Effects of limiting water intake on the rat estrous cycle with observations on LH, prolactin, and corticosterone. By the fifth week of restricting water intake at 1100 to a 15-min period per day, estrous cycle lengths had shifted in most animals (31/40) from 4 to 5 days with the 5-day cycles usually consisting of 3 days of diestrus. In the 5-day cycling rats, plasma corticosterone peaked at 1100 and also at 1900 hr, the proestrous surge in plasma LH was not significantly changed, although the variation in individual animals was greater and the prolactin surge was prolonged. Similar prolonged cycles followed water restriction at 1800 hr with animals returning to regular 4-day cycles when given water to ad libitum. These results suggest that the alteration of the normal corticosteroid rhythm and/or changes in prolactin secretion may account, in part at least, for the changes noted in cycle length after restricting the water intake.


Polyacrylamide gel electrophoresis of twin and nontwin parotid salivary proteins. Parotid salivary proteins from monozygotic twins, dizygotic twins, nontwin sibs, and unrelated male and female subjects of the same age range as the twins were separated by polyacrylamide gel slab electrophoresis at pH 9.0. Variability of the stained protein patterns increased in the order: monozygotic twins; dizygotic twins and nontwin sibs; unrelated subjects. It is concluded that genetic factors are the major contributors to variability of parotid salivary proteins among subjects.


Comparison of withdrawal precipitating properties of various morphine antagonists and partial agonists in relation to their stereospecific binding to brain homogenates. In morphine-dependent rats the withdrawal precipitating properties of various morphine antagonists and partial agonists were studied by quantitatively evaluating a variety of different withdrawal signs. A comparison of the dose response curves of the various substances obtained for the different signs revealed marked differences in respect to the lowest effective doses (EDs) necessary to precipitate the withdrawal signs as well as in the maximum frequencies of the signs induced. The "pure" antagonist, naloxone, which was judged very potent according to the ED, precipitated the lowest levels of jumping, whereas certain partial agonists of the benzomorphane type, which were less potent according to the ED, induced very high levels of this sign. These latter compounds, however, failed to precipitate "complete" withdrawal, as evidenced by the nearly complete absence of some of the withdrawal signs. The jumping precipitating potency of the antagonists as judged from the ED was found to be highly correlated to the stereospecific binding of these substances to rat brain homogenate. On the other hand, the ability of the substances to precipitate high levels of jumping was seen to increase, at least within a certain range, with increasing degree of agonistic properties, as indicated by the ratio of stereospecific binding in the presence and absence of sodium.


Necrosis, haemorrhage and complement depletion following bites by the spitting cobra (Naja nigricollis). The Spitting Cobra, Naja nigricollis, is widely and densely distributed in Africa. Fourteen patients with proven N. nigricollis bites, who were seen in the savanna region of Nigeria, did not exhibit the neurological signs, such as cranial nerve lesions and respiratory paralysis, expected following Elapid poisoning. All had local swelling, in eight cases involving the entire limb, and ten developed local tissue necrosis. Spontaneous haemorrhage was detected in three cases and was the probable cause of death in one of them; the other death in this series was unexplained. Haematological abnormalities included prolonged clot lysis anf failure of clot retraction due to a platelet defect. There was no specific deficit in clotting factors and a delayed rise in fibrin degradation products was attributed to extensive tissue damage at the site of the bit. Most patients showed depletion of complement component C3 and glycine-rich beta-glycoprotein (GBG), suggesting activation of the alternative pathway of complement fixation. There was evidence of hepatocellular damage in two out of six patients investigated. There was no evidence that specific polyvalent antivenoms, used in doses of up to 80 ml, prevented any of the effects of N. nigricollis venom. Clinical laboratory diagnosis is discussed. In the past many bites were wrongly classified as viper bites on the basis of clinical findings. Immunodiagnosis is a promising method for assessing the true importance of N. nigricollis bite in West Africa.


[Aims and limits of nuclear medicine methods in investigation of malignant and benign bone lesions (author's transl)]. In primary bone tumors the possibilities of bone scans are discussed. Exact differentiation between malignant and benign disease by this method is impossible. However, scanning provides important information about extent of the disease, metastases, multiplicity of benign lesions and influence of adjoining diseases to the bone. A special indication exists in cases of cerebral meningiomas and an absolute indication for searching osteoplastic metastases, e.g. in carcinomas of the breast and the prostate gland.


Sudden death in the laboratory rat.

Sudden death in the laboratory rat. Vulnerability to sudden death was produced in laboratory rats by manipulating their developmental history. Rats who were reared in isolation died suddenly when placed in a stressful swimming situation. Handling of these singly-housed rats from 25 to 100 days of age potentiated the phenomenon. However, animals who were group housed did not die even when they had been previously handled.


Early radiographic manifestations of carcinoma of the esophagus. The survival of patients with esophageal carcinoma is greatest if treatment is begun when the tumor is small and confined to the esophagus. To better define the early radiographic manifestations of this disease, we analyzed the clinical and pathological information and the radiographs from 9 patients with esophageal carcinomas 3.5 cm or less in diameter. All tumors involved one wall of the esophagus and most appeared as plaques or flat sessile polyps, occasionally with central ulceration. Air-contrast views of the distended esophagus demonstrated the tumors to best advantage and should facilitate early detection.


Subependymal and intraventricular hemorrhage in neonates. Early diagnosis by computed tomography. Computed tomography was used to evaluate subependymal and intraventricular hemorrhage in 11 formalin-fixed brains obtained at autopsy from newborn infants from a population with a known high incidence of cerebral hemorrhage. After scanning, the brains were step-sectioned at levels corresponding to those of the scans. Subependymal and/or intraventricular hemorrhage was demonstrated in 6 of the 11 brains. There was a very close correlation between the scan images and the gross pathological findings in the affected brains. The authors conclude that computed tomography is an accurate method for the diagnosis of neonatal cerebral hemorrhage.


Computed tomography in metastatic disease of the brain. Computed tomography has been found to be a more accurate diagnostic tool in the analysis of brain metastases than radionuclide scanning. Of 1,100 patients studied by CT scan, 57 showed evidence of intracerebral metastasis, and 14 showed evidence of hydrocephalus. Density levels below that of normal brain tissue were found in cases of metastases from the lung (13), breast (7), melanoma (4), kidney (3), lymphoma (3), and nasopharynx (1); levels above normal were found in cases of metastases from melanoma (8), lung (3), colon (3), chorionic carcinoma (2), osteogenic sarcoma (1), and kidney (1).


The diagnostic value of hyperostosis in midline subfrontal meningioma. Roentgenologic analysis of 66 patients with proved midline subfrontal meningioma indicates a very high incidence of hyperostosis. A total of 63 patients (95%) showed varying degrees of hyperostosis involving the cribiform plate, planum sphenoidale, or tuberculum sellae (including the chiasmatic sulcus). The planum sphenoidale is the most common site of hyperostosis (59%). In 19 cases (29%), the region of hyperostosis did not correspond to the site of tumor attachment. Mild or localized hyperostosis may be apparent only on tomograms. Small "blistering" and "saw-tooth-like" osteoma formation are reliable early signs of midline subfrontal meningioma; conversely, midline subfrontal meningioma can be virtually ruled out if hyperostosis is absent.


Lumbar thermography in discogenic disease. Thermography is a simple, noninvasive outpatient procedure which can be performed on patients with clinical symptoms of a herniated disk. A positive thermogram usually indicates that an abnormality will be found by myelography. However, the myelographic findings cannot be predicted by a negative lumbar thermogram.


Rupture of the spleen in a newborn infant: report of a new roentgen sign. The authors report a case of splenic rupture diagnosed preoperatively in a newborn infant. High-dose excretory urography is recommended in newborn infants who exhibit signs of severe anemia or hemoperitoneum.


Duplication of the urethra.

Duplication of the urethra. Ten patients with patent urethral duplication are presented. Nine patients had two independent patient channels originating from the bladder or the posterior urethra. Both voiding cystourethro and retrograde urethrography are necessary to completely evaluate this anomaly. In each instance the ventral channel, regardless of the position of its meatus, proved to be the more functional urethra. In those patients whose dorsal channel was in an epispadiac position, the symphysis pubis was abnormally wide. A functionally and anatomically accurate classification is proposed, and the embryology of these anomalies is discussed.


Symmetrical reversed plantar calcaneal spurs in children. A normal variant? Three cases of unrelated children who have symmetrical posteriorly directed plantar calcaneal spurs are presented. Only one reference to this appearance could be found in the English literature. These spurs are asymptomatic and probably represent variations in the normal development of the calcaneus.


Retained abdominal placenta followed by angiography and ultrasound. In a case of advanced abdominal pregnancy, the placenta was left in situ following operative extraction of the fetus. Ultrasound and angiographic studies provided assistance in planning subsequent surgery. Both types of examination are indicated in such cases.


Aspermia and recovery of spermatogenesis in cancer patients following incidental gonadal irradiation during treatment: a progress report. The 11 patients in this study who received incidental gonadal irradiation from clinical therapy all became aspermic within 8-34 weeks following treatment. The estimated gonadal dose was 118-228 rads. Five of these patients have shown recovery of spermatogenesis; 3 of these have reached fertilizable concentrations. Recovery of semen sperm was noted at 44-77 weeks following treatment. The other 2 patients, after 110-176 weeks, have sub-fertile concentrations of semen sperm. Five patients have not been followed for a sufficient length of time to permit recovery to be noted.


Mushroom worker's lung disease.

Mushroom worker's lung disease. Although usually considered a feature in mushroom worker's lung disease, hilar adenopathy was not found and only 8 of the authors' 26 patients exhibited positive radiographic findings. The etiology of the disease is allergic with a radiographic appearance of alveolitis which may present with consolidation or a reticular pattern. None of the 26 patients exhibited enlargment of the hilar lymph nodes. The acute phase subsides in 10 days to 6 weeks after exposure has ceased.


Differential diagnostic importance of retrograde phlebography in cases of unusual ectasia and renal pelvic deformity. Retrograde renal phlebography is important in the differential diagnosis when carcinoma of the renal pelvis is suspected. Vessel cut-offs, differences in contrast density, variations in vessel caliber, and irregular identations of the vessel wall can be seen with this technique. This seems to be the only method of demonstrating varicositites of the renal veins.


