A comparison of speech discrimination scores by using PB-50 lists and the speech discrimination scale with hearing-impaired adults. Performance-intensity functions were drawn for each of the 5 progressively more difficult 8-word subtests of Gaeth's Speech Discrimination Scale (SDS) with 16 limited-hearing Ss aged 20-88 yrs. Prior examination with the NU-6 test at 24 db SL revealed speech discrimination ability groupings, unrelated either to pure-tone ac hearing losses or to age. The largest (middle) group achieved scored of 50%-correct at -5, 0, 11, and 14 db SL (re pure-tone ac HTL averaged for the better 2 of the frequencies .5, 1, and 2 kc/s) for the subtests Digits, Easy Letters, Easy Words and Hard Letters respectively, as compared with 30 db SL for full PB lists; and never achieved 50%-correct for the Hard Words subtest. The possibility was suggested that the clinician might initiate speech testing with the East Words subtest and proceed to either more or less difficult subtests/levels as S responds. Each item would contain more statistical power than a single item in a 50-word PB list at a single SL.


The speech air-bone gap: some clinical reservations. Air-bone gaps derived from speech and from pure-tone testing were compared for an unselected clinic sample of 67 hearing-impaired Ss (80 ears). A moderately high Pearson r was found between the air-bone gap for speech vs for a pure-tone average (of the order of .80), but while the pure-tone air-bone gap predicted all but 5% of the cases of (confirmed) conductive losses, the speech air-bone gap prediction missed over 25%. When audiograms were grouped according to type of configuration, the flat and the high-frequency sloping types exhibited the largest discrepancies between air-bone gaps by speech vs pure tones; when the audiograms were grouped by degree of impairment, those with moderate-to-severe losses exhibited the largest discrepancies. Until a larger body of data is amassed, it was recommended that the air-bone gap for speech be used in conjunction with, not in place of, other audiometric tests.


Normative data on the cochlear microphonic in rat using differential electrodes. Isopotential (1-muV) cochleograms were obrained from 19 anesthetized rats from electrodes inserted into scala vestibuli and scala tympani of the first turn. The differential electrode technique is suitable for frequencies above 1-2 kc/s in the rat. CM sensitivity in rats as measured with intracochlear electrodes (26 micrometer in diameter) was considerably poorer than in guinea pigs at frequencies below 2 kc/s, but was within 10-14 db at 2 kc/s and above. The shape of the CM input-output functions were similar to those in the guinea pig and chinchilla, except that the intensity level where the CM becomes non-linear is higher in the rat.


Evaluation of the eye following periorbital trauma. Periorbital trauma is usually associated with ocular complications. When confronted with a traumatized patient, one should therefore evaluate the eyes to determine the extent of injury. First, a noncontact examination should be conducted to assess the degree of ocular integrity. Once it is established that the eye is not damaged, further diagnostic work-up and evaluation can be performed. Although most ocular complications are treated by ophthalmologists, eyelid lacerations, orbital hemorrhage, blowout fractures, and brain injuries may be treated by other subspecialists. Before orbital and ocular adnexal reconstructive surgery is performed, however, one must establish the patient's ocular status so that ocular damage will not be increased during surgery.


Permanent control of massive tumor bleeding with intraluminal balloon catheters. Proximal ligation usually controls bleeding from a tumor-eroded carotid artery. When this maneuver failed, two intraluminal balloon catheters were passed distally into the vessel, after which they were inflated and left in place for six weeks. The patient had no neurologic sequelae or further bleeding before succumbing to tumor progression 10 months later.


Annoyance response to recorded aircraft noise. I. Effect of intensity of illumination. Normal-hearing adults aged 19--49 yrs watched TV in a simulated living room and made magnitude estimations of the annoyance of each of 27 levels of noise from 83.9 to 91.8 dbA. Each item was a simulated flyover of an aircraft presented from 4 loudspeakers each outside one of the upper corners of the room. The 27 items were all presented in each of 3 sessions (counterbalanced across groups of 4 S) under room illumination of 21.53 lumens/sg m (i.e., "normal" room illumination), and 2.69 ("dim") and 129.17 ("bright") illumination. Split-half reliabilities indicated that Ss can make reliable responses in these conditions. The intercept of the regression lines of annoyance on noise levels significantly differed, and the slopes tended to differ, among the illumination conditions; indicating that the annoyance may grow more rapidly with increasing noise level under dim than normal illumination. Data predicted that annoyance reduction, which may be equivalent to 5 db attenuation, is obtained when normal illumination is reduced to dim. Similarly, judged annoyance tended to differ between bright and normal illumination.


Temporal artery-based forehead flap.

Temporal artery-based forehead flap. The historical development of the forehead flap is reviewed, and an operative experience using delayed and nondelayed techniques in 30 cases is described. The reliability of the forehead flap is evaluated with regard to patient morbidity and correction of deformity and dysfunction in such sites as the cheek, lip, corner of the mouth, floor of the mouth, tongue, pharyngeal wall, and tonsil. Analyses include length of hospital stay and complications, as well as the relationship of these factors to the methods employed in the reconstructive processes. The advantages and disadvantages of the various techniques are illustrated using individual cases.


Chemosurgery for the microscopically controlled excision of cutaneous cancer. Cancer of the skin and of other accessible structures can be removed under complete microscopic control if the cancerous area is excised layer by layer, and if the undersurface of each layer is then examined under the microscope through systematic use of frozen sections. If the cancer is extensive and complicated, or if the neoplasm is of a type that is readily disseminated, the tissues are fixed in situ with zinc chloride prior to the excision of each layer (fixed-tissue technique). If the cancer is not overly extensive or complicated, the layers of tissue are excised in the fresh, unfixed state (fresh-tissue technique). Both methods are highly reliable. In two consecutive series of basal-cell carcinomas treated chemosurgically, the five-year cure rate achieved was 99.3% for the 9,351 lesions removed by the fixed-tissue technique, and 98.1% for the 196 lesions removed by the fresh-tissue method.


Location of the auditory cortex in the Mongolian gerbil as determined by click stimulation. An investigation was made of the auditory projection area in the cerebral cortex of the Mongolian gerbil (Meriones unguiculatus) using clicks at a standard intensity to map the cerebral hemisphere by the evoked potential method. The major results can be summarized as follows: (1) As is typical for other mammals, click-evoked responses characterizing the gerbil auditory area were initially surface-positive potentials (amplitudes ranging between 0.1 and 1.7 mV) with peak latencies ranging between 13 and 32 msec. (2) Only one click-responsive field was found in the temporal area. However, the data suggest that this area may actually represent two separate projections to the cortex, since a small subarea characterized by longer response latencies was located posteriorally and laterally within the click field in the majority of animals investigated. (3) The size (5 mm long by 4 mm wide) and location (temporal neocortex below the middle cerebral artery) of the gerbil auditory cortex are consistent with mapping results obtained in other rodent species. (4) The validity of the surface maps was confirmed in four cases by demonstrating that the evoked response reversed polarity between the cortical surface and underlying white matter. The reversal was demonstrated by recording with a penetrating microelectrode at representative points "bordering" the auditory projection area.


Comparison of the effects of hearing aid harmonic distortion on performance scores for the MRHT and A PB--50/CM test. The effects of two levels of hearing aid harmonic distortion (0.7 and 15.4%) on performance scores for the P-83 noise condition of the MRHT, and for a PB-50 word list embedded in a competing-message background (PB-50/CM) were compared with two groups each of 15 normal-hearing young adults. The effects of aided distortion were significantly greater for the PB-50/CM test indicating that the P-83 condition of the MRHT probably does not provide an acceptable standardized alternative to the use of an open-ended PB list in noise or in a competing message for which no standardized method exists.


Some trait judgments made on the basis of voice alone. College students were asked to evaluate demographic considerations of four distinctly differing speech samples of the same content. Subjects made decisions based solely on the voice despite the fact that all selections were recorded by the same person but varying the prosody. The results support the hypothesis that we are pre-judged by our voice aspects regardless of the content of our speech.


Self-masking effects from live and recorded vowels. As a means of determining the masking characteristics of spoken (live) vowels, as compared to recorded vowels, 16 normal Ss were trained to track pure-tone swept-frequency thresholds in the presence of vowels used as masking noise. While tracking thresholds, Ss either phonated the vowels /a/, /i/, or /u/ continuously or listened to a taped playback of their own voices. The resulting continuous-frequency audiograms generally resembles the configurations of the vowel spectra. Overall masking effect was significantly greater for the recorded vowels (air-conducted feedback only) than for the live vowels (both air- and bone-conducted feedback) at equal loudness. Recorded vowels tended to have greater masking effect in the higher frequencies, while live vowels tended to have greater effect in the lower frequencies.


The pathology of head and neck tumors: salivary glands, part 2. Acinic-cell carcinomas and mucoepidermoid carcinomas remain somewhat controversial salivary-gland lesions. Because of an ambiguity in the literature concerning their malignant potential and a lack of sufficient follow-up periods, these carcinomas have been underestimated with respect to their morbidity and lethality. The failure of histopathologic evaluation to successfully predict the subsequent biologic course of these neoplasms should not mitigate treatment. Acinic-cell carcinomas are usually isomorphic neoplasms having their genesis in the neoplastic reserve cells of the terminal portions of the duct system. Mucoepidermoid carcinomas, on the other hand, may be described as forming a histologic spectrum or continuum from the most highly differentiated to the most poorly differentiated malignancy. They arise from the interlobular and intralobular ducts. The histopathologic features of these two neoplasms are presented, along with a review of their biologic activity in humans.


