Pulsed nuclear magnetic resonance of potassium (39K) of whole body live and dead newborn mice. Double oscillation frequencies in T1 decay curves. Pulsed nuclear magnetic resonance relaxation curves (T2 and T1) of potassium (39K) have been measured in detail on whole body newborn mice when alive, and on the same mice after death. The T2 curves are simple exponential with respect to time, but are shorter than for 39K in simple solutions. The T1 curves are not exponential decays, but show large oscillations that may be described approximately as the sum of two separate sine waves of different frequencies. Large T1 oscillations of complex waveform were previously observed by us with 39K in cancer tissues. Gyroscopic motion of adsorbed magnetoelectric dipoles is proposed as a possible physical mechanism accounting for the experimental observations.


Influence of superoxide generating system, vitamin E, and superoxide dismutase on radiation consequences. During studies of the mechanism by which hemolysis is induced in irradiated human erythrocytes in vitro, several inducements of membrane lipid peroxidation and protective effects of vitamin E (V.E) and superoxide dismutase (SOD) were investigated. Findings were: (1) Before hemolysis, K+ release from erythrocytes induced by radiation stimulated hemolysis but was inhibited by V.E or SOD. (2) Lipid peroxidation of mitochondria induced by Fe3+, ADP, and superoxide (O2-) generating system, and lipid peroxidation of microsome induced by O2- generating system, were also inhibited by V.E or SOD. (3) X-ray or 60Co gamma-ray radiation stimulated lipid peroxidation of liver homogenate, microsome, and liposome. Some of this peroxidation was inhibited by V.E. or SOD. These results suggest that O2- and/or OH formation by radiation induces membrane lipid peroxidation, which causes deterioration of membrane resulting in change of ion permeability and consequent hemolysis.


Stabilizing effects of cholesterol on changes in membrane permeability and potential induced in red blood cells by lysolecithin. Effects of cholesterol on permeability of K+ ion and on change in membrane potential induced by lysolecithin were studied. Cholesterol inhibited K+ release from rabbit red blood cells treated with lysolecithin (1.25 micrograms/ml), 3.3 X 10(-6) M of cholesterol being the optimum concentration for blocking K+ release. Changes in membrane potential, monitored by changes in intensity of fluorescence of cyanine dye, were induced by lysolecithin and inhibited by cholesterol. The inhibitory action on both K+ permeability and membrane potential varied with the cholesterol concentration. The observed effects are thought to be due to membrane-stabilizing activities such as decreasing membrane fluidity and hardening the membrane at the fluid-phase transition temperature. These properties of cholesterol may have significance in relation to transformed cells (tumor cells, lymphomed cells).


Electron microscopic examination of common red cell ghosts: cytoplasmic contamination. Red blood cell ghost preparations are often cited as providing unequivocal or convincing evidence for the active transport of solutes from a solution of low concentration across a membrane to a solution of higher concentration. Electron microscopic examination of the more widely used ghost preparations show that a considerable quantity of cytoplasmic macromolecules (including hemoglobin) remain within the treated red blood cells. That is, many of the ghost preparations are not hollow membrane perparations. It is concluded that the problem of active solute transport in red blood cell ghost preparations should be reexamined. Furthermore, experiments with ghost preparations purporting to demonstrate active transport should include electron photomicrographs of the preparation utilized.


Transaminative pathway of cysteine metabolism in rat tissues. Enzyme activities of the transaminative pathway of cysteine metabolism in various rat tissues were examined. Liver was found the most active tissue, followed by kidney and heart. Liver and kidney were more pronounced in mercaptopyruvate sulfurtransferase activity than in cysteine transaminase activity; heart was more active in the latter. Red blood cells, which have pronounced sulfurtransferase activity, exhibited no transaminase activity, indicating the pathway is negligible in this tissue.


The role of inert particles in malignant transformations: a hypothesis of carcinogenesis. Controlled cellular growth exists in an aqueous matrix that undergoes a spectrum of reversible solvent and structural conformational changes. In contrast, malignant tumor formation occurs in an irreversible nonpolar aqueous matrix (coacervate); that is, in a physicochemical sense uncontrollable cell growth exists in a hydrocarbon-like milieu. It is proposed that foreign isoluble particles which locate on cellular surfaces can induce such coacervate structuring. Resultant formation of abnormal film matrices could initiate pathological transformations in the morphology, metabolism, and replication of the affected cells. In short, this abnormal matrix formation may be a critical factor in the development of malignancies, both avascular and vascular stages. It would follow that drugs or other agents capable of disrupting coacervated water matrices could be effective in the treatment of cancer. Experimental studies in our laboratory and clinical data from other sources support this hypothesis.


The rhomboid-to-W technique for excision of some skin lesions and closure. A method is descirbed whereby a skin lesion is excised as a rhomboid, and adjacent flaps are then created and transposed to close the defect in a W. A. pleasing scar line results, one which is easily hidden in the natural creases.


Modified three-wall orbital expansion to correct persistent exophthalmos or exorbitism. It is believed that a variation of the 3-wall orbital expansion of Tessier can be used to correct persistent exophthalmos, as well as exorbitism. The operation is described, and the results in 3 patients are shown.


Anatomy of the mandibular branches of the facial nerve. In operative dissections of mandibular branches of the facial nerve, we identified certain branches below the inferior border of the mandible in all cases. These usually supplied the depressor labii inferioris and mentalis muscles, though infrequently the branch to the depressor anguli oris was also below the mandible. At least 3 nerve branches were identified in all dissections. The clinical applications of this include the necessity to identify and protect these nerve branches during operations in the submandibular triangle, as well as when incising the platysma muscle or removing fat from over the body of the mandible in a face-lift procedure.


Changing perspectives in surgical hand rehabilitation in quadriplegic patients. Every motivated quadriplegic patient with resources for strong wrist extension, and lacking irreversible pathological features, is a candidate for reconstruction of at least a basic strong pinch. This basic pinch is better than that obtained with a prosthesis. We feel that this possibility exists in no less than 75 percent of our quadriplegic patients.


Arm dermolipectomy with a quadrangular flap and "T" closure. We present a technique for the correction of obesity and/or ptosis of the arms. It consists of raising a lower quadrangular advancement flap, sliding the upper wound margin downward, cutting the excess off the quadrangular flap, and a T-shaped closure. A compressive elastic bandage is worn continuously for 3 months to help keep the closure scar flat and prevent its hypertrophy.


Experimental study of results of nerve suture under tension vs. nerve grafting. Evoked electromyograms and myelinated fiber caliber histograms were used to compare the results of end-to-end nerve suture and nerve grafting, performed with an operating microscope. The best results were achieved after direct suture without tension. Direct suture under a tension of 25 grams produced results sometimes comparable the that of the zero tension group, but mostly quite inferior to those and even to the grafted group. The regeneration of axons in the nerve graft group was delayed more than in the sutured groups, but by the tenth month the number of regenerating fibers had increased with stable and comparatively good results. After a nerve suture under a tension of 25 grams, there is impairment of the blood flow at the suture site, and the results are not as good. In such situations I believe nerve grafting should be performed. This amount of tension also seems to be the limit which will allow accurate coaptation of a nerve by microsurgical techniques.


Early rotation of a cross-lip flap to repair a defect caused by a human bite. A case is presented of loss of half of the lower lip from a human bite. An Estlander flap was used on the fifth day for reconstruction, with no infection and a good result. This shows the advantage of a "delayed primary closure" in some of these badly contaminated wounds.


Iatrogenic false aneurysms following punch hair grafting. By serial angiograms, we found the pulsating nodules occasionally seen after punch hair grafting are pseudoaneurysms.


Improved method of injecting local anesthetic solutions for breast operations. An improved method of injecting local anesthetic solutions for gynecomastia operations and augmentation mammaplasties is described.


[Angiitis of the CNS (and the problem of its classification)]. The author deals with the different and partially divergent aspects of the classification of inflammatory vascular processes with particular reference to cerebrospinal involvement and forms. The limited pathomorphic tissue reaction of vessel wall elements and blood cells to different etiopathogenetic factors and the different cellular tissue structures observed for similar noxae are especially worth mentioning in this context. Also pointed out by the author in his present paper are the limitations of diagnosis. Central-nervous-system involvement usually brings with it special topographic difficulties and problems.


[Method for studying spinal evoked potentials]. The authors describe a new method of examing evoked spinal potentials. Derivation is by means of unipolar needle electrodes which are ventrolaterally introduced into the cervical disk space as far as the posterior longitudinal ligament. Detection of a spinal potential following the stimulation of brachial and crural nerves allows to exclude the possibility of complete transverse lesion of the spinal cord or severing of the peripheral nerve or plexus.


[From paraphasia through speech disorders to disconnected thinking in schizophrenia]. The author considers paraphrasia to be the principle of the pathophysiology of the nervous system and the clinical manifestations of nervous and mental diseases, which he designates as a disintegrative deviation in the irradiation of nerve processes. By taking as a starting point some of the concepts of Wedensky, Jackson, Pavlov, and Uchtomsky, it would be possible to divide the disintegrative deviation into nondissolutive, dissolutive, and dominant deviations. The paper shows that it is possible to observe typical cases of disintegrative deviation at the speech level (with the necessary modifications) in connection with paraphasic forms of aphasia, the making of mistakes in speaking, and disconnectedness of though in schizophrenia (Kraepilin's derailments).


