Gastric acid secretion, calcitonin and secondary hyperparathyroidism in uremic patients undergoing regular dialysis therapy (RDT). Fortyseven uremic patients on RDT underwent a gastric secretion study and a contemporary evaluation of serum levels of Calcium (Ca), Phosphate (iP), Magnesium (Mg), Alkaline Phosphatase (AP), immunoreactive gastrin (Gas), parathyroid hormone (PTH), calcitonin (CT). Secretory test (pentagastrin 6 microgram/kg) was performed in the morning, after 12 hours of fasting, in the interdialytic interval. Female patients, male patients on RDT from less 1 year and hyposecretor patients were excluded from the study. On the basis of these criteria 25 normal or hypersecretor males between 20 and 55 years old were selected. A significant positive correlation was found between PTH and CT, while a negative significant correlation was found between CT and BAO and CT and PAO. Similarly, a significant negative correlation was found between PTH and BAO and PTH and PAO. Multiple regression study showed that the negative influence of CT on BAO and PAO is more relevant than the positive influence of PTH. These data suggest that PTH and CT are involved in gastric acid secretion in uremia. Since the inhibitory effect of CT is prevailing on the stimulating effect of PTH, patients with higher levels of PTH and CT have a lower gastric acid secretion. CT might therefore be considered as a protective factor against hypersecretion in uremia.


New declotting catheters for arterio-venous shunts. Clotting is a serious problem in patients with A-V shunts. Balloon Embolectomy catheters or irrigating devices are frequently unsuccessful in declotting shunts, resulting in surgical revision of the shunt. Frequent surgical revisions reduce sites of vascular access, making it difficult to perform adequate hemodialysis. New instruments, constructed mainly of stainless steel, have been devised and used to declot A-V shunts. The instruments have been devised for specific purposes and labeled as follows: (1) Explanding Mesh, (2) Helix and (3) Rotating Cutter. These instruments will dislodge and remove organized clots, snare and cut fibrin "flaps", open and enlarge the vessel lumens. They have been used successfully in removing vascular obstructions adjacent to the vessel tips of the shunt or at the site of anastamosis of the shunt and vessel. These are the most common sites of obstruction. By prolonging shunt life we have been able to decrease the number of shunt revisions.


High density tissue culture on microporous membranes perfused by blood: report of a new bioartificial system. A new tissue culture system has been developed to support high density cell growth using the sheep as the host. Cellular nutrition is provided by plasma solutes as they diffuse from arterial blood across microporous polycarbonate membranes into a device attached to an arteriovenous shunt. Culture chambers are constructed with transparent polycarbonate to allow photomicroscopy of the tissue in situ. System performance is demonstrated by the high density growth of fetal sheep thymus allografts and rat soft tissue sarcoma xenografts.


The effect of radiolabeling of human fibrinogen on its adsorption behaviour on a polystyrene surface. Human fibrinogen (HFB) was labeled with different radioactive labels (Technetium -99m and iodine -125) in various ways. Characterization by chromatographic and electrophoretic methods did not show differences between the labeled and the nonlabeled proteins. The effect of the label and the labeling method on the adsorption behaviour of 99mTc and 125I labeled HFB at a polystyrene surface was investigated. In all cases labeled HFB showed preferential adsorption as compared to nonlabeled HFB. The preferential adsorption was expressed in terms of a factor ø (van der Scheer et al. 1978a), which will be 1, when no preferential adsorption occurs. 99mTc - and 125I - HFB showed ø values from 1.48 - 1.88. It is concluded that only meaningful adsorption experiments with labeled proteins can be performed when the possible occurrence of preferential adsorption has been investigated by appropriate methods. The results of prior work on protein adsorption at biomaterials using radiolabeled proteins have to be reconsidered.


A reversible method for sound analysis adapted to bio-acoustical experiments. The paper describes a method of sound analysis, 'modulation analysis', its implementation on a minicomputer PDP12 and some aspects of its application in bioacoustical experiments. Modulation analysis reversibly resolves a given sound signal into time-courses of amplitude and carrier frequency. Since time is preserved as the independent variable the method provides a suitable basis for the computer modification of sounds. Problems of practical performance are discussed with regard to sounds of birds and insects. Further, the use of sound modification in a neurophysiological study of the hearing system of birds is described.


[An automated study of EEG: a method of detection of non-stationary points]. The purpose of this paper is to present an automatic method of signal analysis. To help physicians in their diagnostics, this method is implemented on a minicomputer in order to detect non-stationary points in electroencephalograms. The signal is modelled with an autoregressive filter. The parameters of this filter are adapted at each step. Identification gives the best model in the sense of a cost function representing the mean square error of noise, which is estimated during the optimisation time-window. The cost function is expressed by a quadratic formula. This allows the use of a fast algorithm, the 'conjugate gradient method'. An original statistical test is developed to detect non-stationary points in the signal. The performance of this method is tested with artificial data to determine the sensitivity of method parameters. Detection using real data is presented.


Computer analysis of interacting dopaminergic and cholinergic control mechanisms in the extrapyramidal system. The experimental results of many authors suggest that the output activity of the extrapyramidal motor control system depends on a balance between the levels present of the chemical transmitters dopamine and acetylcholine. In this paper it is proposed that these results are best explained by two feedback regulatory systems interconnected with positive interaction--in the sense of the relative gain array (Bristol, 1966). Using the computer-aided design procedure CAIAD, a simple two-input two-output model is simulated so as to give responses similar to those observed when dopaminergic or cholinergic drugs are applied. The effect of reducing the gain in one control loop corresponds to the effect of lesioning part of the extrapyramidal system in the brain. In addition, the effect of an anti-schizophrenic drug such as haloperidol is interpreted as a disturbance input on one of the interacting paths.


An interface to input analogue signals to a digital computer. An electrical control unit is described which permits analogue signals from most sources to be made compatible with, and optimise the use of, an A/D converter. This circuitry enables the signal to be offset, relative to the electrical zero, and to be reset to zero using a push button. Extension of this unit has enabled mechanical movement, such as rotation of a shaft, to be measured. In order to make the most efficient use of the A/D converter the gain of the output can be varied.


The detection and identification of unknown halogenated compounds in environmental samples. A new method is described in which the mass spectrometer is an element specific detector for a gas chromatograph. The elements investigated in this study are F, Cl, Br, J, S  and N, but the method might be applied to other elements as well. The molecules coming from the gas chromatograph are atomized in a microwave induced discharge, located in the interface between the gaschromatograph and the mass spectrometer. Unknown compounds containing specific elements can be detected and their retention times can be determined. The method is applied to samples of surface water, fat of a grebe and human adipose tissue for halogenated compounds. Unknown halogenated compounds were found. A number of them were identified in samples of surface water.


The role of suggestion in the psychoanalytic therapies. The concept of suggestion in the psychoanalytic therapies is considered as it appears in the literature and in current practice. Bibring's definition of the technique of suggestion is extended differentiating overt and covert suggestion from the effects of unconscious transference fantasies. The use of suggestion as a technique is viewed as antithetical to the aims of exploratory psychoanalytic therapy and presents serious problems in the resolution of transference issues when it is used either inadvertently or as a parameter of the therapy.


Gradients in analyzability.

Gradients in analyzability. A discussion of "Some Communicative Properties of the Bipersonal Field" by Robert Langs, M.D. In response to Dr. Langs' delineation of the bipersonal field concept and his clinical elaboration of a triad of disorders which are graded into classifications of descending analyzability: Types A,B, and C fields. I confirm his thesis and endeavor to demonstrate some underlying foundations of his categorical assumptions, namely the conceptions of projective identification, of the intactness of the background object of primary identification, the conception of a dual-track theory of infantile development in order to delineate the parallel between the separated self and the continuation of primary identification, and the postulation of manic and schizoid types of narcissistic character disorders (Types B and C respectively). All of these conceptions are vicissitudes of the varying ways in which patients confront the depressive position of separation-individuation with rapprochement and, thereby, conform to a gradient in which symbolization interpretations can be utilized in analytic treatment.


Some therapeutic factors in psychoanalysis. Several aspects of the patient-analyst interaction play an important part in the success or failure of analysis. Examining the unconscious and conscious attitude of the analyst in the therapeutic process clarifies the source of the analyst's difficulties in functioning successfully in his professional role. In the attitude which the analyst adopts toward his patients, it is essential, for example, to differentiate antitherapeutic factors such as the tendency of the analyst to collude with his patients from such therapeutic factors as sensitivity, receptiveness, and openness to the patients non verbal and verbal communications. These help the analyst to understand the patients on the level of object relation and ego function which is most meaningful to him. The analyst's peace of mind and his capacity to contain and bring together the patients fragmented mental state is of particular importance in the treatment of borderline and psychotic patients. Certain features in the patient's personality, such as the capacity for early object relations, sensitivity, and capacity for observation and perception, seem to contribute to a more open therapeutic interaction between patient and analyst. Nevertheless, difficulties in the interaction between patient and analyst remain and are a serious threat to the successful function of the psychoanalytic process.


Concerning transference and countertransference. This paper is presented primarily for its historical interest. The author's first attempted publication in psychiatry or psychoanalysis, it was submitted successively to two publications in 1949, rejected by each, and filed away until now. In it, the author suggests that transference phenomena constitute projections, and that all projective manifestations-including transference reactions-have some real basis in the analyst's behavior and represent, therefore, distortions in degree only. The latter of these two suggestions implies a degree of emotional participation by the analyst which is not adequately described by the classical view of him as manifesting sympathetic interest, and nothing else, toward the patient. It has been the writer's experience that the analyst actually does feel, and manifest in various ways, a great variety of emotions during the analytic hour. The analytic usefulness of this actual richness of emotional participation, by the analyst, is detailed.


