Analytic methods in matched pair epidemiological studies. Two methods  of analysis of matched pair epidemiologic studies are presented. The within pair difference between study and comparison individuals is evaluated with respect to additional confounding variables while simultaneously maintaining the matching. The effects of additional confounding variables are quantiated by their association with the response variable (i.e. exposure in a case-control study or disease in a cohort study). For a binary response variable a multiple logistic function is used and a method to estimate the odds ratio is given. For a continous response variable multiple regression is used and a method to estimate an odds ratio function is derived.


An improper use of statistical significance testing in studying covariables. How badly a covariable confounds the association between a disease and a primary trait depends on the strength of two other associations: between covariable and disease, and between covariable and primary trait. To assess the confounding potential by testing one of these associations for statistical significance, using a 'traditional' critical level, is inadequate. Such a preliminary test places the burden of proof in the wrong direction, ignores a major aspect of confounding potential, and may be inappropriately influenced by other factors. If it must be used at all, the significance level should be 0.25 or 0.50, possibly even higher.


Epidemiology 101: the new frontier.

Epidemiology 101: the new frontier. An introductory course in epidemiology for pre-baccalaureate junior and senior undergraduate students is described as part of a Public Health Option programme. The course was similar to that given in schools of public health with additional material on vital statistics. It was well received by the students and stimulated several students to enter graduate programmes in epidemiology in schools of public health. Epidemiology has now matured as an independent scientific discipline so that consideration should be given to establishing University Departments of Epidemiology similar to those in such fields as statistics and biology.


The adipocyte volume in human adipose tissue: II. Observations in diabetes mellitus, primary hyperlipoproteinemia and weight reduction. Body-weight index does not appear suitable as a measure of metabolic risk, since the prevalence of diabetes mellitus, hypertriglyceridemia and hypercholesterolaemia increases only up to a Broca index of 1.2. Attempts were therefore made to demonstrate an abnormal adipocyte enlargement in the subcutaneous adipose tissue of the abdomen in patients suffering from various metabolic disorders. To eliminate the influence of sex and body-weight index, normal curves of the adipocyte volumes in 142 controls were used as basis of comparison. Adipocyte hypertrophy exceeding the degree predicted by the normal curves was observed in patients with subclinical diabetes (n = 20), patients with maturity-onset diabetes (n = 56) and in patients suffering from hyperlipoproteinemia of type IIb (n = 10), type III (n = 8), type IV (n = 42) and type V (n = 24). Excessive hypertrophy could not be detected, however, in juvenile-onset diabetics (n = 11) and in hyperlipoproteinemia type IIa (n = 9). Weight reduction gave further insight into excessive adipocyte hypertrophy. This was effected by reducing caloric intake combined with physical exercise for four to five weeks until 10 per cent of initial weight was lost. Adipocyte shrinking per kg loss of body weight was significantly more pronounced in patients suffering from subclinical diabetes (31 pl/kg,n = 10), from maturity-onset diabetes (26 pl/kg,n = 23) and from hypertriglyceridemia (17 pl/kg, n = 11) in comparison with the controls (7 pl/kg,n = 25).


Factors determining weight loss in obese patients in a metabolic ward. A metabolic unit is described in which it is possible to make controlled measurements of energy balance in patients with various types and degrees of obesity. Thirty-seven obese women were studied for three consecutive one-week periods on a diet which provided an average of 3.4MJ (800 kcal) daily, and some also undertook an exercise programme involving the expenditure of 850--1275 kJ (200--300 kcal) extra per day. The distribution of energy intake was varied from week to week, and within the day (nibbling and gorging), but neither these variations in dietary pattern nor the exercise programme significantly affected the total weight loss over the three-week study period. Very large variations were observed between individuals. Total weight loss over the three-week study period ranged from 1.6 to 9.8 kg. The best predictor of weight loss in a patient on a strictly controlled diet is the resting metabolic rate. The previous diet also affects weight loss: patients who had been keeping to a reducing diet before admission lost less weight, especially in the first week, than those who had not been dieting immediately before admission to hospital.


Abnormal dentition and decrease in body weight in the genetically obese mouse (genotype, ob/ob). Loss of body weight accompanied by cannibalism occurred in obese mice (genotype, ob/ob) at seven months of age. The onset was sudden. The animals had accompanying abnormalities of their incisor teeth. Some upper incisor teeth had no erupted part. The unerupted part of all the incisor teeth showed ridged thickening. Body weight loss was prevented by grinding the pelleted food to a powder. Possible causes of the teeth abnormalities are discussed.


Circular dichroism spectra of isolated soybean and chickpea trypsin-chymotrypsin inhibitors. Circular dichroism spectra of trypsin-chymotrypsin inhibitors from soybeans and chickpeas have been determined in acidic, neutral and highly alkaline solutions. Neither protein contains alpha-helix although a small amount of beta-structure cannot be excluded. Negative dichroism above 250 nm has been assigned largely to disulfide bonds in both molecules with neither showing evidence for tyrosine residues buried in hydrophobic regions. The spectra of these inhibitors between 230 and 250 nm have been compared with the spectra of a number of structurally related proteins suggesting that previous interpretations of this region may have been incomplete or incorrect.


Removal of t-butyl and t-butoxycarbonyl protecting groups with trifluoroacetic acid. Mechanisms, biproduct formation and evaluation of scavengers. The trifluoroacetic acid-mediated removal of t-butyl groups in protected amino acids leads to the formation of t-butyl trifluoroacetate. This t-butyl ester alkylates in trifluoroacetic acid methionine and tryptophan. The t-butyl trifluoroacetate ester can be destroyed by scavengers commonly employed for t-butyl cations, and the reaction rates of the scavengers with the ester are used in the evaluation of scavengers. Scavengers of sulphide structure react with t-butyl trifluoroacetate to form sulphonium compounds, which possess alkylating properties. In the presence of a scavenger during acidolysis, the trifluoroacetic acid and the scavenger will compete in reacting with the t-butyl cations. Kinetic studies show comparable reaction rates with thiophenol as scavenger. The usefulness of adding scavengers to trifluoroacetic acid in deblocking reactions is due to the removal of t-butyl trifluoroacetate in addition to the removal of t-butyl cations. Isobutene reacts with trifluoroacetic acid and yields t-butyl trifluoroacetate. The reaction reaches an equilibrium displaced in favour of the ester at room temperature. Hence no isobutene can be expected to escape during a deblocking reaction in trifluoroacetic acid.


Isolation and partial sequence of the cyanogen bromide peptides from calf thymus non-histone chromosomal protein HMG 1. Peptides produced by cyanogen bromide cleavage of non-histone chromosomal protein HMG 1 have been isolated and characterized, and their partial sequences determined. The sequence data presented here account for over half of the sequence of the HMG 1 molecule and, together with previously published results, provide interesting information on the charge distribution within the molecule.


Side reactions in peptide synthesis. IX. Suppression of the formation of aminosuccinyl peptides with additives. The base-catalyzed ring closure of beta-benzylaspartyl peptides was efficiently suppressed by the addition of phenols (with electron-withdrawing substituents) to the reaction mixtures. From a series of compounds tested, 2,4-dinitrophenol and pentachlorophenol were the most effective. No direct relationship was found between the acidity of the additives and their ability to suppress the formation of aminosuccinyl peptides. The applicability of 2,4-dinitrophenol and pentachlorophenol in practical syntheses was also examined.


Purification and characterization of an acid protease from Monascus kaoliang. An acid protease from Monascus kaoliang was purified by consecutive applications of fractional acetone precipitation, batchwise CM-cellulose method and DEAE-cellulose column chromatography. The preparation was homogeneous on disc polyacrylamide gel electrophoresis at pH 4.5 and 7.5. The yield was about 30% with overall increase in specific activity of about 6-fold. The molecular weight as determined by SDS gel electrophoresis was about 34,000. The enzyme was a glycoprotease as indicated by specific carbohydrate staining on gels. It possessed the nature of an acid protease with a pH optimum at 3.0 toward heat-denatured casein and was stable over the range of pH 3.0 to 6.0. Reducing agents and thiol poisons had no effect on this enzyme, suggesting that free sulfhydryl groups were not required for enzyme activity. Diisopropyl fluorophosphate did not inactivate this protease, indicating the probable absence of serine residue in the active site. The enzyme was inactivated by reaction with the carboxy-group specific reagent, 1,2-epoxy-3-(p-nitrophenoxy) propane (EPNP). Pepstatin, a specific inhibitor for pepsin, was shown to inhibit this enzyme strongly. However, biacetyl (2,3-butadione) had little effect on this protease, although it inactivated pepsin to an 85% activity loss. Also, p-bromophenacyl bromide, another specific inhibitor of pepsin, failed to inactivate this acid protease.


Purification and properties of non-precipitating antibodies to cobrotoxin. The heterogeneity of precipitating and non-precipitating antibodies to cobrotoxin was demonstrated by their elution pattern on cobrotoxin-Sepharose and chromatography on DEAE-cellulose column. Gel filtration patterns on a Sepharose 6B column revealed that the soluble complexes formed from non-precipitating antibody and HNB-cobrotoxin at a different molar ratio all emerged in the void volume, indicating that the molecular weight of the soluble complex is around 4,000,000 or larger. Unreacted free non-precipitating antibody coincided with the peak of IgG and was proved to be free from HNB-cobrotoxin. The molar ratio of antibody to antigen for the soluble complex was found to be 0.79 to 0.97 indicating that 1.58--1.94 molecules of non-precipitating antibody are bound to HNB-cobrotoxin instead of three molecules as in the case of precipitating antibody.