[Experiences and investigations with a Polish abbreviated form of the MMPI (DKO 74)]. Starting from a description of the advantages and weaknesses of the Minnesota multiphasic personality inventory (MMPI) test, the authors discuss the development, standardization, and normalization of an abbreviated form (DKO/74) which is used in Poland. Results of investigations made to determine the suitability of the method for establishing diagnoses, which included comparative examinations of various groups of Polish and G.D.R. patients (schizophrenics, neurotics, alcoholics, oncological subjects, and criminal offenders) as well as studies into factorial validity, are presented and show the test to be a suitable instrument for clinical and psychodiagnostic examinations.


[Differences in the drinking behavior between alcoholic men and women in the Schwerin district]. The present paper demonstrates some typical differences in drinking behaviour between female and male alcoholics. We investigated especially the difference in quantities of consumed pure alcohol. The ratio of the mean consumption per year by women and men was 1 : 1,9. The difference in due to differences in the drinking habits and a different alcoholic tolerance in both sexes. Generally we found that in both family and society alcohol abuse is less tolerated in women.


[Suicide attempts with drugs].

[Suicide attempts with drugs]. A sample of 352 subjects, who had made a suicide attempt by ingesting pills examined in the aspects of age and sex, number and origin of used tablets and combination of pill ingestion with alcohol or other methods. Younger people under 20, took nearly exclusively tablets, which they accidentally found at home. Elder patients over 50, used nearly exclusively prescribed drugs. The typical patients attitudes to this suicidal method gives us the right to speak about such suicide attempts as "attempts by tablets". The pharmacological substance is unimportant and plays a secondary role. The seriousness of suicide attempts depends on topical situation of person, biological and social factors; it does'nt dependent on number or pharmacological substance of tablets.


[Contents and peculiarities of the activity of psychologists in psychiatry and neurology under the conditions of a university hospital of neurological psychistry]. The qualification of clinical psychologists and their theoretically possible and practically realized employments are discussed from the practical psychologist's viewpoint and with reference to the historical development of clinical psychology.


The hospital and the borderline patient: management guidelines for the community mental health center. Controversy over the treatment of borderline patients in regression has frequently left underfined the practical approaches to hospital management of these patients. The nature and context of the regressive episode, and the implications of potential interventions for specific types of patients are basic considerations in formulating such an approach. Subgroups of borderline patients can be usefully distinguished on the basis of the major management problem to which each is particularly prone.


Community mental health treatment: what works for whom? The research literature does not establish with any consistency an integrated model of what type of patient functions best in what type of community setting. The findings do, however, identify the relationship of certain patient characteristics to re-hospitalization: number of prior hospitalizations, length of hospitalization and history of unemployment being positively related; educational level, occupational level, and race being unrelated; and sex, marital status, age, and diagnosis being inconsistently related. Also identified in the literature were those community programs that were found to be the most effective based on a review of four outcome measures including recidivism, symptomatology, social functioning, and employment.


Day hospital versus outpatient treatment: a controlled study. This study compares day hospitalization with traditional outpatient treatment effecting rehospitalization, symptomatology, mood, community, and vocational adjustment for 30 recently discharged schizophrenic patients. Results indicate day hospital patients were significantly more involved in work and training activities, but had no significant difference in the other areas of measurement.


State mental hospitals and the future.

State mental hospitals and the future. There seems to be a general acceptance of the idea that at some future date mental hospitals will disappear to be replaced by community mental health services of various kinds. The author points out that remarkably little interest is focused on the possibility of a new model of residential care to replace the outmoded hospital. Some form of residential mental health care will probably always be needed, and should be complementary to the developing nonresidential services. A strategy for revitalizing mental hospitals is outlined.


Clinical considerations in the prescription of group, brief, long-term, and couples psychotherapy. Differential clinical considerations for treatment prescription as an aspect of outpatient evaluation for psychotherapy is presented in overview. The indications and contraindications presented for each of the treatment modalities of group therapy, brief therapy, long-term therapy and couples therapy are based on psychotherapy evaluation, selection criteria and outcome research to date. The information and fund of knowledge of the psychiatrist about appropriate treatment prescription matched to the patient, his problems, and his motivation to work psychotherapeutically is an essential aspect of the initial evaluation.


On examination dreams.

On examination dreams. The literature concerning examination dreams is reviewed, and the case of a patient who had a number of examination and examination-like dreams is described. Examination dreams are related to traumatic dreams, "idiosyncratic" dreams, and various behavioral expressions. In addition, constitutional factors involving impulse-defense imbalance, childhood experiences with physical difficulties and medical examinations, and ambivalent identifications and object relations seem to find representation in these dreams.


The search for the mother: narcissistic regression as a pathway of mourning in childhood. Previous observers, following Freud's formulations in Mourning and Melancholia, have disagreed over the question of whether the child can mourn. To support the thesis that the child does mourn but in a different way from the adult, the author focuses on the importance of the child's identification with the lost love object, the narcissistic regression, and the associated autoerotic activities. Clinical material is presented from the analysis of a latency child and of an adult, both of whom lost their mothers during childhood.


Bulimia nervosa: an ominous variant of anorexia nervosa. Thirty patients were selected for a prospective study according to two criteria: (i) an irresistible urge to overeat (bulimia nervosa), followed by self-induced vomiting or purging; (ii) a morbid fear of becoming fat. The majority of the patients had a previous history of true or cryptic anorexia nervosa. Self-induced vomiting and purging are secondary devices used by the patients to counteract the effects of overeating and prevent a gain in weight. These devices are dangerous for they are habit-forming and lead to potassium loss and other physical complications. In common with true anorexia nervosa, the patients were determined to keep their weight below a self-imposed threshold. Its level was set below the patient's healthy weight, defined as the weight reached before the onset of the eating disorder. In contrast with true anorexia nervosa, the patients tended to be heavier, more active sexually, and more likely to menstruate regularly and remain fertile. Depressive symptoms were often severe and distressing and led to a high risk of suicide. A theoretical model is described to emphasize the interdependence of the various symptoms and the role of self-perpetuating mechanisms in the maintenance of the disorder. The main aims of treatment are (i) to interrupt the vicious circle of overeating and self-induced vomiting (or purging), (ii) to persuade the patients to accept a higher weight. Prognosis appears less favourable than in uncomplicated anorexia nervosa.


Plasma cortisol levels in depression and other psychiatric disorders: a study of newly admitted psychiatric patients. Morning and evening plasma cortisol levels were checked in 123 consecutively newly admitted psychiatric patients with a variety of diagnoses. Questions asked were whether there were differences among groups with more severe illness, type of depression, alcohol abuse, or particular symptoms. Morning cortisol elevation was found in 33% of patients and was not associated with any particular diagnostic category. Evening cortisol elevation occurred in 85% of the subjects. It was significantly higher in those with unipolar depression and organic brain syndrome, also in those patients who abused alcohol regardless of diagnosis. Evening cortisol elevation was twice as common in patients with diagnoses of more severe psychiatric illness than in those with minor disorders. Further study is suggested to see if these patterns of cortisol elevation are sustained beyond the stress-of-admission period.


Tryptophan disposition in psychiatric patients before and after stress. Non-esterified fatty acid and total and free tryptophan were determined in the plasma of psychiatric patients unselected with respect to psychiatric diagnosis and in the plasma of normal subjects before and after physiological and psychiatric tests. Retarded patients had significantly low total and free tryptophan values which correlated negatively with agitation. Total tryptophan fell significantly after testing in the non-retarded subjects. The only biochemical abnormality significantly associated with a diagnosis of primary depression was the rise of plasma non-esterified fatty acid after testing. Thus, tryptophan abnormalities were associated more with psychiatric rating scores than with diagnoses.


Attentional deficit in the siblings of schizophrenics. A study of attentional deficit in the relatives of schizophrenics and in a matched control group is reported, in which the relatives are found to have poorer scores on a vigilance test and on a choice reaction time test. It is concluded that this deficit points to one of the primary symptoms of schizoprenia, and suggestions for further research are made.


Parasuicide in young Edinburgh women, 1968--75. Between 1968 and 1975 there was a marked, non-artefactual rise in the numbers of young female parasuicides admitted to the Regional Poisoning Treatment Centre in Edinburgh. The greatest increase in rates occurred among girls aged 15--19 (for events, persons and 'first-ever' episodes). Among teenagers the most marked increase occurred for those who were married; this group also reported a greater increase than did the non-married in the frequency of physical violence and serious debt. 'Marginel' social-sexual roles have also become progressively more common in this age group. The 20- to 24-year group showed a more modest increase in rates, similar for the married and the non-married. In this age group there was no consistent pattern of change for reported violence or debt over the study period, nor were changes in these variables related to marital status. An increase in consumption of alcohol before parasuicide was noted for both age groups.


Influence of experience and nationality on assessment and outcome of parasuicide. In Sheffield 544 consecutive cases of attempted suicide (parasuicide) were seen at 2 large hospitals over a 12-month period, and allocated in sequence to the junior and senior psychiatric staff, of British and foreign origin. During the follow-up period of 12 months, 31 patients had a further episode of parasuicide and 5 patients committed suicide. The outcome (as measured by repeat parasuicide or suicide) was not significantly affected by the country of origin of the psychiatrist, nor his length of training in psychiatry.


Psychiatric symptoms in self-poisoning patients. Self-poisoning patients admitted to hospital were studied for persistence of psychiatric symptoms over a 3-month period and evaluated at 3 points in time with the General Health Questionnaire and the Present State Examination. Symptoms were identified which had a high or low prevalence at 3-month follow-up. GHQ and PSE scores correlated at 0.8. The implications of the study are discussed, particularly the earlier need for out-patient help in those who had a moderate or high number of symptoms at initial interview.


