Psychotherapy of the family as a measure for preventing relapses and improving the prognosis in schizophrenic patients. The increasing interest in the relationship among psychoanalysis, linguistics and higher nervous activity (neurodynamic) is recalled. As most of the works on the therapy of the family have been based upon psychodynamic interpretations, the authors shall try to speculate on how much room this field should be given in the phenomena related to higher nervous activity. The study of Pavlov, Gantt and others on biological and social factors influencing human behaviour have been discussed in relation to the system represented by the family nucleus. Some aspects have been taken in consideration like the double bind, the perverse triangle and the formation of a scapegoat. Double bind theory and praxis is representing a paradoxical situation similar to unavoidable conditioned patterns. The behaviour of the "designed patient" may be interpreted as a tentative escape to express his disagreement to the fixed situation. What happens is a kind of abnormal conditioning which is realized through a progressive stratification of discordant learning. The final result is the disorganisation of cognitive processes. In the meantime, we observe a discordance of the activity of the first and the second signaling system because, very often, an apparent external calm is accompanied by intense cardiovascular or visceral turmoil. Every kind of communication should take care of both processes, the congnitive and the neurodynamic. The analysis of the verbal, as well as the non-verbal communication in the family setting, may be fruitfully based upon the study of the progressive significance of the cognitive-emotional dissyntony, as well as the dissyntony between the 1st and the 2nd S.S., and the transactional dissyntony implicit in the double bind. A group of 25 families of schizophrenics followed by one up to five years has been examined following the concepts above mentioned.


Electrodermal and heart-rate measurements in chronic and partially remitted schizophrenic patients. Electrodermal activity and heart-rate were recorded in the laboratory from partially remitted schizophrenic patients living in the community, chronic schizophrenic inpatients and normal controls. Althoug all patients had faster heart-rates, no consistent electrodermal differences between patient groups and normals were evident, nor was there a bimodal distribution of responding within the patient group. Laboratory recordings did not reflect differences in community patients tested in their homes and associated with environmental and social factors. This emphasized the limitations of laboratory testing in investigating a disorder such as schizophrenia whose course may be markedly influenced by environmental and social factors.


[Psychodramatic group and game. A psychoanalytical perspective (author's transl)]. The author presents a psychoanalytical perspective on psychodrama as a passage from alienation to desire, the cure and relational modifications acting as supplementary benefit. The psychodramatic project is explained in four summarized directions: 1. the subject's assumption of his history in a process of symbolization through language, and this through game and group; 2. the renunciation to the master of language and the recognition of desire as unknown and nonsense; 3. the renunciation to alienating identifications and imaginary questing; 4. the obstacle of the other's desire and the recognition of its radial and separate identity.


Review of the acute admissions of 442 foreign born in closed psychiatric wards (Antwerp, 1967-1975). Comparison to native borns for age, sex, descent and diagnosis. After reviewing the literature on transcultural psychiatry, the admissions in the closed service of the Hospital Stuyvenberg in Antwerpen were analysed for 1967-1975. Immigrants were compared with other nationals, for age, sex and psychiatric diagnosis, with regard to patients born in Belgium. For the foreigners, statistical evaluation was done for age, sex, civil status, land of origin, and jewish religion. Interesting results were obtained for paranoid syndromes in patients originating from Eastern Europe and in menopaused women.


Obsessive-compulsive neurosis, anancastic symptomatology and ABO blood types. Determinations of ABO blood types was carried out in 38 patients with obsessive-compulsive neurosis, 48 schizophrenics with anancastic symptomatology, 31 depressives with anancastic symptomatology, 260 schizophrenics free of anancastic symptomatology and 65 depressives free of anancastic symptomatology. Results were compared with a representative sample of the general population. The findings of the present study provide evidence of an association between obsessive-compulsive neurosis and phenotype A, whilst a similar association between ABO blood types and anancastic symptomatology occurring in the course of psychotic disorders was not found. The significance of these findings is discussed with regard to current diagnostic and aetiological issues in obsessive-compulsive neurosis.


Acute confabulatory psychosis: a rare form of unipolar mania? Emil Kraepelin's paper on false memories (Erinnerungsfälschungen) was probably the most extensive and incisive analysis of these phenomena ever made. Using his views as a starting point, the concept of confabulation is then defined in a Kraepelin-oriented manner, making it also applicable to the phantastic false memories found in some rarer forms of functional psychotic illness. Kraepelin and Leonhard have been preeminent in their concern with such clinical states; thus, Leonhard's confabulatory euphoria and confabulatory paraphrenia can be symptomatically and syndromally linked up with points of view on paranoid mania and confabulatory paraphrenia held by Kraepelin. An "ideally typical" case is also presented to highlight some of the difficulties involved in trying to distinguish mania from schizophrenia when the clinical picture is dominated by phantastic "functional" confabulations.


[Homogeneity of defence mechanisms in a group of infarct patients and impact of these defences on the expression of their emotions (author's transl)]. This study made use of the EMO-Questionnaire of Baehr and Baehr and the DMI of gleser and Ihilevich. The first purpose of this study is to evaluate the homogeneity of a group of infarct patients as to what the defence mechanisms are concerned. The wards statistical procedure showed the group was composed of two subgroups amounting respectively 66% (group I) and 34% (group II) of the subjects. The discriminant function analysis reveals how much the two groups are differentiated but coherent. The subjects of group I use predominately intellectualization and denegation; they use moderately turning against self and projection; they use rarely turning against object. The subjects of group II make moderately use of all these defence mechanisms. The second purpose is to precise in which measure the way of expression of affects is related to the defence mechanisms. The U-test of Mann Whitney reveals lower scores among the subjects of group I as compared to those of group II, in aggressiveness, anxiety, inferiority feelings, somatisation, fantasy productions and withdrawal.


[Validation of a psychological questionnaire to differentiate subjects with propensities for hypertension, tachycardia or angor from normal subjects (author's transl)]. The present work allows us to draw a psychological profile of patients suffering from hypertension, tachycardia and angina pectoris. It confirms the fact that patients affected by cardiovascular symptoms are not relevant to one and the same structure of personality. It lays stress on the necessity to differentiate the studied symptoms and to homogenize the cardiovascular samples.


[Psychological links and coronary diseases. I. Physiological correlations of certain psychological variables (author's transl)]. Twenty-one infarct patients were compared with 21 normal subjects regarding several hemodynamic, lipidic and neuroendocrine variables, in various stress situations and at rest. Correlations were tabulated between those bioclinical measurements and various personality patterns drawn from the MMPI. This study shows that the physiological reactions to stress vary in subjects with psychological cardiovascular risk factors as compared to subjects without psychological risk factors. The bearers of psychological risk factors show a higher systolic and diastolic blood pressure, a specific lipids pattern and a lower rate of platelets. In summary, psychological risk factors link with physiological reactions to stress which appear to be by themselves cardiovascular risk factors.


Effects of steroid hormones on the binding of ioglycamide (bilivistan) to human blood serum. The binding relationships between ioglycamide and steroid hormones were determined in a liquid two-phase system with labelled ioglycamide and by direct measurement of ultraviolet light absorption. It was found that an interaction between ioglycamide and steroid hormones, particularly progesterone, existed, relative to the binding to human serum protein.


Selective phlebography in carcinoma of the pancreas. Eighteen patients with obstructive jaundice were examined by pancreatic phlebography. In 15 cases the final diagnosis was carcinoma of the pancreas, in 3 cholangiocarcinoma. The normal phlebographic anatomy and the morphologic abnormalities in patients with carcinoma of the pancreas are described. The accuracy of pancreatic phlebography in the diagnosis of carcinoma of the pancreas and cholangiocarcinoma is evaluated.


Evaluation of solitary renal cystic lesions. The diagnostic approach in cases of expanding renal lesions is reviewed on the basis of 106 patients with cystic lesions. Differential diagnostic aspects of cysts, tumor masses and cystic tumors are given. Ultrasound examination is considered to reduce the need of nephroangiography otherwise required. The value of nephroangiography with angiotensin in equivocal cases is emphasized.


Angiotensin effect in the human kidney.

Angiotensin effect in the human kidney. The renal effect of angiotensin has been recorded in patients by determination of variations in the length of the kidney and by selective injection of contrast medium into the renal artery with special angiographic techniques. The experiments demonstrate the rapid onset of the angiotensin effect on the renal vessels. The effect on kidney length was considerably prolonged compared with the vascular effect.


Malignant thymoma with renal metastases. Report of a case. A patient with metastasizing thymoma is presented. This case, as well as 31 previously reported cases in the literature, demonstrate that thymoma may give distant metastases and that the behavior of the tumors cannot be predicted on histologic grounds. The case reported here is the first case where angiography was performed.


Ileocecal abnormalities in appendiceal abscess. The radiologic findings were reviewed in 16 patients with surgically proven appendiceal abscesses. The indirect indication of abscess comprised displacement of the cecum or small bowel, deformation of the cecum and filling defects or non-filling of the appendix. One or more of these abnormalities were observed in all the patients. In addition a fistula and a cavity were filled in 2 patients.


Effect of somatostatin on intestinal motility. The effect of somatostatin on intestinal motility has been investigated. The demonstrated inhibition of the motility has proved to be suitable for performing double contrast examinations of the small intestine, particularly as the tolerability to somatostatin is better than to other comparative substances.


Experimental colonic tumours in the rat. I. Preparation and technique of examination. A method is described for demonstrating the mucosal appearance of the colon of the rat with double contrast and magnification radiography. The rats were examined at regular intervals. Double contrast examinations were performed 1 570 times in 418 rats. The animals were prepared by cleansing the colon with enemas. The mortality rate for different forms of anesthesia was recorded. An anesthesia with intraperitoneal administration of chloralhydrate and atropine-sulfate was the most appropriate.


Scanning electron microscopy of the spreading of barium sulfate suspensions on the gastric mucosa of the rat. Effect of wetting agents, bile salt and lecithine. Scanning electron microscopy was performed on the rat stomach mucosa after application of BaSO4 and three barium-containing commercial contrast media. The degree of flocculation was assessed; flocculation could be prevented by using synthetic wetting agents and by physiologic, natural emulsifiers, sodium taurocholate and lecithine.


