Interaction of light and chemicals in carcinogenesis. Interactions between chemicals and UV light, as they may affect the carcinogenic process, are examined in terms of the three-component system: chemical, light, and biologic target. Various two-component interactions, in addition to unique three-component interactions, are considered. Available information is incomplete concerning such possibilities as promotion by noncarcinogenic light, the contribution of acute or chronic phototoxic events to chemical or physical carcinogenesis, and the relationship between either photochemical carcinogenesis or chemically enhanced photocarcinogenesis and demonstrable phototoxic activity. Interactions such as optical absorption by, or photochemical alteration of, chemicals are considered primarily as confounding variables in experimental situations. It is argued that realities of human exposure may reduce the complexity of these problems in practical safety or regulatory considerations.


Ultraviolet light in the oncogenic transformation of cultured C3H/10T1/2 mouse embryo cells. Skin tumors are produced in rats, mice, and humans by exposure to UV light. We developed a mouse embryo fibroblast line C3H/10T1/2, which can be transformed by chemical carcinogens, X-irradiation, UV radiation, and oncornavirus. When we irradiated these cells with 10, 25, 50, 100, 150, or 200 ergs/mm2 of UV light, neither transformation nor cytotoxicity was observed at the two lower doses. When the irradiated cells were cultured in medium containing 0.1 micrograms TPA/1 ml (a potent tumor promoter) starting from 0-120 hours after irradiation, a high frequency of transformation was always produced. When the cells were initiated with subeffective concentrations of 0.1 micrograms MCA/ml followed by UV radiation at different intervals, no transformation occurred; however, these initiated cells were transformed after TPA treatment. When we treated the cells with multiple exposures to UV light, no transformation occurred then nor when the cells were treated with TPA followed by UV irradiation at different intervals. Thus UV in our system acts as a pure initiator in the two-stage process of oncogenic transformation.


Transformation frequency of Syrian golden hamster cells and its modulation by ultraviolet irradiation. UV (253.7 nm) exposure of Syrian golden hamster cells seeded for colony formation caused an induction of transformation without any other insult. Analysis of the quantitative data demonstrated a lack of a threshold response and a transfomation frequency proportional to UV dose. No transformation occurred in unirradiated colonies. When cells seeded for colony formation are exposed to UV and subsequently treated with AcAAF, a carcinogen known to induce UV-like damage, neither an additive nor a synergistic effect occurred. Caffeine at nontoxic concentrations potentiates lethality caused by AcAAF and also the number od colonies transformed by AcAAF when added post-AcAAF. The addition of a constant amount of caffeine (50 micrograms/ml) for 48 hours at different intervals after carcinogen resulted in maximum enhancement (10- to 17-fold) when added 4 hours post-AcAAF. UV-associated transformation was enhanced by pretreating the cells with a nontransforming dose of X-irradiation 48 hours before UV. The increase in transformation frequency was 6- to 12-fold per colony and 3- to 6-fold per dish.


The biologic effectiveness of ultraviolet light. The biologic effects of visible and UV light result from photochemical changes in cell components. The amount of photochemical change induced in a small non-self-shadowing structure is proportional to the number of photons traversing it per unit area normal to the direction of propagation, summed over all component beam directions. Within an optically complex, absorbing, and scattering structure, this quantity is difficult to determine, but for skin it is approximately proportional to the total number of photons per unit area entering its outer surface. The magnitude of some photobiologic effects depends on the total amount of photochemical change induced, whereas others depend on the rate of photoproduct formation or on a more complex relation. The nature of the dependence must be determined before light measurements can be related to the magnitude. The effect of a polychromatic illumination depends on its wavelength distribution, weighted by the effectiveness of each wavelength (the action spectrum) under the conditions employed. Until the latter is known, no dosimetric characterization of the light is possible. The wavelength distribution can be determined by spectroradiometric measurement, with the weighting performed numerically, or (more conveniently, though less accurately) by the use of an analog reaction with an action spectrum like that of the photobiologic effect.


Stability and oscillation in interpersonal awareness: a clinical-developmental analysis. This paper has examined the research questions and strategies used by those who attempt to study social development from a cognitive-developmental orientation. It began by pointing to the need to integrate the descriptive work done by social-cognitive developmental researchers with some of the approaches taken by clinical and social psychologists in studying the same general phenomenon: interpersonal relations. An issue-by-stage social-cognitive map developed on the basis of both conceptual and empirical investigations was described, as were some of the properties which defined these stages. Following this, empirical evidence was cited from several ongoing studies which both supported the theoretical claims of logical coherence and pointed research in several new directions. One direction of particular importance is the naturalistic study of social and interpersonal reasoning and relating. Taken together, the interview data and the naturalistic observations appear to present a paradox. Evidence from the descriptive research appears to support the principle of stage consistency across categories of experience. On the other hand, the impact of the naturalistic findings is to point out oscillations in reasoning across varying real-life conditions. It should be noted, however, that several of the children in the classroom study did reason fairly consistently across a wide range of contexts; these children, perhaps not coincidentally, were the ones who had shown the greatest improvement in their interpersonal functioning and were soon to return to a more traditional educational milieu. Such clinical evidence points to the strong need to study better-adjusted children under similar conditions to see if real-life oscillation is as pronounced as it is in more pathological groups (Inhelder, 1943/1968). Our conclusion is that the cognitive-developmental approach, viewed in the proper perspective, can accommodate and make coherent data which suggest both variability and uniformity of reasoning, but that for such an accommodation to take place, greater attention must be paid to the critical social psychological and clinical variables which reciprocally interact with level of social-cognitive capability.


The development of knowledge about visual perception. This chapter describes recent theory and research in one limited area of social-cognitive development, namely, the childhood acquisition of knowledge about visual perception. The author and his co-workers have hypothesized that there are two developmental levels of such knowledge. At earlier-developing Level 1, the child understands that others as well as the self see objects, and is also able to infer correctly what objects they do or do not currently see if provided with adequate cues. At later-developing Level 2, the child understands not only that people can see objects, but also that they can have differing visual experiences while seeing the same object; most notably, they can have different spatial perspectival views of it when looking at it from different positions. Arguments and evidence for the developmental distinction between Level 1 and Level 2 knowledge are briefly presented in Section I. A more detailed model of Level 1 knowledge is presented in Section II, together with an account of several studies of its development during the first four years of life. During these early years, children appear to learn a great deal about how to produce visual percepts in others (showing and pointing to things), how to deprive others of percepts (hide objects), and how to diagnose the percepts they currently have (follow others' direction of gaze and pointing gestures). Section III similarly reviews recent theory and research on the development of Level 2 perspective-taking knowledge in older children. This work is focused mainly on the acquisition and use of very general perspective-taking rules, such as the rule that two observers who look at an object array from the same spatial position must on that account necessarily have identical perspectival views of the array. Section IV described further developmental research that could be or is being done on Level 2 knowledge, Level 1 knowledge, and on the Level 1-Level 2 distinction.


Responses of directionally selective neurons of the frog tectum mesencephali, their adaptation and extrapolation features. Tectal directionally selective neurons were investigated in frogs. The highest measure of agreement in the character of response and dynamics of latent periods of neuron pairs was found with interelectrode distances of up to 300 mu, a fact which is evidently connected with the dimensions of the zones of ramification of the afferent fibers. Adaptation and extrapolation properties were discovered for most neurons and they were more marked in the nuclear layers of the tectum than in the fibrous layers. The more stable responses of neurons in the fibrous layers indicate the possible representation there of branches of fibers of the retinal ganglion cells, whereas neurons with high adaptivity (novelty neurons) are located in the nuclear layers.


Neuronal organization of the thermosensory region of the anterior hypothalamus. Changes in extracellular unit activity of 236 neurons of the medial preoptic and septal regions to local temperature stimulation were studied in acute experiments on rabbits anesthetized with urethane and chloralose. Of this total number of neurons 27% were highly sensitive to changes in brain temperature (15% to heat, 12% to cold). Altogether 6% of neurons gave an on-response and 5% a prolonged after-effect to temperature stimulation. The possible role of these neurons in the regulation of temperature homeostasis is discussed.


Somatosensory evoked potentials in healthy people. The results of a study of somatosensory evoked potentials recorded in 37 healthy subjects of both sexes are described. Comparison of the results of tests on three age subgroups showed selectivity in the change in latencies and amplitudes of waves of the somatosensory responses depending on the subject's age. Ipsilateral responses show greater variability but a lower amplitude and frequency of appearance of the individual components than contralateral responses. Their latent periods also were longer than those of the contralateral responses.


Unitary responses of the caudate nucleus to direct stimulation. Unitary responses of the caudate nucleus to stimulation of various parts of it were investigated by extracellular recording. Latent periods of response discharges varied from 3.5 to 40 msec. Most neurons were excited by stimulation of the most rostral part of the head of the caudate nucleus. Irrespective of the site of stimulation, in most cases responses consisted of initial excitation in the form of one or, less frequently, two discharges followed by a period of depression of spontaneous activity. Recovery of activity took place gradually, without postinhibitory facilitation. No afterdischarges or periodic repetitions of spikes were observed after the initial response. Repetitive stimulation of the caudate nucleus showed that the neurons of this nucleus reproduce frequencies of stimulation badly above 30/sec, and under these circumstances in many cases they continued to discharge on average at a frequency of 5--15/sec. The results are examined from the standpoint of participation of the caudate nucleus in the formation of spindle activity.


Electrographic manifestation of drowsiness in the isolated cat cortex. Electrical activity of the neuronally isolated cortex during waking and the onset of sleep was investigated in experiments on freely behaving cats. The transition from wakefulness to sleep is accompanied in the isolated cortex by the appearance of a stage of drowsiness, accompanied by corresponding changes in the electrocorticogram of the isolated hemisphere. The electrographic manifestation of the stage of drowsiness in the isolated cortex depends on the time elapsing after the operation and it is most marked in the late period after isolation of the cortex.


