Mustard operation for transposition of the great arteries in a 3-day-old infant, complicated by acute renal failure. A successful operative treatment of a three day old girl with transposition of the great arteries is described. Post-operative course was complicated by furosemide resistant anuria which was treated by peritoneal dialysis. At the age of eight months, she is a pink, active baby, developing normally. This case report demonstrates the importance of aggressive treatment of severe congenital heart lesions in the first few days of life. The importance of post-operative care is emphasized.


A sensitive method for measuring polymerized and depolymerized forms of tubulin in tissues. A rapid method for measuring polymerized and depolymerized forms of tubulin in tissues has been developed. The procedure consists of homogenization and centrifugation of the tissue in a microtubule-stabilizing solution and depolymerization of the precipitated microtubules; polymerized and depolymerized forms of tubulin are quantitated by a colchicine-binding assay. The validity of the technique was assessed by electron microscopy and recovery studies with labeled and unlabeled preparations of polymerized and depolymerized forms of rat brain tubulin. The sensitivity of this technique allows quantitation of tubulin in 150 micrograms of tissue, wet weight. The method demonstrated that both the polymerized and depolymerized forms of tubulin were present in rat liver cells, and that in the fed state 31.3 +/-0.7% of the total tubulin pool was in the polymerized form.


Role of the tubulin-microtubule system in lymphocyte activation. The role of the tubulin-microtubule system was examined in human peripheral blood leukocytes after activation with phytohemagglutinin (PHA). Soluble tubulin and microtubules were measured with a [(3)H]colchicine-binding assay. It was found that the tubulin content of PHA-activated lymphocytes was consistently increased relative to total protein content after 36 h of culture. There was no increase in the proportion of total tubulin synthesis which was present as microtubules at 36 h. Nevertheless, as a result of increased tubulin synthesis, there was a two-to three-fold increase in total microtubular mass. Colchicine, which disrupts microtubles, was used to assess the role of microtubule assembly in the sequence of events which follow lymphocyte activation, namely lymphokine release, protein synthesis, RNA synthesis, and DNA synthesis. Colchicine consistently inhibited DNA synthesis but did not inhibit release of the lymphokine, osteoclast activating factor (OAF). Protein and RNA syntheses were inhibited much less than DNA synthesis. The fact that some effects of PHA on lymphocytes appear to require intact microtubules and at least one does not suggest that the microtubule dependent step in PHA-stimulated lymphocyte activation occurs at a stage after propagation of the signal from the membrane to the cell interior.


Prosthetic valve surgery in tricuspid area. Up to September 20, 1975, 1,020 cases of valvular heart diseases were surgically treated at the Sapporo Medical University Hospital. In these series, there were 33 cases done for the tricuspid valve which included 27 valve replacements (81.8%) and 6 annuloplasties (18.2%). We have demonstrated that TVR may improve hemodynamic condition for any type of TI, however, postoperative A-V block and sinus bradycardias seemed to be serious complications with relatively high incidence. On the other hand, long term hemodynamic results of TAP was demonstrated to be comparable to that with TVR. Therefore, much more reliable technique of tricuspid annuloplasty may bring much better long term results. We have shown our annuloplasty "Circumferential Annular Constriction" in which a paired purse-string sutures along the tricuspid annulus may produce almost the same constricting effect as the use of a ring material.


Tricuspid valve surgery.

Tricuspid valve surgery. Our purpose was to study the long-term results of the tricuspid valve replacement. It is obvious that tricuspid annuloplasty (Kay, De Vega) has its place in the treatment of functional tricuspid insufficiency that accompanies mitral or mitral and aortic valve disease. The Carpentier ring appears justified for some cases. However tricuspid valve replacement can be the operation of choice for some patients. Our study demonstrated that the Björk-Shiley and Starr-Edwards prostheses remain good substitutes in tricuspid valve surgery and that the long-term results are better than it was anticipated a decade ago.


Correlation between tracheal pressure and pulmonary artery pressure in healthy dogs. The relationship between mean pulmonary artery pressure (PAP) and alveolar pressures, at varying tidal volumes and opposing variable pressure to expiratory flow, was studied in 14 healthy dogs at the end of inspiration and at the end of expiration. Pulmonary blood flow was also studied in 4 dogs. Through the analysis of multiple regression, the equations which show the relation between PAP, tracheal pressure and tidal volume during phases of zero flow were obtained. Our study shows that the co-relation between PAP and tracheal pressure is always highly significant and that, in our experimental conditions, the parameter having the greatest influence on PAP is tracheal pressure, while tidal volume is negligible.


On the mechanism of anaphase spindle elongation in Diatoma vulgare. Central spindles from five dividing cells (one metaphase, three anaphase, and one telophase) of Diatoma vulgare were reconstructed from serial sections. Each spindle is made up of two half-spindles that are composed almost entirely of polar microtubules. A small percentage of continuous microtubules and free microtubules were present in every stage except telophase. The half-spindles interdigitate at the midregion of the central spindle, forming a zone of overlap where the microtubules from one pole intermingle with those of the other. At metaphase the overlap zone is fairly extensive, but as elongation proceeds, the spindle poles move apart and the length of the overlap decreases because fewer microtubules are sufficiently long to reach from the pole to the zone of interdigitation. At telophase, only a few tubules are long enough to overlap at the midregion. Concurrent with the decrease in the length of the overlap zone is an increase in the staining density of the intermicrotubule matrix at the same region. These changes in morphology can most easily be explained by assuming zone mechanochemical interaction between microtubules in the overlap zone which results in a sliding apart of the two half-spindles.


Relationship between the Golgi apparatus, GERL, and secretory granules in acinar cells of the rat exorbital lacrimal gland. The method of secretory granuleformation in the acinar cells of the rat exorbital lacrimal gland was studied by electron microscope morphological and cytochemical techniques. Immature secretory granules at the inner face of the Golgi apparatus were frequently attached to a narrow cisternal structure similar to GERL as described in neurons by Novikoff et al. (Novikoff, P. M., A. B. Novikoff, N. Quintana, and J.-J. Hauw. 1971. J. Cell Bio. 50:859-886). In the lacrimal gland. GERL was located adjacent to the inner Golgi saccule, or separated from it by a variable distance. Portions of GERL were often closely paralleled by modified cisternae of rough endoplasmic reticulum (RER), which lacked ribosomes on the surface adjacent to GERL. Diaminobenzidine reaction product of the secretory enzyme peroxidase was localized in the cisternae of the nuclear envelope, RER, peripheral Golgi vesicles, Golgi saccules, and immature and mature secretory granules. GERL was usually free of peroxidase reaction product or contained only a small amount. Thiamine pyrophosphatase reaction product was present in two to four inner Golgi saccules; occasionally, the innermost saccule was dilated and fenestrated, and contained less reaction product than the next adjacent saccule. Acid phosphatase (AcPase) reaction product was present in GERL, immature granules, and, rarely, in the innermost saccule, but not in the rest of the Golgi saccules. Thick sections of AcPase preparations viewed at 100 kV revealed that GERL consisted of cisternal, and fenestrated or tublular portions. The immature granules were attached to GERL by multiple connections to the tublular portions. These results suggest that, in the rat exorbital lacrimal gland, the Golgi saccules participate in the transport of secretory proteins, and that GERL is involved in the formation of secretory granules.


Release of poly A(+) messenger RNA from rat liver rough microsomes upon disassembly of bound polysomes. Several procedures were used to disassemble rat liver rough microsomes (RM) into ribosomal subunits, mRNA, and ribosome-stripped membrane vesicles in order to examine the nature of the association between the mRNA of bound polysomes and the microsomal membranes. The fate of the mRNA molecules after ribosome release was determined by measuring the amount of pulse-labeled microsomal RNA in each fraction which was retained by oligo-dT cellulose or by measuring the poly A content by hybridization to radioactive poly U. It was found that ribosomal subunits and mRNA were simultaneously released from the microsomal membranes when the ribosomes were detached by: (a) treatment with puromycin in a high salt medium containing Mg++, (b) resuspension in a high salt medium lacking Mg++, and (c) chelation of Mg++ by EDTA or pyrophosphate. Poly A-containing mRNA fragments were extensively released from RM subjected to a mild treatment with pancreatic RNase in a medium of low ionic strength. This indicates that the 3' end of the mRNA is exposed on the outer microsomal surface and is not directly bound to the membranes. Poly A segments of bound mRNA were also accessible to [(3)H] poly U for in situ hybridization in glutaraldehyde-fixed RM. Rats were treated with drugs which inhibit translation after formation of the first peptide bonds or interfere with the initiation of protein synthesis. After these treatments inactive monomeric ribosomes, as well as ribosomes bearing mRNA, remained associated with their binding sites in microsomes prepared in media of low ionic strength. However, because there were no linkages provided by nascent chains, ribosomes, and mRNA, molecules were released from the microsomal membranes without the need of puromycin, by treatment with a high salt buffer containing Mg++. Thus, both in vivo and in vitro observations are consistent with a model in which mRNA does not contribute significantly to the maintenance of the interaction between bound polysomes and endoplasmic reticulum membranes in rat liver hepatocytes.


Mitochondrial growth and division during the cell cycle in HeLa cells. The growth and division of mitochondria during the cell cycle was investigated by a morphometric analysis of electron micrographs of synchronized HeLa cells. The ratio of total outer membrane contour length to cytoplasmic area did not vary significantly during the cell cycle, implying a continuous growth of the mitochondrial outer membrane. The mean fraction of cytoplasmic area occupied by mitochondrial profiles was likewise found to remain constant, indicating that the increase in total mitochondrial volume per cell occurs continuously during interphase, in such a way that the mitochondrial complement occupies a constant fraction( approximately 10-11(percent)) of the volume of the cytoplasm. The mean area, outer membrane contour length, and axis ratio of the mitochondrial profiles also did not vary appreciably during the cell cycle; furthermore, the close similarity of the frequency distributions of these parameters for the six experimental time-points suggested a stable mitochondrial shape distribution. The constancy of both the mean mitochondrial profile area and the number of mitochondrial profiles per unit of cytoplasmic area was interpreted to indicate the continuous division of mitochondria at the level of the cell population. Furthermore, no evidence was found for the occurrence of synchronous mitochondrial growth and division within individual cells. Thus, it appears that, in HeLa cells, there is no fixed temporal relationship between the growth and division of mitochondria and the events of the cell cycle. A number of statistical methods were developed for the purpose of making numerical estimates of certain three-dimensional cellular and mitochondrial parameters. Mean cellular and cytoplasmic volumes were calculated for the six time-points; both exhibited a nonlinear, approx. twofold increase. A comparison of the axis ratio distributions of the mitochondrial profiles with theoretical distributions expected from random sectioning of bodies of various three-dimensional shapes allowed the derivation of an "average" mitochondrial shape. This, in turn, permitted calculations to be made which expressed the two-dimensional results in three-dimensional terms. Thus, the estimated values for the number of mitochondria per unit of cytoplasmic volume and for the mean mitochondrial volume were found to remain constant during the cell cycle, while the estimated number of mitochondria per cell increase approx. twofold in an essentially continuous manner.


