The borderline patient. A comparative analysis of four sets of diagnostic criteria. In reviewing the evidence for the validity of the diagnosis borderline, four descriptions in the literature seem to offer comprehensive criteria for the diagnosis. When the four are compared, a total of 104 criteria are enumerated encompassing the mental status, history, interpersonal relationships, defense mechansisms, and other judgments of personality functioning of the borderline patient. Half of these criteria are mentioned in only one of the four diagnostic descriptions. This apparent lack of agreement over diagnostic criteria has three possible interpretations: (1) the borderline concept is an illusion; or (2) the concept is adequately defined by those criteria held in common, the others being nonessential; or (3) apart from the concept defined by the common criteria, there are subtypes emphasized by different authors. Although we favor the third interpretation, it is suggested that further speculation await an adequate test of existing diagnostic criteria.


Suicide in schizophrenics, manics, depressives, and surgical controls. A comparison with general population suicide mortality. This article reports suicide risk among 200 schizophrenic, 100 manic, and 225 depressive patients, and 160 surgical controls. The suicide experience of the study subjects was compared to that of the population of the state of Iowa, the geographical area and population from which the subjects were selected. The suicide experience of the surgical controls was not significantly different from that of the general population. On the other hand, increased risk of suicide was found in all psychiatric groups except female schizophrenics. Suicide appeared pronounced particularly in male patients with affective disorders during the first decade of the follow-up period.


Patterns of childhood social development in adult schizophrenics. Previous analysis of teachers' comments in school records of schizophrenics showed progressive deviance in their childhood social behavior and sharp differences between the sexes. This report presents a replication of the longitudinal study and a reanalysis of the combined samples. The principal findings from the earlier study were confirmed: in the later school years, preschizophrenic girls were primarily introverted and preschizophrenic boys mainly disagreeable. In the new study, the preschizophrenic girls were also emotionally unstable, introverted, and passive from kindergarten through grade 6, suggesting in earlier history of social disengagement than was previously apparent, and the preschizophrenic boys were emotionally unstable in grades 7 through 12, confirming a nonsignificant trend in the original study. The boys were not behaviorally distinguishable from other boys in elementary grades, so the notion of progressive deviance appears more applicable in their case.


MMPI assessment of psychopathology in the adopted-away offspring of schizophrenics. Previous studies completed in Denmark show a higher frequency of schizophrenia-related psychopathology in the adopted offspring of schizophrenics than in matched controls. This study adds a psychometric dimension to the earlier reports with an analysis of psychopathology in the adopted offspring of schizophrenics based on the Minnesota Multiphasic Personality Inventory (MMPI). A combination of MMPI criteria and interview-based diagnosis identifies 22% of the index cases and 6% of the control cases (P less than .01) as having a schizophrenia spectrum disorder. The findings support a genetic hypothesis, but the use of the MMPI does not fully clarify some issues raised in the earlier reports.


Psychopathology in adopted-away offspring of biologic parents with antisocial behavior. A study of 246 adoptees aged 10 to 37 years separated at birth from biologic parents is used to study genetic heritability of antisocial behavior and to delineate the extent and quality of "antisocial spectrum" conditions. Evidence is presented for a genetic factor in adoptee antisocial behavior and for the following as "spectrum" conditions: (1) hysteria in adult females (Briquet's syndrome) or multiple somatic complaints without medical explanation in younger female subjects and (2) mood swings possibly associated with the symptom of audible thoughts.


Life events and prisoners.

Life events and prisoners. This study explores retrospectively the relationship of the accumulation of life events as it relates to prison incarceration and extends further the concept that coping with increasing environmental changes results in a variety of overt behaviors. The prison sample comprised 176 male inmates of a federal prison (McNeil Island, Washington) and a state penitentiary (Walla Walla, Washington). Life change scores were derived from the Schedule of Recent Experience (SRE). There was an escalation of annual life change scores of prisoners, indicating the mounting frequency of occurrence of life events prior to incarceration. The SRE may have value in the prediction of socially deviant behavior as with health changes. Variables seen as influencing life change scores were race, age, and education. Analyses of life event frequencies as compared to a normative group indicated that prisoners have evolved a coping life-style that reflects antisocial and criminal behavior.


Female criminality and the prediction of recidivism. A prospective six-year follow-up. A prospective, six-year follow-up investigation of 66 convicted female felons indicated that psychiatric, social, and familial factors defined and measured at the time of the index study affected the rate of criminal recidivism. Wide individual variation in the course of female criminality was observed. Prolonged supervision on parole or probation appeared to have therapeutic benefit. The most powerful predictors of recidivism were the diagnoses of drug dependence and antisocial personality, and a history of homosexuality. Familial criminality and maternal hysteria were also associated with an increased risk of serious and persistent recidivism. Educational, marital, and employment status contributed to a lesser extent, while race and type of index offense were only significant (P less than .05) when minor offenses were considered.


Lithium carbonate use in children and adolescents. A survey of the literature. One hundred ninety cases of lithium carbonate use in children and adolescents are reviewed and divided by the authors according to DSM-II criteria into major affective disorders, behavior disorders of childhood and adolescence, and schizophrenia, childhood type. Of these 190 cases, only 46 cases were described in detail. In this group of 25 males and 21 females, aged 3 to 19, there were 30 positive responses to lithium carbonate. A family history of diagnosed manic-depressive illness was reported in only eight cases, while 19 had a family history of other psychiatric disorders. We were impressed by the affective component, irrespective of diagnosis, in youngsters responding to lithium carbonate and by the use of the drug despite multiple neurological problems. Thirty cases had positive neurological findings. Nevertheless, the many incompletely reported cases prevent conclusive generalization and demonstrate the need for well-documented studies correlating clinical, familial, and biochemical indices.


Lithium carbonate and brain function. I. Cerebral-evoked potentials, EEG, and symptom changes during lithium carbonate treatment. Eighteen patients were studied with behavioral ratings and the somatosensory (SER), auditory (AER), and visual (VER) cerebral-evoked response and quantified EEG before and during lithium carbonate treatment. The amplitude of early positive SER components and most AER components increased during treatment, but VER did not change. The intensity of EEG delta and theta frequencies increased, and the dominant alpha frequency slowed. Before treatment, there were few significant correlations to symptom intensity. Patients with an increase in symptoms on treatment had the greatest increase in EEG delta intensity and the dominant alpha frequency slowed in patients who became more depressed. The EEG slowing in patients with a normal sensorium and the change in cerebral cortical activity after transmission in the somatosensory pathway over just three synapses demonstrate a unique and specific effect of lithium carbonate on brain function.


Probenecid-induced norepinephrine elevations in plasma and CSF. Probenecid administered in divided oral doses totaling 100 mg/kg increased levels of norepinephrine (NE) in plasma and cerebrospinal fluid (CSF). This technique is commonly used to measure the rate of accumulation of acidic metabolites of certain brain neurotransmitter biogenic amines in CSF after blockade of their transport into blood. Since levels of 3-methoxy-4-hydroxy-phenylethyleneglycol, a neutral metabolite of NE, are also elevated after high oral doses of probenecid, the increases of CSF and plasma NE levels may be directly related to probenecid-induced release of this amine from noradrenergic neurons. In patients who experienced nausea or vomiting there were lower levels of probenecid in CSF, probably secondary to diminished absorption of the medication. These patients also had lower levels of NE in plasma than did patients who remained asymptomatic.


Cyclobenzaprine hydrochloride effect on skeletal muscle spasm in the lumbar region and neck: two double-blind controlled clinical and laboratory studies. A new drug, Cyclobenzaprine hydrochloride (Flexeril), was compared with diazepam (Valium) and placebo in double-blind trials for efficacy in treating spasms and pain in the neck and low back. Complex recording methods involving clinical evaluations (graded), patient self-ratings, goniometry, motion analysis by computer, electromyography of controlled motions and detailed statistical analysis were used. Clinical improvement over two weeks was statistically significant in all treatment groups with a statistically significant preference for Cyclobenzaprine hydrochloride. The most striking improvements recorded were in the electromyographic findings, which showed statistically significant changes for the Cyclobenzaprine group. Clinical muscle spasms are not accompanied by increased myoelectric activity; the reverse is true. With improvement, myoelectric activity in back muscles is augmented during prescribed stressful movements as measured by electromyography and computer analysis combined with complex electrogoniometry.


Physical and occupational therapy for arthritic patients: a cooperative effort among hospital departments. The importance of a team approach for optimum management of arthritis is recognized, but small hospitals and clinics may have difficulty supporting a team when the number of arthritic patients treated by any one department is not large. A cooperative effort of our 500-bed hospital's sections of rheumatology, physical medicine, and orthopedic surgery provides a physical therapist and an occupational therapist to work exclusively with arthritic patients. By working across departmental lines the therapists perform enough services to pay their salaries. Patients benefit not only from the availability of therapist specialists but also from continuity of care. Presence of the therapists has permitted extension of care to a satellite clinic and to patients' homes. The cooperating sections have acquired personnel and capabilities not available to them if acting independently.


Wheelchair cushion effect on skin temperature. Since a rise of 1.0 C in temperature causes a 10% increase in tissue metabolism, a wheelchair cushion which limits changes in skin temperature, and thus metabolic demand, might effectively reduce ischemic tissue damage. Skin temperature changes were measured under the ischial tuberosities and thighs of normal subjects while sitting on several types of support surfaces. The effect of commercially available wheelchair cushions on sitting surface skin temperatures was measured in five normal men and five normal women, age 20 to 30 years. The sitting surfaces studies were latex rubber cushions with nylon-vinyl and cotton polyester covers, two types of gel cushions, and a water flotation pad. Skin surface temperatures were recorded under both ischial tuberosities and both posterior thighs during each 30-minute test period. Increases in skin temperature averaging 2.3 C to 2.5 C under the ischial tuberosities and 3.2 C to 3.5 C under the thighs were noted when the subjects sat on either of the latex rubber cushions. A temperature drop of 3.1 C was noted under the ischial tuberosities and 2.2 C under the thighs when using the water flotation pad. The skin temperature remained relatively static while sitting on the gel cushions.