Interaction of visceral and somatic afferent systems in the cerebral cortex. Using the method of evoked potentials on chloralose-anesthetized and suxamethonium-immobilized cats, a comparative study was made of the effects of interaction of somatic and visceral afferent systems in the second somatosensory area and in the parietal cortex of the brain. It was found that a common property of the interaction of the two afferent systems is an inhibition of the second response irrespective of which of the systems is activated first. Fairly prolonged inhibition was noted in the association region of the parietal cortex. Preliminary stimulation of visceral nerves caused less prolonged depression on subsequent stimulation of somatic nerves both in the second somatosensory and in the association regions of the cortex. It was demonstrated that the anatomic coincidence of visceral and somatic afferent projections both in the second somatosensory and in the parietal regions of the cortex is evidently responsible for the interaction of these afferent systems.


The serological and immunological relationship of type strains A and D of Pasteurella multocida to field isolates from sheep. Investigations with antisera prepared in rabbits and sheep and active immunity experiments in mice showed that strains of Pasteurella multocida which, according to the haemagglutination test, are serologically related, do not necessarily give rise to cross immunity. Conversely, it was found that serologically unrelated strains may exhibit an appreciable degree of cross protection. The unreliability of the haemagglutination test as an indicator of immunological identity of strains was further confirmed in that peritoneal fluid from immunized mice showed passive protection properties despite the absence of haemagglutinating antibodies. There was no consistent agreement between the results obtained with antisera prepared in different species and active immunity experiments in mice, and this leads to the conclusion that different species probably vary quantitatively and qualitatively in their immune response to immunization with P. multocida. Attempts to determine whether combined bacterins afforded a better immunity than monovalent bacterins were inconclusive.


Parasites of domestic and wild animals in South Africa. XI. Helminths in cattle on natural pastures in the Northern Transvaal. After being exposed to infestation for 4 to 6 weeks, pairs of tracer calves were slaughtered to determine the seasonal incidence of helminth infestation in cattle on natural pasture. Haemonchus placei was recovered from March-July and from November-February, and peak burdens were recorded during December and January. There was marked inhibition in larval development from April-July. Trichostrongylus spp. were recovered from March-June and from November-February, the greatest number of worms being recorded during December. Cooperia spp. infestation occurred from March-August and November-February with peak burdens during April-June and December. From February-August more than 50% of the worms recovered were in the 4th larval stage of development. The greatest number of Oesophagostomum radiatum were recovered from June-January. Longistrongylus sabie and Impalaia tuberculata, parasites normally found in impala, were recovered from many of the survey animals, this being the first record of their occurrence in cattle.


Proteins and free amino acids in the salivary secretion and haemolymph of the tick Amblyomma hebraeum. Electrophoretic and chromatographic separations of the salivary secretion of Amblyomma hebraeum showed a less complex protein pattern than that of Ornithodoros savignyi. A hyaluronidase active component was isolated. The haemolymph protein pattern showed a major protein fraction with a mobility slightly faster than that of bovine serum albumin.


The suitability of various types of dung and vegetable matter as larval breeding media for Stomoxys calcitrans L. (Diptera: Muscidae). The dung of 7 species of domestic animals, 4 plant materials, standard larval breeding medium and 3 mixtures of some of these materials were evaluated as breeding media for Stomoxys calcitrans larvae. S. calcitrans could not breed in pure chicken dung or in either of the 2 types of sawdust tested, but Pinus spp. sawdust plus chicken dung proved an excellent breeding medium. Of the other media tested, Pennisetum spp. clippings were the least favourable for the development of S. calcitrans larvae. None of the media had any effect on the sex ratio of the adults that were cultured or on the viability of their eggs.


The pathology of an inherited lysosomal storage disorder of calves. The clinical symptoms, gross and histopathological, as well as the ultrastructural appearance of a condition in cross-bred Aberdeen Angus calves resembling the inherited lysosomal storage disease, alpha-mannosidosis, are reported. The neurones and perithelial cells in the brain and the reticuloendothelial cells in the lymph nodes and spleen were extensively vacuolated. The vacuoles were filled with a sparse, flocculated to granular material within which membranous structures were frequently seen. No specific substance could be identified within the vacuoles, either histochemically or ultrastructurally. Besides the vacuolation, cystic tubular structures were seen in the kidneys. The lining epithelial cells of the thyroid follicles were vacuolated while some of the follicles contained no colloid.


Surgical transfer of the cysticerci of Taenia hydatigena. Unattached immature cysticerci of Taenia hydatigena were transferred surgically to the peritoneal cavities of 4 sheep. Mature infective cysticerci were recovered from the recipient sheep 3 and 5,8 months later. A fully developed live cysticercus was present in the muscle layers surrounding the scar of the laparotomy site in 2 of the animals.


The effects of elevated glucose levels on the incorporation of glucose and acetate into aortic lipids of the dog. The effect of elevated glucose concentration on the incorporation of labeled glucose and acetate into aortic lipids of the dog was studied. Increased medium glucose concentration (80 mg p. 100-300 mg p. 100) resulted in: 1. an increased incorporation of glucose into aortic total lipids, phospholipids and triglycerides; 2. an increased incorporation of acetate into each lipid fraction studied. In addition, the effect of insulin on glucose incorporation into aortic lipid was assessed. At a concentration of 100 mU/ml, insulin had no effect on glucose incorporation into aortic lipids of the dog.


Studies on the influence of different drugs upon the proliferative answer of ASMC and fibroblasts in culture depending on drug concentration and exposition time. We investigated the proliferation of fibroblasts and A.S.M.C. in culture as a function of concentration and exposition time of D-Penicillamine, Prednisolone, Acetylsalicylic Acid and Chloroquine. For every drug we found a concentration that caused only small initial inhibition of cell growth but did not alter the kind of further proliferation compared with controls. This "optimal inhibiting drug concentration" was characteristic of the drug but uncharacteristic of the cell type. Lower concentrations lead to a slight increase of proliferation, higher concentrations to a decrease of proliferation and finally after specific times of exposure to cell degeneration. Chloroquine showed no proliferation increasing effect even in doses much lower than the equivalent human daily drug dose. The equivalent human daily drug dose for Chloroquine was much higher than the optimal inhibiting drug concentration whereas that for the other drugs was the same as the optimal inhibiting drug concentration. For each drug there was a linear correlation between the degree of inhibition of cell proliferation and the logarithm of drug concentration on every occasion the cell growth was examined. All the relationships demonstrated were true of both fibroblasts--and A.S.M.C.--cultures, which indicates that there is no connection between the type of cell and its reaction to these, specific, chemical, drugs. Our results show that culture methods are suitable for the study of cell drug interactions.


A field trial of suppression of Aedes aegypti population by releasing sterile males into a domestic population. After release of an average of 1260 sterile male each day for a period of sixty two days, the average fertility of Aedas aegypti population remained above 50% in Ererwani village. It is concluded that the irradiated sterile males may not be suitable as a control measure, despite the fact that irradiation was carried out in nitrogen atmosphere.


[Research on intestinal parasitic diseases in dogs of the city of Rome]. A survey on the diffusion of intestinal parasites of dogs in the town of Rome. The results of a survey on the diffusion of cestodes and nematodes in a hundred dogs in Rome are reported. The dogs were subjected to fecal examinations --- using both the flottation method and the McMaster method -- and to the post-mortem examination of the intestine. At post-mortem examination 25 dogs were found parasitized by one or more species of nematodes, 19 by one or more species of cestodes and 12 both by cestodes and nematodes for a total of 56 animals parasitized. The parasites were identifed with the following frequency: Dipylidium caninum 28 per cent, Toxocara canis 17 per cent, Uncinaria stenocephala 15 per cent, Trichuris vulpis 10 per cent, Toxascaris leonina 9 per cent, Taenia pisiformis 4 per cent, Echinococcus granulosus 2 per cent, Ancylostoma caninum, T. hydatigena and Mesocestoides lineatus 1 per cent each. The most frequent parasite found in stray dogs was U. stenocephala (33.3 per cent) while among the dogs with owners the most frequent one was D. caninum (31.8 per cent) which was also identified most frequently in dogs over a year of age (31.1 per cent). The dogs under one year of age were more often affected by T. canis (43.7 per cent). In the paper a review of similar Italian surveys is also given.


Principal clinical features and prognosis in chronic lymphocytic leukemia. A prospective study of 102 patients with chronic lymphocytic leukaemia (CLL) on 30 parameters subdivided into 77 variables was analyzed by correspondence analysis, a variant of principal component analysis, which allows simultaneous graphical representation of patients and variables. This statistical method clearly defined three principal clinical features recognized at the time of diagnosis: lymph node proliferation, lymphoid infiltration and cytopenia. Cytopenia was clearly subdivided into peripheral and central types. Each of these clinical features were derived from clinical and laboratory observations which agreed with each other. Simple examination permitted an evaluation of these three syndromes. They seemed to be independent of each other except for a relationship between central cytopenia and lymphoid infiltration. Thus clinical staging at the moment of diagnosis must record three scales of severity corresponding to the three independant clinical features. Prognosis was essentially related to cytopenia, whatever the mechanism. In a further analysis of the subsequent progress of the disease, a "common path" for patients was found terminating in a region of the graph where marked splenomegaly and cytopenia were plotted. We conclude that it is necessary to consider the three clinical features independently in a clinical staging. This study emphasizes the poor prognosis of cytopenia and splenomegaly and indicates that follow up and treatment should take this feature into account.


