The effects of position and skin temperature on the capillary pressures in the fingers and toes. 1. Direct measurements of the capillary pressure (P(c)) were made in capillaries at the base of the nails of the fingers and toes of two subjects (the authors of this paper).2. With the hand or foot at heart level, P(c) varied over the range of 7-70 cm H(2)O with mean values of 43 cm H(2)O in both the fingers and the toes. P(c) was higher in the arterial limb (mean 49 cm H(2)O) than in the venous limb (mean 34 cm H(2)O) of the capillary loops. The plasma colloid osmotic pressures for the two subjects were 33 and 34 cm H(2)O.3. For capillaries at heart level there was a strong positive correlation between P(c) and skin temperature when the latter was varied over the range 23-36 degrees C.4. When the hand or foot was lowered, P(c) increased less than the local arterial (P(a)) and venous pressures (P(v)). Furthermore the variation in P(c) was reduced. In fourteen measurements of P(c) made on capillaries in the toes of standing subjects, P(c) was no more than 10 cm H(2)O greater than P(v). It is argued that the increase in the ratio (P(a) - P(c))/(P(c) - P(v)) with hydrostatic load represents an increase in the ratio of pre- to post-capillary resistance.5. When P(v) was increased by inflating a sphygmomanometer cuff around the upper arm, (P(a) - P(c))/(P(c) - P(v)) increased in the hand held at heart level. These changes were similar to those seen with changes in position.6. The implications of the results are discussed with respect to fluid balance between the blood and tissues. It is argued that since P(c) in the warm hand was never less than the plasma colloid osmotic pressure, fluid is not reabsorbed from the tissues into the capillaries of the warm skin of the hand even at heart level. Compensatory changes in the circulation appear to minimise the filtration of fluid into the feet of the standing subject but the mechanism of these changes remains obscure.


An ethnic comparison of self-esteem in Portuguese-, Mexican-, and Anglo-American pupils. Three groups of Portuguese-, Mexican-, and Anglo-American boys and girls (N - 158) from 5th through 8th grade were compared in self-esteem. The results of the chi square test indicated that there were no significant differences between Mexican and Anglo Ss. However, significant differences were observed when the Portuguese Ss were compared to the other two groups. Here it was discovered that Portuguese boys--but not girls--had significantly higher self-esteem than all other Ss.


Driving offenders and the defensive driving course--an archival study. Two hundred and seventy-five drivers who had been required by court order to attend a Defensive Driving Course (DDC) were compared on six posttreatment driving measures obtained from archival data with 275 drivers who also had had a court appearance and standard treatment. The DDC group showed greater reductions in serious and accident-promoting convictions but no greater reduction in accidents when compared with the standard treatment comparison group.


Sequential response shift rate: a correlate of human adaptivity measureable with existing personality inventories. The rate at which Ss changed responses to successive personality inventory items was investigated. It was hypothesized that frequent shifts usually reflect the capacity and motivation to respond differentially to different situations; or that, conversely, too few shifts show a perseverative tendency paralleling inadaptivity in real-life behavior. Eight separate groups (students in nursing, education, social work, and human services paraprofessionals) totaling 286 normal Ss were tested, and their shift rates were compared with supervisory ratings of practical performance. Lanyon's Psychological Screening Inventory, Gough's California Psychological Inventory, or the Minnesota T-S-E were used to elicit shift rate or its approximate antithesis, linear perseveration. Results tended to confirm a moderate, sometimes curvilinear, relationship between shift rate and important practical performance criteria. Sequential shift rate and perseveration are crude but meaningful behavioral measures relatively independent of conventional self-descriptive scores, demonstrating that some inventories detect a previously unrecognized response variable related to general adaptivity.


Cognitive deficiencies in emotionally disturbed children. This research investigated development of cognitive abilities in a normal vs. emotionally disturbed school age population (N = 240) ages 6-12. The Ss had to display skills on the Southern Illinois University Test necessary to show understanding of Piagetian concepts of class inclusion, class exclusion, and complement of set. A three way analysis of variance indicated significant main effects for age, sex, and emotionality factors. There were, however, no significant interactions among these factors. Emotionally disturbed children were not only deficient in the measured cognitive skills, but even the rate of development of these cognitive skills was inferior to that of the normal population.


Analysis of cognitive ability for rural white culturally different children. The study investigated WISC-R subtest pattern scores of 176 rural mountain culturally different white children (111 boys and 65 girls) ranging in age from six years three months to 16 years six months. The variation in subtest scores was analyzed by a 1 X 10 analysis of variance with repeated measures on a single factor. Differences between individual subtest means were analyzed by the Newman-Keuls test for simple effects. The evidence indicates that high subtest scores on Comprehension, Object Assembly, and Picture Completion and low scores on Coding, Information, and Similarities were characteristics of this group. The study did not support a Verbal-Performance discrepancy in favor of the Performance skills for these culturally different white children. The WISC-R was found to provide a valid measure of functional or operational intellectual capacity for this sample.


Degree of reported speech anxiety under two descriptive conditions. Previous research has suggested that Ss' responses to fear questionnaires may vary with the degree of descriptive detail provided. In a recent study, rather wide variation in the parameters of a situational test of speech anxiety produced little difference in behavioral-physiological measures. In the present study, 263 male and female undergraduates were asked to rate their degree of discomfort about public speaking under two levels of descriptive detail. Results indicated that self-report measures were not affected by the degree of detail, at least for public speaking anxiety. In addition, data tended to support the contention that large, live audiences may not be needed in analogue research on speech anxiety.


Relationship of state-trait anxiety and type of practice to reading comprehension. The effects of state-trait anxiety and distribution of practice on reading comprehension were studied in male and female undergraduates of average aptitude. In Experiment 1 no significant differences were found on an 8-item test between 18 high and 18 low A-trait students who studied a reading passage with a 5-sec or 2-min intertrial interval. Experiment 2 employed a total of 60 students, a state-trait measure of anxiety, a 36-item test, ego-involving instructions, and 5-sec or 2-min intertrial intervals. The following significant (p less than .05) results were found: (a) high A-trait students responded to the ego-involving instructions with greater elevations in  A-state; (b) low A-trait students demonstrated superior reading comprehension; (c) a low level of A-state immediately prior to the comprehension test produced a higher test score; (d) the A-state level of high A-trait students was reduced with the 2-min intertrial interval. Collectively, the results supported a trait-state conceptualization of anxiety.


Contrasting personality profiles of male and female medical students. The Millon-Illinois Self-Report Inventory Form P, the State-Trait Anxiety Inventory, and the Personal Orientation Inventory were administered to 155 male and 37 female students across the four years of medical school to assess the personality differences between male and female medical students. Differences in mean scores were found between males and females on eight scales from the tests. The results indicated that female medical students' style of interpersonal relating is characterized by less emotional indifference and uninvolvement, less competitiveness and self-centeredness, less constriction and authoritarianism, and more impulsivity and negativism than that of their male colleagues. Further, compared to male students, the females were more likely to endorse items reflecting anxiety, emotional difficulties, and a value orientation that stresses being sensitive to one's own needs and feelings. The results were compared to those of previous research with male and female medical students.


The treatment of smoking as a self-defeating behavior. This study (n = 18 men and women) sought to determine whether (a) the Eliminating Self-Defeating Behaviors Workshop would help smokers significantly decrease their smoking behavior, (b) this decrease would be maintained for four weeks, and (c) the Rotter I-E Scale could predict which smokers would show the most significant decrease and maintain this reduction. The results indicated that members of the experimental group made significant decreases in their smoking rates (p less than .001) and maintained this reduction for four weeks. The experimental group also made significant changes toward more internal locus of control at the conclusion of the workshop (p less than .10) but did not maintain this change at the four-week follow-up. The Rotter I-E Scale was unable to predict which individuals would show the most significant decrease in smoking rate and maintain this reduction.


Economic status, family anomie, and adolescent suicide potential. This study attempts to ascertain the existence and economic characteristics of the anomic family as a determinant of high suicide lethality among adolescents. An inverse relationship was hypothesized between economic status, family norm consensus, family power, and adolescent suicide risk. Fifty-five Ss of at least moderate suicide risk--and their families--were obtained from a total sample of 194 adolescents, 13 to 18 years old, who attempted suicide during a three month period. A summary of the descriptive demographic data is as follows: 32.7% of the sample were male and 67.3% female; their mean age was 16.3 years; race was categorized into 81.9% white and 18.1% nonwhite. Correlation coefficients were used to test the hypothesis. Statistically significant differences in the degree of family normlessness and powerlessness were found for suicidal and nonsuicidal adolescents and their families.


General adaptation syndrome and magnetostatic field: effects on sleep and delayed reinforcement of low rate. In order to study the effects of a magnetostatic field on the organism, continuous exposure was applied and the resulting effects were observed for a period of 20 days. The Ss were four rats which were continually exposed, one by one, to a vertical field of 2800 oersted for uninterrupted periods of time. In a first series of experiments, the variation of the sleeping period for each of the four SS was observed. An evolution quite characteristic of the different phases of the general adaptation syndrome was noted: reaction, counterreaction, and resistance. The same phenomenon was observed in the response under delayed reinforcement of low rate (DRL) at 5 and 10 seconds. In each case, a slowdown of the weight growth was noted. One can thus consider the magnetostatic field as an agent responsible for a nonspecific general effect similar to other stressing agents. These behavioral observations suggest a verification of these effects on the endocrine system and illustrate the necessity of long exposures for the study of specific and nonspecific effects of the exposure to the magnetostatic field.


A comparison of externality, anxiety, and life satisfaction in two aged populations. An attempt was made to find the relationship between locus of control, anxiety, and life satisfaction and to assess the impact of environmental factors upon these variables in two distinct elderly populations (20 nursing home residents and 20 active elderly). It was hypothesized that internality would be positively correlated with low anxiety and high life satisfaction and that the active elderly group would score higher on internality and life satisfaction and lower on anxiety than the nursing home group. Assessment instruments included a revision of Rotter's I-E Scale, questions from certain MMPI scales, and a life satisfaction questionnaire. Results showed significant correlations between the three measures of locus control, anxiety, and life satisfaction in the nursing home group but not in the active elderly group. As predicted, the active elderly were more internal (p less than .05), showed higher life satisfaction (p less than .01), and reported less anxiety (p less than .01) than the nursing home group.