Spinal cord injury in an inner city hospital. During the first six years of existence of the rehabilitation unit in a black inner city major municipal hospital, 53 patients with spinal cord injury were admitted. A retrospective study of these patients sought answers to questions concerning etiology, patient characteristics, services provided and method of delivery, and advantages and disadvantages of rehabilitation in a community hospital. Findings revealed differences in causation of spinal cord injury between women and men and between patients with paraplegia and quadriplegia. tthe male paraplegic patients were the youngest; their life style led to spinal cord injury. Social factors such as inadequate housing, lack of transportation, and insufficient financial resources were deterrents to rehabilitation. An approach that emphasized consideration of all the psychosocial factors was developed. Evaluation and treatment were extended into the community. Lack of peer groups and multiphasic programs were the major disadvantages.


Urinary calculi composition in patients with spinal cord lesions. Because of the reported production of predominantly phosphatic calculi by hypercalciuric patients there was a need to confirm the analysis of such stones using quantitative methods. Calcium, magnesium, ammonium, orthophosphate, oxalate, carbonate and urate were therefore determined in 148 calculi from 113 patients with spinal cord lesions. There were 145 (98%) composed of calcium phosphate and magnesium ammonium phosphate. Only trace amounts of calcium oxalate were present in most. The remaining 2% were calcium oxalate stones. The ratio of nonoxalate calcium to magnesium was inversely related to the duration of paralysis. This study revealed that, when this variable was taken into account, the composition of a stone was not related to its weight, site of occurrence, level of the cord lesion, sex of the patient, or therapy with acidifying drugs.


Neonatal paroxysmal monorhythmic alpha activity. Thirteen infants with neonatal seizures showed paroxysmal monorhythmic electrographic activity, predominantly in the alpha range (8 to 13 Hz) and localized to the rolandic cortical areas. This rhythmic discharge, which is commonly lateralized, represents an electrical seizure discharge. Such discharges may exist as the only electrographic seizure activity, but in the majority of cases (8/13) independent epileptiform discharges are observed in other cortical areas. All infants with paroxysmal monorhythmic alpha activity had clinically observed seizures. Computerized tomography performed six or more weeks after observing the electrographic abnormality demonstrated diffuse as well as localized cortical atrophy in a distribution similar to the monorhythmic alpha activity. In other cases, localized monorhythmic alpha activity was correlated on subsequent evaluations with focal neurological abnormalities (eg, hemiparesis and hemiatrophy) and a high incidence of microcephaly (83%). On the basis of these findings, we suggest that encephalomalacia may be important in the pathogenesis of paroxysmal monorhythmic alpha seizures in the neonate.


Posterior fossa subdural hematomas in neonates. Posterior fossa subdural hematomas in the newborn infant are rare but potentially treatable. The infants are normal after birth, but within days, hydrocephalus hypotonia, and irregular respirations develop. Seizures and third nerve pareses are unusual. We report a neonate in whom this process was identified by computerized tomographic brain scan. We also discuss potential misinterpretations of the computerized tomographic brain scan in neonates.


The benign lateral medullary syndrome.

The benign lateral medullary syndrome. Four young, otherwise healthy men developed the signs and symptoms of lateral medullary ischemia following extraordinary outdoor exercise. The syndrome was short-lived, with excellent long-term prognosis. We suggest that the designation "benign lateral medullary syndrome" is appropriate for this transient nonrecurring state.


Computerized tomography. An adjunct to early diagnosis in the cauda equina syndrome of ankylosing spondylitis. This article describes a case of the cauda equina syndrome associated with ankylosing spondylitis. The typical myelographic features and the computerized tomography (CT) scan of the lumbar spine are included. The CT scan may aid in elucidating the pathogenesis of the disorder.


Pattern shift visual evoked responses. Two hundred patients with optic neuritis and/or multiple sclerosis. Fifty-one patients with clinically pure optic neuritis (ON) and 149 with possible, probable, or definite multiple sclerosis (MS) were tested with pattern shift visual evoked responses (PSVER) and compared with a group of 43 normal subjects. Attention was paid to response latency, intereye latency difference, as well as differences in amplitude or duration of the major positive peak (P100). Abnormal PSVER cannot be recorded from everyone with confirmed ON. Abnormal responses were recorded from 91% of all patients (including those with MS) who had a history of ON, 57% of all MS patients, and 36% of patients without a history of ON or an abnormal eye examination. Measurements of amplitude and duration proved to be of little value in this setting. Though abnormalities of PSVER are not "specific" for ON or MS, because they also result from other disease processes, they afford more reliable, quantitative documentation of abnormal conduction in visual pathways than any other clinical test.


Investigations on the inheritance of nemaline myopathy. Extensive investigations on 11 patients with nemaline myopathy (six index patients, five relatives), their parents, and some healthy relatives were carried out. In one family, nemaline myopathy was inherited as an autosomal dominant trait. No linkage between the locus of nemaline myopathy and the locus of seven informative genetic markers (out of 25 investigated markers) was found. In two families an autosomal recessive inheritance could be demonstrated with certainty. In these families, both parents of each index patient had rods and an increased number of fibers with internal nuclei. In two other families, one or both parents of each index patient had an increased number of fibers with internal nuclei, also indicating the possibility of autosomal recessive inheritance in these cases. It can be concluded that there are two types of nemaline myopathy. However, these two diseases could not be separated on a clinical or histopathological basis.


Survival after spinal cord trauma. A life table analysis. The records accruing from the care of spinal cord injury patients in hospitals of Veterans Administration (VA) make available a unique opportunity to study survival rates of a large group. This study analyzes the survival experience of patients whose initial treatment in a VA hospital for trauma to the spinal cord occurred between Oct 1, 1955, and Sept 30, 1965. Life table methodology enabled survival rates to be calculated for various intervals after injury and allowed for maximum use of each patient's experience. Age at injury, level of lesion, and extent of paralysis were all found to be important factors in survival. High mortality occurs in the first three months regardless of age at injury or level of lesion. Of those paraplegic and quadriplegic patients who survived the first three months after injury, the ten-year survival rates are quite similar, 86% and 80%, respectively.


Arachnoid cyst and associated subdural hematoma. Observations on conventional roentgenographic and computerized tomographic diagnosis. Information about computerized tomography (CT) of arachnoid cysts of the middle fossa (ACMF) is increasing, and it appears that certain CT characteristics may be diagnostic. The association of ACMF and subdural hematoma has been emphasized previously but is not common knowledge. We present three new cases of ACMF and associated subdural hematoma studied by plain roentgenograms, EEG, conventional brain scanning, CT scanning, and angiography. The cysts were clearly shown in each case by CT scan, but no subdural hematoma was visualized in our first two cases. Angiography was necessary to establish the associated hematoma. We review and emphasize computerized tomographic characteristics that may be pathognomonic of ACMF. It is suggested that angiography be included in the study of patients symptomatic with ACMF because associated subdural hematoma is not an uncommon lesion and may fail to visualize on CT scan. Angiography still remains the most conclusive study to establish or exclude the diagnosis of subdural hematoma.


Developmental dyslexia. Evidence for a subgroup with a reversal of cerebral asymmetry. The computerized brain tomograms of 24 patients with developmental dyslexia were analyzed for cerebral asymmetry. Ten patients showed a reversal of the pattern of asymmetry regularly observed in normal right-handed individuals so that the right parietooccipital region was wider than the left. The ten dyslexic patients with this reversal of cerebral asymmetry had a lower mean verbal IQ than the other 14 dyslexic patients in this study. The reversal of cerebral asymmetry that occurred in ten of the dyslexic patients may result in language lateralization to a cerebral hemisphere that is structurally less suited to support language function and thus act as a risk factor for the development of reading disability.


Pseudocaloric nystagmus.

Pseudocaloric nystagmus. Pseudocaloric nystagmus (PCN) is an appropriately beating nystagmus induced by cold caloric irrigation of an ear with abolished vestibular function. The nystagmus is not the result of endolymph flow but probably represents unmasking a latent nystagmus by altering the patient in this case, through tactile (caloric) stimulation. Pseudocaloric nystagmus has the following characteristics: (1) mild intensity (eyes closed-slow phase velocity usually less than 8 degrees/sec), it has not been observed with the eyes open, (2) always beats away from the diseased ear; therefore, any nystagmus induced by cold irrigation will be appropriately (contralateral) beating while that induced by warm irrigation will be inappropriately (contralateral beating; 3) the induced nystagmus will not reverse direction after inverting the ampulla. Establishing bidirectional sensitivity of the cupula by demonstrating appropriately beating nystagmus to ampullopetal and ampullofugal flow of endolymph not only assures that the lateral semicircular canal (SCC) is functionally intact to caloric stimulation but will avoid errors in electronystagmorgraphic (ENG) interpretation.


Disseminated Hodgkin's disease with bilateral orbital involvement. Hodgkin's disease was diagnosed in a patient by lymph node excision. Orbital infiltration was demonstrated by echography and computerized axial tomography. Subsequent orbital biopsy specimens showed lacrimal gland involvement with definite Reed-Sternberg cells.


Glaucoma-inducing mechanisms in eyes with retinoblastoma. A total of 149 eyes with retinoblastomas were examined histopathologically to determine the types and frequencies of mechanisms inducing glaucoma. The most common mechanism was iris neovascularization with secondary peripheral anterior synechiae formation. In such cases, the tumor was almost always located at the posterior pole with involvement of central retinal vessels and with growth of a highly vascularized tumor mass into the vitreous. The second most common mechanism was massive exudative retinal detachment causing pupillary block and angle closure. In such cases, tumor growth was present within and under the retina. The third most common mechanism was a combination of the aforementioned mechanisms. Uveitis and/or necrotic tumor tissue in the anterior chamber as the sole mechanism inducing glaucoma was infrequently seen.