Response of emotionally disturbed children to auditory discrimination tests in quiet and in noise. A population was used of 18 children (6--13 yrs median = 9--1 yrs) enrolled in a psychiatric day care center where they received daily educational instruction and on two occasions per week they received psychotherapy. Intelligence was normal (Wechsler Full Scale mn = 96). Ss were individually given the Goldman-Friscoe-Woodcock Test of Auditory Discrimination both in quiet and in the noise condition. Median scores in quiet and in noise were both lower than general forms for these ages, lying indeed within the range of "poor discrimination" for the GFW, but the relative scores for the quiet and the noise conditions did not differ significantly from the pattern for normal children. However, 6 of the 18 Ss scored relatively better in noise than in quiet, and a Wilcoxon Matched-Pairs Signed-Ranks test demonstrated that this was a significantly larger number (p less than .025, one-tailed test) than in the general population. Explanations were offered in terms of a reduction of internal noise, and of relative attention on the part of emotionally disturbed children.


Treatment of patients with prolactinomas. Fifty-one female patients with prolactin producing tumors (PRL 1100 to 88,000 microU/ml) and 26 male patients with prolactin producing tumors (PRL 6500 to 400,000 microU/ml) were studied. Only 25% of the females had visual field defects which were present in 70% of the males. All females had amenorrhea but only 35 had galactorrhea. Hypopituitarism was rarely seen in the females but in most of the male patients. Twenty-four females and all male patients were operated (transphenoidal or transfrontal operation). PRL normalized in only eight females and in none of the males. Two patients became pregnant postoperatively, four after postoperative treatment with bromocriptine. Bromocriptine induced regular menses in 4 other patients operated by transsphenoidal route. Eight patients with microadenoma (PRL less than 4000 microU/ml) were treated with bromocriptine alone of whom two became pregnant. The males were also treated with bromocriptine leading to a significant fall of the PRL level accompanied by improvement of libido, sexual potency and headache. Two patients received radiation postoperatively, which led to a fall of PRL and improvement of visual fields. Since PRL levels remained low after withdrawal of bromocriptine for several months an antiproliferative effect of this drug is suggested. Thus differential therapy of PRL producing tumors is possible: In females selective neurosurgery can alone or combined with medical therapy normalize PRL secretion and ovarian function. In patients with microadenoma bromocriptine alone can be successful. In patients with inoperable large tumors radiation should be advocated. Additional bromocriptine therapy may be helpful to stop tumor growth and alleviate the effects of hyperprolactinemia.


Adrenal hyperandrogenism: detection by adrenal scintigraphy. Hyperandrogenism is a common endocrinopathy in women. Localization of the source of excess androgen production is mandatory for proper management. Ovarian hyperandrogenism has been implicated in the majority of patients studied, though the true prevalence of adrenal hyperandrogenism is not yet known. Adrenal scintigraphy is a simple non-invasive technique which detects adrenal functional abnormalities. The detection of adrenal hyperandrogenism by adrenal scintigraphy in three women with mild hirsutism is discussed.


Endemic goitre and iodine metabolism in schoolchildren from the Daunia uplands (province of Foggia, Italy). A study of endemic goitre was carried out in the western part of the province of Foggia (Daunia's pre-Appennines). About 50% of a total of 2719 children aged 6-15 years examined in the agricultural and hill towns of Accadia, Bovino, Candela, Deliceto and Sant'Agata di Puglia (500 to 800 m above sea level), presented a thyroid enlargement (usually of Grade 1). Urinary creatinine values were normal, while urinary iodine was low: 37.7 +/- 28.39 mug/g creatinine (mean +/- SD for 319 subjects). Serum levels of thyroid hormones were normal: T4 = 7.89 +/- 2.61 mug/dl; T3 = 114.72 +/- 40 ng/dl; T3 (T4 X 100) = 0.166 +/- 0.09. Subjects with Grade 2 thyroid enlargement had significant lower urinary iodine and serum T4, and higher T3 and T3/T4 ratio than children without goitre (Grade 0). Serum thyrotropin was rather high (3.79 +/- 4.17 muU/ml), but bore no straight relation to the thyroid size; in subjects with Grade 2 thyroids there was an inverse relationship between plasma T4 and TSH levels. Drinking water iodine was generally low (2-3 mug/l), though some richer sources (18, 38, 66 mug/l) were noted. Iodine contents of locally produced foodstuffs were below those found in food on Turin markets.


Effect of pinealectomy on arterial blood pressure and food and water intake in the rat. Pinealectomy in the rat induces a significant increase of the arterial blood pressure within 15 days from the surgical procedure; this hypertension is still present 30 and 60 days after pinealectomy while after 90 days it returns to the normal range. Histological examination of the kidneys of pinealectomized hypertensive rats shows wall thickening and lumen narrowing of the arterioles, adventitial and periadventitial fibrosis, dense glomeruli. The vascular lesions are not diffuse but patchily distributed. Body weight is higher in pinealectomized rats compared with normal and sham-operated animals: this difference becomes significant about 40 days after pinealectomy and gradually decreases until it disappears at the end of the third month. Food and water intake is higher in pinealectomized rats up to the 7th week; during the 8th week they return to the normal range.


A rapid semi-automated method of determining total estrogens in non-pregnancy urine. A rapid routine method of determining estrogens in non-pregnancy urine is described. It involves the following steps: 1) Dilution of each urine sample with an equal volume of saturated ammonium sulfate solution; 2) Addition of Sephadex G-15 beads; 3) Filtration of the mixture; 4) Liberation of the estrogens from the Sephadex by washing the beads on the filter with 0.1N NaOH; 5) Automated fluorimetric analysis of the alkaline filtrate according to the procedure used for the determination of estrogen in pregnancy urine. A correction for non-specific fluorescence remains necessary and is achieved by measuring background fluorescence with a second fluorimeter.


Sympathetic innervation and noradrenaline content of normal human thyroid tissue from fetal, young, and elderly subjects. In man, as well as in the mouse, there is morphologic and functional evidence for a direct, stimulatory influence of the sympathetic nervous system on the secretion of thyroid hormone by noradrenaline (NA), released from interfollicular adrenergic nerve terminals. In mice and rats, an age-related reduction of the sympathetic innervation of the thyoid has recently been observed. In the present study, possible age-related variations of the sympathetic innervation and the concentration of NA in human thyroid tissue were examined. Interfollicular adrenergic nerve terminals were studied by fluorescence histochemistry, and the tissue concentration of NA was measured by fluorometry. In apparently normal thyroid tissue, obtained from fetuses, young (20-45), and elderly (greater than 60) euthyroid people with thyroid cancer or hyperparathyroidism, the number of interfollicular adrenergic nerve terminals appeared to be reduced with increasing age, and the thyroid tissue concentration of NA was significantly lower in elderly than in young people. These findings may have functional importance.


Effect of neurotensin on glucose and insulin portal blood levels in hyperglycemic rats. A new multiple sampling technique for obtaining blood from the portal vein has been used to investigate the effects of neurotensin on insulin and glucose portal blood levels in rats rendered hyperglycemic by a constant glucose infusion. The peptide has been first injected acutely (2 microgram/rat iv), and then constantly infused (0.5 microgram/min for 55 min). The preliminary results indicate that no effect of the acute injection could be observed, but hyperglycemia and hyperinsulinemia were induced by the constant infusion of the peptide. It is suggested that neurotensin may stimulate the release of insulin probably through a direct mechanism.


A general zone theory of color and brightness vision. I. Basic formulation. A general theory of color and brightness vision, developed from basic principles of the Helmholtz and Hering points-of-view on color vision is presented in a general mathematical form suitable for quantitative analysis. Visual sensation is described by a vector expressed in terms of Hering-like elements for color and brightness which underlie in their spatial-temporal variations the perceptions of form and change. The photic stimulus of vision is recognized to act first and only through photoabsorption producing a Helmholtz-like vector of quantum absorptions. The physiological transformation of the Helmholtz photochemical excitations into the Hering sensation responses is represented as a vector of general operators. The result is a mathematical framework encompassing traditional psychophysical and sensory scaling experiments. The theory is utilized to demonstrate that for many traditional (Class A) psychophysical observations, the physiological operator reduces to a linear (matrix) transformation. For static, uniform, focal stimulation, this reduction is seen to be the basis for earlier specific linear models of color vision. We also illustrate that static intensity-level effects (Bezold-Brücke hue shifts, unique hue invariance) can be modeled from the theory by power, but not logarithmic, intensity-level dependence for the sensation elements.


A general zone theory of color and brightness vision. II. The space-time field. The elements of vision are brightness and color varying in time and space, constituting a vector space-time function: the visual sensation field. The sensory-field generated from the light-field variations on the retina is analyzed here in terms of elemental space-time responses (Green's functions). Both chromaticity and intensity variations in either time or space are included in a unified theory, to bridge the existing gap between color theory and analyses of spatial and temporal brightness. Sensory Green's functions are here related to standard color models and to familiar responses for special stimuli, and are shown to be advantageous for nonhomogeneous and/or nonstationary visual conditions. The theory is first applied for intensity space-time variations, to elucidate existing intensity-contrast analyses. Then the general theory including chromatic contrast is illustrated by deriving color vision generalizations of the Bloch and Ricco laws and a general space-time reciprocity law, by analyses of wavelength-pulse and color-flicker experiments, and by derivation of Abney's law of luminance additivity for heterochromoatic flicker and minimally distinct borders.


Theory of flicker and transient responses. III. An essential nonlinearity. From our stead-state flicker data, Kelly's (1971) model correctly predicts the transient thresholds for rectangular pulses of variable duration when the (flickering or flashed) stimulus is a 4 cycle/deg grating, but the same prediction fails for a uniform (8 degrees) field. However, if we augment the model with a "hard" nonlinearity, we can fit both types of transient thresholds as well as the steady-state thresholds. The most plausible embodiment of this essential nonlinearity is an asymmetric recifier, which seems to represent the behavior of retinal ganglion cells. Unlike the symmetric models of Roufs and Rashbass, this asymmetry also correctly predicts that the decrement thresholds for some stimuli are smaller than the corresponding increment thresholds.