[Some aspects of the allelic interaction in family studies of normal A1B and A2B subjects (author's transl)]. The authors have selected three series of families presenting several heterozygous AB gene combinations: the same gene A and the same gene B; the same gene B and different genes A; and the same gene A and different genes B. The results concerning these families show that the quantitiy of A1 and A substances (for A1B) or A (for A2B) is related to the "quality" of the alpha-D-galactosyl transferase acting on a more or less important H substratum. The alpha-N-acetyl-D-galactosaminyl transferase seems to have a minor function.


[Hemoglobin Pyrgos beta 83 (EF 7) Gly leads to Asp in a Malian: structural identification and functional properties (author's transl)]. The second observation of hemoglobin Pyrogos is reported. This abnormality was initially described in a Greek family, in our case it concerns an African negro originating from the Republic of Mali. The abnormal hemoglobin was without clinical or hematological consequences. The structural defect is a substitution of an Asp for a Gly in the immediate vicinity of lysine beta 82. This leads to a large inhibition of the corresponding tryptic cleavage and therefore to difficulties in the determination of the mutation. A second feature is a slight modification occurring near one of the 2.3 DPG binding site. As a consequence, the regulatory effect of this organic phosphate is smaller in the purified and stripped component than on hemoglobin A.


[Suppression of hepatic myeloid metaplasia after irradiation of the spleen in a case of spent polycythemia (author's transl)]. In a case of spent polycythemia after irradiation of the spleen alone (450 rad in 17 sessions and 28 days) the suppression of any hepatic myeloid metaplasia was observed simultaneously with the regression of myelemia and erythroblastemia and the drop in the number of circulating granulomonocytic stem cells. These observations allow to discuss the mode of action of the splenic radiotherapy and the relationship between myeloid metaplasia and the circulating hematopoietic cells (proliferating granulocytic and erythrocytic cells and stem cells).


[Ineffective erythropoiesis in myeloid splenomegaly: the 59Fe test, bone marrow histologic and cytologic data]. Eight patients presenting primary myelofibrosis or spent polycythemia were submitted to a ferrokinetic study, a triphine bone marrow biopsy and a bone marrow puncture. In all cases before treatment (splenic radiotherapy) ferrokinetic measurements demonstrated an ineffective erythropoiesis, the intensity of which was precised on bone marrow biopsies, in numbering the erythroblasts per surface unit. Bone marrow biopsies permitted also, through a semiquantitative estimate of the bone marrow cellularity, to evaluate an aplasia component not always expected with ferrokinetic study. Study of bone marrow allowed to precise the site of the erythroblastic abortion; cellular death might occur during the last nitosis of the erythroblastic series (transition from the polychromatophil erythroblasts to the acidophil erythroblasts). In order to delineate the general pattern of erythropoiesis before treatment and when assessing the results of a treatment, besides ferrokinetic measurements, the study of bone marrow biopsy and smears appears relevant.


[Double medular scintigraphy using 99mTc-colloids and 111In-transferrin in myeloid splenomegaly (author's transl)]. Simultaneously with bone marrow biopsy and 59Fe kinetic study, bone marrow scintigraphy using 99mTc-colloids and 111In-transferrin was performed in 15 patients with a documented diagnosis of agnogenic myeloid metaplasia. This rapid, simple and non-traumatic method permits visualization of changes in the reticular and the erythropoietic marrow which are not always the same. The technique can demonstrate diminution of active marrow in the axial skeleton, peripheral extension of bone marrow and its heterogeneity from site to site. These abnormalities, which vary from case to case, correlated well with the results of 59Fe external countings. The degree of splenic myeloid metaplasia, as judged by 111In uptake, is also well correlated with 59Fe uptake into the spleen. There was poor correlation between scintigraphic and iron kinetic data on the hand, and bone marrow cellularity assessed by marrow biopsy on the other. While scintigraphic studies are chiefly qualitative, they appear to provide useful information for diagnosis, and possibly for prognostic and therapeutic decision.


[Hemoglobin anomalies and medico-biological data in 10,000 Africans (author's transl)]. Since 1962, the hemoglobin of all the foundation scholars of the French Cooperation addressed to the C.E.A.B.H. for a medical examination at their arrival in France was systematically studied. The distribution and the incidence of hemoglobin S and hemoglobin C were recorded in fourthy ethnic groups from Africa South of Sahara. Few significant correlations between the frequency of anomalies detected by the medico-biological check-up and the presence of an abnormal hemoglobin were found; AC seems to be less asymptomatic than AS. Some rare hemoglobins were detected.


[Usefulness of "Chirurcoll-Polfa" tissue adhesives for increase of resistance against distention of bladder wounds in rabbits]. The usefulness of the polish tissue adhesive "Chirurcoll-Polfa" for the increase of the bladder wound resistance against distention was investigated on 24 rabbits. The measurements were performed after 3, 7, 10 and 14 days, applying a water manometer. The results proved a distinctly increased resistance against distention of the bladder wounds in the experimental group during the first week. In the latter period of time there were no differences observed between the control and the experimental group.


Purification and characterization of mitochondrial cysteine aminotransferase from rat liver. Cysteine aminotransferase has been purified over 300-fold from rat liver mitochondria. Transamination between L-cysteine and 2-oxoglutarate, and the reverse reaction, were observed to be catalyzed by the purified enzyme but inhibited by L-aspartate. The enzyme also catalyzed transamination of alanine, 3-sulfinic acid, aspartic acid, and cysteic acid. A new reaction assay method was devised, contributing an indication that mitochondrial cysteine aminotransferase is identical to mitochondrial aspartate aminotransferase. The latter apparently catalyzed 3 transamination reactions in the cysteine degradation process within mitochondria.


Left ventricular mural force changes as reflections of induced alterations in myocardial pump performance. Strain gauge measurements of changes in left ventricular mural force seen during the ejection phase of the cardiac cycle were examined for a relation to ventricular emptying efficiency. Left ventricular pressure and mural force were recorded at aortic valve opening and closing, then residual fractions were calculated using (a) a representative radius determined from the LaPlace formula (MF = pi PR2), (b) mural force recordings alone, and (c) intraventricular pressure recordings alone. These fractions were compared to other residual fractions simultaneously obtained by thermodilution. Comparisons were made during changes in blood pressure, heart rate, and cardiac contractility. Findings were: 1. Significant correlation is seen when residual fractions, calculated from mural force alone or representative radii (mural force and left ventricular pressure) are regresed against the residual fraction obtained by thermodilution. 2. No relation is seen when residual fraction, calculated from intraventricular pressure, is similarly regressed against the residual fraction obtained by thermodilution. 3. It follows that mural force changes occurring during ventricular ejection do reflect ventricular dimension changes during this period. Moreover, directly recorded mural force can be used to calculate representative ventricular radii which more accurately reflect ventricular size changes. On the other hand, intraventricular pressure, which does not necessarily determine ventricular size, does not reflect ventricular emptying efficiency.


Thermal anomalies in acetylcholine release: evidence for control of membrane fusion by interfacial water. Thermal anomalies in the rate of acetylcholine release from electrically stimulated guinea-pig ileum have been demonstrated at 18 degrees C and 30 degrees C. Because similar anomalies occur in many aqueous systems where interfacial water plays a dominant role, it is concluded that the anomalies in acetylcholine secretion may indicate domination of the release process by interfacial water. Sharp breaks in the Arrhenius plots at the temperatures of the anomalies separate non-linear portions of positive gradient from a linear portion of negative gradient. The negative curve probably results from the rate of a competitive reaction (such as the rate of removal of calcium from the nerve terminal) while the positive portions may arise from cooperative H-bonding of water molecules. It is proposed that water-dominated phase transitions in membrane lipids may also mediate the effects of both temperature and calcium ions on neurotransmitter release in particular and membrane fusion in general.


Nuclear magnetic resonance investigation of the freezing of water in rat kidney tissues. The proton linewidth and the integral of the absorption signal of water in rat kidney tissue have been measured at sub-zero temperatures. The water, fresh or stored at +4 degrees C for 24--48 h, shows a supercooling effect down to -10 degrees C to -14 degrees C. At -20 degrees C, 10--20% of the total tissue water remains unfrozen. The supercooling effect is diminished by prior storage at positive temperatures but completely eliminated by storage at several degrees below 0 degrees C. This suggests that the freezing behavior of tissue water varies with change in the physiological state of the tissue. Tissue samples stored at positive temperatures were observed to be more vulnerable than fresh tissue to freezing damage. Storage at several degrees below 0 degrees C for the same period of time appeared to be even more damaging.


Anatomical localization of human detection of weak electromagnetic radiation: experiments with dowsers. Positive responses (dowsing signals) were evoked from 14 male "dowsers" by exposure to artificial electromagnetic (ac) fields. When the kidney area was shielded, such responses failed to occur. This suggests that magnetic sensors exist in man, probably located in the renal vicinity. Extinction of response was also observed when the head was shielded. This suggests the existence of additional magnetic sensory apparatus in the brain. Discrimination among magnetic patterns (signatures) is hypothesized to account for the apparent ability of dowsers to find specific underground substances, notably water. Such discrimination would require functional association of the sensory apparatus with a signature processor. Data are presented suggesting that this sensor-processor complex does indeed exist and may be located in the vicinity of the pineal gland.


[Biliojejunoduodenostomy: morphofunctional aspects and radiological problems (author's transl)]. An analysis is made of the anatomofunctional features of biliojejunoduodenostomy, in comparison with different kinds of biliodigestive anastomoses; special attention is paid to roentgensemeiological problems as related to the method of investigation.


[The employment of pharmacodynamic tests in the radiological examination of the digestive tract (author's transl)]. The indications, contraindications and usefulness of pharmacodynamic tests in current radiological diagnosis of diseases of the digestive tract are reviewed and iscussed. Various examples are presented.


[Radiological assessment of acute pancreatitis in 110 patients (author's transl)]. 110 patients with acute pancreatitis have been investigated with simple X-ray examinations of the abdomen and chest and in 35 cases by investigating the upper digestive tract with contrast medium. The frequency of the main radiological signs and their significance in relation to clinical diagnosis are reported and discussed.


