Stimulus factors which influence the perceived externalization of sound presented through headphones. Several experimental conditions were arranged to study the influence of binaural difference cues on the externalization of sound. Broadband, high- and low-pass noise bursts were generated in a sound-treated but not echo-free room and tape recorded from electret microphones placed at the entrance to the ear canals in a live model. The tapes were processed in special ways in an attempt to dissociate the binaural differences in time, intensity, and spectrum which normally appear together and congruently when listening to a sound 90 degrees off midline. These variously processed tapes of trains of noise bursts were played back via headphones to 12 normal-hearing Ss; they were asked to estimate the apparent distance of the acoustic image. No significant differences in distance judgments were found among listening conditions which consisted of: (1) interaural differences in time, intensity, and spectrum (i.e., simulating free-field listening); (2) interaural differences in time and spectrum only; and (3) interaural differences in time only. With respect to interaural time differences, it was found in a second experiment with 16 normal-hearing Ss that differences in time of stimulus arrival promoted externalization of sound, since when these were eliminated (leaving only interaural differences in the ongoing aspects of the fine structure of the stimuli) all sounds appeared significantly nearer the head. A consistent finding was that high-pass noise bursts appeared nearer the head than low-pass noise bursts irrespective of the conditions of stimulus presentation.


Choice reaction-time of natural speech as affected by adaptation. Ss judged a pair of consonants as "same" or "different." There were 15 consonant pairs each judged by a separate group of 10 college students. For 5 of the pairs, judgments were preceded by an adaptation exposure to one of the consonants in the pair, at the rate of 1/sec for 2 min. The choice reaction time (CRT) was noted in msec for every response of each S. "Same" judgments were uniformly faster. Some support was given for a differential mediation of transient and steady-state acoustic speech cues in short-term storage, as demonstrated by a tendency for fricative consonants to yield faster CRTs than stop consonants. A post-adaptation increase in CRT was demonstrated; however, this effect was general and not selective for the repeated consonant. The implications of this research for theories of speech perception and for further investigation are (1) that the CRT procedure is appropriate for making inferences about the temporal aspects of the acoustic speech storage mechanism, (2) that the CRT and adaptation procedures can be combined to make judgments regarding the neural mechanisms of speech perception, and (3) that there are different memory storage modes for different types of speech information.


Distinctive features for short-term memory of consonants in noise. Wickelgren's (1966) short-term memory paradigm was used to investigate distinctive features of consonants in noise; 18 English consonants paired with the vowel /a/ were presented to 3 normal listeners in a CV context. Ss were tested in a quiet sound field at most comfortable listening level in experimental conditions of (1) quiet, (2) speech and noise at 0, (3) --5, and (4) --10 db S/N. Errors in auditory perception were eliminated from the data analysis and only errors in short-term memory recall were used as input to INDSCAL analysis. Results revealed that few errors were made in the quiet condition, but that all the noise conditions had deleterious effects on features.


Hearing threshold for a decaying oscillatory waveform. Hearing thresholds for a damped wave signal are measured at 8 frequencies from .35 -- 4 kc/s, and compared with hearing thresholds for pure-tone signals of the same frequencies. Hearing threshold for a damped wave signal is expressed in peak db re 20 uPa. Differences range somewhat irregularly from 8.6 to 19.6 db in favor of pure-tone signals. The difference between both threshold levels is described by a simple model.


Purification and enzymatic properties of rat serum carboxylesterase. Rat serum carboxylesterase [carboxylic ester hydrolase, EC 3.1.1.1] was purified by ammonium sulfate precipitation, chromatography on DEAE-cellulose, QAE Sephadex A-50 and brushite, and gel filtration on Sephadex G-200. This purified enzyme was shown to be a single protein band on slab gel electrophoresis and its final specific activity was 49.5 units/mg protein. This enzyme was very sensitive to diisopropylfluorophosphate (DFP) but not to p-chloromercuribenzoate (PCMB), eserine, o-iodosobenzoate, NaF or ethylenediamine tetraacetic acid (EDTA). The pH profile of the reactions catalysed by this enzyme showed broad optimum between pH 6.0 and 8.8. The activity of purified enzyme was not affected by Ca2+, Mg2+, Mn2+, Cu2+, Zn2+, Co2+, and Cd2+ at 1 mM concentration. The molecular weight measured by gel filtration was approximately 84,000 and the isoelectric point was 4.4. The enzymatic properties were not changed by neuraminidase treatment with regard to heat stability, pH optimum, sensitivity to metal ions and inhibitors, and Km values for p-nitrophenylesters of different acyl C-chain length.


Inducible effect of colchicine on alkaline phosphatase in rat liver in vivo. A single injection of colchicine, 1 mg/kg body weight, remarkably increased the activity of alkaline phosphatase in rat livers, followed by its increase in serum. Combination of bile duct ligation with colchicine administration had an additional effect on the alkaline phosphatase level above those induced by the individual treatments alone. Treatment with cycloheximide significantly inhibited the inducible effect of colchicine on the enzyme suggesting that protein synthesis is prerequisite to the elevation of the alkaline phosphatase caused by colchicine treatment.


Simple hydrazidation method for carboxymethyl groups on cross-linked dextran. A novel method for the use of CM-Sephadex in affinity chromatography is described. This method involves a carbodiimide-mediated synthesis of a lactone derivative, which is subsequently hydrazinolyzed to CM-Sephadex hydrazide. More than 90% of the carboxyl groups was converted to the hydrazide form by this method without any discernible degradation of the Sephadex beads. The hydrazide beads were further converted to the axide form and coupled with D-arginine and D-phenylalanine derivatives. These Sephadex derivatives contained more than 0.5 mmol of each amino acid per g dry beads and were found to be effective and specific adsorbents for carboxypeptidase B. This CM-Sephadex hydrazide should be useful in affinity chromatography because the resulting specific adsorbents involve stable amide coupling linkages and retain the physical properties of their precursor, Sephadex, which are favorable for column operation.


Acid phospholipase A1 requiring phospholipids or Triton X-100 in the cytosol of cultured cells. A new type of soluble phospholipase A1 [EC 3.1.1.32] was found in the supernatant fraction (cytosol) obtained by centrifugation at 105,000 x g for 90 min of homogenates in 0.25 M sucrose of FL cells and several other cultured cells (L-132 cells, Vero cells, and BEK-1 cells). Phospholipase A1 in FL cell cytosol showed activity only in the presence of a non-ionic detergent, Triton X-100, or certain phospholipids such as phosphatidylinositol, cardiolipin,  phosphatidylserine, phosphatidic acid, phosphatidylethanolamine, and lysophosphatidylcholine, among which phosphatidylinositol was the most active stimulator of the activity. This soluble enzyme in FL cells acted optimally at acidic pH like lysosomal acid phospholipases A1 and A2, which were recovered in the soluble subfraction of the lysosomal fraction. The acid phospholipase A1 in the cytosol was shown to be different from the lysosomal phospholipase A1 on the following counts: (1) the cytosol enzyme showed activity on the addition of phospholipids or Triton X-100, whereas lysosomal phospholipase A1 was present in the active form even in the absence of these activators; (2) no release of the lysosomal acid phosphatase and Triton X-100-independent phospholipase A1 or A2 into the cytosol occurred during cell fractionation; (3) the heat stabilities of these two enzymes as well as the effects of detergents on them were different. Similar Triton X-100-dependent enzyme activity was also found in the cytosol of several rat tissues.


Studies on luciferase from Photobacterium phosphoreum. XI. Interaction of 8-substituted FMNH2 with luciferase. The interaction of bacterial luciferase from Photobacterium phosphoreum with reduced flavin was investigated using various 8-substituted FMNH2 analogs. Flavins tested were FMNH2 and FMNH2 substituted at the 8 position with HO-, CH3O-, C2H5O-, Cl-, Br-, I-, H2N-, (CH3)HN-, and (ch3)2n. 8-ch30-, c2h5o-, cl-, and Br-FMNH2 showed luminescent activity in the luciferase reaction with emission peaks at various wavelengths. 8-HO- and I-FMNH2 were competitive inhibitors toward FMNH2 in the luminescent reaction. 8-Amino analogs of FMNH2 showed no luminescent or inhibitor activity. The dissociation constant of the luciferase-FMNH2 analog complex was determined kinetically as a substrate or inhibitor constant. A contribution of the imino group at position 5 in the isoalloxazine ring to the FMNH2 binding to luciferase was suggested by a Hammett plot of the dissociation constants.


Properties of serum lipase in patients with various pancreatic diseases. Analysis by a new serum lipase assay method (the BALB-DTNB method) in combination with gel-filtration and iso-electrofocusing techniques. Very low levels of lipase can easily be measured by a new serum lipase assay method (the BALB-DTNB method), using BAL-tributyrate (BALB) as a substrate, 5,5'-dithiobis(2-nitrobenzoic acid) as a chromogenic SH reagent, phenylmethylsulfonylfluoride as an inhibitor of esterases and sodium dodecyl sulfate as a surfactant. The BALB-DTNB method has a higher sensitivity than the conventional serum lipase assay methods, and proved useful for analyzing the properties of serum lipases in combination with gel-filtration on a Sephacryl S 200 column and isoelectrofocusing in an Ampholine column. Serum samples containing high levels of lipases from patients with pancreatic diseases or patients in whom the pancreatic exocrine gland had been stimulated by injecting caerulein and secretin were analyzed by these methods. The lipolytic profiles obtained indicated the presence of a lipase with an estimated molecular weight of 46,000 and isoelectric points of 7.4, 6.8, or/and 6.4. A lipase with properties similar to those of the serum lipase was found to be present in human pancreatic juice.


Some characteristics of a new glycopeptidase acting on aspartylglycosylamine linkages. A new type of glycopeptidase hydrolyzing beta-aspartylglycosylamine linkages was partially purified from almond emulsin by chromatography on Sephadex G-200 and DE 52. The enzyme degraded stem bromelain glycopeptide, Asn-Asn(Man3,Xyl1,Fuc1,GlcNAc2)-Glu-Ser-Ser, to yield equimolar amounts of intact oligosaccharide, peptide (Asn-Asp-Glu-Ser-Ser), and ammonia. The Km value for the stem bromelain glycopeptide was 4 mM, and the optimum pH was 5.2. The enzyme was markedly inhibited by 10 mM Cu2+, Fe3+, and Zn2+. Thiol inhibitors and actinomycete protease inhibitors had no effect. The glycopeptides used as substrates were prepared from stem bromelain, ovalbumin or ovotransferrin. The enzyme hydrolyzed glycopeptides with 3-11 amino acid residues, whereas it did not hydrolyze glycopeptides with 1-2 amino acid residues. Furthermore, Asn-oligosaccharide was not inhibitory to the enzyme.


