A technique for the direct observation of the unanesthetized fetal sheep. A method is described for the chronic implantation of a lucite window in the uterus of a pregnant ewe which allows direct access to the amniotic fluid compartment in the unanesthetized state. The window can be directly connected to an extrauterine viewing compartment allowing repeated observations and measurements of physiologic function. The compartment also provides an easy method of changing the fetal environment.


Plasma levels of norepinephrine during the periovulatory period in normal women. Further studies. Eleven normally cycling women in whom laparotomy was indicated for benign gynecologic pathology were studied. Surgery was performed on day 0 (expected day of ovulation). Blood samples were drawn daily from day -8 to day -4, and every 8 hours from day -3 to day +2; estradiol (E2), progesterone (P), norepinephrine (NE), and LH were determined by RIA. Ovulation was certified by ovarian visualization and biopsy during laparotomy. In nine ovulatory patients mean E2 peak was found 48 hours before LH peak. Mean NE levels showed minimal variations until 48 hours before LH peak; 8 hours after E2 peak mean NE values increased significantly, fell 8 hours later, and rose immediately again, reaching maximal levels 24 hours after E2 peak. These values remained high until 16 hours before the LH peak and decreased gradually, thereafter reaching basal levels 32 hours after LH peak. Two anovulatory patients showed an atypical pattern of ovarian steroids and LH secretion and NE showed large variations without any correlation with estradiol or LH levels. This study confirms previous findings in women and experimental work in animals regarding the existence of a noradrenergic trigger mechanism to the LH ovulatory discharge.


Comparison of women seeking early and late abortion. The differential characteristics of 697 women desiring induced abortion were studied according to when in pregnancy they presented. Age, marriage, and level of formal education were inversely related, those with greatest delay tending to be young, unmarried, and minimally educated. Religion was relevant, but generally was not. Nulliparity was only a weak correlate of delay. Contributory factors of denial, ambivalence, fear, and preceding menstrual irregularity accounted for two thirds of cases; they were uniformly distributed over the range of gestational age, but constituted the greatest proportion of reasons among those delaying decision longest. Physician delay and laboratory error accounted for all but one tenth of the remainder; they were concentrated particularly among gravidas presenting for care in the early part of the midtrimester. Fear characterized the young, poorly informed noncontraceptors, and had the greatest relative impact in protracted delays; denial was more likely to be found among older and ostensibly better informed women.


Evolution of the Gynecology Teaching Associate: an education specialist. The traditional pelvic examination instruction methods were reviewed and found to be deficient: the student learning experience was compromised by the triangular setting of patient, student, and instructor for early pelvic examination instruction. Over the past decade, a new education specialist, the Gynecology Teaching Associate (GTA), has evolved to help improve the initial gynecology teaching experience. The evolution of the GTA is described. The qualities she brings to the instructional system include sensitivity as a woman, educational skill in pelvic examination instruction, knowledge of female pelvic anatomy and physiology, and, most important, sophisticated interpersonal skills to help medical students learnin in a nonthreatening environment. Reinforcement learning theory is the foundation of this educational system. Student acceptance of this system is documented.


The importance of cauterization to maintain a healthy cervix. Long-term study from a private gynecologic practice. A total of 13,897 patients from a private gynecologic practice were retrospectively analyzed with special regard to the benefits obtained from hot linear cautery. This has been performed as an office procedure since 1937, providing unique long-term follow-up. The exposed cervical transitional zone and mild, atypical, or dysplastic cervical cytology were so treated in 6,364 patients. A significantly higher percentage of carcinoma in situ and invasive disease was found in the noncauterized cervices. With the trend of cervical intraepithelial neoplasia (CIN) toward development at an earlier age in today's population, the importance of office cauterization in preventing cervical cancer becomes apparent.


Stage IB carcinoma of the cervix, the Norwegian Radium Hospital, 1968-1970: results of treatment and major complications. I. Lymphedema. Different methods of treatment have been debated over the years for Stage IB carcinoma of the cervix, especially in view of the results and complications. We have reviewed the experience of the Norwegian Radium Hospital for carcinoma of the cervix, Stage IB, for the years 1968, 1969, and 1970; most of the patients receive preoperative intrauterine and intravaginal radium, followed by radical hysterectomy and pelvic lymphadenectomy; if the nodes are involved, they also receive external pelvic irradiation. During this period, 437 patients had Stage IB; the 5 year survival was 80.2% (not corrected). We focused our attention on lymphedema following such a method of treatment; of 402 patients operated upon, 23.4% developed lymphedema ranging from mild to moderate to severe; 20 patients (5%) had severe lymphedema; factors involved are analyzed.


Clinical estimation of gestational age: rules for avoiding preterm delivery. Reliable knowledge of the duration of pregnancy prior to birth is often of crucial importance in making obstetric care decisions. Laboratory methods for estimating fetal maturity have received considerable attention, but the usefulness of historical information has only rarely been addressed. In order to examine the value of clinical estimators of fetal gestational age (GA) in 690 pregnancies, the correlations of menstrual history (LMP), first unamplified audible fetal heart tones (FFH), and quickening (Q), with GA, based on the modified Dubowitz examination at birth, were examined. Evaluation of each of the data sets used alone reveals that in order to be 90% certain that an infant will be mature at delivery (greater than or equal to 38 weeks), a reliable LMP must have been noted for 42 weeks prior to birth, the FFH heard for 21 weeks, and Q felt for 25 weeks. These findings suggest that carefully obtained historical and physical examination information remains a cornerstone of appropriate obstetric care.


Cytologic evaluation of the endometrium in women with postmenopausal bleeding. The records of 143 patients who had postmenopausal bleeding and underwent diagnostic curettage were reviewed. Of these patients 69% had benign endometrial tissue and in 8% there was insufficient tissue for histologic interpretation; 23% of the patients had endometrial carcinoma. In order to ascertain if endometrial cytology could predict which patients which patients may be harboring endometrial carcinoma, a prospective study was carried out on 69 patients complaining of postmenopausal bleeding. Prior to curettage, an endometrial cell sample was obtained with a disposable endometrial cell sampler. The preliminary data indicate good correlation between endometrial cytology and histology. There was one false-negative cytology report and one false positive report. Such a technique could eliminate an endometrial curettage in those patients in whom there is no clinical suspicion of endometrial carcinoma and the cytology is negative.


Reoperation after initial treatment of endometriosis with conservative surgery. One hundred and fifty-three patients with pelvic endometriosis met the study criteria of inferility, tissue diagnosis, treatment with conservative surgery, and adequate follow-up. The extent of disease was classified according to Acosta and and associates. Pregnancy rates were 10 to 100% in various subclassifications of patients; these pregnancy rates were related to the extent of disease and the existence of concurrent inferitility factors. One hundred and seventeen patients were followed up for three years. Reoperation in this group was carried out in 28 patients for recurrent pain and/or persistent infertility. Each patient had diagnostic laparoscopy preceding relaparotomy. The reoperation rate was 40.6% in those patients who remained infertile, whereas this rate was only 3.7% in those patients who conceived following initial operation. The incidence of conception after a second conservative procedure was 12%. However, an equal number of patients in this group required total abdominal hysterectomy as a third procedure for control of recurrent pain. Thus, repeat conservative surgery should play a secondary role in the treatment of patients with infertility and recurrent endometriosis.


Surgical management of urethrovaginal and vesicovaginal fistulas. This report reviews a 50 year period during which 157 vesico- and 24 urethrovaginal fistulas were managed. Although the etiologic factors have changed, there has not been a dramatic decrease in the incidence of this complication. In the last 17 years we have noted an increased number of both types of fistula, primarily related to the increased frequency of gynecologic operative procedures. Only 11 (6%) of the fistulas reported in this series resulted from surgical procedures performed in our department. In this series 96% were repaired vaginally but the abdominal approach was used for certain complicated fistulas. Our initial cure rate was 89% and the final success rate in 157 vesicovaginal fistulas was 94.3%. The urethrovaginal fistulas represent a special problem because of the location, scarring, and lack of sufficient fascia for a second-layer closure. In such instances we have successfully used the bulbocavernous fat pad. The success rate for 24 patients with this type of fistula was 87.5%.


A review of office urethroscopy and cystometry. The authors review the indications and findings of urethroscopic and cystometric examinations carried out on 279 patients. The most common indication was urinary incontinence, stress and urge types. Other indications included dysuria, recurrent urinary infections, and preoperative indications. The most common finding was chronic urethritis. Other findings included urethral stenosis, unstable bladder, anatomic stress incontinence, and urethral diverticulum. Changes in the vesical neck, characteristic of anatomic stress incontinence, were found in 43% of patients who complained of stress incontinence. This resulted in fewer patients being treated operatively. Chronic urethritis was present in 48% of patients with urinary incontinence. Many patients became continent after medical treatment for chronic urethritis. Office urethroscopy and cystometry are invaluable to properly select patients for operative treatment of stress incontinence. Chronic urethritis often will be found to be the source of many pelvic complaints.


Pregnancy and its complications following cardiac valve prostheses. Approximately 100 cases of pregnancy in women with cardiac valve prostheses have been reported in the world's medical literature. In most instances, the need for continuous anticoagulation therapy constituted a major concern in the obstetric management of these high-risk pregnancies, particularly since coumarin has been implicated as causing an increased frequency of fetal wastage or birth defects (or both). Of all women who received cardiac valve prostheses at the Mayo Clinic between 1965 and 1975, 23 conceived 40 times after the procedure. Fetal wastage was more than doubled in women receiving coumarin therapy at conception and during the first trimester, as compared with that in women not receiving coumarin therapy. Fetal wastage exceeded 80% in women with multiple-valve prostheses who received coumarin therapy throughout early pregnancy. There were no serious maternal sequelae in any of the women. One infant of a mother receiving anticoagulation therapy had mild nasal hypoplasia, but there were no other congenital anomalies in which coumarin had been previously implicated.


