Action of physostigmine on inherited ataxias. Physostigmine improved videotape scores of ataxia in patients with various inherited ataxias. This improvement occurred in 12 out of 12 patients when the drug was given as a single dose and in nine of 11 patients when the drug and placebo were given in a long-term, double-blind randomized trial. Patients report various mild to moderate clinical benefits after the sustained use of physostigmine for 6 to 36 months. Videotape scores showed an average of 30% numerical improvement in seven patients after 6 months' sustained treatment. The acute responses are not blocked by methylscopolamine, methylscopolamine did not make ataxia more severe, nor have any patients had fasciculations or changes in strength while on physostigmine. We therefore presume that a central cholinergic mechanism plays some role in the pathophysiology of the inherited ataxias. We do not have direct data on the site or nature of this mechanism. Further studies with other cholinergic agents are now required to investigate the effects and potential clinical efficacy of this class of compounds more completely than has been done up to now.


Ataxia and disorders of purine metabolism: defects in hypoxanthine guanine phosphoribosyl transferase and clinical ataxia. A relationship between disordered metabolism of purines and the central nervous system has been established by the Lesch-Nyhan syndrome. In this disorder a virtually complete defect in the activity of HGPRT is associated with a syndrome of severe mental retardation, choreoathetoid cerebral palsy, and bizarre, self-mutilative behavior. In patients with partial defects in HGPRT, two have had symptoms that have been labeled spinocerebellar. Neither were appreciably ataxic, and the relationship between the symptoms and the enzyme defect remains to be established. Analysis of HGPRT in members of a large kindred with spinocerebellar degeneration revealed normal levels of the enzyme. These observations suggest that a relationship between the activity of HGPRT and clinical ataxia is remote.


Joseph's disease: an autosomal dominant neurological disease in the Portuguese of the United States and the Azores Islands. Our objective has been to trace Joseph's disease to its geographic origins and to determine the spectrum of clinical manifestations. This goal we have achieved by documenting type I and II disease within the Joseph and Sousa families. The major neuropathologic findings are a progressive neuronal loss involving the striatum, nigra, dentate nucleus of the cerebellum, and lower motor neurons in the brainstem and spinal cord. The homozygote form of the disease produces type I disease with onset in early childhood of progressive dystonia, athetosis, and spasticity. Type I disease tends to have its onset by age 25 years in heterozygotes and lasts about 15 years on the average. Type II disease, which we consider the result of a single dose of the mutant gene, usually begins somewhat later and runs its course over a 20-year period. Type III disease documented in the Thomas family is the most benign. Its onset is often in the fifth decade, and it progresses slowly into the eighth decade. Patients may benefit from antiparkinson medication including dihydroxyphenylalanine and anticholinergic agents (e.g., amantadine). A molecular marker for the disease is being sought actively, and several interesting patterns have already been documented by means of patient fibroblast cultures and two-dimensional acrylamide gel protein separations. The mutant gene is clearly outside the HLA complex but may be linked to it. The only biochemical change noted thus far is a reduced CSF level of HVA that probably reflects the loss of dopamine-synthesizing neurons in the substantia nigra and is thus a secondary effect of disease. Although the disease is a very old one which we can trace back to the early 19th century on the island of Flores, it may be recurring de novo by new gene mutations at an unstable gene locus in a genetically vulnerable population. Now that the spectrum of clinical expression has been identified and the mode of inheritance established as an autosomal dominant wherever the disease has been found, it is believed that its true incidence will become more evident by virtue of better detection and that the true incidence will actually increase because of increased assimilation of affected persons into other ethnic groups.


Hemorrhoids, fistulae and fissures: office and hospital management--a critical review. We have tried to present a comprehensive survey of present-day management of hemorrhoids, fistulae and fissures, be it in the office or in the hospital. There is great socioeconomic pressure lately for cost-containment, which is apt to effect better medical judgment in the selection of type and place of management. Minor operations can and should be done, as always, on an outpatient basis. General anesthesia is not a minor matter and hemorrhoidectomy is not a minor operation. The major function of outpatient service in the management of anal disease is that of accurate and comprehensive diagnosis. Hundreds of patients come to us only because they fear cancer and it is not enough for us to hunt for and treat the vague little disorders of which they complain. The incidence of cancer of the colon rectum in this country just recently has slightly surpassed that of lung cancer. Adjuvant treatments (e.g., chemotherapy, radiotherapy, immunotherapy and their combinations) are promising but still in the investigational stage. Early diagnosis is our finest weapon with subsequent surgical management. The challenge and responsibility for early diagnosis of colorectal cancer is ours alone. We must first recognize it and then meet it firmly and squarely. We must feel for (digital rectal), look for (sigmoidoscopy), and search for (barium enema x-ray examination) colorectal cancer in all of our patients regardless of the insignificance of anal symptoms and anal findings. Our countrymen fear cancer. We have the devices to allay their fears or to cure their cancers if they are found early enough. We have a straightforward moral commitment and a national trust.


Renovascular hypertension.

Renovascular hypertension. In summary, renovascular surgery has evolved during the past 20 years to become a highly efficacious therapeutic modality provided proper patient selection is practiced. Surgical techniques are now well established, and with the advent of ex vivo techniques practically any extraparenchymal renal artery lesion may be repaired. At present, much investigative work is in progress in an attempt to develop better means of selecting patients who will benefit from renovascular surgery. The newer modifications of renal vein renin assays may permit better patient selection. Many factors must be weighted when considering medical versus surgical management of hypertension. Paramount among these must be the quality of life of the patient. The inconstancy of pressure control and the frequency of undesirable side effects in the more extreme medical regimens are the primary disadvantages of nonsurgial management. An aggressive surgical approach appears to be warranted in selected patients with atherosclerosis and in almost all patients with fibromuscular dysplasia.


Ulcers of the leg.

Ulcers of the leg. The catalog of possible causes of ulceration of the leg is unending. It has been the purpose of this article to cover in some detail those ulcers seen most commonly in Western Europe and America. Neoplastic ulcers, tropical ulcers, ulcers due to underlying bone disease, ulcers associated with blood dyscrasias, ulcers due to foreign bodies and self-inflicted injury, and injection ulcers all occur but are rare and are covered in detail elsehwere. In summary, it must be emphasized that an ulcer of the leg needs a correct diagnosis before appropriate treatment can be administered. Diagnosis often is difficult and far from obvious, requiring considerable care and clinical experience.


Hormonal influences on gastric secretion. Gastric secretion in response to a meal is stimulated by a variety of neurohumoral agents. Acidified chyme flowing into the duodenum evokes a series of events that bring about the neutralization of H+ or suppression of further acid secretion. The actions of several proven and putative stimulatory and inhibitory agents are summarized in Figure 8.


Treatment of perforated diverticular disease of the colon. Diverticular disease of the colon now is recognized to be functional disease resulting from altered neuromuscular activity in the colon. Inflammatory complications, when they occur, usually result from inflammation around a single diverticulum. This may lead to the formation of a pericolic or pelvic abscess. Free perforation of these leads to purulent peritonitis. The original communication with the lumen of the bowel usually is obliterated. More rarely, with either rapid evolution or failure of the diverticular neck to obliterate, a free communication develops between the bowel lumen and the peritoneal cavity, leading to fecal peritonitis. Fecal peritonitis results in an extremely high mortality rate. The operative approach for a patient with perforated diverticular disease should be individualized and depends on the stage of the disease present, the general condition of the patient, the experience of the surgeon in colon surgery and the availability of facilities and personnel to provide intensive care. In larger institutions when these conditions are optimal, primary resection of the diseased bowel with or without anastomosis is becoming the procedure of choice. In smaller institutions or if conditions are not optimal, right transverse colostomy with drainage of the perforated segment can be relied on to control the disease with a mortality rate compared to that of primary resection. If free perforation and fecal peritonitis are present, exteriorization or primary resection of the perforated segment must be carried out. We would not recommend primary anastomosis under these circumstances.


[Results of school inspections in the county of Karl-Marx-Stadt (author's transl)]. Within the Health Protection in Childhood and Adolescence Research Project a hygienic inspection questionnaire was designed for schools. To test this questionnaire, 248 schools in 11 districts of the county of Karl-Marx-Stadt were inspected. From the ascertainments made, several instances are cited to point out the priorities of school hygiene.


[Remarks on finding "real" sexual differential values--presented by the example of measurements of vital capacity (author's transl)]. Investigations conducted over many years have lead to the proposal to use - on the basis of classes of equal stature - the "female-male-index" (Ifm) for anthropometric, physiological and physical-athletic measured or performance values, respectively, which correlate significantly with stature. A "standard table for measurements of vital capacity by dry spirometer" is used to present this method of applying the "real" sexual differential values.


[Reliability, heritability, correlation in longitudinal studies (author's transl)]. An analogy exists between the mathematical models of psychological test theory and quantitative genetics, as well as between the parameters, reliability and heritability, derived from these models. With the same results, heritability and correlation in longitudinal studies are only different approaches to the same problem, the reliability of measurement in the long run, that is of fundamental consequence for personnel selection.


[Organisation of bronchitis dispensaries-problems and present situation in the north-eastern region of the GDR (a pilot study of the bronchitis dispensary of the Pediatric Clinic, University of Greifswald) (author's transl)]. The dator on the care of children with CNSLD obtained from pediatricians working at out-patient departments in 15 districts of the Rostock and Neubrandenburg counties (in the north-eastern region of the GDR) are analyzed in a pilot study. This survey shows that there are 6 standard bronchitis dispensaries and on additional dispensary with highly specialized diagnostic equipment (Pediatric Clinic of the University of Greifswald) in 7 of the districts. In the remaining districts care of these children is provided within the framework of general medical outpatient care. 2% of the children having CNSLD only 36% receive medical treatment, which is a rather low percentage. This situation will be improved on the basis of better cooperation with the family doctors and the out-patient departments for lung diseases.