Formation of interchain disulfide bonds in Bence Jones proteins and Fab(t) fragments of immunoglobulin G through thiol-disulfide interchange. The formation of interchain disulfide bonds from partially reduced Bence Jones protein (Nag, type lambda) and Fab(t) fragments of IgG1 myeloma proteins was studied in the presence of various disulfide reagents. The results could be well explained in terms of the scheme proposed previously (Kishida et al. (1976) J. Biochem. 79, 91-105). In this scheme, it was assumed that two kinds of intermediate, which form mixed disulfides with either of the paired thiol groups, are produced. For type lambda Bence Jones proteins, only one of the two intermediates can form the inter L-L disulfide bond. The fraction of intermediate having the ability to form the inter L-L disulfide bond was estimated to be 72% of the total Nag protein and was the same irrespective of the kind of disulfide reagent examined. For Fab(t), on the other hand, both intermediates equally can form the inter Fd-L disulfide bond. On the basis of the results with cystamine, it was shown that the formation of an inter Fd-L disulfide bond from the intermediate proceeds about 100 times as rapidly as that of an inter L-L disulfide bond.


Content and composition of the gangliosides of forebrain, brain stem and cerebellum of the rat during normal and restricted growth. The effect of undernutrition was studied on the content and composition of the gangliosides of forebrain, brain stem, and cerebellum of Wistar rats. Undernourishment from before birth upto 21 days of age did not produce any significant change in the content of gangliosides in any brain area, but when continued upto 121 days it resulted in a significant decrease of the lipids in each of these brain regions. At this age the different ganglioside fractions were, however, affected differently in the different brain areas. Thus the accumulation of the ganglioside GD1a was most affected in the forebrain, of ganglioside GD1b in the brain stem, and of ganglioside GT1 in the cerebellum. These were the largest fractions of total gangliosides in the respective brain areas at 121 days of age. The results suggest that the brain may be vulnerable to undernourishment at any time when a biochemical process in development of the tissue is in progress.


Determination of sites in rabbit muscle glycogen phosphorylase b modified by an adenosine 5'-monophosphate analog, N6-p-bromoacetaminobenzyladenosine-5'-phosphate. To identify the residues modified by radioactive N6-p-bromoacetaminobenzyladenosine-5'-phosphate in phosphorylase b, the peptic peptides of the modified enzyme were purified. Two radioactive peptides were isolated, each of which had a cysteine residue modified. The cysteine residue involved in the AMP site was determined to be cystein-317 and the other eactive cysteine residue was cysteine-171.


In vivo effect of androgen and cycloheximide on the RNA synthesis in isolated nuclei of rat ventral prostates. Castration results in a rapid decrease in the activity of RNA polymerase I (or A) of isolated nuclei of rat prostates. The decrease was mainly ascribed to the diminution in the number of in vivo initiated RNA chains. The "free form" activity of the enzyme, however, which was estimated by the use of exogenous template and actinomycin D, increased 24 h after castration, then dropped rapidly. The administration of testosterone to castrated rats caused an increase in the activities of both RNA polymerases I and II (or B), which started 2 h and reached the maximum 12 h after the administration. No initial rise in RNA polymerase II activity was observed during the first 2 h. The administration of cycloheximide to normal rats caused a very rapid decrease of the activity of template-bound RNA polymerase I of isolated prostatic nuclei (t1/2=1.7 h), while the "free form" activity of the enzyme did not appreciably change until 3 h. The androgen-stimulated increase in the "engaged form" of the RNA polymerase I of isolated nuclei was completely abolished by the administration of cyclohexmide 60 min before killing. Based on the results obtained, the role of protein(s) with a rapid turn-over which is/are androgen-dependent and presumably participating in the control of preibosomal RNA synthesis is discussed.


Biochemical studies on rat liver Golgi apparatus. IV. Effects of various treatments in vivo on the Golgi apparatus. The effects of various treatments in vivo on the intracellular contents of the Golgi apparatus and microsomes (endoplasmic reticulum) in rat liver were studied. Partial hepatectomy increased the content of Golgi apparatus. Laparotmy also increased the content of Golgi apparatus, but to a lesser extent than partial hepatectomy. In contrast, the content of microsomes remained unchanged by these treatments. On the other hand, the plasma seromucoid content was markedly increased by laparotomy, but unchanged by partial hepatectomy. Papain administration also caused an increase in the content of Golgi apparatus. The contents of both organelles were increased by the injection of phenobarbital. These results indicate that the control mechanisms of proliferation of Golgi apparatus are different from those of endoplasmic reticulum. These findings are discussed in relation to the functions of the Golgi apparatus, and it is suggested that  the major function of the organelle at a given time is determined by the major metabolic demands at that time.


Nature of tryptic attack on cytochrome b5 and further evidence for the two-domain structure of the cytochrome molecule. Rabbit cytochrome b5 was incorporated into single-walled phosphatidylcholine liposomes, and the cytochrome b5-liposome complex thus formed was digested with trypsin. Protein chemical characterization indicated that the main products formed were 1) a hydrophilic (heme-containing) fragment of the cytochrome corresponding to the sequence consisting of the masked NH2-terminus through residue 88, 2) a hydrophobic peptide which spans residue 91 to the COOH-terminus (residue 133), and 3) a dipeptide, seryl-lysine, derived from residues 89 and 90. The hydrophobic peptide was obtained in the form of its complex with liposomes. It was concluded that trypsin cleaved rather specifically the peptide bonds between residues 88 and 89 (Arg-Ser) and between residues 90 and 91 (Lys-Leu). Tryptic digestion of free, unbound cytochrome b5 also resulted in the cleavage of the same peptide bonds. These results are not consistent with the proposal of Visser et al. (Visser, L., Robinson, N.C., & Tanford, C. (1975) Biochemistry 14, 1194-1199) that the hydrophilic and hydrophobic domains of cytochrome b5 are connected to each other by a link peptide consisting of some 15 amino acid residues and that this link peptide  can be cut out by the action of trypsin. The circular dichroism spectrum of intact cytochrome b5 or its complex with liposomes in the far-ultraviolet region was closely similar to the sum of the spectra of the hydrophilic fragment and the hydrophobic peptide (or its complex with liposomes). This indicates that the tryptic cleavage of the cytochrome molecule does not induce any significant changes in the conformations of the hydrophilic and hydrophobic moieties of the molecule and thus provides further evidence that the three-dimensional structures of the two domains are independent of each other.


Isolation and characterization of a sulfated glycoprotein from rabbit small intestine. Complex saccharides were extracted with 0.9% NaCl at 0 degrees C from rabbit small intestine, then fractionated with cetylpryridinium chloride (CPC), followed by DEAE-Sephadex A-25 column chromatography and by GEON-zone electrophoresis. An acidic glycoprotein (Fr. A-1) thus obtained was shown to be homogeneous by electrophoreses on cellulose acetate membrane and on sodium dodecyl sulfate (SDS)-polyacrylamide gel, as well as by gel filtration on Sepharose 4B. It contained 40.0% protein, 52.7% carbohydrate, and 1.6% sulfate. The principal sugars in the sulfated glycoprotein were galactose, glucosamine, galactosamine, and sialic acid. Small quantities of mannose, L-fucose, and glucose were also present. Glutamic acid, threonine, aspartic acid, alanine, serine, leucine, proline, glycine, valine, and histidine were the major amino acids of the protein moiety. Small amounts of other basic amino acids, sulfur-containing amino acids and aromatic amino acids were also present.


Isolation and characterization of a novel ganglioside, monosialosyl pentahexaosyl ceramide from human brain. A novel monosialosyl ganglioside was isolated from human brain in a yield of 2.1 nmol of the lipid-bound sialic acid per g of wet weight (0.09% of total lipid-bound sialic acid). The ganglioside was resistant to the action of Vibrio cholerae neuraminidase. By treatment with N-acetylhexosaminidase, methylation analysis, CrO3 oxidation, and partial acid hydrolysis, the structure of this ganglioside was determined to be; GalNAc(beta, 1-4)Gal(beta, 1-3)GalNAc(beta, 1-4)Gal(beta, 1-4)Glc(beta, 1-1)ceramide. (formula: see text). The treatment of the ganglioside with 1 N formic acid at 80 degrees C for 2 h produced mainly gangliotetraosyl ceramide, suggesting that the terminal N-acetylgalactosamine was more labile on formic acid treatment than galactose at nonreducing terminal.


GM3 ganglioside in various tissues of rabbit. Tissue-specific distribution of N-glycolylneuraminic acid-containing GM31. Molecular species and concentrations of GM3 ganglioside in rabbit tissues, brain, thymus, lung, liver, stomach, intestine, kidney, testis, muscle, and erythrocytes were determined. The highest concentration was found in lung (431.7 nmol/g wet tissue). With the exceptions of brain, thymus, and erythrocytes, GM3 was the dominant ganglioside and comprised more than 50% of the total gangliosides. In brain and thymus, GM3 composed 0.76% and 17.28% of the total gangliosides, respectively. The sialic acid composition of GM3 was determined by mild methanolysis and neuraminidase treatment combined with either permethylation or trimethylsilylation. N-Glycolylneuraminic acid-containing GM3 was found in thymus, lung, kidney, and intestine in addition to N-acetylneuraminic acid-containing GM3, but N-acetylneuraminic acid was the sole sialic acid of GM3 in the other tissues. Sixty-four percent of the thymus GM3 consisted of N-glycolylneuraminic acid. High concentrations of C-20 sphingosine and stearic acid were characteristic for brain GM3 and the major long chain base of the other tissues was C-18 spingosine. The fatty acid composition of GM3 varied in each tissue. The difference in mobility on a thin-layer plate was due to the difference in its molecular constitution, being derived from a combination of fatty acid, long chain base, and sialic acid.