Psychiatric diagnosis in self-poisoning patients. The Present State Examination was administered to 539 patients who attended a casualty department after an act of self-poisoning during the course of a year. Computer analysis by means of the Catego program showed that 30% of the patients had insufficient symptoms to be considered as psychiatric 'cases'. Fewer than 4% had symptoms of functional psychosis. About 60% of the patients were classed as depressed: on several indices this group was less severely ill than a group of depressives feceiving psychiatric treatment. It is suggested that psychiatric treatment is essential for only a small proportion of self-poisoning patients. The effectiveness of psychiatric treatment for the large group of patients with depressive disorders of minor severity and probably short duration has still to be evaluated.


The contextual threat of life events: the concept and its reliability. The reliability of Brown's contextual measure of threat is assessed and found to be highly satisfactory. Previously inexperienced raters achieve highly reliable ratings after only brief training. The implications for the concept of the threat of life events are discussed.


The effect of sex, marriage and age at first admission on the hospitalization of schizophrenics during 2 years following discharge. Two hundred and eighty-two schizophrenics discharged from St John's Hospital, Stone, were followed-up. The reliability of the diagnosis was measured by the extent of agreement among the hospital clinicians. The number of readmissions and the time spent in hospital were ascertained and correlated with the sex, civil state and age at first admission of the subjects. It was found that a higher proportion of males than of females was readmitted; that the proportion of single persons among male schizophrenics is higher than among comparable age groups in the general population; that single males are more frequently admitted than single females; that the peak age of first admission for males is 10 years earlier than for females and that men whose age at first admission is below the median are more frequently readmitted than those whose age at first admission is above it. Women are more frequently married than men at the onset of schizophrenia, giving rise to the suggestion that marriage has a protective effect in schizophrenia. This hypothesis was not supported by our findings. The bearing of these findings on the course, genetics and marital handicap of schizophrenia is discussed.


An international comparison of two systems of community mental health care. A neighbourhood health centre in the US is compared with the mental health services in an area of the UK. Patients with severe, but long-standing psychiatric illnesses, or patients with transient emotional problems are likely to be treated by a general practitioner in London and by non-medical mental health specialists in Boston. These patients receive more overall care, more specialist, non-medical care but make as many visits to a medical provider, other than a psychiatrist, in Boston as they do in London. Psychiatrists see more acutely ill patients for a shorter time than non-medical specialists in both places, and in both Boston and London there is a highly selective referral process which results in psychiatrists from both areas seeing approximately the same proportion of the population of their catchment areas. The integration of these findings with community attitudes in planning services is discussed.


Organization and interaction in psychiatric day centres. One of the major problems in the care of chronic patients is the design of suitable long-term environments. Following from the work of Tizard and his colleagues, a study is described which investigated the aspects of the organization, management practices and social interactions in 4 local authority day centres for the care of chronic patients in the community. It was found that these centres differed markedly in terms of their organization and management practices and that these differences were correlated with the nature and quality of staff-client (although not staff-staff) interactions. Client-oriented management attitudes were correlated with a more personal approach to clients' problems and a warmer quality of interaction. These differences did not seem attributable to different kinds of clients being involved in each centre. The results are discussed in terms of the possible causal mechanisms involved and their implications for designing systems of long-term care.


Interactions in contingency tables: a brief discussion of alternative definitions. The purpose of this note is to indicate how the disagreement between Tennant & Bebbington and Brown & Harris has arisen. The difference between the 2 pairs of authors is due, at least in part, to their use of different models for the analysis of the data in question. There can be no final answer as to which model is correct - the data are simply open to more than one interpretation. Nevertheless, it is interesting that the use of a multiplicative model, seemingly ignored by Brown & Harris, leads to a simple description of the data in which the 'vulnerability factor' and the 'provoking agent' may be considered to act independently on the response. Consequently, in stating that their data contain an interaction so obvious that it can be detected by 'visual inspection', Brown & Harris may have been somewhat rash.


The extent of mental and physical ill-health of clients referred to social workers in a local authority department and a general attachment scheme. Information regarding the physical and mental health of clients referred to social workers in a local authority intake team and to a general practice attachment scheme was collected over a 3-month period. Although returns to the Department of Health and Social Security during this period indicated that a very low proportion of clients were physically or mentally ill, it is clear that these figures greatly underestimate the extent of illness present. While social workers operating outside hospital and general practice attachments have been shown to have little contact with medical staff, in this study high proportions of their clients were ill and their social problems were often associated with their illness.


Lymphocyte and granulocyte reactions during sleep deprivation. The possible influence of 48 hr of sleep deprivation on in vitro DNA synthesis of blood lymphocytes and on the adhesiveness and intracellular, stainable activity of alkaline phosphatase in blood granulocytes was studied in twelve young male volunteers. Following the sleep deprivation, all 12 subjects showed marked reductions of DNA synthesis after stimulation with phytohemagglutinin. Pre-exposure levels were regained 5 days after terminating the vigil. No changes were noted in granulocyte adherence or alkaline phosphatase activity. The results suggest that sleep deprivation may decrease cell-mediated immune reactions and thereby impair some aspects of host defense.


Cortical evoked potentials and extraversion. Stimulus intensity modulation was studied in extraverts and introverts. Auditory evoked potentials were recorded in 29 subjects and visual evoked potentials in 55. In both sensory modalities, extraverts showed considerably larger amplitudes of the late components of the evoked potentials, suggesting that they were more "open" to stimuli than introverts. In this way, extraverts' responses to simple stimuli could be seen as similar to their interchange with the complex stimuli of the social world.


Family attitudes reported in youth as potential predictors of cancer. In long-term prospective study of a cohort of former medical students, men who later developed cancer reported different family attitudes in youth from those of their healthy classmates. The items checked on a Family Attitude Questionnaire by the future cancer group indicated a lack of closeness to parents compared with the items checked by the healthy group. Family attitudes of the future mental illness/suicide group resembled those of the cancer group, while those of the essential hypertension and coronary heart disease groups were like those of the healthy group. These prospective findings appear to fit with those of retrospective studies concerning early family relationships in cancer patients.


Sleep and temperature regulation during restraint stress in rats is affected by prior maternal separation. During restraint stress, 30-day-old rats uniformly show an abrupt and persistent decrease in activity with a corresponding increase in quiet wakefulness. However, the effect of restraint on sleep and body temperature depends on whether maternal separation had previously occurred at the customary age (day 22) or 7 days earleir (day 15). If maternal separation took place on day 22, subsequent restraint on day 30 has no effect on the amount of time spend in sleep or on body temperature, relative to a comparison sgroup of unrestrained rats. But if maternal separation took place on day 15, restraint on day 30 elicits a marked initial increase in sleep and a later decrease in sleep and body temperature. The results are consistent with the interpretation that premature maternal separation retards the normal maturation of these behavioral and thermoregulatory responses to restraint stress.


Assessing personality factors in essential hypertension with a brief self-report instrument. A 16-item self-report instrument was designed and cross-validated, comparing essential hypertensives with normotensives. After item selection using two sets of standardization groups, scores obtained from three additional sets of hypertensive and normotensive groups were significantly different. The scores were not significantly related to variables such as age, sex, socioeconomic status, hypochondriasis, social desirability or target organ involvement. The instrument's factorial structure for hypertensives consisted of factors labeled anger arousal, resentment, anxiety, and attention seeking. Hypertensives reported higher levels of hostility and anxiety than normotensives. High and low scoring subgroups on the instrument were examined on the 16 PF, with hypertensive high scorers demonstrating a different profile than low scoring hypertensives. The existence of two psychological types of essential hypertensives was suggested.


Emotional disturbance and cognitive deficits in hyperthyroidism. Assessment of cognitive and emotional variables in 19 females with hyperthyroidism was made pretreatment, at 3 weeks, and after euthyroidism was established. A matched group of normal controls was similarly tested. Group differences on cognitive measures did not reach statistical significance, but cognitive deficits and symptoms of emotional disorder were significantly associated with the severity of thyroid toxicity previous to treatment. Measures of cognitive function and personality features moved towards control group values as euthyroidism was established. The implication of these findings is discussed in the context of a review of previous literature. The observed cognitive disturbance and emotional distress appear to be reflections of thyroid toxicity.


Teaching the future general practitioner. Medical students today still graduate with insufficient skills for their role as general practitioner (family doctor, primary care physician). In particular they are lacking in their ability to use psychotherapeutic and counselling techniques for patients with psychological and psychosomatic problems. The author presents the results of a study which suggest that it is unrealistic to teach skills that demand more than, say, 15 min a session on a total of four occasions. This severe limitation poses difficult questions for those teachers who customarily think in terms of 50 min a week over many months as the basis of the model for psychotherapeutic help. The challenge of these implications is considered, and some practical ways of meeting the requirements are suggested.


Psychosomatic aspects in self-help groups made up of medical patients. Presented on the example of the ostomy group. We present the psychosomatic aspects in self-help groups containing medical patients on the examples of the ostomy group. Following the demonstration of the psychodynamic group processes, the patients' psychological characteristics are described as well as the aims of this type of self-help group. The specific ostomy group activities concern the visitors' service and the group work. Finally, we describe the psychotherapeutic interventions of the psychosomaticist.


Hebiatric psychosomatic medicine.

Hebiatric psychosomatic medicine. Adolescent disease should not be considered as something similar to infantile pathology or adult sicknesses. Special consideration must be given to the adolescent as such, taking into account the characteristics of adolescents as described in the 'Normal Adolescence Syndrome'. Symptom formation follows the same pattern as described elsewhere for children, adolescents and adults, but with very special differences in this stage of human development. Hysterical, hypochondriacal and psychotic types of psychosomatic illnesses can be described with the qualification of 'adolescent type'. Hebiatric medicine must be the specialized approach to illnesses in this developmental stage and must define its study object: the adolescent. Interviewing, clinical examination, diagnosis treatment and prognosis are of a specialized kind and the psychosomatic approach is also different. There are some more typical hebiatric pathologies that must be considered properly.