The soleal line: a cause of tibial pseudoperiostitis. An unusually prominent soleal line (a normal anatomic variant) may mimic periosteal reaction along the posterior margin of the proximal tibial shaft. This area of pseudoperiostitis is differentiated from hyperostoses arising from the anterior tibial tubercle and the interosseous membrane. It is always associated with normal, undisturbed architecture of the underlying bone.


Luteal function in sheep injected with prostaglandin F2alpha directly into the corpus luteum. Groups of ewes received either saline or prostaglandin F2alpha (PGF2alpha) as an injection directly into the corpus luteum. Changes in circulating progesterone levels were measured as well as subsequent histological examination of the corpora lutea. Saline, or PGF2alpha given at the two lower doses (60 and 120 mug respectively), failed to suppress progesterone levels permanently, or to induce degenerative changes in the corpora lutea. Treatment with a higher dose of PGF2alpha (240 mug) was followed by a marked elevation in progesterone levels. These results are discussed in relation to reported effects of PGF2alpha arriving at the ovary via the arterial circulation.


[The effect of oxytocin and dihydrostilbestrol on various uterine cations (author's transl)]. The effect of dihydrostilbestrol diacetate and oxytocin on the Na+, K+, Ca++ and Mg++ content in uterine Wistar rats has been studied. A bilateral ovariectomy on the animals was performed. After seven days dihydrostibestrol (0.25 mg/kg a day) and oxytocine (0.025 U.I./kg a day) were administered separately and simultaneously i.p. during a period of five days. Twenty four hours after the first, third and fifth administration, five rats from each group were decapited and the above uterine cation content was determined by atomic absorption spectrometry. Dihydrostibestrol induced a marked increase and a slight decrease in K+ and Na+ contents respectively, lowering the Na/K ration. It also increased greatly Ca++ and Mg++ content. Oxytocin induced a Na+ and K+ increase, a Ca++ decrease, and slight changes in Mg++. These results partially confirmed the bioelectric and biomechanic alterations produced by the above hormones on the uterine cells.


[Free endogenous aminoacids in perfused intestine in rats (author's transl)]. The intestinal content of free aminoacids from endogenous origin is studied by perfusion through the small intestine of rats under the influence of several factors, pancreatic and biliary secretions, the addition of L-glutamic acid at two different concentrations to the perfusion liquid either with the pancreatic and biliary secretion or without them. The conclusion is reached that the pancreatic juice contributes significantly to the intestinal amount of free aminoacids; the addition of L-glutamic acid to the perfusion liquid under the fixed experimental conditions decreases the amount of free amino acids transfered by active mechanisms in the intestinal contents. This effect shows a certain selective preference to the essential aminoacids against the non-essential aminoacids. Such effect is not observed, however when the pancreatic secretion is not present in the intestinal contents.


Urinary 3,6-anhydroglucosamine.

Urinary 3,6-anhydroglucosamine. A compound, isolated from acid hydrolysates of urine samples from normal children, characterized as 3,6-anhydroglucosamine by chromatography on a cation exchange resin and by gas-liquid chromatography, could not be detected in hydrolyses of urine from Morquio patients.


Inhibition of hepatic uptake of alpha aminoisobutyric acid by ethanol: effects of pyrazole and metabolites of ethanol. Ethanol inhibits the uptake of AIB by the isolated perfused rat liver. However, if the metabolism of ethanol is blocked by pyrazole, there is no reduction in accumulation of AIB by the liver. Acetaldehyde and acetate, metabolites of ethanol have no effect on AIB uptake by the liver. The inhibition of urea synthesis by ethanol is also prevented by pyrazole. Neither of the metabolites of ethanol inhibit urea synthesis in the isolated liver.


Inhibition of drug metabolism by fluoxetine. Fluoxetine hydrochloride (Lilly 110140: 3-p-trifluoromethylphenoxy-3-phenyl-N-methyl-propylamine hydrochloride) inhibited the metabolism of hexobarbital and ethinamate in rodents and prolonged the hypnotic effects of these drugs.


Dose of progesterone and allantoic fluid volume in conceptuses in ovariectomised goats. The volume and composition of fetal fluids in conceptuses from untreated goats and from ovariectomised goats in which pregnancy was maintained with a high (0-76 mg per kg body weight) or low (0-35 mg per kg body weight) dose of progesterone, were determined. The mean allantoic fluid volume per conceptus was similar in the untreated goats (77-0+/-13-49 ml) and the ovariectomised goats which received the higher dose of progesterone (81-4+/-18-24 ml) but was significantly greater in the ovariectomised goats which received the lower dose of progesterone (251-5+/-66-49 ml). The increase in allantoic fluid was associated with a rise in K+ concentration.


99mTc in evaluation of sacro-iliac arthritis. Profile scintigraphy using 99mTc has been employed in the study of sacro-iliac joints in order to achieve objective registration of inflammatory activity in the notoriously difficulty investigated sacro-iliac joints. The study showed good correlation between uptake values of the profile curve and inflammatory activity in the sacro-iliac joints. Differences between the means of the 99mTc uptake for patients with arthritis in the sacro-iliac joints, compared with those in the controls were highly significant (P less than 0.001). The method gives quantitative results which are comparable between different individuals. The shape of the uptake curve is informative. Side differences can be demonstrated and are valuable in estimation of asymmetric inflammation of sacro-iliac joints.


[The value of diagnostic laparotomy in patients with malignant lymphomas]. From 1972 to 1974 a collaborative prospective study was undertaken to determine the incidence, causes and clinical course of chronic renal failure (CRF) in pediatric patients (age 1/2-16 years) in Switzerland. In addition, information concerning the occurrence of terminal CRF observed between 1967 and 1971 was obtained. CRF is defined as persistently elevated serum creatinine greater than 2 mg/100 ml. The small size of Switzerland (population 6.27 million) and the availability of specialized medical care favoured relative completeness of data. a) Non-terminal CRF. - Prevalence was 4.5 per million total population = 18.5 per million children (1/2-16 years old)(n = 28 at 31. 12. 1974); Causes: renal disease was acquired in 14% and congenital in 86% (hereditary nephropathies excluding polycystic kidneys 4%, polycystic kidneys 14%, hypoplasia 14%, urinary tract abnormalities 54%). Progression of CRF: mean time interval in which serum creatinine doubled was, in the group of acquired renal diseases, 8.3 months (n = 6); in hereditary nephropathies 14.3 months (n = 4); in the group of polycystic kidneys and hypoplasia 41.2 months (n = 6), and in patients with urinary tract abnormalities 35.8 months (n = 15). Body height was reduced in all groups as compared with normal children: 1.0 SDS (standard deviation scores) in acquired renal diseases (n = 9), 5.1 SDS in cystinosis (n = 2), 0.4 SDS in polycystic kidneys (n = 4), 1.6 SDS in hypoplasia (n = 5), and 2.3 SDS in urinary tract abnormalities (n = 16). b) Terminal CRF. - Mean yearly incidence (1967-1974, n = 68) was 1.36 per million total population = 5.6 per million children (1/2-16 years). Causes: In contrast to the situation in non-terminal CRF, acquired diseases were observed in 56% of all patients. Hereditary nephropathies were found in 12%, polycystic kidneys in 1.5%, hypoplasia in 4.5%, and urinary tract abnormalities in 26%. Between 1970 and 1972, 7 of 21 patients, and during 1973/1974 13 of 1n. On 31. 12. 1974, 18 of these 20 treated patients were alive, and of these 14 had a functioning graft.


[Silicosis, chronic bronchitis and smoking habits]. In 333 patients suffereing from silicosis the incidence of chronic bronchitis and/or obstruction of the respiratory tract has been correlated with cigarette smoking. The incidence of chronic bronchitis and/or airway obstruction in patients who had acquired either slight or severe silicosis in Switzerland was over 50%. A positive correlation between cigarette smoking and chronic bronchitis and/or airway obstruction could be found only in younger patients with slight silicosis. Chronic bronchitis and/or airway obstruction was not more frequent in foundry-workers suffering from silicosis where they had been exposed to fumes which irritated the respiratory tract. Deformation of the respiratory tract due to silicosis has a greater bearing on the development of chronic bronchitis and airway obstruction than immoderate cigarette smoking.


Hemoglobin synthesis in somatic cell hybrids: independent segregation of the human alpha- and beta-globin genes. Hybrid somatic cells containing a partial complement of human chromosomes were used to demonstrate that the human alpha- and beta-globin genes are located on different chromosomes. Two cell lines consisting of a cross of mouse with human fibroblasts contained the human alpha- and not the beta-globin gene, while a cross of human marrow cells with mouse erythroleukemia cells expressed the human beta- but not the alpha-globin gene.


Two functional effects of decreased conductance EPSP's: synaptic augmentation and increased electrotonic coupling. Three electronically coupled motor neurons, which mediate inking behavior in Aplysia californica, receive both increased and decreased conductance excitatory postsynaptic potentials (EPSP's). The increased conductance EPSP's reduce electrical coupling among the cells, whereas the decreased conductance EPSP's increase electrical coupling. The decreased conductance EPSP's also augment the action of a previously ineffective sensory input and this augmentation is enhanced by the increase in electrical coupling. Both effects combine to trigger a stereotypic behavioral response.


Polysplenic syndrome in association with a rudimentary spleen. A case report is presented which contains a constellation of congenital anomalies often found associated in the polysplenia syndrome. A single ectopic rudimentary spleen was found instead of the typical polysplenic malformation. The case is discussed in relation to the variability of both the asplenia and polysplenia syndromes.


Percutaneous puncture of pancreatic cysts guided by ultrasound. Fifteen pancreatic cysts have been successfully punctured percutaneously under the guidance of ultrasonic B scanning. The procedure may be used for verification of ultrasonic diagnosis, for definitive therapy, for decompression in the case of threatening rupture and for allowance of time for maturation of the cyst membrane before surgical intervention.