Correction of muscle imbalance in spasticity. A summary is presented of observations made and results obtained during evaluation and preliminary treatment of twenty-one predominantly spastic cerebral palsied subjects, whose neuromuscular function was studied in each of four positions (supine, prone, kneeling and sitting on the floor) and in three dynamic situations (rising to standing, maintaining standing balance, and ambulating). A description is given of the procedures utilized to; (i) correct the imbalance of muscle tone imposing abnormal "resting" joint positions and limiting the range of their voluntary movements, and (ii) assist them in developing the sensorimotor function requisite for postural stability and voluntary motor control, involving exercises performed in each of the four positions and in transitions between them. Resistance exercises performed with the investigator and independent exercises both were included in the program. Case studies of a six-year-old spastic with "pre-athetoid" tendencies, an 11-year old spastic and a 32-year-old spastic are provided to illustrate typical initial evaluations, therapeutic activities subsequently utilized to improve neuromuscular function, and results thereby obtained.


Uptake of labeled palmitate by the intact liver: role of intracellular binding sites. The multiple-indicator dilution technique was utilized to examine the hepatic uptake of albumin-bound labeled palmitate from the portal vein blood of the pentobarbital-anesthetized dog, in a fasted state and after infusion of a variety of compounds that were expected to bind to Z protein, the cellular cytosolic protein binding free fatty acids, and their acyl-CoA derivatives. Analysis of the data indicates that after infusion of alpha-bromopalmitate, 16-bromo-9-hexadecenoate, and sulfobromophthalein sodium (which also bind to albumin), the palmitate label influx, efflux, and metabolic sequestration (removal of label from the pool of free fatty acids able to leave the cell) all increase and that, after infusion of flavaspidic acid, label efflux and metabolic sequestration increase. In vitro competitive binding studies carried out on the cellular cytosol indicat that the basis for the increase in efflux and metabolic sequestration is displacement of labeled palmitate from high affinity sites on the intracellular Z protein (which are presumably in equilibrium with and may be taken to be representative of other intracellular binding sites). These studies also suggest that increased uptake is due to similar displacement from high affinity sites on serum albumin.


Effect of a bovine hypothalamic extract on glucose utilization by rat adipocytes. This study was undertaken to assess whether a hypothalamic extract has any direct metabolic action on adipose and muscle tissues. An acid bovine hypothalamic extract (HE) was tested for its effect on the utilization of D[U-14C]glucose by isolated rat adipocytes and rat hemidiaphragms. The HE was ineffective in stimulating the conversion of labeled glucose into CO2 and glycogen by rat hemidiaphragm. However, in isolated adipocytes, the HE had significant lipogenic activity. This lipogenic effect was independent of insulin and nonsuppressible by insulin antibodies. The dose-response curve was linear and saturable. That insulin and the HE were not additive at maximal concentrations suggests that they act through a common rate-limiting step, possibly a receptor site. Other hypothalamic substances tested (thyrotropin-releasing hormone, luteinizing hormone-releasing hormone, and substance P) showed no lipogenic activity. Somatostatin (6 microgram/ml) was an insulin potentiator but only when preincubated with the fat cells. It is concluded that the hypothalamic regulation of body weight may be mediated by a neurohumoral mechanism affecting adipose tissue stores.


In vitro and in vivo inhibition of renin by fatty acids. Circulating neutral lipids inhibit the in vitro renin reaction. To identify the inhibitor(s), free fatty acids were added to human renin and homologous substrate. Capric, lauric, palmitoleic, linoleic, and arachidonic acids each inhibited the rate of angiotensin I production in vitro (P less than 0.01). Inhibition by polysaturated fatty acids (linoleic and arachidonic) was less (P less than 0.01) after catalytic hydrogenation of the double bonds. To evaluate an in vivo effect of renin inhibition intra-arterial blood pressure responses to infusions of renin and angiotensin II (5.0 microgram) were measured in anephric rats (n = 6) before and after infusion of linoleic acid (10 mg iv). Mean increase of blood pressure to angiotensin II before (75 mmHg +/- 9) and after (90 +/- 12) linoleic acid did not differ (P greater than 0.05). However, the pressor response to renin after linoleic acid (18 +/- 3) was less (P less than 0.00)) than that before (102 +/- 13). In summary, several fatty acids inhibit the in vitro renin reaction, and in part inhibition is dependent on unsaturation. Linoleic acid also inhibits the in vivo pressor response to renin. These results suggest that fatty acids may modify the measurement of plasma renin activity and may also affect angiotensin production in vivo.


Epinephrine and dopamine beta-hydroxylase secretion from bovine adrenal. The perfusate of the isolated, acetylcholine-stimulated bovine adrenal was studied for epinephrine (E) concentration and dopamine beta-hydroxylase (DBH) activity. Analysis of single stimuli showed that DBH disappeared from the perfusate with a t1/2 of 19.1-29.0 min. whereas E disappeared with a t1/2 of 0.78-1.0 min. Stimulation every 5 min over 105 min caused a gradual decline in E concentration to 36% of its initial value, whereas DBH activity reached a plateau after the second stimulus and thereafter remained unchanged. The decline in E was not influenced by addition of catecholamine precursors and biosynthetic cofactors to the medium and was not accompanied by a shift in the ratios of E and norepinephrine (NE) in the perfusate. Inhibitors of DBH activity were not detected in the perfusate and nonexocytotic leakage of DBH into the perfusate did not occur. These results document the temporal dissociation of the appearance and disappearance of DBH and E after a single stimulus and the progressive dissociation of DBH and E secretion under conditions of prolonged perfusion with rapid and repetitive stimulation. Possible explanations of these observations are offered.


Increased serum growth hormone and somatic growth in exercising adult hamsters. In freely feeding adult hamsters, voluntary exercise induces accelerated somatic growth and increased food consumption that last through several days of retirement. We examined the effects of exercise on serum concentrations of growth hormone (GH) and insulin during ad libitum or restricted intake of food. Serum insulin and GH concentrations were measured by radioimmunoassays in exercising, retired, or sedentary hamsters during ad libitum or restricted intake of food. Linear growth was delayed in food-restricted, exercising hamsters until they were retired and unlimited food consumption was allowed. Serum GH concentrations were increased during exercise and after retirement; serum insulin concentrations were increased only after retirement during both dietary regimes. In food-restricted hamsters, endocrine changes were noted after 4 h of feeding but not after a 14-h fast. We conclude that 1) in adult hamsters voluntary exercise leads to increased secretion of GH even when ingested nutrients are insufficient to support increased growth, and 2) increased secretion of insulin is not related directly to exercise.


Glucoprivic feeding behavior in absence of other signs of glucoprivation. When rats were denied immediate access to food after subcutaneous injection of 2-deoxy-D-glucose (2DG), the glucoprivically induced sympathoadrenal hyperglycemia subsided spontaneously within 6 h. However, if food was returned to the rats 6 h after 2DG injection, they still ate significantly more than after saline control injections. Rats injected with insulin also increased their feeding even when food was withheld until the animals had returned to normoglycemia. Injections of exogenous glucose sufficient to elevate blood glucose concentrations above normal failed to inhibit increased feeding observed when food was returned 6 h after injection of regular insulin. These data show that 2DG and insulin-induced feeding can occur in the absence of overt signs of glucoprivation and suggest that the glucoprivic control may be operable in the day-to-day control of feeding when other signs of glucoprivation are not readily observable.


Bile acid structure and biliary lipid secretion. II. A comparison of three hydroxy and two keto bile acids. The effect of five bile acids on biliary lipid secretion was studied in the pentobarbital-anesthetized cat. The dihydroxy acid, taurohyodeoxycholic acid, was indistinguishable from another dihydroxy acid, taurochenodeoxycholic acid, but secretion of both phospholipid and cholesterol was considerably reduced with two mono-keto dihydroxy acids, tauro-3alpha,12alpha-dihydroxy-7-keto-5beta-cholanoic acid and tauro-3alpha,7alpha-dihydroxy-12-keto-5beta-cholanoic acid. The effect of a trihydroxy bile acid, taurocholic acid was as previously described. The effect of the keto bile acids may be explained by the ability of these bile acids to solubilize lipid, but such an explanation is inadequate for the difference between di- and trihydroxy bile acids. An intracellular effect of bile acid is postulated.


Influence of intrinsic nerves on electromyogram of cat colon in vitro. The electromyogram of the circular muscle layer of the cat colon was studied in vitro in superfused strips of muscle. Records exhibited electrical slow waves and migrating spike bursts, as described previously. Both the neurotoxin, tetrodotoxin, and the local anesthetic lidocaine, (P less than 0.05) prolonged the duration of migrating spike bursts, but migrating spike bursts were not affected by the adrenergic alpha-antagonist, phenoxybenzamine, nor by the adrenergic beta-antagonist, propranolol. Also, physostigmine and atropine did not affect them. Large concentrations of catecholamines did abolish them. This suggests that the migrating spike burst represents periodic release of the muscle from the tonic influence of nonadrenergic inhibitory nerves in the intramural plexuses. Slow-wave frequency and the congruence of slow waves were not affected (P greater than 0.05) by the antagonists listed above, nor by cholinergic and adrenergic agonists. This suggests that the slow waves are not importantly controlled by intrinsic nerves.


Relative rates of tumor, normal gut, liver, and fibrinogen protein synthesis in man. Fractional protein synthesis rates of tumor, normal intestinal tissue, liver, and fibrinogen were measured in a series of patients with gastrointestinal malignancies. Protein synthesis rates were measured by the continuous infusion of 95+% [15N]glycine. Twelve to eighteen hours prior to the clinically indicated surgical excision of the tumor, 1-2 g of 95+% [15N]glycine was infused at a constant rate into each subject. During the surgical procedure, 0.05-2 g of tumor, normal intestinal tissue, liver, and 30 ml of venous blood were obtained. Protein synthesis rates were estimated from the ratio of 15N incorporated into tissue protein to the 15N enrichment of the tissue-free amino acid pool. The major findings were: i) the 15N enrichment of the tissue-free amino acids in malignant tissue was greater than and proportional to that in the corresponding normal tissue (P less than 0.02); ii) tumor protein synthesis rates were greater and proportional to the corresponding intestinal tissue rates (P less than 0.05); iii) the fibrinogen synthesis rate was greater than the liver protein synthesis rate (P less than 0.01), but there was no correlation between them.


