Effects of root or nerve destruction on vibrotactile sensitivity in trigeminal neuralgia. Vibrotactile thresholds were determined at 7 frequencies between 25 and 300 Hz at the medial edge of the cheek in 11 patients who had been or were currently being treated for major trigeminal neuralgia, tic douloureux. A control group, comparable in age but without neural pathology, was also tested. Results indicate essentially no difference between normal and affected sides of the face prior to surgery. The drug carbamazepine (Tegretol), commonly used to control pain of trigeminal neuralgia, did not affect vibrotactile thresholds. Infraorbital neurectomy resulted in an initial loss of sensitivity at all frequencies, followed by a gradual return of sensation which reached preoperative levels at approximately one year. The return of sensitivity was followed by the return of neuralgia. Following alcoholic gasserian rhizolysis, low-frequency thresholds were elevated considerably as after neurectomy, but sensation above 100 Hz was lost completely. A return of high-frequency sensitivity accompanied the recurrence of pain in some patients who had been injected up to 13 years prior to testing. The results are discussed in terms of recent anatomical, electrophysiological, and clinical findings.


A comparison of primary dysmenorrhoea and intrauterine device related pain. A pain questionnaire designed to measure sensory, affective, evaluative and temporal components of pain was administered to 119 patients with primary dysmenorrhoea and 75 patients with intrauterine device (IUD) related pain. In addition "self-report" information was obtained on the behavioural effects of pain, global ratings and biographical details of these patients. It was found that dysmenorrhoea and IUD related pain were generally similar in nature. This led to the conclusion that IUD insertion does not in general lead to an exacerbation of presenting dysmenorrhoea, nor does it radically alter the type of sensations experienced by the patient. While no differences between patient groups emerged, the implications of the different pain components did vary. Thus, pain intensity scores were reflected in a larger sensory component with IUD users, whereas with dysmenorrhoea the affective component predominated. The results show sufficient consensus in the two patient groups of word adjectives used to describe their pain, to allow the development and evaluation of a rapid card sort system for pain assessment.


The pain ward follow-up analyses.

The pain ward follow-up analyses. Two-year and 3-year follow-up analyses show that those who did not receive surgery for pain relief did as well as those who did receive such surgery during their stay, both groups showing consistently lower pain levels and analgesic intake than on admission, while activity levels progressively increased. The surgical patients were more likely to be readmitted for their pain problem than were the others, whereas the others were more likely to be readmitted for other medical problems.


Transfer of immunity to Trichinella spiralis in the mouse with mesenteric lymph node cells: time of appearance of effective cells in donors and expression of immunity in recipients. Cells capable of transferring immunity to Trichinella spiralis, i.e. of accelerating adult worm expulsion, were present in the mesenteric lymph nodes of mice infected for 4, 6 or 8 days, but not in mice infected for only 2 days. The time-course of worm expulsion in mice infected on the day of transfer was similar in recipients of day 4 or day 8 cells, expulsion becoming marked only when the recipients had been infected for at least 6 days. Transfer of cells 4 or 6 days after infection did not result in an accelerated worm expulsion; transfer 1 or 2 weeks before infection did not enhance the level of immunity in recipient mice. In contrast to the results obtained with mesenteric lymph node cells (MLNC) on immunity was transferred when recipients were given spleen cells taken from donors infected for 8 days. It is suggested that MLNC do not cause worm expulsion directly, but cooperate with another component of the host's defence mechanism. Accelerated expulsion in recipients of cells was accompanied by a premature decline in fecundity of female worms. Evidence is presented to show that worm expulsion and impaired reproduction may represent independent aspects of the immune response to T. spiralis.


Evidence for the involvement of a bone marrow-derived cell population in the immune expulsion of Trichinella spiralis. When mice were irradiated immediately before infection with Trichinella spiralis there was a profound and long-lasting interference with their ability to expel adult worms from the intestine. Irradiation given after the fifth day of infection was progressively less effective in this respect. The ability to expel worms was not restored when mesenteric lymph node cells (MLNC) were transferred (a) on the day of infection in mice irradiated one day previously, or (b) on day 7 of an infection in mice irradiated on day 6, even though the MLNC transferred immunity to intact recipients. Transfer of bone marrow (BM) alone was also without effect. However, worm expulsion was restored if, following irradiation and injection of BM, 10 days were allowed for BM differentiation before transfer of MLNC. This restoration was effective even after lethal levels of irradiation and was clearly dependent upon a donor-derived BM component cooperating with, or responding to, the activity of the transferred MLNC. The possibility that the BM component is non-lymphoid in nature is discussed.


The development of Haemonchus contortus, a nematode parasite of the ovine abomasum, in the laboratory rabbit. The development and growth of Haemonchus contortus was studied in the stomach of the laboratory rabbit. Less than 1% of the ensheathed infective larvae given to rabbits became established, whereas after exsheathment in vitro under physiological conditions, 20-30% of the larvae administered developed to the 4th stage. Following doses of up to 10000 larvae, nearly all worms were lost from the 16th to the 21st day after infection, but after doses of 50000 larvae considerable numbers of 4th-stage larvae were recovered 25 days after infection. No adult worms were recovered and no eggs were found in the faeces. Infection was accompanied by inflammation, haemorrhage, disruption and flattening of the mucus secreting cells and by mononuclear infiltration. No cellular reactions in the immediate vicinity of the nematodes in the mucosa or changes in the pH of the stomach contents were observed.


Pholeter anterouterus Fischthal & Nasir, 1974 (Digenea: Opisthorchiidae) redescribed, together with remarks on the genera Pholeter Odhner, 1914 and Phocitrema Goto & Ozaki, 1930 and their relationship to the centrocestine heterophyids. Photoleter anterouterus Fischthal & Nasir, 1974, from Pelecanus occidentalis Linnaeus and Pelecanus erythrorhynchos Gmelin from Florida, USA and the ventro-genital complexes of Photeleter gastrophilus (Kossack, 1910) from Delphinus delphis Linnaeus from Queensland, Australia and of Phocitrema fusiforme Goto & Ozaki, 1930 from Alopex lagopus (Linnaeus) and Phoca vitulina Linnaeus from Alaska are redescribed. The genus Photoleter Odhner, 1914 is emended and compared with Phocitrema Goto & Ozaki, 1930 and both genera are compared with members of, and as a result transferred from the family Opisthorchiidae Looss, 1899 to, the subfamily Centrocestinae Looss, 1899, family Heterophyidae Odhner, 1914.


Interference with Fasciola hepatica snail finding by various aquatic organisms. Previous studies using radioactive miracidia have shown that a number of non-host snails and bivalves, interposed as 'decoys' in linear test channels, may interfere with the capacity of Fasciola hepatica miracidia to infect Lymnaea truncatula. Applying similar experimental principles, the role of several other potential interferents have been analysed in the present study. Daphnia pulex (Cladocera) and larvae of Corethra sp. (Diptera) exercised significant interfering effects by protecting 'target' snails from infection. Evidence suggested that this effect was a result of their normal predatory behaviour. Other organisms including Herpobdella testacea and Helobdella stagnalis (Hirudinea), Acellus aquaticus (Isopoda), Planaria lugubris (Turbellaria) and L. truncatula egg clusters failed to interfere with miracidial host-finding. Nor did P. lugubris and L. truncatula 'conditioned water' interfere with the capacity of the miracidia to infect their host snail.


Babesia bigemina in Kenya: experimental transmission by Boophilus decoloratus and the production of tick-derived stabilates. A Babesia-free batch of laboratory reared Boophilus decoloratus ticks was infected with a Kenyan strain of Babesia bigemina by feeding them on a steer infected by inoculation of a blood stabilate. The engorged female ticks showed developing stages of B. bigemina in their haemolymph and subsequently their progeny transmitted the parasite to a susceptible splenectomized steer. Attempts were made to produce stabilates from pre-fed larvae and nymphs derived from infected batches of B. decoloratus. Only the stabilates derived from the nymphs pre-fed either on cattle or rabbits produced B. bigemina infection when inoculated intravenously into susceptible cattle.