Responses to creativity in psychoanalysts. A discussion of "Concerning Transference and Countertransference" by Harold Searles, M.D. Searles's study, written and rejected for publication in 1948-49 contains six original contributions to these subjects. They include the definition of determinants of transference in the immediate analytic interaction, the role of projection in transference and its evocation by the analyst, its basis in actual traits of the analyst which are exaggerated, and its expression as an effort to elicit confirmatory responses. Searles also details the fullness of the analyst's participation in the therapeutic interaction and the constructive usage of countertransference reactions. The negative responses to Searles's creativity prompt the thesis that every professional has a wish to both accept and destroy the innovator and his innovations. Factors include envy, a dread of inner turmoil, impingements on countertransference defenses, and deviations in the conditions of training analysts. These reactions are paralleled by refractoriness to the patient's unconscious creativity and efforts to cure the analyst. The manifestations of these hostile reactions and the innovator's responses to them are discussed.


Deviation from confidentiality and the therapeutic holding environment. It is an accepted premise that certain ground rules of treatment are crucial to successful outcome. One such ground rule, confidentiality, has been replaced by such deviations as contact with relatives of the patient and with arrangements for other professionals to be involved with the patient. This last deviation is discussed in relationship to the "secret self" and the boundaries of the bipersonal field. During the in-patient treatment of a borderline personality, deviations from confidentiality incited an aggressivized reaction, a mixture of transference and nontransference leading to acting in and acting out. This failure to maintain the boundaries of the therapeutic relationship led the "secret self" to fear annihilation; the distance of the "rapprocher" was increased; and the "non-ego" reached a crisis. This patienterminated treatment prematurely. Some implications of this deviation from confidentiality for other settings are discussed.


Interpretations couched in mythical imagery. Conventional guidelines favor terse, mundane, unambiguous phrasing of interpretations, and the use of fanciful interpretations is rare in psychoanalytic literature. Some theoreticians have advocated interpretations that have multiple meanings and evoke primitive sensory and emotional responses. The latter functions can be served by metaphorical and especially by mythical interpretations, and their use in analytic therapy is suggested. Mythical interpretations tend to help the patient experience and express the forbidden and irrational; they imply that the therapist has a deep understanding of the patient. These effects are attributable to the psychodynamic determinants of myths and their cultural functions. Mythical interpretations further tend to provide implicit gratification to the patient, foster regression, and influence the patient's perception of and response to the therapist. Indications for use have yet to be worked out beyond preliminary speculations, and countertransference possibilities appear substantial. All of these considerations bear on the therapist's discretionary use of mythical interpretations.


Dream analysis in the treatment of an eleven-year-old boy. The treatment of an eleven-year-old boy with severe enuresis, facial tic, marked social maladjustment, passivity, and effeminacy was guided by the following principles: (1) Personality development was set in motion by encouraging age- and gender-appropriate behavior, by providing and identification model, and by upholding values which reflect normal male behavior. (2) Unconscious pathogenic forces were mobilized, analyzed, and resolved. (3) Environmental factors which facilitated growth were added and those which inhibited growth were removed. (4) The doctor took a clear stand for health and against sickness. (5) Responsibility for the conduct, progress and outcome of treatment rested with the doctor. The treatment was therefore guided by a synthesis of three conceptual models: developmental, analytic, and medical. The patient was seen for one hundred hours over a two-and-one-half-year period. Dream analysis provided the primary means by which unconscious conflicts were brought into consciousness.


Dreams: royal road but challenging journey. A discussion of "Dream Analysis in the Treatment of an Eleven-Year-Old Boy" by Harold M. Voth, M.D. This discussion endeavors to make three points: (1) Advances in ego psychology have led to a shift in technique from the content interpretation of dreams to the ego-defense analysis of intrapsychic conflict, using dreams and associations to them as raw data in that process. Questions are raised as to how thoroughly Dr. Voth completed this process with his patient. (2) Transference and countertransference elements seem to have been overlooked; there is evidence of the mutual expression of transference-countertransference issues within the relationship. (3) Perhaps it is better to describe what Dr. Voth offered the young patient as a corrective emotional experience, rather than as a truly psychoanalytic one.


Developmental considerations in the psychotherapy of latency-age children. A discussion of "Dream Analysis in the Treatment of an Eleven-Year-Old Boy" by Harold M. Voth, M.D. An investigation of the role of memory in free association is presented. It is described that the mode of registration and recall (sensory images and/or words and/or abstractions) differs in the child of latency age from that in the adult. The child in the latency-age period undergoes a marked series of developmental changes in the elements used in memory organization. To the extent that these differences in the mode of manifestation of memory exist, there are differences between the free associations of the child and the free associations of the adult. Children do free associate. It is necessary to understand the principles which govern age-appropriate memory elements in the child before these free associations can be used therapeutically. The memory organizations, memory modes, and the theory of their ontogenesis is presented, followed by clinical examples of the application of this theoretical material in the psychotherapy of children.


Psychodynamic conflicts in hearing children of deaf parents. A case study documents the consequences of parental deafness on the personality development of hearing children. Of central dynamic significance are unacknowledged feelings of resentment generated by (1) acute feelings of humiliation experienced about the parents' imperfections, (2) identity confusion resulting from the parents' suspicious attitude toward the hearing world, and (3) the inevitable role-reversal resulting from the parents' handicapped status. The possibility of taking triumphant pleasure in more fortunate life circumstances evokes intense guilt and forms the basis for a conflictual attitude toward success. A proclivity toward guilt appears to be an outstanding psychological characteristic of children of handicapped parents, irrespective of the nature of the handicap. Some relevant variables include: greater resentment due to unavoidable early frustrations, a reluctance to direct aggression outward, despair about making reparations to parents seen as damaged by the child's aggression, and absence of external controls on the expression hostility (victories are easy). Some parallels are noted between conflicts displayed in hearing children of deaf parents and children of immigrant parents.


Oedipus was not the son of Laius and Jocasta. Neurotics have family-romance fantasies, which they sometimes take to be real and which make them think that their parents are not really their parents. They have other unconscious fantasies in which they feel that their sexual objects are really their parents and in which trivial acts acquire the value of incest and parricide. From these psychoanalytic findings we can interpret the Oedipus legend as a special manifestation of the family romance which has arisen from guilt feelings and an intense desire for punishment. Oedipus fantasies the rulers of Thebes to be his parents and takes his behavior toward them as both incestuous and parricidal. As a displacement on the adult level, the Oedipus legend symbolizes the genital situation of the child both before and during the creation of the superego. As Oedipus was happy in his love life before the plagues afflicted Thebes, the child enjoys, during his infancy, sexual pleasure with his mother and rejects his father as his rival. Later just as Oedipus did, the child learns from his parents and from the rest of his environment, that his incestuous and parricidal behavior is dreadful and that he must feel very guilty and be punished severely. The child also learns this must be repressed: He must no longer perceive these things. In the legend this is symbolized by Oedipus blinding himself. The usual interpretation of the Oedipus legend, which wrongly believes that he really committed incest and parricide, does not take into account the distortions of judgement and preception which guilt feelings can give rise to.


Oedipus: history, legends, plays, complexes. A discussion of "Oedipus Was Not the Son of Laius and Jocasta" by Angel Garma, M.D. The thesis that Oedipus was not the son of the Theban royal pair but his Corinthian "foster parents" raises questions as to which Oedipus is under discussion--one of several different "historical" and legendary accounts, the hero of the plays of Sophocles, or the synthesized "Oedipuses" of millions of individual and ethnic fantasies. Oedipuses, in whom the particular variant described by Dr. Garma can be discerned, certainly abound and should be included among the many possibilities to be considered.


The role of the superego in exhibitionism. The exhibitionist's relationship to his superego is a definitive feature of his general psychopathology of which the exhibitionistic act is only one manifestation. This relationship involves a compelling and persistent active defiance of those aspects of the superego which impose moral and ethical restrictions on behavior and a pervasive resistance to those aspects of the superego which demand adequate standards of functioning and conduct. Some of the implications of this as regards the treatment of exhibitionists are discussed.


Transsexualism and a new type of psychosurgery. A discussion of "The Transsexual Wish in a Psychotic Character" by Katherine MacVicar, M.D. Patients in increasing numbers are seeking sex-reassignment surgery. The topic receives coverage in both the lay and professional press; many advocate surgery as the only "cure". Clinical study reveals that these patients have borderline personality organization and are seeking to discard bad and aggressive features and to replace them with a new idealized perfection. Surgical procedures in these cases can usefully be conceptualized as a new type of psychosurgery.


Transsexualism and psychosis.

Transsexualism and psychosis. A discussion of "The Transsexual Wish in a Psychotic Character" by Katherine MacVicar, M.D. This paper reviews some of the major reports gradually emerging in the psychoanalytic literature which validate the belief that beneath the desire "to change sex" may lie serious, if not overwhelming, psychopathology-even of a psychotic nature. Transsexual wishes may arise from oedipal conflict, preoedipal fixation, or schizophrenic processes. This paper briefly describes the mechanisms involved in the development of psychotic reactions in those schizophrenics who desire and undergo sexual transformation surgery.


The transsexual wish in a psychotic character. The case discussed here illustrates one type of transsexual wish. The paper clarifies the dynamic considerations and treatment process in a patient who was psychotic and who, from time to time, wished to change his sex. One of the patient's chief difficulties was an inability to regulate adequately the intrapsychic distance between the self and objects. In the relatively nonpsychotic state, the patient used coercive behavior and splitting to establish a tenuous balance between fusing with the object and losing it entirely. When these defenses were adequate, the patient did not experience wishes to be a woman. However, when threatened with the loss of an important internal object (the mother or therapist), the patient would attempt to fuse with the object by experiencing strong transsexual wishes. The wish thus served to stabilize and control internal objects at a comfortable distance. The wish also served a restitutive function, holding off a frightening psychotic state; a loss of an important object threatened the patient with feelings of fragmentation. It was thus somewhat similar to a delusion or hallucination.


