Ketamine anesthesia in strabismus surgery. Because of the conflicting opinions in the ophthalmic literature concerning the efficacy of Ketamine anesthesia in strabismus surgery, we decided to report out experience in 44 children operated upon between the ages of six months and six years. Satisfactory anesthesia was achieved in all cases except two who required intubation and inhalation technique in order to complete the surgery. No serious side effects were observed during or after the surgery. Its ease of administration, freedom from side effects, and satisfactory anesthesia, make Ketamine our primary anesthetic choice for strabismus surgery in children.


Posterior choroidal involvement in Letterer-Siwe disease. A five-year-old child with Letterer-Siwe disease in remission was found to have decreased vision in on eye produced by a choroidal mass and secondary retinal detachment with cystic degeneration. Echography confirmed a vascularized disciform-like mass with possible involvement of the optic nerve. Florescein angiography showed a well vascularized, intensely staining lesion, with optic disc edema, destruction of the retinal pigment epithelium and cystoid macular edema.


Megalocornea in nonketotic hyperglycinemia. A nine-month-old girl with nonketotic hyperglycinemia and bilateral enlargement of the corneas is reported. There was no evidence of elevated intraocular pressure or iridocorneal angle anomalies. The corneas have remained clear and lusterous without tears in Descemet's membrane. The possibility that the elevated glycine level may play a part in the buphthalmia of this patient is discussed in light of what is known about the effect or excessive dietary glycine on the developing chick eye. Further ophthalmologic study of patients with various forms of glycinemia might provide further understanding of the ways in which the developing eye may enlarge.


Unusual case of acute orbital cellulitis. A three and one-half year-old female who presented with orbital cellulitis and leukocoria is described. Enucleation was performed as the eye was microophthalmic, blind, and painful. Histopathologic study revealed uveitis with total retinal detachment. The etiology of the retinal detachment was indeterminable. The differential diagnosis of orbital cellulitis in children is reviewed.


Congenital Leber amaurosis, keratoconus, and mental retardation in familial juvenile nephronophtisis. Two siblings suffering from congenital Leber amaurosis were found to be affected also by juvenile nephronophtisis. Keratoconus in one child and mental retardation in the other developed during their later growth. An extensive laboratory study showed normal results but revealed an impaired urinary concentrating ability. The hereditary pattern operating in this complex disease was found to be consistent with an autosomal recessive trait.


Catecholamine metabolites in the aqueous of retinoblastoma. The aqueous humor of five patients with histologically proven retinoblastoma were analyzed for the main catabolic products of norephinephrine and epinephrine. In each case, there were no detectable levels of normethanephrine, metanephrine, vanilmandelic acid (VMA), and 3-methoxy, 4-hydroxy phenoglycol. The techniques are sensitive to 1 microgram/ml but will not detect the presence of homovanillic acid (HVA).


Ocular findings in children with homozygous sickle cell anemia in Nigeria. The ophthalmological findings in 91 Nigerian children with homozygous sickle cell anemia is reported. While the most constant sign was abnormality of the conjunctival vasculature, seen in 74(81%) of the patients, retinal lesions were found in a total of 53(58%) patients. Only tortuosity of major vessels was seen in some patients but several others had more than one type of retinal lesion.


Retinopathy of prematurity in the intensive care nursery. Retinopathy of prematurity (retrolental fibroplasia) is once again a problem of major concern to neonatalogists and ophthalmologists. Infants of low birth weight and gestational age seem to be most at risk. The clinical course of the disease is reviewed and a classification, simplistic in its approach, is presented. The discovery of retinopathy of prematurity in an infant should stimulate the ophthalmologist to follow the course of the disease very carefully. Preliminary experience may indicate that intervention on behalf of the infant is possible.


Optic nerve hypoplasia with diabetes insipidus. Two patients with the combination of bilateral optic nerve hypoplasia and diabetes insipidus are reported. One patient also had absence of the septum pellucidum (septo-optic dysplasia), which previously has been associated primarily with abnormalities of anterior pituitary function.


Posttraumatic subgaleal hematoma extending into the orbit as a cause of permanent blindness. A delayed subgaleal hematoma developing after blunt head trauma extended into the right orbit to form a subperiosteal hematoma on the orbital roof. Permanent blindness was found in the involved eye six days after the injury.


Lens opacities in thalassemia.

Lens opacities in thalassemia. This is the first case report of cataracts in patients with thalassemia major. Desferrioxamine, an iron-chelating agent is being used with increasing frequency in the treatment of transfusion-induced iron overload. There has been some concern in the literature about possible cataract formation with use of this drug. It is therefore important to document any lens opacities seen prior to administration of desferrioxamine, or record the appearance of lens opacities after its use. The possible eitology of these lens opacities is discussed.


Duane's retraction syndrome associated with muscular dystrophy. A case of unilateral type I Duane's syndrome associated with muscular dystrophy is presented. The diagnosis of muscular dystrophy (Duchenne type) is firmly established by clinical, biochemical, electrophysiological, and histological observations. The ocular anomali is clearly distinguished from other congenital disorders of eye movements. The combination of these two congenital anomalities is considered to be quite rare.


Psychogenic amblyopia in children.

Psychogenic amblyopia in children. Forty-three children with unexplainable low visual acuity were diagnosed to have psychogenic amblyopia. Twenty-eight children returned after a mean interval of 20 months. Sixteen children had a normal visual acuity, but 12 children again presented themselves with a low visual acuity that normalized rapidly under the influence of the same kind of persuasion that was used in the first examination. Psychological tests did not confirm the hypothesis of hysteria but the neurosomatic score was significantly high. The results of the psychological tests and the interviews of the parents suggest a neurotic conflict not on the basis of an oedipal conflict but on the basis of a conflict between the wish to express feelings of hostility and the wish not to lose the love of the parents.


Congenital (infantile) esotropia: psychiatric aspects. There is increasing evidence that the general apperance of the child plays a profound role in the developing parent-child relationship. The manifest and obvious ocular misalignment present in the child with congenital (infantile) esotropia is one barrier to the eye contact necessary for a proper relationship to take place. The early correction of esotropia removes the barrier to the normal development of parent-child relationship.


Ocular cysticercosis.

Ocular cysticercosis. Eight cases of ocular cysticercosis are reported. A rare case of cysticercus in the anterior chamber, and another case with bilateral involvement and two cysts in one eye are reported. The reasons for its prevalence in this region are discussed.


Bilateral acute dacryocystitis in a premature infant. A premature infant with bilateral acute purulent dacryocystitis was presented. The possibility of a contamination before delivery was raised. Treatment with antibiotics proved to be helpful in curing the disease.


Antipodean squint.

Antipodean squint. Strabismic cases which are exotropic fixing with one eye, and esotropic fixing with the other eye are rare and a result of anisometropia, unequal accommodation, paresis or restriction, and previous ocular muscle surgery. Three cases of antipodean squint are reported without known etiology factor. An extensive survey of experts in the field of strabismus was unable to document other similar cases where a cause could not be determined.


Persistent hyperplastic primary vitreous in an adult: case report with fluorescein angiographic findings. The clinical features and fluorescein angiographic findings of an 18-year-old man with PHPV are reported. The case is unusual in that the eye survived into adulthood. The lens resorbed spontaneously, thereby permitting study of the retrolental mass by fluorescein angiography. Fluorescein leakage from the  persistent vessels was very slow but present, thus indicating a probable disruption of the endothelial tight junctions of the tunica vasculosa lentis.


Vernal conjunctivitis in Nigerian children. Vernal conjunctivitis in 92 Nigerian children are reported. Males are more affected than females. Majority of the patients are in the first decade of life. The disease is usually chronic and palpebral form is twice as common as the limbal. More patients are seen in the early wet season and only in about 10 percent is a history of atopic diseases obtained. The variations of this disease in this series may be due to geographical rather than racial factors.


Vertical offsets of the horizontal recti. The results of an analysis of the surgery performed to correct both horizontal and vertical strabismus in patients without fusion potential is presented. Recession and resection of the horizontal recti combined with vertical offsets was the procedure employed. These results indicate that both esotropia and exotropia along with a coexisting hypertropia can be made cosmetically acceptable by this procedure.


Macular cysts and holes.

Macular cysts and holes. The ocular findings in an eight-year-old Negro male with unilateral axial myopia and bilateral macular cysts and holes are presented. Normal psychophysical, electrophysiologic, and angiographic findings were noted despite obvious anatomic changes. The constellation of observed findings in this patient appears to be unique.


Cryptophthalmos with an orbital cyst and profound mental and motor retardation. The cryptophthalmos syndrome generally consists of cryptophthalmia, dyscephaly (cleft lip and palate, nasal and ear defects, meningoencephaloceles, etc.), syndactyly, and urogenital malformations. This disorder is rare. Approximately 55 cases have been reported, with only a few described in the American literature. A three-year-old boy with this rare syndrome is described. Major clinical findings include: asymmetric bilateral cryptophthalmos, unilateral orbital cyst of the nasofrontal area, bilateral anophthalmos, right choanal atresia, right microtia, right auditory canal atresia, hypodontia, ankyloglossia, cartilaginous synchondroses of the cervical vertebrae, and bilateral acetabular dysplasia. Striking features of this case, in addition to the above, were profound mental and motor retardation. Syndactyly and renal anomalies were not observed.


Optic nerve hypoplasia.

Optic nerve hypoplasia. Optic nerve hypoplasia is rarely met in otherwise normal eyes. Three unilateral cases of patients with small optic disks, reduced visual acuity, and convergent squint on the affected eye are presented. The anomaly is probably caused by failure of development of the ganglion cell layer of the retina causing a small optic nerve head with normal central vessels. Inheritance or induction by drugs could not be found in our cases.


Ophthalmological findings of muscular dystrophies: a survey of 53 cases. An ophthalmological survey of 53 cases of muscular dystrophies is presented. Patients were classified into a congenital type of dystrophies (21 cases) and a Duchenne type of dystrophies (32 cases). High incidence of myopia, weakness of the orbicularis oculi, lacking of Bell's reflex and blinking at rare intervals are found in congenital dystrophies. No pigmentary retinal degeneration was found and cataracts were rare. Atrophy of optic nerve is seen in several cases of congenital dystrophies. This fact is considered to suggest that congenital muscular dystrophies are not only a myogenic disorder but also involve the central nervous system with degenerative changes.