Nuclear pore complexes. Elimination and reconstruction during mitosis. Nuclear structures similar to those of the nuclear pore complex were found on chromosomes. This finding indicates that part of the pore complex is retained by the chromosomes through mitosis in the absence of the nuclear membrane. The formation of approximately the same number of pore complexes in the presence and absence of protein synthesis during the first 4 h after mitosis proves the reassembly rather than new synthesis of the pore complex. The structure of pore complexes reconstructed in the absence of protein synthesis cannot be distinguished from the structure of those of control cells.


Cell-to-cell transfer of glial proteins to the squid giant axon. The glia-neuron protein trnasfer hypothesis. The hypothesis that glial cells synthesize proteins which are transferred to adjacent neurons was evaluated in the giant fiber of the squid (Loligo pealei). When giant fibers are separated from their neuron cell bodies and incubated in the presence of radioactive amino acids, labeled proteins appear in the glial cells and axoplasm. Labeled axonal proteins were detected by three methods: extrusion of the axoplasm from the giant fiber, autoradiography, and perfusion of the giant fiber. This protein synthesis is completely inhibited by puromycin but is not affected by chloramphenicol. The following evidence indicates that the labeled axonal proteins are not synthesized within the axon itself. (a) The axon does not contain a significant amount of ribosomes or ribosomal RNA. (b) Isolated axoplasm did not incorporate [(3)H]leucine into proteins. (c) Injection of Rnase into the giant axon did not reduce the appearance of newly synthesized proteins in the axoplasm of the giant fiber. These findings, coupled with other evidence, have led us to conclude that the adaxonal glial cells synthesize a class of proteins which are transferred to the giant axon. Analysis of the kinetics of this phenomenon indicates that some proteins are transferred to the axon within minutes of their synthesis in the glial cells. One or more of the steps in the transfer process appear to involve Ca++, since replacement of extracellular Ca++ by either Mg++ or Co++ significantly reduces the appearance of labeled proteins in the axon. A substantial fraction of newly synthesized glial proteins, possibly as much as 40 percent, are transferred to the giant axon. These proteins are heterogeneous and range in size from 12,000 to greater than 200,000 daltons. Comparisons of the amount of amino acid incorporation in glia cells and neuron cell bodies raise the possibility that the adaxonal glial cells may provide an important source of axonal proteins which is supplemental to that provided by axonal transport from the cell body. These findings are discussed with reference to a possible trophic effect of glia on neurons and metabolic cooperation between adaxonal glia and the axon.


Evidence for the glia-neuron protein transfer hypothesis from intracellular perfusion studies of squid giant axons. Incubation of intracellulary perfused squid giant axons in [3H]leucine demonstrated that newly synthesized proteins appeared in the perfusate after a 45-min lag period. The transfer of labeled proteins was shown to occur steadily over 8 h of incubation, in the presence of an intact axonal plasma membrane as evidenced by the ability of the perfused axon to conduct propagated action potentials over this time-period. Intracellularly perfused RNase did not affect this transfer, whereas extracellularly applied puromycin, which blocked de novo protein synthesis in the glial sheath, prevented the appearance of labeled proteins in the perfusate. The uptake of exogenous 14C-labeled bovine serum albumin (BSA) into the axon had entirely different kinetics than the endogenous glial labeled protein transfer process. The data provide support for the glia-neuron protein transfer hypothesis.


Membrane particle changes attending the acrosome reaction in guinea pig spermatozoa. To examine the freeze-fracture appearance of membrane alterations accompanying the preparation of sperm membranes for fusions-the first preparatory stage occurring before physiological release of the acrosomal content, the second afterward-we induced the acrosome reaction in capacitated guinea pig spermatozoa by adding calcium to the mixture. The most common features observed before fusion of the acrosomal and plasma membranes were the deletion of fibrillar intramembranous particles from the E-fracture faces of both membranes, and the clearance of globular particles from the P face of the plasma membrane-events taking place near the terminus of the equatorial segment. Large particles, >12nm, remained not far from the cleared E-face patches. The P face of the outer acrosomal membrane is virtually clear from the outset. In addition, when fusion was completed, occasional double lines of large particles transiently embossed the P face of the plasma membrane (postacrosomal) side of the fusion zone. Behind the line of fusion, another series of particle-cleared foci emerged. We interpreted these postfusion membrane clearances as a second adaptation for sperm-egg interaction. Induction of the acrosome reaction in media containing phosphatidylcholine liposomes resulted in their apparent attachment, incorporation, or exchange in both the originally and secondarily cleared regions. Our observations support the concepts that membranes become receptive to union at particle- deficient interfaces, and that the physiologically created barren areas in freeze-fracture replicas may herald incipient membrane fusion.


Gap junction structures. I. Correlated electron microscopy and x-ray diffraction. X-ray crystallographic methods and electron microscope image analysis have been used to correlate the structure and the chemical composition of gap junction plaques isolated intact from mouse liver. The requirement that the interpretations of X-ray, electron microscope, and chemical measurements be consistent reduces the uncertainties inherent in the separate observations and leads to a unified picture of the gap junction structures. Gap junctions are built up of units called connexons that are hexagonally arrayed in the pair of connected cell membranes. X-ray diffraction and electron microscope measurements show that the lattice constant of this array varies from about 80 to 90 A. Analysis of electron micrographs of negatively stained gap junctions shows that there is significant short range disorder in the junction lattice. even though the long range order of the array is remarkably regular. Analysis of the disorder provides information about the nature of the intermolecular forces that hold the array together.


[Severe ligamentous injury due to trauma of the mobile spinal segment of the cervical column (author's transl)]. The mobile spinal segment includes anatomically, all the soft parts which lie between two neighbouring vertebrae. Its involvement in trauma is not always obvious on initial X Ray. However, the course may lead to complete vertebral dislocation. The initial diagnosis is based on opening of the joint spaces, study of the mobility between two vertebrae by dynamic radiography. The distinction between a benign and a severe ligamentous sprain may thus be made. The attitude in cases of mobile spinal segment involvement, i.e. severe ligamentous injury, should include arthrodesis of the mobile segment affected and this is discussed here.


[Recentering of the patella; treatment of choice in lateralised femoropatella arthrosis (author's transl)]. The authors have followed up for than 2 years, 22 cases of lateralised femoro-patella arthrosis treated by recentering of the patella. They confirm the value of this operation and emphasize the necessity of controlling the precise position of the patella during the operation. They also believe that one should avoid, especially if the treated arthrosis is not too advanced, perfect reaxation which may favour progressive narrowing of the joint space, once weight beraring is allowed and which may be the origin of the secondary functional degradation of this series.


[Polycystic liver. Report of one case and therapeutic discussion (author's transl)]. The authors report a new case of polycystic liver associated with polycystic kidney. The functional disorder due to distension of the cysts led to surgery. The impossibility of carrying out removal of the liver, owing to the diffuse character of these lesions, led the authors to choose the method described by Tien Yu Lin in 1968. This seems to be indicated in a few cases owing to the remarkable functional results.


[Surgical attitude in pre-pyloric stenosis due to corrosive substances. Intravascular segmental antrectomy in Y-V. Report of 80 cases (author's transl)]. The author reports 80 cases of gastric stenosis due to caustic substances, of which 20 were limited only to the stomach and 60 were accompanied by esophageal stenosis. In most cases (78.8 p. cent), the site of the gastric stenosis was antral, pre-pyloric and the duration of onset was, on average, 3 weeks. Surgical treatment depended on the extent of the corrosive lesions. In limited antral stenosis, we carried out antrectomy with gastroduodenal anastomosis. In pre-pyloric stenosis situated 3 to 5 cm from the pylorus, the author recommends conservation of the non-functioning pylorus by double pylorotomy and anastomosis with the whole of the border of the stomach, describing a personal procedure named intravascular Y-V segmental antrectomy. The criterion which decides the proximal border of the resection, should be the appearance of the gastric mucosa, the section should pass immediately above the caustic ulceration. In extensive gastric stenosis (more than 75 p. cent) of the stomach and in evolutive corrosive lesions, we recommend Y-shaped jejunostomy, of Maydl type. In post-caustic pre-pyloric stenosis we operated on 76 cases out of 80 with 3 deaths (3.9 p. cent mortality). In 25 patients we carried out esophagoplasty about 6 months after the accident. We preferred restrosternal isoperistaltic coloesophagoplasty by Kelling's procedure. To increase the circulation through the left colic artery and marginal artery, we ligatured the middle colic artery and right colic artery at the same time as the gastrostomy.


[Artificial left ventricle in paracardiac position between the apex of the heart and the ascending aorta (author's transl)]. A device for assistance of the left side of the heart in acute failure is placed in the paracardiac position. The blood is drained into the apparatus through the apex of the heart and is reinjected into the ascending aorta by an artificial pump. The flow of blood within the prosthesis and at the level of the inlet and outlet values is studied by a system of lighting in thin layers. Several types of original valve have been tested but the most satisfactory results were obtained with a classical bead valve.


[Artificial left ventricle between the apex of the heart and the ascending aorta (author's transl)]. The artificial left ventricule is placed in the paracardiac position to ensure a short circuit of the natural left ventricule which is left in position. The prosthesis is implanted on the tip of the heart to ensure wide drainage of the left ventricule and on the ascending aorta to obtain systolic injection under physiological hemodynamic conditions. On both sites of implantation are sutured dacron tubes which permit insertion of the prosthesis without interrupting the general circulation and its withdrawal by simple ligature of the tubes of dacron.


