The permeability of lung capillary and alveolar walls as determinants of liquid movements in the lung. The lungs of the exteriorized fetal lamb offer an unusually good opportunity for measuring the permeability of lung capillary and alveolar walls, because access to plasma, interstitial fluid and alveolar liquid can be obtained without seriously disturbing their physiological relationships. Although there are probably some differences in permeability between fetal and air-breathing lungs, the underlying pattern appears to be similar. Large water-soluble molecules, including proteins, can penetrate capillary but not alveolar walls. The latter appear to be impermeable to molecules with diffusion radii greater than 0.5-0.6 nm. Pore theory can be used to characterize these permeabilities and to obtain estimates of osmotic reflection coefficients for various water-soluble substances. From them, predictions can be made of the bulk movements of liquid to be expected in a variety of circumstances, including the adaptation of the lungs at birth, lung oedema and drowning in sea water or fresh water.


Interstitial fluid and transcapillary fluid balance in the lung. Alterations in extravascular lung water content when capillary pressure or plasma colloid osmotic pressure is increased have been evaluated in isolated, continuously weighed, plasma-perfused pairs of rabbit lungs. After modest increases in left atrial pressure, most preparations rapidly reached a new stable weight, and thus a new transcapillary fluid balance, but no significant increase in extravascular lung water content could be detected. In preparations where there was still a steady, slow gain in weight and thus still some transvascular filtration of fluid 15 min after the increase in pressure, a moderate but significant increase in extravascular water could be detected. It is concluded that only very small transvascular shifts of fluid occur in the lungs when capillary pressure changes, as long as this change is kept below the level that causes oedema. This limitation of pressure-induced transvascular shifts of fluid in the lung could be explained by the existence, close to the capillaries, of a small interstitial space containing fluid with a high protein concentration. Alterations in the colloid osmotic pressure exerted by this fluid would then contribute markedly towards continuous readjustment of the transcapillary fluid balance in the lung. Experiments by other workers indicate that alveolar pressure can markedly affect the transcapillary fluid balance of the isolated perfused lung.


Dynamics of subatmospheric pressure in the pulmonary interstitial fluid. Systems analyses are presented for several aspects of pulmonary fluid dynamics, especially those related to (1) transport of fluid between the pulmonary interstitial spaces and the alveoli, (2) the possibility of a mechanism for concentrating protein in the lymph vessels, and (3) the effects of very high resistance to fluid flow in the alveolar septal wall. The analysis of fluid transport between the interstitial space and the alveoli, assuming that there is no active secretory or active absorptive process, shows that the interstitial fluid pressure in the normal lung cannot be more positive than the fluid pressure in the alveoli. Since the surface tension of this fluid causes it to have a subatmospheric pressure, the calculated maximum pressure for interstitial fluid in the normal lung is about -2 mmHg (-0.266 kPa). At any pressure more positive than this the alveoli will fill with fluid. The systems analyses for concentrating protein in the pulmonary lymphatics and for the effects of high resistance to fluid flow in the alveolar septal wall offer possible explanations for very negative pressures of pulmonary interstitial fluid, even though calculations of the interstitial fluid pressure based on the assumption that the colloid osmotic pressure of pulmonary interstitial fluid is equal to the osmotic pressure of pulmonary lymph give estimated pressures of pulmonary interstitial fluid approaching 0 mmHg.


The nature of pituitary large growth hormone as studied by immunoabsorption. Porcine pituitaries were homogenized in neutral pH buffer and the supernatant layer after centrifugation was fractionated by gel filtration on Sephadex G-200. The void volume peak contained 0.2-0.5% of the immunoreactive growth hormone (large GH), the remainder (small GH) eluted at Kd 0.6. The isolation of large GH was attempted with anti-GH coupled to Sepharose 2B: of the immunoreactive large GH 50-60% was absorbed to a large excess of anti-GH Sepharose during an 18 h incubation at 4 degrees C. Over 80% of the absorbed immunoreactivity could be eluted with neutral 6M-sodium thiocyanate at 4 degrees C. The eluate, when rechromatographed, contained small GH, RNA which had absorbed to anti-GH Sepharose remained in the void volume on rechromatography. RNA was also absorbed when Sepharose-coupled bovine serum gamma-globulin was substituted for anti-GH Sepharose or when rat liver was substituted for porcine pituitaries. No RNA was absorbed when large GH was converted into small GH with 6M-NaSCN and rechromatographed before immunoabsorption. However, significant absorption of prolactin was found. After a two-hour incubation of porcine pituitary slices with [3H]leucine, GH dissociated from large GH had a specific activity 10-100 times that of small GH but appeared similar to it by gel chromatography and polyacrylamide gel electrophoresis. We conclude that pituitary large GH represents a different metabolic pool from pituitary small GH and may be newly synthesized small GH not yet incorporated into granules, thus being susceptible to non-specific binding to RNA during the extraction procedure.


Hyperthyroidism.

Hyperthyroidism. Hyperthyroidism is a clinically dramatic but usually benign syndrome that is most commonly associated with the clinical triad known as Graves' disease. Although the diagnosis and treatment usually are straightforward and clinically rewarding, there are occasional patients in whom considerable clinical and laboratory expertise are required before the problem is identified and solved. Although among the most common endocrine disorders, the etiology of the hyperfunction of the thyroid gland in Graves' disease remains unknown and the mechanism by which thyroid hormones produce their effect is equally obscure. However, if the rate of progress in the past decade is typical, both these questions may well be answered before another 10 years have elapsed.


[The clinical picture, motor activity, electro-encephalographic, neurophysiologic and linguistic findings in a case of left-sided hemispherectomy (author's transl)]. In a patient aged 35 the left cerebral hemisphere was surgically removed for a cerebral angioma. Cerebral function has been examined clinically and from neurophysiologic, neuropsychologic and linguistic aspects. History, pre-and postoperative clinical findings are described. Post-operative motor-activity was registered continuously with 6 electromyograms. It is described, compared with a case of right sided hemispherectomy and discussed. On the basis of a survey of the literature the cerebral activity before and after operation, examined with quantitative EEG analysis, is described and discussed. After a general exposition of the linguistic ability of the right non-dominant hemisphere it is shown that this must have been a case of left dominance. On this assumption the formal-quantitative linguistic findings after left-sided hemispherectomy are described. The neuro-psychologic tests, pre- and post-operatively carried out with several techniques (LPS, HAWIE, FLT, Token-Test), are compared with each other and the results of further tests (a short form of the "Minnesota-test and our own collection of aphasia tests) after hemispherectomy added. After a survey of relevant descriptions in the literature the postoperative linguistic findings (lexic and morphology, syntax, relationship between idea and expressive realization) are described and compared with similar findings in the literature.


Microwave oven for improved biological solids determination. This paper describes the evaluation of the use of microwave power to evaporate the water from biological solids in the suspended solids analysis for wastewater treatment plants. when microwave power was applied to the sample at a level of 1.8 watts per gram of water a constant weight was achieved in twelve minutes. This compares with sixty minutes drying time in the conventional test where thermal ovens are utilized. Solids results from microwaves oven drying were more precise than the results from drying with a thermal oven.


The relation of sex, age, and weight of mice to microwave radiation sensitivity. It is of interest to determine whether the weanling mouse, the sexually mature mouse, or the aged mouse of both sexes are similarly sensitive to microwave radiation. This study included 114 male and female mice irradiated to death with 2450 MHZ microwave radiation at 7.5 watts forward power, a minimum of 14 mice being used for any single set of variables. Weanling mice of 1 month of age are fully developed with respect to most organ systems except the reproductive. Two month old mice are sexually and otherwise mature, fully capable of survival and reproduction. The age mice of both sexes were ex-breeders which had been used for constant litter production for at least 12 months, and had waning reproductive potential. They were therefore about 14 months of age. It was found that the male mice on the average weighed more than the females (least difference at weaning) and both showed considerable weight increase with age; that weanling males irradiated to death absorbed slightly more radiant energy than did the weanling females, but they were also slightly heavier; that time to death under constant exposure from the beam increased with age for both sexes, indicating increasing microwave resistance with age and/or weight; that the mean absorbed dose at death did not show significant differences related to age or weight within the same sex; that the males showed slight increase in radio-tolerance with age and/or weight as measured by the absorbed dose at death when compared with the females which showed a decline in radio-tolerance with age and/or weight; that in all cases sex seemed to be somewhat more important than did age or weight in determining the lethal absorbed dose at death; and that it took longer longer for the older mice to die due probably to the fact that the rate of absorption of radiation was slower with their increased weight. It is the absorbed dose in joules per gram that is biologically significant and the data shows that the mean absorbed dose to death within either sex shows no significant difference with respect to age or weight, but that the difference between the sexes are significant, particularly among the aged ex-breeders.


Microwave heating of malignant mouse tumors and tissue equivalent phantom systems. Studies were conducted on the free-field heating of mammary tumors on the flank of mice and of tissue equivalent phantoms. A 200 watt, P.M., 2450 MHZ source was marginal in heating 1 cm tumors from room ambient to 38 degrees C. A technique was developed using warm air to raise the thermal baseline of the tumors to body core temperature and microwaves to produce significant hyperthermal levels. This allowed the production tumor temperatures of 45 degrees with greatly reduced microwave power and with significantly more uniform temperatures. However, the non-uniformity in temperature achieved with monodirectional microwave heating is still considered to be excessive: +/- 1 degrees C.