Field dependency, brain asymmetry and psychophysiological differences. Field dependent individuals differ psychologically from field independent subjects. They use more primitive defense mechanisms, and are more responsive to social forces around them than field independent subjects. Psychophysiological differences exist between these groups which will be reviewed. Obesity and alcoholism are also related to field dependency, as well as other psychosomatic disorders. Our series of experiments show that field dependent subjects are less left cerebrally dominant, and show most elements (in subclinical form) of a left cerebral lobe (Gerstmann's) syndrome. Implications for psychosomatic medicine are noted in the psychophysiological differences seen.


Amygdaloid nucleus syndrome and dehumanization syndrome. Through statistical tests 3 groups of impulsive-aggressive patients were studied: group 1, 100 individuals with temporal dysrhythmia; group 2, 18 individuals with temporal dysrhythmia submitted either to group analytical therapy or to psychoanalysis; group 3, 25 impulsive-aggressive individuals. Moreover the author differentiates between the amygdaloid nucleus and dehumanization syndromes, through psychoanalytical or psychiatric studies, and stresses the importance of the molding periods in relation to social factors (frustration-aggression-injustice). Amygdalotomy of the hippocampus was suggested in special cases.


Emotional behavior and the brain.

Emotional behavior and the brain. Basic behaviors were defined as those controlled by the hypothalamus, and emotion and instinct were defined as the drives of such behaviors. A learning method showed that fear-escape is obtained from the medial hypothalamic area except for the ventromedial nucleus. It was suggested that some neural systems responsible for threat, attack, rush and retreat are overlapped in the ventromedial nucleus. Functions of the amygdala and the septum were discussed in relation to hypothalamic activity in emotional behavior. A behavioral sequence composed of stimulation, classical conditioning, drive, reward learning and behavior was discussed, and learning, anxiety in neuroses and Morita therapy were examined from the viewpoint of the behavioral sequence.


Interaction of genetic and psychosocial factors in stress-reaction patterns: a systems approach to the investigation of stress-coping mechanisms. Selye refers to stress as 'the nonspecific response of the body to any demand made upon it'. Our experimental data indicate that: (1) there are significant constitutional differences in the types of stress reactions exhibited by different breeds of dogs; (2) inability to achieve an adaptive consummatory response or to develop a sense of control over stressful situations may lead in susceptible individuals (low adaptation dogs) to the development of maladaptive distress reactions, evidenced by persistent psychovisceral turmoil; (3) such maladaptive distress reactions represent a physiologic substrate of anxiety and frustration; (4) exposure of the low adaptation dogs to similar stressors but under conditions where the animals can develop avoidance responses, inhibited the psychovisceral disturbances, suggesting that it is the inability to develop control over psychosocially aversive situations that is primarily responsible for psychophysiologic disorders.


The psychosomatic key as a core approach to the modern plagues of mankind. The severest plagues of manking today, from myocardial infarction to cancer, are rising exponentially the world over. For the mechanistic medical science they are mostly 'mystery diseases', as well as a mystery is their uncontrolled exponential trend. Statistics reveal that they rise higher, the more a community is developed. But why? The too easy excuse of a higher 'concrete' pollution seems unreliable, where significant difference rates are recorded by different human groups in the same environment, but exposed to different values of 'psychosomatic involvement', or delta psi. The latter symbol, meaning 'the variation of psi tone induced by a stimulus-event', belongs to a highly predictive system of quantitative psychosomatics, which enables--through a logico-mathematical tool--the ascertaining of personal levels of delta psi. Since a chronic exceeding of its tolerance threshold seems to give rise to the whole set of psychosomatic diseases, cancer perhaps included, it is suggested that the said system may help in diagnostically clearing the matter, perhaps also in controlling it.


Psychosomatic illness as a result of a deficit in ego-structure under consideration of the genetic. Dynamic, structural, and group dynamic point of view. Psychosomatic illness is an illness of ego-structure as a result of a narcissistic deficit reassembling the phenomenology of anaclitic depression in regard to the mother and the primary group. Psychosomatic illness has to be understood on a scale of ego-illnesses related to identity defects. The psychosomatic symptom restitutes the integration of the personality and constitutes the identity of a psychosomatic patient. The role of group dynamics is particularly stressed in relation to psychogenetics, psychodynamics, and the change of symptoms.


The right of falling ill. On pathological health behavior. There are people who never permit themselves to fall ill. This negative illness is called by the present author: counter-hypochondriasis. Several defense mechanisms in counter-hypochondriasis are described, especially in relation to infantile roots. Pathological health is considered as a neurotic symptom formation in which disorders in object relationship are all-important.


The clinic as an interpersonal field of dynamic psychiatric treatment of psychosomatic diseases. In Günther Ammon's structural personality model, psychosomatic illnesses are understood to be the expression of a structural ego-defect--especially in the central ego-function of the body-ego, of identity and of constructive aggression--which owes its origin to an insufficient mother-child symbiosis. The dynamic psychiatric clinic realises an interpersonal field, into which the defects are externalised and remedied by the process of a late ego development. The clinic offers various therapeutical levels: the clinic as a whole, the analytical milieu, group and individual therapy, whereby working-through of the interdependence of patient and staff dynamics has a main integrating function.


Psychosomatic studies of allergic disorders. It is generally conceded that allergic disorders occur in individuals who have a hereditary or congenital allergic constitution. Clinical symptoms of allergic disorders, however, often disappear due to changes of the individuals' life situations and/or their adaptive patterns. In a comparative study of allergic predisposition in students with allergic disorder (asthmatics) and students who had become completely free from childhood asthma for more than 3 years, without specific treatment, there was no significant difference in allergic predisposition between the two groups. The same tendency was also found between adult patients with allergic disorder (asthmatics) and persons who had shown complete remission for more than 3 years, having had psychosomatic treatment. These findings suggest that allergic predisposition does not influence the prognosis of allergic disorders as much as do socio-psychological factors. It is thought that the effect of psychosomatic treatment reconditions these socio-psychological factors which disturb homeostatic balance and which facilitate the clinical manifestation based on the allergic predisposition.


Alexithymic features of the patients with chronic pancreatitis. 61 patients suffering from chronic pancreatitis were studied in order to clarify the psychosomatic aspects of this disease. They were classified into 5 types, out of which 3 types were examined in detail according to their personality traits and life habits. It was found that the mind-body relationship took the primary form in the psychosomatic and neurotic types, while in the organic type it took the secondary form such as distorted life habits. This finding indicated that the distortion in the personality structure and that of life habits were closely interrelated. The authors also discussed the clinical features of chronic pancreatitis from the standpoint of alexithymia. The patients with the organic type were most alexithymic, which were followed by the psychosomatic type. It was learned that alexithymic problems were reflected in the patients' life habits.


Psoriasis: psychosomatic aspects.

Psoriasis: psychosomatic aspects. On the basis of the findings of this study it could be concluded that the hereditary proneness alone is not sufficient to cause the breakout of psoriasis. Only when additional causes intervene, the disease breaks out. The importance of stress and emotional factors in causation and precipitation of the disease is discussed. The traumatic emotional experience and the aggravation of disease as result of improper approach of the society towards the patient's illness is reviewed. The impact of the disease on the treating doctor and the doctor-patient relationship is reported. Means of prevention of the breakout of the disease and the proper approach of the doctor in treating his patient is suggested and specified.


Alexithymia: anxiety and hostility in psychosomatic and psychoneurotic patients. Verbal samples obtained from 40 psychoneurotic and 40 psychosomatic patients, matched with respect to age, sex, intelligence and some social indicators, were examined using different methods of content analysis. According to the concept of 'alexithymia' it was postulated that the restricted fantasy life and difficulty in expressing feelings attributed to psychosomatic patients would be reflected at the speech level (psycho-analytic interviews). The measurement of anxiety and hostility using the Gottschalk-Gleser scales gave the following results: with total anxiety in particular, and its subscales guilt, shame, separation and diffuse anxiety, and with hostility, the psychosomatic patients showed lower values than the neurotic patients, which were in part highly significant. The results confirm the existence of the 'psychosomatic phenomenon' but they do not permit statements concerning its etiology.


Problems in interaction between patients undergoing long-term hemodialysis and their partners. 186 patients undergoing hemodialysis and their partners were examined with a personality inventory (Giessen test) and a questionnaire which was specially developed for this purpose. The instrument was used to measure the social interaction between patient and partner. The Giessen test was applied in four versions: self-description, description by the partner, referring to the present, referring to the past. One of the main interests of the analyses was in finding dependencies of the variables upon the types of hemodialysis setting (unit, private unit, and at home). Various correlations were found.


Biofeedback and behavioral medicine: an overview. Biofeedback is a behavioral method of achieving or enhancing voluntary control of physiological processes. Basic studies indicate that a variety of autonomic nervous system and other internal bodily changes can be modified with the method. It has been shown that specific responses and patterns of responses can be controlled. Biofeedback appears to be a promising method of altering symptoms of psychophysiological and medical disorders, e.g., high blood pressure, vascular changes in migraine, neuromuscular abnormalities, and cardiac arrhythmias. This research has stimulated a renewed interest in the role of behavior and the usefulness of behavioral principles in the etiology, treatment, and prevention of medical disorders. The term 'behavioral medicine' calls attention to this new perspective in medicine.