Management of colitis caused by irradiation. Radiation therapy has assumed a role of primary importance in the management of gynecologic and other malignant growths.  To be effective, the treatment dosage must be adequate. However, with higher dosages for curative radiation therapy, damage from the treatment may promote prolonged morbidity and even death. The effects of this treatment may be intensified by predisposing conditions within the patient, but the damage seems to be related to the insertion of radium. Prior to therapy, each patient must be individualized, and any predisposing factors should be kept in mind during treatment to recognize and treat these complications early. Once complications have arisen, the most conservative modality of dealing with the irradiated tissue is best, since these areas of intestinal injury do not heal. This requires early diversion or resection as conservative therapy, because fistulas and bleeding will become recurrent and intractable. If diversion fails to control bleeding, resection is necessary, even if it involves an abdominoperineal resection. Therefore, conservative can become radical for this supposedly benign illness.


Saccadic visual suppression and down-beat nystagmus: a case of Arnold-Chiari malformation. A case is reported in which visual disturbances associated with the sole physical finding of downbeat nystagmus led to investigation of a patient for a foramen magnum lesion. The Arnold-Chiari malformation was suggested by air study and confirmed at surgery. It is suggested that the phenomenon of saccadic suppression was responsible for the patient's visual disability. This was unaccompanied by any of the other neurological manifestations of the Arnold-Chiari malformation. Cases presenting in this manner, with only visual disturbances, may run the risk of being unrecognized for some time as a result.


Myelomatous metastasis to the pineal body. The case is reported of a large metastasis to the pineal body in patient with plasma cell leukemia, a disorder akin to myelomatosis. There were no apparent clinical effects from the tumor in the pineal body. The brain was otherwise uninvolved. A discussion of the relevant literature is given.


Hemodynamic effects of intra-arterial injection of drugs of abuse. Acute vascular insufficiency following intra-arterial injection of a variety of drugs has been recognized for many years. The present study addresses the hypothesis that this vascular insufficiency may be due to vasospasm. Intra-arterial injections of logarithmic doses of drugs of abuse from the barbiturate, narcotic, non-narcotic analgesic, and amphetamine groups were studied in baboons. All drugs except amphetamine produced significant increases in femoral flow. Dextroamphetamine produced insignificant alteration in flow. Solid excipients, cornstarch, and talcum powder when injected intra-arterially decreased flow, and vascular obstruction was shown angiographically. These data suggest that vasospasm is not a primary response of intra-arterial injection of drugs of abuse.


Congenital partial pericardial defect: surgical correction by partial pericardiectomy through a median sternotomy. A case of symptomatic congenital pericardial defect with herniation of the left atrial appendage is reported. The patient had experienced increasing fatigue, chest pain, shortness of breath, and slight cyanosis. A partial pericardiectomy through a median sternotomy was performed and the patient made an uneventful recovery.


Some sources of nongenetic variability in steroid-induced cleft palate in mice. C57BL/6JKt female mice mated to A/JKt males were each injected im with 50 mg/kg triamcinolone 13 days post-VP, and the roles of a number of nongenetic factors underlying variability in the frequency of cleft palate (CP) induced in the fetuses were analyzed. Litter size and number of young per uterine horn, overall, were not significantly related to the CP rate. But nearly one-quarter of litters (almost all larger-sized ones) contained CP rates deviating from-mostly less than-expected on a random basis. Analysis of litters with deviant CP distribution, as well as of all suitable litters, indicated that only maternal treatment-day weight was significantly associated, inversely, with CP frequency-in spite of the treatment dosage having been weight-based. There was no clear relation between the CP and resorption rates; but litters with deviant CP distribution had a significantly greater resorption rate than the others. Fetal weight was inversely related to CP rate even in litters of uniform size. Fetuses occupying uterine positions immediately caudal to those with CP had a significantly higher CP rate than those next to normals, and conceptuses caudal to resorptuses a significantly higher resorption rate than those next to surviving fetuses; but the reverse was not true: CP and resorption rates were not greater in those next to resorptuses and surviving fetuses, respectively.


Prenatal effects of Ochratoxin A in hamsters. Pregnant golden hamsters were injected ip with 2.5-20 mg/kg ochratoxin A on one of gestation days 7-10. The largest dosages when given on day 7,8, or 9 increased prenatal mortality and on day 9 diminished fetal growth. Malformations, such as micrognathia, hydrocephalus, short tail, oligodactyly, syndactyly, cleft lip, micromelia, and heart defects occurred, but no skeletal malformations were noted. These results add to the prenatal effects of ochratoxin A previously reported in mouse, rat, and chicken embryos.


Developmental anomalies in a human fetus of 17 weeks' gestational age. Chromosome studies of a therapeutically aborted male fetus, after amniocentesis of a 41-year-old woman, showed an abnormal karyotype of 47, XY, + 18. The fetus had many of the external anomalies described in newborns with trisomy 18; macrodissection revealed many internal anomalies consistent with this syndrome. The external and internal findings are described.


A 94-mm human fetus with the VACTERL association of anomalies. A spontaneously aborted human male fetus of 94 mm crown-rump length had multiple malformations including atresia of the esophagus with tracheoesophageal fistula, anorectal agenesis, anomalies of the heart and great vessels, kidneys, bladder, and left testis, and a single umbilical artery. This association of defects has not previously been described in a fetus at this immature stage of development.


Association of congenital heart defects with season and population density. Infants born in New England with congenital heart defects were examined for association with time of year or population density. Moderate seasonal peaks in births were noted for complex ventricular septal defect, malposition defects, and transposition of the great arteries. Positive associations with population density were found for pulmonary atresia with ventricular septal defect, ventricular septal defect with secondary anomalies, and tricuspid atresia.


Cholinomimetic teratogens. III. Interaction with amino acids known as neurotransmitters. The amino acids gamma-aminobutyric acid, taurocholate, guanidine, glycine, and beta-alanine, known to have putative functions as neurotransmitters, when given as supplement to carbachol or decamethonium, greatly reduced the incidence of malformations produced in chicken embryos by these depolarizing cholinomimetic teratogens. In combination with the nondepolarizing teratogens neostigmine and pyridostigmine similarly beneficial effects occurred only by supplementation with gamma-aminobutyric acid.


Some aspects of the epidemiology of human minor birth defects and morphological variants in a completely ascertained newborn population (Madison study). In 4319 infants examined at birth who were without major birth defects those with a "remarkable" pregnancy outcome, i.e., low birth weight (less than 2500 g), long gestation (greater than or equal to 43 weeks), stillborn, or twin status, were more likely to have a minor birth defect than the remainder. With regard to the 2 most frequent defects, simian crease and folded helix, the increase in the former was of about the same order (1.6-2.1 -fold) in those with remarkable outcome of all types, but the increase in the latter was particularly great in twins (approximately 3.1-fold) compared with the other remarkable outcomes (approximately 1.3-fold). With regard to variants, which were defined as those features scored that occurred in 4% or more of the newborn population, some (flat and small hemangioma on face and scalp, Brushfield spots, flat nasal bridge, hyperflexed thumbs, hydrocele, and mild calcaneovalgus) exhibited a trend towards negative association with low birth weight and a trend to positive association (with exception of hemangioma and calcaneovalgus) with long gestation, suggesting they may simply be indirect markers of gestational age. There was a trend to a slight decrease in the frequency of minor defects with increasing maternal age, similar to the trend for major defects.


Cytogenetics of postimplantation rabbit conceptuses following delayed fertilization. The chromosome complement and anatomical development of 10-16-day rabbit embryos were studied following delayed fertilization. Preimplantation loss was 40% in the experimental group compared with 17% in control animals. Also, a greater number of embryos retarded in growth or with structural anomalies was seen in the delayed-mated group. Cytogenetic analysis revealed a trisomy for a small metacentric chromosome in 104 control embryos. Only 1 triploid embryo was found in 84 implantation sites from rabbits that had been delayed mated. The incidence of triploidy postimplantation was much less than the 13% found previously in 6-day blastocyts. Increased embryonic loss at the time of or shortly after implantation may be responsible for the discrepancy.


Tolbutamide treatment of pregnant mice: repeated administration reduces fetal lethality. Pretreatment of pregnant BALB/c mice with several low doses of tolbutamide protected against the fetolethal effects of a high dose. Pregnant mice were given single ip injections of 400 mg/kg in saline on day 13; 100 mg/kg/day on days 10, 11, 12, and 13; or 100 mg/kg/day on days 10, 11, and 12 and 400 mg/kg on day 13. On day 16 the single-treatment group had a significantly higher resorption rate than any other group. Fetolethality was not related to hypoglycemia. The protective effect of pretreatment may have been due to induction of maternal microsomal enzymes.


Morphogenesis of the secondary palate in normal and hydrocortisone-treated hamsters. Fetal palate morphogenesis was studied in normal and hydrocortisone-treated hamsters. Formation of the normal palate was completed between day 12:00 and 13:00 of gestation, and during this period 8 distinct developmental stages were recognized. Following hydrocortisone administration the early stages, during which vertical-to-horizontal shelf reorientation occurs, appeared to be unaffected, but subsequent fusion between opposing shelves was inhibited. Both chronological age and fetal weight provided reliable criteria for stages of normal palatal development. Following hydrocortisone administration, however, fetal weight was a poorer indicator of stage of palate organogenesis than chronological age.


Phytohaemagglutinin and transfer factor in the leucocyte migration inhibition test in patients with sarcoidosis. A new system of phytohaemagglutinin stimulation in vitro using the leucocyte migration inhibition test has been applied to patients with active and inactive sarcoidosis and subjects with a persistently negative response to tuberculin. Patients with active sarcoidosis and the tuberculin-negative subjects have a depressed response to the mitogen. This response is improved by the addition of transfer factor to the cultures.


[Gonotrophic dissociation in Culex pipiens pipiens L. (author's transl)]. Under certain conditions gonotrophic dissociation has been observed in Culex pipiens pipiens. To contribute to a better understanding of the factors which govern the appearance of this phenomenon and of its ecological importance a population in Northern Germany has been investigated. Follicular development, feeding activity and occurrence of gonotrophic dissociation were examined in females obtained from wild-caught larval stages and kept under outdoor conditions after emergence in July and August. In addition overwintering females collected in cellars in September and October were investigated after reactivation by exposure to 16 hours illumination periods and 28 degrees C. In females emerging in August the follicles were generally small, the feeding activity was very low but the rate of gonotrophic dissociation appeared to be higher than that in mosquitoes which had emerged in July. Overwintering females had small follicles and did not take a blood meal during the first days under reactivation conditions. Only after five days a development of follicles and an increase in feeding activity became apparent. Through the effect of long illumination and high temperature the state of diapause was gradually overcome and the females were fully reactivated. At the same time the rate of gonotrophic dissociation in fed females which was high in the early time of exposure to reactivation conditions became low. This suggests that gonotrophic dissociation occurs commonly in females with low feeding activity, i.e. those which are not reactivated completely. In Northern Germany the overwintering females are unfed and nulliparous and gonotrophic dissociation does not seem to play an important role for the overwintering of the mosquito in this area.


