol in sera (less than 1 microgram/ml) and urine (less than 3 microgram/ml), but its major part was transformed to glucuronide and sulphate conjugates. Pharmacokinetics were not altered significantly by hepatic lesion. In renal insufficiency, serum levels of both carbenicillin and conjugated phenol were higher and their decrease delayed, while urine concentration was low. Carfecillin treatment was successful in 20 out of 30 patients with UTI.


Criteria for the evaluation of cytostatic chemotherapy. The evaluation of cytostatic chemotherapy is difficult because the criteria are multivarious and the system for testing is complex. The clinical trial only is a reliable method. But the clnical trial require a cooperative study and a cooperative study is very expansive. It is necessary to search for methods less expensive but statistical sufficient.


Effects of flufenamic acid, dexamethasone, and SP 54 (a pentosanpolysulphate) on the histological appearance of murine embryonic tibia explants cultured in vitro. The histological investigation of cultured, embryonic tibia explants of NMRI-mice showed, after a six day period, that incubation concentrations of Flufenamic acid, SP54 (a Pentosanopolysulphate), and Dexamethasone (9alpha-Fluor-16-beta-Methyl-Prednisolone) predominantly induced resorptive and degenerative processes, in different degrees, affecting cartilage and bone matrix. In the experiments with Flufenamic acid and Dexamethasone, the degenerative processes were found to be accompanied by the inhibition of the synthesis of cartilage matrix. The investigations with SP54, on the other hand, showed a medium increase of cartilage matrix.


Studies on absorption and elimination of drugs. Part VII. Fitting of a three exponential equation to the observed drug concentration data after single extravascular administration. A simple program in fortran language was written for the polish digital computer ODRA 1304. It permits the fitting of the three exponential equation C1 = A-e-alphat + A2-e-betat + A3-e-kat to the plasma or serum concentration data observed after single extravascular administration of a drug.


Thiolysis of Nim-2,4-dinitrophenyl-histidine peptides with 2-mercaptoethanol. An explannation for the pH optimum. The thiolysis of Nim-2,4-dinitrophenyl-histidine peptides with 2-mercaptoethanol demonstrates an optimal rate between pH 8.5 and 9.0. Base lability of both reactants and product was investigated as a possible cause for the pH optimum. N-2,4-Dinitrophenylimidazole, a model for Nim-2,4-dinitrophenylhistidine peptides, 2-mercaptoethanol and the product of thiolysis, 2,4-dinitrophenyl-S-mercaptoethan-2-ol, were subjected to aqueous basic conditions (pH 8.5 to 12.0). The reactions were followed spectrophotometrically, and products were identified by comparison of their ultra-violet spectra with commercially available or synthetic compounds. Mechanisms and rate constants for base hydrolysis of 2,4-dinitrophenyl-thio ethers are presented. Although N-2,4-dinitrophenylimidazole and 2,4-dinitrophenyl-S-mercaptoethan-2-oldohydrolyze, it is the oxidation of 2-mercaptoethanol to 2-mercaptoethanol disulfide which results in the decreasing rate of thiolysis above pH 9.0.


Primary specificity of alakaline mesentericopeptidase. Kinetic parameters for the hydrolysis of alpha-N-acetyl-L-amino acid methyl esters. The steady-state kinetics of the alkaline mesentericopeptidase-catalysed hydrolysis of esters of the general formula Ac-X-OMe(OEt) has been studied, "X" being an amino acid residue (Ala, Val, Leu, Ile, Phe, Tyr, Trp, Lys). The values of the specificity ratio kcat/Km indicate that the bonds involving the carboxyl group of amino acids with aromatic and bulky aliphatic side chain are hydrolysed most effectively. On account of this, alkaline mesentericopeptidase is classified as a chymotrypisn-like alkaline protease. The primary specificity of mesentericopeptidase reveals the similarity of this enzyme to the group of subtilisins, as well as the distinctive characteristic feature of the enzyme to hydrolyse Ac-Leu-OMe with an efficiency practically equal to that of aromatic amino acid derivatives. Suggestions are made about the nature of the substrate-binding centre, taking into consideration Schechter's and Berger's concept of the secondary specificity.


Sequence comparison of human plasma alpha1-acid glycoprotein and the immunoglobulins. The amino acid sequence of human plasma alpha1-acid glycoprotein, upon comparison with the sequences of other blood proteins, was shown to possess significant similarity with the immunoglobulins. Employing direct and corrected sequence identity, the average mutation value and two different computer comparisons for the evaluation of sequence similarity, the following two regions of this alpha-globulin, which account for approximately half of the total amino acid sequence of the protein, were found to possess sequence similarity with the immunoglobulins. a) The region from residues 77 through 125 proved to be related to the variable region of several human H and L chains, and b) the region from residues 136 through 166 was found to be related not only to the constant region of a human and a mouse L chain but also to the third and fourth constant region of a rabbit and a human H chain, respectively. These results suggest that alpha1-acid glycoprotein is probably related to the immunoglobulins and further suggest that it possibly diverged from the immunoglobulin evolutionary tree prior to the formation of the primitive L chain.


The active site of an inducible arylacylamidase from Pseudomonas acidovorans. Though very effectively ibhibited by both SH-group directed reagents and inhibitors typical for serine hydrolases, the inducible arylacylamidase from Pseudomonas acidovarans is a serine enzyme rather than a sulfhydryl enzyme. The amino acid sequence around the reactive serine residue is Gly-Ser-Ile. The sequence of a larger peptide from the active site is described.


Structural studies on the succinylated bovine serum albumin. An analysis of succinylated bovine serum albumin showed that all of the 62 epsilon-amino groups of lysine residues, 13 hydroxyamino acid residues and 12 tyrosin residues were succinylated, but the succinylated tyrosines were later deacylated. Structural properties of the modified protein have been studied with circular dichroism and sedimentation velocity. At neutral pH (pH 7.60) and in a salt-free aqueous solution the modified protein is in an expanded form and its helical content is only 30% of that of unmodified protein. The increase of ionic strength restores the original conformation of the protein, whereas the increase of pH further disorganizes the structure of the protein. The results suggest that the electrostatic force alone is responsible for the compact structure of the protein molecule. The same mechanism is believed to underlie the effect of H3O+ and the effect of succinylation of the side chain groups on the conformation of bovine serum albumin.


A theoretical study of the structures of (Gly-Pro-Leu)n and (Gly-Leu-Pro)n. Theoretical conformation studies have been carried out for the polytripeptides (Gly-Pro-Leu)n and (Gly-Leu-Pro)n and the Fourier transforms of the structures have been calculated. X-ray powder patterns of these polymers had indicated that both these polymers take up coiled-coil triple-helical structures, but in the case of (Gly-Pro-Leu)n it was not clear whether the triple helix is formed by three parallel polypeptide chains or by a single chain folding back on itself (Scatturin et al 1975). Our studies show that both the polytripeptides can take up stereochemically satisfactory triple-helical structures with three parallel chains. There is also very good agreement between the calculated intensity distribution and that of the observed X-ray pattern, in each case.


Specific configurations of hydrogen bonding. I. Hydrogen bonding and conformational preferences of N-acylamino-acids, peptides and derivatives. From a reexamination of the X-ray studies of the crystal structures of 27 N-acylamino acids, peptides and their derivatives and 30 linear peptides, it is concluded that specific formation of short intermolecular hydrogen bonds (2,5 to 2.6 A) from the carboxyl OH to the N-acyl oxygen is an important feature for N-acylamino acids. For N-acyl-N-amides, the formation of hydrogen bonds 2.7 to 2.9A long between N(acyl-H...O(amide) is strongly preferred. The dihedral angle delta between the N-acyl and carboxyl groups or adjacent amide groups shows a preference for values near 20 degrees or 90 degrees for N-acylamino acids and 90 degrees for N-acyl-N-amides.


Small group dynamics and survival on chronic hemodialysis. Two groups of patients undergoing hemodialysis for chronic renal failure were prospectively studied for twenty-four months. Group A patients (n=12) were dialyzed on Mondays and Thursdays; Group B patients (n=9) on Tuesdays and Fridays. Although patients were supposedly assigned to dialysis groups on a random basis, over a twenty-four month period Group A had significantly more deaths (7 patients) than did Group B (none). This phenomenon is interpreted in the framework of an ongoing intergroup interaction among patients and between patients and staff, as conceptualized in the Tavistock Model propounded by Bion. It is hypothesized that in the dialysis unit, unconscious splitting by the staff led to a bias in patient-group assignment, such that those patients with more severe personality disruption, and "bad" in that sense, were assigned to Group A. Since patients in Groups A and B did not differ significantly in biological or demographic parameters at time of entry into the study, it is suggested that the increasing density of psychopathology in Group A was related to poorer care, more physical morbidity and a decreasing survival rate. Although no intermediary psychobiological mechanisms were defined, these findings suggest a significant interaction between the social, psychological and biological factors determining survival on chronic renal hemodialysis, beginning with the treatment decision and continuing throughout the course of treatment. These phenomena should be studied further and may have important implications for planning patient care and patient-staff interactions.