Relative rates of gastric emptying of glucose vs. fat in rats fed nonliquid meals. Sprague-Dawley rats were briefly starved, fed various test meals, and killed at measured intervals, and the average fractional emptying (disappearance from stomach) rates for glucose (Kgl) and for fat (Kfat) were determined. The Kgl/Kfat ratio was calculated as a measure of the degree to which the stomach emptied glucose preferentially to fat. The size of the meal affected this ratio, which was 7.6 for a small (0.5 g) meal and 2.4 for a large (2.0 g) meal of a nutritionally complete diet. When test meals contained one of two levels of fat (0.4 and 0.1 g) and of glucose (1.2 and 0.3 g), the high level of fat depressed Kgl and Kgl/Kfat, whereas the high level of glucose depressed Kgl and particularly Kfat and, therefore, raised Kgl/Kfat. Kgl/Kfat was also affected by strain of rat and was reduced almost to 1.0 by mixing the meal into a viscous gel of xanthan gum. In the absence of this gel, the percentage of water existing in stomach contents shortly after the test meals varied between 53 and 79% and was suspected of influencing Kgl/Kfat.


Effects of portacaval diversion on lipid metabolism in rat adipose tissue. Male rats were submitted for 3 wk either to portacaval shunt or to portacaval transposition. In both cases, sham-operated pair-fed rats served as controls. After an overnight fast, insulinemia was similar in all groups, but glucagonemia was significantly higher (by 65%) and serum glucose significantly lower (by 35%) in rats with a portacaval shunt. The lipid metabolism of epididymal adipose tissue was studied in vitro, as well as in vivo. In rats with a portacaval shunt, in vitro lipogenesis from [U-14C]glucose, [1-14C]acetate, or 3H2o was 60-80% lower than in sham-operated pair-fed controls. Twice as much in vitro basal lipolysis could be determined. In addition, in vivo lipogenesis from 3H2O was markedly decreased (6 times). By contrast, in rats with portacaval transposition, in vitro lipogenesis was higher (by 80-140%) and basal lipolysis lower (by 63%) than in pair-fed controls. Thus, even when the nutritional state was taken into consideration, the type of portal diversion was the determining factor in influencing lipid metabolism in epididymal adipose tissue.


Glomerular permselectivity: barrier function based on discrimination of molecular size and charge. The formation of glomerular ultrafiltrate is dependent on the interplay of glomerular pressures and flows as well as the intrinsic permselectivity properties of the glomerular capillary wall. These intrinsic permeability properties serve to exclude macromolecules from the urinary space, based on size as well as net molecular charge discrimination. Neutral dextrans with molecular radii less than 20 A cross the glomerular wall without measurable restriction, whereas dextrans with radii greater than 42 A are almost completely barred. For any given size, negatively charged macromolecules are restricted to a greater extent than neutral molecules. Additionally, positively charged molecules are enhanced in their ability to cross the glomerular wall compared to similarly sized neutral polymers. The concept of a charge barrier, due to fixed negative charges within the glomerular wall, is also supported by morphological studies. Glomerular injury, leading to proteinuria, has been associated with loss of the charge-selective properties of these capillaries. Loss of glomerular fixed negative charges may also result in the foot process fusion and mesangial cell dysfunction often observed in proteinuric states.


Magnesium metabolism in potassium-depleted rats. In rats, a diet depleted of potassium caused a significant hypokalemia and hypermagnesemia, a diuresis and natriuresis, a decrease in urinary and fecal excretion of potassium, a magnesiuria, and a decrease in fecal excretion of magnesium. Balance studies revealed that potassium metabolism was negative in potassium-depleted rats and that magnesium metabolism was positive and higher than in control rats. In potassium-depleted rats, potassium and magnesium contents in muscle were reduced, whereas the sodium level was increased and plasma aldosterone was significantly lower. Therefore, the elevation in plasma concentration of magnesium induced by a diet poor in potassium is the result of a more positive metabolic balance of magnesium and of shifting of magnesium from the tissue into the plasma compartment. Results of additional preliminary studies support the possibility that the hypermagnesemia may be mediated through the depression in mineralocorticoid activity induced by the depletion of potassium.


Contribution of leaked load to solute transport by renal tubules. Renal tubules reabsorb solutes from the glomerular filtrate. The relationship between "filtered load" and reabsorption has been previously discussed and analyzed in detail. One aspect which has not been emphasized, however, is that, when reabsorption of a solute causes its concentration (or activity) in the tubule lumen to decrease below the level in the blood, solute may enter the tubule down this concentration gradient adding a "leaked load" to the filtered load. The leaked load should be taken into account when quantifying tubular transport. In the present study we derived equations for estimating the leaked load and its contribution to transport. The importance of the leaked load of glucose in the rabbit proximal convoluted tubules is evaluated with parameters derived from in vitro perfusion and by solving the equations numerically. It is shown that, depending on the conditions, the leaked load of glucose may account for a substantial part of the glucose present in the tubule lumen and reabsorbed from the tubule. Also, the leaked load could conceivably be an important factor in the transport of other solutes such as lactase and bicarbonate in proximal tubules.


Action of phlorizin on luminal and antiluminal membranes of proximal cells of kidney. In accord with results of others, we have observed that the infusion of phlorizin at low rates (2.16-117 microgram-kg-1-min-1) progressively increases fractional excretion of glucose from 0.47 to 0.85. Further increasing the rate of infusion to 2.19 mg-kg-1-min-1 increases fractional excretion to 1.0. The relationship appears to describe a single function having characteristics of an adsorption isotherm. The metabolism of the kidney, expressed as rate of total CO2 production from all substrates, is modestly and variably reduced by infusion of phlorizin at both high and low rates. The metabolism of glucose, expressed as rate of CO2 production, is variably but not consistently altered by infusion of phlorizin. The oxidation of [14C]lactate derived from [14C]glucose is negligible and introduces no significant error into measurement of 14CO2 from [14C]glucose. The percent of total CO2 derived from glucose does not differe significantly in control periods from the mean of all periods following phlorizin. Accordingly interaction of phlorizin with peritubular membranes at high rates of infusion, in the sense of blocking penetration of glucose, does not occur. Our methods do not rule out nor do they prove adsorption of phlorizin to these membranes.


Renin secretion as a function of renal renin content in dogs. The in vivo and in vitro rates of renin secretion were measured in kidneys from five groups of dogs in which renal perfusion pressure, salt diet, and neural input were varied to cause large changes in renin secretion rates and renal renin content. It was found that both the in vivo and in vitro secretory rates were proportional to the renal renin content. However, in vitro secretion rates were dependent on content up to 100 ng angiotensin I/mg tissue per h. At higher renin contents no increment in in vitro secretion rate was seen. In vivo secretion rate did not appear to reach a maximum until renal renin content was above 250 ng AI/mg tissue per h. The data are interpreted to support the hypothesis that there exist at least two pools of renin. One releases renin at a fractional rate of about 1.5% of the total content per hour. The other releases renin at a rate dependent on the magnitude of the stimuli acting on the kidneys. It is also suggested that the rate of renin synthesis may be a determinant of the basla rate of renin secretion.


Calcium transport across peritubular surface of the marine teleost renal tubule. Isolated renal tubules of seawater-acclimated flounder (Pseudopleuronectes americanus) readily accumulated Ca and Mg when exposed to increased concentrations of these ions. Evidence based on the ability of the tubules to maintain high K levels indicated that the Ca was neither free in the cytosol nor taken up by mitochondria. Two phases of Ca uptake were seen. The fast phase was kinetically complex and not affected by Mg, dinitrophenol, cytochalasin B, or Na-free medium, but was stimulated by ouabain. The slow phase showed Michaelis-Menten kinetics and was inhibited by Mg and dinitrophenol, but was stimulated by Na-free medium, cytochalasin B, and ouabain. The slow phase was also more responsive to changes in bath Ca activity and was thought to be involved with the powerful divalent cation secretory system of these tubules. No correlation between divalent cation uptake and fluid content of the tubules was seen.


Depression of regional blood flow and wall thickening after brief coronary occlusions. The effects of a 15-min coronary occlusion and subsequent reperfusion were investigated in conscious dogs previously instrumented for measurement of left ventricular pressure, dP/dt, regional wall thickening, electrograms, and myocardial blood flow. Coronary occlussion reduced overall left ventricular function only slightly but eliminated systolic wall thickening in the ischemic zone and reduced regional myocardial blood flow in the ischemic zone from 1.04 +/- 0.04 to 0.27 +/- 0.02 ml/min per g and the endo/epi flow ratio from 1.23 +/- 0.04 to 0.44 +/- 0.04, while S-T segment elevation increased from 1.1 +/- 0.3 to 8.2 +/- 0.9 mV. After release of the occlusion, S-T segment elevation disappeared within 1 min while reactive hyperemia in the previously occluded artery and a transient increase in cardiac diastolic wall thickness occurred and then subsided by 15 min. In contrast, systolic wall thickening and the endo/epi flow ratio remained significantly depressed for more than 3 h. Thus reperfusion after a 15 minute coronary occlusion results in a prolonged period of reduced regional myocardial blood flow, particularly in the endocardial layers, which correlates with the prolonged depression of regional myocardial shortening and wall thickening.


Effects of coronary flow reduction on capillary-myocardial exchange in dogs. The effects of coronary flow reduction on tracer capillary permeability surface area (PS) and distribution volumes were studied in open-chest dog preparations. A mixture of 51Cr-labeled red blood cells, 125I-labeled albumin, [14C]sucrose, and tritiated water (3H2O) was introduced into a shunt connecting the carotid and left anterior descending coronary arteries. Sampling from the coronary sinus produced a multiple indicator curve from which [14C]sucrose PS and 3H2O volumes were computed. Curves were observed in control situations and after the cannula was partially clamped. In six dogs, cardiac lymph was collected and analyzed for total protein. Paired comparison of control and flow-restricted indicator curves showed that flow reduction decreased the absolute values of PS and tracer volumes. The ratio of sucrose volume to weight of perfused tissue increased with flow reduction. The ratio of sucrose PS to weight of perfused tissue increased with moderate flow reduction and decreased with severe flow reduction. The results suggest that flow reduction has two effects which competively affect exchange: 1) flow restriction reduces surface area by capillary derecruitment, and 2) the remaining functional capillaries appear to undergo an increase in permeability to small molecules.