Relationships between self-concept, self-esteem, popularity, and social judgments of junior high school students. This study examined the relationship between social self-concept and popularity for 93 male and female seventh, eighth, and ninth graders. It also assessed ability to make accurate social judgments and social self-esteem as a function of self-concept. The results revealed a moderate relationship (r = .29) between self-concept and popularity. No evidence was found to suggest that either self-esteem or ability to make accurate social judgments was related to accuracy of self-concept.


Comparison of cold conization and directed biopsy. A study was performed to compare the results of directed biopsy with those of cold conization of the cervix in the private practice community. The intent of the study was to determine whether the two procedures were comparable in accuracy, to compare them in terms of economic impact and to compare the complications of each procedure. The study shows that directed biopsy is as accurate as cold conization of the cervix, is less expensive for the patient and is not fraught with as many serious hazards as is cold conization.


Perinatal outcome in the diabetic pregnancy: a retrospective analysis. A retrospective analysis was done of all pregnancies in class B through R diabetics over a two-and-one-half-year period. This study demonstrates that early hospitalization, assessment of fetal status via estriols and oxytocin challenge test, fetal maturity studies, close medical supervision of the diabetes problem and advances in neonatology have combined to significantly reduce perinatal morbidity and mortality. The expense of prolonged maternal hospitalization is justified by the savings in newborn and child care, which would otherwise be increased. This approach can be used in any obstetric center. The philosophic question is discussed of the increased incidence of congenital malformations and diabetes in offspring of diabetic mothers.


The role of the family physician in the care of obstetrics and gynecology patients. Primary care is a major interest of all medical specialties today. That level of medical care stresses management of problems common in the population served. Studies of problems presented to general practitioners/family physicians indicate that a high proportion of the most common problems are obstetric/gynecologic. Departments of family medicine and of obstetrics and gynecology can base their mutual training efforts on care of these problems. The complementary relationship thus developed between residents in the two fields could lead to appropriate regionalization of services and optimum use of current knowledge and technology. Quality of care for the obstetric/gynecologic patient is a shared goal and can be achieved through col-laborative efforts of physicians in these two specialties.


Technical aspects of ranged directional doppler: a new doppler method of fetal heart rate monitoring. A new technique for clarifying the fetal heart Doppler signal (Ranged Directional Doppler) for fetal heart rate (FHR) monitoring has been developed. Ranged Directional Doppler enhances the signals of interest and, in addition, permits a separation of the Doppler signals generated by fast-moving structures of the fetal heart either toward or away from the transducer. The separation of the Doppler signals provides increased clarity and reduced baseline clutter. These Doppler signals may approach the fetal scalp ECG in signal-to-noise ratio, and they may provide a signal that allows more accurate external monitoring of long-term and short-term variability patterns of the FHR.


Case report of uterine rupture after an automobile accident. The pregnant woman who is involved in an automobile accident carries the risk of injury to her uterus and fetus. The following is a case report of a woman in her third trimester of pregnancy who had extensive lacerations of the uterus that almost completely severed the fundus from the lower uterine segment. The fetus was stillborn as a result of complete separation from the placenta.


Amniotic fluid contamination during internal fetal monitoring. The risk of infections associated with intrauterine fetal monitoring was evaluated in 30 consecutive labors. Amniotic fluid samples collected through the intrauterine catheter were found to be contaminated with bacteria in 15 of 30 consecutively monitored patients during labor. Aerobes were the exclusive isolates in eight, anaerobes in five and both in two patients. Eleven patients developed puerperal fever. One patient developed gonococcal amnionitis, and her newborn infant later developed gonococcal septicemia. The equipment--catheters and fetal scalp electrodes--was sterile. The overall risk of infection associated with internal monitoring in our study was 50% for amniotic fluid contamination and 37% for puerperal febrile morbidity.


Changes in ionic conductances and in sensitivity to amiloride during the natural moulting cycle of toad skin (Bufo viridis, L.). The resistance of the apical membranes of toad skin (Bufo viridis) was measured during its natural moulting cycle using a fast flow technique. The skin behaved in all periods of the moulting cycle as a nearly perfect sodium electrode. In the presence of amiloride (10(-4)M), the total resistance of the same skin was identical with solutions which contained either sodium or potassium. The resistance of the skin with potassium was sensitive to amiloride in the period just after moulting. The resistance of skins which were made shunted by treating them with urea on the outside area was insensitive to amiloride in solutions containing potassium; a small effect was still observed with sodium. It is suggested that the transient sensitivity to amiloride, with potassium, is the result of differentiation of the sodium specific sites at the apical membranes of the skin.


A quantitative resolution of the spectra of a membrane potential indicator, diS-C3-(5), bound to cell components and to red blood cells. Cationic cyanine dyes have been widely used to measure electrical potentials of red blood cells and other membrane preparations. A quantitative analysis of the binding of the most extensively studied of these dyes, diS-C3-(5), to red blood cells and their constituents is presented here. Absorption spectra were recorded for the dye in suspensions of isolated red cell membranes and in solutions of cell lysate. The dependence of the spectra on the concentrations of dye and cell constituents shows that the dye binds to these membranes as monomers with an absorbance maximum at 670 nm instead of 650 nm as for free aqueous dye and the dye binds to oxyhaemoglobin partly as monomer but primarily as dimer, with absorbance maxima ca. 670 and 595 nm, respectively. Quantitative estimates are derived for all binding constants and extinction coefficients. These estimates are applied to suspensions of whole cells to predict the dye binding, absorbance spectra, and calibration curves of binding and fluorescence vs. membrane voltage. Satisfactory agreement is found with binding and absorbance data for whole cells at zero membrane potential and with the binding and fluorescence data reported by Hladky and Rink (J. Physiol. (London) 263:287, 1976) for cells driven to positive and negative potentials using valinomycin. The marked tendency of oxyhaemoglobin to bind dye as dimer is not shared by some other proteins tested, including deoxyhaemoglobin and oxymyoglobin.


Passive electrical properties of cultured murine lymphoblast (L5178Y) with reference to its cytoplasmic membrane, nuclear envelope, and intracellular phases. Dielectric dispersion measurements over a frequency range 0.01-100 MHz were made with the suspensions of a cultured cell line, mouse lymphoma L5178Y, and an attempt to explain the observed dielectric behavior by taking explicitly into consideration the possible involvement of cell nucleus has been presented. The use of a conventional "single-shell" model in which the cell is represented by a homogeneous sphere coated with a thin limiting shell phase did not duplicate the observed dispersion curves, whereas a "double-shell" model in which one additional concentric shell is incorporated into the "single-shell" model gave a much better fit between the observed and the predicted dispersion curves. Based on the latter model, we analyzed the raw data of dielectric measurements to yield a set of plausible electrical parameters for the lymphoma cell: CM approximately or equal to 1.0 muF/cm2, CN approximately or equal to 0.4 muF/cm2, epsilonk approximately or equal to 300, kc/ka approximately to or equal to 0.9, and kk/kc approximately or equal to 0.7. Here, CM and CN are the specific capacities of plasma and nuclear membranes; epsilon and k are the dielectric constant and conductivity with subscript a, c and k referring respectively to the extracellular, the cytoplasmic and the karyoplasmic phases.


Effect of calcium upon sodium inactivation in the giant axon of Loligo pealei. Giant axons of Loligo pealei were voltage clamped in artificial seawater solutions containing varying concentrations of calcium from 10 to 100 mM, and the sodium conductance inactivation was measured with a series of two-pulse experiments. The h infinity vs. voltage curve showed a shift of about 10 mV in the depolarizing direction on the voltage axis for a tenfold increase in external calcium without substantial alteration in the slope of the voltage dependence. The kinetics of the inactivation process were found to be exponential for hyperpolarizing prepulses, but showed some indication of a sigmoidal decay for depolarizing prepulses in all calcium concentrations employed. Increasing calcium increased the delay in the sigmoidal response. The inactivation time constant tauh increased as a function of calcium concentration over the potential range studied, -10 to -90 mV. The values of the rate constants alphah and betah are decreased with an increase in calcium and these effects are not consistent with parallel shifts of the rate constant vs. voltage curves along the voltage axis for changes in calcium concentration. Magnesium does not behave as an equimolar substitute for calcium. The effect of a solution containing 10 mM calcium and 50 mM magnesium is intermediate to that of solutions containing 10 and 30 mM calcium alone. Predictions of a recent model for the sodium conductance (Moore, J.W., Cox, E.B., 1976 Biophys. J. 16:171) which employs calcium binding were compared with the experimental data.


Viability of the human cervical epithelium with dysplasia and carcinoma in situ. Autoradiograms of histologic slides of 58 human cone specimens with dysplasia and carcinoma in situ were analyzed after tissue samples were incubated with labeled RNA precursors. Both the vertical and lateral distributions of labeled cells were rather uniform in the major part of the epithelium, which suggested that the tissue remained metabolically active during incubation. Only the uppermost epithelial cells in heavily labeled areas were devitalized as deduced by the morphologic appearance of the cells, the absence of labeling in the cells, the trypan blue exclusion test, and the trypsin digestion test. The viability of large epithelial areas suggested that the previously reported focal distribution of proliferating and nonproliferating areas in the cervical epithelium is a genuine phenomenon and not the result of focal epithelial devitalization acquired during incubation.