[Place of the splanchnic nerves in the pathogenesis of shock due to retroperitoneal hematoma (author's transl)]. The clinical picture of retroperitoneal hematoma includes usually a state of shock. The author's experiment implies that the splanchnic nerves are directly involved in the pathogenesis of this fall in blood pressure. Simple therapeutic implications result from this.


[Jejuno-ileal short-circuit operations in the treatment of obesity. 16 personal cases (author's transl)]. The authors report a personal experience of 16 cases and in the light of data in the world literature, the authors discuss the controversial method of treatment of very severe obesity when medical treatment has failed. The onset of various complications linked mainly to intestinal malabsorption, should make one careful in the indications for surgery which may, however, be applicable in certain cases.


[Leiomyomas of the esophagus. Report of 20 cases (author's transl)]. The authors report 20 cases of leiomyoma of the esophagus operated on between 1964 and 1976. The diagnosis depended on the existence of dysphagia without loss of weight, the integrity of the mucosa on endoscopy and the findings of the esophagogram, suggested the true origin of the mediastinal image. Surgical operation usually permits simple enucleation of the leiomyoma. Postoperative mortality was nil. The late postoperative period was uneventful. There was no relapse of the histologically benign leiomyoma.


[Pancreatic reflux into Wirsung's duct during peroperative biliary radiomanometry in acute and chronic pancreatitis (author's transl)]. Pancreatic reflux during radiomanometry is more frequent during acute and chronic pancreatitis. In acute pancreatitis, it is due in 1 case out of 3, to distal obstruction which must be overcome very rapidly. There is no prognostic significance. Santorini's duct when opacified and when it opens into the duodenum, permits one to suggest a better prognosis than in cases of canalicular pancreatitis. In chronic pancreatitis, reflux is twice as common and 3 times more often organic. When Wirsung's duct is dilated, there is almost always a distal obstacle at the level of the sphincter of Oddi due to a gall stone. If chronic pancreatitis is associated with gall stones, sphincterotomy should be carried out.


[Spontaneous intra-mural rupture of the oesophagus (author's transl)]. A case of spontaneous intra-mural rupture of the oesophagus is presented. In the light of this, and the review of the other four previously reported cases, it is possible to formulate the clinical picture of this condition and to adopt definite therapeutic measures.


[Special aspects of colo esophagoplasty in post-caustic esophageal stenosis for corrosive stricture of the esophagus (author's transl)]. The author reports 12 cases which illustrate unusual aspects of colo esophagoplasty in post-caustic esophageal stenosis. 8 cases respresented post-caustic pharyngolaryngeal stenosis in which he recommended anastomosis of the colon with the oropharynx according to a personal technical variant. In 1 case associated with amputation of the epiglottis, he carried out a double pharyngo-colic Y-shaped anastomosis. He classified the pharyngotomy types in relation to the 3 main nerves, the lingual, hypoglossal and superior laryngeal nerves. In 3 cases the author carried out successfully retrosternal transposition of a colonic segement 6 months, 1 year and 4 years after pre-thoracic colo esophagoplasty. He reports 1 case of intrathoracic strangling of the colonic tube which occurred 1 year after retrosternal colo esophagoplasty, and wich was cured by intra-vascular vertical clectomy. In all cases the good results were maintained for a long period.


[Post-traumatic arteriovenous communication of the renal pedicle producing severe hypertension (author's transl)]. Post-traumatic arteriovenous communications of the renal pedicle with the inferior vena cava, the kidney remaining in position, are rare. The present case, to our knowledge, is the fifth in the world literature (Cohen et al., Rex et al., McAlhany et al., Sechas et al.). The diagnosis was made, first by the clinical signs of murmur and thrill, furthermore, by the characteristic finding of diastolic hypertension and by cardiac hypertrophy, and the diagnosis was confirmed by angiography. Treatment was surgical, in an attempt to save the kidney by means of reconstruction of the vessels of the renal pedicle. Finally, as the renal lesions were not reversible and as the state of the patient was aggravated by epilepsy, nephrectomy was carried out during a second operation. One should note the fall in arterial blood pressure during the first postoperative period.


[Interest of fistulography in the treatment of infection of arterial prostheses (author's transl)]. In groin distal anastomosis suppuration of an aorto or ilio-femoral prosthesis, preoperative opacification of the fistulous tract was used to assess the extent of infection along the prosthesis. In two patients, one with an ilio-femoral by-pass whose entire length was infected, and the other having an aorto-bifemoral by-pass with only one infected distal anastomosis, fistulography enabled us to plan the operative procedure consisting of venous by-pass and resection of the infected segment.


[Thoracic kidney: traumatic hernia or post-traumatic diaphragmatic hernia (author's transl)]. The discovery of a thoracic kidney a few months after a rupture of the diaphragm repaired as an emergency raises the problem of its congenital or acquired origin. In the latter case, treatment should be adopted?


[Electric study of myotomy of the small intestine (author's transl)]. The electric activity of the small intestine above and below an oblique myotomy was studied in the rabbit. In most cases, there was noted a definite increase in the amplitude of the electric recording above the functional obstruction showing increased peristalsis. This phenomenon seems to become attenuated with time, perhaps owing to the technical conditions of this study. Myotomy of the small intestine seems, in the light of these recordings, to be very efficacious. The authors compare it with other procedures which may be used to slow intestinal transit and suggest carrying out long or multiple myotomies, perhaps associated with one of the other techniques to increase the efficacy.


[The resistance to infection of digestive sutures. Experimental study (author's transl)]. The authors study the effects of severe sepsis due to pathogenic gems in large quantity an healing of the suture of the ileum in the rabbit. Contamination of the suture did not lead to any breakdown of the suture whatever the germ. These experimental facts, compared with the data in the literature suggest that the peritoneal serosa ensures efficacious anti-infectious defence, permitting healing of intra-peritoneal digestive sutures in spite of the septic nature of the intestinal contents.


[Surgery of 19 bilateral simultaneous pulmonary metastases]. 19 patients with bilateral simultaneous pulmonary metastases were operated on between 1954 and april 1976 at the Marie-Lannelongue surgical centre. Sarcomas were twice as common as carcinomas. In 10 cases the thoracotomy was only unilateral, either because thoracotomy was not attempted on the other side owing to the diffuse nature of the lesions (8 cases) or because prior chemotherapy had permitted complete reduction of the metastases on the opposite side (2 cases). This thoracotomy remained exploratory in 47 p. cent of cases, radical removal of all the tumour nodules was possible in 53 p. cent of cases (10 patients). Peripheral resections of the lesions were the rule. But in 4 cases, lobectomy was carried out on one side. 7 of the 9 bilateral operations were performed during the same stage. There were no operative deaths. The late results are encouraging considering the number of sarcomas in which the prognosis is usually poor. Bilateral lesions are thus not an absolute contra-indication, provided one remains within reasonable anatomical and functional limits, in the fields of well-conducted anti-cancer strategy.


[Assessment of 81 traumatic vascular lesions of the limbs (author's transl)]. A review of 81 cases of vascular trauma of the limbs in 75 patients treated at the Grenoble University Hospital from 1967 to 1975 confirms the classical etiological, pathological and clinical findings. Analysis of the results led us to emphasise the necessity of bone and vascular repair which should be complete from the start, verified by peroperative radiological control. The application of now well-established rules to the treatment of vascular trauma should lead to a better prognosis in the case of popliteal lesions (76 p. cent of good results out of 17 revascularisations).


[Conservative treatment of cavo-hepatic traumatic disinsertion. Report of one case (author's transl)]. Lesions of the main hepatic veins constitute a special entity in the field of liver trauma. Their originality resides: in their immediate severity (difficulty of hemostasis) and secondary consequences (disturbance of the venous blood flow), in their frequent association with other traumatic lesions, The serious consequences of partial emergency hepatectomy which is the usual treatment. There are a number of factors which permit one to propose in a certain number of favourable cases, treatment of the wound or disinsertion of a hepatic vein by vascular ligature, or, preferably, reinsertion on the inferior vena cava after prior suture, associated with conservation of the hepatic parenchyma affected by the vascular lesion. This method seems to us particularly justified when there exist accessory hepatic veins undamaged during the trauma. The possibility of secondary complications cannot be excluded, but in the special case of severe multiple trauma, the immediate vital prognosis is more important than the risk of secondary complications and the difficulty of possible reoperation. Favoured by modern means of vascular exclusion of the liver, conservative treatment may have a place in lesions of the hepatic veins where emergency partial hepatectomy cannot be undertaken without a risk to life.


[Can one treat cases of multiple trauma in several stages? (author's transl)]. Treat a case of multiple trauma in a single operative session is an ideal which in practice meets with several obstacles. A study of 125 cases of multiple trauma of which 66 were treated in one stage and 55 in several stages permits in spite of the difficulty of such a comparison, several conclusions. The mortality is not increased in cases of multiple operations, on the contrary, as we noted 27 p. cent of deaths in cases operated on in one stage, and only 15 p. cent in cases submitted to repeated surgery. The complications observed in lesions of the limbs were less numerous (8.8 p. cent) when operation was deferred. In fact, lesions treated as an emergency gave rise to 14 p. cent complications. In spite of the difficulty of interpretation of these figures due to the large number of factors influencing the results, it seems possible to affirm that it is not only possible but even advisable to operate on cases of multiple trauma in several stages, visceral lesions which endanger life and open fractures are the only lesions requiring emergency treatment. The other lesions should be operated on during one or several later stages drawing up a careful plan in relation to the lesions and their localisation.


[Treatment of perforated duodenal ulcer. Reflections concerning 110 cases. (author's transl)]. Based on the analysis of 110 perforated duodenal ulcers, and the revue of the literature, the authors present the following comments: 1) The mortality in the acute phase depends mainly on the general condition of the patient; that is the reason why the Taylor's method, which is the least aggressive, is indicated in the debilitated patients, but only if it proves quickly its efficiency. In all the other cases, this method is not suitable because of its numerous early and late failures. 2) The immediate and late results of the simple suture of the ulcer are not always beneficial to the patent. 3) The good results of the elective surgical treatment of the peptic ulcer disease are also found in the patients operated on for acute perforation. The authors propose a therapeutic protocole in which the indications depend more on the general state of the patients than on the classical criteria, and in which a surgical approach to the peptic ulcer disease is emphasized.