Denial and rehabilitation of the post-infarction patient. The use of denial has been widely accepted as an adaptive and protective coping mechanism in the acute phase of myocardial infarction. Although instrumental in lowering anxiety and mortality in the acute phase of coronary care, the use of denial creates hazards for the patient in convalescence. These hazards, not well known to intensive care personnel but all too apparent to the liaison psychiatrist working in cardiovascular rehabilitation, include a high vulnerability to disruptive anxiety and even psychosis at times of transition from greater to lesser intensity nursing care and a maladaptive resistance to rehabilitation efforts in convalescence. Failure of denial under the stress of transition may produce a transient paranoid psychosis with a clear sensorium, a variant of Abram's "cardiac psychosis." Maintenance of the defense in convalescence leads to noncompliance with medical advice and rejection of rehabilitation efforts, increasing the risk of reinfarction. A case report is presented illustrating both hazards. Recommendations for management include early recognition, supportive psychotherapy, education and mobilization in the acute phase of coronary care. Cardiovascular conditioning and reshaping of risk factors follow in convalescence. The physical and psychological benefits of this approach are reviewed. The adaptive value of denial in coronary patients is challenged from the long-term perspective of rehabilitation.


Traction intolerance syndrome: a psychiatric complication of femoral fractures. Traction Intolerance Syndrome is defined as a behavioral and/or emotional reaction related to skeletal traction severe enough to require psychiatric consultation and/or the use of major psychiatric medication for prolonged periods in the absence of pre-existing major psychiatric illness. Patients often attribute these reactions to the predicament of traction. This syndrome was present in five of nine patients between the ages of sixteen and forty-five who underwent traction for more than three weeks admitted to the UCLA Orthopedic Service during calendar year 1975. Moreover, all the patients were between sixteen and twenty-six years of age, and all the patients in that age range developed the syndrome. The multiple contributions to the pathogenesis of these reactions are described, and the interventions of the liaison psychiatrist in intervention at the biological, psychological, family and hospital staff levels are discussed.


Coping behavior and intelligence in the prediction of vocational rehabilitation of dialysis patients. As part of an intensive psychiatric and psychological examination before starting hemodialysis, forty-seven patients with terminal renal failure, thirty-one men and sixteen women with an age range from the late teens to the mid fifties, had been administered with WBII and the Shanan Sentence Completion technique. The hypothesis was that coping style would predict adaptation to hemodialysis as assessed by vocational rehabilitation. Intelligence, level of education, and the tendency to perceive sources of conflict in the outer world rather than within oneself, were found predictive of subseuqent adaptations for the whole group. On all these variables, men and women showed different patterns of significant correlations between the different aspects of coping and vocational rehabilitation. Subsequent multiple step-wise regression showed women (percentage of explained variance: 75) to be more predictable than men (40%) with different variables contributing differentially to predictability. These findings, interpreted to support the general working hypothesis, are discussed in terms of their implications for treatment.


Can the primary care physician be better trained in the psychosocial dimensions of patient care? Our modern health care system has tended to emphasize technological competence and subspecialization. The primary care internist/family physician has recieved limited training in the behavioral aspects of medicine and, resultingly, is less able to obtain and apply the knowledge and skills necessary to effectively help the patient handle those mutually interacting somatic, phychological and sociological dimensions of his illness. Through the use of selected case histories the author has attempted to illustrate how utilization of these skills, obtained during a supervised fellowship program, leads to psychological growth and better understanding of his role as physician. Ultimately this effects clinical improvement in his medical patients with longstanding difficulties.


Psychiatrict themes in the rehabilitation of mastectomy patients. The author discussed the psychological variables involved in the rehabilitation of patients who have undergone a mastectomy. The scope of the problem, the psychological meaning and fears suffered by mastectomy patients, and importance of body image is discussed along with the psychological treatment.


Infantile factors in two cases of ulcer colitis. In a third investigation of psychological factors in the etiology of ulcerative colitis the author again utilizes selected cases in which the variables preceding illness are limited. A first and second investigation had utilized patients who were afflicted with partial deafness and organic brain damage respectively in addition to ulcerative colitis. All patients displayed a marked trend to ojbectlessness in the prodromal period. The patients with organic brain damage displayed an intense rage reaction as well. The present investigation focuses upon two patients with ulcerative colitis who had been traumatically separated from their mother at age six months. The prodromal period of illness in both cases was initiated by an event which possessed a strong associative link with the primal loss. During the prodromal period both patients displayed an intense rage reaction and a trend to objectlessness which were similar to the reactions of the patients with organic brain damage. This particular emotional configuration appears to represent the revival of the emotional configuration which had prevailed following the loss in infancy. Some tentative ideas regarding the role played by the revival of the archaic emotional configuration in the production of physical changes are discussed.


Evaluation of the vitamin status in pregnancy. Circulating blood levels and enzyme activation in a group of Dutch parturient women and their full term newborns. Blood levels of vitamin B1, B2, B6, B12 and folic acid were measured in a group of 37 Dutch parturient women and their full term newborns. For the evaluation of the vitamin B1, B2 and B6 status also transketolase-, glutathion reductase- and transaminase activities with their respective activation ratios were measured. In the circulation of the newborn blood levels and enzyme activities were found 1.5-2.0 times higher compared with those of the mother. Interpretation of the data obtained from the mothers using criteria coming from a group of healthy adult blood donors, revealed a relatively high incidence of marginal vitamin status, especially for vitamins B6, B12 and folic acid. By means of the enzyme activation tests even higher percentages of cases were found within the marginal or deficient range. The actual extent of vitamin deficiency in pregnancy could not be estimated, however, secondary effects seem to be involved affecting both vitamin blood levels and enzyme activities.


Intestinal absorpiton of ascorbic acid and its passage through the lipoid membrane of guinea pigs. Diffusion of ascorbic acid takes place through intestinal lipoid membrane of guinea-pigs. In consequence, plasma and leucocyte concentrations of ascorbic acid increase. Intestinal absorpiton of ascorbic acid in scorbutic guinea-pigs is impaired in contrast to that in normal and saturated guinea-pigs as shown by the accumulation of ascorbic acid in the intestinal mucosal cells of guinea-pigs.


Effect of administration of alpha- and gamma-tocopherol on tissue distribution and red cell hemolysis in rats. Four groups of rats fed a tocopherol-free diet from weaning were administered, orally, 1.5 mg/day of either alpha- or gamma-tocopherol for 12 weeks or 5 mg/day of these compounds for 6 weeks. The fifth group was continued on the tocopherol-free diet. At the end of the experimental period the concentration of the two tocopherols was measured in plasma, RBC, liver, kidney, heart, spleen, muscle, testes and lungs. At the lower dose levels alpha-tocopherol, but not gamma-tocopherol, protected the RBC from hemolysis. At the higher levels both compounds were effective in this respect. While liver and spleen appeared to be the preferred storage tissues for both alpha- and gamma-tocopherols, a considerable amount of these compounds were found in RBC, muscle, heart and lung. The content of alpha-tocopherol in the liver was significantly greater than that of gamma-tocopherol. Whether this difference is the reflection of preferential utilization of gamma-tocopherol remains to be determined. The other tissues showed a more or less equal accumulation of the two compounds. At the higher levels of supplementation with the tocopherols the accumulation of gamma-tocopherol in most tissues was significantly greater than that of alpha-tocopherol.


Effect of vitamins, antioxidants and sulfhydryl compounds on in vitro rat brain lipid peroxidation. The effect of retinol, retinylacetate, alpha-tocopherol, alpha-tocopherylacetate, synthetic antioxidants (DPPD, BHT, DAH, and Ethoxyquine) sulfhydryl compounds (reduced glutathione and cysteine) on rat brain lipid peroxidation has been studied using the TBA method. Retinol and retinyl acetate inhibit brain lipid peroxidation, alpha-tocopherol is less effective than vitamin A, while alpha-tocopherol acetate has no antioxidant property. Ascorbic acid stimulates the peroxidation, at pH 5.0. The synthetic antioxidants are all potent inhibitors of brain lipid peroxidation, DPPD being the most effective, while the sulfhydryl compounds at a concentration of 1 x 10(-3)M has a slight potentiating effect.