Studies on the livestock of Southern Darfur, Sudan. II. Production traits in cattle. The results of an intensive 12 months study of a number of herds in the migratory and sedentary sectors of the livestock economy of Southern Darfur are recorded. In almost every production parameter the performance of the former is superior to that of the latter but, overall, production appears to be static or declining. During 1973 the cattle population of the area is estimated to have declined 7 per cent. Meat production per kilogramme of breeding female was calculated to be 0-057 kg in the migratory sector but only 0-023 kg in the sedentary sector. Calculated calving rates are significantly higher at 65 per cent in the migratory sector than the 40 per cent of the sedentary sector. Deaths in the former sector were only 15 per cent compared with the 35 per cent of the latter. It is concluded that total settlement of the migratory sector is not the answer to the current problem of the livestock sector of Southern Darfur.


Cavernospongiosum shunts in treatment of priapism. Our experience with cavernospongiosum shunts in the treatment of patients with priapism seen during the past four years is reviewed, and the surgical technique and results are presented.


Renal actinomycosis.

Renal actinomycosis. Renal actinomycosis is an endogenous systemic fungal disease with rare renal involvement. Diagnosis, pathogenesis, and therapy are discussed.


Benign melanosis and malignant melanoma of penis and male urethra. Malignant melanoma of the penis and male uretha are unusually aggressive tumors which only rarely are cured by radical surgery. Melanosis of the penis may be confused with malignant melanoma, and we report a case of melanosis originally diagnosed and treated as melanoma with survival for twenty years. We contrast this with another case of malignant penile melanoma with a fatal outcome.


[Comparative studys on ages-related changes in collagen structures of Achilles and tail tendons in rats]. The rate and degree of age changes in collagen structures of the Achilles and tail tendons were studied in 0.5, 1, 3, 12 and 24 month old rats. The hydration degree and imino acid content were determined in the tendon collagen fibres. The proline/hydroxyproline ratio and collagen content in tendons were calculated. The wide-angle X-ray studies in the air-dried samples obtained from collagen fibres were conducted for estimating orientation and texture degree of collagen fibres. By all the studied parameters the formation and development of collagen structures in the Achilles tendons are more rapid and intensive than in the tail ones.


Diagnosis and surgical treatment of page kidney: Selected aspects. The Page kidney is a well-recognized cause of correctable hypertension. The case described herein illustrates certain select diagnostic features including the method of radiographic visualization of the capsule and subcapsular fluid-which appears to be related to both the volume of contrast material injected and the proper timing sequence of the radiographic examination. The chosen therapeutic approach was aimed at curing the hypertension while preserving maximal renal function. Aspiration therapy was used as an initial conservative procedure. Removal of the entire pseudocapsule followed in preference to nephrectomy.


[Enzymes participating in the formation of ammonia in various experimental liver diseases]. The activity of adenosine desaminase AMP-desaminase and glutaminase was studied in blood serum and the liver tissue at the normal state and with acute, subacute experimental affection of the liver as well as with the CCl4-induced liver cirrhosis and obturation jaundice in different periods. It is shown that the degree and trend of changes in the enzyme activity in the affected liver depend on the character and duration of the affecting agents action. The acute and subacute affection of the liver and one-day obturation jaundice are accompanied by a decrease in the activity of all the studied enzymes in the liver tissue. With cirrhosis induced by a multiple administration of CCl4 for three months or with a month obturation jaundice the activity of glutaminase in the liver tissue lowers and that of adenosine desaminase and AMP-desaminase increased sharply. In blood serum the activity of adenosine desaminase and AMP-desaminase increases more considerably with acute affection and cirrhosis, especially with billar one.


Angiographic aspects of tumors of renal pelvis and ureter. Selective renal arteriography was done in 5 patients with transitional cell carcinoma of the renal pelvis and upper ureter. In 2 cases, the presence of tumor vessels was unequivocally diagnostic. In the remaining 3 cases, the arteriographic changes were not as prominent but were suggestive of neoplasm and were helpful in differentiating other causes of filling defects in the collecting system.


Adrenergic innervation and stimulation of canine urethra. Sympathetic nervous innervation of the canine urethra was studied using catecholamine histofluorescent straining and the in vitro muscle bath. Morphologically, adrenergic nerves were found terminating on the urethral smooth muscle. Pharmacologically, urethral strips responded like muscle strips from the bladder base to adrenergic stimulation. This evidence supports the concept that the sympathetic nervous system supplies and modulates the function of the smooth muscle stimulation of the rich periurethral vasculature nerve supply.


Observations on the repeated treatment for fascioliasis of stock on a farm in south-west England. The effects of a programme of repeated dosing of all stock for fascioliasis over a four year period on a north Devon farm is described. There was a decline in the average percentage of infection. Observations on the snail intermediate host and on a neighbouring farm suggested that at least some of the improvement was due to environmental factors. Although at the end of the period the level of infection was lower, there was no evidence that further intensification of the programme would lead to eradication.


The effect of disturbances on milk production in cows. Observations were made at the evening and morning milkings immediately before, and the corresponding milkings immediately after, cows had either been injected with tuberculin or disturbed by parties of visitors. At the evening milkings both types of disturbance reduced yield and solids-not-fat (SNF) and protein percentages, but the tuberculin tests increased, and the party visits decreased, the fat percentages. For all these parameters compensatory opposite results were obtained at the milkings the following mornings.


The effect of the molluscicide N-tritylmorpholine on transmission of Fasciola hepatica. Field trials were carried out in north Devon to investigate the relationship between molluscicide treatment of pastures and control of liver fluke infection in sheep. Seven tracer lambs per plot were used to estimate the infectivity of 17 pairs of 0.20 hectare plots. One plot in each pair was treated with the molluscicide Frescon (N-tritylmorpholine). There was a highly significant difference (P less than 0.001) between the numbers of Fasciola hepatica recovered from lambs grazed on treated and untreated plots in the period after molluscicide treatment. The overall degree of snail control achieved by one application of molluscicide to 17 plots was about 90 per cent and this was matched by a comparable degree of liver fluke control. There was considerable variation between the plots and there was no simple correlation between snail numbers and liver fluke numbers (r = -0.03). The use of molluscicides is discussed in relation to the biotic potential of Lymnaea truncatula and environmental factors which limit its population growth.


Protection by acetylsalicylic acid and other agents in experimental acute interstitial pneumonia of calves. In experimental acute interstitial pneumonia caused by Ascaris suum, therapy with aspirin (acetylsalicylic acid) provided symptomatic control of the condition, reducing or abolishing the characteristic "setback". Treatment with antihistamines or antiserotonin agents caused no observable clinical improvements.


Incidence of canine heartworm (Dirofilaria immitis) in Malaysia. A total of 764 adult dogs were examined for microfilariae and adult worms of D immitis and 197 (25-8 per cent) were found to be infected. Direct blood examinations revealed only 47-2 per cent of the infected dogs whereas the blood serum examination detected 57-8 per cent of them. These results showed that the absence of circulating microfilariae could not be relied upon to be an accurate indication of the absence of patent heartworm infection. The average number of heartworms per dog was 5-5 with a range of one to 50.


Growth plate defects in foals.

Growth plate defects in foals. Local disorders of bone growth form an important group of the orthopaedic problems that occur in foals. The recognition of the condition presented is essential so that the appropriate corrective measures may be instituted, and an accurate prognostication made. A knowledge of the applied anatomy of the growth plate is essential to the understanding of these cases. Consideration is given to epiphyseal separation and to angular deformity, from the point of view of diagnosis, prognosis and treatment.


[The development of antibiotics resistance among Salmonella bacteria of animal origin in the Federal Republic of Germany and Berlin (West). 3rd Communication: 1972 Annual Report (author's transl)]. 2273 Salmonella strains received from veterinary laboratories in the Federal Republic of Germany including Berlin (West) in 1972 were examined for their resistance against tetracyclines, ampicillin, chloramphenicol, kanamycin, nitrofurazone, and furazolidone. 13.3% of the strains studied were found to be resistant to one or more of these antibacterial substances. The proportion of resistant strains was 37.5% for S. typhimurium (excluding var. copenhagen), 3.1% for S. typhimurium var. copenhagen and 57% for S. panama. 79.8% of resistant strains were found to belong to these types. From 303 resistant strains found, resistance determinants were present in 87.4% to tetracyclines, in 37.2% to ampicillin, in 15.8% to chloramphenicol, in 4.6% to kanamycin, in 0.9% to furazolidone, and in 1.3% to nitrofurazone. 16 combinations of resistance determinants were found to occur 95.0% of strains transmitted resistance to E. coli K-12. A transmission of resistance determinants to furazolidone and nitrofurazone could not be demonstrated. Resistance patterns differed considerably from one serotype to another.


[Effect of interferon inducers on the development of specific resistance to tick-borne encephalitis]. Various natural and synthetic interferon inducers stimulate postvaccination immunity to tick-borne encephalitis virus in mice. This capacity was found not only in macromolecular synthetic polyribonucleotides such as (poly I)-(poly C), (poly G)-(poly C), (poly A)-(poly U) and substances with  much lower molecular weight such as copolymers of vinylpyrrolidone with maleic anhydride, crotonic acid or metacrylic acid but also in a low molecular interferon inducer tiloron. These and other interferon inducers examined (endotoxin S-typhi, statolon) exhibited no parallelism between the intensity of their stimulating effect of immunogenesis and levels of interferon production induced in mice and the associated resistance to tick-borne encephalitis. The results indicate a possibliity of using various interferon inducers for stimulation of post-vaccination immunity to tick-borne encephalitis.


