Complete differentiation of adipocyte precursors. A culture system for studying the cellular nature of adipose tissue. Evidence for the complete morphological maturation of precursor cells into adipocytes in vitro is presented. Cells were isolated from the stromal fraction of adipose tissue from adult humans and from rats and were grown in culture. Abdominal skin fibroblasts were used as controls. All cell strains were initially fusiform and replicated. On reaching monolayer confluency, they were transferred to an enriched growth medium in which the human and rat adipocyte precursors differentiated into a homogeneous population of cells, morphologically indistinguishable from mature adipocytes. In contrast, skin fibroblasts from the same person or animal, and grown under identical culture conditions, did not accumulate lipid and retained their fusiform contour. The same results were obtained in the first six subcultures that were studied. Thus, there is firm evidence that fat tissue of adult humans and rats contains adipocyte precursors that differentiate into mature fat cells. The culture system that has been described will facilitate the elucidation of the factors involved in replication and differentiation of adipocyte precursors.


The ultrastructure of campaniform sensilla on the eye of the cricket, Gryllus campestris. The structure of the campaniform sensilla of the cricket eye was investigated by light and electron microscopy. Each sensillum is innervated by a single bipolar neuron. Its axon extends through the retina into a side-branch of the nervus tegumentarius. The dendrite extends through a cuticular channel to the surface of the cornea. The distal part of the dendrite, the sensory process, contains a tubular body and is attached to a cuticular cap which is obliquely inserted into the exocuticle between the corneal lenslets. Some particular structural features as well as the function of the campaniform sensillum of the cricket eye are discussed.


Occurrence and regional distribution of calcareous concretions in the rat pineal gland. Serial sections of 90 Sprague-Dawley rat brains with the pineal in situ were scanned to determine the occurrence and regional distribution of calcareous concretions within the pineal gland and its surrounding leptomeningeal tissue. In 90% of the cases examined concretions were found in varying number and appearance, predominantly lying in the dorsal region of the pineal gland and in the distal portion of the pineal stalk. Discussing the hypothesis advanced by Lukaszyk and Reiter (1975) that the origin of pineal concretions may be related to a neurosecretory process involving a pineal carrier protein, called neuroepiphysin, it is thought that, in view of the intra- and extra-pineal occurrence of concretions, processes other than secretion should be considered. Since in the pineal organ lymphatics are lacking it may well be that, due to a reduced drainage of tissue fluid, the coagulation of intercellular organic debris mingled with minerals increases with age.


Cholinergic nerves in the thyroid gland. The cholinergic innervation of the thyroid gland has been studied in the human. AChE positive nerve fibers are localized in the wall of the thyroid artery, arranged in two plexuses, a superficial (adventitial) and a deep one (medial). The glandular tissue is provided with cholinergic nerve fibers, localized between and around thyroid follicles. The present results suggest that the endocrine activity of the thyroid gland is also under the control of the autonomic nervous system.


Elevated ejection fractions in patients with the anginal syndrome and normal coronary arteriograms. The etiology of chest pain in patients with the anginal syndrome and normal coronary arteriograms has not been established. There has been no explanation for the association of electrocardiographic, hemodynamic, and myocardial metabolic abnormalities consistent with myocardial ischemia observed in some patients with this disorder. Historical, clinical, laboratory, and hemodynamic data of 45 patients (24 females, 21 males), mean age 47.5 years, with chest pain and normal coronary arteriograms are reviewed. Left ventriculograms were analyzed utilizing the single-plane cineangiographic measurement of left ventricular volume. Systolic ejection fractions for the 45 patients ranged from 0.66 to 0.91 (mean 0.80 +/- 0.01 SEM). Ventricular volumes determined angiographically revealed mean end-diastolic and end-systolic volumes of 83 +/- 5 ml and 18 +/- 2 ml, respectively. The mean changes in longitudinal and transverse segmental axis shortening that occurred during ventricular systole were 28.8% and 50.7%, respectively. These elevated values for ejection fraction, and reduced measurements of ventricular volumes, indicate that some patients with chest pain and normal coronary arteriograms may have small hearts with hyperdynamic ventricular contraction. These findings suggest that hyperdynamic ventricular contraction may play a causative role in the development of transient, angina-like chest pain in these patients. The etiology of the proposed hyperdynamic ventricle is unknown, but it may be attributable to increased beta-sympathetic stimulation of the myocardium.


Ergonovine testing for coronary artery spasm in patients with angiographic mitral valve prolapse. Coronary artery spasm (CAS) has been postulated to be a pathophysiologic mechanism in the production of ischemic-like chest pain and ECG changes in patients with idiopathic mitral valve prolapse syndrome. To evaluate the possible role of symptomatic CAS evoked by ergonovine maleate, this agent was administered (0.05 to 0.4 mg IV) to 24 patients with chest pain and mitral valve prolapse who had no significant (less than 50%) coronary artery obstruction. Symptoms, ECG and blood pressure changes were monitored in all patients following ergonovine administration. No significant changes were observed in heart rate, systolic blood pressure, or double product. Six patients developed their typical chest pain. In two of these six with chest pain, ST segment shift greater than 1 mm were seen. Post-ergonovine left ventricular end-diastolic pressure (LVEDP) and coronary angiographic changes were also studied in subgroup of 12 of these patients, including five of the six chest pain responders. In the five chest pain responders, pain was associated with a significant rise in LVEDP, whereas no significant change occurred in those patients not experiencing chest pain (p less than 0.01). Chest pain was also associated with significant CAS (greater than 50% lumen reduction) in two patients, each with ST segment shifts greater than 1 mm. In summary, ergonovine stimulation failed to evoke symptoms, ECG or blood pressure changes in three quarters of mitral valve prolapse patients studied. Six patients developed chest pain. Chest pain was assoicated with ECG changes characteristic of CAS in two of these patients, each with angiographic CAS. Thus, symptomatic CAS induced by ergonovine was absent in the majority of these 24 patients with idiopathic mitral valve prolapse syndrome.


Artifact production with micromanometers used to record intracardiac pressure and sound. In horses experimental right and left heart catheterization using a catheter with two microtransducers 9 cm apart, usually in a transvalval position produced pressure and sound artifacts that confounded the diagnosis. Most were probably due to malpositioning resulting in movement through a valve during recording or impingement on the valve cusps or the chordae tendineae or lodgement in the apex of the heart. The recognition of these artifacts is particularly important in studies of large animals in which catheter siting cannot be monitored by radiography.


Echocardiography in the diagnosis of Lutembacher syndrome. In two patients with Lutembacher syndrome cardiac catheterization demonstrated a large atrial septal defect but no diastolic gradient across the mitral valve. Echocardiography was compatible with right ventricular volume overload and mitral stenosis. Surgical exploration of the mitral valve at the time of atrial septal defect correction is warranted when the echocardiogram is suggestive of mitral stenosis.


Transmural myocardial infarction in the absence of coronary arterial luminal narrowing in a young man with single coronary arterial anomaly. Reported is a case of single coronary arterial anomaly (SCAA) with its origin from the right sinus of Valsalva as demonstrated by selective coronary arteriography. No branches coursed between the great vessels. Electrocardiography and vectorcardiography were consistent with inferior wall myocardial infarction, although subsequent coronary arteriograms were free of luminal narrowing. While this is an infrequently recognized isolated coronary anomaly, it may carry significant risk of myocardial ishcemia. This risk may not depend alone upon the passage of a branch of SCAA between the great vessels. Evidence of precocious ischemic heart disease should alert the angiographer to look for anomalous coronary anatomy.


New performed catheter and method for retrograde left atrial or complete left heart catheterization. Employing a new catheter and technique complete retrograde left heart catheterization was accomplished in 96 of 100 consecutive patients. These 96 patients included 37 with ischemic heart disease, 13 of 17 with isolated aortic valve deformities, 11 with isolated rheumatic mitral valve deformities, 10 with combined rheumatic aortic and mitral valve deformities, and 25 with other problems. The only failures were in 4(of 27) patients with aortic valve deformities. No untoward complications occurred. The retrograde catheterization fluoroscopy time was usually less than 2 minutes. The shortest time was 44 seconds, the longest, 6 minutes and 2 seconds. These data indicate that this new catheterization method achieves safe, reliable (when the aortic valve is not deformed), simple, and rapid complete left heart catheterization. They further indicate it may be useful in assessing patients with mitral stenosis, pulmonary hypertension, hypertrophic obstructive cardiomyopathy, and left-to-right shunt problems.


A new technique: right ventriculography using a preshaped catheter. Right ventriculography with a preshaped catheter (J- or L-shaped) was evaluated in make the diagnosis of tricuspid regurgitation. Thirty normal subjects who did not have valvular disease showed no evidence of tricuspid regurgitation or premature ventricular contractions during injection except in one case. On the other hand, 24 patients with combined aortic and mitral valve disease showed mild to moderate tricuspid regurgitation in 11 patients and severe tricuspid regurgitation in eight patients. Only two patients developed frequent run of premature ventricular contraction during injection. Seven patients with severe tricuspid regurgitation were found to have severe tricuspid regurgitation during surgery. No evidence of tricuspid regurgitation was found in all six patients with isolated aortic valve disease. We can conclude that right ventriculography by the preshaped catheter improves the diagnostic accuracy of tricuspid regurgitation and a grading system of tricuspid regurgitation by angiography is proposed.


Origin and length of left main coronary artery: its relation to height, weight, sex, age, pattern of coronary distribution, and presence or absence of coronary artery disease. The distance from the base of the left coronary sinus to the origin of the left main coronary artery was measured in 54 patients. The length of the left main coronary artery and the pattern of arterial dominance were determined in the last 37 patients. These variables were correlated with height, weight, age, sex, and presence or absence of coronary artery disease. Average distance from the basis of the left coronary sinus to the origin of the left main coronary artery was 19.4 +/- 2.7 mm. Average length of the left main coronary artery was 9.7 +/- 4.3 mm. There was a large inherent variability between distance from the base of left coronary sinus to the origin of the left main coronary artery and height of the subjects. Other variables did not show positive correlation. Similar large variability was noticed between of the left main coronary artery and height of the subjects. Thus, from these observations it was not possible to predict the distance from the base of the left coronary sinus to the origin of the left main coronary artery or the length of the left main coronary artery using height or any other variable. The importance of these findings in relation to coronary angiography is discussed.