Isolation of antitumor proteins abrin-A and abrin-B from Abrus precatorius. Two toxic proteins were purified from the seeds of Abrus precatorius by DEAE-A 50 and Sepharose 4B chromatography. One of them does not bind on the Sepharose 4B column (Abrin-b) and the other (Abrin-a) is eluted with 0.2 M galactose. The amino acid compositions and tryptic maps of these two proteins were similar, but not identical. The molecular weights estimated by SDS-gel electrophoresis were 67,000 for abrin-b as compared with 65,000 for abrin-a. In the presence of mercaptoethanol, both abrin-a and abrin-b gave rise to two bands. The lethal doses of abrin-a and abrin-b for mice recorded within 48 h were 10 and 25 microgram per kg of body weight respectively. Abrin-a at 0.8 microgram per ml concentration level agglutinated human 0-type erythrocytes, whereas abrin-b showed no such activity. Abrin-a at 5 microgram per ml concentration level agglutinated both the Sarcoma 180 cells and Ehrlich ascites tumor cells, but it required 150 microgram per ml for abrin-b. Both these two proteins at a sublethal dose could inhibit the growth of Ehrlich ascites tumor cells which were injected simultaneously with these proteins. 131I-abrin-a and 131I-abrin-b were able to bind Sarcoma 180 cells, and the binding of abrin-a could be inhibited by lactose, raffinose, galactose and rhamnose, but none of 15 sugars tested inhibited the binding of abrin-b.


Preparation and properties of tritiated human beta-endorphin with high specific radioactivity. Tritiated human beta-endorphin, specifically labelled at Tyr27, has been prepared with 50 Ci/mmol. Various physicochemical investigations indicated that tritiated peptide is identical with the native betah-endorphin. In addition, opiate activity of the tritiated product possesses the same potency as the native peptide.


Human anthrax in Iran: an epidemiological study of 468 cases. The study of 468 cases of cutaneous anthrax admitted to the Firoozabadi Hospital during the 13 years show that 59.83% of cases were male and 40.17% female. 42.93% of patients were below the age 30. As occupational background concerned 27.86% belongs to industrial workers. On the other hand 20.73% of cases have contracted the disease through contact with sick animals whereas 74.24% have the history of contacts with animal products and 5% have infected due to the use of spidab. All patients were treated by penicillin or other antibiotics. 78 cases having massive oedema were additionally treated with cortisone. The death rate was slightly higher in females when compared with males.


Patoc 1 and Rufino strains of Leptospira biflexa, as screening antigens in the diagnosis of leptospirosis. Patoc 1 and Rufino from L. complexo bifexa strains employed as screening antigen in the serologic diagnosis of liptospirosis in human and in six different animal species in comparison with a battery of 1.9 L complexo interrogans antigens, Patoc strain showed a 98.8% accordance in the sera agglutination tests, in humans; in animal it showed a low percentage of accordance in the sera agglutination tests in humans and in animals.


Cultural conceptions and the role of the psychiatrist in Germany and America. Matched samples of mental hospital staff and high school students completed mental health questionnaires in Germany and America. The results were factor analysed. One factor concerned the role of the psychiatrist. The role of the psychiatrist in each culture seems to reflect basic cultural conceptions of mental disorders. Reference to two earlier papers indicates that patients, staff, and public share these basic conceptions and these conceptions affect patient-staff relationships.


Factors associated with length of treatment in a barrio-neighbourhood mental health service. Factors which discriminate between lower socio-economic largely Mexican-Americans who continue in treatment for few interviews, from those who continue longer were investigated. Demographic and treatment data were obtained from 356 consecutive cases. The factors which significantly differentiate short from long treatment contact patients were: self-referral, age, marital instability, and complaints of anxiety, depression, social or family incompatibilities. Non-self referral and financial or situation problems characterise the short treatment patient. While there were few Anglos in the sample they were disproportionately high in the long treatment group.


Prospects for change in public mental institutions. Because of the incompatibility of variables (viz. actors, milieu concept, institution, society) with each other as well as the potential areas of strain contained within each variable, it is improbable that state mental institutions can adapt a patient-centered (therapeutic) milieu. Evidence is presented in order to substantiate this hypothesis.


The utilisation of a community mental health service by Mexican Americans. The study of the staff, services, and patient population of the East Los Angeles Mental Health Service seven years after its initial operations revealed that: 1 the staff remained predominately bilingual and bicultural; 2 there was a greater demand for direct treatment services than anticipated; 3 the majority (79%) of the patient population was Mexican American, with an increase of foreign-born Mexican Americans; 10% were of other Latin descent; 4 there was an increase of Spanish speaking patients totalling 44% of the entire patient population; 5 the majority of the patients were unemployed or on Medi-Cal; and 6 self referrals increased to a total of 29%, and 10% were referred by former patients of ELAHMS. These conclusions strongly support the argument that Mexican Americans and other Latins would utilise mental health services if personnel and policies were responsive to bilingual and bicultural needs.


Study of psychiatric illness in adolescence, psychiatric breakdown in adolescence: diagnosis and prognosis. A discussion on the pitfalls of studying adolescent psychiatric breakdown emphasises two difficulties, firstly that of delineating the age of adolescence, and secondly the difficulty in applying adult diagnostic criteria. A study of 52 adolescents has been made to establish an initial, and a two year follow-up diagnostic formulation, and to attempt through a detailed survey of the adolescent's early history to identify prognostic indices. The difficulty of formal diagnoses is shown, but prognostic factors of relevance can be identified in the group which have helpful predictive value. Outcome in a group of 50 treated adolescents showed a satisfactory conclusion at two year follow-up, in 70% of cases.


Separation experiences and other emotional traumata in childhood, and their relationship to subsequent adolescent breakdown. This paper forms part of an M.D. Thesis presented at the University of Cambridge. One hundred adolescents and their parents were interviewed to ascertain details of their early history. Fifty were obtained from adolescent patients in psychiatric units in Newcastle-upon-Tyne, and were compared with fifty matched individuals who had no psychiatric history, obtained from other departments in the hospital. A comparison of these two groups showed a significantly higher incidence of separation experiences in the childhood of the patient group than in the control group. This was also true of other traumatic events occurring in childhood. These factors also related adversely to prognosis in a two year follow-up of the patient group.


Empathetic relationships in adolescents and their relevance to prognosis in psychiatric breakdown. Many authors have shown that adolescent breakdown is often associated with emotional deprivation in childhood. Psychotherapeutic intervention before the personality becomes too fixed and rigid should offer a means of improvement through the creation of substitute empathetic relationships, and prognosis should be improved to the extent to which this is successful. This hypothesis is tested through a follow-up study involving 100 adolescents, and the hypothesis is found proved in the diagnostic category of adolescent personality disorder, but of no apparent relevance in other groups.


Gonorrhea card test: an agglutination test for uncomplicated gonorrhea. An antigen extracted and purified from Neisseria gonorrhoeae B370, type 4, was employed to sensitize charcoal particles for use in an agglutination assay of human sera for antibodies that indicate active gonorrheal infection. The screening card test is more sensitive than the fluorescent gonorrheal test-heated (FGT-H), especially in men. A simple one-step absorption improved the specificity without reducing the sensitivity of the test.


A neuraminidase in duck embryo rabies vaccine. While studying variations amony immunizing potentials of rabies vaccines, we were led to consider the possibility that the antigen in the vaccine derived from duck embryos may have been degraded by enzymes arising from host tissues. Such an enzyme, a neuraminidase, was found in duck embryo rabies vaccine through the application of a periodate-linked thiobarbituric acid assay. This acitvity could not be found in two other rabies vaccines derived from tissue cultures. We have thus concluded that there is a strong possibility that a modified antigen is present in duck embryo vaccine. In addition, the injection of this vaccine will introduce a neuraminidase which may produce localized effects in the tissues of the recipient.


Occupational health and safety programs in schools of veterinary medicine. From a survey of 22 U.S. veterinary schools and the university campuses where they are located, it was found that none of the schools had a full- or part-time health and safety officer whereas 16 campuses did. On 18 campuses some form of safety committee existed whereas such committees had been formed in only 12 schools. There was no relationship between the level of school or campus safety organization and presence (10 schools) or absence (12 schools) of an OSHA approved state occupational safety and health plan. An occupational health "bookshelf" reference list is appended.


Certification of medical and public health laboratory personnel by professional organizations. Since 1928, 22 professional agencies have established certification procedures for 52 categories or levels of health laboratory personnel. Surveys indicate that 55% of technical personnel are certified by at least one registry or board. After reviewing some of the pros and cons of certification and its expanding role, the author concludes that certification has become a positive factor in calling attention to the need for quality personnel in health laboratories and has helped meet the needs of individuals and the public. Current movements to work together in a National Commission for Health Certifying Agencies and toward national certification standards are encouraging.


Documentation: the first step in laboratory management. This article will try to point out an often over-looked tool of management that most laboratory technologists are familiar with. The laboratory technologists that suddenly find themselves as chief technologists or managers would do well to remember their bench training. Specifically, document everything you do. The article lists suggestions and examples pertaining to documentation, that chief technologists could well benefit from. Four specific examples of documentation forms are as follows, (1) Pre-employment evaluation interview, (2) Laboratory orientation check list, (3) Documentation of employee counseling, and (4) Report of corrective interview.


Surface topography of Acanthamoeba culbertsoni extracted from cerebrospinal fluid. An axenic culture of Acanthamoeba culbertsoni, strain A-1, was obtained from the American Type Culture collection and injected, via the cisterna magna, into the subarachnoid space of dogs. Attention was focused on the pleomorphic surface specialization of the pathogens suspended in cerebrospinal fluid and compared with those from trypticase soy broth suspensions. Light and scanning electron microscopic comparisons of both inoculated and stock (control) specimens demonstrated similar surface features such as microvillous-like to bleb-like microappendages projecting from variably smooth to undulating membranous exteriors. This study introduces a potentially useful morphological technique that could possibly be of assistance in the more rapid diagnosis of these infections facilitated by SEM screening of the cerebrospinal fluid.