[Principles of classification and nomenclature in families with striking social peculiarities shown by an example of the district of Osterburg (author's transl)]. The necessity of an uniform characterization for the so called "families with social perculiarities" is explained. Criterias and designations for this purpose are proposed and used in a survey in the district of Osterburg. It is shown, that social risks concentrate in villages. They increase with a rising number of children, especially in families with 5 and more children, and that the social burden of numerous children is "infectious" in respect of peculiarities. Alcoholism is the most negative of them. The most important tasks are the care of potators and of families with childbirth intervals of less than two years.


[On social diagnosis and prognosis concerning childhood--experiences in Czechoslovakia. Part I (author's transl)]. The term "social" is defined multidimensionally. For the child, the most important structural unit of the social environment is the family, whose normal function influences the child's development significantly. Familiar disturbances threaten or damage it. From these aspects a social prognosis can be derived. The intuitive assessment of a singular case should be replaced by an objective, generalizable method.


[Group talk psychotherapy with adolescents (author's transl)]. The authors give a report about their experiences of five years on group talk psychotherapy with adolescents. The indication to take part in this method which is integrated in a multidimensional therapeutic concept, consists in psychosocial disturbances with crises. Mainly adolescents of 14-18 years of age are taken care of in the groups. Meetings take place once a week and last about 90 minutes each. We have to deal with open groups, e.g. the duration of participation is different depending on the patient's problems. New member to the group are admitted continuously, in most cases after clinical preparation. A rapid integration of new patients is possible through members who have already been in the therapeutic process for a certain time. In this paper the importance of the behaviour of the therapeutist is discussed too. Here more activity is necessary than in groups of adults.


The physician's role in radiation protection. Examinations which should not be regularly performed include: chest and lower back x-ray examinations in routine physical examinations; tuberculosis screening by chest radiography; chest x-rays for hospital admission of patients under age 40 (unless there is a clinical indication of chest disease); chest radiography in routine prenatal care, and mammographic examinations for women under age 50 who do not have symptoms or a positive history. X-ray examinations of possibly pregnant patients require appropriate measures to protect the fetus.


Evaluation of suicide risk.

Evaluation of suicide risk. The family physician has the unique opportunity to evaluate suicidal ideas, behavior and risk by using his demographic and medical knowledge, applying interview skills and involving the family and friends in the initial assessment. Having made an intelligent and complete assessment of the suicide threat, he can then select the most appropriate management for his patient, constantly keeping in mind the need to reevaluate for suicide risk at frequent intervals.


Orbital auscultation.

Orbital auscultation. Orbital auscultation is recommended as a screening technique in patients with subjective bruit or tinnitus, persistent conjunctivitis, exophthalmos, headache, seizure disorder and other neurologic and psychiatric symptoms. It can reveal carotid-cavernous fistula, cerebral arteriovenous malformation, an intracranial mass which is producing increased intracerebral pressure, Paget's disease and other vascular abnormalities.


Frequency of sensitization to different pollen groups and results of specific immunotherapy. Of all the diseases produced by the inhalation of allergens, it is perhaps pollinosis in which specific immunotherapy with pollen antigens is most indicated. For this reason, the present work studies the symptoms and the results of skin tests, before and after the completion of a correct and specific course of immunotherapy for three years. We selected 345 patients with a clear history of pollinosis, suffering from rhinitis (90.7%), conjunctivitis (71%), bronchial asthma (51%) and urticaria (4.3%). The most sensitizing pollens were those of grasses, which affected 97.68% of the patients, followed by flowers (70.14%), shrubs (59,13%) and trees (47.82%). Multiple pollen sensitizations were found in 88.2%, but only 27.24% were sensitive to grass pollens alone. After specific polyvalent treatment with aqueous extract a notable improvement was found in the results of the skin tests (73.8%) and in clinical symptoms (87%). On the other hand, we found a deterioration in the skin test results in 5.9% and a worsening of symptoms in 1.5%. These unfavourable results were probably due to the failure to include all sensitizing pollens in the immunotherapy extract. These results suggest to us that the only worthwhile treatment for pollinosis is immunotherapy based on a polyvalent and specific extract individually prepared, whether aqueous or depot type, according to the skin test results.


Allergic manifestation in Nigerian asthmatics. Intracutaneous and inhalative provocation tests performed on 185 asthmatic Nigerian patients and 50 control patients using indigenous antigen extracts as well as imported ones showed that moulds, house dust and D. farinae are the most common allergens responsible for the patients' asthmatic symptoms. Food allergy, though present, does not play a significant role among the patients. Pollinosis is not a common symptom among the patients although the Nigerian pollens are believed to possess antigenic properties. Environmental factors were thought to be responsible for the scarcity of pollen allergy in Nigeria. The importance of making use of indigenous antigen for allergy tests in stressed as this would reveal the true allergic state of the people.


BCG adjuvant immunotherapy in carcinoma of the prostate: an interim report. Twenty-eight patients with a confirmed histological diagnosis of adenocarcinoma of the prostate received BCG immunotherapy in addition to conventional therapy. Patients receiving BCG exhibited significant changes in IgA, IgM, WBC's, acid phosphatase and in cutaneous hypersensitivity when compared to an age-related control group of prostatic cancer patients receiving only conventional therapy. Survival from the time of diagnosis was 8 months longer in patients receiving BCG. Side effects of BCG vaccination were minimal consisting of local inflammation and pruritus at the site of inoculation. There were no deaths of systemic reactions.


The use of triamcinolone acetonide in the treatment of severe intrinsic bronchial asthma. A group of 145 patients with severe intrinsic bronchial asthma symptoms was treated with repeated intramuscular injections of triamcinolone acetonide (Kenalog) during an average period of two years. Kenalog was administered mainly to persons with persistent attacks of asthmatic dyspnea and frequent recurrent infections of the respiratory tract in which other drugs, including orally administered steroids, did not lead to any improvement in the asthmatic symptoms. The results of therapy were excellent (total disappearance of asthmatic manifestations) or good (considerable improvement of asthma symptoms) in 88.3% of treated cases, while in 11.7% of patients, Kenalog had no effect. In 13.8% of cases, side effects, especially weight gain, disturbances in menstruation, increase in blood pressure, edema and spontaneous echymoses were observed. The triamcinolone acetonide depot-preparation is, in the authors' opinion, highly effective in the management of severe intrinsic asthma cases, unsucessfully treated by other methods. The prolonged use of Kenalog can, however, like other steroids provoke, several side effects.


Management of breech presentation and delivery. Vaginal delivery of a fetus in breech position carries a risk three times that of vertex delivery. Patients must be carefully selected for vaginal delivery. The position should be that of a frank breech; the child should not be excessive in size; the mother's pelvis should be normal, and there should be no other complications of pregnancy. The fetal heart rate should be carefully monitored throughout labor. When patients with breech position are carefully studied, about two-thirds will be delivered by cesarean section.


Report on carcinogenesis bioassay of 1,2-dichloroethane (EDC). In a carcinogenesis bioassay of the halogenated solvent 1,2-dichloroethane (ethylene dichloride, or EDC), oral administration of the compound produced cancers in rats and mice. In male rats, dosage with EDC caused forestomach cancers, hemangiosarcomas (vascularized cancers) of multiple organs, and subcutaneous fibromas (cancers beneath the skin). Female rats exposed to EDC developed mammary (breast) cancers--in some high-dose animals as early as the 20th week of the study. The chemical also caused breast cancers as well as uterine cancers in female mice, and respiratory tract cancers in both male and female mice.


Hearing levels of aerospace workers as affected by duration of employment. Studies of the audiograms of a sample of male aerospace workers to establish the relationship between hearing level and occupational exposure indicate that hearing levels at 4000 Hz of the sample are essentially the same as the general U. S. male population under age 45 but show a greater loss over age 45. Partial correlation studies relating hearing level changes to duration of employment, with age effects held constant, attribute this difference to factors other than occupational exposure. The correlation studies of the overall sample show a slight trend for increasing loss with longer durations of employment. The net effect is of no practical significance. Detailed age group correlation studies indicate that this age-related change occurs primarily in the under age 35 group, a factor of significance to hearing conservation activities.


Biological monitoring of exposure to styrene by analysis of combined urinary mandelic and phenylglyoxylic acids. Human volunteers were exposed in an experimental chamber to styrene (4 or 8 hours at 40 to 200 ppm) in order to obtain a quantitative relationship between exposure and urinary elimination of the metabolites mandelic and phenylglyoxylic acids (MA and PGA). For the analysis of PGA a new GC-method was used, based on reductive transformation of the relatively instable PGA into MA, which is stable enough for shipping and handling until final processing. The analysis of the post-exposure elimination shows that spot urine sampled in the morning after exposure and analysed for the sum of MA and PGA is the most reliable index for reflecing a preceding exposure to styrene.


Establishing a protocol from laboratory studies to be used in field sampling operations. A laboratory procedure is described that has been used in determining the breakdown products of plastic compounds used in injection molding operations. These compounds include polyvinyl chloride, polystyrene, acrylonitrile-butadiene-styrene, methyl methacrylate, polyethylene, polypropylene, and nylon. Laboratory samples were generated at injection molding temperatures and collected on various solid sorbents. Detector tubes were used for qualitative information to indicate whether certain classes of compounds were present. Compounds identified from the analyses of these laboratory samples are listed. Qualitative gas chromatography-mass spectormetry (GC/MS) data obtained from charcoal tube samples collected at a tire molding and a rubber producing company are also presented.


Body temperatures in relation to heart rate for workers wearing impermeable clothing in a hot environment. Thermal reactions and heart rate were measured for men wearing impermeable clothing in a hot environment. Even at rest, the Ts increase was remarkable. At the 30th minute, Ts reached 37.2 +/- .4 degrees (+/- SD). Experimental walking (wearing impermeable clothes) occasioned significant (p less than .001) rises in thermal reactions and HR in comparison to control walking; Tr, Tb, Ts at the 30th minute were 38.4, 38.4, 38.1 degree C respectively, and HR was 162 beats/min. No plateau for these responses was reached during 30 minutes of experimental walking. Tr continued to rise after the subjects stopped exercising. The regression equation of Tr on HR in experimental walking differed from that of control walking. If Tr is used as an index for work safety, a lower Tr is needed under such severe conditions.