Effect of major nutrient substitutions on body weight gain, blood glucose and cholesterol levels, and the rate of drug metabolism in the liver. Rats were fed diets resembling a normal human diet, except that, in a complete factorial fashion, safflower oil and/or mineral oil were substituted for part of the fat, while fructose, lactose and/or cellulose were substituted for carbohydrate, and zein was substituted for milk protein. Food intake and weight gain were not influenced by cellulose and mineral oil, but zein decreased both substantially. Plasma cholesterol was unchanged by safflower oil or mineral oil but was decreased by fructose. Plasma glucose was reduced as the starch-to-sugar ratio increased. The rate of aniline metabolism was increased by lactose and/or zein, but the rate of ethylmorphine metabolism was decreased by safflower oil or mineral oil.


Family members' perceptions of communications in late stage cancer. A study of patterns of communications in families with a terminal cancer patient being treated at three urban institutions revealed that may first-order relatives (spouses, children, siblings) of patients did not have a communication link to the physician, especially if direct communication was not established at the time of diagnosis. Family members were frequently critical of the way information was communicated, yet relied upon the physician's interpretation of the patient's status to form their own opinion of the patient's future. Intra-familial communications regarding illness and dying were frequently discordance and guarded, leading to preceptions that the patient was withdrawing, and fostering a reliance upon the hospital for terminal care. More than half of the family members were uncomfortable visiting the patient in the hospital, experiencing feelings of helplessness, or sensing helplessness in the patients. Bearing the patient's pain was seen as particularly difficult.


[Arginase activity in the liver of growing rats with manganese deficiency]. Rats weaned early at 13 days of age exhibited at 10% lower growth within 6 weeks when Mn supply was deficient compared to control animals (P is less than 0.005). While the reduction of the dietary Mn content from 50 to 6 ppm did not yet affect growth, the animals already showed a 60% lower arginase activity at this median level of Mn supply. The values of the depleted animals (0.7 ppm Mn) had fallen by 71% compared to the control group. Therefore, the arginase values may be applied to differentiate between suboptimum and optimum Mn supply.


[Effects of sodium nitrite on various vitamin concentrations in rat tissues]. For 6 months 2 groups of 10 male Wistar rats were fed on a chow ration, and to drink they were given either de-ionized water or a solution of sodium nitrite, 0.3 g per litre. At the end of the experiment thiamine, riboflavin, vitamin B6, niacin, biotin and pantothenic acid were estimated in various tissues (liver, heart, muscle, encephalon, kidneys, spleen, lungs and duodenum); nitrogen, phosphorus, retinol and ascorbic acid were estimated in the liver only. There was no difference between the groups in changes in bodyweight or fluid intake, nor in weight of different organs. But in the animals given sodium nitrite there was an increase in riboflavin, vitamin B6, niacin and pantothenic acid spleen concentrations, and a decrease in liver niacin and encephalon biotin contents.


Influence of supplemental dietary fat on the relative proportions of three classes of lipid in the epiphyseal cartilage of dwarf and non-dwarf chicks. One hundred and forty-four day-old chicks were allotted to six groups in a 2 x 3 factorial design involving two strains (dwarf, dw and non-dwarf, Dw+) and three levels of supplemental dietary fat (none, moderate and high). The birds were killed at four weeks of age. The overall weight gain and the total lipid content, amount of neutral lipids, glycolipids and phospholipids in the epiphyseal cartilage of the tibia were examined. Supplemental dietary fat resulted in improved weight gain, with the non-dwarfs showing a greater increase. There was no change in total lipid in epiphyseal cartilage with different levels of dietary fat. Increase in dietary fat elicited, in both strains of birds, an increase in the proportion of glycolipids and a concomitant decrease in the proportion of neutral lipids and no change in that of phospholipids. That the stimulatory effect of dietary fat on growth was exerted through an increase in glycolipids at the site of calcification is suggested.


Experience with diagnosis and management of pre and early cancers of the cervix. The aim of our clinic is to diagnose and keep under observation all cases of moderate dysplasia. We consider cone biopsy to be purely diagnostic in all cases of severe dysplasia and carcinoma in situ. Once the diagnosis is confirmed, we recommend hysterectomy for all except an occasional young patient who has not completed her family. In view of the high incidence of invasive cervical cancer, poor follow-up rate and lack of sophisticated radiation techniques in our country, we do not believe in keeping such patients under observation. These views are further substantiated by a low morbidity rate for surgery at this stage of the disease.


Operative injuries to the bile ducts. Report on 12 cases. We have reported on a series of 12 operative injuries to the bile ducts. We estimate the frequency of these accidents at 0.2% during cholecystectomy and 0.4% after gastroduodenectomy. We stress the importance of systematic cholangiography during the operation to prevent unrecognized lesions. Immediate repair of these lesions by an end-to-end anastomosis appears to be the best technical method. When faced with a high mortality rate, often due to non-recognition of a lesion, we stress the importance of prevention to limit the risk of such accidents occurring and non-recognition of those that do occur.


Gynecologic surgery using the CO2 laser (light amplification by stimulated emission of radiation). The laser is a new tool which can be a precise and accurate instrument for tissue removal under colposcopic direction in the areas of the cervix, vagina and vulva. Healing is rapid since the laser inflicts minimal tissue destruction. Postoperative pain is minimal and healing is without scar formation. The expense of the equipment and training of the operating surgeon are its only drawbacks.


Chemotherapy of ovarian cancer.

Chemotherapy of ovarian cancer. Chemotherapy using a modified Cooper's regimen was applied during the past few years on 41 cases of advanced cancer of the ovary. We believe this scheme has not been attempted elsewhere. Twenty-five cases (60%) responded positively to this regimen. Two patients with generalized ovarian cancer may be cured. The combination of palliative surgery and polychemotherapy in cancer of the ovary may prove to be one of the most effective multidisciplinary approaches to generalized cancer.


Poststerilization tubal torsion.

Poststerilization tubal torsion. Four cases of torsion of the fallopian tube following sterilization are reported. This is a rare complication that may occur two to eight years after tubal ligation. It is more likely to occur after Pomeroy's, Irving's or the Viennese school technique of sterilization, in which the free distal segment of the fallopian tube is suspended by a narrow mesentery. Hydrosalpinx, which is common after sterilization, seems to predispose to torsion.


Solitary lung involvement from clear cell carcinoma of the endometrium. Clear cell (Müllerian) carcinoma of the endometrium is relatively seldom reported. It is a disease with an unfavorable prognosis. A patient in whom a lung metastasis was diagnosed accidentally and excised is herein presented. The patient is alive five years after hysterectomy. The histopathologic pattern of the tumor is briefly described, and some of the clinical aspects of endometrial carcinoma are discussed.


Hematocolpos with imperforate hymen.

Hematocolpos with imperforate hymen. A case of hematocolpos with imperforate hymen in a 16-year-old, well-developed African girl is reported. Diagnosis was established by the presence of an abdominopelvic doughy mass, a boggy mass filling the vagina and an imperforate, bulging hymen, and cryptomenorrhea despite the presence of characteristics of pubescence.


Cimetidine in the treatment of severe metabolic alkalosis secondary to short bowel syndrome. Successful treatment with cimetidine of a case of severe metabolic alkalosis secondary to gastric hypersecretion in the short bowel syndrome has been presented.


The effect of cimetidine on stress ulcers. We used 135 male Wistar rats. Stress ulcers were formed with standard methods of restraints and cold. The severity of the ulcer was graded from 0--3 and determined for each group. Ulcers occurred in the glandular portion of the stomach. Pre- and post-treatment with cimetidine was compared with controls and pre-treatment with saline or antacid. Cimetidine was significantly more effective in preventing stress-induced ulcers in rats when instilled in the stomach before the stress than either antacid or saline.


Rapid access airway: surgical device and technique. A simple, inexpensive, readily assembled device that provides immediate temporary access to the subglottic airway for oxygenation or anesthesia induction has been presented. The device can be used in emergency clinical situations, in difficult anesthesia inductions and in children where it is difficult to introduce an endotracheal tube because of supraglottic disorders. The child can be anesthetized via this device prior to securing the airway by tracheostomy. There has been no morbidity or mortality associated with use of this device.