Modification of papain with tetranitromethane. Papain [EC 3.4.22.2] polymerizes readily upon treatment with tetranitromethane (TNM) by forming intermolecular covalent linkages through its tyrosine residues (Tsukamoto, S. & Ohno, M. (1974) J. Biochem. 75, 1377-1380). Polymerization occurred optimally at pH 9.0 with S-sulfenylsulfonate papain. Circular dichroic spectra of polymerized papains showed a small change in ellipticity when compared with that of unmodified papain. Esterolytic activity of the modified enzyme toward benzoyl-L-arginine ethyl ester (BAEE) was almost fully retained, at least up to the formation of hexamer, with an unchanged Km value. Spectrophotometric and amino acid analyses indicated that two or three tyrosine residues are involved in intermolecular crosslinks depending on the amount of TNM used. The tyrosine residues nitrated were identified as those at positions 61, 116, 103, and 4, the extent of nitration decreasing in this order. When activated papain was treated with increasing molar ratios of TNM, an essential sulfhydryl function was first oxidized and, at a 2-fold molar excess of the reagent, restoration of activity was no longer observed even after addition of dithiothreitol (DTT). The evidence obtained in the present study eliminates the possibility of inactivation due to nitration of a tryptophan residue, which had been suggested previously.


Involvement of an acidic protein in regulation of smooth muscle contraction by the tropomyosin-leiotonin system. An acidic Ca-binding protein of about 18,000 dalton, different from both modulator protein and troponin C, was found to be involved in the regulatory mechanism of smooth muscle contraction by the tropomyosin-leiotonin system.


The occurrence of an inhibitor of Ca2+-dependent neutral protease in rat liver. The occurrence of a novel and specific inhibitor of Ca2+-dependent neutral protease in rat liver has been demonstrated. The partially purified product is a heat-stable and acid-stable protein of an approximate molecular weight of 3x10(5), and readily inactivated by tryptic digestion. The inhibition of Ca2+-dependent protease is not a result of the binding of Ca2+ by the inhibitor.


Surface chemical analysis of Avcothane and Biomer by Fourier transform IR internal reflection spectroscopy. During the solvent casting process, one side of the polymer film is exposed to air while the other side is in contact with a substrate, used as a mold. We have studied the effect of this difference in exposure during casting on the chemical composition of two types of segmented polyurethane, Biomer and Avcothane, by using Fourier transform IR internal reflection spectroscopy. Also, a depth-composition profile was obtained by placing a thin barrier film between the reflection plate and the polymer film. In Avcothane, the air side, which is the blood-contact side, contains a greater amount of the soft segment than the substrate side, and this is more  pronounced in the layer closer to the surface. The anisotropy in composition is more drastic when the silicone content is compared. In a layer about 1.5 mu thick, one can detect a greater amount of silicone in the substrate side than in the air side. However, when one averages the concentration in a layer of about 0.8 microns the trend in reversed; i.e., the greater amount of silicone is now present in the air side than in the substrate side. In Biomer films, the anisotropy in chemical composition is less pronounced. Only a modest increase in the relative content of the soft segment/hard segment is observed in the air side when a depth-composition profile is obtained.


Evaluation of a precipitation hardened wrought cobalt-nickel-chromium-titanium alloy for surgical implants. A Co-Ni-Cr-Ti precipitation hardening alloy is evaluated for use as a surgical implant alloy. Static and fatigue strength studies indicate that the alloy is equivalent, or superior to, present implant alloys. In vitro and in vivo corrosion studies indicate that the material has good general corrosion resistance but may be susceptible to crevice corrosion. However, there appear to be no inherent difficulties in using precipitation hardened alloys for surgical implants and therefore it may be possible to develop a new class of materials possessing ultra-high strength and excellent corrosion resistance for use in surgical implant applications.


Evaluation of couple/crevice corrosion by prosthetic alloys under in vivo conditions. Alloys of cast Co-Cr-Mo, wrought Co-Cr-W, wrought, Co-Ni-Cr-Mo(MP35N), Ti-60% Al-4% V, and graphite were incorporated in specimens which simulated both a couple and a crevice corrosion condition. These specimens were implanted in a dog for 30 months. Post-sacrifice examination showed no substantial evidence of corrosion activity on the surfaces of the metals except for a tarnish film on the titanium alloy specimens. The presence of the tarnish film is taken as more evidence of corrosion activity and this correlated with a thicker average fibrous membrane, cellular activity in and near the fibrous membrane, and some increased vascularity. These must be regarded as preliminary observations.


Adhesion of synthetic organic polymer to soft tissue. III. Effect of some monofunctional compounds. Previous work in this series has shown that some aromatic and n-alkyl isocynates can significantly improve the adhesion of a fast-setting polyurethane prepolymer to internal tissue. In the present study, several acyl or aroyl anhydrides, chlorides, and a triaryl chloroalkane have been found to effect various degrees of improvement in the adhesion of fast-setting prepolymer to tissue. To determine the influence of minor structural changes on adhesion, the isomers of methyl phenyl isocynate and chlorobenzoyl chloride were investigated. The isomers were found to give the same extent of improvement in adhesion of the prepolymer as the parent compound without the methyl or chloro substituents. Among all the reactive monofunctional compounds studied, benzoyl chloride and its chlorobenzoyl derivatives are the most effective. When primed on tissue or admixed as little as a 3% additive in some polymer preparations, these aroyl chlorides can promote the adhesion of many ordinary adhesives to internal tissue. The effectiveness is attributed to the modification of hydrophilic tissue surface by the hydrophobic benzoyl group attached to tissue after reaction. The prosthetic benzoyl group makes the tissue/polymer interface more compatible and the compatibility results in good adhesion.


Corrosion behavior of structural phases in high copper dental amalgam. The effects of crevice corrosion on the major structural phases of a high copper dental amalgam were studied in vitro. Three kinds of samples were used: (1) amalgam prepared from a high copper, single composition alloy, (2) annealed ingots of the Ag3Sn and Cu3Sn phases, and (3) high copper, single composition alloy tablets electroplated with mercury. Specimens were examined in a scanning electron microscope before and after the exposure to a corrosion environment. The Ag3Sn and Cu3Sn phases were least affected by corrosion. The Ag-Hg-Sn phase (gamma1) slowly deteriorated, but the attack was nonuniform. The Cu6Sn5 phase exhibited good corrosion resistance, better than that of gamma1 phase. Particles of a tin rich phase of uncertain origin were observed on some of the samples after long exposures.


Ferrographic analysis of wear particles in arthroplastic joints. Analysis of aspirated synovial fluid appears to be a useful method for the study of the rates, mechanisms, and biological responses to wear in surgical joint replacements. Ferrography, an industrial technique of magnetic separation of particulate matter from samples of lubricating solutions, allows separation of wear debris from synovial fluid. Bichromatic microscopy and SEM X-ray analysis permit identification of metallic particles from arthroplastic joints. Polarized light microscopy characterizes and differentiates polyethylene and polymethacrylate debris. The number and morphology of the wear particles in synovial specimens from arthroplastic joints correlate with the rate and the mechanisms of wear, as confirmed by examination of the implant and the adjacent synovial tissue.


A study of the normal range of strain, strain rate, and stiffness of tendon. This paper describes the result of an investigation of strains and strain rates which normally occur in the tendons of the equine foreleg and presents stress-strain curves and moduli for the tendons at these rates. It has previously been demonstrated that resistance to flexion of the joints of the distal part of the equine foreleg is provided by a passive system of tendons and ligaments. It is therefore possible, using a large displacement, high-rate testing machine, to duplicate in the laboratory the strain rates and forces which are normally produced in the tendons of the foreleg of the running horse. To carry out tendon tests, legs were mounted in the test machine. The superficial flexor tendon was exposed and fitted with an extensometer and a buckle-type force transducer. Stress-strain curve were obtained for 13 tendons. It is shown that strains to 12% and strain rates to 200%/sec occur normally in the superficial flexor tendon. Stress strain curves and tangent modulus are presented for strains from 0 to 10% at rates from 5 to 100%/sec. Tendon modulus is found to be essentially rate in dependent in this range.


Wear characteristics of UHMW polyethylene: a method for accurately measuring extremely low wear rates. The wear of UHMW polyethylene bearing against 316 stainless steel or cobalt chrome alloy was measured using a 12-channel wear tester especially developed for the evaluation of candidate materials for prosthetic joints. The coefficient of friction and wear rate was determined as a function of lubricant, contact stress, and metallic surface roughness in tests lasting two to three million cycles, the equivalent of several years' use of a prosthesis. Wear was determined from the weight loss of the polyethylene specimens corrected for the effect of fluid absorption. The friction and wear processes in blood serum differed markedly from those in saline solution or distilled water. Only serum lubrication produced wear surfaces resembling those observed on removed prostheses. The experimental method provided a very accurate reproducible measurement of polyethylene wear. The long-term wear rates were proportional to load and sliding distance and were much lower than expected from previously published data. Although the polyethylene wear rate increased with increasing surface roughness, wear was not severe except with very coarse metal surfaces. The data obtained in these studies forms a basis for the subsequent comparative evaluation of potentially superior materials for prosthetic joints.


Fibromuscular hyperplasia of the abdominal aorta. The case of a 38-year-old female with fibromuscular hyperplasia of the abdominal aorta causing a leg ulcer is presented. The correct diagnosis was not recognized before or during operation and the lesion was treated as atherosclerosis. This would appear to be the first reported case of fibromuscular hyperplasia of the aorta resulting in clinical impedence of flow.


A gut and mesentery pedicle for bridging lymphatic obstruction: experimental studies. Experiments have been carried out in the pig. Small bowel and its mesentery are rich in lymphatics. A pedicle of ileum (opened and denuded of its mucosa) and its mesentery has been used to bypass lymphatic obstruction. Diversion of lymphatic drainage from the lower limb into the lymphatics of the bridge has been demonstrated lymphographically in the living animals and also by post mortem injection studies.


The origin of Raynaud's phenomenon.

The origin of Raynaud's phenomenon. 107 patients presenting Raynaud's phenomenon attacks were studied. It has been demonstrated by means of arteriographies that in pallid phase of Raynaud's phenomenon attacks not only the digital but also the radial ulnar and interosseous arteries are in spasm. In the cyanotic phase of Raynaud's phenomenon the natural arteriovenous anastomoses are widely open bringing about peripheral skin ischemia. On the assumption that the opening of arteriovenous anastomoses in Raynaud's phenomenon attacks is due to injury of that part of the peripheral nerve which lies in contact with the cervical vertebral column all 107 studied patients were submitted to detailed cervical vertebral column X-ray examinations. In 103 patients i.e. in 96.3% characteristic degenerative changes of cervical vertebrae were recognised. In 100 controls who never had neither Raynaud's phenomenon attacks nor cervico-brachial neuritis the same type of degenerative changes were found in 10% only. The authors presume that the Raynaud's phenomenon attacks are due to peripheral mixed nerve or their roots injury. The blue phase of Raynaud's phenomenon attacks is due to opening of arteriovenous anastomoses.