On the structure of the vascular body in the domestic fowl. The microscopic structure of the vascular body has been described. Three cell types have been identified. The arrangement of blood and lymph vessels has been demonstrated by means of injection techniques, and these vessels have been investigated at an ultrastructural level. The function of the vascular body is discussed.


The relationship of the locus coeruleus to the amygdala in the cat. In eight cats a unilateral lesion was produced in the locus coeruleus using either a 20 degree or a 30 degree rostrocaudal parasagittal electrode approach. The animals were killed after a survival period of 10 days. Ascending locus coeruleus projections found in the five animals with the best area destruction went through the dorsal pontine tegmentum into the mesencephalic central tegmental tract, entered the thalamic centromedian--parafascicularis nuclear complex, and divided into dorsal and ventral fascicles. The dorsal fascicle spread into much of the rostral thalamus, while the ventral one passed to the lateral hypothalamus and zona incerta. The lateral hypothalamic fibres extended rostrally into the preoptic area. No degeneration was seen passing in or through the amygdaloid body or stria terminalis. Critical analysis of our own findings and those of other investigators forces the conclusion that apparent projections to the amygdaloid area are really fibres of passage to the pyriform cortex and septum.


The ultrastructure of rat palatal mucosa maintained in organ culture. Palatal mucosa from neonatal rats was examined by electron microscopy after maintenance in a chemically defined medium in organ culture for periods up to 24 days. Throughout the culture period there was little overall change in the explants. Apart from limited disturbances of the basal lamina complex early in the culture period, and the presence of occasional degenerating keratinocytes after 18 days in vitro, the epithelium displayed an ultrastructure comparable with that at the time of explantation. The connective tissue showed greater changes, but despite considerable cell death a viable cell population apparently capable of both phagocytosis and synthesis of extracellular material was maintained. It is concluded that this organ culture system is a valid model for experimental investigations into the behaviour of oral mucosa.


The analysis of normal stepping movements as a possible basis for locomotor assessment of the lower limbs. Sagittal plane rotations of the thigh and shank when leading or trailing during forward or backward and during upward or downward stepping manoeuvres (one step, starting and finishing with erect stance) were recorded by polarized light goniometry in the form of thigh-knee angle diagrams. Angles and limb projections corresponding to key features of the diagrams were measured for 21 normal subjects and at three step heights. Correlations of the measurements with the height of step relative to stature were examined and predicted norms presented for a step equal to 10% of stature. The eight possible movements on a given step consist of four conjugate pairs; the members of a pair have reversed time-sequences and gravity assists one while opposing the other. The similarities of the conjugate manoeuvres were analysed statistically. A test of locomotor function is suggested on the premise that disturbances of function would be revealed by within-subject comparisons of conjugate manoeuvres. The suitability of 10% step tests for clinical use and the problems of selecting data of manageable proportions are discussed.


Serotonergic projections to the suprachiasmatic nucleus and the median eminence of the rat: identification by fluorescence and electron microscope. The identification of serotonergic input to the rat median eminence and nucleus suprachiasmaticus was carried out by fluorescence and electron microscopy. The clear differentiation of serotonin (5-HT) from catecholamine (CA) neurons was possible with an improved new filter system. 6-hydroxytryptamine (6-HT) was selectively taken up by 5-HT terminals and produced an intense yellow fluorescence. The yellow fluorescence of 5-HT disappeared 2 weeks after treatment with 5,6-dihydroxytryptamine (5,6-DHT), whereas the blue-green fluorescence of CA persisted. Combined treatment with either 6-HT and reserpine with addition to alpha-methyl-p-tyrosine, or with 6-HT and 6-hydroxydopamine, caused a marked reduction of CA and yellow fluorescence prominent only in 5-HT terminals. Under the electron microscope, 6-HT and 5,6-DHT were selectively taken up by the 5-HT terminals and produced electron-dense cores in the small vesicles with a diameter of 50 nm. The quantitative study revealed that the density of serotonin boutons marked with such dense-cored vesicles was 4.3 +/- 0.5% (mean +/- S.E.M.) in the suprachiasmatic nucleus and 4.8 +/- 0.8% in the perivascular region of the median eminence. Several studies have indicated an important functional role of 5-HT in the control of gonadotrophin secretion. The present study suggests that the serotonergic terminals exert their influence on the anterior pituitary function, not only at the level of the suprachiasmatic nucleus, but also at the level of the perivascular region of the median eminence, either through the axo-axonic synapses with the axons containing the releasing hormone or by the direct release of 5-HT into the portal vessels.


Energy absorbing capacity of rat tail tendon at various ages. Fibres from tail tendons of male rats aged 1--18 months were stretched to breaking point by an 'Instron' tensile apparatus. The energy absorbed during stretching of the tendon was calculated. A sharp increase was found in the energy value during the first 6 months of postnatal life. The following components of this energy were also evaluated: (1) energy absorbed during the period of linear relationship between force and extension; (2) energy absorbed during the period of non-linear relationship. Both components showed rapid increases in value during the first 6 months after birth, after which they levelled off.


On the ultrastructure of modified Sertoli cells in the terminal segment of seminiferous tubules in the boar. The seminiferous tubules are linked to the tubuli recti by a short terminal segment which is lined by a single layer of modified Sertoli cells whose long cytoplasmic processes occlude the lumen and form a plug-like structure in the 'receptacle. The main features of the modified Sertoli cells are: enormous numbers of microtubules and microfilaments, many crystalloids, abundance of rough endoplasmic reticulum, and paucity of smooth endoplasmic reticulum. The intercellular spaces are considerably dilated, and the cells posses intracellular spaces having well developed microvilli. Degenerated spermatozoa were seen engulfed by the modified Sertoli cells. Desmosome-like devices and tight junctions were observed joining adjacent cells. The configuration of the epithelium and the fine structure of the cells of the terminal segment are discussed in relationship to their possible roles as modifiers of the seminiferous tubule fluid and as regulators of fluid reflux from the rete testis into the seminiferous tubules.


[A reliable orthopedic technic in the treatment of humeral diaphyseal fractures in the adult: the hanging plaster. Report of a series of 74 cases (author's transl)]. The authors treated 74 humeral shaft fractures with "hanging cast" technique. They study the benefits and difficulties of the method, compared to other orthopaedic and surgical possibilities. Stiffness of the shoulder represent the most important part of 12% bad results. There are only 3% pseudarthrosis. It is a simple and safe treatment, with appliance to most humeral shaft fractures in cooperant patients.


[Fractures and dislocations of the lumbar vertebrae (author's transl)]. The authors report 6 cases of fracture and dislocation of the lower lumbar vertebrae (L3, L4, L5) and note that they were usually lesions following violent trauma usually in hyperflexion. The following were treated 1 dislocation L3-L4, 2 dislocations L4-L5, 2 comminuted fractures of L4, 1 fracture of L5, and included in all cases intersomatic arthrodesis at one (five cases) level or two levels (one case) and one posterior internal fixation with Kempf's material. The simplicity of the follow up and the stability of the fixation, permit us to propose the method for all unstable lesions of the lower lumbar vertebrae.


[Isolated sarcoidosis of the stomach (author's transl)]. The authors report a case of isolated sarcolidosis of the stomach. They emphasise the rareness of isolated involvement of this organ. The clinical picture and further investigations suggested carcinoma of the stomach and the patient underwent subtotal gastrectomy. Histological examination of the operative specimen gave the diagnosis of isolated sarcoidosis of the stomach. Corticotherapy is the only treatment of this disease. Operation in the present case was justified and necessary in view of the isolated nature of the lesion and the possibility of surgical operation.


[A case of carcinoma of the stomach revealed by a testicular metastasis (author's transl)]. A testicular metastasis from a gastric carcinoma is exceptional among the rare secondary localisations of a visceral neoplasm in the testis. It should however be remembered for the testicular tumour sometimes precedes the clinical manifestations of the primary neoplasm. The diagnosis of the testicular metastasis from a gastrict carcinoma can only be made by histological examination and required the use of slides stained with mucicarmine. The method of spread to the testis seems mainly due to inversion of the lymph flow by neoplastic obstruction of the latero-aortic lymph nodes. In the cases reported in the literature, the presence of a testicular metastasis from a carcinoma of the stomach is a factor suggesting a poor prognosis.


[Eosinophil granuloma of the stomach. Report of three cases (author's transl)]. The authors report three cases of eosinophil granuloma of the stomach are presented with different symptoms. The authors discuss the problems concerning the etiology, pathology and the symptoms of this rare disease. Special importance is attributed to problems of diagnosis and surgical treatment. The authors conclude that local excision of this lesion is sufficient in most cases except the rare cases with intestinal obstruction.


[Colonic preparation for surgery. Interest of digestive irrigation (author's transl)]. Colonic surgery is still relatively lethal and there is a morbidity related to the breakdown of sutures which seems linked to the quality of the colonic preparation. Although everyone agrees today that this preparation is necessary, the choice of the procedure remains debated. High flow rate digestive irrigation with a solution of 10% mannitol presents numerous advantages compared with standard preparations. It definitely ensures better emptying of the colon; its role on the colonic flora is variable, minor and transient, which raises the problem of complementary antibiotic therapy. The encouraging results with regard to septic post-operative complications should lead one to extend the indications and to undertake random studies after definition of strict criteria of comparison on large series to find the procedure best adapted to each situation.


[Use of gas-liquid chromatography for the study of nitrilases and amidases (author's transl)]. A gas-liquid chromatographic procedure is described for the determination of nitrilasic and amidasic activities. This method allows to monitor the kinetics of the hydrolysis of volatile nitriles and amides and because of its sensitivity, to determine the Michaelis constants Km of the acetonitrilase and the acetamidase of Brevibacterium R 312. For these enzymes, a correlation is shown between the kinetics monitored by proton nuclear magnetic resonance spectroscopy and gas-liquid chromatography.