Common duct stones in infancy.

Common duct stones in infancy. The term "bile ascites" is used when the bilirubin content of the ascitic fluid is higher than it is in the serum. Two cases of newborn infants with bile ascites associated with common duct stones are reported. Review of the literature reveals 11 additional cases of common duct stones that presented as bile ascites. The surgical treatment of bile ascites and common duct stones is described. In spite of the severity of the problem, the outcome is successful in most cases (83.3% survival in this review).


Hepatic resection for isolated tumor-like nodules in the liver. We have reported two cases of focal nodular hyperplasia of the liver in adults. One case is the first in which the regenerative process that occurred nine months after localized hepatic necrosis was implicated in the development of focal nodular hyperplasia. The other case concerned an idiopathic isolated liver nodule that occurred in a woman who never had taken oral contraceptives. These tumor-like lesions were removed by a right and a partial hepatectomy respectively. The two patients remained asymptomatic during the first 13 postoperative months with no additional therapy.


Localized fibrous mesothelioma of the pleura. A benign fibrous pleural mesothelioma was found in a dissecting room cadaver. The gross anatomical relationships to other thoracic structures are fully described. Vascular connections with the thoracic wall, azygos vein and lung were found. The tumor conformed to earlier histologic descriptions of this type of tumor. The potential for vascular shunts within this tumor and the diagnostic problems presented by a tumor of this type are discussed.


Duodenal tuberculosis.

Duodenal tuberculosis. Two patients with duodenal tuberculosis have been presented. Signs and symptoms of the disease are non-specific but may mimic duodenal ulceration. The relevant aspects of the disease process have been reviewed.


Fibromuscular annular pancreas. A variant of pancreatic malformation? All reported cases of annular pancreas consist of histologically normal pancreatic tissue. The most widely accepted theory of the pathogenesis of the pancreatic annulus agrees with, and is partially based on this fact. The pancreatic annulus encircling the stenotic second part of the duodenum in our patient was composed of fibromuscular tissue with lymph glands and a few pancreatic acini scattered among the smooth muscle fibers. This unique histologic variant of annular pancreas possible arose from a double fault in the ventrial anlage of the embryonal pancreas: faulty rotation (giving rise to the annular malformation) and abnormal histologic structure.


Hysterectomy for pregnancy termination and sterilization. I have presented opposing views from the literature and my results in both the first and second trimester of pregnancy. I feel that those who already favor vaginal hysterectomy for sterilization alone would have their opinions reinforced by the additional benefit of pregnancy termination. I hope that those who oppose using vaginal hysterectomy for sterilization alone might be convinced that the added benefit of elective termination of pregnancy makes it acceptable, since a double benefit will be offered. Many gynecologists already teach this method as regards early pregnancy. Perhaps some will be convinced to terminate more advanced pregnancies in this manner.


Atrial myxoma. Clinical manifestations and surgical treatment. Four patients with atrial myxoma underwent successful surgical excision with the aid of cardiopulmonary bypass at the Medical University of South Carolina. This report describes their clinical manifestations and treatment with special emphasis on advances in surgical technique. This report also emphasizes the malignant potential of this tumor and reviews the recent literature.


Perception of simulated lung lesions.

Perception of simulated lung lesions. Two series of test radiographs were produced, each containing a single nodular lesion. Each series was identical except that the lesions were spatially shifted with respect to adjacent structures, resulting in matched pairs of chest radiographs simulating a stereoscopic examination. Observation of each set singly and in pairs (non-stereoscopically) demonstrated a marked improvement in observer performance when the shifted pairs were viewed side-by-side.


Thermographic assessment of intestinal viability following ischemic damage. Reactive hyperemia has been shown to be a characteristic of viable ischemic tissue that has been revascularized. A segment of small bowel was made ischemic by arterial occlusion and the ischemia maintained for 2 1/2 hrs (ischemic, viable bowel) or 8 hrs (ischemic, nonviable bowel) before circulation was restored. Thermograms and surface temperature measurements of exposed ischemic and non-ischemic bowel segments were obtained before and every five minutes after revascularization. Thermograms of segments revascularized after 2 1/2 hrs of ischemia demonstrated reactive hyperemia and a one to four degree increase in surface temperature compared to normal surrounding bowel. No hyperemic response was seen in bowel segments that were ischemic for 8 hrs. Our results indicate that thermograms can document reactive hyperemia of an exposed ischemic bowel that has been successfully revascularized and may be an important aid in assessing bowel viability during surgery.


Percutaneous transhepatic portography in the dog. A simple and safe technique for repeated percutaneous catheterization of the portal vein or one of its tributaries in chronic dogs is described.


Radiological evaluation of rat colonic tumors. Colon carcinomata were induced in rats with N-methyl-N-nitro-N-nitrosoguanidine. A magnified double contrast barium enema technique was developed for an in vivo study of tumor growth patterns. Invariably, all small tumors were smoothly outlined and were spherical or ellipsoidal in shape. Irregularity developed only when the tumors grew larger, at which time there was considerable variation in the tumor growth patterns. The onset, shape, progression, spread and number of tumors present can be studied without sacrificing the animal.


Velocity distribution and blood flow measurements using videodensitometric methods. Digital cine-videodensitometry was employed for measuring blood velocity and blood flow in the descending aorta of human subjects. A very small, compact bolus of opaque dye was injected during different phases of the cardiac cycle, and flow through a portion of the aorta was analyzed. From the density vs time curves for different radial locations, the velocity distribution over the vessel cross-section was calculated. The velocity distribution obtained was nearly parabolic. Velocity and flow calculations were also made at different phases of the cardiac cycle.


Computer-assisted tomography of the knee. The potential contributions and limitations of computer-assisted tomography of the knee have been analyzed. The knee was examined in the transaxial, sagittal, semi-sagittal and coronal planes. The positioning for obtaining intra-articular detail is outlined, and the indications are discussed. Delineation of the cruciate ligaments is remarkably clear and clinically applicable. The menisci can be demonstrated, but improvement in spacial resolution and changes in the physical construction of the scanner will be required to permit an adequate clinical evaluation.


Tomographic imaging with nuclear magnetic resonance. A technique is described for obtaining tomographic images of hydrogen distribution in animals using nuclear magnetic resonance (NMR). Resonant frequency is proportional to magnetic field strength, so that spatial resolution is achieved by frequency selection and magnetic field shaping. The results of scanning a phantom and two rats are presented.


Non-A, non-B hepatitis transmission in chimpanzees: a project of the transfusion-transmitted viruses study group. Experimental transmission of non-A, non-B hepatitis was apparently accomplished in 5 chimpanzees following inoculation with presumably infectious human sera. Administration of sera from implicated donors with normal alanine aminotransferase (ALT) values, as well as from those with abnormal ALT levels, resulted in the development of ALT abnormalities in the inoculated chimpanzees. Transmission from donors with normal ALT values implies that healthy carriers of non-A, non-B virus exist. Evidence is presented which indicates that a period of viremia precedes the clinical illness by at least 12 days.


Control of experimental traumatic hepatic hemorrhage by transcatheter embolization. The feasibility of control of traumatic hepatic hemorrhage by angiographic transcatheter embolization was investigated. Bleeding sites were created in the livers of each of twelve dogs, and the hepatic artery was occluded with Gelfoam. Successful control of bleeding was demonstrated by postembolization angiography in all twelve animals. Initial elevations in alkaline phosphatase and serum glutamic pyruvic transaminase values returned to their baseline in four weeks. Recanalization of the hepatic artery in the five surviving animals was shown by follow-up angiograms. Transcatheter embolic control of traumatic hepatic hemorrhage may be a useful adjunct to surgical therapy.


Aedes albopictus cells release a goose red blood cell agglutinin. The presence of a goose red blood cell (RBC) agglutinin (HA) in the culture medium of apparently uninfected Aedes albopictus cells raised the possibility of contamination by an arbovirus. The HA sedimented in sucrose gradients between 18S and 28S and had a buoyant density in sucrose of 1,23 g/cm3. The HA adsorbed to concanavalin A-Sepharose and could be eluted with alpha-methyl-D-mannoside. The apparent molecular weights of the eluted glycoproteins were estimated by PAGE to range from 17,000 to 45,000. Treatment of culture medium from A.albopictus cells with excess goose RBC removed both HA activity and a proportion of the proteins of molecular weight 25,000--35,000. The HA also bound to human group 'O' RBC, It was not possible to inhibit hemagglutination with a variety of anti-arbovirus antisera. These data do not support the hypothesis that the HA is associated with an inapparent arbovirus infection of A.albopictus cells.