[Angiographic research on the blood supply of the colon with a view to oesophagoplasty (author's transl)]. The author presents an angiographic study of 34 cadavers concerning the colonic vessels, and draws up an original classification of colonic vessels which arise from the inferior mesenteric artery. He found 16 variants of the left colonic artery which he groups into 5 main types, the classical type being only encountered in 22.6 p. cent of cases. In 32 p. cent, the ascending and descending branches of the left colonic artery had a separate origin from the inferior mesenteric artery. The variants of the sigmoid arteries and of the left colonic veins were also identified. In one case, the inferior mesenteric vein was absent, being supplanted by the marginal vein. As for colo-oesophagoplasty, the isoperistaltic transverse colon was found to be better than the ileo-colon in 64 p. cent of cases and equivalent in 20 p. cent. In 16 p. cent the ileo-colon was preferable. The site of the arterial sections in colo-oesophagoplasty according to the colonic vascular type is discussed.


[Experimental study of the possibilities of electrical stimulation of the development of bony callus (author's transl)]. The experiment was designed to study: 1) the reliability of an electrostimulator; 2) the possibility of internal fixation. The experimental animal was the dog, which was observed for 15 to 45 days. It appears possible to associate internal fixation and electrostimulation under certain conditions.


Determination of protein molecular weights in denaturing solvents using glyceryl-CPG. Glyceryl-CPG is controlled-pore glass whose surface has been chemically modified to block its slight negative charge in aqueous solution. In contrast to normal controlled-pore glass, glyceryl-CPG can be used successfully for gel filtration of proteins in a variety of denaturing solvents, viz., 8 M urea, 6 M guanidine hydrochloride, and 0.1% sodium dodecyl sulphate.  It has been found that glass with a mean pore diameter near 35 nm is suitable for the molecular weight range 17,000-100,000. Glyceryl-CPG with a smaller pore diameter is more satisfactory for molecular weights below 30,000.  The stable pore size and bed dimensions of controlled-pore glass allows comparison of the conformation of a particular protein in different solvents to be made with the same column.


Quantitative analysis of nonapeptides in pharmaceutical dosage forms by high-performance liquid chromatography. A high-performance liquid chromatographic (HPLC) method is described for determining oxytocin, lypressin and other nonapeptides and their by-products in liquid and solid pharmaceutical dosage forms. The use of injection volumes up to 750 microliter permits accurate determination of, e.g., oxytocin in injection solutions containing only 1 I.U. (international unit) per ml. Reproducibilities between 1.0 and 1.5% (relative S.D) have been obtained for liquid dosage forms and up to 3% (relative S.D.) for tablets. The correlation between results obtained by bioassay and by the proposed method is highly significant and suggests the use of HPLC as an alternative technique for stability and content-uniformity tests on dosage forms and concentrates.


Two-dimensional micro-separation technique for proteins and peptides, combining isoelectric focusing and gel gradient electrophoresis. The two-dimensional combination of gel electrofocusing and gel gradient electrophoresis yields separate information about differences in net charge and molecular weight of macro-ions. A micro-version of this technique is described. The first dimension electrofocusing run is performed in cylindrical polyacrylamide gel of capillary size, using xylene cyanole FF as a reliable marker dye to indicate the final separation stage when proteins reach their isoelectric points. In the second-dimension run the focused proteins are separated in a continuous slab gel gradient of less than stamp size with total acrylamide concentration ranging from ca. 1% to more than 40%. Spreading of peaks in the gradient slab gel is shown to be related to the approach of protein to its pore limit in the gel. This spreading is a useful indicator of the final position of a protein in the gel if molecular weights are estimated according to the separation pattern in the gradient gel. The method described has been developed for the separation of proteins extracted from large single cells (i.e., neurons of the mollusc Aplysia californica.


Isotachophoretic analysis of mandelic acid, phenylglyoxylic acid, hippuric acid and methylhippuric acid in urine after occupational exposure to styrene, toluene and/or xylene. A simple, rapid and sensitive analytical method has been developed for the determination of phenylglyoxylic acid, mandelic acid, hippuric acid and methylhippuric acid; 0-, m- and p-methylhippuric acids are partly separated. These compounds are found as metabolites after occupational exposure to styrene, toluene and xylene. The method has been applied successfully to samples extracted from human urine by diethyl ether. The method can be used to accurately and simultaneously determine as little as 0.5 nmole of all of these acids in less than 20 min.


Gas chromatography-mass spectrometry of the N(O)-heptafluorobutyryl isobutyl esters of the protein amino acids using electron impact ionisation. The N(O)-heptafluorobutyryl isobutyl esters of the protein amino acids have been analysed by combined gas chromatography-mass spectrometry using electron impact ionisation. The spectral data have been used to confirm the structures of the amino acid derivatives.


High-pressure liquid chromatographic analysis of drugs in biological fluids. III. Analysis of disopyramide and its mono-N-dealkylated metabolite in plasma and urine. A high-pressure liquid chromatographic analysis for disopyramide (I) and its mono-N-dealkylated metabolite (II) in plasma and urine is described. The analysis, in which I and II together with an internal standard are chromatographed as ion pairs with heptanesulphonic acid, employs a simple and rapid method of sample preparation. The method is more sensitive, reproducible, and rapid than previously reported gas chromatographic methods.


Determination of di-(2-ethylhexyl)phthalate in human placenta. A simple method has been devised for the analysis of di-(2-ethylhexyl)phthalate (DEHP) in human placenta which relies entirely on three rapid partition steps prior to gas chromatography with electron capture detection. The use of adsorption chromatography with all its attendant disadvantages for sample clean-up is eliminated in this procedure. Placental samples taken from women who had given birth to a normal baby contained 0.06 +/- 0.02 ppm of DEHP. The principal limitation of this method, and of any others, is the high blanks given by laboratory equipment and solvents. The reduction of contamination to workable levels is described.


Gas-liquid chromatographic method with electron-capture detection for the determination of residues of some phenoxyacetic acid herbicides in water as their 2,2,2-trichloroethyl esters. A gas-liquid chromatographic method with electron-capture detection was developed for the determination of residues of 2,4-dichlorophenoxyacetic acid (2,4-D) and 4-chloro-2-methylpenoxyacetic acid (MCPA) in water as their 2,2,2-trichloroethyl esters, and the sensitivity was compared with that for 2-chloro- and 2,2,2-trifluoroethyl esters. The residue is isolated by sorption of the phenoxy acid on Amberlite XAD-4, eluted with benzene and then esterified with 20% (v/v) 2,2,2-trichloroethanol in trifluoroacetic anhydride in the presence of sulphuric acid. The recoveries at the 0.4 ppb level are 92.1 +/- 3.4% (2,4-D) and 87.8 +/- 2.1% (MCPA) and the detection limits for a 1-1 sample of water are 0.096 ppb (2,4-D) and 0.06 ppb (MCPA).


Amino acid analysis by gas-liquid chromatography of N-heptafluorobutyryl isobutyl esters. Complete resolution using a support-coated open-tubular capillary column. Amino acids have been separated by gas-liquid chromatography as their N-heptafluorobutyryl isobutyl esters. Complete resolution of derivatives of all the common amino acids has been achieved using a high-performance support-coated open-tubular capillary column. The analysis time was 30 min. Modifications to the derivatization procedure of MacKenzie and Tenaschuk have been introduced. Acylation by heating at 150 degrees was shown to be destructive; 110 degrees has been selected for routine preparation. To obtain a volatile histidine derivative it has been found necessary to add an antioxidant and to heat samples with ethoxyformic anhydride prior to injection. Amino acid analysis of beta-lactoglobulin after 6 N HCl digestion yielded results in good agreement with those obtained by the conventional ion-exchange method. The method has also been successfully applied to estimation of the different caseins in whole casein and in purified fractions by amino acid analysis of residues liberated by carboxy-peptidase digestion.


Purification of beta-N-acetyl-D-glucosaminidase of the horseshoe crab by affinity chromatography. An affinity column has been synthesized consisting of p-aminophenyl 1-thio-beta-L-fucopyranoside residues attached to Sepharose 4B through succinylated diaminodipropylamine bridges. Surprisingly, it has been found to bind beta-N-acetylglucosaminidase in the serum of Limulus polyphemus (horseshoe crab). The enzyme is eluted with N-acetyl-D-glucosamine at a concentration of 2 mg/ml and with other sugars at higher concentrations. A highly purified enzyme free from other glycosidases is obtained. The enzyme is not eluted by solutions of salt.


Determination of selenium in biological samples by gas-liquid chromatography with electron-capture detection. Selenium can be determined quantitatively in biological samples after nitric acid-magnesium nitrate digestion and formation of 5-nitropiazselenole, by extraction into toluene for gas-liquid chromatography with electron-capture detection. The method is suitable for the determination of selenium in orchard leaves, bovine liver and human placenta, hair, blood and urine.


Some 1,2-diaminobenzene derivatives as reagents for gas chromatographic determination of selenium with an electron-capture detector. 1,2-Diaminobenzene and its derivatives react with selenous acid in acidic solution to form the piazselenols, which can be extracted into toluene. Microgram amounts of selenium can be determined spectrophotometrically by measuring the absorbance of these piazselenols extracted into toluene. A more sensitive method, in which the piazselenols extracted into toluene are detected by electron-capture gas chromatography, has been developed. In order to find a more sensitive reagent, 13 piazselenols were synthesized. The retention behaviour and sensitivity in electron-capture detection gas chromatography and the distribution ratios between aqueous solution and toluene were studied for each piazselenol extracted into toluene. Of these piazselenols, 4,6-dibromopiazselenol, formed by the reaction of 1,2-diamino-3,5-dibromobenzene with selenous acid, was found to be best as regards sensitivity and distribution ratio. Under the optimal conditions for the formation and the extraction of the piazselenol, the practical detection limit was 1 ng. Selenium(VI) and total selenium in NBS Bovine Liver, SRM 1577, were determined successfully.


Gas chromatographic determination of styrene as its dibromide. The selective and sensitive gas chromatographic determination of trace amounts of styrene was studied. Styrene was converted into styrene dibromide by reaction with bromine, and the latter was detected with an electron-capture detector. The minimum detectable amount of the dibromide was about 0.01 ng and the sensitivity to the dibromide was about 500 times higher than the sensitivity of a flame-ionization detector to the styrene monomer. Dodecene-1 and o- and m-cresol gave the greatest interference, but the cresols could easily be removed by reaction with a small amount of a dilute aqueous alkaline solution. The application to a practical specimen, namely urban air, is described.