[Sclerodystrophy of the sphincter of Oddi (author's transl)]. Among 1,645 biliary operation carried out between 1952 and 1974, the authors count 177 organic stenoses of the Oddi region. They recall the authenticity of chronic odditis, the pathological substratum of which is Oddi sclerodystrophy, a primary and progressive lesion. They emphasise the radiomanodebimetric criteria. The risk of an error of interpretation was 2% in this series. After discussing the etiopathogenesis and the physiopathological consequences of Oddi sclerodystrophy, they discuss the therapeutic choice between sphincterotomy and choledoco-duodenostomy. Temporary gall bladder drainage is only of interest in inflammatory labile manifestations without sclerodystrophy. The interest of diagnosis and initial surgical treatment of the lesion is that the classical post-cholecystectomy syndrome almost disappears.


[A rare abdominal emergency: acute phlegmonous gastritis (author's transl)]. In the light of a series of recent observations and a personal case, the authors recall that acute phlegmonous gastritis is a rare disease usually secondary to a bucco-pharyngeal infective focus, characterised by an acute abdominal syndrome accompanied by a very severe infective context. Only laparotomy leads to the diagnosis. Since antibiotics, the mortality has regressed from more than 80% to less than 50%. The prognosis of the antral forms is much less serious than that of the diffuse forms with mortalities of 28% and 71% respectively. In antral gastritis the best therapeutic attitude is early antibiotic therapy associated with 2/3 gastrectomy.


[Isolated rupture of the pericardium after closed trauma of the thorax (author's transl)]. Rupture of the pericardium after closed trauma of the thorax is rare. There are two main clinical presentations: one of severe thoracic trauma with hemothorax requiring an operation which permits the diagnosis, the other of pain and pericardial signs on auscultation which should attract attention. The treatment requires closure of the pericardial tear as a routine owing to the risk of fatal complications due to dislocation of the heart.


Prosthetic replacement of the superior vena cava after resection for malignant mediastinal tumour. The authors describe a case of malignant neoplasm of the mediastinum affecting the S.V.C. and the right lung. Radical removal of the neoplasm involved a right pneumonectomy and resection of the S.V.C. Replacement of the latter with a prosthesis in K Dacron double velour was successful--a success which has lasted 5 months to date.


[Perforation of the abdominal esophagus and peritonitis (author's transl)]. Perforation of the abdominal esophagus is not exceptional, either after endoscopy of the esophagus or after surgery of hiatus hernia. The clinical symptoms are not always clear especially during surgery. Immediate diagnosis is however essential for any delay in treatment causes the mortality to rise from 15% to more than 60% for repairs carried out under septic conditions. The best surgical attitude is difficult to determine under these conditions.


[Compression of the posterior branch of the radial nerve by a benign tumour of the elbow region. Report of three cases (author's transl)]. The authors report three cases of a rare disorder : compression of the posterior motor branch of the radial nerve (ramus profundus n. radialis) by a benign tumor of the region of the elbow, in one case by a lipoma, in the other cases by a pseudocyst. Surgical removal was successful in all three cases. The authors review the literature concerning compression of the posterior interosseous nerve (ramus profundus n. radialis) by lipomas and pseudocysts. Apart from two cases treated at a late stage, surgery permitted complete functional recovery in all the other published cases. This emphasises the interest of early radiological diagnosis and of routine operation even the etiology does not appear obvious, especially as surgery is beneficial in the treatment of the tumour itself.


[Gastro-omental cystic lymphangiomas. General review and report of two cases (author's transl)]. Omental and gastric lymphangioma : a general review of cases and two personal cases. Lesser omentum tumors are rare. They exceptionnally arise from the stomach. Pathologic fractures : there are three types of lymphangioma simplex, cavernous and combined cystic ones. Microscopic examination shows that cysts are lined with endothelium and the wall is infiltrated by lymphocytes. Lymphangioma frequently occur in childhood (stomacal tumors excepted). Symptoms are those observed either in abdominal tumors, or in ascitis or in acute abdominal disease. The diagnosis is not established per-operatively. Surgical treatment consists in resection of the cyst or in simple drainage. Post-operative prognosis is excellent.


[Arterio-venous fistula of the left renal pedicle after nephrectomy. Possibilities and interest of early diagnosis (author's transl)]. The authors study a new case of arterio-venous fistula of the left renal pedicle after nephrectomy for trauma. The interest of this case resides in the existence of a right para-umbilical pulsating mass which corresponds to systolic expansion of the inferior vena cava. This sign, which disappeared after corrective operation has the advantage of orienting towards an abdominal vascular condition. In fact, the diagnosis of iatrogenic arterio-venous fistula was made very early : 6 weeks after nephrectomy. The lesion was treated by the purely abdominal route, in the absence of marked peri-aneurysmal fibrosis. Complete removal of the fistula and of the afferent and efferent vessels corrects recent hypertension and prevents later heart failure.


[Synovial hemangioma of the knee. Report of one case (author's transl)]. Hemangioma of the synovial membrane is encountered in young adults in the form of a palpable articular tumour. The muscle wasting in the quadriceps is out of proportion with the clinical signs and should lead one to suspect the diagnosis. Lengthening of the limb on the side of the lesion by arterio-venous shunt is not rare. Histologically, hemangioma is a vascular tumour and there is the same difficulty in classification as for all vascular tumours. Synovectomy removing the tumour is the operation of choice. Relapse is possible leading to total removal of the synovial membrane. Complementary radiotherapy does not have a clearly defined place in treatment.


Myotonia dystrophica with heart involvement: an electron microscopic study of skeletal, cardiac, and smooth muscle. The electron microscopic features of the striated skeletal muscle, the striated cardiac muscle, and the smooth muscle from a woman who had been suffering for many years from myotonia dystrophica with cardiac involvement are described. The skeletal muscle was studied at two different stages of the disease. In the first material the main changes consisted of centrally situated nuclei, disorganisation of the sarcomeres, and focal disruption of the Z-line. The satellite cells were well represented. Three years later atrophy and degenerative, necrotic changes of the skeletal muscle were evident. The satellite cells were absent. Few changes were seen in the striated cardiac muscle. These consisted of slight interstitial fibrosis and large accumulations of mitochondria with intramitochondrial dense granules. The smooth muscle cells of the oesophagus showed disorientated filaments and mild degenerative changes. It is concluded that the skeletal muscle was more severely affected than the other types of muscle.


Human nails and body iron.

Human nails and body iron. The iron content of human nails has been measured by atomic absorption spectrophotometry and compared with other measurements of iron status including the bone marrow. Four groups of individuals were studied: 40 healthy laboratory staff, five iron-deficient subjects before and during iron therapy, four patients at various stages of treatment with iron, and 15 postmortem cases. The iron status of the individual was reflected by the amount of iron present in nail samples. Nail sampling is proposed as a cheap, noninvasive method of assessing the iron status of the individual.


Diagnosis of Bacteroides fragilis infection with counter-immunoelectrophoresis. In a study of 188 patients and 109 controls, the detection of antibody by counterimmunoelectrophoresis was used as a diagnostic aid in human infections with Bacteroides fragilis. It was found that positive results indicated current infection and negative results were not conclusive. The method used was simple, rapid, and easily performed in a routine laboratory, but further work is needed to enhance antigen potency.


Serological diagnosis of Bacteroides fragilis infections by a complement fixation test. Paired specimens of serum from patients from whom Bacteroides fragilis had been isolated were tested by complement fixation against a crude B. fragilis antigen. A high titre or a rise in titre to B. fragilis was obtained in each of five patients with infection after abdominal surgery but in none of 11 patients with postpartum pyrexia nor in nine with vaginitis.


Propionibacteria as a cause of shunt and postneurosurgical infections. Propionibacterium acnes was isolated from postoperative specimens from nine neurosurgical patients. The role of P. acnes in postneurosurgical infection is discussed.


Platelet function, factor VIII, fibrinogen, and fibrinolysis in Nigerians and Europeans in relation to atheroma and thrombosis. Platelet function, factor VIII, fibrinogen levels, and fibrinolysis were studied in Europeans and in two groups of Nigerians living in Zaria, northern Nigeria, in order to see whether differences could help to explain the low incidence of atheroma and thrombosis in Nigerians. We confirmed the relative thrombocytopenia and observed a rapid disaggregation after ADP-induced platelet aggregation in Nigerians. The most striking difference was a reduced or absent ristocetin-induced platelet aggregation in Nigerian platelet-rich plasma, probably due to a plasma component interacting with the von Willebrand activity (VWF), since factor VIII coagulant activity, factor VIII related antigen, and isolated VWF were normal or high by European standards. Group II (rural population), but not group I (senior university staff in Zaria) of the Nigerians, tended to have high serum fibrinogen concentrations. Spontaneous fibrinolytic activity was enhanced in most Nigerians compared to the Europeans and was normally increased after venostasis in proportion to the initial activity. Fibrinolysis and ristocetin-induced platelet aggregation values for the Nigerians in group I were intermediate between European and Nigerian in the group II values, suggesting that differences were due more to environmental than to genetic factors.Relative thrombocytopenia, disaggregation after ADP-induced aggregation, inhibition of ristocetin-induced platelet aggregation, and active fibrinolysis help to explain the infrequency of thrombotic disease in Africans. Also the low incidence of atheroma may follow from less platelet adherence and less platelet release of mitogenic factors, which cause intimal hyperplasia.


Failure of factor VIII inhibitor bypassing activity (Feiba) to secure haemostasis in haemophilic patients with antibodies. Factor IX concentrates have been widely advocated in the treatment of haemophilic patients with factor VIII inhibitors. Five such patients were given the 'activated' factor IX concentrate--factor VIII inhibitor bypassing activity (Feiba)--for 14 separate bleeding episodes. In six of the episodes, including two with external blood loss, bleeding progressed in spite of treatment. In none of the other eight episodes was there a prompt response, and it was not possible to ascribe a definite therapeutic effect.