Treatment problems of the hospitalized physician. Treatment problems arise both when the physician or other health care professional must be hospitalized for psychiatric disturbance and, even prior to hospitalization, in the process by which the physician comes to recognize and accept in himself an emotional illness of severe proportions. Hospitalization can represent a severe narcissistic trauma, which entails a radical role reversal (from caretaker to patient) and severely undermines the physician-patient's sense of personal and professional identity. Conflicts around these issues tend to become externalized within the hospital setting up characteristic patterns of conflict within the therapy (between patient and therapist) and within the ward community (between patient and ward staff, as well as between treating physician and ward staff). The expression of these conflicts and patterns of interaction are discussed in two cases-both psychotic and suicidal physicians-who, though the patterns of resistance and externalization took divergent forms, nonetheless expressed the same underlying issues.


The perils of homology.

The perils of homology. A discussion of "Treatment Problems of the Hospitalized Physician" by W. W. Meissner, S.J., M.D. and Peter Wohlauer, M.D. Meissner and Wohlauer's paper describing the difficulties attendant upon the treatment of hospitalized physicians has implications for other homologous therapist/patient pairs. Therapists who include ethnic, racial, or ideological characteristics in their professional identifies must be prepared to deal with transference and countertransference problems which arise because of their similarities to their patients. A distinction between self-involved and self-effacing empathy is useful in understanding these vicissitudes of homologous treatment.


Oedipal grief.

Oedipal grief. This paper concerns a common clinical picture, one that is seen particularly clearly in young men. It is a picture which, within a traditional psychoanalytic framework, has much to do with that set of mental structures referred to as the superego and with the patterns which follow from the oedipal period of development. Using two case examples, this paper suggests the outlines of a treatment strategy and looks at some of the theoretical issues involved (in particular, the contribution of an object relations emphasis to classical theory). It argues for the importance of grief in the oedipal dilemma and suggests that the role of grief in the formation and maintenance of morbid conscience can overshadow that more familiar explanation, the struggle with one's own forbidden wishes.


A developmental view of identifications resulting from maternal impingements. This paper attempts to understand in early developmental terms one of a group of patients who demonstrate a powerful identification with a conflicted aspect of their mother. In addition to the strong identification with the maternal pathology, the group is characterized by a history of maternal impingements (Winnicott) through which the infants were exposed to the conflicted psychological state of the mother. A case history of a psychoanalytic psychotherapy emphasizes the vicissitudes of the transference and countertransference. The patient presented had been exposed to premature awareness of separateness from the mother as a result of the maternal impingements. The identification with the maternal pathology is seen primarily as a defensive attempt to create the illusion that the characteristics of the impingements were actually a creation of the patient herself. This defensive identification was strengthened by the mother's inability to be responsive to the patient, except in so far as the patient entered into the "beam" of the maternal pathology. Parts of the work of Melanie Klein, Winnicott and Greenacre which make up the theoretical context for the developmental formulation of the type of identification under discussion are presented and several clinical implications of the developmental formulation are discussed.


Oedipal grief: mourning or melancholia?

Oedipal grief: mourning or melancholia? A discussion of "Oedipal Grief" by Robert May, Ph.D. A clinical syndrome seen in late adolescent men, oedipal grief refers to a depressive state sustained by a vengeful conscience and a pattern of self-punitive acting out. The psychopathology of this syndrome is clarified and differentiated sharply from the normal developmental process of grieving the loss of an idealized oedipal father. As a form of developmental melancholia, the repressed ambivalence and weakening of the ego in this syndrome is highlighted. May's reconceptualization of the structural-instinctual model of the superego and ego ideal is then critically reviewed; his tendency to reduce oedipal to preoedipal developmental phenomena is noted. A more developmentally differentiated theoretical model is suggested in terms of the incomplete internalization of the functions of self-control and self-esteem in the type of adolescent personality organization which underlies, and is perpetuated by, the psychopathology in the oedipal grief syndrome. The main task of brief psychotherapy is thus to promote the ego's capacity to tolerate increased inner conflict so that a developmental shift toward greater internalization can take place. The skillful treatment conducted by May is reinterpreted in these terms; and the therapeutic facilitation of adolescent grieving is placed in the context of structural-developmental change.


Paradox and metaphor: transitional phenomena in the operations of the work ego. Transitional phenomenon, paradox, metaphor, and empathic process are examined with emphasis on discerning what impels the work ego, or autonomous analyzing functions of the analyst, to move alternatively between evenly hovering attention and verbal intervention. The study is based on the premise that there are interfaces, which it attempts to clarify and broaden, between aspects of the psychoanalytic and literary perceptions of human experience, as these latter have been traditionally epitomized and structured in paradox and metaphor. Paradox and metaphor are seen as forms adapted from literature and rhetoric which represent, indicate, and focus on dilemmas, predicaments, and conflicts of living. Provisionally, I conclude that they are adaptive and defensive processes, directed against primitive affects deriving from the separation-individuation period of child development, that they are closely linked with and expressive of adult forms of transitional phenomena and processes associated with the stresses and conflicts of the same period, and that they constitute an important segment of the data from which the work ego draws its stimuli and information. I offer clinical vignettes and literary instances illustrating these connections.


Failure and recovery: a mythic approach to treatment issues in hospitalized psychiatric patients. A discussion of "Ttreatment Problems of the Hospitalized Physician" by W. W. Meissner, S. J., M.D. and Peter Wohlauer, M.D. Both Camus, in The Fall, and Conrad, in Lord Jim, have elaborated their own mythic versions about what happens to someone who has failed or fallen from grace. Hospitalized psychiatric patients have in some sense fallen from grace, most poignantly if they are physicians. The therapist who attempts to help them recover is on the horns of a dilemma. If he takes the pessimistic point of view implicit in Conrad's story, he will try to cure or at least mitigate the basic flaw which he believes is responsible for the failure thus risking a protracted and possibly pointless regression. On the other hand, if he ignores the tendency that some one who has fallen from grace has to recover in his own way-the theme depicted by Camus-his own self-esteem as a therapist will be in jeopardy and he himself may end up as the failure.


Four questions. A discussion of "Introjection and the Idealizing Transference". A discussion of "introjection and the Idealizing Transference" by Theodore L. Dorpat, M.D. The analysis of a patient with a narcissistic disorder is the basis for Dr. Dorpat's thesis that introjections (i.e., object representations) of the analyst as a real person are the basis for subsequent identifications resulting in changes in the self. I disagree with his characterization of the material as representing an idealizing transference. I believe it is better understood as an example of an alter ego or twinship transference. His material demonstrates the crucial role of the analyst as a self-object in the transference, rather than as a real person. The hypothesis that a patient changes as a result of identification with the analyst suggests possible countertransference pitfalls: a rationalized expression of the analyst's unconscious archaic fantasies or the enhancement of the analyst's self-esteem. The perception of such identifications could reflect the personal experience of the analysand who seeks to acquire the characteristics of the training analyst, or they could be apparent rather than real, the result of other therapeutic factors. Dr. Dorpat's paper provides an excellent opportunity  for consideration of these issues, but, at present, such introjection-internalization sequences cannot be accepted as scientific formulations.


Projective identification and maternal impingment. A discussion of "A Developmental View of Identification Resulting from Maternal Impingement" by Thomas H. Ogden, M.D. Dr. Ogden has tried to integrate two very different Kleinian formulations about (1) early infant development and (2) adult mental relationships (both called projective identification) with Winnicott's ideas about the ways in which any mother introduces her own version of consensual reality to her infant and influences the qualities of the infant's first, and forever basic, mental relationship (called impingement). I will use his report to demonstrate some clinical disadvantages and distortions of the psychoanalytic theory of human development which I believe are inherent in these two technical terms.


Unconscious symbiotic fantasy: a ubiquitous therapeutic agent. Evidence is presented that supports the proposition that the deliberate or inadvertent activation of unconscious fantasies of symbiotic gratification can have an ameliorative effect on psychopathology of various kinds. The evidence includes (1) clinically based reports scattered in the psychoanalytic literature on the role of symbiotic gratification in everyday living, in nonanalytic therapies viewed as effecting transference improvements, in meditation, in group activity therapies, and in psychoanalytic treatment, and (2) data from a large number of laboratory experiments coonducted with double-blind procedures and other stringent investigatory controls. In addition to providing powerful support for the clinically derived proposition, the laboratory results allow for extending that proposition and for a more precise delineation of the fantasy that produces symptom amelioration, which when expressed in its verbal form, is most often conveyed by the words Mommy and I are one.


On the verification of psychoanalytic concepts by extraclinical techniques. A discussion of "Unconscious Symbiotic Fantasy: A Ubiquitous Therapeutic Agent" by Lloyd H. Silverman, Ph.D. Extraclinical research on propositions derived from the psychoanalytic process are useful and complementary. The rigor of statistical, reproducible experimental approaches adds strength to analytic knowledge. Caution is recommended, however, in interpreting results, because each method has its own natural yield and significance. The effect of stimulating unconscious symbiotic fantasies as inferred from clinical settings and transferred to an experimental model might be examined from the standpoint of situational and propositional homology, adequacy of methods of verification, experimental bias, and interpretation of the results. Dr. Silverman and his colleague's work is discussed from the vantage points outlined.


An hypothesis about heroin addiction, murder, prostitution, and suicide: acting out parenting conflicts. From interviews with forty subjects, we have developed a preliminary hypothesis which can be refined and deepened and then tested by psychotherapeutic investigation. These murderers, prostitutes, heroin addicts and successful suicides all demonstrated various aspects of difficulty with their capacity for reciprocal tenderness. This arose from their experiences of exploitation and derprivation with their own parents. Their unique characteristics included primitive rage, insatiable demands and capacity for unconflicted manipulation. These characteristics colored the expression of their intrapsychic conflict between the wish to parent successfully and the fear of perpetrating their own childhood experiences upon their children.