Hyperresponsivitiy of spontaneously hypertensive rat to indirect measurement of blood pressure. A chronic, indwelling, tail arterial cannula was implated in conscious undisturbed rats for measurement of blood pressure and heart rate and for obtaining blood samples. As an index of sympathetic activity, plasma levels of catecholamines in arterial blood of conscious animals were assayed by a radioenzymatic, paper-chromatographic procedure. Blood pressures of unrestrained spontaneously hypertensive (SHR) rats in their home cages (161 +/- 3/141 +/- 4 mmHg) were not different from those of pentobarbitol-anesthetized, hypertensive animals but were about 25 mmHg lower than awake animals during the restraint required for the tail-cuff procedure. Basal levels of plasma catecholamines in awake, undisturbed or in pentobarbital-anesthetized animals were similar in age-matched SHR and normotensive Wistar-Kyoto (WKY) rats. SHR rats were shown to have greater increase in plasma catecholamines than WKY rats during forced immobilization or restraint for indirect measurement of blood pressure.


Shear stress and aortic histamine synthesis. Aortic histamine-forming capacity (HFC) has been examined in relationship to the applied mean shear stress intensity created by pulsatile perfusion of rabbit aortas with platelet-free blood for a 1-h period. Mean shear stress intensities ranged from 22 to 109 dyn/cm2. Results indicate that a high correlation exists between the shear stress and the HFC which is described by the regression equation y = 0.28 x -6.1, where y = HFC and x = mean shear stress intensity. Results suggest that the rate of histamine formation is sensitive to the applied shear stress, and that the histidine decarboxylase system of the aorta may have the potential of serving as one coupling agent between applied hemodynamic stress and resultant alterations in aortic wall resistance to macromolecules.


Blood flow distribution in dogs during hypothermia and posthypothermia. Blood flow distribution in tissues of mongrel dogs during hypothermia was studied with radionuclide-tagged microspheres. The animals were cooled at 21 degrees C and rewarmed under thiamylal sodiuni anesthesia. During hypothermia, cardiac output fell to 20% of the control; the highest rate of blood flow relative to normothermic values was observed in the subendocardium of the left ventricle, and the lowest in the hypophysis. Each tissue showed specific reactions to hypothermia. During hypothermia the myocardial and brain-stem blood flows were about 40% of the control; almost all of the digestive tract, striated muscle, adrenal gland, and hypophysis blood flows were maintained at 20% or less of the control. After rewarming, cardiac output recovered to values significantly lower than control. The myocardium, brain, renal cortex, and striated and smooth muscle recovered to control levels; however, blood flow to the digestive organs, bronchial artery flow to the lung, and flow to the endocrine organs did not completely recover by 2 after rewarming.


An accurate and rapid inflation device for pneumatic cuffs. A simple and inexpensive semiautomatic device was constructed and calibrated for rapid and accurate inflation of limb pneumatic cuffs. An automatic timer was designed for use in cuff inflation requiring repetition or exact timing.


Discriminating features of borderline patients. Borderline patients were compared with schizophrenic patients, neurotic depressed patients, and a group of patients with differing diagnoses. The purpose of this comparison was to find out whether borderline patients could be discriminated from other psychopathological groups and whether a discrete list of recognizable characteristics discriminating borderline patients could be isolated. According to the results of the comparison, borderline patients can be discriminated with high accuracy from matched comparison groups with whom diagnostic confusion is common. Seven criteria provided a clinically sensible and practical means of approaching the diagnosis of borderline disorder.


Personality and the prediction of long-term outcome of depression. In a follow-up study of 150 women who had undergone treatment on an outpatient basis for acute depression, it was found that the most important predictor of their long-term clinical outcome (8, 20, and 48 months after the acute episode) was personality as measured by the Neuroticism Scale of the Maudsley Personality Inventory (MPI-N). Age, race, social class, marital status, religion, number of previous depressions or suicide attempts, diagnosis, history of early deaths of or separations from significant others, history of neurotic traits as a child, amount and type of stress in the 6 months before onset, and severity and pattern of pretreatment symptoms were not predictive of outcome.


Side effects in the neonate from psychotropic agents excreted through breast-feeding. Neuroleptics, antidepressants, lithium, anxiolytics, and hypnotics may be excreted in breast milk. Because of the danger to the neonate, drugs such as diazepam, lithium, bromides, reserpine, and opium alkaloids should not be given to lactating women, and barbiturates, haloperidol, and penfluridol should be administered with caution. The side effects produced as a result of breast-feeding of the infant by mothers consuming psychotropic drugs are reviewed and possible preventive measures are discussed.


Parent assessment in research on the vulnerability of children and families to mental disorder. The research methodology for a current study of the assessment of family factors as they relate to the development of psychopathology in high-risk children is described. Factor analysis of preliminary data from 83 families led to the construction of 6 rating scales on the emotional health of the patient, spouse, and child; the family; and the marriage; these should prove valuable in predicting the outcome of the index child and his family.


Explaining the increased arrest rate among mental patients: the changing clientele of state hospitals. The arrest rates of nearly 2,000 psychiatric patients released from psychiatric centers in 1968 and those of nearly 2,000 patients released in 1975 were compared with the arrest rates of a group of 5,000 patients studied 25 years earlier. In general, arrest rates among the two recent samples were considerably higher than general population rates, primarily because of the large proportion of patients previously arrested. Other characteristics related to subsequent arrest were age and admitting diagnosis. One additional finding was that the number of patients with prior arrests had increased markedly over the years.


Causes for the premature interruption of psychotherapy by private practice patients. Thirty patients who discontinued private psychotherapy prematurely were evaluated. Factors stemming from the dynamic interaction between the patient and the treatment process were the most common reasons for dropping out, followed by chronic character traits such as impulsivity and masochism. It is hoped that this assessment of variables in the premature termination of therapy will serve to alert the therapist to the probability that treatment will be aborted, suggest which mechanisms will cause interruption, and enable the therapist to use preventive measures sooner.


Sudden infant death syndrome: impact on families and a direction for change. Until recently, there were no standardized approaches to the diagnosis of sudden infant death syndrome (SIDS), the leading cause of death in the age group of one week to one year in the United States. This has led to confusion among professionals and hardships for parents and families. The Sudden Infant Death Syndrome Act of 1974 provided funding for the dissemination of information, counseling, and education. The author reviews the scope of the SIDS problem, the ways in which it affects families, and mechanisms by which community resources can be mobilized to assist families.


Father-son incest: underreported psychiatric problem? Six families are described in which 10 sons were involved incestuously with a natural father (N=4) or step-father (N=2). Father-son incest as a part of the spectrum of child abuse appears to be a more frequent clinical entity than was thought previously.


Effect of haloperidol and apomorphine treatment on dopamine receptors in pituitary and striatum. Prompted by an interest in the similarity of brain and tuberoinfundibular systems, the authors studied butaclamol-specific neuroleptic and apomorphine binding in pituitary and striatum after chronic haloperidol and acute apomorphine treatment. Striatal binding increases but pituitary binding decreases in haloperidol-treated rats. Pituitary binding changes rapidly in response to apomorphine exposure and striatal binding does not. These findings suggest that factors influencing binding differ in these two tissues.


Psychiatric and neurologic sequelae of infectious mononucleosis. Infectious mononucleosis is usually thought to be a benign disease with occasional neurologic sequelae. Depression, incoordination, a reduction in intellectual ability, and altered EEG patterns were found in two patients; one recovered and the other seemed to have permanent residual effects. The possibility of tranylcypromine as a treatment for the depression and appropriate counselling of patient and family are discussed.


A national survey of resident assessment methods. The authors distributed a questionnaire regarding the assessment of psychiatric residents to 130 directors of residency training programs. Formal examinations were required by 37% of the programs and were being considered by an additional 49%, suggesting that formal examinations may be an integral part of residency training programs within five years. The authors believe that this trend toward utilization of objective measures reflects a growing national concern with accountability in medicine.


The children's psychiatric hospital unit in the community: I. Concept and development. The authors describe a children's mental health unit (CMHU) in a general hospital and cite the need for short- and intermediate-term children's psychiatric facilities within the community. They point out the special need for psychiatric inpatient units for the 3-13 age group and note that in their CMHU the average length of stay and patient turnover ratio compare favorably with adolescent units, which they attribute to the emphasis on diagnosis and treatment rather than long-term rehabilitation.


Extrapyramidal side effects with lithium treatment. The authors neurologically examined 38 patients who had received lithium carbonate for from 3 months to 5 years to determine the presence of extrapyramidal side effects. No patient had received neuroleptics for 3 months before examination. Definite cogwheeling was found in 2 patients. The results confirm previously reported occurrence of cogwheeling in lithium-treated patients.


The poor rich: the children of the super-rich. Because they have little parental contact, many children of the very rich lack self-esteem and clear role models, resulting in shallow values and pathological narcissism. Low self-awareness and the absence of great suffering work against therapeutic progress, as do the efforts of the parents, who may feel threatened, and countertransference feelings of envy or anger by middle-class therapists. A supportive psychotherapeutic relationship is the most likely means of developing trust and self-discipline in these patients.


Cerebrospinal fluid norepinephrine in affective illness. The authors measured cerebrospinal fluid norepinephrine concentrations in manic, depressive, and neurological control patients with and without probenecid administration. Baseline and probenecid norepinephrine values were significantly higher in manic than in depressed patients, who did not differ significantly from the neurological patients. Depressed patients with high levels of anxiety had higher levels of norepinephrine than those with low anxiety. These data suggest that alterations in mood or motor activity may be associated with changes in central norepinephrine metabolism in man.


