5-Hydroxytryptamine (serotonin), copper and ceruloplasmin plasma concentrations in spontaneous abortion. Ceruloplasmin, the blue copper-protein of the blood plasma, is believed by some workers to be involved in the metabolic management of 5-hydroxytryptamine (serotonin) during pregnancy. 5-Hydroxytryptamine is abortifacient in experimental animals. By some authors, a role has been suggested for it in human abortion. The plasma concentrations of 5-hydroxytryptamine, copper and ceruloplasmin were measured in non-pregnant women, in normal early pregnancy and in cases of spontaneous abortion. Compared with normal early pregnancy, cases of inevitable abortion show lower values for both plasma copper and ceruloplasmin and higher values for plasma 5-hydroxytryptamine. The possible implications of these findings are discussed in view of the alterations in ceruloplasmin values in pregnancy and in the light of what is known of the pharmacology and metabolism of 5-hydroxytryptamine. It it believed that these alterations in plasma copper, ceruloplasmin and 5-hydroxytryptamine in cases of inevitable abortion are the effect, rather than the cause, of abortion.


Spontaneous abortions in sibship of children with congenital malformation or malignant disease. Parents of 751 children affected by cancer/leukemia, congenital heart disease, strawberry nevus or mental retardation have been investigated with respect to their reproductive history and their exposure to risk factors for spontaneous abortion. Differences between the four groups were established for the number of children in the sibship, the proportion of multigravidae and the spontaneous abortion rate among these women. The greatest differences were observed in the two groups of malformed children compared with the other two groups, being as marked in those with a severe malformation (heart defect) as in those with a benign one (strawberry nevus). Taking known risk factors for spontaneous abortion into account did not explain the observed differences. An etiological hypothesis is put forward which takes account of the high proportion of quantitative abnormalities of the karyotype associated with congenital heart disease and spontaneous abortion.


Factors affecting the success of mid-trimester amniocentesis. Of 298 women who had mid-trimester amniocentesis carried out in a single hospital unit in a 6-yr period, an increasing proportion were carried out for detection of neural tube defects. A clinical decision could be made following the first amniocentesis in 77% of cases. There were 16% where liquor was not obtained at the first attempt, and a further 7% where cell growth or biochemical testing was unsatisfactory. The outcome was influenced by the experience of the operator and timing of procedure. The success of the first procedure was 59% before 16 wk of gestation and 86% between 16 and 20 wk. The incidence of blood-staining of the liquor was higher with an anterior placenta (19%). Despite difficulties, the abortion rate (3.5%) does not appear to be higher than would be expected.


Binding of (3H)R5020 to progesterone receptor and serum contaminants in human endometrium. The binding of [3H]R5020 to cytosol from human endometrium was utilized to evaluate the concentration of progesterone receptor by means of agar gel electrophoresis, using D-norgestrel as cold competitor. It was observed that radioligand binds predominantly to the receptor, and that serum contaminants such as albumin and corticosteroid-binding globulin do not interfere in the assay procedure.


Levels of estrogen and progesterone receptor in human endometrium during the menstrual cycle. Receptors for estrogens and progesterone have been assayed in 24 samples of normal human endometria at different phases of the menstrual cycle. In the proliferative endometrium the concentration of estrogen binding sites was significantly higher than that of progesterone receptor while, in the secretive endometrium, the concentration of estrogen receptor was low, compared to that of progesterone receptor. The highest concentration of both receptors was observed during the periovulatory period. From the correlation observed between estrogen and progesterone receptors and the levels of the respective steroids in the plasma, it is suggested that the levels of plasma estradiol or its own tissue receptor determine the synthesis of progesterone receptors in the periovulatory period.


Successful artificial insemination in a case of retrograde ejaculation. A case is described of retrograde ejaculation due to bladder neck resection followed by ileal conduit with a non-functioning bladder, where, after unsuccessful attempts at artificial insemination with spermatozoa retrieved from the bladder, ejaculate was obtained at defecation followed by artificial autoinsemination by the male, leading to two consecutive pregnancies.


Successful control of pheochromocytoma in pregnancy. Case report. A patient found to have a pheochromocytoma in the 16th wk of pregnancy was successfully managed by medical treatment with phenoxybenzamine hydrochloride and propranolol. In the 38th wk of pregnancy she was electively delivered by cesarean section, and the tumor was simultaneously removed.


Treatment of vaginal candidiasis with ketoconazole, a new, orally active, antimycotic. The efficacy of a new, orally active antimycotic, ketoconazole, in the treatment of vaginal candidiasis was studied at different doses involving 63 patients. All patients had subjective complaints and were mycologically positive. There was no significant difference in the cure rates of the different doses. The oral treatment was successful in 55 out of 63 patients (87.3%). No correlation was found between the relapse rate of vaginal candidiasis and the dose regimen. There were no serious side-effects, and no significant changes were reported in hematological and biochemical parameters.


The variation of the mean spinability of human cervical mucus throughout the various stages of reproductive life. Automatic measurement and statistical study. The evolution of the mean spinability value of human cervical mucus was studied by means of an automatic device throughout the menstrual cycle and pregnancy and during and after the onset of menopause. The automatic measurement brings to light the major drawbacks presented by manual methods: values previously obtained should be considered as underestimated. The mean spinability value recorded from cyclic mucus exhibits a very significant increase at mid-cycle. Graphical analysis demonstrates that only small differences in the mean spinability value occur as pregnancy proceeds. A progressive and regular decrease in the mean spinability value can be recorded from the very beginning of the menopause. However, the spinability values observed in premenopausal mucus are noticeably higher than those recorded after the onset of the menopause. The numeric data furnished by the automatic measurement are discussed in terms of statistics.


Maternal mortality due to the hepatorenal syndrome of pre-eclampsia. A case report. A maternal death in the 23rd wk of pregnancy is described. The patient was gravida 8, with 6 previous abortions and one growth-retarded term infant. The clinical symptoms and biochemical findings strongly suggest that the mode of death was septic shock, with the hepatorenal syndrome due to pre-eclampsia as the underlying cause.


Comparison of two successive policies of cervical cerclage for the prevention of pre-term birth. The percentage of women receiving cervical cerclage increased from 5% to 18% between two periods at Haguenau maternity hospital, according to a new policy for the prevention of pre-term birth. A parallel reduction of premature deliveries by about a half was observed in the relevant group of women. This suggests that cerclage might be employed on another basis than is currently the case, and that a randomized trial is urgently needed to define its indications more precisely.


Adenomatoid tumor of the fimbrial endosalpinx: report of two cases with discussion of histogenesis. Two asymptomatic cases of adenomatoid tumor, confined to the lamina propria of the tubal fimbria, are presented, and their location within strictly Müllerian territory is offered as indirect evidence for the Müllerian origin of this lesion. To stress the individuality of this distinct entity, the name of Müllerian mesothelioma is suggested.


Female genital actinomycosis.

Female genital actinomycosis. Four cases of female genital actinomycosis are added to the reported total of about 300. The relationship of the disease to the normal microbial flora, intrauterine contraceptive device usage and pelvic sepsis is explored. It is suggested that the disease may be more frequent than hitherto realized.


Combined (stressed and non-stressed) antenatal fetal heart rate monitoring. Acceleration patterns of the fetal heart rate, or a normal heart rate during spontaneous contractions, were used as a short weekly screening test to evaluate fetal well-being in 1102 high-risk pregnancies. When accelerations or contractions were absent during the initial screening, oxytocin was administered to stimulate uterine contractions. The mean duration of the antenatal monitoring was 18.5 min when the initial antenatal monitoring was normal, but 38.8 min when the initial results were uncertain. Oxytocin was administered to 38% of patients. This reduced the number of occasions where the diagnosis was uncertain from 46.6% to 12%. Patients with uncertain antenatal fetal monitoring had significantly more late decelerations during labor as well as newborns with low Apgar scores when compared to those with normal antenatal monitoring. Patients with abnormal antenatal monitoring (positive stress test) had significantly more low 5-min Apgar scores, late decelerations during labor and growth-retarded infants than the patients with normal antenatal fetal monitoring. Only 1 intrauterine death occurred within 7 days of a normal antenatal heart rate recording. No preventable fetal deaths occurred when antenatal monitoring demonstrated an acceleration pattern of the fetal heart rate.


Mechanisms of late decelerations in the fetal heart rate. A study with autonomic blocking agents in fetal lambs. Fetal heart rate decelerations resembling the late deceleration FHR pattern were produced in fetal sheep by periodic occlusion of the maternal common hypogastric artery for 30-60 sec. Transient fetal hypertension also occurred during the occlusions. Alpha-adrenergic blockade with phentolamine eliminated or markedly reduced the hypertensive response. FHR decelerations still occurred intermittently with some occlusions; however, their character was greatly altered. After parasympathetic blockade with atropine, the decelerations were replaced by periodic FHR accelerations during the occlusions. These accelerations were, in turn, eliminated by the beta-adrenergic blocking agent, propranolol. In the presence of combined parasympathetic, alpha- and beta-adrenergic blockade, the FHR remained essentially constant during the hypogastric artery occlusions in non-acidemic fetuses. FHR decelerations persisted after parasympathetic or total autonomic blockade when the fetuses were significantly hypoxic, as judged by depressed arterial blood pH and base excess values. Beat-to-beat variability of the baseline FHR persisted in the face of severe hypoxia and acidosis. These observations demonstrate that reflex mechanisms are involved importantly in the genesis of late deceleration FHR patterns in the acutely hypoxemic fetus, but that direct depression of myocardial rhythmicity becomes a factor as hypoxic acidosis develops.


Pregnancy-induced morphologic changes in lymphocytes; an experimental study on materno-fetal tolerance in the rat. Morphological changes in lymphocyte nucleoli were examined in the course of pregnancy in rats. Small amounts of lymphocytes became activated, most of them producing micronucleoli. These findings show the same changes as found in the course of pregnancy in women. Subcutaneous administration of human placental eluate to non-pregnant rats induced a low degree of activation and high micronucleoli formation, dependent on the dose of placental antigen. Repeated administration of increasing doses of placental eluate revealed almost the same morphological changes in lymphocyte nucleoli as seen in normal pregnancy. This is considered an experimental verification that the morphological changes in lymphocyte nucleoli during pregnancy are due to permanent and gradually increasing doses of foreign antigen.


