Development of hearing in hereditarily deaf white mink (Hedlund) and normal mink (standard) and the subsequent deterioration of the auditory response in Hedlund mink. Behavioural responses have been elicited to acoustic stimuli in hereditarily deaf white mink (Hedlund). This revealed onset of auditory function at an average age of 31 days. The period of hearing lasted on the average only 7 days. Similar observations have been reported in other hereditarily deaf animals (cat, mouse, guinea pig). It is suggested that the onset of auditory function follows a progressive pattern which corresponds to the circulation of blood in the cochlea. Moreover, it is suggested that the subsequent deterioration of hearing follows a regression of this vascular pattern and thus a vascular pathogenesis may be responsible for this type of genetic deafness.


Correlations between cochlear hair cell loss and shifts of masked and absolute behavioral auditory thresholds in the house mouse. Masked and absolute behavioral auditory thresholds were measured in kanamycin-treated C3H mice with a significant damage or loss of outer hair cells (OHCs) near the cochlear base, and in 17--24-month-old NMRI mice with a significant loss of OHCs and inner hair cells (IHCs) in the basal region and of OHCs near the apex. A loss of IHCs is correlated with an increase in absolute thresholds. A moderate damage or loss of OHCs in a cochlear region had no effect on absolute thresholds but correlated with a decrease and other changes of characteristics of masked thresholds in the respective frequency regions. OH C-damage makes masking by continuous white broad-band noise less efficient. It is concluded that masking and critical bands depend on the function of OHCs, which must be assumed to influence intracochlearly the activity of IHCs in processing the information to the brain.


Cochlear electrical activity in the C57BL/6 laboratory mouse: volume-conducted vertex and round window responses. Remote (vertex-positive, volume-conducted) and local (round window, or RW) responses were simultaneously recorded from the C57BL/6 mouse. Volume-conducted responses were obtained which corresponded to the cochlear microphonic (CM), summating potential (SP), and action potential (AP), as measured at the RW. The vertex PI, corresponding to the AP, had a shorter latency to rarefaction than to condensation clicks. At higher SPL's bimodal PI peaks (a and b) were observed. PIb amplitudes were greater at lower, and PIa amplitudes were greater at higher SPL'S. Responses subsequent to the RW N1 and the volume-conducted P1 were eliminated after the ear was isolated from the brainstem.


The effect of potassium on the activity of auditory nerve fibres of the guinea pig cochlea. Scala tympani of the guinea pig cochlea was perfused with solutions having an increased potassium concentration. The response characteristics of single auditory nerve fibres in both normal and kanamycin-damaged cochleas were studied using computer controlled routines. The results indicate that these perfusions caused a marked increase in the spontaneous firing rate of auditory nerve fibres, without loss of threshold sensitivity. Current theories of cochlear transduction support the view that the potassium concentration difference across the reticular plate is fundamental to the sensitivity of the cochlea. The results presented here do not support this view.


The relationship between the cytotoxicity of kanamycin and ethacrynic acid for mammalian cells in vitro and their ototoxicity in vivo. Dose-effect curves for inhibition of growth of P388/P mouse lymphoma cells by ethacrynic acid and kanamycin used alone and in combination were determined in vitro. Ethacrynic acid was 600 times more potent than kanamycin and combinations of the drugs resulted in overall additive effects. These results were compared with known dose-effect data on the ototoxicity of these drugs in vivo. Kanamycin was highly selective in its toxicity for cochlear hair cells compared to cultured cells. The dose-effect data for ethacrynic acid was coincident with that reported for functional and biochemical effects on the cochlea following perilymphatic perfusion with the drug. The potentiation observed following the ototoxic interaction the two drugs in vivo was not observed following combinations of the drugs in vitro.


90Sr placentas, embryos and foetuses of mice, evaluated by whole-body autoradiography. 90Sr is a hazardous fission product from nuclear reactions. Its transplacental passage is of particular interest because of the high sensitivity of embryos/foetuses to ionizing radiation. We have used whole-body autoradiography to study the foetal uptake and retention of 90Sr and the embryonic/foetal transfer of this isotope as a function of gestational age. Fifteen minutes after an intraperitoneal injection of 50 muci 90Sr-nitrate into a 14-day-pregnant mouse, radioactivity was present in the placenta, but not in the foetus. During a 72-hour observation period, 90Sr gradually accumulated in the hard foetal tissues. In the soft foetal tissues, accumulation occurred up to 12--24 hours. After 72 hours, no 90Sr could be detected in the soft tissues. 90Sr crossed the visceral yolk sac placenta during early gestation, the visceral yolk sac and the chorioallantoic placentas during late gestation. Transfer increased considerably at the end of the latter period. There was a marked uptake of 90Sr in all structures of early embryos, whereas the isotope concentrated in the preskeletal and skeletal parts of the foetuses. Intake of 90Sr during early gestation may therefore be more injurious to the offspring than intake during late gestation.


Differentiation of nerve endings in the cochlear nucleus on morphological and experimental basis. The axo-somatic terminals which synapse with the large spherical cells in the antero-ventral cochlear nucleus of the guinea pig are subdivided into three groups by means of different stereological form of their synaptic vesicles. Unilateral stimulation as well as long-term degeneration of the cochlear nerve produce significant changes of the cross sectional area of the terminals and the number of their mitochondria, when compared to the contralateral control. Both parameters are increased after stimulation and decreased following degeneration. These changes occur in different extent in the three groups of terminals. The discussion of these findings has led to the following conclusions: (1) The volume of synaptic terminals and the number of the enclosed mitochondria display the most pronounced plastic changes. Therefore these parameters seem to be very indicative for the study of function-related changes. (2) The volume of terminals, the quantity of their mitochondria, and the total sum of membranes may be increased under stimulation by actual acceleration of the axoplasmatic flow rate and by incorporation of the preterminal portion of the axon. (3) The presence of at least three types of terminals is evident from the different form of their synaptic vesicles and in addition, from their different response to our experimental conditions. It is not decided from the present findings, whether the bouton-like terminals and bulbs of the afferent cochlear nerve axons contain the same type of synaptic vesicles or whether these axons produce heterotypic terminals.


Kinetic studies of dose-dependent metabolism of alprenolol: in vitro and in vivo studies in different species. Kinetic studies of the metabolism of alprenolol were performed with isolated microsomes from the rat, guinea-pig, dog and man at an initial substrate concentration of 0.17--150 micrometer. In all species the rate of aromatic hydroxylation reached a plateu above 50 micrometer of alprenolol in contrast to the rate of desisopropylation, where consistent saturation level was not obtained. The Km-values for the aromatic hydroxylation in the guinea-pig and man, 2,7 micrometer and 1.3 micrometer respectively, showed no concentration dependency in contrast to the rat (Km1 = 0.20 micrometer, Km2 = 26 micrometer) and the dog (Km1 = 0.78 micrometer, Km2 = 66 micrometer). The apparent Km-value of 0.20 micrometer for  aromatic hydroxylation in the rat seemed to be of the same order of magnitude as reported  spectral dissociation constant (Ks = 0.34 micrometer). In vivo experiments in the rat by oral administration of 7--700 mu mol/kg demonstrated a dose-dependent presystemic elimination of alprenolol. The urinary excretion of hydroxy-alprenolol was significantly lower after the highest dose. It is proposed, that the saturation of the aromatic hydroxylation, catalyzed by a high affinity site or subspecies of cytochrome P-450 with a low capacity, contributes to the dose-dependent kinetics in vivo.


An investigation of sympathetic effects on hearing. Absolute and masked thresholds were measured behaviourally in the cat before and after lesion of the superior cervical ganglion and sympathetic trunk. No changes were found, even though testing was continued for up to 2 1/2 years afterwards. However in acute experiments in the anaesthetised animal small increases in the neural N1 potential of the cochlea, without any effect on the microphonic, were found after stimulation of the sympathetic trunk.


Experimental study of the Eustachian tube function with regard to its related muscles. Utilizing electromyography and electrical muscle stimulation, the muscle responsible for opening the Eustachian tube was examined im 12 dogs. Different time values for tubal opening and levator activity indicate little contribution of the levator in the functioning of the tube. By relatively low stimulation of the tensor, the tube opened consistently, while the levator failed to produce any dilation of the tube, regardless of the amount of stimulation, in 6 dogs. Thus, it is concluded that the sole muscle responsible for tubal opening is the tensor, while the levator does not participate in the functioning of the tube.


The binding of CTAB, a cationic surfactant, to the rat erythrocyte membrane. The adsorption of CTAB (cetyltrimethylammonium bromide) to the rat erythrocyte membrane was studied by determining the electrophoretic mobility of erythrocytes treated with CTAB and by SDS polyacrylamide electrophoresis of membrane proteins from erythrocytes treated with 14C-CTAB. At low concentrations of CTAB there was only a small reduction in the electrophoretic mobility of the erythrocytes. At lytic concentrations the electrophoretic mobility of the erythrocytes was markedly reduced. Alterations at the cell surface were found to be a more likely reason for the reduction in the electrophoretic mobility than interactions between the surfactant and charged groups at the cell surface. Very small amounts of radioactivity were found to be associated with the protein and sialoglycoprotein bands of the polyacrylamide gels. It is suggested that the adsorption of CTAB to the rat erythrocyte membrane does not involve electrostatic interactions between the surfactant and negatively charged groups of the sialoglycoproteins and that membrane proteins do not play a major role in the lytic events.


Behavioral auditory function after transection of crossed olivo-cochlear bundle in the cat. IV. Study on pure-tone frequency discrimination. The present report describes the frequency discrimination capability of the cat based on behavioral auditory measurements in conjunction with transection of the crossed olivo-cochlear bundle at the floor of the fourth ventricle. Using the repetitive method, cats were trained to respond to frequency differences from 8000 Hz. For the measurement of the frequency discrimination threshold, instead of using the descending method, the cats were trained to detect the absolute change in the frequency. With the given experimental paradigm, the average pre- and post-operative frequency discrimination thresholds were 114.3 Hz and 133.6 Hz in experimentals, and 128.3 Hz and 140.0 Hz in shams. Differences between the two groups were minimal and may simply represent functional biological variance.