The analytic introject and ego development. A discussion of "Introjection and the Idealizing Transference" by Theodore L. Dorpat, M.D. Ego defects during analysis can be converted into defensive adaptations and then become legitimate analytic material. Two clinical vignettes of patients suffering from an inability to maintain mental representations without reinforcement from external percepts are presented. These patients suffered from an inability to internalize experiences with the outer world and external objects. The resulting ego impoverishment was experienced as tormenting feelings of inadequacy and helpless vulnerability. In treatment, these feelings caused the analyst to feel the same hopelessness the patient did. The analyst, once he regained the analytic composure to view all of the patient's productions in terms of their transference potential and adaptive significance, became a synthesizing force. His presence, in essence, held the patient together. The patient gradually was enable to internalize the analyst as a unifying modality and form an analytic introject. The formation of analytic introject is the outcome of specific clinical interactions. The author discusses the interplay of counter-transference frustration and structuralizing interpretations, even what might be considered wrong interpretations, and stresses the various factors during treatment involved in the acquisition of psychic structure in a particular clinical context.


Morphometric study of the reversibility of testicle alterations in rats submitted to hypervitaminosis A. In a previous paper, Lamano Carvalho et al. [4] demonstrated that administration of excess vitamin A doses to adult rats causes decreased testicle mass, focal lesions in the seminal tubule epithelium, and reduction in the relative volume of interstitial tissue and in the nuclear volumes of Leydig cells. The hypervitaminotic animals also showed alterations in the rhythm of spermatogenesis and reduced hypophysary LH levels. In order to determine the possible reversibility of these alterations, the authors allowed the hypervitaminotic animals to recover for 50 or 100 days. After both recovery periods. the focal lesions in the germinal epithelium were still unreversed. On the other hand, the nuclear volume of Leydig cells and the rhythm of spermatogenesis, as well as hypophysary LH levels reverted to normal during the 50 day recovery period.


The effect of supplemental vitamin E on vitamin A serum levels in cystic fibrosis. Effects of the ingestion of vitamin E with vitamin A on the serum levels of these vitamins and the urinary creatine to creatinine ratios of 18 children with cystic fibrosis disease of the pancreas (CF) was studied. After the daily ingestion for two months of a specially prepared capsule containing 5000 IU vitamin A palmitate and 100 mg d alpha-tocopherol acetate in aqueous dispersible form there was a significant increase in vitamin A as well as vitamin E levels of serum taken 3 1/2 hr postprandially. Creatine to creatinine ratios in single voiding of urine decreased.


[The vitamin B 1 nutritional status of the pregnant rat and its litter as a function of dietary thiamine supply]. Influence of the dietary supply in thiamine on the vitamin nutritional status of the gestating female rat and of the litter. Four groups of gestating female rats were fed diet containing respectively 2, 4, 6, 8 mg of thiamine par kg. In every group, urinary excretion of thiamine was found to be stable up to the 16th day of gestation and then to decrease markedly during the 5 last days. This result and those concerning the changes in vitamin excretion, as related to the dietary intake, support the hypothesis that thiamine requirement is strongly higher at the end of the gestating period. On the other hand, measurements of thiamine concentration in tissues show that, when thiamine is given in suboptimal quantity, it is priorly fixed by the foetus at the expense of the maternal organs particulary of the liver.


Vitamin B6 nutriture during pregnancy.

Vitamin B6 nutriture during pregnancy. The vitamin B6 nutriture was determined during pregnancy beginning at month II until term by means of determination of pyridoxal phosphate in serum of 16 healthy pregnant women. During pregnancy, a biochemical vitamin B6 deficiency occurs gradually. The most significant decrease of pyridoxal phosphate parallels the time of most intensive growth and energy retention of the fetus. Vitamin B6 nutriture of mothers at the onset of pregnancy as well as the decrease of pyridoxal phosphate during pregnancy are in a positive correlation with birth weight of newborns. The most important mechanism leading to maternal vitamin B6 deficiency seems to be the active diaplacental transport of pyridoxal phosphate from mother to fetus. A vitamin B6 supplementation during pregnancy is necessary.


Stereological composition of the liver of biotin deficient and control chicks. In an ultrastructural and stereological study the livers of 28-day-old chicks, fed either a biotin-deficient or a supplemented diet, were investigated. The biotin-deficient chicks showed the known dermal lesions and were significantly retarded in growth. About 30% less hepatocytic nuclei per unit volume liver were found in the deficient chicks than in the controls. In biotin deficiency mainly the rough endoplasmic reticulum (RER) and the mitochondria were affected. RER was diminished in volume and surface density, whereas in mitochondria only the surface densities of the outer and inner membrane were reduced. The reduction of RER is in agreement with the known reduction of protein synthesis in biotin deficiency.


Intestinal ascorbic acid transport following diets of high or low ascorbic acid content. Active transport of ascorbic acid in ileum is mediated by a carrier mechanism at the brush border membrane. This mechanism may show compensatory changes in activity in response to alterations of dietary ascorbic acid content. The unidirectional influx of ascorbic acid across the brush border into epithelial cells of guinea pig ileum was determined in vitro. Influx was significantly reduced in scorbutic animals and following 14 or 28 days of high doses (5 or 25 times normal) of ascorbic acid. The transport rate was reduced by intramuscular administration of ascorbic acid, suggesting that the transport mechanism may respond to circulating levels of the vitamin.


Vitamin C value of fruit mixture containing fresh orange juice. A 70--80% decrease in the vitamin C (ascorbic acid) level was found in a mixture of fresh orange juice, apple, and banana prepared under aerobic conditions as compared with the level present in identical quantities of each individual ingredient. Since it was determined that this decrease was caused mainly by the presence of the banana, we suggest that the latter not be added to fresh orange juice which serves as an important source of vitamin C for infants.


[Biochemical and hematological measures for determination of folate status in humans. 1. Relation between serum folate and segmentation of neutrophil granulocytes]. In a study on 130 student volunteers the segmentation of neutrophil granulocytes was measured. The serum folate concentration was used as biochemical reference. Both parameters indicate the state of folate supply or the degree of folate deficiency, respectively. Considering the haematologic response as an objective criterion only 71% of the examines showed an adequate folate status. 11% were found "deficient" and 18% were in a marginal state of folate supply. This result was confirmed by repeating the experiment. Further studies are to include folate concentration of erythrocytes and urine concentration of formiminoglutamic acid.


[Biochemical and hematological measures for determination of folate status in humans. 2. Comparative determination of folate in blood and in erythrocytes]. Criteria to judge the folate supply have been evaluated in previous studies. The present study is examining parameters to estimate the degree of folate deficiency. Serum folate levels and erythrocyte folate concentrations were measured in 116 volunteers (patients). The erythrocyte folate is to a large extend independent of exterior supply and is lowered only in severe chronic deficiency. Low levels of erythrocyte folate indicate longstanding undersupply. Our experiments show that folate concentration of greater than 250 ng per ml erythrocytes indicate adequate supply. Concentrations below this limit are characteristic for chronic folate deficiency. To confirm this statement further studies will take into account the urine concentration of formiminoglutamic acid.


Chromium status of the aged.

Chromium status of the aged. Plasma chromium levels in the aged ranged from 0.5--22.1 ng/ml and revealed no relationship with serum cholesterol or fasting blood glucose levels. Plasma chromium values showed no consistent relationship with age and were not affected by sex.


Effect of peroral administration of xylitol on the oxidoreductase activity of human blood cells and certain chemical properties of saliva and serum. The effect of xylitol on the activity of certain oxidoreductases of human granulocytes, lymphocytes, and erythrocytes was studied both in vivo and in vitro. The effect of xylitol consumption on certain chemical properties of serum and whole saliva was also investigated. Short-term peroral administration of 0.6 g xylitol or glucose per kg body weight and day had a similar effect on leucocyte peroxidase levels. 0.07-0.2 M xylitol and glucose did not differ in their effects on leucocyte peroxidase levels in vitro either. Peroral administration of xylitol increased the whole saliva lactoperoxidase levels compared to glucose administration, but the differences were not significant. The results suggested that although the consumption of xylitol may under certain circumstances increase the peroxidatic capacity of saliva, that of leucocytes is not significantly affected.


Effect of adjuvant-arthritis on collagen metabolism. In albino rats with adjuvant arthritis, the metabolism of skin collagen was studied. This skin samples were taken from 21 to 49 days after the injection of Freund's adjuvant. Glycine-1-C14 was given 5h before sacrifice of the animals. The analyses of skins showed that compared to uninflammed skins, the adjuvant arthritis group had an increase in neutral-salt soluble collagen and acid soluble collagen contents. But the total and insoluble collagen contents were found to be decreased. The incorporation of C14 glycine into skin collagen and the free glycine content of skins were also decreased. There was no significant change in the total nitrogen, RNA and DNA contents of skins. The analyses of urine at weekly intervals showed an increased value of urinary total, free and non-dialysable hydroxyproline in arthritic group. The results suggest that there is an alteration in the metabolism of collagen.


A gas chromatographic method for the determination of di- and polyamines in human urine. A gas chromatographic method for the determination of di- and polyamines in human urine has been developed. The di- and polyamines have been extracted from standard solutions or from urine by a butanolic method modified to improve its sensitivity in relation to the low concentration of the amines in human normal urine. The quantitation is controlled by using two internal standards: 1,6-diaminohexane for Putrescine and Cadaverine, l-ephedrine for Spermidine and Spermine. Distilled water was the final solvent injected into the GLC column and the detector response was linear between 5 and 100 ng.


The relation between therapy and herpes zoster in Hodgkin's disease. The rate of occurrence of herpes zoster (HZ) was analyzed by the life table method in 108 Hodgkin's disease (HD) patients, diagnosed and treated during the years 1969 to 1976. Three groups, divided according to the degree of severity of the disease, were compared. The cumulative rate of occurrence of HZ at the end of the third year after diagnosis was higher in the group with intermediately extensive disease than in that with the most extensive disease (35 vs. 23%), but the difference was not significant. At the end of the fifth year, the rate was almost identical in both groups (35.3 and 35.6%, respectively). The group with the least severe form of HD had a very low HZ rate (2.2%), which was significantly different from the other two groups and close to the rate reported for normal populations. The five-year mortality rate was 0.0, 20.3 and 40.6%, respectively, in the three groups. These findings were interpreted to mean that in more advanced stages of HD, therapy and not the severity of the disease is the main factor determining the incidence of HZ. Extended field irradiation followed by a few courses of combined chemotherapy appear to have an effect similar to that of prolonged chemotherapy.