Erythema nodosum associated with pregnancy. Case reports. Four cases of erythema nodosum associated with pregnancy are reported and the literature reviewed. Erythema nodosum in pregnancy is a self-limited condition requiring minimal supportive treatment. No adverse effects upon pregnancy course or fetal outcome were noted. It is suggested that pregnancy may serve as an etiological basis for the disease.


Head and neck cancer--emotional management. The complete care of a patient with head and neck cancer should attend to the emotional as well as the physical aspects of the disease; usually the physical component of the disease is emphasized, while care of the emotional response of the patient and family is rarely addressed. There is no single, caring way to respond or cope with the emotional aspects of this disease. Nonetheless, it should be underscored that communication between the providers of health care (i.e., physician, nurse, aid, therapist, etc.) and the patient and family should be maintained during all phases of care. This article describes an approach to providing emotional support to cancer patients and their families during the phases of initial diagnosis and treatment, posttherapy, rehabilitation, recurrence, dying, and death. The emotional response of the health care provider in these circumstances is also addressed.


Treatment of carcinoma of the hypopharynx. In a review of 80 patients with hypopharyngeal squamous-cell carcinoma, 43 patients were found to have had lesions arising in the pyriform sinus, 34 had lesions arising on the postcollateral wall of the hypopharynx, and 3 had lesions in the postcricoid area. Therapeutic modalities included radical radiation therapy in 56 patients, radiation plus surgery in 13 patients, and planned combined therapy in 11 patients. The five-year determinate survival rate of all the patients was 20%. Patients with posterolateral wall tumors had a 23% rate of cure, but those with pyriform sinus tumors had only a 13% rate of cure. The five-year determinant survival rate was 12.5% for patients undergoing radical radiation therapy, 15.4% for those undergoing unplanned radiation and surgery (salvage therapy), and 55.6% for those with planned combined therapy. Over 40% of the patients had a recurrence of their disease; an additional 20% developed distant metastatic spread which usually occurred within the first year. The type of therapy did not alter the rate of recurrence but did affect the rate of distant metastatic spread, with planned combined therapy greatly improving control of the primary lesion. This study suggests that, even with advanced disease, the most effective therapy for hypopharyngeal carcinoma is planned combined radiation therapy and surgery.


Localization of creatine kinase isoenzymes in myofibrils. I. Chicken skeletal muscle. Purified, repeatedly washed, skeletal muscle myofibrils contain approx. 0.2 U of creatine kinase (CK) activity (equivalent to 2.5 micrograms CK) per milligram dry weight; this firmly bound CK activity is estimated to represent 3-5% of the total cellular CK. It had been shown previously that the myofibrillar CK, which can be quantitatively extracted at low ionic strength and purified to homogeneity, is very similar, if not identical, to the bulk MM-CK. It is shown that the two protein preparations also have the same peptide pattern after cyanogen bromide fractionation and very similar specific activities, confirming their identity. The earlier demonstration that the bound CK is specifically located at the M-lines of isolated myofibrils has been confirmed by immunofluorescence. Antibodies directed against purified MM- and BB-CK were used in the indirect fluorescent antibody technique to study the specificity of myofibril binding sites for different forms of CK. With myofibrils from adult muscle, which has only MM-CK, as well as from early developmental stages in which BB-CK is the predominant isoenzyme, M-type CK was localized exclusively at the M-line, while greater or lesser amounts of B-type CK were found at the Z-line. The data provide strong evidence that the MM-CK at the M-lines in skeletal myofibrils is not adventitiously bound but is rather an integral element in the M-line structure. The amount of CK bound is reasonably consistent with the earlier proposal that the CK molecules might be the transverse M-bridges and appears to be sufficient to regenerate all of the ATP hydrolyzed during muscle contraction.


Embryonic development of the head and neck: Part 3, The face. The embryology of the face is presented with respect to changes affecting the mandible, maxilla, upper and lower lips, palate, nose, and oral cavity. The embryonic development of the teeth and salivary glands is also included. Various facial clefts, including cleft lip and cleft palate, are discussed, in addition to some congenital anomalies affecting the nose and oral cavity.


Treatment of radiation-induced alopecia. Radiotherapy is frequently employed in the management of head and neck neoplasia, either as an adjunct to surgery or as the sole treatment modality. Consequently, radiation alopecia--a well-known complication of high-dosage radiotherapy--is seen often. Longer patient survival, especially with earlier discovery of the malignancy and more refined treatment regimens, will provide the surgeon with the opportunity to treat radiation alopecia by means of the punch graft technique of hair transplantation. The technique is substantially similar to that employed in treating male pattern baldness, although the approach to the recipient and donor areas must be modified. A successful case report is documented and a modified approach is highlighted.


Transoral mandibulectomy in advanced osteoradionecrosis. Because vascularity is severely compromised following radiation therapy, aseptic necrosis with secondary infection and extensive bone destruction can result in an advanced state of osteoradionecrosis. Transoral mandibulectomy is an excellent method for dealing with this difficult problem. This article discusses technical aspects of the procedure as well as applied anatomy and a case report. Evidence in the recent literature concerning hyperbaric oxygen therapy is very encouraging.


Twenty-five year experience with primary hyperparathyroidism at Columbia Presbyterian Medical Center. A retrospective review of 500 patients with primary hyperparathyroidism seen from 1951 to 1975 was conducted; the effect of routine screening of calcium and phosphate levels (initiated in 1968) on the incidence and spectrum of the disease was analyzed. The majority of the patients (77%) were diagnosed in the eight-year period after routine biochemical screening was instituted. Comparing the group of patients diagnosed before the advent of biochemical screening and those diagnosed since screening was instituted, we found: (1) a small but significant increase in the number of asymptomatic patients diagnosed (from 2% to 12%); (2) no change in the incidence of related medical disorders, i.e., nephrocalcinosis and hypertension; (3) no change in the incidence of primary hyperplasia and adenoma; and (4) no change in the mean serum calcium level, the mean age at diagnosis, or the number or location of the involved parathyroid glands. Although routine calcium screening has identified significantly more cases of primary hyperparathyroidism, screening apparently does not enable diagnosis at an earlier stage.


Melanoma of the conjunctiva--a rational approach to management. Eleven of 12 patients treated for invasive melanomas of the conjunctiva at the UCLA Hospitals from 1955 to 1976 revealed data sufficient for evaluation. Of these 11 cases, 4 died from 3 to 13 years after treatment as a result of the disease. The plan presented for surgical management of melanosis is based on histologic criteria and on the anatomic location of the tumor. In this series, such management ranged from local excision of noninvasive melanotic lesions to orbital exenteration with parotidectomy and radical neck dissection for invasive melanomas that involved the palpebral conjunctiva or caruncle. Extended follow-up is needed in all patients.


Localization of creatine kinase isoenzymes in myofibrils. II. Chicken heart muscle. Chicken heart muscle contains almost exclusively the BB isoenzyme of creatine kinase (CK), its myofibrils, moreover, lack an M-line. This tissue thus provides an interesting contrast to skeletal muscle, in which some of the MM-CK present as predominant CK isoenzyme is bound at the myofibrillar M-line. Approx. 2% of the total CK activity in a chicken heart homogenate remains bound to the myofibrillar fraction after repeated washing cycles; both the fraction and the absolute amount of CK bound are about threefold lower than in skeletal muscle. Almost all of the bound enzyme is located within the Z-line region of each sarcomere, as revealed by indirect fluorescent-antibody staining with antiserum against purified chicken BB-CK. After incubation with exogenous purified MM-CK, positive immunofluorescent staining for M-type CK at the H-region of heart myofibrils was observed, along with weaker fluorescence in the Z-line region. Chicken heart myofibrils may thus possess binding sites for both M and B forms of CK.


Incorporation of glycoproteins into peripheral nerve myelin. Peripheral nerve myelin contains a dominant low molecular weight glycoprotein called Po. To study the metabolism of this glycoprotein, tritiated fucose was injected into the peripheral nerves of adult mice and developing rats, and the temporal distribution of label was examined by autoradiography and gel electrophoresis. Mice and rat pups, injected with fucose, were sacrificed from 1 h to 98 days later. Series of autoradiographs were prepared. At the shortest labeling periods, newly formed product was confined to juxtanuclear Schwann cell cytoplasm, in association with regions rich in Golgi apparatus. After longer labeling periods, silver grain levels in Schwann cell cytoplasm decreased; concomitantly, there was an increase of silver grains associated with myelin. In adult animals, label associated with myelin was concentrated over outer layers of thickly myelinated fibers. Even at the longest time intervals examined (72 and 98 days), this distribution of label was largely retained. In contrast, in developing animals, label became associated with inner layers of the thicker sheaths. At no time was label observed over axons. Gel electrophoresis revealed that tritiated fucose was a suitable precursor for the faster migrating peripheral nerve glycoprotein(s). At all times examined, there was a single major peak of radioactivity that co-migrated on sodium dodecyl sulfate (SDS) acrylamide gels with the Po protein. Sometimes, a faster migrating shoulder of radioactivity was noted. With increased labeling periods, there was an enrichment of radioactivity associated with Po, indicative of a relatively slow turnover rate.


Changes in thick filament length in Limulus striated muscle. Here we describe the change in thick filament length in striated muscle of Limulus, the horseshoe crab. Long thick filaments (4.0 microns) are isolated from living, unstimulated Limulus striated muscle while those isolated from either electrically or K+-stimulated fibers are significantly shorter (3.1 microns) (P less than 0.001). Filaments isolated from muscle glycerinated at long sarcomere lengths are long (4.4 microns) while those isolated from muscle glycerinated at short sarcomere lengths are short (2.9 microns) and the difference is significant (P less than 0.001). Thin filaments are 2.4 microns in length. The shortening of thick filaments is related to the wide range of sarcomere lengths exhibited by Limulus telson striated muscle.