Ristocetin and the thrombin clotting time. The addition of the antibiotic ristocetin to plasma accelerated the thrombin clotting time (TCT) in 20 out of 22 subjects. Prior incubation of ristocetin with thrombin or plasma did not alter its effect on the TCT. Ristocetin accelerated clotting greatly at low but not at high levels of thrombin. A simple linear correlation between heparin concentrations and the TCT was demonstrated when ristocetin at 2.5 mg per ml was added to plasma containing between 0.05 and 0.5 unit of heparin per ml. There are implications for assay procedures involving heparin and the TCT.


Patterns of nasalance in a sample of normal gerontologic subjects. The purpose of this investigation was to evaluate velopharyngeal adequacy in gerontologic subjects using an acoustic analysis strategy. Sixty normal older subjects (30 male, 30 female), ranging in age from 50 to 80, read three passages developed by Fletcher (1976) that differ in number of nasal sounds. In addition, all subjects sustained the vowel /a/. The speech samples were analyzed using TONAR II, which calculates the ratio of nasal sound pressure level to nasal + oral sound pressure level (nasalance). Tonagrams (plots of nasalance over time) were obtained from all subjects. Results demonstrated that older subjects generally evidenced abnormally high nasalance values for the Zoo Passage (contains no nasal sounds). In addition, females exhibited significantly higher nasalance values than males. Inspection of the tonagrams revealed three abnormal acoustic patterns: (1) pervasively high nasalance, (2) momentary loss of velar control, (3) progressive deterioration in velar control. These results are discussed with reference to known neuroanatomical changes associated with advancing age.


Does the stigma shape the stutterer?

Does the stigma shape the stutterer? The Woods and Williams' (1976) study of Iowans' stereotypes about stuttering males was replicated using 11 speech clinicians and 16 classroom teachers in Virginia. Ratings of 23 possible characteristics were obtained for four hypothetical concepts (typical 8-year-old male, typical 8-year-old male stutter, typical adult male, and typical adult male stutterer) using a semantic differential format. The results of the Woods and Williams' (1976) research were confirmed. Stutters were expected by all rating groups to be more nonassertive, tense, insecure, and afraid to talk than nonstutterers. Not only were stereotype differences within professional groups quite small from one geographical region to the other, but classroom teachers held particularly unfavorable stereotypes of the stuttering boy in both studies. These results suggest the possibility that listener reactions could shape the stutterer's behavior.


A comparative study of hearing-impaired and normal-hearing young adults--verbal and nonverbal abilities. This report describes the results of a study comparing three groups of hearing-impaired young adults with a group of normal-hearing young adults on various measures of perceptual and memory abilities. Twelve paper-and-pencil tests representing intellectual capacity, closure, association, nonverbal short-term memory, and verbal short-term memory were used as dependent variables. Results show that there was no difference between the four groups of subjects except for tests requiring some verbal facility.


A comparison of techniques for measuring intelligibility of dysarthric speech. Eight techniques for quantifying intelligibility of dysarthric speech were compared. Eight dysarthric speakers who represented a wide range of severity were recorded producing single words and sentences. Thirty-two college students performed the following intelligibility quantification tasks: percentage estimates, rating scale estimates, work and sentence transcriptions, word and sentence completions, and word and sentence multiple-choice tasks. Intelligibility scores for transcriptions were compared to estimates and to other objective tasks with the following results: (1) all measurement techniques, except word completion, rank ordered speakers similarly to transcriptions, (2) mean estimates of intelligibility closely parallel transcription scores, but dispersion of listener estimates was large, and (3) objective tasks form a hierarchy with speakers receiving lowest scores on transcriptions, intermediate scores on completions, and highest scores on multiple-choice tasks. Mean scores for words and sentences were similar. Implications of results for clinical management of dysarthria are discussed.


Listeners' impressions of normal-hearing and hearing-impaired children. This study investigated the relationship between speech of hearing-impaired children and listeners' ratings of the speakers' intelligence, achievement, personality, and appearance as a function of whether or not speakers wore hearing aids. Stimuli consisted of (1) tape-recorded speech samples of 12 speakers (4 normal hearing, 4 hard of hearing, and 4 deaf) and (2) two photographic slides of each speaker--one depicting him wearing a hearing aid and another depicting him not wearing a hearing aid. Listeners used a semantic differential scale to rate the stimuli. Analysis shows that there is a systematic increase in "less desirable" ratings with severity of hearing loss and that responses are more negative when the speaker wore a hearing aid.


A clinical prototype for auditory memory span. An initial examination of an experimental test for auditory memory span was administered to 12 children (ages 5,6 to 7,0) with moderate to severe functional articulation problems. The experimental retention test (ERT), based on a minimal-pairs, distinctive feature paradigm, correlated significantly with three indices of articulatory performance: consonantal intelligibility, total sounds in error, and total number of misarticulations. Descriptive data are presented for clinical evaluation and further test development.


Auditory pattern recognition abilities of aphasic and normal subjects: a preliminary study. A comparison of the ability of aphasic and normal subjects to recognize three element auditory patterns of duration was made under the following conditions: monaural right, monaural left; split left leading and split right leading: dichotic. There were eight possible combinations of elements for each condition. In all conditions the normal group clearly outperformed the aphasic subjects with practically no overlap in their performances. Implications of using nonlinguistic stimuli for testing aphasic individuals, assessing progress, and training in pattern recognition is discussed.


The fit between journals and theses.

The fit between journals and theses. The titles of a substantial sample of articles related to speech pathology and audiology over a period of 21 years were catalogued under one or more of 10 categories, e.g., normal audition, defective phonation, and the like. The titles of theses and dissertations in this field of six universities of Ohio over the same period were also catalogued. The articles appeared in 17 journals. The journals were treated as seven groups of "related" journals. The total output of journals was stable over the period studied; a "group" of journals tended to be consistent with itself over successive 3-year periods; the seven groups of journals tended to be unique, and not to replicate each other. The topics treated in the journals were accepted as a criterion for contemporaneousness. The student output of the universities varied in contemporaneousness from one school to another, ranging upward to r = 0.98 (10 categories). The overall correlation between the student and the journal outputs was r = 0.79.


Auditory semantic, syntactic, and retention errors made by aphasic subjects on the Token Test. The Token Test was administered to 25 mild aphasic and 25 matched normal subjects for the purpose of determining the linguistic nature of the auditory verbal comprehension error responses. As was expected, the aphasic subjects obtained significantly poorer scores on the Token Test than did the normal subjects, with minimal overlap between the two groups. In Parts I-IV, the errors were exclusively semantic, and reflected only the amount of required verbal memory. In Part V, the syntactic structures vary, and the aphasic subjects showed a similar pattern of difficulty as did the normal subjects. Syntactic errors were more prevalent than semantic errors in Part V, suggesting that syntactic complexity was the most important factor in verbal comprehension on this part. In comparison to previous research utilizing the Token Test with normal children, the aphasic subjects in the present study generally had high error rates on the same items as did the children.


Membrane oxygenators for acute respiratory insufficiency. Clinical use in 11 patients. Extracorporeal circulation with a membrane oxygenator (ECMO) was used in 11 patients with acute respiratory insufficiency who did not respond to conventional treatment. By pass was veno-arterial in every case, seven times with femoral artery return, three times with axillary artery return, and once with both femoral and axillary return. Five patients died on ECMO. Six patients were taken off ECMO and two of them are long-term survivors. In nine cases ECMO allowed short-term control of respiratory failure. The respective roles of oxygen supply from ECMO and the haemodynamic changes incurred by its use are discussed. Although use of ECMO for long periods seems less hazardous now, present results are restricted by the lack of therapy for the underlying pulmonary lesions.


Acute interstitial pulmonary fibrosis. Comparative light and electron microscopic study of 19 cases. Pathogenic and therapeutic implications. Comparative light and electron microscopic studies of the lung were performed in 19 cases of diffuse acute interstitial fibrosis with various etiologies. Our observations emphasize the relation between hyaline membranes (HM) and the evolution of fibrosis. HM formation is due to fibrinous exudates and epithelial necrosis. This phenomenon recurs during the evolution of the disease and appears to be responsible for new waves of fibrosis. Its pathogenesis (humoral or neurovascular ...) remains hypothetical. Modifications of the alveolar epithelium consecutive to septal fibrosis can be clearly distinguished from "fibrinoid necrosis" -type lesions, which results in HM. The formation of HM is accompanied by fibroblastic stimulation which proceeds in spite of epithelial regeneration. The exact stimulus for the proliferation and collagen hypersecretion of fibroblasts remains to be determined. The use, in association with corticosteroid treatment, of a structural analogue of L lysine, acexamic acid, to impede collagenesis reveals encouraging perspectives for improved therapy.


A rationale for epidural analgesia in the treatment of multiple rib fractures. Thoracic epidural analgesia (EA) is described as an alternative to controlled ventilation in patients presenting with multiple rib fractures. Lung mechanics were especially studied in 6 patients selected from a total of 49. The average ICU stay for this group was 4.5 days (2-11) and the mean age 55.7 years. The EA group was compared with 51 patients primarily ventilated who had an average stay in the ICU of 9.8 days and a mean age of 44.7 years. Mean number of rib fractures of the ventilated group at 6.5 was almost equal to the mean of 6.8 in the EA group. There was a difference in the number of associated fractures, 98 in the ventilated group compared to 35 in the EA group. Severe pulmonary and cerebral contusion were the two most important factors in enforcing the need to ventilate. The success of the method is evidenced by the increase in functional residual capacity (FRC), dynamic lung compliance (Cdyn), vital capacity (VC), the decrease of airway resistance (R) and a significantly increase of PaO2 (p less than 0,001) for the EA group with a balanced fluid therapy. All this accounts for the clinical observation of diminishing paradoxical movement of the flail segment.


Massive digoxin intoxication in childhood. In a 10 year old boy 8 hours after taking about 16 mg beta-acetyl-digoxin a maximum serum digoxin level of 31.8 ng/ml was measured radioimmunologically. This is the highest digitalis level in childhood described to date. The serum potassium level rose to 7.4 mmol/l. Complete atrio-ventricular block, and salves of ventricular premature beats were the most serious rhythm disturbances. The absence of life threatening rhythm disturbances is attributed to the early use of diphenylhydantoin in small frequent doses.


The hazard of acute epiglottitis.