A comparison of the hemodynamic responses to metrizamide and meglumine/sodium diatrizoate in canine renal angiography. Selective renal angiography causes a biphasic change in renal blood flow and vascular resistance. In this study, 5 ml of meglumine/sodium diatrizoate (288 mg I/ml, 1455 mosm/kg), metrizamide (290 mg I/ml, 593 mosm/kg), isontonic saline (287 mosm/kg) and hypertonic saline (1500 mosm/kg) were injected into the renal arteries of seven adult mongrel dogs to determine whether the minimum flow (or maximum resistance) was related to the osmolality of the injected agent. The maximum resistance response was significantly smaller for metrizamide (20 +/- 4%) and isotonic saline (19 +/- 2%) than for diatrizoate (36 +/- 6%) or hypertonic saline (50 +/- 7%). Hypertonic saline produced two distinct types of responses: the typical biphasic response or a severe immediate drop in flow. Thus the maximum resistance response was related to agent osmolality. The "injection artifact," or flow changes occurring during the injection, were different for the four agents, and these differences appeared correlated to agent viscosity. Although both contrast media caused relatively small changes in renal hemodynamics, metrizamide caused significantly smaller changes than meglumine/sodium diatrizoate.


Effect of iopanoate on the biliary and urinary excretion of iodipamide. The effect of sodium iopanoate and iopanoic acid on the biliary excretion of iodipamide in dogs was studied. Enteric administration of sodium iopanoate within one hour of iodipamide infusion reduced biliary iodipamide excretion and increased urinary iodipamide output. The biliary and urinary excretion of iodipamide was not influenced by iopanoic acid administered 40 and then again 16 hrs before iodipamide. These results suggest that iodipamide cholangiography can be employed 16-18 hrs after a standard two-day iopanoic acid oral cholecystogram without decreasing the ability to visualize the biliary ductal system or increasing the urinary iodipamide excretion.


Osmotic effect and solubility of amipaque (metrizamide) in the gastrointestinal tract. Loops of small intestine in seven rabbits were resected with intact pedicle and ligated at both ends after instillation of 0.5 ml of Gastrografin, Urografin 76%, Amipaque 370 mg I/ml, Amipaque 170 mg I/ml or physiologic saline. After half an hour, the amount of fluid in the loops containing Gastrografin and Urografin 76% increases about twice as much as in the loops containing Amipague with the same iodine concentration because of their greater osmolality. The differences between the loops with isotonic Amipaque (170 mg I/ml) and physiologic saline are not significant. Precipitation occurs when sodium and meglumine salts of diatrizoate, metrizoate, iothalamate, iocarmate and ioglycamate are mixed with 0.05 N HCl. No precipitation occurs with Amipaque, not even when the HCl concentration is as high as 1.2 N. Precipitation occurs when Gastrografin is added to gastric juices with low pH, but is not seen with Amipaque should be a suitable contrast medium for gastrointestinal examinations because of its low osmolality and toxicity and good solubility in gastric juice.


In vivo and in vitro studies on nonspecific blocking factors of host origin in cancer patients. Role of plasma exchange as an immunotherapeutic modality. Experimental and clinical data are reviewed on elevated glycoprotein levels in tumor-bearing animals and patients at various stages of disease advancement. The authors report their findings in 232 patients with various solid tumors; these confirm and extend the reports in the literature. It is shown that some of these glycoproteins, rich in sialic acid, exhibit immunosuppressive properties in vitro, and it is suggested that tumors may protect themselves by triggering hepatic synthesis of sialoglycoproteins which "coat" the binding sites of both immunocompetent cells and tumor cells and thereby abrogate recognition and killing of the latter by the immune system. This concept of nonspecific blocking factors of host origin has already been substantiated to some extent by observations on the consequences of plasma exchange in 24 patients with metastatic tumors; eight of these patients exhibited an objective tumor regression. It is suggested that such studies should be extended to postoperative patients and that circulating sialoglycoprotein assays could be one of the ways of monitoring tumor growth, including growth during the nonvisible phase.


L2C guinea pig leukemia. A potential model for structuring multimodality therapy. L2C guinea pig leukemia is a lymphoblastic neoplasm that arose spontaneously in a nonirradiated female strain 2 guinea pig over 20 years ago. Mutation of the original tumor probably accounts for the discordant results which have been reported. The LE-L2C subline was used to develop a multimodality therapy model of acute leukemia. Syngeneic strain 2 animals challenged with 3 x 10(5) LE-L2C cells developed overt leukemia in 14 +/- 3 (SD) days.  When treated with cytoreductive chemotherapy, they relapsed with either systemic or central nervous system (CNS) disease. However, CNS relapse was prevented by craniospinal irradiation, yielding a uniform pattern of relapse. Preliminary studies suggest that active immunotherapy with nonspecific agents, such as BCG, or immunoreconstitution with thymosin may prolong the duration of remission and increase the percentage of long-term survivors. L2C leukemia may represent a useful animal model for structuring the principles that govern the interrelationship between chemotherapy and immunomudulation.


Tumor cell and host properties affecting the implantation and survival of blood-borne metastatic variants of B16 melanoma. The organ distribution, arrest and survival of [125I]5-iodo-2'-deoxyuridine-labeled B16 melanoma cells with low (B16-F1) or high (B16-F10) metastatic potential were studied in a variety of normal and immunosuppressed syngeneic C57BL/6 mice, allogeneic A mice, and athymic nude NIH Swiss mice and their immunocompetent littermates. In addition, the in vitro aggregation properties of these tumor cells with various host organ cells in suspension were examined. Tumor cell arrest and survival following i.v. injection occurred at significantly higher rates in normal mice than in immune-depressed animals irrespective of strain, and, two weeks later, significantly more tumor colonies were found in the normal animals. In syngeneic or allogeneic animals, B16-F10 cells were arrested, survived and formed significantly more gross pulmonary tumors than B16-F1 cells. B16-F10 cells also aggregated in vitro with purified organ cells in suspension obtained from either syngeneic or allogeneic mice at a greater rate than B16-F1 cells. These results indicate that although host properties can affect the arrest and survival of circulating tumor emboli, they do not diminish or abolish the biological differences between the high and low metastatic variant B16 lines.


[Which galenic bases are in use nowadays for skin treatment?]. Different base types are necessary for dermatological preparations. The dominating part is played today and probably will also be played in the future by the hydrocarbon gels and the derivated cream systems. Possible interferences of the ingredients with the base components have to be watched by the dispensing of medical preparations for dermatological therapy. In regard to an optimal distribution of the ingredients solubility of the ingredients in the bases are important. Specific preservatives can be omitted if ethanol is added in concentrations of at least 15 per cent. There is a tendency to use mainly indifferent components.


[Endothelioma of the skin].

[Endothelioma of the skin]. We are reporting on a 71 years old woman suffering from a plaque-like raised nodular neoplasia that existed for two years. The histological changes, though local variable, are characterized by similar structures. The tumor cells are grouped in variably shaped, loose syncytial cords, just by loosing their cytoplasma in vascular-like cavities. Because of their morphological relations to mesenchym Bolck called these tissue-formations "spongiosynchymal" structures. They are considered by this author to characterize the common tissue-attribute of all endotheliomas and similar neoplasias. Additionally the histological pattern of these tumors can show, as in the present case, solid and epitheloid cell formations.


[Morphological variants of folliculitis barbae candidomycetica]. Report on two cases of folliculitis barbae candidomycetica (f.b.c) which mimicked impetigo contagiosa in one case and tinea barbae in the other. Both patients suffered from typical predisposing factors such as leukemia, cytostatic and corticosteroid therapy, and diabetes mellitue. Taking into consideration the morphology of cases described earlier in this journal, three types of f.b.c. can be recognized: folliculitis simplex-like type, tinea barbae-like type and impetigo-like type.


[Prolaction level in the serum of patients with disorders of spermatogenesis]. In 183 out patients of our department FSH, LH, prolactin and testosterone were measured in one single serum sample. In 43 of these, measurements were done prior and 30 min after injection of LH-RH and TRH. An analysis of the ejaculate was performed in each case. If prolactin levels are grouped according to sperm count or testosterone levels, means of prolactin do not differ significantly between these groups. Some individual levels exceed the normal range. The TRN stimulated prolactin levels are lowered when related to high testosterone levels. Significantly statistical correlations do not exist. Mean FSH levels show a clear depression related to high sperm counts and high testosterone levels. A significantly statistical correlation is found between FSH, LH and prolactin levels each. Determination of prolactin in patients with fertility disturbances may be helpful to detect a hyperprolactinemia, which possibly causes inhibition of the spermatognesis.