Training public school teachers in population dynamics: An evaluation of the urban life-population education workshops in Baltimore. Nine population education workshops were held for city school teachers in Baltimore, Maryland during the 1972-73 academic year. The original program schedule was modified two times, at the end of the third workshop and the sixth. Each change resulted in fewer formal presentations, more teacher discussions and greater teacher involvement in the workshop program. From the ideas generated by the workshops, curriculum units suitable for elementary and secondary school students were produced. An evaluation of the program showed that teachers' knowledge of selected demographic concepts and facts increased between the pre-workshop period and the post-workshop period. The changes were greater in the later workshops. The changes in knowledge were statistically significant. While there was some regression to pre-test levels, the teachers retained a substantiol portion of the knowledge they received when measured a second time after the workshop. High school teachers showed greater effective changes in knowledge than lower grade teachers. However, interest in population education appears to be wide-spread among all teachers including lower grade teachers. It is suggested that in the future, programs in population education consider conducting separate workshops for teachers of the same or similar grade level.


Uptake and liberation of mepacrine in blood platelets. 1. Isolated platelets of guinea pigs incubated in Tyrode showed a rapid accumulation of 14C-mepacrine which was less dependent on temperature than that of 14C-5-hydroxytryptamine (5HT). 2. The uptake of mepacrine was not inhibited by imipramine, cocaine, ouabain, KCN, NaF, and reserpine. 3. Various 5HT-liberating drugs, e.g. Ro 4-1284 (benzoquinolizine derivative with reserpine-like action), amphetamine, tyramine and imipramine did not markedly affect the 14C-mepacrine content of platelets previously loaded with this compound. 4. Thrombin and chlorpromazine caused a liberation of 14C-mepacrine from the platelts which was however, less pronounced than that of 14C-5HT. 5. From these and previous findings it is concluded that 14C-mepacrine accumulates in the 5HT storage organelles by a reserpine-insensitive mechanism not dependent on an active transport at the cytoplasmatic membrane level.


Radiologic evaluation of the patient with suspected pulmonary thromboembolic disease. The risks of anticoagulant and surgical therapy for pulmonary thromboembolic disease make a high degree of diagnostic certainty imperative. The pitfalls inherent in basing the diagnosis on clinical and laboratory information are discussed, and the radiologic and isotopic studies available to the clinician are presented, with special emphasis on their sensitivity and specificity and guidelines for their intelligent use.


Medical treatment of the adolescent drug abuser. An opportunity for rehabilitative intervention. Illnesses related to both the pharmacologic properties of abused substances and their methods of administration often bring the teenager to medical attention and may provide sufficient motivation for the adolescent to seek help beyond the acute problem. Successful treatment of an overdose reaction, an abstinence syndrome, or any other medical complication of drug abuse may give the physician a unique opportunity to begine further evalution for future care.


Neuromotor disorders of the esophagus.

Neuromotor disorders of the esophagus. Esophageal motility studies are helpful in diagnosing hypertensive and hypotensive disorders of the esophagus and its sphincters, including the exact measurement of the strength of contraction, temporal sequence and duration of the pathophysiology involved. In addition, the assessment of the extent of neuromotor involvement may be of great help to the surgeon in planning a myotomy. PH metering is probably the most accurate way to assess reflux in hypotonic states.


Crohn's disease.

Crohn's disease. Crohn's disease is manifested by fissure ulcers, transmural inflammation with lymphocytes, and granulomata affecting any part of the gastrointestinal tract. There seems to be a genetic predisposition, conditioned perhaps by environmental factors and possibly a virus. The disease is characterized by spontaneous fistulae, internal and external, anal lesions, stricture formation, and healing by fibrosis. The presenting symptoms are intestinal and systemic (Table 2). Systemic manifestations, such as arthritis, skin lesions, episcleritis and uveitis, pericholangitis, hydronephrosis, renal stones, amyloidosis, arrested maturation, fever, and anemia occur as complications of the intestinal disease. Medical treatment is empirical and supportive. Surgical treatment is reserved for complications. The incidence of Crohn's disease seems to be increasing because our diagnostic techniques are improving, but our treatment is unsatisfactory.


Abnormal uterine bleeding.

Abnormal uterine bleeding. The management of patients with abnormal uterine bleeding requires a logical, rational approach, and an awareness of etiologic factors. A careful history and examination should attempt to answer these questions: (1) Is the bleeding truly from the uterus? (2) Is the bleeding superimposed upon ovulatory cycles or (3) is the bleeding anovulatory? The endometrial biopsy obtained during the bleeding episode, and the basal temperature chart are diagnostically useful. Massive uterine bleeding not due to a complication of pregnancy, neoplasis, or blood dyscrasia, usually responds immediately to curettage, done in operating room or office; follow-up hormonal therapy with progesterone and a progestational agent should control the episode. More chronic forms of abnormal uterine bleeding are approached by identifying and treating the etiologic cause. If the cause is not correctable (e.g., obesity), most patients will respond satisfactorily to the cyclic administration of a progestational agent, or, if indicated, to induction of ovulation.


[Nomenclature of laboratory animals].

[Nomenclature of laboratory animals]. It is essential to use a correct nomenclature for laboratory animals to avoid mistakes in the strain and stock designation, just as it is important to use the correct species name. Firstly the rules of the nomenclature for inbred animals (strains) are dealt with. The strain symbol is followed by a slant line and an appropriate substrain symbol and possible additional symbols. Different types of symbols and combinations are discussed and examples are given. Next the nomenclature of the outbred animals (stocks) is treated. The code of the breeder is followed by a colon, the stock symbol and possible additional symbols.


Multidrug-resistant Proteus rettgeri: an emerging problem. The recent development of multidrug-resistant strains of Proteus rettgeri prompted a 6-year review of infections with this organism. Ninety percent of infections involved the urinary tract. Fifty percent of infections occurred on the neurology ward, where a progressive annual increase in attack rate was noted. Statistically significant (P less than 0.005) increases in total length of hospitalization, length of hospitalization before infection, presence and duration of indwelling Foley catheterization, prior exposure to antibiotics, and the prevalence of paraplegia were present in P. rettgeri urinary tract infections as compared with a control group. A progressive increase in resistance to kanamycin, streptomycin, ampicillin, and gentamicin occurred during 6 years. Disc diffusion sensitivities of recent isolates show total resistance to commonly tested antibiotics. Eighty percent or more of strains are inhibited, however, by 3.13 mug/ml of amikacin and cefoxitin, and 0.4 mug/ml of ticarcillin.


[ANT(4')I: a new aminoglycoside nucleotidyltransferase found in "staphylococcus aureus" (author's transl)]. A new nucleotidyltransferase has been obtained from clinical isolates of kanamycin, amikacin, tobramycin, neomycin and lividomycin resistant strains of Staphylococcus aureus. The enzyme has been purified by affinity chromatography then characterized in a kinetic and physicochemical point of view. The results obtained support that the target of this enzyme is the 4'-hydroxyl group of a number of aminoglycosides. We propose to call it ANT(4')I.


Urinary tract infection in children: general practice survey. Urinary tract infection was in 15 per cent of 804 children presenting in general practice with symptoms suggestive of infection. Only 18 per cent of children with specific urinary symptoms and eight per cent of those with non specific symptoms were infected. All children with a proven urinary infection were investigated radiologically, and one third of these had an abnormality on a micturition cystourethrogram or intravenous pyelogram. Urine culture is the only way of detecting urinary infection, and radiological investigation is essential in all cases of proven infection.


Influenza.

Influenza. The most universally employed measurement of the impact of epidemics and pandemics is the excess of mortality due to influenza and pneumonia. Other criteria are absenteeism from school and work, and all three will show positive indications when epidemics are of substantial size. During the 1974-1975 influenza season in Houston, school and industrial absenteeism and the increase in influenza and pneumonia deaths, despite a newly devised statistical procedure, did not signal an epidemic. However, a system of community surveillance of febrile respiratory illness with cultures for influenza virus during late January and early February 1975 gave unmistakable evidence of an influenza epidemic, with more than 600 virus isolations and an estimated occurrence of 50,000 cases of the disease. It is believed that this type of study can explore facets of the epidemiology of the disease not hitherto adequately examined. From this surveillance, which will continue through the summer months, it is hoped to gain further knowledge of the occurrence of antigenic drift and shift, and of the details of the early origin and progress of epidemics. Current speculation is that there will be another world pandemic before 1980 caused by a derivative of A strains presently circulating; in 1985-1991, a pandemic is predicted to be caused by a virus antigenically related to the swine agent of 1918. The purity of vaccines has been increased in recent years through ultracentrifugation and high-efficiency filtration, so that dosages can be increased while severity of reactions is reduced. The current level of dosage of vaccine for adults is 1200 chick cell agglutinating units, almost double what it was a dozen years ago. Recently, vaccines have been prepared more rapidly by the use of viral recombinants that incorporate the surface antigens of newly emerged epidemic strains into the core of older strains that grow well in embryonated eggs. This practical device greatly reduces the lead time in the preparation of new vaccines. The main problem in immunization against influenza is the need to reimmunize every 1-3 years. This creates an enormous requirement for vaccine and therefore a problem of selection of recipients. Currently, it is recommended that aged persons and those with cardiovascular, pulmonary and other chronic illnesses should receive the vaccine. Pregnant women are not more susceptible than others to the disease, and they should receive vaccine only if they have some other indications for immunization. Schoolchildren probably are important in transmission of the disease, but at present there is no special recommendation to immunize them. Young children occasionally have severe febrile convulsions when immunized against influenza, and those with this history probably should not be immunized. Amantadine is useful as a prophylactic agent in A(H3N2) influenza infections, and several reports suggest therapeutic benefits as well. Its benefits probably have not been fully utilized...


[Attemted suicide in adolescents].

[Attemted suicide in adolescents]. The suicidal history of 91 adolescents aged between 14 and 25 years is examined. There are predominantly crises of juvenile development, abnormal young personalities, neurotic depression and psychoses. The questions of broken-home-situations or chronic conflicts and actual motives leading to the suicide attempts are analyzed. Psychoanalytic aspects, the various tendencies leading to suicide attempts and problems of contemporary history and prophylaxis are discussed.