Accommodative convergence response to off-foveal retinal images. A special stimulus device was designed and developed to present blur stimulation through off-foveal retinal images. An infrared reflecting eye movement monitor was used to measure the dynamic accommodative convergence response to both foveal and off-foveal blur stimulation. In most subjects studies a substantial off-foveal accommodative vergence response was found; however, this response diminished rapidly as image distance from the fovea increased. Considerable variation in the response was noted between subjects, and, to a lesser extent, in the same subject for left-versus-right off-foveal image positions.


Noise suppression in photoreceptors and its relevance to incremental intensity thresholds. Quantal noise is the main limiting factor of visual contrast sensitivity only over an intermediate range of light intensities. At low and high intensities receptor and neural noise determine the bound on sensitivity. In this paper we analyze the effect of receptor nonlinearity on the statistics of visual signals and show its role in the suppression of quantal and receptor noise at high light intensities. This provides adequate physical interpretation of physiological data. Extending this analysis to the behavior of the whole visual system, we arrive at the conclusion that such noise suppression provides a unified explanation of psychophysical incremental threshold data over the whole visual range.


Fading and feedback in the modification of visual acuity. Two experiments assessing the modification of visual acuity by fading plus feedback procedures are presented. The training procedure involved a gradual increase of the distance myopic subjects could accurately discriminate letters requiring a minimum of 20/20 vision at approximately 23 feet. In Experiment I experimental and matched control groups of mildly to moderately myopic subjects were compared on repeated Ortho-rater examinations of visual acuity. The experimental group showed a significant improvement relative to the control group who received no training. Multiple-baseline across-stimuli designs were used in Experiment II to evaluate training effects for another group of subjects with moderate to severe myopia. Two measures of acuity were obtained. Accuracy of discrimination of letters at various preselected distances was determined each session while Ortho-rater examinations were given periodically throughout training. Changes in discrimination accuracy over sessions appeared to be related to fading for three of the four subjects, and Ortho-rater acuity changes were observed for each subject. Some short-term maintenance of improved vision was evident on both acuity measures.


Differential attention in the treatment of operant cough. This case study reports the successful use of differential attention in the treatment of chronic operant coughing of 6 months' duration in a 13-year-old boy. The boy was hospitalized, where the symptom was ignored and his adaptive age-appropriate behaviors were reinforced with points and praise. Fines were levied for self-derogatory statements. Obtrusive and unobtrusive observations revealed the cough rate higher when the patient was aware of being observed than when he was unaware of being observed. After 4 days the cough rate dropped to zero, where it remained except for a slight recurrence on the day of discharge. His parents were trained in maintaining the differential attention contingencies in effect in the hospital and were able to transfer these conditions to the home. Thus, when the cough again returned once the patient was home, they were able to immediately terminate it. Follow-up of over 36 months revealed the boy to be symptom free.


Experimental analysis of EMG feedback in treating cerebral palsy. Three subjects diagnosed as having severe choreoathetoid cerebral palsy were trained in the use of EMG feedback procedures. Both between- and within-session controls, including reversals of baseline, attempted muscle control with feedback, and muscle control without feedback, were employed to analyze the contribution of feedback procedures to improvements in muscle control. The data (1) indicate that feedback enhanced muscle control and (2) provide evidence of generalization of feedback effects to no-feedback conditions and untrained muscles.


Behavioral treatment of Raynaud's disease. In order to assess the efficacy of a behavioral intervention in the treatment of idiopathic Raynaud's disease, 30 female patients were trained to control their digital skin temperature using autogenic training or a combination of autogenic training and skin temperature feedback either in the laboratory or at home. All trained subjects demonstrated a significant ability to maintain digital skin temperature in the presence of a cold stress challenge and reported significant reductions in both frequency and intensity of vasospastic attacks. The addition of skin temperature feedback to autogenic training did not provide additional clinical benefit.


Biofeedback vs. instructional control of skin temperature. The purpose of this study was twofold: (1) to determine the effects of instructions vs. biofeedback on the development of skin temperature self-control and (2) to assess how well learned control over temperature can be retained over time. Sixty female subjects were assigned to one of six groups: (1) response-specific instructions plus feedback, (2) thermal suggestions plus feedback, (3) instructions to rest plus feedback, (4) response-specific instructions without feedback, (5) thermal suggestions without feedback, and (6) instructions to rest without feedback. All subjects participated in five training sessions on 5 consecutive days and two follow-up sessions spaced 1 week and 2 weeks after training. Subjects given either feedback and response-specific instructions, feedback and thermal suggestions, or no feedback and thermal suggestions were able to produce significant increases in digital skin temperature consistently after three training sessions. Subjects in these groups retained the ability to control skin temperature both 1 and 2 weeks after training. Subjects in the remaining conditions showed no evidence of learned control over skin temperature.


The Medical Interview Satisfaction Scale: development of a scale to measure patient perceptions of physician behavior. Patient satisfaction is a variable of increasing interest to researchers, clinicians, and medical educators. Of several studies reviewed, only a few have shown evidence of careful methodology. Most surveys have focused on general evaluations of doctors and/or health care services or of a particular facility. The present article reports the development of a scale to measure patient satisfaction with an encounter with a physician or other primary care provider. Methods of item generation and pretesting are detailed. The overall reliability of the scale (Cronbach's coefficient alpha) is 0.93. The distribution of satisfaction scores is broader than that reported for other scales and approaches the normal in shape. Clinical and research applications of the scale are suggested.


Behavioral treatment of obesity in patients with Prader-Willi syndrome. Self-monitoring combined with contingency contracting resulted in weight loss, modification of dysfunctional eating habits, and increased or sustained exercise rates for two obese, mentally retarded adolescent females with Prader-Willi syndrome. Contingency contracting between clients and their parents/caregivers was used to specify consequences for daily self-monitoring, reduced caloric intake, weight loss, and exercise. Punishment for food stealing was also employed. Results suggest that contingency contracting is an effective technique for producing long-term weight loss in obese mentally retarded adolescents. Further, these techniques offer an alternative to the clinician considering solely dietary restriction or surgical intervention.


Perceived Somatic Response Inventory: three scales developed by factor analysis. Studies of autonomic reactivity and of voluntary control of autonomic responses have suggested the importance of individual differences. An inventory of scales was developed to improve the assessment of different dimensions of somatic functioning. In order to enhance their specificity and incremental validity, the scales were constructed to be relatively independent of already known general personality variables such as Stress Reaction (neuroticism), Locus of Control, Hypochondriasis, and Absorption. Three scales, derived from orthogonal factor analyses, were developed and cross-validated: (1) Autonomic Response Frequency, assessing spontaneous fluctuations in autonomic responding; (2) Autonomic Response to Stress, assessing the amount of autonomic arousal perceived by a subject in stress situations; and (3) Somatic Response Control, a self-report measure of capacity to control both autonomic and fine muscle responses. The hypothesis that sympathetic and parasympathetic awareness might define two distinct dimensions was not supported by the data. The new scales will be useful in testing hypotheses of possible relationships among the factors measured and behavioral and psychophysiological indicators of the response to stress.


Role of incentives in the training of the frontal EMG relaxation response. Male college students were assigned to a feedback condition in which an auditory signal was correlated with forehead electromyographic (EMG) responses or to a control condition in which a constant low tone was provided. Within each condition, half of the subjects were provided with an incentive for successful reductions of EMG levels from session to session. In the control condition incentives were actually given on the basis of performance of yoked feedback partners. The remaining subjects in each condition (no incentive) were instructed that the incentive was available for reliable participation in the experiment. Feedback subjects acquired lower EMG levels than control subjects, and the yoked-incentive subjects acquired lower levels than no-incentive subjects in the control condition. There were no major differences in EMG levels attributable to locus of control orientation. The results are discussed mainly in terms of implications of incentive variables for reinforcement analyses of biofeedback effects and the validity of the locus of control construct in this application.


The MMPI and chronic pain: the diagnosis of psychogenic pain. This study investigates the capacity of the MMPI to discriminate among groups of patients with different types of pain. When multivariate analysis of variance is used, the standard set of MMPI scales discriminates between acute pain and chronic pain but not between chronic pain of two different etiologies (surgical-iatrogenic vs. unknown). The three scales that discriminate acute from chronic pain patients are those in the "neurotic triad," Hs, D, and Hy. The possibility that the unknown pain etiology group could be broken down into psychogenic pain and undetected somatogenic pathology subgroups was explored using cluster analysis. This procedure did not yield any group of patients who could be identified as having chronic pain of psychogenic origin. These results suggest that the MMPI is not a reliable tool for the differential diagnosis of chronic pain. It appears, however, that patterns of findings are partly contingent on population characteristics. Researchers should be cautious about generalizing to populations other than those from which samples are drawn.


The effect of outside work on the menopausal woman. 1,148 women between the ages of 45 and 54 from five different ethnic groups in Israel, representing a traditional-modern continuum were investigated with regard to the relationship of their menopausal symptomatology with their work situations now and what they were when the women were aged 40. A relatively low symptomatology was found among European Jews, North African Jews and Arabs in the peri- or postmenopause where their work load was unchanged or somewhat more than before. On the other hand, the Persian Jews showed a remarkable contrast, namely: those who had never worked at all outside the home suffered less than all the others in all the stages of menopause. These results cannot be explained only by the socioeconomic differences between the five groups, as the North Africans and Persians both belong to the lower urban socioeconomic class and the Arabs to the low rural socioeconomic class, with the Europeans belonging to the middle urban class. Nor can the results be explained merely by the difference in modernity and traditionalism. The matter is more complicated, and additional factors such as physical health, marital relationships and general stability are almost certainly involved. The advice to "go out and work" which is so often given by medical practitioners to menopausal women is thus not always correct, and should not be given automatically.


A review of studies of the psychological symptoms found at the menopause. The scientific literature was reviewed in order to determine whether psychological symptoms were directly associated with the menopause. Aetiology theories of symptoms include biological, psychological, sociological and multifactorial. There is evidence that psychological symptoms do occur in increased frequency in relationship to declining ovarian function. The severity of these symptoms may be affected by sociological variables. Administration of oestrogens alone or in combination with progestogens appear to alleviate some of the symptoms. More detailed research is needed into the relationship between psychological symptoms and the menopause.