The natural course of congenital obstruction of the nasolacrimal duct. In order to establish the rate of spontaneous resolution of congenital obstruction of the nasolacrimal duct, 50 infants, referred from a local pediatric group practice over a period of five years, were followed from the time of first symptoms until 8 to 13 months of age. Among the 50 infants, 65 nasolacrimal ducts were blocked and 58 ducts in 44 patients opened spontaneously. Only seven ducts in six patients required probing for relief of the obstruction. During the same period another seven patients from various referral sources were seen because of noninflammatory swelling of the lacrimal sac at birth. These patients were also found to have nasolacrimal duct obstruction, but early surgical intervention was required in six of the seven patients to relieve the distention of the sac.


The management of persistent congenital occlusion of the nasolacrimal duct: after unsuccessful probing. Persistence of congenital occlusion of the nasolacrimal duct in spite of apparently successful probings is usually due to separation of the nasal mucosa in the region of the exit of this duct and failure to rupture the membrane that causes the occlusion. Cutting of this membrane through a nasal speculum is a simple method that often leads to a permanent cure.


Infantile glaucoma associated with contralateral esotropia. A 20-month-old white male was first seen with an esotropia at four months of age by his pediatrician. The esotropia had been present by history since early in life. After pediatric evaluation, which demonstrated delayed motor development, he was referred for ophthalmic consultation. A comprehensive ophthalmic evaluation established the diagnoses of infantile glaucoma and myopia of the preferred eye, and esotropia and amblyopia of the emmetropic eye. The infantile glaucoma was surgically treated and amblyopia reversed following patching of the glaucomatous eye. Orthophoria was achieved. Esotropia may be the presenting manifestation of unilateral infantile glaucoma of the contralateral eye. Comprehensive appraisal should include pediatric, neurologic, and ophthalmic evaluation.


The use of the ophthalmological services during the preschool age, ocular findings and family background. The series consists of 12,059 children followed-up since their mothers' pregnancy. Of these children, 5.2 percent had visited an ophthalmological department during their first five years. Visits were significantly more frequent among the children of social classes I to III than among those of class IV and the farmers', and thus the frequencies of the diseases based on diagnoses given in the ophthalmological departments were also higher in social classes I to III. These children clearly had the best opportunities to have their diseases diagnosed at an early age. Squint was the most common diagnosis with the prevalence being 18.4 per thousand for the children in social classes I to III and 15.9 for the total series. The second largest group consisted of children without any positive ocular finding. These were mainly risk children having some other disease. The third most common diagnosis was dacryostenosis--its incidence in social classes I to III being 9.4 per thousand and that in the total series 7.9 per thousand. Squint correlated negatively with birth weight and was more common among children with some other disease, especially some nervous or mental disease. Dacryostenosis correlated positively with gestational age. If the mother smoked during the pregnancy she was more likely to give birth to a child with squint and less likely to bear a child with dacryostenosis.


Congenital fibrosis of the extraocular muscles. Congenital fibrosis of the extraocular muscles is characterized by the replacement of normal contractile muscle tissue by fibrous tissue or fibrous bands in varying degrees. The clinical entities which result from the fibrous replacement can be classified under the following headings: general fibrosis syndrome, congenital fibrosis of the inferior rectus muscle with blepharoptosis strabismus fixus, vertical retraction syndrome and congenital unilateral fibrosis, enophthalmos, and blepharoptosis. Genetic factors may or may not be apparent. One pedigree with general fibrosis syndrome was traced through five generations. Light and electron microscopy demonstrated replacement of normal muscles by collagen and dense fibrous tissue with occasional areas of degenerated skeletal muscle. The surgical management attempts to achieve some functional readjustment of the ocular and lid position as well as the abnormal head posture. The surgical results were considered satisfactory when compared with the original position of the eyes and the backward head tilt.


Monozygotic twins discordant for Duane's retraction syndrome. Monozygotic twin boys discordant for the occurence of Duane's retraction syndrome are presented. This appears to be the first report of such discordance between monozygotic twins. The theoretic problems which this situation poses for the explanation of the acquisition of Duane's retraction syndrome is discussed.


Veridicality of cognitive mapping of stressor effects: sex differences. In order to examine the veracity of judgment-questionnaire data regarding the effects of confronting a stressor in various contexts, judgments based on the imagined consequences of these encounters were scaled for both male and female subjects using individual-differences multidimensional scaling analyses. A parallel experiment was then carried out where a second group of subjects were directly exposed to the spectrum of stressor-context combinations previously judged. The two experiments substantially differed with respect to the inferences suggested by their results: while there were no apparent sex differences in the configuration of judgment responses, there were appreciable sex differences in response to the direct stress; other effects were predicted according to the judgment-scaling results but were not obtained upon direct stressor exposure. The study extended past results of equivocal veracity of conclusions drawn from personality questionnaires, ratings and inventories to the domain of stress reactions. The role of antecedent cognitive structuring of threatening situations along stress-relevant dimensions in determining response to direct threat was discussed. Discussion also focused on the configuration of sex differences over the several measures of response to the direct stressor. It was suggested that the stressor was more potent for females leading to increased cognitive coping efforts on their part. The effect of these efforts was the eventual reduction of their subjective stress to the level of that displayed by males.


Acquired "double elevator" palsy and polycythemia vera. A 67-year-old woman had the acute onset of vertical diplopia. Examination revealed that she had a "double elevator" palsy of the fixing left eye which resulted in a right hypertropia. During the medical evaluation of the patient it was established that she had polycythemia vera. It is suggested that the ocular movement disorder seen in this patient resulted from a small lesion adjacent to and including the right superior rectus subnucleus. The increased blood viscosity resulting from the patient's polycythemic state may have been a significant predisposition in the development of an occlusive vascular episode involving this area of the midbrain.


Congenital third nerve palsy with amblyopia of the contralateral eye. A child with congenital third nerve palsy using the palsied eye for fixation is presented. Apparently, amblyopia developed in the secondarily deviating eye. This is the first case report of which we are aware with such a disturbance, ie, primary ocular motor palsy in one eye and sensory amblyopia in the other.


Further comments on criteria for reimbursement for psychological assessments. Bruhn (1978) has offered some comments about criteria for CHAMPUS reimbursement. These criteria are CHAMPUS-specific and subject to modification for other health plans. Deviations are subject to peer review and may be approved for reimbursement. Expert opinion is widely solicited to justify the criteria.


The usefulness of the Rorschach Prognostic Rating Scale--a rebuttal. In rebuttal to the recent article by Garwood (1977), this paper presents a framework for evaluating the usefulness of the Rorschach Prognostic Rating Scale for predicting success in psychotherapy. A critical review of the research findings cited by Garwood is presented, followed by a discussion of the overall usefulness of the instrument as a predictive measure in light of the framework suggested. It is concluded the scale is not yet proven to be of great clinical usefulness, as its degree of discriminability is not great enough for basing clinical judgments.


Tuberculous panophthalmitis.

Tuberculous panophthalmitis. The case of a one-year-old Nigerian with tuberculous panophthalmitis is reported. He presented initially with a localised episceleral mass which was thought to be retinoblastoma due to rapid spread over the fundus induced by subconjunctival depromedrol. Histological examination of the enucleated eye showed that the lesion was due to tuberculosis. The subsequent favorable response of the ocular and radiological chest lesions to antituberculous therapy was quite remarkable. In contrast, there was an adverse response to radiotherapy which had followed enucleation on the strong suspicion of retinoblastoma. Not unnaturally, ocular tuberculosis was not thought of because of the rarity of ocular involvement with this disease. To our knowledge, this is the first case of its type reported from the African Continent.


The Dream Incident Technique as a measure of unresolved problems. The Dream Incident Technique is a psychometric technique that uses dream associations as its basic data. The scales of the DIT are believed to provide information about unresolved problems on a level below that of full conscious awareness. The paper discusses factor analyses of the Technique, data concerning its reliability and studies which offer some support for the validity of the Technique.


Experimenter effects on responses to double-entendre words. The present study examines the possibility that experimenters may contribute to a subject's desire to defend against sexual expression by investigating the interaction between sex of experimenter and sex of subject on response to double-entendre words. The results indicated that subjects are more likely to provide nonsexual words when tested by an opposite-sex experimenter, although this effect is significant only for male subjects, and female experimenters, in general, elicit longer latencies to double-entendre words. These findings were discussed in terms of the dynamics operating within the type of experimental settings used to study human sexual behavior. Implications of these findings for personality assessment are also addressed.


Traumatic hypopituitarism associated with bitemporal hemianopia in a prepuberal child. The case of a boy affected by post-traumatic hypopituitarism associated with bitemporal hemianopia is described. While traumatic bitemporal hemianopia is not an extraordinary occurence, traumatic injuries have been rarely reported among the causes of hypopituitarism. This may be because the cranial trauma in most of the cases is too severe to permit survival. After having considered the diagnostic problems the authors briefly review the peculiar vascular supply to the chiasma and anterior diencephalon and try to consider the pathogenetic mechanism of the syndrome. Direct contusion necrosis and direct intraparenchymal hemorrage in the chiasma and in the hypophysis or hypothalamus are considered the most probable causal factors; however, the concomitant occurence of chiasmal and hypopituitary injury might be explained by a single transient compressive mechanism either on the tubero-hypophysial arteries or on the smaller vessels of the infundibular network. The difficulty of ascertaining both the pathogenetic mechanism and the seat of the endocrine lesions on the basis of the clinical signs is stressed.


Arteriovenous malformation of the orbit and palate. A patient was reported in which orbital and retinal arteriovenous malformations were noted. The value of oral examination in discovery of another palatal arteriovenous malformation is discussed.


Clinical correlates of the PRF Androgyny scale in an alcoholic population. Clinical correlates of the PRF Andro were examined in an alcoholic population. Measures included the Sensation Seeking Scale, Eysenck Personality Inventory, Symptom checklist--90, the Cornell Medical Index and Rotter's Locus of Control. Of 28 possible relationships, only five measures were found to be weakly associated with androgynous subtypes. Androgynous subtypes appear largely unrelated to the psychological and physical health of alcoholics.