Excision of distichiasis eyelashes through a tarsoconjunctival trapdoor. Previously described surgical techniques for distichiasis correction are likely to have complications of trichiasis, entropion, and eyelid margin distortion. A new technique to remove distichiasis eyelashes through a tarsoconjunctival trapdoor achieves a satisfactory functional and cosmetic result and descreases the likelihood of these complications.


Surgical repair of prolapsed lacrimal glands. Herniation of the lacrimal gland is a condition that occurs unilaterally or bilaterally. Either or both lobes of the lacrimal gland may prolapse. Orbital lobe prolapse may be associated with blepharochalasis, a disease of puberty. We developed a surgical technique for the repair of prolapsed lacrimal glands. It is important to have adequate hemostasis and closure of the orbital septum.


Experimental chalcosis: a comparison between in vivo and in vitro findings. The ocular changes following the introduction of a copper foreign body in the eye of rabbits were studied by histological, histochemical, and quantitative analysis. The findings are compared with previously reported changes observed in vivo. The efficacy of ophthalmoscopy and electroretinography in the early detection of chalcosis is compared with the efficacy of a new method, diagnostic X-ray spectrometry.


Posterior zonules and lens extraction.

Posterior zonules and lens extraction. During experimental or surgical lens extraction, the posterior zonules are usually completely removed from the lens; however, many remain attached in a ring to the anterior hyaloid membrane (AHM). This phenomenon was studied in gross and scanning electron microscopic preparations. The posterior zonules were found to be multilayered, with both superficial and deep attachments to the lens. Circumferential zonular fibers were demonstrated increasingly with age. Attachment of the AHM was by a fibrillar perizonular meshwork and small infiltrating bundles. The posterior zonules separated from the lens by tearing into the superficial capsule, favoring preservation of their AHM attachments. This close zonular-AHM relationship is evidence for a coordinated vitreous-zonular action during accommodation. Postoperatively, zonular-AHM attachments may help to stabilize the AHM during movement of the globe.


Lens glide in implant surgery.

Lens glide in implant surgery. The lens glide is a disposable, sterile piece of Silastic that is designed to make insertion of intraocular lenses safer and simpler. Since the use of the lens glide has become part of our routine surgical procedure in implant surgery, there has been a notable reduction in vitreous loss and in postoperative corneal problems.


Illuminated orbital retractor.

Illuminated orbital retractor. An illuminated orbital retractor that has been designed especially for microsurgery is made of methylmethacrylate and is shaped like an Arruga retractor. It is illuminated by fiber optics. Indications for the use of the illuminated retractor include exposure for repairing scleral lacerations, decompressions of the optic nerve, and orbital fractures.


Four hundred consecutive pars plana vitrectomies with the vitrophage. We performed 400 consecutive pars plana vitrectomies, using the vitrophage. Most patients (68%) showed some degree of visual improvement; only 8% had a decline in visual acuity postoperatively. The major operative complications were controllable bleeding from iris vessels and intravitreal stalks (19%) and retinal tears (2%). No retinal dialysis was noted. The major, early postoperative complications were related to corneal decompensation in 38% of the cases; this persisted beyond two weeks in only 7%. Increased intraocular pressure occurred in 19% and postoperative rubeosis iridis developed in 10% of the diabetic patients. Complications related to rebleeding occurred in 18% of the diabetic patients within the first two weeks, and an additional 9% had late rebleeding. Less frequent complications included one case of endophthalmitis, late retinal detachment in 5%, and phthisis bulbi in 2% of all cases. All complications were considerably more frequent and severe in the diabetic population.


Sterile corneal ulcers after cataract surgery in keratoconjunctivitis sicca. Mild keratoconjunctivitis sicca can become dramatically worse after cataract extraction and result in corneal thinning and perforation. Anticipation of this problem can prevent it, but lack of recognition may result in permanent central scarring from ulceration, which responds slowly to treatment.


Ocular toxoplasmosis and Hodgkin's disease: report of two cases. Isolated ocular toxoplasmosis developed in two patients with Hodgkin's disease. The diagnosis was made by ophthalmoscopy of the fundus, serologic tests, and evolution. This raises the possibility that Toxoplasma infection and the localization of retinochoroiditic lesions on the macula could be the results of the immunosuppression associated with Hodgkin's disease.


Evaluation of drugs in ointment for mydriasis and cycloplegia. Ointment preparations of cyclopentolate hydrochloride and tropicamide were compared with aqueous drops of these medications for the production of mydriasis and/or cycloplegia in clinic patients. Mydriasis and/or cycloplegia could be accomplished by the single application of a minute volume (around 0.005 ml) of ointment containing these drugs. With the use of ointment preparation, ocular irritation was minimal, and there was no interference with subsequent ocular examination. A delivery system was devised with a piece of silicone-rubber tubing that was filled with an ointment preparation. By squeezing the tubing, a minute volume (about 0.005 ml) of ointment preparation was expressed.


Epibulbar Kaposi sarcoma.

Epibulbar Kaposi sarcoma. This report illustrates the clinical and pathological features of epibulbar Kaposi sarcoma in an adult who had no other cutaneous or systemic manifestations of the disorder.


Neurophysiological basis of discrimination of speech sounds. The present paper discusses the information processing in the auditory nervous system with particular reference to speech sounds. The main emphasis is laid upon results of recordings from single nerve cells in the ascending auditory pathway and hypothesis about processing of speech-like sounds are put forward on the basis of these results.


The use of high-pass amplification for broad-frequency sensorineural hearing loss. Recent research suggests that persons with sensorineural hearing impairment should derive extra benefit from amplification that eliminates or greatly reduces low frequencies, i.e. frequencies below 1 500 or 2 000 Hz. Such amplification seems to reduce the detrimental effects of the upward spread of masking on speech intelligibility, especially when listening in noisy environments. Also, current research indicates that extended high-frequency amplification, between 4 000 and 6 500 Hz is especially beneficial for optimal speech intelligibility. 9 patients with a relatively flat, moderate to severe sensorineural hearing loss were evaluated in the clinic and for daily listening situations while wearing conventional broad-frequency hearing aids with an upper range of about 4 500 Hz. They were also evaluated under these same circumstances with a hearing aid that reduces low frequencies and extends the high frequencies to nearly 6 500 Hz. Results indicate that these patients performed better and perferred the hearing aid that extends the high and reduces the low frequencies, particularly in noisy places. As a group, they did not prefer this type of amplification in quite listening situations.


Auditory processing disorders and problems with hearing-aid fitting in old age. The hearing handicap experienced by elderly subjects depends only partially on end-organ impairment. Not only the neural unit loss along the central auditory pathways contributes to decreased speech discrimination, but also learning processes are slowed down. Diotic listening in elderly people seems to fasten learning of discrimination in critical conditions, as in the case of sensitized speech. This fact, and the binaural gain through the binaural release from masking, stress the superiority, on theoretical grounds, of binaural over monaural hearing-aid fitting.


Psychology of the hearing-impaired and differential psychological reactions to prosthetic rehabilitation. The present paper discusses the results of classic research on psychological aspects of the hearing impaired and emphasizes the fact that, today, because of the possibility of early hearing aid fitting, the psychological profile of the hearing impaired presents differential features depending upon several factors. In particular, the influence of the mother's education attitude on the psychological reactions to prosthetic rehabilitation and its efficacy depending upon the degree of prosthesis acceptance are analyzed. Finally, the relationship between the hearing aid use and language development is considered.


Comparison of analysis techniques for electromyographic data. Electromyography has been effectively employed to estimate the stress encountered by muscles in performing a variety of functions in the static environment. Such analysis provides the basis for modification of a man-machine system in order to optimize the performances of individual tasks by reducing muscle stress. Myriad analysis methods have been proposed and employed to convert raw electromyographic data into numerical indices of stress and, more specifically, muscle work. However, the type of analysis technique applied to the data can significantly affect the outcome of the experiment. In this study, four methods of analysis are employed to simultaneously process electromyographic data from the flexor muscles of the forearm. The methods of analysis include: 1) integrated EMG (three separate time constants), 2) root mean square voltage, 3) peak height discrimination (three level), and 4) turns counting (two methods). Mechanical stress input as applied to the arm of the subjects includes static load and vibration. The results of the study indicate the comparative sensitivity of each of the techniques to changes in EMG resulting from changes in static and dynamic load on the muscle.


Auditory processing of speech and its implications with respect to prosthetic rehabilitation. The bioengineering viewpoint. A significant approach to medical problems from a bioengineering viewpoint generally implies the description of the biological system behaviour in terms of mathematical models. Some general considerations are reported about biological mathematical models and a short summary is given about the state of the art as far as the acoustical system is concerned. Finally, a general procedure is presented which makes use of mathematical models to conceive and analyse new prosthetic aids for the severely deaf.


Cosmic ray effects on the eyes of rats flown on Cosmos No. 782, experimental K-007. The eyes from six rats were fixed at the recovery site in Russia after they had circled the earth for 19.5 d in a 62.8 degree orbit. The eyes of six more flight rats were fixed 25 d later. These two preparations and eyes exposed to 1000 rad of neon and argon were compared to obtain data on possible radiation effects on the retina. Most of the flight eye tissue was normal; however, necrotic nuclei were found in the outer nuclear layer and channels were located in the outer segment area. Macrophages were seen between the pigment layer and outer segments. Comparison of the Day zero znd 25-d postflight eyes suggested some possible recovery. Light flashes seen by space travelers and damage from cosmic rays appear to arise from two different sites of interaction. The flashes are created by cosmic ray transversal of the outer segments while pathologic change, when it occurs, is quite possibly from interaction with some part of the nucleus. Nevertheless, direct interaction with other cellular components could also occur. Other factors, such as secondaries from spacecraft shielding, may play an important role.