Multiple effects of glucocorticoids and hyperosmolality on isoenzyme expression in cultured KB cells. The KB cell line, though indicted as a HeLa-contamined line, is a useful in vitro model for the study of the regulation of isoenzyme expression. KB cells produced three isoenzymic forms of alkaline phosphatase. When KB cells were grown in the presence of prednisolone and/or in hyperosmolar medium, the total enzyme activity was reduced. This change in activity was coupled with specific alterations in the proportion of each isoenzyme. The slow-moving form (identified biochemically and immunologically as the heat-stable, placental, Regan isoenzyme) was substantially increased by the steroid hormone and/or hyperosmolality. The fast-moving form [identified as the intestine-like, amnion (FL) isoenzyme] was strikingly diminished by either treatment. The intermediate form (tentatively referred to as "hybrid," inasmuch as it shared properties of the other two isoenzymes) was decreased only when KB cells were grown in hyperosmolar medium containing prednisolone. These results corroborated the notion that these stimuli cause the induction of increased levels of the heat-stable Regan alkaline phosphatase only. They also point out the necessity of performing isoenzyme analysis when one is investigating the regulation of this enzyme.


Effects of administration to mice of butylated hydroxyanisole by oral intubation on benzo[a]pyrene-induced pulmonary adenoma formation and metabolism of benzo[a]pyrene. Administration of butylated hydroxyanisole (BHA) by oral intubation 4 hours before challenge with benzo[a]pyrene (BP) inhibited the formation of pulmonary adenomas in A/HeJ mice. Incubation of BP with liver microsomes from mice that received BHA 2,4, or 8 hours before being killed resulted in less binding of BP metabolites to added DNA than occurred with control microsomes. High-pressure liquid chromatography studies of the BP metabolite pattern produced by the incubation of BP with liver microsomes from mice given BHA by oral intubation showed a decrease in formation of BP-4,5-oxide and 9-hydroxybenzo[a]pyrene. In contrast, the formation of 3-hydroxybenzo[a]-pyrene was increased. The was increased. The short interval between the administration of BHA by oral intubation and the observed biochemical changes indicated that BHA could exert a direct effect on the microsomal metabolism of BP. These changes in metabolism of BP occurred under conditions of BHA administration that produced a decreased neoplastic response to this carcinogen.


Flow microfluorometric analysis of P388 murine leukemia after administration of vincristine and maytansine in vivo. Maytansine is a new drug undergoing clinical investigation. It has functional similarities to vincristine. Maytansine and vincristine were given to CDF1 mice with P388 leukemic ascites, and the cytokinetic response of the tumor cells was analyzed with a flow microfluorometer; mithramycin was used as the DNA fluorochrome. The results indicated a similar series of cytokinetic effects after administration of both drugs, though these effects were greater and more persistent after maytansine was given. Although both drugs produced some degree of multinucleation and endoreduplication, vincristine produced a discrete population of cells with a DNA content (fluorescence) equivalent to octoploidy (8C). Microscopy of the sorted 8C cells at 24 hours indicated 54% multinucleation and 33% mitotic figures. Most cells remained blocked in the G1-phase for at least 96 hours after administration of both drugs, which indicated that rapid DNA content distributions can be used to determine not only the effects of drugs on cell cycle distribution but also the duration of drug action.


Antitumor activity of purified cell walls from Corynebacterium parvum. Cell walls (CW), containing peptidoglycan and carbohydrate, were prepared from Corynebacterium parvum and tested for lymphoreticular stimulation and antitumor effects in CBA-T6T6 mice. CW did not induce splenomegaly. Peritoneal macrophages became cytostatic to Rl leukemia cells in vitro after ip injection of CW or of peptidoglycan but not of carbohydrate; however, on a dry-weight basis the activity was low (less than 10%) compared with that of C. parvum. Tumor outgrowth was significantly suppressed after sc injection of mixture of M4 fibrosarcoma cells and CW, but again the activity of CW was less than 10% of the of C. parvum. In contrast to injection of C. parvum, intratumor injection of CW failed to retard tumor growth in normal mice, although a suppressive effect was found in mice presensitized to C. parvum. Again, unlike C. parvum, CW did not act as an adjuvant for tumor-specific transplantation antigen, as judged by a lack of enhanced resistance to tumor challenge after injection of mixtures of CW and irradiated M4 cells. The distribution and persistence of 125l-labeled C. parvum and CW after sc or ip injection were similar. CW activity was not restored by attachment to oil droplets or emulsification in Freund's incomplete adjuvant.


Carcinogenicity of some folk medicinal herbs in rats. Twelve medicinal herbs were bioassayed to correlate a high incidence of esophageal carcinoma in natives of different places with their habitual consumption of these products. Outbred NIH Black rats were given 72 weekly sc injections of the total aqueous extracts of the plant materials. The tanninrich plant extracts from Areca catechu and Rhus copallina produced local tumors in 100 and 33%, respectively, of the experimental animals. Other materials included Diospyros virginiana and extracts from plants not rich in tannins. Diospyros and extracts of Sassafras albidum and Chenopodium ambrosiodes were tumorigenic in over 50% of the treated animals.


Experimental pancreatic carcinogenesis. II. Lifetime carcinogenesis studies in the outbred Syrian golden hamster with N-nitroso-bis(2-hydroxypropyl)amine. A high incidence of pancreatic duct neoplasms was induced in outbred male Syrian golden hamsters following weekly sc injection of N-nitroso-bis(2-hydroxypropyl)amine for life. The first such tumors appeared as early as 16 experimental weeks; the maximum incidence reached 100% by the termination of the study. Tumors in the respiratory tracts and angiosarcomas of the livers of the hamsters were also observed in high frequency. Latency of the induced neoplasms was significantly decreased by the substitution of distilled water for olive oil as the vehicle for the carcinogen.


Effect of hyperthermia on vascular functions of normal tissues and experimental tumors; brief communication. The effect of hyperthermia on vascular volume and vascular permeability of the Walker carcinoma 256, skin, and muscle of inbred SD male rats was investigated. Whereas heating at 43 degrees C for 1 hour induced a significant increase in the functional vascular volume and vascular permeability in the skin and muscle, it did not change these vascular functions in the tumors. The increased vascular volume in the normal tissues suggested an increased circulation, which may enhance the dissipation of heat and result in a differential effect of hyperthermia on normal tissues and tumors.


Management of the nasal tip in the external approach rhinoplasty. This papaer describes some of the advantages of the external rhinoplastic approach in managing the nasal tip, in particular, in revision surgery and cleft palate nose. It also reviews many of the methods of tip management which are essentially similar in the external and closed procedures e.g. altering projection, rotation and shortening of the tip, and management of asymmetries.


Surgery of the nasal dorsum.

Surgery of the nasal dorsum. Careful pre-operative planning is required before the nasal dorsum is changed in profile or width. The highlights of assessment are discussed together with a description of how the surgery should be performed. The advantages of using the external approach to the nasal dorsum are stressed.


Transseptal, transsphenoidal hypophysectomy via the external rhinoplasty approach. The external rhinoplastic method provides a rapid and convenient route for transseptal transsphenoid surgery of the pituitary gland. This procedure offers several practical advantages over the conventional subnasal approach and should be seriously considered by rhinologists active in this area.


External septorhinoplasty--why the fuss? External approach rhinoplasty has engendered controversy. The merits of the procedure are discussed, together with an outline of indications for its use. It is felt that this operation is a useful addition to the rhinoplastic art.


Correction of crooked noses by external rhinoplasty. External rhinoplasty is considered as the approach of choice in correcting nasal deformity following injury, either accidental or surgical. The advantages of a good exposure, lack of injury to the skin, osteotomies under direct vision, and the accurate placing of grafts giving a good anatomical and physiological correction are discussed. Pictorial demonstration of results is accompanied by drawings showing the nasal pathology as seen through the external approach.


Pre- and postoperative management of the rhinoplasty patient. The role of the otolaryngologist has widened to include facial cosmetic surgery. As such it encompasses all aspects of age-diminishing surgery as well as facial contour augmentation, surgical and traumatic scar camouflage, and otoplasty as well as rhinoplasty. It necessarily follows that the rhinoplasty surgeon must view the total face rather than the nose in isolation. A complete understanding of the indications and contra-indications of rhinoplasty is necessary for adequate pre- and postoperative assessment of the patient. These ideas are developed and the analysis of the nasal pathology is discussed.


Management of the twisted nose.

Management of the twisted nose. This presentation discusses the development, pathophysiology, and method of management of the twisted nose. The surgical logistics of staging, open and closed approach, anesthetic method, and reconstructive planning are considered in detail.


Why external rhinoplasty?

Why external rhinoplasty? The indications for, advantages, and disadvantages of external rhinoplasty are considered from a pragmatic and philosophic point of view. The results in more than 200 patients are analyzed.


Identification of Saint Louis encephalitis virus mRNA. Saint Louis encephalitis (SLE) virus-specific RNA was recovered from infected HeLa cells by sodium dodecyl sulfate (SDS)-phenol-chloroform extraction, and the molecular species were resolved by SDS-sucrose gradient centrifugation and agarose gel electrophoresis. Sucrose gradient centrifugation revealed the presence of a 45S species, minor 20 to 30S heterogeneous species, and an 8 to 10 S RNA species in the cytoplasmic extract. Analysis of the same samples by electrophoresis on agarose gels, under both nondenaturing and denaturing conditions, revealed only two virus-specific RNA molecules, the 45S genome-sized RNA and an 8 to 10S species. Varying the gel concentration to facilitate analysis of nucleic acids with molecular weights ranging from 25,000 to 25 X 10(6) failed to reveal additional RNA species, although low levels of a putative double-stranded replicative form could conceivably have escaped detection. From our observations it appears that the heterogeneous RNA species and presumably the 20S RNase-resistant species reported in other investigations of flavivirus RNA are degradation products or conformers of the 45S molecule. Polysomes from SLE virus-infected cells were prepared and separated from contaminating nucleocapsid by centrifugation on discontinuous sucrose gradients. RNA extracted from these polysome preparations was analyzed by sucrose gradient centrifugation and agarose gel electrophoresis. The 45S SLE virus genome-size molecule was found to be the only RNA species associated with the polysomes. This molecule was sensitive to RNase digestion and was released from polysomes by EDTA and puromycin treatment. These findings provide direct evidence that the 45 S SLE virus RNA serves as the messenger during virus replication, in contrast to the 26S RNA species which functions as the predominant messenger during alphavirus replication.