Analysis of mono- and disaccharides by high-performance liquid chromatography of the benzyloxime-perbenzoyl derivatives. A group of biologically important mono- and disaccharides are separated by high-performance liquid chromatography of the benzyloxime-perbenzoyl derivatives on a normal-phase microparticulate column with a hexane-dioxane mixture as the eluting solvent. A single, quantifiable derivative of each sugar is formed easily. These derivatives are detected by UV absorption at either 230 or 254 nm, with a sensitivity in the picomole range at the former wavelength. The sugars in the residues from the evaporation of small aliquots of biologic fluids (10-100 microliter) are derivatized without prior isolation and are determined quantitatively by the use of appropriate internal standards. The analyses could be performed routinely with a simple, inexpensive instrument.


Improved high-performance liquid chromatographic procedure for the determination of tetracyclines in plasma, urine and tissues. An improved extraction procedure for the determination of oxytetracycline, tetracycline and chlortetracycline in urine, plasma and tissues by high-performance liquid chromatography is described. The addition of phenylbutazone (3,5-dioxo-1,2-diphenyl-4-n-butylpyrazolidine) to water, urine or plasma enhances the extraction of these compounds by ethyl acetate. The recovery of oxytetracycline from plasma is increased six fold and the need for two separate extractions of urine and plasma is eliminated. The formation of phenylbutazone-tetracycline ion pairs and their role in the extraction process is discussed.


Continuous-flow automated HPLC analysis of fat-soluble vitamins in tablets. A prototype automated system involving continuous-flow analysis and high performance liquid chromatography (CFA/HPLC) has been developed for the analysis of fat-soluble vitamins in individual pharmaceutical tablets. The novel features are the front-end coupling of CFA to HPLC, injection of hexane solutions on reversed phase columns, separation/quantitation of vitamins A, D2 and E within single chromatographic runs for a wide variety of tablets, and a dynamic range sufficient to accommodate the 1000-fold higher levels of vitamins a and E over D2 in the same tablets. The analysis rate is 10 samples per hour, the precision better than 6% for all three vitamins, and the recovery is 70-90% of that obtained by the standard AOAC method. Although the system is a prototype, it already greatly outperforms current manual analyses which are time consuming, tedious, and demanding in terms of the level of skill and experience of the experimenter. Included in this work are some retention comparisons of commercial columns.


Assessment of expectorated sputum for bacteriological analysis based on polymorphs and squamous epithelial cells: six-month study. Samples of sputum were examined microscopically to determine their suitability for routine culture. When the number of squamous epithelial cells per field was less than 10, the number of bacterial species generally fell within the range of one to four. Squamous epithelial cells were not always a true indication because some unmarked transtracheal specimens showing more than 10 squamous epithelial cells also gave a range of isolation falling between one and four. When the presence of 25 or more polymorphs was used as the parameter, the number of bacterial isolates generally fell within the range of one to three, but this resulted in positive overbiasing with consequent rejection of valid specimens. Later it was found that when a differential system using both polymorphonuclear cells and squamous epithelial cells was applied, a significant number of specimens could be salvaged which would otherwise have been discarded.


Comparison of bacteriophage typing, serotyping, and biotyping as aids in epidemiological surveillance of Klebsiella infections. Bacteriophage typing was used to subdivide Klebsiella obtained from patients in a surgical intensive care unit during a 2-year period. The 15 phages employed to type the strains were propagated by a soft-agar layer technique. In all, 23 phage types were found among the 120 clinical strains. The phage types of repeat isolates were reproducible. Only 70% of the strains tested were phage typable, but when used in conjunction with capsular serotyping and biotyping, a much greater subdivision of the Klebsiella strains was achieved. The addition of phage typing to serobiotyping for epidemiological analysis suggested that the number of cross-infecting Klebsiella strains in the intensive care unit was few, but that these strains persisted in the unit for long periods of time and could infect different body sites.


Bacteriology of human and animal bite wounds. Seventy-three patients with bite wounds (16 patients with clenched-fist injuries, 18 with human bite wounds, and 39 with animal bites) were cultured aerobically and anaerobically. A total of 33 of 34 patients with human bites and clenched-fist injuries and 33 of 39 patients with animal bites had aerobic or facultative bacteria isolated from their wounds. A total of 224 strains of aerobic or facultative bacteria were isolated, the most frequent isolate being alpha-hemolytic streptococci (50 strains). Staphylococcus aureus was isolated from 18 wounds. Penicillin-resistant gram-negative rods were infrequently isolated (12 strains). Anaerobic bacteria were isolated in 18 of 34 human bite wounds and clenched-fist injuries and 16 of 39 animal bite wounds. A total of 88 anaerobic strains was isolated, the most common being various Bacteroides species (36 strains).


Quantitative microbiology of traumatic orthopedic wounds. Quantitative bacterial and fungal cultures carried out on 116 speciments of tissue debrided from traumatic orthopedic wounds yielded 118 bacterial and 8 fungal isolates. The organisms obtained reflected primarily the resident flora of the skin.


Effect of atypical antibiotic resistance on microorganism identification by pattern recognition. We classified microorganisms from the clinical laboratory by using information provided by the Gram stain and antibiotic sensitivity profiles obtained with the Bauer-Kirby technique. Approximately 4,000 microorganisms, routinely identified and tested for antibiotic sensitivities in a large hospital microbiology laboratory, were used as a data set for several pattern recognition classification methods: K--nearest-neighbor analysis, statistical isolinear multicomponent analysis, Bayesian inference, and linear discriminant analysis. K--nearest-neighbor analysis yielded the highest prospective classification accuracy for gram-negative organisms, 90%. When those organisms displaying an atypical antibiotic resistance pattern were excluded from the data, the gram-negative classification accuracy improved to 95%. These results are inferior to currently accepted biochemical identification methods. Microorganisms with atypical antibiotic resistance patterns are likely to be misidentified and are common enough (17% of our isolates) to limit the feasibility of routine identification of microorganisms from their antibiotic sensitivities.


Growth of clinical isolates of anaerobic bacteria on agar media: effects of media composition, storage conditions, and reduction under anaerobic conditions. The quantitative growth, the colony size, and the rate of growth of 47 clinical anaerobic isolates were compared on five different media, namely Brucella agar, brain heart infusion agar, Columbia agar, Schaedler agar, and tryptic soy agar. There was no significant difference in the quantitative growth of the anaerobes inoculated onto the five media. Although no single medium was superior for the growth of all isolates, 12 of 22 isolates, inoculated onto media stored for 4 weeks or less, grew best on Schaedler agar. The effects of supplementation of the media with reducing agents and reduction of the media before use were also analyzed and were found to be affected by the composition and length of storage of the media, as well as the bacteria tested.


Early detection and identification of Trichophyton verrucosum. A new medium for the early detection and identification of Trichophyton verrucosum has been formulated. The key ingredients of the medium are 4% casein and 0.5% yeast extract. T. verrucosum is recognized by its early hydrolysis of casein and very slow growth. Microconidia were produced by 19 out of 35 isolates (54%), and macroconidia were produced by 8 out of 35 isolates (23%). All isolates formed chains of chlamydospores at 37 degrees C, and 24 out of 35 isolates formed chains at 28 degrees C. Nutritional requirements of all 35 strains of T. verrucosum were confirmed. The medium was evaluated by isolating 570 suspected T. verrucosum from skin scrapings. The early detection of hydrolysis, formation of characteristic chains of chlamydospores, and restricted slow growth of this dermatophyte differentiate it from T. schoenleinii.


Vibrio parahaemolyticus: suspicion of presence based on aberrant biochemical and morphological features. Vibrio parahaemolyticus was isolated from a stool specimen of a patient who developed gastroenteritis after ingestion of crab meat. Recognition and identification of this halophilic microorganism was facilitated by the microscopic observation of a darting, vibrant motility in condensate derived from Kligler iron agar and the bizarre morphological aberrations noted in the condensate obtained from Christensen urea agar. Sodium chloride supplementation (1.1%) of biochemical test media revealed the halophilic nature and fermentative capability of the isolate and abolished the aberrent morphology observed in unsupplemented Christensen medium.


Cellular fatty acids of Flavobacterium meningosepticum and Flavobacterium species group IIb. The cellular fatty acid profiles of Flavobacterium meningosepticum and Flavobacterium species group IIb were markedly different from those of related bacteria. The profiles were characterized by the presence of 13-methyl-tetradecanoate and three uncommon acids: 2-hydroxy-13-methyl-tetradecanoate, 15-methyl-hexadecanoate, and 3-hydroxy-15-methyl-hexadecanoate.


Recurrent digital fibroma of childhood.

Recurrent digital fibroma of childhood. Four cases of recurrent digital fibroma of childhood are presented, bringing the total of reported cases to 79. From our material and a review of the literature, the most characteristic features of this entity are delineated. There is no predilection for either sex. Seventy-three percent (58 cases) occurred under one year of age with 14 observed at birth; only four patients were over 5-years-old and the oldest was 15. The localization is highly diagnostic, being limited to the second to fifth carpal and pedal digits and no reported involvement of thumbs or great toes. Two cases were observed in the sole and ulnar side of the hand but associated with others in classical locations. In 50% of cases, the lesions are single at the time of diagnosis. The recurrence rate, based upon cases with adequate follow-up, was found to be 75%. To our knowledge no metastasis has ever been reported. The histology is that of well-differentiated fibroblastic tumor with pathognomonic eosinophilic cytoplasmic inclusion bodies. A review of the available electron microscopic data is presented and the histogenesis is discussed.


Pruritic papules of pregnancy.

Pruritic papules of pregnancy. Sixteen cases of pruritic papules of pregnancy were collected during a 32-month period. This dermatosis was introduced to the literature in 1962 but no histopathologic study of it has been published. Histopathologic presentation of pruritic papules of pregnancy is that of toxic dermatitis. This finding is not characteristic of this condition and clinico-pathologic correlation is needed for a definitive diagnosis.