Microanalysis of the first interview with psychosomatic patients. Microanalysis of the first interview is a technique developed by the author for the subtle translation of the verbal aspects of the doctor-patient contact. Every bit of information, derived from the patient, is translated in the traditional historical dimension, e.g., when did the complaint start, and in the here and now dimension, e.g., in how far does the information imply a cry for help and understanding. Psychosomatic patients, who are usually well adapted, suppress or repress their problems and emotions so much that they are hardly able to express these quite openly. Psychosomatic symptoms reflect the effort of the patient not to behave in a hysterical way. This means that the overt cry for help and attention, which is so characteristic for hysterical patients, is warded off. Especially the microanalytic translation of this hidden cry may be used by the interviewer to detect what the basic problems of the patient are and how the optimal climate for an efficient therapeutic contact can be established. In the Leyden Department of Psychiatry the technique is used to facilitate the training in interview technique. In the paper models will be given for the understanding of the interrelationship of psychiatric and psychosomatic symptoms.


New therapeutic approaches to psychosomatic patients: verbal and preverbal. Many of the patients passed on to us are not in a position to begin with a course of treatment aiming at introspection. Here we think that inpatient psychotherapy is a valuable preparation and initiation to the psychotherapeutic process. In a therapeutic community informal contacts with other patients can provide stimuli facilitating the transposition of physical complaints or concretistically experienced life situations. Concentrative movement therapy, group therapy and other methods are helpful to the psychosomatic patient, so as to bring about an awareness of the problematical nature of own views and attitudes.


Psychological problems of the patient on hemodialysis and their treatment. Patients treated by maintenance hemodialysis are subjected to many stresses. As a result, many of these patients have psychological problems. Depression is the most common psychological complication seen in them. This is reflected in a high suicide rate in these patients. Other psychological problems seen in these patients are anxiety, sexual dysfunctions, problems connected with difficulties in rehabilitation, the problem of the 'uncooperative' patients, and psychosis. Vigilant attention is required so that diagnosis may be made early and treatment started soon thereafter. Important methods of treatment are supportive psychotherapy, behavioral techniques for sexual dysfunctions, and the use of psychologically active drugs.


Psychosomatic approach to medical rehabilitation. The author records his views about the future of medical rehabilitation. He reports some of the evidence on which to advocate the psychosomatic approach for the management of all disease and injury prone to chronic morbidity. As the causes of distress are multiple, clinical service is required from a multiprofessional team. The success of outcome is to be judged in the social adaptation achieved, recognising that this is influenced by such intangible concepts as morale and motivation.


Hypnosis with specific relation to biofeedback and behavior therapy. Theoretical and clinical considerations. Hypnosis as an intrapsychological and interpersonal experience is used as an integrative and amplifying procedure in relation to biofeedback mechanism and behavior therapy. The hypnotic capacity for linking cognitive to affective reactions within a feedback loop of sensory and motor imagery is presented as a dynamic approach to behavior modification during psychotherapy.


Psychosomatic practice and the concept of family confrontation as therapeutical method. Psychosocial dynamics within the family are first touched upon. Relationships between brothers and sisters play a special part in this respect, as do other factors related to personality development. It is one of the special tasks of the general practitioner to be alert to the first signs of emotional disturbances, for he is in an ideal position to intervene before more serious symptoms of illness appear. The physician has to acquire a valid picture of the family unit, with its physical and psychological strengths and short-comings. Continued flight from pressure of vital issues can lead to family neurosis in the long run. Then, the sick person is not really the carrier of disease in the traditional sense of germ or genetic consation. He is only a 'symptom' of a much more widely encompassing disease unit that has grasped a social cell like the family. Are we physicians and scientists in a position, as a consequence of our training, to see this possibility, or are such modes of thinking to be left to special fields like medical sociology? The isolated, sick person can show signs derived from a disturbed family relationship, particularly through psychosomatic disorders. Our 'psychosomatic confrontation' therapeutical method is introduced.


Fasting therapy for psychosomatic disorders in Japan. It has been well known in Japan that fasting therapy has an excellent effect on various kinds of psychosomatic diseases. From 1967 to 1977 the therapy was carried out on about 382 cases of psychosomatic diseases in our clinic with an efficacy rate of 87%. The following diseases were considered as suitable indications for the therapy; irritable colon, behavioral disturbance of eating, functional disorders of the G-I tract, neurocirculatory asthenia, labile hypertension, variable psychosomatic symptoms of puberty, conversion hysteria and many kinds of neurosis with somatic complaints. The mechanism of effectiveness of the therapy is discussed from the psychological and biological aspects. It is concluded that the regulating mechanisms of the autonomic nervous system and endocrine system may change the whole functioning of the body including the brain, resulting in a spontaneous deconditioning of maladaptive bodily and mental behavior and an improved homeostatic adjustment to life.


Integration of occidental and oriental psychosomatic treatments. The Oriental approach to life can contribute to the development of psychosomatic medicine in three major ways, revolving around its realization of the illusion of mind-body dualism, its development of practical somatopsychic techniques for learning self-control, and its orientation towards realizing our true nature. In our department we are currently exploring the use of both standard psychosomatic as well as a variety of somatopsychic techniques, with the ultimate goal of providing a meaningful integration of these approaches. While working to realize the integration of these varied approaches, we feel we are discovering some important clinical principles.


Cerebral control and attention. Science and wisdom. Theoretical explanations of the subcortical and cortical mechanisms of attention are given. All psychophysiological approaches must be reevaluated in terms of attention. Excessive vigilance is in reality a lack of vigilance (law of optimum). Good conditioning strengthens needed vigilance and respects our liberty (liberating conditioning). The legitimacy of traditional wisdom (Zen) can be better understood by the grace of science.


Japanese psychoanalysis and the Ajase complex (Kosawa). In 1932, Kosawa visited Freud at 19 Berggasse, and submitted to him a paper entitled: 'Two kinds of guilt feelings, the Ajase complex. In his paper, Kosawa expounded his theory of the Ajase complex, rooted in Buddhist thought. He discussed the psychological peculiarity of the Japanese as evidenced by the acceptance of oral dependency toward the mother, the repression of the resentment at the mother and 'guilt feeling over being forgiven' and a need to make restitution for harboring this evil intent. This type of guilt feeling is quite different from the guilt feeling as a fear of punishment which Freud embodied in his theory of the Oedipus complex.


Psychosomatic medicine and cybernetics.

Psychosomatic medicine and cybernetics. In our daily psychosomatic medicine clinics, we have adopted four principles from Wiener's cybernetics and von Bertalanffy's general system theory. We use the polygraphic method for the diagnosis of psychosomatic disease (black box principle). For the control of psychosomatic symptoms, we use the biofeedback method (feedback principle). We use systematic desensitization to relieve social stresses which cause psychosomatic disease (open and closed system principle). And lastly, transactional analysis, which corresponds to the information and energy principle.


Difference in the mechanism of emotion in Japanese and Westerner. The author found that cerebral hemisphere dominance of steady-state vowels as well as human emotional and natural sounds are different between the Japanese and the Westerner; the Japanese shows a verbal hemisphere dominance, while the Westerner shows a non-verbal hemisphere dominance. He brought forward the theory of mental structure and vowels stating that such a difference in the brain related to emotional activities forms the starting point of mental structure and culture. In this study the author confirmed the above hypothesis by emotional stimulation of human olfaction.


Yoga as therapy in psychosomatic medicine. Yoga as therapy with psychosomatic disorders has been practiced for many centuries in India, and only recently has become utilized for this purpose in other countries. The yoga system evolved as a 'system of liberation' to allow man to discriminate between his ego-self and pure consciousness, and as such, its medical benefits are really 'side-effects'. Integral yoga practice, however, with which many other self-regulatory somatopsychic approaches have much in common, consists of a holistic technology which functions to restore optimal homeostatis by a variety of special techniques not found in other approaches. Clinical observations of psychosomatic patients indicate that their distorted somatopsychic functioning necessitates their practice of yoga-like therapy. A review of the clinical evidence available indicates that yoga practice has proven most effective with a wide range of psychosomatic and psychiatric disorders. The effectiveness of yoga can be partially understood in terms of neurophysiological theory.


The psychosomatic theory of bronchial asthma. The author discusses the development of the psychosomatic asthma theory as a paradigm of theory formation in psychomatic medicine. The first formulation of the theory was based on clinical and psychiatric observations. It was tested by psychological, physiological and experimental methods and as a result was reformulated and extended. In its present form it regards asthmatic breathing as a reaction of a predisposed personality structure (partly hereditary, partly acquired during a youth situation in which overprotection by a domineering parent played a large role), to an ambivalent conflict with a key figure. The resulting frustration is not acted out by aggressive, flight, or depressive behaviour, but inhibited; thereby the motoric and verbal discharges are displaced into (substituted by) a respiratory behaviour pattern, which is characterised by an abnormally forceful contraction of the abdominal muscles during the expiration. The resulting high intraabdominal pressure is transmitted into the thorax where it pushes the posterior membranaceous wall of the trachea and large bronchi forward into the lumen and thus produces a long stretched obstruction of the large airways. The passage of the air through the compressed large air passages under high pressure and low velocity is the mechanism which causes the typical wheeze and the other manifestations of the asthmatic airway obstruction. A hypothesis is suggested for the ways in which this psychoneurogenic respiratory behaviour contributes to the so-called bronchial hyper-reactivity and the secondary development of allergies.