The hazard of acute epiglottitis. This report is based on a 3 1/2 year's study of 33 cases of acute epiglottitis with 3 child deaths. Suspicion of acute epiglottitis in children with respiratory distress is always an indication for rapid direct laryngoscopy under general anaesthesia with intubation, and preparation for tracheotomy and bronchoscopy. Should the diagnosis of acute epiglottitis not be excluded during this procedure, then a free airway should be ensured by endotracheal intubation, even in cases of apparently less severe character, where the procedure would seem to be more prophylactic than therapeutic. Intubation is often very difficult. It is concluded that the patient should be received at the hospital by an E.N.T.--anaesthetic team conversant with the treatment of this potential killer.


Acute miliary tuberculosis presenting as acute respiratory failure. A 42 year old pregnant woman was admitted in acute respiratory failure. Viral pneumonia was suspected and oxygen therapy, CPAP, water restriction and diuretics were started with good response. She remained febrile and had an abnormal chest X-ray, a diagnosis of miliary tuberculosis was confirmed by transbronchial fibreoptic lung biopsy.


Adult respiratory distress syndrome precipitated by massive salicylate poisoning. Pulmonary oedema has been reported in severe cases of acetyl salicylic acid (ASA) poisoning. Liberal use of intravenous fluids, to establish a forced diuresis, is usually thought to be the precipitating cause. A case of severe ASA poisoning and respiratory failure was found to have increased pulmonary vascular resistance and signs of intravascular hypercoagulability. The patient recovered rapidly on mechanical ventilation with a positive endexpiratory pressure of 18 cm H2O and systemic steroids.


Acoustic determinants of phrase boundary perception. How three supersegmental variables (amplitude, pitch contour, and duration pattern) influence phrase boundary perception was investigated in two studies. Listeners located the phrase boundary in ambiguous algebraic expressions, such as "(A plus E) times O" and A plus (E times O)." In one experiment, two values of each of three variables (appropriate or neutral) were orthogonally varied, using linear predictive coding analysis-synthesis procedures. There was a total of eight manipulations for each expression. In the other, the three suprasegmental variables were exchanged between the two alternative meanings of an expression, yielding a total of eight manipulations for each expression. Results from the two studies were consistent in showing that listeners use all three cues, and just these three to parse such utterances. That is, it was possible to completely shift the meaning of an expression uttered with one meaning into its alternate meaning by exchanging all three variables. In both studies, the effects of duration pattern and pitch contour were additive in total proportion correct. Possible models of how listeners process pitch and duration information independently in making a parsing decision are discussed.


Longitudinal study of hearing in children: baseline data concerning auditory thresholds, noise exposure, and biological factors. Serial auditory thresholds are being recorded at six-month intervals from 224 children and youths aged 4--18 years. The data from the first year show girls have lower threshold levels than boys, especially from 12--17 years, and, in both sexes, those aged 12--17 years have lower thresholds than those aged 6--11 years. Median total noise exposure scores tend to be higher in boys than girls, especially after 10 years of age, but these scores are not significantly correlated with auditory thresholds levels. The incidence of exposure to events associated with noise increases markedly in teenage boys and is related to auditory threshold levels. There are no significant associations between auditory thresholds levels and responses to general health questions or attained stature, but there are associations with meatal abnormalities. There is suggestive evidence, particularly in girls, that rapid maturation is associated with lower threshold levels, especially at lower frequencies.


Subjective loudness of N-wave sonic booms. A loudspeaker-driven simulation booth with extended rise-time capability (down to 0.22 ms) has been used for subjective loudness tests of N-wave sonic booms. The test series compared signatures over a range of  0.22--10 ms in rise time, 100--250 ms in duration and 0.5--2.5 psf (24--120 Pa) in peak overpressure. In one sequence, the tradeoff between rise time and overpressure was measured for equal loudness; in another, the tradeoff between duration and overpressure. For equal loudness 10-ms rise time required 8-dB higher overpressure than for 1-ms rise time. Duration had little effect in the range 100--200 ms, but at 250 ms noticeably enhanced the loudness. These results confirm those measured by Shepherd and Sutherland made at 1-ms rise time and above (except for the anomalous enhancement at 250-ms duration), and extend the measurements down to 0.22 ms. There is also good agreement with theoretical predictions (Johnson-Robinson, Zepler-Harel methods) except for the 10-ms rise time and 250-ms duration cases.


Subjective loudness of "minimized" sonic boom waveforms. For very long supersonic aircraft the "midfield" sonic boom signature may not have evolved fully into an N wave at ground level. Thus in current boom minimization techniques the shape of the aircraft may be tailored to optimize this midfield wave form for reduced subjective loudness. The present investigation tests a family of "flat-top" waveforms cited by Darden: all but one have a front shock height (deltapSH) less than the peak amplitude (deltapMAX). For equal subjective loudness, "flat top" vs N wave (peak overpressure deltapN), the peak amplitude of the "flat top" signature was found to be substantially higher than that of the N wave; thus for equal peak amplitude the "flat-top" signature was quieter. The results for equal loudness were well fitted by an emperical law deltapSH + 0.11deltapMAX = deltapN; the equivalence shows how the front shock amplitude (deltapSH) dominates the loudness. All this was found compatible with predictions by the method of Johnson and Robinson.


Growth function for human response to large-amplitude impulse noise. The U. S. Environmental Protection Agency has proposed the use of C-weighted day/night level for the assessment of impulse noise such as the noise resulting from sonic boom, blast noise (artillery, armor, demolition, etc.) and other large-amplitude impulse sources. One remaining question pertaining to the use of C-weighting has been the growth function for human response to impulse noise. This question arises because work by Kryter and by Young using peak values and/or small amplitudes exhibited growth functions of 6--7dB for a doubling of annoyance, while the growth function for human response to common sources (planes, vehicles, etc.) increases by about 10 dB for a doubling of annoyance. Kyter's and Young's data are reanalyzed herein by using C-weighting and by including only large-amplitude data. This reanalysis results in a growth function for human response to impulse noise which increases by about 10 dB for a doubling of annoyance. This equality of growth function between common A-weighted noise and C-weighted impulse noise further supports the use of C-weighted day/night level for assessment of sonic boom, blast noise, or other large-amplitude impulse noises having similar spectral content.


Stiffness gradient along the basilar membrane as a basis for spatial frequency analysis within the cochlea. Stiffness z of the basilar membrane of the house mouse against a displacement by sound was calculated from data on width and thickness of the membrane. Three functions of the kind log10z = ax + b were obtained which equally express the stiffness change in dependence on the locus x on the basilar membrane. These functions were compared with the one for frequency representation. The result is that the spatial distribution of displacement maxima for frequencies and of stiffness follows the same kind of place-dependent functions over a large portion of the basilar membrane. From this it can be concluded empirically that the frequency and stiffness (calculated from width and thickness of the basilar membrane) scales along the cochlea are generally proportional to each other and that stiffness is a dominant factor for the determination of the locus of the displacement maximum for a given frequency.


These glasses are terrible!

These glasses are terrible! In summary, listen to the patient's complaints, try to identify the problem, suggest what can be done to solve the problem and assure the patient that his visual comfort is your primary concern.


[The evolution of perinatal pathology and its prevention in France. The national enquiries by INSERM in 1972-1976 (author's transl)]. Two national enquiries were carried out in France by INSERM in 1972 and in 1975-76 in order to review the efficiency of using medical discoveries and health programmes. The first was carried out on a representative sample of 11,254 deliveries and the second on a representative sample of 4,685 deliveries. The perinatal mortality rate and the prematurity rate have gone down quite definitely, while on the other hand the birth weight has stayed more or less identically the same and the number of small-for-dates babies has not become less and in fact there is a slight tendency for a rise in the number. Antenatal care has improved considerably for most women, without the idea of high risk factors having really become integrated. The number of maternity units with fewer than 15 beds has considerably dropped,  especially in the private sector. Monitoring of labour and of the newborn has shown a certain progress. These changes exist in a family context which is evolving with more planned pregnancies and a slight improvement in the social and cultural conditions of parents.


[Blue naevus of the cervix. 3 case histories (author's transl)]. Anatomo-pathological features of 3 cases of blue naevi of the cervix are presented and discussed together with the literature. Blue naevi of the cervix are localised in the chorion of the endocervical mucus and sometimes even in a polyp, and can be multiple. They are different from benign melanosis or melanocytes which are found in the basal portion of the malpighian epithelium of the exocervix or the vagina. The blue naevus and benign melanosis can rarely give rise to primitive malignant melanomas of the cervix.


[Serial complement (C3 and CH 50) and immunoglobulin levels in toxaemic pregnancy (author's transl)]. The fraction of complement C3, the total complement activity and the levels of IgG, IgA and IgM immunoglobulins have been estimated in the third trimester of pregnancy in 70 control pregnant women and in 38 hypertensive pregnant women who presented either with "pure toxaemia" or with "superimposed toxaemia". The level of IgG is definitely but not significantly lowered in cases of "pure toxaemia". The other parameters that were studied showed no notable changes in comparison with control pregnant women.


[A case of doubly differentiated epithelioma of the cervix (a mixed carcinoma) (author's transl)]. Following a clinical case of doubly differentiated epithelioma of the cervix, we have reviewed the histological, epidemiological and clinico-pathological characteristics of this epithelioma. This lesion, which is particularly found in young patients, is often associated with pregnancy, and has a strong predilection for lymphatic spread. Finally, this tumour is very aggressive and seems to respond neither to radiotherapy nor to surgery.


[Breast cancer diagnosed in the pre-clinical stage with the phenomena of histological regression (author's transl)]. The discovery of carcinomatous cells in a discharge from a breast, without any other clinical, mammographic or thermographic sign, allowed the removal of a carcinoma in its pre-clinical stage. The histological study in a series of cuts showed a carcinoma that was still intraductal and which showed signs of cellular regression accompanied by marked peri-canalicular sclerosis associated with inflammatory infiltration. This observation allows commentaries to be made concerning the immunological process that goes with carcinoma in its intra-epithelial stage and permits the possibility of predicting an advance in the understanding and treatment of carcinomata which should be diagnosed very early.


[300 breech delivery in continuity (author's transl)]. In this study of 300 breech deliveries in continuity, the authors after a review of the principal attitudes and of the results of other publications; bring their attitude and their results, by a more detailed analysis of cases and specially the small for date--the preterm deliveries and the breech associated with multiple pregnancy, because these associated risks are the most important. Systematic casarian section must not be systematic on term breechs if obstetrical explorations are normal--in these cases 60 0/0 of trials labor perform well with a minimal morbidity and with mortality no account. In the other hand, in cases where risk increase cesarian section is the best solution.