Regulation of cortisol uptake in mammary tissue of cows. Mammary tissue explants from four nonlactating, nonpregnant cows were placed into culture with media containing various combinations of insulin, prolactin, growth hormone, 17beta-estradiol, dexamethasone, and progesterone. Combinations of insulin, prolactin, growth hormone, or 17beta-estradiol had no effect on cytoplasmic or nuclear uptake of tritiated cortisol compared with values at zero time. Combinations containing dexamethasone of progesterone reduced cytoplasmic and nuclear uptake of tritiated cortisol. To examine inhibition by progesterone of binding of tritiated cortisol, mammary tissue from each of four lactating, nonpregnant and four nonlactating, nonpregnant cows were placed in flasks containing tissue culture medium 199, tritiated cortisol (2 ng/ml), and progesterone at concentrations of 0, 10(-12), 10(-11), 10(-10), 10(-9), 10(-8), 10(-7), 10(-6), or 10(-5) X 6.4 M. Cytoplasmic uptake of tritiated cortisol into nonlactating tissue decreased linearly as progesterone increased, whereas tritiated cortisol uptake in lactating tissue did not decrease until progesterone exceeded 10(-7) M. We postulated progesterone is sequestered in milk fat of cytoplasm of lactating tissue whereas in nonlactating tissue progesterone is available to compete with cortisol at sites of cortisol binding.


Induction of lactation by two techniques: success rate, milk composition, estrogen and progesterone in serum and milk, and ovarian effects. Induction of lactation was attempted in 12 heifers and 12 cows with estradiol benzoate (.011 mg/kg body weight per day) subcutaneous for 10 days or that plus progesterone (.1 mg + .25 mg/kg body weight per day) for 7 days. Milking commenced on day 20 for those treated with the mixture and on day 11 for the others. Lactations were induced (minimum of 4.5 kg of milk/day) in five of six heifers and two of six cows by the mixture and in six of six heifers and three of six cows for estradiol benzoate. Milk production was 44% of herdmates in the 16 induced lactations. Cows on the single treatment had lower production than the other three groups. Ovarian status, cycling, cystic, or static, was affected adversely in 5 of 16 animals induced successfully. Two of the 16, both heifers, carried calves to term following induction. The transition to normal composition of milk was slower for single than double treatment. Lactose increased slowly to normal over the 1st wk of milking while protein decreased slowly. Estrogen and progesterone in milk of induced cows were approximately twice as concentrated as in normal postparturient cows, probably because milk production was halved.


Effects of feeding high magnesium to young dairy calves. Holstein bull calves were fed 1, 2, and 4% supplemental magnesium as magnesium oxide. The control diet contained .3% magnesium and consisted of ground corn, soybean meal, cottonseed hulls plus mineral, vitamin, and antibiotic supplements. Diarrhea was the most obvious effect of high intake of magnesium. The extent and intensity of the diarrhea was related closely to the dietary magnesium content. High (2 and 4%) magnesium reduced feed consumption and weight gains. Although there were traces of blood in feces, no abnormalities were observed at autopsy. Large tubular sections of mucus were voided in the feces with a greater prevalance among calves fed 2 and 4% supplemental magnesium. Magnesium in plasma rose sharply in response to the increased intake of magnesium. In calves receiving the 4% added magnesium, the plasma values were triple those of controls. When high magnesium was fed, magnesium increased much more in urine than in plasma. Within 1 wk after calves were returned to control diet, magnesium in urine and plasma declined to control.


Relation between mastitis test score, mineral composition of milk, and blood electrolyte profiles in Holstein cows. The relationship between mastitis, mineral composition of milk, and blood electrolyte profiles was investigated in 54 Holstein cows. Sodium potassium, calcium, magnesium, and chloride in blood and milk were compared under two indices of mastitis, a milk quality test and a milk somatic cell count. Milk from cows with evidence of udder infection had higher sodium and chloride and lower potassium than cows free of mastitis. Although there was a correlation between blood calcium and milk calcium and between milk calcium and milk somatic cell count, as well as differences in mean potassium and calcium in blood between mastitic and nonmastitic cows, there was no direct relationship between the indices of mastitis and electrolyte profiles of blood.


Embryonic mortality in dairy cows estimated by nonreturns to service, estrus, and cyclic milk progesterone patterns. Cyclic patterns of progesterone in milk were studied in 262 Holstein cows. Milk progesterone data were obtained from 153 cows for at least 75 days after conception as indicated by continuous high progesterone concentrations in milk for 28 days or more following artificial insemination. Cycling was reinitiated in 11 of these cows between 28 and 75 days after breeding, for an estimated 7.2% rate of embryo-fetal mortality. This was considerably less than a corresponding rate of 22.7% estimated for this herd by the delayed returns to estrus (28 to 75 days). In 350,180 cows inseminated with semen from Holstein bulls the estimated embryo-fetal mortality by the same delayed return to service method was 12.5%. Biases in this latter method of estimation are discussed.


Blood pressure measurement in the United Kingdom Heart Disease Prevention Project. A blood pressure measurement was part of a cardiovascular screening examination of 8397 middle-aged men taking part in the intervention section of the United Kingdom Heart Disease Prevention Project. Standardised training techniques reduced observer bias to acceptable limits in four out of a total of five observers. The time of day and room temperature both made significant differences to the blood pressure measurement. High room temperatures in particular apparently had a marked effect in reducing the level of blood pressure. There were consistent and large positive associations with increasing age and overweight. The survey revealed a poor degree of blood pressure control in the community at the time of screening--only 7% of the "hypertensive" population had their diastolic pressure controlled to below 100 mm Hg.


Vigorous exercise in leisure time and the death rate: a study of male civil servants. In 1968-70, 17,944 middle-aged male executive grade civil servants in Great Britain provided a record of their leisure-time activities for two sample days and they have been followed until the end of 1977. In a 20% sample (3591 men), 268 have died. Men who had reported "vigorous exercise" (VE) during the two days suffered fewer deaths from coronary heart disease throughout the years 1968-77; there was no significant difference in mortality from other causes. VE men recorded more physical activity in general, and they saw themselves as physically more active than the rest. Total physical activity scores, however, were weakly related to coronary mortality. Men reporting vigorous exercise smoked somewhat less than other men, but the two factors were independently associated with mortality from coronary heart disease.


Employment grade and coronary heart disease in British civil servants. The relationship between grade of employment, coronary risk factors, and coronary heart disease (CHD) mortality has been investigated in a longitudinal study of 17 530 civil servants working in London. After seven and a half years of follow-up there was a clear inverse relationship between grade of employment and CHD mortality. Men in the lowest grade (messengers) had 3.6 times the CHD mortality of men in the highest employment grade (administrators). Men in the lower employment grades were shorter, heavier for their height, had higher blood pressure, higher plasma glucose, smoked more, and reported less leisure-time physical activity than men in the higher grades. Yet when allowance was made for the influence on mortality of all of these factors plus plasma cholesterol, the inverse association between grade of employment and CHD mortality was still strong. It is concluded that the higher CHD mortality experienced by working class men, which is present also in national statistics, can be only partly explained by the established coronary risk factors.


A method for assessing volunteer bias and its application to a cardiovascular disease prevention progamme involving physical activity. Studies of chronic disease may require long-term observation of volunteer participants. This is a characteristic of investigations of primary or secondary prevention of cardiovascular disease by increased level of physical activity. Activation of sedentary, middle-aged, high risk men requires a substantial personal commitment on their part to a long-term programme. Because of self-selection, individuals who volunteer for such programmes cannot be assumed to be representative of the populations from which they come. To the best of our knowledge, there has been no systematic investigation of such self-selection based upon a study designed for that purpose. We found little consistent tendency for vouunteering behaviour to be associated with serum cholesterol, blood pressure, relative weight, level of activity at work, or Type A hehaviour variables.


Long-term consequences of respiratory disease in infancy. In a study of Kent schoolchildren it has been shown that those who had a history of bronchitis under the age of five were more likely to have reported respiratory symptoms as the age of 11 (Bland et al., 1974). After this finding, it was necessary to test whether these differences would continue or diminish as the children grew older. One thousand three hundred schoolchildren in four areas of Kent were studied by physical examination and parental questionnaire at the ages of 5, 11, and 14. The relative risk of having reported respiratory symptoms for children with a history of early bronchitis, asthma, or pneumonia, compared with other children, was the same at the age of 14 as it was at the age of 11. These relationships could not be explained by social class effects, and were probably not due to parental bias in reporting.


Smoking and health: the association between smoking behaviour, total mortality, and cardiorespiratory disease in west central Scotland. The relationship of smoking to total mortality and to the prevalence of cardiorespiratory symptoms has been studied in three prospective surveys in west central Scotland in which 18 786 people attended a multiphasic screening examination. The prevalence of respiratory symptoms, and to a lesser extent cardiovascular symptoms, increased with the number of cigarettes smoked, with inhalation, and with a younger age of starting to smoke. A lower prevalence of respiratory symptoms in both sexes was observed in smokers of filter cigarettes than in smokers of plain cigarettes, and in those who smoked cigarettes with lower tar levels, irrespective of whether these were filtered or plain. In general, the relationships found between smoking and mortality were similar to those reported by other workers. Current cigarette smokers had a death rate from all causes which was twice that of those who had never smoked. No difference was found between the mortality rates of smokers of plain and filter cigarettes.


Four cardiorespiratory symptoms as predictors of mortality. The power of four cardiorespiratory symptoms to predict subsequent mortality has been analysed in data derived from a random sample of the population of Great Britain recruited in 1965 and followed for 12.4 years. The associations of respiratory symptoms with all causes of death (except stroke) and of cardiovascular symptoms with death from coronary heart disease were strong. The trends of these two associations over the 12.4 years of the follow-up differed substantially: the relative death rates associated with respiratory symptoms remained throughout at about the same level, while those associated with cardiovascular symptoms declined after four years. The excess premature deaths associated with presence of one or more symptoms at entry represented about a quarter of the observed deaths of men and one tenth of those of women.