Impaired processing of precursor polypeptides of temperature-sensitive mutants of Rauscher murine leukemia virus. The synthesis and processing of virus-specific precursor polypeptides in NIH/3T3 cells infected at the permissive temperature (31 degrees C) with temperature-sensitive (ts) mutants of Rauscher murine leukemia virus was studied in pulse-chase experiments at the permissive and nonpermissive (39 degrees C) temperatures. The newly synthesized virus-specific polypeptides were analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis after immunoprecipitation with polyvalent and monospecific antisera against Rauscher murine leukemia virus proteins. In cells infected with ts mutants defective in early replication steps (the early mutants ts17 and ts29), and ts mutants defective in postintegration steps (the late mutants ts25 and ts26), the processing of the primary gag gene product was impaired at the nonpermissive temperature. gag-pr75 of all four mutants was converted into gag-pr65; however, gag-pr65 accumulated at the nonpermissive temperature, and the main internal virion polypeptide p30 was not formed. Therefore, the proteolytic cleavage is blocked beyond gag-pr65. Concomitantly, the formation of the env gene-related polypeptide p12(E) of all four mutants was blocked at the restrictive temperature. In contrast, cells infected with the late mutant ts28, which produced noninfectious virions at 39 degrees C, showed a normal turnover of the gag and env precursor polypeptides.


Segments of influenza virus complementary RNA synthesized in vitro. In the presence of Mg(2+) and a specific primer, ApG or GpG, the influenza WSN virion transcriptase synthesizes large, polyadenylic acid-containing complementary RNA (cRNA) (Plotch and Krug, J. Virol., 21:24-34, 1977). After removal of its polyadenylic acid with RNase H in the presence of polydeoxythymidylic acid, the in vitro cRNA distributed into seven discrete bands during electrophoresis in acrylamide gels containing 6 M urea. The eight known segments of virion RNA (vRNA) also distributed into seven bands under these conditions as two, rather than the expected three, large-sized segments were resolved. Each of the in vitro cRNA segments migrated slightly faster than the corresponding vRNA segment. To determine whether this difference in mobility reflects a difference in size between cRNA and vRNA, the double-stranded RNA formed by annealing labeled in vitro cRNA to unlabeled vRNA was subjected to various nuclease treatments and was analyzed by gel electrophoresis. Hybrids treated with RNase T2 or a combination of RNase T2 and RNase H migrated slightly faster than those treated only with RNase H, indicating that RNase T2 removed an RNA sequence other than polyadenylic acid, most probably a short sequence of vRNA not hydrogen bonded to cRNA. These results suggest that the in vitro cRNA segments are shorter than, and thus incomplete transcripts of the corresponding vRNA segments. All eight hybrids were resolved by gel electrophoresis, indicating that all eight vRNA segments are transcribed into cRNA in vitro. We also present evidence suggesting that the ApG primer initiates in vitro transcription exactly at the 3' end of vRNA.


Biological properties and physical map of the genome of a new papovavirus, HD virus. The superhelical DNA of the HD papovavirus is heterogeneous and consists of two discrete size classes with molecular weights of 3.45 X 10(6) and 3.25 X 10(6). Both size classes of DNA are encapsidated into HD virion particles. Their relative intracellular amounts differ, depending on the cell system. Vero-76 carrier cultures in which HD virus was detected contain both size classes of DNA, with the larger molecules prevailing by a factor of 10. Five clonal lines derived from Vero-76 cell cultures contain exclusively the larger DNA. On the other hand, after cocultivation of Vero-76 with CV-1 cells for several passages, minicircular DNA is accumulated such that both size classes are synthesized in equal amounts. Any of the originally viral DNA-producing cell lines may, upon subcultivation, cease yielding virus. The RITA cell line of Cercopithecus aethiops origin is the only cell line among numerous ones tested which upon infection permits the establishment of a one-step growth cycle. However, between 6 and 8 days after infection, viral DNA synthesis is discontinued, and a persistent viral infection cannot be established. Physical maps of the genomes were constructed, and it could be shown that the smaller, minicircular DNA had originated from the larger DNA as the result of a deletion. The sequences missing in the minicircular DNA are confined to the relative map position 0.15 to 0.21.


Isolation and characterization of cytoplasmic inclusions from influenza A virus-infected cells. Influenza A viruses induce the accumulation of electron-dense inclusions in the cytoplasm of infected cells during the latter stages of the replication cycle. Cell fractionation studies showed that these inclusions could be recovered in subcellular fractions containing ribosomes and polysomes. Isolation of these inclusions was accomplished by procedures involving RNase treatment of these fractions followed by repurification, or by fluorocarbon extraction and gradient centrifugation. Electron microscopy indicated that the isolated inclusions exhibited a major periodicity of approximately 8 nm with minor periodicities of approximately 4 nm. Analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed that the influenza virus coded nonstructural protein was the only protein component present in isolated inclusions.


Synthesis of alphavirus-specified RNA.

Synthesis of alphavirus-specified RNA. UV irradiation of chicken fibroblasts infected with Semliki Forest or Sindbis virus has been used to investigate the mechanism of synthesis of 42S and 26S RNA, the major plus-strand virus-specified RNAs formed during the multiplication of standard virus particles. From an analysis of the kinetics of UV inactivation of the synthesis of these two RNAs, we conclude (i) that 26S RNA is formed by internal transcriptive initiation from a point about two-thirds of the way from the 3' end of the 42S negative-strand template; (ii) that there exists a population of plus-strand synthesizing complexes whose members are each capable of synthesizing both 42S and 26S RNA; and (iii) that, on a time-averaged basis, each complex in wild-type virus-infected cells contains one virus polymerase mediating 42S RNA synthesis and three mediating 26S RNA synthesis. The RNA phenotypes of 15 RNA(-)ts mutants of Sindbis virus have been examined after temperature shift to the restrictive temperature. Under these conditions, cells infected with three mutants, N2, N7, and E268, synthesized four to six times as much 42S RNA (relative to 26S RNA) as wild-type virus-infected cells. These studies were extended by examining, in detail, the RNA and polypeptide phenotypes of mutants N2 and E268. These experiments showed that, in N2- and E268-infected cells, one of the virus-specified nonstructural (NS) polypeptides (NS p89; H. Brzeski and S. I. T. Kennedy, J. Virol. 22:420-429, 1977) is thermolabile after shift up to restrictive temperature. This finding, together with the observation that, after shift, the 26S/42S RNA ratio in N2-infected cells changes markedly in favor of 42S RNA synthesis, leads us to conclude that, of the three NS polypeptides, NS p89 modulates 26S RNA synthesis.


Assembly intermediates among adenovirus type 5 temperature-sensitive mutants. Temperature-sensitive mutants from three different complementation groups, ts5, ts19, and 6s58, have been shown to accumulate assembly intermediates at the restrictive temperature. The polypeptide composition of these intermediates is similar to that of the wild type, including the precursor polypeptides pVI, pVII, and pVIII. ts5 and ts19 also contained cleaved precursors, indicating assembly into defective virions. The increase of infectious virus after temperature shift-down of ts19 and ts58 was rapid when compared with that of ts24, which does not accumulate intermediates, suggesting that intermediates formed at nonpermissive temperature may be processed to mature virus. However, shift-down experiments reveal that only a fraction of the intermediates are utilized for virus assembly and that degradation of intermediates occurs at the restrictive temperature.


Identification of hemagglutinin and neuraminidase genes of influenza B virus. The genome of influenza B viruses was shown by electrophoresis to consist of eight RNA segments. The fifth largest segment coded for hemagglutinin and the sixth coded for neuraminidase.


Glycoproteins of measles virus under reducing and nonreducing conditions. Measles virus has two glycoproteins. The larger glycoprotein (HA) is composed of 76,000-dalton subunits that are bound by disulfide bonds. The smaller glycoprotein (F) appears to contain a glucosamine-rich portion that is linked to an unglycosylated protein by disulfide bonds.


Neonatal intensive care and radiation.

Neonatal intensive care and radiation. Radiography plays an important role in a neonatal intensive care nursery. Diagnostic radiation was measured in 96 newborns. Mean exposure per neonate was 68.1 milliroentgens (mR) (SD = 132.7) with a median exposure per neonate of 28 mR. Radiation received by neonates was low, but further studies are needed to show the safety of radiation or its delayed effects. The measurement of radiation is simple, and routine radiation recording can prove useful in future evaluations of this high-risk population.


Cyanotic heart disease: "low altitude" risk for carotid body tumor? A young woman with hypoplastic right heart syndrome developed a carotid body tumor at age 28. High altitude habitation is known to predispose to hyperplastic and neoplastic carotid bodies; emphysema and congenital cyanotic heart disease have recently been shown to induce hyperplasia of this oxytrophic tissue. Therefore, a link between congenital cyanosis and carotid body tumor is suggested by this patient. Carotid bodies are nonchromaffin paraganglionic analogues of the adrenal medulla. Congenital cyanosis has an association with pheochromocytoma. In the cyanotic milieu carotid body tumor may be a histological analogue of pheochromocytoma.


The integrated concentration of plasma renin activity and aldosterone in essential hypertension. Measurement of the integrated concentration is most suited for the study of blood components that fluctuate rapidly. The integrated concentration of plasma aldosterone (IC-ALDO) and plasma renin activity (IC-PRA) were measured in 24 patients with essential hypertension and in 10 normal adult subjects, using a non-thrombogenic 24-hour constant blood withdrawal system. The integrated concentration of plasma aldosterone in the control subjects was 7.7 +/- 1.8 ng/100 ml (mean +/- 1 SD). Eight hypertensive patients had IC-ALDOs that were more than 3 standard deviations above the mean. Although the mean IC-PRA of the hypertensive patients was lower than the mean of controls (0.6 +/- 0.6 and 0.9 +/- 0.6, respectively), the difference was not significant. However, high integrated concentration of plasma aldosterone was mostly associated with low integrated concentration of plasma renin activity. Consequently, the ratio of IC-ALDO to IC-PRA in the hypertensive patients was significantly higher (p less than 0.001). In six hypertensive patients the ratio was more than 4 standard deviations above the mean for the normal control subjects (12.2 +/- 7.6). Individuals with inappropriately high integrated concentrations of plasma aldosterone can therefore be identified by the simultaneous determination of IC-ALDO and IC-PRA.