Hodgkin's disease of the lung.

Hodgkin's disease of the lung. The clinical and radiological findings in 16 patients with Hodgkin's disease involving the lung are reviewed. Lung involvement was evident at initial presentation in 11 patients and appeared during the course of the disease in five patients. All the patients had hilar as well as mediastinal lymphadenopathy; most of them--14 of 16--had the nodular sclerosis type of the disease. Patients with these combined findings are apparently more likely to develop lung lesions. Seven of the 11 patients with lung involvement at presentation were symptomatic and received combined chemotherapy in addition to radiotherapy. The lung lesions responded completely in 10 of the 11 patients, and in one they cleared slowly after more than a year of treatment. The question remains open as to whether an asymptomatic patient in the high-risk group, as described above, should receive either adjuvant chemotherapy or radiation therapy to the lung on the prophylactic basis. Our own policy is to add chemotherapy as an adjuvant to female patients and to males who have children.


Effect of alloxan and insulin on carbohydrate metabolism in rat brain. 8 and 24 hours after alloxan administration, diabetic rat brain shows decreased glycogen content, significantly increased FDP, triose phosphates, pyruvate and lactate levels, a large rise in glucose and a 27% activation of anaerobic lactate production from glycogen. 48 hours after alloxan administration there is a recovery of glycogen and a fall in lactate levels. ATP and AMP levels are unchanged 8 and 24 hours after alloxan administration but the former is increased and the latter decreased 48 hours posttreatment. Insulin given to rats 8 hours after alloxan treatment reverses glycogen, FDP, triose phosphates, pyruvate and lactate levels seen in the diabetic rat brain. In addition the increament in glucose is reduced by half and the rate of anaerobic lactate formation from glycogen is restored to control values. G-6-P levels, unaffected by alloxan or insulin alone, are significantly lowered in animals which received insulin after alloxan. Phosphorylase, HK, PFK, ALD, GAPDH, PK, LDH and Glycogen synthetase activities are not modified in rat brain by administration of alloxan or insulin or both.


Toxoplasmosis in Israel, 1970--73: evaluation of laboratory data. Sera from 7,506 patients were examined for toxoplasma antibodies by the Sabin-Feldman dye test and the results were analyzed according to antibody level, by reason for referral, age and sex. Low antibody levels (less than 1:256) were found in 24.7% and significant titers (greater than or equal to 1:256), in 9.96%. The highest prevalence of significant antibody titers was in patients with lymphadenopathy (15.4%). The prevalence of significant titers was high in the age range of 5 to 19 years, whereas the prevalence of low titers rose with age. Toxoplasma antibodies were found in 29% of a control group of 554 apparently healthy adult women, but only in 2.7% was the titer significant.


Fractionation of brain cytosoluble glycoproteins by hydroxylapatite-cellulose gel column chromatography. A simple, rapid and reproducible procedure for fractionation of cytosoluble glycoproteins from calf brain has been developed.  1) The main steps of this procedure were ammonium sulphate fractionation and column chromatography on hydroxylapatite-cellulose gel, six well defined different subfractions being finally obtained. 2) Subfractions, I, II and III were the richest in carbohydrate (15-35 microgram/mg protein) and in N-acetylneuraminic acid; subfraction IV the poorest in carbohydrate; subfractions V and VI the richest in mannose; subfraction VI the richest in fucose. All subfractions contained glucose. The different subfractions had very similar aminoacid composition. The polyacrylamide gel electrophoresis profile of proteins and glycoproteins contained in the different subfractions was different and indicated a certain degree of heterogeneity. 3) The contamination by gangliosides of the first three subfractions was appreciably low and ranged within 1.5-6% (in terms of ganglioside bound NeuNac/glycoprotein bound NenNAC). Subfractions IV, V and VI, the poorest in protein linked carbohydrates, carried higher ganglioside contamination.


Isolates of Yersinia enterocolitica from clinical cases in Northern Israel. Bacteriologic data and some clinical and epidemiologic aspects concerning 53 clinical cases associated with Yersinia enterocolitica are described. This is the first published report of human cases of Y. enterocolitica infection in Israel. Seventy-eight isolates of Y. enterocolitica were obtained from stool cultures of these cases, with 94% on SS agar plates. The isolation of the organism, including its differentiation from related bacteria, is discussed. In 88% of 50 cases, the organisms were of serotype 0:3, biotype 4, phage type VIII and in 12%, serotype 0:1, 2a, 3, biotype 3, phage type XI. Sensitivity in vitro to antibacterial drugs and evaluation of the serologic diagnosis are also considered. With two exceptions, all 53 patients had acute enteritis, clinically similar to shigellosis. The cases came from towns and villages throughout northern Israel and were detected from July 1976 to November 1977. Children under five years of age were 76%  of the cases. Five cases appeared in two small institutional outbreaks. It is suggested that infection probably occurs in other parts of the country as well, and that difficulty in laboratory diagnosis is the reason for the lack of reported cases.


Time dependent changes induced by external perturbations on a low molecular weight RNA. The behaviour of a soluble RNA (MW 19,000) extracted from calf thymus was studied in a partially aqueous solvent. A mixture of dioxane and an aqueous solution of 50 mM NaCl (10:1) was used to dissolve the RNA and the slow optical changes of the solution depending on time and RNA concentration were followed. The relaxation of the RNA was measured after a T-jump in the dioxane-NaCl solvent with an addition of 7 mM methyl red at 470 nm. The relaxation time was measured after experiments carried out with different RNA concentration and the rate process appears to be independent of the RNA concentration.


Experience in reimplantation of amputated digits. Reimplantation was attempted in 24 of 30 amputated fingers in 16 patients; 17 attempts were successful. The indications for surgery, the operative technique postoperative complications and results are discussed. It should be stressed that revival of the amputated digits does not necessarily mean functional success, and a careful evaluation of the results is needed. Organization of the reimplantation service is very important for achieving better results in this branch of surgery.


Purification of renal rat kallikrein and chemical relations with urinary rat kallikrein. A highly purified kallikrein from rat kidney was obtained by a multi-step purification procedure including gel filtration on Sephadex G-100, chromatography on Whatman CM-32 and DE-32 celluloses and Sephadex G-100 superfine. Molecular weight of 40,000 was estimated by sodium dodecyl sulfate polyacrylamide disc gel electrophoresis. On the purified enzyme the aminoacid analysis was determined. Some chemical differences between renal kallikrein and the most abundant rat urinary kallikrein were illustrated.


Demand for general practitioner and internist services. Demand equations for general-practitioner and internist visits were estimated from 1970 CHAS-NORC survey data on health-service utilization and expenditure. Because a large proportion of respondents reported zero visits, observations were grouped according to cross-classified independent variables and regression analyses were performed using group means as data. The results showed significant differences between demand equations for general-practitioner visits and those for internist visits. Of potential importance was an apparent substitution of internists for general practitioners as ability to pay (income or insurance coverage) increased. Own-price elasticities were low for both general practitioners and internists but were even lower for the latter (0.1 to 0.02) than the former (0.2 to 0.3). The demand for services of the two specialties also differed with respect to disability days, age, sex, residence, and race.


Insurance coverage and access: implications for health policy. Data are presented from a recent survey of the United States population comparing the characteristics and levels of access to medical care of persons under 65 years who have group or individual private health insurance, public health insurance, or no third-party coverage. The uninsured group appeared to fall between the privately insured and publicly insured groups on measures of social and economic status. Persons with publicly subsidized forms of insurance coverage utilized services at the highest rates, and uninsured persons used them at the lowest rates. Neither of these groups was as satisfied with the convenience or the quality of the care it obtained as the privately insured group. Implications of these findings for national health insurance and other health policy initiatives are discussed.


A model for regional obstetric bed planning. Utilization of obstetric beds is often inefficient because of the randomness inherent in the occurrence of births. In an effort to increase efficiency, obstetric units admit certain types of nonobstetric patients when beds are available. However, legal and practical restrictions on such admissions make it difficult to estimate the potential increase in efficiency. A stochastic model was developed to forecast the allocation of nonobstetric patient days to the OB unit and to predict the effect of such allocations on demand for obstetric beds as well as beds in other units of the hospital. The model was tested with data from six hospitals, and its possible use in decisions on the merger of units and decertification of beds was explored.


Predicting the response time of an urban ambulance system. Response time, i.e., the time from dispatch of an ambulance to its arrival at the scene of an emergency, is an important measure of performance in an urban ambulance system. We developed a model that predicts the entire distribution of response time, explicitly accounting for the rate and spatial distribution of demand, variable ambulance velocities, and queueing effects. We tested the model using data sampled from 3,936 ambulance runs in Houston and achieved close agreement between empirical and predicted distributions of response time. Our use of probability theory to predict response times yielded a model that complements those previously reported for planning and evaluating urban ambulance systems.


Hereditary fructose intolerance in early childhood: a major diagnostic challenge. Survey of 20 symptomatic cases. Twenty infants and young children with hereditary fructose intolerance (HFI) were admitted to hospital. None was diagnosed at admission. Referals were for vomiting of unknown aetiology (16X), pyloric stenosis or hiatus hernia (5X), toxic condition (3X), and hepatomegaly of unknown origin (5X). Feeding difficulties (20X), vomiting (18X), and failure to thrive (16X) were leading symptoms. The most frequent clinical findings were hepatomegaly (18X), pallor (14X), haemorrhages (13X). Ascites, oliguria, tachypnoea, fever, splenomegaly and rickets were less frequent. Laboratory findings were indicative of disturbed hepatic and renal tubular function and also of disturbed intermediary metabolism (hypokaliaemia, hypophosphataemia). However, hypoglycaemia was found in only 4 out of 15 patients tested. Differential diagnosis after hospital admission centered on metabolic disorders such as glycogenoses, galactosaemia, tyrosinosis, or Wilson's disease. Hepatitis, toxic hepatosis, liver tumour, intrauterine infection and sepsis were also considered. Eleven children had first ingested fructose within the first 6 weeks of life. The diagnosis was usually established only many weeks or months after first fructose intake and appearance of symptoms. This documents how difficult the diagnosis of this disease can be both in practice and in hospital. The course was severe in 11 children and lethal in 4. In only 5 patients was the course mild. The 16 survivors are doing well under fructose-exclusion diet. Irreversible visual impairment after intraocular haemorrhage occurred once. In each case HFI could have been suspected immediately, had a detailed nutritional history been taken. Practising paediatricians should know the composition of commonly used infant formulae. They should never prescribe sugared condensed milk for intractable vomiting prior to excluding HFI. Solution for intravenous infusion containing fructose and sorbitol are life-threatening for undiagnosed HFI patients.