Malignant melanoma with adjacent Hutchinson's melanotic freckle in Black Africans. Hutchinson's melanotic freckle (lentigo maligna) is a well-known pigmented lesion, usually seen on the face of white patients. It may be associated with invasive malignant melanoma. This paper reports the incidence of this lesion in association with invasive malignant melanomas of the feet and hands of Black Africans. In Blacks, as in Whites, malignant melanoma with adjacent Hutchinson's melanotic freckle carries a considerably better prognosis than other histogenetic patterns of malignant melanoma.


Bacteria in neonatal omphalitis.

Bacteria in neonatal omphalitis. A 6-year study of bacteria isolated from swabs taken from clinically apparent infections of the stump of the umbilical cord showed an overall infection rate of 0.7% (200/27,107), with a preponderance of Gram-negative organisms as compared with Gram-positive organisms (171/118), an excess which was statistically significant. When the data were broken down into premature and non-premature nurseries, the incidence of infection in the former was 2.08% (84/4028) and in the later 0.5% (116/23,079), a highly significant statistical difference. Most of the organisms isolated from the premature nurseries were Gram negative (83/120) and this finding too was statistically highly significant.


Histiocytoid cardiomyopathy of infancy: an unexplained myofibre degeneration. An unusual multifocal degeneration of the myofibres of all chambers and the conducting system of the heart was found in a 4-month-old female in whom ventricular pre-excitation (Wolff-Parkinson-White syndrome) had been demonstrated. There was a complex malformation of the brain with hydrocephalus and bilateral corneal opacities and microphthalmos. The affected myofibres had a swollen vacuolated or granular cytoplasm and rounded nuclei giving a histiocytoid appearance. Disruption of myofibrils and gross dilation and disorganization of mitochondria were the major fine structural features. Reports of similar lesions in 8 other young female children are reviewed. 'Histiocytoid cardiomyopathy' is the term preferred over others which refer to an increased lipid content. The aetiology is unknown.


The distribution of dextran macromolecules in the glomeruli of normal and nephrotoxic rats. The incorporation of intravenously injected dextran molecules (molecular weight 500,000 & 2,000,000) by the glomeruli of laboratory rats was studied by electron microscopy. In normal rats some dextran molecules were observed 12 minutes after injection in vesicles and invaginations of both endothelial and mesangial cells. Rats with nephrotoxic serum nephritis showed extensive separation of endothelial cells from the glomerular basement membrane. These subendothelial spaces contained irregular granular material, cytoplasmic extensions of mesangial cells and, in animals injected with dextran, dense accumulations of dextran molecules. There was no apparent difference in distribution of the two test samples of dextran. These findings demonstrated the involvement of both endothelial and mesangial cells in the glomerular localization of circulating material and indicated that immunologically inactive macromolecules can be incorporated into subendothelial deposits following immunological injury to the glomerulus.


Eosinophilia and mast cell hyperplasia induced by parasite phospholipid. Phospholipid preparations from the nematode Ascaris suum or cysts of Echinococcus granulosus (hydatid cysts) induced an eosinophilia when injected into the peritoneal cavity of rats. Peritoneal eosinophilia persisted throughout 21 days of daily injections of Ascaris lipid and was accompanied by blood eosinophilia, mast cell granule lysis and mast cell hyperplasia. The active material consisted of lecithin and lecithin plasmalogen, and in aqueous suspension had a membrane-like appearance. Electron microscopy revealed that the phospholipid was ingested by all types of cells in the peritoneal cavity, including mast cells, and was rapidly broken down by eosinophils. Phagocytosis was found to be complement dependent. The lipid combined with properdin in human serum and stimulated complement breakdown via the alternative complement pathway.


Serum pyridoxal concentrations in children with diabetes mellitus. Serum pyridoxal concentrations were measured in 63 children with diabetes mellitus and compared with those in healthy children of the same age. Twenty-four per cent of diabetic children had concentrations below the limit of normal for age and sex. Diabetic children, as a group, had lower serum pyridoxal concentrations than healthy children.


Tetraploidy and the striate cortex.

Tetraploidy and the striate cortex. A tetraploid population of glial cell nuclei has been identified in layers one, two and three of the entire striate cortex. These have approximately twice the volume of diploid glial cell nuclei.


The effect of gestational age on the effective elastance of the respiratory system in neonates. We measured the effective elastance of the respiratory system (E'RS) in 38 "healthy" neonates, gestational ages ranging from 28-42 weeks. E'RS was calculated by dividing the inspiratory pressure generated after nasal occlusion by the tidal volume of the breath preceding occlusion (E'RS = P/VT). E'RS decreased from 790 +/- 0.070 cm H2O/liter at 30.4 +/- 0.4 weeks of gestation to 520 +/- 0.030 at 34.5 +/- 0.3 weeks (P less than 0.01); then to 340 +/- 0.020 at 40 +/- 0.2 weeks (P less than 0.01). E'RS corrected for lung volume ("specific" E'RS) were 32 +/- 2,32 +/- 4, and 28 +/- 2 cm H2O at the above gestational ages, respectively (P greater than 0.05). We suggest: (1) the increased E'RS observed in preterm infants is lung volume dependent. Changes in lung volume may alter the geometry of the thorax, and therefore, the force/length characteristics of the respiratory muscles; (2) this increased E'RS is not of much benefit to preterm infants who have little respiratory stability when E'RS is maximum; and (3) if E'RS is an index of mechanical stability, apnea in preterm infants is independent of the mechanical properties of the respiratory system.


The effect of maternal starvation on the metabolic response to cold of the newborn rabbit. Acute starvation of the pregnant rabbit before delivery leads to lipid mobilization, the circulating concentrations of free fatty acids (FFA) increase, and more fatty acids cross the placenta and are stored as triglyceride in fetal tissues, particularly the liver and adipose tissue. Thus the newborns from these unfed does are born with larger fat stores than normal. In this investigation the responses of newborns of unfed and fed does were compared with respect to aspects of the metabolic responses to birth and subsequent cold exposure. It was found that at 2 hr of age the newborns of unfed does had higher circulating concentrations of FFA and triglycerides. The glucose and glycerol concentrations were similar in the two groups, but after 2 hr of cold exposure the newborns of fed does had much higher blood concentrations of both glucose and glycerol. In both, a large increase in FFA concentration was seen. The newborns of unfed and fed does had similar minimal metabolic rates, but the maximal rate of heat production was greater on average by 15% in the newborns of unfed does over the first 3 days of life. Maternal nutrition immediately before delivery has considerable effect on the circulating concentrations of metabolites and the responses to cold of the newborn.