[Radiography of the epididymis, vas deferens and vesicle in the investigation of male sterility (author's transl)]. Radiography of the epididymis, vas deferens and vesicle was formed in 72 subjects admitted for sterility. The technique employed, its indications, and the results achieved are discussed. Several examples are presented.


[Neonatal hypophosphatasia (author's transl)]. A case of severe neonatal hypophosphatasia is reported; X-ray aspects are described and differential diagnosis with other forms of foetoneonatal dwarfism is discussed.


[Clinical and radiological study of hypertrophic stenosis of the pylorus with early onset: case contribution (author's transl)]. Two cases of hypertrophic stenosis of the pylorus with symptomatology present at birth are reported and discussed. The cases were diagnosed radiologically and successfully operated.


[Crossed aphasia in a right-handed patient: a report on one case (author's transl)]. The authors report on a 37 year old right-handed patient with a right rolando-parietal infarct which was manifest clinically by not only sensory-motor disorders of the left side of the body, but more especially by an expression aphasia. This observation fulfills the criteria for defining the exceptional case of crossed aphasia in a right-handed patient: aphasic destruction of language engendered by a right unilateral lesion in such a patient, without a previous history of a cerebral lesion or family history of left-handedness. Comparing the aphasic signs in this patient with the rare cases reported in the published literature shows that there is a particular pathognomonic profile, close to the type of aphasic disorganization seen in children and left-handed adults. The authors review the neuropsychopathogenic explanations for this crossed aphasia of right-handed patients.


[Familial periodic paralysis with hypokaliemia, hyperaldosteronism and extracellular vacuolization (author's transl)]. The observation of a 20 years old patient with a periodic paralysis is reported. During a crisis induced by 20 U of insulin and 150 g of glucose, transient hyperaldosteronism was found and the muscular biopsy performed in the left biceps brachii, disclosed vacuoles with a double membrane. The significance of these findings is discussed.


[Interhemispheric disconnection syndrome with diagonistic dyspraxia in the course of Marchiafava-Bignami disease]. The probable diagnosis of Marchiafava-Bignami disease was made in a chronic alcoholic patient because of the rapid onset of signs of inter-hemisphere disconnection. These inclused left visual and tactile anomia, difficulty of a limb to imitate postures presented in the contralateral visual half-field, constructional apraxia of the right hand, agraphia of the left hand, left auditive extinction in the dichotic test, difficulty in responses of the left limbs to verbal orders, which the authors propose to name left "aphasic apraxia" and a bimanual asynergia, sometimes presenting an aspect of diagonistic dyspraxia. These symptoms clearly show the competence of the left hemisphere for verbal tasks, or more generally, those of an imaginary or conceptual nature, and that of the right hemisphere for visiopatial tasks, or more generally, those required by concrete situations.


[Glial histoenzymatic study in human cerebral edema (collateral edema in glial tumors)]. Histoenzymatic study was performed on neurosurgical specimens. Two patterns of reactive astrocytes were found. Normal shape cells with perivascular processes were observed in subcortical white matter and in moderate edematous changes. Hypertrophic cells without processes were seen in severe edematous changes. The role of glia in the selective vulnerability of the white matter is discussed.


[Modifications in urinary homovanillic acid after ingestion of vitamin B6; functional study in autistic children (author's transl)]. Basing their study on the investigations which led to the dopaminergic theory of the psychoses, the authors studied homovanillic acid (principal derivative from dopamine) levels in the urines of 37 autistic children, and 11 normal children acting as controls. The favourable action of vitamin B6 on autism, reported by anglosaxon authors, was confirmed in 15 of the children. Furthermore, vitamin B6 reduces homovanillic acid levels in 33 autistic chilren and increases them in all the control group children.


[Intracranial neurinoma of the spinal nerve (author's transl)]. A patient aged 56 years has developed a syndrome affecting the last cranial nerves--IX, X, XI and XII--on the left side progressively over the last two years, and, more recently, deafness. Apart from a simple radiological examination all other radiological tests were negative. The diagnosis was made during the surgical operation which revealed a neurinoma of nerve XI (spinal) in its intracranial path. The diagnosis was confirmed histologically. After reviewing the published literature, the authors conclude that this is an exceptional case, which justifies publication and enables differential diagnosis to be made between this tumor and the Jugular Glomus tumor.


[Prevalence and seasonal variations of irregular alloantibodies, especially the anti-Lewis]. In order to determine the efficiency of a technical modification of the screening procedure for irregular antibodies, the authors compare results obtained upon two patients' groups. Group I: 47.638 tests done by classical technics (462 antibodies: 105 anti-Lewis and 357 non Lewis antibodies). Group II: 22.437 tests done by the new method (563 antibodies: 262 anti-Lewis and 261 non Lewis antibodies). This new screening procedure is more efficient than classical technics and put in a prominent position the actual frequency of Lewis antibodies. The relationship between Lewis antibodies, ABO blood groups and sex are discussed. It seems to be an accumulation of Lewis antibodies within group A and AB. The frequency of group O is decreased among patients with Lewis antibodies. There is no modification of the frequency of B blood group. The authors suggest that a quantitative relationship exists between ABO phenotype, secretor status and the occurrence of Lewis antibodies. There is no sex difference in the frequency of Lewis antibodies. A seasonal variation in the frequency of irregular antibodies is reported, with a maximum into hivernal months.


[Genetic linkage of HLA-Bf. Study of 19 informative families]. Since the discovery of the linkage between HLA and Bf by Allen in 1974 several reports have shown a very close linkage between Bf and HLA-B. We have studied 19 families with 81 offsprings for the linkage between HLA (A,B) and Bf. The total "lod scores" in our material for the linkage between HLA-B and Bf is 17,167 at theta = 0.00. No recombination was observed between HLA-B and Bf. One recombination out of 79 informative meiotic divisions was observed between HLA-A and Bf. This result would mean that the Bf locus is about 1.3% recombination fraction far from the HLA-A locus. Our estimation is in good agreement with the results of other authors. However the estimation of recombination fractions is only an arbitrary mean to map genetic loci on chromosomal regions and family studies of cases with intra-HLA cross-overs are of more interest. All available data from the litterature are in favour to a very close linkage between Bf and HLA-B and to a situation of the Bf locus between HLA-B and HLA-D. However some conflicting data on Bf gene mapping have been published. More precise informations may be obtained as soon as a more exact structure of the HLA region, in particular of the HLA-D region, will be known.


[Autologous blood transfusion in a department of gynaecological surgery]. A single unit of 350 ml of whole blood was drawn 8 days before surgery, from 50 patients of a gynecological clinic. Hysterectomy was performed in 44 cases. Haematological values did not show any significant modification and no side effects attributable to the phlebotomy was detected before or during surgery. In 88% of cases, the utilisation of autologous blood has avoided an homologous transfusion whose side effects are well known.


[Glanzmann thrombasthenia, PLA1 antigen and anti-Glanzmann antibody]. Six cases of Glanzmann's thrombasthenia were studied using a platelet indirect radioactive Coombs (PIRC). In serum of two among six patients, an antibody was found, which reacted positively with all platelets except those of thrombasthenic patients. Such "anti-public" antibody which shortens the life of transfused platelets is a very serious complication of Glanzmann's thrombasthenia. Attempts to define the PLA group of the six Glanzmann patients, with human allo antisera recognizing PLA1 antigen, gave negative results. Three hypothesis were discussed: (1) Interference in the test of the aggregation defect of thrombasthenic platelets. However, anti-HLA antibodies were normally fixed in the PIRC test. (2) PLA2 gene and Glanzmann gene have a strong gametic association and all Glanzmann's patients are PLA1 negative. (3) Glanzmann gene is coding for the PLA gene substrate. In such case, thrombasthenic patients might be genetically PLA1 positive and phenotypically PLA1 negative. Moreover they would also be PLA2 negative, this could not be tested due to the lack of anti-PLA2 antiserum.


[Can glucose-6-phosphate dehydrogenase deficiency alone explain neonatal jaundice]. Several authors have insisted on the role of a glucose 6-phosphate deshydrogenase (G6PD) deficiency in the occurrence of neonatal jaundice which can be severe, leading to exchange transfusion. Considering the fact that haemolysis, occuring in deficient patients, is most of the time induced, our aim was to search if a neonatal hyperbilirubinemia could be explained by the sole G6PD deficiency or by extra "oxidant stress". Red blood cell G6PD activity of 289 newborn babies of African or Antillian origin was tested by a Tetrazolium linked method. 21 newborns were deficient. 8 female babies were heterozygous for G6PD deficiency. No neonatal jaundice was observed. With Bienzle and all., we can suppose that the "environment" takes an important part in the incidence of neonatal jaundice among G6PD deficient newborn of African or Antillian origin. However as triggering factors could be ignored, we think compulsary to search a G6PD deficiency in every neonatal jaundice necessitating an exchange-transfusion.


[H-deficient variants in the Bulgarian population]. In a systematic study of more than 100.000 subjects, the authors have put forward eight AHm, one AHmB and three OHm. The determination of these phenotypes is based solely on immunogenetic background (quantitative study of A,B,H, antigens, study of anti-H anti-A and anti-B allo hemagglutinins, study of salivary substances). To explain these variants, the authors suggest that suppressor non allelic genes are controlling the phenotypes of H antigens.