Definition, practice, and teaching of psychosomatics. A global survey. Two sets of overlapping questionnaires were distributed world-wide via college members to 200 psychiatrists and 200 physicians. 50% of psychiatrists (n = 101) and 30% of physicians (n = 63), replied, representing 25 countries. Areas surveyed include definitions of 'psychosomatics', physician-psychiatrist attitudes, liaison activities, teaching patterns and methods, and professional affiliation of respondents. Comparative statistical analysis of the two groups reveals significant response differences in certain conceptualizations of 'psychosomatics' and in the diagnostic distribution of referred patients. Cross-continental comparisons revealed greater acceptance of the term 'psychosomatics' by respondents from Asia, differences between North American and European conceptualizations, and a stronger attachment of the field in the Far East to academic departments of medicine as compared with the West.


Goals of education in psychosomatic medicine. The modern concept of psychosomatic medicine is based on a multifactorial, interactional systems model for all diseases in which the behavioral and social dimensions play important roles in the pathogenesis, manifestation, course, and outcome. This psychosomatic approach forms the philosophical underpinning of a modern educational program. A general goal of education for all physicians is understanding the behavioral and psychosocial factors in all illness. Specific goals for the primary physician and the psychiatrist are the instillation of a holistic attitude in patient care through systematic training, and the attainment of skills and knowledge to integrate behavioral and biomedical sciences, respectively. This includes specific diagnostic, treatment, and educational skills. Yale's multilevel educational program in psychosomatic medicine is described.


Teaching psychosomatic approaches as a basis of clinical medicine. We have introduced our idea of psychosomatic approach as a basis of clinical medicine and the present state of psychosomatic teaching and training in our department as well as in other university hospitals in Japan. In teaching and training medical students and postgraduates, we aim at producing psychosomatically minded clinical physicians. For this purpose, multidisciplinary and teamwork approaches in cooperation with paramedicals are needed.


German developments in teaching psychosomatics and psychotherapy to medical students. The necessities for a reform of teaching German medical students were manifold. With the help of those doctors responsible for primary care and by founding a society representing all behavioural scientists within medical teaching it was possible to firmly institutionalize psychosomatics and psychotherapy within the new Medical Approbation Law. It is too early to assess the impact of this drastic reform but some of its advantages are already obvious.


Does history-taking affect learning of attitudes? How can medical students adopt a patient-oriented approach? During the past 7 years approximately 60 preclinical and clinical students joined dynamically oriented group sessions on medical history-taking. An open-ended question technique was used. The student's expectations of the patient were monitored by the repertory grid technique using a self-developed dyad grid form which allowed the estimation of reciprocal expectations as seen by the student. A main component analysis of the ratings obtained was performed. The development in one group was taken as representative of the general development in the different groups. Two main components (MC I, II) were found to account for approximately 40 and 25% of the total variance (distance/empathy and dominance/dependence). The student's main concern is centered on the problem of dependence, MC II. He expects the patient to cling to him. Similarly he feels dependent on the psychosomatic lecturer. He feels as though he is the lecturer's patient. During group work the patient is seen to be less clinging. The student learns that he is not his lecturer's patient but his junior partner. He changes his professional ego-ideal as a future doctor. This is modelled according to his own relationship with the lecturer. It is not modelled according to the usual doctor-patient relationship as perceived by the student. The main characteristic of the change is a lessening of dependency needs as felt in the relationship to the patient. The findings are interpreted as an attitudinal change in favour of a more patient-oriented attitude. The change was affected through confrontation with the patient's needs. Conclusions were drawn: The student has to be trained how to cope with dependency needs. Special learning settings have to be provided which are staffed with patient-oriented physicians.


A reappraisal of some psychosomatic concepts. The paper presents a critical reappraisal of some psychosomatic concepts which have become entrenched in the literature. The limitations of concepts of specificity relating to stimuli, emotional changes and various psychosocial stresses are discussed. The available evidence indicates the importance of the patient's personality, but does not support the claims of specific personality types for each disorder. Concepts of aetiology are discussed. The importance of heterogeneity rather than homogeneity is stressed. Relationships between psychiatric and psychosomatic disorders are considered. The significance of somatopsychic as well as psychosomatic sequences of events are emphasised. Finally, the importance of multifactorial causation in psychosomatic disorders is underlined.


On education and research in ecological medicine (Psychosomatic medicine). Psychosomatic medicine of the year 2000. Because advances in our field have increased the complexity of our work, I feel that the name of this discipline should be changed. I suggest a more pragmatic term, namely, Ecological Medicine. Ecological Medicine is a science relating to physiological, biological, genetic, socioeconomic, cultural, etc., changes now taking place in our cosmos. It is concerned with disease and health processes of several components of the living organism. Its task is to recognize, evaluate, prevent, and treat all the above variables which are in integral part of the disease process. I should like to stress here that the central thinking must be a strategic one: to devise and apply means, ways, and methods for the exchange of information between those working in clinical and humanistic disciplines and of those in laboratories. In other words, I, personally, believe that the research scientists, who are working in any laboratory, cannot afford to ignore the psychological, socioeconomic and cultural factors affecting people's health. Consequently, they must, on one hand, orient themselves in accordance with the above-mentioned demands, and collaborate with the scientists of the humanistic disciplines, on the other. Thus, in this way, only the anthropos can be thoroughly and completely investigated as a unique psychophysiological, socioeconomic, and cultural ecologic entity.


Liaison psychiatry in the West: the view from 1977. Current status of consultation-liaison psychiatry in the West is reviewed. Its aims, functions, and scope in diagnosis and treatment of general hospital patients outside of psychiatric departments are described. A critical appraisal is made with regards to the triadic relationship of its participants. Its benefits vis-à-vis resistances are illuminated in the context of psychosocial process. Its role in research and medical education is recounted. Thoughts about its future developments are offered.


The Job Corps experience with health problems among disadvantaged youth. Health problems in a disadvantaged group of young people were studied by analysis of Job Corps screening and medical termination data obtained during fiscal year 1975. The Job Corps is a federally funded, residential vocational training program. During fiscal year 1975, the program was conducted in 60 centers throughout the United States. Corpsmembers (ages 16-21) come from poverty backgrounds; in 1975, 55 percent were black. Approximately 1 percent of applicants with serious health problems are screened out by a nonprofessional procedure. Comprehensive health services are provided to corpsmembers; however, limited funds and interference with training prevent continuing care for pregnancies and some serious illness and injuries. Corpsmembers with these conditions are terminated from the Job Corps, and arrangements are made for care in their communities. Less than 2 percent of the corpsmembers were terminated for medical reasons during fiscal year 1975. Pregnancy accounted for 359 terminations. Of 44,390 corpsmembers, 457 were terminated for illness or injury. The majority of these terminations were for mental health problems; trauma was the next largest category. During fiscal year 1975, 22 deaths occurred; 21 were from accidents or suicide. The low medical termination rate among these socioeconomically disadvantaged young people suggests that maintenance of relatively good health is possible over a short period through provision of basic health care and health education, which can be provided largely by allied health personnel under professional supervision.


Evidence from the National Survey of Family Growth. Work during pregnancy and subsequent hospitalization of mothers and infants. Large and increasing proportions of women work late into pregnancy and resume work soon after delivery. If work in those periods injures their health or that of their infants, this trend would be of public health concern. Data on ever-married primaparas from the National Survey of Family Growth conducted by the National Center for Health Statistics were used to investigate the relationship between working in the last trimester of pregnancy and two indicators of illness--hospitalization of women for complications of pregnancy and hospitalization of their infants during the first year of life. Hospitalization of the mother or child occurred for 15.0 percent of the primaparas. For primaparas who worked in the last trimester of pregnancy, the percentage was slightly higher--17.1 percent. In two groups, black women and women without hospital insurance for delivery, the percentage of mothers or infants hospitalized was much higher among the mothers who worked in the third trimester than among those who did not. The association of working late in pregnancy with higher rates of hospitalization does not mean, necessarily, that working is a cause of hospitalization. It does indicate, however, the need for epidemiologic and medical research on the relationship.


Completeness and accuracy of reporting induced abortions performed in Hawaii's hospitals, 1970--74. This study examined the completeness and accuracy of reporting induced abortions to the official agency by following up documented cases of abortions performed in hospitals in Hawaii for the years 1970--74. The following two sets of records were initially linked by computer on the basis of first name, maiden name, date of the event, age, and ethnic background: (a) a total of 18,531 induced abortions ascertained in hospitals with complete linking information and (b) official fetal death and live birth records filed at the State health department. Overall, 96.1 percent of the hospital abortions were matched in the official certificates. Of 17,550 abortions classified as elective, 98.7 percent were so recorded in the certificate file, whereas the remainder were reported as mostly either therapeutic or unknown for cause of fetal death. When the probability of matches for those abortions without complete linking information and possible errors in the information were considered, the estimates of underreporting to the health department were a maximum of 3.9 percent and a minimum of 1.2 percent; the mean value was 2.6 percent. The extent of underreporting of induced abortions is becoming serious with the widespread practice of abortion procedures in nonhospital institutions in recent years. The results of the study also demonstrated the utility of the record-linkage process in checking data for completeness and accuracy or studying separate vital events on the same persons.


Hyperpyrexia due to air-conditioning failure in a nursing home. During the period August 9--13, 1976, 21 of 89 residents of a nursing home in southeastern Florida had sudden onset of fever--temperature greater than 38.1 degrees C (100.6 degrees F) with no accompanying symptoms. Five residents, whose temperatures ranged from 39.4 degrees C (103 degrees F) to 41.3 degrees C (106.4 degrees F), died. No viral or bacterial pathogens were isolated. None of the nursing home's 123 employees and volunteers had similar illness. The air-conditioning system was shut down for repairs from August 9 through August 12, a time when recorded peak temperatures outdoors ranged from 30.6 degrees C (87 degrees F) to 32.2 degrees C (90 degrees F). The only recorded temperature inside the nursing home for that period was 31.7 degrees C (89 degrees F). Laboratory and epidemiologic data were consistent with the theory that the illness was due to hyperpyrexia, secondary to environmental conditions, rather than to an infectious agent. The episode was considered analogous to the nonspecific increased mortality of elderly and chronically ill persons during an urban heat wave. The episode points up the need for prompt recognition and intervention when there is the potential for heat stress in elderly and chronically ill patients. Buildings housing such patients must be designed so that alternative ventilation can be provided when the central air-conditioning system fails.