Metabolic rate and body composition in rats nutritionally deprived before or after weaning. In order to manipulate cell size and cell number, rats were subjected to nutrient restriction either prenatally and until weaning at 3 weeks (group I), or from 3 until 10 weeks (group II). Body weights of group I rats were 30% of normal at the height of deprivation at 3 weeks. By 16 weeks of age maximum weights were reached, which remained subnormal in the majority; by 26 weeks only one of six had attained a normal weight. Body weights of group II were 27% of normal at the height of deprivation at 10 weeks; subsequently, only one of six did not recover. The weight, protein, and DNA content of liver, kidney, and heart were significantly decreased. The combined weight and protein content of the three organs was 30% of normal in group I and 25% of normal in group II; the DNA content of the three organs was 57% and 38% of normal in group I and group II, respectively. The greater deficit in weight than DNA content, and the mean protein/DNA ratios reflect a decrease in cell size (or increase in the cell density) of the three organs, which was greater in group I (60%) than group II (71%). Muscle cell density was increased in group I, but not in group II. At 16 weeks of age all parameters were similar in the two experimental groups (ranging from 68% to 82% or normal). Organ weight, protein, and DNA content remained deficient only in group I; these values were 74%, 70%, and 77% of normal, respectively, at 32 weeks. The deficit was proportionate to the deficit in body weight. The basal metabolic rate was measured 17-20 hr after food removal (BMR) on the day the animals were killed. In group I and II correlations between the BMR and four parameters of body composition were linear during a 4-period at the height of deprivation. Comparison of means from the regressions showed no difference between group I and II, or between these groups and normal controls with regard to the BMR per body weight, organ weight, and organ protein. The BMR per mg DNA was lower in group I and II than in normal control rats (P less than 0.05). The BMR of normal rats age 3-32 weeks showed a curvilinear correlation with body weight (BWt), BMR = 1.24 BWt0.583; organ weight (OWt), BMR = 4.30 OWt0.766; and organ protein (OPr), BMR = 4.30 OPr0.604. By contrast, the regression on DNA was linear (BMR = 7.97 + 0.449), although marked changes in body composition occurred between 3 and 32 weeks.


Postnatal triiodothyronine concentrations in healthy preterm infants and in infants with respiratory distress syndrome. Postnatal changes in triiodotyronine (T3) concentration were investigated in 12 preterm infants of 26-34 weeks of gestational age. Blood for measurement of T3 was obtained from the cord at delivery and from infants at 1 day of age and at weekly intervals for 4 weeks. Seven of the babies suffered from respiratory distress syndrome (RDS) and five were considred healthy. Gestational ages and body weight were comparable in both groups. In preterm infants with RDS, cord blood T3 concentration was significantly lower than that in cord blood of babies without RDS (22 +/- 2.6 versus 36 +/- 5 ng/dl, P less than 0.05). There was no significant rise in T3 concentration of RDS babies at 24 hr of age (22 +/- 2.6 versus 34.0 +/- 8 ng/dl, P greater than 0.05), and hypotriiodothyroninemia persisted for 3 weeks. At 4 weeks of age, T3 concentration in babies with RDS, although within the normal range (80-190 ng/dl), was significantly lower than that in the healthy preterm infants (110 +/- 10 versus 165 +/- 11 ng/dl, P less than 0.05). Postnatal T3 changes in healthy preterm infants wre characterized by the absence of the initial hypertriiodothyroninemia and by a gradual rise within the first month of life. The noted difference in the pattern of postnatal T3 changes in healthy preterm infants compared to full term infants may reflect thyroid immaturity. The machanism and the significance of the neonatal hypotriiodothyroninemia in RDS and its long term effects on the development of these babies remain to be investigated.


A paper chromatoelectrophoresis method for the determination of bilirubin binding to serum protein. A technique is described in which paper chromatoelectrophoresis is used to measure the bilirubin binding capacity of albumin in serum. It is equivalent to the Sephadex G-25 method and its results are highly reproducible. From a single pool of serum, multiple determinations indicated the mean bilirubin binding capacity to be 23.7 +/- 0.76 (SD) mg/dl and the greatest difference between any two values was 2 mg/dl. This new technique can determine the bilirubin binding capacity of a serum sample in 15 min. Highly skilled technicians are not needed and very small quantities of serum are required, which gives it a definite advantage over the Sephadex G-25 method.


Human beta-glucuronidase. I. Recognition and uptake by animal fibroblasts suggests animal models for enzyme replacement studies. As part of an effort to develop an animal model for studies of uptake of human beta-glucuronidase, fibroblasts were established from primary explants of connective tissue from nine different animal species, and examined for their ability to take up human platelet beta-glucuronidase. Endogenous fibroblast beta-glucuronidase was inactivated by heating extracts to 65 degrees for 30 min. Human beta-glucuronidase was stable to this treatment. Uptake of human beta-glucuronidase by animal fibroblasts was measured as heat-stable beta-glucuronidase present in fibroblasts after exposure to partially purified human platelet beta-glucuronidase for 48 hr. Althought all animal fibroblasts examined exhibited some uptake capacity for human beta-glucuronidase, the uptake capacity of different animal fibroblasts varied over a 10-fold range. The uptake capacity of bovine fibroblasts was at least 80% that of human fibroblasts. Rat and hamster fibroblasts showed about half the uptake capacity of human fibroblasts. The rat fibroblasts resembled the human fibroblasts in the kinetics of uptake of hihg uptake (platelet) enzyme, poor uptake of human placental enzyme, and lack of appreciable turnover of enzyme taken up over 4 days. Heating extracts of rat organs containing added human beta-glucuronidase at 65 degrees selectively inactivated rat enzyme.


Human beta-glucuronidase. II. Fate of infused human placental beta-glucuronidase in the rat. Human placental beta-glucuronidase could be identified in rat organs by heating organ extracts to 65 degrees which selectively inactivated endogenous rat enzyme. Infused enzyme was rapidly cleared from rat plasma (t0.5 of 3.5 min). From 50-60% of the infused dose was accounted for in rat liver and spleen 24 hr after infusion. Removal of abdominal viscera, including the spleen, and interruption of the portal circulation before infusion slowed the plasma disappearance (t0.5 of 60 min) and allowed significant uptake by bone and other organs. Subcellular fractionation of liver 18 hr postinfusion localized the human enzyme in the mitochondrial-lysosomal fraction. The half-disappearance times of infused human enzyme were 2.6 days in rat liver and 5.8 days in rat spleen. Periodate treatment of human placental beta-glucuronidase destroyed 90% of its binding to concanavalin A-Sephadex rose, reduced its heat stability, and abolished its rapid clearance from rat plasma after infusion.


Menkes' Kinky hair syndrome: studies of copper metabolism and long term copper therapy. A patient with Menkes' kinky hair syndrome was treated with oral CuSO4. Plasma copper, ceruloplasmin, red cell copper, and 24-hr urine copper excretion remained essentially unchanged. Intravenous copper infusion resulted in a rise of serum ceruloplasmin. During administration of a test meal of 64Cu(NO3)2, the patient was given alternately a volume of 0.9% NaCl or an equal volume of plasma intravenously. Radioactivity found in the blood was unchanged after each infusion period. During 427 days of subcutaneous copper, plasma p-phenylenediamine oxidase activity and plasma copper rose toward normal. Subsequent balance studies showed that the patient was in negative copper balance because of large losses in feces. Scanning electron microscopy demonstrated persistent pili torti.