[The prevalence of alcoholism (abuse and dependence) in the state of Bremen]. An attempt was made to establish the prevalence of alcoholism in the State of Bremen in 1973. A sample of the adult population was sent a questionnaire. The selection of questions was based on the principles of the WHO definition of 1952 and on dependence on alcohol. Amount of drinks, behavior, psychosocial consequences and dependence on alcohol were gone into. The assessment of answers was weighted. When very strict criteria are applied, alcoholism existed among 2-2.5% of the population samples. With slightly less strict criteria which probably correspond more closely with reality, it was 3-4%. This, calculated for the whole population of Bremen, shows a prevalence of at least 1.6-2%, probably 2-3%. Alcoholism is not evenly distributed between sexes, age groups, social status and income-groups. The relation between men and women is 2 to 1. Most alcoholics are found among those aged 16-29 years and among unskilled workers, in the income group between 800 and 1399 DM p/month and among those not stating their income. The smallest number of alcoholics was in the group between 40 and 49 years old, among people not in top positions of the civil service or in business and in the lowest income group (less than DM 800 p/month). It is remarkable that no difference was found to be related to educational standards.


[Disturbances of CSF circulation, pathophysiologic, clinical, diagnostic and therapeutic aspects]. Disturbances of CSF circulation arise from the anatomic narrows of the CSF spaces and from the dependence on venous pressure of CSF absorption in the superior sagittal sinus. The author discusses the modern concepts of CSF production and circulation, the causal mechanism for hydrocephalus and the chances of compensating for a rise in CSF pressure by transependymal migration. CSF circulation (CSFc) disturbances can be subdivided into primary processes arising in the internal and external CSF spaces and secondary which are due to distant consequences of intracranial processes via interaction of the blood/CSF volume and parenchyma of the brain within the closed capsule of the skull according to the teaching of Monroe-Kellie. Extra-cranial processes in the neck, the mediastinum and heart are primary CSFc disturbances which-via an increase in intracranial venous pressure-lead to a reduction of CSF absorption. Among the hypotonic CSFc disturbances loss of CSF volume due to fistulae, diagnostic or surgical measures are the most important. 205 cases from the literature are the basis of a description of the clinical picture, the main subjective symptoms and neurologic signs. The problems of diagnosis of CSFc disturvances are demonstrated on 3 cases from the author's department. They were due to a colloid cyst of the foramen of Monroe, a stenosis of the aqueduct and a "normal pressure hydrocephalus". The relative value of additional technical investigations into the diagnosis of CSFc disturbances is assessed critically. The techniques of PEG, ventriculography and radioisotope cisterno- and ventriculography are compared and their special indications determined. Treatment of hypotonic CSFc disturbances is surgical revision and/or an atrio-ventricular shunt. Conservative measures only effect postponement. Treatment of hypotonic CSFc disturbances for which loss of CSF volume cannot be established, has so far had only unsatisfactory results.


3-Deacetoxy-7-(alpha-amino-1-cyclohexenylacetamido) cephalosporanic acid (SCE-100), a new semisynthetic cephalosporin. II. Comparative in vivo antibacterial activities of SCE-100 and cephalexin (CEX). The protective activity of 3-deacetoxy-7-(alpha-amino-1-cyclohexenylacetamido) cephalosporanic acid (SCE-100) against experimental intraperitoneal infections in mice caused by several strains of Gram-positive and Gram-negative organisms, including penicillin resistant strains, was compared with that of cephalexin (CEX). Comparable protective effects by oral administration of SCE-100 and CEX were observed in mice infected with Gram-positive organisms, while in mice infected with Gram-negative organisms SCE-100 was less active than CEX. SCE-100 showed a protective effect in infections of mice with either penicillin G-resistant Staphylococcus aureus or ampicillin-resistant Escherichia coli. The oral ED50 of SCE-100 was similar to or slightly larger than the subcutaneous value.


Comparison of trimethoprim-sulfamethoxazole and ampicillin theraphy for shigellosis in ambulatory. One-hundred seventy-four infants and children with acute diarrhea were treated as ambulatory patients with either ampicillin (100 mg/kg/day orally in four divided doses) or trimethoprim sulfamethoxazole (10 mg TMP and 50 mg SMX/KG/day orally in two divided doses). There were 65 patients with shigellosis. Responses of those treated with TMP/SMX and of those with susceptible Shigella treated with ampicillin were comparable. Patients with resistant organisms failed to respond to ampicillin. All Shigella, including ampicillin-resistant strains, were suseptible in vitro to TMP/SMX, and patients with ampicillin-resistant strains responded favorably to treatment with TMP/SMX. TMP/SMX appears to be the best, currently available drug for the treatment of shigellosis.


The hemodynamic effects of intrauterine hypoxia: an experimental model in newborn lambs. An experimental animal model of intrauterine hypoxia and respiratory distress in newborn lambs was produced by inducing maternal hypotension. Serial hemodynamic data indicated that the oxygenation defect in the lambs was due to right-to-left shunting of blood through fetal channels rather than within the lungs. Shunting was mainly across the foramen ovale, but, in severely distressed animals, significant right-to-left shunt also occurred through the ductus arteriosus. Left-to-right shunts across the ductus arteriosus were found in lambs with milder respiratory distress. The implications of perinatal hypoxia as it affects the pulmonary vascular bed in human neonates with the respiratory distress syndrome (hyaline membrane disease) and persistence of the fetal circulation are discussed. It is speculated that the early pulmonary vascular esponses in the two diseases may be identical.


[Clinical investigation of amoxicillin (clamoxyl 'Beecham') granules in pediatrics (author's transl)]. Amoxicillin granule (100 mg AMPC potency per 1.0 g granule) was administered to pediatric patients with the following results. 1) AAMPC serum concentration and the urinary recovery of two preparations (Clamoxyl 'Beecham' and Sawacillin 'Fujisawa') granule were compared in a cross over trial in 5 healthy adult volunteers. No significant difference in the results was observed between the two granules. 2) The peak serum concentration after oral administration of 10 mg/kg AMPC to 5 children gave an average of 5.06 mug/ml 1 hour after administration. The 6-hour urinary excretion was distributed 51.4 approximatley 78.9%. 3) AMPC was administered at a dose of about 20 mg/kg/day to 35 children with acute pediatric infections that is scarlet fever, acute tonsillitis, tonsillitis lacunalis, acute bronchitis, bronchial asthma +bronchitis and infectious impetigo. An effective therapeutic result was obtained in all cases. 4) The granule was well accepted by young children, and at a dose level of about 20 mg/kg/day for a week no disorder on hepatorenal function was observed in any og the patients.


Colostomates' reactions to hospitalization and colostomy surgery. Six patients having colostomy surgery on an emergency or urgent basis were observed during the morning care period for the entire length of hospitalization. The primary purpose of this clinical study was to provide nurses with information on new colostomates' behaviors which have implications for nursing care during hospitalization and in planning for discharge. The evidence presented strongly suggests that colostomates' reactions and behaviors reflect their struggling with catastrophic events, the resolution of which is not reached by discharge. Colostomates are unique because of the nature of their surgery and the specific learning needs entailed, plus the skill, time, and money required to provide care. Yet their anxieties, fears, affects, the nature of their information-seeking and goal-setting, their efforts to deal with reality by controlling imput, and the ways in which they seek help and socialize, are all themes common among other groups of patients experiencing stress as the result of sudden illness or injury.


Urinary diversion. Select aspects of nursing management. Transition from non-ostomate to ostomate can be an incredibly traumatic experience for the unprepared as well as the prepared individual. Nursing management should resolve when possible those problems that can make life with a urinary diversion unbearable. Successful nursing management will solidly and emphatically underscore everything each member of the rehabilitation team assures and teaches about rehabilitation potential.


An ostomy information clinic. A community resource. This article has included some facets of discussions that take place at the Ostomy Information Clinic in Milwaukee. All types of ostomates attend one or more clinics to obtain information and help with management of their ostomies. Topics explored are management of drainage, odor control, use of the cone irrigation, digestion, nutrition and diet, and travel tips. In addition to ostomates, nurses often attend the clinics with or without their patients. Consultation is also provided to the Visiting Nurses' Association and local hospital nursing staffs. I would like to encourage other nurses to consider conducting ostomy information clinics in conjunction with the American Cancer Society. Not only is there a great need, but it is a personally rewarding and satisfactory experience.


Development of an enterostomal therapy education program. The establishment and conduct of an enterostomal therapy education program is predicated on the firm belief in quality care for the patient with a stoma, on utilization of the registered nurse E.T. assigned in the Department of Nursing for delivery of service to stoma patients, on professional and administrative support, and on an appropriate educational climate.


Psychotherapeutic intervention with the addict-client. In order for the nurse therapist to be most effective with the narcotic-addicted client, she should be aware that his behavioral style many times reflects dependence, low self-esteem, and impaired reality testing. The major defense mechanisms used by the client are denial, projection, and manipulation. An attitude of hopeful expectancy on the part of the nurse is most important therapeutically in the treatment of the addict. Some therapeutic interpersonal interventions between the nurse and client are contracting, goal-setting, limit-setting, and the sharing of the responsibility for growth between the client and the nurse. The total treatment program for the client must also be scrutinized, and more than physiologic detoxification and one-to-one therapy must be provided in order for the client to have the maximum opportunity for change.