Cinematic display of regional function in nuclear imaging. A significant improvement in cardiovascular nuclear medicine has resulted from imaging the beating ventricles by motion-picture display of the intraventricular distribution of 99mTc albumin during 16 phases of the cardiac cycle. We have now begun to make "fast-motion" pictures of other body functions, including the cerebral circulation, pulmonary ventilation, biliary excretion, and renal blood flow. Data obtained over minutes, hours or days are compressed into 16 frames per second. These "compressed-time" images improve our perception of regional dysfunction, and the degree of certainly of our diagnoses. They do so by eliminating the blurring inevitably produced in the usual static images of moving structures, such as the heart, and by revealing small changes in regional function.


Apparatus for the hyperchlorination of rodent drinking water. An apparatus is described which has been in use for some time providing uniform, low concentrations of chlorine in mouse drinking water.


Sexual maturity in rabbits defined by the physical and chemical characteristics of the semen. Semen was collected weekly from New Zealand white rabbits from the 1st positive mounting test to 43 weeks of age by means of an artificial vagina. The mean values of the results obtained in the 1st and 20th collection weeks were respectively: volume (ml) 0.61 +/- 0.30 and 0.70 +/- 0.19; pH 7.22 +/- 0.50 and 7.19 +/- 0.15; concentration (sperm/mm3 X 10(3)) 750 +/- 207 and 381 +/- 90; fructose (mg/100 ml) 117 +/- 58 and 203 +/- 121; citric acid (mg/100 ml) 256 +/- 90 and 200 +/- 97; sodium ions (mEq/l) 133 +/- 31 and 163 +/- 46; potassium ions (mEq/l) 40 +/- 21 and 29 +/- 14. On the basis of these results, New Zealand white rabbits reach sexual maturity by 6 months of age.


Effects of processing and gamma irradiation on the microbiological contaminants of a laboratory animal diet. The numbers and types of microorganisms contaminating a commercially available laboratory animal diet were examined by plate-count methods at all stages of production. During the cooking and pelleting stages of manufacture there was a marked reduction in numbers of heat-labile vegetative contaminants introduced via the raw materials, and at subsequent stages plate counts at 37 and 25 degrees C corresponded closely to counts of viable aerobic bacterial endospores. It would seem that the count on the pelleted diet was determined principally by the numbers of bacterial spores being introduced with the ingredients. The response to gamma-irradiation of the innate microflora contaminating the pelleted diet was characteristic of that generally seen with populations of aerobic bacterial endospores.


Comparison of regional myocardial blood flow and metabolism distal to a critical coronary stenosis in the fibrillating heart during alternate periods of pulsatile and nonpulsatile perfusion. The effect of pulsatile cardiopulmonary bypass on intramyocardial gas tensions and regional myocardial blood flow was studied in 10 mongrel dogs. Following application of a critical stenosis to the circumflex coronary artery (CIRC), animals were placed on total bypass with vented, fibrillating hearts. During three 45 minute periods of perfusion, animals alternately received pulsatile or linear flow with perfusion pressure carefully maintained at 80 mm. Hg. In myocardium supplied by the stenosed CIRC, intramyocardial oxygen tension (PO2) rose from 13 +/- 3 to 19 +/- 5 mm. Hg when a period of linear flow was followed by a period of pulsatile flow (p less than 0.025). Similarly in the CIRC-supplied area, intramyocardial carbon dioxide (PCO2) decreased from 128 +/- 12 to 99 +/- 12 mm. Hg (p less than 0.005) with conversion from linear to pulsatile flow. Myocardial blood flow (microsphere technique) to endocardial and epicardial layers of the CIRC-supplied area was significantly greater (p less than 0.05) during pulsatile than during linear perfusion. In contrast, when periods of pulsatile bypass were followed by periods of linear perfusion, myocardial PO2 fell from 25 +/- 6 to 9 +/- 3 (less than 0.02) and myocardial PCO2 rose from 82 +/- 12 to 154 +/- 12 mm. Hg (p less than 0.001). These data suggest that (1) fibrillation-induced regional ischemia distal to a critical coronary stenosis can be reduced by pulsatile perfusion during bypass and (2) the mechanism for the reduction in regional ischemia is improved myocardial blood flow.


Pathology of the sinus node in d-transposition following the Mustard operation. In a pathological study of 32 necropsy specimens from patients with d-transposition who had undergone the Mustard operation, lesions were commonly present in the sinus nodal artery, the sinus node, and the paranodal tissues. These had resulted from surgical injury during placement of the atrial baffle and/or closure of the atriotomy incision. Our findings confirm the pathological findings of others. The pathological observations correlate well with reported electrophysiological studies that show frequent occurrence of postoperative supraventricular arrhythmias due to sinus nodal dysfunction. Twenty-six of the patients died in the early postoperative period, and the sinus nodal artery had been compressed by sutures in 46 percent of these cases. The sinus node either showed acute necrosis or compression by sutures in 77 percent of cases, and the paranodal areas were involved by acute hemorrhage and/or necrosis in 100 percent of cases. Six patients died in the late postoperative period. The sinus nodal artery was replaced by fibrous tissue in three and was compressed or thrombosed in two additional instances. The sinus node was extensively fibrosed in each of the six cases. In every instance, the paranodal areas were involved by fibrosis and disruption by sutures.


Prophylactic antibiotics and the insertion of permanent transvenous cardiac pacemakers. Prophylactic antibiotics are prescribed frequently for patients requiring permanent transvenous cardiac pacemakers, despite a paucity of data indicating effectiveness. A 10 year retrospective analysis was performed of 298 pacemaker insertion procedures involving 204 patients. On the basis of prestudy criteria relating to timing and dosage of antibiotics, the use of prophylactic antibiotics was judged as adequate or inadequate. There were no postoperative infections in the 108 battery pack replacement procedures despite no or inadequate use of antibiotics in 49 procedures. There were nine infections in the 190 battery pack plus pacing wire procedures for an infection rate of 5 percent. There was no significant difference in infection rate between the group given prophylactic antibiotics and the group given no or inadequate prophylactic antibiotics. Of the 190 battery pack plus pacing wire procedures, no infections occurred in the 50 procedures in which surgical drains were not used (p less than 0.003). In the 140 procedures in which drains were used, there was no correlation between wound infection and absent or inadequate coverage with prophylactic antibiotics. Two severe bacteremic Staphylococcus aureus infections occurred in two patients not given prophylactic antibiotics. The other seven infections were clinically indolent. These results suggest the following: (1) There is no need for prophylactic antibiotics in battery pack replacement procedures; (2) prophylactic antibiotics may decrease the severity of infection in battery pack plus pacing wire procedures; (3) surgical drains should be avoided in battery pack plus pacing wire procedures. A prospective controlled study is necessary to confirm these results.


The electrical dose for direct ventricular defibrillation in man. The threshold electrical energy for direct ventricular defibrillation was measured in 100 patients whose hypothermic hearts were fibrillated for cardiac operations. In 93 cases 10 joules or less was sufficient, and in 48 of these cases 5 joules or less defibrillated the ventricles. Because a shock of 10 joules defibrillated the heart of most of our patients, we recommend an initial shock of 5 to 10 joules rather than the 20 joules used more commonly. Until the safety margin between defibrillation threshold and damage threshold is established for direct defibrillation, use of shocks with adequate but not excessive strength may avoid unnecessary damage to the myocardium. When hearts refibrillate after defibrillation, it is unnecessary to use higher energy settings for subsequent defibrillation attempts. Instead, an antiarrhythmic drug should be administered and another shock of the same intensity that defibrillated the first time should be applied.


Repair of lesions of the descending thoracic aorta with the TDMAC-heparin shunt. Utilizing a heparinized tridodecylmethylammonium chloride (TDMAC) shunt makes it possible to treat various surgical diseases of the descending thoracic aorta without cardiopulmonary bypass. Since the initial report by Gott and associates on the use of the heparinized shunt, few subsequent clinical trials have appeared in the literature. Six patients with Type III dissecting thoracic aneurysm, acquired and congenital coarctation of the aorta, saccular arteriosclerotic aneurysm, and transection of the descending thoracic aorta were operated upon by means of this technique. Only one patient had more than 500 ml. of chest tube drainage in the first 8 hours postoperatively. There were no instances of paraplegia, renal failure, or death. This technique is also recommended for repair of innominate artery aneurysms, endarterectomy of the innominate or subclavian artery, arch aneurysm, penetrating injuries of the thoracic aorta, and proximal abdominal aneurysms. Surgical indications, operative management, and postoperative follow-up are discussed.


Aortico--left ventricular tunnel and sinus of Valsalva aneurysm. Case report with operative repair. Aortico--left ventricular tunnel (ALVT) is a rare anomaly, only 21 such cases having appeared in the literature. This report describes a case of ALVT in which there were features characteristics of sinus of Valsalva aneurysm (SVA). Details of the operative repair are discussed.


Surgical repair of right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum. Five cases of right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum, with or without Kommerell's diverticulum, are presented. Either right or left thoracotomy with divesion of the aberrant retroesophageal left subclavian artery can be accomplished with good results. However, a right thoracotomy is recommended in the presence of a large Kommerell diverticulum because such a diverticulum should be excised. The development of a subclavian steal syndrome later in life may be prevented by reimplantation of the divided left subclavian artery into the aorta or the left common carotid artery.


Cyanosis in a patient with combined ostium primum and secundum atial septal defects and anomalous inferior vena cava with azygos continuation. Case report and surgical considerations. A case is described of combined ostium primum and ostium secundum atrial septal defects and azygos connection of the inferior vena cava plus cyanosis. Emphasis is made to recognize the functional mechanism of cyanosis and to demonstrate the anatomic site of hepatic venous drainage so that an appropriate corrective operative procedure can be planned. A gratifying result was achieved in this case after closure of the atrial septal defects.


Repair of atrial septal defect primum. Results, course, and prognosis. Repair of atrial septal defect primum (ASD primum) continues to be a challenge to the surgeon. The most common problems involve reconstructing the mitral valve and avoiding rhythm disturbances after the operation. In this report we describe our results in 92 patients with ASD primum who were operated upon between 1955 and 1975.