Comparison of respirable coal mine dust concentrations measured with an MRE and a newly-developed, two-stage impactor sampler. The design and laboratory evaluation of a two-stage aerosol sampler using an impaction plate for removing particles above 10 micron, has been reported. The unit was developed to provide an alternative to the two-stage sampling head used on approved coal mine personal respirable dust samplers. The new device offers the potential of increasing the analytical accuracy of samples, and of providing a device more suitable to the mining community for use in their mandated dust sampling program. This paper describes the underground sampling program conducted to establish the factor for converting respirable dust concentrations measured with this device to equivalent concentrations measured with an Isleworth 113A gravimetric dust sampler (MRE). This study demonstrated that the use of the impactor sampling head provides a viable alternative to the currently used sampling head. The results showed that comparative measurements could be linearly related for MRE dust measurements ranging from 0.5 to 5.5 mg/m3. The factor determined for converting measurements made with the new head to equivalent MRE measurements was approximately 0.5.


Chemical material handling guides.

Chemical material handling guides. A system has been developed for providing information regarding chemicals, their hazards, and safe handling requirements to employees of Johnson Wax. To initiate the development of a Chemical Material Handling Guide, physical, chemical, and toxicological information is acquired on the chemical raw material, intermediate, or finished product. The guide is prepared by members of a "guides" committee each of whom is responsible for completing one or more of its sections. The five major sections deal with identification, hazard ratings, protective equipment requirements, emergency procedures, and storage, handling and disposal requirements for the chemical material.


Pneumatic muffler noise.

Pneumatic muffler noise. Sixty-five commercial pneumatic mufflers in the size range of 1/8 to 3/8-inch American Standard Taper Pipe Thread (NPT) were evaluated for noise level as a function of air supply pressure and back pressure. Also, typical directivity pattern and spectral content were determined. A rating system has been devised, as well as individual prediction formulas, to rank order the mufflers and provide a capability of calculating expected noise levels for a given supply pressure. As this study reveals, noise reductions in excess of 40 dBA may be achieved by employing an efficient pneumatic muffler.


Simplified occupational noise hazard prediction for new equipment. A simplified yet accurate method has been developed to predict noise hazards for new equipment by using only dB(A) noise levels, calculating power levels by the Two Surface Method and plotting a predicted noise isopleth. Noise levels can be accumulated for multiple sources. Room constants and other parameters can easily be varied to determine the most feasible and economical solution for noise problems.


Phosphorus vapor exposure in phosphorus using plants. Operator exposure to phosphorus in five areas in the five FMC using plants was documented primarily with area samplers. However, where significant levels of phosphorus vapors were found, personal sampling was also performed. Eight-hour time-weighted-average phosphorus exposure levels were estimated for operators in the phosphorus burning plants from the area measurements. Maintenance worker exposure was also studied. No worker was exposed to phosphorus concentrations above the current 0.1 mg/M3 threshold limit value (TLV).


Behavioral versus process consultation interventions in school settings. Teachers experiencing difficulties in managing disruptive, acting-out children in two parochial first-grade classes were provided either behavioral or process consultation. The behavioral intervention included discussions of behavior modification principles, feedback concerning contingent praise, and individualized behavioral interventions. In contrast, the process consultant used clarifying, supportive, and reflective responses to help the teacher better understand classroom difficulties and enhance her ability to work with problem children. Results of the interventions indicated that during consultation sessions and follow-up, problem behaviors were significantly reduced and attention to desirable behaviors significantly increased. The results were observed in three problem children in the classroom provided with behavioral consultation, and there only. Both teachers rated problem children as being less disruptive following program involvement. Significant positive relations were found between directly observed and teacher ratings of problem behaviors.


Self-disclosure in relation to psychotherapist expertise and ethnicity. The self-disclosure styles of Mexican Americans and their possible role in the limited participation of Mexican Americans in mental health services were explored. Ninety-four Mexican American and 93 Anglo American junior college students listened to one of four therapist introductions, then responded to questionnaires designed to measure self disclosure and self acceptance. Both groups indicated a substantial willingness to disclose about themselves to therapists. Mexican Americans proved lower in self-disclosure scores than Anglo Americans. Mexican Americans were found to disclose less to Mexican American therapists than did Anglo Americans to Anglo American therapists. Sex differences in self-disclosure were negligible. Both Mexican Americans and Anglo Americans scored in the direction of high self-acceptance. The findings held for comparable socioeconomic levels.


A community mental health innovation in mass media preventive education: the alternatives project. An innovative mental health primary and secondary prevention program employing mass media was conducted in the Louisville metropolitan area. For 60 weeks during public service announcement time slots, 21 educational mental health and mental retardation messages were aired on local major radio and television stations. Three project goals were established: (a) improved mental health attitudes; (b) increased awareness of community mental health resources; and (c) increased utilization of community mental health resources. Systematic evaluation, based on data from client-initiated telephone contacts and surveys of the community, indicated that the project appeared to be successful in increasing awareness and utilization of community mental health resources. Positive change was indicated, overall, for attitudes related to cognitive structuring of problem situations. Attitudes related to behavioral resolution of problem situations appeared to be generally uninfluenced. Implications and future directions for the utilization of mass media in community mental health are discussed.


Communication skills training for paraprofessional helpers. The purpose of the present study was to develop and evaluate a training program for paraprofessional helpers. Twenty dormitory counselor candidates were given 20 hours of communication training while 15 other candidates were given no training. The results indicated that the trained subjects demonstrated significantly higher levels of empathy than the untrained subjects and that they maintained their level of empathy after 6 months. Results are discussed in terms of the lasting effects of the training program and the advantages of being able to use trainers with only limited experience.


The effects of expectancy, professional identity, and behavior upon social rejection. Psychiatric residents (n = 16) and undergraduate students (n = 32) listened to four recorded interviews. Each interview was designed to represent a particular combination of impulse control and distress. Two levels of mental illness expectancy were obtained by changing the context of the interviews. The subjects rated the interviewees on scales of social acceptance and psychopathology. Univariate analyses of variance were used to evaluate the data. The evidence indicated that an individual's behavior must be actually perceived as psychopathological before social rejection will occur.


The impact of a community screening program on psychiatric hospital admissions. A rural CMHC screening program significantly reduced admission rates to a state hospital compared with hospital-based screening. Personnel from CMHCs in three counties evaluated each potential admission to the hospital to evaluate their need for hospitalization. Hospital staff screened admissions from the remaining counties of the state. Both community and hospital screening resulted in significant reductions in admissions with community screening producing larger declines. Additional possible advantages of community screening for improved treatment outcomes, efficient utilization of community resources, and reduced costs are discussed.


Alcoholic liver disease presenting with marked elevation of serum alkaline phosphatase. A combined clinical and pathological study. Twenty patients with longstanding alcoholism and biopsy-proven alcoholic liver disease presented with marked elevation of serum alkaline phosphatase (in excess of four times the upper limit of normal). None had a past or present history to suggest pancreatitis or biliary tract disease, nor had any of these patients recently taken medication which could be implicated in cholestatic jaundice. Thirteen (65%) of this group either had radiologic or post mortem confirmation of nonobstructed biliary systems. The histologic findings in this group of patients were compared with those of a group of patients with alcoholic liver disease and normal or only mild elevation of serum alkaline phosphatase. Significantly more hepatocellular necrosis (P less than 0.05), alcoholic hyaline (P less than 0.02), and cholestasis (P less than 0.002) were noted in the severely hyperphosphatasemic group. Minimal degrees of steatosis were found in both groups. These data indicate that intrahepatic cholestasis occurs in patients with alcoholic liver disease, and this may often be secondary to alcoholic hepatitis. Overemphasis has previously been given to alcoholic fatty liver as a cause of this syndrome.


Bridging hepatic necrosis. Etiology and prognosis. The probable etiology and outcome of bridging hepatic necrosis found on a liver biopsy performed within three months of the onset of clinical illness was evaluated in 42 consecutive patients with this finding. Eighteen of the patients (43%) had a probable drug etiology for their hepatitis. Ten patients had HBSAG-positive acute hepatitis. Fourteen patients had neither drug-induced disease nor proven HBSAg-positive hepatitis. One patient from the drug-induced group died, but the other 17 had complete clinical recovery. Eight of ten in the hepatitis B antigen-postive group cleared their antigen and had complete clinical recovery. Chronic hepatitis developed in two who remained persistently HGSAg positive. Eight of the patients in the group with unknown etiology recovered, while six developed evidence of active chronic liver disease. This incidence of active chronic liver disease is significantly greater than that found in the drug-induced group (P less than 0.02). We conclude that drug-induced hepatitiis accounts for a significant proportion of patients of acute hepatitis who have bridging hepatic necrosis on liver biopsy. However, in these drug-induced cases the finding of bridging hepatic necrosis does not appear to be associated with an increased risk of development of active chronic liver disease.


Mannitol and glucose: effects on gastric acid secretion and endogenous gastric inhibitory polypeptide (GIP). Serum gastric inhibitory polypeptide was measured in dogs prepared with Heidenhain pouches and Mann-Bollman fistulae following the intraduodenal (ID) infusion of isotonic saline, 20% glucose, or 20% mannitol. Following ID 20% glucose, serum GIP concentrations rose significantly (P less than 0.05) between 30 and 120 min and there was a significant inhibition (P less than 0.05) of acid secretion in the Heidenhain pouches between 15 and 75 min. A good correlation (r = 0.925) was found between the rise in serum GIP and the inhibition of acid secretion. Although neither ID isotonic saline nor 20% mannitol stimulated GIP release, the latter produced a significant (P less than 0.05) inhibition of acid secretion between 60 and 105 min. We conclude: (1) the inhibitory effect of acid secretion following ID glucose is mediated in part by the release of endogenous GIP; (2) glucose and mannitol probably inhibit gastric acid secretion by different mechanisms.