[Inhibition of platelet migration. A simple technic for typing of PLA1 and the detection  of platelet allo- and autoantibodies]. In vitro, platelets can migrate in an active way. This migration can be immunologically inhibited through specific antibodies. This test (PMI-test) can be easily carried out in any laboratory. In that study this test was used: 1) For the detection of anti-platelet allo-antibodies in neonatal thrombopenia. Out of nine cases studied, two anti-PLA1 were identified and three anti-HLA antibodies (anti-B8, anti-B17+21 and a polyspecific serum) detected thanks to the micro-lymphocyto-toxicity test were confirmed by that test. 2) To find free auto-antibodies in the sera of patients suffering from idiopathic thrombopenic purpura. In five cases out of twelve the presence of auto-antibodies could be shown, that is 41,6%. In some cases, the auto-antibodies showed a certain degree of specificity as it had already been pointed out in other studies. When the thrombopenias were associated with other diseases, all the tests were negative. 3) For the PLA1 typing of donors: 1,85% donors submitted to the test proved to be PLA1 negative. 4) To identify anti-HLA antibodies and to compare this test with the micro-lymphocyto-toxicity-test: the anti-A2, A11, B8, B17, CW3 and CW4 antibodies used titrated the same in both tests. 5) Eventually to study the possible action of ABO-system antibodies in this test; this study shows that only sera containing immune antibodies can bring about an inhibition of the incompatible platelet migration. The sensitivity of the PMI-test which has previously been mentioned as equal to platelet-lysis and superior to aggregometry and platelet factor-3 release, is superior to the complement fixation test since with an 1/16 titre in PMI test for the two anti-PLA1 antibodies, the latter could not be detected through the complement fixation test; it seems to be equal to platelet indirect radioactive Coombs since both sera titrate in the same way.


[Vitamin D].

[Vitamin D]. The authors write a short review on vitamin D : sources, needs, metabolism, actions, methods of dosage of vitamin D and its metabolites.


[Muscular involvement in osteomalacia: clinical, hystoenzymologic and ultrastructural study in 10 cases]. Osteomalacic myopathies are rare. They can prevail, however, and occur before bone abnormalities. The diagnosis must rest on clinical observation since the histopathologic images are not specific. On the other hand the demonstration of muscular weakness is very frequent during osteomalacia. In fact two types of manifestations correspond to the same anatomopathologic lesions. These are myopathic changes observed also during light microscopy, histoenzymologic and ultrastructural examination in the 10 patients examined. On the basis of these morphologic changes, muscular involvement can be considered to be part of the osteomalacia syndrome. The contribution of various factors including secondary hyperparathyroidism, vitamin D metabolism disorders, and phosphorus depletion is discussed. It is probable that many of them act together, causing reversible changes in muscular fibers. The intimate mechanisms of these changes are unknown.


[Vitamin D, parathormone, calcitonin and bone histomorphometry in patients with cirrhosis]. This study deals with 29 patients with cirrhosis, caused by alcohol in 23 cases, at a stage of edematoascitic decompensation. Calcemia was low 88 +/- 7 mg/l) as well as calciuria 87 +/- 92 mg/24 h). Phosphoremia and hydroxyprolinuria were within normal limits. A moderate diminution of 25 OH D3 (29,5 +/- 18 ng/ml) was observed in most patients but one third of them had no or very low levels of parathormone and 10 out of 27 had an elevated level of calcitonin. Bone histomorphometry which was done in 24 cases showed a discrete osteoporosis, a relative hyperosteoidosis and a hyperosteoclasis. There was a very significant relationship between hypocalcemia, and hypoalbuminemia but the other abnormalities could not be correlated significantly with either the duration or the severity of the disease. Hypocalcemia and bone histomorphometric abnormalities of cirrhosis can certainly not be explained only by a lack of liver hydroxylation of vitamin D.


[A case of mitochondrial myopathy with progressive chronic ophthalmoplegia (author's transl)]. Clinical, electromyographic, histochemical and ultrastructural features are described in a case of Chronic Progressive Ophthalmoplegia. The neurogenic-myogenic aspects of the diseases are discussed bearing in mind both electromyographic and histological findings ("red ragged fibres" etc.). Mitochondrial paracrystalline inclusions were found at the level of the ocular muscles as well as in the skeletal muscles. These inclusione suggest that Ocular Myopathy is a form of systemic myopathy secondary to mitochondrial abnormalities.


[Plasma levels of diphenylhydantoin (DPH) and phenobarbitone (PB) in epileptic patients resistant to drug treatment (author's transl)]. The Authors present and discuss the results obtained by assaying plasma DPH and PB in 123 patients chronically treated with antiepileptic drugs. The subjects examined were considered resistant to medical therapy and were all at their first laboratory control. The data obtained show: 1) the very poor correlation existing between the doses of drugs administered and their actual plasma levels; 2) the very high percentage of patients with DPH and PB plasma levels not in the therapeutic range of these drugs. The Authors discuss some of the most frequent errors in planning chronic therapy with DPH and barbiturates due to the lack of knowledge of drug blood levels.


[Internuclear ophthalmoplegia in infectious encephalitis: observation on a case of listeriosis]. An internuclear ophthalmoplegia was diagnosed and recorded electro-oculographically in a patient with pontomedullary listeriosis. The etiological differential diagnosis in case of internuclear ophthalmoplegia is discussed. It is emphasized that listeria monocytogenes encephalitis should be considered because this pathology may be electively located in the pontomedullary area and because of the encreasing frequency of human listeriosis.


Blood-C.S.F. barriers dysfunction in the chronic organic brain syndrome; a R.I.A. study. C.S.F. samples of 35 patients, who suffered from verified chronic, non-tumorous organic brain syndrome, were radioimmunoassayed for T4 and T.S.H., and were compared to C.S.F.-R.I.A. samples from a control group of patients who underwent myelography because of lumbar disc. In addition T4 and T.S.H. plasma levels were evaluated in the O.B.S. patients. C.S.F. T4 and T.S.H. levels were significantly higher in 65% of the O.B.S. group of patients than those of the control group. The average determinations for T4 were: 0.77 muh/100 ml in O.B.S. group as against 0--0.4 micrograms/100 ml in the C.S.F.'s of the control group. P greater than 0,001 T.S.H. C.S.F. levels were 1.33 microU/ml in the O.B.S. group, and 0--0.6 microU/ml in the control group (P greater than 0.005). It is suggested that the elevated R.I.A. values of these hormones in the C.S.F. of the O.B.S. patients reflect a disruption of blood-C.S.F. barriers. Therefore in the organic brain syndrome there seems to exist a pathophysiological dysfunction of brain barriers in addition of the neural damage.


A preliminary experiment on long-term memory with realistic and abstract visual patterns in uniltateral focal hemisphere-damaged patients. Sixty-seven focal hemisphere-damaged patients (38 to the left hemisphere and 29 to the right hemisphere) were tested for forgetting of realistic and abstract visual patterns over a 40-sec to 5-min interval by means of a recognition task. No forgetting took place in any group, even if abstract patterns proved to be poorly recognized both at 40 sec and at 5 min. The authors conclude that focal neocortical unilateral lesions do not significantly hamper the semantic code processes involved in the Long-Term Memory of the patterns employed in this experiment.


Do focal neocortical lesions hamper short-term recognition of visual spatial patterns? A hundred and forty-three patients with focal - mainly neocortical - hemiphere-damage (subdivided in 4 groups according to the side of the damaged hemisphere and the presence/absence of visual field defect) and 70 controls, were given a 20-sec delay recognition test of complex spatial visual patterns. There was one free delay condition and two conditions with interference from visual material of either similar or quite dissimilar patterns to that of memoranda. The results provided by two co-variance analyses are: (i) the comparison of the hemisphere-damaged groups with controls show a significant memory decay of both right groups only when there was perceptual interference from similar patterns; (ii) the comparisons between hemisphere-damaged groups fail to elicit any significant difference in the three memory conditions. There appears to be no specific neocortical area involved in the first steps of memory processing of spatial informations and the interference engendered by interpolated perceptual activity is material-specific.


[Body oriented therapy of schizophrenic ego disturbances. Recommendation of an additional therapeutic possibility and basic thoughts on the topic]. The instrumental construction of 5 basic dimensions of ego-consciousness (ego-vitality, -activity, -consistency, -demarcation, -identity) is presented as a means of synopsis the clinical polymorphism of schizophrenic experience and behaviour. Such consideration leads to the insight how deep in their basic feelings of vitality the schizophrenic person may be endangered. From that a body-oriented therapy is conceived, which is presented in datail. The commentary of G. Benedetti points out, how in different therapeutic approaches a common basic attitude of the therapist and a unifying synthetic relationship between therapist and patient can be seen: in duality, empathic sharing of psychotic experience, symbolic realization the narcissistic deficit is overcome. The resynthesis of the ego starts from the present experience rather than from analytical interpretative historical reconstruction.


[The study of psychotherapy. Analysis of the psychotherapies given in an ambulatory psychiatric service]. Using critisized statistical technics, the authors have studied the psychotherapies done at a given time in a university psychiatric outpatient clinic. Thereupon they display some correlations, more specifically, the importance of sex gender, of patients' socio-cultural level, of unconscious socio-cultural stereotypes present in the therapists, of diagnosis and of the motivation to seek treatment by psychotherapy. Statistical analysis allows a more coherent approach of these problems.


[Voice and vibration sensations in the speech forming organs: clinical and theoretical aspects of rare symptoms specific for schizophrenia]. When studying 750 psychiatric in-patients with psychoses of various diagnostic groups, the symptoms of voice sensations and vibration feelings could only be found among patients with paranoid schizophrenia. In addition, these symptoms were located exclusively in body areas that are involved in the peripheral motor production of voice and speech (areas of head, throat, thorax). In 11 of 15 such cases that could be identified, the sensations of voices and vibrations occurred simultaneously and in identical body parts; in the remaining 4 cases only voices without vibration sensations were reported. Therefore these symptoms can be considered as highly specific for schizophrenia. According to the terminology of Bleuler these two symptoms are because of their rareness to be taken as accessoric symptoms; according to the terminology of Kurt Schneider they have the value of first rank symptoms because of their highly diagnostic specifity for schizophrenia. The pathogenesis of these symptoms is on the one hand discussed under the perspective of language development and the changing function of language for behaviour control; on the other hand, the pathogenesis of these symptoms is discussed from the viewpoint of cybernetic, or neurophysiological-neuroanatomical foundation of speech production and speech control. Both models of explanation have in common that the ideational component of speech is noticed as acustic halluzinations and the motor proprioceptive part of speech is noticed as sensation of vibrations, both in a typically schiphrenic manner, i.e. dissociated and ego-alienated.