Management issues in the organization and delivery of family planning services. Statewide family planning programs have been developed primarily in the Southeast and in a few other States of the nation. They are managed by State public health agencies with a few exceptions. This paper presents issues which are of importance to persons and agencies interested in developing a statewide family planning program; namely State support, allocation of funds, setting goals based on impact rather than efficiency of services, secondary sources of funding, and patient data systems. Arguments for a statewide program include the maximum use of available resources (for example, title V maternal and child health funds), the opportunity to distribute resources equitably throughout the State, the development of a statewide third-party reimbursement system, the opportunity to develop evaluation mechanisms, support for starting a system of fee collection, and the use of a statewide patient data system. Arguments against a State program include some loss of local control of a project, possible organizational battles within State agencies, State political domination of program policy, and a possible shift of funding away from existing strong projects. In the early 1970s, development of statewide systems was coupled with a rapid increase of funding when broad coverage of services and accessibility were key factors. At the present, categorical funding is no longer increasing, and efficiency and maximization of resources are becoming more important.


Systemic lupus with nephritis: a long-term study. Seventy-one patients with systemic lupus erythematosus and clinical evidence of nephritis were seen during a 15-year period, and followed for a mean of seven years. Survival was calculated to be 76 per cent at five years and 57 per cent at ten years from onset of clinical nephritis; and 80, 65, 55 and 55 per cent five, ten, fifteen and twenty years from onset of clinical lupus. Renal biopsies showed mild or focal lesions in 30 per cent of patients, membranous lesions in 14 per cent and diffuse proliferative lesions in 55 per cent. However, there was no difference in the long-term outcome of the different histological groups. Nineteen patients (27 per cent) died during follow up, eleven from renal failure, six from sepsis and two from cerebral lupus. Death in renal failure is now usually a late event in lupus, even in patients with clinical evidence of severe nephritis. The prognosis of even severe lupus nephritis is now better than formerly reported. Reducing the dose of corticosteroid drugs, by the use of cytotoxic drugs such as azathioprine may have diminished the mortality from cardiovascular complications. Side effects of treatment, however, remain an important cause of death and morbidity.


Genetic considerations in human cancer incidence. Analysis by the methods of genetic demography can offer plausible explanations for the unusual distribution of cancer in an area of high incidence. The important demographic characteristics include inbreeding, founder effect, and racial admixture. Inbreeding would elevate cancer incidence if autosomal recessive genes played a role in cancer etiology. Founder effect would limit this phenomenon to those recessive genes observed in the founding group and result in a cancer spectrum different from that of the surrounding populations. The preference of a racially admixed group for classification as white could result in an excess of cancer patients being classified as white. The population groups in southern Louisiana typify the kind of "human genetics laboratory" that inbred groups offer to investigators of the genetic aspects of cancer.


The spectrum of hepatic dysfunction in inflammatory bowel disease. The spectrum and incidence of liver disease is described among a large series of patients with inflammatory bowel disease. The incidence of significant liver disease identified by the presence of serial biochemical abnormalities of liver function was 8.2 per cent. Transient peri-operative changes in liver function tests are common and usually relate to underlying intra-abdominal sepsis. Percholangitis, sometimes termed portal triaditis, is one of the commoner lesions, and is usually associated with extensive colitis and improves with resection of the underlying bowel disease. Cirrhosis of the liver is an important but uncommon complication and is usually associated with extensive long-standing disease. Stenosing cholangitis and biliary tract carcinoma are both important though rare associations. They are both associated with extensive disease of long-standing, but resection of the underlying inflammatory bowel disease does not necessarily protect the individual from these complications. Although stenosing cholangitis is a diffuse lesion of the biliary tree it is important to exclude strictures of the extra-hepatic biliary tree which may be amenable to surgical correction. Hepatic dysfunction is rarely the sole indication for advising surgery for the underlying bowel disease but the identification of the nature of the hepati- dysfunction provides a rational basis for such a decision and opportunities for the surgical correction of the hepatic lesion itself.


Liver disease as presenting manifestation of Hodgkin's disease. Six patients who were referred to the liver unit on account of jaundice are described. A different initial diagnosis has been made in each case, these being fulminant hepatic failure, severe hepatitis with renal failure, toxoplasma hepatitis, extrahepatic obstruction, sclerosing cholangitis, and liver abscess. After delays of four weeks to 12 months from the time of first symptoms all six patients were eventually found to have advanced Hodgkin's disease (stage 4). In four patients the diagnosis was made during life, but in two only at autopsy. In four lymphoma tissue was finally demonstrable in the liver, but in two liver biopsy showed only minor non-specific changes despite grossly abnormal liver function tests. Three of the six patients were treated with chemotherapy, and two of these recovered sufficiently to leave hospital. With the encouraging survival figures now being obtained in Hodgkin's disease, an awareness of the varied hepatic manifestations of the disease may allow treatment to be instituted at an earlier stage.


Angio-immunoblastic lymphadenopathy: report of ten cases and review of the literature. Angio-immunoblastic lymphadenopathy (AIL) is a disease of unknown aetiology and pathogenesis. It has features of hyperimmunity, immune deficiency and can behave like a malignant lymphoma. An underlying abnormality of T-cell regulatory function has been proposed. We report ten patients with AIL followed prospectively and review 200 cases from the literature. As well as showing the typical features described in previous retrospective series namely: constitutional symptoms, generalized lymphadenopathy, hepatosplenomegaly, skin eruptions, hypergammaglobulinaemia and characteristic lymph node histology; four patients had oedema with ascites or pleural effusions associated with hyponatraemia and hypoalbuminaemia. We have also observed low free thyroxine indices in three patients with elevated TSH levels in two, but without clinical features of hypothyroidism. Seven of the patients in this study were treated with prednisone and cyclophosphamide. Three achieved complete remission but only one patient has survived longer than two years. Failure to achieve complete remission has been associated with a 90 per cent mortality within one year of the onset of disease in the reports reviewed. Corticosteroids alone have produced only a 40 per cent rate of remission. The management of poor responders, non-responders and many relapse cases in unsatisfactory. More instensive chemotherapy is very hazardous, increasing the already high risk of severe infections, and is often unsuccessful. Histological features recently reported to represent co-existent immunoblastic lymphoma at diagnosis were recognized in three of our patients, two of which went on to develop definite lymphoma.


Cerebral complications in the treatment of accelerated hypertension. The malignant phase of hypertension is invariably fatal unless treated, and rapid reduction of arterial pressure is thought to be the treatment of choice. Ten patients with accelerated hypertension are described in whom abnormal neurological signs developed following the rapid reduction of arterial pressure. Three patients died without recovering from the neurological damage. A fourth died of an unrelated cause a month later. Areas of ischaemic damage were found in the brains of three of these cases. Of the six survivors, four were left with some permanent neurological disability. It is likely that these changes resulted from the inability of the cerebral circulation in patients with severe hypertension to autoregulate blood flow to the brain, so that a rapid reduction in arterial pressure led to ischaemia, especially of the watershed areas of the brain. Cerebrovascular autoregulation is likely to be compromized in patients with cerebral oedema, stenosis of major cranial vessels or in those patients with long-standing severe hypertension. It is suggested that the blood pressure in patients with accelerated hypertension should be lowered gently over a period of several hours or even days in order to allow time for the cerebrovascular autoregulatory mechanisms to recover.


Chronic subdural haematoma.

Chronic subdural haematoma. A retrospective case note survey of chronic subdural haematomata was carried out in an attempt to throw some light on the difficulties encountered in clinical diagnosis. The combination of raised intracranial pressure headache, fluctuating drowsiness and mild hemiparesis, although highly suggestive of subdural haematoma, is not always encountered, and epilepsy, aphasia, hemianopia and dense hemiplegia can all occur contrary to 'text book' descriptions. Head injury or other aetiological factors are commonly absent. The presentation may mimic tumour, dementia, cerebrovascular accident or subarachnoid haemorrhage. Non-invasive investigations may yield false negative results, although in the case of radionucleide scanning and computerized axial tomography the reliability is approaching 90 per cent. The diagnosis will, however, remain an unexpected finding at angiography in a percentage of cases.


Dissecting aortic aneurysms: a clinicopathological study. I. Clinical and gross pathological findings. One hundred and seventy-one patients with dissecting aneurysm seen between 1951 and 1976 at three hospitals in Manchester were studied. There were 60 proximal dissections, 80 distal dissections, 10 abdominal dissections and in 21 the site of origin was uncertain. Pain was the major symptom in 88 per cent of patients; radiation of pain to the interscapular region was much more common in distal dissections. Systemic hypertension was present in 77 per cent, being commoner in distal dissections (83 per cent) than in proximal dissections (70 per cent). Aortic incompetence, hemiplegia and shock were all more common in proximal dissections. Post-mortem examination was performed in 125 patients. Eighty-four per cent of proximal dissections had ruptured, 74 per cent into the pericardium and five per cent into the left pleural cavity. Seventy per cent of distal dissections had ruptured, 11 per cent into the pericardium and 41 per cent into the left pleural cavity. The extent of the dissection was analysed, and it was shown that 25 per cent of distal dissections had extended proximally into the ascending aorta and arch. This implies that diagnosis of the site of origin of dissection from clinical signs and the plain chest-radiograph is inaccurate. Aortography is required for precise assessment. Since treatment often varies with the site of dissection, aortography should be performed in most patients surviving the first few hours. Attention is drawn to the frequency (10.4 per cent) of multiple aortic lesions, and to the occasional aetiological significance of giant-cell arteritis, and, possibly, hypothyroidism.