Effect of cholestyramine on bile acid kinetics in patients with portal cirrhosis of the liver. Evidence of a selective defect in the formation of cholic acid. The kinetics of cholic acid (C) and chenodeoxycholic acid (CD) were studied in six patients with portal liver cirrhosis. The studies were conducted both before and after 5-6 weeks of treatment with cholestyramine (12 g/day). In keeping with previous observations, the pool size and formation of C showed subnormal values during the pretreatment period, while the production of CD was within normal limits. The pool sizes of C and CD did not change upon treatment with cholestyramine, but the mean total bile acid formation increased by a factor of about 2.5. The ratio between the amounts of C and CD synthesized remained essentially unchanged. Considering the therapeutic response previously observed in normal subjects and in patients with hyper-beta-lipoproteinemia, the present results suggest a selective impairment of the biosynthesis of C in patients with portal liver cirrhosis. It is suggested that the primary defect may reside in the 12alpha-hydroxylase enzyme system.


Increased canine jejunal absorption of water, glucose, and sodium with intestinal pacing. Our aim was to determine if pacing a segment of jejunum backwards with electrical stimuli could increase absorption from it. In four dogs, 75-cm loops of jejunum were isolated from the intestinal stream. After recovery, fluid was infused into the proximal stoma of the loop and effluent collected from the distal stoma for three consecutive 30-min periods. In the second period electrical stimuli were applied to the distal end of the loop to drive the pacesetter potentials of the loop, hence its contractions, backwards. The output of water, glucose, and sodium from the loop was decreased, and the transit of content through the loop was slowed during backward pacing. We conclude that pacing a segment of jejunum backwards with electrical stimuli enhances absorption of water, glucose, and sodium from that segment.


Juvenile and adenomatous gastrointestinal polyposis. This is the fourth report of a case showing an association between juvenile and adenomatous polyposis. Starting at age 14, this patient underwent multiple polypectomies and gastrointestinal resections over a 15-year period. Although initial biopsies were diagnosed as juvenile polyps, later biopsies showed both adenomatous polyps and large polypoid masses with a mixture of juvenile and adenomatous features. Several typical small hyperplastic polyps were also found in the stomach. This case contrasts with the previous three cases in that the gastrointestinal tract is more widely involved and in that there is an unusual marked hyperplasia of argentaffin- and argyrophil-positive cells. The case reported here strengthens the relation between adenomatous polyposis and juvenile polyposis.


Intussusception of sigmoid colon in an adult. Spontaneous expulsion of sequestered bowel and restoration of bowel continuity. A 67-year-old white man presented with bloody diarrhea and passed a 22-cm long segment of full-thickness sigmoid colon following a barium enema. He had advanced peripheral and cerebral vascular disease and had undergone pelvic irradiation for a bladder cancer five years previously. He recovered uneventfully from the bowel sloughage. This was apparently due to an intussusception of the sigmoid colon followed by the formation of adhesions between the edges of the adjacent viable bowel.


A historical and epidemiologic perspective on respiratory symptoms questionnaires. Since 1960 the British Medical Research Council (MRC) standardized questionnaire on respiratory symptoms has been used in epidemiologic investigations of chronic respiratory diseases. This review describes the validity, reliability, and susceptibility to bias of the MRC questionnaire. The validity of the phlegm questions as a sensitive index of sputum production has been established but adequate validation of other symptom questions has been hindered by the absence of appropriate, independent criteria for comparison. Consistency of response averages 80 per cent for symptom questions and may reach 99 per cent for reporting of smoking habits. With proper use, the results of the MRC questionnaire are not biased by the observer, by the season of administration, or by method of administration. Modification of the questionnaire by individual investigators may lead to bias when comparisons are made between studies. Because a large literature based on the MRC questionnaire is now available, any new respiratory symptoms questionnaires should be compatible with the MRC questionnaire, and should be calibrated against it.


A comparison of 1960 and 1973--1974 early neonatal mortality in selected states. Linked birth and infant death records from six states provided the opportunity for comparison of 1960 and 1973--1974 early neonatal mortality rates by weight, maternal age and live birth order. The data were analyzed by fitting linear models to the logarithm of the ratio of 1960 to 1973--1974 early neonatal mortality rates. Although there was substantial variability in these ratios by maternal age and birth order, the ratios were nearly constant for birth weights between 1001 and 4500 gm. The decline in mortality among low birth weight infants (2500 gm or less) accounted for over half of the overall decline in early neonatal mortality. The results obtained here are compared with earlier national studies and possible explanations for the decline are discussed.


Cigarette smoking during pregnancy and the occurrence of spontaneous abortion and congenital abnormality. A multiple logistic regression analysis of 12,914 pregnancies and 10,523 live births, based on a mail survey of professional women in medicine, was carried out to determine the relationship between maternal cigarette smoking, and spontaneous abortion and congenital abnormality. After controlling for interfering variables (age, exposure to trace anesthetic gases, pregnancy history, and mailing response), a statistically significant increase in risk associated with maternal cigarette smoking was found for spontaneous abortions and congenital abnormalities. The risk of spontaneous abortion for the heavy smoker is estimated to be as much as 1.7 times that of the nonsmoker in certain risk groups. The risk for congenital abnormality for babies born of smoking mothers is estimated to be as much as 2.3 times that of the nonsmoker, depending on age, pregnancy history, and other factors.


Oral contraceptives, smoking, and other factors in relation to risk of venous thromboembolic disease. Analysis of data from the Walnut Creek Contraceptive Drug Study showed a significant increase in risk of venous thromboembolic disease in the absence of surgery, trauma, malignancy, pregnancy, and the puerperium for women with a previous history of thromboembolism, hypertension, diabetes, varicose veins, gallbladder disease, and cigarette smoking. Education, marital status, parity, use of noncontraceptive estrogens, and obesity were not associated with an increase in risk of the disease. When only cases of the disease in the absence of all known predisposing causes (idiopathic cases) were analyzed, both oral contraceptive use and smoking remained as independent risk factors; there was no evidence of a positive interaction between them.


Diabetes incidence and prevalence in Pima Indians: a 19-fold greater incidence than in Rochester, Minnesota. The incidence and prevalence of diabetes mellitus were determined in 3733 Pima Indians aged 5 years or over by periodic examinations over a 10-year period. The examinations included modified glucose tolerance tests and medical record review. The age-sex adjusted prevalence rate was 21.1% (SE = 0.7%). Prevalence was low in childhood and plateaued at 40--50% in adults over 35 years of age. The age-sex adjusted incidence rate of 26.5 cases/1000 person-years (SE = 1.9) is the highest reported diabetes incidence known to the authors. Incidence increased from low levels in childhood to peak at age 40 (males) or 50 (females) and then gradually declined. Diabetes incidence was 19 times that in the predominantly white population of Rochester, Minnesota (95% confidence interval, 16 to 22 times). The high incidence rate was found despite using a more stringent diagnostic criterion than customarily employed, and was shown not be due to biased follow-up of subjects.


On the desirability of the Mantel-Haenszel summary measure in case-control studies of multifactor etiology of disease. Interesting properties of Mantel-Haenszel summary measure with important consequences in retrospective epidemiologic investigations are derived directly from the functional form of the weight function. The concept of confounding is examined in the context of case-control studies evaluating the etiologic significance of exposure to more than one risk factor. The use of M-H summary measure is suggested for calculating adjusted risks in multifactor studies.


A case of red-cell adenosine deaminase overproduction associated with hereditary hemolytic anemia found in Japan. A case of red cell adenosine deaminase (ADA) overproduction associated with hereditary hemolytic anemia is reported here. This appears to be the second report. Proband is a 38-year-old Japanese male who had hemoglobin, 15.8 g/100 ml; reticulocyte count, 4.5%; serum indirect bilirubin, 4.9 mg/100 ml; 51Cr-labeled red cell half-life, 12 days; red cells showed moderate stomatocytosis. His red cell ADA activity showed 40-fold increase while that of the mother showed 4-fold increase. The mother was hematologically normal. The father had a normal enzyme activity. The proband and the mother showed slightly high serum uric acid levels. The proband's red cell showed: ATP, 628 nmoles/ml (normal, 1,010--1,550); adenine nucleotide pool, 46% of the normal mean; 2,3-diphosphoglycerate content, 3,782 nmoles/ml (normal 4,170--5,300); increased oxygen affinity of hemoglobin, P50 of intact erythrocytes being 21.8 mmHg (normal, 24.1--26.1). Red cell glycolytic intermediates in the proband were low in general, and the rate of lactate production was low. Kinetic studies using crude hemolysate revealed a normal Km for adenosine, normal electrophoretic mobility but slightly abnormal pH curve and slightly low utilization of 2-deoxyadenosine. The ADA activity of lymphocytes was nearly normal.


Effect of chloramphenicol on colony formation from erythrocytic precursors. In the present experiments, we compare the behavior of erythropoietic precursors and granulocytic precurosors exposed to chloramphenicol. Subcutaneous injection of 20 mg of chloramphenicol sodium succinate on five successive days induced a reduction in the number of erythrocytic colony-forming units (CFU-E) and erythropoietic burst-forming units (BFU-E) in murine marrow and spleen, while no change in number of granulocytic precursors (CFU-C) in murine hemopoietic organs was observed. In vitro studies demonstrated concentration-dependent inhibition of chloramphenicol or chloramphenicol sodium succinate in the colony formatin of all these precursors from murine and human bone marrow. However, erythropoietic burst formation of murine and human BFU-E was completely suppressed by the addition of chloramphenicol or chloramphenicol sodium succinate to the culture medium at therapeutic concentrations (20--40 microgram/ml). From the present results, it can be concluded that the reduced number of BFU-E in mice after injection of chloramphenicol sodium succinate resulted from the selective toxicity of chloramphenicol to BFU-E at therapeutic concentrations.