Undifferentiated and differentiated L6 myoblast plasma membranes. II: Comparison of the morphological and biochemical characteristics of isolated plasma membranes. Plasma membrane vesicles isolated from undifferentiated and differentiated L6 myoblasts show a comparable phase and ultrastructural morphology. Both are agglutinated by Concanavalin A and wheat germ agglutinin, contain approx. 20 polypeptides and have a comparable intramembranous particle density and topography.


Inhibition of kidney tubule induction by charged polymers. Charged polymers, known to alter cell surface characteristics, reversibly inhibit the intercellular communication required in kidney tubule induction. This effect seems to be a function of their charge density. It is suggested that this effect is due to the formation of a molecular barrier between the interacting cell surfaces.


Characterization of differentiation antigens of the mouse mammary epithelial cell (MME antigens) carried on the mouse milk fat globule. The characterization of mouse mammary epithelial (MME) antigens from the mouse milk fat globule (MMFG) is described. Heterologous antisera against fat-free MMFG material identifies by indirect immunofluorescence techniques, cell-type-specific MME antigens on the surface of mouse mammary epithelial cells and MMFGs and not on cells of other tissues. Mammary epithelial cells of all mouse strains tested were positive. However, the intensity of staining differed. Specificity of anti-MME for MME antigens is demonstrated by competition and cross-absorption experiments. The MMFG is composed of 5 main proteinaceous components, 3 of which contain carbohydrate and which are shown to contain the specific MME antigens.


Sulfated glycosaminoglycans of cells grown in culture: dermatan sulfate disappearance in successive fibroblast subcultures. Sulfated glycosaminoglycan content of primary cultures of guinea pig embryo fibroblast in reported. It is shown that changes of sulfated glycosaminoglycans occur in successive subcultures: 1) disappearance of dermatan sulfate and 2) a slight increase in the proportion of heparitin sulfate. The sulfated glycosaminoglycan composition of the mammalian cell established lines: VERO, SIRK, Hep-2, MK-2, BGM, IB-RS-11 (S6) and 3T6 is also reported. It is shown that chondroitin sulfate AC and/or heparitin sulfate are the main glycosaminoglycans of the established cell lines (except 3T6). A possible role of these glycosaminoglycans in cell biology is discussed.


Cell specific effect of ecdysone on RNA synthesis in the differentiated salivary gland of Acricotopus lucidus. The influence of the steroid hormone ecdysone on the RNA metabolism of 2 cell types (main and anterior lobe) of the Acricotopus salivary gland has been investigated. Ecdysone has been found to increase the synthesis of 4S RNA and poly(A)+ RNA in the main lobe, while the anterior lobe remained unaffected by the same treatement. The stimulated poly(A)+ RNA is characterized by its relatively low cytoplasmic turnover. No evidence has been found for the stimulation of ribosomal RNA synthesis in both cell types. Analysis of the metabolic stability of cytoplasmic poly(A)+ RNA after ecdysone administration revealed a different response of the main and anterior lobe cells. Only in the anterior lobe ecdysone causes a shortening of the lifetime of that part of poly(A)+ RNA which is peculiar in its early appearance and relatively low stability in the cytoplasm.


A quantitative assessment of the effect of medium composition on mouse myogenesis in vitro. The effect of variations in medium horse serum (HS) and chick embryo extract on the extent of myogenesis in primary mouse muscle cultures was investigated. Seeding efficiency at 24 h in culture did not vary with medium composition, but total cell number at 8 days was diminished at low embryo extract concentrations. Five media from the range of 16 tested, supported significantly greater myogenesis. Within this group of 5, there was no difference in ability to support myogenesis. The effect of medium composition on myogenesis is discussed.


[Morphogenesis of Mikulicz's cells (electron-optic study)]. In a female aged 83 who had been living in Prague for years, a bioptic diagnosis of rhinoscleroma was made. The disease responded well to Septrin treatment. Electron microscopical examination confirmed the histiocytic origin of Mikulicz cells, but cast doubt upon the belief that the large phagocytic cysts in such cells developed by confluence of smaller vacuoles. The examination revealed that the large cystic formations only contained Klebsiellae and a dense finely granular material identical with that of the bacterial capsiles. The small vacuoles found in the vicinity of the large ones never contained bacteria and their contents was either coarsely granular of finely filamentous. Therefore it rather corresponded to degradation products of the original content of the larger phagocytic cysts. The final picture of the Mikulicz cell are macrophages with only small light rounded vacuoles containing mucoid but no Klebsiellae.


[Primary amyloidosis of the brain in 34-year-old man]. In a male aged 34 dying suddenly with symptoms of cerebral haemoarrhage, amyloid deposits were found in the vicinity of arterioles, venules, small arteries and veins. In the vicinity of lateral ventricles, particularly around the frontal horns, the amyloid formed compact masses macroscopically presenting as grayfish areas showing a distinctly firmer consistency. The perivascular aggregates strongly resembled those occurring in Alzheimer's disease.


[Amyloidosis of the respiratory system]. Tumour-like amyloid deposits of the larynx and lungs were compared. The amyloid was shown to exhibit identical tinctorial properties, but there were more multinucleated cells in the laryngeal localization.


[Morphological findings in RES modified by methylpalmitate]. Intravenous injections of methylpalmitate (MP) suspension in extreme doses of 3 g/kg of the animal's weight were seen developing in rats after 24 hours manifestations of phagocytosis in the cells of the red pulp of spleen followed by red pulp necrosis. Smaller doses of 1-1.5 g MP/kg of b.w. caused no pronounced morphological changes in the animal's organs.


[Congenital radio-ulnar synostosis of children (author's transl)]. 29 congenital radio-ulnar synostosis have been observed in 16 childrens. The authors review the clinical patterns of this affection: most often bilateral, it results in impossibility of pronosupination of the wrist which has but little functional consequence, if the hand is in an intermediary position. On the X-ray its almost always a superior radio-ulnar synostosis but the inferior radio-ulnar joint is abnormal and non functional. Only the children severely handicapped by a hand fixed in pronation should be operated upon. No good result can be hoped from a surgery that tries to restore pro-supination. The best surgical technique seems to be a simple horizontal osteotomy through the synostosis itself which allows a derotation of the forearm into the functional intermediary position. Severe complications can occur. Indications and technique must be very careful since this congenital abnormality is very well tolerated.


[About of 82 obstetrical astro-articular injuries of the new-born (excepting brachial plexus palsies). Limits of initial therapeutic aggression and follow-up of evolution, particulary concerning traumatic separation of upper femoral epiphysis (author's transl)]. Obstetrical fracture has not a bad character, because of quick healing and, above all, because of extraordinary modelling by growth. The authors record 33 fractures of long bones which confirm this good prognosis. 20 birth fractures of the clavicule associated with brachial plexus palsies are recorded on account of their pathogenic, diagnostic and therapeutic intricacies. Prognosis of obstetrical traumatic separation of the epiphysis (epiphysiolysis) would be more preoccupying. This feeling is not given off the series of 28 observations recorded which conern 13 upper humeral, 6 lower humeral epiphysis, 1 of 6 upper femoral and 1 lower femoral epiphysis, of upper and lower of tibia. Diagnosis is not so easy, helped, if necessary, by arthrography. The clinical aspect of "pseudo-dislocation" associated with periostal callus, early appearing (about on the 10th day) rectifies diagnosis. Early treatment, as little aggressive as possible, (essentially orthopedic management by tractions along the axis of limb, giving up an anatomy as close as possible to normality) avoids sequellae, not existing at shoulder nor elbow and, if they exist, extremely decreased at hip, and the surgical management of which is always delayed. Initially good result of one birth dislocation of cervical spine, precedently recorded is considerably impaired.


[Epiphysiodesis in the treatment of discrepancies in length of the lower extremities (author's transl)]. Thirteen children treated only by epiphysiodesis for inequality in the length of lower limbs were reviewed after maturity. The intention was to estimate the value of the predictions of growth used in this work and the effectiveness of the operation. The result of this procedure depends upon the accuracy in predicting the further growth in order to determine at what age the operation should be performed. The imperfect results of epiphysiodesis are attributable to prediction errors and to operation delay in some cases. Prediction can be made using only roentgenographic measurement of the femur and the tibia, skeletal age and growth charts of Green and Anderson. It is not necessary to make use of others factors such as the size of the child.


[Liver inflammatory lesions masquerading tumors (author's transl)]. The Authors report three unpublished cases of tumoral abscess of the liver in infants and children. Two different situations are considered:--clinical findings, laboratory tests and intraoperative examination can be more in favor of a tumor at times. Means of avoiding needless excisions are outlined.--two uncommon types of abscess are considered. One type has an areolar structure whereas the other is in fact inflammatory tumoral fibrosis. This abscess is a true tumor and must be treated accordingly. Pathological studies, etiology, bacteriology and clinical aspects of such abscess of the liver are reviewed.


[Use of arterio-venous fistulas for hemodialysis in children (author's transl]. From September 1977 till December 31st 1977, 21 arterio-venous fistulas were created in 18 children aged 6 to 15 years. Four early failures occured. The probability of fistula survival is 93% at 2 years for children treated only with hemodialysis. At the end of this same period of time, 62% of patients submitted to a combined treatment of hemodialysis followed by kidney transplantation have a functioning fistula. Overgrowth of the involved extremity, infection episodes and cardiac failure were not observed. One arteriovenous fistula is still functioning after 8 years.