Effect of trichloroethylene on cilia activity in rabbit trachea. The ciliotoxicity of trichloroethylene was studied in terms of the time required for ciliostasis in specimens of trachea from 35 male rabbits following exposure of the specimens to different vapour concentrations. The highest vapour concentration was linked with the most rapid ciliostasis but even in the lowest concentration tested, 5.000 p.p.m. (26 g/m3), hastened ciliostasis. Specimens from the upper region of the trachea underwent ciliostasis more slowly than did those from the lower region. The absolute uptake of trichloroethylene was lower in the former than in the latter specimen. The difference in uptake could not be explained by a difference in weight or in lipid content. That ciliostasis occurred at different times depending upon the region of the trachea, favours the theory of a critical tissue concentration for trichloroethylene.


Calcium, nifedipine and arrhythmias in isolated rat atria. Arrhythmias were induced in isolated rat atrial muscle preparations by increasing the calcium concentration of the Ringer solution, while the potassium concentration was kept low. A rise in the resting tension occurred simultaneously. The release of aspartate aminotransferase (ASAT) from the fibrillating atria was not higher than the release from non-fibrillating atria pretreated with a calcium-antagonistic drug, nifedipine 100 microgram/l. It is suggested that calcium-induced rat atrial arrhythmias in the present experiments are caused by a direct effect on calcium influx through the excitable membrane and not as a result of myocardial lesion caused by calcium overload.


Verapamil and nifedipine inhibition of contractions induced by potassium and noradrenaline in human mesenteric arteries and veins. Ring preparations of human mesenteric arteries and veins were contracted by noradrenaline (1.8 x 10(-5)M) or potassium (127mM). Isometric tension was recorded. In the arterial preparations, the maximum response to noradrenaline was 97 +/- 8% (mean +/- S.E.M.) of that to potassium. In the veins, the corresponding figure was 38 +/- 4%. The calcium antagonists verapamil (2.2 x 10(-7)-2.2 x 10(-5)M) and nifedipine (2.9 x 10(-8)-2.9 x 10(-6)M) relaxed both arteries and veins contracted by noradrenaline or potassium, and reduced the responses to these agents when added 15 min. before stimulation. The time course of relaxation of potassium contracted preparations, induced by verapamil and nifedipine, was more rapid and complete than that produced by a calcium-free, high potassium solution. In contrast to verapamil, nifedipine caused a more pronounced inhibition of the potassium than of the noradrenaline evoked contractions in both arteries and veins. After exposure to a calcium-free medium for 30 min., the arterial response to noradrenaline was significantly (P less than 0.05) greater than that to potassium. However, the reverse was found in the veins. In both types of vessel, verapamil (2.2 x 10(-6)M) and nifedipine (2.9--10(-7)M) were equi-effective in reducing the noradrenaline reactivity, not only between mesenteric arteries and veins, but also between, e.g. peripheral and mesenteric vessels. The calcium antagonists nifedipine and verapamil do not have an identical mode of action. However, both agents seem to inhibit influx of extracellular calcium, and might also have an inhibitory effect on the release of intracellular calcium.


Effect of cadmium acetate, copper sulphate and nickel chloride on organ cultures of mouse trachea. Tracheas from albino mice were excised and cut into rings approximately 1 mm thick. After preincubation overnight in Medium 199 with 5% calf serum, they were placed into fresh medium. Cadmium acetate, copper sulphate or nickel chloride was added separately or in combination, to a final concentration of 10--200 micron. Each metal was also added (10 micron) to serum-free Medium 199. The percentage (0--100) of the inner intact epithelium and the rate (0--4) of the ciliary beat in each ring were assessed before and during a 4-hour incubation period and multiplied to yield a relative activity index (0--400). Cadmium acetate at 10--100 micron depressed the ciliary activity significantly more than 10--100 micron copper sulphate (each level P less than 0.05). With 200 micron a 50% reduction of the activity index was observed after approximately 35 min. with cadmium acetate and 85 min. with copper sulphate. At 10--200 micron, cadmium acetate was significantly more suppressive than nickel chloride (each level P less than 0.05). When comparing the inhibitory effects of copper sulphate and nickel chloride a significant difference appeared at 10--100 micron (each level P less than 0.01), but not at 200 microm (P less than 0.05). With 200 micron nickel chloride a 50% reduction in the activity index was observed after 90 min. There was a tendency towards reduced toxicity of cadmium acetate when combined with copper sulphate and of copper sulphate when combined with nickel chloride. In serum-free medium metal toxicity was increased.


Effect of oral administration of calcium carbonate, Camalox and Novalucol on plasma gastrin concentration in duodenal ulcer patients. In 6 patients having duodenal ulcer disease plasma gastrin concentrations were determined before and after the oral administration of 0.5--2 g of calcium carbonate, 2--4 tablets of Camalox and 2 tablets of Novalucol. No significant influence on basal plasma gastrin levels was noted indicating that antacids, whether they contain calcium carbonate or not, do not influence the basal plasma concentration of gastrin at occasional administration.


Haemodynamic effects of the quaternary ammonium compound QX 572 in anaesthetized cats. I. Cardiac chronotropic effects. The haemodynamic effects of the antiarrhythmic compound, QX 572, have been studied in anaesthetized cats. It was found that QX 572 increased the heart rate and decreased the blood pressure of the cats during the infusion of the drug. A slight increase in blood pressure was seen after the infusion was terminated. The same results have been obtained in patients. Experiments on cats pretreated with propranolol or reserpine showed that infusions of QX 572 caused an increase in heart rate by increasing the sympathetic activity in the cats. It is also shown that changes in vagal tone may contribute to the effects of QX 572 on the heart rate.


Haemodynamic effects of the quaternary ammonium compound QX 572 in anaesthetized cats. II. Studies on the mechanism for the cardiac chronotropic effects. The antiarrhythmic compound, QX 572, has been shown to increase heart rate both in patients and experimental animals. In anaesthetized cats the positive cardiac chronotropic effects were mainly due to increased sympathetic activity. The present experiments were designed to localize the active sites within the sympathetic nerve system. It was found that QX 572 caused an increased heart rate in response to electrical stimulation of the cardiac sympathetic nerves, but this was not due to effects on the CNS, the sympathetic ganglia or the cardiac adrenergic beta-receptors. It is concluded that QX 572 by some action increased the amount of noradrenaline released from the cardiac sympathetic nerve endings. The mechanism for this effect has not been clarified.


Iodine-induced hypothyroidism and its effect on the severity of asthma. Among 1107 patients with asthma or chronic asthmatic bronchitis and 96 with hypothyroidism we found 12 patients with both diseases. Seven of these patients had hypothyroidism induced by iodine-containing expectorants. Five of 209 patients with hyperthyroidism had coexistent asthmatic lung disease, but none of these five had been taking iodine. The severity of asthma is considered in relation to changes in thyroid function following withdrawal of iodine. Three patients had an exacerbation of their asthma, while another three had no change in their asthma when the iodine treatment was discontinued and the euthyroid state subsequently restored. All six patients had a marked improvement of their general wellbeing when the euthyroid state was re-established. It is concluded that treatment with iodine-containing expectorants causing hypothyroidism is unwise and should be withdrawn even when the patients praise the beneficial effect of iodine on the asthma per se.


Poisoning with brown fly agaric, Amanita regalis. Three patients ate different amounts of a common northern mushroom, brown fly agaric, Amanita regalis. All of them believed they had eaten delicious parasol mushrooms, Macrolepiota procera. The symptoms of poisoning began 1--2 hours after ingestion of the mushrooms. All the patients had marked gastrointestinal symptoms: nausea and heavy vomiting. Two had central nervous system manifestations and cholinergic symptoms: hallucinations, confusion, or loss of consciousness as well as copious salivation, or sweating. All patients recovered within 4--24 hours without any damage to liver, kidneys or central nervous system. It seems that cooking the mushrooms does not completely neutralize the toxic agents of Amanita regalis. The analysis of fried mushrooms shows that it may be possible to identify mushrooms reliably from the remains of a meal.


Fatal renal vasculitis and minimal change glomerulonephritis complicating treatment with penicillamine. Report on two cases. Two cases with different and not previously described fatal renal complications during treatment with penicillamine are reported. A man with seronegative rheumatoid arthritis with features of systemic lupus erythematosus was treated with penicillamine for six months and developed a mild membranous glomerulonephritis and a severe renal vasculitis leading to uremia and death. A woman with primary biliary cirrhosis was treated with penicillamine for nine months and developed a nephrotic syndrome, the renal biopsy showing minimal change glomerulonephritis. The nephrotic syndrome responded to prednisone but the patient died, probably from septicemia. Penicillamine may thus cause glomerular damage without deposition of immune complexes. A restricted use of the drug is recommended.


Primary sclerosing cholangitis associated with fibrosis of the submandibular glands and the pancreas. A new syndrome of primary sclerosing cholangitis associated with fibrosis of the submandibular glands and the pancreas is described in a 43-year-old male. The sclerosing cholangitis was diagnosed at laparotomy because of cholestasis and the fibrosis of the submandibular glands and pancreas confirmed at microscopical investigation of biopsy specimens. The cholangitis responded well to treatment with a low dose of prednisolone (7.5--10 mg) and an endoscopic retrograde cholangiopancreaticographic examination 10 months after the operation revealed normal bile ducts.


Phasic voltage alternation in spontaneous left-sided pneumothorax. Marked phasic voltage alternation is described in a man with spontaneous left-sided pneumothorax. This ECG change in association with pneumothorax has been described in only one patient previously.


Early and sudden deaths after myocardial infarction. A report from the Swedish CCU study. 1329 patients were discharged alive after acute myocardial infarction initially treated in a CCU. In a five-year follow-up, 537 (40%) of the patients died. Routine data registered uniformly during the CCU period showed that, apart from age, the most important factors regarding long-term prognosis in general were previous ischaemic heart disease and direct or indirect signs of heart failure registered in the CCU. The possibilities to predict sudden death (130 patients died within 2 hours of onset of final symptoms during the follow-up period) were small, although a definite dominance of this mode of death was noted in patients below 60 years of age. The clinical profile of the majority of the 134 patients who died during the first half-year was distinguished by a history of prior myocardial infarction and signs of left heart failure during the CCU stay. However, in a significant number of patients dying early after discharge, none of the ordinary unfavourable prognostic signs had been registered.