BOEL screening: a program for the early detection of communicative disorders. Preliminary reports from a study on 1,000 Finnish infants. Programs for infant screening of communicative disorders should cover the need for information about the development of attention functions--auditory, visual and tactile at an age when the child is on the doorstep of speech acquisition, i.e. before 1 year of age. BOEL is a new screening test, constructed to cheek the capacity of giving priority to signals for hearing, sight and motor attention in infants around 8 months of age. The child's innate program to follow an interesting signal, grasp it and investigate it with his mouth, turn his head after it, and smile responsively is tested with the help of two visual stimuli and four sound sources, ranging between 4 000 and 12 500 Hz. BOEL is meant to be used within the routine health check-ups of, for example, well-baby clinics.


Early discovery of hearing impairment: a critical evaluation of the BOEL test. The BOEL test was originally devised for the early discovery of communication disorders in infants. The sound stimuli employed for hearing testing have been calibrated and standardized and any deviation from normal hearing responses to these stimuli indicate a hearing impairment. Since 1971 the BOEL screening program has been applied experimentally in a number of child health centers in Stockholm. Up to 1975, more than 30 000 infants have been examined and approximately 5% have not responded fully regarding visual or tactile attention, auditory, motor or mental functions or social contact. The results of the audiological follow-up are reported. Application of the BOEL hearing subtest proved very effective. It is pointed out that the BOEL test covers not only hearing defects but also other communication malfunctions and as such it is a more useful technique than simple hearing screening methods.


Radiobiological experiment aboard the biosatellite Cosmos-690. In 1974, the USSR launched the biosatellite Cosmos-690 equipped with a gamma-irradiation unit that carried 35 rats. On the 10th flight day, the rats were exposed to radiation at doses of 220 or 800 rads. During the subsequent 10 d, radiation injury developed in a space environment. Similar ground-based experiments were carried out to simulate space flight environment effects. The results obtained were studied on a comparative basis. The conclusion is made that effects of a short-term space flight, as long as 20 d, do not essentially modify the radiobiological effect.


Vitamins limiting for growth of subjects fed a normal diet under hyperbaric He-O2 conditions. A growth study was conducted of rats continuously exposed for 4 weeks to ambient air, 1 ATA He-O2, or 11 ATA He-O2 conditions and fed one of 16 diets. The diets were the standard diet alone (adequate according to National Research Council standards); the standard diet with additional casein (50%), fat (25%), and all vitamins (25%); or the standard diet with all vitamins (25%), or all vitamins increased (25%) except one, which was supplied at the standard level. The standard diet was inadequate to support a normal rate of growth when fed under 11 ATA He-O2 conditions. Supplemental casein, fat, and vitamins or all vitamins alone adequately provided nutrients necessary for a normal rate of growth by hyperbaric exposed rats. The standard levels of thiamine, pantothenic acid, biotin, and vitamin K were inadequate and the standard levels of niacin, and vitamins A, D, and E were marginal in supporting growth when fed under hyperbaric conditions.


Subjective magnitude of auditory impairment. A pilot study. A study of two samples (one in London, the other in Cairo) of patients who were suffering from an impairment of hearing showed that the subjective magnitude of auditory handicap was significantly correlated to the average hearing level at 2 000 Hz for the two ears. For both samples, the subjective magnitude of the auditory handicap was shown to be a power function of the hearing loss expressed in terms of the sound pressure corresponding to the threshold of hearing. The exponents in the power function applying to the two samples were similar. Age, sex and pain threshold did not influence the estimation of the subjective magnitude of auditory handicap in this study.


Relationships between ambient, cockpit, and pilot temperatures during routine air operations. Thermal data obtained from aircraft flying routine sorties from RAF Germany in summer have been reduced to a form suitable for statistical analysis by describing thermal stress in terms of a modified wet bulb globe temperature (WBGT) index, and thermal strain in terms of mean body temperature (Tb). Ambient temperature could be related to cockpit temperature, and cockpit temperature to pilot Tb, by linear equations of positive slope. Relationships between Tb and sortie time could be represented by exponential equations. The relationships between cockpit temperature and sortie time could also, in fixed-wing aircraft, be described by exponential equations, although in helicopters the relationships were better described by linear equations of negative slope. Models capable of predicting cockpit thermal stress and aircrew thermal strain given ambient temperature and sortie time have been constructed. These provide a description of the temperature relationships within aircraft during flight.


Differential diagnostic value of tympanometry in adhesive processes and otosclerosis. 280 tympanograms were recorded in sound-conductive hearing loss to assess their value in the differential diagnosis of otosclerosis and adhesive process. A normal tympanogram can be recorded in otosclerosis, In 48% of adhesive processes a more or less normal impedance pattern can be demonstrated. Therefore, in evaluating tympanograms in adhesive processes, one must take into consideration the microscopic picture of the eardrum and its mobility.


Increased secretion of growth hormone, prolactin, antidiuretic hormone, and cortisol induced by the stress of motion sickness. The stress of motion sickness was experimentally provoked by Coriolis effect. Significant and reproducible increases from the basal serum level (delta mean +/- S.E.) of antidiuretic hormone delta - ADH: 48.2 +/- 4.6 pg/ml; p less than 0.0005), of growth hormone (delta - hGH: 10.0 +/- 1.2 ng/ml; p less than 0.0005), of prolactin (delta - hPRL: 186.5 +/- 29.9 muU/ml; p less than 0.0005), and of cortisol (delta - F; 12.3 +/- 0.9 microgram%; p less than 0.0005) were observed, whereas the luteinizing hormone levels did not change significantly. The stimulation of hormone secretion induced by different degrees of motion sickness seems to correlate with the severity of motion sickness. The secretion of antidiuretic hormones is the most sensitive indicator for the stress of motion sickness whereas growth hormone, prolactin, and cortisol responses to the stress of motion sickness are more delayed and less pronounced.


Increased urinary excretion of triiodothyronine (T3) and thyroxine (T4) and decreased serum thyreotropic hormone (TSH) induced by motion sickness. We exposed 35 male subjects to a rotary chair and motion sickness was provoked by Coriolis effect. This stress caused an increased excretion of urinary T3 and T4 and a decrease of TSH levels in serum. The increment in urinary excretion of thyroid hormones may serve as a very useful measure for the quantitation of physical stress. Although no statistically significant change of T3, T4, and TBG levels in serum could be observed by the employed techniques, the hypothesis is favoured that motion sickness probably causes an immeasurably small increase of the free thyroid hormone fraction in serum, thereby increasing urinary excretion of T3 and T4 and, in turn, decreasing TSH secretion. Physical or psychological stress situations involve most of the endocrine systems. Contadictory results have been reported in the literature concerning the relationship between thyroid function and stress.


Alterations in erythrocyte survival parameters in rats after 19.5 days aboard Cosmos 782. Rats were subjected to 19.5 d of weightless space flight aboard the Soviet biosatellite, Cosmos 782. Based on the output of 14CO, survival parameters of a cohort of erythrocytes labeled 15.5 d preflight were evaluated upon return from orbit. These were compared to vivarium control rats injected at the same time. Statistical evaluation indicates that all survival factors were altered by the space flight. The mean potential lifespan, which was 63.0 d in the control rats, was decreased to 59.0 d in the flight rats, and random hemolysis was increased three-fold in the flight rats. The measured size of the cohort was decreased, lending further support to the idea that hemolysis was accelerated during some portion of the flight. A number of factors that might be contributory to these changes are discussed, including forces associated with launch and reentry, atmospheric and environmental parameters, dietary factors, radiation, and weightlessness.


Low atmospheric pressure effects on wearing soft contact lenses. The majority of all research in the field of contact lenses has taken place in a normal, ground-level environment. The purpose of this study was to determine if any changes occurred in wearing hydrophilic soft lenses under conditions of low atmospheric pressures. The effects on visual acuity, refraction, keratometry, and biomicroscopy were investigated with eight naval volunteers while wearing soft contact lenses at simulated altitudes up to 30,000 ft (9144 m) in an aviation hypobaric chamber. The results indicated that the low atmospheric pressure at high atitude in itself did not affect the fit of soft contact lenses.


Psychogenic G-force intolerance revisited. Three cases of psychogenic G-force intolerance are presented with a discussion of common factors. This syndrome was first described in 1958 but there has been no attention to it in the aeromedical literature since then. The significant common factor in these cases appears to be inadequate or inappropriate motivation.


Hypertension in the civilian flying population: significant or not? Hypertension is a significant illness that affects a large portion of the population of the United States. We have determined the extent of this illness within the civilian pilot population of the U.S. We reviewed data pertaining to the current prevalence of hypertension in the general population and compared these results to similar data on the pilot population. Though there are some limitations to a direct comparison of these data, we found the pilot population to be significantly different from the general population. The prevalence of hypertension in the general population was 30 times greater than for pilots. Though the overall prevalence in pilots was small, we still consider hypertension to be a significant illness in this group.


Guidelines for defining and disposing of medical waste. Considerations of ecology, public health hazards, and rising health costs have been critically reevaluated in the matter of appropriate medical waste disposal at nursing homes and hospitals. The Maryland Department of Health has intermittently received reports from the public of human tissues, bandages, and other inappropriate, unaesthetic materials visible in landfill areas. The Department has experienced increasing concern for communicable disease transmission, e.g. hepatitis, to landfill waste handlers and to the general public. Incineration had been considered as an alternative to landfilling of medical wastes, but fear of increasing hospital costs dampened initial enthusiasm for this possibility, particularly when coupled with fears of air pollution by smoke and noxious fumes generated by incineration. Other problems requiring resolution were conflicting definitions of medical waste and disposal requirements by federal, state, and local regulatory bodies. On-site incineration of all waste generated at hospitals is proposed as an economical and ecologically feasible solution to this public health problem in Maryland.