Evaluation of a slow-release lithium carbonate formulation. A slow-release lithium preparation was compared with a standard formulation in normal volunteers and in patients. Pharmacokinetic parameters of normal volunteers were examined after a single dose of each form and the steady-state levels after a b.i.d. dose of the slow-release form. These initial single-dose data suggested that the two formulations are not bioequivalent. However, the area under the curve of the two forms was similar, and the essentially complete recovery of lithium from urine in steady state indicates equal bioavailability. The patients' steady-state levels for the two formulations essentially confirmed the normal subjects' data: with the slow-release form plasma lithium levels were slightly higher, and the postdose lithium level variability was decreased by as much as 50%.


Impact of neuroleptic chemotherapies on schizophrenic psychoses. The author reviews the impact of neuroleptic chemotherapy on various forms of schizophrenia in the 25 years since the introduction of chlorpromazine in psychiatry. The activities of the different types of compounds are related to the symptomatic and progressive forms of the psychosis, with an emphasis on the "dual structure" of the illness. Problems of drug efficacy, the need for new drug treatments, and methodological issues in research in these areas are discussed.


Cross-sex supervision for cross-sex therapy. The female supervisor can help the male therapist in training to overcome problems in cross-sex therapy by presenting herself as a role model, providing relevant literature, and sharing her own experiences as a woman and as a professional. By enabling the male trainee to identify safely with a woman in a position of relative power, she can help him to deal with the intrinsic limitations of empathy and with other problems, such as "countertransference deafness," that may block his work with female patients.


The runaway center as community mental health center. The runaway centers that evolved in the late 1960s in response to the needs of troubled young people are fulfilling many of the goals of the community mental health center (CMHC) movement. These centers provide their young clients the five basic CMHC services--inpatient services, outpatient services, emergency services, partial hospitalization, and consultation and education--in an individualized and economical manner. They can serve as a model for a variety of community services, such as drop-in centers for troubled individuals, mediation centers for families, shelters for battered women, and residences for people suffering an acute psychotic break.


Psychological treatment of obesity with phentermine resin as an adjunct. The author treated 12 patients who had demonstrated only a minimal response to psychiatric treatment alone for their obesity with a combination of psychotherapy and an anorectic, phentermine resin. Psychotherapy was directed toward developing an awareness of the underlying anxiety related to the problem of obesity and fostering the subsequent ability to change the pattern of overeating. All 12 patients were treated successfully, and 9 reached ideal weight. Weight loss was maintained or additional weight was lost when the medication was discontinued.


Signs and symptoms as predictors of outcome: a report from the International Pilot Study of Schizophrenia. The prognostic significance of signs and symptoms taken individually rather than in diagnostic clusters was investigated in 61 schizophrenic patients seen at 5-year follow-up in the Washington Center of the International Pilot Study of Schizophrenia. Best and worst outcome patients (Ns = 20) were selected on the basis of total outcome score from a reliable 9-item schedule; 21 middle-outcome patients were excluded. Data from these two groups were analyzed to determine which signs and symptoms assessed 5 years previously were associated with outcome. Only restricted affect predicted poor outcome: depression, anxiety, and nuclear symptoms of schizophrenia were not significant predictors. The findings are discussed within the conceptual framework of productive and defect symptoms.


The prevalence of schizophrenia: a reassessment using modern diagnostic criteria. Using strict research diagnosis criteria, the authors found a hospital admission prevalence of schizophrenia of about 6%. Other recent studies yielded similar figures, with correspondingly low figures for the morbid risk of schizophrenia in the general population and in the relatives of schizophrenic probands. In view of the data supporting the validity of this "narrow" concept of schizophrenia, the authors suggest that the true prevalence of schizophrenia is much lower than generally accepted.


Suppression of prolactin by dopamine agonists in schizophrenics and controls. Prolactin levels were determined in plasma samples obtained before and after administration of apomorphine or L-dopa to otherwise unmedicated chronic schizophrenic patients or control subjects. Basal prolactin levels did not differ in these two groups. Suppression of prolactin levels after each dopamine agonist was highly significant. Suppression in schizophrenics was slightly less than in controls following apomorphine and slightly greater following L-dopa. The authors discuss the implications of these findings as well as the limitations of the prolactin regulatory system as an index of dopamine agonist sensitivity.


A controlled study of penfluridol in the treatment of chronic schizophrenia. Twenty patients were treated with penfluridol and 21 with fluphenazine for a period of up to 1 year. Penfluridol, an oral neuroleptic administered weekly was as efficacious as fluphenazine administered twice daily and appeared to be superior to fluphenazine in improving emotional withdrawal and anergia. The low incidence of side effects and other signs of toxicity, coupled with an effective prophylactic activity, suggests that penfluridol is an important addition to our therapeutic armamentarium for the treatment of chronic schizophrenia.


Psychiatric aspects of radiotherapy.

Psychiatric aspects of radiotherapy. The authors evaluated 200 cancer patients, half of whom received betatron therapy and half linear accelerator therapy. The incidence and severity of anxiety and depression were high in both groups; as radiotherapy continued these symptoms tended to decrease in intensity among the patients treated with the linear accelerator and to increase among the betatron patients. Patients who denied knowledge of their diagnosis were initially less depressed and remained less depressed than those who knew or suspected that they had cancer.


Anxiety and depression associated with caffeinism among psychiatric inpatients. Among 83 hospitalized adult psychiatric patients, 22% reported being high caffeine consumers (750 mg or more per day); these patients scored significantly greater on the State-Trait Anxiety Index and the Beck Depression Scale than moderate and low consumers. High consumers described significantly more clinical symptoms, felt that their physical health was not as good, and reported greater use of sedative-hypnotics and minor tranquilizers. Since caffeine modifies catecholamine levels, inhibits phosphodiesterase breakdown of cyclic AMP, and sensitizes receptor sites, association of caffeinism with both anxiety and depressive symptoms is possible.


Psychiatrists and physical examinations: a survey. Alumni from the 1965-1974 psychiatric residency classes at the Los Angeles County-University of Southern California Medical Center were surveyed about their individual practices regarding physical examinations. Ninety-eight of 155 alumni returned the anonymous questionnaire. None of the respondents routinely performed physical examinations on new outpatients. The 61% who had inpatient practices usually delegated the hospital admission physical examination.


Tardive dyskinesia in an adolescent.

Tardive dyskinesia in an adolescent. The frequent use of neuroleptic drugs in the treatment of disturbed children and adolescents demands that clinicians be aware of the danger of tardive dyskinesia in this age group. A case history of a 15-year-old boy who developed incapacitating tardive dyskinesia that resolved during treatment with deanol is presented. The recognition, differential diagnosis, and management of this syndrome in children are discussed. Lithium carbonate was a useful alternative to neuroleptics in managing the adolescent's disturbed behavior.


The medical-student spouse syndrome: grief reactions to the clinical years. Medical students beginning the clinical years experience a change in routine that results in their spouses suffering the partial loss of a loved one. The author describes the way in which the spouses react to this loss as a grieving process with three stages--protest, despair, and detachment.


Paranoid episodes in manic-depressive psychoses. The author reports on 7 patients with a primary diagnosis of manic-depressive psychosis who had brief but well-defined episodes of paranoid symptomatology. These episodes apparently represent alterations of psychic defense structure during the dynamic flow of the psychosis toward recovery. In manic-depressive psychosis, with its genetic and physiologic components, the paranoid episodes reaffirm the unitary nature of humans, in whom heredity and physical and psychological factors inextricably interact.


Thoughts on aging.

Thoughts on aging. Aging has not received attention in proportion to its effect on the life of every individual. Much of society's reluctance to deal with old age results from "ageism," a personal and cultural dread that stems from a view of aging that sees only the negative aspects. If we are to understand human development, we must learn about its outcome, old age. One means of doing this to listen to the reminiscences of old people. Psychiatrists can apply their special expertise in working to overcome ageism. Current and future legislative and research efforts can help identify and resolve some of the economic and physical problems of the elderly and thereby improve the quality of their lives.


Private psychiatric hospitals: "excellence is their watchword". Throughout their history private psychiatric hospitals have been a major force in psychiatry, and their humanistic concern for the mentally ill has resulted in numerous innovations in treatment. Over the past two decades the sharp increase in psychiatric patient care episodes has resulted in a greater reliance on private psychiatric hospitals, and they have reponded by modifying their role, broadening the spectrum of patients served, and developing alternatives to inpatient treatment. In addition to continuing to provide high-quality inpatient care, private psychiatric hospitals in the future should expand various alternatives to such care, explore opportunities for collaboration with other health care systems, and provide more patient services to the underserved.


The illusion of simplicity: the medical model revisited. Traditional medical models have been found to be linear, restrictive, and oversimplified. Only a truly biological model, encompassing evolutionary as well as molecular and cellular biology, can account for the complex origins, forms, and effects of disease, which are illustrated by a discussion of hepatitis B and slow virus disease. An updated biological model of disease takes into account predisposition to disease, the timing and route of infection, multiple disease forms, variable adaptive response, and the role of social and cultural factors and views disease as a failure of adaptation in one or more systems. Its application to psychiatry is shown in a discussion of stress, bereavement, and separation.


Anagram solution speed as a joint function of manifest anxiety and number of category sets. Anagrams constructed from words in 1,2,3, or 4 conceptual categories were administered in random sequences to subjects scoring at the extremes of the Taylor Manifest Anxiety Scale. Scince explicit instructions were given to the subjects concerning the nature of the categories involved, it is assumed that sets for responding with words from these categories were present from the start. The results demonstrate a negative relation of solution rate to number of category sets and an interaction of this variable with manifest anxiety. Anxiety facilitates performance in the presence of a single category set but inhibits performance when multiple sets are concurrently operative. The latter finding is consistent with the drive interpretation of manifest anxiety by Taylor and Spence.