Nasal heterotopia of the macula with persistent hyaloid vessel. A 22-year-old woman presented with nasal dragging of the disc and nasal ectopia of the macula due to persistent hyaloid vessels. The causes of this entity are presented. Patients with strabismus should have ophthalmoscopic fundus exam to rule out ectopic maculae.


[Intracranial pressure. IV - Relationships with post capillary vascular pressures (author's transl)]. The authors have demonstrated experimentally in dogs that, in all cases, the cortical venous pressure (Pvco) is higher than the intracranial pressure (PIC), which always remains higher than the sagittal sinus venous pressure (PSLS). The difference between Pvco and PIC remains statistically equal to 8 mm Hg and can be explained by the "Vascular Waterfall" phenomenon; during Queckenstedt's test, the intracranial venous volume does not change, and is not the cause for the increase of PIC; this increase is due to the constancy of the difference between PIC and PSLS, which is induced by the resorption of CSF through the arachnoïd villi. Increases in Pvco and PIC are shown to be equal to 70% and &2% respectively of the change in PSLS. Any other factor that increases PIC (injections in the cisterna magna, pharmacological effects) does not change PSLS, which remains equal to zero. As long as the cerebral blood flow is constant, the increase in cerebro-vascular resistance of the veins at the site of their junction to the sagittal sinus must be compensated upstream by a vasodilatation, which leads to a new distribution of the pressures along the cerebro-vascular bed.


[Effects of hypertonic solutions on the excitation-contraction coupling of the skeletal muscle fibre of the crab. II. Ultrastructural aspects (author's transl)]. Experiments were performed to investigate the modifications of electrical activity and the loss of contraction by examination of the ultrastructure. These alterations were obtained with a control physiological solution (artificial sea water, ASW) which was made hypertonic by adding sucrose, glycerol, choline chloride or urea. 1. Under these conditions, the ultrastructural results show that: a) all those substances induce a modification of the coupling junction (either diad or triad). This modification can explain the inhibition of the mechanical phenomenon; b) sucrose (Figs. 6C and 6D) and glycerol (Figs. 4A and 4B) induce alterations of the surface membrane and of the tubular system (less important with glycerol). They can explain the decrease of the resting potential and the abolishment or the modification of the action potential; c) in contrast, choline chloride (Figs. 7A to 7E) and urea (Figs. 9A to 9F) only modify the organisation of the coupling junction. The action potential is maintained. 2. A short exposure of the fibre in an isotonic sucrose solution (Figs. 5A to 5D) deeply modifies the tubular system, particularly, in cutting it off from the sarcolemma. 3. Choline chloride and urea produce similar changes in the ultrastructure but as urea is not ionized, it can be added to the ASW to investigate the electrical phenomenon which cannot be modified by contraction.


Is the rhythm amplitude related to the ability to phase-shift circadian rhythms of shift-workers? The magnitude of the circadian acrophase adjustment deltaphi to a phase shift of socio-ecologic synchronizers (as in shift-work) varies from subject to subject. According to J. Aschoff, the ability to adjust rapidly to a phase-shift could be associated with having a small amplitude for certain circadian rhythms. To test this hypothesis, the correlation coefficient (r) between the mean circadian rhythm amplitude A and the acrophase shift deltaphi (measured after the first night-shift) were calculated from estimates of chronobiological time series analyses (Halberg's single cosinor method). Data were obtained from two groups of selected shift-workers (20 and 5 subjects, respectively). A negative correlation between A and deltaphi (the smaller the amplitude, the greater the delpaphi) was observed in the circadian rhythms of the following variables: oral temperature (r = .63;P less than .01), peak expiratory flow (r = . 53: P less than . 01), and urinary 17-OHCS (r = . 60; P less than . 01), but not for other variables such as : grip strength, urinary K+ and Na+. The small amplitude of certain circadian rhythms could be considered as an index of an individual's ability to phase-shift easily. However, chronobiological characteristics, other than the small circadian rhythm ampliture, remain to be identified, for both a better detection of one's ability to do shift-work and a better knowledge for practical applications.


[O2 chemoreflex drive of ventilation in the awake rat (author's transl)]. Resting ventilation, arterial pH and gas tensions in the arterial blood and ventilatory responses to transient O2 inhalation were studied by plethysmography, under normoxic and hypoxic (FIO2 = 0.12) conditions, in the awake rat before and after chronic bilateral denervation of the carotid bodies. 1. In the intact rat, the O2-chemoreflex drive of ventilation controlled about 50% of the normoxic minute volume, and 85% in hypoxia. 2. Chronic bilateral carotid body denervation reduced the chemoreflex drive to half, and was accompanied by a hypoventilation with arterial hypercapnia. 3. In acute hypoxia hyperventilation was reduced in carotid-body denervated animals, and was accompanied by a light respiratory insufficiency. These results suggest that the rat has a powerful arterial chemoreflex drive of breathing which is essential in determining the eupneic level of ventilation in acute hypoxia.


[Patterns of motor innervation of the catfish (Ictalurus nebulosus Les.) deep lateral muscle fibres (author's transl)]. 1. Some patterns of the motor innervation of the Catfish (Ictalurus nebulosus) deep lateral muscle have been investigated using the Koelle method of demonstrating cholinesterase activity and intracellular recordings. 2. In the superficial region of the muscle, facing the visceral cavity, neuro-muscular junctions are located in the middle part of the muscle fibres. Stimulating the motor nerve with shocks of increasing amplitude evokes first end-plate potentials and then typical propagated action potentials. This result supports the occurrence of at least two motor axons at each junction. 3. In the deep region of the muscle, neuro-muscular junction are confined to the ends of the muscle fibres. Individual fibres show two junctions, one at each end. Stimulating one of the two terminal junctions initiates action potentials which are propagated up to the other end of the muscle fibre.


Scheduled-training of cats to a simple reaction time performance. Cats were trained to release a lever at the onset of a sound, using a simple reaction time paradigm with different foreperiods. The training of the subjects was controlled by a PDP 8/L computer with a training schedule that avoided the problems of manual shaping except for the preliminary step, the lever press. This schedule successfully trained the cats in about 6 daily sessions up to the reaction time paradigm with a 3 sec criterion. In contrast, a programme designed to reduce the criterion value so as to induce the subjects to perform shorter latency movements failed because the cats learned to control it through an escape procedure.


Isospora gallicolumbae sp. n. from Beccari's ground dove (Gallicolumba beccarii Salvadori) in Papua New Guinea. Isospora gallicolumbae sp. n. is described from Beccari's ground dove, Gallicolumba beccarii Salvadori, in Papua New Guinea. The ellipsoidal oocysts average 16.0 times 20.0 micron. The oocyst wall is light green, single-layered (approximately 0.8 micron), and becomes distorted within 10 min in sugar solution. Micropyle and oocyst residuum are absent; one polar granule is present. Sporocysts are ovoid, 8.0 times 12.0 micron, with prominent conical Stieda body. Sporocyst residuum is a spherical mass (approximately 5.0 micron) of lighter and darker granules. This is the first species of Isospora reported from a host in the avian order Columbiformes.


Fine structure of the oocyst wall of Eimeria nieschulzi. Oocysts of Eimeria nieschulzi from the laboratory rat, Rattus norvegicus, were studied by scanning and transmission electron microscopy. Oocysts had a rough outer wall with apparent random depressions. The oocyst wall is composed of 2 layers: an osmiophilic outer layer consisting of a rough external and smooth internal surface, and a relatively thick, electron-lucent inner layer. The outer layer is composed of a dense, coarsely granular matrix. The inner layer consists of homogenous fine granular material interspersed with coarse osmiophilic granules and contains one closely applied membrane on the outermost surface. Several raised lenticular areas are seen on the coarse outer surface of the inner layer. These layers are 102 (75-128) and 176 (135-204) nm thick, respectively. The sporocyst wall is thin, consisting of 3 to 4 unit membranes, and measures (18-34) nm thick.


Ultrastructure of excystment of Toxoplasma gondii oocysts. The excystation of sporozoites from intact Toxoplasma gondii oocysts or mechanically released sporocysts was studied by light and electron microscopy. Both intact oocysts and free sporocysts excysted in 5% bovine bile in 0.9% NaCl solution after 30-60 min incubation at 37C. Sporozoites were first activated in either intact sporocysts or oocysts within 2-12 min of incubation in bile. Sporozoites escaped from sporocysts through 4 plate-like sutures in the sporocyst wall, and from the oocyst as the oocyst wall ruptured at one or more points.


Lectin analysis of Trypanosoma congolense bloodstream trypomastigote and culture procyclic surface saccharides by agglutination and electron microscopic technics. Living, intact bloodstream trypomastigotes and culture procyclic forms of Trypanosoma congolense were tested for aggulination with the lectins concanavalin A (Con A), phytohemagglutinin P (PP), wheat germ agglutinin (WGA), soybean agglutinin (SBA), and fucose binding protein (FBP). Similar experiments were conducted with living bloodstream and culture forms treated with trypsin or dextranase. Parasites were incubated for 30 min at 25 C in various concentrations of each lectin, then examined for agglutination by dark-field microscopy. Control preparations consisted of parasites incubated alone or with 0.5 M of the specific competing sugar, with or without the corresponding lectin. Electron-microscopic localization of lectin binding sites on the surface of intact and dextranase-treated bloodstream and intact culture forms was accomplished with Con A, reacted with horseradish peroxidase (HRP) and then diaminobenzidine (DAB). In addition, FBP and SBA were coupled to HRP, then utilized for the localization of binding saccharides on the surface of bloodstream forms by the DAB technic. Similar studies were conducted with culture procyclics incubated with WGA-, SBA-, PP- or FBP-HRP conjugates and then reacted with DAB. Controls were utilized to confirm the sugar specificity of all positive reactions. Intact living bloodstream forms were agglutinated in a concentration-dependent manner with all the lectins tested. Agglutination levels were scored as Con A greater than FBP greater than WGA = PP = SBA. Sugars resembling alpha-D-mannose, N-acetyl-D-glucosamine, N-acetyl-D-galactosamine, and alpha-L-fucose are evidently present on the surface of the parasites. No agglutination was noted in any control preparations. Identical lectin-induced agglutinations were obtained with trypsin- or dextranase-treated bloodstream forms. Trypsin disrupted but did not entirely remove the surface coat of bloodstream forms, while dextranase did not alter the ultrastructure of the parasites. Con A-, SBA- and FBP-binding saccharides were distributed uniformly on the surface coat of intact bloodstream forms; a similar distribution of Con A receptors was noted also on the surface of dextranase-treated cells. No lectin-binding saccharides were visualized by electron microscopy on any control preparations. Intact, trypsin- or dextranase-treated, procyclics were agglutinated in a concentration-dependent fashion by Con A and WGA, but not by the other lectins tested. Control preparations did not agglutinate and the enzymes did not affect the ultrastructure of the parasites. Con A- and WGA-specifically binding saccharides were uniformly distributed on intact procyclics and control preparations were lectin-negative. Thus, T. congolense procyclics retained surface saccharides resembling alpha-D-mannose and N-acetyl-D-glucosamine but lost sugars resembling N-acetyl-D-galactosamine (or D-galactose) and alpha-L-fucose...