[The development of antibiotics resistance among slamonella bacteria of animal origin in the Federal Republic of Germany and Berlin (West). 4th Communication: 1973 Annual Report (author's transl)]. 2894 salmonella strains received from veterinary laboratories in the Federal Republic of Germany including Berlin (West) in 1973 were examined for their resistance against tetracyclines, ampicillin, chloramphenicol, kanamycin, nitrofurazone, and furazolidone. 24.4% of the strains studied were found to be resistant to one or more of these antibacterial substances. The proportion of resistant strains was 63.9% for S. typhimurium (excluding var. copenhagen), 6.5% for S. typhimurium var. copenhagen and 51% for S. panama. 81.3% of resistant strains were found to belong to these types. From 708 resistant strains found, resistance determinants were present in 92.9% to tetracyclines in 27.9% to ampicillin, in 22.0% to chloramphenicol, in 13.6% to kanamycin, in 1.4% to furazolidone, and in 1.7% to nitrofurazone. 20 combinations of resistance determinants were found to occur 90.9% of strains transmitted resistance to E. coli K-12. A transmission of resistance determinants to furazolidone and nitrofurazone could not be demonstrated. As in the preceding years, there was a clear difference of resistance patterns from one serotype to another.


[Postmortem diagnosis of mixed respiratory virus infections in children]. Mixed respiratory virus infection in fatal cases in children was documented in the laboratory in 41% of cases though clinical and morphological signs had been determined only in half of the cases. Most effective tests in diagnosis of the mixed infection include immunofluorescent examinations of impressions of respiratory organs as well as tissue culture infected with blood or specimens of parenchymatous organs. In some cases detection of adenovirus antigen or isolation of adenovirus were regarded as a manifestation of latent infection, particularly when adenovirus antigen was discovered in  impressions of the spleen, tonsils or lymph nodes. Only intravital detection of virus antigens in all cases coincided with the presence of clinical and morphological signs of mixed disease.


A prospective study of drugs and pregnancy. II. Anti-emetic drugs. In a prospective study of anti-emetic drug use during 6 376 pregnancies, the previously demonstrated negative correlation between the use of such drugs and miscarriage was confirmed. It is probably completely due to less frequent and possibly less severe morning sickness complaints in pregnancies ending with a miscarriage. A slight positive correlation is found between the use of anti-emetics and infant malformation. A detailed analysis showed that this was mainly due to a high incidence of drug use (mainly promethazine) among women giving birth to infants with congenital dislocation of the hip. The probable indirect relationship is discussed.


Plasma and urinary oestriol during late uncomplicated pregnancy. Plasma levels of unconjugated oestriol and urinary excretion of conjugated oestriol were measured in ten healthy women with uncomplicated late pregnancy and with normal renal function. Considerably larger differences within or between days were noted for the plasma levels than for the urinary excretion of oestriol. Significant correlation between plasma levels and urinary excretion was found in only three out of ten patients. Due to the large variations within and between days, the estimation of unconjugated oestriol in plasma might be unsuitable as a substitute for the estimation of urinary conjugated oestriol in the supervision of complicated pregnancies.


Increasing caesarean section rate.

Increasing caesarean section rate. At the University Hospital in Uppsala 719 Caesarean Sectons (C.S.) were performed 1966-1970. The total number of deliveries was 16 708. The C.S. rate increased from 2.0% to 7.8%. This trent was mainly due to an increasing frequency of C.S. performed for cephalopelvic disproportion fetal distress "bad obstetrical history" and failed induction of labour with intravenous oxytocin drip. No maternal deaths occurred. The perinatal mortality was 5.0%. In infants with a birth weight of 1 500 g or less the perinatal mortality was 57% and in infants with a birth weight of more than 2 500 g and a gestational age of 37 weeks or more it was 0.9%. In 207 elective C.S. on healthy mothers at term no perinatal deaths were noted.


[Role of lymphocytic choriomeningitis virus in the etiology of congenital hydrocephalus]. By the indirect immunofluorescence test, antibodies to lymphocytic choriomeningitis virus in titers of 1:32 to 1:512 detected in 12 out of 32 infants under 1 with congenital hydrocephalus. The majority of the mothers of these infants were also shown to possess these antibodies in low and moderate titers. The assumption that lymphocytic choriomeningitis virus infecting the fetus in utero may cause the development of hydrocephalus is substantiated. In 11 of 12 seropositive infants foci of chorioretinal degeneration were found.


N-acetyl-beta-glucosaminidase of lymphocytes in the premature infant with special reference to the fetal development of the lysosomas apparatus. N-acetyl-beta-glucosaminidase activity was determined in peripheral blood lymphocytes by means of Hayashi's cytochemical method in 50 premature infants born between the 21st and 37th weeks of gestation. The lymphocytes exhibited three types of enzymatic cytochemical reaction, i.e. granular, diffuse and mixed (both granular and diffuse). The total count of enzyme-positive lymphocytes was significantly lower in the group of premature infants born between the 21st and 28th weeks of gestation as compared with those born later. This difference was due to the smaller numbers of enzyme-positive lymphocytes with granular reaction type in the group of more immature infants. The formation of enzyme-positive lysosomal granules within the lymphocyte cytoplasm during the last months of fetal development has been suggested and the relationship between the enzymatic equipment of lymphocyte lysosomes and immune response discussed.


Hyperprolinaemia: a disease which does not need treatment? The authors observed two cases of hyperprolinaemia (one of type I and the other of type II) which were asymptomatic. The anomalies described up to the present time in association with hyperprolinaemia are inconstant, nonspecific, and extremely heterogeneous. This suggests that the relationship between hyperprolinaemia and other anomalies is purely coincidental, and that a therapeutic approach by diet is unjustified.


Control of respiration in newborn babies. IV. Rib cage stability and respiratory regulation. The recordings from an earlier study regarding the respiratory depth and rate changes induced by exposure to 4% CO2 in air in 13 babies with PM age varying between 32 and 43 weeks were reexamined with regard to the pattern of thoracic abdominal breathing excursion in breathing immediately prior to the CO2 exposure and the type of response induced. The pattern was called "stable" when the thoracic breathing excursions were in phase and congruent with the abdominal ones. When the thoracic excursions in comparison with the abdominal excursions were totally inverted, or incongruous but in phase, or rapidly varying between those two, the pattern was called "unstable". "Unstable" pattern of the breathing prior to the CO2 exposures was followed in an incidence of 60% by the type of response to CO2 which is characterized by a prompt rate increase (the "Type B" response) and only in 16% by the type characterized by an increased breathing amplitude (the "Type A" response). When the excursion pattern of the breathing prior to the CO2 exposures was "stable" "Type A" responses were induced in 59% and "Type B" responses in only 14%. The excursion pattern present when a baby is exposed to 4% CO2 thus seems to affect the type of respiratory depth and rate changes achieved. With increasing postmenstrual age the excursion pattern of the spontaneous breathing is more often "stable" and respiratory depth and rate changes of the "Type B" induced by CO2 less common. The variabilities of the breathing seen preferably in the preterm baby regarding regularity, rate and tidal volumes (as they could be approximated by the registration methods used) were noted most when the excursion pattern was "unstable". The results can be hypothetically interpreted to indicate a dynamic interaction between the thoracic wall and pulmonary mechanoreceptor systems of respiratory regulation. The decreasing variability of the breathing seen with increasing maturation in the baby could be explained by an increasing maturation of the neuromuscular ability to provide stability to the rib cage which would act stabilizing on the pulmonary vagal afferent input to the respiratory center.


A case of multiple neonatal haemangiomatosis with favourable outcome following steroid therapy. A case of multiple neonatal haemangiomatosis is described. A short course of steroid therapy produced rapid and marked improvement of cutaneous lesions, without any effect on testicular involvement. The authors emphasize the value of an early treatment with steroids.


The effect of leucocytosis on leucocyte ascorbic acid levels. White-blood counts, polymorph counts, leucocyte ascorbic-acid and plasma ascorbic-acid levels were measured in 91 samples of blood obtained from patients admitted to a geriatric assessment unit. There was a correlation between both white-blood counts and polymorph counts and leucocyte ascorbic-acid levels. There was no correlation between white-blood counts and polymorph counts and plasma ascorbic-acid concentrations. It is suggested that this phenomenon represents migration of ascorbate-rich polymorphs to areas of infection and infarction.


Information loss in limb-lead electrocardiograms compared with twelve-lead tracings in a population survey among the elderly. A total of 235 telve-lead electrocardiogram tracings representing all those traces with positive Minnesota codings from a population sample of persons aged 65 and over were re-coded on the basis of the six limb-leads alone. The over-all loss of information amounted to about 22.3 per cent of major abnormalities, as defined, but was higher than 50 per cent for some individual abnormalities such as abnormal Q and QS waves. Possible implications of these findings are discussed.


Varicose veins.

Varicose veins. Varicosities may be due to congenital weakness of the vein walls or valves, or may be secondary to deep thrombophlebitis. The latter leads to loss of valve competency in the communicating veins and transmission of relatively high pressures to the superficial system. Edema, thrombophlebitis and stasis dermatitis are common side effects. Adequate surgical therapy is successful in 90% of cases. Sclerosing agents are of limited use.


Self-anchoring electrode for implantable pacemakers. The writers describe a self-anchoring monopolar electrode for use in implantable pacemakers, intended to prevent migration. The device was implanted in 63 patients observed for 36 months, and results are considered very favorable.


Left ventricular performance in coronary artery disease evaluated with systolic time intervals and echocardiography. Simultaneous determinations of systolic time intervals (preejection period index [PEPI], left ventricular ejection time index [LVETI] and ratio of preejection period to left ventricular ejection time [PEP/LVET]) and echographic measures of left ventricular performance (percent change in minor axis diameter [%delta D], circumferential shortening rate [Vcf] and end-diastolic diameter [Dd]) were obtained in 25 normal subjects and 37 patients with previously documented transmural myocardial infarction. The group with previous infarction demonstrated significant (P less than 0.001) differences from the normal group in each of the noninvasive measures. PEP/LVET and %deltaD were the most sensitive measures of left ventricular dysfunction. Deviation from the normal range in these measures occurred, respectively, in 70 and 65 percent of patients without dyspnea or fatigability (20 patients) and 85 percent of those without angina pectoris (13 patients). Abnormalities in systolic time interval and echocardiographic measures were related to the severity of dyspnea and fatigability but not to that of angina. Neither the presence of phonocardiographically documented third or fourth sound gallops nor an abnormal cardiothoracic ratio by chest roentgenogram reliably detected patients with abnormal left ventricular performance. The range of abnormality in left ventricular performance did not differ between patients with prior anterior or diaphragmatic myocardial infarction. The frequency of abnormal performance was greatest among patients with combined sites of prior infarction. Among 26 patients studied by coronary arteriography, abnormal left ventricular performance as determined by values for PEP/LVET and %deltaD occurred in fewer  than 30 percent of those with 70 percent or greater obstruction of one coronary artery and in more than 80 percent of those with two or three vessel involvement. There was a high correlation between systolic time intervals, %delta D and Vcf, the closest correlation occurring between PEP/LVET and %deltaD (r = -0.93). These data document the sensitivity of the noninvasive systolic time intervals and echographic measures and their superiority over current clinical bedside methods in evaluating left ventricular performance in patients with prior myocardial infarction.