Large auditory and small visual effects in the recall of consonant letters. Eighty-six adults serially recalled lists of visually presented consonant letters similar in auditory or visual features or dissimilar in both feature sets. There were significantly more errors at every auditory list position than at the corresponding visual and neutral list positions, which did not themselves differ. There was a positive correlation between the tendency toward phonetic coding and overall performance, with 75 subjects making more errors on the auditory list than either of the other lists. The eight subjects who made more errors on the visual list showed poor performance in the recall of all lists. Factors governing the perceivability of stimuli apparently do not continue to operate significantly in controlling their recallability, at least in the case of veridical visual input.


A decade of international change in abortion law: 1967-1977. Modern thinking on abortion, reflected in recent legal developments around the world, has turned from concentration upon criminality in favor of female and family well-being. New laws enacted during the last decade are coming to focus upon conditions of health and social welfare of women and their existing families as indications for lawful termination of pregnancy. Regulations governing the delivery of services may be restrictive, however, so as to limit in practice access to means of safe, legal abortion made available in theory. Requirements may be imposed that only medical personnel with unduly high qualifications perform procedures, or that they be undertaken only in institutions meeting standards higher than similar health care requires. Approval procedures may be established involving second medical opinions or committees to monitor observance of the law, which may delay abortions and therefore increase their hazards. Parental and spousal consent requirements may exist in addition with the same effects, or to veto a pregnant female's request. Regulations may be employed more positively, however, to encourage contraceptive practice. A disappointment with legislative reform is that it may fail to improve circumstances if public resources are not applied to achieve the supply of services newly rendered legitimate, and illegal practice may persist.


Genetic counseling as part of hospital care. In order to determine whether genetic counseling was part of routine inpatient care in a medical school affiliated children's hospital, a retrospective review of selected patient charts was performed. The charts of a sample of 478 patients with any of ten specified types of genetic or congenital disorders were carefully studied to document whether the recording of genetic counseling had been given, "offered only," or "considered only." The disorders included were of four types: chromosomal, single gene, polygenic, and those characterized by multiple congenital anomalies, with or without a syndrome designation. One thousand six hundred and thirty-three (4.2 percent) of the hospital's patients had one of the ten disorders, but in the sample of charts studied genetic counseling was given five times and "offered only" twice; in no case was it "considered only." [The authors suggest that under-utilization of genetic knowledge and resources may be remedied in part by incorporation of a formal genetic disposition into hospital discharge protocols.]


Manpower planning for nurse personnel.

Manpower planning for nurse personnel. A technique is described which can be applied to manpower planning for nurse personnel at a state or regional level. An iterative process explores the implications of alternative planning policy decision strategies intended to balance manpower supply and requirements. Impacts of the following policy alternatives are estimated: scale of operations of education institutions; interstate migration patterns; labor force participation rates; and job design of licensed practical nurse (LPN) and registered nurse (RN) positions.


An international look at school-based children's dental services. School-based dental clinics, when well-managed, can bring good quality care to children where they normally congregate, thus avoiding many of the problems found where children must be taken to private offices out of school hours. Both capital and running expenses for primary care can be substantially reduced. Utilization figures for school-based dental services now reach 98 per cent of eligible children in New Zealand, where dental nurses do simple operative dentistry including cavity preparation and fillings. Australia, where a modified New Zealand plan has been expanding for about 12 years, is moving rapidly to attain similar utilization. In Sweden, 95 per cent of the school-age population is reported to receive school-managed dental service through a government program. In the United States, however, it is commonly reported that less than one-half the school-age population receives good periodic dental care.


Reoperation after abdominal trauma.

Reoperation after abdominal trauma. A five year experience with 782 patients requiring laparotomy for trauma is reviewed. Specifically, the 70 patients requiring unplanned reexploration have been studied to delineate the indications for and implications of such repeat laparotomies. The major indications for such reoperation were intraabdominal abscess (45.7 per cent), bleeding (15.5 per cent), peritonitis (12.1 per cent), and small bowel obstruction (8.6 per cent). There were 16 negative reexplorations (13.8 per cent). Overall mortality in the reexplored patients was 21.4 per cent, all victims of gunshot or blunt trauma. Mortality correlated with the number of required reexplorations, being 67 per cent in those requiring four operations. Of the 31 laparotomies performed initially for diffuse or localized intraabdominal sepsis, only 15 were highly suspected, and 13 of these by simple chest x-ray findings. If after laparotomy for repair of intraabdominal trauma a patient fails to meet the anticipated norm of convalescence, a high index of suspicion for early postoperative hemorrhage, or later sepsis, should be maintained. Such patients have far more to gain than lose by reexploration.


Ileorectal anastomosis for ulcerative and Crohn's colitis. Except in the presence of severe perineal suppuration or sphincter damage by previous surgery for fistulas, the rectum was preserved in all patients considered candidates for surgery for inflammatory disease of the bowel. A primary anastomosis with a single-layer 5-0 monofilament stainless steel wire was carried out when a relatively healthy rectum with erythema and granularity presented. For patients with more severe disease of the rectum, a two-stage operation with intensive interval treatment of the rectum stump with topical corticosteroids was carried out. Of a total of eighty-six patients with involvement of the colon and rectum with either Crohn's disease or chronic ulcerative colitis, fifty-six patients were treated by local abdominal colectomy and ileorectal anastomosis. Twenty-four had primary anastomosis and thiry-two had a two-stage operation. One anastomotic dehiscence developed. A mean follow-up of 8.4 years (6 months to 20 years) has been satisfactory. Only three anastomoses have been taken down for unsatisfactory results. With the proper selection of patients and with appropriate treatment of the diseased rectal segment, a large majority of patients with inflammatory disease of the bowel can have long-term salutory results after colectomy and ileorectal anastomosis.


Primary neoplasms of the small bowel.

Primary neoplasms of the small bowel. The treatment of thirty-one malignant and eleven benign neoplasms of the small intestine is reported. The most common symptom was abdominal pain followed by vomiting, diarrhea, weight loss, constipation, and gastrointestinal bleeding. In four cases small bowel perforated. Intestinal obstruction occurred in 31 per cent of patients. Preoperative diagnosis was made in 19 per cent of patients. All eleven patients with benign neoplasms were curatively treated by resection and primary anastomosis. Eighteen of the thirty-one patients with malignant tumors had curative resection, five had palliative resection, and eight had laparotomy and biopsy only. The most common benign tumor was leiomyoma. The most common malignant tumor was lymphoma (67 per cent) followed by adenocarcinoma (16 per cent), carcinoid (10 per cent), and leiomyosarcoma (3 per cent). Twenty-four patients were available for follow up; thirteen remain alive and eleven died, seven within one year and four within two years.


Giant duodenal ulcer: a dangerous variant of a common illness. Giant duodenal ulcers are large posterior penetrations of the duodenum which, when undiagnosed, have a high mortality. Radiographic and endoscopic diagnosis, although not always feasible, enables prompt appropriate management with improved results. Nonoperative treatment is dangerous. Preoperative diagnosis permits planned operative treatment and enables the surgeon to avoid a difficult duodenal dissection. The Bancroft operation, or modification thereof, is the operation of choice. Sixteen consecutive patients with giant duodenal ulcer are described. The success of their treatment is attributed to accurate diagnosis and appropriate operative therapy.


Carcinoma of the papilla of Vater. A review of fifty-seven cases. Fifty-seven cases of carcinoma of the papilla of Vater are reviewed. Clinical and pathologic features as well as results of various surgical treatments are summarized. The Whipple operation may be the operation of choice for cancer of the papilla of Vater, offering a chance for cure and obviating further surgery.


Unsuccessful postoperative extraction of retained common duct stones: an analysis. An analysis of unsuccessful extractions of retained biliary calculi using basket catheters reveals more than half the failures are related to the selection, placement, and size of the T tube. A new T tube has been developed which will improve postoperative access to the common duct and facilitate removal of retained calculi.


Present features of gallstones in Japan. A collective review of 2,144 cases. A collective review of 2,144 patients operated on for cholelithiasis during the last twenty-two months has shown that younger Japanese adults have predominantly cholesterol stones in their gallbladders and that elderly persons still frequently have bilirubin stones not only in their gallbladders but also in their common bile ducts. Recent westernization of dietary habits in Japan is considered to be the most probable factor causing the increased incidence of cholesterol stones. The decreased incidence of bilirubin stones is considered to be caused by the decreased incidence of biliary infection and increased intake of proteins in food.


A new treatment of ischemic bowel disease: steroid delivery via retrograde venous route. The present therapeutic approach to occlusive mesenteric disease is unable to alter its high mortality and morbidity. We attempted to stabilize the intestinal lysosomal population with steroid prior to revascularization and thus reduce the lysosomal effluent. Steroid delivery during the occlusive period was accomplished via retrograde venous flow in the portal system. During revascularization steroid was further infused via the superior mesenteric artery. Our experimental model compared systemic venous delivery with retrograde portal venous delivery of steroid. Analysis of tissue acid phosphatase levels suggested steroid delivery via retrograde portal venous flow is the most efficient method of lysosomal stabilization.


A new method of pancreatic juice collection in the conscious dog. A simplified method for the collection of pancreatic juice in a conscious dog is described and the results of pancreatic secretions in response to both exogenous and endogenous stimulations are presented. This new method, simple to perform and providing easy collection of pancreatic juice, is also applicable to the intraduodenal infusion experiments.


Bedside monitoring of heparin therapy.

Bedside monitoring of heparin therapy. Continuous infusion heparin therapy was monitored in twenty-five patients with simultaneously performed activated partial thromboplastin times and activated clotting times. These data were then compared by means of the coefficient of correlation. Significant correlation is demonstrated between the APTT and ACT in 88 per cent of cases.


Lung resection for metastatic sarcoma.

Lung resection for metastatic sarcoma. Our experience with lung resection in fifty patients with metastatic sarcoma is presented. Seventeen patients underwent lung resection for solitary lung metastasis and thirty-three had multiple metastases. The overall estimated median survival of the patients was 22.2 months. Shorter tumor doubling time was found to indicate poor prognosis. The tumor-free interval, length of the waiting period, and the number of metastatic lesions removed did not influence the postoperative survival rate. Surgical therapy of solitary as well as multiple metastatic sarcoma of the lung appears to produce acceptable therapeutic results.