[Epidural anaesthesia associated with induction of labour. A clinical study. Electronic monitoring of the physical and biological parameters (author's transl)]. 73 case histories of induction of labour under epidural anaesthesia have been studied very thoroughly from the different parameters of the uterine contractions as well as the fetal heart rate and the acid base balance of the fetus. From this study it is clear that the basal tone, the intensity and the frequency of contractions and the activity of the uterus are increased in comparison with different studies of normal labour. This increase however is within physiological limits and does not change in any marked way the cardiac rhythm nor the acid base balance of the fetus. The Apgar score at birth is equal to or above 8 in 89 p. 100 of cases at 1 minute and in 100 p. 100 of cases at 5 minutes. Finally, in the last phases of the labour dilatation is quicker than in normal delivery. It follows therefore that maternal comfort has not been bought at the expense of the fetus.


[Autoradiographic detection of tritiated choline chloride in brain tissue. A method of microscopic detection in paraffin sections]. It is presented a autoradiographic method for microscopical detection of 3H-choline chloride activity after intraventricular application in freeze-dried and paraffin-embedded brain sections. The 10 micrometer thick sections are treated with diethyl ether and than exposed during 90 days above calcium chloride at 4 degree C using the sandwich technique (with stripping film). After separate film explanation and section staining the film and the brain sections are mounted together.


Dendritic range of the neurons of the intermediate gray at the levels of the first and second lumbar segment of the spinal cord in the cat 1. The range dendrites of the central region neurons. Spinal cords of kittens and mature cats were examined at the levels of L1 and L2 segments. Using Golgi impregnation method it has been stated that dendrites of the small and medium neurons lying in the central region of the intermediate gray ramify mainly within the region in question. Some of them, however, penetrate the neighbouring regions. The dendrites of large neurons reach the lamina III (according to Rexed's division), paramedially the white commisure, the intermediomedial as well as the thoracic nuclei. These dendrites reach even the lateral horns of the spinal cord (laterally) and the motor nuclei (ventrally).


[Antenatal diagnosis. A psychological study. I. The intervention of doctors in pregnancy (author's transl)]. Antenatal diagnosis enables certain fetal abnormalities to be detected "in utero", and in particular mongolism. This examination is often undertaken in the process of medical attention in pregnancy. This explains why interviews with pregnant women about this far from ordinary act have become so superficial. Men and women react differently to this take-over. The former take part in a scientific discussion, the latter, who are more closely involved, which is to say with their whole bodies, set themselves against both good and bad doctors and often try to resist this test. We have attempted to understand the meaning of wanting to or not wanting to know the sex of the child in this context before its birth, and what happens to the wish to have a child after this kind of medical care.


Postnatal development of the mouse cerebral neocortex. III. Some dynamical aspects. In this paper we analyse our data from the quantitative cytoarchitectonic study of motor and sensory areas 10--4--3 and 2(Leuba and coll., 1977) and of visual and auditory area 5--17--18a--18--41 and 20 (Heumann and coll., 1977). The analysis of neuronal densities and cortical depths shows the following facts during the postnatal maturation: 1. Generally the sequence of maturation of the cortical layers is the same in the 9 studied areas: first layers I. and V, then VIb and VIa followed by III and IV and finally II. 2. This sequence is the same between 5 and 10 days as between 10 and 30 days. Still the maturation is much faster between 5 and 10 days. After 30 day differences between the layers are not very important. 3. For layers I, V and VI our 9 areas show an approximately similar degree of development from 5 days on. 4. Layers II, III and IV are in a faster period of development between 5 and 10 days. At this moment and for these layers, areas 17, 2, 3, 4 and 10 are less well developed than areas 41, 20, 18 and 18a. 5. One can thus consider that in mice the maturation of the areas seems to be more correlated with their localization than with their function. Effectively areas 41, 20 and 18a are in the vicinity of the rhinal fissure and a maturational gradient may start in this fissure. 6. In terms of neuronal densities and cortical depths an adult aspect of the layers and of the areas seems to be reached around 30 days. But some other phenomena of maturation exist after 30 days.


[The outlook and the quality of pregnancies resulting from treatment with clomiphene citrate and chorionic gonadotrophin. 53 consecutive cases (author's transl)]. The study of 53 pregnancies which were the result of induction of ovulation using a standard treatment with 100 mg of clomiphene citrate and 3 injections of 1,500 I.U. of H.C.G. showed no increase in the risk of fetal malformation. Before treatment this same group of women has a high risk of spontaneous abortion (43p. 100). After treatment in 53 conceptions 7 ended with an abortion which, is 13p. 100. The risks which follow this treatment are above all dominated by the definite increase in twin pregnancies and in prematurity which follows from this factor.


[Embryonal development of the brain of the shark Scyliorhinus canicula (L.). I. Formation of the shape of the brain, the migration mode and phase and the structure of the diencephalon]. Brain structure of the shark Scyliorhinus canicula has been studied on the basis of a series of embryonic stages. The incubation time was 157 days in average (under constant conditions of 15 centigrades and density of 1.026). 1. The first predominant characters of the external brain shape are the optic tectum, cerebellum, telencephali hemispheres and oculomotor root. In addition, the brain axis is characterized by new flexures in the cerebellar and prosencephalic level. A nuchal flexure in absent. 2. The ontogenetic pattern of the matrix layer differs in different brain parts. Generally, ventral columns develop earlier than dorsal ones. Matrix development and cell proliferation occur especially late in the cerebellum. For the most part the results agree with findings by KAHLE (1951) concerning the human brain. The telencephalon is an exception and shows a developmental retardation, while a regular development is observed in Scyliorhinus. 3. The hypothalamus overlaps the other regions of the diencephalon. The ventral thalamus is small, a dorsal thalamus is not observed. The pretectal region is remarkably differentiated and contains a rich set of nuclei. 4. The epithalamus is asymmetrical; a phenomenon that occurs after hatch. The left habenula is distinctly larger than the right-one.


[Embryonal development of the brain of the shark Scyliorhinus canicula (L.). II. The optic tectum and its stratification]. The stratification of the optic tectum of the shark Scyliorhinus canicula is comparable to patterns of other vertebrates. Thus it is possible to homologize part of the cortex layers with those described by P. RAMON (1896) and HUBER & CROSBY (1933b). 1. As for other vertebrates, it makes sense to collect the large number of zones (layers) into three groups: periventricular, central and superficial. 2. Ramon's periventricular zones 1--3 are distinct; fibrous zone 4 and cellular zone 5 are partially mixed. The central zones (6, 7) are mixed. All superficial zones are recognized, with the exception of zone 14, which was not found. 3. The trigeminal mesencephalic nucleus develops in the early embryo.


[Quantitative age-dependent variations in dendritic spines in the hippocampus (CA1, CA3 and fascia dentata) of the albino mouse]. The dendritic spines of the apical and basal dendrites of pyramidal neurons in CA1 and CA3 and of granule cells in Fascia Dentata were investigated in 19 stages of age, from the 10th to the 190th postnatal day. The results were statistically evaluated. In CA1 and CA3 a first increase in the number of spines (with a maximum at 35 days) is followed by a subsequent decrease up to the 65th day and a further increase up to the 190th day. This developmental pattern is found in the apical dendrites of CA1 and CA3 in all its investigated segments. On the contrary the basal dendrites differ from this pattern. The spines in the Fascia Dentata show a rapid increase up to the 15th postnatal day followed by a slow but constant increase up the end of our study.


Dendritic range of the neurons of the intermediate gray at the levels of the first and second lumbar segment of the spinal cord in the cat. 2. The range of dendrites of the paramedial region neurons. The lumbar segments (L1 and L2) of spinal cords in 8 kittens and 6 mature cats were examined using several modifications of Golgi method. Within the paramedial region two groups of neurons were distinguished (besides the thoracic nucleus), i.e. the intermediomedial nucleus and paracommissural neuronal group. Small cells of the both groups send their dendrites in the relatively short distances over the nuclei. Medium cells dendrites of the intermediomedial nucleus penetrate the thoracic nucleus, the central region of the intermediate gray, the lamina VII, and the white commissure. Dendrites of the paracommisural cells penetrate the lateral horn as far as motor nuclei, the intermediomedial nucleus, sometimes the thoracic nucleus, the central and lateral regions of the intermediate gray as well as the white commissure. Possible afferent connections of these neurons with various centers of the cord, with supraspinal centers as well as with peripheral afferents are discussed.


Alcohol abuse among lesbians: a descriptive study. Intensive interviews with 10 lesbian alcohol abusers revealed strong dependency needs, low self-esteem, and a high incidence of depression. Drinking increased power-related behaviors, enhanced self-esteem, and for many subjects increased feelings of depression. The findings suggest that lesbians with alcohol problems need (a) therapists who will accept their sexual orientation and (b) treatment that will help them increase their sense of power and self-esteem without alcohol.


On "doing" and "being" gay: sexual behavior and homosexual male self-identity. The possible relationships between sexual behavior and homosexual male self-identity are examined within a symbolic interactionist frame-work. The presence or absence of definitions of homosexuality, the nature of these definitions, and the rules learned by the individual for their application to himself and others determined how he perceived his feelings, his behavior, and his sexual identity. The identity histories of the men illustrate how the peer groups in which they were socialized and the behavior of their friends prevented them from defining their behavior in terms of the "homosexual pattern." They began to reinterpret their behavior as "homosexual" when they perceived changes in the behavior and definitions of their behavior by their friends, or when they came into contact with self-defined homosexuals.


The relationship of perceived societal hostility, conformity, and psychological adjustment in homosexual males. The present study examined the relationship between the perception by homosexual males of positive or negative societal reaction to homosexuality (PSR), their degree of conformity to heterosexual norms, and their degree of psychological adjustment. In this study respondents with high PSR were those who perceived negative societal reaction to homosexuality. Respondents with low PSR were those who perceived positive societal reaction. The study differentiated between the effects of putative societal reaction and actual societal reaction and was based on a three-group sample of homosexual men who (a) were, (b) had been, or (c) had never been heterosexually married. Findings showed that putative societal reaction was a critical variable producing conformity and psychological maladjustment in homosexual males.


Androgyny scores of matched homosexual and heterosexual males. Twenty-sex white homosexual males and 26 white heterosexual males were matched on age, education, occupational level, and sampling frame. One-half of the pairs were volunteers, and one-half were paid for participating. Masculinity, femininity, and androgyny scores were obtained on the Bem Sex Role Inventory. The homosexual sample was "androgynous", and the heterosexual sample was highly "masculine sex typed," by definition (Bem, 1974). This difference was tested by a derived "androgynyscore" and was significant (p less than .05).