[Aneurysms of the distal anterior cerebral artery]. The authors present six cases of subarachnoid hemorrhage secondary to rupture of an aneurysm of the pericallosal artery. Four of these were of the berry type and were located at the genu of the corpus callosum; in two instances the aneurysm was found at the bifurcation of an azygous or a bihemispheric pericallosal artery respectively. A fifth lesion was of the fusiform type and the sixth one represented most probably a false aneurysm. All patients have been operated upon, but in three only clipping of the neck was feasable. In the remainder one pericallosal or the azygos artery was occluded intentionally. Postoperatively, severe mental perturbation, incontinence and seizures were encountered, but all symptoms cleared during the follow-up period, and subarachnoid hemorrhage never recurred.


Introduction to clinical decision making. In the last few years there has been a remarkable increase in the amount of clinical data in the average hospital chart, and more and more problem-solving algorithms have been developed. We need better "thinking tools" to help us handle the flow of information. The term "clinical decision making" is used to describe a systematic way to handle data and algorithms to decide on a best course of action. This introductory article discusses some of the problems in establishing a decision criterion, both for a population and for an individual patient. Comparing the probabilities and utilities of various diagnostic outcomes (true positive, false positive, etc.) leads to a diagnostic strategy. The article also discusses conditional probability. Bayes' theorem, and likelihood ratios.


Some perspectives on the decision theoretic approach to medical images. An image often contains information that is not extracted by the human decision maker. This is due to two limitations of the eye-brain system: the existence of a contrast threshold, as with any device that works in the presence of noise (internal or external), and an evolutionary pattern that has not fitted us for viewing noisy scenes, leaving us suboptimal in that regard. Since it is often impossible to overcome these limitations simultaneously--even electronically--multiple displays of the image content must be available to the human viewer, and contrast scale and degree of sharpness/smoothing must be tunable. Our planning must anticipate these requirements, a greater dependence on digital computers for the image manipulation, and the computer's inevitable involvement in the decision process.


Clinical application of decision analysis: a detailed illustration. The clinician must always optimize the patient's chance for the best possible outcome, but the complex task of deciding which diagnostic study to perform and which therapeutic agent to administer is usually carried out using imperfect information. These critical decisions are usually made in a covert fashion without explicit consideration of the multiple factors that impact on the outcome. Decision analysis is a quantitative method for making such diagnostic and therapeutic judgments, incorporating both probabilistic data and value judgments in the analysis of clinical problems. This article presents a brief overview of decision analysis and a detailed illustration of its use in an actual complex clinical situation. The clinical problem described consists of the management of suspected pulmonary embolism in a patient with a high risk of complications from both pulmonary arteriography and long-term anticoagulation. The example chosen also points up the virtue of decision analysis in considering prospectively both the information content and the attendant risks of contemplated diagnostic procedures.


Optimizing the clinical value of hepatic scintiphotography. Hepatic scintiphotography serves as a highly useful anatomic liver function test. When the descriptive features of the liver scan are carefully related to underlying pathology, the resulting data base permits a detection sensitivity of 90% for metastatic cancer and for the diffuse parenchymal diseases. The consequences of false positive (FP) interpretations for patient care must be minimized by attention to perceptual and technical details, by incorporating other tests into the evaluative algorithm, and by knowledge of the distribution of diseases in the population examined. The liver scan would be more beneficially applied to patient management if referring physicians were made aware of its capabilities. They, in turn, must develop more explicit strategies for disease management in order that scintiphotography be effectively applied in clinical decision making.


Myocardial imaging with 201thallium: an analysis of clinical usefulness based on Bayes' theorem. Rest-exercise thallium-201 (201Tl) myocardial imaging and rest-exercise electrocardiography were performed in 137 patients with suspected coronary artery disease (CAD). The final diagnosis of coronary disease was made by arteriography. Sensitivity and specificity for the ECG and thallium studies alone or combined were then determined. Based on these data, the posttest probability of CAD with a normal or abnormal test was calculated using Bayes' theorem for disease prevalences ranging from 1%--99%. The difference between the probability of disease with a normal test and the probability of disease with an abnormal test was also calculated for each prevalence range. The results demonstrate that 201Tl imaging discriminates between disease absence or presence better than does the ECG. However, both the ECG and thallium studies provide rather poor discrimination between disease and no disease when the disease prevalence is low (less than 0.20) or high (greater than 0.70). Because of this characteristic, it is unlikely that screening tests for CAD will prove useful unless the disease prevalence in the group under study is in the moderate (0.20--0.70) range.


The case of Ann: a sleep disturbance in a 3-year-old child. Ann, a 3 1/2-year-old girl, was brought to a pediatric clinic for a chronic, severe sleep disturbance which had precipitated a serious family crisis. A developmental interactional approach was used by the pediatrician and a social worker who evaluated her case; the problem formulation included a reciprocal separation issue between Ann and her mother. Over a 2-month period, dynamic casework around the behavior problem revealed an unresolved grief reaction. Intervention resulted in resolution of the sleep disturbance and an untangling of the relationship between Ann and each of her parents.


Social work intervention with families of children with cancer: the changing critical phases. There are several critical phases through which pediatric cancer patients pass. It is important for the social worker to identify these stressful periods in order to give maximum help to the patient and his family. With constructive equilibrium.


Social work undertakes its own audit.

Social work undertakes its own audit. This paper presents the findings of a Social Health Care Evaluation designed with a system of data collection that can serve as part of an ongoing audit mechanism. It can provide data necessary for the generation of profiles on patients served, on practitioners, and on the department's utilization patterns as a whole. In addition, it offers a method by which norms, criteria, and standards may be promulgated from demonstrated social work interventions. The approach is based on a social work frame of reference and is not disease specific. It focuses on assessments of social problems and outcome that can be correlated with any medical or nursing audit.


Factors related to preventive health behavior: implications for social work intervention. As acute and infectious diseases become controlled, further improvement in the health status of a population increasingly depends on prevention. Social workers are frequently involved in activities designed to influence individuals and groups to use preventive services or engage in health-maintaining practices. Understanding the determinants of preventive health behavior should contribute to the effectiveness of these social work activities. Therefore, this article reviews numerous empirical studies of preventive health behavior and attempts to integrate them into a theoretical framework. A series of factors that may serve as barriers or supports to preventive health behavior are identified, and their implications for social work intervention are discussed.


Social work and nursing in hospital settings: a study of interprofessional experiences. Social workers and nurses in hospitals often work together on interdisciplinary health care teams. Collaboration between these two professions can be enhanced through a better understanding of each other's roles, skills, and practice expectations. One way to acquire knowledge in these areas is through opportunities to interact with individuals from the other discipline. This article reports the findings of a study that investigated the kinds of interprofessional experiences occurring between hospital social workers and nurses during their educational preparation and clinical practice.


Delivery of clinical social work services in the emergency room: a description of an existing program. This article describes a program of social work delivery in an emergency room. The application of crisis intervention theory as practiced by the emergency room social worker and the utilization of a system of clinical evaluation, community referral, and advocacy are delineated. Problem categories and protocols in social work treatment of patients and families in cases of death, rape, child abuse, and suicide attempt are discussed. Fees for specific social work services in the emergency room are described. Social work interventions in reducing stress and pressures of the setting that affect staff are noted.


Consultation: capitalizing on hospital social work resources. Concern about the steady increase in the transfer of patients to nursing homes as well as the need for social work coverage of local nursing and shelter care homes led to the development of a social work consultation program. This program is provided as a departmental service of a community hospital's Social Service Department. This discussion deals with issues and practice in consultation followed by some notes on the structure for establishing such a consultation program.


Evolving social work roles in health care:The case of discharge planning. This paper examines changing definitions of social work's role in health care and the continuing struggle for professional autonomy, in the context of the profession's responsibility for discharge planning. Planning for posthospital care is seen to be a major function of social work today and of traditional importance since social work's inception in the hospital setting. Major role and value conflicts are highlighted in a review of social work's traditional ambivalence toward the role of discharge planner and current recognition of the initial contribution of the profession to the continuing care of hospitalized patients.


The social work role in hospital discharge planning: an administrative case history. This paper examines the historic and contemporary commitment of social work to discharge planning in the context of current threats from external systems as well as dilemmas within the profession. Through the examination of events in one hospital, the authors identify legislative and fiscal trends and place the social work role with its specific skills and knowledge at the forefront of the planning process. Finally, there is a discussion of crucial developments and implications for directions and for needed professional growth.


Impediments to the course and effectiveness of discharge planning. This paper examines the proposition that "timing" (of referral) is a crucial element in determining the effectiveness of the discharge planning process. A brief review of the relevant literature is followed by the description of a study undertaken to assess the impact that various impediments had upon discharge planning practice in two matched ward populations of a large, acute care university hospital. Along with timing, three other impediments were identified and their influence assessed; (a) noncompletion of transfer forms required; (b) unavailability of an appropriate (i.e., needed level of care) bed in an approved facility; and(c) unanticipated change in the patient's medical condition. Some implications of the findings are examined and discussed, and directions for future study are identified. Appended are facsimiles of the instruments employed.


Emergency department social work: a program description and analysis. This article reports on the development of a social work component in the Emergency Department of a teaching-research hospital. It examines the rationale for developing the service and the objectives of the program. It also presents a statistical analysis of the first 2 full years of service. Finally, some of the major problems experienced in establishing such a program are discussed and possible solutions recommended.