[Surgical treatment of hyperhidrosis axillaris]. Radical sweat gland excision is the treatment of choice in axillary hyperhidrosis. After a review of the common surgical techniques the own technique is discribed. It consists of a vertical excision of the hyperhidrotic skin area and primary wound closure. No recurrences of hyperhidrosis were seen in the follow up period.


Profitability analysis in the hospital industry. Measures of marginal profit are derived for the two payment classes--cost payers and charge payers--that the hospital industry must consider in profitability analysis, i.e., prediction of the excess of revenue over expenses. Two indexes of profitability, use when payment mix is constant and when it is nonconstant, respectively, are derived from the two marginal profit measures, and one of them is shown to be a modification of the contribution margin, the conventional measure of profitability used in general industry. All three measures--the contribution margin and the two new indexes of profitability--are used to estimate changes in net income resulting from changes in patient volume with and without accompanying changes in payment mix. The conventional measure yields large overestimates of expected excess revenue.


The estimated survival probability index of trauma severity. An index of survival rates associated with ICDA injury codes was constructed with data from the 1973 Hospital Discharge Survey (HDS). Discharge records from three regions covered by the HDS allowed estimation of survival rates among patients suffering single injuries coded under 92 ICDA integers. These estimated rates were then applied to records from the fourth HDS region, including those for patients suffering multiple injuries: estimated survival probability index values were generated as the product of the single-condition survival rates for each patient's various injuries. Mortality rates predicted from the index values correlated well with mortality rates estimated for the universe of patients discharged in 1973 from the fourth region. The index is intended for retrospective analysis of discharge records as a possible approach to care evaluation.


Infant mortality in SMSAs before Medicaid: test of a causal model. Path analysis is applied to data on infant mortality, supplies of physicians and hospital beds, and population percentages of blacks and low-income families in 201 standard metropolitan statistical areas (SMSAs) to test the hypothesis that medical resources mediate the effects of racial composition and low income on infant mortality rates. The hypothesis is not supported for the SMSA data: direct effects of racial composition and low income on infant mortality are stronger than indirect effects. The use of SMSA data for analysis is contrasted with the use of county data in a discussion of study by Anderson, from which the hypothesis was drawn.


The Johns Hopkins ambulatory-care coding scheme. A classification and coding system for ambulatory-care problems has been developed at the Johns Hopkins Medical Institutions and three affiliated institutions. The provider's statement of the patient's problem, as recorded on an encounter from, is kept in a computer file. Codes from the classification scheme, based on those used in four existing schemes, are automatically assigned to diagnoses, symptoms, well-care services, and treatment procedures categorized by physiological system and subsystem. About 85 percent of recorded problems are machine-codable; the remainder are alphabetized for efficient manual coding. The coding system is integrated with an overall information system that allows linkage of coded problem data to diverse data on patient and provider characteristics. Examples are given of the uses and limitations of the linked data for care evaluation, management, and clinical research.


Multiple transfusions of HLA compatible blood in thalassaemia major. The effect of polytransfusion regimen is studied in two patients with thalassaemia major over a period of 74 and 56 months respectively. In both cases we have observed an improvement of the general condition in the growth as well as a reduction of hepatosplenomegaly and cardiomegaly. Furthermore a decrease of reticulocytes, erythroblasts and fetal hemoglobin values was obtained. The consequences of these frequent transfusions on iron storage metabolism are discussed. The advantage of giving HLA compatible blood is demonstrated by only a weal alloimmunization in one patient having received 77 HLA compatible transfusions and the lack of immunization in the second patient after 52 transfusions. In 6 other patients affected with thalassaemia major and 3 more with bone marrow aplasia, transfusion with incompatible HLA blood was followed by immunization of variable importance.


In vivo studies of the phenylalanine-4-hydroxylase system in hyperphenylalaninemics and phenylketonurics. An in vivo determination of the phenylalanine-4-hydroxylase (E.  C. 1.14.16.1) activity is described. Subjects were loaded wit deuterated L-phenylalanine-d5 (200 mg/kg), and the deuterated tyrosine and deuterated phenylalanine in plasma was analyzed using mass fragmentography. Six phenylketonurics (PKU), four hyperphenylalaninemics and two healthy controls were investigated. This method allowed a specific differentiation between PKU's, hyperphenylalaninemics and health controls. The remaining enzyme activity in hyperphenylalaninemics and in PKU patients can be estimated with relatively high accuracy. The hyperphenylalaninemic patients showed 7--17% of the phenylalanine-4-hydroxylase activity found in the two control persons. The PKU patients under diet showed approximately 2--3% of the activity found in the control group. In the PKU patients, loaded while showing high phenylalanine blood concentrations, no remaining activity could be measured. The logarithm of phenylalanine-d5 over tyrosine-d4 in plasma 1 h after loading gives the best differentiation. One single plasma sample of approximately 0.5 ml is sufficient.


Oculocutaneous albinism associated with motor neuron disease. The patient described is a 14-year-old girl who suffered from an oculocutaneous albinism. The developmental milestones were reached with some delay. Gradually she experienced fatiques, and wasting of the pelvic girdle muscles and weakness appeared. In suralis nerve biopsy sections no abnormalities were found. In muscle biopsy sections the characteristic findings of a primary central neuronal muscular atrophy were seen. Based on clinical and histopathological findings it may be stated that the patient is suffering from a motor neuron disease. The chance of the combined occurrence of oculocutaneous albinism and motor neuron disease can be estimated to be one out of 750 X 10(6), unless an incestuous relation is supposed.


[Repetitive supraventricular tachycardia. Case report and electrophysiologic bases]. A typical case of repetitive supraventricular tachycardia is reported. Periods of normal heart rate are interrupted by short bursts of supraventricular tachycardia. In the case described this phenomenon can be explained by coexistence of reentry and an automatic rhythm from a subsidiary pacemaker. This pacemaker was found to be in the bundle of His; its automaticity showed a rate somewhat faster than that of the sinus node. Careful analysis of the surface electrocardiograms allowed a definition of the electrophysiologic events starting a run of tachycardia. The circus movement entertaining the tachycardia itself was found to result from AV nodal reentry.


Acetylesterase isoenzymes in rat uterus and placenta. The occurrence of acetylesterase activity in the uterus and placenta of the rat has been investigated using a general histochemical simultaneous coupling technique after separation on polyacrylamide gradient gels. apart from a complex band associated with serum esterases which was demonstrated in all the tissues studied, several other isoenzyme bands were demonstrable in differing degrees in the yolk sac and the virgin uterus. Two of these bands were evident in metrial gland up to day 16 of pregnancy, and a third became present by day 17. Unlike the other two bands, this new band did not seem to be associated with the large granules of the granulated metrial gland cells. None of these bands were detected in trophoblast. The metrial gland isoenzymes reacted as well at acid pH as at neutral pH. The yolk sac isoenzymes reacted either as well or slightly better at acid pH, and one extra band was demonstrable under acid conditions.


The light and electron microscopic distribution of acid phosphatase activity in human normal oesophageal epithelium. Acid phosphatase activity in human normal oesophageal epithelium was studied with light and electron microscopic techniques. The maximum activity was found to be in the prickle and lower functional layers. Electron microscopic examination revealed activity to be localized in GERL, lysosomes and membrane coating granules. These last structures probably secreted their content into the intercellular space in the central part of the functional layer. Thick sections (0.5 micron) with tilting showed GERL to consist of anastomosing tubules.


A comparison of the PAS-reaction in the dermis of diabetic and non-diabetic humans. Dermopathy is a part of the diabetic syndrome that decreases the solubility of dermal collagen. In the present study, the PAS-reactive component of collagen has been analysed in diabetic and non-diabetic human dermis by photographic densitometry. The PAS-reaction was significantly lower in diabetics than non-diabetics, and age seemed to be of no consequence. The results are interpreted to indicate a decrease in collagen-associated sugar residues in diabetics.