[Post-traumatic stenosis of the bronchus (author's transl)]. The authors describe the unusual symptomatology presented by 2 cases of traumatic bronchial rupture in childhood. The first concerns a boy with rupture of the left superior bronchus revealed by a contra-lateral hemopneumothorax. The second cases concerns a young girl with rupture of the right main bronchus: wheezing appearing on the tenth day permitted the diagnosis. They emphasize the eventuality of partial bronchial lesions in cases of moderate and serious thoracic trauma in the child, which should be investigated by bronchoscopy the slightest doubt exists.


[Association of left diaphragmatic hernia, lung agenesia and esophageal atresia (author's transl)]. A literature study has been written about each failure concerning a very particular mishaping linking an agenesy of the left lung and of the left diaphragm to an esophagal atresia (type III). None similar case has been discovered in the literature. Concerning the diaphragmatic agenesies, the authors report several familial cases and outline the possibility of a genetic pathogeny.


[Dumping syndrome, a serious complication of Nissen's opération a report of four cases (author's transl)]. A rare complication of Nissen's operation is described on the basis of four cases. Appearing secondarily, its Clinical signs are hyperperistaltic diarrhea, without bacterial infection and a fall or levelling of the weight curve. Its constant features are:--acceleration of intestinal transit and principally of gastric evacuation;--a characteristic modification of glucose absorption and of the curve of the oral glucose tolerance test compared with the normal intravenous glucose tolerance test. Overload of dissacharides in the intestine and hypervagotony could explain the symptomatology, which responds with difficulty and sometimes only partially to a diet excluding rapidly absorbed surgars. This complication supervenes often in babies operated on at less than six months, and is an indication for post ponement of operation.


[Is separation of sternopagus conjoined twins possible? (author's transl)]. One case is reported of female sternopagus conjoined twins. One appeared normal, the other presented spina bifida with hydrocephalus. Separation was not made. Embryological study and postmorten findings demonstrate the actual impossibility of separation of sternopagus conjoined twins.


Study of the value of CPK and LDH isoenzyme determinations in the differential diagnosis of ischemic chest pain. 1. One hundred consecutive patients admitted with ischemic chest pain to the Emergency Department of Vancouver General Hospital were studied. The diagnosis was based on clinical assessment, EKG changes and the total CPK and LDH activities. However, unknown to the clinician. CPK and LDH isozyme determinations were also carried out and their possible impact on the diagnosis and management of the patients was evaluated retrospectively. In 37 patients with definitive myocardial infarction by all the above mentioned criteria the isozyme dterminations were of no further help. Similarly, the isozyme analysis was of no value in 22 patients with negative findings. In 26 patients with normal or unchanged EKG but elevations in either LPK or LDH, the isozymes were not absolutely necessary for the diagnosis but would have been highly reassuring to the clinician. 2. In the remaining 15 patients, the isozyme analysis would have enabled the clinician to make diagnosis of myocardial damage in 12 and rule out myocardial infarction in 3.


Children's housing and their health and physical development. The housing conditions of children in the National Child Development Study were related to their health and their height at the age of 16. Although children in crowded homes missed more school for medical reasons, the only illness they reported more often than children in better conditions was bronchitis. Those with inadequate amenities did not miss more school, although they also reported more bronchitis, as well as bilious attacks. Children in council houses were shorter than those in owner-occupied homes, but the only difference in height related to the conditions of the home was that crowded boys were slightly shorter than those who were not crowded. There was therefore little evidence of an association between poor housing and either ill-health or retarded growth among Britain's 16-year-olds in the 1970s, and this was still the case for children who had spent longer periods of their childhood in unsatisfactory housing.


Simple and rapid system for screening and identification of reducing sugars in urine. As part of our screening programme for metabolic disorders we needed a rapid, simple, inexpensive means to detect reducing sugars in urine, with a simple but precise test for their identification. Our system comprises a bismuth reduction test for reducing sugars, with unidimensional thin layer chromatography on silica gel and color development with diphenylamine--aniline for definitive identification.


Playfulness and the development of divergent thinking abilities. The purpose of this paper is to extract from current literature about play those concepts which seem to have most significance in the psychomotor development of the young child. For the purposes of this paper physical education is limited to that physical activity which occurs within the confines of a school. Very brief reference is made to play in relation to sport and the wider context of present-day culture. The concept of mastery play and stimulus seeking are examined as part of the child's growing maturity and the question is posed whether playfulness shown at an early age may be associated with a particular style of thinking in later years.


Structuring movement experiences for pre-school children. It is proposed that a conceptual framework should be used as a basis for the provision of movement experiences for young children. Developmental levels and classifications of movement are considered in order to structure environments that provide suitable opportunities for self-initiated movement for pre-school children.


A scheme for the evaluation of methods in clinical chemistry with particular application to those measuring enzyme activities. Part I: general considerations. A 20-point system is presented whereby commercially produced clinical chemistry procedures, i.e., in vitro diagnostic kits, may be assessed for adequacy of packaging, labelling and enclosed literature. Criteria are given for the selection of a reference method to use in the test method evaluation and the design of a patient comparison study using these two methods is described. The importance of standards and calibration materials as they relate to accuracy and specificity is discussed. A procedure for assessing accuracy by recovery studies is outlined. A method for the assessment of precision on a within-day and a day-to-day basis is described.


A scheme for the evaluation of methods in clinical chemistry with particular application to those measuring enzyme activities. Part II: analysis of data and performance assessment. Recommendations are made concerning the editing of day-to-day reproducibility data for establishment of precision in the evaluation of a clinical chemistry method. The concept of diagnostic and equalized diagnostic indices is introduced together with formulae for their generation from the usual precision and accuracy data acquired in method evaluations. These indices allow direct comparison of data obtained from procedures for measuring enzyme activities which employ a variety of experimental conditions and units in their protocols. The equalized diagnostic index permits assessment of the suitability of the normal range assignment. Permissible limits of variation (PLV) and permissible limits of discrepancy (PLD) have been developed empirically from detailed examination of data from method evaluations and proficiency testing surveys in the published literature. The application of the diagnostic indices and the two permissible limits of criteria have been illustrated using data from the assessment of 19 kits measuring CPK activity. The inconsistency of the correlation coefficient in method comparisons is confirmed.


Methods of assessment for use with the visually and mentally handicapped: a selective review. Literature published during the last 15 years and concerning assessment techniques applicable to the visually and mentally handicapped is reviewed. Aspects of assessment considered include professional organisation of health teams, electrophysiological measures, psychometric methods and some experimental investigations. The value of more reliable behavioural observation relevant to the client's future practical training needs is stressed.


Can we effectively assess hyperactivity in schools? All too often, restless, fidgety children who do not sit still or pay attention at school, and who may be disruptive and difficult to manage, are labelled 'hyperactive' by their teachers. The legitimacy of such a diagnosis is seldom challenged. Just what, though, does a child have to do to be hyperactive? This article sets out to review some of the measures which have been employed and to look, in particular, at their relevance in the assessment of activity levels within the classroom.


Sample application position and the resolution of protein separation on the Beckman Microzone Electrophoretic System. Many clinical laboratories use the Beckman Microzone electrophoretic system (Beckman Instruments Inc. Fullerton, CA 92634) for serum protein separation. Although detailed instruction is supplied in the manufacturer's manual (1) for protein separation, the effect of different sample application positions on the cellulose acetate membrane is not discussed. We have processed the serum specimen in various application positions and found that there is a definite relationship between the resolution of fractionated protein bands and the application position, particularly with specimens from patients with monoclonal gammonpathies. The resolution of the protein bands increases as the sample is applied closer to the anode end of the cellulose acetate strip. Although studies were carried out on the Beckman electrophoretic system, a similar application effect may be anticipated with other electrophoretic systems.


Electroencephalography and computerized transaxial tomography in epilepsy diagnosis. Over a 6-month period 89 patients with epileptic seizures were systematically examined by EEGs and CT. Forty-two percent of all cases showed pathological findings in CT compared to 89% with abnormal EEGs. CT is very useful in identifying organic lesions in the epileptic patient. CT identified 11 cases of supratentorial tumour which were correctly localized by EEG. In patients with seizures after trauma or encephalitis the EEG abnormalities were more than could be detected by CT. The EEG and CT findings in cerebrovascular disorders, alcoholism and other diseases are discussed. A remarkable result is the relatively high percentage of hydrocephalus (23%) in the group of cryptogenic epilepsy. Positive EEG findings as to epilepsy could be seen in 62% of the cases.


Toxic encephalopathy from chlorobenzilate poisoning: report of a case. Chlorobenzilate is an organochlorine insecticide with toxicity like those of Dichlorodiphenyltrichloroethane (DDT). A patient who developed toxic encephalopathy after exposure to chlorobenzilate mist, with associated clinical and EEG abnormalities, is briefly reported. Some unusual features of his clinical picture are pointed out.


The value of electroencephalographic recordings in dialysis encephalopathy: case-reports and review of literature. The electroencephalographic abnormalities with dialysis dementia are described in five patients with this disorder. The tracings of all patients showed a mild to moderate slowing of the background rhythm, intermixed with paroxysmal and rhythmic waves, most prominent on the frontal areas. Epileptiform discharges were seen in only one record. Clinical features, hypotheses regarding pathogenesis, and treatment of this usually fatal encephalopathy are briefly discussed.


Changes in otological teaching following analysis of failures in surgical technique. An analysis was made of the results of mastoid surgery performed in the Professorial Unit of the Royal National Throat, Nose and Ear Hospital, London, between the years 1970 and 1974. Most of the surgery was performed by trainee surgeons at the end of the teaching programme. The incidence of unsatisfactory results was greater with open mastoid surgery than with closed mastoid surgery. The causes of failure were analysed, and the underlying defects in the teaching programme identified. The subsequent modification in the teaching methods that resulted are illustrated.