Ultrastructural study of GERL in beige mouse alveolar macrophages. Alveolar macrophages of the beige mouse mutant have a system of smooth-surfaced elements with the hallmarks of GERL. GERL also appears to produce residual bodies, and both organelles show cytochemically demonstrable acid phosphatase activity. When cells are exposed to colloidal silver, the tracer is endocytosed via pinocytic vacuoles to GERL.


Glucocorticoids modulate the in vitro development of the embryonic rat pancreas. The effect of the glucocorticoid analogue, dexamethasone, on the development of the embryonic pancreas was studied in tissue culture. It specifically enhances the accumulation of exocrine enzymes without altering the level of general cell proteins. The enhancement, however, is not symmetrical: the cellular levels of the two major exocrine products, amylase and chymotrypsinogen, are increased about 10- and 2-fold, respectively. Two other zymogens that are present in minor quantities, procarboxypeptidases A and B, are also increased, whereas no effect is seen on lipase A. Coordinate with these effects on synthesis, there is a dramatic change in the morphology of dexamethasone-stimulated acinar cells. Their number of zymogen granules is higher and crystalline arrays are found in the rough endoplasmic reticulum. Dexamethasone also inhibits cell replication, perhaps by selectively inhibiting the last cell divisions of the culture period. At the same time, there is a disproportionate reduction in the insulin content of cultured rudiments. We find that pancreatic development is normal in the absence of dexamethasone and that this glucocorticoid does not precociously induce the appearance of the specific secretory products, but rather enhances by a constant degree their synthesis and accumulation. Therefore, we conclude that glucocorticoids may play a modulatory but not an inductive role in pancreatic development.


Isolation and characterization of the vitelline layer of sea urchin eggs. The vitelline layers (VLs) of unfertilized sea urchin eggs were isolated by homogenization in a hypotonic medium containing Triton X-100 and EDTA. The surface topography of the VL is not changed by isolation. The thickness of the isolated VLs (300-400 A) is greater than that reported for VLs on intact eggs (100-200 A). Sperm adhere to the isolated VLs. When both internal and external VL surfaces are accessible to sperm, the sperm attach only to the external surface, suggesting that the external surface may carry sperm receptor proteins not present on the internal surface. Sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis shows that isolated VLs are composed of numerous proteins ranging from greater than 213,000 to 25,000 daltons. Lactoperoxidase-catalyzed 125I-iodination of unfertilized eggs labels two high molecular weight bands that stain faintly for carbohydrate. VLs are 90% protein and 3.5% carbohydrate. No predominance of a single amino acid or class of amino acids was found. Carbohydrate analysis yields fucose, mannose, galactose, glucose, xylose, glucosamine, galactosamine, and sialic acid. Controls for purity indicate that isolated VLs contain 2% protein of cytoplasmic origin and no more than 2.5% egg jelly.


Interference with thyroid histogenesis by inhibitors of collagen synthesis. Histogenesis of thyroid follicles in the chick embryo begins with a penetration by cells of the mesenchymal capsule into a solid epithelial primordium. Before penetration occurs, slits containing fibrillar material form between the epithelial cells. The fibrillar material is an epithelial cell product as shown by its formation within channels that form in cultures of isolated epithelial primordia. The drugs L-azetidine-2-carboxylic acid (LACA) and alpha, alpha'-dipyridyl, which interfere with collagen synthesis, prevent the formation of fibrils in cultured epithelial primordia and in cultures of whole thyroids. Furthermore, mesenchymal cells do not invade when whole thyroid primordia are cultured in the presence of either drug. The effects of alpha, alpha'-dipyridyl are reversed by washing out the drug; the effects of LACA are reversed by incubation with equimolar or greater amounts of L-proline added to the medium along with the drug. The results are interpreted to mean that the fibrillar material is collagen of epithelial origin, that the collagen in some way plays a role in mesenchymal penetration of the epithelial primordium, and that the epithelium is responsible for the pattern of lobulation within the developing gland.


Functional correlation between cell adhesive properties and some cell surface proteins. The adhesive properties of Chinese hamster V79 cells were analyzed and characterized by various cell dissociation treatments. The comparisons of aggregability among cells dissociated with EDTA, trypsin + Ca2+, and trypsin + EDTA, revealed that these cells have two adhesion mechanisms, a Ca2+-independent and a Ca2+-dependent one. The former did not depend on temperature, whereas the latter occurred only at physiological temperatures. Both mechanisms were trypsin sensitive, but the Ca2+-dependent one was protected by Ca2+ against trypsinization. In morphological studies, the Ca2+-independent adhesion appeared to be a simple agglutination or flocculation of cells, whereas the Ca2+-dependent adhesion seemed to be more physiological, being accompanied by cell deformation resulting in the increase of contact area between adjacent cells. Lactoperoxidase-catalyzed iodination of cell surface proteins revealed that several proteins are more intensely labeled in cells with Ca2+-independent adhesiveness than in cells without that property. It was also found that a cell surface protein with a molecular weight of approximately 150,000 is present only in cells with Ca2+-dependent adhesiveness. The iodination and trypsinization of this protein were protected by Ca2+, suggesting its reactivity to Ca2+. Possible mechanisms for each adhesion property are discussed, taking into account the correlation of these proteins with cell adhesiveness.


Turnover of rod photoreceptor outer segments. II. Membrane addition and loss in relationship to light. The rate of disk addition to rod outer segments (ROS) varies widely in Xenopus laevis tadpoles kept in cyclic light (12L:12D). When measured as radioactive band (3H-band) displacement during the 2nd day after injection of [3H]leucine, 75% of the daily increment of displacement occurred during the first 8 h of light. During the same interval, the number of open disks at the ROS base increased more than threefold. During the last 8 h of darkness, 3H-band displacement was undetectable and the number of open disks was reduced. These observations suggest the possibility that disk addition may occur discontinuously. During the 3rd and 4th days after injection of [3H]leucine, maximal displacement of the 3H-band occurred later in the day than on the 2nd day, its movement no longer corresponding to the increase in open disks. This delay in 3H-band displacement may reflect a time delay as a result of propagation of compressive stress in an elastic ROS system. Maximal disk loss from ROS as reflected in counts of phagosomes in the pigment epithelium occurred within 1 h of light exposure, and phagosome counts remained high for 4 h before declining to a low level in darkness. Modified lighting regimes affected the daily rhythms of shedding and disk addition differently, suggesting that control mechanisms for the two processes are not directly coupled. During 3 days in darkness, disk addition was reduced 50% compared to controls (12L:12D), whereas shedding was reduced by about 40%. Although reduced in level, shedding occurred as a free-running circadian rhythm. There was no evidence of rhythmicity of disk addition in darkness. In constant light, the rate of disk addition was not different from controls, but shedding was reduced by about 80% after the 1st day. This resulted in a 21% increase in ROS length. Among animals kept on a 2.5L:21.5D cycle, the rate of disk addition was reduced by 40% while shedding was maintained near control levels, resulting in a slight decrease in ROS length. These observations indicate that normal shedding requires alternating light and darkness, and that the daily rhythm of disk addition is due primarily to daily stimulation by light.


Transformations in the structure of the cytoplasmic ground substance in erythrophores during pigment aggregation and dispersion. I. A study using whole-cell preparations in stereo high voltage electron microscopy. Pigment migration in cultured erythrophores of the squirrel fish Holocentrus ascensionis, after manipulation with K+, epinephrine, 3',5'-dibutyryl cyclic adenosine monophosphate, theophylline, and caffeine, is essentially identical to that observed in this chromatophore in situ. For such observations, the erythrophores are dissociated from the scales with hyaluronidase and collagenase, and allowed to spread on an amorphous collagen substrate, where they resemble the discoid erythrophore in situ. In this state, they are readily fixed by glutaraldehyde and osmium tetroxide, and are then critical-point dried for whole-cell viewing in the high voltage electron microscope. The organization and fine structure of the erythrophore cytoplast was stereoscopically examined after fixation of the pigment granules in four experimental states: pigment dispersed, pigment aggregated, pigment aggregating, and pigment dispersing. In the dispersed cell, granules are contained in an extensive three-dimensional lattice composed of radially oriented microtubules and a network of fine filaments 3-6 nm in diameter (microtrabeculae), whereas in the aggregated cell, the microtrabecular system is absent, and the majority of the microtubules appear displaced into the cortices on the cytoplasmic surface of the plasma membrane. In cells fixed while aggregating, few microtrabeculae are observed, although formless thickenings are observed in the cortices, on granules, and between clumped granules. In dispersing cells, the microtrabecular system is reformed from material stored in the cortices and with the granules in the centrosphere. These observations suggest that the granules are suspended in a dynamic microtrabecular system that withdraws during pigment aggregation and is restructured during pigment dispersion. The microtubules guide linear granule motion not by defining physical channels, but by a recognizable affinity of microtubules, microtrabeculae, and granules for one another.


Distribution and content of microtubules in relation to the transport of lipid. An ultrastructural quantitative study of the absorptive cell of the small intestine. To determine whether microtubules are linked to intracellular transport in absorptive cells of the proximal intestine, quantitative ultrastructural studies were carried out in which microtubule distribution and content were determined in cells from fasting and fed animals. Rats were given a 1-h meal of standard chow, and tissue was taken from the mid-jejunum before, 1/2 h, and 6 h after the meal. The microtubule content of apical, Golgi, and basal regions of cells was quantitated by point-counting stereology. The results show) that microtubules are localized in intracellular regions of enterocytes (apical and Golgi areas) previously shown to be associated with lipid transport, and that the microtubule content within apical and Golgi regions is significantly (P less than 0.01) reduced during transport of foodstuffs. To determine the effect of inhibition of microtubule assembly on transport, colchicine or vinblastine sulfate was administered to postabsorptive rats, and the lipid and microtubule content of enterocytes determined 1 and 3 h later. After treatment with these agents, lipid was found to accumulate in apical regions of the cells; this event was associated with a significant reduction in microtubule content. In conclusion, the regional distribution of microtubules in enterocytes, the decrease in assembled microtubules after a fat-containing meal, and the accumulation of lipid after the administration of antimicrotubule agents suggest that microtubules are related to lipid transport in enterocytes.