Mutants of Acanthamoeba castellanii resistant to erythromycin, chloramphenicol, and oligomycin. Cell lines of Acanthamoeba castellanii resistant to erythromycin (EryR), chloramphenicol (CapR), and oligomycin (OliR) have been isolated. These may be the first such mutants for A. castellanii. These mutants have been phenotypically stable for 2 years, surviving storage and vegetative multiplication in the absence of drugs. Resistance was specific for each drug, but double mutants (e.g. EryRCapR) were obtained by stepwise selection. Mutant frequencies were determined in multiwell plates; less than 10 colony forming units (CFU/10(5) amebas were observed in wild-type populations 12 days after incubation in 500 microgram Ery/ml, 2.5 mg Cap/ml, or 15 microgram Oli/ml. After 30 days, averages of 100 CFU/10(5) amebas were observed in Ery and Cap, whereas, frequencies for Oli remained unchanged. Frequencies for EryR and CapR were consistent with rates of recovery from these drugs in batch cultures. We were unable to obtain spontaneous mutants resistant to cycloheximide, emetine, 5-fluorodeoxyuridine, or ethidium bromide. EryR, CapR and OliR could be mitochondria mutants.


Some factors influencing the in vitro infectivity and replication of Encephalitozoon cuniculi. Rabbit Encephalitozoon cuniculi were propagated in vitro using rabbit choroid plexus (RCP) cells. The organisms reached maximum titer and numbers by 15 days. The source and in vitro passage level of RCP cells moderately influenced the sensitivity of the cells to infection. Cells less than 1 week old were significantly less sensitive than older cells. A moderate increase in infectivity for RCP cells was demonstrated with increasing organism passage level in vitro. Rabbit E. cuniculi were not affected by penicillin-streptomycin or gentamicin in the culture medium. The organism survived more than 9 days in buffer at 37 C and least 24 days at 4 and 20 C. Storage at -70 C or in liquid nitrogen was successful for at least 6 months. Encephalitozoon cuniculi survived 60 but not 120 min at 56 C. They were killed after 10 min of autoclaving and by 2% (v/v) Lysol, 10% (v/v) formalin and 70% (v/v) ethyl alcohol. The organisms survived at least 24 h at pH 9 or pH 4 and were not affected by sonication, freezing and thawing, or distilled water but lost significant infectivity after 24 h in CsCl or 40% (w/v) sucrose.


Differences in the life cycles between a vaccine strain and an unmodified strain of Babesia bovis (Babes, 1889) in the tick Boophilus microplus (Canestrini). Developmental forms of 2 strains of Babesia bovis (Babes) were studied in the tick vector Boophilus microplus (Canestrini). One strain (designated T) was shown to be infective for the tick, and the other (NT) to have lost infectivity for the tick, because of repeated blood passaging in cattle. Parasites of the 2 strains in gut contents of adult female ticks were similar during the first 16 h post-repletion (PR), but thereafter their structure differed. From 16-64 h PR, the majority of T strain parasites were spherical and without processes. During the next 32 h elongate forms and vermicules developed. Fission bodies were seen within epithelial cells of the gut by 96 h PR. T-strain parasites in gut contents decreased in number from approximately 96 h and were difficult to find at 144 h, the time of the final observation. In contrast, NT strains parasites were plentiful throughout the period of observation. They were predominantly spherical, ranging in diameter from 1.5 to 15 micron. Forms with obvious processes measuring up to 81 micron in length were seen in large numbers at seemingly regular intervals from 16-44 h PR, suggesting that a process of development and divisions was being repeated. No vermicules or fission bodies were seen. T-strain, but not NT strain parasites, were seen in hemolymph and ova of the ticks and in their larval progeny. It is suggested that continuous blood passaging of the NT strain had resulted in selection of parasites incapable of penetrating gut epithelial cells of the tick.


Eimeria tenella: vitamin requirements for development in primary cultures of chicken kidney cells. Development of Eimeria tenella was studied in primary cultures of chicken kidney cells maintained in Medium 199 lacking each of the following: vitamin A, biotin, p-aminobenzoic acid, folic acid, nicotinamide, Ca pantothenate, pyridoxine, pyridoxal, riboflavin, thiamin, ascorbic acid, calciferol, alpha-tocopherol, and menadione. Data obtained concerning numbers of mature schizonts or total numbers of parasites or both indicated that all of the vitamins are needed for 1st- and 2nd-generation schizogony, and all except calciferol and folic acid are needed for gametogony.


An audit of prescribing by peer review.

An audit of prescribing by peer review. This study describes how a group of general practitioners were made aware of their own prescribing habits. This was done by analysing carbon copies of prescriptions and reporting the analysis to a meeting of the doctors. The effects of this knowledge on subsequent prescribing were monitored.


Prescribing costs and patterns of prescribing in general practice. Prescriptions issued by 14 general practitioners during December 1974 were examined to elicit possible determinants of differences in doctors' prescribing costs per registered patient. Higher costs were associated with a generally increased prescribing rate but differences were particularly marked for certain drug groups (such as anti-rheumatic drugs). Costs were not related to list size, size of practice unit, urbanization, proportion of elderly patients, or date of qualification of the doctor, and the cost differences were too large to be accounted for by differences in morbidity. The frequency of prescription of drugs considered to be undesirable was also not associated with level of costs.An index of quality of prescribing was constructed. No relationship was found between scores on this index and any of the practice variables studied, nor was there any relationship with high-cost prescribers.


Drug advertising and prescribing.

Drug advertising and prescribing. A study of the amount of drug advertisements received by general practitioners and the amount of the drugs practitioners prescribed showed a strong correlation of 0.80. Analysis suggests that a straight line graphic relationship provides the best fit for the results obtained.FURTHER ANALYSIS OF THE QUANTITY OF ADVERTISING IN RELATION TO THE AMOUNT OF PRESCRIBING REVEALED TWO GROUPS OF DRUGS: those which were relatively more and those which were relatively less often advertised in proportion to the number of prescriptions issued for them.


Errors on doctors' prescriptions.

Errors on doctors' prescriptions. All prescriptions dispensed by one pharmacist during one month were examined for errors. Only 5.1 per cent of 2,237 prescription forms contained an error which meant the pharmacist had to contact the doctor. Thirty-seven per cent of prescriptions were either wholly or partly written by the receptionist. There was considerable variation between doctors and this varied from zero to 64 per cent; 4.0 per cent of prescriptions written by the doctor contained errors while those written by the receptionist were almost twice as likely (seven per cent) to do so. The majority of mistakes were obvious and trivial but five were potentially serious.It is recommended that if doctors expect their receptionists to write prescriptions they should ensure that they are adequately trained to do so. The pharmacist can be a valued and trusted colleague who serves to protect patients from doctors' errors.


Mental state and other prognostic factors in femoral fractures of the elderly. Fifty elderly patients with fractured femurs were followed up for six months. A hospital stay of less than 28 days and a good prefracture mental state were such important favourable prognostic factors that their absence made the outlook poor and carried clear implications concerning management.


The prevalence and diagnosis of headache in an urban practice. During a six-month study, one person in every 24 of the practice population consulted us about headache. There were more than twice as many females as males, and the largest group of females was in the 20 to 40 year age group.The majority of patients were managed entirely in the practice; only 10.4 per cent were investigated and four per cent were referred to hospital. The commonest cause was tension. Two patients had headaches due to serious pathology and one of these died.


How much child psychiatry does a general practitioner do? Eleven general practitioners recorded information on relevant psychological and social factors on 1,127 consecutive attendances of children and adolescents under the age of 18 years. The proportion of 'pure' psychological problems was low (3.5 per cent of all attendances), but in 25.7 per cent of attendances a psychological component to the presenting problem existed. Non-specific 'emotional' problems were the most frequent psychological symptoms noted, but management problems in infancy and early childhood were also common. There were significant differences between practitioners in the proportion of 'purely physical' diagnoses made and in action taken at the time of attendance. The findings suggest that paediatric training of general practitioners should contain a considerable child psychiatric component.


Difficulties in consultations reported by doctors in general practice. General-practitioner trainers in Scotland responded to a questionnaire on difficulties in consultation significantly more readily than did non-trainers. Their answers to some questions were significantly different.Trainer and trainee views of difficulties in communication with different types of patients and situations are broadly similar. Because of this similarity of views, the experienced doctor can plan an approach to training which is valid for the inexperienced trainee. He may, however, modify his estimate of the degree of difficulty for the trainee of consultation by involving some categories, for example, adolescents (easier for the trainee), dying patients (more difficult), patients of socioeconomic status which is different to that of the doctor (more difficult).SOME ASPECTS OF THE CONSULTATION MERIT SPECIAL ATTENTION: techniques such as those appropriate to ending the interview and discovering the patient's reasons for seeking medical help.While trainees' problems associated with lack of familiarity with patients and their circumstances are likely to decrease with time spent in the teaching practice, adequate records can help to diminish the trainees' insecurity.This survey confirms the need to continue to focus attention on patient management as a component of training as relevant as the detailed diagnosis and treatment of disease.