Nonlinear numerical prediction of human head/helmet crash impact response. A nonlinear, finite-element, model is used to examine the biodynamic impact response to helmeted and unhelmeted headforms having human response characteristics. The human response headform is modeled as a spherical brain of nearly incompressible material, a covering of linear elastic dura, a linear elastic spherical skull, and a layer of nonlinear scalp material. The helmet system is modeled as a partially spherical, highly nonlinear, helmet liner material and a linear elastic fiberglass helmet outer shell. In the case of unhelmeted head impact, the brain pressure response predictions made with the model achieve good qualitative correlation with experiments on impacted human cadaver heads. The model is then used to investigate the response attenuating characteristics of a range of nonresilient helmet liner materials. The results of the study establish the importance of matching surrogate structural compliance and mechanical impedance to that of the human system being simulated if proper assessment of safety system performance is to be achieved.


Evaluation of biomechanical response and potential injury from thoracic impact. An analytical model for the anteroposterior thoracic impact response of the human thorax is investigated to: 1) establish a comparison between the model and available cadaver data for blunt impacts, 2) demonstrate typical force, deflection, and acceleration impact response characteristics as well as additional parameters, such as stored and dissipated energies and associated powers, and 3) develop biomechanical response characteristics for frontal impacts of varying severity (i.e., mass: 2-26 kg and velocity: 2-24 m/s) within the range of model applicability. The analysis provides fundamental relationships between thoracic impact characteristics and biomechanical response and human injury potential.


Biodynamic finite element models used in brain injury research. Three-dimensional finite models for the monkey, baboon, and human brains have been developed and are described. Isoparametric brick elements and membrane elements represent the soft tissue and partitioning internal folds of dura, respectively. By specifying the finite element mesh on the skull inner surface, the irregular shape of the brain is generated. Each model is subjected  to the same skull acceleration to investigate response relationships between species. Important dynamic response differences are revealed by comparing the computed intracranial pressures. Experimentally derived head injury data are correlated with model dynamic responses. Using the baboon and monkey models, brain injury tests are simulated and model response measures are compared to produced injury. Using the human model, computed stresses are compared to intracranial pressures measured in cadaver impact tests.


Finite element dynamic structural model of the human thorax for chest impact response and injury studies. The component model modal synthesis technique has been successfully adapted to the finite element structural dynamic model of the human thorax for chest impact response and injury studies. The complete thorax was modeled as an assembly of a thorax module with viscera subsystems. The module was further subdivided into rib components. Major model development was conducted at the component level to provide cost saving and modeling flexibility. The results show that the thorax can be successfully treated as a linear system. A two-step procedure was developed to obtain viscera response. The analysis results of THORAX III, a first cut thorax model, were favorably compared with Kroell-Nahum cadaver experiments. The sensitivity of the chest response due to variation in input pulse shape and peak force were analyzed. The pulse shape can affect the force-deflection relationships while peak force affects the peak response. Further sensitivity studies and experiments are proposed.


Identification and classification of vertebral fractures following emergency capsule egress from military aircraft. This paper deals with systematically classifying the type, level, and severity of traumatic lesions to the spinal column associated with the crew module escape system. Its objectives are to describe characteristic spinal injury encountered in the crew escape module and to shed additional light on the pathomechanics and dynamics of spinal column damage. An analysis of this type is necessary for complete understanding of the clinical, roentgenographic, and pathological findings. Knowledge of the orthopaedic biomechanics of injury is required before the factors responsible for spinal injury are identified and meaningful corrective actions are taken.


Theory and application of a three-dimensional model of the human spine. A three-dimensional, discrete model of the human spine, torso, and head was developed for the purpose of evaluating mechanical response in pilot ejection. However, it was developed in sufficient generality to be applicable to other body response problems, such as occupant response in aircraft crash and arbitrary loads on the head-spine system. The anatomy is modelled by a collection of rigid bodies, which represent skeletal segments such as the vertebrae, pelvis, head, and ribs, interconnected by deformable elements, which represent ligaments, cargilagenous joints, viscera and connective tissues. Results are presented for several conditions: different rates of onset, ejection at angles, preejection alignment, and eccentric head loadings. It is shown that slow rates of onset and angling the seat reduce both the peak axial loads and bending moments. In the presence of eccentric head masses, such as helmet-mounted devices, the reflected flexural wave is shown to be the key injury mechanism.


Distribution of spinal disc pressures in the seated posture subjected to impact. A musculoskeletal model for the human spine developed by the authors is used for this study. The model takes into account the equilibrium of the vertebral bodies, the intervertebral discs and segments of the upper extremities under the influence of all major muscle and joint forces. Linear programming techniques are used to obtain the muscle load sharing and the disc pressures, based on a preselected linear criterion. The criterion is formulated as a combination of all muscles forces (F), joint forces and ligament action (R,M) with suitable weighting factors, and a minimization is sought of U = F + k1R + k2M. The model is used to study the effect of sudden forward or backward acceleration forces, such as during the impact situation, on the distribution of disc pressures in the spinal column in the unsupported seated posture.


Analytical model of the fatigue characteristics of bone. The existing data for the bending fatigue strength of bone are analyzed to determine the effects of various test procedures for human and bovine bone. Additional experiments, using bovine bone, are presented to evaluate the effects of stress frequency and stress reversal on fatigue life. An analytical model which relates fatigue life to ultimate strength, stress amplitude, stress frequency, and stress reversal is developed.


Systems identification scheme for the estimation of the linear viscoelastic properties of the intervertebral disc. In recent years, traumas due to pilot ejection, automobile accidents, etc., have generated much interest in the biomechanical modelling of the responses of the human spine to high rates of loading. The predicted responses of these models, however, are dependent on the assumed mechanical properties of the discs and vertebrae. The knowledge of these mechanical properties constitute an important aspect of any mathematical model of the spine, i.e., in both quasistatic and dynamic simulations.


Biodynamic model of a parachutist.

Biodynamic model of a parachutist. A three-dimensional, gross-motion, finite-segment model of a parachutist is presented. The model is a modification of the UCIN Crash Victim Simulation Code. It is designed for study and analysis of the effects of opening shock and wind loading on the dynamics of a parachutist. The model consists of 11 rigid bodies linked together to simulate the human figure of a parachutist. Springs and dampers are used to model the joint forces and moments. The parachute forces are modelled by riser forces applied to the torso of the model. The wind loading is modelled as a profile drag force on each body of the model. The governing dynamical equations of motion for the system are coded into a computer program and they are then integrated numerically. Comparison with experimental data on parachutist head acceleration shows good agreement between model and experiment.


Aerodynamic forces exerted on an articulated human body subjected to windblast. A potential flow solution is presented for estimating the pressure distribution around the forearm of a human body subjected to windblast. The forearm is examined in three positions: resting and pressing against an armrest; resting, but not pressing against and armrest; and not resting at all against any surface. Results show that a high-speed wind stream approaching the limb at some finite angle of attack has a tendency to dislodge the forearm from a surface with which it is in contact. This is due to the generation of stagnation points in the flow which lead to adverse pressure gradients as high as six times the free-stream dynamic pressure. When the inviscid analysis is corrected for the effects of flow separation, it is possible to predict the presence of a pressure drag which acts to throw the forearm outward, away from the thorax. Both of these effects increase with angle of attack and they are mildly dependent on the taper of the forearm geometry.


Validation of the CALSPAN gross-motion-simulation code with actually occurring injury patterns in aircraft accidents. Digital simulation of aircraft-accident kinematics has heretofore been used almost exclusively as a design tool to explore structural load limits, precalculate decelerative forces at various cabin stations, and describe the effect of protective devices in the crash environment. In an effort to determine the value of digital computer simulation of fatal aircraft accidents, a fatality involving an ejection-system failure (out-of-envelope ejection) was modeled, and the injuries actually incurred were compared to those predicted; good agreement was found. The simulation of fatal aircraft accidents is advantageous because of a well-defined endpoint (death), lack of therapeutic intervention, and a static anatomic situation that can be minutely investigated. Such simulation techniques are a useful tool in the study of experimental trauma.


Mathematical modeling of the head and neck response to -Gx impact accelration (minimum articulation requirements). Data on the dynamic response of the living human head and neck to -Gx impact acceleration was analyzed. The Calspan 3-D Computer Simulator of a Motor Vehicle Crash Victim was used to provide estimates of the head and neck response to be expected for the very specific deceleration profiles simulated. Two segments connected via a pivot were used to represent the head-neck system. The monitored T1 deceleration profile was used to drive this system and the simulation head-neck response was checked for accuracy in replicating motional characteristics and trends in the response mechanism. Two head pivot locations were considered. The first was the occipital condylar point and the second was a theorized hingepoint in the head which minimized the distance from this point to the T1 anatomical coordinate system over the range of body orientations observed in the photographic data. For the two geometrical representations, a successive approximation technique was employed to analyze the resulting data. This approach initially removed all constraints to head and neck motion, and the resulting simulation results were compared to the human data. Restrictions to head and neck motion were then successively added until an adequate replication of the human data was obtained. This approach made it possible to correlate specific events, such as loading of the head-to-neck dorsiflexion limiting angle, to head deceleration profile characteristics. Results were compared to calculations obtained for eight additional subjects and proved to be in good agreement.


Comprehensive, three-dimensional head-neck model for impact and high-acceleration studies. A three-dimensional, 54-degree-of-freedom computer model of the head/neck system is presented and discussed. The model consists of nine rigid bodies representing the head and vertebrae together with a series of nonlinear springs and dampers modelling the soft tissue. The soft tissue modelling involves the discs, muscles, and ligaments. The discs are modelled as two-parameter viscoelastic solids; the muscles are also modelled as two-parameter viscoelastic solids, but only able to exert force in tension; and the ligaments are modelled as nonlinear elastic bands exerting force only in tension. Equations of motion are written for this model by using Lagrange's form of d'Alembert's principle, a virtual work type principle. Computer algorithms are written to efficiently compute the numerical coefficients of these equations. The equations are integrated numerically for a number of specific cases where experimental data are available. Results show excellent agreement between the model and the experiments.