The effect of estriol succinate therapy on plasma renin activity and urinary aldosterone in postmenopausal women. The effects of estriol succinate (Synapause, 2 mg daily) on the renin-aldosterone system and blood pressure (RR) were studied in 14 postmenopausal women after bilateral oophorectomy. Plasma renin activity (PRA) and daily urinary aldosterone excretion (dU-Ald) were determined 1 mth after the operation and before estrogen treatment, at the end of 2 mth therapy, and, for the third time, 2 mth after the termination of treatment with the drug. No changes in PRA, dU-Ald or RR were found in normotensive women, or in 3 women with hypertension in this group. Another group of 11 postmenopausal women was investigated after long-term estriol succinate therapy, which had lasted for 5-8 yr after oophorectomy. PRA, dU-Ald and RR were measured during treatment and 2 mth after terminating the therapy. No changes were found either in hormone differences in the mean levels of PRA or dU-Ald. The results suggest that estriol succinate is devoid of general harmful effects on the renin-aldosterone system during postmenopausal therapy for climacteric symptoms.


The prevention of endometrial cancer in postmenopausal women with progestogens. Due to adverse publicity alleging an increased risk of endometrial cancer with estrogen therapy, a prospective study was begun in 1976 to determine the incidence of this disease in postmenopausal women. During 5,025 patient-years of observation in 1976-1977, 6 adenocarcinomas of the endometrium were diagnosed for an incidence of 1.2:1,000 postmenopausal women per year. No endometrial malignancies were detected in 2,552 patient years of therapy with estrogens and progestogens. In 1,028 patient-years of observation where estrogens only was the therapy, there were 3 endometrial cancers for an incidence of 2.9:1,000. Adenocarcinoma of the endometrium was found in 2 of the untreated group, which gave an incidence of 3.0:1,000. The sixth endometrial cancer occurred in a patient using estrogen vaginal cream. During this same period, 139 perimenopausal and postmenopausal women were treated with progestogens for endometrial hyperplasia. The hyperplasia was reversed to normal endometrium in 133 patients (95.7%). Hyperplasia is a precancerous lesion and should be treated with either progestogens or hysterectomy. All postmenopausal women with a uterus should be given the Progestogen Challenge Test and the progestogen continued each month as long as bleeding follows. These methods will prevent most endometrial cancers.


A new way of looking at environmental variables that may affect the age at menopause. Environmental variables that might affect the age at menopause were analysed by means of the segmentation method AID. Marital status, occupation, smoking habits, age at last pregnancy and height were shown to be significant discriminating variables. The material and design of the study and the method of analysis are given and its results are discussed. A proposal is made concerning the nature of a 'secular trend'.


Is there a secular trend in age of menopause? A review of the difficulties encountered in analyzing a secular trend in age of menopause is given with emphasis on the advantages and disadvantages of the recollective and "status quo" methods. It is suggested that no methodology except that which is prospective will give accurate ages of menopause. Accepting this given, a review of the literature from 1864 to 1964 is undertaken, that suggests there may be a secular trend in Denmark, England, France, Germany, Russia and the USA. This must, however, be corroborated by longitudinal, cross cultural, generational research of mothers' and daughters' ages at menopause, or at least, cohort analysis of specific populations.


Serum oestriol, oestrone and oestradiol concentrations during oral oestriol succinate treatment in ovariectomized women. Serum oestriol, oestrone and 17 beta-oestradiol concentrations during oral oestriol succinate treatment were investigated in ovariectomized women. Either a single dose of 8 mg or two doses of 4 mg were given daily. With the second divided dosage the serum oestriol levels remained uniform. The oestriol concentrations were clearly higher than in the beginning or in the middle of the normal menstrual cycle in the fertile woman. With both treatment schemes the ratio E3/(E2 + E1) was clearly higher than before treatment and during the normal menstrual cycle. Oestriol succinate treatment lowered the ratio E1/(E2 + E3), which was rather similar to the one during normal menstrual cycle.


Serum oestrone, oestradiol and oestriol concentrations during oral oestradiol valerate and oestriol succinate therapy in ovariectomized women. Serum oestrone, oestradiol and oestriol concentrations were investigated during oral treatment with oestradiol valerate and oestriol succinate in ovariectomized women. The dosages used were 1 mg oestradiol valerate in the morning and 2 mg oestriol succinate in the evening of the first day and 2 mg oestradiol valerate in the morning of the second day of treatment. The other group of patients received the same therapy in reverse order. The variation in the serum oestrone and oestradiol concentrations with a daily dose of 1 or 2 mg of oestradiol valerate were considerable. 2 mg oestriol succinate caused a fairly small elevation of serum oestriol concentration. In both treatment groups the quotient E3/(E2 + E1) was similar to that found at the 6-7th day and in the middle of the normal menstrual cycle, the quotient E1/(E2 + E3) was somewhat higher than during normal cycle.


The effects of oestrogens and progestogens on the postmenopausal endometrium. Cyclical regimens of unopposed oestrogens are associated with the development of endometrial hyperplasia and the incidence of hyperplasia is dose-related. As no pattern of vaginal bleeding serves as a reliable indicator of underlying endometrial pathology and as hyperplasia can develop subsequent to the finding of a normal endometrium and at any time from 2 to 35 mth after the start of treatment, serial biopsies are required on every patient. Oral oestrone and oestradiol complexes both give rise in the plasma principally to oestrone and therefore the term "Hormone replacement therapy" is inappropriate. The incidence of hyperplasia during sequential oestrogen/progestogen therapy is greatly reduced and therefore progestogens are capable of protecting against the development of this condition. Sequential regimens can also reverse oestrogen-related hyperplasia to normal endometrium.


Management of postmenopausal bleeding to prevent endometrial cancer. The primary goal in management of postmenopausal bleeding is to insure that no malignancy is present. In this study of 3,682 climacteric women, 340 patients (9.2%) presented with postmenopausal bleeding during an 18-mth period. The pathology at curettage was reported as normal endometrium in 33.8%, atrophic endometrium in 24.7%, and hyperplasia in 39.1%. Adenocarcinoma of the endometrium was diagnosed in only 5 patients (1.5%), a reduction from 3.0% found in a previous study performed in 1972-1973. The second goal in management of postmenopausal bleeding is to identify and treat those patients with endometrial hyperplasia since this is a precancerous lesion. Cyclic progestogens were given to 105 of 133 women with hyperplasia of the endometrium for 3-6 mth and curettage repeated. The hyperplasia reverted to normal endometrium in 101 of the 105 patients (96.2%). In those 4 women with persistent hyperplasia after progestogen therapy, a hysterectomy was performed. Hysterectomy was the primary therapy for 20 women with hyperplasia because of associated findings such as leiomyomata uteri. The incidence of curettage was highest in the untreated women (23.2%), lowest in the estrogen-progestogen users (3.9%) and indicated in 14.2% of those patients receiving estrogens alone.


[Thermodynamics and electrophysiology of the nervous system]. This study expresses a theory designed to associate the fundamental thermodynamic concepts to the electrophysiology of the nervous system. An analogy is drawn between the thermodynamic and electrical events of the myocardial cell during its mechanical phases with those thermodynamic and electrical events of the nerve cell during conduction. Although the myocardial and nerve cells are designed to perform different functions, their processes of membrane potential activation and corresponding directions of thermodynamic and entropy changes are basically the same. A thermodynamic view of nerve cell "active" potential corresponds to a passive downhill process during which the entropy of the system (nerve cell) increases. In contrast, the so called "resting" membrane potential corresponds to an active uphill process. Thus, there is a paradox because the nerve cell is thermodynamically passive during the "active" membrane potential, whereas it is thermodynamically active during the "resting" membrane potential. It is suggested that inhibition in the nervous system may be considered a thermodinamically active process. If the negentropic process fails, the result is the malfunctioning or the final destruction of the system.


[Child psychiatry and social security].

[Child psychiatry and social security]. The historic development of the units that provided psychiatric care to children and adolescents, which finally yielded the first child guidance clinic early this century is briefly reviewed. We describe the organization of a child psychiatry unit within a social security institute (ISSSTE). The importance of a child psychiatrist, a psychologist and a social worker working together in a team approach to the evaluation and treatment of children is emphasized. The ISSSTE has provided psychiatric care to children and adolescents since 1961. For this purpose the Institute has five psychiatric units, four of them within a general hospital, the other in a neuropsychiatry out-patient clinic. This clinic admitted 749 new cases to the Child Psychiatry department during 1976. Up to December 1976, the total population of the clinic was 14 271 patients, of which 5 471 are children and adolescents. Last but not least, we describe an ambitious project for an in-patient unit for children and adolescents as part of a psychiatric hospital.


[Hospitalized psychiatric population in the Mexican Institute of the Social Security, 1971-1976]. This paper emphasizes the importance of having an objective registration system for clinical cases in a psychiatric hospital. For this purpose, special sheets were designed to register all cases comparing the years 1971 and 1976. During these years, 1 202 and 1 835 cases were obtained. Data included: age, sex, marital status, schooling, occupation, diagnosis, psychiatric family history and therapy. The results for those years are shown.


Wernicke-Korsakov syndrome lesions in coronial necropsies. The clinical and pathological features of the Wernicke-Korsakov syndrome are described in 12 cases in which the syndrome had not been recognised before death. In a 1 year period there were 9 cases (5.3%) among 169 necropsies ordered by the coroner in unexpected or unexplained non-violent death. The characteristic brain lesions were grossly apparent in 5 cases and identified only histologically in 7 cases. The findings suggest that in cases of coma or patients found dead who might have been alcoholics, adequate postmortem examination of the brain is likely to demonstrate the lesions of the Wernicke-Korsakov syndrome in a significant number.