Preparative countercurrent chromatography with a slowly rotating helical tube. The capability of a simple countercurrent chromatographic scheme for obtaining high-resolution preparative-scale separations was demonstrated with the separations of a series of dinitrophenyl (DNP) amino acids and peptides. Basic studies on stationary phase retention and partition efficiency with a low-viscosity chloroform-acetic acid-0.1 N hydrochloric acid (2:2:1) phase system together with the results previously obtained with a vascous n-butanol system suggest a general applicability of low-interfacial tension phase systems by the present method.


High-pressure liquid chromatography of glycosphingolipids (with special reference to gangliosides). The analysis of mixtures of gangliosides from adult human or bovine brain, supplemented with Tay-Sachs ganglioside, and haematoside from dog erythrocytes by high-pressure liquid chromatography using a moving-wire detector system is described. The complete separation of six gangliosides within 40 min has been achieved, using silica as the stationary phase and acidified chloroform-methanol-water mixtures as the eluent on a 25-cm column. Neutral glycosphingolipids, viz., the major components from normal human erythrocytes, can be completely separated on the same column, using non-aqueous and non-acidic eluents. It is shown that the methods described are useful for both analytical and (micro)-preparative purposes.


Comparison of two gas-liquid chromatographic methods for the determination of nitrazepam in plasma. Nitrazepam in plasma was determined by gas-liquid chromatography with a nickel-63 electron-capture detector, unchanged by a direct method and also by a hydrolysis method. The extraction in the direct method was carried out with benzenedichloromethane (90:10) and in the hydrolysis method with diethyl ether. The hydrolysis was performed with 6 N sulphuric acid. The hydrolysis product was extracted with toluene-n-heptane-ethyl acetate (80:20:5) directly from acid. Thus the commonly used change in pH was omitted. Nitrazepam concentrations in plasma were determined in 10 healthy volunteers after two oral doses (5 and 10 mg); 0.5 ml of plasma was used for each determination and clonazepam, methylbromazepam and methylnitrazepam were used as internal standards. The recoveries of the methods are almost quantitative (greater than 96%). The two methods are clinically comparable. The high sensitivity and specificity make these methods useful in clinical determinations of nitrazepam in plasma. Advantages and disadvantages of both methods are discussed.


Isolation of substances from urine by affinity chromatography. The applications of affinity chromatography for the isolation and purification of physiological substances from urine have been reviewed. The use of affinity supports for the detection and measurement of various urinary components has also been briefly examined. These examples illustrate the usefulness of urine as a source of fine reagents and the versatility, simplicity and practicality of affinity isolation procedures.


Quantitative analysis of trifluoroacetic acid in body fluids of patients treated with halothane. A simple procedure for the quantitative analysis of trifluoroacetic acid (TFA) in urine and serum from patients narcotized with halothane is described. This involves addition of sodium hydroxide to the body fluid, evaporation of the aqueous phase and esterification of TFA in concentrated sulphuric acid with 2,2,2-trichloroethanol. The gaseous phases above the reaction mixture were then analyzed by gas chromatography with a nickel-63 electron-capture detector. The detection limit was 1 microgram of TFA per mililitre of body fluid (200 microgram of body fluid are analysed) and the relative standard deviation was +/-6%. Patients treated with ethrane, another commercial anaesthetic, did not produce any detectable TFA.


Determination of chlordiazepoxide, diazepam, and their major metabolites in blood or plasma by spectrophotodensitometry. An analytical procedure was developed for the determination of chlordiazepoxide, diazepam and their major metabolites in blood or plasma. Demoxepam, a metabolite of chlordiazepoxide, is determined by spectrofluorometry after extraction. The remaining compounds are determined by spectrophotodensitometry after thin-layer chromatographic separation. The sensitivity limit of the spectrofluorometric determination of demoxepam is 0.1 to 0.2 microgram while that of the spectrophotodensitometric determination of chlordiazepoxide, diazepam and their N-desmethyl metabolites is 0.05 to 0.2 microgram. The sensitivity and specificity of the assay renders it suitable for monitoring plasma levels of chlordiazepoxide and its major metabolites following single or chronic oral administration of chlordiazepoxide hydrochloride. The sensitivity limit for diazepam and nordiazepam, its major metabolite, renders the assay useful only for the determination of plasma concentrations resulting from high dosage of diazepam. The assay was used to determine chlordiazepoxide and its metabolites following oral administration of Librium. The data showed a significant correlation to those obtained on the same specimens by differential pulse polarography and by radioimmunoassay.


Selective analysis for adenosine using reversed-phase high-pressure liquid chromatography. A high-pressure liquid chromatographic procedure for the selective determination of adenosine in the presence of other nucleic acid components is reported. Reversed-phase microparticle columns and an isocratic elution mode of dilute potassium dihydrophosphate and anhydrous methanol were used. The analysis is specific for adenosine and is achieved in less than 10 min. An example of the use of this analysis in a biomedical study is reported.


Rapid separation of urinary acids by high-performance liquid chromatography. Over a hundred acidic urinary constituents were separated within 30 min by using 5-micron octadecyl-silica columns and gradient elution with increasing acetonitrile concentration in dilute aqueous phosphoric acid solution at 70 degrees. The column effluent was monitored with a UV detector at 280 nm or with a fluorescence detector at 260 nm excitation and 340 nm emission wavelengths. The high sensitivity and speed of analysis, the excellent reproducibility and adequate resolution obtained suggest that this technique may be useful to obtain metabolic profiles in routine clinical work.


The measurement of the vitamin D-binding protein in human serum. The concentration of the vitamin D-binding protein was measured in human serum by single radial immunodiffusion. Normal serum concentrations were slightly higher in normal women than in normal men. No race-related difference was found between white people from Belgium and black people from Zaire. Lower concentrations were found in cord serum and in patients with cirrhosis of the liver. Increased serum levels were observed during pregnancy or during the intake of estro-progestogens. The serum level of the vitamin D-binding protein was not altered in various diseases of calcium metabolism (primary osteoporosis, primary and secondary hyperparathyroidism, rickets, osteomalacia or vitamin D intoxication). No correlation was found between serum levels of 25-hydroxy vitamin D and those of its binding protein. From these data the following conclusions can be drawn: 1) The serum concentration of the vitamin D-binding protein (about 6.10(-6)M) largely exceeds the normal serum concentration of 25-hydroxy vitamin D (about 4.10(-8)M), so that this protein is normally for less than 1% saturated, 2) Normal serum levels of the vitamin D-binding protein were observed in several diseases of calcium metabolism, and 3) The free concentration of 25-hydroxyvitamin D is not regulated at a constant level.


Somatomedin on insulin-dependent diabetes mellitus. Somatomedin activity in sera from twelve insulin-dependent diabetics was measured by the chick embryo cartilage assay system. All patients required insulin for control of hyperglycemia, and had been continuously treated with exogenous insulin for 3 to 25 years. Mean fasting somatomedin activity was elevated in this group of diabetics, and activity did not correlate with the simultaneous blood glucose concentrations. No significant differences were demonstrable between levels in diabetics with and without retinopathy or in patients with and without proteinuria.


Subacute (de Quervain's) thyroiditis: association with HLA-Bw35 antigen and abnormalities of the complement system, immunoglobulins and other serum proteins. The HLA antigens in 40 patients with subacute thyroiditis were investigated. An association between subacute thyroiditis and HLA-Bw35 antigen as previously reported, was confirmed. Further immunological observations included a decrease in Serum Clq, C4 and C3 activator levels; conversely, there was an increase in serum C3, IgM, alpha1-acid glycoprotein and alpha1-antitrypsin levels. Serum IgA levels were decreased in those patients who were Bw35 negative, but were normal in the patients who were Bw-35 positive, with serum alpha2-macroglobulin levels the opposite was found. These studies support the view that a genetic factor(s), viz., the major histocompatibility system, plays a role in the pathogenesis of subacute thyroiditis. A "nosological clustering" around the Bw35 antigen as a marker for viral susceptibility is suggested.


The influence of beta-adrenoceptor blocking agents on plasma thyroxine and triiodothyronine. The effect of the beta-adrenoceptor blocking agent propranolol on plasma levels of thyroxine and triiodothyronine was studied in eleven hyperthyroid patients and in six hypothyroid patients on L-thyroxine substitution therapy. In all patients a decrease in plasma-triiodothyronine was found. The per cent decrease of plasma-triiodothyronine was the same in both groups. Plasma levels of thyroxine and thyrotropin increased in the hypothyroid patients, but remained constant in the hyperthyroid subjects. The decrease in plasma-triiodothyronine during propranolol medication is most likely caused by an inhibition of the peripheral conversion of thyroxine into triiodothyronine.


The importance of phosphate in regulating plasma 1,25-(OH)2-vitamin D levels in humans: studies in healthy subjects in calcium-stone formers and in patients with primary hyperparathyroidism. We observed that plasma 1,25-(OH)2-D concentrations average 87 +/- 30 SD pmol/l in 48 healthy adults without a personal or family history of kidney stones. Plasma 1,25-(OH)2-D concentrations were significantly elevated among 26 patients with recurrent calcium-containing renal stones and hypophosphatemia: 150 +/- 74 pmol/l; P less than 0.001, and among 9 patients with proven parathyroid adenoma and hypophosphatemia: 200 +/- 54 pmol/l; P less than 0.001. Plasma 1,25-(OH)2-D levels in these 3 groups were inversely correlated with serum phosphate concentration: plasma 1,25-(OH)2-D, pmol/l = 282 - 141 X serum PO4, mmol/l; r = 0.51; P less than 0.001. During dietary PO4 deprivation lasting 11 to 16 days in 10 healthy women, serum PO4 fell and plasma 1,25-(OH)2-D concentrations rose whereas in 8 healthy men neither serum PO4 nor 1,25-(OH)2-D concentrations changed. The change from control in plasma 1,25-(OH)2-D levels were correlated with the change from control in serum PO4 concentrations: delta1,25-(OH)2-D, pmol/l = 1 - 82 X delta serum PO4 mmol/l; r = 0.59; P less than 0.01. We conclude that reductions in serum PO4 concentrations, either directly or indirectly, stimulate renal synthesis of 1,25-(OH)2-D in humans.