Effects of psychological distress on perceptions of physical health and use of medical and psychiatric facilities. Psychological distress not only contributes to bodily symptoms but also affects the way people perceive their physical health status and their use of medical care. Reporting on a program of research, this paper reviews evidence that psychological distress is an important component of illness behavior and response and must be taken into account in the appropriate organization of medical services.


The stress interview: unfinished business. The stress interview, once a common method of psychophysiological research, is today unused because of concerns for research design and ethical issues. As it almost uniquely allows direct structured observations of bodily responses to stress in man it ought to be revived, incorporating modern instrumentation, current methods of refinement of subjective judgments, and now-conventional ethical safeguards. A considerable range of prospective applications to current needs in gastrointestinal research is presented, and the ethical justification for such studies is reviewed. The potential gains far outweight the small risks which would be incurred.


Conspicuous in its absence: the lack of positive conditions as a source of stress. Sress research has concentrated on the presence of negative conditions as a source of stress and largely has ignored stress reactions that result from a lack of positive conditions. In an attempt to demonstrate the seriousness of this omission of stress theory, for samples of students (N = 84) and professionals (N = 205) the presence of negative and absence of positive life and work features were each related to the experiences of life and work tedium and satisfaction/dissatisfaction. Two hypotheses were proposed: that the presence of negative and lack of positive life and work features are (1) both significantly related to tedium and satisfaction/dissatisfaction and (2) are independent of each other. The hypotheses were confirmed for both samples except in the case of work satisfaction/dissatisfaction, which was related only to the lack of positive features. These results highlight the need in stress research to consider lack of positive conditions as a source of stress.


Behavioral and environmental aspects of hypertension. Relationships of behavioral and environmental influences on the development and maintenance of hypertension have been reviewed. The evidence for such influences arises from studies in five areas, namely, retrospective correlations between emotional events and hypertensive disease; acute changes in blood pressure with stress in animals and man; chronic blood pressure change following stress in animals and man; changes in blood pressure produced by behavioral modifications; and the personality patterns and particular behaviors of hypertensive subjects. Data from these studies have been briefly but critically reviewed with emphasis on the interreactive nature of the environmental, behavioral, genetic and other biological factors which eventuate in hypertension. It is emphasized that the issue for the future is not whether behavioral factors play any role in hypertension but rather to what extent, under what circumstances, and in which individuals behavioral factors are acting as important pressor stimuli in the overall homeostatic distortions that result in hypertension.


Use of enteric vaccines in protection against chlamydial infections of the genital tract and the eye of guinea pigs. Guinea pigs in a test group were fed living guinea pig inclusion conjunctivitis (GPIC) organisms classified as Chlamydia psittaci in 60% yolk-sac suspensions as enteric vaccines, while animals in a control group received uninfected yolk sac. Seven test animals and 14 control animals were challenged 11 or 22 days later with 1,000 50% infectious doses of GPIC organisms in either the conjunctiva or the vagina. Evidence of protection from mucosal infection in both sites was noted in test animals. Clinically, the disease was less severe, and microbiologically, lower percentages of mucosal cells were infected. The results suggest that enteric vaccination against mucosal infections of the eye and the genital tract with chlamydial agents is possible.


Granulocyte function and levels of immunoglobulins and complement in patients admitted for withdrawal from alcohol. Chronic alcoholics who had been drinking heavily until admission for withdrawal from alcohol were studied to determine their level of granulocyte function, immunoglobulin concentration, and complement system activity. Although most had some mild derangement in results of liver function tests, serum albumin concentrations were normal, and there was no clinical evidence of malnutrition or cirrhosis. Granulocyte adherence was slightly depressed in two subjects (52.4% and 54.1%; normal, 76.0% +/- 12%), although mean adherence for the group was normal. Mean chemotaxis was significantly below normal (2,103 vs. 7,943 counts per min), and the impairment was related to a defect or inhibitor in the serum of patients. Phagocytic activity was less than half that of control subjects in two alcoholics, but mean values were not depressed. Bactericidal activity was normal in all. Serum concentrations of immunoglobulins and total hemolytic complement activity were above the normal range for the group. The general inhibition of chemotaxis or the occasional defects in other granulocyte functions may contribute to the difficulty that alcoholics have with infection.


Effect of protein A on the antistaphylococcal defence mechanisms of the murine lung. The importance of IgG attached to protein A in the initial reaction of inspired Staphylococcus aureus and alveolar macrophages was studied by infecting unimmunized mice with aerosols of S. aureus strains 566 and Wood 46 with high and low protein A content. At 2, 4, and 8 hr after infection, the presence of IgG attached to S. aureus and rates of staphylococcal ingestion and killing by macrophages were determined. IgG was detected by staining of sections of the right lung with fluorescein-labeled goat antibody to mouse IgG. For S. aureus strain 566, 25%--40% of the total number of bacteria, as determined in equivalently sized subjacent sections stained by the Brown and Brenn tissue gram stain, contained attached IgG. A few S. aureus strain Wood 46 were surrounded by dimly fluorescing complexes. Since rates of bacterial ingestion and killing were similar for both strains in this in vivo model of infection, IgG binding to protein A does not affect the bactericidal capacity of alveolar macrophages.


Reflux nephropathy and chronic atrophic pyelonephritis: a review. Chronic atrophic pyelonephritis is associated with vesicoureteric reflux in infancy. Reflux disappears during childhood in 50% of cases. It is more commonly detected in infants (49%) and children (26%) with infection than in adults (4.4%). Severe reflux may persist in adults and is usually (94%) associated with scarring. Patients with end-stage renal failure due to pyelonephritis are much younger than patients with end-stage renal failure due to other causes. The incidence of reflux according to sex is equal in infancy, but after infancy both pyelonephritic scarring and reflux are far more common in females. Infection is the likely cause of progressive scarring in females. Hypertension is associated with chronic atrophic pyelonephritis. Proteinuria is the worst prognostic feature in patients with reflux nephropathy and pyelonephritic scarring. Intrarenal reflux determines the site of scarring. The role of surgical correction of vesicoureteric reflux remains uncertain, but meticulous control of infection appears to prevent progressive scarring.


Antibody to Tamm-Horsfall protein in patients with urinary tract obstruction and vesicoureteral reflux. Urinary tract obstruction and vesicoureteral reflux, which are often associated with urinary tract infections, may lead to progressive renal damage. Relatively little is known about the pathophysiology of this process, and a need exists for noninvasive methods of its detection in its early stages. Because urine is refluxed into the venous and lymphatic drainage of the kidney in severe vesicoureteral reflux and urinary tract obstruction, an immune response to urinary tract components might play a role in the pathophysiology of progressive renal damage and serve as a serologic marker for its presence. A solid-phase radioimmunoassay for a protein found only in the urine (Tamm-Horsfall protein [THP]) was developed and used to measure antibody to THP in the serum of 60 subjects. Significant elevations of antibody to THP were observed in five of 15 patients with obstruction and infection of the urinary tract and in one of 10 patients with infection alone, when these patients were compared with 12 healthy control subjects. Similar elevations of antibody to THP were not seen in uninfected patients with urinary tract obstruction or in patients with low-grade vesicoureteral reflux or sepsis of nonrenal origin. These results suggest that the measurement of antibody to THP might be useful in the identification of patients with obstruction and infection of the urinary tract.


Staphylococcus saprophyticus: a frequent cause of acute urinary tract infection among female outpatients. The frequency of Staphylococcus saprophyticus, formerly Micrococcus subgroup 3, as the cause of bacteriuria is reported. Of 787 consecutive female outpatients with signs of bacteriuria, 173 (22.0%) yielded S. saprophyticus, predominantly in pure culture and in high counts. In the age group 16--25 years, this organism was demonstrated in no less than 42.3%. In hospitalized women and in men with signs of bacteriuria, on the other hand, S. saprophyticus was a rare finding (0.9% and 0.5%, respectively). The figures in female outpatients aged 15--30 years were similar over a three-year period, but higher during summer and fall as compared with those in winter and spring. The patients regularly had rather severe symptoms of acute urinary tract infections with dysuria and often loid pain. Hematuria and pyuria were common. All strains of S. saprophyticus had a fairly even and high susceptibility to antimicrobial agents except nalidixic acid. Recurrent infections were common. The origin of this infection is still obscure.


Bacteremic superinfections of patients with bacteremia: occurrence, bacteriology, mortality, and duration of hospitalization at Boston City Hospital during 12 selected years between 1935 and 1972. During the course of hospitalization of 6,414 patients with bacteremic infections identified at Boston City Hospital (Boston, Massachusetts) during 12 selected years between 1935 and 1972, 6.0% developed verified bacteremic superinfections with organisms not isolated or identified in the primary bacteremic infection. Analysis of these cases reemphasizes the increasing occurrence of serious hospital-acquired infections despite the successive introduction and intensive use of a large number of effective antibacterial agents. The bacteremic superinfections, like the primary hospital-acquired bacteremias, increased in incidence over the years, particularly since 1961; they were more frequent and were associated with a higher mortality rate and longer duration of hospital stay in the primary hospital-acquired cases than in the patients in whom bacteremia was considered to be community-acquired. The organisms in superinfections were similar to those in primary hospital-acquired bacteremias. Superinfection was more frequent among the patients who died than among the survivors.


Quantification of infection with Schistosoma haematobium in relation to epidemiology and selective population chemotherapy. II. Mass treatment with a single oral dose of metrifonate. Determination of the efficacy of mass treatment of schistosomiasis is usually based on the rate of cure. However, schistosomes do not multiply in the human host, disease tends to cluster in the small proportion of individuals with heavy infections, and reinfection continually occurs in endemic areas. Thus drastic reduction in worm burdens can be a reasonable goal for mass treatment campaigns. The standard dose and regimen of metrifonate for the treatment of schistosomiasis haematobia is 7.5 mg/kg administered in three doses two weeks apart. This treatment results in a cure rate of approximately 50% and a reduction in egg output of 94.5%. In the present study, 72 infected children with egg counts before treatment that averaged from 0.1 to 2,334/10 ml of urine were treated with a single oral dose of 10 mg of metrifonate/kg: the cure rate was 22%, and the reduction in egg output was 96.5%. No side effects were recorded.