Doctors' attitudes to information systems: a survey of Derbyshire general practitioners. This paper describes the results of a survey of all 365 general practitioners in Derbyshire. It deals in particular with their attitudes to information systems and the factors which affect them. The results show that there is much more interest in continuous data collection from primary care than is often supposed. This is particularly so among younger general practitioners. The survey thus describes the possible interest in information recording amongst a typical population of general practitioners.


The work of a clinical psychologist in primary care. The data presented suggest that general practitioners would be likely to refer a large number of patients with diverse problems to clinical psychologists working in health centres. Compared with a centrally organized clinical psychology service, the work of the primary care psychologist is likely to offer the following advantages:1. Access to psychological help for patients with a need for such help, but who could not attend a central clinic owing to problems associated with travel, work, physical disability, or even a presenting problem such as agoraphobia.2. Greater continuity of care of patients.3. Increased communication between the psychologist and members of the primary care teams.4. Possibility of the psychologist seeing the patient earlier, before the problems have become entrenched.5. Less need for referral to other agencies.6. Reduced stigma for the patient.7. Development of new therapeutic approaches relevant to problems presenting in primary care.8. More flexible and more relevant therapy due to seeing the patients in their home setting.9. Greater therapeutic involvement of the patient's family.10. Reduced costs and inconvenience for the patient's family.11. Reduced administrative and ambulance service costs.While these points do not overcome the need for a formal evaluation of the work of psychologists in primary care, they do suggest that there are advantages in this type of service over the services which are currently available and that a full evaluation would be worth undertaking.


Some suggestions for teaching about cooperation between social work and general practice. From the Standing Liaison Committee of the Royal College of General Practitioners and the British Association of Social Workers. This discussion document emphasizes the importance of co-operation between general practitioners and social workers during their training. Sample aims and objectives suitable for trainees in both professions are listed and discussed.


Social work in general practice.

Social work in general practice. A questionnaire seeking details of working arrangements and problems encountered was circulated to social workers working in general practice.THE MAIN DIFFICULTIES WERE: insufficient preparation for the scheme, poor communication between general practitioners and social workers, and the inadequate provision of facilities for social workers in practice premises.Most of the respondents had not experienced big difficulties. Two thirds had enjoyed a rewarding professional experience, which is a testimonial to interdisciplinary co-operation.


Why standards?

Why standards? My experiences of growing up in a general practitioner's home and practice led me to want to be a general practitioner myself.The early 1950s were critical years for general practice. Three developments - the foundation and work of the College, the introduction of vocational training, and the development of postgraduate medical centres - have led to its revival.The next main change may well be the interest in, and development of, clinical standards. In my opinion this ought to be done by general practitioners themselves rather than by society via the Ombudsman.


A clinical trial of indomethacin and ibuprofen in dysmenorrhea. Forty patients with primary dysmenorrhea were treated with antiprostaglandin agents. Seventeen were treated with indomethacin, with 71% obtaining significant relief. Of 23 treated with ibuprofen, 87% obtained significant relief. Nausea occurred in 49%, vomiting in 23% and stool frequency in 35%. All of these gastro-intestinal symptoms were relieved by both drugs. Ibuprofen was free of side effects, but four patients had headaches or peculiar psychic effects on indomethacin.


An infected ovarian hematoma as the presenting symptom of systemic lupus erythematosus. A patient with systemic lupus erythematosus (SLE) and an associated coagulation defect presented with the clinical picture of an inflammatory pelvic mass. The laboratory data led to the diagnosis of SLE. A laparotomy revealed an infected hematoma of the left ovary. The SLE-induced coagulation deficit may have caused an intraovarian hematoma at the time of ovulation that became infected secondarily and led to an inflammatory pelvic mass as the first sign of SLE.


Cervical hemangioma: a case report and review of the literature. A case of cervical hemangioma is reported. This is a rare lesion of the uterine cervix, is not usually large and characteristically has a deep wine-red color. A review of the world literature indicates that all such hemangiomas that have been reported are benign. It is thought from this information that they may be treated conservatively.


Further treatment after conization.

Further treatment after conization. Conization was performed on 1,500 patients with carcinoma in situ of the uterine cervix. One hundred and seventy-five needed further treatment, 165 because of residual disease and 10 because of a recurrence. This finding indicates a recurrence frequency similar to the incidence of carcinoma in situ in a normal population.


Midtrimester abortion utilizing intraamniotic prostaglandin F2alpha, laminaria and oxytocin. The combined use of 40 mg of intraamniotic prostaglandin F2alpha, followed immediately by the insertion  of one or more laminaria tents, and of a high-dose oxytocin infusion of 166 milliiunits per minute is a safe, effective, and efficient regime for midtrimester abortion. In 100 consecutive patients between 16 and 20 weeks of gestation, no failures occurred. The mean injection-abortion time was 15.7 hours. Six patients required the reinjection of 20 mg of prostaglandin F2alpha at 24 hours. The placenta was removed with instruments after four hours in 19 patients and done electively in seven patients in less than four hours. Physician-patient contacts were minimized, for all the abortion-initiating techniques were accomplished concomitantly, as opposed to regimes with laminaria pretreatment, or deliberately staggered prostaglandin injections were used. Most of the patients were able to be discharged after one day in the hospital. Thus, the patients' inconvenience and expense were minimized, with no sacrifice in safety.


Genital tuberculosis and reproductive function. Interesting hypotheses about the effects of genital tuberculosis on reproductive function are that diseased men may in rare instances transmit the condition to their female partners and that diseased women are usually sterile unless they conceived and gave birth before the onset of their lesions. These two hypotheses were reviewed with the help of biopsy materials obtained from the Igbos of Nigeria and were considered, as a whole, to be valid in this West African ethnic group.


Occult pregnancy as a factor in unexplained infertility. Occult pregnancy is defined as a pregnancy that terminates so soon after blastocyst formation that there is no clinical suspicion of its occurrence. A series of seven patients with unexplained infertility were studied by means of a specific hCG assay. Two of these other wise randomly selected patients showed the presence of occult pregnancies, as evidenced by positive titers, whereas five did not in the one cycle studied. The significance of this finding is discussed. It is suggested that a search for occult pregnancy may eventually form part of a routine infertility investigation.


Pregnancy complicated by pelvic abscess. Tuboovarian abscess in pregnancy is a rare occurrence. The case presented and discussed is one in which a tuboovarian abscess was diagnosed and managed conservatively, with subsequent delivery of a viable infant.


Tubal ectopic pregnancy with contralateral corpus luteum: a report of five cases. In a series of 92 ectopic tubal pregnancies studied pathologically, 5 cases were associated with contralateral corpus luteum. Berlind's theory of ovum transmigration in the etiology of tubal pregnancy is revived and brought into line with Iffy's delayed ovulation-reflux hypothesis. The need for further delineation of etiologic factors is stressed, especially with a view to prevention.


Requests for abortion and outcomes of pregnancy in Jerusalem, Israel. Outcomes of pregnancy were examined for 480 women who requested abortions at a Jerusalem hospital during the years 1972 to 1975. Of 149 women denied abortions, 80 apparently obtained illegal ones. Since illegal abortions performed by physicians are easily and safely obtained in Israel, the liberalization of Israel's abortion laws will not have a major impact upon Israel's population growth.


Connective tissue disease and hyperviscosity syndrome with cryoprotein and immune complexes. Report of a case with autopsy findings and review of the literature. A case is reported of chronic polyarthritis, hepatitis and hyperviscosity syndrome associated with the presence of intermediate and high molecular weight plasma complexes, a mixed cryoprotein and widespread endarteritis obliterans of small muscular arteries. The features of this case are compared with those of other reported cases of connective tissue disease associated with hyperviscosity syndrome.


Nail lesions in systemic lupus erythematosus. Unusual nail changes have been observed in 42 of 165 patients with systemic lupus erythematosus (SLE) followed at the Wellesley Hospital, Toronto, Canada, over the past seven years. These changes had almost the same frequency as mucous membrane ulcerations seen in 31% of the patients. Nail changes were associated with active disease in 39 of the 42 patients. Patients with nail changes had a significantly higher incidence of Raynaud's phenomenon and mucous membrane ulcerations than patients without these changes. There was no increased incidence of other skin manifestations or of systemic vasculitis in these patients. Thus, nail changes may be an additional helpful criterion in the diagnosis of SLE.


A systematic survey of the HLA B27 prevalence in inflammatory rheumatic diseases. HLA B27 has been tested systematically in 246 patients attending a rheumatology clinic for chronic inflammatory arthritis or spondylitis. Patients were allocated to nine groups: typical ankylosing spondylitis, ankylosing spondylitis with moderate involvement without peripheral arthritis, ankylosing spondylitis with moderate involvement and with peripheral arthritis, juvenile chronic arthritis, Reiter's syndrome, Yersinia arthritis, arthropathies of inflammatory bowel disease, psoriatic arthritis, seronegative and seropositive rheumatoid arthritis. Except for seropositive rheumatoid arthritis, a significant association with HLA B27 antigen was found in all groups. In the seronegative rheumatoid arthritis group HLA B27 was present in 40% of the cases in contrast to 5.6% of the seropositive rheumatoid arthritis cases. These data confirm that a wide range of the so called "seronegative arthropathies" are associated with HLA B27 and suggest that sex and HLA B27 antigen are important factors in the manifestation of rheumatic disease. Women had less severe spondylitic changes but more peripheral arthritis of the small joints. Ankylosing spondylitis in its various forms had a comparable sex distribution despite relatively mild disease in females. The mean age of onset in the HLA B27 associated diseases was found to be significantly lower than in the seropositive rheumatoid arthritis group.


Human rights and distributive justice in health care delivery. This paper was first presented at the Annual Meeting of the American Society of Christian Ethics, Toronto School of Theology, Toronto, Ontario in January 1977. Robert Shelton aims to focus on the concept of 'right to health care,' its related principle, 'distributive justice' in an attempt to suggest 'where we are' at present and where we perhaps ought to be heading. The paper is divided into three parts, which in their turn explore the moral grounds, the US general public's policy and the part justice and government are likely to play in the development and distribution of health care. He concludes by highlighting 'omissions', an intentional one of his own and the other a major gap in the literature.