Episodic fluctuations of serum gonadotropins in pre- and post-pubertal girls and boys. The concentrations of LH and FSH were determined in serum samples obtained at 15 min intervals during a 4 h period from seven normal girls, 9.5-16.5 years of age, and eight normal boys, 9.0-16.8 years of age. An episodic pattern of LH secretion was found in all subjects. There was no significant (P greater than 0.1) difference between girls and boys as to number of episodes (3.0 +/- 0.6 vs. 3.0 +/- 0.0 per 4 h), absolute LH increase (2.6 +/- 1.1 vs. 2.4 +/- 1.0 mIU per ml) or "apparent LH half-life" (64.3 +/- 20.8 vs. 76.1 +/- 23.4 min). Mean absolute increase during secretory episodes correlated (R = 0.89, P less than 0.005) with the mean LH concentration per 4 h, and a significant (P less than 0.025) inverse correlation (R = -0.52) was found between the mean per cent increment of the LH secretory episode and the mean "apparent LH half-life." Minor fluctuations of FSH were also observed. In girls and boys, the mean concentration of both gonadotropins increased with advancing puberty. The increase in LH concentration was due to an increase in the amplitude of secretory episodes rather than to an increase in the number of episodes. The increase in FSH concentration reflected a consistent elevation throughout the period of sampling.


A new and superior adrenal imaging agent, 131I-6beta-iodomethyl-19-nor-cholesterol (NP-59): evaluation in humans. We have reported tissue distribution studies in rats and dogs with a new adrenal imaging agent. 131I-6beta-iodomethyl-19-nor-cholesterol (NP-59). This agent concentrated five times higher in the adrenal cortex than 131I-19-iodocholesterol without increased concentration in non-adrenal tissues. We now report in 34 patients, the findings on scintigraphy with NP-59 compared with angiograms and/or adrenal vein hormone levels and histopathology, including 13 patients with hypercortisolism, 12 with primary aldosteronism, 2 with low renin hypertension, 5 with catecholamine excess, 1 with a liver metastasis from an aldosterone producing adrenal cortical carcinoma, and 1 with anaplastic adrenal cortical carcinoma. NP-59 adrenal cortical uptake was more rapid and intense and background activity was less prominent, allowing earlier and more definite interpretation of images than was possible with 131I-19-iodocholesterol.


A specific and rapid determination of human skin dihydrotestosterone cytosol receptor. The 5 alpha-Dihydrotestosterone (DHT) receptor in cytosol prepared from foreskin fragments was identified and measured by polyacrylamide gel electrophoresis (PAGE). 14 normal subjects, 4 boys with hypospadias and two patients with male pseudohermaphroditism (MPH) were studied. The amount of DHT receptor was comparable in the normal subjects and those with hypospadias. No receptor was found in the 2 cases of MPH.


Comparative recovery of Streptococcus mutans on ten isolation media. The ability of Streptococcus mutans (Bratthall serotypes a through e) to grow on 10 isolation media was examined. The number and morphology of the colonies were observed to vary on different media. The use of blood-sucrose media consistently produced the highest recoveries. Mitis salivarius agar (MS) and higher recovery values than modified medium 10 (MM10SB), Trypticase-yeast extract-cystine medium (TYC), or MS with 1% tellurite (MST). MST with 40% sucrose (MS40S), MST with 20% sucrose and 0.2 U of bacitracin per ml (MSB), and Carlsson medium with 1% sulfasoxazole (MC), media formulated for the selection of S. mutans, were the most inhibitory for all serotypes. The morphology of several S. mutans strains was atypical on MC and MS40S, making positive identification difficult. Absence of growth of serotype a strains on MSB and serotype d strains on MC were the two major differences observed among the serotypes. Results are discussed in terms of the difficulties in making quantitative determinations from cultural data.


Modified staphylococcal absorption method used for detecting rubella-specific immunoglobin M antibodies during a rubella epidemic. A recently described method for detecting rubella-specific immunoglobulin M (IgM) antibody based on absorption of IgG by Staphylococcus aureus strain Cowan I has been applied to 198 sera collected during a recent rubella epidemic in Israel. Modification of the original method introduced for the present study includes treatment with 2-mercaptoethanol of antibody remaining after absorption by staphylococci. This treatment confirms that the residual antibody is IgM (sensitive to 2-mercaptoethanol) rather than IgG (2-mercaptoethanol resistant). None of the 67 control patients (seropositive for rubella but without history of recent illness or contact) had specific IgM when tested by this method, though 15 showed some residual antibody after staphylococcal absorption. A total of 125 of 131 rubella convalescents (95%) were positive 4 to 49 days after onset of the clinical symptoms. Six patients had no IgM antibodies when tested by the method described, and all were convalescents tested late in relation to onset of clinical symptoms (beyond 3 weeks). When density gradient centrifugation was applied to clarify some results, 2 of 3 convalescents classified as IgM negative by the staphylococcal absorption method did in fact possess IgM antibody. None of 10 controls tested by density gradient centrifugation was IgM positive. This combination of staphylococcal absorption and 2-mercaptoethanol treatment is recommended as a screening test for selection of IgM positives, in addition to the use of a more sensitive method (such as density gradient centrifugation) on at least some samples classified as IgM negative.


Syphla-Chek: a qualitative study.

Syphla-Chek: a qualitative study. A qualitative evaluation of the newly marketed Syphla-Chek Test (Hyland, Div. of Travenol Laboratories, Inc., Costa Mesa, Calif.), a macroscopically read, nontreponemal card test, was undertaken in order to further evaluate the validity of this procedure as an aid in the diagnosis of syphilis. A total of 1,074 randomly selected sera submitted to the Texas Department of Health Resources for routine analysis, for confirmational analysis, and as a result of problems in analysis, were examined using the Venereal Disease Research Laboratory (VDRL) slide test, the Rapid Plasma Reagin (circle) Card Test (RPRCT), Syphla-Chek Test, and the fluorescent treponemal antibody absorption (FTA-ABS) test. Comparison of the reagin testing procedures studied versus the FTA-ABS procedure led to the following order of agreement with FTA-ABS reactive results: Syphla-Chek, 88.8%; RPRCT, 87.1%; and VDRL, 83.2%. Agreement with FTA-ABS nonreactive results was in order: RPRCT, 86.7%; Syphla-Chek, 79.6%; and VDRL, 78.7%. The relatively few minor procedural problems encountered with the Syphla-Chek Test during this study are also discussed.


Electron capture gas chromatography detection and mass spectrum identification of 3-(2'-ketohexyl)indoline in spinal fluids of patients with tuberculous meningitis. A basic, extractable, indolic type of compound, which was derivatized with heptafluorobutyric anhydride and pyridine, was obtained from the cerebrospinal fluids of patients with acute tuberculous meningitis. The compound was detected by frequency-pulsed, modulated electron capture gas-liquid chromatography, and it was tentatively identified by mass spectrometry as 3-(2'-ketohexyl)indoline. The compound was found to be valuable for differentiating between tuberculous, cryptococcal, and aseptic meningitides.


Malar mass due to Actinomyces odontolyticus. Actinomyces odontolyticus was isolated from a patient with a soft tissue mass in the malar region. The organism was identified on the basis of morphological, cultural, and biochemical characteristics. On histological examination, the tissue mass contained several granulomatous foci with small, basophilic staining areas resembling microscopic sulfur granules. This is believed to be the first reported case of actinomycosis due to A. odontolyticus.


Cellular fatty acids of Peptococcus variabilis and Peptostreptococcus anaerobius. Cellular fatty acids of Peptococcus variables and Peptostreptococcus anaerobius were identified by gas chromatography, mass spectrometry, and associated analytical techniques. Iso- and anteiso-branched-chain acids were major components in both species.


Vibrio alginolyticus infections in Hawaii. Clinical and bacteriological features of eight cases of Vibrio alginolyticus infections in Hawaii are presented. These isolates occurred in superficial sites, primarily related to infections caused by swimming.


Rapid diagnosis of lymphocytic meningitis by frequency-pulsed electron capture gas-liquid chromatography: differentiation of tuberculous, cryptococcal, and viral meningitis. Cerebrospinal fluid specimens from patients with tuberculous (17 cases), cryptococcal (15 cases), and viral (14 cases) meningitis were analyzed by frequency-pulsed electron capture gas-liquid chromatography and mass spectrometry. Compounds that disappeared after therapy were found to be present in each of these specimens and were not detected in controls. They occurred in repetitive patterns such that these three types of meningitis could be rapidly distinguished. The compound associated with tuberculous meningitis has been tentatively identified. These finding have implications for rapid diagnosis, pathophysiological studies, and possible new therapeutic approaches.


Comparison of coccidioidin and spherulin in complement fixation tests for coccidioidomycosis. Coccidioidin, an extract from the saprophytic mycelial form of Coccidioides immitis, has been a very useful antigen preparation in serological tests for coccidioidomycosis. Its sensitivity has been very good for detecting most types of clinical disease, but tests with coccidioidin have been negative for 40% or more of patients with chronic pulmonary disease, the clinical entity which must be differentiated from other cavitary, nodular, or fibrotic pulmonary disease, e.g., tuberculosis and cancer. The specificity of coccidioidin has also been good although it results in positive tests for an average of 16% among patients with noncoccidioidal mycoses. Recently spherulin, an extract from the parasitic endosporulating spherule form of C. immitis, was reported to be more sensitive than coccidioidin in concurrent complement fixation tests with sera from selected cases. We have compared coccidioidin and spherulin in concurrent complement fixation tests with 614 sera submitted routinely for coccidioidal serology and with 159 selected sera from patients with noncoccidioidal mycoses. Among the former, spherulin was positive with 25% and coccidioidin with 23%, and correlation of titer scores was highly significant. Statistical analysis revealed no significant differences with respect to frequency of positive specimens, titer scores, or diagnosis for current coccidioidomycosis. The results with sera from noncoccidioidal mycoses revealed marked differences. Coccidioidin was positive with 20%, and spherulin was positive with 48%. The titer scores with spherulin were consistently and significantly higher, and there was no correlation for results with the two antigens. Thus, coccidioidin and spherulin were equally sensitive, but spherulin was considerably less specific.