Methods of denaturation and renaturation of DNA in interphasic chromatin: cytochemical quantitative analysis by Methyl Green staining. Almost diploid nuclei (as judged from the microdensitometric evaluation of the Feulgen positive material) of granular and Purkinje cells of the rat cerebellar cortex, were submitted to in situ DNA denaturation and renaturation experiments. We assessed the double-strandedness of DNA, by Methyl Green staining according to Scott (1967). Under these conditions a stoichiometric ratio between bound dye and DNA exists, suitable for quantitative microdensitometric measurements. Our data show that DNA in the interphasic chromatin is never completely denatured after the treatments we used. Furthermore, the renaturation takes place in a different way in the two cell types. Owing to the unlike chromatin packing of granular and Purkinje nuclei, we suggest that nuclear proteins must interfere differently on the in situ denaturation and renaturation processes.


Capping of saccharides on the plasma membrane of lymphocytes as studied by fluorescein-labelled lectins. The capping of saccharides on the plasma membrane of rat splenic lymphocytes was studied by means of fluorescein-labelled lectins. Treatment of unfixed splenic lymphocytes with any one of the three lectins, concanavalin A (Con A), Ricinus communis agglutinin (RCA) and wheat germ agglutinin (WGA) led to the formation of caps of each saccharide receptor on the plasma membrane. Treatment of unfixed lymphocytes with Con A was found to result in the formation of caps of saccharide receptors for RCA, whereas cap formations were never noted in such double treatment of the cells with all other combined uses of two lectins. These results are taken to indicate that the saccharide receptors for Con A are associated with those for RCA in the plasma membrane of rat splenic lymphocytes.


Microdensitometric quantification of the lead capture method for the histochemical demonstration of acid phosphatase in cultured cells. A fibroblast-like BHK-21 (C-13) line, grown as monolayer on glass cover-slips, was incubated for the demonstration of acid phosphatase by the lead capture method. The density of final reaction product was measured with a scanning microdensitometer. A peak absorption was found at 510 nm. The extinction of discrete areas of stain was within the range of linear response of the instrument. The frequency distribution of the density of reaction product in 100 cells was normal (Gaussian), and the density increased linearly with incubation time. It is concluded that this method is valid for the measurement of the density of lead sulphide reaction product in cultured cells.


Peptidergic (VIP) nerves in the pancreas. Vasoactive intestinal peptide (VIP) was found to occur in nerves in the pancreas of all species examined, as demonstrated by immunohistochemistry. Immunoreactive nerve terminals were seen to run in the stroma, around acini, and in the wall of blood vessels. Clusters of immunoreactive nerve cell bodies were encountered in the parenchyma; in addition other ganglia were densely innervated by VIP nerves. A particularly dense network of VIP nerves accurred in the wall of the main pancreatic duct. The present observations provide the morphological basis for accepting the action of VIP on pancreatic secretion as physiological.


Localization of inorganic ions by precipitative freeze dissolution. A new method for localization of inorganic diffusible ions in tissue is introduced. It has been applied to localization of Tl+ and Rb+ in barley roots and is probably also suited for Cs+, Ca2+, Cl-, Br-, PO 3/4- and perhaps K+. Its principle consists of dissolution of the ice from frozen tissue in a concentrated aqueous solution of a precipitating agent that is kept at a temperature just above its melting point.


[Risk of inner ear damage from ototoxic eardrops (author's transl)]. Antibiotic eardrops with ototoxic properties are widely used in the treatment of discharging ears and have also been used in cases with perforated tympanic membranes. There has thus far been no information available on the incidence of ototoxic inner ear damage caused by such treatments. An inquiry among the members of the Swiss Otolaryngological Society uncovered 15 such cases with inner ear damages: 8 patients with total loss of hearing and 7 patients with profound deafness. The risk of such ototoxic injury is approximately 1 case in 1--3000 treatments. The present study indicates that topical treatment in cases with perforated tympanic membranes should not be given longer than 10 days, or it should be interrupted as soon as mucosal swelling subsides.


[Reconstruction of the ossicular chain (author's transl)]. 197 consecutive tympanoplasties involving reconstruction of the ossicular chain were analyzed. After a one-year followup, the interposition of a homologous ossicle between the mobile stapes and the long process of the malleus with intact anterior half of the drum has given a satisfactory result in 93% of the patients. Unsatisfactory results were obtained in 50% of those patients presenting with only the stapes or its footplate intact. Reasons for the failures were: graft lateralisation, fixation, atrophy or displacement of the homologous ossicle used. The twostage tympanoplasty with utilisation of John Shea's TORP prosthesis has considerably improved the hearing result achieved in the second category of patients. One has to await, however, long-term results in order to assess whether or not the TORP Plastipore prosthesis should be recommended in middle ear surgery.


[First results using the SHEA-Torp in middle ear surgery (author's transl)]. Initial results with the Plastipore TORP (Total Ossicular Replacement Prosthesis) show good results in large groups of ear in which all or most of the ossicles have been missing or not suitable for reimplanting. The reconstruction of the sound conducting mechanism of the middle ear is not difficult using the TORP prosthesis. Tissue readily grows into the large pores of the Plastipore, significant hearing gain can be achieved, and no rejection of the prosthesis has occurred thus far.


[Laryngotracheal stenosis: results of surgery (author's transl)]. Between 1973 and 1977 seven adults and five children with severe larynx stenosis were operated upon successfully with a modification of Rhéti's technique. The main features of this new technique are: 1. The cricoid and the upper tracheal rings are split longitudinally in their anterior and posterior portion. 2. The stabilisation of the enlarged laryngeal lumen by the interposition of a piece of notched costal cartilage in the posterior wall of the split cricoid.


[Phoniatric and laryngological aspects of systemic scleroderma (author's transl)]. Organs which contain collagen can have connective tissue new growth in systemic scleroderma. The occurrence of scleroderma of the larynx and organs of speech is rare. The disease develops in the mucous membrane in three stages: oedema; infiltration and induration; and atrophy. The oedema stage is generally the shortest. Three patients with systemic scleroderma with involvement of larynx and organs of speech have been seen. In one is described (graphically, sonographically and with stroboscopy) the progress of the disease from an initial severe hoarseness to later resolution of the oedema. In another patient involvement of the soft palate produced rhinolalia. In spite of the limitation of tongue movement in 2 patients there was no disorder of articulation.


[Clinical and roentgenological manifestations of unilateral subluxation of the cricothyroid joint (author's transl)]. The case of a 44-year-old professional singer is described, who was admitted to the hospital with a severe laryngeal contusion following a sport's accident. After recovering from acute symptoms, he complained of a complete loss of his falsetto voice. At lower pitches, his voice function had returned to normal. Xero-radiography revealed a left unilateral subluxation of the cricothyroid joint. However, intensive voice therapy over 12 months failed to restore the former quality of the falsetto voice. In this patient, the impairment of vocal range could be explained by a disturbance of the tilting mechanism between the cricoid and thyroid cartilages.


[Nose and speech discrimination with specific hearing aid systems (author's transl)]. This study compares speech discrimination and the use of hearing aids of the PC (peac-clipping) system and the AGC (compression) system. After random selection 34 subjects were used and grouped according to the unit system they had been supplied with. Both groups were tested under the same conditions. During noise exposure the group supplied with the AGC aids achieved better results significantly at a 5% level. The results indicate that the assumption that PC hearing aids operate better in noise than AGC aids cannot be substantiated.


Dynamic viscoelastic properties of the canine trachea. The dynamic elastance (E) and viscous resistance (R) of the canine intrathoracic trachea were determined by submitting excised tracheal segments to periodic variations of pressure at frequencies between 0.5 and 9 Hz, and by relating simultaneous transmural pressure and volume variations. Mean values of E and R are, respectively, 17.3 cmH2O.cm-1 and 0.16 cmH2O.cm-1.s, or, expressed in volume changes per cm length of the trachea, 53.5 cmH2O.ml-1 and 0.49 cmH2O.ml-1.s. E and R increase at higher longitudinal tension of the trachea and under the influence of acetylcholine.


Interaction between serotonin and efferent vagus nerves in dog lungs. We anesthetized, paralyzed, and ventilated 32 dogs. In 16 dogs we measured total pulmonary resistance (RL) during inhalation of acetylcholine (ACh), serotonin (5-HT), and histamine (Hist) aerosols. Cooling both cervical vagi reduced the bronchoconstriction caused by 5-HT 64% (P = 0.001), reduced Hist-induced bronchoconstriction 17% (P = 0.003), and did not significantly reduce bronchoconstriction due to ACh. In seven dogs, we ventilated both lungs separately through a double-lumen catheter. Application of 5-HT to one lung increased the transpulmonary pressure amplitude in the homolateral but not in the contralateral lung. Cooling the homolateral vagus reduced this response 32% (P = 0.02). In nine dogs, we stimulated the peripheral ends of both cut cervical vagi before and during aerosol application of ACh, 5-HT, and Hist. ACh and Hist increased baseline RL 97 and 134%, respectively, without increasing the effect of vagal stimulation. 5-HT increased baseline RL only 27% but greatly augmented the effect of vagal stimulation (mean increase, 271%, P = 0.001). We conclude that 5-HT acts to potentiate vagal effects on airway smooth muscle via the efferent vagal pathway.