Non-invasive assessment of cardiac function in meningitis. Non-invasive registration of systolic time intervals (STI) and ECG were used in evaluating cardiac function in 12 patients with bacterial and 16 with viral meningitis. On admission, 14 (50%) of the patients had abnormal STI. The preejection period (PEP) was prolonged in 11 patients, while left ventricular ejection time (LVET) was prolonged in two and shortened in four. The PEP/LVET index was increased in eight patients. At discharge PEP was still prolonged in eight patients; seven of these were from the viral meningitis group. LVET increased significantly (p less than 0.02) from the first to the last registration. In the patients with abnormal PEP and PEP/LVET on admission, there was a significant fall (p less than 0.05 and p = 0.02, respectively) to discharge. There was no difference in STI between the patients with viral or bacterial meningitis. Eighteen (64%) of the patients had abnormal STI on one or more registration. ST-T changes in ECG and prolongation of the Q-T interval were found in three patients. Cardiac affection in meningitis seems to occur more often than can be shown by ECG.


Menopausal age in relation to smoking.

Menopausal age in relation to smoking. A population study of women revealed more smokers among 50-year-old postmenopausal women than among women of the same age who still menstruated. The difference was statistically significant. The postmenopausal smokers had on average smoked as long as or longer than the smokers who still menstruated. The higher number of smokers among postmenopausal women could thus not be explained by these women starting to smoke in connection with the menopause. Non-smoking women were on average heavier than smoking women. Previous studies indicate that an increased amount of adipose tissue might delay the menopausal age. It is therefore possible that the difference in menopausal age between smoking and non-smoking women might be explained either by a delayed menopause in non-smoking women due to an increased amount of adipose tissue in these women, or by a precocious menopause in smokers due to toxic effects from smoking. Probably both factors are of importance, but our results indicate that smoking per se is the main factor. The increased number of smokers among women with precocious menopause can probably explain part of the overrepresentation of women with precocious menopause among those who have myocardial infarction.


Decreased renal plasma flow during propranolol treatment in essential hypertension. The pharmacodynamic effect of propranolol (80 mg b.i.d.) on the renal and systemic circulation was studied after 1 and 8 months of treatment in 13 patients with essential hypertension, using non-invasive radioisotope techniques. Effective renal plasma flow (ERPF) fell from (mean +/- S.E.M.) 244 +/- 18 to 208 +/- 14 after 1 month and to 187 +/- 13 ml/min.m2 after 8 months of treatment. Concomitantly cardiac index (CI) fell from 3.24 +/- 0.15 to 2.62 +/- 0.11 and 2.75 +/- 0.10 l/min.m2, respectively. The coefficient of correlation between the decreases in ERPF and CI was 0.49. Mean arterial blood pressure decreased from 138 +/- 5 to 118 +/- 5 and 116 +/- 4 mmHg, respectively. Left ventricular work was reduced by 30.2 and 27%, while peripheral resistance was unchanged. Total plasma volume was increased from 19.3 +/- 0.5 to 20.3 +/- 0.6 ml/cm after 1 month, but was within the same range as the control values after 8 months of treatment. Pulmonary plasma volume was unchanged, indicating that there was no pooling of plasma in the pulmonary circulation. The interventricular circulation time was increased from 6.9 +/- 0.4 s to 8.4 +/- 0.3 s and varied with the change in heart rate. It is concluded that the fall in ERPF might be explained by reduced cardiac output in addition to interference with the hemodynamic autoregulation in the kidney.


Febrile seizures.

Febrile seizures. Thirty to 40 percent of children who have a febrile seizure between the ages of six months and six years are at risk for further and more serious febrile seizures and possibly for afebrile seizures. The risk is heightened if the child is less than one year of age and if the seizure lasts more than 20 minutes or is focal rather than generalized. A history of epilepsy in a first-degree relative also increases the risk. The use of long-term phenobarbital therapy is advocated when the seizure is "atypical".


Psychotropic drugs: a biopsychosocial approach. A biopsychosocial theory and approach to drug-seeking behavior suggests new questions for the family physician to ask his patient when psychotropic drugs are being considered. The theory and rational guidelines for prescribing allow the physician to make more appropriate decisions when faced with difficult situations. Pharmacotherapy can then be directed toward alleviating anxiety that inhibits the patient's existing coping skills or toward activating the depressed/apathetic patient to use his existing skills. With this approach, social, psychologic and biologic coping devices can be simultaneously mobilized.


Effects of oral contraceptives on nutritional status. Major effects of oral contraceptives on nutritional status are elevation of triglycerides, decline in glucose tolerance, an apparent increase in the need for folate and vitamins C, B2 and B6, and a decrease in iron loss. Women at greater risk of nutritional deficits due to oral contraceptives include those who have just had a baby, are planning to have a baby later, already show nutritional deficiencies, have had recent illness or surgery, have poor dietary habits, are still growing or have a family history of diabetes or heart disease.


Amantadine and influenza A.

Amantadine and influenza A. Amantadine hydrochloride is currently licensed for the prophylaxis and symptomatic treatment of influenza A infections. Although its efficacy is based on considerable clinical experience, amantadine has had relatively little use for that purpose in the U.S. It is well tolerated and generally nontoxic. It may be particularly useful in the prophylaxis of unvaccinated high-risk individuals and critical personnel. Effective use of amantadine depends on rapid detection of influenza A activity in the community.


Current concepts in the management of hearing loss. The family physician is the logical first step for the hard-of-hearing patient who is seeking aural rehabilitation. Permanent, irreversible, sensorineural hypoacusis is becoming more prevalent. Recent FDA regulations mandate a physician's clearance before the patient can be fitted for a hearing aid. The family physician must be able to advise the patient about modern otologic and audiologic rehabilitative procedures for a sensorineural hearing loss.


Staphylococcal bacteremia: distinguishing endocarditis. Staphylococcus aureus is a frequent cause of endocarditis as well as bacteremia arising from noncardiac sites. Differentiation of endocardial from nonendocardial S. aureus bacteremia is often difficult, especially in febrile patients with S. aureus sepsis and no indentifiable focus. A number of clinical and laboratory features help distinguish these two bacteremias.


Management of gout.

Management of gout. Although the traditional oral colchicine regimen is often used for the acute attack, the intravenous route has advantages. Indomethacin, phenylbutazone, oxyphenbutazone and the newer nonsteroidal anti-inflammatory agents, such as ibuprofen, naproxen and fenoprofen, are quite successful. For chronic management of hyperuricemia, it is helpful to distinguish between overproducers of uric acid, for whom allopurinol is the rational therapy, and underexcreters of uric acid, for whom probenecid or sulfinpyrazone is indicated.


Neurogenic bladder dysfunction.

Neurogenic bladder dysfunction. The combined use of cystometry and perineal electromyography permits the physician to detect abnormalities in the synchronization of bladder contraction and urinary sphincter relaxation. With each pattern of neurogenic bladder disease, the coordination between bladder and sphincter determines whether urinary tract problems will develop. Treatment is tailored to specific bladder and sphincter defects.


Common otolaryngologic problems of flying. Pressure-volume changes associated with changing atmospheric pressure precipitate acute inflammation of the sinus and middle ear cavities, known collectively as barotrauma. Barotitis occurs during descent from high altitudes. A partial vacuum develops, manifested by a retracted tympanic membrane. Hemorrhage may occur as a consequence of the vacuum. Similar pathophysiology causes barosinusitis. While the cause of aerodontalgia is not known, pain in the teeth does occur during ascent rather than descent.


Acute epiglottitis in a community hospital. Acute epiglottitis is a fulminating pediatric emergency which should be managed with antibiotics and the establishment of an airway. Either tracheostomy or nasotracheal intubation is employed for airway intervention. Because of the morbidity associated with tracheostomy, recent reports have stressed the use of nasotracheal intubation. Experience in 21 cases of acute epiglottitis emphasizes nasotracheal intubation as the treatment of choice in a community hospital.


Arthritis of the temporomandibular joints. The most common disease of the temporomandibular joint (TMJ) is osteoarthritis. Rheumatoid arthritis and psoriatic arthritis may also involve this joint. Other diseases that may occasionally affect the TMJ include familial Mediterranean fever, systemic lupus erythematosus, gout, Sjögren's syndrome and infectious arthritis. Many cases of TMJ syndrome are labeled as idiopathic facial pain syndrome, a category that probably represents a number of different entities. The role of dental malocclusion has been greatly overemphasized in the past.


Drug therapy in the elderly.

Drug therapy in the elderly. Special considerations must be invoked when prescribing medications for the elderly. Although basic absorption is unchanged, many elderly patients are prone to chronic diarrhea or constipation, either of which may alter intestinal contact time and, thus, absorption. Concurrent use of such drugs as antacids or iron preparations may affect the availability of some compounds for absorption. The problem of drug interactions after absorption is also important, since studies have shown that elderly patients commonly receive several drugs concurrently.


Qualitative radionuclide angiocardiography in the diagnosis of corrected transposition. Seven patients with corrected transposition were studied by qualitative radionuclide angiocardiography. In four patients with situs solitus with apex on the left, the pulmonary artery was in a medial and posterior position, to the right of the aorta, with its root attached to the morphological left ventricle positioned on the right. The aorta arose from the ventricle placed on the left and had an anterior position. The ventricle located on the right has a triangular shape. In the case of situs solitus with dextroversion, the pulmonary artery was to the right of the aorta and had a right-to-left direction. The ventricle placed on the right was ovoid. In one single case of situs inversus with levoversion, the pulmonary artery was on the left, emerging from the morphological left ventricle placed on the left, and was ovoid in shape, while the aorta was on the right arising from the morphological right ventricle. In one case of situs inversus with dextrocardia, atrioventricular relationships were the same as in levoversion but the apex was on the right and the morphological left ventricle was triangular. Qualitative radionuclide angiocardiography is a simple and non-invasive method for obtaining morphological data for the precise diagnosis of corrected transposition.