An alternative to breathing.

An alternative to breathing. If carbon dioxide is removed by an extracorporeal membrane lung ventilated with room air, the natural lung can be used for oxygen transport alone; we have demonstrated this in lambs by maintaining lungs "inflated" with 100 percent oxygen at constant pressure and removing all carbon dioxide through the membrane lung. This process is a variant of "apneic oxygenation" without its disadvantages, because the arterial pH, PCO2, and PO2 all remain normal. No nitrogen washout is needed. These studies were carried out in five lambs anesthetized and paralyzed for 24 hours. For carbon dioxide removal, blood from the subclavin artery was pumped through an extracorporeal membrane lung and was returned into the external jugular vein. For oxygen delivery, the lungs were inflated through a tracheostomy tube with 100 percent oxygen to a pressure of 5 cm. H2O. There was no significant change in arterial blood PO2 after perfusion had begun or at the end of the perfusion 24 hours later. The arterial PCO2 remained steady, and there was no change in acid-base balance. The functional residual capacity (FRC) and static lung compliance remained unchanged. The total dead space was 10 to 15 ml. All animals recovered and survived in good health. At equilibrium, alveolar nitrogen partial pressure was always equal to the partial pressure of nitrogen in the ventilating gas of the membrane lung and was the sole determining factor in controlling alveolar oxygen concentration. Direct measurement of pulmonary gas showed alveolar gas at the level of the carina.


Anomalous origin of left main cononary artery from anterior sinus of Valsalva with myocardial infarction. The origin of the left main coronary artery, or its branches, from the right or anterior sinus of Valsalva is a recognized congenital anomaly. The origin of the entire left main coronary artery from a separate ostium in the right sinus of Valsalva and its course to the right and behind the ascending aorta, in a living patient without associated congenital heart disease, has not been described. This anomaly was recognized as the cause of an anterior myocardial infarction in a 12-year-old girl, and it is the subject of this case report.


Surgery for mitral and tricuspid insufficiency associated with secundum atrial septal defect. Pure mitral insufficiency associated with secundum atrial septal defect is not an unusual finding. Thirteen patients with significant mitral insufficiency and an associated secundum defect were operated upon. Two of these patients also had severe tricuspid insufficiency. The mitral valve was repaired in 12 patients and replaced in one. The tricuspid valve was reapired in the two patients with associated tricuspid insufficiency. There were two early deaths due to mediastinitis and one late death due to a cerebral embolus in the only patient who had valve replacement; this patient died 3 years after the operation. It is concluded that mitral and tricuspid valve repair should be performed for patients with significant mitral and tricuspid insufficiency associated with atrial septal defect of the secundum variety. Replacement of the values should be avoided if possible.


Incidence of emboli with cloth-covered Starr-Edwards valve without anticoagulation and with varying forms of anticoagulation. Analysis of 183 patients followed for 3 1/2 years. One hundred eighty-three patients with cloth-covered valves were studied from 1 1/2 to 8 years after operation, with an average follow-up time of 3 1/2 years. Over the total period, patients taking Coumadin sustained a 4 percent embolic incidence (1.2 per 100 patient-years); those taking aspirin had a 7 percent incidence (2.6 per 100 patient-years); and those taking Persantine had a 43 percent incidence (10 per 100 patient-years). Patients on no regimen of anticoagulation had a 16 percent embolic rate (four per 100 patient-years), whereas another group of patients who stopped anticoagulants after a year incurred a 13 percent embolic incidence in the subsequent 2 years (6.4 per 100 patient-years). These data showed a significantly lowered embolic rate with anticoagulation and suggest that all patients with cloth-covered valves should be taking anticoagulants. That these valves become epithelialized and do not form thrombus after a year was not borne out by this study. Persantine alone is not a satisfactory anticoagulant. Coumadin appears to be the superior anticoagulant, but if careful monitoring of its use is in question or if serious bleeding complications ensue, aspirin may provide satisfactory protection.


Ball variance and fracture of mitral valve prosthesis causing recurrent thromboemboli. This report documents the ninth case of ball variance in a Starr-Edwards Model 6000 mitral prosthesis occurring 10 years, 9 months after implantation. It is the fourth case of fracture of a mitral ball of any type. As this case illustrates, the presence of ball variance in the mitral position may be subtle. One must carry a high index of suspicion if the diagnosis is to be made and treatment undertaken before catastrophic events take place. The incidence of ball variance is likely to increase with the length of implantation. We recommend surgical replacement of the defective prosthesis immediately upon confirmation of diagnosis.


Malfunction of Cutter-Smeloff mitral prosthesis. An echocardiographic diagnosis. Progression of intermittent partial or total impaction of the poppet from a prosthetic mitral valve may be difficult to evaluate in patients with chronic obstructive pulmonary disease and atrial fibrillation. Heart sounds may be distant; opening and closing clicks of the poppet are muffled and irregular. Echocardiography provides a noninvasive method to detect early prosthetic malfunction at a time when the patient is clinically asymptomatic.


Intracranial bypass grafts for vertebral-basilar ischemia. Fourteen operations in which an occipital branch of the external carotid artery was anastomosed to the posterior inferior cerebellar artery were performed for occlusions or inaccessible stenotic lesions of the vertebral arteries proximal to the site of origin of the posterior inferior cerebellar artery. Eight patients (group 1) had no major focal reurologic deficit but were considered to be at high risk for a posterior circulation infarct; six patients (group 2) had been severely or moderately disabled before the operation. Postoperative angiography revealed that 13 of the 14 grafts were patent. In 9 of the 13 patent grafts, the bypass graft served as the sole or major blood supply of the vertebral-basilar system; in 4, flow was limited to the distribution of the posterior inferior cerebellar artery. Five of the eight patients in group 1 have returned to full employment or normal retired life. Two of the six patients in group 2 have resumed normal activities with only minimal neurologic dysfunction. This procedure may have a role in the management of highly selected patients suffering from vertebral-basilar ischemia, and it may be useful in the management of selected aneurysms in the vertebral-basilar system.


A reappraisal of clinical, roentgenographic, and endoscopic features of the Zollinger-Ellison syndrome. Recent experience with 40 patients with the Zollinger-Ellison syndrome at all Mayo Clinic suggests that traditional clinical criteria for diagnosis are often absent or invalid. Patients are younger have a shorter duration of symptoms, and often present without prior gastric surgery. Clinical, roentgenographic, and endoscopic findings indistinguishable from those of idiopathic duodenal ulcer or erosive duodenitis were the only presenting features in half of the patients in this series. Therefore, increased diagnostic use of serum levels of gastrin and gastric analysis appears desirable, particularly in patients selected for elective surgical treatment of duodenal ulcer disease, because specific therapeutic approaches may be required.


Transsphenoidal removal of pituitary microadenoma in Cushing's disease. Twenty-two of 32 patients with Cushing's disease seen at the Mayo Clinic during a 3-year period were carefully studied radiologically (triaxial spiral tomograms of the sella and bilateral carotid arteriograms with magnification and subtraction techniques). Eighteen of these 22 pat-ents had radiologic evidence of small pituitary gland tumors and underwent transsphenoidal microsurgical exploration of the pituitary. A microadenoma (less than 10 mm) was found in 17 of the 18 patients. Hypercortisolism was corrected, and a clinical remission occurred in 16 of the 18 patients; the hypercortisolism persisted in 2 patients. A period of hypocortisolism occurred after removal of the pituitary tumor in all patients who experienced a remission. Remissions have been associated with normal anterior pituitary and adrenocortical function in a large percentage of patients who were adequately studied 6 months or more after pituitary surgery.


Prothrombin Quick. A newly identified dysprothrombinemia. The rarest of reported inherited plasmatic coagulopathies involve prothrombin. Only 10 families with significant reductions of this plasma protein (hypoprothrombinemia) have been observed. Even fewer, six families, have been found to have a functionally abnormal prothrombin (dysprothrombinemia) in their blood. An as yet undefined prothrombin abnormally has been recognized in eight other families. One of the first patients previously identified by Quick and his associates as having a defect in her plasma prothrombin has been shown to have about half the normal amount of prothrombin antigen but virtually no prothrombic function. We propose that this dysprothrombin be designated prothrombin Quick. An additional patient also first described by Quick was found to be truly hypoprothrombinemic--that is, to lack both functional and antigenic prothrombin. Briefly summarized are the other five families with dysprothrombinemia, nine with hypoprothrombinemia, and the eight in whom the defect has not been classified.


Quantitative imaging of the structure and function of the heart, lungs, and circulation. A 28-x-ray-source, cylindrical-scanning, transaxial tomographic x-ray-imaging system is in the process of being fabricated. This system will scan synchronously up to 250 parallel transverse cross sections of the human body over an axial range of 25 cm within 0.01 second at a maximum rate of 60 scans per second. The system will provide numerous variations of scanning configurations to permit quantitative assessment of the relative importance of transverse section thickness, image contrast, spatial and temporal resolution, and related computerized algorithms and display techniques. Synchronous imaging at high temporal resolution of a three-dimensional volume--for example, the heart--eliminates the need for successive periods of breath-holding and gated imaging techniques and is essential for quantitation of cardiovascular and pulmonary function and structure in intact animals or humans. Initial clinical applications are expected to be in the early detection of lung cancer and the diagnosis of the nature and degree of congenital and acquired cardiovascular disabilities.


Cardiobacterium hominis endocarditis. Four cases with clinical and laboratory observations. The clinical and microbiologic features of Cardiobacterium hominis endocarditis in four patients seen at the Mayo Clinic from 1971 through 1976 are described. All four were men ranging in age from 39 to 60 years. The precipitating factor in three was a dental procedure, and the illness was a prolonged, chronic one, with symptoms having been present 10 to 18 months before diagnosis. The other patient had a late prosthetic valve  endocarditis and had had symptoms for only 3 months. Three patients were cured; the fourth died after 32 days of adequate therapy and what was considered a bacteriologic cure. Because of the pronounced fastidiousness of these bacteria, in vitro susceptibility tests could be done in only two of the four; the minimum inhibitory concentration for penicillin G was 0.07 microgram/ml in both. The therapeutic regimens were penicillin G plus streptomycin in the first case, predominantly penicillin G alone in the second, penicillin G for 2 weeks in the third, and ampicillin for 4 weeks in the fourth (prosthetic valve case) in addition to valve replacement. Clinical and laboratory experiences in the total reported cases lead us to believe that 3 weeks of therapy with penicillin G or ampicillin alone is adequate therapy for C. hominis endocarditis of natural valves.