The chronically reserpinized rat as a possible model for cystic fibrosis. VI. Synergistic effects of isoproterenol on Ca++ and protein in the submaxillary gland. Elevated calcium and protein concentration are a consistent abnormality in submaxillary saliva from patients with cystic fibrosis (CF) and from experimental animal models developed by the chronic administration of either isoproterenol (IPR) or reserpine. The possibility that the effects of the two drugs may be additive was investigated by assessing their combined effects on glandular and salivary C++ and protein in the rat submaxillary gland. Individually, their effects were also assessed in relation to the dose used. Results indicate that: (1) treatment for 7 days with 0.05, 0.50, and 5.0 mg/kg daily dose of reserpine caused, respectively, a 45%, 95%, and 120% increase in glandular Ca++ and a 9.3%, 16.5%, and 37.4% increase in glandular protein; (2) treatment for 7 days with a 5.0 mg/kg daily dose of isoproterenol caused a 138% increase in gland Ca++ and a 12.38% increase in gland protein. Treatment with a 5.0 mg/rat daily dose of this drug caused increases of 166% and 10.3% in gland Ca++ and protein; (3) in experiments involving a combination of the two drugs, isoproterenol was administered in a 5.0 mg/kg daily dose from days 1-7 and reserpine in a 0.5 mg/kg daily dose from days 4-10 of the treatment schedule. This procedure resulted in (a) a 217% increase in gland Ca++ and a 25.7% increase in gland protein; (b) a marked accumulation of a granular, basophilic material in acinar cells and the development of intraductal precipitates; (c) the secretion of turbid saliva with high Ca++ and protein concentrations after a secretory dose of isoproterenol (this type of stimulation also reduced the gland Ca++ (50%) and protein (20%) contents and produced vacuolization in the acinar cells); (d) the secretion of saliva with elevated Ca++ and protein in response to pilocarpine (these elevated concentrations were, however, one-fifth of those obtained after isoproterenol stimulation); (e) the secretion of smaller volume of saliva after both types of stimulation. These findings indicate that both IPR and reserpine have a dose-related and significant effect on submaxillary gland Ca++ and protein and that their individual effects are synergistic. The implications of this synergism for the physiologic state of the submaxillary gland and for the secretory abnormality of cystic fibrosis are discussed.


Possible mechanisms and significance of the neonatal surge in glucagon secretion: studies in newborn lambs. Studies were conducted in newborn lambs to gain insight into the significance and mechanism(s) responsible for the rapid rise in plasma immunoreactive glucagon (IRG) which occurs in human and other newborn species immediately after delivery. Three sets of experiments were conducted: group A, control studies (n = 5) in which delivery into room air was followed 1 hr later by cutting of the umbilical cord and periodic blood sampling for a further hour; group B, studies (n = 5) in which somatostatin (SRIF), a known inhibitor of IRG and insulin (IRI) secretion, was infused int othe fetus for 10 min before, and for 1 hr after delivery and immediate cord cutting; group C, studies (n = 5) in which an identical dose regimen of SRIF was infused into fasting newborn lambs aged 24-72 hr. The doses of SRIF used were several fold higher than those proven to suppres pancreatic hormones secretion in other species. In the control studies, plasma IRG levels remained stable until the cord was cut, after which event levels rose 5-6-fold (59 +/- 15 pg/ml to 305 +/- 98 pg/ml, P less than 0.05). Simultaneously, plasma free fatty acid (FFA) concentrations rose significantly (280 +/- 80 to 780 +/- 100 muEq/liter, P less than 0.05) and IRI remained unchanged. Plasma glucose concentrations, however, in contrast to observations in other species, did not fall, and therefore, hypoglycemia was not the stimulus for the glucagon surge. SRIF infusion at birth (group B) did not prevent the rise in IRG. Again blood glucose values did not fall, but in contrast to the control studies plasma IRI levels rose and the rise in FFA did not occur. Later SRIF infusion (group C) resulted a prompt and sustained suppression of IRG and IRI and a significant fall in blood glucose. These results suggest that an adrenergic mechanism rather than curtailment of nutrients is the major stimulus to the neonatal surge in IRG.


The renin-angiotensin-aldosterone system in the newborn lamb: response to furosemide. Nine newborn lambs between 24 and 48 hr of age were studied before and after infusion of furosemide (2 mg/kg) over 1-2 min. Plasma renin activity (PRA) increased within 8 min after furosemide from a baseline value of 12.6 +/- 3.5 ng/ml/hr (mean and SEM) to a level of 24.1 +/- 8.6 ng/ml/hr (P less than 0.05), and peaked 20 mins after the furosemide infusion at a level of 33.1 +/- 8.0 ng/ml/hr. Plasma aldosterone concentration increased from a baseline of 12.2 +/- 3.1 to 22.8 +/- 9.1 ng/dl 35 min after the furosemide infusion, P less than 0.05. There were no changes in plasma sodium or blood hemoatocrit and minimal changes in blood pressure and plasma protein concentrations during the first 35 min after the furosemide infusion. The results indicate that the renin-angiotensin-aldosterone system responds promptly to furosemide stimulation despite initially high PRA and aldosterone levels.


The influence of antenatal corticosteroids on hypoglycemia in newborn rats with intrauterine growth retardation. This study examines the effect of maternally injected glucocorticoid on the pattern of hypoglycemia exhibited by rat pups with intrauterine growth retardation (IUGR). The majority of surgical procedures designed to produce small-for-gestational age (SGA) newborns for biochemical studies were carried out on days 18 and 19 of gestation because of favorable vields of pups with IUGR at those operative days. At birth, normal controls showed a mean +/- SE plasma glucose value of 63 +/- 2 mg/dl; mean glucose for the group with IUGR was significantly lower at 43 +/- 2 mg/dl. There was a further decrease in the plasma glucose concentration of pups with IUGR at 2-4 hr of age, whereas values in the control littermates did not fall during this interval. Through the first 2 hr of neonatal life, 46% of the pups with IUGR exhibited plasma glucose values less than 40 mg/dl, whereas only 18% of the control littermates manifiested hypoglycemia. During the 2-4-hr interval, the incidence of hypoglycemia in animals with IUGR increased to 91%; however, the incidence in control remained at 18% from 2-4 hr and fell to 4% at 4-6 hr of age. At birth, the pups with IUGR had a lower mean liver weight compared to their control littermates, but glycogen concentration of liver was similar to the control mean +/- SE of 25.7 +/- 1.8 (IUGR = 22.2 +/- 1.3 mg/g wet weight). Total hepatic glycogen stores, however, were markedly lower in dysmature rat pups (IUGR = 2.96 +/- 0.17 mg; control = 7.23 +/- 0.43 mg). Concentrations of plasma glucose at birth of individual control and IUGR animals were found to correlate significantly (r = 0.64, p less than 0.001) with total liver glycogen content. The decline in plasma glucose values in pups with IUGR was not present in animals whose dams received glucocorticoid injection 24 and 48 hr before delivery. At 4-6 hr of age, for instance, the mean plasma glucose concentration in the corticoid-treated IUGR group (70.1 +/- 6.9 mg/dl) approximated that of the control group. Instead on the 91% incidence of hypoglycemia noted in the nontreated dysmature pups, an incidence of 55% was found at 2-4 hr of age in offspring of mothers given glucocorticoid. At 4-6 hr, the treated group showed an incidence of 18% compared to a 67% figure in the nontreated IUGR animals. The concentration of liver glycogen in these animals also differed in that the treated IUGR pups showed significantly higher values (26.9 +/- 1.7 mg/g wet weight, mean +/- SE) than nontreated progeny. It is concluded that antenatally administered corticosteroid influence the development of neonatal hypoglycemia in the dysmature rat pup and that the major effect is not at birth, but during the 2-4-hr period of neonatal life.


Regulation of fetal lung phosphatidyl choline synthesis by cortisol: role of glycogen and glucose. Twenty pregnant rabbits were studied in pairs. Half were given cortisol subcutaneously on days 24, 25, and 26 of gestation in dosage of 2 mg/kg/day. Half served as controls and received saline. The fetal lungs were studied on the 27th day of gestation by incubating lung slices in the presence of [6-14C]glucose. Glucose consumption significantly increased in the tissue from animals treated with cortisol, 17.61 "/- 5.56 (SD) mumol/g in the controls (P less than 0.05). The glycogen content of tissue treated with cortisol was significantly reduced compared to the controls, 2.42 +/- 0.97 (SD) mg/g wet lung versus 3.81 +/- 1.05 (SD) mg/g (P less than 0.05). Treatment with cortisol resulted in significantly enhanced incorporation of the 14C label into glycogen and phosphatidyl choline (Tables 3 and 4). These data suggest that glucocorticoids affect fetal lung phosphatidyl choline production by promoting glycogenolysis and increasing glucose incorporation into phosphatidyl choline.