Preliminary observations on the pharmacokinetics of methylphenobarbitone. The pharmacokinetics of methylphenobarbitone and phenobarbitone were studied following the administration of methylphenobarbitone on a chronic basis in 77 patients, and after a single dose to each of 4 subjects who had received no other drugs and 4 subjects who had been pretreated with various anticonvulsants and other agents. At steady-state, plasma phenobarbitone concentrations correlated better with methylphenobarbitone dose than did plasma methylphenobarbitone concentrations. In this group the ratio of plasma phenobarbitone level to plasma methylphenobarbitone level was in the range of 7 to 10:1. In the single dose studies, mean values of elimination rate constant (0.0155h) and clearance (1.85L/h) for untreated subjects were different from those for the pretreated subjects (0.0375h and 5.10L/h), while the apparent volumes of distribution did not differ significantly between the two groups (120.3L vs 140.8L). The data are interpreted as most probably indicating induction of hepatic microsomal enzymes in the pretreated group.


A comparison of the absorption of phenobarbitone given via the oral and the intramuscular route. 6 patients were given 180mg phenobarbitone, and 1 patient 120mg, and the plasma levels measured within the first 4 hours or so. These doses of phenobarbitone were quite ineffective in achieving, in a reasonable time, the levels generally recognised as being protective against seizures. 5 patients were loaded with phenobarbitone alternately via the oral and intramuscular routes to assess the relative absorption of phenobarbitone by each route. The oral route of administration appeared to be at least as good as the intramuscular, there being no significant difference between the two as judged by the peak levels of plasma phenobarbitone measured, or the amount of drug absorbed.


Posterior fossa arachnoid cysts: two case reports. 2 cases of posterior fossa arachnoid cyst are discussed. In the first, it is likely that perinatal factors were responsible for the temporal lobe pathology and the formation of the cyst. Progressive dilatation of the temporal horn may have then been caused by obstruction from the cyst. In the second case, minor head trauma was a possible mechanism for the cyst production, although it seemed irrelevant to the mode of clinical presentation.


The causalgia syndrome treated with regional intravenous guanethidine. Two cases of the causalgia syndrome have been presented, one probably related to a mild peripheral neuropathy and the second, more classically, following trauma. The technique of regional infusion of guanethidine has been shown to be efficacious in relieving the pain, if only temporarily, but as it is largely without risk it may be repeated is necessary. It should probably be performed as a routine before consideration of surgical sympathectomy in order to assess whether surgical intervention is likely to be effective. Mechanisms of the causalgia syndrome itself are considered and a rationale for the efficacy of the procedure is suggested.


Visuo-motor skill and visual perception in left and right handed children of superior intelligence. It was thought possible that the proximity of the right parietal cortex to the leading hand area in left handed subjects may confer an advantage in tasks requiring visuo-motor function. However, the study showed the left handed group to be defective in the performance of the Wechsler Block-design Sub-test. As some mature left handed individuals may excel in tasks requiring refined visuo-motor skill, it is suggested that any constitutional deficiency is not fixed, but may be expected to disappear with increased maturity, or as the result of training.


Individual free fatty acids and migraine. Total plasma free fatty acids (FFAs), platelet serotonin content and plasma stearic, palmitic, oleic and linoleic acids were estimated in 10 migrainous patients before, during and after a migraine attack. Total and individual plasma FFA levels rose and platelet serotonin fell in most patients. Comparison of the pre-headache and headache mean values showed that of the FFAs linoleic acid rises most during headache. 10 non-migrainous controls had platelet serotonin content estimated before and after the ingestion of 20g linoleic acid. All showed a significant fall in platelet serotonin in the post-ingestion period. It is shown that linoleic acid releases platelet serotonin in vitro, and this study suggests that it has the same action in vivo. Further, it is the precursor of all prostaglandins in the body and its marked elevation during migraine may serve as a source of increased prostaglandin E1 (PGE1) synthesis. It is suggested that linoleic acid plays an important role in the biochemical process of the migraine attack, acting both as a serotonin releasing factor and a source of PGF1, the vasodilating action of which can aggravate the clinical symptoms of migraine.


Autonomic dysfunction in the Landry-Guillain-Barre syndrome. Tests of autonomic function have been performed on 7 patients with the Landry-Guillain-Barre syndrome and 5 control subjects. These included a sweat test, and measurement of both postural hypotension and baroreflex sensitivity. Sweating was definitely abnormal in 5 patients. Postural hypotension was present in 4 patients. The baroreflex sensitivity was significantly reduced (p less than 0.01) in the patients when compared with the control group. The results demonstrate that both the sympathetic and parasympathetic nervous systems may be affected in the Landry-Guillain-Barre syndrome.


Electromyographic study of polysynaptic responses from muscles not supplied by the stimulated nerve: preliminary report. 15 subjects with normal neurological examinations, 7 hemiplegic patients, 5 patients with dementia and 4 with Parkinsonism were examined. A 1msec duration pulse below the pain threshold was applied to the median and ulnar nerves at the elbow and wrist. The activities of the biceps, triceps, flexor carpi radialis, forearm extensors and abductor pollicis brevis were recorded with surface electrodes. The most frequently observed response in normal subjects and hemiplegic patients occurred in the biceps, and had a latency of about 30msec. The other frequently elicited response in normal subjects and hemiplegic patients was in the forearm extensors. Recovery curves were obtained for the biceps response. A significant difference between normal subjects and hemiplegic patients was found. In the patients suffering from Parkinsonism, as well as in demented patients, one could record easily polysynpatic reflexes from other forearm muscles. This suggests the presence of basal ganglia damage in atrophic dementias.


Delayed radiation-induced damage to the brachial plexus. Three patients are described who developed a brachial plexus neuropathy following radiation treatment for cancer of the breast. The clinical features consisted of a painless, slowly progressive sensory motor disturbance, affecting especially the hand. The latent period between the radiation therapy and the onset of the neuropathy was exceptionally long, being 8, 15 and 15 years respectively. Two patients were initially incorrectly diagnosed as having a carpal tunnel syndrome. The possible mechanisms of the insidious neuropathy are discussed. At the present time no treatment is of proven benefit.


Primary empty sella syndrome and benign intracranial hypertension. Two patients presenting with headache and radiological features of an enlarged sella turcica were found to have the primary empty sell syndrome. Whilst under observation, 1 patient developed papilloedema and was shown to have benign intracranial hypertension. The second patient also had raised intracranial pressure. A relationship between the empty sella syndrome and benign intracranial hypertension has previously been reported and it is suggested that in a patient with a congenitally incompetent diaphragma sella, chronically raised intracranial pressure caused herniation of the subarachnoid space into the sella turcica. Subsequently, sella turcica enlargement and remodelling occurs, sometimes with endocrine, visual and other sequelae. The clinical, radiological and CT scan features of the empty sella syndrome are discussed and the indications for major radiological studies are considered.


Occipital neuralgia.

Occipital neuralgia. The findings in 23 cases of occipital neuralgia are presented. The clinical features of the condition are pain and sensory change in the distribution of the relevant nerve, localised nerve trunk tenderness and a clear response to local forms of therapy. The clinical picture is often complicated by migrainous and trigeminal nerve features and the mechanisms by which these come about are discussed. Occipital neuralgia is generally neglected in both the standard textbooks and the literature. The condition occurs sufficiently commonly to warrant more consideration in the differential diagnosis of head pain than it has received to date.


Patterns of response to levodopa in Parkinson's disease. The broad results of the treatment of patients with idiopathic Parkinson's disease who have received levodopa or its variants are reported. 50 patients, 24 males and 26 females, with a mean age of 66.5 years were treated with levodopa, in daily doses ranging from 0.25g to 6.0g or 'Sinemet' in daily doses of 300mg to 750mg. Periods of treatment ranged from 4 months to 8 years, with a mean of 4.02 years. The relationships of patients' age, onset of Parkinsonian symptoms and interval between initial treatment with levodopa and the current clinical state were studied. Patients were classified according to their clnical response into 3 categories: satisfactory response, progressive deterioration or intolerance of levodopa. The proportion of patients in each category was 66%, 22% and 12% respectively. The clinical results of treatment correlated with those of Webster Disability Testing Scale. Analysis showed that the majority of patients tolerated levodopa and showed an initially satisfactory response. Patients who responded well were considerably younger than those who failed to respond. Patients receiving the drug for a shorter period (less than 3 years) showed a better response. After 3 years' treatment, the response declined. Patients who had had Parkinson's disease for more than 4 years appeared to do less well than those with recently diagnosed disease, but many patients responded well even when treatment was initiated 10 years after the onset of symptoms. Patients discontinued levodopa treatment because of psychoses, nausea, dyskinesia or exacerbation of urinary incontinence. The commonest side effects were nausea (34%), postural hypotension (22%), psychoses (10%) and 'on-off' phenomena in 12% of patients.


Parasitic diseases of the nervous system in Thailand. In Thailand there are 3 parasites that commonly cause neurological diseases in man. 1) In gnathostomiasis man becomes an accidental host by eating infected under-cooked fresh water fish. The tissue nematode involved, Gnathostoma spinigerum, because of its high motility, may cause widespread damage in the spinal cord and brain stem. The common presenting neurological symptoms are severe nerve root pain, paralysis of limbs and urinary retention. Less frequently seen are cranial nerve palsies and symptoms of subarachnoid haemorrhage. The disease has significant morbidity and mortality. 2) Eosinophilic meningitis caused by Angiostrongylus cantonensis, the lungworm of rats, has a more benign, self limiting course. It occurs in Thai people of lower socio-economic groups who acquire the parasite by eating infected raw Pila snails. 3) Cysticercus cellulosae, caused by Taenia solium, commonly results in epilepsy, and sometimes increased intracranial pressure from intraventricular obstruction or from basal arachnoiditis. Spinal cord and cauda equina involvement occurs much less frequently. Cysticercus complement fixation tests on the CSF and computerised axial tomography have been found to be of great diagnostic value.