Prediction of head/neck dynamic response of selected military subjects to -Gx acceleration. Eighteen young male subjects with NAMRL sled test experience to 15 G in --Gx acceleration were measured for physical characteristics of the head and neck and general body anthropometry. Measurements taken include head/neck range of motion, neck muscle stretch reflex time, neck muscle isometric strength capabilities, and seated and standard anthropometry. Data from these tests were tabulated and five subjects whose physical characteristics were most similar were selected for use in simulations. Experimental data from NAMRL sled tests were obtained for the five subjects in 6- and 15-G test runs. Measurements data from the five subjects were used to establish a data set for the MVMA-2D Crash Victim Simulator and acceleration profiles for 6- and 15-G sled runs were used as input to the model. Simulation results for head angular acceleration, head angular velocity, head angular position, head resultant acceleration, and T1 resultant acceleration were compared with the averaged experimental curves for the five subjects. In general, excellent agreement between simulation and experimental results was obtained although some consistent differences were noted. Effects of varying levels of muscle activation were investigated. Variations in muscle tension level were found to have significant effects on simulation results at both 6 and 15, G, especially on head angular position. The effects were noticeably greater at lower acceleration's, however. The model was also used to investigate some of the biomechanical mechanisms behind observed response characteristics.


Predictive model of dynamic response of the human head/neck system to -Gx impact acceleration. This paper describes the mathematical framework, underlying an empirical model, that predicts human head response using only the motion present at vertebra T1. Based on this framework, a model for --Gx impact acceleration was developed from data obtained on six volunteer subjects participating in the NAMRL impact acceleration experiments. Model performance was evaluated by comparing the errors in the predicted head responses with the normal variations observed between the responses of different subjects under identical impact accelerations. Independent sets of data were used for building and testing the model. The results of the evaluation indicate that the model will be useful in subsequent studies of human response to impact acceleration.


Application of the response probability density function technique to biodynamic models. A method has been developed, which we call the "response probability density function technique," which has applications in predicting the probability of injury in a wide range of biodynamic situations. The method, which was developed in connection with sonic boom damage prediction, utilized the probability density function of the excitation force and the probability density function of the sensitivity of the material being acted upon. The method is especially simple to use when both these probability density functions are lognormal. Studies thus far have shown that the stresses from sonic booms, as well as the strengths of glass and mortars, are distributed lognormally. Some biodynamic processes also have lognormal distributions and are, therefore, amenable to modeling by this technique. In particular, this paper discusses the application of the response probability density function technique to the analysis of the thoracic response to air blast and the prediction of skull fracture from head impact.


Response of the skeletal system to helicopter-unique vibration. An 18-month prospective skeletal system study was conducted on flying and nonflying personnel relative to chronic low-frequency vibration as experienced in helicopter flight. The aviators were initial entry students in rotary-wing training while the non-flying participants were beginning basic military training. Comparisons were made on the basis of anthropometric measurements, radiological studies, and bone mineral density changes as measured by photon absorption. The bone mineral densitometry showed no significant variation in the aviator group. A short-term 10% demineralization of the distal ulna in the non-flying group was noted immediately following the physical training. The final bone mineral density of basic training subjects returned to the initial level 18 months after the physical training. It was concluded that the helicopter aircrew members under study were exposed to levels of vibration below the threshold of vibration required to produce a measurable change in the skeletal system.


Determination of optimum vibroisolation systems for a sitting human operator. Optimum vibroisolation systems were obtained for a sitting human operator subjected to stochastic vertical vibrations. Is was concluded that there exists a physically realizable optimum function phi(s), which describes the desired fibroisolation system (s = iomega). The theory for finding an optimum vibroisolation system was developed on the basis of a specific a priori criterion, and assuming, for input, random, ergodic vibrations given by power spectral densities of accelerations of the vibration base. Examples are given for human body models consisting of a mass, a linear or nonlinear spring, and a damper.


Method to quantify ride comfort and allowable accelerations. When the motion of a vehicle includes "shocks" or impulsive velocity changes, R.M.S. acceleration has no relation to crew comfort or injury. Existing (R.M.S. G) methods of ride assessment can show lethal accelerations as being perfectly safe, and vice versa. It follows that R.M.S. acceleration is not meaningful for nonsinusoidal "random" vibration either. This paper presents a method of evading the difficulty, using fairly well established biodynamic modeling techniques, and an extension of Allen's "shock tolerance" concept. Among other advantages, the method "automates" the assessment of ride quality so that personal judgments are not involved and the relative ride quality of different vehicles can be placed on a quantitative basis. Since this work was inspired by the problem of Navy crew tolerance to the motions of high-speed ships, the discussion is in those terms. Also, the proposed criteria should probably be scaled down for more general populations.


Model of the supine human body and its reactions to external forces. Mechanical impedance and vibration transmissibility measurements were conducted on supine humans using sinusoidal vibrations. The frequencies tested were 1-20 Hz with a constant acceleration amplitude of 0.3 G. The tests were repeated with 4.54 kg pure mass placed on each segment. Both results were used to calculate a multi-degree-of-freedom lumped parameter model. The nonlinear reactions of the body are revealed by comparing the model parameters under "no load" and "load" conditions. When the results are compared with impedance measurements conducted under sustained acceleration, it becomes obvious that the thorax, due to its anatomical design, reacts differently from the remaining body parts.


Mathematical model of the cardiovascular system under acceleration stress. The pooling of blood in the lower part of the human body when it is subjected to longitudinal +Gz acceleration is one of the major reasons for cardiac insufficiency and the consequent impairment of certain important physiological functions. Headache, abdominal pain, change in heart rate, chest pain, impairment of vision, and hemorrhage are some of the manifestations of acceleration trauma. To predict the effects of time-dependent accelerations on the circulation, a mathematical model independent of assumptions extrapolated from normal G conditions must be considered. The model in the present study consists of a closed-loop hydrodynamic system comprising a heart pump, elastic tubes to represent the large arteries and veins, and a baroreceptor feedback mechanism to help to overcome cardiac insufficiency. The governing equations consist of the Navier-Stokes equations for fluid motion in the blood vessels, and equations of motion for time-dependent blood vessel deformation and ventricular contraction derived from nonlinear elasticity theory. In a numerical example, an experimentally measured deceleration profile is used and the calculated aortic flow is compared with the experimental values.


Nonlinear behavior of sitting humans under increasing gravity. To determine the nonlinear properties of the upright sitting human body, driving-point impedance as well as the transmissibility from seat to head were determined under increased gravity on a centrifuge. Under this condition a shift of resonances to higher frequencies was observed. At the same time the transmissibility increased distinctly. To explain this behaviour with a model, a nonlinear multi-degree-of freedom model of the upright sitting body was calculated. It elements represent identifiable body parts. Protective measures for normal gravity conditions, as well as for sustained acceleration, were derived.


Personalized, electro-kinematic, neuromuscular model of a human forearm. Electromyography, the recording of muscular activity, is of importance in industrial, biomechanical, and sports research as well as in medical diagnoses. When a muscle is activated, an electric potential in the order of microvolts (muV) is generated. This potential can be picked up, amplified, and displayed on an oscilloscope or strip chart recorder. Researchers have developed ways of analyzing these signals in terms of their characteristics. A numerical index, which reflects the basic characteristics of the electromyogram, mainly amplitude, frequency, and duration, can be used to provide quantitative information. The method used in this work for EMG processing consisted of filtering, rectification, and integration over very small intervals of time. Both analog and digital filtering proved necessary. Angular accelerometer and rotational potentiometer data were used in conjunction with limb inertia parameters obtained from existing biochemical models for the individual tested for obtaining the torques as a function of time. A system parameter identification method was used to determine the muscle parameters, such as occur in the single muscle Hill model, of four muscle groups for a human arm. The main results consist of personalized arm muscle group models. It was concluded that the method provided excellent (fit) personalized arm muscle group models under dynamic conditions. This method could lead to fundamental scientific information about a living muscle group from experiments in vivo.


Biomechanical models for vibration feedthrough to hands and head for a semisupine pilot. A series of tracking experiments under vibration has been carried out on the AMRL/BBV shaker facilities covering three axes of vibration with sinusoidal and random waveforms and different control stick configurations. Based on this and other data, a lumped-parameter biomechanical model has been evolved to suit the needs of aircraft control system designers for the new generation of low-altitude, high-speed bombers and highly maneuverable fighters. This paper shows that measured vibration  feedthrough to hands and head can be adequately described by this model when linearized about the appropriate configuration of display, posture, and control. The model includes effects of: semisupine torso; sliding hip, plus rocking chest supported on a compliant buttocks/seat; head bobbing on an articulated neck; upper arm and forearm links plus grip-interface compliance, driven by an active neuromuscular system; elbow rest (optional); and stick "feel system" dynamics. Examples are given of the model's application to predict effects of: a 65 degrees semisupine seat, apparent impedance increase of a control stick under pilot control, and a sliding arm rest.


Conceptual stress study model.

Conceptual stress study model. The conceptual stress study model (SSM) is basically a schematic representation of the key elements associated with the study of mechanical forces on the human operator. It has been a useful tool for systematically describing the scope and effects of vibration stress study efforts. The model structure is organized in a hierarchy of four levels established to reflect four different levels of description of human response complexity. In order of increasing complexity, these four classes of responses are biodynamic, physiological, psychophysical, and performance. The model also depicts the internal energy and/or information pathways that are likely to occur in the formation of a response to specified vibration inputs. The present utility of this model is to provide a conceptual scheme to help guide vibration study efforts. It is not a general mathematically predictive model. It could prove useful in pulling together the many-segmented modeling results achieved over the last several years to form a centralized interpretive data base.