Response of the regional lymphatic system of the sheep to acute stress and adrenaline. An acute pain stimulus resulted in elevated lymph flow and output of cells from the popliteal lymph node of the sheep in the first 15 min after the stress. Efferent lymph flow increased by an average of 93% above the mean resting flow and cell output rose by an average of 170% during this period, but by 30 min after the stress, values for both lymph flow and cell output had returned to normal. The cell content of the efferent lymph was significantly higher in the first 15 min after the acute stress and it is suggested that there is a sizeable pool of lymphocytes within the resting popliteal node which can be mobilized into the lymph by an acute stress. A single intravenous injection of 1 mg adrenaline the efferent lymph flow in all the sheep examined but gave rise to an increased cell output in only 50% of the sheep. This indicated that there may be other factors, possibly hormonal, involved in the movement of the pool of lymphocytes out of the regional lymph node following acute stress. Both acute pain stress and adrenaline resulted in an increased afferent popliteal lymph flow and output of cells from the regional tissues in the first 15 min after administration. The results are suggestive of a small pool of lymphocytes in the regional tissues which may be readily mobilized by either acute stress or adrenaline. Part of the increases in efferent and afferent lymph flow observed following acute stress and adrenaline appeared to be due to an increased lymph formation, presumably as a result of an increased capillary pressure. Nevertheless, it is considered that the greater part of the increased flow of lymph from both regions resulted from an accelerated movement of performed lymph.


Increased water drinking induced by sodium depletion in sheep. Forty-eight hours of sodium depletion by acute cannulation of a parotid duct, via the buccal papilla, in the sheep, resulted in a progressive decrease in salivary secretion rate, salivary, urinary and plasma [Na] and no change in plasma [K]. In the first 24 h of Na depletion water intake was significantly increased. As normal sheep parotid saliva [Na] is higher than plasma [Na] and salivary loss over the first 24 h represented Na loss in excess of water relative to extracellular proportions, increased water intake was not osmotically induced. However, the animals did not replace their water deficit on either of the 2 days of Na depletion. This would appear to be valuable experimental model of increased water intake probably induced by hypovaolaemia, but uncomplicated concurrent osmotic stimuli, or any other factors which might result with the other commonly used experimental stimuli of thirst such as haemorrhage.


[Incidence and treatment of salmonella carriers in tejus and tortoises (author's transl)]. In seven groups of teju-lizards and tortoises, twenty-five tejus and thirty tortoises were found to be harbouring Salmonella. The serotypes of the Salmonella organisms harboured by these animals were identified. The animals positive for Salmonella were treated with 75 mg. of ampicillin and 250 mg. of chloramphenicol per animal daily. Of the animals treated for five days, twenty out of twenty-three (both tejus and tortoises) became free from Salmonella. The strains of Salmonella isolated after treatment all were adequately sensitive to the antibiotics administered. All animals, i.e. two tejus and seven tortoises, became negative following treatment for ten days. In seven strains of Salmonella isolated from tejus prior to treatment, sensitivity to ampicillin, chloramphenicol, streptomycin and terramycin was determined. Sensitivity to the three first-named antibiotics ranged from adequate to moderate, sensitivity to terramycine being slight or absent. In five out of six cases, serotypes other than those isolated prior to treatment were isolated from those animals which continued to be positive after treatment.


[Functional analysis in experimental respiratory distress syndrome (author's transl)]. After injection of an anti-lung -serum a respiratory distress syndrome could be produced in spontaneously-breathing guinea pigs. Reduced compliance, increased resistance and work of breathing was found. Morphological investigations showed intraalveolar and interstitial bleedings and a lung edema. Biochemically a decreased total phospholipid content could be found. Surface tension characteristics, examined with the Langmuir balance, were deteriorated. A complete restitution of surface tension parameters and total phospholipid content was obtained by administration of bromhexin metabolit Na 872.


Clinical, epidemiologic and bacteriologic observations of an outbreak of methicillin-resistant Staphylococcus aureus at a large community hospital. Over a 12 month period, 61 isolates of methicillin-resistant Staphylococcus aureus (MR-SA) were obtained in 23 hospitalized patients. Eight-six per cent of the patients were over 50 years of age, and 91 per cent were in the postoperative period. In 10 patients (42 per cent), MR-SA was the major pathogen, producing either pneumonia, empyema, osteomyelitis, lung abscess, enterocolitis, wound infection or bacteremia with sepsis. Three patients in this group died despite therapy with antibiotics with in vitro activity against these organisms. All the patients probably acquired their MR-SA in the hospital, and five carriers of the organism were identified among hospital personnel. This outbreak demonstrates the ability of MR-SA not only to colonize many patients in a relatively brief period of time, but also to produce serious disease.


Antibiotic susceptibility of Staphylococcus aureus in Saigon, South Vietnam. Methicillin resistant staphylococci are unevenly distributed throughout the world; the explanation for this is not known. During a survey of local hospitals for methicillin resistance, a number of strains from South Vietnam became available for study. Tests were performed in microtiter plates using various concentrations of several antibiol. With the larger number of organisms in the inoculum, 17% of strains required 12.5 mug/ml or more of methicillin for inhibition. This is in contrast to a very low percentage of methicillin resistant staphylococci from local sources encountered in our laboratory. An unexpected finding was the occurrence of considerable lincomycin resistance in staphylococci from South Vietnam.


Drug abuse in Afghanistan.

Drug abuse in Afghanistan. 1. The two major drugs abused in Afghanistan are hashish and opium. Opium is either smoked or eaten. Hashish is only smoked. 2. Solitary abuse of one single drug, either hashish or opium, is the common feature of drug abuse in Afghanistan. 3. Abuse of other patent drugs as well as multiple drug abuse by the same individual, increasingly common elsewhere, is quite rare. 4. Self-treatment is a major cause of drug abuse in Afghanistan while escape from boredom and lack of work and motivation is another. 5. Hashish as well as opium is commonly abused by people of a low socioeconomical standard. 6. Alcohol, a more recent introduction by the upper class, is becoming popular among city dwellers with major risks involved for the future. 7. Drug abuse in Afghanistan has so far not created problems comparable to those in the West, although there is no guarantee that in future it will not do so. Coercive measures aimed at depriving an individual of his drug of choice may involve the greater risk of drug substitution which will then be an even more difficult problem to manage. 8. Factors involved in prevention as well as cure of the drug-dependent population in Afghanistan have been discussed.


[Synopsis of transvestism and transsexualism (author's transl)]. A general review of literature delivers information about relevant publications pertaining to the question of transvestism and transsexualism. By and large German and Angloamerican literature is quoted on this subject. Consideration has been given to the variations of the syndrome in both males and females. The display of these symptoms is mainly in accordance with the psychopathological structure of the clinical picture. Symptomatologic and psychodynamically related sexual deviations (fetishism, effeminated homosexuality) as well as endogenous psychoses have been considered from a differential diagnostic point of view. The differential nosology characterizes the efforts made in dealing with the heterogenity of the syndromes. Moreover it is indicative of the sexually specific styles of manifestation. In the etiological approach somatogenic (chromosomal, hormonal and cerebral) and psychogenetic types are differentiated. Interesting results in child and family therapy have been mentioned on the latter type. The contributions of psychotherapy, behavior therapy and surgical operations aiming at sexual transformation including their legal repercussions have been given full consideration in the therapy chapter.


International aspects of problems associated with the use of psychoactive drugs. Problems of terminology, use and consumption, advertising, effectiveness and appropriate information and education on psychoactive drugs are outlined and advantages of international collaboration in attempts to establish standards for controlled clinical trials in psychopharmacology are discussed.


Research into expressions of attitudes about drugs--what use is it? The authors draw attention to an assumption often implicit in presentation and utilisation of attitude data, that attitudes are the cause of behaviour. They then present attitude data collected from English schoolchildren with various levels of familiarity with drugs--these data could be interpreted in many ways and are compatible with the hypothesis that pupils' social experiences and behaviour may precede and influence their attitudes. It is suggested that the concept of the "transitional process" between socially available roles may be useful to researchers, evaluators and programme planners.


Pharmacological activity of three fractions obtained by smoking cannabis through a water pipe. In a collaborative work, six chemical fractions obtained from smoke of cannabis, prepared by the Department of Biological Chemistry, University of Athens, were assayed pharmacologically at the Department of Psychobiology, Escola Paulista de Medicina, Brazil. The chemical fractions, obtained through burning cannabis mixed with a special tobacco through a water pipe similar to that used by Greek smokers, were: fraction IS composed of water-soluble compounds, fraction IIS made up of water-insoluble substances that condensed at the top of the water phase due to their low solubility; and fraction IIIS, of water-insoluble highly volatile substances, corresponding to the part that reaches the human lungs. Fractions IB, IIB and IIIB were placebo fractions obtained from burning only the special tobacco, called "tubeki", which is mixed with cannabis by the Greek smokers. The six fractions were assayed pharmacologically, in a blind fashion, using the following methods: barbiturate sleeping time in mice, catatonia in mice, corneal reflex in rabbits (Gayer test), and spontaneous motor activity in mice. Fraction IS, and its placebo fraction IB, were inactive in all methods employed, revealing no water-soluble active substances in cannabis. Fraction IIS revealed to be the most active as it induced significant effects in all 4 methods used; its IIB placebo fraction was inactive. Fraction IIIS, composed of the only substances that reach the human lungs, was moderately active; it produced significant effects on barbiturate sleeping time of mice and on the corneal reflex of rabbits, but was inactive in inducing catatonia and in decreasing spontaneous motor activity of mice. These results indicate that devices such as the water pipe used by Greek smokers retain active principles from cannabis.


The effectiveness of hourly cuff deflation in minimizing tracheal damage. The efficacy of hourly endotracheal tube cuff deflations in minimizing tracheal damage has not been clearly established. Two investigations which specifically address this question arrive at differing conclusions. These investigations fail to report important variables which may have explained the difference in their results. The present study examined the effects of hourly cuff deflations in minimizing tracheal damage in mechanically ventilated, anesthetized dogs over a 72 hour test period. Variables which may influence tracheal damage were measured and reported. Three groups of dogs received either continuous cuff inflation, hourly 5 minute cuff deflations, or a continuous air leak. The air leak group had significanlty less damage than the continuous inflation group (P less than 0.05) and the hourly deflation group (P less than 0.01). There was no significant difference between the continuous inflation group and the 5 minute hourly deflation group.