Effects of the pregnant uterus on the abdominal aorta and its branches. The pregnant uterus was found to exert pressure upon the lumbar region with a maximum over the midline of the lordosis and diminishing laterally. Those parts of the arterial system formed by the aorta and its dorsal branches and displaceable at autopsy, were accordingly dislodged by the uterus, whereas the fixed parts were compressed. The pressure effects extended cranially during pregnancy. Symptoms of compression can be relieved by avoiding supine and prone positions.


Gastrocnemio-semimembranosus bursa and its relation to the knee joint. III. Pressure measurements in joint and bursa. Pressure measurements in the knee joint and gastrocnemio-semimembranosus bursa were performed on patients and autopsy cases. A normally occurring closure mechanism between the joint and the bursa was demonstrated and analysed. Two patients were also found to have a partial valvular mechanism in the form of a hindrance to spontaneous passage of fluid from the bursa to the joint but no hindrance in the other direction.


Soft tissue radiography for evaluating clinical activity of rheumatoid arthritis. The value of soft tissue radiography in assessing the activity of rheumatoid arthritis was investigated in 67 patients and correlated to the clinical activity of the disease. Soft tissue radiography using a technique for mammary radiography was combined with immersion. Radiologically demonstrated periarticular oedema was most closely correlated to clinical activity. A close correlation also existed between soft tissue radiographic lesions and 99Tcm accumulation in hands.


Nuclear area and sex chromatin frequency in oral mucosa and hair root sheats of human females. In 36 oral mucosa and in 25 hair root sheath slides nuclear area was measured in about 100 nuclei per slide. Within one slide no differences were found in nuclear area between nuclei with or without sex chromatin, or with a non-peripheral sex chromatin. No correlation was found between nuclear area and sex chromatin frequency, except for a weakly significant negative correlation between nuclear area and those nuclei without either peripheral or non-peripheral sex chromatin.


Biochemical investigation of lens induction in vitro. II. Demonstration of the induction substance. An organ culture method to study the process of lens induction in the chick is described. To see whether or not a direct contact between the participating tissues is required for lens formation, agar slices (0.5 mm thickness) were cultured between the eye cup and the ectoderm. New lenses were formed in 43% of the transplants. Both the eye cup and the ectoderm originated from 72 hours old embryos (stage 18). By culturing agar slices on the eye cups during 2--24 hours and afterwards culturing these slices separately in combination with ectoderm, it was proved that lens inducing substance (s) penetrate into the agar slices. 3-4 hours of culturing on the eye cup is sufficient to obtain "inducing" agar slices. The same eye cups were shown to be able to induce a lens for more than one time. By using millipore filters with a 0.65 mu pore size, induction occurs in 36% of the cultures. The possibility of a restraining influence of the formed lens on the induction capacity of the eye cup was noticed.


Binding of labelled antigens and immune complexes to macrophages and dendritic cells in cryostat sections of normal mouse spleen. It has been shown that, when cryostat sections of normal mouse spleens were incubated with labelled immune complexes, label accumulated in the dendritic cell areas of some follicle centres. No label, more than background, was found in the periphery of the follicles. This localization pattern is different from that obtained when labelled immune complexes had been injected intravenously in mice. Apart from the cells involved in follicular trapping of immune complexes, labelled cells were also found in the white pulp, especially in the periarteriolar lymphocyte sheaths and in the red pulp. These cells could be identified as macrophages. When incubation of the cryostat sections took place with labelled antigen, in the absence of the complexing specific antibody, only the macrophages were labelled but not the cells in the follicle centres. These results are discussed in relation to the binding mechanisms of antigens and immune complexes to macrophages and dendritic cells.


Significance of the ventricular fluid pressure wave form in the diagnosis of cerebral circulatory arrest and brain death. The fluctuations in the absolute value of the ventricular fluid pressure (VFP) with simultaneous changes in the amplitude and frequency of the oscillations of the ventricular fluid wave form are described in seven patients who developed brain death following either a head injury or a cerebrovascular accident, and are compared with those observed in nineteen patients who survived similar brain pathology. The findings in the two groups were significantly different. It is suggested that VFP monitoring does provide reliable evidence of brain death even while the patient is on artificial respiration.


Size of posterior fossa in Chiari type 1 malformation in adults. The clinical and neuroradiological findings in five patients with Chiari Type 1 malformation presenting symptoms in adult life are presented. New posterior fossa ratio methods have been applied to this material. The posterior cranial fossae are demonstrated to be small, and the most significant deviation from normal gave the ratio h/Tw: posterior fossa height in proportion to Twining's line. The implications of these findings are discussed in relation to the static and dynamic factors that are operating in the development of neurological symptoms in Chiari type 1 malformation. A final discussion is given comparing the Chiari type 1 malformations to meningo-myelocele. The findings using posterior fossa ratio methods may strengthen the indications for suboccipital craniectomy in these patients.


Distension of the operation site after posterior fossa surgery. In 130 posterior fossa operations 6 cases of progressive distension of the operation site have been recorded and documented. The possible causes of this complication and the surgical management are discussed. Isotope studies after injection of Ytterbium 169DTPA into the underlying cyst have shown abnormal patterns in CSF circulation and absorption. All the cases have resolved after ventriculo-peritoneal shunts.


Spinofacial anastomosis.

Spinofacial anastomosis. Removal of large acoustic neuromas may still be followed by facial nerve palsy. The results of fourteen cases of spinofacial nerve anastomosis have been studied and compared with the results of spinofacial and hypoglossal-facial anastomoses reported in the literature. Other standard treatments of facial palsy have been briefly reviewed and criteria developed by which the most appropriate therapy for facial paralysis may be selected.


Peripheral nerve tumour composed of neurilemmoma and haemangioma elements. Five cases of a peripheral nerve tumour with both neurilemmoma and haemangioma components are reported. Three tumours were intraspinal, one tumour originated in the acoustic nerve, and one was in the brachial plexus. Because of rapid progression these mixed tumours should be considered in the differential diagnosis of intraspinal malignancies.


Schwannoma of the olfactory groove. Case report and review of previous cases. A personal case, the third in the literature, of an olfactory groove schwannoma in a young man aged 19 is reported, and the two cases previously described are revieweed. Occurrence in young males and long histories are characteristic.


[Paraplegia with a cauda equina syndrome due to stenosis of the spinal canal caused by tabes arthropathy]. The authors present a case of cauda equina paraparesis due to compression by tabetic osteo-arthropathy. Diagnosis was confirmed by the typical clinical picture of tabes and by the history of a chancre 53 years earlier. Radiography of the spine showed vertibral osteo-arthropathy. Opaque contrast myelography showed compression at the D 11/D 12 and L 4/L 5 levels, with poor contrast filling athe the L 1/L 3 level. Surgical treatment by decompressive laminectomies from D 12 to L 4 led to a satisfactory result with motor recovery and regression of the cauda equina syndrome.


Psychological factors and adolescent illicit drug use: ethnicity and sex differences. Of four psychological factors examined in a representative sample of New York State secondary school students, only two, depressive mood and normlessness, show a positive relationship with the use of illicit drugs, especially drugs other than marihuana. The association of depressive mood and normlessness with illegal multiple drug use varies by ethnicity and sex, being consistently stronger among girls and among whites. In addition, depressive mood is negatively related to multiple drug use for black and Puerto Rican boys. These findings suggest that psychological factors play a different role in adolescent drug involvement within various social and cultural groups.


A comparison of self-esteem, dogmatism and fantasy in psychiatric inpatient adolescents and their parents with non-hospitalized adolescents and their parents. Forty in-patient adolescents and 40 non-hospitalized adolescents, comparable in age, sex, education, birth position and socioeconomic level, and their parents were administered the Rokeach Dogmatism Scale, Barksdale Self-Esteem Evaluation Scale, the Singer and Antrobus Imaginal Process Inventory, and the Elms Empathic Fantasy Scale. Distinct differences were found between the in-patient adolescent and his/her parents in aspects of fantasy, empathy, dogmatism, and self-esteem, while the non-hospitalized adolescents were very similar in fantasy with both parents. In addition, both parents of the nonhospitalized adolescents had greater levels of self-esteem with less dogmatism evident in the fathers. The results are discussed in terms of the identification process and modeling, the socialization process with its suppression or reduction of taboo drive manifestations and fantasy as a means of achieving unattainable drives.


The management of obesity in the post-adolescent developmentally disabled client with Prader-Willi syndrome. A discussion of the problem of obesity control in post-adolescent residents who are diagnosed as having Prader-Willi Syndrome is presented with a description of the syndrome, a brief case history of one of the residents with the syndrome, and an outline of the program used by a residential facility for exceptional young adults in managing this difficult problem.


Secondary prevention and associated drug therapy. In secondary prevention, the treatment of serious disorders is undoubtedly necessary. This applies to the treatment of latent or manifest heart failure with digitalis glycosides, the treatment of coronary insufficiency with suitably active medicaments, and the administration of antiarrhythmics to patients with cardiac arrhythmias, who could be particularly endangered under certain circumstances. Raised arterial blood pressure, one of the most important risk factors of coronary heart disease, requires suitable drug treatment. Similarly, the additional administration of medicaments that affect lipid metabolism and of substances that lower raised uric acid levels together with a suitable diet is often inevitable. It is patently obvious that diabetes mellitus must be optimally controlled. Whether the long-term administration of beta-sympatholytics has a protective effect on the onset of sudden deaths through cardiac arrhythmias or on the incidence of reinfarction is, in the present state of knowledge, quite possible, but still not definitely proven. Different indications and dosages of the medicament, and thus the absence of standardized conditions, scarcely permit an assessment of the success of associated drug therapy in secondary prevention.