The incidence, site, treatment and fate of labyrinthine fistula. Although the incidence of labyrinthine fistula appears to be similar in most reported series, the number of patients reported to have a positive response to the fistula test do not. This may be due to a lack of uniformity in the performance of the test. The method of the author, the direction of eye movement and its diagnostic significance are described. The occurrence and mechanism of severe sensorineural hearing loss in 5 out of 20 patients in whom the matrix was removed accidently from the fistula during mastoidectomy is discussed.


The etiology of chronic otitis media.

The etiology of chronic otitis media. Various current theories regarding the aetiology of chronic otitis media are considered in detail. The concept that it originates from an acute middle ear infection no longer appears tenable. Recent experimental work has demonstrated the role of invading skin causing invasive osteitis. It is postulated that in some instances osteitis may follow erosion of the metal skin and proceed to widespread chronic disease of the temporal bone. The important difference between obstruction and inadequacy of the Eustachian tube and the significance of the latter in chronic middle ear disease is emphsized. The Eustachian mechanism of cholesteatoma formation may best be studied by observing the development of retraction pockets following tympanoplasty.


Reconstruction of old radical cavities.

Reconstruction of old radical cavities. The methods as well as the primary and late results of 74 partial and 93 total reconstructions of old radical cavities were described. In partial reconstructions the tympanic cavity was reconstructed, but the cavity was not eliminated, as it was dry or could be kept dry. In total reconstructions the tympanic cavity and auditory canal were reconstructed, and in most cases the cavity was obliterated, either by muscle or by combined grafts of muscle, tragal cartilage, and homologous septal cartilage. On the basis of the late results, functionally 10--20% poorer than the  primary ones, the indications for reconstruction of old radical cavities were discussed. If there is chronic aural discharge, and if the cavity is lined with granulations, the ear can be rendered dry by total reconstruction in 90% of the cases.


Homograft stapes in middle ear surgery.

Homograft stapes in middle ear surgery. Descriptions are given of various uses of stapes homografts in tympanoplasty on ears with missing stapedial arch. The use of homograft stapes-incus assembly, placing the head of the homograft stapes on the patient's own footplate and on top of that an incus, is a method which at long sight has proved to afford better results than the use of an incus columella.


Ossicular reconstruction in the absence of stapedial crura. The reconstruction of the ossicular chain when the stapes crura are absent presents a difficult problem in achieving satisfactory functional results in the treatment of chronic oitis media by tympanoplasty. When the malleus handle is present, the cases have been treated mostly by repositioning part of an incus or a piece of cartilage between the malleus handle and the mobile footplate. The problem becomes more difficult in tympanoplastic management of old radical cavities with no ossicules apart from the stapes footplate. Apart of repositioning a part of incus or a cartilage strut between the fascial graft and the footplate, the author has tried, in the management of these cases during the last 3 years, a new "umbrella type" of prosthesis made entirely of tragal cartilage. This prosthesis enables a good resting surface for the new tympanic membrane and the hearing improvement seems to be greater than that resulting from other types of ossicular reconstruction.


Aeration in chronic otitis media.

Aeration in chronic otitis media. The mastoid air cell system must be looked upon as an air reservoir. The tympanic membrane is an air pressure regulator. The smaller the air volume of the mastoid the more pronounced is the volume displacement of the tympanic membrane. The more inefficient the Eustachian tube function, the more pronounced is the tympanic membrane displacement. The significance of these factors must be considered not only when discussing the etiology of chronic otitis media including cholesteatoma, but also when it comes to selecting procedures in restoring middle ear anatomy and physiology in chronic middle ear surgical disease.


Modified technique of tympanoplasty with functional results of 494 cases after 3 years. This paper gives the functional preliminary and final results of tympanoplasty as modified by Khan in types I--III in the form of a comparison. We examined 494 patients who were operated according to our modified technique. It is emphasized that in reconstruction of the middle ear, the use of a prepared fascial graft, homograft incus cartilage and external auditory meatal flap is sufficient. The preliminary and final results were documented with the aid of audiograms which were described and critically appraised according to two different types of evaluation. The evaluation did not only include the hearing results of tympanoplasty, but also the change in individual frequencies for all types. According to our appraisal of the operations with regard to social hearing the functional results of operations performed in our clinic may be considered above average. The hearing gain achieved from the preliminary postoperative control to the final examination is especially satisfying, since it also includes an improvement in bone conduction values.


External auditory canal cholesteatoma.

External auditory canal cholesteatoma. Cholesteatoma of the EAC is a rare otologic problem, particularly when keratosis obturans otica is excluded. The predominant features of EAC cholesteatoma are acute external symptoms, severe pain, recurrent physician visits, and paucity of X-ray findings. Poorly responding otitis externa should always alert the physician to the possibility of neoplasm, diabetes, or some other underlying condition which will not respond to just topical treatment. Cholesteatoma of the external auditory canal should also be considered in refractory cases of otitis externa. Three patients with EAC subperiosteal cholesteatoma are reviewed.


Longterm results in cholesteatoma surgery. From the results of 689 cases of cholesteatoma operated and followed over a period of 9 years, are discussed the respective indications of opened and closed techniques. The intact canal wall tympanoplasty with mastoidectomy is the preferred technique. It is undertaken on the understanding that it will be done in 2 stages over a 1-year interval. From the revised 460 cases, the presence of residual cholesteatoma was found in one out of 2 cases. Cause of high incidence are analyzed and commented. Retraction pockets or true recurrence of cholesteatoma whose incidence was 11% at the beginning of the series have practically disappeared since it was started to repair the tympanic frame with cartilage. Open techniques, modified radical mastoidectomy, with or without obliteration, are done when a 2-stage procedure is not possible. They are also indicated in particular cases related to the nature of the disease, mastoid pneumatization, condition of the attic wall or the patient's age. Auditory results do not show any significant difference between the open and closed techniques when the ossicular chain is complete or the stapes intact. However, in cases of subtotal ossicular defects, preservation of the tympanic frame provided the most favourable conditions for a functional restoration.


Tympanoplasty and tuberculosis of the middle ear. This report concerns 6 cases of middle ear tuberculosis. Typical clinical signs for this infection nowadays consist in a pale-coloured mucosa, spontaneous facial paresis, pneumatization of the mastoid and in a changing performation of the tympanic membrane. These signs can occur single or in combination. Under a specific chemotherapeutic treatment even in tuberculous infection of the middle ear tympanoplasty can be performed without danger for the newly transplanted tympanic membrane. One should consider tuberculous infection especially in cases when for apparently inexplicable reasons necrosis of the transplant occurs postoperatively.


Fistula of the lateral semicircular canal. The principles enunciated by Adam Politzer concerning the management of fistula of the lateral semicircular canal are as true today as they were during his time, in spite of the advances made in otologic surgery during the past 25 years or more. If a fistula of the lateral semicircular canal is suspected or proven, the patient's hearing has a greater chance of being preserved if the fistula is left undisturbed. Several illustrative cases are presented.


The role of antibody in the inhibition of the growth of Meth.A tumour in syngeneic experiments in vivo and in vitro. An in vitro technique for detecting anti-tumour responses was studied and shown to involve non- T cells. Further examination of the effector mechanism revealed that tumour inhibition was antibody mediated, probably through complement dependent lysis; ADCC was considered unlikely. The amount of antibody involved was small, as shown by indirect immunofluorescence labelling of tumour cells, but was nevertheless effective in vitro and in causing regression of tumours in vivo. These findings may have important implications for the manipulation of the host responses to tumours.


Migration inhibition of sensitized mouse spleen cells by cell-associated transplantation antigens: effect of method of antigen presentation. The migration of specifically sensitized mouse spleen cells following exposure to allogeneic cells (antigen) in vitro was studied. The migration inhibition recorded when sensitized cells were admixed with allogeneic cells in capillary tubes (mix method) was compared to the inhibition observed when allogeneic cells were suspended in the culture chamber media (non-mix method). Specificity as well as a higher degree of migration inhibition were obtained using the mix method, suggesting that this method is superior to the nom-mix method.


Effect of cyclophosphamide on Toxoplasma gondii infection: reversal of the effect by passive immunization. Treatment of mice with cyclophosphamide (CY) at a dose of 250 mg/kg body weight 24 hr prior to infection with an avirulent strain of Toxoplasma gondii delays the appearance of antibody by about one week and results in 70% mortality. To discount other effects of CY besides inhibition of antibody synthesis, CY-treated infected mice were passively immunized with a pooled specific serum collected from chronically infected syngeneic animals. Passive immunization reversed the effect of CY treatment if the titre of antibody in recipients reached 1 : 512 or more, as measured by the indirect immunofluorescence technique (IFT). It is therefore suggested that antibody plays an important role in establishing an infection-immunity (premunition) in this system.


Reactivity of ovine lymphocytes to phytohaemagglutinin and pokeweed mitogen during pregnancy and in the immediate post-parturient period. Lymphocytes from sheep in late pregnancy and at parturition showed markedly impaired proliferative responses to phytohaemagglutinin (PHA) in vitro when cultures were supplemented with foetal bovine serum (FBS), as compared to the responses of lymphocytes from non-pregnant sheep, sheep at 40 days of gestation and sheep at 80 days of gestation. Similar responses to PHA were observed when the medium was supplemented with autologous plasma (AP), although the responses were of a lower order. In both cases elevated responses to PHA were apparent at 10 days post-parturition. The response with FBS was more marked than with AP. Progressive reduction of lymphocyte responses to pokeweed mitogen (PWM) in the presence of FBS and AP were less obvious, although it was still apparent that responses to PWM were depressed at 120 days of gestation and at parturition, when compared with lymphocyte responses during early pregnancy (at 40 days and 80 days of gestation). The difference was much more apparent with AP than with FBS and responses during early pregnancy were markedly higher than those with FBS. An increase in lymphocyte responsiveness to PWM 10 days post-parturition was evident whether FBS or AP was incorporated in the cultures. The response with FBS was again more marked than with AP.