Coronary reserve and right ventricular function in awake newborn lambs with persistent right ventricular hypertension. Right ventricular function curves as measured by right ventricular stroke work were normal in all control lambs, whereas three of five lambs with banded pulmonary arteries had relatively flat curves. Left ventricular function was similarly normal in the control group as compared to a near zero slope function curve in the banded group. Regional myocardial blood flow to the septum and right and left ventricles was similar in control and banded lambs. At rest right ventricular coronary vascular resistance was lower in the banded than in the control group and decreased in both groups during both isoproterenol and dextran stress states. In general, both groups had a similar ratio of right to left ventricular oxygen supply to demand ratio. These results show first that there is minimal, if any, biventricular functional reserve in lambs with persistent right ventricular hypertension, and second, that there is substantial coronary vascular reserve in both normal and banded groups.


Long-term outcome of Hemophilus influenzae meningitis related to antiobiotic treatment. Of 82 patients treated for Hemophilus influenzae meningitis from 1968 to 1975, a total of 22 (26.8%) showed neurologic or psychologic sequelae, or both. Auditory impairment was the most common type of sequelae; it occurred in 15 patients. Complications during acute illness were more frequent in patients who later developed sequelae than in patients who recovered completely. Sequelae were more often found in patients who received both ampicillin and chloramphenicol concomitantly compared with patients who were treated with one of these drugs. A possible antagonistic interaction between ampicillin and chloramphenicol is discussed.


Children in divorce: intervention in the phase of separation. Divorce of their parents can create difficulties for the development of young children. The ability of children to integrate the various losses involved in the breaking up of a family is impeded by limitations of their cognitive understanding of events taking place during the separation phase. Because their thinking process is as yet immature, children often feel responsible for the divorce, and they otherwise distort the meaning of the events about them. The pediatrician can often guide and encourage parents to facilitate their children's understanding and acceptance of the changes in their lives.


Summer camp hemodialysis for children with chronic renal failure. A hemodialysis unit was established at a rural summer camp for children. Required medical treatment was planned so as to interfere as little as possible with normal camp programs. Campers who require dialysis were mixed fully into the population of normal campers. Twenty-two children participated during the first summer of operation. Our experience indicates that children on maintenance hemodialysis can be integrated with normal peers in a recreational program and can improve their self-image and self-confidence. The program also demonstrates that chronic pediatric hemodialysis can be safely performed in a rural satellite unit.


Sudden infant death syndrome: normal QT interval on ECGs of relatives. Genetically determined prolongation of the QT interval on ECGs has been proposed as one basic pathogenetic mechanism for the sudden infant death syndrome (SIDS). ECG studies in a total of 108 first-degree relatives of 26 patients with this syndrome in comparison with 99 such subjects from 22 control families failed to show any significant differences in the QT interval in these two groups. Hereditary prolongation of the QT interval is therefore unlikely to be a significant factor in the etiology of the vast majority of cases of SIDS.


Ambiguous genitalia in XX male children: report of two infants. Two infants with ambiguous genitalia were recognized to have the XX male syndrome. Although most XX males have normal penile development, a review of the reported cases showed that eight of the 14 affected children, diagnosed before age 15 years, had penile abnormalities, most commonly hypospadias and/or chordee. This syndrome should be considered in children with incomplete genital differentiation. The available indirect evidence suggests that deficient testosterone production by the fetal testes accounts for the genital ambiguity. Although no explanation has been established for the presence of testes in the apparent absence of the Y chromosome, studies of the X-linked Xg blood group in XX males demonstrate a high frequency of unusual inheritance patterns. This implies that the abnormality in the transmission of maleness in affected families may also be X-related rather than autosomal.


Serum gastrin levels in infants and children. Fasting serum gastrin concentrations were determined by radioimmunoassay for 124 infants and children free of gastrointestinal disease. Values for the entire group ranged from 1.1 to 167.9 pg/ml (mean, 32.3 pg/ml). Mean serum gastrin levels for children who fasted eight or more hours were 22.5+/-23.9 pg/ml while the mean serum gastrin levels for children who fasted four to eight hours ranged from 42.4+/-33.9 pg/ml to 59.2+/-49.6 pg/ml. The mean serum gastrin levels varied inversely with body surface area among children who fasted the same length of time.


Children's behavior during automobile rides: do car seats make a difference? The behavior of children riding in automobiles with their mothers was assessed by having an observer accompany them on repeated 15-minute automobile rides. Children riding in car seats exhibited very high levels of appropiate or safe behavior, whereas children not riding in car seats exhibited very low levels of appropriate behavior. When car seats were introduced to those children who previously had not used them, the level of appropriate behavior improved dramatically. These results were maintained at three-month follow-up observations. Prevention or reduction of disruptive child behavior on car rides is an obviously important, but previously unreported, benefit of the use of child restraint seats. This fact might very well be used by the pediatrician to further encourage or persuade parents to purchase and use child restraint seats. The use of a child restraint seat to reduce disruptive behavior during automobile rides is an advantage, beyond the safety aspects, of introducing car seats to young children.


Sudden infant death trends in six metropolitan communities, 1965-1974. Data from six geographically dispersed metropolitan areas in the United States in which special sudden infant death syndrome (SIDS) surveillance programs for detection and autopsy diagnosis existed during the period 1965 through 1974 reveal considerable diversity in overall ten-year incidence rates as well as in annual rate distribution patterns. A downward trend in SIDS incidence occurred in some areas but not in others. Non-SIDS postneonatal death rates, which were used for comparison, also decreased in some areas. Rate trends for whites and nonwhites were not consistent. During the same period, the fertility rate in the United States decreased by about a third for both whites and nonwhites. To explain the observed trends we postulate that concomitants of the fertility rate decline may have reduced the number of "high mortality risk babies" to a variable degree in different places and at different times.


Surgical correction in infancy to reduce mortality in transposition of the great arteries. The mortality for infants with transposition of the great arteries (TGA) prior to the introduction of medical and surgical septostomy was over 80% by 6 months of age. The mortality has fallen recently, due to balloon atrial septostomy (BAS), but still exceeds 25% by 6 months of age in major centers. The cumulative mortality rises to 40% by 1 year of age with or without additional surgical atrial septectomy. In our center, 12 patients with an average age of 3 months were operated on for interatrial baffle correction of their TGA under surface-induced deep hypothermia. BAS had been done preliminarily in those patients without an adequate atrial communication. Ten of these 12 patients (83%) survived. These patients have been followed up from one month to eight years with an average follow-up of over four years. Surgical correction during infancy offers a better survival rate for infants with TGA than does medical management, with or without palliative surgery.


Reversible perspective figures and eye movements. Eye movements and perspective reversals were continuously recorded on film for 9 subjects who fixated a central point on black line drawings of the Necker cube and Rubin vase figure. There were significantly more Necker cube reversals than Rubin figure reversals in the 1 1/2-min. test periods. Perceptual reversals were unrelated to the occurrence of eye movements but appear possibly to be related to the perceived tridimensionality of the figures.


Movements while driving cars around curves. The eye fixations of 5 experienced and 4 inexperienced car drivers were analyzed while driving curves to the left and to the right. For experienced drivers in a curve to the left the mean duration of eye fixations was longer and the amplitude of the eye movements greater than in a curve to the right. No such difference was observed in inexperienced drivers who manifested neither uniformity within the same curves nor differentiation between the two types of curves. Mean duration of eye fixations of experienced subjects was shorter while driving in a curve to right, but their amplitude of eye movement was greater in a curve to left than those of inexperienced drivers. In Esp. 2, it was pointed out that there is already a change in the pattern of eye movements prior to entering a curve. Upon approaching the curve the mean duration of eye fixation decreased, and the fixations were mainly shifted toward the future driving path. Results are interpreted in terms of the adequacy of the eye fixations (supposedly influenced by prior long-term learning) for information at near distance for vehicle control and at longer distances for setting proprioceptive forward programs for possible future sensomotoric activity.