Mössbauer effect: studies of the electronic structures of the heme. On the basis of experimental Mössbauer evidence, the electronic structures of heme iron are discussed for Mb and Hb. In the deoxygenated state, it is concluded from the electric field gradient tensor and the temperature dependence of the quadrupole splitting that the ferrous iron is not in the tetragonal ligand field with the symmetry axis perpendicular to the heme. The experimental results are well explained solely by rhombic perturbation. The electronic ground state is a component of the 5E term, and the principal axis of the anisotrophy is parallel to the heme plane. In the oxygenated state, there is no decisive conclusion on the bonding structure of the O2 molecule to the heme. Still, the two models of Pauling and Griffith are consistent with experimental results. Considering a relaxation between two possible conformational states, the peculiar temperature dependence of the quadrupole splitting is resolved in Fe-O2 model compounds.


[Allergy and anaphylaxis].

[Allergy and anaphylaxis]. Acute undesirable drug reactions following the application of one of the modern amiglycoside antibiotics only occur in some exceptional cases. Those compounds reveal low sensitizing capacity, in contrast to streptomycin. Following topical applications, allergies of delayed type have been recorded, especially in the case of neomycin, a widely used topical antibiotic. Aminoglycosides exhibit anaphylactoid activity; they cause a degranulation of mast cells. Via this mechanism, histamine reactions are provoked. Such "anaphylactoid" reactions are clinically indistinguishable from true allergic (anaphylactic) phenomena and repeatedly have been erroneously interpreted. For allergological test series as well as for the correct interpretation of acute unwanted drug effects it is important to consider the anaphylactoid activity of the aminoglycosides.


[Pharmacologic studies or aminoglycoside antibiotics (amikacin, gentamicin, sisomicin, tobramycin)]. In a randomized study of 12 healthy subjects, the pharmacokinetics of gentamicin, sisomicin and tobramycin were determined after a one-hour infusion of each drug (1.0 mg/kg body-weight). There were no pharmacokinetic differences of therapeutic significance between the three drugs. The mean serum concentrations at the end of infusion were 3.85 microgram/ml for gentamicin and 4.66 microgram/ml for sisomicin, falling to 0.12 and 0.26 microgram/ml, respectively, after eight hours. The biological half-life varied between 96 and 122 min and the apparent volumes of distribution corresponded closely to the size of the extracellular space.--The pharmacokinetic data of amikacin were determined after a one-hour constant infusion, the mean amikacin serum concentration was 37.5 microgram/ml and, 8 hours later, decreased to an average of 1.3 microgram/ml. The biological half-life amounted to a mean of 114.2 +/- 16.7 min, and the apparent volume of distribution could be calculated with 18.1 +/- 1.81/100 kg body weight.


[The differentiation of potential nephrotoxicity of various aminoglycosides in animal experiments]. Experimental differentiation in the animal of nephrotoxicity of various aminoglycosides. Animal experiments showed that all aminoglycosides cause similar toxic tubular and glomerular damage when investigated by qualitative morphology. Quantitative differences in tubular nephrotoxicity of gentamicin, tobramycin, sisomicin, kanamycin, kanendomycin, amikacin, and butirosin were demonstrable by evaluation of the excretion rates of tubular cells and urinary enzymes in rats. By this means dose-effect-relationships were found resulting in reproducible different toxic threshold doses for each antibiotic, and thus in a scale of increasing nephrotoxicity. The aminoglycosides differed by their affinity to kidney tissue as measured by determination of the accumulating renal concentrations of the drugs at different times during multiple-dose administration. This had a modifying influence on excretion rates of cells and enzymes affecting the scale of toxicity in long-term studies. Comparative investigations on nephrotoxicity in rats and guinea pigs gave similar results. In addition, a study in man suggested that the test results of nephrotoxicity are not species-specific. For human therapy it is concluded that even more caution should be practised with the new aminoglycosides than with gentamicin in order to avoid renal damage.


[Comparative studies on the nephrotoxicity of aminoglycoside antibiotics using renal enzyme elimination in rats as a model]. Determinations of renal enzyme excretion in rats inform on the relative nephrotoxicity of drugs. The data obtained in such studies are of clinical relevance. For the screening of new aminoglycosides, the renal enzyme excretion technique is a rather simple, but valuable model. New compounds can easily be compared to well-known ones about which clinical cata are available already.--Comparative investigations with netilmicin, a semi-synthetic sisomicin derivative, and with gentamicin are reported. Netilmicin in three different doses provoked significantly less increase in urinary alkaline phosphatase and "leucine aminopeptidase" activities.


Pathological changes of cerebral vessel endothelial cells in spontaneously hypertensive rats, with special reference to the role of these cells in the development of hypertensive cerebrovascular lesions. Changes of endothelial cells of the cerebral arterial system in spontaneously hypertensive rats were investigated using scanning electron and transmission electron microscopes. The endothelial cells revealed on the one hand, progressive changes such as enlargement, increased plasmalemmal pits, numerous microvilli and well-developed marginal folds. On the other hand, regressive changes such as balloon-like protusions and craterlike concavities were also noted. Platelet adhesion was often encountered on the injured  endothelial surface of the cerebral arteries in SHR. The significance of these findings in the development of hypertensive cerebral vascular changes was discussed.


Hypertension and the blood-brain barrier. Acute hypertension leads to alternating regions of dilation and vasoconstriction of surface cerebral vessels. It remains to be determined conclusively if either or both of those calibre changes are essential in the production of degenerative vascular changes of malignant hypertension. There is no evidence of ischemic or other morphologic change to components of the blood-brain barrier including the interendothelial tight junctions which remain intact. An early phase of evolving cerebral edema is swelling of astrocytic foot processes that occurs only in regions of abnormal protein permeability. The cortical location of these acute hypertensive lesions stands in contrast to the ganglionic location of the microaneurysms found as complication of chronic hypertension in man. The location of permeability changes to protein do not necessarily reflect changes in brain water permeability susceptible to sympathetic regulation.


Microcirculatory disturbances during the early phase following experimental spinal cord trauma in the rat. The early (primary) lesion of the microvasculature and neurons in the gray matter of the rat become mainfest within 0-3 min, long before the development of secondary ischemic-anoxic changes. The central hemorrhagic necrosis of the gray matter, induced by the impact injury, seems to depend primarily on theseverity of trauma. However, since the lesion is limited to the gray matter of one or two segments, these primary changes are not responsible for the irreversible transverse lesion. Additionally, the experimental cord injury in the rat demonstrates that secondary vascular changes (i.e., the pathological permeability of vessels in the white matter) produce a progressive edema that spreads into the necrotic zone and leads to definite transverse lesion. Not least of all, the increased pressure of the spinal tissue may promote the self-destructive process leading to irreversible damage to white matter.


Microangiographic observations of morphological vessel changes after experimental spinal cord trauma. In 36 rabbits the spinal vessels were investigated by microangiography during and immediately after spinal cord compression, and at a long time after decompression. Vessel constrictions, obliterations, injuries, perivascular bleeding, insufficient filling of the surface arterial net, obliterations of the V. spin. post., and venous stasis were found. The vessels in the gray matter were insufficiently filled, whereas those in the periphery were adequately filled. The vessels in animals observed immediately and at a long time after decompression were more often filled than those in animals observed during the compression. Mechanical compression of the vessels may play an important role here.


Demonstration of early capillary lesions in the brain by means of artificial reperfusion. Nine patients are reported in whom functional brain death was determined as exactly as possible by neurological (in part also electroencephalographic and/or angiographic) examination in combination with analysis of the clinical history. During the first hour, at 2-4 hr, and later than 4 hr after the occurrence of functional brain death, the mean systemic pressure was raised to 30% above normal by infusion of Arterenol. The infusions lasted 15-30 min; in spite of the raised blood pressure, the patients died of cardiovascular attention to vascular damage; none was found whenever the reperfusion was completed within the first hour after determination of circulatory arrest. In all three cases in which reperfusion was performed, after more than 4 hr the neuropathological findings were similar. In one case the EEG showed a burst-type pattern during reperfusion within the first hour after determination of brain death.


Cerebral artery spasm: histological changes in necropsies of cases of subarachnoid hemorrhage. A group of 20 necropsies of subarachnoid hemorrhage (SAH) were selected because of the known complication of cerebral vasospasm. Evidence for vasospasm was radiological and pathological in 17 cases and pathological alone in 3 cases. A histological examination of the large arteries in areas known formerly to be in spasm showed that in the 13 early cases (death before 3 weeks) there were relevant changes in all layers of the arterial wall, the most significant being a degeneration of the media and elastica. In the 7 late cases (death after 3 weeks), in addition to the sequelae of the acute changes, there was marked concentric intimal thickening; and the localization was again in the particular segments of arteries formerly in spasm. Changes found in the small arteries, capillaries, and veins in the early and the late cases were thought to be caused by the ischemia due to the vasospasm. These changes were also seen in control material.


Vasomotor response of cerebral blood vessels to dopamine and dopaminergic agonists. The vasomotor response of dopamine and dopaminergic agonists was studies on feline isolated middle cerebral arteries in vitro and pial arterioles in situ following microapplication. The action of various inhibitors was tested to define the receptors involved. The contractile response could be blocked by alpha-receptor as well as serotonin receptor antagonists. The mode of inhibition suggested that serotonin receptors rather than alpha-adrenoceptors mediated the dopamine-induced contraction. A dose-dependent dilation could be evoked by the dopaminergic agonists on actively contracting pial arteries in vitro and by apomorphine in situ. The relative potency for the agonists together with blocking experiments indicated that the vasodilation was mediated by specific dopamine receptors.


Competency-based education and creative thinking. When creativity is considered as an approach to problem-solving, rather than as an innate talent, then education can play an important role in its development. This paper postulates that competency-based education, because of its emphasis on stated objectives, feedback, self-evaluation, and alternative learning experiences, is an approach to curriculum design that should lead students to become more creative thinkers. A description of competency-based-education is given, and research on educational methods and creativity is surveyed. The implications of this type of program for occupational therapy education are considered.