Comparison of task performance of master's and bachelor's degree social workers in hospitals. The purpose of this article is to report on the current practice of social work in the hospitals in a 16-county area of central Illinois. A comparison was made between the master's degree workers' and bachelor's degree workers' perceived importance of selected social service tasks and their view of the frequency with which these tasks were carried out. The data indicate no significant difference between the attitudes of master's degree workers and bachelor's degree workers toward the importance of the tasks; however, there were several significant differences in the frequency with which some of these tasks were performed. The implications of these findings to social work practice and education are discussed.


Corrosion rates of dental amalgam in Ringer solutions and artificial saliva. Corrosion currents of dental amalgams in Ringer solution, Ringer lactate solution and an artificial saliva were determined as a function of flow rate using the linear polarization technique. The obtained results show that corrosion is far more intense in Ringer solutions than in saliva. Also, flow rate dependence is evident for Ringer solutions but not for saliva in the range investigated.


Intracranial pressure regulation: a comparative model of cerebrospinal fluid systems. A comparative model of the cerebrospinal fluid (CSF) system in rat, dog and man was derived from manometric data using low volume, short duration infusions into the subarchanoid space in order to describe the mechanisms governing intracranial pressure dynamics. The mathematical model indicates that steady-state elevations of intracranial pressure are regulated primarily by a nonlinear, pressure dependent outflow resistance to CSF reabsorption. While the form of the resistance relationship is similar for the three species tested, differences in the magnitude of CSF outflow parameters are apparent. Model stimulation on a digital computer suggests that parameter changes within the resistance relationship can have a profound effect on the intracranial pressure. In contrast, intracranial compliance acts only to buffer transient changes in volume prior to the establishment of steady-state CSF pressures.


Schedule-induced drinking: entrainment by fixed- and random-interval schedule-controlled feeding. Six underweight rats drank in a polydipsic pattern of single post-reinforcement bursts of licking before bar-pressing for subsequent food reinforcers scheduled at fixed 60-sec intervals. With a 60-sec random interval schedule they frequently oscillated between barpressing and drinking. On both schedules mean drink durations were shorter than average inter-reinforcement times, but longer drinks occurred under the fixed-interval schedule. We concluded that intermittent reinforcement entrains drinking because food plus water is more reinforcing than dry food alone, and that polydipsia develops when opportunities for drinking do not compete with opportunities for feeding.


Antidiuretic hormone secretion and urine flow in aged catheterized patients. Repeated measurements of urine flow, every 10 min, and plasma ADH levels, every 20 min, were done in six aged, supine catheterized patients for seven hours. Orthogonal spectral analysis revealed 80 to 130 ultradian rhythms in urinary osmolality and in Na+ and K+ concentrations, but not in the flow of urine that fluctuated rapidly. Plasma ADH levels were constant, ranging from 0.5 pg/ml to 1.5 pg/ml, without evidence for pulsatile episodic secretion.


[Potentiometric determination of urinary thiocyanates (author's transl)]. A sensitive, reproductible and specific technique for the quantitative determination of urinary thiocyanates is proposed. Its analytical characteristics make it feasible for epidemiological surveys of populations potentially exposed to cyanides.


[Acute poisoning by Gyromitra esculenta (author's transl)]. This kind of poisoning is scarce in France, on the contrary it is most frequent in Eastern Europe. Clinical picture associating cytolytic hepatitis, seizures, and hemolysis reminds us intoxication by hydrazine. In fact there is some evidence that the toxin of this mushroom--called gyromitrin--is transformed in the stomach in methylhydrazine. The mechanism of hepatotoxicity of the later can be compared with that of the metabolites of isoniazid.


Echis colorata bites in Israel: an evaluation of specific antiserum use on the base of 21 cases of snake bite. Specific Antiserum for Echis colorata snake bite has been in use since 1965. To date 25 cases of bite by this snake have been reported, most of which are included in this series. As the antiserum was not routinely used I had the opportunity to compare the results in patients receiving antiserum to the results in patients not receiving it. The conclusion is that the use of specific antiserum should be limited to patients demonstrating severe bleeding and not reacting to treatment of consumption coagulopathy. The clinical picture, laboratory results and the post mortem results of a fatal case of E. colorata bite are included.


[Comparison of the acute toxicity and the ulcer inducing power of zinc sulphate and pantothenate carried out in animals (author's transl)]. Zinc sulphate and pantothenate are two drugs capable of inducing ulcer. An experimental was performed in order to determine the acute toxicity of both drugs. The obtained data were in favour of a lesser ulcer inducing capacity of zinc pantothenate, associated to a better diffusion of this salt in the peripheral tissues. These results suggest a plausible use of zinc pantothenate as a therapeutic agent.


[Toxic effects of essential oil of Cannabis sativa L. and main constituents on planarian (Dugesia tigrina) (author's transl)]. Regenerating pieces of planarian worms are able to absorbe insoluble substances deposited on the base of the vessels in which they are cultivated. This biological test was used to study the toxic effects of the essential oil of Cannabis sativa L. The hydrocarbons such as pinene (alpha and beta), caryophyllene and so on were not toxic. On the contrary caryophyllene oxide was highly toxic. It was not possible to detect any protection by 5-hydroxytryptamine as it was the case against delta 1-tétrahydro-cannabinol and cannabidiol.


Inhibitors of neovascularization in relation to diabetic and other proliferative retinopathies. The demonstration of an inhibitory effect on the potent source of corneal neovascularization which is elicited by the stromal implantation of solid tumours raises the possibility that similar inhibition may be obtained in the animal model of retinal neovascularization. A major program has been initiated to extend the inhibitor studies observed in cornea to the retina.


Hyperoxic myopia.

Hyperoxic myopia. We have reported the development of 1.6 diopters of myopia in a group of patients exposed to reptitive oxygen breathing at two atmospheres absolute pressure. No significant change in corneal curvature accompanied this refractive change. During the three months following termination of the hyperoxic exposure, the myopia gradually disappeared. It is speculated that hyperoxygenation alters the metabolism of the adult lens producing an increase in its dioptric power.


Centrifugal nerve fibers in the adult human optic nerve: 16 days after enucleation. The optic nerve stump of a 56-year-old patient was removed 16 days after enucleation of the corresponding eyeball. The stumps of numerous centrifugal (efferent) nerve fibers are demonstrated histologically in this optic nerve central to the 16-day old surgical cut. Electron-microscopic views of the centrifugal nerve fibers are offered for the first time. The findings are further evidence for the existence of centrifugal fibers in the human optic nerve. The nerve fiber stumps exhibit reactive terminal swellings pointing towards the surgical cut indicating axoplasmic flow in that direction. It is of special interest that the centrifugal nerve fibers of this 56-year-old patient lack any evidence of attempted regeneration that has been observed under similar conditions in th optic nerve stump of a child.


Continuous in vivo recordings of intraocular capillary and aqueous humor flows. Multiple-point recordings of the initial slopes of xenon 133 and human serum albumin I125 washout from various ocular regions were utilized to visualize changes in capillary and aqueous humor bulk flow in vivo. Preservation of slope linearity is essential for sensitive responsiveness of recordings to flow change. Linearity is enhanced by the initial slope approach in which stability of physiological values and drug effects are maintained and slopes are closely fitted to multiple points. As examples of intraocular flow changes which may be observed and computed from such slopes, responses recorded in forty feline washout studies are presented and the fundamentals of washout recording interpretation are discussed.


Congenital fibrosis of the extraocular muscles. Congential fibrosis of the extraocular muscles is characterized by the replacement of normal contractile muscle tissue by fibrous tissue or fibrous bands in varying degrees. The clinical entities which result from the fibrous replacement can be classified under the following headings: general fibrosis syndrome, congenital fibrosis of the inferior rectus muscle with blepharoptosis, strabismus fixus, vertical retraction syndrome and congential unilateral fibrosis, enophthalmos and blepharoptosis. Genetic factors may or may not be apparent. One pedigree with general fibrosis syndrome was traced through five generations. Light and electron microscopy demonstrated replacement of normal muscle by collagen and dense fibrous tissue with occasional areas of degenerated skeletal muscle. The surgical mangement attempts to achieve some functional readjustment of the ocular and lid position as well as the abnormal head posture. The surgical results were considered satisfactory when compared with the original position of the eyes and the backward head tilt.


The ocular aspects of carotid artery bypass surgery. A new neurosurgical procedure, anastomosis of the superficial temporal artery to the middle cerebral artery, is being performed with increasing frequency. Over a 7-year period (1971 through 1977), 121 patients have undergone this operation in our institution. Ophthalmodynamometry may be of great help in identifying occlusion of an internal carotid artery. Progressing venous stasis retinopathy and ischemic orbital pain are believed to be indications for bypass surgery of the carotid artery.


Arterial embolization of orbital hemangiomas. A patient with multiple orbital hemangiomas benefitting from the adjunct treatment of transcatheter selective arterial embolization has been presented. The interdisciplinary team effort for this relatively new modality of treatment is called to the attention of the ophthalmologist for consideration in management with difficult or inoperable orbital vascular lesions or arteriovenous malformations with or without intracranial manifestations.


Suspension of the globe during intraocular surgery. The unopened eye maintains a relatively stable spherical contour due to the expansile influence of the intraocular pressure. When the eye is opened this expansile pressure is lost and some degree of collapse of the scleral shell ensues. In eyes with a relatively flaccid sclera an anterior segment incision may induce significant reduction in the volume of the posterior segment of the globe. During intracapsular cataract extraction on such eyes, scleral collapse can cause anterior displacement of the lens and iris when the eye is opened and vitreous loss as soon as the lens is extracted. Scleral collapse tends to occur during intraocular surgery on previously aphakic eyes. In this situation it may become difficult to achieve a vitreous-free anterior sement by open sky vitrectomy. Metallic scleral supporters prevent inward collapse of that portion of the sclera  to which they are attached. They do not prevent downward collapse of the posterior sclera shell. Upward traction is required to prevent the downward component of scleral collapse. A system for controlled suspension of the globe during intraocular surgery has been devised and used in a variety of surgical procedures. The apparatus is simple and it does help to minimize downward scleral collapse. It does not prevent scleral identation or distortion by external forces and cannot substitute for inadequate anesthesia and akinesia or faulty surgical technique.