Pump dysfunction after myocardial infarction: importance of location, extent and pattern of abnormal left ventricular segmental contraction. To delineate the relative effects on left ventricular function of the site, extent and nature of the abnormal left ventricular segmental contraction (dyssynergy) and thereby determine the mechanism by which anterior myocardial infarction results in greater depression of left ventricular performance than does inferior infarction, 43 patients with remote myocardial infarction of similar extent (average 38 percent of left ventricular systolic perimeter) and associated hypokinesia or dyskinesia confined to either the anterior or inferior wall were compared; 10 additional patients were evaluated who exhibited generalized dyssynergy (72 percent of left ventricular perimeter). When the pattern of dyssynergy and extent of infarction were similar, the location alone of dyssynergy did not influence variables of left ventricular function. However paradoxical outward systolic movement (dyskinesia) of the anterior or inferior wall resulted in greater depression (P less than 0.05) of measures of left ventricular performance than did diminished inward systolic motion (hypokinesia) associated with infarction of similar extent and location. All measures of left ventricular performance were considerably more depressed (P less than 0.05) in the 10 patients with generalized dyssynergy than in the 43 patients with localized dyssynergy. Thus, the location of infarction is not a unique determinant of left ventricular performance. Instead, the size of infarction is the principal characteristic of dyssynergy that impairs left ventricular function; the severity of the pattern of dyssynergy is significant but of lesser importance. It is therefore concluded that the greater reduction of left ventricular function in anterior than in inferior myocardial is largely the result of the more extensive area of necrosis rather than of the location of the infarction.


Cross-sectional echocardiography in evaluating patients with discrete subaortic stenosis. Ten patients with discrete subvalvular aortic stenosis were examined using a real time, high resolution cross-sectional echocardiographic scanner. There were two patients (Group I) with a thin discrete subvalvular membrane, five (Group II) with a more extensive area of subvalvular narrowing and three with a residual area of outflow tract obstruction after surgical revision (Group III). In patients with a thin obstructing membrane (Group I),  two distinct linear echoes were observed in the outflow tract. These echoes were not continuous with the walls of the outflow tract and showed some dynamic motion during the cardiac cycle. In four of the five patients with diffuse outflow tract narrowing (Group II), a relatively extensive area of inward bowing of both the anterior and posterior margins of the outflow tract was noted. In the fifth case, there was a prominent localized shelf-like increase in thickness of the basal portion of the muscular septum with a corresponding echo projecting anteriorly from the mid-portion of the anterior or mitral leaflet. The three cases examined after surgical revision of the outflow tract (Group III), had different patterns of outflow tract narrowing, but narrowing was clearly demonstrated. This study suggests that cross-sectional echocardiography offers an alternative and probably improved method for the noninvasive visualization of the left ventricular outflow tract.


Systemic atrioventricular valve regurgitation in corrected transpositon of the great vessels. Angiographic differentiation of operable and nonoperable valve deformities. Abnormalities of the systemic atrioventricular (A-V) valve are frequently present in patients with corrected transposition. Systemic A-V valve regurgitation is usually present and may be amenable to operative correction with valve replacement if the regurgitation is caused by normally positioned but deformed valve leaflets or a dilated valve ring, or both. Systemic A-V valve regurgitation secondary to the more common Ebstein-type malformation of the inverted tricuspid valve is an inoperable conditon at present. Displacement of the valve leaflets below the level of the valve ring may be seen in the angiocardiograms of patients with this finding and is the differentiating feature between the two lesions. Ten cases of systemic A-V valve regurgitation in patients with corrected transposition are reviewed to illustrate these features.


Mid-ventricular obstruction: a variant of obstructive cardiomyopathy. In two patients with clinical and catheterization findings of hypertrophic obstructive cardiomyopathy, the level of intraventricular obstruction was found to be in the mid-ventricular area rather than at the junction of the inflow and outflow tracts. One patient died suddenly shortly after unsuccessful outflow tract myectomy. In vivo recognition of this probably rare variant form of obstructive cardiomyopathy rests mainly on the angiograhic appearance of the left ventricle and on the recording of pressures in multiple sites of the left ventricular cavity. Surgical relief of the obstruction in these patients is not likely to be obtained by a transaortic left ventricular outflow myectomy but may require either papillary muscle resection by the transatrial or transventricular approach or mid-ventricular septectomy, or both.


Nomograms relating aldosterone excretion to urinary sodium and potassium in the pediatric population: their application to the study of childhood hypertension. The lability and diurnal variation of blood pressure in normal and hypertensive children were examined and found to be less than that described in adults. Nomograms were prepared relating urinary sodium and potassium to urinary aldosterone in children ranging in age from infancy to 22 years. These nomograms reveal that the relation of aldosterone excretion to sodium excretion is described by a hyperbolic function. Most values for normal children, children with mild essential hypertension and children with severe essential hypertension fell between two hyperbolic curves representing the 5th and 95th percentile, respectively. Hypertensive children with low and high plasma renin activity were found to have an inappropriately high level of urinary aldosterone excretion in relation to urinary sodium excretion. No relation was found between potassium and aldosterone excretion. By means of these nomograms the normal standards for aldosterone excretion in children were refined, permitting classification of hypertensive children into distinct groups. This classification may have prognostic significance.


Postnatal differentiation of Leydig cells in the rabbit testis. After the gradual disappearance of fetal Leydig cells in the first week after birth, the interstitial tissue of the rabbit testis is composed principally of undifferentiated mesenchymal cells between one and five weeks of age. Also present during this time are scattered partially differentiated cells with oval-shaped nuclei, prominent nucleoli and abundant cytoplasm. These cells exhibit some of the cytoplasmic features of steroid-secreting cells, but extensive development of smooth endoplasmic reticulum and the grouped perivascular arrangement of characteristic of fully differentiated Leydig cells are not present. The latter features appear at five weeks of age, indicating the formation of mature Leydig cells at that time. By seven weeks, the bulk of the interstitial tissue consists of Leydig cell aggregates, typical of the appearance in adult testis. Since spermatogonial mitoses first appear at seven to eight weeks of age, the findings indicate that Leydig cell differentiation precedes the onset of spermatogenesis.


Copper, iron, and zinc contents of mature human milk. Daily, weekly, and within-day variations in copper, iron, and zinc contents of human milk were investigated in order to determine whether one sample from an individual is representative of these elements. Total solids, fat, and protein contents were also measured. Fifty women in their 6th to 12th week of lactation each provided seven milk samples consisting of five consecutive daily samples and two additional samples collected either within a single day or at weekly intervals. Fat varied the most of all constituents and total milk solids reflected this variability. Values ranged from 0.2 to 10.4 g/100 ml for fat and from 8.58 to 17.49 g/100 ml for total solids. Protein varied from 0.76 to 2.04 g/100 ml among individuals, with little variation within an individual. Copper content varied considerably among women and within the same woman. With a large proportion of low values, the range was 0.09 to 0.63 mug/ml. Iron content was also found to vary within women as well as among women. Values ranged from less than 0.1 to 1.6 mug/ml with a preponderance of low values. Zinc content was more evenly distributed over the range of 0.14 to 3.95 mug/ml,and within an individual it did not vary widely. A representative estimate of copper and iron contents would therefore require multiple samples, whereas only one sample may provide a representative estimate of zinc content. Comparison of morning, midday, and evening values showed that copper and zinc are higher in the morning and iron is lower at this time. Increased amounts of copper, iron, and zinc were found in multiparous women whether or not they had previously lactated. Milk from older women had lower iron and higher copper and zinc contents than that from younger women. No differences were found in milk of women receiving dietary mineral and vitamin supplements. Calculations indicated that fully breast fed infants under 3 months of age receive approximately 0.35 mg/kg per day of zinc and 0.05 mg/kg per day of both copper and iron.


Cyclic variations in folate composition and pteroylpolyglutamyl hydrolase (conjugase) activity of the rat uterus. The "free" and "total" folate content and the activity of conjugase (pteroylpolyglutamyl hydrolase) were determined in homogenates of rat uteruses from animals sacrificed at specific stages of the reproductive cycle. Among 47 animals, conjugase activity was approximately twice as great during proestrus as in any other stage (P less than 0.001). A significant increase in total folate content (P less than 0.01) was observed in these animals, associated with a relatively greater increase in the free component than in the polyglutamyl component during proestrus. A similar decline in the ratio of total to free folate was observed (P less than 0.02) in a second group of 43 animals in which conjugase was inactivated even more rapidly than in the first group. Vascular engorgement was excluded as an explanation for the changes observed in proestrus. Since certain polyglutamyl derivatives of folate are potent inhibitors of thymidylate synthetase, the observed shift in ratio between total and free folates could be conducive to enhanced activity of this rate-limiting reaction of cellular proliferation. The data suggest that cycles of uterine cell growth and involution may be mediated through hormonally induced changes in enzymes governing the length of gamma-glutamyl folate chains. It is postulated that the mechanism involves the conversion of metabolic inhibitors into active coenzymes for one-carbon transfer reactions, and vice versa.


Occlusive phlebitis in multifocal fibrosclerosis. Multifocal fibrosclerosis, as the name implies, concerns disseminated fibrous processes that manifest as Riedel's thyroiditis, idiopathic retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, and pseudotumor of the orbit. Certain cases of fibrosis of the parotid gland, the lacrimal glands, and the lung may belong in the same category. The cases of two patients with Riedel's thyroiditis, one of whom also has retroperitoneal fibrosis, are described. Unusual changes in the small and middle-sized veins in the fibrous tissue in the thyroid and in the retroperitoneum, best designated "occlusive phlebitis," seem to be characteristic of the multifocal fibrosclerosis. They may contribute to the disease process.