Morphometry of the renal corpuscle during normal postnatal growth and compensatory hypertrophy. A light microscope study. Renal corpuscles from the juxtamedullary and subcapsular regions of the renal cortex were morphometrically analyzed in young rats and in adult rats that had been unilaterally nephrectomized or sham-operated at an early age. Mean corpuscular volumes increased 4.5-fold during normal development, and 7.7-fold as a result of compensatory hypertrophy in both cortical regions. Relative and absolute volumes were determined for Bowman's space, the glomerular tuft, and five glomerular components: epithelial, endothelial, and mesangial cells, capillaries, and the filtration membrane. Normal and hypertrophic enlargement of Bowman's space was slightly greater than glomerular growth, and the growth response of subcapsular glomeruli was greater than that of juxtamedullary glomeruli. The ratio of mean glomerular volumes between outer and inner glomeruli was 1:2 in both adult groups. Both adult groups also developed nearly identical proportions of all glomerular component structures, representing a relative decrease of epithelial cells and increase of capillaries compared to the young animals. Normal and hypertrophic maturation involved absolute increases in all glomerular cell populations, the length of capillary loops and the surface area of the filtration membrane, all nearly in proportion to the respective four- and seven-fold increases in glomerular volume. Changes in the filtration surface area are consistent with published data for glomerular filtration rates in normal and hypertrophied kidneys. The mean cell size in epithelial and mesangial populations doubled during growth, but was not greater than normal in mononephrectomized rats. Hyperplasia among all populations of glomerular cells is indicated in normal growth, and to a greater extent in compensatory renal hypertrophy.


Ability of polymorphonuclear leukocytes to orient in gradients of chemotactic factors. Polymorphonuclear leukocyte (PMN) chemotaxis has been examined under conditions which allow phase microscope observations of cells responding to controlled gradients of chemotactic factors. With this visual assay, PMNs can be seen to orient rapidly and reversibly to gradients of N-formylmethionyl peptides. The level of orientation depends upon the mean concentration of peptide present as well as the concentration gradient. The response allows an estimation of the binding constant of the peptide to the cell. In optimal gradients, PMNs can detect a 1% difference in the concentration of peptide. At high cell densities, PMNs incubated with active peptides orient their locomotion away from the center of the cell population. This orientation appears to be due to inactivation of the peptides by the cells. Such inactivation in vivo could help to limit an inflammatory response.


Homosexual identity formation: a theoretical model. A six-stage model of homosexual identity formation is outlined within the framework of interpersonal congruency theory. Stages are differentiated on the basis of the person's perceptions of his/her own behavior and the actions that arise as a consequence of this perception. The person is seen to have an active role in the acquisition of a homosexual identity. Alternative paths of development are proposed within each stage. The notion that people can accept homosexuality as a positively valued status is assumed. Several factors believed to be influential in determining whether a person takes one line of development or another are discussed. The model is intended to be applied to both female and male homosexuals.


Attitudinal homophobia and support of traditional sex roles. The present study investigated the relationships among various attitudes toward homosexuality and the maintenance of traditional male/female gender distinctions. The results supported both the importance of separate attitude dimensions describing reactions to homosexuality and the meaningfulness of an overall pattern of homophobia. Components of homophobic style were evaluated and related to components of support for traditional male/female roles. An individual's own congruence with traditional gender expectations and his/her attitudes toward sex-role incongruence were evaluated within the context of social psychological research on deviance.


Representations of homosexuality in health science textbooks. Discussions of homosexual behavior in 35 publications (textbooks, trade books, pamphlets) in the fields of health science and sex education were reviewed. Ten books referred to the subject. Major findings of the study were: homosexual behavior receives significant attention in only 1 of the 10 publications; discussions of homosexuality contain a number of hidden biases; a large number of factual errors can be identified in most publications; and most authors seem to believe that homosexual behavior may be tolerated during adolescence but, at the same time, should be a source of concern to teenagers.


Lesbian sexuality.

Lesbian sexuality. A study was conducted to determine what physical sexual activities lesbians engage in and what attitudes lesbians have toward various aspects of their sexuality. The sample consisted of 286 homosexual women. This article reports results in the following areas: first orgasm, first sexual experience with another women, sexual fantasies, number of sex partners, faking orgasm, sex toys, initiating sex, techniques used to reach orgasm with partners, and the attitudes of respondents toward their own lesbianism, erotica, female genitals, masturbation, emotional involvement with sex partners, monogamy, sex toys, oral sex, tribadism, group sex, and sadomasochism. The study suggests that the sample group has very positive attitudes about their lesbianism, their own bodies, masturbation, and the various ways in which they express sexuality with their partners.


Growing older female: heterosexual and homosexual. An analysis of the age-related content of "Personals" ads placed by heterosexual and homosexual women was undertaken to test hypotheses derived from theoretical notions about differences and similarities between lesbian and nonlesbian aging. No support was found for a hypothesized overrepresentation of older advertisers of either sexual orientation. Contrary to popular notions, lesbians were not found to be seeking young partners. However, age differences between groups did indicate support for "accelerated aging" among heterosexual women. Possible advantages of lesbian over nonlesbian women in their experience of aging are presented.


The collection and analysis of documents for the Civil Liberties and Sexual Orientation Project. This article shows how documents are collected and analyzed as part of a complex methodology to supplement and verify data gathered for the Civil Liberties and Sexual Orientation Project. During interviews, respondents are shown a checklist and asked if they have documents that may support their belief that they have experienced discrimination. Interviews are considered fully documented if materials are obtained which demonstrate that action was taken against a respondent and that the action was based on sexual orientation or on departures from social sex-role stereotypes. Documents are also collected to see if other attributes of a respondent were involved in the action. In addition, supplemental information is obtained that augments interview data.


A study of lesbian lifestyles in the homosexual micro-culture and the heterosexual macro-culture. Ninety-one lesbians were surveyed in an effort to determine how homosexual women function within the heterosexual macro-culture and the homosexual micro-culture. Those sampled tended to be young, white, urban, and well-educated professionals. By exploring four major categories (demographics, lesbian lifestyles/homosexual culture, social relationships, and participation in the heterosexual culture) it was found that respondents felt isolated from the heterosexual macro-culture and turn to the homosexual micro-culture for friends, emotional support, and social interaction. It was also discovered that while lesbians do feel isolated from the majority of society, they function productively in a dual role within their general environment.


A cross-cultural perspective on theory and research on male homosexuality. In an effort to uncover useful directions for future research, this paper examines the cross-cultural data on male homosexuality in light of various theories that might account for its variation. Looking first at different psychological explanations, the study suggests that the sex of one's childhood companions may be an important factor in the origin of homosexuality. Two possible explanations for an association between male homosexuality and mixed-sex playgroups are offered: In one, gender identity serves as an intervening variable; in the other, the notion that "familiarity breeds contempt" is studied. A cultural materialist theory, which views homosexuality as adaptive under conditions of population pressure, is shown to be supported by the correlation between a society's natalist policy and its attitudes toward homosexuality.


Gay ghetto.

Gay ghetto. Gay people have claimed that there exist within major cities "gay ghettos", neighborhoods housing large numbers of homosexual men and women as well as gathering places where homosexual behavior is generally accepted, and have designated as such certain sections of Boston, New York, Chicago, San Francisco, and Los Angeles (Aiken, 1976, p. 27; Altman, 1971, p. 42; Brill, 1976, p. 27; Chicago Gay Liberation, 1970, pp. 3-4; Kantrowitz, 1975, p. 48; Nassberg, 1970, p. 1; Russo, 1976, p. 47; Shilts, 1977, p. 20; Whitmore, 1975, p. 45; Whittman, 1972, pp. 167-168). Sociologists have picked up the term, using it repeatedly in research (e.g., Humprheys, 1972a, pp. 80-81; Weinberg & Williams, 1974, p. 43). Typically, however, these authors offer no observations to support their use of the phrase. This paper analyzes the validity of "gay ghetto" as a sociological construct, limiting discussion to the male homosexual community.


Deep fellowship: homosexuality and male bonding in the life and fiction of Joseph Conrad. Conrad's biography reveals only peripheral, though suggestive, awareness of homosexuality. His fiction, however, shows a continuing concern with some underlying features of female and male homosexuality. Suggestions of a positive view of homoerotic relations can be discerned in the strong works of his early career, specifically Lord Jim and "The Secret Sharer." The later novels and stories, usually characterized as sentimental and conventional, dramatize an overt fear of homosexuality consistent with Conrad's hostile reaction to the Casement revelations. Chance features an evil lesbian, Victory an equally destructive homosexual male. Only the autobiographical A Shadow Line shows a return to the earlier positive attitude toward male bonding with sexual overtones. Scholars have been reluctant to notice these concerns, since Conrad is considered a "man's" writer.


Performance evaluations for diagnostic x-ray equipment. Technical factors influencing the performance of x-ray equipment are: focal spot size, focal spot growth, leakage radiation, accuracy of the exposure timer, kilovoltage, exposure reproducibility, linearity of exposure, x-ray beam quality, and collimation. An evaluation of these factors is necessary to determine x-ray equipment performance characteristics.


Clients' treatment expectations at a community mental health center. Clients' expectations about mental health care, particularly differences in these expectations as a function of social class, and the relationship of discrepancies between expectations and perceptions to treatment outcome, is examined in this study with 317 Caucasian clients. In contrast to the majority of studies, no differences in treatment expectations relating to clients' social class, sex, or marital status were found. Nor were discrepancies related to course or outcome of therapy. Discussion focuses around explanation and interpretation of these findings. Particularly relevant is the need to determine the extent to which nonusers in the community share the attitudes and expectations of clients.