Fellow eyes of giant retinal breaks.

Fellow eyes of giant retinal breaks. INCIDENCE OF RETINAL BREAKS AND DETACHMENT IN FELLOW EYES. The fellow eyes of 226 giant retinal breaks were followed in order to determine the incidence and natural course of chorioretinal and vitreous pathology. During the period of observation which ranged from 18 months to 16 years, the incidence of retinal breaks and retinal detachment increased from 36.1 percent to 51.3 percent. By the end of the follow-up period, the incidence of bilateral giant retinal breaks was 12.8 percent; retinal tears 11.9 percent, retinal holes 10.2 percent, retinal dialysis 0.4 percent, and retinal detachment 15.9 percent. The average duration of follow-up was 3.7 years, therefore, the incidence of retinal breaks in fellow eyes is probably significantly higher. VITREORETINAL CHANGES PRECEDING THE DEVELOPMENT OF RETINAL BREAKS. Syneresis, liquefaction, and condensation of the vitreous base were observed in the majority fellow eyes that developed retinal tears or giant retinal breaks. Follow-up of fellow eyes revealed that the development of a giant retinal break is often preceded by increasing white with pressure associated with increasing condensation of the vitreous base. MANAGEMENT OF FELLOW EYES. Bcause of the high incidence of retinal breaks developing in the fellow eye, regular and thorough examination of the vitreous and retinal breaks even though the fundus may appear normal at the initial examination. PROPHYLACTIC TREATMENT. This study suggests that prophylactic treatment is beneficial in the management of fellow eyes of giant retinal breaks. During this study, retinal breaks developed in 27.3 percent of untreated eyes and in 2.4 percent of eyes treated prophylactically. PROPHYLACTIC TREATMENT OF FELLOW EYES OF GIANT RETINAL BREAKS. Its seems prudent to prophylactically treat retinal holes or dialyses in eyes without retinal detachment with cryotherapy. Scleral bucking seems justified in the prophylactic treatment of eyes with retinal tears of lattice-like degeneration with retinal breaks or highly myopic eyes with increasing white with pressure and increasing condensation of the vitreous base.


Preschool visual acuity screening tests. The purpose of the study was to evaluate the relative merits of two screening tests used for visual acuity assessment of preschool children. The tests that were compared were the Good-Lite Company versions of the E-Test and of the STYCAR (Screening Test for Young Children and Retardates). The former is the most popular method for evaluating central acuity in young children in this nation; the STYCAR is a relatively new letter-matching-test developed in England, where it is widely employed. The E-Test poses left-right orientation problems which are eliminated by the symmetrical letters H, T, O and V utilized in the Letter-Matching-Test. Both visual acuity tests were administered on two separate occasions by personnel from the Prevention of Blindness Society of Metropolitan Washington to 633 preschool children in Washington, D.C. By random selection, 150 of the children received the E-Test at both sessions, 162 children received the Letter-Matching-Test at both sessions, 160 chilt athe the second session, and 161 children received the Letter-Matching-Test at the first session and the E-Test at the second session. The author medically examined the eyes of 408 of the 633 children without knowledge of which test had been initially administered. Statistical analysis of the data obtained from the study indicated that the Letter-Matching-Test was significantly better in terms of testability rates, group and individual instruction time, and performance time. The E-Test was more reliable in terms of test-retest acuity scores and was also more valid in terms of agreement between pass-fail results obtained at the first screening session and two levels of pass-fail refraction criteria.


The diagnosis and treatment of sickled erythrocytes in human hyphemas. Four patients with sickle cell hemoglobinopathies (one SC; three AS) and hyphemas were found to have more erythrocytes sickled in their anterior chambers than in their circulating venous blood. Intraocular pressure was severely elevated, despite relatively small amounts of intracameral blood. Systemic hypotensive agents were not always successful in reducing IOP, and in patients with sickle cell hemoglobinopathy, are probably contraindicated in high or repeated dose regimens. Moderate elevation of IOP in sickle cell hemoglobinopathy patients may produce rapid deterioration of visual function, perhaps because of a greater effect on vascular perfusion in the CRA and optic nerve. Early anterior chamber paracentesis may be the best treatment for this type of hyphema-induced secondary glaucoma.


Flux of topical pilocarpine to the human aqueous. Aqueous fluid was withdrawn from eyes of patients undergoing cataract extraction at various intervals after administration of two drops 2% pilocarpine-HCl in a standard manner. Determination of aqueous pilocarpine concentration was made both by spectroscopy of a ferric hydroxylamine complex and by gas-liquid chromatography. These methods were consistent in indicating that concentration does not rise beyond 5 micrograms/ml at any time following topical instillation. The mean of 71 GLC determinations of aqueous tapped between 2 and 32 minutes after drops was 1.67 micrograms/ml. With assumption of a total chamber volume of 400 microliter, the average total pilocarpine in aqueous in these circumstances is less than 1 microgram. These findings correlate well with investigations of transcorneal flux of pilocarpine for the rabbit in a partial in vitro transport chamber system, with which comparable low flux efficiency was found after simulated drop administration. This serves to validate in some measure in extrapolation of other findings in chamber experiments to the living human eye. The combined in vitro and in vivo experimental results suggest that two distinct mechanisms govern the flux of pilocarpine across the cornea. High doses, comparable to those in standard clinical use, whether administered in drops or in constant flow, are transported inefficiently with kinetics indicating a diffusional mechanism and are associated with intracorneal retention or degradation of a substantial moiety. Low doses, if continuously applied, are much more efficiently transported. Hydrogel polymer vehicles appear to mobilize this low-dose mechanism by retaining drug against mechanical dissipation and elution by tear flow, but also by retaining drug against the capability of the cornea to take up more pilocarpine than can be transported to produce an intracorneal drug "depot." Although the exact nature of the "depot" is not clear, it is not elutable as pharmacologically active drug. It is consistently associated with the relatively poor flux efficiency found with high doses, and thus may act in some manner to disable a more efficient mechanism. The flux efficiency found with hydrogel mediation is more than double the best found in constant flow determinations. Vehicular mediated flux is rate limited by the cornea, independent of dose, linear with time despite exponentially secreasing available drug, and not associated with an intracorneal drug "depot." These features are consistent with carrier mediation of some type.


Rubeosis iridis in retinoblastoma and pseudoglioma. The high incidence of rubeosis iridis accompanying retinoblastoma has been reaffired. Factor common to ocular tumors in general and retinoblastoma, as well as reactions to retioblastoma that have some contributory effect upon vascularization of the iris have been studied and complied. No single causative factor emerged, although tumor necrosis obviously played an important role. To a lesser extent, the site, location, and intraocular extension bore some relationship to neovascularization. That iris neovascularization carries a more grave prognosis, until now only a clinical impression, was definitely confirmed. Clinicians, therefore, studying patients with retinoblastoma would be well advised to pay more attention to the iris and anterior segment since recognition of changes leads to more timely and knowledgeable management. It was hoped that increased recognition of rubeosis would differentiate between eyes with retinoblastoma and those with pseudoglioma; however, an equally high incidence of neovascularization accompanied certain pseudogliomas. In both studies, as is often the case, numerous interesting observations were made; several with clinical implications. Finally, a frequently associated glaucoma, suggested by the anterior segment histologic features, went urecognized and unrecorded in these patients.


Delayed absorption of subretinal fluid after scleral buckling procedures: the significance of subretinal precipitates. A delay in absorption of subretinal fluid after surgical repair for rhegmatogenous retinal detachment beyond 6 weeks was recognized in 39 of 575 consecutive cases undergoing scleral buckling procedures. The most common preoperative condition that was identified in these eyes was large clumps of cells on the undersurface of the detached retina. These cream-colored aggregates appeared similar to mutton-fat keratic precipitates and are referred to as subretinal precipitates. Most likely caused by aggregates of macrophages, they were present in 12 percent of the overall series of cases; subretinal precipitates also were recognized and documented before operation in nearly half of the eyes with delayed fluid absorption, a relationship that is highly significant in statistical analysis (P less than 0.001). On recognizing them before operation, the clinician can expect that approximately a fourth of the eyes will have fluid persisting beyond 6 weeks from the time of surgical repair until complete absorption. A second relatively common condition associated with delayed absorption of fluid that could be recognized in advance of surgical treatment was a long-standing peripheral (usually inferior) retinal detachment, which typically spared the macula, was associated with demarcation lines, and was caused by round atrophic holes with or without lattice degeneration. The presence of demarcation lines (reflecting relatively long-standing retinal detachment) was also positively correlated with delayed fluid absorption (P less than 0.02). Other conditions associated with delayed absorption of fluid included detachments of long-standing duration by history (especially when associated with previous unsuccessful efforts to repair the retina), vitreoretinal traction, and conditions whereby the choriocapillaris-retinal pigment epithelial complex and been significantly disturbed. Such conditions included hemorrhage into the subretinal space as a complication of surgical relase of subretinal fluid, previous retinal surgery, and possibly heavy treatment with cryopexy, especially when associated with exudative detachment. An analysis of subretinal fluide from 39 eyes showed a positive relationship between protein concentration and duration of the detachment but no relationship to a variety of other factors, including the presence of subretinal precipitates. Commonly identified cellular structures in the subretinal space consisted of pigmentladen macrophages. When studied by electron microscopy, some of these were thought to have originated from the retinal pigment epithelium.