Terminology in chronic obstructive lung diseases. Until the 1960's there was great confusion, both within and between countries, on the meaning of diagnostic terms such as emphysema, asthma, and chronic brochitis. Proposals made by a group of British doctors in 1959 gradually received widespread acceptance but in recent years some new problems have developed. These include difficulties in the definition of airflow obstruction, recognition that what used to be regarded as a single disease, chronic bronchitis, comprises at least two distinct pathological processes, and uncertainty about the degree of variability which distinguishes asthmatic from more persistent forms of airflow obstruction. These are all problems which could be solved by continuance of appropriate research and of riqorous attention to the principles which determine accurate and acceptable definitions of disease.


Cigarette consumption per adult of each sex in various countries. Estimates of cigarette consumption per adult male and female available from surveys in eight countries are examined and the figures of national consumption per adult implied by the surveys are compared with national averages obtained from government data and other sources. The errors likely to be found in the surveys are considered and corrected figures are calculated. Estimates are also made of cigarette consumption per woman of childbearing age.


Monitoring disease in England and Wales: methods applicable to routine data-collecting systems. This paper reviews routine data-collecting systems and methods for disease surveillance in England and Wales. It discusses population-based correlation studies, which seek to explain disease trends by relating routine health statistics to possible causative agents on a secular, geographical, or occupational basis. It describes recent developments in linking information collected by routine general purpose systems as a means of identifying and following individuals exposed to potential hazards.


Cigarette smoking and bronchial carcinoma: dose and time relationships among regular smokers and lifelong non-smokers. In a 20-year prospective study on British doctors, smoking habits were ascertained by questionnaire and lung cancer incidence was monitored. Among cigarette smokers who started smoking at ages 16-25 and who smoked 40 or less per day, the annual lung cancer incidence in the age range 40-79 was:0.273X10(-12). (cigarettes/day+6)2. (age--22.5)4.5. The form of the dependence on dose in this relationship is subject not only to random error but also to serious systematic biases, which are discussed. However, there was certainly some statistically significant (P less than 0.01) upward curvature of the dose-response relationship in the range 0-40 cigarettes/day, which is what might be expected if more that one of the "stages" (in the multistage genesis of bronchial carcinoma) was strongly affected by smoking. If a higher than linear dose-response relationship exists between dose per bronchial cell and age-specific risk per bronchial cell, this may help explain why bronchial carcinomas chiefly arise in the upper bronchi, for dilution effects might then protect the larger areas lower in the bronchial tree.


The redundant factor method and bladder cancer mortality. Of the three factors, age at death, epoch of death, and epoch of birth, one seems almost superfluous. It may nevertheless be worthwhile to include all three in a mortality analysis, allowing for the constraints that the redundancy imposes. This procedure is applied to data for England and Wales on bladder cancer mortality from 1951 to 1970.


Psychophysical pitch biases related to vowel quality, intensity difference, and sequential order. This study investigates two types of psychophysical pitch bias, one related to vowel acoustical characteristics and the other to sequential order. Based on the analysis of the variation of the subjective equality of pitch in subjects' responses, a multivariate interaction model is used to explain the experimental results and also to demonstrate the existence of the two types of psychophysical pitch bias. The first pitch bias related to a vowel acoustical characteristic is due to the vowel quality difference as a pitch difference at equal fundamental frequency. By using /a/ as a common reference, this bias for three test vowels /e, i, u/ is found to be lower than /a/ by values of 0.54 1.25, and 2,80 Hz, respectively. The other pitch bias related to acoustical characteristic is due to the vowel intensity difference. With intensity difference ranges from 0 to 30 dB, the pitch shift (bias) does not exceed 0.2 Hz at a test F0 of 100 Hz. Apparently, an intensity difference produces insignificant pitch shift in vowel sounds. The pitch bias related to the sequential order of stimuli presentation is a --0.33-Hz bias, i.e., a trend of overestimating the pitch of the second sound in temporal pitch comparison. The pitch discriminability, i.e., the just noticeable difference (JND) at 75% threshold, in an environment with three acoustical parameters varing simultaneously is found to be 1.5%, about three times greater than the previously reported 0.5% DL when F0 varies alone. Finally, the psychophysical bias of vowel is also found to depend upon the power spectrum and negatively correlated to the magnitude of the F0 production discrepancies of the average vowel sounds.


Generating vocal tract shapes from formant frequencies. An algorithm that uses only the first three formant frequencies has been devised for generating vocal tract shapes as seen on midsagittal x-ray diagrams of most English vowels. The shape of the tongue is characterized in terms of the sum of two factors derived from PARAFAC analysis: a front raising component and a back raising component. Stepwise multiple regression techniques were used to show that the proportions of these two components, and of a third parameter corresponding to the distance between the lips, are highly correlated with the formant frequencies in 50 vowels. The recovery algorithm developed from these correlations was tested on a number of published sets of tracings from x-ray diagrams, and appears to be generalizable to other speakers.


Loudness of complex sounds as a function of the standard stimulus and the number of components. The purpose of this study was twofold: to determine if the measured loudness level of a signal depends on the standard stimulus used and to measure loudness as a function of the number of components in a wide-band signal. The stimuli were a pure tone, tone complexes with frequency separations of 231 and 1592 Hz, and noise bands with widths of 220 and 1592 Hz. The center frequency was 1 kHz and the loudness level was approximately 65 phons. Loudness matches between all combinations of stimuli showed that the measured loudness of the sounds did not depend on the standard stimulus used and the measured loudness level of a wide-band sound increased as a function of the number of components. Individual observers were consistent in their loudness estimations; the greatest source of variability was among subjects. Additional measurements indicated that the rate at which loudness increased beyond the critical band appeared to be greater for noise bands that for two-tone complexes.


Regression interpretation of differences in time-intensity trading ratios obtained in studies of laterality using the method of adjustment. This paper proposes a regression interpretation of the laterality matching data recently reported by Young and Levine [J. Acoust. Soc. Am. 61, 607-609 (1977)]. Under this interpretation, the difference between the trading function obtained when delta t is adjusted and that when delta I is ascribed to a judgmental bias associated with the method of adjustment. Arguments against associating the results of Young and Levine with the issue of dual images are presented.


Basilar membrane motion in a spiral-shaped cochlea. To examine the influence of the spiral coiling of the cochlea upon the motion of the basilar membrane, a mathematical model of the cochlea is constructed. The formulation of the problem leads to Laplace's equation in three dimensions in a curvilinear coordinate system plus corresponding boundary conditions. By basing the choice of the coordinate system upon the form of the helix representing the centerline of the basilar membrane, a relatively simple formulation is obtained. The helix parameters appear only in the Laplacian, not in the boundary conditions. From experimental data the equations of the basilar membrane's centerline are derived for a human cochlea, both in intrinsic form and in regular form. The relative simplicity of the formation permits the tentative conclusion that, in spite of the large curvature near the apex, the spiral shape of the cochlea has only a small influence upon the motion of the basilar membrane.


Effect of intermittent truck noise on percentage of deep sleep. Sleep was divided into only two categories, "deep" and "shallow," the latter including waking, stage 1, and dreaming. For the sake of objectivity and precision the criterion was the level of alpha frequency and/or the audibility of spindles (from a speeded up tape recording of the EEG signals from frontal electrodes), which were timed by stopwatch. Twenty truck noises, presented every other night at peak levels of 65 dB (A-weighted), reduced deep sleep of 12, mainly young subjects by an average of 3%. Adaptation of the waking response occurs despite the separation of the noise nights by at least one quiet night. Adaptation to sleeping in the laboratory appears to continue for more than the one or two nights usually assumed.


Longitudinal pulse propagation characteristics in striated muscle. The real part of the complex Young's modulus of whole frog sartorius muscle in the resting state was derived from step pulse propagation data in the frequency range 1.0-10 000 Hz. The derivation was based on Fourier integral analysis of the shapes of the propagated pulses to obtain velocities and attenuation coefficients for various harmonic frequencies. The results were consistent with previous sinusoidal wave propagation studies in the higher-frequency range. The general frequency response of the muscle was analogous to the "standard linear solid" model. The relaxation time spectrum derived from the modulus-frequency function showed similar spectral contents to spectra obtained with other methods. The advantages and limitations of the pulse method are discussed.


Linear prediction analysis of speech based on a pole-zero representation. Speech analysis and synthesis by linear prediction is based on the assumption that the short-time spectral envelope of speech can be represented by a number of poles. An all-pole representation does not provide an accurate description of speech spectra, particularly for nasals and nasalized sounds. This paper presents a method for characterizing speech in terms of the parameters of a pole-zero model. In this method, an impulse response representing the composite filtering action of the glottal wave, the vocal tract, the radiation, and the speech recording system is first constructed from the speech signal. This impulse response is obtained by performing several stages of all-pole LPC analysis. The pole-zero parameters are determined from the impulse response by solving a set of simultaneous linear equations. The method, being noniterative, is very suitable for automatic analysis of speech. The method has been applied to real speech data and the results show that the speech spectra derived from the pole-zero model agree very closely with the actual spectra derived by direct Fourier analysis.


Technique for the perceptual investigation of F0 contours with application to French. Two experimental techniques were used in this study: (1) an analysis of F0 contours of French sentences containing words likely to express the speaker's attitude (modals, negative, adverbs, quantifiers) and (2) listeners' judgements of the naturalness of synthetic sentences in which the F0 contour was systematically manipulated. The F0 contours were characterized by schematic patterns [J. Vaissière Res. Lab. Electron., Q. Prog. Report No. 115, MIT, 251-262 (1975)]. For all the sentences that were studied, the configurations of patterns frequently observed in the analyzed corpus were judged most natural when synthesized. This result suggests that the features of the F0 contours most relevant to naturalness are preserved in the pattern representation. Three types of patterns were distinguished: (1) a prominent, demarcative pattern (P2); (2) A PROMINENT, NOndemarcative pattern (PE); (3) nonprominent, nondemarcative patterns, A P2 pattern often occurred at the end of a syntactic constituent. Listeners' judgements showed that a P2 at the end of a syntactic constituent is rarely required for naturalness, but a P2 in contradiction to syntax causes unnaturalness. Prominent patterns (P2 or PE) often occurred on negatives, adverbs, and quantifiers. However, the presence or absence of a prominent pattern on these words does not affect naturalness.