Multiple drug resistance in Pasteurella multocida and Pasteurella haemolytica from cattle and swine. The results of antimicrobial susceptibility testing on 262 strains of Pasteurella multocida and 141 strains of Pasteurella haemolytica isolated from cattle and swine from 1971 to 1974 were analyzed for patterns of resistance to streptomycin, penicillin, tetracycline, and chloramphenicol, using a modified Kirby-Bauer procedure. Resistance was recorded for 80.5% of the isolants of P multocida and 92.2% of those of P haemolytica. Resistance to streptomycin was most frequent, followed by resistance to penicillin and tetracycline. Most cultures of P multocida and P haemolytica were susceptible to chloramphenicol. There were 9 patterns of resistance with the aforementioned antibiotics. The combinations, streptomycin and penicillin and streptomycin and tetracycline, each accounted for approximately 10% of the resistance patterns of P multocida. Approximately half of the 14 isolants of P haemolytica were resistant to the combination of streptomycin, penicillin, and tetracycline. These observations underscore the need for antimicrobial susceptibility testing of clinical isolants of P multocida and P haemolytica.


MORLUC numeric system for the identification of Enterobacteriaceae. Foul hundred eighty-six members of the Enterobacteriaceae representing nine genera were identified by conventional methods, and the results were compared with MORLUC (Biotrol Company Inc., Jamaica, N.Y.). MORLUC, an acronym for melibiose, ONPG (o-nitrophenyl-beta-galactopyranoside), rhamnose, lysine decarboxylase, urease, and citrate, are six prepackaged reagent-impregnated paper loops which are sealed within a plastic packet. The hydrogen sulfide reaction obtained from a triple sugar iron slant is coupled with MORLUC results and is readily converted into a three-digit numerical code, which is referenced on a preprinted single page listing. Additionally, the triple sugar iron is used to confirm the glucose fermentation by an unknown isolate. Comparisons of individual MORLUC tests and standard methods results in a better than 92% agreement, except for unrease. Four hundred sixty-six of the 486 bacterial isolates, or 96% of the strains which were numerically identified by MORLUC, agreed with conventional diagnoses.


Intra-abdominal sepsis.

Intra-abdominal sepsis. Intra-abdominal sepsis remains one of the major challenges to the surgeon. With a proper appreciation of the bacteriology and pathophysiology involved and an awareness of new diagnostic and therapeutic modalities, hopefully, mortality and morbidity rates can be reduced.


Pseudo A-V block. Part I.

Pseudo A-V block. Part I. An example of junctional premature beats with concealed conduction has been presented. The arrhythmia mimics Mobitz Type II second-degree A-V block. Awareness of this arrhythmia when added to the fact that Mobitz Type II block is rarely seen with IWMI will prevent an improper or hasty diagnosis. Cardiac arrhythmias should be interpreted and managed in context of the clinical setting.


Relationship between resistance to metallic ions and production of beta-lactamase in strains of Staphylococcus epidermidis. Thirty five strains of Staphylococcus epidermidis were tested for resistance to penicillin G, erythomycin, metallic ions Zn, As3, As5, Cd, Hg, Pb and activity of beta-lactamase. These studies have shown that the majority of tested staphylococci were resistant to penicillin G, erythromycin, and produced beta-lactamase. No correlation between the activity of beta-lactamase and the resistance to metallic ions has been shown.


Contraception and the adolescent female. Although most teenagers have some knowledge of birth control methods, most sexually active adolescents do not  use one consistently. Some young women are too apathetic or irresponsible to use birth control, even if the method is available. However, most teenagers do not want to become pregnant. If factual information is given, the method is easily accessible and is acceptable to them, and if they have come to terms with their own sexuality, most young women will accept the responsibility of preventing an unwanted pregnancy.


Nursing behaviors in bereavement: an exploratory study. Twenty-five pairs of terminally ill patients and their loved ones were studied to determine nursing behaviors which offer greatest support, comfort, and ease of suffering to the loved ones. The Q-sort methodology, consisting of 88 cards, each with one behavior, was used. A three-tier classification of behaviors was derived: those that promote the dying patient's comfort and hygiene; those that indicate understanding of the emotional needs of the dying patient; and those that indicate understanding of the impact on the bereaved of grief, grieving, and loss. The most-desired behaviors pertained to the patient, and the most-desired behavior of the total group was to "keep the patient well groomed." The least-desired behavior (ranked 88th) was to "encourage me to cry."


Perceived dimensions of job satisfaction for staff registered nurses. To measure the importance of dimensions of job satisfaction 144 females registered staff nurses in four East Coast metropolitan hospitals were given an 18-item Likert-type instrument. Results indicated that the traditional intrinsic/extrinsic dichotomy, which exists in elements of job satisfaction, did not apply. The nurses perceived their job satisfaction in a more complex fashion, in that four statistically independent dimensions emerged with "relationship orientations" accounting for almost 24 percent of the total variance. The study implies that previous considerations in job satisfaction for the professional may need to be reexamined in terms beyond the traditional in trinsic/extrinsic dichotomy.


Values of male nursing students.

Values of male nursing students. Values of male nursing students (MNS) at the Ohio State University (OSU) were compared with values of OSU female nursing students, collegiate men in general, medical students, teachers, and personnel and guidance workers, using the Allport-Vernon-Lindzey Study of Values Scale. The scale measures relative importance to the subject of six basic interests: theoretical, economic, esthetic, social, political, and religious. The sample included 34 men and 841 women who entered the School of Nursing in 1971, 1972, and 1973. The OSU groups scored highest on the social scale, lowest on the economic scale. Males scored higher than females on theoretical and lower on religious scales. When OSU males' scores were compared with national norms, MNS scored higher than general college males on social and esthetic scales and lower on economic and political scales; MNS scored higher than medical students on economic and social scales and lower on theoretical scale; MNS scored higher than teachers on esthetic and social scales and lower on the religious scale; and MNS scored higher than personnel and guidance workers on the esthetic scale.


Orientation of senior nursing students toward access to contraceptives. Attitudes of 264 senior students of nursing toward providing contraception services to all who want them were assessed in 1974 through a questionnaire. In general, the students expressed permissive attitudes toward dispensing contraceptives to all except one group-very young tennagers. They were reluctant to endorse educating young people about contraception prior to puberty; one-half considered 15 or older the best age to educate. When contraceptive dispersal outside professional control was considered, students evidenced restricitive attitudes. Less than one-third endorsed placing nonprescription contraceptives in vending machines or food markets. Students with more permissive attitudes toward free access to contraceptives were more likely to express permissive attitudes toward premarital sex, nontraditional views of woman's role, and high concern about population problems. They were less likely to consider religion important, to attend sectarian schools, or to be of the Catholic faith.


Relationship of sex role identity to occupational image of female nursing sutdents. In this study to determine whether a relationship exists between sex role identity and image of nursing, sex role identity was measured by the Mf scale of the Minnesota Multiphasic Personality Inventory (MMPI) and the image of nursing was measured by Frank's (1969) Image of Nursing Questionnaire (INQ). In the spring of 1973, the MMPI Mf scale and the INQ were administered to 430 female senior nursing students in two baccalaureate, five associate degree, and five diploma programs in northern Illinois. A secondary purpose of the study was to determine whether identifiable groups, i.e., students who differed in age, type of nursing program, and education and occupation of parents, differed in their image of nursing. Sex role identity had a significant (p less than .001) positive relationship to image of nursing. The student's image of nursing was more in harmony with the image advanced by the profession when the student's sex role identity was more masculine. However, analysis of variance indicated that students with a highly feminine sex role identity had significantly lower total INQ scores and were, therefore, in disharmony with the professional image of nursing. Graduates of associate degree and baccalaureate programs had an image of nursing more in harmony with that advanced by the profession than students who graduated from diploma prgorams. Underlying causes for these findings and implications for nursing were explored.


Patients with hypertension: a study of manifest needs with self-actualization. Nursing intervention may help patients with hypertension reduce their anxieties. Two successful instruments for determining areas in which patients need counseling and/or nursing intervention are the Edwards Personal Preference Schedule and the Personal Orientation Inventory.


Disease-related learning and disease control in diabetics as a function of locus of control. This study investigated the relationship between the individual difference variable, locus of control, and a patient's response to diabetes. Since internal persons have been found to be active information seekers as compared to external persons, it was predicted that internal diabetics would know more about their disease and would, therefore, demonstrate more control over it. As predicted, internal diabetics did have more diabetic information, although this superiority over externals diminished as the length of the disease increased. Contrary to prediction, internal diabetics seemed to incur more problems with disease than externals as the disease progressed. This finding was interpreted as presenting a limiting case to the usual thinking about the superiority of an internal's response to problem situations.


Effect of pulse palpation on cardiac arrhythmia in coronary care patients. In a study of 62 coronary care patients, 31 of whom exhibited types of cardiac arrhythmia, the frequency of ectopic beats changed significantly when a nurse palpated the pulse. This finding suggests that autonomic responses to human contact can significantly alter the rate of ectopic impulse generation. These findings further suggest that studies of cardiac arrhythmia should attend to the nature of the social field in which data are collected.


Health care for women: I. Current social and behavioral issues. The medical interview. Problems in communication. Medicine is a middle-class phenomenon. The medical interview, an encounter often shrouded with emotion for the patient, may be carried on in jargon with which the patient is not familiar. Major breakdowns in communication exist when doctors cannot or will not speak the patient's language, or vice versa. Recent research examines how much patients are led to feel that they must communicate in the doctor's language, as well as the extent of miscommunication.