A process model for competency-based education. This article describes a process model for design and development of curricula. The model is based on learning theories of competency-based education. It is suggested that curricula so designed will, in conjunction with accreditation and credntialing, provide an additional mechanism for ensuring quality in professional practice.


Reflections concerning an activity consultant by a nursing home administrator. The problems a therapist can expect as a part-time consultant in a nursing home are explored. These problems include understanding the nature of patient population, incomplete information on specific characteristics of the nursing home, and the relationships among the various constituencies found in the facility. Activities can be helpful in counteracting physical problems and especially depression and withdrawal. The consultant must be independent, objective, informed, able to stimulated creative approaches, make value judgments and appropriate decisions, and above all, must be involved.


Chaining strategies for teaching sequenced motor tasks to mentally retarded adults. This study arose from a need to determine which of two techniques was the most efficient means for assisting the mentally retarded to achieve optimum independence in functional living skills. Twenty-four educable mentally retarded adults were assigned to two groups and instructed in a sequenced motor assembly task. One group was taught using a forward chaining method and the other, a backward chaining method. Subjects were measured for learning time and retention performance. Results supported the hypothesis that subjects taught using backward chaining required less time to learn the task than those taught using forward chaining. There was no significant difference in retention between the two groups.


Clinical placements by computer program. A computer allocation and recording system was developed and implemented to permit an integrated, sequesntial and, to some extent, individually tailored clinical experience for occupational therapy students. Necessary technical information is described for those who may wish to adapt the program to their needs. A difficult administrative task was solved by a machine well known for its speed and accuracy, extensive memory, and copy-typing capabilities.


Infective endocarditis in heroin addicts: epidemiological observations and some unusual cases. The total number of cases of heroin-induced endocarditis occurring over a four-year period were reviewed in order to explain an increase in the number of cases in the last year studied (1975). Brown heroin was noted to be used more frequently by addicts during the period of increased incidence. Cultures of "street samples" of brown and white heroin as well as cocaine were obtained in order to elucidate a possible relationship between the increased use of brown heroin and the increased number of endocarditis cases. Despite frequent contamination of both white and brown heroin, none of the common endocarditis-causing pathogens were isolated from the samples. Staphylococcus aureus, the most common etiological agent, frequently resulted in tricuspid endocarditis. That the accepted criteria for tricuspid endocarditis may be present without actual cardiac valve involvement is demonstrated by a most unusual case of hepatic vasculature infection.


The temperature course in acute myocardial infarction. The rectal temperature course was studied retrospectively in 192 consecutive patients with acute myocardial infarction (AMI). The ordinary temperature course after AMI was characterized by four points: 1. The morning temperature on the first day in hospital was seldom above 38.2 degrees C. (in four of 50 cases) 2. The maximal morning temperature was seldom recorded before day two or after day five in hospital (in five of 150 cases) 3. The maximal morning temperature seldom reached above 39.0 degrees C. (in one of 150 cases) 4. The morning temperature seldom increased more than 0.6 degrees C. after day five in one or more steps (in nine of 150 cases). Seventy-four per cent of the patients were afebrile after one week, and 96% after two weeks. Patients with higher SGOT (ASAT) maxima had longer duration of fever. Eleven per cent of the patients did not have fever at all.


Systolic flutter of the mitral valve.

Systolic flutter of the mitral valve. Systolic flutter of the mitral valve was observed in 11 cases during the past 3-1/2 years. All patients had mitral regurgitation due to mitral valve prolapse or flail leaflets, and nine of the 11 (82%) had prior or concurrent bacterial endocarditis. Systolic flutter is uncommon in the absence of endocarditis and was observed in only two of 15 patients (13%) with proven chordae tendinae or papillary muscle rupture without historical and pathological evidence of infection involving the mitral valve. Systolic flutter was also not seen in a large number of patients with mitral regurgitation due to other causes. It is postulated that the regurgitation jet of blood across the edge of a structurally abnormal but flexible mitral leaflet is important for the development of flutter.


The management of anticoagulation during noncardiac operations in patients with prosthetic heart valves. A prospective study. Based on previous thromboembolic complications associated with the interruption of anticoagulation during subsequent noncardiac operations in patients with nonbiological mitral prostheses, a protocol was developed for this high risk group. We report the successful management of 26 such operations in which anticoagulation was interrupted for 12 hours and then rapidly restored by means of heparin in the postoperative period. Since an earlier study suggested no adverse effect from the interruption of chronic anticoagulants for three to five days among patients with isolated aortic valve prostheses, simple interruption was again employed during 16 subsequent noncardiac operative procedures in this group with no complications. There were three episodes of hemorrhage observed in patients receiving therapeutic doses of heparin postoperatively, but only one required blood replacement.


Organized left atrial mural thrombus demonstrated by coronary angiography. Small coronary artery fistulas terminating at the site of adherent, organized mural thrombi in the left atrial appendage were observed during selective coronary angiography in patients with mitral stenosis. The angiographic features of this abnormality can be distinguished from those of cardiac tumors, vascular malformations, and coronary artery fistulas that are not associated with organized thrombus. This coronary angiographic abnormality may indicate the presence of left atrial thrombus that is not revealed by echocardiography and is not manifest clinically by systemic emboli. The size of the collection of radiographic contrast material in the left atrium is not proportional to the size of the thrombus.


Idiopathic familial myocardiopathy in three generations: a clinical and pathologic study. A peculiar non-hypertrophic myocardiopathy is described which occurred in three and possibly five generations of a single family. Clinical features included systolic murmurs, electrocardiographic abnormalities, and sudden cardiac death with a paucity of symptoms of cardiac dysfunction. Pathological studies in three generations showed a striking similarity of cardiac findings including globular and dilated ventricles, endocardial fibroelastosis, and mitral valve thickening. Myocardium in two showed basophilic degeneration and fibrosis. A retrospective genealogic analysis and a prospective clinical evaluation of living family members suggested an autosomal dominant mode of inheritance with variable penetrance. The cause of this heritable myocardiopathy is presumably a mutant gene; the biochemical defect to which the mutant gene gives rise remains unknown.


Occurrence and significance of echocardiographically demonstrated tricuspid valve prolapse. Echocardiograms from 562 patients were examined for evidence of the pattern of tricuspid valve prolapse. Criteria for the diagnosis can be established similar to those applicable to mitral prolapse. In 500 consecutive patients without mitral valve prolapse, there were no cases of isolated tricuspid valve prolapse. Eleven of 53 (21%) patients with mitral valve prolapse also had tricuspid valve prolapse. Four of six (67%) patients with Marfan's syndrome and mitral valve prolapse also had tricuspid valve prolapse. The occurrence of this echocardiographic pattern as an isolated finding as well as associated with mitral valve prolapse was significantly less than previous angiographic reports. Patients with both these findings tended to be older than those with mitral valve prolapse alone, but clinically differed in no other way. Use of standardized technique can minimize errors in diagnosis.


Rapid, sensitive detection of myoglobulinemia by improved counterimmunoelectrophoresis in cases of acute myocardial infarction. A counterimmunoelectrophoresis technique for detection of serum myoglobin (Mb) was improved using non-ionic polymer dextran. Precipitin lines were graded according to their strength, which was ascertained by radioimmunoassay data. By this method, serum Mb in concentrations of 500 ng./ml. before stain and of 200 ng./ml. after stain were detected. Electrophoretic time was 60 minutes. Among 32 cases of acute myocardial infarction (AMI) whose blood samples were collected within 24 hours after disease onset, precipitin lines were detected in 25 cases (78%) before stain and 31 cases (97%) after stain. Considering the early peak concentration time (approximately 10 hours) of serum Mb after AMI onset, diagnosis becomes more rapid and exact with this method, especially in severe cases.


The importance of R on T phenomenon.

The importance of R on T phenomenon. The onset of ventricular tachycardia was examined in 44 patients with various types of heart disease. In only six patients (14%) the ventricular tachycardia was initiated by an ectopic ventricular complex interrupting the T wave. The findiings suggest that the importance of R on T phenomenon may have been over-emphasized.


Pleural effusion as a manifestation of Dressler's syndrome in the distant post-infection period. A 65-year-old woman developed a bloody pleural effusion 2-1/2 years after the onset of Dressler's syndrome. Since an extensive evaluation failed to reveal a specific etiology, the effusion was presumed to be a manifestation of Dressler's syndrome. Because of the therapeutic implications involved, we are reporting this case to emphasize that pleural effusions may occur as a manifestation of Dressler's Syndrome in the distant post-infarction period.


Criteria for the evaluation of methods for the collection of organic pollutants in air using solid sorbents. A small tube containing a solid sorbent is convenient to use for collecting and concentrating trace organics in ambient air and worker breathing zones. Many techniques for air sampling with solid sorbents, especially for the long term eight hour sample, are relatively new. It is necessary to have criteria to judge methods utilizing these techniques and to establish guidelines which are accurate and practical. Parameters which affect collection and recovery and information necessary to define, develop and evaluate a sampling method are discussed. Progressive steps for the development and validation of air sampling methods are recommended.


Fiber counting: a source of error corrected. Optical counting of fibers (from a filter sample of industrial air, for example) involves determining how many fibers are within counting fields which are squares of side lengths. It is correct to count all those fibers which are completely within the field and half of those which intersect only one side. It is shown here to be incorrect to count half those fibers which intersect two sides; the magnitude of this error is calculated, the calculations being verified through a Monte Carlo simulation. The fractional overcount for fibers of length L less than or equal to s is (L/s)2/2pi.


Dust levels and particle-size distributions in high-capacity cotton gins. Dust samples were collected inside high-capacity cotton gins with the personal, stationary personal, and the vertical elutriator cotton dust samplers. Dust particles collected on the filters were sized with a particle measurement computer system. Particle-distribution data revealed that gin dust contains a high percentage of dust particles larger than 20 micrometers in diameter.