Effects of triiodothyronine on the anemia of chronic renal failure. The present study was done in order to determine whether treatment with triiodothyronine (T3) would improve the anemia of chronic renal insufficiency. Four patients with stable renal failure and anemia were treated with 75 microgram/day of T3 for a period of four weeks. The patients were not in chronic dialysis, had normochromic normocytic anemia and hypocellular bone marrow, and showed no evidence of external blood loss during the study. They had received no iron, folic acid, or androgenic steroids for at least six months prior to the study. The administered dose of T3 was adequate to depress the serum levels of thyroid-stimulating hormone (TSH); however, there was no detectable improvement in the levels of hemoglobin, hematocrit, bone marrow cellularity, serum and erythrocyte folate determinations, serum iron (Fe), 59Fe half-life, plasma iron turnover rate, percentage Fe incorporated into red blood cells, or in the ratio of surface radioactive counting over bone marrow/liver and spleen. It is concluded that the experimental observations concerning direct bone marrow stimulation by T3 in anephric rats are probably not clinically applicable for the treatment of the anemia associated with uremia.


Proliferative function of cadaveric bone marrow cells. The proliferative function of human and murine cadaveric bone marrow was studied using methylcellulose clonal cell culture assays and the murine spleen colony technique. The study revealed persistence of hemopoietic functions for as long as 19 postmortem hours in cadaveric marrows of some patients. Studies of murine cadaveric marrows corresponded with those of human marrows. These results strongly suggest that human pluripotent hemopoietic stem cells survive in cadaveric marrows.


Control of hemoglobin synthesis in fetal erythroid cells by L-thyroxine. Fetal mouse liver cells were incubated in the presence of L-thyroxine, Globin synthesis by cells from the 13th to 15th days of gestation was stimulated by the presence of the hormone. Although protein synthesis by cells from the 17th day of gestation was stimulated, the protein was not identified as globin. A tentative conclusion was drawn that fetal erythroid tissue may be preferentially stimulated by thyroid hormone.


Demonstration of a platelet bypass mechanism in the clotting system using an acquired anticoagulant. A lupus-type anticoagulant which causes strong inhibition of the partial thromboplastin time with kaolin (PTTK), the stypven time, and the thrombin generation tests has been investigated. All tests for platelet function were normal, as were all specific coagulation factor assays with the exception of a slightly reduced factor XI in this patient. A diethylaminoethyl-cellulose-immunoglobulin (DEAE-cellulose-IgG) fractionation of the patient's plasma produced two peaks containing inhibitory activity in the PTTK test. The first of these peaks had a cloudy appearance, suggesting the presence of immunoglobulin aggregates. Studies with IgG aggregates prepared from normal IgG and from the patient's IgG demonstrated that such aggregates were not the cause of inhibition. It was possible to neutralize the inhibitory activity of the purified IgG but not platelet-poor plasma (PPP) with a rabbit anti-IgG. The inhibition of the patient's PPP in the thrombin generation, the contact product, and the stypven time tests were corrected by the inclusion in the test system of platelets activated either by aggregation due to adenosine diphosphate (ADP) or formalin fixation and washing. These studies lend support to earlier findings that platelets interact at several sites in the coagulation cascade.


Cytosine arabinoside modulation of the mitotic index in treatment of adult acute leukemia. Twenty-three unselected adult acute leukemic patients were treated with an initial intravenous pulse of cytosine arabinoside (Ara-C) 5 mg/kg. The mean mitotic index dropped from 7.7/1,000 to 2.8/1,000 at 4 hours after Ara-C pulse and rebounded to 6.7/1,000 at 18 hours. Infusions of Ara-C 7--10 mg/kg were given for 9 or 12 hours, depending on changes in the mitotic index. The group of responders (M1 or M2 marrows) could be predicted by the initial blast count in the marrow and the change in the mitotic index 18 hours after the Ara-C pulse. There were 9 (39%) complete and partial remissions. Six patients remained in remission more than 200 days. Since the changes in the mitotic indices induced by Ara-C were indistinguishable from those of another more successful trial, we infer that factors other than modulation of the cell cycle are critical to the success of this mode of therapy.


Genetic and demographic aspects of Nova Scotia Niemann-Pick disease (type D). All known cases of Nova Scotia Niemann-Pick Disease (type D) were traced to a couple born in Nova Scotia in the late 1600s. It is speculated that this disease is the result of a single mutation in one of the ancestors of Yarmouth County French Acadians. In the district where most affected children lived, the heterozygote frequency was estimated to be between 10% and 26%.


The Aymara of Western Bolivia. IV. Gene frequencies for eight blood groups and 19 protein and erythrocyte enzyme systems. A total of 315 individuals, mainly of Aymara origin, from western Bolivia were examined for genetic variation at eight red cell antigen and 19 serum protein and red cell enzyme loci. The gene frequencies for polymorphic loci and the discovery of several rare variants are discussed in terms of previous work among the Aymara and the closely related Quechua. The effect of inclusion of related individuals in the sample on gene frequency, variance of gene frequency and genetic distance, is discussed.


Phenotype dependence in the inhibition of red cell acid phosphatase (ACP) by folates. Red cell acid phosphatase (ACP) is shown to be inhibited by folic acid and various folates. The degree of inhibition is phenotype dependent with a pattern of variation differing from that of the well recognized variation in red cell activity levels. The pattern of variation is ordered ACP1B less than ACP1A less than ACP1C in terms of the relative allelic contributions to the observed inhibition. This pattern correlates with previously observed patterns of risk for two hemolytic disorders and may thus provide a key to their understanding.


More on regulation: a reply to Stephen Weiner. In Volume 3, Number 3 of this journal, Professor Havighurst wrote a brief Comment in which he observed that the function of health care cost-containment regulation is the rationing of health care resources, and argued that the fostering of health care consumers' and providers' free choice in the competitive marketplace is preferable to conventional cost-containment regulation as a mechanism for such rationing. He briefly outlined various reforms, including changes in federal tax treatment of health insurance premiums, aimed at implementing his approach. Subsequently, in a Comment in Volume 4, Number 1, Stephen M. Weiner, then Chairman of the Massachusetts Rate Setting Commission, criticized Professor Havighurst's analysis by asserting that it failed to acknowledge the validity of regulation in the health care field; that it overemphasized free market economics; and that it failed to appreciate the essentially political nature of regulatory processes. Mr. Weiner argued that health care regulation is here to stay, and called for renewed efforts to clarify and implement appropriate relationships between health care regulation and (1) health care rationing, (2) health care planning, and (3) health care competition. In the Comment below, Professor Havighurst replies both to specific statements in, and the general direction of, Mr. Weiner's critique, asserting that it inaccurately represented the earlier Havighurst Comment in several important respects. Professor Havighurst states, for example, that, Mr. Weiner's opinion notwithstanding, Havighurst--both in his earlier Comment and in his other writings--has considered extensively the political nature of regulation, and, furthermore, has been constructive in his critiques of regulation. He charges Mr. Weiner with attempting to stifle debate on the question of the volume and direction of health care regulation, and suggests that Weiner's criticisms may reflect a bias against the individual's right to choose for himself and to have his preferences registered in the economic marketplace.


Report on the American Society of Hospital Attorneys of the American Hospital Association. Since the time of its formation, the American Society of Hospital Attorneys has provided focus and leadership in the field of health law. It was, for example, the principal force in moving the American Bar Association in 1974 to recognize "health care and hospital law" as a field of law that can be listed in legal directories such as Martindale-Hubbell. It membership includes most of the leaders in the field of health law, including the elected and administrative heads of most other health law groups. Because it had a dedicated and active leadership, an extensive and diverse membership, and a unique relationship with the American Hospital Association, the Society with continue to play a major role in the development and exposition of "health care and hospital" law. In so doing, it will always attempt to hew to its original purpose: service to the attorneys representing the nation's hospitals, to enable them to better represent their client institutions.


The "brave new baby" and the law: fashioning remedies for the victims of in vitro fertilization. The birth of the world's first "test-tube baby", a child conceived by in vitro fertilization (IVF), raises serious medical, ethical, and legal problems. This Note explores the present controversy over the use of IVF and advocates federal regulation of the technique. Furthermore, this Note argues that, in order to deter unduly hazardous use of IVF and to compensate its victims, an experimenter should be subject to civil liability for either negligent, or willful and nonconsensual, destruction of an IVF conceptus, and held strictly liable when an IVF child is born with severe defects that are attributable to the use of the technique.


A systematic approach to medical technology curriculum development. A systematic approach to medical technology curriculum development resulted from a multidisciplinary, federally funded, competency-based curriculum development project in the School of Allied Medical Professions at The Ohio State University. This approach includes processes for identifying medical technology competencies, evaluating the effectiveness of an ongoing curriculum, and developing a domain-referenced framework for organizing, sequencing, evaluating, and updating the requisite professional knowledge, skills, and attitudes.


Pernicious anemia in childhood.

Pernicious anemia in childhood. Two children from different families with pernicious anemia are described. The defect appears to be the lack of intrinsic factor in the acid gastric juice. The correct diagnosis and proper therapy are essential for insuring a normal growth and development. Studies performed in other members of both families failed to reveal any hematologic disorder. The prolonged and close follow-up of the first case enabled the authors to assist in the birth of a normal offspring.


Smoking and its effect on mortality of the elderly. The effects of smoking on the mortality experience of elderly populations are considered by comparing the mortality rates for elderly smokers, ex-smokers and nonsmokers. This question arose since a recent study, using similar data, suggested that there was no health benefit for elderly cigarette smokers who discontinue cigarette smoking. Although ultimately in the latter part of the life-span, the benefit which might be gained by giving up smoking would not increase life-span significantly, the present study shows that for all of the older age groups investigated, a lower mortality from all causes of death is observed for nonsmokers and ex-smokers compared with elderly smokers. Consequently, even though no direct evidence is available, from this or other studies, as to whether it is desirable for elderly smokers to discontinue smoking, because of the general consistency of the data for the younger and older age groups, it seems probable that giving up smoking represents a health benefit for most older smokers.