Reduced immunoglobulin concentration and impaired macrophage function in mice due to diphenylhydantoin. Diphenylhydantoin (DPH) depresses serum IgA and IgM concentrations and polyvinyl pyrrolidone (PVP) clearance in mice.


Stimulated autoantibody response and increased longevity in NZB/NZW mice treated with cyclophosphamide and tilorone. The experiment described in this report was designed to study the effects of immunostimulatory therapy in cyclophosphamide-treated hybrid New Zealand mice. Autoantibodies, renal histology and neoplasms were studied in seventeen female NZB/NZW mice treated with daily injections of the potent immunosuppressive drug, cyclophosphamide. Results were compared with fifteen female NZB/NZW mice who received both cyclophosphamide and tilorone, an interferon inducer which stimulates the immune system. Fifteen control mice received saline. The controls died with spontaneous arteritis and immune complex glomerulonephritis; their mean age at death was 46 weeks. In the cyclophosphamide group anti-DNA antibodies and renal disease were suppressed. Mean longevity was prolonged significantly to 80 weeks. Two mice died of iatrogenic causes, and the remaining fifteen mice died with neoplasms. Eleven mice had multiple neoplasms; a total of twenty-seven neoplasms appeared. In mice receiving combination therapy, autoantibody responses were not suppressed. Nevertheless, glomerulonephritis was controlled partially and the mean lifespan was prolonged to 82 weeks. Eighteen neoplasms appeared in ten mice in the combination treatment group, and five mice had more than one neoplasm. The appearance of lymphomas was delayed in mice receiving two drugs. It was concluded that concurrent therapy with tilorone stimulated autoantibody production and altered the expected pattern of neoplasia in cyclophosphamide-treated NZB/NZW mice.


The immunogenicity of milk from various species for the guinea-pig. Young guinea-pigs, sensitized and challenged by the parenteral administration of bovine and human milks, died of anaphylaxis while others, sensitized and challenged with guinea-pig milk, were unaffected. The type of milk fed to young guinea-pigs from birth did not alter the basic immunogenicity of cow's milk or the lack of immunogenicity of guinea-pig milk for the young guinea-pig.


Increase in non-specific antibody mediated cytotoxicity in malarious mice. The K cell activity in the spleens of mice infected with Plasmodium chabaudi has been investigated. Chicken red cells coated with antibody were the target cells used. Increased K cell activity was found 6 to 15 days, but not 3 days, after infection with the malaria parasites.


Factors influencing the secondary antibody response to flagellin in man. The secondary antibody response to 5.0 microgram flagellin was studied by haemagglutination in 132 healthy or convalescent subjects given a primary challenge with 5.0 microgram flagellin from 1 to 44 months previously. The peak titre, expressed as total antibody, occurred at 2 weeks and was mainly immunoglobulin (Ig)G. The magnitude of the titre of total antibody was influenced predominantly by that of total antibody in the primary response (P less than 0.001), the interval between primary and secondary responses (P less than 0.005) and the subjects' age (P less than 0.05) and sex (P less than 0.08). Together these accounted for 23% of the variability observed in the secondary response, with total antibody titre in the primary response accounting for 11% of the variability. The titre of IgG antibody was likewise influenced by these four variables, but the influence of age or sex on IgG antibody was not statistically significant. In human vaccination programmes, choice of the appropriate interval between primary and booster inoculations could increase prophylactic effectiveness and, if two inoculations were to prove as effective as three, there would be reduced work and increased public acceptance. Moreover, the demonstrable capacity for responsiveness of aged and debilitated persons should encourage the wider use of appropriate prophylactic immunization in these groups.


Activation of lymphocytes in CLL by protein A from Staphylococcus aureus. The mitogenic activity of protein A (PA), leucoagglutinin (LA) and pokeweed mitogen (PWM) was tested in six cases of chronic lymphatic leukaemia (CLL), and the response to PA and LA in six healthy controls. The effect of foetal calf serum (FCS) and pooled human AB serum in the cultures was tested in two patients. The response to LA in the patients was about one tenth of that in the controls. The response to PA was strong both in patients and in healthy controls. However, in lymphocytes from CLL patients this response was serum-dependent, being very strong with FCS in the culture medium, but absent when the medium contained human AB serum. Lymphocytes from normal controls responded to PA in the presence of AB serum.


Activation of the alternate complement pathway in Staph. aureus infective endocarditis and its relationship to thrombocytopenia, coagulation abnormalities, and acute glomerulonephritis. Twenty-four patients with infective endocarditis (IE) are described, fourteen with Staph. aureus and ten with other organisms. Despite the acute nature of the infection, ten of the fourteen with Staph. aureus IE were hypocomplementaemic; six of these ten had normal levels of C4 associated with low C3 levels, suggesting activation of the alternate complement pathway. Factor B (C3PA) was also low in three of these six cases. In the ten patients with non-Staph. IE, three had hypocomplementaemia with low levels of C4, C3, and Factor B, probably due to C1 (classical pathway) activation with feedback activation of the alternate pathway. In addition, thrombocytopenia was noted in nine of the twenty-four patients and was associated with hypocomplementaemia; the degree of renal insufficiency noted in these patients also correlated with hypocomplementaemia. In Staph. aureus IE thrombocytopenia and hypocomplementaemia, occurring early in the course of the disease, may be due to a non-immune interaction of Staph. cell wall products (Protein A) with immunoglobulin, complement components, and thrombocytes.


Longitudinal effects of clinical therapy and the edentulous state on the transformation of lymphocytes from patients with severe periodontitis. Twenty dentulous subjects undergoing clinical therapy for severe periodontitis were used to determine the longitudinal effects of bacterial plaque reduction in vitro lymphocyte transformation. The therapy consisted of either complete extractions or partial extractions and periodontal surgery combined with rigorous oral hygiene. Prior to therapy lymphocytes from these subjects responded significantly to Streptolysin O (SLO) but were not transformed significantly by solubilized dental plaque. However, after therapy lymphocytes from these same subjects responded significantly to both solubilized dental plaque and SLO. This indicates that the severe periodontitis patients were specifically unresponsive to solubilized dental plaque prior to therapy. The mechanism of the unresponsiveness is not clear, but probably does not involve serum factors because supplementation of the lymphocyte cultures with pooled homologous plasma from individuals with gingivitis or moderate periodontitis (instead of the patient's autologous plasma) did not significantly change the mean lymphocyte responses to solubilized dental plaque. In addition, lymphocytes from eleven long-term (5--18 yr) edentulous subjects, who were free of oral inflammation, were significantly transformed by solubilized dental plaque. The latter lymphocyte responses and those of the treated periodontitis patients could be due either to the presence of low levels of oral bacteria in the edentulous mouth or to the lymphocyte transformation assay being a measure of previous antigen sensitization rather than current disease status. In either case, lymphocyte transformation to solubilized dental plaque is not a useful diagnostic tool in periodontitis, but should continue to be a valuable research tool for investigating pathological mechanisms in periodontitis.


Damaged membrane fragments and immune complexes in the blood of patients with Behcet's syndrome. Electron microscopic examination of centrifuged pellets of serum from patients with Behcet's syndrome and recurrent oral ulcers revealed the presence of a large number of membrane fragments. Some of these membranes showed numerous 10 nm holes that were identical to lesions produced by the action of complement. An attempt was made to correlate complement levels, antibodies and cellular immunity with the presence of the membrane fragments, without success. However, a significant correlation was found between the membranes and the IgG class of immune complexes. The finding of membrane fragments with complement-induced damage predominantly in the blood of patients with Behcet's syndrome, and the association with soluble immune complexes suggest that the latter may generate C5b-9 complexes which may bind to the surface of cells in result in cell lysis.


Circulating immune complexes in active Behçet's disease. Levels of immune complexes (IC) were determined by the Raji-cell and C1q-binding radioimmunoassays in the sera of eighteen patients with Behçet's disease. Eight patients (44%) were found to have significantly elevated levels of IC (range 56 to 1600 microgram equivalent aliquots of heat aggregated IgG (AHG/ml) by the former test and nine by the latter (7 to 500 microgram equivalent AHG/ml). The presence of IC showed a significant correlation with disease activity score (P = 0.003, Mann-Whitney Rank Sum Test). Abnormal values of IC tended to remain abnormal when sera were retested after 1 year. There was no correlation between IC and duration of disease or any specific organ involvement. The IC were found predominantly in fractions of about 19S and greater when fractionated by sucrose density gradient or Sephadex column techniques. The results suggest the possibility that IC may contribute to the pathophysiology of Behçet's disease.


Immune complex detection and complement activity in rheumatoid arthritis: a comparative study of a radioimmunoassay using monoclonal rheumatoid factor, gel diffusion techniques and C4 activity. Paired sera and synovial fluids from forty-nine patients with rheumatoid arthritis and twenty-five with other forms of arthritis were tested for immune complexes by a radioimmunoassay using monoclonal rheumatoid factor and gel diffusion procedures with monoclonal rheumatoid factor and C1q. Synovial fluid hemolytic C4 and C4 adjusted for IgG concentration were determined in both groups of patients. Immune complexes were detected at similar high frequencies in the rheumatoid synovial fluids by precipitin formation with monoclonal rheumatoid factor (68%) and C1q (71%). In contrast, immune complexes in rheumatoid sera were detected in low frequency by precipitin reactions with monoclonal rheumatoid factor (10%) and C1q (0%). Using the monoclonal rheumatoid factor radioimmunoassay, thirty-one (63%) synovial fluids exceeded the mean non-RA binding activity by one standard deviation. Similarly, twenty-four (49%) rheumatoid sera exceeded the mean non-RA binding activity to one standard deviation. Synovial fluid C4 adjusted for IgG as well as IgG alone distinguished between the two groups of patients whereas the C4 values did not. The C4/IgG value showed a strong negative correlation with the monoclonal rheumatoid factor radioimmunoassay and C1q precipitin formation.