Adaptation level and retroactive interference in motor short-term memory. 5 groups of 10 subjects were required to make and recall a linear self-generated arm-positioning movement. 4 of the groups made and recalled 4 interpolated self-generated positioning movements before the recall of the criterion was attempted. The lengths of the interpolated movements relative to the criterion varied from group to group. For one group all interpolated movements were longer, for another they were all shorter, and two groups produced alternating shorter and longer movements. Results indicated a significant difference in percentage algebraic error at recall of the criterion movement between the groups experiencing longer and experiencing shorter interpolated movements. The evidence is suggestive of two components in retroactive design studies, interference and adaptation level.


Relation of the Aubert-Foerster phenomenon to manifest anxiety. The relation of the increase in distance to narrowing of the visual angle was investigated with 20 subjects in high and low anxiety states. Stimulu were introduced from the periphery, and readings were taken at the limits of sharp perception of figures. The investigation partially confirmed that increase in distance resulted in narrowing of the visual field for the group low in anxiety. However, the visual angles were greater for the group high in anxiety.


Reaction time in simultaneous motions.

Reaction time in simultaneous motions. EMG-RTs of biceps and triceps brachii muscles were measured in 3 different tasks: isolated motions, flexion or extension of either forearm; bilateral symmetrical motions, flexion or extension of both forearms; bilateral opposite motions, flexion of a forearm and extension of the other. EMG-RTs of opposite motions were slower than those of isolated and symmetrical motions, EMG-RTs of symmetrical motions were nearly equivalent to those of isolated motions. Simplicity and complexity of simultaneous motions are discussed.


Maintenance of vigilance by non-task-related stimulation in the monitoring environment. The effects of non-task-related stimulation on the performance of a simple visual vigilance task were investigated. 40 subjects monitored a stimulated CRT display for two 90-min sessions. The independent variables were variable vs constant intensity lighting and variable vs constant intensity noise. Probability of detection was not significantly different for the noise conditions; however, probability of detection was significantly higher under variable than under constant intensity lighting.


Perception of horizontality by male and female college students. Understanding of the principle of horizontality was tested by having 314 university students draw the water surface on pictures of tilted bottles. Adults appear to have difficulty with this task and females performed much more poorly than males.


Subjective and objective symmetry in perception of form. A new quantitative measure of the physical symmetry of 2-dimensional shapes is proposed which relates it to the proportion of translational and rotational (TR) overlap between a figure and its mirror image. Category ratings of the apparent vertical symmetry of distorted diamond figures correlate highly with this measure while it is also an important contributor in the prediction of the apparent symmetry and geometricity of random polygons.


Mode of input in long-term recognition.

Mode of input in long-term recognition. Recent research by Garabedian, Yekovich, Sherman, and Dean has demonstrated that recognition from long-term memory was superior for words presented visually over those presented auditorily. Because their results could have been influenced by the salience of the projected visual items, the present investigation attempted to eliminate the possible visual bias. 16 undergraduates were presented a list of nouns of mixed input modality and were tested 6 min. later for incidental recognition of input mode. The present data corroborated findings by Garabedian, et al. who postulated that subjects use some form of stored visual information when identifying the input mode of words.


Components of asymmetrical visual encoding of geometrically transformed scripts. Austrian and Israeli subjects were presented tachistoscopically with geometrically transformed numbers, nonsense syllables in Latin letters and Hebrew words (only the Israeli). Opposite reading and writing habits and different hand dominance were used as experimental variables. Criteria for evaluating the data were scanning pattern (voluntary preferred reading direction) and reading performance. A difference in reading pattern was found between Austrian right- and left-handed subjects but no difference in their reading performance. Also between Austrian and Israeli right-handed subjects a difference in the reading pattern appeared as well as in reading performance. Furthermore, the scanning pattern used by Austrian right-handed subjects in reading geometrically transformed numbers was different from their pattern in reading syllables. Distinguished were two sources of asymmetries, an intrinsic in visual mechanisms and a structural one in the stimulus itself.


Background Interference Procedure and discriminant function analysis in predicting clinically determined categories of learning disability. There is a need to determine the extent to which the "Background Interference Procedure" as an adjunct to the Bender-Gestalt can account for criterion variance beyond that level predicted by an optimal battery. Discriminant functions empirically classified subjects into clinical categories of learning disability. A reduced battery of intellective and visual-motor predictors generated two significant functions, accounting for 91% of the variance. The first dimension reflected over-all intellectual functioning, the second, psychomotor skills. Empirical classification accurately categorized 71% of all subjects across five criterion groups. The functions efficiently separated the criteria, but the six Background Interference Procedure predictor variables did not improve prediction. Implications include using the Background Interference Procedure for early screening of learning disabilities and employing discriminant functions for data reduction and construct validation of teachers' and judges' ratings.


Originality and perceptual set: comparative study of Hungarians and Americans. 208 Hungarian and 200 American college adults were administered Sounds and Images. The criterion for breaking away from perceptual set was the production of non-sound images given sound stimuli. In response to four sounds presented three times, the greatest number of non-sound images was produced to the second and fourth sound stimuli by all subjects; Hungarians produced more non-sound images to the second and Americans to the fourth stimulus. Further, Americans produced a significantly greater number of non-sound images than Hungarians.


Effect of weight and sex on perception of line length. 56 obese and 103 normal-weight college students were asked to make line-length estimations of lines on either a light or dark background. Analysis of the results showed significant interactions between weight and contrast and sex and contrast, with the line estimations by women and normal weight individuals being more dependent on the contrast.


Time estimation by hyperactive and normal children. In two studies [a pilot (12 7- to 10-yr.-olds) and a main study (100 8- to 12-yr.-olds)] hyperactive and normal children were compared on the ability to estimate time intervals ranging from 7 to 60 sec. The differences between estimated and elapsed time were larger for hyperactives than for normals, with the differences between the groups increasing with the length of the interval to be estimated.


A personal construct approach to perception of disclosure targets. Investigating the perception of targets for self-disclosure from the perspective of the psychology of personal constructs, it was predicted that respondents from a mixed-nationality group would (a) characterize friends more than acquaintances in terms of 'superordinate' personality-descriptive dimensions, (b) 'differentiate' friends more than acquaintances by extensive application of constructs to them, and (c) 'polarize' targets for high disclosure by construing them sharply and meaningfully in terms of personally significant dimensions of meaning. All predictions received significant support for 34 college students (Mdnage 22 yr.) who responded in writing to a questionnaire. The results suggest the fruitfulness of further examining self-disclosure and friendship formation from a vantage point which emphasizes the perceptual and interpretive framework of an adult person.


Novelty-seeking, fantasy, and sensitization in chronic insomniacs. 13 chronic primary insomniacs and a matched group of normal sleepers were studied in terms of their level of novelty-seeking, ability to fantasize, and cognitive rumination. All-night electroencephalographic patterns confirmed insomniac-control sleep differences. Chronic insomniacs differed from normal sleepers on a measure of cognitive activity as a defense pattern (Byrne's Repression-Sensitization Scale) but did not differ on measures of need for cognitive stimulation (Pearson's Internal and External Cognition Scales), ability to fantasize (Betts' imagery task), or preference for fantasy (Pearson's Internal and External Sensation Scales).


Ability factors in motor learning.