Low serum somatomedin activity in celiac disease. A misleading aspect in growth failure from asymptomatic celiac disease. In 4 children with celiac disease, aged 7 months to 11 years, serum somatomedin activities (SMA) were consistently low: less than 0.40 U/ml (N greater than 0.50 U/ml). Basal plasma growth hormone (GH) levels were not elevated and increased normally under arginine-insulin stimulation in 3 patients. Human GH administration at a dosage which usually determines an increase of serum SMA in children with GH deficiency (4 mg/day/2 days) did not modify significantly the low serum SMA. However, in 1 child a clear-cut increase of serum SMA (0.22-0.82 U/ml) was noted under a higher dosage of human GH (8 mg/day/2 days). In 3 patients serum SMA was studied 3 weeks to 4 months after starting the gluten-free diet and was found to be normal. A limitation of the somatomedin generation unrelated to a deficit in GH secretion and probably resistant to GH appears therefore to be present in celiac disease. The rapid normalization of serum SMA under gluten-free diet suggests that the low serum SMA is induced through some unknown hormonal or metabolic signal by the protein malabsorption and/or the nutritional deficiency present in celiac disease.


Further studies on lymphocyte beta-glucuronidase abnormality in cystic fibrosis. Possible relations to carboxypeptidase B-like activity. The presence in the serum of both cystic fibrosis (CF) homozygotes and heterozygotes of a factor inhibiting the response of lymphocyte lysosome beta-glucuronidase activity to in vitro phytohaemagglutinin (PHA) stimulation is confirmed. Studying lymphocyte beta-glucuronidase activity on PHA stimulation represents a way to confirm CF diagnosis and to screen CF heterozygotes. For technical complexity, however, the method cannot be used for mass screening, but it can be useful for confirming the diagnosis in suspected cases. Relationships between serum factor inhibiting the effect of PHA on beta-glucuronidase, ciliary dyskinesia factor and carboxypeptidase B-like activity are discussed.


Hyperinsulinemia in childhood cirrhosis. Circulating insulin was determined by radioimmunoassay in ten children with cirrhosis of the liver and in 6 age-matched controls. They were found to be elevated in cirrhotics during fasting as well as at 1/2, 1, 1 1/2 and 2 h during the oral glucose tolerance test. These determinations were also carried out in two children with extrahepatic portal hypertension to show the possible role of portal systemic shunts for the elevated serum insulin levels. We believe that the hyperinsulinemia of these patients was related to decreased insulin degradation by the liver as well as to portal-systemic shunting.


Glycosylated hemoglobins and their relation to the control of juvenile diabetes mellitus. Patients with juvenile diabetes mellitus were studied over a period of six months. During this time their metabolic control was classified and the relation between the blood concentration of the glycosylated hemoglobins Hb A1a + b + c and the degree of diabetic control was established. 12 out of 37 diabetic children were under good control, whereas 6 patients were poorly controlled. Well controlled children had low concentrations of glycosylated hemoglobins, within the range of non-diabetic subjects. Those under poor control showed an almost twofold increase of the concentration of these minor hemoglobins. Hb A1a + b + c levels of 8 newly diagnosed diabetics were also extremely elevated. Since the hemoglobin-sugar linkage is irreversible, these components remains much longer elevated than the blood glucose itself. It is concluded that the determination of Hb A1a + b + c levels is a valuable tool for the evaluation of the efficiency of diabetic therapy in addition to blood and urinary glucose measurements.


[Psychosomatic aspects of pseudocroup].

[Psychosomatic aspects of pseudocroup]. Based on 14 paediatric case histories we present a hypothesis--to our knowledge for the first time--concerning the role of psychogenetic factors for the occurrence of pseudocroup attacks. Anxieties, insecurity and impaired ability to communicate with each other characterize the relationship of the patient and his mother. The developing independence of the child is hindered. The frightening pseudocroup attack tightens mother and child close together, allows a regression to an early childhood state of mother-child relationship, and demonstrates in a pathological way their interdependence and the dangers of autonomy.


[Isolated right ventricular hypoplasia]. A 2-day-old female infant was presented with severe cyanosis without cardiac failure. The ECG revealed a normal axis and left ventricular hypertrophy. Chest X-ray examination showed a slightly but uncharacteristically enlarged heart. Cardiac catheterization and angiography showed isolated right ventricular hypoplasia with atrial septal defect. A large right to left shunt at atrial level produced marked systemic arterial desaturation. Up to the age of now nine months the patient remained in good health without cardiac failure. The clinical findings and surgical treatment of this rare malformation are discussed. Differential diagnosis with clinically similar malformations such as tricuspid atresia type 1 B or pulmonary atresia type 1 (with intact ventricular septum) is impossible without angiography.


Calcium-binding sites as determined by electron microscope X-ray microanalysis in the electrocytes of the electric organ of Torpedo marmorata. Application of the Oschman and Wall technique to slices of non-stimulated electric organs of Torpedo marmorata reveals electron-dense deposits along the uninnervated and innervated membranes and in mitochondria of the electrocytes as well as in synaptic vesicles of the nerve terminals. As identified by X-ray microprobe analysis, the area containing these deposits reveal higher concentrations of calcium than the other probed regions in which they are lacking. The deposits generally occur in the form of rounded corpuscles, of about 10--20 nm in diameter in the plasma membranes to 30 nm in synaptic vesicles. In mitochondria, they can reach 100 nm or more. These results are briefly discussed with regard to previous data concerning calcium involvement in cholinergic transmission and its possible role in ionic regulation of the electrocyte.


Freeze-fracture autoradiography: the in-vacuo coating technique. Freeze-fracture autoradiography (FFA) was introduced in 1976 as a new method for electron microscopic autoradiography of diffusible compounds (Fisher and Branton, Rix et al.). With the original technique, the film monolayer was applied to the cold specimen in a cryostat at atmospheric pressure. Coating under these conditions did not exclude the risk of artifacts, mainly due to uncontrolled ice contamination of the cold specimen surface. A new method has been developed for coating the frozen specimen, immediately after replication, in the maintained vacuum of the freeze-fracture unit. Two main components of the new technique are described in detail, a specially designed coating device, and the use of spreading substances, promoting adhesion of the film in vacuo. Using this technique artifacts so far inherent in the FFA method can be eliminated.


Intracellular and intramitochondrial binding of lanthanum in dark degenerating midgut cells of a collembolan (insect). Lanthanum is known to be a marker of extracellular spaces. Intracellular organelles are always devoid of stain. But dark and damaged cells may be entered by the marker, as studied at the cellular level, using the electron probe X-ray microanalyser. The technique may be used to detect increased permeability at a stage when no fine structural abnormality is discernible.


Influence of autolysis on rat gastric endocrine cells. Histochemical and electron microscopical study. In the present study histochemical parameters of the rat gastric endocrine cells were followed up in the course of 24-h autolysis, and their ultrastructure was studied during autolysis lasting for 60 min. The autolysis occurred at 37 degrees C. In the light microscope, with the histochemical methods applied, only EC, ECL and G cells could be identified during the one-hour autolysis. With the autolysis proceeding for 6 and 12 h, only argyrophil method according to Grimelius (1968) enabled visualization of gastric argyrophilic cells. After 24 h of autolysis, none of the methods applied (not even the Grimelius method) proved to be adequate for successful demonstration of the gastric endocrine cells. In the course of 60-min autolysis, electron microscopic examination provided identification of the EC, ECL, AL, D1, and G cells with the characteristical ultrastructural appearance of granules. The granules of the endocrine cells (G cells included) were found to be considerably resistant to autolysis. The effect of 60-min autolysis did not induce granule "emiocytosis" or dissolution of granule content. Autolysis exceeding five minutes resulted in damage of the mitochondria of different degrees and in dilatation of the profiles of endoplasmic reticulum (particularly in G and AL cells). The results obtained in the present study demonstrate the feasibility of in vitro experimental stimulation since the endocrine granules have proved to be resistant to the effects of simultaneously developing autolysis.


The location of non-specific esterase in human lung macrophages. An ultrastructural study. The non-specific carboxyl (serine) esterase of the human pulmonary alveolar macrophage was localized ultrastructurally using alpha-naphthyl acetate and hexazotized pararosanilin. The reaction product principally outlined the outer side of the plasma membrane. Consequently, this esterase is an ectoenzyme which may function as mediator of cell response to injurious agents from the outside.


Acetylcholinesterase activity in the normal and retino-deprived optic tectum of the quail. Light and electron microscopic histochemistry and biochemical determination. Acetylcholinesterase localization has been studied by electron microscopic histochemistry in the quail optic tectum. Ultrastructural analysis reveals that the different neuronal types in the tectum possess the metabolic pathways for AChE synthesis to different degrees. From the site of synthesis in cell bodies the enzyme spreads towards areas of neuropil. In the neuropil of AChE-rich areas a balance seems to exist between enzyme stored in dendrites (and sometimes axon terminals) and enzyme released into the extracellular spaces. Precise identification of cholinergic synapses by means of AChE localization is in most cases impossible, due to extensive spread of the enzyme through the extracellular compartments of the neuropil. Unilateral ocular ablation causes disappearance of the stratum opticum and decrease in thickness of the superficial tectal layers in the contralateral optic tectum, but only minor modifications in AChE localization. This finding is in agreement with biochemical results which show equivalence of the relative concentration of AChE in the right and left optic tectum 1 or 2 months after ablation of the right eye. The experimental evidence suggests that cholinergic mechanisms are not related to the discharge of retinal afferents on receptive tectal neurons, but more likely to intrinsic neural circuits which might be involved in the modulation of tectal activity.