Survival of chlamydiae after cooling to -196 degrees C. Factors influencing the survival of chlamydiae after freezing were reexamined. From the data presented, it is suggested that preservation of laboratory-grown chlamydiae is best achieved through the use of sucrose as the cryoprotective agent, in the presence of 10% serum. Dimethyl sulfoxide and glycerol are more toxic. The period of exposure to sucrose before freezing must be kept as short as possible and be at 4 degrees C rather than at room temperature. The rate of cooling during freezing in sucrose is not important; however, cooling at a rate slower than 1 degrees C/min should be avoided. Since chlamydial survival is increased by rapid thawing, the volume of the sample should be kept to a minimum. Thawed suspensions should be inoculated onto cell monolayers without delay. The application of these methods may increase the proportion of stored clinical specimens in which chlamydiae can be found.


Campylobacter fetus septicemia with concurrent salpingitis. Campylobacter fetus was isolated from the blood of a nonpregnant young woman who had a clinical diagnosis of salpingitis. A description of the isolate of C. fetus is given. An increasing awareness of human infections and capability of growing this microaerophilic organism should contribute to our understanding of the incidence and virulence of this bacterium.


Lack of characteristic hexagonal surface structure on a newly isolated influenza C virus. The hexagonal surface structure believed to be characteristic for influenza C virus was not initially observed for a newly isolated virus of this type. After a few additional egg passages of the virus, however, the hexagonal structure could be readily seen on many virions.


Incidence of Simonsiella in the oral cavity of dogs. The gliding bacterium Simonsiella (Cytophagales, Simonsiellaceae) was found in palate samples from 66 out of 67 dogs. It is considered a common resident in the oral cavities of dogs.


Strains of Achromobacter xylosoxidans from clinical material. Eleven strains of Achromobacter xylosoxidans have been received from among 1106 strains of Gram-negative, non-fermentative bacteria submitted to the National Collection of Type Cultures for computer-assisted identification since 1 January 1972. The strains showed resistance to a wide range of antimicrobial agents and five of the isolates possibly played a pathogenic role. The biochemical characteristics of these 11 strains were compared with those of three culture collection strains.


Lack of evidence for mutation to erythromycin resistance in clinical strains of Staphylococcus aureus. The properties of 100 erythromycin resistant strains of Staphylococcus aureus obtained from clinical material have been compared with the properties of mutants selected in vitro for resistance to erythromycin. The properties, including inducibility of the resistance and cross-resistance to spiramycin and lincomycin, of the two groups of isolates were always different. The risk that staphylococci will mutate to erythromycin resistance during therapy with this antibiotic is remote.


Novobiocin and the differentiation of peptococci and peptostreptococci. Paper discs containing 5 microng of novobiocin were used as a presumptive test to differentiate peptococci and peptostreptococci. Zone diameters were measured and minimum inhibitory concentrations (MIC) of the antibiotic for each group were performed to ascertain the activity of the antibiotic against these genera. All strains of peptococci showed no zone of inhibition in the disc test together with an MIC of 25 microng/ml or greater. All strains of peptostreptococci showed zones of inhibition of at least 15 mm diameter together with an MIC of 1-6 microng/ml or less.


Simplified method for the rubella haemagglutination inhibition screening test. A modification of the rubella haemagglutination inhibition (HAI) test in which both pretreatment and serum titration are carried out in wells of the same microtitre plate saves time, labour, and materials and gives results comparable to a conventional HAI procedure.


Hydroxyproline excretion in infantile gastroenteritis. Total hydroxyproline/creatinine ratio (THP:Cr) was measured in random urine specimens from 18 infants with gastroenteritis. THP:Cr was sometimes increased during the acute phase of the illness and the reasons for this are discussed. Seven patients failed to thrive after the acute phase and THP:Cr was low in all of these. The test appears to be a sensitive indicator of the onset of failure to thrive, and it is suggested that it may be of value in the management of these patients.


The erroneous haemoglobin-hyperlipidaemia relationship. Hyperlipidaemia, whether primary or secondary to parenteral feeding with intravenous lipid emulsions, causes the haemoglobin level to be erroneously high when measured spectrophotometrically. Contrary to a previous report, evidence is presented which suggests a relationship between the amount of the false rise in the haemoglobin level and the type and degree of hyperlipidaemia.


West Midlands regional quality control scheme for haematology. A regional quality control scheme is described together with details of the organisation, preparation of material, and an evaluation of the results.


Platelet adhesiveness in young patients with ischaemic stroke. A significant increase in platelet adhesiveness was observed in 13 patients who developed ischaemic stroke at high altitude and in 43 patients who developed stroke at low altitude when compared with a similar group of normal healthy volunteers. Eighty-eight percent of the patients were below the age of 40 years. The role of platelet adhesiveness in the pathogenesis of cerebral schaemia in young patients is discussed.


Alveolar rhabdomyosarcoma presenting as subacute intravascular coagulation. A patient with rhabdomyosarcoma is described in whom the presenting clinical and laboratory features were those of disseminated intravascular coagulation. The patient's rapid downhill course was primarily expressed by haemorrhagic tendency. An alveolar rhabdomyosarcoma, affecting many organs, including vascular and cardiac lumina, was found at necropsy and was considered to be the cause of the consumption coagulopathy.


Retinogeniculate projections in the rabbit: an autoradiographic study. As shown by autoradiographic techniques, the pattern of retinogeniculate projections in the pigmented rabbit is generally similar to that described in previous studies. Each retina projects bilaterally to the alpha segment of the dorsal lateral geniculate nucleus (LGd) and to the external segment of the ventral lateral geniculate nucleus (LGv). The beta segment of the LGd and internal layer of the LGv receive contralateral inputs only. The alpha segment of the LGd contains an irregularly shaped region which receives overlapping bilateral projections. Within this region the ipsilateral input is continuous and predominant. This pattern of ipsilateral projection can account for both the laminar arrangement perpendicular to the lines of projection and the "hidden lamination" which have been described previously for the rabbit LGd. A separate bilateral projection is identified for a group of cells lying between the LGd and LGv rostrally. Caudally this intergeniculate leaflet extends medial and ventral to the LGv and appears to merge with the zona incerta.


Horizontal cells of the pigeon retina.

Horizontal cells of the pigeon retina. Two types of horizontal cells are seen in Golgi-impregnated retinas of the pigeon. Type I horizontal cells are compact, "brush-shaped," and have an axon ending as an irregular spinous arborization. The majority of the dendrites terminate in the distal part of the outer plexiform layer (OPL) as clusters which contact cones, but some terminate as single expansions in the proximal part of the OPL. The axon terminal spines are found only in the distal part of the OPL and contact both rods and cones. Pigeon Type I horizontal cells are Cajal's "brush-shaped" cells, and their axon terminals resemble Cajal's "stellate" cells. Type II horizontal cells have irregular, wavy, multi-branched dendrites, appear horizontally flattened, and lack axons. The dendrites terminate in the proximal part of the OPL as isolated spines and contact only cones. The Type II horizontal cells of the pigeon have not been previously described in the avian retina.


Postnatal differentiation of cell body volumes of spinal motoneurons innervating slow-twitch and fast-twitch muscles. Distribution of cell body volumes of motoneurons innervating the soleus (slow-twitch or tonic) and medial gastrocnemius (fast-twitch or phasic) muscles was examined in adult cats and a series of kittens ranging from one to 140 days in age. To identify the soleus (Sol) and the medial gastrocnemius (MG) motoneurons, each group of motoneurons was labeled differentially by utilizing retrograde axonal transport of horseradish peroxidase injected into the muscles. It was verified statistically that in the adult cat, the mean cell body volume of the Sol motoneurons was smaller than that of the MG motoneurons. Difference of the mean cell body volume between the Sol and MG motoneurons was found to be significant around the tenth postnatal day. The mean cell body volumes of both Sol and MG motoneurons increased mainly during the third to the seventh week after birth. After this period, increase of the cell body volume was relatively slight and in the fifth month after birth, some of the motoneurons still appeared to be growing. Our findings also suggested that the MG motoneurons may exhibit the adult pattern of distribution of cell body volume in an earlier postnatal stage than do the Sol motoneurons, and that differentiation of motoneurons into the gamma and alpha types may occur earlier than differentiation into the tonic and phasic types.


Fine structure of unmyelinated nerves in neonatal skin. The fine structure of unmyelinated cutaneous nerve fibers in newborns was examined in lesions of adnexal polyp of neonatal skin. In the neonatal cutaneous nerves, unmyelinated fibers outnumbered myelinated ones. The unmyelinated fibers consisted of Schwann cells, axons and basal lamina. Their ultrastructural organization was basically similar to that in the adult skin. However, some of the unmyelinated fibers contained axonal bundles which suggested a state of cytoarchitectual immaturity or incomplete growth. Phagocytosis of melanosomes by Schwann cells was also observed.


Cutaneous microflora of patients with repeated skin infections. The microflora of normal skin in 16 patients with repeated staphylococcal and streptococcal skin infections was examined to determine whether abnormalities existed which would indicate a protective role for the indigenous flora against colonization by pathogens. Five sites-hands, feet, axilla, groin and back-were examined quantitatively and qualitatively and compared with a control group. Total populations of indigenous flora were significantly higher from patients with repeated skin infections of the back, axillae and feet. The frequency of isolation of different species from normal skin was comparable between the control and experimental groups, with the exception of the incidence of Staphylococcus aureus and Proteus species which were isolated only from patients with repeated skin infections. Gram-negative bacteria were isolated with comparable frequency between the two groups, but patients with repeated skin infections tended to carry gram-negative bacteria on multiple sites. It was concluded from the high population of indigenous flora and the types of microogranisms present that the microflora of normal skin did not appear to protect patients with repeated skin infections against colonization by pathogens. The presence of high populations of Staphylococcus aureus on the normal skin of patients with repeated skin infections would appear to be the most important contributing factor.


Volumetric modifications of X-irradiated keratinocytes. The number of epithelial cells per unit volume of tissue (NV) and the relative volume (VV) occupied by the spinous and basal layers of X-irradiated and non-irradiated rat-tail epidermis were studied using techniques of stereologic cytology. By a simple calculation, the absolute volumes of basal and spinous keratinocytes were determined in irradiated (and in non-irradiated, control) epidermis, 24, 48, 72 and 96 h after exposure to a single dose of 16 Krads. During this post-irradiation period, the absolute volumetric values of both basal and spinous keratinocytes increased gradually, reaching a three-fold increase 96 h after irradiation. At the same time, the relative volume of the spinous layer increased from 58% to 75% of the total epidermis, whereas the volume fraction occupied by the basal layer decreased from 20% to 16%. These findings support previous evidence that lethally and sublethally damaged keratinocytes are capable of a metabolic effort resulting in a cell hypertrophy which in some circumstances could lead to repair and recovery from radiation damage.