Team obstetrics and the nurse-midwife. Issues in patient acceptance. In this discussion we have presented findings from a study of patient acceptance of a nurse-midwife. The significance of the initial encounter for patient acceptance has been interpreted in terms of a primacy effect. The negative effect of the obstetrician's presence during initial encounters between patient and nurse-midwife has been discussed in terms of expectation theory. The theory leads us to predict that the patient's perceptions of competence of the nurse-midwife were more favorable when the obstetrician was absent from the initial encounter than when he was present. Finally we have interpreted the overall ease of communication between the nurse-midwife and patients as a result of mutual participation, and complementary rather than crossed interactions. This ease of communication is a major factor accounting for the general enthusiasm of patients for the nurse-midwife in the provision of office care. The importance of interpersonal relationships between health professionals and patients for effective patient care cannot be overstated. Romano has stressed the importance of the doctor-patient relationship in obstetrics and gynecology because of the many anxieties and concerns of women concerning their health problems. Hopefully, our findings will encourage physicians to explore the role of mid-level health professionals and particularly nurse-midwives in enhancing the overall quality of health care for women.


Prevention of unwanted pregnancy among teenagers. A psychosocial constellation that appears to predispose many teenage girls to risk unwanted pregnancy includes hostility in the parents' marriage, alienation from the mother, and a seductive father-daughter relationship. The dynamics which lead into sexual acting out include attempts to (1) compensate for low self-esteem by seeking male approval and (2) reduce anxiety over sexual fantasies or behavior with the father by counterphobic coital contacts with other men. Provision of a contraceptive method alone is sometimes insufficient to protect a woman with these dynamics from unwanted pregnancy because her conflicts over dependency needs and sexuality may interfere with taking responsibility for reliable use of contraceptives. Supplementary intervention, either by the primary care physician, a psychiatrist, or other mental health professional, is recommended where the high risk family history is evident.


Sexual and contraceptive behavior in young unmarried women. The psychological determinants of sexual and contraceptive behavior among young women are complex, variable over time, and individually unique. While the approach of an individual clinician or clinical program can be shaped by certain common developmental sequences, a given individual's behavior is determined by many factors which come together in a unique way at a given point in time, and thus the most successful encounter will be that which involves face-to-face, one-to-one contact between client and practitioner.


Female s-xual response. Hormonal and behavioral interactions. Recent studies suggest that hormones do play a role in the expression of female sexual behavior, and the inconsistency of findings between various groups does not mean that hormonal effects can be disregarded. Hormones may interact with other situational variables to sometimes enhance sexual behavior, and at other times suppress it. Sexual activity may itself trigger alterations in hormone levels, just as hormones may activate changes in behavior.


Social factors in the psychology of menstruation, birth, and menopause. Information about possible social influences on the psychology of reproduction, supplemented by a clinical understanding of the psychodynamics of the individual and scientific knowledge about the effects of hormones on behavior, provides insight into the experience of a particular woman in a particular social milieu. Such insight is an appropriate basis for effective treatment of many of the clinical problems in the area of psychosomatic obstetrics and gynecology.


Early human interaction: mother and child. Studies of the differing means of definition problems of parturition and neonatal dependence, the extent of human variability underlying them, and the possibilities for enrichment of experience in early human interaction call into question such standard practices as isolation of the newborn, separation of mother and infant immediately after birth, and division of the family unit at the very time when it is symbolically and in reality becoming a family unit.


Burns; office evaluation and management. Accidental burn injuries are common. Estimates by the Department of Health, Education, and Welfare indicate that two million individuals of all ages sustain burn injuries each year. One hundred thousand of these require hospitalization and the remainder are managed as out-patients. Physicians involved in primary care are potentially responsible for initial evaluation, decision-making about referral and hospitalization, and office treatment of individuals who do not require hospitalization.


Psychiatric consultation for physically ill children. In addition to age-appropriate information about his physical condition and its treatment, the child needs help with the feelings associated with being ill or injured. If the feelings are so powerful that a state of despair exists, or are strongly defended against with self-defeating and unresponsive behavior, consultation with the child psychiatrist should be requested.


The "barker" (neonatal respiratory distress) syndrome in the pig: its occurrence in the field. A new syndrome, characterised by acute respiratory distress and by abnormalities of the skin, hair and thyroid, was the apparent cause of neonatal death in 35 (24 per cent) of 146 piglets sired by a large white boar in four small commercial pig units. The syndrome appears to be of genetic origin, inherited as an autosomal recessive trait. Its similarities with the respiratory distress syndrome (RDS) of the newborn infant and the "barker" syndrome of the newborn foal are discussed.


[Present possibilities of antibiotic therapy in chronic non-specific respiratory diseases (author's transl)]. Due to the mainly infectious genesis drug-therapy with antibiotics is essential in chronic non-specific respiratory diseases. But they are only indicated when a bacterial infection is suspected. The broad spectrum antibiotics usually have a reliable efficacy. Bacteriological examination is no obligate supposition. But it is necessary if new drugs with limited effectiveness are intended to be given. In most cases of chronic bronchitis an intermittent application is sufficient. A continuous treatment is indicated only in a few cases. Some details of antibiotic therapy (kind of drugs, dosage, duration of treatment, side-effects etc.) are discussed. The possibility of antibiotic therapy in respiratory virus infections is inquired.


What is nuclear medicine all about?

What is nuclear medicine all about? The field of nuclear medicine, defined as the application of radioactive tracers to medical diagnosis and treatment, has progressed significantly over recent years. At one time, only measurements of the concentrations of the radioactive tracers or other chemicals in blood, urine or other biologic material could be obtained at various intervals after the administration of a tracer or chemical. Therefore, prior to development of radiation detectors that reveal the distribution of radioactive tracers within the body, the function of the body could be studied only as a whole. It now is possible to study both regional and total body function by using the many radioactive tracers available and suitable imaging devices. By using the short-lived tracers (which have improved the quality of the images and reduced the radiation dose to the patient) and the recently developed scintillation camera, rapid dynamic studies of the course of the tracers through regions of the body may be performed, so that both spatial and temporal resolution is obtained. The use of computers has added a new dimension to the field of nuclear medicine. It is possible to improve greatly the quality of the information obtained. As a result, the regional distribution of radioactivity can be quantified and the changes that take place over a period of time in serial studies evaluated. Thus using a variety of radioactive tracers, each measuring a specific function, we can construct a mosaic of quantitative measurements of regional function. In this way, nuclear medicine may develop a body of coherent knowledge and become a clinical science as well as a collection of useful technics.


[Effects of methamphetamine and a reserpine-like drug on norepinephrine and dopamine metabolism in the rat brain]. Simple and sensitive methods for the separation and determination of catecholamines and their metabolites by thinlayer microcrystalline cellulose chromatography have been developed and applied to the analysis of norepinephrine (NE) and dopamine (DA) metabolism in the brain of Wistar rats given 12C-NE or 14C-DA intraventricularly. 14C-DA in the whole brain declined more rapidly than did 14C-NE. The percentage of unchanged 14C-NE in total radioactivity in the brain of rats administered 14C-NI was high, while on the other hand, the percentage of unchanged 14C-DA in cases of 14C-DA was low. In the metabolism of 14C-DA, the deaminated and O-methylated deaminated metabolites showed transient and delayed temporary rises, respectively. Drugs which affect the metabolism of catecholamines were also examined. Methamphetamine reduced NE, deaminated and O-methylated deaminated metabolites, and markedly elevated normetanephrine in the brain of rats given 14C-NE. Regarding the metabolism of DA, methamphetamine increased 3-methoxytyramine and homovanillic acid and reduced deaminated metabolites, but had no effect on DA and NE. On the other hand, a reserpine-like drug (Ro4-1284) reduced NE and increased deaminated and O-methylated deaminated metabolites in the metabolism of NE, and reduced to a great extent DA and NE and increased homovanillic acid in the metabolism of DA. From these results, it is concluded that the effect of methamphetamine was more evident in NE metabolism than DA, while the effect of Ro4-1284 was more evident in DA metabolism than NE.


His bundle recordings: their contribution to the understanding of human electrophysiology. His bundle electrocardiography has increased our understanding of the electrophysiology of the conducting system and has confirmed a number concepts which evolved from analysis of surface electrocardiograms. Electrophysiologic evaluation of conduction disease in the cardiac catheterization laboratory has become an accepted diagnostic procedure in determining the site of atrioventricular and ventriculo-atrial block as well as in the evaluation of patients with pre-excitation resulting from conduction through Kent and James bundles. Recent reports suggest that His bundle electrograms may prove to be of clinical and therapeutic significance in determining the site of re-entry in patients with PSVT as well as in determining the short-term prognosis of patients with acute myocardial infarction complicated by incomplete bundle branch block. As our knowledge and understanding of the basic mechanisms, specific therapy, and prognosis of cardiac arrhythmias are expanded, the data derived from His bundle electrocardiography will become more useful in the clinical practice of cardiology.


Myoglobinuria.

Myoglobinuria. Myoglobinuria is still considered to be an uncommon occurrence, however, with the advent of better diagnostic tests it is being increasingly recognized as a potentially life-threatening complication of muscle necrosis. The pathologic consequences of myoglobinuria, including respiratory failure, hyperkalemia, and acute renal failure demand recognition by all who work in areas where this syndrome may develop. This article describes the role of myoglobin in the muscle and how myoglobinuria may develop. It includes the symptoms, differential diagnosis, and treatment of myoglobinuria and possible complications.


The amount of blood withdrawn for diagnostic tests in critically ill patients. This study involved the measurement of blood withdrawn from critically ill patients for diagnostic tests during their first 3 days in eight intensive-care units. The study was conducted over a 2 to 3 week period. Data were collected on the number of draws performed per day, the total volume of blood withdrawn per day, and the volume of blood per draw on 253 patients. The subject population was divided into four general diagnostic categories: Post-open-heart surgical, surgical, medical, and cardiac. Approximately 85 per cent of the blood samples were drawn via venipuncture with arterial and capillary samples performed less frequently. The results demonstrate that the total volume of blood withdrawn differed among the diagnostic categories and hospitals. The average amount ranged from 20 ml. per day in surgical patients to 50 ml. per day in post-open-heart surgical patients. The volumes withdrawn daily from the subjects were generally lower than the authors had anticipated.