Iatrogenic prematurity due to elective termination of the uncomplicated pregnancy: a major perinatal health care problem. In a series of 1,000 newborn infants referred to a regional neonatal center, 32 iatrogenically preterm infants were identified. All had been delivered following elective termination of uncomplicated, apparently term pregnancies, without prior documentation of fetal lung maturity or ultrasonic determination of fetal biparietal diameter. Associated acute morbidity included asphyxia neonatorum in 10, respiratory distress syndrome in 24, and pneumothorax or pneumomediastinum in nine patients. One infant died. Hospital costs totaled $150,643, for a mean of $4,701 per patient. The unexpected premature births were associated with major parental grief reactions and alterations in their daily activities, Iatrogenic prematurity is a major regional health care problem which, when viewed on a national basis, may affect thousands of newborn infants and their families annually. Our data suggest the need for more accurate assessment of fetal maturity, before elective termination of pregnancy, by well-established techniques.


The single-unit delivery system--a safe alternative to home deliveries. The need has arisen for the development of a health care/delivery system that can allow for a natural and personalized childbirth experience, within the safe confines of a modern obstetric unit. The single-unit delivery system (SUDS) is designed to achieve this objective by: strict prenatal screening of patients into low- and high-risk categories, utilization of a single room for the entire labor process, and close personalized supervision of women in "normal" labor by trained midwives/monitrixes. Physicians supervise the entire unit and are directly responsible for the management of all high-risk and complicated labors. The SUDS concept has been tried in clinical practice and has been proved to be an effective method of providing safe and satisfying obstetric care without compromising modern obstetric standards.


Outbreak of Mycoplasma pneumoniae infection among hospital personnel. An outbreak of illness due to Mycoplasma pneumoniae occurred among employees of a large hospital. The spectrum of disease ranged from severe upper respiratory infection to multilobed pneumonia. No unusual increase in the incidence of respiratory illness due to this organism was observed in the surrounding community during the period under investigation. It was not possible to identify any single area of the hospital frequented by enough of the involved personnel to explain the spread of the infection among the hospital's employees. This is the first outbreak of M pneumoniae disease to be reported among hospital personnel.


Antepartum fetal heart rate testing: the nonstress test. Antepartum assessment of fetal well being relies heavily on the observation of RHR. Fetal stress testing was introduced in the early 1970's in an attempt to define the fetus at risk. The stress factor most widely used has been uterine contractions, which isolate the fetus from its oxygen supply, and in the compromised fetus would be anticipated to provoke late decelerations in the FHR. Although the contraction stress test or "oxytocin challenge test" is useful in evaluating fetal condition, it is time consuming, not easily quantitatable or repeatable, and many times difficult to interpret. An attractive alternate approach of antepartum FHR testing (AFHRT) is the "nonstress" test. The positive experience of European investigators has led to interest in this method of fetal assessment in North America. Investigation from the literature contrasting the "stress" versus "nonstress" methods is discussed and observations derived from 2 year experience at LAC/USC Medical Center are presented. A protocol for AFHRT currently being evaluated clinically is presented.


Case report: acute pancreatitis following corticosteroid and azathioprine therapy. Several drugs have been implicated as causes of acute pancreatitis. This report presents four patients, three with lupus nephritis and one with membranous glomerulopathy, who developed acute pancreatitis while being treated with corticosteroids alone or in combination with azathioprine. Two of the reported patients died with a hemorrhagic pancreatitis and one of the patients developed a pancreatic pseudocyst. The pathogenesis of corticosteroid and/or azathioprine-induced pancreatitis is discussed.


Case report: eosinophilic gastritis simulating a neoplasm. A case of eosinophilic gastritis that presented with a gastric mass and simulated a malignancy is described. The patient underwent a gastric resection, developed a recurrence and then had a spontaneous remission. His radiographic, endoscopic, histologic, and electron microscopic findings are discussed. A review of the literature on eosinophilic gastroenteritis is included.


Case report: Hypophosphatemic hemolytic syndrome of alcoholics--a common city hospital problem. This report describes three male alcoholics with acute hemolytic anemia secondary to hypophosphatemia who were seen within one year at a large city hospital. The basic etiologic association between low serum phosphorus and hemolytic disease was not initially appreciated in each instance.


Comparison of partial-thickness and full-thickness filtration procedures in open-angle glaucoma. We compared the results of partial-thickness (trabeculectomy) vs full-thickness (trephine) filtration surgery when used as the primary surgical treatment of medically uncontrolled open-angle glaucoma. Prospectively acquired data were used from a series of patients who were examined and operated on by one surgeon. Both groups of data were gathered consecutively and concurrently. The choice of operation was made on the basis of the pressure level required for control of the glaucoma, the full-thickness procedure being chosen for eyes with the most advanced cupping and field loss. The partial-thickness group had a significantly higher postoperative pressure and signficiantly lower incidences of postoperative flat anterior chambers and identifiable filtration blebs.


Acute macular neuroretinopathy.

Acute macular neuroretinopathy. A 17-year-old boy had minor visual impairment, paracentral scotomata, and parafoveal retinal lesions following a presumed viral infection. Contact lens biomicroscopy demonstrated the retinal defects to be located at the level of the deep sensory retina. Fluorescein angiography revealed subtle areas of hypofluorescence which corresponded to the visible disturbances of the sensory retina. Follow-up examination three months later revealed persistent complaints of paracentral scotomata and persistent, but less recognizable retinal lesions. We believe the primary site of involvement to be the deep sensory retina.


Bare sclera closure in retinal detachment surgery. Our modification of the limbal peritomy technique in retinal detachment surgery involved recession of the confunctiva 3 mm posterior to the corneoscleral limbus as the conjunctiva was closed. This recession offered some advantages over the standard nonrecessed method: fewer sutures were required; postoperative ophthalmoscopy was not impaired by conjunctiva swelling over the cornea; the eye was comfortable and quiet in appearance because there was no suture material or inflamed conjunctiva adjacent to the corneoscleral limbus. We have not encountered any disadvantages in several hundred cases.


A simplified scleral reinforcement technique. A simplified scleral reinforcement technique performed on 52 eyes with myopic degeneration prevented further visual loss by strengthening of the sclera over the posterior pole. This scleral homograft was useful not only in older patients with high myopia and posterior staphyloma, but also in younger patients in whom the degenerative process could be stopped at an earlier stage. In all cases in which follow-up was possible, the visual acuity remained at the preoperative level before surgery was performed or it improved.


Juxtapapillary retinochoroiditis with a psychiatric disorder possibly caused by toxoplasma. A 32-year-old man suffered from juxtapapillary retinochoroiditis in the right eye and a psychiatric disorder. The diagnosis of toxoplasmosis was supported by the clinical ocular findings, serologic examinations, and isolation of the organism from the cerebrospinal fluid. As the retinochoroidal lesion absorbed, the psychiatric symptoms also disappeared during the course of six weeks.


Central retinal vascular occlusion associated with oral contraceptives. A 40-year-old woman took oral contraceptives for four years. She developed a vascular glaucoma and one year later the eye was enucleated. No other apparent cause for the occlusion was present. The vascular occlusion consisted of a combined central retinal artery and vein occlusion with severe intimal hyperplasia. An intravascular granulomatous reaction is attributed to chronic vascular injury.


Comparative clinical assessment of corneal sensation with a new aesthesiometer. A new version of an aesthesiometer offers particular advantages such as portability without risk of damage to the filament, easy filament replacement, and an expanded stimulus range. We compared the performance of this new instrument to that of the Cochet-Bonnet aesthesiometer in a clinical setting on herpetic patients. Using both instruments, we obtained paired measurements on the normal and diseased corneas from five test loci placed over the corneal surface. Statistical analysis of the normalized data showed that the data obtained by the new instrument were similar to those of the Cochet-Bonnet aesthesiometer.


Use of dilute drug solutions for routine cycloplegia and mydriasis. Clinic patients and students were given several regular drops of commercial 10% phenylephrine HCl, and 1.0% cyclopentolate HCl or 1.0% tropicamide HCl. The drops were given three times at five-minute intervals. Mydriasis and cycloplegia were determined and compared with the results obtained by using one of the following: microdrops (0.005 or 0.01 ml) of a mixture of 5% phenylephrine HCl and 0.5% tropicamide HCl, or regular drops of mixtures of 1% phenylephrine HCl, or 0.4% hydroxyamphetamine hydrobromide with 0.1% cyclopentolate HCl, or 0.1% tropicamide in a vehicle of 1.6% or 1.0% methylcellulose 400, or artificial tears or lubricants (Absorbobase, Contique, Isopto Tears, Liquifilm, Lyteers, Ultra Tears). Except for an initial lag in the production of mydriasis with the diluted mixtures, the results were similar for all preparations. The diluted solutions produced little ocular irritation or tearing.


Stereoscopic acuity measurement in aphakia. We performed a variety of tests to assess binocular function on monocular aphakic patients wearing contact lenses, monocular pseudophakic patients, bilateral spectacle-wearing aphakic patients, bilateral aphakic contact lens wearers, and bilateral pseudophakic patients. Stereoscopic acuity levels at distance and near when visual acuity was at least 6/12 (20/40) provided the most useful data. Pseudophakic patients and contact lens wearers performed equally well and outperformed spectacle wearers. Implant patients did not have superior stereoscopic acuity.


Trauma to the lacrimal system in children. We repaired damage to the lacrimal drainage system in a series of 393 children who had lacrimal obstruction caused by congenital obstruction or facial injuries. Delayed surgery for traumatic obstruction of the nasolacrimal duct in children, including infants, was successful in all cases.


New flat air injection cannula.

New flat air injection cannula. I developed a 6-mm long, flattened, 30-gauge air cannula with a polished tip for instillation and extraction of air and fluids from the anterior chamber during intraocular surgery. The polished flattened tip prevents Descemet's membrane detachments and the extra length allows easy instillation of air over an intraocular lens.


Axial length and the Hirschberg test.

Axial length and the Hirschberg test. Axial lengths of 30 eyes (15 subjects), measured by ultrasonography, ranged from 20.6--26.3 mm. Using a fixed light source, each eye was photographed as monocular fixation was changed over an 8-deg range in 2-deg steps. Hirschberg ratios obtained from the photographs show a low correlation with axial length (0.07), and the mean value, 24 prism diopters per millimeter (S.D. = 7), further supports recent recommendations that the traditional ratio of 12 or 14/1 be replaced by a more correct ratio of 22/1.