Giant-cell arteritis of the uterus. Report of two cases. Two cases of giant-cell arteritis of uterus were found incidentally in association with uterine prolapse. One similar case has been reported in the literature. Microscopic examination disclosed fragmentation of the elastic laminae of the myometrial arteries with a giant-cell and mononuclear infiltrate. The relationship between giant-cell arteritis of the uterus, temporal arteritis, and polymyalgia rheumatica is discussed in view of similar cases reported in the literature.


Erythema infectiosum. An elementary school outbreak. An outbreak of erythema infectiosum (fifth disease) occurred in a North Carolina elementary school. Because rubella virus has been implicated as a possible cause of some cases of erythema infectiosum, we conducted an investigation to determine if the children were infected with rubella virus and to learn whether or not rubella virus vaccination prevents the disease. Throat swabs were obtained for viral isolation from 20 children with erythema infectiosum and from 25 healthy classmates; questionnaires were completed for 617 of the school's 817 students. One hundred fifty children (24%) reported having an acute exanthematous illness during the study period, and 45% of the ill children had one or more household contacts with a similar rash. No viruses were recovered from the children, and a history of rubella vaccination did not affect the risk of developing erythema infectiosum.


Multiple birth defects in a newborn exposed to Mycoplasma pneumoniae in utero. A newborn baby girl with progressive hydrocephalus and congenital defects of the skin and eyes was born to a mother who experienced bilateral bronchopneumonia in her first trimester. At the time of her infection, the mother's serum cold agglutinin titer was 1:128 and at delivery the mother's and baby's serum samples had complement-fixation titers to Mycoplasma pneumoniae of 1:1,024 and 1:256, respectively. At 1 week of age the baby's serum IgM value was 44 mg/100 ml (98% of cord IgM values in normal newborns range from 0 to 20 mg/100 ml). The baby died of progressive hydrocephalus, which may have had an inflammatory basis in view of the cerebrospinal fluid (CSF) protein level of 192 mg/100 ml. We realize that the significance of this association is questionable, but we believe that it is worthwhile to call the coincidence of events to the attention of others.


Unusual anomaly of the small intestine with malabsorption. Malabsorption as a complication of anatomic congenital anomalies of the small bowel is uncommon. In this case, malabsorption syndrome in infancy, with features suggestive of coexisting disaccharide intolerance and blind loop syndrome, was the major clinical presentation of a combined anomaly, consisting of a large saccular dilation of the ileum containing heterotropic gastric mucosa, and an adjacent small intramesentric cyst partially lined by small bowel epithelium. Prompt reversal of metabolic and nutritional abnormalities followed surgical resection.


Mortality among rubber workers. II. Other employees. Mortality among female, black male and white male salaried employees in Akron, Ohio, is described. Standard mortality ratios for all causes of death are: females, 78: black males, 62: white salaried males, 65. Excess deaths from cancer occurred in females: uterus, bladder, brain and multiple myeloma; in black males: Hodgkin's disease; and in white salaried males: bladder and lymphatic. Also, proportional mortality among white male employees of six non-Akron plants is reported. Excess deaths from cancer include brain and lymphatic and hematopoietic.


Sahel nutrition survey, 1974.

Sahel nutrition survey, 1974. In time of food shortage, accurate assessment of nutrition status is important so that effective aid may be directed to those in greatest need and, in the future, the impact of this aid on the nutritional situation may be assessed. Using a population proportional sampling method and the index weight for height (which is relatively independent of sex, race, and age) as a criterion of nutritional status, CDC investigators determined that about 10% of the sampled population (aged about 6 months through 6 years) in Mali, Mauritania, Niger, and Upper Volta and over 20% in the sampled population in Chad were severely and acutely undernourished. Apparently younger children were affected first, but as the food shortage became more severe the prevalence of undernourished older children increased. This method of nutrition surveillance has proven itself during a stressful period and should be considered a fundamental tool when rapid assessment of acute undernutrition in children in developing nations is required.


A simple geometric method for determining fetal weight in utero with the compound gray scale ultrasonic scan. A method to estimate intrauterine fetal weight by calculating fetal volume from simple parameters measured on echograms is described. The comparison between assesed weight of 50 fetuses and actual birth weight is presented.


Inhibition of spontaneous contractility of the human and the rabbit fallopian tube by potassium. Spontaneous contractions of circular and longitudal muscle of the ampulla and isthmus of human and rabbit Fallopian tubes were recorded isometrically. Addition of K+ to tissue in K+-free medium always caused immediate inhibition of spontaneous contractility. K+-induced inhibition was prevented by ouabain and reversed by removal of K+. It is suggested that K+ caused inhibition of contractility by activating electrogenic Na+ pumping with resultant hyperpolarization of the muscle cells.


In vitro ovulation from adult hamster ovary. The purpose of the study was to achieve in vitro ovulation in order to acquire corpora lutea in vitro at "time zero" of their formation. Such in vitro corpora lutea would later be the subject of studies on maintenance and lysis of corpora lutea in vitro. Ovaries from adult hamsters, explained into chemically defined medium between 23:00 hours on the day of proestrus and 01:00 hours on the day of estrus, were examined in the culture medium at 10:00 hours on the day of estrus i.e., after 9 to 12 hours of incubation. Ovulated follicles (young corpora lutea) of differing stages of corpus luteum formation were observed in some of the explants, but not at all. Almost all ovulated ova, surrounded by their cumuli oophori, remained adherent to the area of rupture when the incubation was ended. In vitro ovulation occurs in chemically defined medium without added hormones. It is possible to obtain corpora lutea in vitro at "time zero" of their formation.


Epidermoid cysts of the ovary: a report of five cases with histogenetic considerations and ultrastructural findings. Five cases of epidermoid cysts of the ovary are added to the two-reported in the literature. This rare lesion was uniformly an incidental finding in the study of hysterectomy specimens. Its main interest is in its histogenesis, which is suggested to involve metaplasia of the coelomic surface epithelium of the ovary. Ultrastructural evidence is one case strongly favors this possibility, thus adding another line of differentiation to those already established for the multipotent coelomic epithelium. However, some cases may be teratoid in origin, as has been suggested for the analogous lesion in the testis.


Assessment of marital relationships of hemodialysis patients. In addition to the somatic problems associated with uremia and dialysis it is apparent that successful hemodialysis is dependent upon psychological adjustment to this type of therapy. While previous studies have focused on the patient or spouse as individuals, patterns of marital interactions and conflicts have not been systematically evaluated. These factors ere examined in 17 medically stable patients maintained on hemodialysis for a mean duration of 22 +/- 4 SE months. Standardized pssychiatric evaluation forms ere used to examine mood and cognition disturbances in all patients and spouses, and a deailed marital questionnaire, which each patient and spouse filled out independently, was used to evaluate fundamental aspects of the marital relationship...


Studies on the cytodynamics of human endometrial regeneration. II. Transmission electron microscopy and histochemistry. The morphologic observations made in this study indicate that postmenstrual endometrial resurfacing occurs by proliferation of epithelial cells originating from the stumps of residual basal glands and uterine surface lining, bordering the denuded areas, respectively. Endometrial stromal cells or glands of the residual spongiosa are not involved in uterine surface repair. The mechanism whereby the new surface develops, it is proposed, is by endomitotic division. This contention is supported by the accelerated nuclear DNA and intracytoplasmic RNA synthesis, and absence of mitosis in the newly formed surface epithelial cells. The results indicate, furthermore, that uterine surface reconstruction, which is completed by cycle day 5, is independent of ovarian hormonal stimuli, whereas further endometrial growth, connective tissue remodeling, and metabolic enzyme synthesis are influenced by the gradual increase of preovulatory estrogens.


Maximum stimulation of insulin secretion in children with chemical diabetes and obesity. The response of plasma insulin concentration to an oral glucose tolerance test (OGTT) and to the maximum stimulatory effect obtained with administration of glucose, glucagon and tolbutamide was studied in 24 siblings of diabetic children and in ten obese children. Five siblings of patients with diabetes sound to have chemical diabetes had hyperinsulinism during the OGTT. Serum insulin concentrations during the maximum stimulation of the beta cells in the children with chemical diabetes, although diminished at 15 minutes, were considered not significantly different from controls. Obese children had hyperinsulinism during the OGTT and the maximum stimulation of the beta cell. The data suggest that hyperinsulinism may precede or accompany carbohydrate intolerance in siblings of diabetic children.


The obstetrician's role in reducing the risk of aspiration pneumonitis. With particular reference to the use of oral antacids. Aspiration of gastric contents is the commonest cause of maternal anesthetic death. If the pH of the contents is below 2.5, morbidity and mortality rates are likely to be higher than if the pH is above 2.5. A study of 146 patients in labor shows that one in four patients is "at risk" to acid aspiration. No time interval between last mean and either onset of labor or delivery can guarantee an empty stomach. The use of oral antacids during labor reduces the number at risk to 1 in 35. Other methods by which the obstetrician may contribute to reducing the risk are discussed.


Fetal blood sampling in midtrimester pregnancies. Sonographically directed placental aspiration has been investigated as a method for obtaining fetal erythrocytes. The technique is generally successful and the fetal red cells are generally usuable for the prenatal diagnosis of the hemoglobinopathies.


Placental ratio in white and black women: relation to smoking and anemia. In a study of 7,000 pregnancies it was found that, particularly in black women, hemoglobin levels were lower in smokers than in nonsmokers. This is the reverse of previously reported findings in nonpregnant persons. At delivery, the mean ratio of placental weight to birth weight (placental ratio) was higher in the infants of smokers than of nonsmokers. This observation is discussed in the light of reported elevated placental ratios at high altitudes or after severe anemia of pregnancy. The relationships are complex, and are not uniform with respect to ethnic group.


Placental transfer of clindamycin and gentamicin in term pregnancy. The pharmacokinetics of clindamycin and gentamicin were studied in women given these antibiotics prior to cesarean section. Maternal clindamycin levels were within the normal range and cord levels were within the therapeutic range for this antibiotic. For gentamicin, however, maternal levels were depressed, with a concurrent depression of cord levels. This may have significant implications for the use of gentamicin in maternal and fetomaternal infections.


Adolescent sexuality and paramarriage.