Environmental adaptation of the mental patient. An ecological model suggests looking at the hospitalized mental patient in terms of how well the resources available in the environment fit his individual needs. This study explores the relationship between the environmental fit of patients while they are in the hospital and their adaptation to the community once they have left. Data on individual needs and evaluations of environmental resources were obtained through a series of structured interviews. Results indicate that the more a patient feels the hospital environment is a good fit, the longer he stays there. Hospital fit is positively related to fit in the community, but the latter is related only to the degree of symptomatology exhibited by the expatient in the community and not to how long he is able to remain out of the hospital. Implications of the findings and the model are discussed.


The effects of life crisis on psychological adjustment. In this survey study the question was asked how "life crisis," social conditions, and ratings of quality of life are related to psychological adjustment. The survey included 454 residents, and data were collected on five social conditions: income, education, age, marital status, and religious participation; four ratings of life quality: family, personal life, income, and overall quality of life; the number of recent changes in the lives of the respondents; and two indicators of psychological adjustment. These data were analyzed with multivariate analyses of variance and stepwise regression. Life crisis was associated directly with psychological adjustment. Social conditions and life quality ratings also had significant effects. People with high life-crisis scores reported more psychological distress, and poor social conditions appeared to further exacerbate their adjustment problems. Regardless of the magnitude of the crisis, quality of life ratings had sizable effects on reports of psychological adjustment.


Reactions to intravenous pyelography contrast media. Reactions to contrast media used for intravenous pyelography are everyday possibilities in a radiology department, and statistics indicate that the incidence of fatalities has increased after a period of decline. The physiology of reactions and how to be prepared for them, as described here, are important parts of the technologist's knowledge.


The responsiveness and equality of mental health care to Chicanos and Native Americans. An examination was made of the services received by Chicano and Native American clients in 17 community mental health facilities. Although these minority clients differed from Anglos in demographic variables, there was no evidence that they were rendered inferior or discriminatory services. However, failure to return for therapy was much higher among minority clients. Possible reasons for this failure to return are discussed. It is suggested that for ethnic group clients, equality of services may not mean responsive services.


Radiological health attitudes of college students. The purpose of this study was to measure and evaluate attitudes of college students regarding various aspects of radiological health hazards. The attitudes surveyed were related to controversial issues such as nuclear power plant operations, color television sets, microwave ovens and genetic effects from medically related x-ray exposure.


The client as consumer and evaluator of community mental health services. Discussion of ethical issues which concern community psychologists and other mental health professionals has generated new emphasis on the psychiatric client as consumer. In light of the studies questioning the efficacy and ethics of various clinical procedures, it would seem that the client-consumer is being asked to accept treatment which is often less than desirable. In light of recent trends to safeguard the rights of the client-consumer, it is now appropriate to focus on the client as evaluator of services contracted. Having clients evaluate clinical services finds its logical fruition in the creation of client advisory boards. Avoiding many of the problems of citizen mental health advisory boards, client boards ensure continued and systematic client evaluation of community mental health services. The accomplishments of one client board are offered as evidence that there should be increased emphasis on the consumer as evaluator.


Breast exposure: nationwide trends; a mammographic quality assurance program--results to date. BENT (Breast Exposure: Nationwide Trends), a federal-state sponsored mammographic quality assurance program has demonstrated that unproductive radiation exposure can be reduced by identifying and correcting problems that result in poor image quality. BENT provides clinical personnel with knowledge on the performance of their mammographic system as a basis for possible improvements in image quality and for reductions in patient exposure.


Organization development: a new modality for community mental health. Organization development (OD) is discussed as being a valid tool for advancing mental health and for promoting the present goals of community mental health centers, as well as for accomplishing organization development's traditional objectives of increasing organizational effectiveness in business, industry, and government agencies. A comparison is made between the main objectives of the community mental health movement in the United States and the major thrusts of current OD practice, showing how the foci of the two fields are essentially similar. The psychological aspects of OD are presented in their relation to mental health. Organization development is demonstrated to be both a legitimate and an effective modality for the community mental health practitioner to use in reaching large numbers of people in promoting positive mental health, primary prevention, improved interpersonal relations, and personal growth activities in the community.


Participation in decision-making by staff in community mental health programs. Staff participation in decision-making was examined in 22 community mental health programs in Michigan. A questionnaire was completed by 164 practitioners employed at least half time. The response rate was 94%. For virtually every work-related decision examined, the practitioners wanted significantly greater participation in decision-making than they currently have. Also, those working in programs where practitioner participation was high reported greater job satisfaction, less role ambiguity, greater use of their skills, better communication among staff, and greater goal clarity and attainability. Practitioner participation was lowest in programs serving more disturbed, less successful populations, such as inpatient, mental retardation, and drug-abuse programs. Para-professional practitioners in all programs reported less participation in their jobs than professional practitioners. Finally, practitioners who typically interact more with clients also reported lower levels of participation.


Trends in community mental health programming. One hundred-seventy-three mental health centers responded to a survey inquiring about allocation of staff time for mental health services and about the availability of an array of services at present, 3 years previous, and 3 years hence. The data reflect an emphasis upon reactive services as opposed to those considered proactive, and on services directed to individuals as opposed to other groups. However, this emphasis seems to be changing. Future projections call for a de-emphasis on individual reactive programs and increased emphasis on programs directed toward families and small groups, and toward proactive programs directed to the communities-at-large. Data about specific programs and services further suggest de-emphasis of services that involve the mental health professional and the client in direct interaction, and continued growth in services that can be delivered by less formally trained mental health workers or volunteers.


The treatment of narcolepsy-cataplexy with nocturnal gamma-hydroxybutyrate. Sixteen patients with narcolepsy and cataplexy were treated with gamma-hydroxybutyrate (GHB) given at night and tailored to achieve as continuous a night's sleep as possible. The dosage usually consisted of 1.5-2.25 gm orally at bedtime and then one or two further 1.0-1.5 gm doses with awakenings during the night, and totaled about 50 mg/kg. Apart from one patient who took only the bedtime dose, the subjective quality of night sleep improved in all patients and the number of irresistible daytime attacks of sleep and cataplexy substantially diminished. Some residual daytime drowsiness remained and this usually responded well to low doses of methylphenidate. Improvement has been maintained for up to 20 months without the development of tolerance. Two patients experienced adverse side effects necessitating withdrawal of GHB treatment, but no serious toxic effects have occurred.


Diphenylhydantoin and pulmonary function. Thirty-nine epileptic patients underwent pulmonary function testing. Twenty-one of these patients, ranging in age from 16 to 44 years, had taken diphenylhydantoin (DPH) for 2 to 17 years. Eighteen patients, who had taken other anticonvulsants for similar time periods served as controls. Five patients in the DPH group had lung volume abnormalities, four had abnormal airway function, and five had abnormalities of alveolar gas mixing. One patient in the control group had lung volume abnormalities, two had abnormal airway function, and five had abnormalities of alveolar gas mixing. Statistical analysis revealed no significant differences between the groups, or between either group and predicted values.


[Histopathologic and neurochemical correlations as a function of lesions of the locus coeruleus region in the cat (I)]. Unilateral lesions in the area of the loci coeruleus and subcoeruleus in the cat are associated with a significant and sustained decrease of noradrenaline (NA) in the ipsilateral cerebral cortex without any important change in the concentrations of NA in the contralateral cortex and in the spinal cord of both sides. The serotonin (5-HT) concentrations of the spinal cord and cerebral cortex of both sides remained unchanged in the same groups of animals. Bilateral lesions in the same area result also in a marked decrease of NA in the cerebral cortex of both sides. The latter lesions also result in slight decreases of NA in the hypothalamus and of NA and 5-HT in the spinal cord but the NA and 5-HT concentrations of the striatum and thalamus and the 5-HT concentrations of the cerebral cortex and hypothalamus are unmodified by such lesions. Unilateral lesions of the area immediately rostral to the locus coeruleus (praelocus lesions) result in a very significant decrease of NA in the ipsilateral cerebral cortex without any change of NA in the contralateral cerebral cortex and spinal cord of both sides. Similar lesions produced bilaterally in another group of cats resulted in marked decreases of NA in the cerebral cortex of both sides and a slight decrease of NA in the thalamus without any change of NA in the striatum, hypothalamus and spinal cord and of 5-HT in the cerebral cortex. In the same group of animals with lesions which, however, extended more closely to the midline than in cats with locus coeruleus lesions, 5-HT is markedly decreased in the striatum and thalamus and slightly decreased in the hypothalamus and spinal cord. These results support the view that the noradrenergic coeruleo-cortical pathway is made up of fibers which originate in the loci coeruleus and subcoeruleus and predominantly end ipsilaterally to their origin in the cerebral cortex. Ascending NA fibers ending in the thalamus appear to originate from NA neurons located more laterally in the upper pons and more specifically at the level of the parabrachial nuclei.


The effects of atropine and reserpine on cortical kindling in the rat. The effects on cortical kindling of atropine (a muscarinic, cholinergic blocking agent) and reserpine (a depleter of catecholamines and 5 hydroxytryptamine) were tested in this study. Atropine, which had previously been found to retard amygdaloid kindling, had similar but somewhat weaker effects on cortical kindling. Reserpine also had similar effects on cortical kindling compared to subcortical kindling in that it potentiated seizure responses.


The incorporation of 3H (G) L-leucine into single muscle fibers in Duchenne dystrophy and Charcot-Marie Tooth disease. The results are reported of single muscle fiber uptake of tritiated leucine in muscle biopsy material from Duchenne dystrophy and Charcot-Marie Tooth disease. The uptake in the two conditions is compared and suggests that the previously reported increase in synthesis of cytoplasmic proteins in muscular dystrophy are probably related to regenerative efforts by the muscle fibers.