Patients, doctors and experimentation: doubts about the Declaration of Helsinki. The World Medical Association's Declaration of Helsinki offers guidelines to doctors engaged in biomedical research with human subjects. The fundamental distinction of the Declaration is between clinical research combined with professional care and non-clinical scientific research. If hospital patients are the experimental subjects, then the former research must be carried out by the patient's own doctor, whereas the latter research must not be; it must be carried out by other doctors. The relevance of the distinction between the patient's own doctor and other doctors is challenged and an alternative conception of the patient-doctor relationship is drawn, together with an alternative justification, based on the work of Hans Jonas, of the use of patients in research. Finally, the political nature of the patient-doctor relationship is mentioned, and it is claimed that the alternative conception of this relationship developed in the paper is more in line with the ethical principles of the Hippocratic tradition.


Dying while living: a critique of allowing-to-die legislation. Several US states are enacting 'right-to-die' laws, in the wake of the Karen Quinlan case. But the way such a law is drafted may cast doubt on a patient's existing common law right to control all aspects of his own treatment; it may give legal sanction to a lower standard of medical care that society at present expects from doctors; and it may lead to conflict between the patient's directive and his doctor's clinical judgement which cannot readily be resolved. The laws themselves are categorised as a) legalising active killing or b) defining rights of patients to control treatment or c) assigning to others the rights to control treatment where the patient is not competent. The California law is discussed critically. The conclusion is that such legislation is not a satisfactory answer to the ethical problem of euthanasia.


Case conference. Fain would I change that note. The recording and transmission of medical information poses many problems. The patient generally rarely sees his or her notes and possibly gives little thought to how or what is recorded, trusting that the doctor 'knows best' and will be noting, in a professional manner, that which will be useful for the diagnosis. In two cases presented, one of the patients sees her notes and is very upset by what she reads, the other requests that certain information be deleted from her case record. The actions of the doctors and patients were discussed in a preliminary conference at a recent postgraduate meeting. All the names in this Case conference have been changed.


Estimation of proportion of new mutants among cases of Duchenne muscular dystrophy. Using a number of different methods, it is confirmed that approximately one third of all cases of X-linked Duchenne muscular dystrophy are new mutants, the remainder being sons of carriers.


The Gardner syndrome: a cell culture study on kindred 109. In vitro studies on skin cultures established from 49 members from Kindred 109, in whom the Gardner syndrome was first delineated, showed that increased in vitro tetraploidy occurred only in those cultures derived from branches with the full expression of the Gardner gene (colorectal polyps with multiple extracolorectal benign tumours) and not in those derived from branches showing only extracolorectal lesions. Increased in vitro tetraploidy appeared to identify only those family members at risk who had, or would ultimately be expected to show, full expression of the Gardner gene including colorectal polyps which become malignant.


Familial atypical multiple mole-melanoma syndrome. A family is described showing concordance for malignant melanoma and a cutaneous phenotype characterised by multiple large moles of variable size and colour (reddish-brown to bright red) with pigmentary leakage. Transmission of the cutaneous phenotype in the subject family, and in several others currently under investigation, shows an inheritance pattern consistent with a simple autosomal dominant factor. This cutaneous phenotype signifying melanoma risk may now be added to an increasing body of knowledge dealing with cancer-related genodermatoses.


Spontaneous regression of metastatic malignant melanoma in 2 sibs with xeroderma pigmentosum. The clinical and pathology findings in 2 sibs with xeroderma pigmentosum (XDP), complicated by metastatic malignant melanoma which underwent spontaneous regression, are described. The pathology of one of these patients showed features of possible spontaneous regression, namely foamy histiocytes, capillary proliferation, and a chronic inflammatory infiltrate which was devoid of malignant cells, suggesting the possibility that an immunological mechanism was at work. It was of interest that a recent review of 27 cases of spontaneous regression of metastatic melanoma since 1900 contained a patient with XDP. Adding our 2 cases, at least 10% of the spontaneous regressions of metastatic melanoma occurred in patients with XDP. This unusual association raised the question that the genotype for XDP may possibly foster control of metastatic malignant melanoma in some as yet unknown way.


The Marden-Walker syndrome.

The Marden-Walker syndrome. The characteristic facies, joint contractures, muscular hypotonia, and growth and developmental delay of the Marden-Walker syndrome were present in a 19-month-old boy. Extensive evaluation of the neuromuscular system failed to identify a specific abnormality. Electromyography was normal with low amplitude. Light and electron microscopy of a skeletal muscle biopsy was normal. Histochemical study of this biopsy material was also normal. The pathogenesis of the syndrome is discussed.


Trisomy 16p in a liveborn infant and a review of partial and full trisomy 16. An abnormal female infant, who survived for 10 months with almost complete trisomy 16p and monosomy of sub-band 21q22.3, is described. The chromosome anomaly was the result of an unbalanced segregation of a maternal balanced translocation t(16;21)(p11;q22.3). The partial monosomy was considered to have had little or no adverse phenotypic effect. Cases with trisomy of chromosome 16 material are reviewed. It appears that while full trisomy 16 always results in early spontaneous abortion, trisomy 16p or 16q may be compatible with limited postnatal survival.


Segregation of an insertional chromosome rearrangement in 3 generations. The interstitial deletion of a segment of chromosome 13, 13q21 leads to 13q22, and its inversion and insertion into the long arm of chromosome 3 at breakpoint q12, was found to segregate in 3 generations of a family. Segregation of this 3 break rearrangement gave rise to individuals monosomic, trisomic, or balanced for the involved segment. Monosomy for 13q21 leads to 13q22 was associated with mental retardation, expressive aphasia, microcephaly, hand abnormalities, and short stature. Partially trisomic individuals had normal mentality, extremely high arched palate, and mild dysmorphic features. There was no evidence for retinoblastoma in the individuals examined. The balanced carriers were normal. Comparison of monosomic individuals with one previous report of a similar deletion reveals marked phenotypic similarities.


Pericentric inversions inv(2)(p11q13) and inv(2)(p13q11) in 2 unrelated families. Pericentric inversions in chromosome 2 were traced in 2 unrelated North American black families. In the case of inv(2)(p13q11) no effect on reproduction was observed. In the case of inv(2)(p11q13) some reproductive abnormalities were noted which might be related to the inversion.


47,XX,+der(18),t(9;18)(p24;q21) mat: a distinct partial trisomy 18q--syndrome? A moderately retarded girl had a 47,XX,+der(18),t(9;18)(p24;q21)mat abnormality that was inherited from her mother, who had a 46,XX,t(9;18)(p24;q21) karyotype in most cells, and a minor cell line of 47,XX,+der(18),-t(9;18)(p24;q21). Her dysmorphic features--bilateral epicanthic folds, low-set, abnormal ears, low posterior hairline, clinodactyly of the 5th fingers, and broad great toes--were similar to those of other patients with an additional number 18 chromosome in which all or most of the long arm was missing, thus raising the possibility of a distinct syndrome.


The phenotype Ae1B: a probable result of chimerism. An apparently normal healthy adult with the blood group phenotype Ae1B is described. The unusual ABO group is apparently the result of chimerism, the proportion of the minor population of cells being so small as to be only detectable by absorption and elution techniques.


Absent left hemidiaphragm, arhinencephaly, and cardiac malformations. An infant is reported with absent left hemidiaphragm, hydrocephalus, arhinencephaly, and cardiovascular anomalies. The parents are second cousins.


An iterative approach to the analysis of EM autoradiographs. I. The method. An iterative scheme is described for determing the most appropriate "model" for dividing micrographs of EM autoradiographs into identified items of known relative specific activities in such a way that the dispersion of silver grains over the autoradiographs is fully and satisfactorily explained. A trial model is first set up for which, using a square matrix of estimates of notional cross-fire between the chosen items, a "solution" is obtained. The quality of the model is then tested using extended cross-fire data contained in rectangular matrix. If the model is shown to be unsatisfactory, an improved model (of tissue subdivision) is postulated and the whole process repeated until the model is deemed to be satisfactory. The computations are such that the data can be processed rapidly on the laboratory bench using a small machine. The logical estimation of errors is facilitated by this approach.


An iterative approach to the analysis of EM autoradiographs. II. Estimates of sample sizes and confidence limits. The errors inherent in EM autoradiography are discussed and certain of them deemed to be of particular practical significance in the quantitative assessment of preparations. A method is described for estimating the standard errors attributable to each of several sources of variation and thence for obtaining the overall standard error value to be attached to relative activity estimates obtained in the method of Downs & Williams (1978). In an appendix, a fully worked example is given illustrating clearly the strategy of the method and the magnitudes of error estimates that are to be attached to the final specific activity values.


A photoelastic substrate technique for dynamic measurements of forces exerted by moving organisms. The forces produced by small moving organisms have been quantitatively measured by having the organisms move on a polymeric substrate which transduces the applied stress into an optical birefringence signal (photoelastic effect). The optical signal can be rigorously interpreted to give static force measurements, and by calibrating the substrate empirically, dynamic measurements are obtained. The technique measures stresses, forces applied to an area, so it is not possible to determine ultimate sensitivity of the technique for measurements of forces without regard to area. The technique is especially useful when small forces are exerted over very small areas as, for example, may be the situation with moving tissue cells. The technique is noninvasive, requires minimal equipment, and is easily performed on microscopes adapted for polarized light measurements. Gelatin has the highest sensitivity and adaptability as a photoelastic substrate.


Thermodynamics of peptide bond formation at clay mineral surfaces. The possibility of surface catalysed condensation of unsubstituted amino acids on kaolinite in aqueous systems at elevated temperatures was investigated; no evidence of clay catalysed polycondensation has been found. The thermodynamic feasibility of the hypothetical lysine/dilysine condensation reaction in the temperature-range up to 90 degrees C was evaluated for a range of experimental conditions by the combination of measured free energies of lysine/dilysine cation exchange on kaolinite and on montmorillonite, and free energies for the analogous condensation reaction in homogeneous solution. The results indicate that, in spite of the high selectivity of the clays for the adsorption of cation dimers from dilute solutions, the thermodynamic barrier to the surface condensation of unsubstituted amino acids on clay minerals in aqueous systems up to 90 degrees C is not lower than it is in homogeneous solution.