Vertebral metastases and spinal cord compression. Clinical interest in spinal compression and resultant paraplegia due to metastases has mounted in recent years. This has stimulated attention to the neuropathology of the condition. 14 cases of spinal cord compression due to vertebral metastases are compared with over 100 traumatic cases. In the traumatic lesions there is central haemorrhagic necrosis leading to cavitation and gliosis with nerve root regeneration in the late stages. In the metastatic cases, lesions are often peripheral, pie-shaped and are related to vascular factors. The neuropathology of cord necrosis due to metastatic spinal disease is therefore different from that caused by trauma. These observations have clinical importance in planning treatment.


Tissue analysis of plasticizer in dogs.

Tissue analysis of plasticizer in dogs. Acute renal failure was produced in animals and analytical procedures for DEHP estimation in urine and tissues of dogs developed. The presence of DEHP in urine samples of control and sham operated dogs indicated that significant excretion of this plasticizer by kidney occurred. Delay in elevation of DEHP serum levels in nephrectomized dogs and similar concentrations of DEHP in 72 hr and 96 hr serum samples in all 3 groups indicate possible metabolism and/or uptake of DEHP by tissues. DEHP levels in brain, heart, and lung tissues of nephrectomized dogs were higher than those in control and sham operated dogs; however, the highest concentration of DEHP was found in lung regardless of grouping. Gas chromatographic spectra of kidney and liver homogenates showed several extraneous peaks with shorter retention times than DEHP, probably representing metabolites of DEHP. Identification and quantitation of DEHP metabolites in tissues are presently under way in our laboratory.


Echocardiography in the diagnosis of pericarditis in patients with uremia. Uremic pericarditis occurred in 39 uremic patients who were treated in our program during a 4 yr period. The diagnosis was considered, but could not be established, in an additional 55 patients. A presumptive etiology remediable to a specific plan of treatment was identified in 9 patients who developed pericarditis following the initiation of dialysis. Uremic pericarditis occurring in patients who had yet been dialyzed, regularly responded to aggressive dialysis treatment. Echocardiography was the single, most important test to evaluate patients with suspected pericarditis. Limited pericardiectomy was safe and effective treatment in those patients not responding to conservative management.


Bone scan evidence of renal osteodystrophy in undialyzed uremic patients. Scintigraphy with the 99m-Tc complexes offers serveral distinct advantages to the nephrologist. The procedure is both easily performed and readily available, there have been no reports of toxicity, and the radiation exposure to the patient is lower than that of conventional radiography. We suggest that scintigraphic evidence of metabolic bone disease is present at the onset of terminal uremia with much higher frequency than is detectable by radiographs, and that unsuspected soft tissue calcification may also be detected on occasion. Therefore, 99m-Tc scans may be a valuable addition to the diagnostic regimen of the uremic, and should be thoroughly evaluated with more extensive studies, including quantitative analyses.


A double blind crossover comparison of high and low sodium dialysis. A single high sodium dialysis results in a rise in serum sodium that osmotically parallels the fall in BUN. Effective net weight loss is accompanied by strikingly fewer disequilibrium symptoms, fewer muscle cramps, and less hypotension during high sodium dialysis compared to standard, hyponatric dialysis. Fewer muscle cramps during the following interdialytic interval and no increase in blood pressure or weight gain during the following interdialytic interval occurs with high sodium dialysis.


Inhibitors of erythroid colony forming cells in sera of azotemic patients with anemia of renal disease. 1. The plasma clot method of McLeod, et al8 was used to study the inhibitors of erythroid colony forming cells (CFU-E and BFU-E) in sera of patients with anemia of uremia. 2. Compared to sera from hematologically normal human subjects, sera from undialyzed patients with anemia of uremia produced a significant inhibition of CFU-E and BFU-E. 3. A marked reduction in the inhibitor(s) of CFU-E was seen in sera of 3 out of 4 patients following 16 wks of intermittent hemodialysis. 4. Creatinine, guanidine, guanidinosuccinic acid and guanidinobutyric acid had no effect on the erythroid colony forming cells. 5. Together with the relative erythropoietin deficiency, inhibitor(s) of the erythroid progenitor cell compartment may play a major role in the mechanism of the anemia of renal insufficiency.


Geographical dimensions of terrestrial net and gross primary productivity. The paper presents a comparative summary of previous attempts by the author to assess and map global primary productivity using environmental parameters as predictors. The individual components of the productivity process, net production, gross production, dark respiration as well as their regional rates are computed for 10 degree latitudinal belts. A new version of the Miami Model (Lieth, 1973, 1975) is presented predicting net primary productivity from an increased number of averages of temperature and precipitation. Net primary productivity values in form of dry matter accumulation and caloric energy equivalents are compared.


The enrichment of (18)O in leaf water under natural conditions. The enrichment of (18)O in the water of transpiring leaves under natural conditions is described. In the first series two, later three species at the same location and at the same time are compared (birch Betula pubescens L., oak Quercus robur Ehrh., larch Larix decidua Mill., and spruce Picea abies Karst). All four show parallel enrichment properties. In addition two beeches (Fagus silvatica L.) were observed, one at Jülich, the other at the Solling hills. They show similar (18)O/(16)O ratio fluctuation in their leaves during the time of observation. Three plant communities (beech forest B1, spruce forest F1, and meadow W, sites of the "Solling-Project", German Research Foundation, part of International Biological Program, at the Solling hills) show a daily course of the (18)O enrichment comparable to each other.


Seed germination as a thermobiological problem. Thermal effects on seed germination are considered through the changes brought about by temperature in the germination capacity, in the germination rate, and in the distribution of the relative frequency of germination along the incubation times. A number of questions of general thermobiological interest are thus raised, entailing the need of an analysis of the temperature dependence of the seed germination rate. A treatment of these rates by the activation-energy approach cannot be general, for their Arrhenius plots are not always linear. Moreover, it is shown that any process displaying a temperature optimum (as happens in the germination of most seed species) cannot follow one of the fundamental tenets of the collision rate theory. The need of a theoretical treatment stressing the essential role of the partition of energy within the seed system has led to an anlysis using the absolute reaction rate theory. New experimental prospects for the physiology of seed germination are thus raised, concerning the meaning of the temperature cardinal points, the growth pattern of the embryo in germinating seeds, the dual effect of protein thermodenaturation, the effects of high hydrostatic pressures, and a whole pharmacological line of work. The cybernetic counterpart of the thermodynamic view of seed germination appears in the study of the distribution of the relative frequency of germination along the isothermal incubation time. In some species of seeds the thermal communication between the environment and the seed growth effector can be shown to proceed by molecular collisions at all germination isotherms. In the seeds of Dolichos biflorus this communication through random thermal noise prevails only at temperatures close to both extreme limits of germination. Both in this species and in Calotropis procera there is a temperature range (encompassing the optimum) within which a temperature signal is superimposed upon the gaussian noise. An interpretation is proposed according to which the temperature signal is transduced in a protein-conformation code.


[The victim within the framework of criminology]. The Author makes a 'tour d'horizon', albeit summarized, of the problems brought about by the victim "from crime" in the exclusive picture of criminology. After defining the dogmatic relations between criminology and victimology, stating that such a (new) discipline highlights the entirety of the criminal event centering upon the dyad criminal-victim, the latest classifications of the victim viewed individually and also in his manifold relationships with the acting subject, are reviewed, in the attempt of identifying, on the basis of the various situations of victimization as they occur, if not some causal laws proper, at least some constants and some emerging lines susceptible of an in-depth analysis. After hinting to the problems brought about by the victim in the supranational prospect, and by the crimes so-called without a victim, the importance of the victim from the criminalistics and criminal execution angle, is outlined, and the Author closes up, by way of conclusion, and at the operational level, broadly hinting to the most suitable methods for the prevention and repairing in regard of the victims of crime.


Studies on blood-brain barrier permeability after microwave-radiation. Since the reported alterations of permeability of the blood-brain barrier by microwave radiation have implications for safety considerations in man, studies were conducted to replicate some of the initial investigations. No transfer of parenterally-administered fluorescein across the blood-brain barrier of rats after 30 min of 1.2-GHz radiation at power densities from 2--75 mW/cm2 was noted. Increased fluorescein uptake was seen only when the rats were made hyperthermic in a warm-air environment. Similarly, no increase of brain uptake of 14C-mannitol using the Oldendorf dual isotope technique was seen as a result of exposure to pulsed 1.3-GHz radiation at peak power densities up to 20 mW/cm2, or in the continuous wave mode from 0.1--50 mW/cm2. An attempt to alter the permeability of the blood-brain barrier for serotonin with microwave radiation was unsuccessful. From these studies it would appear that the brain must be made hyperthermic for changes in permeability of the barrier induced by microwave radiation to occur.


Impaired oxygenation during sleep in excessive polycythemia of high altitude: improvement with respiratory stimulation. Although polycythemia of high altitude is usually due to excessive hypoxemia, in some patients the hematocrit is elevated out of proportion to the degree of hypoxemia measured awake. One possible explanation is that severe hypoxemia occurs during sleep in these subjects. We therefore monitored oxygen saturation (SaO2), breathing pattern, and electroencephalogram (EEG) during sleep in five normal high-altitude residents and in five patients with excessive polycythemia. The polycythemic patients were studied as part of a placebo--drug double-blind crossover trial of the respiratory stimulant drug medroxyprogesterone acetate (MPA). The polycythemic patients while taking placebo were much more hypoxemic during sleep than the normals (all-night mean SaO2: 79.4 +/- 1.7% versus 87.8 +/- 1.7%, p less than 0.01). Abnormalities in breathing patterns were observed in all the subjects, especially during REM stage sleep. In polycythemic subjects, this resulted in precipitous hypoxemia with SaO2 as low as 50%--70%. Severe hypoxemia was not observed in control subjects despite similar abnormalities in breathing. Significant improvement in nocturnal SaO2 occurred when the polycythemic patients were taking MPA, mean SaO2 rising from 79.4 +/- 1.7% to 83.7 +/- 0.7%, p less than 0.05. Of probably greater importance, MPA largely prevented the precipitous drops in SaO2, mean lowest SaO2 rising from 64.6 +/- 4.7% to 76.0 +/- 2.1% p less than 0.05. The severe decreases in SaO2 during sleep may explain elevations in hematocrit that are out of proportion to the awake SaO2 in man at high altitude. The therapeutic effect of MPA in this condition may be due to amelioration of sleep hypoxemia.