Model for human controller performance in vibration environments. A model has been developed to predict biomechanical response and human controller performance as a function of vibration environment and tracking-task parameters. The model consists of three major elements: 1) a biodynamic model to predict limb and body motion resulting from platform vibration, 2) a pilot/vehicle model to predict tracking performance, and 3) an interface model to relate changes in certain pilot-related model parameters to biodynamic response. Linearity of biodynamic response mechanisms is demonstrated, and the model is shown to predict accurately the effects of tracking performance of vibration amplitude and spectrum, control gain, R.M.S. tracking input, and direction of vibration input.


Recent advances in modelling the effects of roll motion on the human operator. An experiment is presented in which the effects of roll motions on human operator performance were investigated. The motion cues considered were the result of commanded vehicle motion and vehicle disturbances. An optimal control pilot-vehicle model was used in the design of the experiment and to predict system performance prior to executing the experiment. The model predictions and experimental results are compared. Of the model predictions, 78% are within 1 S.D. of the means of the experimental results. The high correlation between model predictions and system performance indicate the usefulness of the predictive model for experimental design and for prediction of pilot performance influenced by motion cues.


Modelling human responses to vibration.

Modelling human responses to vibration. Biodynamic measurements of human response to vibration may be nonlinear as a result of active control of the response, complex body movements, or tissue characteristics. Experiments using a random Gz stimulus were designed to explore the extent of these nonlinearities under normal conditions. The input transfer function was found to exhibit near-linearity, but transmission measures suffered from errors arising from complex body movements. The technique developed was found to be valuable for investigation of the variables affecting human response, and examples are given of the effects of body restraint and the relationship between intraabdominal pressure and input acceleration. It is argued that improved techniques and careful consideration of variables lead to a greater acceptance of the biodynamic approach.


[Artificial prozones].

[Artificial prozones]. When immune serums are inactivated, heat-labile antibodies are changed into specific inhibitors which, in sufficiently high concentrations, cause prozones. These prozones are called artificial prozones, thus distinguishing them from prozones with different (spontaneous) origins. Their importance in diagnosis is discussed, with special reference to the complement fixation reaction.


[The spermatogenetic capacity of male beagles]. Daily, weekly and twice a week sperms were collected from 4 eighteen month aged Beagles for spermatologic and spermatogenetic examinations. The spermatologic results of 260 ejaculates showed in all parameters great differences. Sperm collection which were done twice a week showed a higher total amount of sperms than the daily and weekly collected ejaculates. Daily sperm collections taken over more than three weeks did not lead to a decreasing libido sexualis and were qualified for the evaluation of the daily sperm production ability of dogs.


[The pig in the ante and post-partal period. 1. Studies on serum electrolyte concentrations (Ca, inorganic phosphorus, Mg) and on the serum and milk content of Fe and Cu]. A group of 23 sows, with their first or second litter, were tested for the development of the calcium, anorganic phosphate, magnesium, iron and copper levels in the blood serum in the peripartal period up to the end of the 3rd week of lactation. It could be shown that in some of the sows (25%) in the first three days after giving birth a condition which could be called latent hypocalcaemia occurred, while the other animals retained almost the previous amount of calcium concentration. Statistics showed that (p less than or equal to 0.05--0.01) all the animals had a decrease in anorganic phosphate content post partum (p.p.). No marked changes in the Mg concentrations were found during the research period. However, there was a considerable decrease in the Fe concentrations in the blood serum within the first 24 hours after birth (p less than or equal to 0.05). The iron value after the end of the 3rd week of lactation was lower than the value before the birth -- 132.8 +/- 42.7 microgram/100 ml as against 144.7 +/- 51.1 microgram/100 ml: -- 8.2% under. On the other hand there was an increase in the serum Cu content (p less than or equal to 0.05--0.01). The Fe as well as the Cu concentration decreased in the milk within the first 8 days by more than a half.


[Clinical study on experimental Theileria annulata infections of cattle. 1. Clinical-chemical studies]. The extent of liver and kidney damage in 10 young steers, infected with a stabilate of Theileria annulata, was estimated by the determination of enzymes (GOT, GPT, SDH, ALD), serum levels of bilirubin and urea. At the same time the effectiveness of some liver protecting medical agents was tested. The following results were obtained: Change in the activity of the enzymes GOT, SDH and ALD and the increase of bilirubin during the advanced course of the disease are indicative of severe tissue damage in the liver. The levels of urea were found to be in the normal range with only a few exceptions. This seems to exclude the involvement of the kidney in the disease. The group of animals receiving liver protecting medication did not show any difference compared with those animals without medication.


[The occurrence of antibodies to Brucella canis in domestic dogs in the Federal Republic of Germany]. 1000 random serum samples of pet dogs were examined in the serum tube agglutination test for antibodies to Brucella canis. Agglutinating antibodies to Br. canis antigen were detected in 18 cases in a serum dilution of 1 : 50, in 29 cases in a serum dilution of 1 : 100, in 13 cases in a serum dilution of 1 : 200 and in a serum dilution 1 : 400. But the positive results of the agglutination tests were confirmed by complement fixation, agargel-precipitation and indirect immunofluorescence only in 2 cases (0,2%) with titers of 1 :200 and 1 :400. These serological findings indicate that in the Federal Republic of Germany Br. canis infections are rarely in pet dogs as compared with dogs (Beagles) held in research kennels.


[Cryoprotective ability of glycerin and DMSO in the deep freezing of dog sperm]. The sperm-bearing fractions of 163 ejaculates collected from 6 Beagles aged two years were used to test the cryoprotective effect of DMSO and glycerol in deep freezing investigations. It could be shown that the cryoprotective capacity of glycerol was better than the one of DMSO. Glycerol should rather be added to the sperms at + 5 degrees C than at + 25 degrees C. The best preservation results were achieved by a combined addition of DMSO and glycerol under the following conditions: time of cooling down to +5 degrees C of the extended sperm fractions 50 minutes, final concentration of DMSO 1% (max.), final concentration of glycerol 8% (max.), glycerol equilibration time 30 minutes.


[The suitability of the enzyme-linked immunosorbent assay (ELISA) for the demonstration of babesia antibodies in hyperimmune serums with the use of ectoantigens]. From sera of highly parasitised mice and dogs with Babesia rodhaini, B. galagolata and B. canis ectoantigens were isolated by column-chromatography and tested in the ELISA for their serological properties. Hyperimmunsera against the three Babesia species were prepared in rabbits, mice and dogs. Serologic cross-reactions occurred between the investigated Babesia species although distinct titer differences could be observed between B. canis on one hand and B. rodhaini and B. galagolata on the other hand. The ELISA appears to be suitable for serological field surveys of babesiosis.


General theory of critical periods and development of obesity. The general systems theory (GST), the general theory of organization (GTO), and the general theory of critical periods (GTCP) have been applied to some nutritional problems. This theoretical approach seems to be in good agreement with most of the data of the literature and with the personal experience, pointing at the possibility to use a simple general model to interpret the complex problem of obesity.


Experimental basis of obesity.

Experimental basis of obesity. The methods utilized in our laboratory for a biochemical approach of obesity include dietary manipulations, fatty acid analysis of tissue lipids, in vivo lipogenesis from [3H H2O and [1-14C] acetate, in vitro utilization of [3H] H2O, [U-14C] glucose, [U-14C] fructose, [U-14C] alanine and [1-14C] acetate by adipose tissue fragments, hormone sensitivity (to insulin and catecholamines), and the activity of enzymes such as fatty acid synthetase and adenylate cyclase in adipose tissue extracts. With these methods at hand, it is possible to estimate the major biochemical factors responsible for fat accumulation in adipose tissue. As an example, the case of obese (ob/ob) homozygotic animals of the C57BL/6J strain of Bar Harbor, which suffer from an autosomal recessive obese-hyperglycemic (O-H) syndrome, is compared to that of control nonobese (ob+/ob+) mice from the same strain. The hereditary O-H syndrome in ob/ob mice is characterized by obesity, resistance to the action of insulin, and hyperinsulinism. The development of obesity depends on high lipogenesis in fat depots. Contribute also to obesity a large influx of fatty acids of hepatic and dietary origin, and reduced lipolysis. In these mice, a high fat diet is more propitious to fat accretion than a high-carbohydrate diet.


Some recent findings in obesity.

Some recent findings in obesity. The tendency of some obese subjects to an energy-sparing reaction can be induced temporarily by attempts of the patient to reduce his overweight by prolonged starvation. This regulatory reaction may be induced by regulatory especially thyroid mechanisms. In obesity of both sexes a tendency to anaerobic energy utilization in the muscle can be revealed and so a tendency to decrease energy utilization in general. The differences in insulinemia (IRI) displayed a prevalence of maternal obesity in the group with higher levels of basal and stimulated IRI values, which decline after changes in diet and body weight. This behavior of IRI levels and amount and composition of diet indicate a possible permissive role of previous food consumption habits.


Radiographic abnormalities of rheumatoid arthritis in patients with diffuse idiopathic skeletal hyperostosis. Radiographic abnormalities of rheumatoid arthritis (RA) in 8 patients with diffuse idiopathic skeletal hyperostosis (DISH) included atypical features: lack of osteoporosis, bone sclerosis and proliferation about erosions, osteophytosis, and bony ankylosis. Atypical clinical features included a high incidence of flexion contractures of elbows, wrists, ankles, or knees. It is not surprising that bone production occurs about involved articulations in patients with RA-DISH, as the latter disorder is characterized by bony proliferation at sites of ligament and tendon attachment to bone in the axial and extraaxial skeleton, perhaps related to stress.