Effects of prostaglandin F2alpha on lung mechanics in nonasthmatic and asthmatic subjects. Prostaglandins have been implicated as secondary pharmacologic mediators in allergic bronchial asthma. We have studied the effects of the intravenous infusion of prostaglandin F2alpha (PGF2alpha) on pulmonary mechanics in nonasthmatic and asthmatic volunteers. Before and during the infusion, measurements were made of total lung capacity and its subdivisions, static deflational transpulmonary pressure-volume relationships (PV), and maximal expiratory flow-volume curves with air and after a washing of an 80% helium-20% oxygen mixture. In both groups, PGF2alpha caused significant decreases in vital capacity and maximal flow and increases in residual volume. There were not significant differences between groups in either the absolute magnitude or the percent change in the variables, a result which may have been due to the similarity of the pulmonary mechanics in both groups prior to infusion. Changes in density dependence were bidirectional in both groups, indicating that relative contributions of large and small airways to flow limitation changed differently among individuals. The single between-group difference in responses noted was a leftward shift of the PV curve in the asthmatics, suggesting recoil of the lung which occurs in asthma.


Analysis of the configuration of maximum expiratory flow-volume curves. The ratios of the instantaneous tangent slopes to corresponding chord slopes are sensitive to curvatures of flow-volume curves; and these dimensionless slope ratios, SR, plotted against fractional volumes remaining to be expired, VCf, are sensitive to the shape of flow-volume curves but insenitive to flow or volume magnitudes. SR-VCf curves predicted for lungs which empty homogeneously differ substantially from those predicted for lungs which empty nonhomogeneously, the latter showing systematic increases in SR with VCf which may extend beyond the homogeneous range. SR-VCf curves for some 80 healthy subjects show systematic changes with age (range 6-64 yr), but all are consistent with advanced obstructive lung disease (chronic bronchitis, emphysema, asthma) are consistent with nonhomogeneous emptying, but it does not seem likely that SR-VCf curves will prove useful for detecting early stages of disease.


Early response of plasma contents on exposure of working men to heat. Twelve men block-stepped (35 W) 4 h/day for 12 days and were divided into two similar groups on the basis of Vo2max. All were exposed to 33.8 degrees C dry bulb, 32.7 degrees C wet bulb for 2 h (E1) while working (30% Vo2max). Venous blood was obtained at 10-min intervals during hour 1 and at 20-min intervals during hour 2. Group 1 was acclimatized to heat. Group II continued to train. The test exposure was repeated (E2). During E1 a trend toward hemodilution was evident but not significant for either group. Protein moved into the vascular volume and a decrease in plasma osmolarity was significant only after 30 min. For both groups during E2 significant hemodilution occurred during the first 10 min. Only group I remained significantly hemodiluted for 2 h. Protein movement and osmodilution again occurred in both groups. These results support earlier suggestions as to the mechanisms of hemodilution based on 1-h blood samples. Conflicting evidence as to the pressure or absence of hemodilution upon heat exposure is noted, and a hypothesis is proposed which appears to reconcile divergent results.


Microvascular responses to norepinephrine in skeletal muscle of cold-acclimated rats. The microcirculation of the spinotrapezius muscle in normal and cold-acclimated (4 degrees C) rats was observed by an in vivo microscopic technique. The responses of the arterioles and venules in the skeletal muscle microcirculation to topical application of norepinephrine (NE) were recorded by a photomicrographic method. Results show that the skeletal muscle microcirculation possesses both alpha- and beta-adrenergic vascular receptors. Stimulation of the alpha-receptor results in vasoconstriction, and of the beta-receptor, vasodilatation. These microvascular responses are antagonized by specific alpha- and beta-adrenergic blockers. Cold-acclimation (4 degrees C) for 3 wk decreases the responses of the skeletal muscle microvessels to NE stimulation. This diminished sensitivity is due to an attenuation of the alpha-adrenergic receptor mechanism.


Effects of age on regional residual volume. Forty-one normal non-smokers between the ages of 20 and 80 were studied to determine if the increased residual volume, known to occur with aging, results from increased residual volume throughout, or only in specific regions of the lung. The subjects were dividied into groups consisting of 20-29, 30-39, 40-49, 50-69, and 70+ yr. Measurements of regional residual volume to regional total lung capacity ratio (RVr/TLCr) were made using zenon-133 and a multidetector analysis system in which five zones (from top to bottom) were analyzed in each lung. Closing volume was also measured. The subjects were in the sitting position for all studies. The results showed regardless of age, the RVr/TLCr was higher at the top than at the bottom of the lung. In addition, the ratio of upper to lower RVr/TLCr was not significantly different between any of the age groups. The results can be explained if airways throughout the lung close at higher volumes as age increases, or if altered emptying sequences within regions occur due to retarded emptying of highly compliant lung regions.


Partitioning of inspiratory pressure swings between diaphragm and intercostal/accessory muscles. We tested the hypothesis that the inspiratory pressure swings across the rib-cage pathway are the sum of transdiaphragmatic pressure (Pdi) and the pressures developed by the intercostal/accessory muscles (Pic). If correct, Pic can only contribute to lowering pleural pressure (Ppl), to the extent that it lowers abdominal pressure (Pab). To test this we measured Pab and Ppl during during Mueller maneuvers in which deltaPab = 0. Because there was no outward displacement of the rib cage, Pic must have contributed to deltaPpl, as did Pdi. Under these conditions the total pressure developed by the inspiratory muscles across the rib-cage pathway was less than Pdi + Pic. Therefore, we rejected the hypothesis. A plot of Pab vs. Ppl during relaxation allows partitioning of the diaphragmatic and intercostal/accessory muscle contributions to inspiratory pressure swings. The analysis indicates that the diaphragm can act both as a fixator, preventing transmission of Ppl to the abdomen and as an agonist. When abdominal muscles remain relaxed it only assumes the latter role to the extent that Pab increases.


Aerobic work capacity in chronically undernourished adult males. Maximal O2 consumption (VO2max) and maximal endurance time at 80% Vo2max (T80) were determined in 49 subjects with varying degrees of nutritional compromise. Vo2max was lover by 21% and 52% in subjects with moderate and severe undernutrition, respectively, when compared to men with mild nutritional compromise. Most (80%) of the change in Vo2max could be related to the estimated differences in muscle cell mass (MCM). A significant reduction (-18%) in the Vo2max per unit of MCM was found in the severely undernourished subjects, indicating basic physiological changes. Total body hemoglobin showed the highest correlation with Vo2max (r = 0.709) and at constant MCM (partial r = 0.796). A multiple regression equation was derived to estimate the Vo2max of populations on the basis of simple anthropometry and blood hemoglobin levels. T80 (93-103 min) and estimated maximum sustained 8-h percent effort (32%) in mild, intermediate, or severe undernutrition were not significantly different; by contrast, endurance at a given absolute work load was markedly lower in severe undernutrition (8 vs. 1.5 h) due presumably to the difference in Vo2max.


Effect of force environment on regional pulmonary displacements and volumes in dogs. Regional displacements of lung parenchyma due to respiratory movements at 1 G and 7 Gy were studied in anesthetized dogs in the left decubitus position in a water-filled respirator that provided control of respiratory volumes and rate and minimized inertial shifts in position and shape of the thorax and abdominal contents and related effects on the lungs. Inspiratory movements at 1 G were relatively uniform, although regional volume increased more in the nondependent (right) lung than in the dependent (left) lung. Regional functional residual capacity (FRC) increased in the nondependent lung and decreased in the dependent lung during exposures to 7 Gy. The greatest inspiratory increase in volume occurred near the midlung, where regional FRC changed the least during acceleration. The decrease in dependent and increase in nondependent lung volumes during acceleration are attributed to the increased weight and consequent downward displacement of the higher specific gravity mediastinal contents concomitantly with upward displacement of pulmonary gas, producing an exaggeration of the dependent-to-nondependent gradient in alveolar size.