Dissecting aortic aneurysms: a clinicopathological study. II. Histopathology of the aorta. The aortas from 83 patients with dissecting aneurysm were studied histologically. There were two examples of giant-cell arteritis, one of non-specific arteritis and one of syphilis. Apart from these, no constant feature was found in the cases of dissection when compared with 20 controls. In particular there was no difference in the grades of cystic medial necrosis, medionecrosis and fibrosis. Focal fragmentation of elastica was present in the majority of dissections (63 per cent) but similar abnormalities were seen in most controls (85 per cent). The vasa vasorum showed no special features in dissection. Intimal fibrosis and intimal longitudinal muscle were present in both groups studied. Sixteen cases showed 'old' dissections as manifest by either granulation tissue or fibrosis. The histopathological features of the four cases diagnosed clinically as having Marfan's syndrome did not differ from controls.


Clinico-pathological features of the nephrotic syndrome in South African children. One hundred and thirty children of whom 74 were Africans and 56 Indians with contrasting clinicopathological patterns of the nephrotic syndrome are described. Eighty-six per cent of African children had obvious structural glomerular lesions which were associated with unresponsiveness to steroids while 75 per cent of Indians had minimal change nephrotic syndrome which was steroid responsive. The treatment history of a further 41 unbiopsied children with nephrotic syndrome (nine Africans, 32 Indians) support and emphasize this difference. Extramembranous and a tropical variety of extramembranous (36.5 per cent) together with proliferative (20.2 per cent) lesions accounted for most of the histological types in African children. The disease in Indian children was similar to that in other countries in age of onset, sex distribution, frequency of histological types and steroid responsiveness although there was a preponderance of frequent relapsers (69 per cent). Africans differed from children in other continents in the frequency of histological categories (therefore in steroid responsiveness) and occasionally in clinical behaviour. They also differed from children in tropical Africa in a lower incidence of the disease, male dominance and absence of malarial nephropathy. The aetiology of nephrotic syndrome in nearly all the children remains unidentified.


Pericarditis and inflammatory bowel disease. Pericarditis is an uncommon but important complication of inflammatory bowel disease. Five new cases are described and the published literature on nine other cases is reviewed. The pericarditis occurred during an active phase of the colitis in all our cases and was associated with other extra-colonic manifestations of colitis in three. No other cause for the pericarditis was identified and in all five cases it responded promptly to the administration of corticosteroid drugs.


Acute post-streptococcal glomerulonephritis in adults: a long-term study. The long-term outcome after acute post-streptococcal glomerulonephritis was studied in 57 patients (52 aged 16 or over) followed for a period of one to 14 years (mean seven years). All patients presented with hypertension, haematuria and proteinuria. The antistreptolysin-0 titre was raised or the serum complement was low in all cases at the initial episode. All patients had histological evidence of a diffuse proliferative and exudative glomerulonephritis at onset. Follow-up renal biopsy was performed in 33 patients; in 18 patients this was carried out five years or more after the initial illness. Five patients died beyond two years, only two having had abnormal renal function at the time or death. Four patients were found to be mildly hypertensive without other clinical abnormalities. Eleven patients had proteinuria, haematuria or abnormal renal function; in three of these repeat renal biopsy was normal, incomplete resolution was reported in five, obsolescent glomeruli in one, and two others were not biopsied. No patient who had normal renal function at the time of follow-up had abnormal renal histology on biopsy. Obsolescent glomeruli were present in two other biopsies in association with evidence of incomplete resolution. It was concluded that the majority of patients with acute PSGN have a good prognosis. Histological resolution of the renal lesion may not occur for nine years.


Cancer, the public, and the radiographer. All radiographers can help bring about more cancer cures. In this context one's specialty--diagnosis or therapy--is less important than the fact that, because radiographers are seen by the public to be knowledgeable about health matters, they can exert an influence on how people think about the cancers. Why public attitudes to cancer adversely affect the number of patients cured and how radiographers might help improve the present lamentable situation is the subject of this paper.


[Diagnostic value of sonography of the bile ducts (author's transl)]. In obstructive biliary disease sonography proves to have a high diagnostic informative value. Dilatation of intra-and extrahepatic bile ducts is documented sonographically. In the majority of cases, analysis of sonographic findings will clarify the cause of biliary obstruction like cholecysto-cholangiolithiasis, carcinoma of the head of the pancreas, or various neoplastic disease in the area of the liver hilus. The obtained information is independent from contraindications like contrast medium allergies and severe parenchymal liver disease with impaired biliary secretion of contrast media.


[Sonograhic-radiologic evaluation of obstructive jaundice (author's transl)]. Retrospective evaluation of indication and technical procedure and its value in sonography of 110 patients with jaundice. A correct diagnosis (by ultrasound) of hepatogenic jaundice was made in 36/38 patients (94%) and of obstructive jaundice in 69/72 patients (96%). In additional 31/72 patients (43%) ultrasound gave important diagnostic clues by demonstrating dilated bile ducts as well as the location of obstruction. For verification and for the demonstration of morphologic changes, sonographically guided fine needle aspiration puncture, percutaneous transhepatic cholangiography with a fine puncture neede (Chiba-needle) and ERCP are indicated.


[Improved diagnosis in percutaneous transhepatic cholangiography (PTC) (author's transl)]. PTC is a good radiographic method in the diagnosis of cholestasis. Complications are rare, primarily due to the ultra-thin Chiba needle. For penetrating the liver we recommend to keep a distance of at least 4 cm between needle and spine (measured on the monitor). Our experience has shown routine liver tomography to be very helpful. Furthermore, delayed radiography can show extrahepatic bile ducts not seen on initial films.


[Direct cholangiography: endoscopic-retrograde or percutaneous transhepatic? (author's transl)]. Indications, success-rate and disadvantages of endoscopic retrograde (n = 928) and percutaneous transhepatic cholangiography (n approximately 360) at the Surgical and Medical University Clinics of Freiburg/German are discussed. Direct cholegraphy is the method of choice in cases of cholestasis of unknown origin. Endoscopic retrograde procedures usually preceed the percutaneous transhepatic approach. PTC either complementary or decisive when ERCP has failed. Therapeutic possibilities of both methods are not yet totally utilized.


[Percutaneous transhepatic drainage of the biliary tract for preoperative and palliative therapy of obstructive biliary lesions (author's transl)]. The percutaneous transhepatic catheterisation is an important method in the management of obstructive jaundice. The results of the percutaneous transhepatic drainage - external and internal - in 14 patients are reported. The technique is described and the difficulties, complications, indications and contraindications are discussed. The value of this procedure is the temporary decompression of the obstructed biliary tract prior to radical surgery or as a palliation in patients with non-operable tumors; the risk of the procedure is low.


Effects of the host matrix on the 57Fe-species produced through EC-decay in 57Co-labelled tris(phenanthroline) cobalt (II) perchlorate. Emission Mössbauer spectroscopic studies of 57Co-labelled [Co(phen)3]clO4)2 in host matrices [M(II)(phen)3](ClO4)2(M=Co, Fe, and Ni) indicate that the relative intensities of the anomalous species produced through the EC-decay depend on the kind of the host matrix. The largest intensity was observed with the cobalt (II) matrix, and the smallest with the iron (II) matrix. Emission spectra of 57Co-labelled [Co(2-CH3-phen)3](ClO4)2 2H2O in the matrix of [Fe(2-CH3-phen)3](ClO4)2 were also studied. The high-spin state (5T2) was predominantly observed at 4.2 K in the emission spectrum, while the low-spin state (1A1) was mainly observed in the absorption spectrum at 78 K. The results are discussed in terms of the stability of the lattice.


[Accumulation mechanism of 111In in malignant tumor (author's transl)]. In order to clarify the accumulation mechanism of 111In in maligant tumor, subcellular distribution of 111In was quantitatively determined. Buffalo rats bearing Morris hepatoma 7316A were injected intraperitoneally 111In-chloride and tumor tissues were removed 24 hours later. Subcellular fractionation of tumor tissues were carried out according to the method of C. de Duve, et al. and radioactivity of each fraction was counted. Most of the total radioactivity was distributed among the soluble, nuclear and lysosomal fractions. On account of its low protein content, the relative specific radioactivity was the highest in the lysosomal fraction. The lysosomal fraction was solubilized gradually and the resultant stepwise release of 111In and acid phosphatase activity were measured. There was a close relationship between them. From these results it was concluded that 111In accumulated especially in the lysosomes. In the electron micrography the tumor lysosomes had already engulfed many foreign materials, so that the lysosomal function would be depressed.


[Re-operations for biliary disorders in cholecystectomized patients]. A total of 125 cholecystectomized patients are analized, that underwent new surgery for major biliary disturbances. From this study were excluded patients in whom re-interventions were performed for immediate postoperative complications, for surgical accidents, those in whom the primary intervention involved the major biliary pathway, as well as those in whom reintervention was necessary because of other disturbances. 72,8% of the patients in whom reinterventions had to be performed presented one or more obstacles in the major biliary pathway in the authors' opinion coexisted with the initial cholelithiasis. The authors consider that reinterventions should be performed as early as possible, interpretation of the disturbances sequellae of cholecystectomy representing a futile temporization and making more severe the evolution of the patient's condition.