Microenvironmental exposure to mercury vapor. Work area and breathing zone samples were collected in a factory utilizing metallic mercury and analyzed for mercury vapor content. Breathing zone samples averaged several fold higher in concentration than concurrent area samples, reflecting a "microenvironmental" exposure to mercury vapor, presumably from contaminated clothing and hands. Blood and corrected total urine mercury values correlated well with the average microenvironmental exposure level for each worker. Measurements of unbound mercury in urine samples were sensitive at picking up minimal exposures. Excessive amounts of unbound mercury were not found in the urine, even with wide day-to-day swings in microenvironmental mercury vapor levels, suggesting that the human body can adapt to a chronic, moderate exposure to mercury vapor.


Sampling for organic chemicals in workplace atmospheres with porous polymer beads. Porous polymer bead collection columns are frequently used in air pollution measurements. They are also useful for industrial hygiene applications when used with miniature personal pumps. Analytical procedures using this type of collection column are described which use thermal desorption for sample recovery followed by GC or GC/MS analysis. A means is shown to modify a gas chromatograph for this type of analysis. A technique which permits splitting of the collected sample is also described. Precision and accuracy data for recovery of nineteen chemicals are presented. Advantages of porous polymer bead procedures include high sensitivity (the total collected sample is analyzed), ease of sample handling and ability to analyze polar materials not recoverable from charcoal.


Pulmonary pathology from inhalation of a complex mineral oil mist in dogs, rats, mice and gerbils. Dogs, rats, mice, and gerbils were exposed for 6 hours per day, 5 days per week, for periods up to 2 years, to an atmosphere containing a complex mineral oil-base mist at concentrations of 5 and 100 mg/M3. The mass median diameter of the oil droplets was approximately that  found in textile plants ( approximately 1.0 mu). In addition, these test atmospheres contained 1000 ppm acetone,an acetate fiber solvent, in order to simulate fiber plant conditions. Evidence of oil mist was detectable within lung macrophages of all species tested and at both concentrations. Only at the higher concentration (100 mg/M3),, in dogs and rats, but not in mice and gerbils, was a retention of oil of such a magnitude so as to result in the development of oil microgranulomas. Rats given a 10-month recovery period following 12 months of exposure did not completely recover from the oil microgranuloma. These results indicate that the presence of typical textile fiber adjuvants in mineral oil and the concurrent presence of 1000 ppm acetone in the atmosphere do not significantly alter the inhalation toxicity of pure white mineral oil mist.


The inertial behavior of fibers.

The inertial behavior of fibers. The inertial deposition is given considerable credit in the deposition of inhaled particulate matter in the upper respiratory tract. A determination of the parameters governing the impaction of fibers must be the basis of evaluating the role of impaction in the respirability of fibrous dusts. The study reported here describes an experimental method of defining the inertial behavior of fibers. The results of the experiments show that the aspect ratio of the fibers plays a much more important role than hitherto considered. The results of the experimental work gave an empirical mathematical model for the prediction of the impaction of fibers from the physical properties of fibers such as density, fiber diameters and aspect ratio. In addition an equivalent diameter based on inertial properties of the fiber is developed.


An evaluation of ultraviolet radiation personnel hazards from selected 400-watt high intensity discharge lamps. A study of selected mercury and multi-vapor lamps, commonly used for working environment illumination, was underta ken to evaluate the scope of the ultraviolet personnel hazards one may expect under various operating conditions of the lamps. Spectral irradiance measurements were made for operating conditions with and without reflector-type luminaires, glass covers on luminaries and outer glass bulbs on the lamps.


Congenital aortic stenosis secondary to dysplasia of congenital bicuspid aortic valves without commissural fusion. The hearts of nine children with clinical evidence of congenital valve stenosis and a congenital bicuspid aortic valve were reviewed. Aortic stenosis was diagnosed on the basis of cardiac catheterization data in four patients, operative findings in two and auscultatory findings in three. The patients were 1 month to 9 years old; six were male and three female. In each patient the two commissures of the valve were free to the aortic wall. The cusps were thickened, rolled and redundant; microscopic studies revealed that they consisted of immature loose connective tissue consistent with a dysplastic or incompletely differentiated valve. The valve orifice was obstructed by the dysplastic cusps, and dysplastic changes rather than the commissural fusion were responsible for the observed aortic stenosis. These valves do not appear amenable to valvotomy because obstruction is due to the abnormal valve tissue. These findings may explain the occasional poor results of valvotomy in infants and children with congenital aortic valve stenosis.


Echocardiographic features of total anomalous pulmonary venous drainage into the coronary sinus. Echocardiograms were obtained from five infants with total anomalous pulmonary venous drainage to the coronary sinus or the portal system or the superior vena cava and from one child with a secundum atrial septal defect and a large coronary sinus due to persistence of the left superior vena cava. The results demonstrate that an enlarged coronary sinus is positioned consistently posterior to the left atrium in approximately the same horizontal plane as the aortic valve. Echocardiographically the coronary sinus can be located as an echo complex behind the left atrium by using the aortic root as a reference point. The echo complex can be differentiated from the other spurious echoes in the left atrium by its characteristic phasic motions. The additional demonstration of the enlarged common pulmonary venous chamber behind the right atrium confirms the diagnosis of anomalous pulmonary venous drainage to the coronary sinus. For other types of anomalous pulmonary venous return, anatomic diagnosis with single crystal M mode echocardiography is not always possible because of the positional variability of the common pulmonary venous chamber in relation to the left atrium.


Remission of clinical angina pectoris: the Framingham study. The anginal status of the Framingham cohort was ascertained in a uniform manner during 20 years of follow-up studies. There were 74 men and 84 women with newly acquired angina that was not complicated with other manifestations of coronary heart disease. Remission of new angina pectoris for at least 2 years occurred in 32 percent of the men and 44 percent of the women. In angina that had persisted for several years, the subsequent remission rates were lower (14 percent for men and 19 percent for women). The similarity of coronary risk attributes of subjects with transient or persistent angina supports the hypothesis that both conditions may be true manifestations of coronary artery disease. Persistence of symptoms seems to indicate a more severe form of the disease characterized by nonspecific S-T segment or T wave abnormalities. It is associated with a greater incidence of myocardial infarction and death than in subjects with transient angina. The generally high remission rates must be taken into account in considering drastic surgical or medical remedies for clinical angina pectoris. Also, other possible causes for the chest pain should be sought.


Three cases of hypotension and syncope with ventricular pacing: possible role of atrial reflexes. Hypotension with lightheadedness and near syncope occurred in three patients during effective ventricular pacing. Hemodynamic studies demonstrated a decrease in cardiac output ranging from almost no decrease to 15 percent, presumably related to the loss of effective atrial contraction. The decrease in output was too small to explain by itself the reduced blood pressure, which resulted from paradoxic reduction of total peripheral resistance in one patient and from failure of resistance to increase in two. Baroceptor reflexes (Valsalva response) were normal in all three patients; hence it is suggested that the failure of compensatory increases in total peripheral resistance may be due to a reflex from the sudden atrial distension that occurs during atrioventricular (A-V) dissociation. The fluctuations in arterial pressure during ventricular pacing were synchronous with the appearance of cannon waves in the right atrial pressure tracing. Arterial pressure during A-V dissociation thus appears to be balanced by two opposite reflexes: the baroceptor reflex, which attempts to compensate for reduction in output, and atrial distension, which reduces peripheral resistance.


Cardiac sarcoidosis. Diagnosis with endomyocardial biopsy and treatment with corticosteroids. A 27 year old woman was hospitalized for progressive dyspnea, fatigue and retrosternal chest pain. She had progressive cardiac enlargement with clinical and laboratory confirmation of a dilated cardiomyopathy. Transvenous percutaneous right ventricular endomyocardial biopsy yielded a specimen showing a noncaseating granuloma. The patient's dyspnea responded dramatically to steroid therapy with corresponding improvement in radiographic and echographic measures of ventricular performance. This case illustrates the problem of diagnosing cardiac sarcoidosis when there is no apparent evidence of other organ involvement.


Lack of connection between the atria and the peripheral conduction system in a case of corrected transposition with congenital atrioventricular block. This is the first documented histologic study of the heart of a patient with corrected transposition of the great vessels and congenital atrioventricular (A-V) block with no connection between the atria and an anterior type of peripheral conduction system. Musculature in the superior (anterior) walls of both atria was absent, as was the anterior A-V node. The peripheral conduction system began with the bundle of His. In place of the absent atrial musculature, fibrosis and calcification were present. The relation of laboratory evidence of connective tissue dyscrasia in the mother to the congenital A-V block in the child is discussed.


Comparison of S-T segment changes on exercise testing with angiographic findings in patients with prior myocardial infarction. Ninety-seven patients with a prior transmural myocardial infarction who underwent coronary angiography and treadmill stress testing were studied retrospectively to assess the reliability of the exercise electrocardiogram in detecting additional disease in patients with a prior infarction. In patients with a previous inferior wall infarction, the S-T response to the treadmill stress test had a high degree of sensitivity (87 percent) and specificity (90 percent) in detecting additional significant coronary artery disease. However, in patients with a previous anteroseptal wall infarction, the S-T response had much less sensitivity (52 percent), but the degree of specificity remained high (90 percent). In this group a positive test suggested the presence of ischemia in the lateral or inferoposterior region of the myocardium, or both. A negative S-T response was of little value in distinguishing among groups of patients with single or multiple vessel coronary artery disease. The presence of an anterior ventricular aneurysm is most likely responsible for this low sensitivity rate because it generates an opposing force to the ischemic vector, thereby cancelling the S-T segment changes and producing a false negative treadmill stress test. The resting surface electrocardiogram proved useful in predicting a false negative exercise test. The presence of Q waves in the precordial leads extending to lead V4 or beyond decreased the sensitivity rate of treadmill stress testing to 33 percent.