Abnormal septal motion in patients with postoperative right bundle branch block pattern. Echocardiograms were performed on 25 patients with postoperative right bundle branch block pattern 3 to 93 months after surgery to assess the possible effects of abnormal cardiac excitation on septal motion. Each of the 25 patients demonstrated a unique pattern of septal motion characterized by the presence of an early systolic anterior septal notch, brief in duration and unrelated to subsequent systolic septal motion, right ventricular size, or surgical procedure. Beginning approximately 70 to 80 msec. after the initial QRS deflection, the septum abruptly moved anteriorly 2 to 7 mm. and then returned to a baseline position. The total duration of this abnormal septal motion lasted 78 to 155 msec. This echocardiographic pattern was not seen in any of 30 patients in two control groups. Twenty had a normal QRS pattern and ten demonstrated right ventricular hypertrophy. In addition, patients who underwent open heart surgery and had normal right ventricular conduction postoperatively did not show this echocardiographic pattern with either normal or paradoxical septal motion. This previously undescribed echocardiographic pattern demonstrates that septal motion is uniquely affected in patients with postoperative right bundle branch block pattern.


Heparin therapy: a randomized prospective study. Eighty patients were assigned randomly either to continuous or to intermittent heparin therapy, with control by the Lee-White Clotting Time (LWCT). Major bleeding complications occurred in 7.5 per cent and minor complications in 18 per cent of the entire group. The incidence of major bleeding complications in the continuous group (5 per cent) did not differ significantly from the incidence in the intermittent group (10 per cent). In contrast, bleeding complications were significantly more frequent in patients with soft-tissue trauma due to such procedures as thoracenteses and cut-downs, vascular damage due to other causes, and LWCTs over 35 minutes for 2 consecutive days. The incidence of bleeding complications appear to be the same in patients receiving intermittent as in those receiving continuous heparin therapy. Thoracenteses, cut-downs, and other forms of soft-tissue injury predispose to bleeding complications while laboratory monitoring with the LWCT may help to reduce bleeding complications.


Hazards in treatment of systolic hypertension. Eight patients with arteriosclerotic systolic hypertension whose blood pressure had been nonresponsive to conventional antihypertensive therapy, were given minoxidil in daily doses of 4 to 15 mg. Within 2 to 5 days the blood pressure of seven patients was brought to more "normal" levels. After 10 to 20 days of treatment, a significant weight increase was observed with a concomitant rise of blood pressure, which could be overcome by more vigorous diuretic therapy. However, six of the seven blood pressure responders and the one nonresponder complained of severe adverse effects curtailing further use of the drug. It is concluded that despite the effectiveness of arteriolar vasodilation in the reduction of elevated systolic blood pressure, such lowering may be deleterious in patients with atherosclerotic involvement of vital organs.


The incidence and pattern of angina prior to acute myocardial infarction: a study of 577 cases. In order to determine the incidence and pattern of angina as a premonitory symptom of acute myocardial infarction, 577 consecutive patients with acute myocardial infarction were questioned shortly after hospital admission about the presence and pattern of chest pain prior to onset of infarction, with particular emphasis on the month prior to infarction. Two hundred and seventy-six patients (48 per cent) had no angina before infarction (Group I), whereas 301 (52 per cent) did. One hundred and seventy-nine patients (31 per cent) had a history of chronic angina, and of these, 75 had no change in the pattern of angina prior to infarction (Group II) while 104 noticed worsening of their symptoms in the month prior to infarction (Group III). One hundred and twenty-two patients (21 per cent) had new onset angina in the month prior to infarction (Group IV). The number of patients with unstable angina prior to infarction (Groups III and IV) was therefore 226 or 39 per cent of the total series. In patients with unstable angina, the increase in severity of symptoms or the development of new onset angina occurred within a period of 1 week or less in 69 per cent. Patients with a history of previous infarction or chronic angina had a higher incidence of unstable angina prior to infarction than patients without such a history (p less than 0.05). Patients with prior angina (Groups II, III, and IV) had a higher incidence of subendocardial infarction than patients without angina (p less than 0.05). The hospital mortality rate in the four groups did not differ significantly.


Phasic changes in human right coronary blood flow before and after repair of aortic insufficiency. We have shown previously that acute aortic insufficiency in chronically instrumented dogs reverses the normally high ratio of diastolic to systolic coronary blood flow. Phasic blood flow in the dominant right coronary artery was measured directly with an electromagnetic flow meter during surgery in eight patients with severe aortic insufficiency before and after relacement of the aortic valve. Before the insufficiency was eliminated, right coronary flow average 116 +/- 37 ml./minute and the diastolic to systolic flow ratio was 0.88 +/- 17. Mean arterial blood pressure averaged 106 +/- 17 mm. Hg, heart rate 84 +/- 19 beats/minute, and mean diastolic pressure averaged 67 +/- 10 mm. Hg. After the aortic valve was replaced with an average heart rate of 90 +/- 15 and mean blood pressure of 103 +/- 13 mm. Hg, the average right coronary blood flow increased to 180 +/- 40 ml./minute with a D/S ratio of 2.18 +/- 0.8. In all cases the right coronary blood flow increased after the aortic insufficiency was eliminated surgically. Right coronary flow probably increased because of the improved diastolic perfusion pressure and the change from predominantly systolic to diastolic coronary flow.


Gap phenomenon in "the right and left bundle branch systems" during retrograde conduction in man. Gap phenomenon in right and left bundle branch systems during retrograde conduction is described in two patients with manifest reentry within the His-Purkinje System (V3 phenomenon). In this form of gap the premature impulse (S2) initially blocked in the right bundle branch system and conducted retrogradely via the left bundle branch system as manifested by sudden prolongation of S2H2 interval and appearance of V3. At close coupling intervals S2 impulse encountered retrograde block in the left bundle branch system and resumed retrograde conduction via the right bundle branch system with S2H2 intervals shorter than critical value and was not followed by V3. However, on further shortening the S1S2 intervals S2 impulse blocked again in right bundle branch system and resumed conduction via the left bundle branch system with S2H2 intervals longer than critical values and V3 reappeared. The mechanism of these gaps is not clear but we believe is similar to the one proposed in Types I and II gaps in antegrade bundle branch conduction and involves proximal delay allowing distal recovery. The similarities and differences between the gap phenomenon in bundle branches during antegrade and retrograde conduction are discussed.


Atropine-induced ventricular fibrillation: case report and review of the literature. A bradycardic and mildly hypotensive acute myocardial infarction patient developed sinus tachycardia, ventricular tachycardia, flutter, and fibrillation following intravenous atropine. Previous case reports are reviewed and the literature regarding the advisability of this mode of therapy is discussed. In the light of conflicting opinion as to the necessity of atropine in the mildly hypotensive and bradycardic acute myocardial infarction patient, and in view of its potentially deliterious effects on ischemic myocardium, a cautious and selective application of this drug is advised.


Significance of reduced regional myocardial blood flow in asynergic areas evaluated with intervention ventriculography. Results of studies combining washout of xenon-133 and postextrasystolic potentiation. Nineteen patients with coronary artery disease were studied to determine the significance of reduced regional myocardial blood flow (50 ml/min per 100 g or less) in areas of abnormal wall motion. Regional myocardial blood flow was measured in four regions of the left ventricle with an Anger camera after the injection xenon-133 into the left main coronary artery. Abnormal wall motion was evaluated with biplane left ventriculography at rest and during postextrasystolic potentiation, a potent inotropic stimulus. Abnormal wall motion was defined as hemiaxis shortening of less than 20 percent. Four hemiaxes were designated as corresponding to the four regions of myocardial blood flow. Of 76 hemiaxes evaluated in the 19 patients, 54 manifested normal wall motion and 22 abnormal wall motion; 8 of the 22 hemiaxes had reduced regional myocardial bood flow. In these 8, hemiaxis shortening increased 6 +/- 2 percent (mean +/- standard error of the mean) above values at rest during postextrasystolic potentiation (with normalization of hemiaxis shortening in only 1 of the 8), compared with an increase of 19 +/- 4 percent (P less than 0.001) in the 12 hemiaxes with borderline regional myocardial blood flow (with normalization of hemiaxis shortening in 9 of the 12, P less than 0.05). These results indicate that the presence of reduced regional myocardial blood flow in areas of abnormal wall motion usually predicts a poor response to post-extrasystolic potentiation, whereas abnormal wall motion without reduced regional myocardial blood flow usually predicts a good response. The combination of reduced regional myocardial blood flow and abnormal wall motion suggests scarred and nonviable myocardium.


Effect of dilation of the distal coronary bed on flow and resistance in severely stenotic coronary arteries in the dog. Studies were performed to evaluate the hemodynamic response of severely stenotic coronary arteries to dilation of the distal coronary bed. A critical stenosis was produced with an adjustable wire snare on the left anterior descending or circumflex arteries of open chest dogs. Coronary flow, distal coronary pressure and aortic pressure were measured. In one group of experiments, coronary arteriolar dilatation was induced by transient occlusion of the artery distal to the stenosis. After the release of a transient occlusion in vessels without a critical stenosis, flow increased (from 33 +/- 4 to 85 +/- 8 ml/min, P less than 0.01), distal pressure decreased slightly (from 86 +/- 4 to 80 +/- 4 mm Hg, P less than 0.01), and large vessel resistance did not change significantly (from 0.06 +/- 0.02 to 0.08 +/- 0.03 units). After the release of a transient occlusion in vessels with a critical stenosis, flow decreased (from 23 +/- 3 to 12 +/- 2 ml/min, P less than 0.01), distal pressure decreased to persistently low levels (from 63 +/- 2 to 29 +/- 2 mm Hg, P less than 0.01), and large vessel resistance increased (from 1.4 +/- 0.3 to 6.7 +/- 1.8 units, P less than 0.01). In a separate group of experiments, radio-opaque contrast medium was used to dilate the distal coronary bed. In these studies dilation of the distal coronary of arteries with a critical stenosis again resulted in a decrease in coronary blood flow (from 35 +/- 4 to 19 +/- 3 ml/min, P less than 0.01), a decrease in distal coronary pressure (from 84 +/- 6 to 35 +/- 6 mm Hg, P less than 0.01) and an increase in large arterial resistance (from 1.0 +/- 0.2 to 5.5 +/- 1.2 units, P less than 0.02). Therefore, in coronary vessels with severe stenosis, dilation of the distal coronary bed may result in a paradoxical decrease in coronary blood flow.