Pulmonary artery catheterization and thermodilution cardiac output determination in the management of critically burned patients. Pulmonary artery catheterization was performed in thirty-nine critically burned patients. Hemodynamic changes, induced by thermal injury and its therapy, were measured. Pulmonary wedge pressure was found to be a more reliable indicator of circulating volume, whereas central venous pressure was often misleading. Measurements of both pulmonary hemodynamics and cardiac output were necessary to manage patients requiring high levels of pulmonary end-expiratory pressure (PEEP). These measurements enable one to define optimum PEEP levels which provide maximum oxygen delivery to the tissues. Depressed myocardial function was seen in the early phase of the injury. In this period dopamine administration increased left ventricular stroke work index with minimal changes in filling pressures. The usefulness of dopamine in treating this early myocardial depression deserves further study. Catheter-related complications were minimal when the catheters were used for periods of three days or less.


Acute leukopenia during topical burn therapy with silver sulfadiazine. Leukopenia, with a mean white blood cell count of 2,680/mm3, was observed in nine patients with thermal injury early in the course of topical treatment with silver sulfadiazine. All manifested absolute neutropenia with a concomitant increase in immature band forms in the peripheral blood smear. The leukocyte counts returned to within normal limits within 48 to 72 hours of discontinuation of silver sulfadiazine therapy in four patients, and also did so in five patients in whom silver sulfadiazine therapy was continued. Leukopenia secondary to silver sulfadiazine application is currently believed to be an innocuous, self-limited phenomenon.


An evaluation of the wire mesh prosthesis in primary reconstruction of the mandible. A stainless steel wire mesh prosthesis was used as a primary mandibular replacement in 102 patients after resection of malignant neoplasms arising in the head and neck. In sixty-seven patients the prosthesis was considered successful. Failure of the host to tolerate the prosthesis was associated with a history of previous irradiation, extensive resections, and loss of distant skin flaps used for coverage of the prosthesis. We conclude that the wire mesh mandibular prosthesis is an excellent means to accomplish prompt functional and cosmetic reconstruction after mandibular loss and does not preclude the use of a more complex modality of reconstruction if the initial implant is removed.


The evolution of the ileal segment bladder substitution operation. The historical background and events leading to the development of ileal conduit bladder substitution are reviewed. The reported results of twenty-five years experience with the operation are discussed with special reference to the early and long-term complications and risk to renal function. The importance of continued efforts to minimize these risks, especially when the operation is done in children and for benign disease, is emphasized. It is suggested that some of the more promising variations in the operation should be set up as prospective studies in order that meaningful comparisons may be possible in the future.


Breast cancer presenting as renal colic. A unique case of breast cancer presenting as renal colic due to ureteral obstruction is presented. Although antemortem diagnosis has been uncommon, ureteral metastases frequently are found in autopsy studies. Improvements in the management of patients with disseminated breast cancer may lead to more frequent recognition of this problem. Therapy should be directed against the tumor in general, and not specifically against the ureteral lesion unless renal function is jeopardized. Hormonal manipulation is the treatment of choice in patients with estrogen receptor-positive tumors. Ureteral catheterization or urinary diversion should be attempted only in combination with systemic injury.


A surgical technic for high (cardial or juxtacardial) benign chronic gastric ulcer. A surgical technic for cardial or juxtacardial ulcers is presented. The surgical principle consists of resection of the distal stomach including the ulcer in a way that the esophageal mucosa remains intact. Reconstruction of the transit is accomplished by a Roux-en-Y esophagogastrojejunostomy in one layer. A variable portion of gastric reservoir is preserved, and alkaline reflux is highly improbable due to the long intestinal loop. This technic has been performed in six patients with excellent postoperative results. Clinical and radiologic follow-up to three years has shown no esophagitis or strictures of afferent loop syndrome.


A technic for freezing an extremity in preparation for amputation. Freezing of an extremity permits delay in amputation, and the time gained can be devoted to such intensive therapy as may be indicated. A safe, efficient, and convenient technic is described.


Modified Buie amputation for extensive hemorrhoidal disease. Radical anal surgery of the type described for complicated hemorrhoidal and mucosal prolapse has good to excellent anatomic and functional results in 90 per cent of patients. This has been demonstrated in a group of 100 consecutive patients followed for an average of more than two years.


Rapid closure of defects in serosal membranes. The use of surgical clips (Hemoclips) for closure of defects in omentum and mesentery is an efficient and safe alternative to sutures. It avoids the problem of hematoma formation from inadvertent injury of vessels by the needle.


Ketamine infusions. Observations on technique, dosage and cardiovascular effects. A continuous infusion of ketamine, following an initial dose of 1 mg/kg, has been used as sole anaesthetic in over 200 adult patients. The pre-operative use of 4 mg lorazepam has made this acceptable with respect to emergence sequelae and dreams. The technique can be used with neuromuscular blocking drugs and controlled ventilation with air, but here pancuronium is best avoided because of excessive tachycardia and hypertension. Hypertonus was the main problem encountered in the non-relaxant cases. The amount of ketamine required for anaesthesia has been analysed in detail and recommendations on dosage are given. The cardiovascular effects have also been analysed in detail. There is a need for a similar investigation to be carried out in circumstances where inhalation agents are not available and where there is a shortage of anaesthetists.


Two cases of untoward sequelae associated with thiopentone. Two cases of adverse sequelae associated with the use of 2.5% thiopentone are reported: one involved extensive local venous thrombosis at the site of the injection causing great distress to the patient; the other involved a histaminoid reaction in a patient who, like others who have been reported with this type of reaction, had a history of allergy.


Semiconductors in anaesthetic vapour analysis. The use of chemically sensitive semiconductors and their performance during the measurement of the vapour concentration of five volatile anaesthetic agents is described.


Psychological and psychiatric aspects of pain. The relationship of pain to personality and the significance have been discussed. Pain may first be evidence of tissue damage, secondly it may be used as a means of communicating emotional distress to others and thirdly, it may be a means of manipulating others, expressing hostility or relieving guilt. The evidence is clear that an understanding of mental life and its relation to pain is important if this symptoms is to be dealt with effectively, irrespective of whether it is physical or psychogenic in origin.


Suxamethonium pains and early electrolyte changes. Significant changes in the plasma electrolytes were found in a group of ninety-two female patients in the first 5 min following suxamethonium administration. The plasma potassium rose to a higher level in those patients who developed suxamethonium pains than in those who did not; the plasma calcium decreased in the former group, but increased in the latter. The plasma sodium decreased early in most patients, with the greatest reduction in those patients who did not develop symptoms. A decrease in the level of plasma calcium at 1 min correlated well with the incidence of 'the pains'. There were significant differences in the electrolyte changes, depending on whether thiopentone or Althesin was used for induction, but there was no difference in the incidence of suxamethonium pains. Suxamethonium pains are attributed to damaged muscle-spindles with enhanced calcium release playing an important part.


Unexpected metabolic acidosis during rectal surgery. A case is reported in which severe metabolic acidosis developed during rectal surgery in a patient who was normal in all other respects. The possible connection of pre-operative whole gut irrigation with the development of the acidosis is discussed.


Pre-operative approach to patients.

Pre-operative approach to patients. Thorough explanation of an operation can and should be given to a large number of patients. They are selected by a non-leading question once they have been assessed, and given a logical talk with simple drawings. A pilot questionnaire study shows that such a procedure is harmless and reassuring. It is justified as a supplement to the pre-medication but could well be done by other doctors, such as general practitioners or surgeons. Good explanation increases patient's confidence in the surgeon, never undermines it.


Cardiovascular effects of spinal and epidural anesthesia. The cardiovascular effects of epidural anesthesia are complex and are related to the level of anesthesia, the amount of anesthetic injected, the addition of epinephrine to the local anesthetic solution and the clinical of the patient. In general, these results indicate that spinal anesthesia tends to produce a greater degree of cardiovascular depression as demonstrated by the greater fall in mean arterial pressure, cardiac output and heart rate. Thus, at similar levels of anesthesia, spinal blockade produces a greater depression of the cardiovascular system than does epidural anesthesia, which probably reflects a higher level of sympathetic blockade following similar analgesic levels of spinal and epidural anesthesia.


[Concentrations of Bupivacaine in the CSF following subdural application (author's transl)]. The subarachnoid concentration of isobaric bupivacaine following intrathecal injection was determined in 11 patients by periodic sampling. After injection of 15 mg/ml of bupivacaine, the maximal concentration in CSF averaged 284 microgram/ml. The decline was exponential after 240 min a residual concentration of 7 microgram/ml was determined. The area of sensory block was maximal after 20 min regression began from cranial at 90 min, from caudal at 150 min. Bupivacain could not be determined in blood.


[The combination of etomidate and fentanyl as a short acting and introduction anaesthesia in the dog in experimental medicine (author's transl)]. The effects of a combination of etomidate (1.0 mg/kg bw) and fetanyl (0.005 mg/kh bw) on haematology, blood gases, acid-base balance and haemodynamics were investigated in 8 mongrel dogs. The only significant change in haematology was leucopenia. Blood gas values and acid-base balance initially showed a depression of respiration and a tendency to slight metabolic acid dosis. Decreased heart rate caused diminution of cardiac output, while systemic and pulmonary resistance as well as stroke volume were not altered significantly.


[An improved bronchoscope (author's transl)]. This bronchoscope differs from those normally used in the following ways: 1. In the endobronchial position the bronchoscope makes possible improvement in ventilation of the contralateral lung by increasing the area of the side-openings above the bifurcation. - 2. An inflatable cuff on the outer tube seals the bronchoscope against the trachea like a breathing tube. - 3. Jet-ventilation van be employed when the bronchoscope is open.