Selective decrease in antibody-dependent cell-mediated cytotoxicity in systemic lupus erythematosus and progressive systemic sclerosis. With the use of two target cells (chicken erythrocytes and Chang cells), the antibody-dependent cell-mediated cytotoxicity (ADCMC) of peripheral blood mononuclear cells from patients with systemic lupus erythematosus (SLE) and progressive systemic sclerosis (PSS) was studied. Patients with active SLE had a significant reduction in ADCMC against Chang cells whereas cytotoxicity against chicken erythrocytes did not differ significantly from that of a control population. Similarly, a group of PSS patients with positive anti-DNP antibodies demonstrated a selective reduction in ADCMC against Chang cells. These findings support the concept that different effector cells mediate ADCMC against chicken erythrocytes and Chang cells, and indicate that in some patients with SLE and PSS there is a selective reduction or blockade of the ADCMC effector cell active against Chang cells.


Defective yeast opsonization and C2 deficiency in atopic patients. Twenty-seven per cent of atopic patients initially presenting with infantile eczema or hay fever were defective for yeast opsonization and 18% had low levels of C2; these deficiencies were mutually exclusive, suggesting that they are primary. Both defects were associated with each of four different atopic syndromes, some of which were related to certain HLA haplotypes.


Effects of ageing, surface sialic acid and glycopeptides of erythrocytes on auto-rosettes in man. Human red blood cells can bind in vitro to autologous peripheral blood lymphocytes forming auto-rosettes. The percentage of rosett-forming cells (A-RFC) depends on erythrocyte ageing in vivo. Old untreated cells given an A-RFC percentage lower as compared with the young ones. The same age groups of cells treated with neuraminidase show a parallel increase of A-RFC as compared with untreated cells. No significant difference is found between young and old cells with high concentrations of neuraminidase. The rosetting formation is inhibited by the pre-treatment of lymphocytes with erythrocyte glycopeptides released by trypsin. This suggests that auto-rosetting is mediated by erythrocyte surface glycopeptides in which sialic acid plays a role directly or not.


Cutaneous and vulvar melanoma: an update. In conclusion, cutaneous malignant melanoma, regardless of site, is best managed by early recognition and appropriate conservative surgical treatment. Depth of tumor invasion at the time of definitive surgical intervention is the most accurate measure of prognosis. Radical surgical measures for deeply invasive high-risk primary lesions have yet to be proven effective in altering prognosis, and the patient's quality of life should be considered when such procedures are contemplated.


Antecedents of teenage pregnancy.

Antecedents of teenage pregnancy. Antecedent factors operative in the causation of adolescent pregnancy include: The sexuality of contemporary society, especially the media. Prolongation of educational any vocational preparation in industrialized western society. Normal physical maturation at an early age. Peer and social pressure. Low expectations of life among minority and economically poor individuals. The conspiracy of silence surrounding sexuality and the inability of society to admit and deal realistically with the sexual activity of adolescents. Failure to provide sex education, clarification of values, family-life education, preparation for parenthood, and knowledge of birth-control and family-planning services targeted to teenagers, including adolescent males. Psychological and emotional problems. Failure to provide available and accessible early pregnancy-detection services with adequate counseling and support services. Failure to provide abortion services. Failure to provide supportive services to adolescents who have a child in order to prevent repeated pregnancy. Pregnancy, childbearing, and motherhood represent ultimate feminine fulfillment to many in our society, and unless attainable expectations and desirable alternatives are available, adolescents will continue to see little reason to postpone pregnancy and childbearing.


Meeting the special needs of pregnant teenagers. There is no one best method of contraception for postpregnant teenagers. Most emphasis, however, needs to be on preventing unwanted teenage pregnancies. Contraceptive history must be considered in prescribing. Effective and continuing contraceptive use is enhanced by careful counseling and follow-up and sensitivity to the special needs of teenage users of contraceptives for support, reinstruction, reassurance, guarantee of privacy, and comfort in the clinical setting. Use of oral contraceptives or IUDs should be encouraged since their use-effectiveness in teenagers is so much greater than other methods. But even more important is acceptability to the teenager as this provides the greatest assurance that the method will be used effectively.


Radionuclide image patterns of hepatic metastasis and pyogenic abscess: difficulties in differential diagnosis. A case of hepatic metastasis with a clinical differential diagnosis of amebic and bacterial abscess is presented. Hepatic scanning with 67Ga-citrate did not diagnostically differentiate the lesion. Hepatic arteriography combined with a therapeutic trial of metronidazole proved useful in defining the lesion. An understanding of the pathophysiologic process involved in 67Ga scanning of hepatic lesions suggests a non-invasive method of discriminating among these clinical diagnostic possibilities.


Serial 67Ga-citrate imaging during treatment of acute osteomyelitis in childhood. To test the hypothesis that abnormalities on 67Ga-citrate scans parallel the clinical course of acute osteomyelitis and revert to normal with successful antibiotic therapy, serial scans were performed in ten children. Scans improved markedly within the first two to four weeks of treatment, but abnormalities persisted at six or more weeks in over 50% of the cases, despite complete clinical resolutions of disease.


Increased concentration of 99mTc-methylene diphosphonate and 67Ga-citrate in extracranial bone metastases from pinealoma. A rare case of extracranial bone metastases from pinealoma is reported. 99mTc-methylene diphosphonate and 67Ga-citrate scans were of great clinical value in confirming the presence of bone metastases. Bone lesions were positively delineated by both radionuclides, but the concentration of 67Ga-citrate was more extensive than that of 99mTc-methylene diphosphonate.


Bone scan in Tietze's syndrome.

Bone scan in Tietze's syndrome. Bone scans of a 45-year-old man with Tietze's syndrome showed abnormal increased activity at the involved costochondral area. X-ray and biopsy examinations of the abnormal area did not reveal any abnormality.


Resolution of bone scan changes in hypertrophic pulmonary osteoarthropathy in untreated carcinoma of the lung. The bone scan appearance of hypertrophic pulmonary osteoarthropathy (HPO) in patients with pulmonary neoplasms and a variety of other lesions has been described by several investigators. It is well known that after therapy, the bone scan changes resolve. This report deals with a patient who had no therapy for a pulmonary neoplasm. In a study done three months later, changes in his initial bone scan that had suggested pulmonary osteoarthropathy had resolved completely, even though the patient had no treatment for his carcinoma.


Quantitative hepatic scintiangiography.

Quantitative hepatic scintiangiography. A new method has been developed which quantitatively assesses the relative arterial and portal venous blood flow in both normal and diseased liver tissue. Using a standard dedicated computer and routine clinical programs, the hepatic blood flow time/activity curve was analyzed. Specific indices were calculated: alpha1 represents aortic blood flow; alpha2, portal blood flow; alpha1/alpha2, the ratio of arterial to portal blood flow; and delta T, the difference in time between the peak of the arterial curve and the junction of the arterial and portal phases of the hepatic curve. Student's t-tests showed that these indices may be used to differentiate between the normal population and patients who have metastases or moderate to severe hepatocellular disease. Patients with early hepatocellular disease could not be differentiated from the normal population, but they could be separated from patients with more advanced hepatocellular disease. Patients with severe hepatocellular disease could not be separated from those with metastases. The most important uses of this technique may be in following a patient and determining when hepatocellular disease has become irreversible, and in following the course of treatment of a patient with metastatic disease to the liver.


Subdural empyema associated with an apparent regional hyperperfusion (luxury perfusion). A patient with a subdural empyema demonstrated a late arterial "blush" during a 99mTc-pertechnetate cerebral dynamic flow study which "washed out" in the delayed images. Cerebral arteriography and subsequent autopsy documented inflammatory tissue surrounding the empyema, resulting in this scintigraphic pattern.


The place of surgery in the treatment of ovarian cancer. If the role of surgery has receded somewhat in other areas of gynaecological cancer, the reverse would seem to be true in ovarian cancer. The problem of the scope for increased surgical procedures outside the general run of gynaecological operations is high-lighted by the difficulty in achieving accurate preoperative diagnosis. Carcinoma of the ovary may well be found unexpectedly by the relatively inexperienced surgeon operating for a tumour presumed to be a fibroid uterus. Improvement in the survival of patients treated for cancer is only rarely the result of a single therapeutic advance. Generally it is achieved by the meticulous and individual application of multi-modal therapy. In this context careful and occasionally bold surgery remains a key treatment in the management of ovarian cancer.


The treatment of carcinoma in situ of the uterine cervix in the Mersey Regional Cancer Registry Area with some comments on incidence. One thousand and twenty-four patients were registered with carcinoma in situ of the cervix at the Mersey Regional Cancer Registry from 1962 to 1973. The number of new cases reached a peak in the over-35s during 1968-70, but later in the under-35s. Fifty-five per cent of patients were treated initially by hysterectomy and 39% by cone biopsy or amputation. In the former group two patients developed invasive recurrence and one patient in situ recurrence. In the latter group one patient developed invasive recurrence and 15 patients developed in situ recurrence. This evidence is in agreement with other studies and supports the view that cone biopsy is an effective treatment for c. in situ of the cervix.


Percutaneous aspiration biopsy of malignant lung lesions using the Chiba needle. An initial experience. The fine gauge Chiba needle was evaluated in percutaneous aspiration biopsy in 20 patients with suspected malignant lung neoplasm. Adequate aspirate can be obtained with one biopsy. A confident cytological diagnosis of malignancy was made in 19 out of 20 patients. Most of the patients were elderly. Nine patients developed pneumothoraces which were small and asymptomatic. The needle is easy to handle and very acceptable to patients. This needle therefore appears to be very suitable for percutaneous aspiration biopsy of lung neoplasms and possibly other non-neoplastic lesions too. It promises to supersede the larger aspiration needles currently in use.