Cardiac damage produced by direct current countershock applied to the heart. This study examined the pathophysiology of the myocaridal damage produced by direct current shock over a dose range of 10 to 90 watt-seconds, applied directly to the heart in 26 dosgs. The extent of injury produced was assessed with creatine kinase depletion and light and electron microscopy, and was correlated with in vivo imaging and tissue distributions of the isotopes technetium-99m pyrophosphate and thallium-201. Changes in intramyocardial temperature and regional myocardial blood flow were also measured. Uptake of technetium-99m pyrophosphate occurred exponentially with graded increases in shocks, and this agent was more sensitive than thallium-201 in detecting injury both on imaging and at tissue level. The threshold for significant injury was approximately 30 watt-seconds, and on electron microscopy a characteristic feature was marked dehiscence of the intercalated disks between the damaged myocytes. The use of different-size paddles did not appear to affect the total number of cells damaged. However, with large paddles the injury was more superficial and spread over a wider area. With short time intervals between successive shocks, a greater amount of injury occurred, in part because of a compounding of the thermal component of the damage. Hypothermia can reduce the degree of injury.


Ejection phase indexes by invasive and noninvasive methods: an apexcardiographic, echocardiographic and ventriculographic correlative study. A new noninvasive method of measuring ejection fraction and the mean velocity of circumferential fiber shortening from the apexcardiogram and carotid pulse tracing is described and compared with the echocardiographic and angiographic measurement of these values in 35 patients with coronary artery disease. The correlations of the apexcardiographic derived values with the angiographic measurements were excellent (r = 0.89 and 0.96, respectively, P less than 0.001) even though asynergy was present in 14 of the 35 patients. Only 6 percent of the derived ejection fractions and none of the mean velocity measurements were discordant with the angiographic data. In contrast, correlations of the echocardiographic measurements of the ejection phase indexes with the same angiographic data were poorer (r = 0.75 and 0.66, respectively, for ejection fraction and mean velocity, P less than 0.01). Twenty-eight percent of echocardiographic ejection fraction measurements and 20 percent of the echocardiographic mean velocity measurements were discordant with the angiographic data. It is concluded that the apexcardiogram is a dependable bedside test for estimating left ventricular function and is superior to the echocardiogram for measuring ejection phase indexes.


Use of contrast echocardiography in the diagnosis of partial anomalous pulmonary venous connection. Contrast echocardiography is useful in diagnosing the presence of partial anomalous pulmonary venous connection, particularly when it occurs in association with an atrial septal defect. Injections of saline solution, Cardiogreen or the patient's own blood were made in the inferior vena cava, left atrium and pulmonary veins of 27 patients. In all patients, the inferior vena caval injections showed only right heart clouding with no evidence of a right to left shunt. In 21 patients, the left atrial and pulmonary venous injections showed clouding of both the right and left heart structures, indicating a left to right atrial shunt and normal pulmonary venous connection. In six patients, the left artrial injections showed right and left heart clouding, but the right pulmonary venous injections showed only right heart structures, indicating a left to right atrial shunt with partial anomalous pulmonary venous connection. Contrast echocardiography proved to be a sensitive method of diagnosing the anomalous venous connection without the use of dye curves. The method is not useful when a right to left atrial shunt is present and may show false positive results for partial anomalous pulmonary venous connection it left atrial visualization is not adequate during injection into the pulmonary vein.


Muscular ventricular septal defects: a reappraisal of the anatomy. Among 79 autopsy specimens of heart with an isolated ventricular septal defect, there were 29 cases of muscular defect. Among 60 hearts with complete transposition of the great arteries and a ventricular septal defect, there were 13 cases with a muscular defect. All muscular defects could be classified in three different types, based on the specific pathologic anatomy of the ventricular septum. The central and posterior defects were usually large and single, the marginal defects were frequently small and multiple. In hearts with transposition, central muscular defects were extremely rare, whereas these defects were by far the most frequent muscular defects in isolated ventricular septal defect. Alternatively, the posterior type was more common in cases of transposition. Marginal muscular defects were rare in both groups of malformations.


Efficacy of a new oral agent (tocainide) in the acute treatment of refractory ventricular arrhythmias. To assess the efficacy of tocainide, a new oral analog of lidocaine, 30 patients with ventricular arrhythmias refractory to quinidine, procainamide and propranolol were treated with this agent. The dose of tocainide ranged from 400 to 800 mg every 8 hours. Peak tocainide blood levels 1 to 4 hours after administration ranged from 5.0 to 15.0 microgram/ml (mean 10.3). The suppression of ventricular premature beats by 75 percent or more was arbitrarily used as a measure of drug efficacy. In 13 patients who met this criterion, ventricular premature complexes, assessed with 24 hour ambulatory tape monitoring, decreased by an average of 88 percent. In 8 of 11 patients, repeated symptomatic bouts of ventricular tachycardia were completely suppressed. Considering both the response of ventricular premature complexes and the abolition of ventricular tachycardia, 18 patients (60 percent) responded to tocainide. Twenty-one patients (70 percent) had initial gastrointestinal and central nervous system side effects; most of these were transient or responded to a reduction in dose. In two patients disorientation and a skin rash required withdrawal of tocainide. These adverse effects did not appear to be due to the interaction of tocainide with other antiarrhythmic agents. It is concluded that tocainide is an effective oral agent for the therapy of potentially lethal ventricular arrhythmias refractory to other medication.


Evaluation of therapeutic methods in high altitude pulmonary edema. The effect of treatment with bed rest alone was evaluated in 16 patients with high altitude pulmonary edema of mild to moderate severity at an altitude of 3,750 meters in the central Peruvian Andes. The results were compared with those in 20 patients who received conventional therapy including the continuous administration of oxygen and bed rest. A system of grading the severity of high altitude pulmonary edema based on clinical symptoms and signs, radiologic findings and heart rate and respiratory rate was developed. The severity of pulmonary edema as evaluated with the grading system was similar in the two groups of patients. Treatment with bed rest alone resulted in complete recovery in all patients over a mean period of 60 hours. No treatment failure occurred. Similar results were obtained with oxygen therapy combined with bed rest, except that the relief of symptoms was more rapid, the decrease in heart rate and respiratory rate was greater and the recovery period was slightly shorter. High altitude pulmonary edema of mild to moderate severity can be treated successfully with bed rest alone without the administration of oxygen and without moving the patient to a lower altitude. Oxygen therapy is more effective and when available should be used in all cases of high altitude pulmonary edema.


Noninvasive documentation of Prinzmetal's angina. A 57 year old women with substernal nonexertional chest pain and angiographically patent coronary arteries was evaluated with two dimensional echocardiography and myocardial perfusion scintigraphy after provocation of pain with methacholine. Simultaneous with the development of angina pectoris, the electrocardiogram demonstrated S-T segment elevation in leads II, III and aVF, followed by atrioventricular block. The echocardiogram revealed akinesia of the previously normally contracting left ventricular posterior wall during pain followed by hyperkinesia after the administration of nitroglycerin. Perfusion imaging suggested reversible inferior wall hypoperfusion. Thus, these studies provided noninvasive documentation of segmental left ventricular dysfunction and hypoperfusion during variant angina.


Ultrastructure of the tubular nephron of the garter snake Thamnophis sirtalis. Ultrastructural features of the tubular nephron of the garter snake, with special reference to modifications for conservation of water, were studied using transmission electron microscopy, freeze-fracture and tracer experiments. Although a nephric loop (loop of Henle) is lacking, the tubules appear to be structurally well adapted for efficient ion and water reabsorption. The most prominent features are well developed microvilli in the proximal tubule and elaborate latteral folds, particularly in the distal tubule and collecting ducts. The latter structures are highly interdigitated, creating complex intercellular channels, perhaps facilitating transepithelial fluid transport. Only the proximal tubule actively absorbs and degrades protein tracers from the lumen. The cells of the collecting duct secrete mucus which may precipitate and bind urate salts in the lumen. This may be significant in the excretion of these salts, a process which combines maximal removal of salts and nitrogenous wastes with minimal loss of water.


The effect of lanthanum on the nexus of the anterior byssus retractor muscle of Mytilus edulis L. The nexus of the anterior byssus retractor muscle (ABRM) of Mytilus has been observed with freeze-fracture techniques. Pits appear in the EF face and particles in the PF face, designating it as an A-type nexus. Under control conditions (lanthanum-free) the center-to-center spacing of pits and particles ranged from 14.0 nm to 15.5 nm. When lanthanum chloride (5 mM) was used in incubation media before fixation and glycerination, marked changes in the nexal membrane were observed. These changes involved close packing and long-range ordering of pits in the EF face, as shown by optical diffraction. In the presence of lanthanum the center-to-center spacing of the pits was 11.7 nm, while the particles remained at a spacing of 15.0 nm. From this we conclude that specific agents can alter the array of pits and particles in a nexus (gap junction).


Development of cell types and of regional differences in the postnatal rat epididymis. The development of cell types and regional differences in the rat epididymis was studied in specimens of the initial, middle and terminal segments prepared at intervals between birth and postnatal day 94. The development of the epididymis was divided into three phases: (1) an undifferentiated period; (2) a period of differentiation, and (3) a phase of expansion. During the undifferentiated period, from birth to day 15, the epithelial cells had a uniform appearance. Halo cells, which are believed to be migratory leukocytes, appeared on day 14. The period of differentiation extended from day 16 to day 44. Slender, densely staining cells, termed narrow cells, appeared in the epithelium of all three segments on day 16, constituting the first evidence of differentiation of cell types in the epididymal epithelium per se. In addition to their shape and apical nuclei, the narrow cells were distinguished from other epithelial cells by the presence of cup-shaped apical vacuoles and mitochondria with tubular cristae. Principal cells and basal cells were identified on day 28, which also marked the firsh distinction of differences in epithelial height among the different segments. Narrow cells persisted into the adult in the initial segment. In the middle and terminal segments, however, narrow cells disappeared by day 35, when light cells made their appearance. The major event of the period of expansion, from day 45 to 3 months, was the appearance of sperm in the lumen between days 45 and 52. A model for differentation of cell types in the epididymis is proposed and it is suggested that narrow cells are precursors to light cells in the middle and terminal segments. The development of ultrastructural features of adult cell types preceded the appearance of sperm in the lumen.