Is the treadmill exercise test useful for evaluating coronary artery disease in patients with complete left bundle branch block? To aid in the study of coronary artery disease, 57 patients with complete left bundle branch block underwent clinical evaluation, treadmill exercise testing and cardiac catheterization. The patients were classified into two groups according to coronary angiographic findings: 30 patients with significant stenosis (70 percent or greater luminal narrowing) of at least one major vessel and 27 with no significant coronary artery disease. There was no difference in age, presenting symptoms or previous medical treatment between the two groups. There were more men in the group with coronary artery disease. Exercise-induced S-T changes were similar in the two groups; the sensitivity and specificity of these changes for the diagnosis of coronary artery disease were unacceptable irrespective of the criterion chosen. With additional S-T depression of either 1 or 2 mm below the baseline value, the predictive accuracy was only 53 percent. Combined exertional chest pain and 1 mm S-T depression increased the predictive accuracy of exercise testing to 71 percent. These data indicate that exercise-induced electrocardiographic changes do not facilitate detection of coronary artery disease in patients with complete left bundle branch block.


Coronary artery disease in young women: clinical and angiographic features and correlation with risk factors. Coronary arteriography was performed because of suspected coronary disease in 239 women less than 45 years of age. Normal coronary arteries were found in 112 women, and a further 23 had insignificant stenosis (less than 50 percent narrowing of luminal diameter). Of the remaining 104 women, 56 had one vessel, 22 two vessel and 26 three vessel disease. Hyperlipidemia, hypertension, diabetes, smoking and a family history of coronary disease were significantly more frequent in women with significant stenosis than in women with normal arteries. Significant coronary disease was found in 55 percent (100 of 182) of women with more than two risk factors but in only 7 percent (4 of 57) of those with less than two risk factors (P less than 0.0001). Evaluation of symptoms and the resting electrocardiogram also discriminated between women with and without coronary disease, but exercise testing was of little value. Only 4 of the 46 women with previous myocardial infarction had normal or near-normal coronary arteries. Among women with segmental wall motion abnormalities on ventriculography, the site was anterior in 90 percent (19 of 21) of women who used oral contraceptive drugs but in only 60 percent (21 of 35) of nonusers (P less than 0.05). However, in most respects, coronary artery disease in young women does not appear to differ from coronary disease in other patients.


Nonobstructive coronary thrombosis in sudden cardiac death. Careful histologic studies were performed on the coronary arteries, myocardium and conduction system of the hearts of six men aged 32 to 44 years who died suddenly with no history of heart disease. All six hearts demonstrated coronary atherosclerosis without evidence of complete obstruction or myocardial infarction. A nonobstructing mural coronary thrombus was found in all six hearts; in four, the thrombus was located in the left anterior descending coronary artery. Distal microthrombi were found in four hearts. In these six men, the terminal event, often a ventricular arrhythmia, may have been related to the mural coronary thrombus. Small fragments originating from such lesions can obstruct the microcirculation producing sudden lethal arrhythmias. Nonobstructing mural coronary thrombosis may be more prevalent and more significant than previously suspected and should be considered in cases of sudden cardiac death.


Association of left dominant coronary arterial system with congenital bicuspid aortic valve. Clinical angiographic studies have documented an association of left dominance of the coronary arteries with aortic stenosis and congenital bicuspid aortic valve. The postmortem arteriograms of 973 autopsy patients were reviewed for pattern of coronary dominance and the hearts examined for the nature of any aortic valve disease. There were 673 hearts (70 percent) with a right dominant pattern, 198 (20 percent) with equal dominance and 102 (10 percent) with left dominance. Of 34 hearts with congenital bicuspid aortic valve, 10 (29 percent) had left dominance, a difference significant at the 0.005 level. Of 44 hearts with calcific aortic stenosis, an acquired valve lesion, 9 (20 percent) had left dominance. Rheumatic aortic valve disease (47 cases) and aortic regurgitation (27 cases) had no apparent relation to the coronary arterial pattern. The results confirm the association of left coronary arterial dominance with congenital bicuspid aortic valve. It is suggested that a left dominant coronary system may arise as a consequence of disproportionately decreased blood flow in the left heart chambers, one cause of which is aortic valve stenosis, during early cardiogenesis.


Problems in ultrasonic estimates of septal thickness. Problems related to cardiac anatomy and ultrasonic instrumentation affect the accuracy of echographic identification of endocardial echoes. A cadaver model and 13 patients were studied, with direct identification or with the aid of echographic contrast techniques, to identify accurately the endocardial echo. The study showed that (1) echographic contrast agents delineate an endocardial echo in the central portion of the ultransonic beam; (2) a specular reflector exists within the right ventricular cavity; (3) specular reflectors within the septum may give the false appearance of border-forming echoes; (4) septal thickness varies by 1 to 5 mm after the endocardial echo has been identified by the contrast agent; and (5) spurious echoes, related to a wide beam angle, can be confused with the endocardial echo. In light of these problems, three criteria were utilized for endocardial echo identification: the prominent notch in the left septal echo, the specular quality of the right septal echo, and the association of multiple myocardial echoes moving in parallel. With these criteria, the endocardial echoes in 11 of the 13 patients could be accurately identified without the use of a contrast agent. The identification of these problems should provide helpful guidelines in developing more accurate and reproducible criteria for septal thickness measurements.


Cerebrovascular abnormalities in postoperative coarctation of aorta. Four cases demonstrating left subclavian steal on aortography. Fifteen children, aged 0.3 to 10.5 years (mean 3.8 years) after repair of coarctation of the aorta, underwent cerebral arteriography as part of postoperative catheterization. Four manifested central nervous system symptoms postoperative catheterization. Four manifested central nervous system symptoms postoperatively: Two had persistent headaches, one had exercise-induced hemianopsia and one had major motor seizures. All four had greater blood pressure in the right arm than in the left and evidence of subclavian steal, with retrograde filling of the left vertebral and left subclavian arteries on selective right vertebral arteriography. Ligation of the left vertebral artery in three patients and left subclavian graft arterioplasty in one resulted in disappearance of symptoms. None of the 11 asymptomatic patients manifested cerebrovascular anomalies, and no patient in the series had berry aneurysm. This study suggests that patients with central nervous system symptoms and a disparity of blood pressure in the arms after surgery for coarctation of the aorta should be evaluated carefully to exclude subclavian steal as the cause of the symptoms.


Evidence of a role for cell death in the disappearance of the embryonic human tail. The development and disappearance of the human tail between stages 14 and 22 were studied using scanning and transmission electron microscopy, supravital staining and light microscopy. The tail is a prominent feature of the human embryo during stage 14 and is composed of paired somites, mesenchyme and extensions of the neural tube, notochord and gut. The tail grows with the embryo through early stage 17 when it extends more than a millimeter from the trunk. Overgrowth by the trunk at the base of the tail may account for the loss of part of its length during late stage 17 and stage 18. However, during stage 17 cells begin to die in all structures throughout the tail. Cell death continues in the succeeding stages reaching massive numbers by stages 18 and 19, and the tail becomes less and less prominent with developmental time. Most of the dead cells are phagocytosed. The debris-laden macrophages appear to migrate from the tail to the body. By late stage 21 or early stage 22 there is no free tail. We conclude that cell death has a major role in the destruction of tail structures and the concurrent loss of the human tail.


Effect of vitamin A and methylprednisolone on canine prostate in organ culture. Organ explants from the canine prostate with and without methylprednisolone pretreatment were cultivated for ten days in Trowell's T-8 medium or medium supplemented with testosterone and/or vitamin A. Upon termination of the experiments, explants were fixed and examined histologically. All glands from the most central section of each explant were graded according to epithelial type, and from these grades the proportion of acini with maintained columnar cells was calculated for each explant. Stromal cellular maintenance was also estimated. While a small proportion of explants from the vitamin-treated and methylprednisolone-pretreated groups showed epithelial maintenance, a combination of these treatments significantly increased such maintenance. Stromal maintenance was enhanced with methylprednisolone pretreatment but not by vitamin A. These results are in accord with the hypothesis that methylprednisolone acts to stabilize the lysosomal membrane, thus protecting tissue against the effects of ischemic shock. In protected explants vitamin A is able to maintain a columnar glandular epithelium. In a subsequent experiment a series of linoleic acid dosages was tested in the presence or absence of vitamin A. In neither case was this fatty acid of value in improving epithelial or stromal maintenance.


A freeze-fracture study of exocytosis and reflexive gap junctions in human ovarian decidual cells. Fine-structural features of ovarian decidual cells and their mode of secretion were examined by means of freeze-fracture microscopy. Unique cortical peduncular processes contained secretory vesicles within the expanded peduncle tip, the membrane-leaflets of which exhibited a particle-poor E face adjacent to the vesicle lumen and a P face containing a greater particle number. Exocytosis from attached peduncles involved release of vesicular profiles 40-55 nm in diameter; small particles 8.5-11.5 nm in diameter were also observed at degranulation sites. In fractures revealing the E face of the plasmalemma, cytoplasmic portals at the bases of peduncular stalks were distinguishable from endocytic vesicles. The frequent occurrence of reflexive gap junctions associated with peduncles was shown by freeze-fracture. However, there appeared to be no consistent spatial relationship between gap junctions, secretory peduncles, or sites of exocytosis. Freeze-fracture analysis of the topography of reflexive gap junctional profiles revealed that such gap junctions share basic similarities with intercellular gap jum particle-free aisles. The finding in the present study of reflexive gap junctions occurring between peduncles and the cell soma, as well as between peduncles, suggests that the original definitiof the same cell should be broadened to include any gap junctional specialization formed between portions of the plasma membrane of one cell.