Chondrosarcoma of the manubrium. Resection and reconstruction with pectoralis major muscle. Chondrosarcomas of the sternum are best treated by resection with tumor-free margins. Reconstruction of the manubrium and superior aspect of the sternum is one of the most difficult challenges for the reconstructive surgeon. In the past, most of the structural stability following resection of this area has depended on the formation of dense fibrous tissue and scar. We presented a case of reconstruction of the bony defect with autogenous bone grafting in conjunction with transposition of the pectoralis major muscle for increased protection and stability of the chest wall as well as for nourishment for the bone graft.


Neural and endocrine development after chronic tryptophan deficiency in rats: II. Pituitary-thyroid axis. Long-Evans female rats, 21 days of age, were weaned and placed on a control (Purina Rat Chow) diet, on a tryptophan deficient diet (T-) and on a diet complete in quality (Purina Rat Chow) but restricted to the daily amount consumed by the rats on the T- diet (pair-feeding). All animals were maintained on these diets for 1 and 2 months and then one group of T- rats was returned to the complete (Purina) diet and kept on this diet for several periods of time (up to 2 months). Growth was interrupted during the period of tryptophan deficiency and pair-feeding, but was restored to normal when the animals were returned to the Purina diet. In control rats, blood levels of TSH, T4 and T3 as determined by radio-immunoassay showed characteristic development patterns. In T- rats, hormonal developmental patterns were similar to those of controls after 1 month on the T- diet but levels fell significantly below control values after 2 months. On the other hand, hormonal levels of pair-fed rats were already significantly low 1 month after treatment and continued to remain low after 2 months. The decrease in thyroid function reported in these experiments as a result of severe dietary restrictions not only may explain the retardation of growth and development characteristic of nutritionally deficient animals, but also suggest some long-term interaction of nutrition and thyroid function on the aging process.


A look at the basic correlates of longevity: is longevity a superficial trait? Nature appears to have distributed life spans, whether long or short, entirely upon the possession or non-possession of a few physiologically superficial characteristics, namely, immunity of mature, full-sized specimens from the effects of: (1) predation, (2) competition, (3) fire, (4) disease, and (5) the existence of a definite usefulness for long life spans in bridging lengthy periods unfavorable to the reproduction and/or maturation of offspring. Extremely strong correlations are presented in proof of the above relationships. Since longevity mechanisms can closely correlate to superficial traits, it is unlikely that they comprise an integral part of basic structural or biochemical processes. In the case of trees, all five of the above traits are apparently required for the achievement of potential life spans in excess of 1000 years. By contrast, the longest live animal species appear to fully possess only (1) and (3) of the five prerequisite traits above. This observation may fully account for the fact that maximum life spans of trees are 30-40 times greater than those of the longest lived animals.


Accumulation and identification of lipofuscin-like pigment in the neurons of Bulla gouldiana (Gastropoda: Opisthobranchia). A few reports suggest that pigmented granules found in molluscan neurons accumulate with age as do lipofuscin granules in vertebrate cells; however, no reports on molluscan neurons include detailed descriptions of granule accumulation or histochemical tests to identify the pigment as lipofuscin-like. In this study light microscope observations of living ganglia from 1.7, 2.7, and 3.0 cm and larger (shell length) sized Bulla gouldiana showed an increasing accumulation of orange-red pigment in the perikaryon corresponding to increasing shell size (i.e. age). With the electron microscope similar results were obtained, and lipofuscin-like granules were seen in the nerve cell cytoplasm of veliger larvae and in all adult sized Bulla. Staining with Sudan black B, Nile blue, chrome alum hematoxylin, PAS reagents, and exposure of the neurons to u.v. light to observe subsequent autofluorescence, yielded positive results in the areas of pigmented granule accumulation. Thus, the brillant orange-red granules that accumulate with age in the peripheral cytoplasm of adult Bulla neurons, and which are probably also present in larval stages, chemically resemble the lipofuscin granules of vertebrates. Similarities and differences between molluscan pigmented granules and vertebrate lipofuscin granules, in relation to structure and mechanisms of development and accumulation, are discussed.


[Problems of strumectomy from the ENT viewpoint]. During surgical ENT-treatment of the neck often operations including the goitre have to be performed. The reason for interferance is the mechanical obstruction of the air and food passage and not a functional leason of the gland. The problems of strumectomy connected with surgical treatment of tumors, with dystopic thyroid tissue and with the stenotic trachea are shown. Possibilities to preserve damage to the recurrent nerve and to restitute a sufficient glottic with in case of palsy are discussed.


[Goiter from the ENT viewpoint].

[Goiter from the ENT viewpoint]. Patients with struma have to submit a complete ENT-examination, audiometry included, indispensible for operative indication or contra-indication. The usual labor-parameters, the indication for operative therapy, drugs, and radiological measures are mentioned briefly. The drug-prophylaxis must be continued through the whole life. Case report with an improving influence of a hypothyreotic hypacousis by substituting therapy.


[Is the prophylactic hemithyreoidectomy indicated in radical neck dissection? (author's transl)]. To find an explanation for tumor-recurrences around the tracheostoma, in 59 cases of squamous cell cancer of larynx, hypopharynx, oropharynx and tongue the ipsilateral hemithyreoidectomy was included into the tumorexstirpation and radical neck dissection. This histological work up of the thyroid showed no evidence of metastases within the gland. However in cases of extended metastasis or difficult surgical approach to the prae- and paratracheal areas the hemithyreoidectomy is advised.


[Clinic and therapy of the lingual thyreoid (author's transl)]. A case of a lingual thyreoid without any orthotop thyreoideal tissue is presented. Dystopia of thyreoideal tissue is due to disturbances in the embryological development of the thyreoid gland. The clinical picture, diagnosis and differential diagnosis, therapy and prognosis are discussed in regard of cases of literature.


[Phoniatric therapeutical possibilities for paralysis of the vocal lips in paramedian position following a strumectomy (author's transl)]. The phoniatric-logopedic therapeutical possibilities and results of the two most frequent causes of paralysis following a Strumectomy are presented here. The major aspect of this treatment is the application of electric therapy. Its correct usage will be explained. This "conservative" therapy should precede every operative measure and should follow again once the wound has healed. A new post-operative phoniatric therapy method following Glottis widening surgery will also be described. This therapy is based upon the functioning of the Ventricularis muscle, which operates independent of the Recurrens nerve. Furthermore, this therapy functions independent of the operation methods and leaves the natural vocal cord phonation intact, despite vocal cord paralysis.


[Medicolegal consequences of a recurrent nerve palsy after thyroidectomy. (Including a contribution on the function of the medical expert) (author's transl)]. An Ear, Nose and Throat surgeon was accused because a unilateral recurrent nerve palsy arose after a thyroid operation. The patient was making unreasonable financial claims. The otolaryngologist who provided the medicolegal report recognised that the whole personality of the plaintiff should be assessed by an additional neuro-psychiatric examination. The reporting specialist concluded that she was suffering from an involutional depression and that her symptoms and complaints against the surgeon were attributable to her depression and not to the operation. The facts of the litigation, medicolegal details and judgement rejecting the indictment are presented. The possibility of a reverse "malpractice suit" is discussed by the authors.


[The "negative" SISI-test (author's transl)]. The SISI-test has gained increased recognition during the past few years and can now be considered as the most important recruitment hearing test. In addition to the positive, negative and not determinable result there are frequent cases of incorrect negative interpretation. A "negative" SISI-test can be the result of insufficient or excessive hearing loss, missing adaptation, pathological threshold shift, aggravation, psychogenic deafness, cerebral sclerosis, imbecility etc. A negative result always requires additional audiometric differential-diagnosis.


[Quantitative results of the brainstem audiometry in middle ear, cochlear, and retrocochlear hearing damage (author's transl)]. After a discussion of the technique and validity of the objective audiometry using acoustically evoked brainstem potentials, we demonstrate the shape of potentials at various locations of the scalp. We compare the objective findings for middle and inner ear hearing losses with the subjective audiogram. Disturbances in the middle ear are marked through a letency shift corresponding to the hearing loss with normal bone conducted reaction. When the cochlea is damaged we notice a quick decrease in amplitude from the loudnesscompensation to the threshold with normal latencies. As examples for retro-cochlear damages we give the cases of a child, retarded after encephalitis, of an infant and of a patient with stato-acoustic neurinoma, whereby also the cochlear, subcortical and cortical potentials are evaluated.


[Multivariate variability investigations of acoustically evoked slow potentials (AEP) (author's transl)]. By means of the multivariate variance analysis the ratio of intra- and interindividual variability of the AEP--time function was investigated. 90 AEP from 9 normal hearing persons (10 AEP from every person, averaging sessions spread over 10 weeks) were analyzed. The 10 AEP of every person were treated as a random sample. A multivariate pair comparison (single comparison between samples) on the basis of 12 variables (time points) showed only for 1 out of 36 sample pairs no significant differences between the sample averages. By applying the discriminant analysis false classifications resulted only for 7 out of the 90 AEP (approximately 8%). These facts mean, that even throughout the time of 10 weeks the intraindividual differences of the AEP--time behavior are significantly smaller than the interindividual ones.


[Teratoma in the maxillary sinus (author's transl)]. Report is made about a patient, with a malignant first sized teratoma of the nasillary sinus, which extended to the orbit. The tumor has been removed surgically one year before and the patient is free of symptoms.


The psychodynamics of terrorism.