Evolution of acid phosphatase-1 in the genus Drosophilia. Immunological studies. The enzyme acid phosphatase-1 was partially purified from 10 Drosophila species. Four antisera were produced and the ten enzymes were reacted against each serum. The method used to quantitate the reactions involved the electrophoretic separation of antigen-antibody complexes from uncomplexed enzyme, followed by densitometry of the free enzyme. Immunological distances were used to obtain correlation coefficients for all pairwise combinations of the 10 species. From these correlation coefficients, a dendrogram was constructed which is very similar to one diagramming the presumed phylogenetic relationships of the ten species. In addition, the data indicate acid phosphatase-1 has evolved at different rates in different lineages within the genus. A preliminary estimate of the unit evolutionary period for this enzyme is 3.25 million years. The method of determining immunological distances which was used in this study is compared to the method of microcomplement fixation in the Discussion.


Theoretical considerations of the sensitivity of quantitative subunit hybridization. The theoretical basis of the quantitative subunit hybridization technique and its ability to measure evolutionary amino acid substitutions is examined. Homospecific:heterospecific enzyme ratios found after subunit reassociation depend upon K1.2, the equilibrium constant for the dissociation of the heterospecific enzyme. It is shown that if this constant is near the geometric mean of the two homospecific enzyme dissociation constants, as it should be in enzymes whose subunits pair isologously, the quantitative subunit hybridization method will not detect most changes in the subunit contact regions of homologous proteins.


Heteropolynucleotides as templates for non-enzymatic polymerizations. We have studied a number of condensation reactions involving ImpU, ImpT, ImpC, ImpA, ImpG, ImpUgG and ImpCpA as activated nucleotide donors and a variety of homo- and hetero-polynucleotides as templates. We did not not obtain any evidence of a template effect with ImpU and ImpT, but observed some condensation of ImpC with GpG on appropriate templates. ImpA and ImpG take part in a number of more or less efficient template-directed reactions, as do ImpUpG and ImpCpA. Our results suggest that, on the primitive Earth, pyrimidine nucleotides could most easily have been incorporated into polymers as constituents of short oligomers, which contained one or more purine nucleotide. The linkage of the product depends strongly on the nature of the substrates; the percentage of the natural 3'-5'-linkage was, in some cases, less than 10% and, in others, as high as 70%. Wobble-pairing was often very effective in promoting condensations, suggesting that transition mutations would have been very frequent in prebiotic polynucleotide replication.


Acetylcholinesterase activity in ventricular and cisternal CSF of dogs: effect of chlorpromazine. Acetylcholinesterase (AChE) activity in dog plasma is significantly higher than in either ventricular or cisternal CSF. However, since protein levels in plasma are about 100-fold higher than in CSF, the specific activity of AChE is lower in plasma than in CSF. Acetylcholinesterase activity in plasma represents only 22% of total cholinesterase (ChE) activity, while preliminary findings indicate that in ventricular CSF it is 50-60%. Acetylcholinesterase activity in ventricular CSF is significantly lower than in cisternal CSF. Chlorpromazine (10 mg/kg, intravenous), a drug which increases acetylcholine turnover, increased AChE-specific activity in all dogs. Our results support the hypothesis of a neuronal origin of AChE activity in CSF.


Biochemical markers of ethanol effects on brain. Because sialic acid is a potential biochemical marker of membrane development or alteration, we compared acute and chronic ethanol effects on sialic acid. Experiments were conducted with 50 adult male Wistar rats (approximately 400 gm), housed in groups of five. Rats drank ad libitum a vitamin-fortified diet (Nutrament) that was adulterated with ethanol; ethanol intake averaged for each rat 10-18 gm/kg/day. Controls were fed an equal total volume, made isocaloric with sucrose. Rats were sacrificed weekly for four weeks, and an acute challenge dose of ethanol (2 gm/kg, intraperitoneally) was given 45 minutes before sacrifice of both control and ethanol-consuming rats. Some controls were challenged only with saline. We replicated our earlier findings of regional differences in sialic acid and in cerebellar deoxyribose (measured as a necessary adjunct in the autoanalyzer modification of the Warren-Delmotte methods). In the saline-challenged controls, levels of both compounds were higher at four weeks than after one week. Similar increases occurred also in the chronic ethanol-consuming group, but not in the ethanol-challenged controls, which had significantly lower values. Results in saline-challenged controls suggest that the chronic treatment either 1) created a tolerance which protected cells from damage by the challenge dose of ethanol, or 2) killed neurons, thus promoting proliferation of glial cells.


Ethanol tolerance: evidence of "protective" effects on brains of adult rats. Previous research with two biochemical markers of acute ethanol damage (sialic acid and 2-deoxyribose) raised the possibility that tolerance developed by chronic ingestion of ethanol could protect brain cells from "damaging" effects of large, acute doses of ethanol. However, this hypothesis required demonstration that chronic consumption was not damaging. This issue was investigated histologically in adult rats that voluntarily consumed massive doses of ethanol daily (range of 11 to 18 gm/kg/rat/day) for 28 days. By all indices (thickness measures of neocortex, hippocampus, and cerebellar molecular layer; and specific cell counts of neocortex and cerebellum), none of the ethanol-exposed rats, even those with intentional nutritional deficiencies, revealed any physical sign of damage compared to control rats.


Studies on the effects of chronic ethanol ingestion on the properties of rat brain ribosomes. Previous observations have demonstrated decreased in vivo and in vitro protein synthesis by brain ribosomal systems following long-term ethanol ingestion. For further investigation of the properties of brain ribosomes, the 40S and 60S ribosomal subunits were successfully isolated from control and chronic 10% ethanol-drinking rats. For a successful dissociation of ribosomes into subunits NH4Cl, puromycin and a high-salt treatment at 10 degrees C were essential with a critical concentration of Mg2+ since ribosomes could not be resolved at less than 7 mM Mg2+. Analysis of the A260 profile of the subunits on the sucrose gradients showed no significant differences between the control and ethanol-ingesting groups. Studies on 3H-labeled ribosomes following in vivo RNA labeling showed correspondence of the radioactive profiles from the incorporation of [5(-3) H) orotic acid into RNA with the sucrose gradient absorbance profile of 60S and 40S ribosomal subunits. Furthermore, active reassociation of both subunits occurred at 37 degrees C as demonstrated by the increased [14 C]-phenylalanine incorporation in the presence of poly(U). Results further showed that the poly(U)-dependent [14C]phenylalanine incorporation was significantly reduced by the subunits from the ethanol-ingesting animals. These findings suggest that long-term ingestion of ethanol caused functional changes in the properties of brain ribosomes, specifically on the reassociation process of the two subunits.


Histochemical mapping of acetylcholinesterase and butyrylcholinesterase in the medulla oblongata and pons of squirrel (Funambulus palmarum). The distribution of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) has been investigated in a series of sections passing through the medulla oblongata and pons of the squirrel brain. A comparison of the two enzymes has given an interesting picture of their selective localization in the different nuclei. Marked AChE activity has been observed in the cranial nerve nuclei. BChE activity in various nuclei of the medulla oblongata and pons is variable and occurs diffusely between the cells. Possible reasons pertaining to marked variation in AChE and BChE contents of various nuclei and fiber tracts have been discussed.


Biochemical decomposition of coal-tar dyes. I. Biochemical decomposition and identification of decomposed products. Biochemical degradation test of food coal-tar dyes using sludge was studied in order to evaluate their safety. It was found that some dyes were little decomposed under aerobic condition but four azo dyes were readily decomposed under anaerobic condition. These were Food Yellow No. 4, No. 5, and Food Red No. 2, No. 102. Decomposed products of these four azo dyes by sludge under anaerobic condition were identified as sulfonilic, naphthionic acids and so on.


Biochemical decomposition of coal-tar dyes. II. Acute toxicity of coal-tar dyes and their decomposed products. Twenty kinds of coal-tar dyes were subjected to median tolerance limit (TLm) test by use of Himedaka (Oryzias latipes) for the comparision of their acute toxicities. It became clear that 4 kinds of halogens substituted xanthene compounds dyes showed strong acute toxicities. From the fact that uranine had the lower acute toxicity than halogens substituted compounds and the toxicities of these 4 dyes increased through irradiation, it was assumed that halogen atoms in dyes might be responsible for these strong acute toxicities to fish.


Testosterone-induced focal myocarditis in rats. I. Morphological and biochemical studies with special reference to pathogenetical mechanism and species differences. Focal myocarditis characterized by interstitial edema, round cell infiltration and fibrosis occurred in rats given a subcutaneous administration of testosterone propionate in a dose of 50 mg/kg for 30 consecutive days or longer. Biochemical analysis showed a two to five time increase of deoxycorticosterone and a moderate decrease of corticosterone in blood plasma of these rats as well as in those treated with 50 mg/kg of testosterone propionate for 15 days. It was also shown that myocarditis did not occur in adrenalectomized rats after administration of testosterone propionate 50 mg/kg for 30 days, while subcutaneous injections of deoxycorticosterone acetate in a dose of 15 mg/kg for 30 days invariably produced cardiac lesions in both adrenalectomized rats and sham-operated rats. Regarding species difference, administration of testosterone did not produced either a high blood level of deoxycorticosterone or focal myocarditis in guinea pigs or rabbits. From these results, it is concluded that focal myocarditis in rats after administration of large amounts of testosterone propionate is related to the elevation of deoxycorticosterone in blood plasma but not to the direct effects of testosterone propionate on the myocardium.


Testosterone-indued focal myocarditis in rats. II. Morphological and biochemical observations of the adrenal in relation to the pathogenetical mechanism of cardiac lesions. Correlative morphological and biochemical studies were made on the adrenal of rats treated with daily subcutaneous injections of testosterone propionate in a dose of 50 mg/kg for 30 consecutive days. Histologically, there is a thinning of the zona fasciculata with a decrease of cell numbers, swelling of the cell body and the occurrence of large lipid droplets in the cytoplasm. Electron microscopic examination revealed swelling of mitochondria with reduction of cristae and hypertrophy of smooth-surfaced endoplasmic reticulum with cluster formation or whirl-like arrangement. In in vitro biochemical experiments, it was noted that conversion of deoxycorticosterone to corticosterone or 18-hydroxydeoxy-corticosterone was decreased to 45% of the control level in the testosterone-treated group.