The annular hematoma of the shrew yolk-sac placenta. The annular hematoma of the shrew, Blarina brevicauda, is a specialized portion of the yolk-sac wall. In this study, we have examined the fine structure of the different cellular components of the anular hematoma. Small pieces of the gestation sacs from seven pregnant shrews were fixed in glutaraldehyde and osmium tetroxide and processed for transmission electron microscopy. In the area of the trophoblastic curtain, the maternal capillary endothelial cells were hypertrophied and syncytial trophoblast surrounded the capillaries. Cellular trophoblast covered part of the luminal surface of the curtain region, whereas masses of apparently degenerating syncytium were present on other areas of the surface. Maternal erythrocytes, released into the uterine lumen from the curtain region, were phagocytized and degraded by the columnar cells of the trophoblastic annulus. No evidence of iron or pigment accumulation was evident in the parietal endodermal cells underlying the annular trophoblast. Parietal endodermal cells were characterized by cuboidal shape, widely dilated intercellular spaces, and cytoplasm containing granular endoplasmic reticulum. Endodermal cells of the visceral yolk-sac accumulated large numbers of electron-dense granules as well as glycogen in their cytoplasm. Hemopoietic areas and vitelline capillaries were found subjacent to the visceral endoderm. The various portions of the yolk-sac wall of Blarina appear to perform complementary functions which are probably important in maternal-fetal iron transfer.


Decidual cells in the human ovary at term. I. Incidence, gross anatomy and ultrastructural features of merocrine secretion. Decidual tissue occurring within the human ovarian cortex was examined by light and electron microscopy. Of 21 ovarian specimens obtained at term (36-42 weeks of gestation), decidual cells were confirmed in each. Decidual cells were found within the tunica albuginea as single cells, in nodules, in polyps or in confluent sheets. Decidual cells exhibited several characteristics of cells engaged in secretory activity: abundant rough and smooth endoplasmic reticulum, numerous profiles of the Golgi complex and a large, euchromatic nucleus devoid of heterochromatin and displaying a prominent fibrous lamina. Peduncular protrusions at the periphery of the cell contained numerous dense bodies 0.4-0.9 micron in diameter. These dense bodies were bounded by a single membrane and contained granular subunits 30-60 nm in diameter. These granular subunits were observed in the process of apparent exocytosis, as well as free in the extracellular space. Secretory bodies and their granular content also were observed both in the region of the Golgi complex and partially extruded into peduncular processes. By far the greatest number of secretory bodies occurred within peduncular processes where they may be stored prior to release. Migration of a secretory body into a peduncular process and exocytosis from such a process appears to be an unusual mode of meocrine secretion, perhaps unique to decidual cells.


Synthesis and migration of glycoproteins in cells of the rat thymus, as shown by radioautography after 3H-fucose injection. Young male rats received a single intravenous injection of 3H-fucose and were killed after various time-intervals. Light- and electron-microscopic radioautographic studies of the thymus in animals killed shortly after injection showed that all of the different cell types present incorporated 3H-fucose label. The heaviest uptake occurred in macrophages and in hypertrophic epithelial cells located near the cortico-medullary border. Somewhat lighter incorporation was observed in medullary and cortical stellate epithelial cells and in cells designated as special cells, while the lightest reaction appeared over lymphocytes. In all cells the label was localized initially to the Golgi apparatus, where, presumably, it was incorporated into glycoproteins. With time, some of the labeled putative glycoproteins in all cell types migrated to the plasma membrane. In macrophages, much of the label migrated to lysosomal bodies, while in the special cells the label migrated to dense bodies which may also be of lysosomal nature. In stellate and hypertrophic epithelial cells much of the label migrated to characteristic vacuoles. The possible relationship between the observed glycoprotein synthesis in these cells and hormone production is discussed.


Immunocytochemical localization of thyroglobulin in the endostyle of the anadromous sea lamprey, Petromyzon marinus L. Thyroglobulin (TG) was localized in the endostyle of the anadromous sea lamprey, Petromyzon marinus L. by means of the unlabeled antibody peroxidase-antiperoxidase immunocytochemical method. TG was found localized on the apical surface and within the cytoplasm of type 2c and 3 cells and in some type 5 cells. By identifying the cells of the endostyle immunocytochemically it may be possible to study more readily the events of endostylar transformation during metamorphosis.


Dendritic atrophy in the dentate gyrus of the senescent rat. Quantitative electron microscopic analysis of the supragranular zone of the dentate gyrus molecular layer has shown that the number, volume fraction and surface area of dendritic shaft profiles are significantly decreased in senescent rats, relative to young adults. These modifications of dendritic morphology, which are not associated with age-related changes in dimensions of the molecular layer or in numbers of granule cells, may result from a decrease in the number and/or length of dendrites. In either case, the decreases in the number, volume fraction and surface area of dendritic shaft profiles found in the dentate gyrus of senescent rats signify an age-related atrophy of dendrites. Comparison of changes in the number and volume fraction of dendritic shaft profiles has demonstrated that age-related dendritic atrophy involves predominantly dendritic branches.


Morphological changes in isolated lymphocytes during preparation for SEM: freeze drying versus critical-point drying. A quantitative comparison of isolated lymphocytes prepared for SEM by the critical-point drying (CPD) and freeze drying (FD) methods revealed that the mean cellular diameter dropped from 7.9 micron after fixation to a final diameter 6.9 micron after FD, and to 5.7 micron after CPD. In addition to their larger sizes, FD lymphocytes were immediately distinguishable by their more complex surfaces, featuring wider microvilli which often emanated from ridges on the cell surface and branched extensively near their bases. The mean width of microvilli was 0.22 micron after FD and 0.12 micron after CPD. The number of microvilli per cell was essentially the same by the two methods. In view of these findings, a critical comparison of the CPD and FD methods using the particular cells or tissue to be investigated is an essential prelude to a rigorous SEM study.


Myology of the shoulder of Pontoporia blainvillei, including a review of the literature on shoulder morphology in the cetacea. The purpose of this paper is to describe in detail the shoulder myology of the La Plata River Dolphin, Pontoporia blainvillei, and to review the literature on cetacean shoulder myology. Three fetal and one adult animal were used for the collection of morphological information. Pontoporia is less specialized in its shoulder anatomy that most delphinid cetaceans, and shares several characteristics with some mysticetes. The omohyoid and anterior serratus anterior muscles are found in both Pontoporia and the mysticete Balaenoptera, but are absent in most delphinids. The pectoralis abdominalis and three rhomboideus divisions are found in Pontoporia and Kogia, but in only a few delphinid species described in the literature. It is suggested that these characteristics are associated with a generalized use of the forelimb in Pontoporia.


Sexual differences among duodenal glands of hamster. This histochemical study was undertaken to determine whether sexual differences existed in the duodenal glands of hamster. Alcian blue staining and atomic absorption spectrophotometry (for copper content of the bound Alcian blue) showed the duodenal glands of males to contain about double the acid mucosubstance of the female glands. Periodic acid Schiff staining was stronger in the females over a larger portion of the gland than in males. It was concluded that sexual differences were evident in duodenal glands of hamster.


Phagocytosis of photoreceptor outer segments during retinal development in utero. The retinal pigmented epithelium of the fetal guinea pig was examined for evidence of phagocytosis and degradation of outer segments. Beginning at the early stages of outer segment formation and continuing through the remaining fetal period, pigment epithelial cells contained large and small phagosomes with multi-lamellated internal structure. Thus, mammalian retinal photoreceptor cells which normally develop and mature in utero in the absence of light undergo a process of phagocytosis of outer segemnt fragments comparable to that found in species whose retinae mature postnatally outside of the uterus.


Assessment of protein reserves (cellular mass) in Aboriginal children. The body protein reserves, assessed indirectly by the measurement of intracellular water, was determined in free-living Aboriginal children and adolescents located in Central and Northwestern Australia. Fifty one individuals were studied--31 males and 20 females. Significant reductions were observed in intracellular water or cell mass relative to the cube of body length for Aboriginal females when compared to a control female group. Only marginal or borderline differences for the same parameters were observed when Aboriginal males were compared with controls. Comparison of Aboriginal females with Aboriginal males demonstrated significant reductions in cell mass (intracellular water) relative to body length cubed in the female. This finding in the Aboriginal female is of concern because many become pregnant in the early teenage years. Evidence was found during the course of this study that plasma zinc concentrations were frequently low. This led to a concomitant study on serum and plasma trace metals in two Aboriginal settlements (364 individuals) to be published in a subsequent paper.


The influence of a wide range of absorbed cholesterol on plasma cholesterol levels in man. The influence of absorbed dietary cholesterol on plasma cholesterol concentration was studied in two populations, one Seventh Day Adventist (SDA) vegetarian and one nonvegetarian, representing a broad range of plasma cholesterol values and dietary cholesterol intakes. As a group, the SDA vegetarians had significantly lower levels of plasma cholesterol and triglycerides than did the nonvegetarians. This hypolipidemic pattern in the SDA vegetarians was apparently closely related to dietary habits, sinceanother group of SDA who were nonvegetarian had significantly higher plasma cholesterol and triglyceride levels than their vegetarian counterparts. Both the dietary intake of cholesterol and the percentage absorption of cholesterol were lower in vegetarians than in nonvegetarians. The mass of cholesterol absorbed increased linearly with the mass of cholesterol ingested in all groups, but no relationship could be demonstrated between absorbed cholesterol and plasma cholesterol concentration.


Metabolism and recycling of urea in man. The rate of breakdown and reutilization of urea in man has been measured in five normal and two septic patients using 15N and 13C labeled ureas. The labeled molecules of the 15N urea dose were distinguished from the labeled molecules of the recycled urea by analyzing in a mass spectrometer the isotopic nitrogens produced when the recrystalized urine urea was treated with a hypobromite solution. In a normal subject with regular nitrogen intake, it was found that only 4/5 of the produced urea was excreted in urine and the rest was endogenously degraded. Seventy percent of the nitrogen and 63% of the carbon of the degraded urea were returned to the urea pool. On a nitrogen-free diet or after neomycin treatment with regular diet in the normal, the extent of urea splitting is considerably reduced. In the septic patients, breakdown, as well as recycling of urea was almost eliminated. It appears that the reate of endogenous catabolism of urea depends mainly on the activity of the gut flora which may be affected by dietary intake and clinical status of the subject. The method developed here could be applied for the quantitation of urea dynamics under different physiological and pathological conditions.