Ventricular pseudo-bigeminy due to sustained myoclonus. An elderly unconsciocus patient with anteroseptal myocardial infarction showing ventricular pseudo-bigeminy (artifact) due to sustained myoclonus is reported. The reason why the artifacts coincided with his cardiac contraction is not clearly understood. The artifact is completely eliminated following intravenous injection of succinylcholine chloride. This is the first reported case of such a puzzling electrocardiographic finding to our knowledge. It is extremely important to distinguish between a true and pseudo-arrhythmia. Otherwise, an erroneous diagnosis frequently leads to an erroneous therapeutic approach.


Pseudo A-V block. Part II.

Pseudo A-V block. Part II. This vignette demonstrates the importance of analyzing arrhythmias in the context of their particular clinical setting. Analysis and treatment of an arrhythmia without clinical information leads to errors in judgment. Arrhythmias may be interpreted as a didactic exercise that is used in the process of teaching and learning. However, when the question is asked, "How do you treat this arrhythmia?", then all clinical information ambient to the arrhythmia in question has to be available for analysis and judgment.


The relation of dose rate of microwave radiation to the time of death and total absorbed dose in the mouse. This experiment demonstrates that for microwave radiation, absorbed dose determination alone is not dosimetrically sufficient. The average absorbed dose to death in this experiment increases as the rate of absorption decreases. This observation is not surprising since microwave energy produces heating of the biological tissues. Hence, with a higher rate of heating the body of an animal, the less it is able to retain homeostasis through metabolic regulation than with a lower rate of heating. The absorbed dose rate and the duration of exposure must both be determined in any microwave biological effects experiments.


On the role of storage granules in the functional utilization of newly synthesized dopamine. Previous studies have provided evidence for the prime importance of newly synthesized dopamine as compared with the large endogenous stores of amine in the functional mobilization of dopamine under conditions of a heavy demand on the neuron such as in the presence of a neuroleptic. The present study was designed to examine the role of storage granules in the utilization of newly synthesized dopamine and to examine the mechanism of the cataleptic action of reserpine-like drugs. It was found that the injection of a small dose of L-Dopa did not reverse the catalepsy produced by the short-acting dopamine depleter, Ro 4-1284, either when the depleter was given alone or was given after tyrosine hydroxylase blockade by alpha-methyltyrosine, provided that the L-Dopa was given at a time when Ro 4-1284 was present. However, the same dose of L-Dopa quickly reversed catalepsy when given at a time of dopamine depletion but in the absence of Ro 4-1284. Since alpha-methyltyrosine alone does not produce catalepsy until exhaustion of the large endogenous dopamine pool, but quickly potentiates neuroleptic-induced catalepsy, it is suggested that under normal conditions the slow transfer of stored dopamine to a releasable site is sufficiently rapid to maintain striatal function. However, the transfer rate appears to be too slow for adequate mobilization of the store under conditions of a heavy demand. It is further suggested that a prime role of storage granules is to channel newly synthesized dopamine into the synaptic cleft. Reserpine-like drugs appear to produce catalepsy, not by depletion per se of the main dopamine pool, but by interference with this granule channeling function.


The Roy adaptation model. Using the adaptation model in a practitioner curriculum. We believe that nurse practitioner role mastery should occur through supplementation of former roles, beginning early and continuing throughout the entire educational process, rather than through realignment to a new role. The educational process should therefore enable the student to identify with and build upon her role as a nurse, rather than abandoning it and adapting to a new quasi-role. If role mastery is to occur by gradual assimilation rather than by abrupt change, a nursing model is needed on which both preparation for and practice in the role can be based. The adaptation model provides the necessary framework to give direction to practitioner education; offers a relevant way of viewing the older adult in relation to his environment; and delineates guidelines for nurse practitioner action.


A model for areawide coordination of pediatric clinical experiences. In the opinion of the project committee, clinical experience should be a primary consideration in the curriculum design process, not merely a stepsister to the cognitive aspects. Further, clinical experiences enable practitioners to develop the competencies required for meeting the needs of people they serve; thus, educational objectives should be based on the present and future health care needs of the consumers. In this project, the nursing needs of the child/family have been carefully delineated, and the available learning environments have been identified and assessed. One educational constraint unique to clinical practice is that the immediate welfare of the client must supersede the educational objectives of the learner. In this model, we have taken great pains to safeguard the client requirements. The person who is ill--especially the child--is vulnerable to fatigue, fright, insecurity, and sensory overload. The quotas developed for this study provide essential learning for the student but at the same time protect the integrity of the patient. Intensive study of clinical learning experiences by nursing is long overdue. We believe we have described one approach toward facilitating educationally sound curriculum and clinical decisions. The model as it stands provides variables, parameters, conditions, and assumptions which can now be manipulated and tested by those seeking answers to clinical resource allocation. Only by careful allocation and cooperative use of clinical facilities is it possible to provide appropriate learning experiences while maintaining the integrity of the care process.


A framework for family assessment in chronic illness. Family assessment can enable the nurse to expand the internal and external resource potential of the family unit. Specifically, the nurse may be able to determine what information the client and family need to cope effectively with the illness condition. Additionally, the nurse may supply the family with consumer information regarding qualifications, cost, and appropriate points of entry for additional health and welfare services, and intervene as client advocate by documenting more specific information relevant to the agency's criteria for acceptance. With an adequate knowledge base obtained through the use of such an assessment, and with knowledge of local health-care delivery systems and community agencies, the nurse will be able to assist the family more fully. Specific information about resources, points of entry, costs, and quality of services may be offered to the family members to enable them to evaluate alternative courses of action appropriate to the specific situation and select the most beneficial solution.


Inducible oxacillin-hydrolyzing penicillinase in Aeromonas hydrophila isolated from fish. An inducible penicillinase was shown to be present in a strain of Aeromonas hydrophila subsp. hydrophila isolated from freshwater fish. Enzyme induction was observed with benzylpenicillin or 6-aminopenicillanic acid, and the enzyme was cell bound. The penicillinase was purified 50-fold from a crude cell extract. The molecular weight was estimated to be 23,000 by gel filtration. The pH and temperature optima for the enzyme activity were 8.0 and 35 degrees C, respectively. The penicillinase showed a unique substrate profile by hydrolyzing oxacillin about twice as rapidly as benzylpenicillin. The enzyme activity was weakly inhibited by sodium chloride but was not affected by p-chloromercuribenzoate. The property of penicillinase production by the A. hydrophila strain could not be transferred to Escherichia coli and also could not be eliminated from the bacteria by ethidium bromide treatment.


Genotypic stability of methicillin resistance in Staphylococcus aureus at supraoptimal temperature. Methicillin resistance in a highly resistant mutant of Staphylococcus aureus could not be diminished by elevated temperature. After 100 subcultures at 43 degrees C the resistance to methicillin was retained when determined at 37 degrees C.


Intestinal exfoliated cells in infant diarrhoea: changes in cell renewal and disaccharidase activities. Lactase deficiency, manifested clinically by lactose malabsorption, is often the only biochemical evidence of a residual disturbance of jejunal mucosal function after Escherichia coli enteropathy in the infant. Villous morphology is usually normal. A sustained depression of the processes of biochemical differentiation of lactase biosynthesis has been postulated to explain similar states of lactase deficiency, but a possible influence of altered epithelial cell turnover on the mucosal lactase levels has not been investigated. In ten infants with a residual lactose malabsorption, after E. coli infection, jejunal cell renewal activity and disaccharidase activities were studied by analysis of the exfoliated cells collected by lumenal perfusion. Significant increases in DNA and protein exfoliation and in the brush border activities of sucrase and lactase were observed during recovery from the malabsorptive disturbance. DNA and protein efflux increased almost linearly during a 20-day period. Lactase was initially four times more deficient than sucrase activity in the exfoliated cells. Both enzyme activities increased at almost identical rates. Therefore, it took longer for lactase activity to return to normal levels. The lactase/sucrase ratios approached normal at the end of the 20-day period. The changes in the exfoliating levels of the two enzymes, when analysed in relation to the increases in cell renewal activity, suggested a relationship between sucrase and lactase levels and cell age.


Viral gastroenteritis: recent progress, remaining problems. Infants and young children are particularly susceptible to a recently identified viral enteritis which is highly contagious and seems both common and universal. In this disease, virus invades the upper intestinal epithelium, causing acute diarrhoea with early fever and vomiting. We studied a similar disease in pigs, infecting three-week-old animals with transmissible gastroenteritis virus (TGE), which also invades the upper intestinal epithelium. In this model, diarrhoea is massive 16-40 hours after infection, when stools contain increased electrolytes but no excess of sugar. In the jejunum of intact pigs at the 40-hour stage we found altered Na+ and water flux, decreased mucosal activities of disaccharidases and Na+, K+-ATPase, but normal adenylate cyclase activity. At the same stage the response of Na+ flux to glucose was blunted in jejunal epithelium studied in Ussing short-circuit chambers and in suspensions of villous cells; Cl- flux responded normally to theophylline, and thymidine kinase and sucrase activities of cells isolated from jejunal villi were similar to those found in crypt cells. Probably by 40 hours after infection most virus has been shed from the mucosa. Viral diarrhoea clearly differs from enterotoxigenic diarrhoea. Consideration of its pathogenesis must take into account the dynamic nature of the mucosal epithelium and the factors governing differentiation of enterocytes as they migrate from crypt to villus. Sufficient information is available now to characterize one specific and apparently prevalent viral enteritis in man and to identify additional viral enteritides. There is hope that preventative therapy can be developed. Our understanding of the mechanisms of viral diarrhoea is limited, but the availability of an animal model and the promise of others makes us optimistic that these deficiencies can be remedied. Greater understanding of the pathogenesis of viral diarrhoea should better the active therapy of affected infants and children.