Pigmented storiform neurofibroma.

Pigmented storiform neurofibroma. A case of pigmented storiform neurofibroma (PSN) is presented. The lesion was present in the shoulder of a 7-year-old black girl and recurred after 10 years. The characteristic storiform pattern and melanin production are the relevant features for histologic diagnosis. The histogenesis and taxonomic position of this lesion is discussed with emphasis on its relationship with dermatofibrosarcoma protuberans (DFSP) and cellular blue nervus.


Teacher attitudes toward educational and psychological services for conduct problem children. Ninety-nine teachers participated in a survey designed to assess teacher attitudes toward and experience with a variety of strategies for dealing with conduct problem children in regular classes. Results indicated that (a) a majority of teachers favored placing conduct problem children in regular rather than special classes; (b) current sources of assistance (school psychologists, clinical psychologists, principals, parents, and other teachers) were uniformly perceived as only slightly affective in helping teachers handle problem children; and (c) of 14 alternative educational and psychological assistance delivery strategies, teachers most frequently preferred smaller classes, teacher aides, increased counseling staff, and resource classrooms.


Differentiating psychiatrically disturbed children on the basis of a structured interview. A structured psychiatric interview designed for both clinical assessment and data collection was given to 50 pairs of well-matched pediatric and psychiatric clinic children and their mothers. The two groups were shown to be clearly distinguished on the basis of numbers of symptoms. Behavior and school symptoms gave the sharpest distinction between the two groups. Neurotic and somatic symptoms were the poorest discriminators. The psychiatric children showed significantly more antisocial symptoms than their matched pediatric peers. Age differences showed the expected trends with the widest divergence in the number of symptoms being in the oldest age group.


Relative efficacy of two token economy procedures for decreasing the disruptive classroom behavior of retarded children. Numerous studies have demonstrated that disruptive classroom behavior can be decreased by delivering tokens contingent upon periods of time during which children do not engage in it or by removing tokens contingent upon its occurrence. To date, the best controlled of these studies have consistently reported the two procedures to be qually effective. However, in these studies, token the two procedures to be equally effective. However, in these studies, token contingencies have been combined with instructions regarding the contigencies. The present study compared these two procedures when no instructions were given regarding the token contingencies. Token delivery was not effective in decreasing disruptive behavior in any of the children, while a combination of token delivery and removal was effective for three of four children. The results token delivery and removal was effective for three of four children. The results suggest that the combined procedure may be effective with certain populations that are not readily controlled by instructions.


Distribution of DSM-II diagnoses in a child psychiatric setting. While DSM-II contains more diagnostic categories related specifically to children than did the earlier DSM-I, clinical utilization studies of the various categories have not been extensive. The present study reports data on the distribution of diagnoses of childhood disorders and analyzes relationships among several diagnostic categories and subject variables. Results indicate that clinicians are using a wide range of DSM-II diagnoses for childhood disorders, including some which were intended for use with adults as well as those which were designed specifically for children. Transient Situational Disorders and Behavior Disorders are assigned almost equally to two-thirds of the sample. Chi-square analyses revealed a relationship between diagnostic categories and subject variables of age and sex. These data suggest that boys, particularly between the ages of 6 and 13, are more frequently than girls categorized as Behavior Disorder, and that the Transient Situational Disorder category is overutilized for adolescents, both male and female.


"Think aloud": a program for developing self-control in young aggressive boys. "Think Aloud" was designed as a training program to improve self-control in 6- to 8-year-old boys. It involved modeling and verbalization of cognitive activity to foster use of verbal mediation skills in dealing with both cognitive and interpersonal problems. It was hypothesized that this training would lead to improvement in test performance and teacher ratings of classroom behavior in hyperaggressive boys. Twelve aggressive second grade boys participated in daily, 30-minute, individual sessions for 6 weeks. Normal and aggressive control subjects received no intervention. Teachers rated both trained and untrained aggressive boys as improving in aggressive behaviors but they rated the experimental group as showing improvement on a significantly larger number of prosocial behaviors. The pattern of performance on cognitive tests also changed significantly in the experimental group. On pretest, their pattern differed from normals and resembled the aggressive control group, while on posttest their pattern resembled normals and differed from agressive controls. Suggestions were made concerning additional refinements needed in the program, but overall results indicated potential value in the present approach for providing assistance to aggressive boys in the early grades.


Enhancement of maturity of moral judgment by parent education. Relationships between maturity of moral judgment of parents, role-taking opportunities in the home, roletaking ability in children and maturity of children's moral judgment were studied. A parent intervention program designed to increase role-taking opportunities in the home thought to lead to an increase in the maturity of moral judgment of children was utilized. Suggestive evidence for the claim that it is possible to accelerate rates of moral maturity of children through intervening indirectly to train their parents was found. Significant relationships were also found between maturity of moral judgment in children and role-taking AND OPPORTUNITIES FOR role-taking in the home. Maturity of moral judgment of parents was not found to be significantly related to maturity of moral judgment of their children.


Improving the validity of global ratings. To examine the effects of behavior sampling on global ratings, four groups of 10 teachers each received varying amounts of observation training, practice, and feedback. Teachers viewed a series of seven videotapes depicting two, boys whose percentage of distractible behavior was systematically manipulated. Ratings of distractibility were obtained for each taped vignette. Results showed that teachers who received observation training and who routinely collected data in their own classroom submitted ratings which corresponded to actual levels of distractible behavior. Teachers who received no training, or who were trained but did not practice, submitted ratings that were significantly less accurate.


Agreement of mothers' and teachers' hyperactivity ratings with scores on drug-sensitive psychological tests. Hyperactivity ratings were obtained from parents and teachers for 45 hyperactive, children. The children were also given several psychological tests. Teachers' ratings, but not parents' ratings were negatively correlated with performance on the psychological tests that require sustained attention and on which performance is improved by stimulant drugs. This pattern of correlations was interpreted as evidence that teachers, but not parents, have an opportunity to observe children performing daily tasks that require sustained attention.


The emotionally disturbed child: disturbed or disturbing? The notion that a child's behavior may be more "disturbing" than disturbed has been of interest to educators of behaviorally deviant children. Behavior indicative of deviance in child was studied with respect to the relating degree of "disturbingness" which each was judged to reflect. Four factor dimensions of disturbingness were identified and discussed with regard to future research and educational implications.


Orientation on understanding interpersonal influence. Everyone influences and is influenced by others. Are you satisfied with the impact your influence has on others? If not, it can be changed by examining and working on the dimensions of your "style of influence," such as activity, visibility, involvement, and productivity. The author analyzes some of the opposites on a spectrum or "wheel of influence," showing how they may be melded by moderation to achieve the kind of impact you may wish. For instance, there is the analyzer vs. the performer, the leader vs. the follower, the experimenter vs. the organizer, and the asserter vs. the listener. As modes of influence, extremes in any dimension are self-defeating, but by balancing aspects of both sides, desirable "compromises" can be developed. Should you wish to change your style of influence, helfpful procedures to follow are suggested, which, hopefully, will result in satisfying interpersonal relationships and understanding.


Nutritional problems of hospitalized patients. A preliminary survey. Of sixty-seven adult, non-selected patients admitted to the medical wards of two New York City teaching hospitals over a six-week period, 91 per cent were found to have overt or potential nutritional problems of clinical significance. While they usually received sophisticated diagnostic studies and complex drug therapy, their nutritional needs, for the most part, were not given comparable attention. Major examples of nutritional neglect included failure to: Obtain a dietary history when indicated; record body weight on admission and at appropriate intervals thereafter, ascertain "relative weight" or some similar measure of deviation from a desirable standard; provide appropriate dietary management, including nutrient supplements; and furnish nutritional counseling. At no time was a dietary history obtained by a dietitian, and no plans were made at discharge for follow-up nutritional care.


Objectivity of food-symptomatology surveys. Questionnaire on the "Chinese restaurant syndrome". The Chinese restaurant syndrome consists of a characteristic symptom complex, with limited times of onset and duration after eating in a Chinese restaurant. There is widespread belief that the C.R.S. is due to monosodium glutamate used in preparing food in Chinese restaurants and that as many as 25 per cent of the general population may be susceptible to the syndrome. Questionnaires were developed to determine the unpleasant symptoms which 530 subjects associated with specific foods, eating places, and "ethnic" styles of preparing food. Over 90 per cent of respondents associated unpleasant symptoms with specific foods, but only 6.6 per cent experienced an event which would "possibly" represent the characteristic C.R.S. Nevertheless, when the phrase "Chinese restaurant syndrome" was introduced in a second questionnaire, 31 per cent of respondents believed that they were personally susceptible to it. Many people do experience unpleasant symptoms after eating, and particularly after eating food associated with a different culture. Although the responses to food symptomatology questionnaires represent an important aspect of the sociology of eating behavior, this procedure should not be considered an objective data collecting system.


Normal and pathological nostalgia.

Normal and pathological nostalgia. Nostalgia is distinguished from homesickness from which it was originally derived, and from fantasy to which it is related. It is described as an affective-cognitive experience, usually involving memories of places in one's past. These memories are associated with a characteristic affective coloration described as "bittersweet". It is concluded that the locales remembered are displacements from objects whose representation was repressed. Nostalgia is a ubiquitous human experience that is evoked by particular stimuli under special circumstances and, while it is generally a normal occurrence, pathological forms occur. Among those discussed are: nostalgia as a substitute for mourning, as an attempted mastery through idealization and displacement of a painful past, as a resistance in analysis, and as a counterphobic mechanism. Nostalgia not only serves as a screen memory, but may also be said to operate as a screen affect.


The genetic point of view: antecedents and transformations. It seems educationally advantageous to focus renewed attention on the different sets of propositions encompassed within the genetic point of view. Those assumptions fall into two major classes: antecedents and transformations. Custom and usefulness seems to have brought these two together in the present classification of metapsychology. This re-emphasis of the differences between them appears warranted to further assert their distinctions and enhance the applicability of both.