Ability factors in motor learning. Research dealing with the role of basic ability factors in motor learning has been characterized by an ever increasing realization of the high degree of task specificity associated with the acquisition of motor skills. Although various theoretical arguments have been offered to account for the changing factor structure of abilities which apparently accompanies increase in proficiency in motor performance, such theories have, by and large, ignored the role of information-processing models, as well as factors pertaining to human neurological organization. Theoretical positions and empirical research concerning the role of ability factors in motor learning are discussed and analyzed in the light of the limitations imposed by factors of task taxonomy.


Two-pulse temporal resolution threshold in the peripheral visual field. Using a 700-nm light-emitting diode, the minimum inter-pulse interval between two successively flashing pulses presented to 21 retinal loci along horizontal and vertical meridian were measured. The results showed inter-pulse interval changed as a W-shaped function of eccentricity on both meridians.


Field articulation and predictive judgments: an exploratory study. The relationship of differences in accuracy between men and women in interpersonal predictive judgments to those reported in field articulation research was explored. Field-dependent (ns = 14,12) and field-independent (ns = 21,12) men and women (ns = 35, 24) were tested for accuracy of predictive judgments. No statistically significant differences were found between thses undergraduate field-dependent and field-independent judges; however, under the field-independent condition, a cell-by-cell examination suggests greater accuracy. There were no significant differences in accuracy of prediction between male and female judges, but statistically significant differences in accuracy scores were found when the person whose behavior was being predicted was female as opposed to male.


Analysis of processing demands in partial report. Processing demands in the Sperling (1960) whole- and partial-report tasks were evaluated with the simple reaction-time probe procedure. 6 subjects responded to a buzzer probe presented at various temporal locations in the processing interval associated with performance in whole or partial report. The results showed relative increases in processing demands in partial report in the temporal vicinity (+/- 200 msec.) of the delivery of the auditory indicator cue as indicated by increases in probe reaction-time. Furthermore, reacting to the probe during this interval interfered with partial-report performance. This mutual interference was not detected when whole report was performed concurrently with the probe task. The results were interpreted in terms of an analysis of central processing capacity.


Changes in GSR and heart rate during listening to tones, words, and nonsense syllables. In order to compare the habituation of orienting responses to tones, words, and nonsense syllables, GSR and heart rate were recorded following mass (habituation) and discrete presentations of the stimuli. Each of 36 10-yr.-old boys and 36 male undergraduates listened to two presentations of a tone (word and nonsense syllable in a random order) under discrete condition in contrast to 40 presentations under mass condition. Immediately following 2 or 40 presentations, habituation of orienting response was measured while five instances of the stimulus were slowly presented. Results indicated (i) habituation of GSR but not of heart rate, (ii) nonsense syllables evoked the strongest GSRs and heart-rate changes among the three stimuli, and (iii) children showed stronger reactions than the adults in some measure of GSR and heart rate. These results were discussed in terms of the theory of Sokolov.


Use of distance and location in short-term motor memory. A retroactive interference paradigm was used to determine whether kinesthetic distance, location, or distance and location cues are used at recall of a blind, simple linear movement. Students performed interpolated movements which varied distance and location cues separately or jointly. Relative to a rest condition, joint distance and location interpolation produced significant interference while no significant interference was found for interpolation of individual distance or location. The results were interpreted as supporting the involvement of multiple kinesthetic cues in the establishment of memorial representations of motor movements.


Cross-national comparisons of projected social distances from mental patient-related stimuli. A figure-placement procedure was used to assess attitudes toward mental patients and related items by measuring projected social distances which students from Australia, Great Britain, South Africa, and the U.S.A. perceived between themselves and several pertinent stimuli. While all male students responded similarly to all items, the responses of the female students were only similar on the neutral items and showed significant differences on the mental patient-related items. However, for all students the items "Mental Hospital," "Male," and "Female Mental Patient" were always most distant. The power of attraction to the opposite sex for most male students was interesting; despite differences between groups, none reflected such attraction for the "Female Mental Patient."


Selective attention in a multiple-response reaction-time task. Consistently higher correlations (.74 to .89) were noted between hand and foot RT of 7 subjects assigned to a contralateral group than for another 7 assigned to an ipsilateral group (rs = .80 to .51). Subjects button pressed to onset of a light.


Orientation bias in the Rod-and-Frame Test. Rod-and-frame data for a sample of 21 males and 25 females showed marked asymmetries in the magnitudes of the frame effects for left and right frame-tilt. These asymmetries are interpreted as an underlying tendency for individuals to set the rod systematically clockwise or counterclockwise of true vertical, independently of the influence of the visible frame, and the term "orientation bias" is used to describe this tendency. 14 males and 14 females demonstrated orientation biases significantly different from zero. In group comparisons males differed significantly from females, the mean bias for males as a group lying significantly left (counterclockwise) of vertical while the mean for females as a group did not differ from zero. Implications for conventional measures of field dependence are discussed. Possible diagnostic significance of orientation performance for brain injury is also considered, and an unusual individual performance is described.


An experimental reunion of psychoanalytic theory with perceptual vigilance and defense. Reply to Blum. Methodological criticisms are answered, and additional reasons for questioning Blum's theory and method are offered.


Childhood depression: an explanation of a behavior disorder of children. Depression is an important cause of behavioral disturbances in children. Childhood depression is an episodic disorder characterized by 10 criteria, symptoms of dysphoric mood, self-deprecatory ideation, agitation, loss of energy, reduced socialization, altered school performance, altered school attitude, sleep disturbance, appetite disturbance, and somatic compliants persisting for at least one month. Diagnosis and appropriate treatment can successfully alleviate the symptomatology in depressed children.


Effect of verbal and nonverbal short-term memory coding with normal and retarded children. 20 retarded children (CA 11.7 yr.), matched with 20 normal ones, were assigned to verbal or nonverbal stimulus conditions. Pairs of 8-point random shapes were shown as styrofoam objects or drawings. d' measures for adjacent positions showed better recall for verbal coding and three-dimensional stimuli. Serial position effects were noted. Coding and dimensionality interacted.


Noise and attention span.

Noise and attention span. The effect of emotional arousal, as induced by broad-band noise, upon breadth of attention was investigated. Four intensity levels were employed (no noise, 75 db, 85 db, and 100 db). Two of the tasks, Stroop color-word test, rod-and-frame test, required narrowed attention and the third, Tsai-Partington pathways test, required broader attention. Arousal level did not significantly affect performance on the rod-and-frame test or the pathways test, althouth in the latter a curvilinear trend was suggested. A complex relationship between arousal level and Stroop performance was obtained; performance of the 85-db group was superior to that of other groups, which did not differ significantly from one another. Results were discussed in terms of Easterbrook's (1959) arousal hypothesis.


Hemispheric asymmetry in making absolute judgments of monaurally presented pure tones. Some recent studies have suggested that hemispheric asymmetry may be related to the quantity of information contained in a stimulus. To test this possibility, 20 subjects were given an auditory absolute-judgment task in which they were required to identify 3, 5, or 7 pure tones recorded on a tape. The presentation was monaural, and headphone placement was randomly alternated across subjects. The left ear showed a statistically significant advantage tones. The result is discussed in terms of previous work on auditory channel-capacity and the desirability of using an absolute-judgment paradigm to study hemispheric asymmetry for other kinds of stimuli is indicated.


Relationship of field-dependence--independence to posture and judgment of time duration. Relationships between 84 field-dependent subjects and 84 field-independent subjects, posture, and judgment of duration of time were examined. An analysis of variance yielded no significant difference between the two groups of subjects in the judgment of a 40-sec. interval while in the standing, sitting or horizontal postures or in the comparison of the three postures. Mean judgments of durations became larger from standing to sitting to horizontal postures and over trials for the three postures. It was suggested that the lengthening of the judgment of the 40-sec. interval could be related to a decrease in kinesthetic stimulation with a resultant increase in muscular relaxation which led to a decrease in vigilance.