Identification of deleted consonants.

Identification of deleted consonants. VC transitions have often been found to be better cues for the identification of deleted consonants than CV transitions. The lower score for CV transitions could very well be due to an interfering "click sensation" caused by the abrupt begining of these transitions. In the present investigation the abrubt onset was eliminated by replacing the deleted portions of the consonants with noise bursts; this also caused the incomplete syllables to sound more natural. The results show that the identification of deleted initial voiceless plosives is greatly improved by the addition of noise. The original difference between initial and final plosive transitions disappears almost completely.


Selective anchoring and adaptation of phonetic and nonphonetic continua. A series of four experiments compared the effects of unequal probability anchoring and selective adaptation on phonetic and nonphonetic judgments. The basic stimulus series was a synthetic stop consonant continuum ranging from /b/ to /d/. On this continuum were superimposed covariations in fundamental frequency, intensity or vowel. In each experiment subjects listened to identical test tapes under two judgment conditions: place of articulation, and pitch or loudness or vowel judgments. The two types of judgment were significantly dissociated under both anchoring and adaptation paradigms, thus demonstrating that the former may be no less selective than the latter. From this and other evidence, it was concluded that the two paradigms are, in principle, equivalent, and that the main factors in speech adaptation effects are peripheral fatigue and central auditory contrast. If the selective processes of fatigue and contrast are taken to reflect functional channels of analysis rather than the operation of feature detectors, the same broad processes can be seen at work in both speech and nonspeech adaptation.


Invariant cues for place of articulation in stop consonants. In a series of experiments, identification responses for place of articulation were obtained for synthetic stop consonants in consonant-vowel syllables with different vowels. The acoustic attributes of the consonants were systematically manipulated, the selection of stimulus characteristics being guided in part by theoretical considerations concerning the expected properties of the sound generated in the vocal tract as place of articulation is varied. Several stimulus series were generated with and without noise bursts at the onset, and with and without formant transitions following consonantal release. Stimuli with transitions only, and with bursts plus transitions, were consistently classified according to place of articulation, whereas stimuli with bursts only and no transitions were not consistently identified. The acoustic attributes of the stimuli were examined to determine whether invariant properties characterized each place of atriculation independent of vowel context. It was determined that the gross shape of the spectrum sampled at the consonantal release showed a distinctive shape for each place of articulation: a prominent midfrequency spectral peak for velars, a diffuse-rising spectrum for alveolars, and a diffuse-falling spectrum for labials. These attributes are evident for stimuli containing transitions only, but are enhanced by the presence of noise bursts at the onset.


Some figural properties of auditory patterns. Listeners identified one of six permutations of three frequencies, presented as brief three-note melodies. Identification performance remained high in spite of transposition of the original three frequencies throughout a two-octave range, so long as the musical intervals or frequency ratios between the adjacent pairs of frequencies remained constant. Even when those intervals were compressed or expanded, while remaining about equal to each other, identification was quite good for the range between the lowest and highest frequency of no more than approximately 1/3 octave. Performance decreased sharply when the span was much wider. Unequal intervals, where the low and middle frequencies were closer together or farther apart than the middle and high frequencies, did not retain good identification performance. When the three-tone patterns were embedded in longer sequences of seven or eight tones, the identification performance was best when the pattern occurred at the beginning or the end of the sequence, and when the range of frequencies from which the irrelevant background tones were chosen lay outside the range of pattern frequencies. Under conditions where the background frequencies were fixed and the pattern frequencies were moved, thus combining the manipulation of embedding with that of transposition of the pattern, overlap of pattern and background frequencies was still the principal cause of deterioration in performance. The findings are related to some analogies to the perceptual rules of Gestalt theory, as well as to certain aspects of musical practice.


Stimulated acoustic emissions from within the human auditory system. A new auditory phenomenon has been identified in the acoustic impulse response of the human ear. Using a signal averaging technique, a study has been made of the response of the closed external acoustic meatus to acoustic impulses near to the threshold of audibility. Particular attention has been paid to the waveform of the response at post excitation times in excess of 5 ms. No previous worker appears to have extended observations into this region. The response observed after about 5 ms is not a simple extension of the initial response attributable to the middle ear. The oscillatory response decay time constant was found to change from approximately 1 ms to over 12 ms at about this time. The slowly decaying response component was present in all normal ears tested, but was not present in ears with cochlear deafness. This component of the response appears to have its origin in some nonlinear mechanism probably located in the cochlea, responding mechanically to auditory stimulation, and dependent upon the normal functioning of the cochlea transduction process. A cochlear reflection hypothesis received some support from these results.


Temporal factors and suppression effects in backward and forward masking. We discuss several experiments examining the influence of temporal parameters on suppression effects in backward and forward masking. The signal is always a brief 10-ms 2-kHz sinusoid; the masker a narrow band of noise of 40-dB spectrum level, 200-Hz wide, centered at the signal frequency. In some conditions, the presence of a second band of noise of the same spectral level in the region of 2300--3700 Hz appears to suppress the effects of the masker. Changes in the amount of suppression are examined as functions of the delay and duration of the suppressor (experiments 1 and 2). Adding the suppressor during the 50-ms interval nearest the signal produces changes in the signal threshold that are similar to those produced by reducing the level of the masker during this interval for both backward and forward masking (experiment 4). The similarity of these results suggests the operation of peripheral processes common to both backward and forward masking. However, if one increases the duration of the suppressor beyond this 50-ms interval there is no effect on forward masking, but large additional reductions in backward masking. This difference, in conjunction with other recent experiments, suggests the operation of additional central processes in backward masking. For some observers, these additional processes appear to operate over fairly long periods of time (250-500 ms). Such long durations are inconsistent with the estimates of integration time (less than or equal to 200 ms) obtained for these same observers (experiment 3).


Action potentials in the cat at low sound intensities: thresholds, latencies, and rates of change. The interpretation of whole-nerve action potentials is a topic of increasing importance in both clinical and research settings. This effort has been hampered by a lack of data on the action potential that are theoretically interpretable and systematically measured over a wide range of frequencies and at low sound intensities. Therefore, the present study was designed to measure the thresholds, latencies, and rates of change in the whole-nerve action potential in response to constant-spectral-width tone pips at eight frequencies between 0.5 and 20 kHz in the cat ear. These quantities were calculated by a linear regression technique from round-window potentials in 28 normal ears. They were found to be consistently within approximately 18 dB of previously published behavioral measures, a difference attributable to temporal integration. The interanimal variability had a standard deviation of about 5 dB and the intra-animal variability was extremely low. The growth of amplitude across frequencies, the rate of change of latency with intensity changes, and the latency at threshold all demonstrated orderly relationships which are presented. The data were all consistent with contention that the potentials were being produced by a single population of cells located at a place consistent with the frequency of the eliciting tone. The methods used provide exceedingly stable measures and should be applicable in both clinical and research settings.


Effect of sensorineural hearing loss on acoustic stapedius reflex growth functions. The growth function of the acoustic stapedius reflex was measured in subjects with normal hearing and sensorineural hearing loss of cochlear origin. The effects of age and magnitude of hearing loss were controlled. Activating stimuli were 500, 1000, and 2000 Hz tones and broadband noise. Stapedius muscle activity was inferred from acoustic impedance measures in the contralateral ear. The mean growth functions for tones were essentially linear in log-log plots with the rate of growth equal for the two groups. The mean growth function for the noise signal was curvilinear for the normal hearing groud had linear for the hearing loss group. Comparison of slope functions derived from the fitted data indicated that the rate of reflex growth for the noise signal, over a limited range above reflex threshold, is greater in ears with cochlear lesions than normal ears. For higher level noise signals, however, the rate of reflex growth is similar for normal and pathological ears. The effect of a cochlear lesion on the input-output function of the cochlea for both tonal and noise stimuli is to maintain the rate of reflex growth but shift the function along the intensity axis of a tonal signal and the response axis for a noise signal.


Temporal integration of two-component tone glides. Temporal integration of complex signals composed of two linearly combined tone glides was studied in a 60-dB SPL noise background. When both glide tones increased or decreased in frequency, integration functions differed for durations shorter than 50 ms in a manner similar to results obtained for single-component tone glides. That is, rising two-component glides were detected at lower thresholds than were falling two-component glides. However, when one component increased in frequency and the other decreased, thresholds were the same, regardless of which component increased and which decreased.


Uterine progesterone receptors in the aged golden hamster. Uterine capacity to form cytoplasmic progesterone receptor was compared in ovariectomized golden hamsters at three months and 15-17 months of age. A dose-response test with 17beta-estradiol(E2) showed that the uterine content of progesterone receptor (pmole/uterus) was equal in young and old at all dose levels. However, heavier old uteri had less receptor per gm tissue. Old and young hamsters were mated, ovariectomized on day 7 post coitum and after two weeks, all were given the same dose of E2. Endometrium was separated from myometrium before analysis of progesterone receptor. Myometrium was analyzed for both estrogen and progesterone receptors. Myometrium of both groups had comparable levels of both receptors. The mean concentration of progresterone receptor (pmole/gm tissue) was higher in old endometrium. Some old animals with liver, kidney and adrenal disease had more endometrial reaction after E2 treatment. A few with low endometrial receptor levels had normal livers but at least one sterile uterine horn. There was, however, no general decline with age in intrinsic uterine capacity to form progesterone receptors.