Kinetic studies of phagocytosis. I. The serum independent particle uptake by PMN from patients with rheumatoid arthritis and systemic lupus erythematosus. The initial phagocytic rate of IgG coated polyvinyl toluene latex particles was assayed for isolated PMN cells. The kinetic studies of phagocytosis were performed in serum-free medium using an electronic particle counter. The mean phagocytic rate for the reference group of apparently healthy individuals was 0.60 min-1. PMN cells from 5 of 26 patients with rheumatoid arthritis (RA) had subnormal values of particle ingestion rate, although the mean of the group was not significantly reduced compared to the controls. Correlation coefficient between the log of rheumatoid factor titer and phagocytic rate was 0.58 (P less than 0.001). During penicillamine treatment an increased rate of phagocytosis was observed in patients with RA. Granulocytes isolated from 17 patients with systemic lupus erythematosus (SLE) had a significantly increased (P less than 0.001) mean initial rate of phagocytosis (0.91 min-u). Two patients in this group had an acute exacerbation of disease activity and were treated with large doses of prednisone. An appreciable decline in phagocytic rate was observed during the intensive corticosteroid therapy.


Micromeasurement of plasma salicylate in arthritic children. A micromethod has been developed for determination of plasma salicylate. Frequent determinations of plasma salicylate levels in children with juvenile rheumatoid arthritis may be expected to provide greater therapeutic efficacy with reduced incidence of aspirin toxicity and consequently less need for use of secondary, more toxic, agents.


Proliferative synovitis in hemophilia: biochemical and morphologic observations. The synovium removed from the knee of a 10-year-old with hemophilia A was characterized morphologically and biochemically. The specimen showed villous hypertrophy with hyperplasia of synovial lining cells which contained abundant intracytoplasmic granules of hemosiderin. Monolayer cultures prepared from enzymatically dispersed tissue were characterized by pigment-laden fibroblast-like cells and round cells. Both explants of synovium and adherent cells secreted a large amount of latent collagenase and neutral proteinase into the culture medium. The secretion of these enzymes dropped sharply and intracellular pigment decreased with passage of these cultures. Lysozyme was secreted by the explants but was not detected in the monolayer culture medium. These data establish the degradative potential of the synovitis found in hemophilia and support the concept that recurrent hemarthrosis without inflammation is sufficient in and of itself to produce proliferative synovitis.


Hemarthrosis as the presenting manifestation of true myeloma joint disease. This is the first reported of a patient with hemarthrosis due to invasion of the synovial membrane by myeloma cells. With angiographic studies of the affected joint it was apparent that the tumor tissue extended from the destructive bone lesion of the femoral condyle into the synovial membrane. Intraarticular spontaneous bleeding was the first manifestation of a monoclonal IgG multiple myeloma; the hemarthrosis recurred after drainage but was controlled with local roentgen therapy.


Shoulder swelling in rheumatoid arthritis secondary to subacromial bursitis. A patient with rheumatoid arthritis was seen whose main complaint was marked swelling of the shoulders. Surgical exploration revealed the swelling to be secondary to subacromial bursitis; the glenohumeral joint appeared normal.


Direct evidence for circulating DNA/anti-DNA complexes in systemic lupus erythematosus. Fifteen serum cryoprecipitates from 28 patients with systemic lupus erythematosus (SLE) contained DNA demonstrable by counterimmunoelectrophoresis after exhaustive digestion of cryoimmunoglobulin with pronase. The majority of these cryoprecipitates also exhibited increased DNA binding activity in a modified Farr assay. Both DNA and anti-DNA antibody were enriched in the cryoprecipitates relative to the supernatant serum level. These data provide direct evidence for the presence of DNA/anti-DNA complexes in the circulation of patients with SLE.


Comparative studies of antilymphocyte, antipolynucleotide, and antiviral antibodies among families of patients with systemic lupus erythematosus. Antilymphocyte, antipolynucleotide, and antiviral antibodies in 15 Soviet systemic lupus erythematosus (SLE) probands and their 41 relatives were compared with those in 57 members of 15 control Russian families. Seventy-eight and three-tenths percent of SLE relatives were positive for antilymphocyte antibody versus 26.3% positive reactions in controls. Antipolynucleotide antibody closely paralleled antilymphocyte antibody in both groups. Antiviral antibody was significantly increased in SLE relatives as compared to control family members. No correlation was noted between quantitative IgG, IgA, or IgM levels and various antibodies studied.


Oral mucosal ulceration in systemic lupus erythematosus. In 182 patients with systemic lupus erythematosus (SLE), oral mucosal ulceration occurred in 47 patients (26%), was usually painless (82%), and most often involved the hard palate (89%). Oral ulceration was associated with an increase in overall clinical activity, although this was not accompanied by significant changes in the levels or titers of C3, anti-DNA antibodies, and anti-nuclear antibodies. Necrotizing vasculitis was not observed. Microscopic changes were similar to the skin lesions of SLE and immunoglobulin and complement were found in both the basement membrane and blood vessel walls.


Some effects of mianserin on monoamine metabolism in the rat brain. 1 Mianserin does not affect the uptake of biogenic amines into rat brain, in contrast to tricyclic antidepressants which block amine uptake. 2 Mianserin increases the turnover of noradrenaline (NA) in rat brain after acute or chronic administration, whereas tricyclic antidepressants reduce turnover of NA and 5-hydroxytryptamine. 3 It should not be assumed that a compound must inhibit amine re-uptake mechanisms before it can be considered as a potential antidepressant.


Muscle disease in progressive systemic sclerosis: diagnostic and therapeutic considerations. Upon careful examination, 23 of 24 patients with progressive systemic sclerosis (PSS) were found to have abnormalities of muscle. Nineteen patients presented a homogenous pattern of muscle abnormalities, which untreated was associated with a stable course ("simple myopathy"). Three patients demonstrated inflammatory muscle disease indistinguishable from polymyositis while a fourth patient developed marked weakness associated with a generalized neuropathic process. Muscle enzymes, electromyogram, and muscle biopsy permitted distinction among the different muscle disorders, a distinction that could have prognostic and therapeutic importance.


Relative toxicity of amitriptyline, imipramine, maprotiline and mianserin after intravenous infusion in conscious rabbits. 1. Amitriptyline, imipramine, maprotiline and mianserin were administered intravenously to conscious rabbits. 2. Of the four compounds, mianserin was the least toxic, as assessed by the occurrence of convulsions, cardiotoxicity and eventual death. 3. The applicability of the results from this test system to man is debatable, but the indications are that the relative toxicity of mianserin may be low.


Migrainous phenomena in systemic lupus erythematosus. Eleven patients with systemic lupus erythematosus (SLE) also had headaches and/or visual hallucinations typical of those found in migraine. These migrainous symptoms were commonly associated with exacerbations of SLE and abated as disease activity subsided. In some cases corticosteroids were more effective than conventional antimigraine therapy in controlling headaches and scotomas. The data suggest that migraine-like phenomena may arise as a result of vascular dysfunction in SLE.


Fat droplets and synovial fluid leukocytosis in traumatic arthritis. The presence of fat droplets in synovial fluid signifies major or minor joint trauma with damage to the bones or adjacent supporting structures. Synovial fluids aspirated after traumatic hemorrhage usually have a low white blood cell count. In this report 2 patients with hemorrhagic effusions had synovial fluid leukocytosis, presumably secondary to lipid droplet phagocytosis. Lipid globules intra- and extracellulalary in the synovial fluid and a top fatty layer in the hematocrit spin of the hemorrhagic synovial fluid are indications of the traumatic etiology of this inflammatory arthritis.


Association between HLA-BW38 and peripheral psoriatic arthritis. The frequency distribution of HLA antigens was studied in a group of psoriatic patients with and without arthritis. HLA-BW38 was found significantly increased in the group with peripheral psoriatic arthritis. There were no differences in the clinical features of the arthritis in the BW38 positive (+) and BW38 negative (-) individuals. It is suggested that BW38 is a genetic marker and/or an indicator of peripheral joint involvement in psoriatic patients.


Mianserin: a decade of scientific development. 1 Mianserin is a tetracyclic piperazino-azepine compound synthesized in 1966 for its peripheral anti 5-hydroxytryptamine properties. Animal screening showed that mianserin was centrally active, but the profile did not indicate possible antidepressant activity. Following clinical observations of sedative and possible mood-lifting effects, a quantitative electroencephalogram (EEG) study showed that the EEG effects of mianserin are similar to those of amitriptyline. 2 Subsequent clinical and pharmacological studies have indicated that mianserin is an effective antidepressant which differs from the tricyclic antidepressants not only chemically but also in its pharmacological and clinical profile. Mianserin seems to lack anticholinergic and cardiotoxic properties, and has unusual effects on monoamine metabolism. 3 On the basis of the initial profile a series of clinical and pharmacological studies has been carried out, and the results of many of these studies are presented in these Proceedings.


Susceptibility of rheumatoid and nonrheumatoid synovial cells to antibody-dependent cell-mediated cytotoxicity. Fibroblastic cells derived from rheumatoid (RA) and nonrheumatoid (N-RA) synovial tissue (synovial cells) were used as targets in assays of antibody-dependent cell-mediated cytotoxicity (ADCC). Synovial cells that had been pretreated with human alloantisera were rapidly lysed by normal human blood mononuclear cells. RA and N-RA synovial cells were equally susceptible to ADCC under these assay conditions. Antibody to autologous synovial cells was not detected in sera from 10 patients with RA by this method of assay.


Pulmonary infection and rheumatoid arthritis. Five of eleven patients with bronchiectasis and/or cystic fibrosis developed a polyarthritis with positive tests for rheumatoid factor. Possible mechanisms of this complication are discussed.


Rifampicin-dependent antibodies in a patient with hepatorenal failure. We report a case of hepatorenal failure complicating rifampicin administration in which rifampicin-dependent antibodies were demonstrated. Hepatorenal failure during rifampicin treatment has been reported before but in none of the previous cases were rifampicin-dependent antibodies described.


Intrathoracic lymphoma associated with atrial arrhythmias and artrioventricular conduction defects. The case of a patient with lymphoma associated with atrial arrhythmias and atrioventricular conduction defects resulting in heart failure is presented. Management included temporary cardiac pacing. Cytotoxic treatment was associated with resolution of the conduction abnormalities. Aetiology and management are discussed.