Fluoroscopically controlled transbronchial biopsy of solitary peripheral pulmonary lesions using the fibreoptic bronchoscope. Experience of fluoroscopically controlled transbronchial biopsy using the fibreoptic bronchoscope in 30 patients with solitary lesions in the peripheral lung fields beyond bronchoscopic vision is described. At the time of submitting this paper for publication (30 January 1978) no account of the technique has been reported in the British literature. In 21 patients with a final diagnosis of bronchial carcinoma a positive biopsy diagnosis was obtained in 14 (67%). Five of seven patients (71%) with a final diagnosis of an inflammatory condition showed evidence of acute or chronic inflammation on biopsy. There were no complications. The procedure is indicated when a definitive diagnosis is required for management planning in clinically inoperable patients, or when a tissue diagnosis is particularly desired in an attempt to obviate the need for thoracotomy. The relative safety makes this the biopsy technique of choice for the evaluation of isolated peripheral pulmonary opacities.


Duodenal loop widening in pancreatic diseases. The magnitude of the duodenal loop in patients with a variety of pancreas-associated disease has been accurately measured and compared with those values encountered in a series of normal subjects in order to assess if any widening had occurred. Using a Student's t-test all the patients with pancreatic disease were indistinguishable from the control subjects at the 5% level, and the validity of this effect as a diagnostic tool is questioned.


A clinical evaluation of isotope scanning, ultrasonography and computed tomography in pancreatic disease. In a prospective study of 46 patients with suspected pancreatic disease the provisional diagnoses arrived at independently by isotope scanning (IS), ultrasonography (USS) and computed tomography (CT) have been compared. In the control group, IS and CT were associated with a higher false positive rate than USS; The isotope scan was abnormal in most patients with proven chronic pancreatitis and cancer. The results from USS and CT were similar when structural changes were present. USS was superior in diagnosing pancreatic carcinoma and was a convenient means to follow the progression of acute pancreatitis to final resolution or the development of a pseudocyst. CT proved especially useful in accurately delineating cysts, pseudocysts and calculi prior to planning surgery and in assessing disease in contiguous viscera.


Endoscopic retrograde cholangiography in primary biliary tract carcinoma. The appearance of primary biliary tract carcinoma revealed at endoscopic retrograde cholangiography in 16 patients and surgically confirmed, are classified as to location, type of margin of the lesion and degree of obstruction. Differential diagnosis towards infiltrating tumour of the gallbladder is considered. The conclusion is drawn that endoscopic retrograde cholangiography will establish the diagnosis of malignancy of the biliary tract with an acceptable certainty.


Limitations of the cholecystogram.

Limitations of the cholecystogram. There is a little doubt that the spontaneous passage of gallstones occurs sometimes without pain or jaundice. This is probably more frequent than is realised. While the cholecystogram is a reliable investigation and of great assistance to the clinician, occasionally a normal gallbladder will be demonstrated, when it has previously been the resting place of small gallstones. Four cases are described in which patients suffering clinically from cholelithiasis are shown to have a normal cholecystogram, but on repeat examinations gallstones are demonstrated in each case over intervals of one or two years. It is suggested that gallstones had been present in all these cases at the time of the initial symptoms, but could well have passed prior to the first examination.


Radiology in early slipped femoral capital epiphysis. In a study of 38 hips showing only minor abnormality on the AP radiograph, it was found that the most reliable sign of an early slip was blurring of the junction between the metaphysis and the growth plate. The diagnosis could not be made on the AP film alone in 11% of cases and it is recommended that a routine lateral radiograph is obtained when slipped epiphysis is a clinical possibility. The importance of the radiologist in the early diagnosis of the condition is stressed and the causes of diagnostic delay are considered.


Osteo-articular tuberculosis: its presentation in coloured races. Four hundred and ninety-nine cases of osteo-articular tuberculosis have been analysed with special emphasis on the "unusual" presentation. Sclerotic bone reaction in association with active tuberculous osteitis is not at all uncommon and may occur in any affected bone. Maintenance of disc spaces with tuberculous spondylitis is not uncommon. Periosteal reactions, often very gross, occur commonly both in multicystic tuberculosis as well as in isolated lesions. Multiple bone involvement occurred in 8.2% of this series. Tomography delineates the total extent of involvement especially in central involvement of vertebral bodies. Healed tuberculosis may give rise to block vertebrae indistinguishable from the congenital type except for the absence of waisting at the level of fusion.


Lethal chondrodysplasia punctata.

Lethal chondrodysplasia punctata. The radiological findings in five infants, with chondrodysplasia punctata, who died during the neonatal period are presented to illustrate the role of radiology in diagnosis and prognosis in this syndrome. Rhizomelic shortening of the limbs almost inevitably indicates an early demise. In the non-rhizomelic group, features such as excessive stippling and tracheal calcification are unreliable prognostic factors of early morbidity and mortality.


Soft tissue radiography of the testes.

Soft tissue radiography of the testes. A technique of soft tissue radiography of the testes is presented. The normal radiological appearances are described, and also the radiological features seen in 75 patients with testicular lesions. Of these, 18 patients had malignant neoplasms and 57 patients had benign conditions. Testicular tumours appeared as very radio-opaque, quite sharply defined shadows. Benign conditions were less radio-opaque and often had ill-defined margins. A diagnostic accuracy of 88% was achieved in differentiating between testicular tumours and benign conditions.


Local complications of ascending phlebography. In order to estimate the rate of local complications of phlebography we studied a one-year series of 477 patients. Half of the patients were examined with a comparatively highly concentrated contrast medium and half with a more diluted one. Eight patients had local complications, verified by biopsy and/or thermography and plethysmography. One had a deep vein thrombosis, five had a superficial thrombosis and two had a skin necrosis. There were more complications after the use of the more concentrated medium, six against two. The frequency of clinically significant complications to phlebography is rather low, but high enough to warrant attention to the risks of the method. The concentration of the contrast medium should be as low as possible, and the time that the vessels are exposed to the chemical trauma as short as possible. A hypothesis is brought forward that skin necrosis with slow healing could be secondary to arterial thrombosis caused by extravasal contrast injection.


Toxicology of poinsettia.

Toxicology of poinsettia. 1. The acute oral LD50 of poinsettia in Sprague Dawley rats were greater than 25 gm/kg for all plant parts tested. 2. Exaggerated oral dosing over a five-day period with as much as 125 gm/kg total dose did not produce any gross or microscopic pathology in Sprague Dawley rats. 3. A five-day total diet study of poinsettia produced no gross pathology in Sprague Dawley rats. 4. Poinsettia latex induced no local toxicity when instilled into the buccal cavity of Sprague Dawley rats. 5. Poinsettia latex induced no damage when instilled into the eyes of albino rabbits. 6. Upon repeated exposures poinsettia exhibited mild skin irritation in the albino rabbit. It is not considered to be a primary irritant. 7. Poinsettia induced skin photosensitivity in albino rabbits.


Effective use of organic solvents to remove drugs from biologic specimens. While studies on the extraction of drugs by various organic solvents are numerous, very few direct comparisons of all the commonly used extraction solvents have been made. Review of the literature and some specific studies undertaken by the author show that the solvents more frequently used in toxicology are not all alike but vary with respect to type of drug being extracted. Hexane, 1-chlorobutane, dichloromethane, chloroform, isopropyl ether, ethyl ether, ethyl acetate, and 1-butanol all extract nonpolar drugs quite efficiently; drugs which have polar functional groups such as alcohols, phenols, carboxylic acids, imides, amides, esters, and sulfonamides require more polar solvents for their removal from aqueous solution in high yield. Ethyl ether and other ethers, ethyl acetate, and ketones are hydrogen bond acceptor molecules and therefore extract electron donor solutes more readily than chloroform, the most commonly used electron donor solvent. Alcohols such as 1-butanol are excellent general drug extractors but pose other problems such as odor and emulsion formation. Hexane, on the other end of the polarity scale, extracts polar solutes very poorly. Thus, chloroform and ethyl ether are the most versatile solvents, although dichloromethane and 1-chlorobutane are finding more use. Solvent costs and health hazards vary within the group of solvents discussed. 1-Chlorobutane and chloroform are relatively expensive, while ethyl ether, hexanes, and dichloromethane are less expensive. No solvent is 100% safe with respect to fire, explosion, and health hazard. While chloroform has the lowest TLV, a safety limit, some of the other solvents have higher vapor pressures. The most useful solvent for small volume extractions is chloroform or chloroform with a small percentage of an alcohol. Although poor recoveries are obtained for many drugs by the small volume extraction technique, more and more use of this approach is expected in the future.


Ethylene and diethylene glycol toxicity. 1. Blood concentrations of ethylene and diethylene glycol were evaluated in Sprague-Dawley rats at varying intervals following oral dosages of the glycols. 2. Ethylene and diethylene glycol in rat blood stored under refrigeration at 4 degrees +/- 10 degrees C for a period of 30 days exhibited minimal concentration losses, contrary to previous reports. 3. The amount of oxalate in the blood and kidneys of Sprague-Dawley rats doses with ethylene and diethylene glycol was quantitated. The animals dosed with ethylene glycol demonstrated significantly higher oxalate levels, particularly at 8 hr post-dosing, than similar animals dosed with diethylene glycol. 4. Ethylene glycol induced oxalate deposition within the kidney without significant histologic changes. Diethylene glycol induced histologic changes within the kidneys without kidney oxalate deposition. 5. Maximal kidney oxalate levels, following ethylene glycol dosage, occurred concurrently with peak blood oxalate concentrations. In the case of diethylene glycol, kidney oxalate levels did not peak until 4 hr after maximal blood oxalate levels. 6. Ethylene and diethylene glycol induced different modes of death in Sprague-Dawley rats.