Relationship of granulovacuolar degeneration in hippocampal neurones to aging and to dementia in normal-pressure hydrocephalics. Neuropathological findings could not explain the dramatic improvement after shunting exhibited by one patient demented with a "normal-pressure" hydrocephalus (NPH)-like syndrome. He contrastred markedly with the unchanged condition of four similar dements also shunted successfully. Quantitative morphometry was done on the five brains to determine the degree of granulovacuolar degeneration in hippocampal neurones. The severity of this change, like that of neurofibrillary tangle formation quantified in earlier work, was not attributable merely to aging, being greater in the four unimproved cases that that in age-matched control brains from 18 normal subjects, and falling in the same elevated range as that of eight dements with necropsy-confirmed Alzheimer's disease. The intensity of granulovacuolar degeneration in the one shunted dement who improved was within normal limits. A positive linear correlation existed between the Granulovacuolar Indices and the total duration of dementia. A similar relationship had been shown for Tangle Indices. These data suggest that earlier diagnosis may improve the chances of reversing dementia in NPH-like syndromes before histopathology is too severe; and that a more careful search for laboratory features of NPH may be warranted in some cases of Alzheimer's dementia.


Burned-out schizophrenia: evidence for age effects on schizophrenic symptomatology. The long-term outcome of chronic schizophrenia has classically been accepted to be pessimistic, most often leading to a terminal demented state. An examination of recent literature that has followed schizophrenic patients into the involutional years is not so convincing. The few studies that so report upon elderly schizophrenics demonstrate substantially altered symptomatology, most often coinciding with the onset of the involutional years (ages 55-64). This under-investigated phenomenon has real implications for the continuing need of institutionalization and/or pharmacologic treatment for these older schizophrenic patients and warrants rigorous investigation.


The impact of personality and social status factors upon levels of activity and psychological well-being. The fact that the relationship between levels of activity and psychological well-being is not a simple one that suggests an optimal theory of aging has been previously recognized. Explanation of individual differences in levels of activity and psychological well-being, however, remains a salient theoretical issue. In the present study, multiple regression is used to examine the impact of both personality and social status variables upon levels of activity and psychological well-being in a sample of 380 white males and females, aged 50-76. The results indicate that both personality and social status factors are significant predictors, although levels of activity and psychological well-being are best predicted by different variables. The most striking finding of the study is the substantial power of personality factors to significantly predict psychological well-being.


A taxonomy of situations for an elderly population: generating situational criteria. The present study examined the feasibility of a taxonomic strategy for generating situational criteria useful in the assessment of competence for older adults, with competence viewed as adaptive responding in specific situations. The first phase of the strategy involved (a) sampling a population of situations relevant to the experience of an older urban population, (b) selecting and empirically testing the reliability of four attribute dimensions (social-nonsocial; high-low activity; common-uncommon: supportive-depriving), which, in combination, taxonomized 16 classes of 80 situations, and (c) adapting these situations to a Q-sort technique. In the second phase, taxonomized situations were Q-sorted by 20 older individuals(x age = 71 years) on three response dimensions (self-rated ease of coping, affect, and frequency of encounter). Significant MANOVA main effects and interactions for each response dimension were found. Implications of this approach for generating ecologically-valid situational criteria useful in assessing adult competence are discussed.


Cardiovascular disease and changes in intellectual functioning from middle to old age. The relationship between cardiovascular disease (CVD) and intellectual functioning was investigated using a categorical division of a previously studied cross-sequential sample into groups with and without clinical cardiovascular diagnoses during the period of assessment. CVD was found to be a significant predictor of performance on several cognitive subtests, even when chronological age (cohort) was included as a factor in the statistical analysis. However, the pattern of effects was not completely consistent with a model relating CVD to intellectual decrement over time. Further breakdown of subjects into CVD subgroups (e.g., hypertension) showed the CVD effect to be specific to some subgroups, but did not fully resolve the inconsistency with the decremental model. The results also suggest CVD to be one of the factors leading to subsequent attrition from the sequential sample.


Vocal versus manual response as a determinant of age difference in simple reaction time. The decrease in response speed usually found to occur with advancing age is felt by many investigators to be a phenomenon common to all speeded tasks, regardless of the exact nature of the sensory stimulus or motor response involved. In the present experiment, however, the type of response the subject made determined whether or not an age difference existed in simple reaction time to a visual stimulus. When subjects responded manually, by releasing a key, the usual age decrement in response latency was found. When the same subjects responded vocally, by saying a word, there was no significant age difference in reaction time. This result suggests that slowing of psychomotor latency with age is not a general phenomenon, but may be limited to certain neural systems.


[Prenatal prevention and women behaviour (author's transl)]. A psychosociological survey was carried out at the "Maternité Baudelocque", in Paris; 645 women were interviewed during their stay at the hospital after delivery, according to a semi-structured questionnaire. The main purpose of this survey was to study the factors able to improve the quality of prenatal care and women behaviour during pregnancy. The interview was composed of questions on the kind of medical care received during pregnancy, the participation in training for childbirth program, the changes in daily life (rest, nutrition, smoking) and the search for extra-information about pregnancy. On the whole, the interviewed mothers received intensive prenatal care. However, some individual features influenced the quality of this medical care, especially the active role of the women themselves. The data pointed out not only the impact of the involvement in training for childbirth, but also the influence of a personal search for information, which promotes the understanding and acceptance of the medical team requirements.


[Ultrasonic size of fetal crump-rump length in first trimester of pregnancy. Accuracy of gestational age assessment (author's transl)]. The fetal crown rump length was measureed by means of pulsed ultrasound. The normal values between 49 and 94 days from the onset of the last menstrual period were determined in 72 patients. Statistical analysis showed a good correlation between gestationnal age and fetal crown rump length. The usefulness of this measure is so demonstrated: assessment of gestational age, within few days.


[Evolution of human endocervical cilio-secretory epithelium during the menstrual cycle. Scanning electron microscopy study]. The anatomy of the ventral epithelial surface of the human uterine endocervix was investigated by S.E.M. from biopsies taken at various periods of the menstrual cycle and from whole cervices obtained by hysterectomy on the 17th and 22nd day. Ciliated and secretory cells which constitute the epithelial surface appeared to be associated at random in various manners without apparent connection with the menstrual cycle. Considerable variation was observed at the same cycle period, depending on the patients. The release of mucus took place mainly according the macro-apocrine extrusion process, whose evolution was clear throughout menstrual cycle. Apocrine extrusions were found to be particularly intense and numerous from the 12th to the 16th day, with a peak on the 14th day. Some ciliated cells were also seen to exhibit protuberant mucus protrusion. The merocrine extrusion process was seen very rarely and thus seemed to be of minor importance. An evolutive provess also seems to occur at the level of ciliated cells: from the 9th to the 16th day, some secretory cells were seen to bear miniciliae of increasing length beside their typical microvillae. This could be interpreted as a transformation process of secretory into ciliated cells during the second third of the menstrual cycle.


[Idiopathic perforations of the caecum after caesarean section. A new case report (author's transl)]. The authors in this work report a further case of idiopathic dilatation of the colon which was complicated by perforation of the caecum following a Caesarean operation. The aetiology of this condition is uncertain, the diagnosis difficult and the prognosis poor. It is necessary to try to operate before the caecum perforates and to do this by decompression, which should for preference be carried out at a site in the transverse colon.


[Immediate reconstructive surgery in the treatment of ectopic pregnancy (author's transl)]. In cases of non ruptured tubal ectopic pregnancy, the first results of immediate reconstructive surgery demonstrate the need to give up classical salpingectomy, and the possibility of avoiding a second laparotomy. The technique used in this series of six unruptured ectopic pregnancies of the ampulla consisted in a subserous enucleation-excision of the ectopic ovum with end-to-end anastomosis on a polyethylene wire, followed by early hydrotubations. Hysterosalpingographic controls performed 3 months after the operation showed in all six cases bilateral passage and peritoneal spill of the contrast medium. Three patients have at the time of writing intrauterine pregnancy (16, 22 and 33 weeks old). Thus the anatomical integrity of the fallopian tubes could be restored in every case, as early as the emergency laparotomy for suspicion of unruptured ectopic pregnancy confirmed by laparoscopy. No early or late postoperative complications occurred in this series.


[The plasma and urinary hormone profiles during treatment with human gonadotrophins (author's transl)]. This study presents 6 cases of sterility that had anovulation or disturbances of ovulation treated by HMG HCG. Induction of ovulation was monitored by daily urinary oestrogen assays. The parallel study of the plasma profiles of oestradiol 17 beta, of FSH, and of LH obtained during the induction of ovulation show that the cycles in induced ovulation are not physiological in character. On comparison of the plasma profiles with the urinary profiles a significance delay is shown in the urinary oestrogen profile as compared with the plasma one and explains to a certain extent the results that were obtained.


[Accidents that can occur during fetal direct electro-cardiographic recording. Concerning a fracture of the scalp electrode (author's transl)]. The authors report a case of fracture of a double spiral scalp electrode. One of the two spirals stayed in the scalp tissue when the electrode was being removed. This spiral was localised by X-Rays and was removed under local anaesthetic. There were no complications. No similar case of such an accident has been reported in the literature and this is the first happening in our 2,472 cases of monitoring. Of the other serious complications which are mentioned in the literature, abscess of the scalp is the most frequent at 0.4 per cent (9). We have had no complications in 2,472 cases of monitoring. The outcome of such an abscess is usually quite benign, but there have been two cases of septicaemia followed by death reported. The complication of infection is serious and has to be treated carefully by disinfection. Two other complications have been noted and that is, tearing or ripping off a little of the scalp (2 cases in 2,472 monitorings). Spinal fluid leakage has been reported when an electrode was placed on a fontanelle and haemorrhage. Most of these complications took place when the clip electrodes which have now been abandoned were used and, their frequency being rare, does not invalidate the definite advantages of direct monitoring of the fetus in labour.