[Prisons following reform. Current status and prospects]. The Author has examined the period successive to July 1975, namely, from the approval of the new prison System to the present day, highlighting the manifold negative aspects due to the incomplete application of the reform and not neglecting to review also the positive aspects of the regulations applied. The Author laid special stress on the distorted interpretations given to some different regulations of the System and on the ensuing wrong procedure that has been established, whose correction represents the only way not only towards a proper application of the reforming law, but also for preventing the most serious risk the reform is liable to run; that of being made the object of revisions and abrogations that might ultimately change their nature and jeopardise their objectives. The Author reviews the practical consequences of both the erroneous interpretations of the law and of its misapplications, dwelling on Article 30 in the first place, which has prompted some to define the law the "reform of leaves". Also examined was the problem of the special prisons, the usefulness of which is confirmed by the Author, who upholds the view that they must function in full observance of the regulations, for reasons of equity and opportuneness. From the rehabilitation treatment angle, the prison work, the participation of the extramural community, the "leasure time", the assistance after release. Still in the framework of his critical approach as to the prison reality, the Author illustrates the situation of the health service, and reviews the positive points that have been achieved in the implementation of some reform institutions, with special regard to the new disciplinary approach and its satisfactory results that have already been statistically observed. More adequate talks and correspondence by letter or through the telephone, a better compensation for the prison work, the convict representation in some sectors of intramural life, the measures as an alternative to enprisonment, all these actions represent the practical results of the reform achieved so far in a rather satisfactory way. After dealing with the figure of the surveillance judge, of the director and of the military personnel of prisons, setting forth observations and proposals to enhance their work, the Author declares, by way of conclusion, that he is fully convinced that the reform will ultimately attain its important targets, laying stress on the fact that the good will and the contribution of all those who are called upon to participate in its realization, may prove instrumental in shortening the period of time required for making the reform fully operative.


Effects of sleep deprivation on awakening thresholds and sensory evoked potentials in the rat. The EEG desynchronization response to stimuli presented during slow-wave sleep was studied in 25 chronically implanted rats after 12 hr of sleep deprivation and during control periods of normal sleep. Compared to normal sleep, sleep after deprivation was accompanied by a significant decrease in the number of EEG desynchronization responses to auditory stimuli and by an additional disproportionate decrease in the number of sustained desynchronization responses. Thalamic auditory evoked potentials were not reduced in amplitude during postdeprivation sleep, thus the decrease in number of EEG desynchronization responses to the auditory stimuli was apparently not mediated by decreased responsiveness in the peripheral auditory system. On the other hand, postdeprivation sleep was not accompanied by any significant change in total number of EEG desynchronization responses to direct trigeminal nerve stimulation nor by any change in the duration of responses to trigeminal stimulation. The results suggest that recovery from sleep loss in accompanied not by a nonspecific increase in the threshold for arousal per se but instead by a selective increase in the threshold for arousal to certain classes of peripheral stimuli.


Impotence and blood pressure in the flaccid penis: relationship to nocturnal penile tumescence. Evaluations of nocturnal penile tumescence (NPT) and penile blood pressure were performed on (1) a group of nondiabetics with normal NPT, (2) a group of nondiabetics with abnormally diminished NPT, and (3) a group of diabetics with abnormally diminished NPT. The 12 subjects in each group complained of impotence. Analysis of blood pressure data taken before the NPT evaluation suggests the possibility of selective low arterial blood pressure in impotent patients who show no obvious signs of other vascular disorders.


Effects of sleep deprivation on short duration performance measures compared to the Wilkinson auditory vigilance task. The effects of one night's total sleep deprivation were examined using the Wilkinson vigilance task and four 10 min duration performance tests. A repeated measures design was used in which eight male subjects experienced one night of sleep loss, the order of sleep loss being balanced across subjects. The four short duration performance tests consisted of choice reaction time, simple reaction time, short-term memory, and a motor task, handwriting. The results confirm the effects of one night's sleep deprivation on the vigilance task and also show that performance on the two reaction time tests was significantly impaired by the loss of sleep, but not at such a high level as for the vigilance. The short-term memory test failed to show any adverse effects of sleep loss and similarly for the handwriting. The experiment shows that two portable and brief (10 min) performance tests are sensitive indices of sleep loss and should be particularly useful for assessing levels of alertness in the field.


Long-term ambulatory temperature monitoring in a subject with a hypernychthemeral sleep--wake cycle disturbance. A portable temperature data logger was used for prolonged rectal temperature monitoring in an ambulatory subject with a longer than 24 hr (hypernychthemeral) sleep-wake cycle. The mean period of the sleep-wake and circadian temperature cycles was 24.8 hr. However, the period of the sleep-wake cycle fluctuated considerably, being less than 24.8 hr when he slept during the socially desirable sleep hours and more than 24.8 hr when he slept during the day. In the first instance, the daily temperature fall occurred later than, and in the second earlier than, sleep onset. During the times of desynchronization of the two cycles, he complained of insomnia, fatigue, and reduced performance. We postulate that his hypernychthemeral cycles were the result of either a primary defect in the mechanism of entrainment or "weakened" social zeitgebers due to a personality disorder. These concepts are supported by a sleep-wake pattern resembling that of relative coordination. We therefore raise the possibility that 24 hr was beyond the range of entrainment of the subject's circadian temperature cycle during the study.


Evaluation of hearing aid fitting based on the patients' experiences from everyday listening conditions. We found that a relationship existed between degree of sensorineural hearing loss and discrimination score obtained in free field with convenient hearing aids against background noise. However, the standard deviation was so great that we could not elaborate a diagram from which, with any reasonable degree of accuracy the expected discrimination score with suitable hearing aids could be predicted for each individual patient. Then 20 patients with sensorineural hearing losses tried different hearing aids under everyday listening conditions, and simplified speech audiometry against background noise was performed. We found that none of the patients achieved better discrimination scores with aids they rejected under everyday listening conditions than with aids they preferred. This indicates that we need to pay attention to the patient's experience with hearing aids under everyday listening conditions in each individual case, when a hearing aid is to be selected.


The effect of hearing aid use on the user's residual hearing. A follow-up study. This paper reports on a follow-up study into the effect of hearing aid amplification on the user's residual hearing. Four groups of deaf children; 18 in group A, 14 in group B, 15 in group C and 8 in group D were followed up for a period of four consecutive years. The children in group A and in group B were using monaural hearing aids throughout this period with maximum acoustic outputs ranging from 130-136 dB SPL and 116--128 dB SPL respectively. The children in group C were not using hearing aids during the first three years but during the fourth year they were monaurally fitted with similar hearing aids as those issued to children in group B. The children in group D were using binaural hearing aids during the first three years but in the fourth year they were restricted to only one hearing aid. The hearing aid levels of the children at 500, 1 000, 2 000 and 4 000 Hz were ascertained both at the beginning of the investigation, at subsequent 6-monthly intervals for the first three years and at the end of the fourth year. It was found that the hearing acuity of the hearing aided ears showed slight "improvement" during the investigation while the hearing acuity of the unaided ears showed slight "deterioration" in all frequencies tested.


High-frequency thresholds using a quasi-free-field technique. A free-field transducer system for high-frequency audiometry was applied on two groups of otologically normal, non noise-exposed subjects tested at the frequencies 4--8--10--12--14--16--18--20 kHz. The former group consisted of 46 children 10--12 years old and the second group of 40 adults aged 18--24 years. All participants in the youngest group were able to hear 20 kHz and no difference between right and left ear or between sex could be shown. A similar result was found in the adult group except that 4 males were unable to hear 20 kHz. Hearing thresholds for the two groups were almost identical at 8--14 kHz. Above this frequency range the youngest group showed a statistically significant lower threshold at 18 and 20 kHz. This group might be used for a zero-dB hearing threshold level in further high-frequency studies. The advantage of transferring the SPL value from the entrance to ear canal to absolute ear drum pressure level is discussed.


The acoustically evoked potentials in the case of stimulation by frequency modulation (FM) near the hearing threshold, compared with tone burst stimulation. The present investigation concerned the possibility of obtaining higher AEP amplitudes at or near the hearing threshold by stimulation with frequency-modulated sinusoidal tones (FM stimulation) than by tone burst stimulation. With FM stimulation the frequency changes may lead to changes in the coupler sound pressure level in the headphone (additional amplitude or intensity modulation) as well as changes in sensation levels due to frequency-dependent hearing sensitivity which have to be compensated for. To ensure comparability of FM and tone burst stimulation it has also to be considered that the FM frequency increment does not substantially exceed the critical bandwidth of the human ear. With these conditions taken into account, no combination of FM stimulation parameters was found that resulted in a larger AEP amplitude than tone burst stimulation. With comparable stimulation parameters, the AEP amplitudes were identical for FM and tone burst stimulation.


Effects of long rise time stimuli on the latencies of the slow V potentials. Tone bursts with 5, 250 and 500 msec rise time and 70 dB HL (ISO) intensity at the plateau were used to evoke the slow V potentials in ten adults. The mean prolongations of the latencies have been determined and correlated with the subjective auditory thresholds, obtained before each test by conventional push-button audiometry. In normal-hearing subjects our results show a prolongation of the latencies of the slow V potentials when stimuli with longer rise time were used. In subjects with elevated auditory thresholds an almost linear correlation was found between the prolongations of the latencies and the subjective auditory thresholds.