Toxicity of heavy metals and insecticides on slime mold Physarum polycephalum. Toxicity of heavy metals and insecticides on the slime mold Physarum polycephalum was investigated in order to examine and estimate with ease the toxicity of environmental and occupational contaminants and also to study the effects of various agents on the cell membrane. Changes in survival time and in membrane potential of the slime mold were measured using a double chamber method. The results obtained suggest that their toxicity for the slime mold is accompanied by some change in the cell membrane, and that studies on toxicity for various chemical substances in the slime mold can be used as a screening method.


Effect of single exposure to toluene on Sidman avoidance response in rats. Effects of single exposure to toluene on Sidman avoidance response in rats were studied. The animals, in which the behavioral base line had been established, were exposed 0, 1,000 and 3,000 ppm of toluene vapor for 4 hours and the effects on the behavioral pattern were investigated using Sidman avoidance test for one hour after the termination of toluene exposure. 1) Exposure to 0 or 1,000 ppm of toluene did not produce marked change on the operant behavior. After the exposure to 3,000 ppm, the animals produced increased responses with shortening of the inter-response-time (IRT) and no changes in shock counts from the beginning to the 50 min. zone of the Sidman avoidance test when compared with those before exposure. The behavioral change indicated here appears to be caused by a temporary breakdown of the established timing of lever pressing. 2) The effect of toluene on the operant behavior was strongest immediately after the termination of the exposure and the behavior recovered in about an hour. This result suggested that toluene is rapidly transfered to and removed from the brain.


Acute thallotoxicosis: neuropathological and spectrophotometric studies on an autopsy case. Acute thallotoxicosis has been studied in an autopsy case with characteristic neurological symptoms. Pathologic findings were composed of a rarefaction in cerebral white matter, swelling and fragmentation in peripheral nerve fibers and some chromatolytic changes in neurons of cranial nerves and spinal cord. Trace amounts of thallous salt were measured in the tissues from the brain, liver and kidney using spectrophotometric technique. The locus of thallium affection is assumed to be a mitochondrial membrane with a specific affinity to the thallous ion.


Toxicological approaches to the metabolites of Fusaria. XIII. Hematological changes in mice by a single and repeated administrations of trichothecenes. A single or repeated administration of trichothecene mycotoxins to mice induced leukocytosis and leukopenia. Acute and sub-acute toxicosis of trichothecenes was characterized by hematological and pathological observations.


Oral hyperpigmentation and occult malignancy--report of a case. Melanocytes exist in the oral and laryngeal mucosa capable of responding with a hyperpigmentation response to occult malignancy. Such a case is presented and its differentiation from other disease processes is discussed.


Bilateral paroxysmal positioning nystagmus. The term "bilateral paroxysmal positioning nystagmus" (BPPN) refers to the occurrence of paroxysmal positioning nystagmus when the patient's head is placed in both right and left head-hanging positions. BPPN was found in at least 15% of 114 patients with benign positional vertigo. Head injury, central nervous system disease or both were causative in over half of patients with the finding. In some instances, paroxysmal positional nystagmus may be found when the abnormal ear (side) is uppermost rather than directed toward the floor; this fact may have important implications if singular neurectomy is to be performed.


Absolute and relative reliability of several response parameters used in vestibular assessment. This experiment investigated the reliability of five indices used to express the magnitude of induced vestibular nystagmus. The investigation was undertaken because information concerning the reliability of the various response parameters when caloric testing is repeated on the same subject is limited. Electronystagmographic assessments of the nystagmus response to the Fitzgerald-Hallpike test were obtained from 16 subjects on three occasions with equal intervals of time between occasions. The data were statistically treated with an analysis of variance technique that allows the generation of correlation coefficients. The findings showed that speed of the slow phase, total beats, culmination frequency, and total amplitude reliably express the magnitude of induced nystagmus on repeated tests. Duration of the induced reaction was not as reliable as the other indices on repeated testing. In addition, difference scores were more repeatable than absolute scores and the caution that must be maintained when using correlation coefficient analyses to estimate reliability is highlighted.


A case of progressive supranuclear palsy--neurotological findings and etiology. The eye movements of a case of progressive supranuclear palsy were recorded over a period of time with the aid of electronystagmography. The etiology of this syndrome is not clearly understood as yet. In this case, however, we cannot neglect the influence of solvent intoxication.


[Audiovestibular study in Friedreich's ataxia]. A preliminary report is presented of the audiovestibular findings in 16 cases of typical Friedreich ataxia. Many ENG abnormalities of the central type were found, the most frequent being square waves, ocular dysmetria, and disorganized pursuit of the pendulum. The other abnormal findings were less frequent or less specific. Peripheral vestibular  and auditory impairment were not the rule. Eventually, the electronystagmogram could become an early paraclinical screening test of Friedreich's disease.


Clinical investigation of the alteration in the middle ear impedance in patients with intracranial hypertension. Marked pulsation occurring during middle ear impedance measurements may be caused by an intracranial hypertension sydnrome, with pulsations being transmitted to the middle ear by a variety of preformed natural pathways. Impedancemetry is a useful technique for diagnosing and following the syndrome.


A re-appraisal of intrinsic laryngeal muscle action. Anatomical dissection and electrical stimulation of three intrinsic laryngeal muscles, the lateral cricoarytenoid, posterior cricoarytenoid, and thyroarytenoid, have demonstrated findings that contradict current teaching on laryngeal muscle action. The posterior cricoarytenoid and the thyroarytenoid muscles demonstrated complexities of movement which have not been previously described. Both have three forces of action capable of moving the arytenoid cartilage in three directions. These directions of movement were dependent upon the finite anatomy of the cricoarytenoid joint. The lateral cricoarytenoid muscle, because of its attachments and the direction of its fibres, acts as both an abductor and a dynamic ligament in arytenoid cartilage movement.


Hyposensitization in allergic rhinitis--a comparison of aqueous extracts and Allpyral by means of rhinomanometry. Fifty-six patients with seasonal allergic rhinitis were hyposensitized with aqueous extracts (23 patients) and Allpyral extracts (33 patients). The clinical course was appraised objectively on the basis of rhinomanometry findings at examinations performed before hyposensitization and one year later. There was no essential difference between the two groups of patients as regards the relief of symptoms. A reduction of nasal congestion was recorded in 54 and 58% of the patients, respectively. Complications were less severe and less frequent in the Allpyral group.


Otolaryngological manpower III--February 1978. The number of otolaryngologists in Canada appears to have dropped dramatically since 1975. Immigration regulations may further compound this and may also seriously threaten the viability of some of our teaching programs. A system that would allow us to continuously monitor our ability to provide optimum health care in otolaryngology should be developed by the Canadian Otolaryngological Society (COS) as a permanent "agency" of the Secretariat. Such a manpower information source backed by hard statistical data would enable the specialty itself to advise government agencies, the Royal College, provincial licensing boards, and otolaryngologists seeking placement of the present state of the nation.


Lesions associated with Philometroides huronensis (Nematoda: Philometridae) in the white sucker (Catostomus commersoni). Lesions associated with Philometroides huronensis in the white sucker (Catostomus commersoni) of southern Ontario occurred during the spring (April-June) and were related to the development and release of first-stage larvae from the gravid nematode. With movement of the subgravid female into the membranous region of the fin, subepidermal tissues were mechanically disrupted and compacted near the nematode. Gravid females were encapsulated by fibrous tissue. Release of first-stage larvae from the gravid nematode was facilitated by a cutaneous opening, disruption of the fibrous capsule and rupture of the nematode. An acute local inflammatory response was associated with this function. Spent nematodes were sequestered and resorbed.


Bone marrow and hematologic values of wild raccoons. Blood and bone marrow samples were obtained from wild raccoons in the State of Connecticut to determine leukocyte and erythrocyte counts, hemoglobin, hematocrit, and peripheral blood and bone marrow differential counts. Calculations were made to determine mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration.


The parasite fauna of the American alligator (Alligator mississippiensis) in South Carolina. Twelve American alligators (Alligator mississippiensis) were obtained from three different areas of South Carolina. One species of pentastome (Sebekia oxycephala), two species of nematodes (Dujardinascaris waltoni and Multicaecum tenuicolle), four species of trematodes (Polycotyle ornata, Acanthostomum coronarium, Archaeodiplostomum acetabulatum and Pseudocrocodilicola americaniense) and one species of hemogregarine (Haemogregarina crocodilnorum) were recovered. Polycotyle ornata was observed only in alligators from Par Pond while P. americaniense was found in Par Pond and coastal hosts, A. acetabulatum from Kiawah Island and coastal alligators, and A. coronarium only at Kiawah Island. These patterns suggest disjunct distributions for the trematode species in South Carolina alligators. The other parasites were found in alligators from all three locations. The only parasite observed to initiate damage or lesions in the alligator was the pentastome.


Cerebrospinal parelaphostronglylosis in llamas. Four of 11 llamas (Lama guanicoe) from a ranch near Houston, Texas developed clinical signs of a neurologic disease. Tissues from 2 of the 4 llamas were submitted for microscopic examination. Lesions in the central nervous system of both llamas appeared to have been caused by a migrating parasite. An adult nematode having morphologic features of the meningeal worm (Parelaphostrongylus tenuis) was found in the brain of one llama. The findings suggest that the neurologic disease in the llamas were caused by P. tenuis.


Pancreatic duct adenoma and strangulation of the small intestine in a California sea lion (Zalophus californianus). A 16 year-old female California sea lion (Zalophus californianus) died in a zoological garden following a period of insidious weight loss. Necropsy revealed a loop of intestine strangulated by a fibrous ring connected to a pancreatic mass. Histopathologic diagnosis of the latter was pancreatic duct adenoma.


Haematologic parameters on various species of strigiformes and falconiformes. Normal mean values for packed cell volume, total erythrocyte count, total leukocyte count, total protein and mean corpuscular volume were obtained from 37 species of Strigiformes and Falconiformes representing 207 individuals.