Adolescent sexuality and paramarriage. The problems of adolescent sexuality as parent and physician encounter them are briefly presented. The situation as regards venereal disease, inadvertent pregnancy, and abortion appears to be worsening. The author proposes participation of our specialty in a program directed toward (1) improved understanding between parents and child, (2) sex education throughout elementary school and high school, and (3) consideration of a new relationship between the sexes, entitled "paramarriage." Such an undertaking is a logical step in the new role of obstetricians and gynecologists as primary physicians to women.


Diagnostic ultrasound for detection of intrauterine growth retardation. There were 738 fetal BPD determined in 468 normal obstetric patients between 16 and 43 weeks in whom (1) the size of the uterus on initial examination corresponded to the duration of amenorrhea +/- 1 week and (2) there were no complications during the pregnancy. The mean BPD +/- 2 S.D. was determined for each week. The rate of BPD growth was found to be 0.26 cm. per week from 18 to 38 weeks. One hundred random high-risk obstetric patients in whom the size of the uterus on initial examination corresponded to the weeks of amenorrhea +/- 1 week were studied. Two patterns of suspected IUGR are observed: one shows BPD values more than 2 S.D. below the mean; the other manifests a decreased delta BPD. Combinations of the two may be seen. At delivery seven neonates were identified who were SGA and could not be detected in utero by single BPD measurements.


Infiltrative carcinoma of the vulva: results of surgical treatment. During a 40 year period 374 patients with infiltrative carcinoma of the vulva were evaluated. Some form of radical surgery was the treatment chosen for 278 patients. The absolute 5 year survival rates for all clinical stages treated with some form of radical surgery was 66.8 per cent with a corrected rate of 73.9 per cent. The corrected 5 year survival rate for patients treated with radical vulvectomy and groin lymphadenectomy approximated 80 per cent and if the regional lymph nodes were negative, it approximated 93 per cent. The size of the primary lesion and the incidence of regional lymph node metastases seemed directly related. Lymph node involvement itself significantly reduced the chance for survival. Furthermore, the inaccuracy of preoperative evaluation of the groin lymph nodes approximated 25 per cent. The assumption that a lesion is "early" does not justify less than radical surgery. Conversely, the "advanced" lesion when geographically localized can be treated quite satisfactorily with pelvic exenteration. The treatment of choice is discussed.


Peripapillary changes in glaucoma.

Peripapillary changes in glaucoma. Three observers, unaware of the clinical status of the patients and using projected 35-mm color transparencies, independently graded the degree of peripapillary halo and atrophy in 240 eyes. Analysis of the results revealed that, although patients with glaucoma had more prominent (4+) halos, the average degree of halo was statistically identical for both the glaucomatous and normal eyes. Peripapillary atrophy, on the other hand, was significantly (P less than .01) more extensive in glaucomatous eyes, and 4+ atrophy was seen primarily in eyes with more advanced disease of long duration.


Concentration-dependent dissociation of factor VIII in 1 M NaCl. Plasma, cryoprecipitate, Hemofil, and human factor VIII concentrate were dissolved in 1.0 M NaCl and chromatographed on Bio-Gel A-5m. With high concentrations of factor VIII the activity eluted as a symmetrical peak in the void volume; with a low factor VIII concentration the procoagulant activity was retarded. Dilution curves were performed for several human factor VIII concentrates. When the concentration of factor VIII was decreased, elution patterns showed a gradual transition from a peak in the void volume to a peak with a Ve/Vo of 1.7. Cryoprecipitate exhibited a similar behavior in 1.0 M NaCl, but the percent dissociation was greater than expected at high concentrations of factor VIII. When gel filtration was performed with 0.25 M CaCl2, significant dissociation occurred at all concentrations of factor VIII tested. The behavior of factor VIII in 1.0 M NaCl closely fit a theoretically derived curve for the dissociation of a protein from its binder. We conclude that the dissociation of factor VIII in 1 M NaCl is dependent on the concentration and purification of the procoagulant protein.


Services for the aged in community mental health centers. The author studied the services provided for the elderly at eight community mental health centers. He describes discrimination against the elderly, the reasons why relatively few elderly persons seek care, and innovations in treatment. He discovered that high-quality care depends more on staff awareness of the unique problems of the elderly than on specialized services. The author recommends a more public-health-oriented approach that would set priorities on the basis of community needs.


Experiences of psychiatry board exam casualties: a survey report. The author collected completed questionnaires from 52 psychiatrists who had failed to pass the examinations of the American Board of Psychiatry and Neurology (ABPN) on their first try. He quotes from the responses of 6 of these psychiatrists, showing the profound emotional impact of their failure. He recommends that the ABPN explain its low pass rate, supply feedback on the exam results, provide the specific criteria by which competence is judged, allow candidates to take the written exam on a trial basis, and drop the oral exams if their reliability cannot be documented. He also recommends that the profession of psychiatry take responsibility for the certification procedure.


Decreased blood platelet MAO activity in unmedicated chronic schizophrenic patients. The authors found lower platelet monoamine oxidase (MAO) activity in 13 unmedicated chronic schizophrenic male patients in comparison to 13 mentally normal control male subjects--a finding that agrees with previous studies showing MAO activity to be low in the platelets of chronic schizophrenic patients. The authors urge that studies exploring endocrine factors and the role of hospitalization be undertaken to attempt to explain this finding.


Transsexualism in two male triplets.

Transsexualism in two male triplets. The authors present clinical and case material on two male triplets with aberrant gender identity. Their findings coincide with those of the few family studies reported in which there were two or more transsexual members; they also reveal patterns generally in keeping with the psychological determinants of transsexualism suggested by Stoller.


The Vietnam warrior: his experience, and implications for psychotherapy. The psychodynamic experience of the Vietnam trooper is described and emotionally evoked by the author, who is both a psychiatrist and a combat veteran of that war. It is shown how that experience continues to affect the lives of these men. The special implications of that experience for psychotherapy are then discussed.


Foreign policy, ego-defense mechanisms, and balance-of-power vulnerability. The concept of balance-of-power vulnerability is proposed as a heuristic tool to understand the varying states of anxiety which occur when America's national integrity or security is threatened. Corresponding to the different states of vulnerability are the groups of ego-defense mechanisms which are arranged in a hierarchical pattern. These defense mechanisms are defined as spontaneous or premediated strategies for problem solving, containing elements of intrapsychic and social processes. The Vulnerability-Ego Defense construct is then used to compare America's foreign policy with respect to different nations and with respect to one nation over a protracted period of time.


Ejaculatio retardata. Conventional psychotherapy and sex therapy in a severe obsessive-compulsive disorder. An obsessive-compulsive patient was treated with modified analytic therapy to enable him to complete his first college year. As an assistant professor, he returned 19 years later complaining of retarded ejaculation. Traditional psychotherapy (52 sessions) failed to resolve the problem. After eight sessions of solo sex therapy, the ejaculatory dysfunction was mastered.


Emergence of Vibrio parahaemolyticus as an important cause of diarrhea in Malaysia. Vibrio parahaemolyticus was isolated from 47 of 2,699 stools examined primarily for the exclusion of cholera. All strains grew well in alkaline peptone water containing 0.5% NaCl and in Monsur's medium. Serotyping showed them to be of various types. Adults were mainly affected. The importance of looking for V. parahaemolyticus in clinical specimens from cases of diarrhea is emphasized.


Natural cutaneous leishmaniasis among dogs in Panama. A search for cutaneous leishmaniasis among dogs was conducted in several forest settlements of central Panama from 1968 to 1973. A total of 11 (3.3%) of 333 animals examined was found infected and, in 9 of these, parasites were isolated in culture and characterized as Leishmania braziliensis. Infected dogs occurred in three settlements, one of which was free of human leishmaniasis. In the latter case, infections were acquired in the nearby forest during hunting excursions. Ulcerated skin lesions primarily on the lower aspect of ears, or depigmentation and inflammation of the nostrils were manifested, with persistence as long as 45 months. The parasites did not disseminate from the lesion to viscera or other areas of the skin. The dog may serve as an incidental reservoir host of human leishmaniasis and/or a liaison of the infection between the jungle and forest settlements in the Republic of Panama.


Onchocercal dermatitis: ultrastructural studies of microfilariae and host tissues, before and after treatment with diethylcarbamazine (Hetrazan). Specimens of skin from four Cameroon patients with severe onchocercal dermatitis, before and after treatment with diethylcarbamazine (DEC), were studied by light and electron microscopy. Microfilariae of Onchocerca volvulus have ultrastructural features resembling those of microfilariae of other genera. Between the surface layer of the cuticle and the trilaminate membrane, there is an electrolucent zone which is much wider in degenerating microfilariae than in intact microfilariae. Widening of the zone may result from DEC-induced release of component(s) of the cuticle, possibly collagen or mucopolysaccharide. Between the cuticle and dermal collagen there are granular deposits which might be immune complexes involving the collagenous component of cuticle. Others have shown that DEC does not kill microfilariae in vitro. Treatment with DEC presumably "unmasks" microfilariae in the skin so that they are recognized as foreign bodies and are destroyed by the host's defenses. Histiocytes and eosinophils are seen in close proximity to degenerating microfilariae. Enzymes from histiocytes and eosinophils might readily penetrate the cuticle altered by DEC treatment, and digest various components within the microfilariae. Alternatively, the widening of the electrolucent zone might result directly from the action of leucocytic or histiocytic enzymes, after the microfilaria has been killed by other mechanisms.


Studies on schistosomiasis in Saudi Arabia. During studies on schistosomiasis in Saudi Arabia, urine and stool samples from inhabitants of various areas (mostly rural) were examined, and 97 aquatic habitats in 46 localities were searched for snails. The results indicate the occurrence of both urinary and intestinal schistosomiasis in most parts of the country, with a patchy distribution and varying infection rates. The snail intermediate host of Schistosoma mansoni was found to be Biomphalaria arabica. For S. haematobium three species of snails, namely, Bulinus truncatus and B. beccarii in the west and B. reticulatus wrighti in the northeast, may transmit the infection; the susceptibility of the two former species has been confirmed in the laboratory. The limitation in the size of snail habitats--which consist of wells, small canals, cisterns, small swamps, interrupted streams, and ponds--creates a special type of transmission which can be defined as "oasis transmission," making control of the disease both simple and practical.