Vitamin B6 status of the hospitalized aged. Nutritional status of vitamin B6 was investigated in two groups of 102 hospitalized aged. Vitamin B6 intake was estimated. Erythrocyte glutamic-pyruvic transaminase stimulation in vitro with pyridoxal phosphate and SGOT were studied as the biochemical criteria of vitamin B6 status: 18.6% of the subjects consumed less than 0.66 mg of vitamin B6 per day; 28.4% showed a percentage stimulation in vitro with pyridoxal phosphate of more than 15%. There was no significant correlation between basal erythrocyte glutamic-pyruvic transaminase activity and dietary protein, dietary vitamin B6 dietary vitamin B6/100 g of protein, SGOT, hemoglobin, mean corpuscular volume, and iron. All the biochemical parameters used for evaluating vitamin B6 status appeared higher in females, but no statistical difference between male and female groups was noted. Only SGOT levels of female subjects reflected their vitamin B6 status. A large individual variation of vitamin B6 requirement was indicated in both groups studied. Supplements with 2.5 mg of vitamin B6 to deficient subjects caused an increase in transaminase levels, though females showed a higher response. A higher recommended allowance of vitamin B6 for the aged male and female subjects was considered desirable.


Vitamin B6 status of Nigerian women using various methods of contraception. The vitamin B6 status of Nigerian women, and the effects of three contraceptive methods--intrauterine contraceptive device, injectable progestogen, and combination estrogen-progestogen oral contraceptive pills--on the vitamin B6 status of these women were assessed by measuring the erythrocyte alanine aminotransferase (Ala-AT) activity both with and without in vitro stimulation by pyridoxal-5'-phosphate. The unstimulated Ala-AT activity and the Ala-AT index (ratio of pyridoxal-5'-phosphate-stimulated:unstimulated activity) were used as indications of vitamin B6 status. The criterion for vitamin B6 deficiency was an Ala-AT index greater than 1.25. Of the 238 women in the total sample, 11% were judged to be deficient. There were no significant differences in the mean Ala-AT activity, mean Ala-AT index or rate of deficiency foun in the control and three contraceptive groups. The absence of an effect of oral contraceptives on vitamin B6 status is in contrast with other cross-sectional studies, but in agreement with controlled longitudinal studies. The packed cell volume and reticulocyte count were also measured and were significantly affected by contraceptive steroids, but these effects are not thought to be of clinical importance.


Magnesium levels in patients with chronic ischemic heart disease. Serum magnesium was measured in 89 control subjects ages 19 to 86 years and in 64 patients (ages 35 to 82 years) who had suffered from acute myocardial infarction at least 6 months previously. No differences were found in the serum magnesium levels due to age or sex nor was there any statistical difference between the mean levels in the two groups. It is concluded that the level of serum magnesium is not associated with the presence or absence of clinically evident ischemic heart disease.


Iron absorption from South-East Asian diets and the effect of iron fortification. The increase in iron absorption was measured when different amounts of ferrous sulphate were added to rice-based South-East Asian meals. The study comprised 158 subjects--118 women and 40 men. Iron fortification of simple meals composed of rice, boiled vegetables, and a curry to a level of 5 mg of iron per meal increased the absorption by about 0.2 to 0.3 mg of iron per meal. The additionof fish to such a meal doubled the absorption increase at a fortification level of 5 mg per meal. This absorption increase was about the same as obtained with composite western-type meals containing fish or meat. The results indicate that iron fortification programs may be effective in countries with rice-based diets provided that there is a suitable vehicle available for fortification.


Zinc nutrition and growth in a childhood population. Plasma zinc concentrations are a useful indicator of the zinc nutritional status in humans. This study was designed to evaluate plasma zinc levels in a population stressed by a low-income diet and rapid growth. Plasma zinc concentrations of an inner city childhood population are analyzed by polynominal regression analysis. The resultant age-related plasma zinc curves for male and female subjects are markedly different. Concentrations are lowest during the years of rapid growth, infancy and puberty. The growth velocities (growth indices) of these two populations are calculated and mirror the variation of plasma zinc concentrations. The data suggest that lowered plasma zinc concentrations result from inadequate zinc nutrition during periods of rapid growth.


Selenium concentration and glutathione peroxidase activity in blood of New Zealand infants and children. The blood selenium (Se) concentrations of New Zealand children were lower than those reported for children living in other countries. This low blood Se was primarily determined by the low dietary intake of the children which, in turn, reflects the low Se content of New Zealand soils. Blood Se also varied geographically, with age, and with differences in quantities and types of food eaten. Children with phenylketonuria and maple syrup urine disease on synthetic diets had low Se intakes and blood Se concentrations compared with children on normal diets, and blood Se was seen to decrease with the length of time on these diets. A strong correlation (r = 0.62, P less than 0.001) was found between the blood Se levels and glutathione peroxidase activities for 107 children. Glutathione peroxidase activities of the children were lower than activities observed in New Zealand adults, refelecting their lower blood Se concentrations.


Triglycerides in clinical medicine. A review. There have been many relevant advances in our knowledge of triglycerides as they apply to clinical medicine. Some of the basic concepts of triglyceride metabolism are reviewed in a context of clinical applicability. Hypertriglyceridemia may be associated with dramatic symptoms and signs such as acute abdominal pain, hepatosplenomegaly, and neuromuscular abnormalities, or it may be asymptomatic until an atherosclerotic complication occurs. There is an increased risk of atherosclerosis with elevated endogenous triglycerides, but it is not clear if this is due to triglycerides per se, or the cholesterol content of the common lipoprotein that transports both lipids. Serum triglycerides are affected by diverse underlying disorders. Several factors play a role in the pathogenesis of hypertriglyceridemia including diet, body weight, genetic influences, glucose metabolism, and insulin concentrations. Treatment by diet and/or drugs is quite effective in relieving many of the clinical manifestations of hypertriglyceridemia. Whether a beneficial effect also occurs in atherosclerosis is still unknown.


Nutritional status of selected teenagers in Kentucky. A nutrition survey was conducted in a six-county area of Kentucky which included 118 teenagers of both races and sexes, with a mean age of 15.5 years. Data collected included one 24-hr dietary recall, meal practices, smoking, and physical activity. Fasting blood and urine were analyzed. White boys had higher intakes in overall nutrients and had more regular meal taking habits than others. Intakes of calcium, iron, and vitamin A were grossly deficient among girls of both races, and vitamin A was most deficient in diets of boys, but the serum vitamin A and carotene values did not confirm a dietary deficiency of vitamin A. Black teenagers of both sexes had less acceptable mean hemoglobin and hematocrit values. High incidences of low hemoglobin values below acceptable range were observed in all groups studied. A high incidence of overweight among girls of both races, of high blood pressure in black boys, and of elevated serum cholesterol and beta-lipoprotein levels in blacks of both sexes were observed. Intake of energy was correlated with work metabolic rate/basal metabolic rate ratio for both sexes. Blacks were less physically active than whites. Serum cholesterol, triglyceride and beta-lipoproteins were positively correlated (P less than 0.01) to body weight of girls. Serum cholesterol and beta-lipoproteins were negatively correlated (P less than 0.05) to the degree of physical activity of boys.


Dietary assessment of coal miners in southern Illinois. A survey was conducted in southern Illinois with a population of 46 coal miners and ex-coal miners ranging in age from 42 to 86 years. All the subjects were suffering from some degree of respiratory insufficiency. Three 24-hr dietary recalls were obtained from each participant and the mean daily intakes of 11 nutrients and calories were calculated by computer. Selected hematological analyses of blood were performed. Dietary intakes of calcium, vitamin A, and vitamin C were lowest within the population sample. The mean blood values indicative of iron status were within normal range. Physical inactivity among some of the miners accompanied by inadequate calcium intakes could predispose them to calcium-related skeletal infirmities. Inadequate intakes of vitamin A by the majority of subjects were particularly significant in this population. The role of vitamin A in maintaining healthy epithelial tissues is discussed and its possible association with a coal miner's susceptibility to pulmonary complications resulting from chronic exposure to coal dust. The results emphasize the value of assessing the nutritional status of individual coal miners and the need for personal dietary counseling.


Serum cholesterol levels in the population of Punjab in north west India. In an epidemiological survey the serum cholesterol levels of 3057 persons belonging to the middle or lower socioeconomic groups were checked. None of these persons suffered from any disease that might affect the lipid metabolism. The values varied according to the age: in children and adolescents 133.46 mg/dl (3.45 mmole/liter); in adults 160.82 mg/dl (4.15 mmole/liter); in persons over 50 years of age 181.02 mg/dl (4.68 mmole/liter). No differences were found between the sexes. Three smaller, highly selected groups showed higher levels. Among 324 obese persons the mean values appeared around 20 mg/dl higher per age group. 168 individuals from higher social classes had readings between 204.25 to 232.85 mg/dl (5.29 to 6.03 mmole/liter), depending on the age. In 311 patients with diseases of the cardiovascular system the mean cholesterol levels were 215.45 mg/dl (5.58 mmole/liter). The average caloric intake per day of the population of Punjab is highest all over India (2500 cal). Most of the calories derive from wheat and cereals, only 20 to 25% from milk and milk products. This, and the fact, that most people have normal weight, might explain why the serum cholesterol levels in the population of Punjab do not differ much from findings in other, less developed state of India.


Determinants of fasting and postprandial serum bile acid levels in healthy man. The relationship between serum levels of conjugates of cholic acid measured by radioimmunoassay, bile acid absorption, and hepatic clearance was studied in order to define the determinants of fasting and postprandial serum bile acids in healthy man. Acute or chronic interruption of the enterohepatic circulation caused a significant decrease in basal serum levels of cholyl conjugates, while liquid or solid meals caused a marked and reproducible increase in serum cholyl conjugates. A temporal correlation was demonstrated postprandially or after intravenous cholecystokinin between intestinal transit of bile acids and simultaneous changes in levels of serum cholyl conjugates. Finally, the plasma disappearance of intravenously injected cholylglycine was shown to be unaffected by serum levels of endogenous cholyl conjugates. These data are consistent with the interpretation that, in the presence of normal hepatic function, the major determinant of serum bile acids is their rate of intestinal absorption.