Meldola blue: a new electron carrier for the histochemical demonstration of dehydrogenases (SDH, LDH, G-6-PDH). A new electron carrier, Meldolar Blue (8-dimethylamino-2,3-benzophenoxazine; Boehringer Mannheim GmbH, Deutsche Patentschrift P 1959410) was tested for its usefulness in the histochemical demonstration of dehydrogenase activity in adrenal cortex, liver, heart muscle of guinea pig and human oviduct and compared with PMS. For demonstrating SDH activity Meldola Blue (MB) is as efficient as PMS. A decisive advantage of MB as compared with PMS is its low sensitivity to light exposure, facilitating direct visualisation of histochemical reaction processes. Generally, a high diffusion rate of reduced electron carriers (PMS and MB) from the section into the incubation medium (PVA) leads to a loss of reduction equivalents, particularly in the demonstration of NAD- or NADP-dependent dehydrogenases (LDH, G-6-PDH) with lower TNBT concentrations. However, no inhibition of SDH-, LDH- and G-6-PDH activities was observed with incubation media containing the tested concentrations of PMS and MB.


The effect of spatial separation of speech and noise sources on the optimal setting of the master hearing aid. The sound fields in which hearing aid evaluations are performed with tests of speech discrimination are far from standardized. This investigation was concerned with the nature of the sound field in terms of separation of speech and noise sources as related to the optimal setting of a master hearing aid as indicated by listener performance scores on tests of speech discrimination in noise. Two sound fields were used in this investigation, one with speech and noise from the same source and another with speech and noise sources separated by 90 degrees and 45 degrees off the axis of the midsagittal plane of the listener. The repeatability of the optimal setting of the master hearing aid from one configuration to the other and the resolution available in each sound field, were of prime interest. The data indicated that the sound field configuration has no bearing on the optimal setting of the master hearing aid. The data did indicate that maximum resolution was available in the case of speech and noise from the same source.


The use of masking level differences in the identification of children with perceptual problems. The purpose of this investigation was to determine whether masking level differences (MLD's) could differentiate between normal children and children with suspected auditory processing problems. MLD's for speech and 500-Hz tones were measured for an experimental group consisting of 24 normal-hearing children suspected of having auditory perceptual dysfunction. Fourteen children with normal auditory processing abilities and 11 normal-hearing adults comprised the control groups. Results indicated that (1) there was no difference between MLD's for "normal" children and normal adults; (2) there was no difference between speech MLD's for the two groups of children; however, (3) tonal MLD's for the children with suspected auditory perceptual problems were significantly lower than those for the normal groups. Using a cut-off tonal MLD of 7 dB, 79% of the experimental group were positively identified whereas only 12% of the normals were identified. The tonal MLD can be a strong addition to a central test battery, especially because it can be used with nonverbal children who cannot complete many tests because of limited linguistic skills.


Acoustic impedance values in the elderly. The purpose of this study was to evaluate the effects of age on acoustic impedance values in the elderly. Pure tone, otoscopic, and impedance testing were conducted with subjects from 20 to 29, 60 to 69, and 70 to 79 years of age. Results revealed a slight, but nonsignificant, tendency for static compliance values to decrease with age, suggesting that the use of separate compliance norms for the elderly may not be warranted.


Reliability of tympanometric measures obtained with children. Conductance and susceptance measurements at probe frequencies of 220 and 660 Hz from eleven children's ears at intervals of 1 min, 10 min, 1 day, and 1 week (7 to 10 days) were obtained utilizing the Grason-Stadler Otoadmittance Meter model 1720. All test-retest correlation coefficients were found to be statistically significant (p less than 0.05); therefore, reliability of tympanometric measures using this instrument with children seems to be adequate for clinical use.


Listener-assessed intelligibility of hearing aid-processed speech. The capacity of listeners to yield reliable and valid preferences for hearing aid-processed speech was evaluated by the method of paired comparisons. Discourse by a male talker with General American dialect was processed by five hearing aids under conditions of quiet and a background of multitalker babble. Hearing aid-processed Revised Central Institute for the Deaf Sentences spoken by the same male talker and embedded in the same multitalker background were used as stimuli in establishing criterion intelligibility performance. All stimuli were tape-recorded and delivered via monaural earphone to 90 normal listeners. Test-retest results revealed reliability coefficients of 0.94 and 0.65 on the paired-comparison condition in quiet and in babble, respectively. A low-positive relationship was observed between responses on the two subjective tasks. Essentially negligible correlations were found between subjective preferences on these individual conditions and performance on the sentence task. General conditions are hypothesized under which paired-comparison judgments of intelligibility might be expected to correspond favorably with objective performance.


Ventriculostomy for removal of foreign bodies from sarus cranes. Of 7 captive sarus cranes (Grus antigone) that ingested foreign metallic objects, 3 became ill, and 1 of the 3 died. Clinical signs included difficulty in standing, sitting on hocks, and diarrhea. A surgical approach was developed, using pigeons as models, to open the gizzard for removal of the foreign bodies. The surgery was performed successfully 3 times on 2 of the cranes that had signs of illness.


The effect of middle ear disorders on noise-induced hearing loss. Two groups of subjects, 50 noise-exposed and 50 non-noise-exposed, both with unilateral conductive hearing loss, were studied in terms of the amount of conductive hearing loss and difference in the bone conduction thresholds at 4 kHz between the two ears. The results support the hypothesis that middle ear disorders provide the ear some protection from noise-induced hearing loss.


Mycotic keratitis in a reticulated python. An adult male python was observed to have an inflamed right eye. After several weeks of antibiotic and corticosteroid therapy, a granulomatous mass was noticed on the cornea. The condition became progressively worse and the eye was enucleated. The histologic diagnosis was granulomatous mycotic keratitis with panophthalmitis.


Suspected transportation-associated myopathy in a dolphin. A pacific bottle-nosed dolphin became depressed and immobile following 22.5 hours of transportation. Creatine phosphokinase and lactate dehydrogenase activities were increased, suggesting muscle damage. Though a definitive diagnosis was not reached, the condition in the dolphin was similar to that of capture myopathy in wild terrestrial animals.


Fibrous osteodystrophy in a wild dolphin. Skeletal lesions observed during necropsy of a wild mature male dolphin (Delphinus delphis) were consistent with fibrous osteodystrophy when examined microscopically. The lesions were pronounced in the ribs, scapulae, and pelvis, with no apparent skull or vertebral involvement. Whether the cause was nutritional or nonnutritional was not determined.


Comparison of anesthetic agents in the sea otter. Five anesthetic agents (C1744, etorphine, fentanyl, ketamine hydrochloride, and halothane) were tested to establish the dosage of a safe, effective, short-acting anesthetic for use in the sea otter. Etorphine, at a dosage of 0.75 mg per adult otter and used in conjunction with diazepam, at a dosage of 1.25 mg per adult otter, met most of the requirements for use under field conditions. Halothane, administered through an anesthetic machine, proved to be effective for use in a veterinary hospital.


Hazards of disease transfer from marine mammals to land mammals: review and recent findings. In a 5-year study (1972-1977) of microbial agents isolated from both clinically normal and diseased marine mammals, it was shown that certain disease agents are widespread in a diversity of ocean populations and that some are also transmissible to a number of terrestrial mammal species. Leptospira interrogans serovar pomona has been isolated repeatedly from 2 species of pinnipeds (Zalophus californianus califonianus and Callorhinus ursinus). Some of the more important bacterial pathogens for land mammals that were isolated from wild marine mammals are Pseudomonas mallei, Clostridium chauvoei, C novyi, Neisseria mucosa var heidelbergensis, Klebsiella pneumoniae, Salmonella spp, and Pasteurella multocida. Numerous serotypes of viruses classified as caliciviruses were isolated from a variety of marine mammals. Some of these are known to infect several land mammal species including swine horses, and primates. For this reason., precautions should be taken to ensure that disease agents shed by captive marine mammals are not transmitted to susceptible terrestrial mammals, including animal handlers and other human beings.


Meningoencephalitis secondary to otitis in a gorilla. An adult female gorilla died following a 13-day illness and was necropsied. Gross and microscopic findings included a 2-cm straw deep in the external auditory meatus, suppurative otitis media and interna, and suppurative meningoencephalitis. Proteus mirabilis was cultured from the internal acoustic pore.


Cesarean delivery in a gorilla.

Cesarean delivery in a gorilla. A mature lowland gorilla (Gorilla gorilla) in the Los Angeles Zoo had destroyed 3 successive infants. To avoid a recurrence, active intervention was instituted during its 4th pregnancy. The period of gestation was estimated by physical examination, radiography, and amniocentesis. Intrauterine growth was followed by serial ultrasonographic cephalometry. When fetal maturity was achieved, as determined by amniotic fluid phospholipid profile, the fetus was delivered by cesarean section.


Endodontic surgery for treatment of a fistulated molar abscess in an orangutan. An adult Bornean orangutan was treated for bacterial labyrinthitis, which was a sequela to a molar abscess and maxillary sinusitis. Antibiotic therapy and endodontic surgery led to complete remission of clinical signs.


Suppurative arthritis in an infant orangutan. A 12-day-old male orangutan (Pongo pygmaeus) was removed from its mother because of oral ulcers and reluctance to suckle. Close examination revealed ulcerations extended to the mandibular bone. Staphylococcus aureus was cultured from the oral lesions. Despite intensive antibiotic therapy, the infection progressed to septicemia, with suppurative arthritis of the left coxofemoral and right radiohumeral joints. Treatment included removal of synovial exudate by aspiration, indwelling drains, and arthrotomy. Antibiotics were administered systemically and by joint irrigation. The infant responded well to the treatment, which lasted for approximately 2 months.