A transmission and scanning electron microscopic study of the saccule in five species of catfishes. The sacculi of five species of catfishes were studied by transmission and scanning electron microscopy. In four species, the sagitta exhibited a multifluted anterior part and a tapered posterior part; in Corydoras aeneus, however, the fluted part was absent, and a vertical component extended dorsally to terminate near the opening of the transverse canal. In all species, the otoliths had a laminar structure. An otolithic membrane was present, and hair cell bundles projected into cavities on the macular surface of the membrane. Attachments of the otolithic membrane to the neuroepithelium included short extensions of the membrane to the tallest components of the hair cell bundles of the peripheral cells and more delicate connections to the kinocilium and taller stereocilia of central cells; in addition, attachments to the microvilli of supporting cells were present. In both hair cells and supporting cells single microtubules and bundles of microtubules were present; the bundles had an orderly arrangement and were associated with cytoplasmic densities surrounding the desmosomes. The hair cells were innervated by both afferent and efferent nerve endings. Studies of the polarization of the hair cells in all species (except C. aeneus) showed that there was a single longitudinal axis that divided dorsally polarized cells from those oriented ventrally. In Doras spinosissimus and Bunocephalus bicolor, an additional line of polarization was evident in a small area in the anterior part of the macula; therefore, in these forms there was a double bipolar orientation.


Postnatal development of the canine kidney: quantitative and qualitative morphology. The normal postnatal development of the canine kidney was investigated utilizing qualitative and quantitative histologic methods. Kidneys were examined at 2, 4, 8, 14, 22, 70, and 200 days of age. A subcapsular nephrogenic zone was present in the kidneys until approximately eight days of age. This zone contained tissues which interacted to produce new nephrons and interstitial tissues. Several developmental stages of forming nephrons were identified in this zone. Beneath the nephrogenic zone, renal corpuscles of increasing maturity were located at successively deeper cortical levels. The total number of nephrons was estimated to be 445,000 per kidney. This number did not vary significantly during growth. The corpuscular volume per nephron increased 249% from 14 to 200 days of age. During the same period there was a 303% increase in the tubular volume per nephron. Although the developing kidney differed anatomically from the adult kidney, the individual nephrons maintained volumetric corpuscular-tubular balance during growth.


A light microscopic study of the developing human neural retina. Human embryonic and fetal eyes from 4 mm to 200 mm crown-rump length (26 days to 21 weeks of gestation) were studied in 0.75-micron sections impregnated with silver and toned with gold. The layer of Chievitz was formed by an inward migration of ganglion-cell and Müller-cell nuclei from the outer neuroepithelium and then, after further changes in nuclear location, the layer of Chievitz was cleared of ganglion-cell nuclei to become the definitive inner plexiform layer. Müller-cell nuclei later populated all retinal layers in the fetus. The argyrophilic Müller-cell cytoplasm associated with neuronal development is discussed in relation to glia-neuron interactions, with emphasis on the particular needs of retinal tissue.


Innervation of the ventral prostate of the rat. The autonomic innervation of the rat ventral prostate was studied in an attempt to evaluate the role of innervation in the normal function of the gland. Specific histochemical methods for both catecholamines (the formaldehyde-induced fluorescence method, FIF) and acetylcholinesterases (the Gomori-Koelle thiocholine method) were used. The neuro-effector contacts were studied by electron microscopy using both 3% glutaraldehyde and 3% potassium permanganate (KMnO4) as  fixatives. It was found that the rat ventral prostate receives dual autonomic innervation. Adrenergic fibers, which formed the majority of the nerves, were often seen in close contact with the smooth muscle cells around both the prostatic alveoli and secretory ducts. The non-adrenergic nerve fibers, which were fewer in number, did not form such intimate contacts with the muscle cells. No direct synapses with epithelial cells were detected.


Cobalt iontophoresis of sensory nerves in the rat lung. By iontophoretically introducing, first, cobalt and, subsequently, sulfide ions into the vagus nerve, it is possible to trace sensory nerves to their endings in the rat lung. Nerve fibers and terminals are found predominantly in the adventitia of the airways and blood vessels. Some nerves are found in the submucosa of the bronchi and bronchioles. Some are found in the cardiac muscle on the periphery of pulmonary veins, and a few nerves are seen to end among smooth muslces of the blood vessels and the airways. At least three types of nerve endings can be identified at the light microscopic level: (1) free nerve endings; (2) brush-like endings; (3) knob-like terminals.


Effect of chemotaxis on the interaction of cholera vibrios with intestinal mucosa. Earlier reports from this laboratory have shown that chemotaxis is an important mechanism that expedites the in vitro association of cholera vibrios with intestinal slices and that affects the in vivo colonization and virulence of these bacteria to a significant degree. The data reported in the present communication indicate that there appears to be a chemotatic gradient attracting cholera vibrios not only to the surface of the mucus gel, but that this gradient continues for at least a considerable distance toward the base of the villi. It is shown further that a strain of Vibrio cholerae was attracted by all 20 amino acids tested, in contrast to Escherichia coli AW405 which is repelled by several of these. Finally, experiments are described that show that superior in vivo colonization of chemotatic vibrios (compared to nonchemotactic mutants) was correlated with a significantly higher degree of mucosal association. Such increased mucosal association of chemotatic vibrios has previously been shown only with mucosal slices in vitro.


Fermentations by saccharolytic intestinal bacteria. Most nonsporing anaerobes of the intestinal tract use the Embden-Meyerhof-Parnas scheme to ferment carbohydrates. Almost all of them oxidize pyruvate, the key fermentation intermediate, to acetyl coenzyme A and CO2 with reduction of a low-potential electron acceptor. H2 is formed from the low potential acceptor or from NADH. Pyruvate is a precursor of lactate, and phosphoenolpyruvate is a precursor of succinate and propionate. Ethanol, acetate, and butyrate are formed from acetyl coenzyme A. Formate is produced by reduction of CO2 by Ruminococcus albus. Heme is required by human Bacteroides for the formation of succinate and, in the presence of vitamin B12, propionate. A fermentation equation derived from the concentration of volatile acids found in human feces suggests that the fermentation in the large intestine is similar to the rumen fermentation.


Clindamycin-induced colitis.

Clindamycin-induced colitis. The hamster model of enterocolitis after the administration of clindamycin was used to study various drugs used in treatment of the disease in humans. Current evidence strongly suggests toxigenic, clindamycin-resistant Clostridium difficile is a cause of the disease in hamster and man. This organism is susceptible to vancomycin and metronidazole, and the disease could be prevented in the hamster so long as the antibiotics were given orally. A fatal colitis almost invariably ensued once they were discontinued. Administration of cholestyramine significantly prolonged survival of hamsters, but did not pervent death or colitis. Corticosteroids or atropine-diphenoxylate (Lomotil) did not alter the disease. The hamster model may be useful in studying other kinds of treatment of this disease.


Effect of dietary composition on insulin receptors in normal subjects. Six normal subjects were placed on a high carbohydrate diet (80%) and a high fat diet (60%) for 2 weeks each. Glucose tolerance testing with plasma immunoreactive insulin levels was performed along with insulin receptor quantitation after a control period and after each of the dietary manipulations. Despite improved carbohydrate tolerance and decreased plasma immuno-reactive insulin after the high carbohydrate diet (evidence for increased insulin sensitivity) insulin receptor number and affinity were unchanged. These studies suggest that the increased insulin sensitivity induced by a high carbohydrate diet is due to some adaptive change in postreceptor activity. Manipulations of dietary composition fail to alter insulin binding to peripheral mononuclear cells.


Folate conjugase activity in fresh vegetables and its effect on the determination of free folate content. The levels of naturally-occurring folate conjugates in fresh asparagus, broccoli, Brussels sprouts, cabbage, cauliflower lettuce, and spinach were determined together with the effect on the hydrolysis of pteroylpolyglutamates during the extraction phase of the Lactobacillus casei assay. The levels of conjugate activity vary widely among the vegetables tested, from a low of 0.30 +/- 0.21 in lettuce to a high of 106.2 +/- 6.6 mumoles/hr per 100 mg of fresh weight in spinach. The free folate values (L. casei activity before chicken pancreas conjugase treatment) in the fresh vegetables boiled 1 hr after homogenization were significantly higher than those in vegetables boiled before homogenization, while there were no significant differences in total folate (L. casei activity after treatment with conjugase from chicken pancreas). The increase in free folate values must have been due to the action of endogenous conjugases on the pteroylpolyglutamates from the time the vegetables were homogenized until the conjugase was inactivated by heat. It is concluded that reliable free folate values in fresh vegetables can be obtained only if the naturally present conjugases are inactivated before homogenization of sample in order to prevent the hydrolysis of the pteroylpolyglutamates in the vegetables.


WBC count and differential. Value in predicting bacterial diseases in children. To assess published criteria for distinguishing between bacterial and non-bacterial infections by examination of the WBC count and differential, we reviewed 328 consecutive inpatient admissions to a pediatric communicable diseases service. In our experience, the WBC count and differential could not differentiate between bacterial and nonbacterial disease.


Dermatitis after exposure to a garden plant (Euphorbia myrsinites). Six pediatric cases of erythematous papulovescicular skin eruptions were due to exposure to Euphorbia myrsinites. These rashes may be confused with allergies, infections, or other dermatoses. Symptoms followed two to eight hours after exposure to the irritant sap, they increased in severity for an additional 12 hours, and they resolved within three to four days. No sequelae were noticed. Treatment indicated was pain relief, prevention of infection, and reduction of swelling.


Infantile atlantooccipital instability. The potential danger of extreme extension. During early infancy, adventitious sliding and slipping movements between the vertebral column and skull are possible in the cadaver. In ten of 17 infants, the posterior arch of the atlas inverted through the foramen magnum during extension of the head on the atlas, resulting in the anatomic potential of bilateral vertebral artery compression. These anatomic conditions may be the basis for a chain of events that contributes to death in some neonates and infants with conventioanl diseases and may be one source of unanticipated death.


Retropharyngeal masses in infants and young children. Six patients are described who illustrate different causes of retropharyngeal mass lesions in infants and young children. Differential diagnosis, clinical history, physical examination, and adequate roentgenographic evaluation of the neck are important.