Evaluation and control of Durasoft lens rotation. Fifteen subjects forming three groups of refractive astigmats (astigmation less than 1.00 D., astigmatism greater than or equal to 1.00 D and less than 2.00 D, and astigmatism greater than or equal to 2.00 D) were fitted with spherical DuraSoft lenses. Rotation was assessed from slit-lamp photographs taken after 30 min and after 4 hr of lens wear. The results show that incorporating either a prism or a single truncation alone into a spherical DuraSoft lens suffices as a method of stabilization, stabilization being effectively achieved with this lens in subjects with refractive astigmatism less than 2.00 D.


Relative tensions in the extraocular muscles. Two methods have been devised to assess the relative tensions required to point the eye in a given direction. One method uses an ophthalmotrope, which will assess the tensions and the lengths of the muscles. The second uses a computer program. In each method the direction of the eye is analyzed into components of elevation, azimuth, and cyclorotation. Such a combination of devices is needed in finding the patterns of innervation involved in Listing's law, cyclorotation associated with convergence, and also cocontraction associated with convergence.


Corneal-thickness response to ultra-thin Bausch & Lomb Soflens (polymacon) contact lenses. A study was conducted to test the hypothesis that a more favorable corneal-edema response for hard-to-fit patients might be expected from ultra-thin Bausch & Lomb Soflens (polymacon) contact lenses than from standard-thickness lenses because of the additional oxygen reportedly available to the cornea. Corneal edema was monitored by measuring changes in corneal thickness over 6 hr of lens wear with an electronic pachometry assembly. Statistical analysis showed significantly less edema for a group of hard-to-fit patients wearing ultra-thin lenses than for a group of successful patients fitted with standard-thickness lenses.


Comparison of vision screening performed by optometrists and nurses. The rates of patient referral by optometrists and nurses working independently and conjointly in vision screening of schoolchildren are compared. Very few studies in the literature have examined the difference in referral rate; this difference is important because of the shortage of qualified manpower to screen the large number of children in the present school population. The study determined that the nurses correctly referred a greater percentage of children following an educational program and collaboration with the optometrist, but this increase in referral was not statistically significant.


The effect of light flashing at 9 Hertz on rivalry suppression. The translid binocular interactor (TBI), which presents binocularly out-of-phase lights flashing at 9 Hz, was designed to reduce suppression of amblyopes. To determine the effect of such flashing lights on rivalry suppression, subjects who showed strong suppression during binocular rivalry were exposed to a modified form of the TBI for a total of 2 2/3 hr over 4 days. A similar group of subjects was exposed to steady binocular light. The modified TBI had no effect on rivalry suppression; the changes in suppression that did occur were equivalent in the two groups.


Angioid streaks: a case report.

Angioid streaks: a case report. A case of vision loss in a patient with angioid streaks and pseudoxanthoma elasticum is described. Discussion includes the natural course and clinical appearance of the disease, the role of trauma, and recommended optometric management.


Biofeedback of accommodation to reduce functional myopia: a case report. A 30-yr-old man received biofeedback training of his accommodation to reduce his functional myopia. There were seven training sessions for a total time of 34 min. Each training session consisted of a baseline-level recording period followed by a feedback period, a second baseline-level recording period, and then a second feedback period. Reduction of the functional myopia was learned within a few minutes. Since the training was conducted in a dark environment, myopia reduction was not expected in an illuminated environment. Nonetheless, some generalization was demonstrated with a reduction in the subjective measures of myopia (about 1 D for the right eye, 0.50 D for the left eye) and improvement in unaided visual acuity (from about 20/50 to 20/30 for each eye).


Comparison of evoked potentials in the same hand in normal subjects and in patients with carpal tunnel syndrome. The amplitude of the evoked median and ulnar sensory action potential (SAP) was measured in fifty normal volunteers (4) and median and ulnar SAP in opposite hands were compared. In addition, the amplitude of the median response was compared to the ulnar response. It was found that the lower limit of the range of observations for the median amplitude was 20 muV, the range of observations for the median/median SAP ratio was 50--100%, and that in only 3 observations out of 100 normal hands was the median/ulnar SAP ratio less than 80%. In a series of 60 patients with carpal tunnel syndrome (CTS), 22 had bilateral involvement. The median SAP was obtainable in 62 of these diagnosed cases of CTS. Forty of these 62 cases could be identified by one of the three amplitude criteria: median SAP of less than 20 muV; median/median amplitude percentage of less than 50%; or a median/ulnar amplitude of less than 80%.


Bioconverter for upper extremity rehabilitation. The bioconverter is a simple instrument which uses the output of the Basmajian-Emory myotrainer to activate electrical devices, such as radios, television, etc. It can be used to assist in training by providing an acceptable and/or pleasurable stimulus (such as a radio) as muscle activation improves. The myotrainer contains adjustable sensitivity circuits, and the bioconverter has a pre-set holding circuit of 2, 4, or 6 seconds duration. A case of a deaf and blind patient is presented where the bioconverter is used to activate other sensory (skin) stimuli rather than audio-visual ones. The bioconverter can also be used in relaxation training. In this mode of operation the controlled equipment is on when no EMG is present and is turned off when too high an EMG level exists.


The inheritance of palmar and hallucal dermatoglyphic patterns in fifty-four American Caucasian families. We searched for single gene effects determining certain palmar and plantar patterns - two interdigital and the hypothenar areas, palmar main line sequence, and hallucal pattern. Our subjects were 108 parents from central Louisiana and 123 of their offspring; there were  127 females and 104 males. For the third and fourth interdigital areas, we classified for presence of a pattern (+) or no pattern (-). For the hypothenar area, we classified arch, anteform, and open field as no pattern (-) and other configurations as a pattern (+). Main line sequence we determined by the distal to proximal ordering of the five main lines. We analyzed the hallucal area by combining three loop patterns. Segregational analyses followed. For the third interdigital area, the frequency of + was 51%. For the fourth interdigital area, the frequency of + was 45%. We set out the six mating types by the bilateral occurence of pattern in each area and found similar results. The proportion of ++ offspring was highest with both ++ parents and diminished as the parents became increasingly more --. Evidence for genetic determination of six different main line sequences consisted of the proportion of related/(related + unrelated) which averaged 0.48. Parent-offspring occurrence of an accessory triradius and absence of the c triradius suggested monogenic control. Segregation of the hallucal patterns was less suggestive. We conclude that the results offer evidence for substantial genetic determination of palmar dermatoglyphics, and for some patterns possible monogenic determination.


Ethnic communities in Israel: the genetic blood markers of the Babylonian Jews. One hundred eighty-eight Jewish individuals who either they or whose both parents were born in Iraq were typed for 7 blood groups (ABO, MNS, Rh, Kell, Duffy, P and Kidd), 12 red cell enzyme systems and 2 serum proteins. Iraqi Jews are characterized by a high frequency of A (in ABO), N (in MNS), low cde (Rh) and low Hp-1. Several rare electrophoretic variants were encountered: PGM1 6-1, PHI 3-1 and PHI 2-1, and an unidentified AK phenotype. No evidence of Negroid admixture was found in their gene pool. Comparisons with results previously obtained in Iraqi Jews show general similarities in frequencies while comparisons with neighboring non-Jewish populations suggest divergence in most systems investigated. The difficulties of assessing relationships on the basis of a few selected differences and the need for careful interpretations of similarities are emphasized.


Ethnic communities in Israel: the genetic blood markers of the Moroccan Jews. One hundred and ninety-six Moroccan Jews now settled in Israel were typed for 7 blood groups, 12 red cell enzymes and 2 plasma protein systems. Their blood group picture is in agreement with results previously obtained on different samples of Moroccan Jews: rather high B in ABO, somewhat elevated frequencies of cDe and cDE in Rh and K in Kell. Differences in various blood markers exist between them and other North African Jewish communities. This fact, together with data on disease distribution and HLA frequencies, supports our assumption that Jews in the North African diaspora lived as small secluded isolates even within the same geographical zones. Comparisons with meager data on the neighboring non-Jewish populations do not disclose any resemblance to either Arab or Berber inhabitants of Morocco.


ABO blood groups and fertility--with special reference to intrauterine selection due to materno-fetal incompatibility. The purpose of the present investigation was to study whether there is differential fertility between different mating types of ABO blood group system. Selective force which is operating through maternal-fetal incompatibility has been observed in the differential fertility between compatible and incompatible mating groups in the present sample of 183 families of Visakhapatnam town of Andhra Pradesh,India. The differences in the mean numbers of pregnancies as well as living children between the two major mating groups, compatible and incompatible are significant. The fertility rates of O fathers and O mothers were significantly higher than those in matings in which neither parents belongs to O. The selection is operating to reduce the gene ratio of A and to increase the gene ratios of O and B in this sample.


Heritability of permanent tooth size.

Heritability of permanent tooth size. The aim of this investigation was to quantify the relative contributions of genetic and environmental influences to the observed variability of permanent tooth size in a group of Australian Aboriginals. Tooth size data were obtained from dental casts of Aboriginals living at Yuendumu in the Northern Territory of Australia. The custom of polygyny practised by these people enabled the analysis of associations between full-siblings and half-siblings. Phenotypic variability of tooth size was partitioned into four variance components; between sides, between fathers, between mothers and between offspring. From these components, the relative genetic and environmental contributions were quantified and heritability estimates for tooth size derived. Additional estimates of heritability were obtained by regression analysis from a small sample of parent-offspring data. Results of the analyses suggested that about 64% of the total variability of permanent tooth size could be attributed to genetic factors, while a further 6% was due to common environment. Although the findings confirm a relatively strong genetic component, they emphasise the importance of non-genetic influences in the determination of tooth size variability.


Admixture estimation using skin reflectance data. Several different methods are suggested for the estimation of admixture proportions in hybrid populations based on skin reflectance data. These methods are applied to hybrid populations of known ancestry and yield results generally quite similar to those expected based on a simple genetic model. Results indicate the usefulness of these methods in hybridization studies and in the development and refinement of models of the genetics of skin color.