Cystinuria in a maned wolf.

Cystinuria in a maned wolf. A renal calculus composed principally of the amino acid, cystine, was found in an 8-year-old male maned wolf (Chrysocyon brachyurus). Cystine crystals were found in the urine sediment. The renal clearance of 10 amino acids was abnormal, whereas reabsorption of others was normal. The renal clearance of cystine, lysine, ornithine, and arginine exceeded the filtered load. The renal tubular handling of glucose, phosphate, sodium, potassium, and uric acid was identical to that for the clinically normal dog. These findings indicated an isolated renal tubular defect for cystine and other amino acids.


Evaluation of xylazine for chemical restraint of captive arctic wolves. Xylazine at dosages of 2.7 to 3.9 mg/kg of body weight was administered to 23 captive arctic wolves. The optimal dosage was higher for excited and socialized adults and lower for juveniles than for unexcited unsocialized adults. Mean time to initial effect was 2.5 minutes and mean time to sternal recumbency was 3.7 minutes. Maximal effect was achieved within 15 minutes, with adequate sedation lasting 30 to 60 minutes. Mean recovery time was longer for old (greater than 7-year-old) adults than for young (2- to 3-year-old) ones (2.4 vs 1.7 hours). Induction of and recovery from barbiturate anesthesia was smooth and quiet. Although a few adverse reactions were found, the use of xylazine with physical restraint was an excellent combination for many clinical procedures.


Capillaria hepatica infection in coyotes of Louisiana. Capillaria hepatica infection was diagnosed by histologic examination in 21 of 71 (30%) coyotes in Louisiana. All infected coyotes were at least 1 year old, and most (19 of 21) were more than 2 year years old. Capillaria hepatica was not found in any livers from 31 red foxes and 20 gray foxes examined.


Naturally occurring Tyzzer's disease in the gray fox. Four gray fox became anorectic and developed diarrhea. Their condition worsened until death. Diagnosis of Tyzzer's disease was made on the basis of clinical signs, gross and microscopic lesions, and the demonstration of Bacillus piliformis in the liver.


Chronic frontal sinusitis and osteolysis in desert bighorn sheep. Chronic frontal sinusitis and osteolysis in a herd of desert bighorn sheep (Ovis canadensis nelsoni) in Zion National Park, Utah, was attributed to bacterial infection secondary to aberrant nasal bot migration. Analysis of skulls and live adult sheep (equal to 1 year old) showed that 9 to 22 animals were affected. One ram and 1 ewe were treated by trephination and irrigation. Treatment was successful for the ewe, but not for the ram. Radiography, thermography, and blood profiles were used in an attempt to find a way to diagnose sinusitis in its early stages; at this point, only thermography shows promise.


Brucellosis in feral swine in Florida.

Brucellosis in feral swine in Florida. Serums from 95 feral swine trapped in Glades County, Florida, were tested for brucella antibodies, using the standard tube, card, rivanol, and complement-fixation tests. Fifty (53%) of the animals were seropositive to at least 1 test. The standard tube test detected 98% of the serums positive to any of the 4 procedures. The prevalence of brucella antibodies was significantly lower (P less than 0.0005) in feral swine less than 6 months old than in those greater than or equal to 6 months old. The prevalences by sex were similar. Necropsies were performed on 9 of the feral swine. Brucella suis, biotype 1, was recovered from all 9, with lymph nodes being the tissues most commonly infected. Only the standard tube test detected brucella antibodies in all 9 culture-positive animals.


Poisoning of palm doves with dibutyltin dilaurate. Dibutyltin dilaurate was inadvertently introduced into dairy feed which was consumed by wild palm doves (Streptopelia senegaleniss). About 150 dead and dying doves were found within several days. Extremely high concentrations of tin were found in samples of liver and skeletal muscle in these birds. A sample of the feed, which was found to contain about 2,500 ppm tin, was fed exclusively to 2 normal palm doves. On the 8th day of feeding, one dove died and the other was moribund. High concentrations of tin (27 to 141 ppm) were found in the livers of poisoned birds. Signs of poisoning in both the naturally occurring and experimentally induced poisonings were severe depression and yellow diarrhea.


Systemic fungal infections in cats.

Systemic fungal infections in cats. Pneumonia and ileitis due to Aspergillus spp was diagnosed at necropsy in an adult female cat. In a 2nd cat, Aspergillus spp caused acute focal necrotizing pneumonia. A 3rd cat had severe necrotizing colitis caused by a phycomycete. Two of the cats had clinical signs and pathologic lesion compatible with feline panleukopenia, which probably increase their susceptiblity to fungal infection. The ability of Aspergillus spp and phycomycetes to invade tissue was probably enhance by prolonged treatment of the cats with antibiotics.


Pulmonary aspergilloma in a rat.

Pulmonary aspergilloma in a rat. Small grayish white nodules were observed in the lungs of a young female rat. Microscopically, the pulmonary nodules were composed of granulomatous tissue and septate branching mycelia. The organism was identified as Aspergillus sp by direct fluorescent antibody technique.


Clinical and pathologic conditions of female nude (athymic) mice in two conventional maintained colonies. Two colonies of female outbred nude (athymic) mice were maintained by conventional standards of husbandry, but with special sanitary methods and segregation from other rodents. A total of 1,526 mice entered the colonies. Of these, 802 were untreated and most remained healthy. Necropsies were performed on 312 untreated mice that were sick and were killed or died naturally, and the tissues were examined microscopically. Clinical and pathologic conditions in the untreated mice included subcutaneous abscessation, dermatitis, subcutaneous edema due to glomerulonephritis (nephrotic syndrome), rectal prolapse, and lymphomas and other neoplasms.


Production of a novel red pigment, rubrolone, by Streptomyces echinoruber sp. nov. I. Taxonomy, fermentation and partial purification. A taxonomic study of Streptomyces X-14077 (NRRL 8144), which produces a water-soluble purple-red pigment complex, revealed it to be a new species which has been named Streptomyces echinoruber sp. nov. The pigment complex was produced in deep culture fermentation and isolated by solvent extraction and concentration. The major pigment component, rubrolone, has low toxicity and may have potential as a food coloring agent. It appears to be devoid of antibiotic activity.


Production of a novel red pigment, rubrolone, by Streptomyces echinoruber Sp. Nov. II. Chemistry and structure elucidation. Streptomyces echinoruber sp. nov. produces several red pigments. The major component, rubrolone, has been identified as 8(R),9(R),10(S),10a(R)-tetrahydro-9,10,10a,11-tetrahydroxy-3,8-dimethyl-1-propyl-6aH(S)-pyrano[2",3":5',4]furo[2',3':5,6]azuleno[2,3-c]pyridine-5,13-dione (1) by single crystal X-ray analysis of a suitable derivative. A second pigment, B, is probably structurally closely related.


Absorption, distribution and excretion of SCE-963, a new broad-spectrum cephalosporin, in mice, rats, rabbits and dogs. A single dose of 20 mg/kg of SCE-963 [7beta-]2-(aminothiazol-4-yl)acetamido]-3-[[[1-(2-dimethylaminoethyl)-1H-tetrazol-5-yl]thio]methyl]ceph-3-em-4-carboxylic acid] was administered subcutaneously to mice, intramuscularly to rats, rabbits and dogs. Plasma and tissue levels of SCE-963 reached a peak in 15 approximately 30 minutes after administration. In mice, rats and dogs, SCE-963 was distributed at high concentration in the descending order in the kidney, liver, plasma, lung and spleen, and in rabbits, in the kidney, plasma, lung, liver and spleen. The SCE-963 levels in the liver of mice, rats and dogs were higher than those of cefazolin, cephaloridine and cephalothin. The plasma and tissue levels of SCE-963 in mice and rats diminished rapidly, but those in rabbits and dogs declined gradually. SCE-963 was mainly excreted in the urine. The rate of excretion of SCE-963 in the bile was two to three times higher than that of cefazolin.


Anaerobic susceptibility tests. Evaluation of the stability of antimicrobials in Wilkens-Chalgren broth and the effect of media prereduction. The stability of eight antimicrobial agents in WILKENS-CHALGREN broth was evaluated. The activities of only carbenicillin and benzyl penicillin were significantly decreased after storage for eight weeks at--20 degrees C. Anaerobic reduction of the susceptibility testing broth prior to inoculation was found to be unnecessary.


Patient and physician characteristics influencing medical decisions in asthma. The present study explores the complex interplay of objective indices of illness-severity and personal characteristics of patients and physicians as they influence judged illness-severity and medical decisions concerning length of hospitalization and intensity of prescribed oral corticosteroids in a chronic asthmatic population. The results indicate that, depending on the physician's personal characteristics, he may: a) confuse his patient's psychological physical distress, resulting in medical judgment and decisions being influenced by patient personality; b) accurately distinguish between psychological physical distress but treat a psychological problem as though it were a medical problem; c) judge and treat the patient's illness objectively, regardless of the patient's personality. These findings stress the importance of expanding the present biomedical model of medicine to include a better appreciation of how social, psychological, and behavioral factors influence the medical decisions about treatment and the resulting outcome.


Development of an audiometry data processing system. The development was reported of an electronic data processing system of computerized automatic audiometry and of Bekesy audiometry. This system using a microcomputer has the following features: (1) The large amount of data obtained through (a) automatic audiometry, (b) Bekesy audiometry (measurement at fixed or continuous frequency plus test practice, and (c) the Temporal Tone-Decay test can be stored on-line in real time, and are processed and displayed off-line at any time. (2) When retrieved, the output format of these audiometric data is of the same pattern as the conventional audiogram. (3) The output pattern on the CRT graphic display can be hard-copied whenever desired. (4) The system can be operated manually in the same way as the conventional method. (5) The SISI and DL tests can be executed manually and the resultant data keyed into computer storage. And (6) The operation from the data input to the retrieval output is performed interpretively through the CRT display, so that anyone even without special computer or audiological training can operate it at any time.