Fluctuation of plasma cortisol levels in multiple sclerosis. Using radioimmunoassay, the levels of plasma cortisol of 23 patients with multiple sclerosis and 10 control subjects were determined at three or more times over a one-year period. The status of the disease was ascertained by neurological examination at the same time. Twelve of the patients were considered stable because they showed no changes in their disease status during the year. The remaining 11 patients were designated active since each had one or more relapses. The levels of cortisol of the control and stable groups remained relatively constant during the one-year period, but the levels of the active group fluctuated significantly more than either of the other two groups. Furthermore the active patients who had more than one episode had the greatest fluctuation in their cortisol levels. The fluctuations could indicate some endocrinological aberration in patients with active multiple sclerosis or may be secondary to the influence of the disease.


New introducer for subcutaneous placement of cerebrospinal fluid shunts: technical note. A new introducer system for subcutaneous placement of shunt tubings is described. The advantages of this system over previous introducers are discussed.


Syncope of obscure nature.

Syncope of obscure nature. One hundred and eleven cases of syncope or loss of consciousness are analyzed. Most are of obscure nature while some illustrate features of syncope that deserve further scrutiny. The cases are divided into six groups: Resembling cardiac syncope (30 cases); vasovagal syncope (22 cases); features of both cardiac and vasovagal syncope (12 cases); orthostatic hypotensive (29 cases); akinetic seizure? (12 cases); and miscellaneous (5 cases). Some groups are subdivided according to the circumstances surrounding the spells, for example, seated eating, nocturnal, associated with bowel movement, response to anticonvulsant therapy, etc. The following conclusions seem warranted: The evidence favors the existence of a type of akinetic seizure resembling cardiac syncope; loss of consciousness while seated eating (prandial syncope) may comprise a syndrome; syncope related to bowel movement or abdominal pain is a striking association; sporadic nocturnal syncope due to temporary hyporeactivity of baroreceptors is not sufficiently recognized; alcohol ingestion may precipitate orthostatic hyporeactivity of baroreceptors is not sufficiently recognized; alcohol ingestion may precipitate orthostatic hypotension. Familial syncope, syncope proneness and cold drink syncope are illustrated.


Smoking patterns during and before pregnancy: weight, length and head circumference of progeny. This study indicates that tobacco smoking by the mother is associated with a significant reduction of the newborn's size. This effect cannot be explained by either an association of the smoking habit with malformation, premature birth, exaggerated consumption of coffee matrimonial status or paternal smoking, or by a combination of malformation, prematurity and any one of the other factors. The effect is also unrelated to the continuation or discontinuation of smoking during pregnancy. Paternal smoking seems to be associated with a reduced weight in children born to nonsmoking mothers.


Patient recall of induced abortion.

Patient recall of induced abortion. 15 of 92 women who underwent induced abortions and subsequently gave birth denied their abortions in a medical interview. Religious women and women with fewer children were more likely to deny than others. Obstetricians as well as investigators examining the effects of induced abortions must be aware that women may fail to provide accurate abortion histories.


Age at menarche and menopause of uterine cancer patients. An investigation was undertaken of the ages at menarche and at menopause of cervical and endometrial cancer patients for the years 1950-55 and 1960-65. Analysis of the ages at menarche in relation to the year of birth did not show a difference between the uterine cancer groups, whereas the age at menopause did show such a difference. The menopause occurred later in the endometrial than in the cervical cancer group. There was an earlier mean age at menarche and a later mean age at menopause per decade. Therefore, the menopause seems a constitutional factor involved in the development of endometrial cancer and perhaps also cervical cancer.


Four years' experience of antenatal chromosome diagnosis. The culture of fetal cells obtained by amniocentesis has become a useful and often reassuring investigation for couples having an increased risk of giving birth to an abnormal child. The present report illustrates the experience at one center where the work has been carried out for a number of years.


Transfer and dynamics of uric acid in the pregnant rhesus monkey. I. Transplacental and renal uric acid clearances. Data from the literature suggest that uric acid produced by the fetus could pass across the placenta and contribute to the observed increase in maternal plasma levels of uric acid in preeclamptic pregnancy. To investigate this hypothesis, fetal transplacental and renal uric acid clearances were estimated in 4 term pregnant rhesus monkeys by means of the steady infusion method using 14C-labeled uric acid. Allantoin clearances were determined in one pregnant monkey. Samples of maternal and fetal arterial blood were collected at regular intervals. The total amount of fetal urine produced during the experiment was collected at the end of the experiment. In addition, maternal endogenous renal uric acid and creatinine clearances were measured in 6 term pregnant monkeys. Fetal transplacental uric acid clearances appeared to be almost entirely limited by placental permeability and varied between 3.6 and 8.6 ml X min-1 X kg-1 of fetal weight; fetal renal clearances were between 0.11 and 0.20 ml X min-1 X kg-1. The allantoin clearances were found to be of the same magnitude. Maternal renal clearances of uric acid and creatinine were almost equal (mean 3.2 +/- 0.6 and 3.0 +/- 0.5 ml X min-1 X kg-1 of maternal weight, respectively). Extrapolation of these data to human preeclamptic pregnancy reveals that it is unlikely that fetal uric acid could significantly contribute to the maternal uric acid load.


Transfer and dynamics of uric acid in the pregnant rhesus monkey. II. A mathematical model. The objective of the present study was to develop a mathematical model of the dynamics of uric acid between fetal and maternal compartments in the term pregnant rhesus monkey. In 3 different animals 14C-labeled uric acid was injected into the fetal circulation, the amniotic fluid and the maternal circulation, respectively. In one experiment no uric acid was administered and the fetus was deliberately killed at the beginning of the experiment. Samples of fetal and maternal blood, maternal urine and amniotic fluid were collected at regular intervals. Semilogarithmic time-activity curves were constructed and time constants were determined. An open four-compartment model (fetal-placental plasma, fetal-placental interstitial space, amniotic fluid and maternal plasma) was applied to describe the intercompartmental dynamics of uric acid. Transplacental clearance was approx. 1 ml X min-1 in both directions, maternal renal clearance was about 17 ml X min-1. These results and the calculated values of the other intercompartmental clearances support earlier results, obtained with the steady infusion method. Uric acid concentrations in amniotic fluid and fetal plasma appeared to increase significantly during the experiments. The rise in amniotic fluid levels can only be explained by accepting a yet undefined compartment in which uric acid is produced and cleared directly into the amniotic cavity. It is speculated that this additional compartment could be the fetal lung.


Inhibition of lactation and ovarian function: a possible animal experimental model for humans. Lactating Texel ewes are hyperprolactinemic. Hyperprolactinemia persists for at least the first 50 h after weaning, when the udder is swollen and tender. Oral administration of bromocriptine lowers hyperprolactinemia dramatically within 4 h, correlated with 'shrinking' of the udder. During lowering of hyperprolactinemia there is no immediate increase in LH.


The pharmacology and subacute toxicology of dopamine. Preclinical studies with dopamine showed a unique spectrum of biological activities which suggested that it might be of therapeutic use in the clinical syndromes of shock and low cardiac output. Most prominent among these were its effects on cardiac output, renal perfusion, and vital organ flow. The unique effect on renal function and the subsequent studies by Goldberg and his colleagues led to the recognition of a previously unknown catecholamine receptor site, the 'dopaminergic receptor'. Studies on the toxicology of dopamine in our laboratories suggested that dopamine could be safely used in the clinic.


Dopamine in the management of shock.

Dopamine in the management of shock. Shock is a syndrome with serious prognostic implications--the harbinger of death. Hypoperfusion of essential organs is common, though total blood flow may be significantly greater than normal. Specific therapy is directed to the specific inciting event--infection, abscess, tamponade, &c. Symptomatic therapy keeps the patient alive until we discover the specific problem or until he recovers spontaneously. The intravascular volume must be carefully monitored and corrected, using the pulmonary wedge pressure as the principal guide, and colloid osmotic pressure must be maintained. If the patient does not respond to volume augmentation alone then inotropic drugs may be needed, and of these dopamine is a selective vasodilator which redirects blood flow to the critical organs. The outstanding challenge in shock is the maldistribution of perfusion in the microvasculature. Although this may be ameliorated by the early administration of large doses of glucocorticoids, there is little convincing that these drugs constitute more than supportive therapy. Of greatest importance is reevaluation, reevaluation, and reevaluation. The patient in shock becomes a new patient every five minutes. Drugs that formerly worked, doses previously optimal--these are no guide because the situation changes so rapidly. The principles of management are to monitor vital functions, constantly vary drugs and doses, and continually attempt to put right all the parameters measured. This strategy will be more effective when we know what parameters to measure.


Dopamine effects on circulation and myocardial oxygen supply. We measured the action of dopamine given intravenously at dosage ranging from 2.5 to 320 micrograms/kg per min in closed chest anaesthetized dogs. Dopamine produced a dose-dependent increase in heart rate, cardiac index, mean arterial pressure, total peripheral resistance, pulmonary artery pressure, left ventricular end diastolic pressure, coronary flow and myocardial oxygen consumption. At dopamine dosage of 80-320 micrograms/kg per min, the coronary vascular resistance, the stroke volume index, the efficiency of heart work and the central venous pressure are all decreased. The maximum effect of dopamine on the circulation was seen at a dose between 40 and 80 micrograms/kg per min.


Control of upper-limb prostheses: a case for neuroelectric control. A discussion is presented on the control aspects of upper-limb prostheses, with emphasis on the areas of necessary improvements in current designs. Arguments are presented to indicate that it should be possible to obtain a substantial improvement in prostheses control by properly training the amputee, improving the dynamics response of the prostheses, and improving the quality of the forward-path control signal. Augmentation of feedback information, although useful, may not be essential. The limitations of the myoelectric (muscle) signal as a forward-path control signal, especially for multiple degrees-of-freedom prostheses, is discussed. Most of the limitations of the myoelectric signal can be overcome if the neuroelectric (nerve) signal is used as a forward-path control signal. Results of a series of experiments which demonstrate the feasibility of constructing an electrode capable of being implanted around severed nerves and of detecting neuroelectric signals for prolonged periods of time are presented. A possible scheme for employing neuroelectric control is also presented.