Disseminated intravascular coagulation in the newborn. We have reviewed 53 cases of disseminated intravascular coagulation (DIC) in the newborn, including 29 cases that were confirmed at autopsy. Factors predisposing to DIC included maternal complications (60%), low Apgar scores (30%), hyaline membrane disease (62%), and sepsis (26%). Diagnostic criteria common to autopsy-proved cases included presence of fibrin degradation products, low factor V activity, a prolonged prothrombin time, and a prolonged partial thromboplastin time and/or thrombocytopenia. There appeared to be no difference in coagulation response or in mortality among patients treated with different therapeutic regimens. Survivors were older gestationally, had higher birth weights, and higher Apgar scores.


Mediastinal and cervical histoplasmosis simulating malignancy. A 12-year-old boy had a purulent mass in the anterior cervical region in association with an anterior mediastinal mass caused by Histoplasma capsulatum. The cervical mass probably represented spread of the disease, perhaps along the same pathways followed in Hodgkin's disease and other conditions that are known to involve the anterior mediastinum and the anterior cervical nodes simultaneously. An infectious disease (histoplasmosis) can cause a constellation of symptoms suggestive of a lymphoma or other malignancy.


Will mothers use free household safety devices? This study was intended to determine if mothers of small children would use free safety devices to help safety-proof their homes. The study population consisted of an experimental group of 101 families receiving general health education on home safety proofing and a control group of 104 families. Each of the 205 families received two types of safety devices: Kindergards (which are plastic locking devices for cabinets and so forth) and covers for electric outlets. The families were given identical instructions on their use. There was significant increase in the use of the outlet covers in both subgroups, with experimental group using them more (P less than .05) than the control group. There was no significantly increased use of the Kindergards.


Transient neonatal diabetes mellitus. Treatment with chlorpropamide. Nonketotic diabetes mellitus developed in a "small-for-dates" baby at the age of 6 days. The disease was controlled initially with insulin but beginning at the age of 40 days, chlorpropamide was substituted gradually for insulin over a 24-day period. Treatment was stopped at the age of 13 weeks and the baby remained well thereafter. It is suggested that chlorpropamide might be useful in the treatment of transient neonatal diabetes.


Intrauterine hyperparathyroidism. Postmortem findings in two cases. Intrauterine hyperparathyroidism is a self-limited condition seen in the neonate born of a mother with poorly controlled hypoparathyroidism. In this report, we describe the histologic findings in bone and parathyroids in twin infants with this condition who died from other causes. The skeleton showed osteopenia with evidence of increased bone turnover and defective mineralization, and there was parathyroid gland hyperplasia of the water-clear cell type. One twin died at birth, and the histologic findings were indistinguishable from those of infantile primary hyperparathyroidism; but the second twin, dying at 3 months of age, demonstrated noticeable improvement in the bone and parathyroid abnormalities.


Hypertriiodothyroninemia in hypothyroidism treated with thyroglobulin. Hypertriiodothyroninemia during therapy with thyroglobulin was noted in six hypothyroid patients aged 9 to 25 years. Causes of hypothyroidism were thyroiditis, congenital athyreosis, cryptothyroidism, or goitrous hypothyroidism. Serum thyroxine level, measured at the same time, was below normal in three patients. Findings attributable to excess of thyroid hormones were none other than slight nervousness or transitory heat intolerance. Substitution of levothyroxine for thyroglobulin was done in all patients and was associated with return to normal of serum triiodothyronine (T3) values in those tested. A high content of T3 in thyroglobulin used for medication seems the most probable cause of the observed hypertriiodothyroninemia. Since similar findings have been reported previously for hypothyroid patients treated with desiccated thyroid preparations, it seems clear that therapy with levothyroxine offers a significant advantage over the use of desiccated thyroid or thyroglobulin.


Congenital intraspinal neuroblastoma.

Congenital intraspinal neuroblastoma. Congenital neuroblastoma is a well-recognized entity with a very favorable prognosis for tumor cure. However, a newborn with neurologic deficit owing to intraspinal extension of this tumor is very unusual. Eleven such cases in the world literature are reviewed, and an additional case of a new born with paralysis and a neurogenic bladder at birth is presented in detail. The prognosis for tumor cure is excellent regardless of the mode of therapy used. Because of this fact, treatment should include safe surgical decompression and chemotherapy only. The outlook for the return of normal neurologic function is poor.


Congenital unilateral ichthyosis in a newborn. Ichthyosiform erythroderma is a rare phenomenon occurring in about 1/300,000 live births. Congenital unilateral ichthyosis, described in this case report, is a clinical variant of ichthyosis. Only five previous cases have been reported. In the patient described in this report, superimposed infection of the affected skin developed. Her immunologic system was intact. She manifested failure to thrive, in spite of an adequate caloric intake, and markedly delayed psychomotor development. This patient also demonstrated absorption from the affected dermis of topically applied urea hydrophilic base ointment. She died before her first birthday.


Teratoma of the tonsil in a premature infant. Case report and review of the literature. Among the causes of respiratory distress in the neonatal period, a tumor involving the oropharyngeal area is rare. The present case report describes a premature infant with a teratoma of the tonsil and reviews the clinical presentation and management of this tumor in the neonatal period.


The stretch modulus of human cervical tissue in spontaneous, oxytocin-induced, and prostaglandin E2-induced labor. A total of 62 strips of cervical tissue from 28 patients at term were tested for stiffness (stretch modulus) by elongation and measuring the tension produced by a given stretch. The stretch modulus was taken as the slope of the linear regression curve derived from the linear portion of the stress-strain relationship. The data were obtained from three patient categories: (1) 17 strips from seven patients undergoing spontaneous labor, (2) 18 strips form 10 patients with labor induced by PGE2, and (3) 27 strips from 11 patients with labor induced by oxytocin. The stretch moduli of cervical tissue obtained from spontaneous and oxytocin-induced labor patients were similar. The stretch moduli of cervical tissue obtained from PGE2-induced labor patients were significantly lower than those from either the spontaneous or the oxytocin-induced labor groups. These results show that PGE2, when used for induction of labor at term, has the ability to lower the stiffness of cervical tissue. This property of prostaglandin may be useful therapeutically for the indicated induction of labor in patients with an unfavorable cervix.


Antepartum fetal heart rate testing. I. Evolution of the nonstress test. On May 1, 1975, at Women's Hospital, Los Angeles County--University of Southern California Medical Center, a new antepartum fetal heart rate (AFHRT) protocol was put into clinical use. This included the widely used contraction stress test (CST) and a new concept of nonstress testing (NST). The NST was based on FHR response associated with fetal movements and was categorized as reactive (normal) or nonreactive (abnormal). The nonreactive fetus was then evaluated with a CST if not contraindicated. During the 24 months, May 1, 1975 to April 30, 1977, a total of 2,422 NST's were done in 1,169 patients with 1,547 (64 per cent) reactive and 829 (35 per cent) nonreactive. CST was done 939 times, with 851 (90.6 per cent) negative, 29 (3 per cent) positive, 13 (1.4 per cent) equivocal, and 46 (5.0 per cent) unsatisfactory. There were ten (3.3 per cent) perinatal deaths within one week of a negative CST, five (1.0 per cent) within one week of a reactive NST, and two (8.7 per cent) with a positive CST. A reactive NST was as predictive of good outcome as was a negative CST. Analysis of the nonreactive NST showed that two or more accelerations were not associated with abnormal CST's. Also, some nonreactive fetuses became reactive with oxytocin and had good outcome. These observations were utilized in the development of a newer, shorter NST which allows for fetal stimulation in an attempt to further define fetal well-being.


Antepartum fetal heart rate testing. II. Intrapartum fetal heart rate observation and newborn outcome following a positive contraction stress test. The positive contraction stress test (CST) has been looked upon as a predictor of fetal compromise. On this basis, some reports advise routine cesarean delivery on the assumption that the compromised fetus should not tolerate labor. Other authors advocate selective cesarean delivery, based on obstetrical factors such as the inducibility of the cervix and the practicality of fetal monitoring. Finally, an attempted trial of labor may be allowed on the basis of occurrence of fetal heart rate acceleration with fetal movement, or "reactivity." The occurrence of "false positive" tests is not infrequent (20 to 45 per cent). The definition of such is unclear and little quantitative information regarding intrapartum performance is available. In this series of 27 patients, a trial of labor was undertaken in 20. Vaginal delivery occurred in 11 (55 per cent) and cesarean section in nine (45 per cent). Fetal heart rate abnormalities thought to indicate "distress" occurred in five patients (25 per cent). The "positive" window or repetitive late deceleration as equivalent to the positive CST was seen in only three patients during labor. A trial of labor should be attempted in the face of a positive CST whenever obstetric factors are favorable and careful intrapartum monitoring can be performed.


Intrauterine growth retardation in renal insufficiency: an experimental model in the rat. Experiments described here with partially nephrectomized pregnant rats with pair-fed controls and controls fed at will indicate that decreased maternal food intake is a major factor in the intrauterine growth retardation associated with moderate renal insufficiency during the last trimester of gestation. Although renal disease in human pregnancy is often associated with vascular insufficiency, the possibility that maternal undernutrition may also play a contributory role in the fetal growth failure associated with certain cases of human renal compromise merits further study.


Blunting of spontaneous and alanine-stimulated glucagon secretion in newborn infants of diabetic mothers. Spontaneous and alanine-stimulated glucagon secretion, and its relation to plasma glucose concentration was investigated in two groups of infants during the initial two hours of life. At birth, plasma glucagon and glucose concentrations were not significantly different in healthy term newborn infants (control subjects) and infants born to insulin-dependent diabetic mothers(IDM-l). In control infants during the first hour of life, glucose fell by 43 +/- 16 mg per deciliter (mean +/- S.E.M.) while plasma glucagon rose by 44 +/- 16 pg. per milliliter (p less than 0.05 for both). However, in IDM-I despite a fall in glucose greater than in control infants, plasma glucagon failed to significantly increase. Intravenous alanine, 150 mg. per kilogram, given at one hour of life, elicited significant increments in glucose and glucagon which were positively correlated in control infants. No significant change in glucose or glucagon occurred in the diabetic group. None of the control infants developed symptomatic or biochemical hypoglycemia (plasma glucose less than 20 mg. per deciliter) whereas five of ten IDM-I developed hypoglycemia. These results suggest that spontaneous and alanine-stimulated glucagon secretion is obtunded in IDM and that this may contribute to hypoglycemia in these infants.