The psychodynamics of terrorism. The authors propose a dynamic and social explanation for the 'malignant aggression' of the terrorist. No specific terrorist character is to be looked for. Rather, terrorism can occur whenever political conditions provide social legitimation for the acting out of deeply repressed hatred. The origins of this hatred lie in parental abuse, leading to murderous rage in the child, which must be deflected onto safer targets than the terrifying parent, such as the parent's enemies, or the authorities of one's country. Political terrorism therefore involves the exploitation of mental illness, connived at in turn by the international public through the media.


Some requisites of community residential practice models. This paper seeks to ascertain the major requirements for practice models in community-based treatment programs. Particular concern is directed toward adaptation of current therapeutic models to community residential practice (foster homes, halfway houses, group homes). Standards for assessing the appropriateness of existing therapies for adaptation to practice in community programs are identified.


Child abuse in terms of a public health model. A public health model for child abuse has been developed to assist in investigating and understanding the multiple factors in causation of the problem and in designing appropriate intervention strategies. The parents responsible for abuse of the child are viewed as the host, the physical and social setting in which the abuse occurred as the environment, and the child is seen as the agent. The vector is conceptualized as influences affecting relations between host and agent. Intervention strategies relate to identification of high-risk parents, high-risk environments and high-risk children, as well as development of non-specific approaches applicable to all three.


No speak much English: (or how I stopped worrying about the theory and began treating the indigent Greek). A group comprising lower-class Greek immigrant patients with chronic psychiatric illness has been conducted for over three years. The barriers of language, culture and class have been overcome. An analysis of these barriers, as demonstrated in the group, is provided. Contentions about the effects of culture on psychopathology and treatment are discussed.


Culture, personality, and behavior: a field study in Jerusalem. In the setting of Jerusalem's Eastern-Jewish immigrant communities, the author tests the hypothesis that non-Western societies have a theory of disease causation which is at variance with a Western model. What emerges from participant observation, informal interviews, and a formal questionnaire supports the hypothesis, reveals changing attitudes over time, and identifies a category of disease-causation which merits further investigation. These observations may be valuable in the identification of epidemiological aspects of disturbed behavior associated with supernatural beliefs.


Teaching literature through creative drama--an aid in the development of 'balanced expression. An experimental method using literature as a creative and acculturating instrument is described. Universal 'social models' are elicited from literature which are used in the learning process by students through their application to situations they personally experience. This assists in the expansion of their creativity and personal socio-cultural development.


Suicide prevention in Great Britain.

Suicide prevention in Great Britain. An account is given of a unique, national suicide prevention movement. Random study of over 2,000 adults in 1975 showed a 92% level of knowledge and a highly favourable 'public image'. This supports the suggestion that the Samaritans have contributed significantly to the one-third suicide reduction in Britain since the movement was nationally organized.


Nurses' rejection and acceptance of patients. A study of a chronic hemodialysis unit. A questionnaire used to study the phenomenon of rejection of psychiatric patients by the staff was applied to the nurses of a chronic hemodialysis unit. The main findings of the present study are: (a) High emotional involvment of staff in patients. (b) The tendency to reject was much stronger when compared to the staff of the psychiatric unit. (c) The nurses' tendency to reject patients did not correlate to personality measures used in the study (ATDP and Rotter). (d) Although the amount of rejection varied between the nurses, there was a very definite team opinion about which patients are accepted and rejected. (3) Two factors seem to influence the acceptance/rejection of patients by the staff: patient's adjustment and patients' actual behaviour in the unit. It was suggested that the high involvement as well as high rejection found in the staff is one of the main sources of stress for the nurses. It was further suggested that some of the hostility is caused by frustration of nurses' expectations about patients' adjustment and behaviour.


The dilemma of traditional childhood education in Africa, south of the Sahara. This paper is based on the thesis that a community approach to childhood and child-rearing practices has serious implications for the mental rehabilitation of children born into such a community. Examining such traditional views of childhood and child-rearing practices in an African context, the writer emphasizes that social, religious, economic, and political contacts with Europeans and Arabs, particuarly since the nineteenth century, have radically altered the African Community's view of childhood and child-rearing practices. For instance, socio-educational problems that no one ever thought of in an African traditional perspective are on the increase: abandoned children, delinquent children, broken homes, child stealing, weakening of the mother-child bond, abortion, family planning, etc. These changes are happening to the dismay (not without protest) of Africans who are still guided by traditional African value systems. The paper concludes with the dilemma: How can the Africans advance with the rest of the world, economically, politically, educationally, and socially, and at the same time maintain and preserve their traditional value systems with minimum maladjustment to their mental health?


The optimum principle in community psychiatry. In community psychiatry, just as in dynamic psychotherapy, aiming too high may be just as ineffective as setting too minimal goals. In this article, causes and effects of maximalistic and minimalistic attitudes in therapists, community workers and their patients are discussed. The optimum principle and the optimal preventive and therapeutic approaches are presented at a theoretical level. Three clinical examples, where therapeutic techniques based on the optimum principle were applied, are described in detail.


Student-constructed examination items.

Student-constructed examination items. Student-written items were compared with teacher-written items on an objective examination given to first year medical students. While student scores were higher on the student-written items than on teacher-written items, there was a positive correlation between the scores. Student items did not differ from teacher items in the course, according to student ratings of emphasis. As a by-product of this study, correlations were found which suggest that student scores on an item often reflect the degree of teaching emphasis given the content area of the item rather than the inherent difficulty of the content. It is suggested that further research is needed to determine whether students learn through the process of writing examination items. Therefore, if the process proves to be educational, this study indicates that it will be feasible to incorporate the student-constructed items in examinations.


The continual assessment of medical students. At the new Medical Faculty at the University of Dar-es-Salaam (East Africa) a number of innovations were instituted. The most significant was continual assessment of students. During the first 3 years of the course, results of weekly testing may comprise three-fourths of each student's assessment. Later they are assessed on each rotation and clerkship; and these must be completed satisfactorily before Final Examinations are taken. These assessments never contribute less than one-half of the final results. Failures were reduced from 10 to 2% with no reduction in standards or performance levels. The method utilizes Reinforcement Theory techniques; specifically referred to are schedules of testing, grades as reinforcers, and frequent feed-back for students, self-shaping of study strategies and for constant surveilance of its teaching by the Faculty.


An evaluation of a course for undergraduate teaching of general practice. This paper presents an evaluation of the undergraudate fifth year course of teaching in general practice in the Queen's University, Belfast. Two Modified Essay Question papers were randomly selected from those used for some years past in the Department of General Practice, as learning aids and class tests. These were administered to twelve randomly selected groups of students before and after completion of a five week course of teaching. Results show that the composite mean MEQ scores doubled between pre- and post-course tests. The correlation coefficients tabulated do not indicate that the marked improvement in mean scores before and after the course in general practice was influenced to any extent by knowledge acquired in other disciplines. The overall findings clearly establish the value of small group clinical teaching of general practice based on a problem orientated approach to learning. They suggest that the intellectual skills and attitudes required in the 'holistic' approach to problem solving in general practice may differ in some ways from the skills required in specialized areas of medicine. The evaltion justifies the time spent on clarifying the undergraudate educational objectives.


Verbal communication in medical instruction. Thirteen teachers lecturing to first and second year students at the University of Rochester, School of Medicine and Dentistry were studied. The investigation was designed to identify aspects of teaching, through the use of:(1) questionnaires to students; (2) questionnaires to the teachers; and (3) by means of a classroom interaction analysis instrument, the Sequential Analysis of Verbal Interaction (SAVI). The findings showed that few among possible categories of expression were used in lectures. The categories most frequently recorded were Description, Opinion, and Proposal. Two teachers were identified as expressing more Opinion than the others, and two other teachers were similarly identified as having a more descriptive style than the others. Both teachers who were found to use Opinion often were for the most part regarded by the students as being less effective. One teacher who was found to use Description most often was one of the best regarded teachers.


Effective combination chemotherapy of adult malignant histiocytosis (histiocytic medullary reticulosis). Adult malignant histiocytosis, also known as histiocytic medullary reticulosis, has been, in the past, considered a very aggressive disorder usually resistant to chemotherapy. Management in the past has included either single agent therapy or splenectomy. Recently, several cases have been reported that have responded favorably to combination chemotherapy. This paper reports on our experience with combination chemotherapy for this disorder. Of three patients treated, all three responded with a complete remission and two remain alive and free of disease at the present time. The outlook for patients with this diagnosis appears to be changing favorably with the advent of new treatment regimens.


Optic neuroretinitis in association with BCNU and procarbazine therapy. A 53-year-old man with multiple myeloma and plasma cell luekemia developed severe, acute bilateral optic neuroretinitis 8 days after chemotherapy with BCNU, procarbazine, cyclophosphamide, and prednisolone. He showed some return of function over the following 6 weeks before his death. Both BCNU and procarbazine are known to cross the blood--brain barrier. Procarbazine is known to interfere with neurological function. BCNU has been reported to transiently interfere with vision and, although this patient had highly morbid disease, the onset of optic neuroretinitis 8 days after combination therapy with these 2 drugs raises the possibility that one or both in combination may have been the cause of the optic neuropathy.


Calcinosis in nonparathyroid malignant disease: an unusual case report and clinicopathologic review of 17 cases. An unusual finding of systemic calcinosis in a patient with a nonparathyroid malignant neoplasm stimulated us to do a sclinicopathologic review of similar cases at our institution in the past seven years. Of 3,268 autopsies performed from 1968 to 1975, a total of 17 cases of calcinosis were found, 11 with solid tumors and 6 with hematopoietic neoplasms. Calcinosis was most prominent in the lung, kidney, heart, and stomach and was rarely discovered prior to death. Eighty-two percent of the patients had hypercalcemia and 53% had associated bony metastatic disease. Corticosteroid or phosphate treatment for the hypercalcemia may have contributed to the tissue deposition of calcium. Significant hepatic, renal, metabolic, and pulmonary dysfunctions were also associated with this disorder. Thirty-six percent of the patients had hypercalcemia without skeletal involvement; tumor-produced parathormone-like substances may be responsible for these calcium abnormalities. Calcinosis was a significant complication of neoplastic disease in these patients and contributed to morbidity and mortality.