Education and professional training of biomedical engineers in West Germany. The health service and educational systems, together with industry and research centres, are the primary institutions involved in the development of the bio-engineering profession in West Germany. Since industry and research institutions in West Germany are similar in structure to those in other countries, for the purposes of international comparison only the health service and educational systems are described. The questions "how many bioengineers are needed?" and "how many should be trained?", were the motivation for a professional field analysis commissioned by the German Society for Biomedical Engineering. This commission found a need for about seven thousand bioengineers and biotechnicians in West Germany. It is shown, however, that there are actually very few positions open, and some measures to create more positions are discussed.


Chemical engineering in medicine in North America. An examination has been made of the involvement of chemical engineers in medicine in North America. Fields of Study and subjects of research are briefly given in tabular form and the general statistical picture of chemical engineering in medicine discussed. Further details of the workers and references to their published work can be obtained from the author if required.


Automatic recording of biological impedances. An automatic recording system for measurements of biological impedances at different frequencies is described. The system comprises a signal synthesizer and a network analyser controlled by a desk calculator. The impedance and phase angle are recorded at one hundred and sixty logarithmically-spaced frequencies between 100 Hz and 1 MHz. A pilot study was conducted to explore the usefulness of the system for investigating fluid balance problems.


Parkinson's disease as a disorder of movement. The diagnosis of Parkinson's disease is mostly likely to be made when it is kept in mind, when it is thought of in a broad context, when patients are seen while moving, and when the tests for the three disorders of movement are systematically performed.


Differential diagnosis of paralysis agitans. Paralysis agitans may be mimicked by other disease processes and drugs which disturb the structural or functional integrity of the dopaminergic nigrostriatal system. In another group of patients, isolated symptoms or signs such as tremor or increased muscle tone are considered out of the context of the total clinical picture and may suggest parkinsonism.


Respiratory dysfunction in Parkinson's disease. The respiratory picture in the patient with parkinsonism may be described as one in which there is a stiff thorax which resists rapid movement, assumes a resting state of overexpansion, and exhibits poor coordination of repetitive function. In consequence there is progressive limitation in the capacity to ventilate. Respiratory care becomes important when the patient becomes sedentary.


Parkinsonism and the gut.

Parkinsonism and the gut. Digestive symptoms are frequent in parkinsonism and occasionally dominate the picture of the disease. Symptoms seem to flow from skeletal-muscular and visceral effects of the central lesion.


Neurogenic dysfunction of the urinary bladder in Parkinson's disease. Involvement of the urinary bladder in Parkinson's disease was recognized in the 1950's, when the accidental discovery of a neurosurgical means of treating the disease brought more attention to it, with increasing research and study. In more recent years, the advent of more specific medical treatment has led to closer examination of the disease, and has enlarged our awareness of its complications. This has been paralleled by progress in the field of urology, with more precise methods of measuring dysfunction of the urinary bladder.


Hip fracture in the patient with Parkinson's disease. Although treatment of the parkinsonian with hip fracture has progressed because of more effective operative intervention, the prognosis is not nearly as good as for the patient without parkinsonism. The patient's personal physician needs to be aware of possible complications, and the family should be made aware of the seriousness of the problem.


Home care of patients with Parkinson's disease. This article is written in order to help the patient with Parkinson's disease function as independently as possible. It is not meant to be a complete treatment program, but a collection of helpful ideas based on the experience of physiotherapists who work with these patients daily, and on information acquired from such patients. The techniques are applicable at home and in the hospital.


Self-care aids for the parkinsonian patient and his family. Methods and aids for helping the individual with Parkinson's disease overcome some of the problems encountered in daily living. Only by a continuous, on-going program, much patience, and knowledge of how and what can be done can the patient be helped to maintain his interests and independence within the range of his abilities.


Anesthesia in the patient with parkinsonism. Medical control of parkinsonism has resulted in a longer life expectancy and better quality of life for these patients, who are now presenting for surgical treatment of a variety of conditions. In addition to the risks associated with age, these patients are more prone to restrictive pulmonary problems. General anesthesia should be avoided when possible.


Antiparkinsonian therapy.

Antiparkinsonian therapy. Powerful new tools for the treatment of parkinsonism include levodopa, decarboxylase inhibitors, and dopaminergic agonists. Yet earlier drugs still have a useful role to play. The decision to begin pharmacotherapy must be adjusted individually for each patient.


Levodopa in the treatment of Parkinson's disease. Levodopa is at present the most effective treatment of Parkinson's disease. Its use in combination with a peripheral decarboxylase inhibitor prolongs the elevation of plasma levels and decreases the incidence of peripheral side effects. Severe psychiatric and neurologic side-effects may necessitate reduction or cessation of the drug.


Psychiatric disturbances occurring during levodopa therapy of Parkinson's disease. Psychiatric problems constitute one of the prime reasons for failure in levodopa therapy in Parkinson's disease. While a variety of symptoms may be seen, the levodopa itself does not produce a defined set of psychiatric symptoms. The single most important factor determining the psychiatric response to levodopa therapy is the mental state of the patient before therapy.


Amino acid composition of amniotic fluid, maternal and umbilical vein serum in intrahepatic cholestasis of pregnancy, pre-eclampsia and rhesus incompatibility. The levels of free amino acids in maternal and umbilical venous serum and in amniotic fluid were determined in 7 patients with normal pregnancy, 11 with intrahepatic cholestasis of pregnancy, 4 with pre-eclampsia and 9 with rhesus incompatibility. In maternal venous serum there were only small differences in the amino acid concentrations in complicated pregnancies when compared with normal subjects, and the only statistically significant difference was a lowered level of histidine in intrahepatic cholestasis. In umbilical venous serum, as in amniotic fluid, the amino acid concentrations were generally elevated in intrahepatic cholestasis of pregnancy and generally decreased in rhesus incompatibility when compared with control values, and in amniotic fluid the concentration of 13 amino acids was significantly higher in intrahepatic cholestasis than in normal pregnancy. Thus, the placental amino acid transfer seems to be increased in intrahepatic cholestasis of pregnancy and slightly decreased in rhesus incompatibility, and changes in the placental transfer system are parallel for most amino acids.


Nucleotide sequence of cro, cII and part of the O gene in phage lambda DNA. A nucleotide sequence comprising 960 base pairs of bacteriophage lambda DNA has been determined. The sequence includes the entire genes of the regulatory proteins cro and cII, and part of the O gene, together with control elements for their transcription and translation. The right-hand boundaries of the lambdaimm434 and lambdaimm21 substitutions and the cy42 mutation have been located.


Serous otitis media.

Serous otitis media. Serous otitis media, as seen in children, may be an insidious disease which provides few signs and symptoms. Its effects may cause significant problems in the preschool and school-age child with respect to acquisition of necessary developmental skills. The nurse practitioner can effectively diagnose, treat, and manage children with serous otitis media. An algorithm is presented to aid in effective differential diagnosis of the disease.


Nucleotide sequence of tRNAPhe from the seeds of lupin (Lupinus luteus). Comparison of the major species with wheat germ tRNAPhe. The nucleotide sequence of tRNAPhe of yellow lupin seeds (Lupinus luteus) is deduced from the composition of pancreatic and T1 ribonuclease digestion products and compared with tRNAPhe of wheat germ. Major lupin tRNAPhe, unlike pea tRNAPhe, differs from wheat germ tRNAPhe in the first base pair of stem TpsiC ("e").


Nucleotide sequence of Xenopus borealis oocyte 5S DNA: comparison of sequences that flank several related eucaryotic genes. Genomic Xenopus borealis oocyte-specific 5S DNA (Xbo) contains clusters of 5S rRNA genes. The number of genes varies among clusters, and the distance between genes within a cluster is about 80 nucleotides. The spacer DNA between gene clusters is AT-rich and heterogeneous in length due in part to variable numbers of a tandemly repeated 21 nucleotide sequence. A cloned fragment of Xbo 5S DNA (Xbo1) containing three 5S rRNA genes has been sequenced. The sequences of Xbo1 genes 1 and 2 are very similar to the dominant 5S RNA sequence, whereas 15 of the 120 residues in the third gene are different. The sequence of gene 3 is as different from the dominant gene sequence as the X. laevis pseudogene is from the 5S RNA gene. Sequence analysis of genomic DNA shows that gene 3 is an abundant component of the multigene family. All three genes are transcribed when added to an extract of X. laevis oocyte nuclei, and a fragment of Xbo1 lacking the AT-rich spacer DNA and the 5' end of the first gene supports transcription of genes 2 and 3 in this in vitro system. Thus the 80 nucleotides preceding each 5S gene are sufficient for promoter function. Nucleic acid sequences preceding several eucaryotic genes that are transcribed by RNA polymerase III were analyzed and the following common features were found: a purine-rich region; at least one direct repeat; the absence of dyad symmetry; transcription beginning with a purine; a pyrimidine residue immediately preceding the first nucleotide of the gene; and the oligonucleotides AAAAG, AGAAG and GAC, located approximately 15, 25 and 35 nucleotides, respectively, before the start of transcription. The 10 base pair (bp) spacing between the homologous oligonucleotides is that expected for a recognition signal on one face of a DNA double helix. The extensive sequence differences between most of the spacers that precedes these genes make the three conserved oligonucleotides more striking. Parts of the 5' flanking regions of the three Xbo1 gene (-12 to -40), which include the conserved oligonucleotides, are identical. In contrast, 7 of the first 11 nucleotides that precede the third 5S RNA gene in Xbo1 differ from those that precede the first gene. The sequences following the X. borealis oocyte and somatic 5S genes are identical in 12 of the first 14 residues and contain two or more T clusters, as does the corresponding region of X. laevis oocyte 5S DNA. The 3' sequences of the Xenopus 5S rRNA genes and several other eucaryotic genes contain features in common with procaryotic transcription termination sites. The 3' end of the gene is GC-rich and contains a dyad symmetry. Termination occurs in an AT-rich region containing one or more T clusters on the noncoding strand.


Comparison of cloned rabbit and mouse beta-globin genes showing strong evolutionary divergence of two homologous pairs of introns. Cloned beta-globin genes of both mouse and rabbit each contain a large and a small intervening sequence (intron) of about equal length at precisely the same positions relative to the coding sequence. The homologous introns show some sequence similarity, particularly at the junctions with the coding sequence. They most probably arose from a common ancestral sequence and diverged substantially during evolution.