Breast-feeding, weaning and the diarrhoeal syndrome in a Guatemalan Indian village. Prospective studies in Mayan Indian children living in their natural setting were carried out from 1964 through 1974; observations began at birth and extended at least throughout the first three years of life. Adequate growth and survival were characteristic of exclusively breast-fed infants in the first months of life. Despite the high rate of infection, children exhibited a considerable resistance to intestinal protozoa, enterobacteriaceae and enteric viruses. Resistance against colonic invaders is attributed to the bifidus flora, and that against agents acting in the small bowel, to specific antibodies present in colostrum and milk. Diarrhoeal disease was least in this period and increased with weaning to reach maximum peaks at the time of weaning. The protracted weaning consisted of progressive administration of foods of low biological value given under deficient sanitary conditions. The nutrient value of the diet as a function of the child's weight was adequate in protein but in most cases it was markedly deficient in calories. Infectious diseases, particularly diarrhoea, were found associated with pronounced reductions in the already deficient calorie intake. Infection and infectious disease were common particularly during the first 6 to 18 months of life. Weight loss was a frequent finding during and after episodes of disease. The consequence of the malnutrition-infection interaction is a marked stunting of growth, clearly evident from examination of the growth curves of village children. Nutrient intake did not correlate with growth velocity. By contrast, the duration of breast-feeding was strongly associated with growth in the linear segment of the curve, while in the period of faster growth the correlation was inverse. On the other hand, morbidity was inversely correlated with calorie and protein intake and this was more obvious in the second than in the first year of life. The data indicate that infection is one of the leading factors associated with reduced calorie (and protein) intakes during the critical period of onset of malnutrition and mortality in childhood. By preventing infection, particularly diarrhoea, the food intake, nutrition and growth of children could be significantly improved.


[Attempted suicide in Lübeck 1947-1968, data and tendencies (author's transl)]. Evaluation of 2937 case notes of patients admitted for attempted suicide to the department in Lübeck between 1947 and 1968. This series can be seen as resentative for the Lübeck region. During this period the number of cases has increased about fourfold and has been rising since. Mortality could be reduced to 3% or below. Earlier typical differences between the sexes have since approached each other so that in the end men and women showed the same increase by age during the third decennium. Women were admitted significantly more frequently than men. Drugs, particularly sleeping pills and transquilizers, have greatly increased in suicide attempta. Earlier attempts occurred in 30% of cases. Measured by additional diagnoses, the morbidity of the series lay be 44.8%.


[Origin and treatment of the hypokalemic paresis (author's transl)]. The abuse of laxatives and a prolonged treatment with diuretics has to be brought into consideration as the most common cause for renal or intestinal loss of potassium. Besides characteristical alterations at the E.C.G. and besides intestinal disturbances there do occur again and again acute, life-threatening aspects of cases connected with tetraplegias and a respiratory failure. By means of 3 cases from our hospital and 27 casuistics in literature symptomatology and dynamic in the development of hypokaliemia is discussed. The mean of potassium in the serum of the 16 patients, those having quadriplegias, ran up to 1,7 mval/l (range 1,4-2,5). Paralysis develops peracutely in 4 of the cases within hours and in 12 of the cases within days. In the anamnesis symptoms of adynamia could be traced with nearly every patient. A functional psychosis (reversible physically founded psychosis) couldn't be detected in any of the cases. With the help of a administration of potassium one could achieve a total retrogression of the symptoms. Besides this a normalisation of the acide-base equilibrium is required because of a metabolic alkalosis, detectable in most of the cases.


[Interaction of phsychologic and somatic factors in headache (author's transl)]. It appears that a uniform "psychosomatic headache" does not exist. This is due to 1. the variety of phenomenology, 2. the variety of causes and 3. the variety of results in the psychodiagnostic and psychotherapeutic field. Analysis of the factors active in headache was attempted in a field study and on the basis of a systematic survey of many years of clinical experience. Within the framework of the concept of multifactorial causation of headaches we found 3 particularly important factors: vasolability, depression and the cervical spine. From the psychodynamic situation disturbing factors appear to be able to produce or maintain headache in this way. Physical examination by itself without taking psychodynamics into account will have to be called just as incomplete as an approach based exclusively on depth psychology alone. The questions on endogeneicity versus exogenicity have to be thought about both from points of phenomenology and individual analysis of the psychodynamic background of every patient, as part of a complex concept of treatment. Headache as an early sign of schizophrenia is rare but should not be forgotten. Among the many factors causing headache it is by no means always clear what is cause and what effect. Often there appears to be interaction which continues in the end autonomously or increases. It has been described on the example of the painspiral in the region of the cervical spine. For diagnosis we try to determine the various pathogenic factors via an anterospective program of examination. This will serve as the basis for our "targetted polypragmasia" i.e. we attempt to influence at one and the same time many of the factors which have been recognized as pathogenic. Drugtherapy apart we favor somatic vegetative stimulation. The results of our field study (strong preponderance of headaches among the non-manual professions together with clinical experience) support our view that in this way we enter an etiologically highly effective circuit. The effectiveness of phsychotherapy lies for the greater number of headache-patients within the zone of initial clearance, less in the direct action on the syndrome of pain. As main therapy psychotherapy has proved effective only in individual cases of predominantly psychogenic headache. We could also discuss the role of neuroleptic sleep cures which soothe psychologically and act also biochemically. No short-cuts and no sound simple prescriptions for the treatment of headache could be given. But the author hopes to have contributed to understanding of a complex field which may result in multi-layered but also clearly defined factors and their more effective therapy.


[Atypical symptoms in spinal tumors--peripheral and pseudoperipheral symptoms (author's transl)]. Sciatic symptoms and positive sciatic findings may represent a leading, but at the same time missleading symptom of a spinal tumor in every possible level for months and years ahead. The study of literature--so far scarcely taken notice of in German speaking Countries--as well as own observations lead to an organisation or array of the atypical symptoms, i.e. remote symptoms of tumors above the 12th thoracic vertebra shown as predominantly "central pseudoperipheral sciatica", more rare general peripheral findings in the lumbosacral region due to early tumoral irritation of the spinothalamic tract or the dorsal funiculi or congestional changes of the spinal fluid as well in the vascular apparatus. Tumors below the level of the 12th thoracic vertebra show an almost indistinguishable mixture of remote and local symptoms of the above nature preceeding typical clinical tumor manifestations.


[An important cause of shoulder-pain: the "incisura scapulae syndrome" (author's transl)]. Analysis of 124 of the author's cases shows that an isolated mechanical compression of the suprascapular nerve lies often at the bottom of shoulder pain without obvious cause. The term "incisura scapulae syndrome" is recommended. Causes, symptoms, diagnosis and treatment of this tunnel-syndrome are described in detail.


[Continuing registration of muscle temperature during electromyography]. Measurements of muscle temperature were performed during and after contractions of human skeletal muscle using an electromyography-needle-electrode, which contains a thermo-element. The investigations aimed at explaining a drop in temperature during contraction, earlier described, and getting some aspects of possible employment of temperature measurements carried out simultaneously with electromyography. 1. The course of temperature during contraction (increase or decrease) depends on the heat of contraction, blood flow through muscle, penetration depth of the thermoelement, gradient of temperature and efficacy of a compression of blood vessels. It results from a superimposition of the single effects. 2. A decrease in temperature in various extremity muscles during contraction is explained by a compression of blood vessles caused by the shortening of muscle, as described earlier by other authors. 3. The interpretation of temperature curves, especially the quantitative interpretation, becomes very uncertain because of various sources of error. A differentiation between muscle heat and influence of blood flow is not sufficiently possible. 4. Nevertheless measurements carried out under conditions of disturbed blood supply, myopathies and polyneuropathies consistent with experiments performed during cooling and warming muscle in a water-bath, causing a reactive hyperemia or a defective circulation by using a blood pressure instrument show that changes in blood circulation are expressed by changes in temperature curves. Measurements carried out simultaneously on agonists and antagonists show satisfactorily the contrary changes in blood circulation known from the literature.


[Clinical electrodiagnostic findings in peroneal muscular atrophy (author's transl)]. 43 patients and 27 relatives suffering from a hypertrophic type of peroneal muscular atrophy have been examined. Following the classification of peroneal muscular atrophy by Dyck and Lambert early age of onset and considerable reduction of nerve conduction velocity served as criteria for allotting them to the hypertrophic type. In all patients a typical deformity of the foot developed before the age of 10. Among the relatives there were some without this deformity and with only slight clinical signs. Assessing consistency and thickness of peripheral nerves by palpation proved difficult and unreliable. These findings also varied considerably between members of one family. The motor nerve conduction velocity was less than one half of the normal on average. Even those patients with only minor clinical signs had a nerve conduction velocity reduced by one fifth. In about 60% of the patients there was dominant inheritance, in 3 it was recessive and in about one third nothing was known. 10 of the patients without dominant inheritance had rather severe neurologic disturbance and a kyphoscoliosis. Whether this is hypertrophic neuritis of Dejerine und Sottas is discussed. Data form the literature differ. Another common type of peroneal muscular atrophy is the neuronal type. In contrast to the hypertrophic type it generally begins in adults and nerve conduction velocity is hardly affected.


Ampicillin-resistant Haemophilus paraphrophilus laryngo-epiglottitis. A case of life-threatening laryngo-epiglottitis is reported, caused by ampicillin-resistant Haemophilus paraphrophilus. Clinicians and microbiologists should be aware of a beta-lactamase-mediated resistance among Haemophilus species other than H. influenzae.


Preliminary investigation of the reliability and validity of a tool for the assessment of body position and motor activity. A recently developed tool which symbolically records body position, gross motor activity, and the intensity of this activity has potential for use in a variety of settings. To examine the instrument for interrater reliability and validity, activity of 14 children engaged in normal play was observed and recorded by two raters. Scores obtained were compared to actometer scores. The technique, it was concluded, is a reliable and sensitive method of assessing and recording changes in body position and activity levels which warrants further study in other situations.