Pelvic actinomycosis in women using intrauterine contraceptive devices. Several recent reports have indicated the possible association between pelvic infection caused by Actinomyces and the use of intrauterine contraceptive devices. Seven cases of infection or colonization of the female genital tract have been detected among women using intrauterine contraceptive devices (IUD's) at Grady Memorial Hospital, Atlanta, Georgia, from March, 1975, until May, 1977. No single IUD type has been incriminated. The shortest duration of consecutive IUD use before the diagnosis was two and a half years. Six of these cases were detected incidentally at the time of endometrial or endocervical biopsy. The diagnosis in each case was made histologically. One patient presented with severe pelvic inflammatory disease and had Actinomyces identified. This is the first reported death associated with pelvic actinomycosis in a woman using an IUD. This organism must be considered as a possible pathogen whenever a patient with an IUD develops pelvic inflammatory disease.


An electron microscopic investigation of human familial bone dysplasia. Inhibition of osteocytic osteolysis and induction of osteocytic formation of elastic fibers following calcitonin treatment. Familial bone dysplasia with hyperphosphatasemia is characterized by excessive bone resorption early in life with resulting severe skeletal deformity. The disease can be ameliorated by treatment with human calcitonin. We have the studied the ultrastructure of bone from diseased patients before treatment and at intervals during 1 year of treatment with calcitonin. Pretreatment osteoblasts, osteoclasts, and osteocytes exhibited mitochondria which contained vast amounts of dense microcrystal deposits. Osteocytes were also distinguished by minimal organellar development. Osteoclasts were rare. Calcitonin treatment included a progressive development of a more normal bone structure. Intramitochondrial crystal deposits were absent in mitochondria of osteocytes and osteoclasts but were still present in mitochondria of osteoblasts. Surprisingly, the developing bony matrix during calcitonin treatment exhibited large numbers of elastic fibers. These appeared to develop normally in alignment with the surface membrane of osteocytes. Calcitonin treatment caused a proliferation of osteocyte organellar development. It is concluded that familial bone dysplasia is primarily a disease of osteocytes and that osteocytic activity is influenced by calcitonin.


The resistance of spontaneous mouse hepatocellular neoplasms to iron accumulation during rapid iron loading by parenteral administration and their transplantability. Spontaneous mouse liver nodules were found to be resistant to iron accumulation induced either by dietary overload or by a rapid protocol of subcutaneous injection of iron dextran. Transplants of 11 liver nodules into the mammary fat pad gave rise to neoplastic growth. Transplants of the less differentiated nodules grew more frequently and rapidly than better differentiated nodules and produced pulmonary metastases. Therefore, these mouse liver nodules are considered to be neoplasms, and their resistance to iron accumulation suggests that this marker will be useful in studying their histogenesis.


Phenomenology associated with depressed moods in adolescents. The authors studied phenomenology associated with depressed moods in 30 adolescents within a semi-structured interview format using defined symptom items. The results suggest that while there is some symptomatic similarity between adolescent depression and depression in adults, there are many differences that warrant more cautious comparison and further study.


Freeze-fracture analysis of intramembrane particles of erythrocytes from normal, dystrophic, and carrier mice. A possible diagnostic tool for detection of carriers of human muscular dystrophy. Careful examination of plasma membrane protein particles on fractures faces of erythrocyte plasma membranes from mice with muscular dystrophy, carriers of the sex-linked recessive gene for this disease, and from nondystrophic control animals revealed a 42% decrease in the number of intramembrane particles in erythrocytes of carriers (and a 33% decrease in dystrophic erythrocytes) compared with samples from control animals. These results support the notion that quantitative analysis of intramembrane particles in freeze-fractured erythrocyte plasma membranes may represent a new, rapid, simple, and highly accurate diagnostic tool for detection of carriers of human muscular dystrophy.


The "Moonies": a psychological study of conversion and membership in a contemporary religious sect. The authors undertook this study to enhance psychiatric understanding of contemporary charismatic religious sects. After a pilot study, a representative sample of members of the Unification Church (N = 237) completed a 216-item structured questionnaire. Respondents were below the mean for an age- and sex-matched group on a psychological general well-being scale, and they reported significantly greater neurotic distress before conversion. The authors discuss correlates of an improved emotional state following conversion and employ attribution theory, drawn from social psychology, to put the conversion process into a psychiatric perspective.


Effects of interpreters on the evaluation of psychopathology in non-English-speaking patients. Non-English-speaking patients in need of psychiatric services are usually evaluated with the help of an interpreter. Discussions with psychiatrists and lay hospital interpreters who had experience in these interviews and content analysis of eight audiotaped interpreter-mediated psychiatric interviews suggested that clinically relevant interpreter-related distortions could lead to misevaluation of the patient's mental status. The author notes that pre- and post-interview meetings of clinicians and interpreters have been found useful in minimizing these distortions.


Personality, sexual adjustment, and brain lesions in patients with conversion symptoms. To clarify the interrelationships of conversion symptoms, hysterical personality, sexual adjustment, and cerebral organic disorders the authors studied 89 patients with classic motor conversion symptoms (group L) and compared a subgroup of 24 of these patients (group H) with 24 matched control patients (group C). They found hysterical personality in 19% of group L, 21% of group H, and none of group C and passive-immature-dependent personality in 19% of group L, 21% of group H, and none of group C. Forty-eight percent of group L, 50% of group H, and 58% of group C had some cerebral disorder. Patients with conversion symptoms who also had hysterical and passive-immature-dependent personalities were especially likely to have sexual abnormalities.


Childbirth-related psychosis and familial symbiotic conflict. The authors present 3 cases of childbirth-related psychosis in young women to illustrate an interpersonal psychodynamic pattern that may contribute to such reactions. In each instance, the woman is the submissive partner in a symbiotic relationship with her husband and/or mother. The baby's presence threatens the symbiotic equilibrium of these relationships and leads to the dominant partner's overt or covert aggression against the woman, which precipitates the psychosis. A personal or family history of psychosis may increase the woman's vulnerability to becoming psychotic in this situation.


Required educational objectives in community psychiatry. Community psychiatry is an essential requirement of approved residency training. The authors present a format of required educational objectives for this experience. They feel that recent attempts to limit psychiatric consultation to the consultation-liaison model are restrictive and incomplete. In their view of the psychiatrist's role, community consultation techniques are essential skills for the psychiatric practitioner.


Cosmetic surgery as an antecedent of life change. Of 42 patients who underwent cosmetic surgery, 4 patients, who gave no indication of an impending life change before surgery, obtained a legal separation or divorce 3-6 months later. These 4 patients had had strong parental domination and hostile relationships with younger siblings; they had a need for success on their own terms and for the rapid closure of potential conflict. The authors suggest that such patients are undergoing significant identity changes that become conscious only after cosmetic surgery, which tests out their shift from passivity and withdrawal to activity and participation.


Air pollutants and the admission rate of psychiatric patients. The authors studied the correlation between mean daily levels of several air pollutants and the number of emergency room visits and inpatient admissions to a psychiatric hospital in St. Louis during one summer and fall. Nitrogen dioxide and carbon monoxide showed a positive correlation with emergency room visits by all patients, and nitrogen dioxide also had a positive correlation with inpatient admissions of subjects with diagnoses that were unknown or could not be specified as psychotic. Nitrogen monoxide showed a negative correlation with inpatient admissions during working days (but not during weekends and holidays) for all patients, as well as for those with diagnoses that were unknown or could not be specified as psychotic.


The role of a cinema seminar in psychiatric education. As the goals of psychiatric education are evaluated and innovative teaching methods are sought, the current cinema represents an untapped resource. Thoughtful viewing of contemporary films with serious discussion of them in a film discussion group as part of the residency training program is a useful and enjoyable teaching format that helps bridge the gap between the art and science of psychiatry.


Pseudoepilepsy: a study in adolescent hysteria. Of 19 adolescents with diagnosed psychogenic seizures, 13 had hysterical convulsions and 4 had amnesiac fugues. Sixteen of the patients were given a diagnosis of hysterical neurosis; 2, process schizophrenia; and 1, borderline psychosis. Thirteen of the patients were initially diagnosed incorrectly as having epilepsy and were treated for an average of 15 months with anticonvulsant medication. The therapist should always consider the possibility of psychogenic factors in children and adolescents who suffer from seizures.


Child psychiatry education for general residents. There is continuing debate about what child psychiatry experiences should be included in a general residency. The author describes the program at the University of Michigan in an effort to provide some insights into the interface between child psychiatry and general residency training. This program is unique in several respects: a 12-month rotation in child psychiatry is offered, and the faculty size and budget of the youth services are comparable to those of the adult services. A survey of all residents and faculty pointed up numerous disagreements as to the length of the rotation and priorities in curriculum. The author discusses the influence of the various competitive processes on the educational program.


Trends in university environmental health research and training. A survey of 157 college and university programs in the United States indicates that, during the ten-year period from 1967 through 1976, the number of people completing graduate programs in environmental health specialties at the master's, doctoral, and post-doctoral levels doubled. In 1974-75, 75 per cent of those completing master's degree programs were in the specialty areas of water pollution, air pollution, and occupational health; 76 per cent of those completing doctoral programs were in water pollution, toxicology, radiation protection, air pollution, and cancer research; and 61 per cent of those completing post-doctoral programs were in cancer research and toxicology. Including those whose current positions could not be ascertained, less than 10 per cent of all graduates accepted employment outside the field of environmental health. Funding for university environmental health research continued to increase throughout this ten-year period. The sources of this funding, however, changed dramatically, with the relative contributions from the U.S. Department of Health, Education, and Welfare decreasing significantly, while those from industry and other federal agencies increased. In contrast, funding for university environmental health training increased significantly between 1966 and 1971, but showed no increase from 1971 to 1975. During this latter period, training support provided by HEW remained essentially constant, that by the Environmental Protection Agency decreased to less than half, while that from the universities approximately tripled. (Am. J. Public Health 69:125-129,1979.)