The nucleotide sequence of the right-hand terminus of adenovirus type 5 DNA: implications for the mechanism of DNA replication. The nucleotide sequence of the right-hand terminal 3% of adenovirus type 5 (Ad5) DNA has been determined, using the chemical degradation technique developed by Maxam and Gilbert (1977). This region of the genome comprises the 1003 basepair long HindIII-I fragment and the first 75 nucleotides of the adjacent HindIII-F fragment, extending from the right-hand terminus to the sequences from which the main body of the mRNA of early region 4 is transcribed. One of the origins of adenovirus DNA replication is located within this part of the genome. The sequencing results are discussed in relation to several models proposed for the mechanism of replication of linear DNA molecules, which invariably depend on the presence of specific arrangements of nucleotides at the termini of those linear DNAs.


The dog as an instruction model for surgical correction of mandibular prognathism. Intraoral sagittal splitting of the mandible in dogs is an instructional exercise for correction of prognathism. The dog was selected as a surgical model for several reasons including the ability of this species to open the mouth widely. Comparative anatomical features of the mandibles of man and dog suggest that a sagittal splitting technique practiced in dogs may give expertise that would avoid complications, such as cutting vessels and nerves in humans. In addition, the dog should be carefully considered as a model for long-term study of surgical complications and of the effects of surgery on mandibular growth in young patients.


A cephalometric guide to the diagnosis of midface hypoplasia at the Le Fort II level. A cephalometric study of the relation of the malar eminence to the A point has been made. It is proposed that the orbital-NA distance is of clinical importance in patients with SNA of less than 79 degrees in whom a Le Fort I osteotomy procedure is contemplated. The measurement of the angle SNO is a significant guide to the malar-maxillary relationship and will assist in complete cephalometric evaluation of these patients.


Use of bupivacaine hydrochloride in oral surgery-a clinical study. A study was developed in an attempt to investigate the possible usefulness of the local anesthetic agent, bupivacaine hydrochloride, for oral surgery. The results show that bupivacaine hydrochloride is an effective local anesthetic agent. It has a rapid onset time, a high frequency of surgical anesthesia, a long duration, and a low incidence of side effects. In comparison to lidocaine, bupivacaine has a greater potency, a lower toxicity at equipotent doses a longer duration, a possible pain-free period after return of normal sensation, and it does not require a vasoconstrictor for consistent profoundness.


Panfacial cellulitis with contralateral orbital cellulitis and blindness after tooth extraction. A case of panfacial cellulitis with contralateral orbital cellulitis and blindness after extraction of a tooth has been reported. Contralateral orbital involvement, with sparing of the ipsilateral eye, constituted the unusual feature. This was considered to be a result of hematogenous spread rather than of direct extension.


Internal carotid pseudoaneurysm as a late complication of maxillofacial missile wound. A delayed formation of a pseudoaneurysm of the internal carotid artery occurred secondary to a gunshot wound of the maxillofacial region. Its treatment concurrent with the treatment of a severely comminuted fracture of the mandible has been reported.


Cat scratch disease: report of case and discussion. A case of cat scratch disease with a submental mass as the initial symptom has been presented. The disease should be considered in the evaluation of swellings and masses of the cervicofacial region. However, because of the benign course of cat scratch disease, other more serious disease processes must be ruled out before establishing the diagnosis of cat scratch disease.


Odontogenic keratocyst associated with an intramandibular chondroma. The unusual feature of an intramandibular chondroma in association with an odontogenic keratocyst in a 59-year-old man is described. The keratocyst recurred and required two reoperations. The coexistence of an odontogenic keratocyst and a chondroma of the jaw was probably a coincidence of two simultaneous but otherwise unrelated lesions. The possibility that the keratocyst and the chondroma were due to a single developmental disturbance of the region cannot be excluded. No signs of a recurrence were seen at the last follow-up examination four years after the operation.


Primary adenocarcinoma of the lip.

Primary adenocarcinoma of the lip. A report of a primary adenocarcinoma of the lip, arising from minor salivary tissue, is presented. Adenocarcinomas of the lips are unusual and account for only 1% of the reported adenocarcinomas of oral tissues.


Myxoma of the maxilla: report of case.

Myxoma of the maxilla: report of case. A review of the literature and a report of a case of myxoma of the maxilla in a 1-year-old Negro girl have been presented. This case is interesting because of its rarity at this age and its location. Originally, a Weber-Ferguson approach was considered. However, a transoral approach provided excellent access for complete visualization and removal of the tumor. This reinforces the advantages to the patient that result from the cooperation of different surgical services.


A simple method of eminoplasty for correction of recurrent dislocation of the mandible. A simple surgical method of eminoplasty has been described that is rapid and has few complications. Its value in the treatment of recurrent dislocation of the mandible is now well established. Whether the procedure works by providing greater freedom of motion or by limitation is a moot point as the operation is highly successful.


Second vertical osteotomy 15 years after initial operation. A case of mandibular prognathism that existed 15 years after a previous attempt at correction has been presented. The initial procedure was the vertical osteotomy done via an extraoral approach. A second attempt at correction was undertaken with use of the same approach. The anatomic changes existing as a result of the first surgical procedure were of extreme interest. A decreased anteroposterior length of the sigmoid notch with posterior placement of the coronoid process was observed. Also, an increased thickness of the mandibular rami in a mediolateral plance was present. The clinical problems encountered as a result of these changes were difficulty in overlapping proximal and distal segments without definite osseous reductions and the inability to set back the mandible further without coronoidectomy. When these procedures were done, the patient's treatment was managed very successfully.


Bone marrow cellularity determination: comparison of the biopsy, aspirate, and buffy coat. Bone marrow biopsies (244) performed with a Jamshidi needle were evaluated in 53 children with leukemia or aplastic anemia. Adequate specimens were obtained in 85%. Results of cellularity estimated by biopsy were compared to the cellularity of the aspirate versus volumetric determination of the myeloid-erythroid layer (buffy coat). A wide discrepancy was noted between marrow cellularity confirmed by biopsy versus the aspirate or buffy coat. The greatest variance was seen in the hypercellular or normocellular marrows, as estimated by biopsy, in which 39% were misinterpreted as moderately or severely hypocellular by aspirate. Volumetric measurement of buffy coat was least acceptable for estimating cellularity. Thus the biopsy has proved to be an important and reliable indicator of bone marrow cellularity.


Electrophysiological evidence against negative neuronal feedback from the forebrain controlling midbrain raphe unit activity. The hypothesis that the activity of serotonin (5-HT)-containing neurons of the midbrain raphe is subject to negative neuronal feedback regulation was examined. This hypothesis is based primarily on the observation that the administration of drugs which increase the synaptic availability of 5-HT depress midbrain raphe neuron discharge. Since the preponderance of midbrain raphe efferents are ascending, transections which interrupt both the main efferent outflow, as well as all inputs from anterior levels, ought to disrupt the functional integrity of a neuronal feedback loop. The effect of complete transections of the neuraxis placed just rostral to the midbrain raphe nuclei on the efficacy of two drugs which elevate synaptic serotonin, chlorimipramine and p-chloroamphetamine, was investigated in the chloral hydrate anesthetized rat. Such transections neither blocked nor attenuated the depressive effect of intravenously administered chlorimipramine (0.33 or 0.15 mg/kg) or p-chloroamphetamine (1.25 mg/kg) on midbrain raphe unit discharge. These results suggest that neuronal feedback involving the forebrain dose not mediate the depressive effect of drugs which elevate synaptic serotonin on midbrain raphe neuronal activity. An action at serotonergic synapses intrinsic to the midbrain raphe is suggested as an explanation for the persistence of drug effects in transected animals.


Distribution of palatal and other arteries in cleft and non-cleft human palates. Cleft lip and cleft palate are two possible effects of fusion failure of embryonic facial processes. Aberrant facial morphogenesis suggest aberrant arterial distribution. Prompted by surgical need, studies detailing major branches of the third or pterygopalatine portion of the maxillary artery acquire practical significance. Therefore postomortem arteriographic studies were undertaken to ascertain location of these major arteries and their branches in twelve near-term human fetuses. Comparison was made between arterial distributions in three cleft and nine non-cleft fetal palates. The question of bilateral symmetry was examined. It is known that these major branches are commonly present on both sides, but the study revealed numberous variations in each facial half in both cleft and non-cleft palates. Variation implies morphologic contradiction with sterotype presentations. So numberous are the variations that occasionally they may account for sudden and unexpected hemorrhage during surgery/and retarded healing or sphacelus of flaps following surgery.


Prenatal mandibulofacial dysostosis (Treacher Collins syndrome). The clinical, radiographic, and histologic aspects of Mandibulofacial Dysostosis (Treacher Collins Syndrome)--MFD--are described as observed in a human fetus of approximately 15 weeks gestation age. Findings in the present study do not differ significantly from those previously reported, as the abnormal fetus exhibited the peculiar ocular, otic, and mandibular defects common in descriptions of postnatal survivors. Although exhibiting the major signs and symptoms of MFD even at this early developmental stage, previously unreported relationships dealing with the ossification of the mandible and salivary gland hyperplasia are noted. Contrary to expectation, vascularization appears excessive. The pathogenesis of the events leading to the deformities of the first and second branchial arches is extrapolated to seven weeks in utero.


Anthropometry of the face in lateral facial dysplasia: the bilateral form. The morphology of the head, face, and ears was studied in 26 patients with bilateral lateral facial dysplasia in The Hospital for Sick Children, Toronto, using anthropometric and cephalometric methods. The anthropometric data of the maxilla and mandible were compared to the cephalometric findings. The study showed that, in the majority of the patients, one side of the face was more damaged than the other was was associated with a high frequency of defects in all areas of the face. The microtic ear was not necessarily part of this syndrome. The anthropometry proved to be a valuable supplement to the x-ray cephalometry assessment of the malformed face.