Sex discriminatory effectiveness using combinations of root lengths and crown diameters. Using optical-scanner (OPTOCOM) and radiogrammetric measurements on mandibular permanent teeth, root length alone affords sex-discriminatory effectiveness equal to or exceeding conventional crown diameters. Combinations of root length and crown dimensions yield up to 80% accuracy in sexing with as few as two teeth, and discriminatory effectiveness of 87% with mandibular teeth alone.


Activities of pongid thigh muscles during bipedal behavior. Electromyographic recordings were taken from 12 thigh muscles (or major parts of them) in a gorilla, from 6 thigh muscles in a chimpanzee, and from 2 thigh muscles in an orangutan as they engaged in bipedal positional behavior, including stance, reaching overhead, lunging, leaping and walking. In the African apes, symmetric bipedal stances with hindlimb flexure were accompanied by notable EMG potentials generally increased to or remained at moderate and high levels. Our studies on the gluteal (Tuttle et al., '78) and thigh muscles of African apes partly confirm Kummer's ('75) prediction that considerable gluteal and hamstring activity would be required in order for them to stand bipedally with flexed hip and knee joints. The gorilla's thigh muscles exhibited considerable EMG activity during the stance phase and remarkably little activity during the swing phase of bipedal steps. The activity patterns of most thigh and gluteal muscles (Tuttle et al., '78) in the African apes are much more similar to those of bipedal gibbons than to their counterparts in man. The bipedal locomotor cycles of human subjects are accompanied by many more biphasic and triphasic EMG patterns in the thigh muscles than the locomotor cycles of other anthropoid primates are. The evolutionary anthropological significance of these findings should become clearer when they are complemented by EMG studies on human running, arboreal bipedalism and vertical climbing in apes, and central pattern generation in man and apes.


Distribution of HLA antigens in Polish and German populations in Milwaukee, Wisconsin. Gene and haplotype frequencies for HLA-A and HLA-B antigens were determined in Milwaukee blood donors of German and Polish descent. Gene frequencies for A25 and B18 were significantly higher in Poles than in Germans. Significant gametic associations were noted for A1-B8, A29-B12 and AW30-B13 in both populations. Gametic association for A3-B7 was only found in Germans, while the A25-B18 haplotype frequency was significantly increased in Poles. Since  the latter haplotype has also been found in Yugoslavs, Ukrainians and Czechs, it is possible that A25-B18 represents a Slavonic marker.


Relationship between body size and long bone lengths in Pan and Gorilla. Measurements of body length (vertex to heel) were abstracted from the field notes of Pan and Gorilla specimens from the Powell-Cotton Museum. Biocondylar femur and humerus length were measured on each skeleton and correlation coefficients with body length were computed. In both the separate sex and the combined sex samples of Gorilla, and in the combined sex sample of Pan, long bone lengths are significantly correlated with body size, but in Pan only 20% of the variance in body length is reflected in the long bone measurements.


Methods of isoelectric focusing.

Methods of isoelectric focusing. The method of isoelectric focusing has been avoided by many workers because of expense, technical difficulty, and problems of interpretation. Inexpensive, easy, and interpretable results are possible using equipment and reagents commonly available. Methods which allow these results are presented and explained.


The relationship of buccal pits to caries formation and tooth loss. It is demonstrated that in mandibular molars there is a statistically significant tendency for teeth with buccal pits to be lost premortem more frequently than teeth without buccal pits. The mandibles of a large ossuary population (ca. 1600 A.D.) are examined with regard to buccal pitting, caries formation and premortem tooth loss. A log likelihood ratio test is used to test the relationship between age and frequency of buccal pits. A G-value of 20.84 (p less than 0.025) indicates that the frequency of pits is significantly higher among individuals under ca. 18 years. It is argued that caries formation is the mechanism through which the molars are lost, given high caries frequencies that approximate pitting frequencies in their distribution.


Altitude, heredity and body proportions in northern Chile. Recent studies of the effects of hypoxia on human growth and adult size have focused mainly on the variability of single measurements. In this paper we explore changes with altitude and ethnicity (Spanish-Aymara ancestry) in body proportions of permanent residents of an altitudinal gradient (0-4000 meters) in northern Chile. Body proportion or shape is assessed by anthropometric indices and principal components of 14 bone measurements. Ethnicity independent of altitude had its major effect on proportions and a lesser effect on size. Aymara had larger relative sitting heights, broader builds and prominent facial development as compared to non-Aymara (Spanish). Altitude also affected head and chest proportions during growth. On the whole, the effects of altitude and Aymara ancestry on the measurements and indices were independent (not necessarily of similar direction or magnitude), in spite of a correlation of ethnicity and altitude in Andean populations.


Cherokee admixture and its estimation by the gene identity method: a critique. A previous application to a Cherokee hybrid population of two methods for measuring admixture proportions by use of gene identity probabilities was examined. The results suggest that neither procedure has been correctly applied, and that underlying statistical difficulties limit their reliability.


The Krapina dental remains.

The Krapina dental remains. An analysis of age, specimen associations, demographic characteristics, and metric features is presented for the Krapina dental sample. A critical analysis of emergence criteria applicable to skeletal samples leads to an occlusal eruption schedule which can be used to determine wear rates. These are used to provide dental ages for the Krapina jaws and isolated teeth. A number of individual associations of isolated teeth with existing jaws and with each other result in an estimated individual count between 75 and 82. Demographic analysis indicates that the specimens do not accurately sample a living population; numerous adults as well as children under the age of three are not represented. Metric analysis indicates a moderate range of variation. The interproximal wear rates are low, and no evidence of tooth size associated differential survivorship can be demonstrated. The sample fits in a European evolutionary sequence of reducing posterior and expanding anterior permanent teeth, while the deciduous teeth seem to undergo expansion through the Würm glaciation.


Modeling of plasma disappearance of unlabeled insulin in man. Fifty-two portal and 68 peripheral, brief infusions of unlabeled insulin were given to ambulant, nondiabetic patients. After intraportal insulin infusion (5--50 mU/kg), plasma clearance rate (PCR, dose/area of the incremental plasma insulin concentrations) decreased with increasing dose, varying from 32 to 14 ml-min-1-kg-1 at normoglycemia. After peripheral insulin infusion (5--30 mU/kg), PCR (mean value 15 ml-min-1-kg-1) showed no certain dose-dependence, but transfer rate constants and distribution volumes did. Despite a detectable reentry of insulin from one or more extravascular pools to the plasma pool, transfer rate constants or distribution volumes could not be accurately determined. The shortcomings of conventional noncompartmental and compartmental models did not appear to be due to the dose-dependence demonstrated. Instead, the limitations of these models were caused mainly by the difficulty of defining a proper base-line concentration and, in particular, by the imprecision of the experimental data, indicating that it will be difficult to find more appropriate models from data obtained with unlabeled insulin.


Effect of prolonged anaerobiosis on 125I-insulin binding to rat soleus muscle: permissive effect of ATP. The specific binding of 125I-insulin by rat soleus muscle was depressed when muscle ATP was depleted, either by prolonged anoxia or more rapidly with 2,4-dinitrophenol. Insulin binding was not eliminated in ATP-depleted muscle, but was reduced by 70--80%. Insulin binding by aerobic muscle could be resolved into two components; a high-affinity, low-capacity site (KD = 7.8 nM) and a low-affinity, high-capacity site (KD = 390 nM). The stimulatory effect of insulin on xylose uptake could be correlated with binding to the high-affinity site. These results indicate that there is some ATP-dependent process involved in the regulation of insulin binding by soleus muscle. It is suggested that this could be a phosphorylation-dephosphorylation system, acting either on the receptor itself or on some closely related membrane protein.


Lactate metabolism in perfused rat lung. Glucose utilization and lactate metabolism were studied in isolated rat lungs perfused with a Krebs-Henseleit bicarbonate buffer, pH 7.4, containing either [U-14C]lactate, [U-14C]glucose, or [U-14C]alanine. Glucose uptake showed an apparent Km of 4.7 mM and a Vmax of 107 mumol-g dry wt-1-h-1. Lactate production under these conditions showed a Vmax of 82.9 mumol-g dry wt-1-h-1. At high circulating lactate level (7 mM), the perfused lung showed an increased capacity to utilize [U-14C]lactate with preferential incorporation into lung lipids. At equal molar concentration (5 mM) [U-14C]lactate was preferentially incorporated over [U-14C]glucose. Addition of 5 mM lactate to the perfusion medium did not affect lactate production. Perfused lungs from fasted rats showed higher lactate production, with increased amounts of [U-14C]alanine converted to lactate by the perfused lung, indicating lactate can also be derived from noncarbohydrate sources. These data show that under aerobic conditions the perfused lung can produce and utilize lactate simultaneously, and lactate can serve as a potential substrate for lung lipids.


Renal excretion of prostaglandins E2 and F2alpha in diabetes insipidus rats. On the assumption that the antagonism between prostaglandin E2 and vasopressin might represent a negative feedback system, we evaluated the hypothesis that vasopressin stimulates, in vivo, the renal production of prostaglandins. For these studies we used Brattleboro homozygous rats with diabetes insipidus and Long-Evans rats for controls, Brattleboro homozygotes show a substantial reduction in the renal excretion of prostaglandin E2 and prostaglandin F2alpha. Homozygotes excreted 39 +/- 5 ng/24 h prostaglandin E2 and 40 +/- 4 ng/24 h prostaglandin F2alpha, compared to 217 +/- 40 and 221 +/- 18 ng/24 h, respectively, in control rats (P less than 0.001). Therapy of homozygotes with vasopressin tannate in oil resulted in a prompt increase in the urinary excretion of prostaglandin E2 and prostaglandin F2alpha. 1-Desamino-D-arginine vasopressin, a nonpressor analogue of vasopressin, also enhanced the renal production of prostaglandin E2. We conclude that vasopressin (antidiuretic hormone) stimulates renal production and excretion of prostaglandin E2 and prostaglandin F2alpha in vivo. It is possible that this increment of prostaglandin synthesis serves a negative feedback function by modulating the action of vasopressin on the renal tubule.