The effect of metoclopramide on the lower oesophageal sphincter in late pregnancy. The effects of intravenous metoclopramide (Maxolon) on the lower oesophageal sphincter (LOS) were studied in three groups of patients, one group being normal control and the other two being pregnant females, one without heartburn and the other with. Metoclopramide increases the LOS pressure 20.5, 15.2 and 10.2 cm H2O respectively (p less than 0.005, p less than 0.005 and p less than 0.05). These findings suggest that for patients undergoing elective or emergency obstetrical anaesthesia, intravenous metoclopramide may help reduce the incidence of regurgitation of gastric contents.


Studies of d-tubocurarine pharmacokinetics in humans and dogs. The pharmacokinetics of d-tubocurarine was studied in man during single and multiple administrations of d-tubocurarine, and in dogs during single administrations. The simplest model consistent with out data was a two-compartment open model. The mean half-lives for the two phases in the human studies were 8.9 and 123.8 minuts. For the greyhounds these mean values were 2.8 and 77.4 minutes. The animals did not demonstrate a difference between the arterial and mixed venous concentrations of d-tubocurarine.


Some cardio-pulmonary effects of infra-renal clamping of the abdominal aorta. No significant changes were found in heart rate, blood pressure, cardiac output, arterial blood gases or physiological deadspace: tidal volume ratio before and after clamping and unclamping the abdominal aorta below the renal vessels. Nevertheless, drugs should be available to reduct the afterload on the heart if any evidence of myocardial ischaemia appears during the period of aortic clamping. The importance of maintaining an adequate circulating blood volume at all times is stressed.


Radial artery cannulation: influence of catheter size and material on arterial occlusion. A randomized, prospective trial of four different cannulae used for percutaneous radial artery cannulation was carried out in one hundred and forty-eight patients undergoing cardiopulmonary bypass surgery. Arterial occlusion was assessed using a modified Allen's test and an ultrasonic flow monitor. The incidence of complete occlusion eight days after decannulation was 34% for 18-gauge polypropylene and 0% for 20-gauge Teflon cannulae. Both the size and material of the cannula are important factors in the occurrence of arterial occlusion. This complication can largely be eliminated by the use of small Teflon cannulae.


Foetal hypoxia--an anaesthetist's approach to classification and prevention. Nearly one third of perinatal deaths are due to hypoxia occurring during pregnancy and labour. Many factors contribute to foetal hypoxia and in order to group these into orderly categories a classification of hypoxia, which is familiar to anaesthetists, has been applied to the maternal and foetal circulations. This theoretical approach forms a logical guide to our understanding the cause, prevention and treatment of foetal hypoxia.


Case report: digital ischaemia following radial artery cannulation. A case of digital ischaemia following radial artery cannulation is described. The ischaemia developed following three hours hypotension seven days after the radial artery cannula had been removed. Patients with a thrombosed radial artery and a poor ulnar collateral circulation should be identified pre-operatively.


Anaphylactic reactions to gallamine triethiodide. Three cases of severe anaphylaxis to gallamine triethiodide are described. All reported cases of anaphylaxis to gallamine have occurred in women, and all the confirmed cases in Australasia. There is evidnece that women may be exposed to some substance which leaves them sensitive to gallamine triethiodide.


An oxygen failure warning and patient protection system. The Howison Unit. A device is described which sounds an alarm to warn of oxygen supply failure. A the same time the nitrous oxide flow is cut off, and a reservoir in the device provides a continuing oxygen flow to the patient for about a minute. This results in increased inspired oxygen levels temporarily, reducing the risk to the patient while the oxygen failure is being corrected.


Anaphylaxis to alcuronium.

Anaphylaxis to alcuronium. Five cases of severe anaphylactic reactions to alcuronium are described. Investigation suggested that these are probably true anaphylaxis to the drug. The cases illustrate the value of intradermal testing in detecting the drug involved and the necessity of using colloidal solutions and adrenaline in the management of hypotension due to anaphylaxis.


Clinical evaluation of etomidate as an induction agent. A comparative study between Etomidate and Thiopentone was carried out on 100 healthy female patients scheduled for post-partum abdominal sterilization under epidural analgesia. Our results show Etomidate to be a safe and effective induction agent, comparable to Thiopentone in having a rapid onset of action and rapid recovery time. The pulse rates and blood pressures remained relatively stable during the use of Etomidate. However, there was a high incidence of transient respiratory upsets while causing less respiratory depression than Thiopentone. The objectionable features of Etomidate are high incidence of pain on injection and involuntary muscular activity, which account for the low anaesthetist acceptance rate.


Infundibular spasm in Fallot's tetralogy - an account and its management in anaesthesia. The value of propranolol in relieving infundibular spasm is illustrated. The pathophysiology of infundibular spasm in Fallot's tetralogy and its management in anaesthesia is reviewed.


A case of rhabdomyolysis associated with suxamethonium. A boy presenting for oesophagoscopy developed myoglobinuria during convalescence from the procedure. A susceptibility to malignant hyperpyerexia was considered in the differential diagnosis but was felt to be unlikely on the basis of in vitro testing of muscle biopsy specimens. A review of relevant papers suggests that rhabdomyolysis of significant degree following suxamethonium administration may be more common than generally appreciated, particularly in children.


Cortical blindness following hypoxia during cardiac arrest. Two patients with cortical blindness following hypoxic episodes are reported. The characteristics of the syndrome are described. Attention is drawn to the lack of awareness of this complication of hypoxia.


A visual monitor for piped oxygen supply systems to anaesthetic machines. A pressure sensitive recording device for monitoring piped oxygen systems supplying anaesthetic machines is described. The monitor displays a colour change and is powered by pressure of oxygen from the piped oxygen supply line.


An air-machine for infants and children. Modifications to the Jobson Air-machine are described which permit its use in infants and children under three years of age.


No ignition risk with hyperbaric enflurane. A series of experiments was undertaken with Enflurane under hyperbaric conditions to determine whether or not it was explosive under these conditions. No risk of detonation was shown with concentrations of Enflurane up to 5% in either oxygen or nitrous oxide mixtures under conditions of hyperbaria to 3 A.T.A. (Atmospheres Absolute).


Device for humidification and controlled oxygenation during spontaneous breathing. A system for humidification with adjustable flows and oxygen concentrations for use in spontaneously breathing patients is described.


A new intubating forceps.

A new intubating forceps. A new intubating forceps is described. The forceps grip the endotracheal tube from the front and back instead of from the side as do Magill's forceps. The advantages of the forceps are a more secure grasp; improved field of vision; better manipulating ability and reduced likelihood of trauma to tissues or tube cuff.


A technical aid to performance of neurolytic lumbar sympathectomy. The injection of ten ml of air into the retroperitoneal space outlines the anterior margin of the psoas muscle. This been found to be useful, using an Image Intensifier, for the accurate location of needle tips in the performance of neurolytic lumbar sympathectomy.


Progenitor cells of erythroblasts: an in vitro investigation of erythropoietin-responsive cells of guinea pig bone marrow. The experiments were designed to test whether or not erythroblast progenitor cell function could be demonstrated in a morphological cell type designated as "transitional cells." Two cell fractions, were obtained from the bone marrow of normal and polycythemic guinea pigs. One fraction (F1) was enriched in transitional cells and contained few, if any, other cell types which could be considered as candidates for erythropoietin responsive cells (ERC). The other fraction (F2) contained undifferentiated blast cells as well as transitional cells. The effect of human urinary erythropoiesis stimulating factors (ESF) on heme synthesis was compared in these two fractions by measuring 59Fe incorporation into heme. ESF was more effective in stimulating heme synthesis in guinea pig bone marrow cells than homologous sera obtained from anemic or hypoxic animals. The majority of ERC sedimented in F2, but the stimulation index was comparable in the two fractions. It was confirmed by radioautography that the ESF response in F1 was due to the generation of proerythroblasts and basophilic erythroblasts that incorporated 55Fe. The generation of these cells in F1 was dependent on the addition of ESF to the cultures, whereas 55Fe-labeled erythroblasts were recovered from cultured of F2 not supplemented with ESF. ESF induced a proportion of transitional cells to incorporate 55Fe in both F1 and F2. Transitional cells were the only cell type in which heme synthesis was dependent on ESF. in other cells of clearly nonerythroid morphology (mononuclear phagocytes and reticular cells), 55Fe incorporation occurred independent of ESF. Although the fractionation procedure employed is unsuitable for the separation of ERC from bone marrow, it permitted the enrichment of transitional cells, a cell type defined by morphology. Radioautography with 55Fe identified a proportion of these cells as ERC in both F1 and F2 fractions of bone marrow obtained from normal and polycythemic guinea pigs. Although there may be other cell types in F2 capable of responding to ESF, the present studies show that some transitional cells function as progenitors of erythroblasts because they respond to ESF by initiation of heme synthesis and by transformation into the earliest recognizable erythroid cells.


Ultrastructure of the anterior medial glands of the rat nasal septum. The anterior medial glands lying in the submucosa of the rat nasal septum were studied by light and electron microscopy. The glands consist of a single long duct, which is studded with numerous solitary acinar formations connected perpendicularly to the main duct by short intercalated ducts. Proximal acini (those furthest from the stoma of the main duct) consist of typical serous cells with many dense secretory granules and an extensive rough endoplasmic reticulum. The most distal acini consist of cells whose major feature is the enwrapment of each mitochondrion by a cisternal profile of rough endoplasmic reticulum. Myoepithelial cells are absent from proximal acini, but are abundant on distal acini. Intracellular nerve terminals are extremely common, particularly in distal acini. The main ducts resemble, to a degree, the striated ducts of salivary glands.


Spatial orientation of microtubules in contractile fibroblasts in vivo. Contracting fibrous tissues from skin wounds in pigs, and scars around silicone implants in humans, contained fibroblasts that had multiple bundles of 60--80 A microfilaments with electron-dense bodies, features typical of contractile fibroblasts both in vivo (myofibroblasts) and in vitro. These in vivo fibroblasts contained many 220 A diameter microtubules, which paralleled plasma membrane in these myofibroblasts strongly suggests a bracing or scaffolding function.