Predictive evaluation in animals of the contact allergenic potential of medically important substances. I. Comparison of different methods of inducing and measuring cutaneous sensitization. Groups of guinea pigs were sensitized with a 0.1% solution of dinitrochlorobenzene (DNCB) by the Draize intracutaneous method. The course of the induction process, the influence of the vehicles used and the extent to which the reactions are amenable to assessment according to objective criteria were examined. The sensitivity of the standardized Draize test was then compared with that of various other sensitization techniques, including: The intracutaneous test with adjuvant (optimization test) The maximization test according to Magnusson & Kligman (1969) The epidermal sensitization test The epidermal sensitization test with prior irritation of the contact site (by croton oil or sodium lauryl sulphate). Comparison of these methods revealed that either the additional application of adjuvant or prior irritation of the contact site augmented the degree of sensitization of DNCB just as greatly as the simultaneous use of adjuvant and prior irritation of the skin, (maximization test). The improved sensitization methods, and in particular the standardized optimization test, may prove to be of particular value for the study of so-called weak allergens.


Histologic aspects of patch test reactions in allergic contact dermatitis. Twenty subjects with allergic contact dermatitis were patch tested with the responsible allergen applied to four fixed points on the back. Skin biopsies of the four sites were obtained after 6, 12, 24 and 48 hours, fixed in neutral formalin and stained with hematoxylin-eosin, Giemsa and toluidine blue. Sections were examined and lymphomonocytes, mast cells, eosinophils and basophils counted. In all cases the infiltrate consisted mainly of lymphomonocytes (80-82%); mast cells (5%) and basophils (0.2%) do not present clear variations within the given time. Eosinophils showed a definite numerical increase in six cases out of 20.


Contact urticaria from synthetic cassia oil and sorbic acid limited to the face. A patient with contact urticaria with skin and respiratory symptoms was found to be sensitive to both sorbic acid and synthetic oil of cassia. The contact urticaria was only elicitable on intact skin of the face by open testing. The source of the patient's contactants was her shampoo and toothpaste.


Comparison between 24- and 48-hour exposure time in patch testing. A pilot study was performed to compare the results obtained by leaving the test substances recommended by ICDRG on the backs of the patients for 24 and 48 h, respectively. The Pirilä chamber test method was used. We got different results between the two methods of application time as reported, and intend to continue the study.


Outpatient anesthesia at the Ambulatory Surgery Center, Tucson Medical Center. The safety, economy and acceptability of the concept of the ambulatory surgical facility have been proved; its future depends upon the support it receives from us as physicians. The role of the anesthesiologist in the short-stay surgical facility is also well established.


Nitrous-narcotic-relaxant anesthesia vs. volatile anesthesia in the adult surgical outpatient. A review of the advantages and disadvantages of nitrous-narcotic-relaxant vs. inhaled volatile anesthesia for outpatients results in the following conclusion: For most anesthesiologists in most settings, inhaled volatile anesthesia (with or without supplemental neuromuscular blocking agents) is probably superior to nitrous-narcotic-relaxant anesthesia (Table 1). Every anesthesiologist administering anesthesia to adult surgical patients on an outpatient basis must evaluate the surgical procedure being performed and his own anesthetic skill in deciding which of these techniques is best suited to any particular patient. It is only by constant attention to all factors that we can continue to provide the finest in anesthetic care for adult outpatients.


Constructional apraxia and visuoperceptive disabilities in relation to laterality of cerebral lesions. The main purpose of the present study was to determine whether constructional apraxia is due to a visual perceptual disorder in right but not in left brain-damaged patients. In order to resolve this question, 36 normal controls and 73 brain-damaged patients with lesions restricted to the right (N = 30) or to the left (N = 43) cerebral hemisphere were given a graphomotor and a multiple choice version of the Benton Visual Retention Test. The graphomotor version of the V.R.T. was used as a test of constructional praxis, whereas the multiple choice version of the V.R.T. was used as a test of visual form discrimination. No difference was found between right and left brain-damaged patients with respect to incidence and severity of visuo-constructive and of visuo-perceptive disabilities. Contrary to the hypothesis, the relationship between perceptual and praxic tasks was higher in left than in right brain-damaged patients. The high level of correlation found between graphomotor and perceptual scores within the left hemispheric group was due chiefly to the poor performances obtained on both tasks by aphasic patients. These findings are interpreted as suggesting that the basis for visuoconstructive disturbances is a perceptual disorder, independently of the hemispheric side of lesion. The contrasting results of our intercorrelational study and of analogous studies reported in neuropsychological literature are interpreted as being due to sampling differences, in the absence of clearcut qualitative or quantitative differences between visuo-constructive disabilities of right and left brain-damaged patients.


Problem-solving strategies and manifest brain asymmetry. The dichhaptic stimulation procedures developed by Witelson (1974) for the study of brain lateralization in children were modified and extended for use with adults. Consistent with findings in children, an overall left hand advantage was found under conditions of simultaneous or dichhaptic stimulation, although it was not found under conditions of monohaptic stimulation. The major purpose of the study was to determine whether in adults hand differences (assumed to reflect hemisphere utilization) could be influenced by the use of differential problem-solving strategies. Half the Ss were instructed to approach the haptic learning and recognition problems in a "sequential" or "analytic" manner, and half to approach them in a "holistic" or "Gestalt" manner. The results indicated that the degree of left hand superiority was indeed influenced by this manipulation, although it is to be noted that the actual basis of the effect is unclear. The results were consistent with the idea that brain lateralization must be defined, not strictly by tasks, but by strategies used by subjects to perform the tasks used to detect and study that lateralization. It is suggested that this immensely complicates the issue of interpreting the origin and basis of individual and group differences in laterality effects.


A cognitive approach to Korsakoff's syndrome. Ten Korsakoff and ten alcoholic subjects were compared on their ability to take advantage of meaningful and linguistic factors in five verbal memory experiments. Korsakoff subjects were deficient in the use of visual imagery, in remembering random letters and in learning relatively easy paired-associates; there was a suggestion that they did not benefit from variation in word class. The effect of word frequency, the ability to remember very easy paired-associates, and possibly the effect of pronounceability were preserved. These findings were interpreted as supporting a model which emphasised the disruption of some higher cognitive structure whilst leaving intact simpler memory functions.


Reading reversals and developmental dyslexia: a further study. The pattern of errors in reading isolated words was studied in two groups of children with respect, particularly, to reversals of letter sequence and letter orientation. One group (the Institute group) consisted of children 8 to 10 years old who had been diagnosed "dyslexic" according to medical and psychoeducational criteria. The other (the School group) included all the children in a second-year elementary school class (see Liberman, Shankweiler, Orlando, Harris and Berti, 1971) who fell into the lowest third on a standard test of reading achievement. Although the Institute children were somewhat poorer in word recognition than the backward readers selected purely on psychometric grounds, the groups did not differ significantly in the incidence of reversal errors. Also, for both groups, reversals represented a small proportion of the total number of reading errors. The performance of the two groups differed in two respects: in relation to directional bias in letter reversals and in the presence or absence of a significant correlation between letter-reversing and word-reversing tendencies. It was concluded from this that directional problems do not loom large in importance in most cases of reading backwardness, but may provide an additional source of difficulty for some dyslexic children. Other aspects of the error pattern were remarkably the same for both groups. The bulk of reading errors made by both groups reflect their common difficulties in phonemic segmentation of words in the lexicon, in phonetic recoding, and in mastery of the orthography--difficulties, in short, with linguistic characteristics of words rather than with their properties as visual patterns.


A developmental study of hemisphere specialization for recognition of faces in normal subjects. In a developmental study of hemisphere lateralization for recognition of faces in normal subjects three groups of subjects (mean ages: 7 years 9 months; 13 years 10 months; and 19 years 6 months) were tested. The procedure was a go-no go reaction time task in which the subject responded to faces tachistoscopically presented to the right or left visual field. A left visual field superiority was found for the two older age groups, which is interpreted as a right hemisphere dominance for recognition of faces. However, the 7 and 8 year old group did not demonstrate a significant visual field difference. These results indicate that the hemisphere specialization (lateralization) for recognition of faces involves processes which develop with increasing age through childhood and is not well-established until some time after the age of 8 and before age 13.


Handedness and the mental rotation of perceived patterns. The present experiment investigated the effect of hemispheric dominance, as indicated by handedness, and perceptual processing. Displays containing two visual patterns were presented to right- and left-handed subjects who classified the two patterns as being the same or different. Also the two patterns in a display were in either an identical orientation or nonidentical orientations. Overall, left handers were faster than right handers at the "same-different" judgement. Additionally, latency increased with the angular discrepancy in orientation between patterns for both handedness groups but this increase was smaller for left handers than for right handers. Apparently, left handers evaluate overall perceptual similarity faster than right handers and they also mentally rotate perceived patterns of discrepant orientations faster than right handers. These findings contradict previous generalizations that left handers are deficient perceptually. Moreover, the present results support the position that left handers should be faster at global perceptual tasks because left handers have less neural distance than right handers mediating the transmission of information between the locus of perception and the locus of dominance.


Simultaneous performance on verbal, nonverbal and motor tasks by right-handed adults. A series of four dual task experiments was conducted in which different groups of right-handed Ss (N1 = 24; N2 = N3 = N4 = 18) simultaneously performed a repetitive finger tapping task in conjunction with: (a) a verbal fluency task (Experiment I); (b) listening to logical memory stories from the Weschler Memory Scale (Experiment II); (c) reading logical memory stories (Experiment III); and (d) scanning an array of faces (Experiment IV). Results indicated that all three verbal tasks produced significant asymmetrical depression in tapping performance, with the right hand being more disrupted then the left. The visuo-spatial task, however, exerted symmetrical bilateral depression of both hands. Performance on the cognitive tasks (number of words produced in the verbal fluency task; recall of stories either listened to or read, recognition of faces) was unaffected by simultaneous digital tapping.


Sex and hemispheric differences in the recall of verbal and spatial information. Arrays of four digits were presented in a 3 X 3 matrix for 80 msec to either the left or right visual field. Women recalled digits presented to the left and right visual fields equally well, while men recalled digits more accurately after presentation to the right visual field. Both men and women recalled the positions of the digits presented to the left and right visual fields equally well. Overall, men's recall of positions was superior to that of women. Handedness correlated only with recall of positions presented to the right visual field, positively for women and negatively for men.