The validity of the derived cochlear nerve and brainstem evoked responses of the human auditory system. It was considered that for a number of reasons, the derived response concept might not necessarily be valid when applied to the cochlear nerve and brainstem evoked responses (CBER). A statistical comparison of response measures of amplitude and latency was made between derived and non-derived responses, each representing response contributions initiated by the same locations along the cochlear partition. Relatively few statistical differences were detected. Therefore the technique of waveform summation and the production of derived response waveforms from complex responses, recorded under appropriate masking conditions, was considered to be a valid operation.


Frequency specific components of the cochlear nerve and brainstem evoked responses of the human auditory system. A technique of high-pass (HP) masking was used to obtain masked cochlear nerve and brainstem evoked responses (CBER) of the human auditory system. The masking noise was extended progressively into the lower frequency regions of the cochlea for consecutively recorded responses, and the effect upon the response waveform was observed. Masked response waveforms were then subtracted to produce derived CBER waveforms representing activity initiated at specific frequency locations along the cochlear partition. Derived response components from various frequency bands were characterized and related to changes in the complex CBER during the process of frequency selective high-pass masking.


Progressive hearing loss in Goldenhar's syndrome. A family with Goldenhar's syndrome is presented. The pattern of inheritance is autosomal dominant with incomplete penetrance. The mutant gene in question has variable phenotypic expressivity. Evidence of progressive hearing loss is reported. Congenital facial palsy is suggested to be a part of the syndrome.


Modification and application of the computerized automatic audiometer. Recently, medical information processing systems applying computers have achieved marked advances in parallel with the development of highly accurate automatic measuring instruments. The authors already in 1974 developed and reported a computerized automatic audiometer containing a micro-computer which stored a program for audiometric procedures. Subsequently the authors have developed a compact, multi-purpose audiometric instrument which executes the standard air-bone conduction audiometry, with the exclusion of masking, automatically with a built-in micro-computer. An outline of the instrument is as follows: 1. The instrument is composed of a memory, a control unit, programs for data processing and measurement, a character display for instructing subjects and an audiogram display. It can be operated manually in the same way as a conventional audiometer. 2. Test errors and any abnormally large differences between the responses of the two ears can be detected automatically, and the tests can then be re-executed manually after finishing the automatic procedure for correction of the data. 3. The instrument is provided with output terminals for connection to an external computer or other peripheral equipment. It is designed to be compact and light weight.


Cochlear travelling wave velocities calculated from the derived components of the cochlear nerve and brainstem evoked responses of the human auditory system. From the latency difference between corresponding components of the different derived cochlear nerve and brainstem evoked responses (CBER) and the cochlear location difference between the appropriate derived band centre frequencies (CF), estimates of the travelling wave velocity at various locations along the cochlear partition were calculated. Calculated velocities compared favourably with velocity data obtained using widely contrasting techniques. Derived CBER waveforms were therefore considered to truly represent neural activity initiated by activity at specific frequency regions along the cochlear partition.


Derived cochlear nerve and brainstem evoked responses of the human auditory system. The effect of masking in the derived band. Derived cochlear nerve and brainstem evoked responses (CBER) were obtained for various frequency bands and were masked using special maskers. These maskers were designed to match exactly the intensity/frequency profile characteristics of the bands from which derived CBERs were obtained. Derived responses were markedly affected whenever the masker frequency limits coincided with the corresponding derived band. Other derived responses from adjacent bands were not affected. Since adjacent derived bands overlap, these overlapping regions were not considered to be represented in the derived responses. Therefore the actual frequency regions which the derived responses represented were considered to be smaller than the derived bands calculated from the physical parameters of the high-pass masking noises.


A model for the auditory evoked brainstem responses. The present research was undertaken to approach the formation of the Brainstem Evoked Response (BSER) by means of modelling techniques similar to those previously successfully adopted to interpret the generation of the Auditory Nerve Action Potential. The definition of a model intended to reproduce the compound electrical response of a given ensemble of neural units, firing after stimulation, is taken as the basic constituent for the formulation of the complete model. The activity of the primary auditory neurons is assumed to be the input to the BSER model; then, a simplified structure for the connections among the neural complexes contributing to the BSER is proposed to account for monaurally evoked, homolaterally recorded responses. Computer simulations of the model show a satisfactory degree of approximation between the experimental data taken as reference and the final output, in spite of the rather small number of parameters and the simplicity of the structure used. Even though this work has to be considered as preliminary in character, at least in certain respects, some applicative implications of the present approach can be outlined.


Estimation of the critical bandwidth from loudness summation data. An automatic method for critical band estimation from loudness summation data is presented. A mathematical model, based on a power function, is fitted to the data and the critical bandwidth is defined at the intersection of the asymptotes. The model is designed for clinical use, involving the treatment of the data from single test persons; it represents an operational solution to a difficult task. The model is able to describe data from normals and patients with a sensorineural hearing loss. Variability of the critical band estimates, intrasubject as well as intersubject, is larger than for visually obtained estimates. However, visual estimation is difficult, subjective, and probably heavily biased. The model produces estimates which in logarithmic form have a Normal distribution at medium loudness level, while visual estimation gives rise to irregular distributions at all levels. A normal range for model estimates from sets of data obtained at medium loudness level is defined by mean and standard deviation.


Clinical critical band estimation.

Clinical critical band estimation. A modified version of the method of loudness summation, developed for clinical critical band estimation, is presented. The stimuli are noise bands centred around 1 kHz. The standard procedure includes 1) determination of the "sensitivity curve": the loudness difference between broad band noise and narrow band noise as a function of the level. For clinical use this function is necessary for evaluation of the level with the most rapid growth of loudness with bandwidth, i.e. the optimum level for sharp determination of the critical bandwidth. 2) Determination of the critical band function, i.e. the difference in sound pressure level required for equal loudness of the test noise band and the reference as a function of the bandwidth. This determination is performed at a level with maximum growth of loudness, evaluated by the sensitivity curve. 3) Critical band estimation by a mathematical model, described in another work (Bonding et al., 1978) from the data obtained. The method is analysed regarding feasibility and reproducibility.


Temporary threshold shift after exposure to pop music. Temporary threshold shift (TTS) was studied in pop musicians as well as in listeners. It appears that TTS is less pronounced in pop musicians than in listeners. This can only in part be explained by slightly inferior hearing threshold levels than in the audience before exposure. Further, male listeners showed more TTS than female listeners. After 2 hours of exposure to live pop music a TTS2 appears in pop musicians after an exposure to 98 dB(A) as opposed to listeners where TTS2 appears at 92 dB(A). When the present results are related to the CHABA risk criteria it seems that exposure to live pop music at 100 dB(A) for 2 hours is a limit which should not be exceeded if the risk of permanent hearing loss is to be avoided.


The effectiveness of two infant hearing screening programmes in New Zealand. Early detection of congenital hearing loss is vital. A neonatal hearing screening programme and a 9 month at risk hearing screening programme are analysed. Neither contributed significantly to the detection of deaf infants, though 9 month at risk screening can be worthwhile if well administered. Age of detection data for deaf preschoolers in New Zealand are presented.


Compound impulse response for the brain stem derived through combinations of cochlear and brain stem recordings. To overcome some of the problems involved in the application of brain stem evoked responses (BSER) in otoneurological diagnosis an approach is developed which combines cochlear and brain stem recordings. The activity of the cochlea and brain stem generators, as seen from the far-field recording electrode, is considered to be the output from a single system. The impulse response of this system can be derived through deconvolution of the brain stem evoked responses, BSER, with the compound action potential, AP, followed by appropriate filtering. This method is used on the recordings from 15 subjects with various degrees of cochlear hearing loss. The results show that the compound impulse response, CIR, for the brain stem consists of five recognizable peaks. From the individual subjects this response pattern is largely independent of intensity. By plotting the amplitude and latency of the individual peaks for all 15 subjects a set of normative data is retrieved. The variation in the data is small, probably because interfeerence from the periphery is eliminated and the separation of activity from the different brain stem generators is improved.


Screening tympanometry in newborn infants and during the first six months of life. Tympanometry was performed in 151 healthy children at birth and at 3 and 6 months of age. At birth 10.5% of the ears had a pressure of -100 mmH2O, and 0.3% a pressure of -125 mmH20. The pressure in most of these ears later became normalized. At 3 months of age 17.9% had a pressure of -100 mmH2O or less, and at 6 months of age 39.2%. At 6 months of age 1.3% of the ears had flat curves and middle ear effusion, and 9.6% had a pressure between -200 and -300 mmH2O. The pressure changes and their cause were analysed. Catarrhalia occurred in 23% of the infants before 3 months of age and in 60% in the 3-6 month period. This is an important though not the only etiological factor for the reduced ventilation in the middle ear, which probably occurs via oedema of the tubal mucosa and mild internal tubal occlusion. Ventilation was significantly reduced at 3 months of age in catarrhal girls, and in catarrhal boys at 6 months of age.


Comparison of unaided MCLs and use-gain of hearing aids. Unaided MCLs for narrow bands of noise centered at 1 000, 2 000, 3 000 and 4 000 Hz were compared with the use-gain of hearing aids worn by 10 subjects with sensorineural hearing loss. In addition, for eight subjects, MCLs measured at the time of the hearing aid evaluation were compared with MCLs observed at the time of hearing aid follow-up. Results of the study suggest that (1) hearing aid use-gain can be accurately predicted on the basis of the MCLs for the narrow bands of noise, and (2) the hearing-impaired subjects were highly consistent in their MCL judgments for narrow-band noise.


Decoding of human compound action potentials. The physiological formation of the action potentials is presumed to be well-known and a method of decoding these potential is therefore based on this knowledge. The method uses the reverse process, i.e. deconvolution of the recorded AP's with a unit response, and a subsequent nonlinear transformation of the obtained waveforms (sigma PST-compound PST) from the time- into the location domain (distance along the coclear partition). The transformed waveforms are called excitation patterns. Stimulus polarity seems to have only a minor influence on the excitaton patterns and it is possible to produce frquency-specific information of the coclear function. A clinical case demonstrates the concordance between the excitation patterns and the puretone audiogram.