Comparison of external and internal individuals' ability to perceive viewpoints of others. College undergraduates scoring as internal (6 male and 42 female) and external (14 male and 41 female) on locus of control on Rotter's I-E scale were administered a modified version of Laurendeau and Pinard's Coordination of Perspectives Test. Internals were superior to externals in ability to perceive the viewpoints of others in regard to object arrangements.


Transformation of stimulus information from very short-term memory. Observers were shown a simple stimulus pattern, a mask pattern, and a test pattern on each trial. Different types of test patterns were used to assess transformations of material from very short-term memory. The durations of the initial stimulus pattern and the mask pattern were also varied. Significant differences in average response data were found between types of test pattern over exposure durations; however, sensitivity measures showed minimal differences between types of test pattern. This suggested some distinctions between input processing and response selection in the paradigm. Selective feature analysis seems to be a characteristic of response selection.


Selective attention in fast and slow learners. 64 children aged 8 yr. were trained on a tactile simultaneous discrimination task. Selective attention was measured in terms of percentage contact time per trial to the relevant dimension. Inter- and intra-couplings per trial were also recorded. Multivariate analyses were carried out to examine the role of component factor scores, obtained from a component curve analysis of the percentage touching time per trial, and selected cognitive variables in differentiating between the fast and slow learner groups. Percentage touching time factor scores and a memory factor were significant, but there was no significant difference between the groups in the number of couplings made. As learning progressed the number of inter- and intra-couplings decreased.


Judged brightness as a function of dark, intermediate, and light adaptation. 33 subjects were randomly assigned to a dark-, intermediate-, or light-adapted condition. They were then presented with two lighted surfaces of different brightness and asked to adjust the comparison stimulus to apparent equality with that of the standard stimulus. Results showed a significant interaction between adaptation level and stimulus intensity. The dark-adapted group showed greater accuracy at low stimulus intensities than at medium or high, while the intermediate- and light-adapted groups were more accurate in judging brightness at medium and high stimulus intensities. Differences in perceived brightness were cited as contributing to this finding.


Individual differences in responses to induced perceptual conflict. Examining reactions to experimentally induced perceptual conflict may be a useful method of studying perceptual/cognitive disorganization and adaptive features of personality. Changes in field-dependence (rod-and frame test) were assessed in introverted and extraverted subjects (17-19 yr.) who were exposed to inversion of the visual field. Tolerance of ambiguity was also assessed. There were no significant differences between introverts (n = 20) and extraverts (n = 16) on preinversion measures of field-dependence. However, extraverts became more field-dependent on first exposure to inversion and maintained a generally higher level of field-dependence. Introverts became more field-dependent only after walking in the inverted visual condition and after a major change in exposure conditions. No significant differences in post-inversion levels of field-dependence were observed.


Perception of exertion in the elderly, effects of aging, mode of exercise and physical training. Ratings of perceived exertion by the Borg psychophysical scale have been made on 26 men and 30 women aged 60 to 70 yr. All were volercise lines relating the ratings of exertion to heart rate were closely similar in men and women, scores at all heart rates being 2 or 3 units higher than in young adults. A brief progressive exercise protocol on the treadmill yielded somewhat lower ratings than bicycle ergometer work, the discrepancy being marked in women. At any given oxygen intake, ratings were higher for females than malesy nd higher for old than young subjects. However, when oxygen intake was expressed as a percentage of the directly measured maximum oxygen intake, scores became independent of sex and age. A 35-wk. period of conditioning substantially reduced heart rates but had little effect on the perception of effort at a given work load. This unexpected result may reflect a closer approximation of core and skin temperatures with reduction of sub-cutaneous fat.


The detection of line segments.

The detection of line segments. Many simple cells of the visual cortex have long narrow receptive fields, which are strongly excited by lines oriented along their long axis. In the present psychophysical analysis, we assume that there are similar independent 'subunits' which contribute, by probability summation, to the detection of a line. If a line segment is shorter than the subunit length, then extending the line length will increase the sensitivity of all the subunits affected by the line, and a relatively large increase in visual sensitivity will occur, corresponding to this 'physiological summation' within subunits. However, for a line segment which is much longer than the subunit length, the main effect of extending line length is to stimulate more subunits, resulting in a relatively small increase in sensitivity owing to probability summation. Thus a study of sensitivity (reciprocal threshold) as a function of line length may be used to test the subunit model and to estimate the subunit length. Here we use a quantitative model to demonstrate that sensitivity/line length data may be well fitted, assuming independent subunits having a constant length of 8-6'--in good agreement with the length of Adrews' "ff" units.


Auditory-visual interactions and the correspondence between perceived auditory space and perceived visual space. Changes in the physical rate of a clicking or fluttering sound caused changes in the rate at which a simultaneously viewed light appears to flicker, even though the physical flicker rate remains constant. Perceived flicker rate increases in response to a rate of change of flicker frequency, and this auditory 'driving' does not depend on whether the auditory and visual sources have the same location. Visual evoked potentials do not correlate with 'driving'. Thus, the effect of auditory flutter upon perceived visual frequency is not due to the properties of Morrell-type bimodal neurons, nor does it reflect the activities of neurons responsible for maintaining correspondence between perceived auditory space and perceived visual space. The effect is possibly due to modification of a subjective criterion rather than, as previously suggested, to the entrainment or time-locking of physiological signals in the visual pathway.


Binocular convergence as a determinant of reaching behavior in infancy. Reaching behavior in eighteen- to thirty-two-week-old infants was studied as a function of binocular convergence. The infant looked at the object to be reached for through prism arrangements which changed convergence only. The reaches obtained were nearly always directed at the virtual object defined by convergence. Corrections of the reaches, if any, were made rather late and often not before the hand arrived at the place of the virtual object.


Stability of Wilkinson's linear model of prism adaptation over time for various targets. Prism adaptation as measured by negative aftereffects (NA), proprioceptive shifts (PS), and visual shifts (VS) was assessed as a function of amount of exposure time and target specificity, whether an exposure and a test target background were the same or different, to determine the validity of Wilkinson's linear model (NA = PS + VS). With few exceptions the model was found to hold well up to 40 min of prism viewing regardless of type of exposure background. In addition target specificity affected magnitude of the NA component of adapation but not the PS and the VS components.


Spatial-frequency adaptation and afterimages. The contribution of afterimages to spatial-frequence adaptation was studied by comparing a number of different fixation paradigms designed to maximize of minimize afterimages. While it is clear that adaptation is not an afterimage artifact, nevertheless afterimages are produced at low spatial frequencies and can considerably distort the results of adaptation experiments unless steps are taken to eliminate them.


Existence and implications of a tilted binocular disparity space. The existence of a tilted binocular disparity space was experimentally established. The results of the experiment showed that a texture surface which under binocular viewing appears to be oriented vertically and perpendicular to the line of sight in fact is tilted such that the portions of the texture surface above and below fixation incline toward and away from the observer, respectively. Under monocular viewing such a discrepancy between apparent and objective vertical tilt is not observed. This suggests that under binocular viewing the cortical representations of the upper and lower visual hemifields are biased toward uncrossed and crossed disparities, respectively. The tilted binocular disparity space is explained in terms of an experientially induced disparity gradient effected during development of the binocular system.


The effects of temporal modulation on the oblique effect in humans. Contrast thresholds were measured for vertical and oblique grating patterns. As shown previously, at higher spatial frequencies sensitivity for vertical is much greater than that for oblique. Present results show that this difference is sensitivity is found only with low rates of temporal modulation; with higher temporal frequencies this orientation difference disappears. Moreover, when contrast thresholds are based on the perception of flicker, vertical and oblique sensitivities are essentially identical even at low flicker rates. These results indicate that the so-called "oblique effect' is confined to mechanisms with poor temporal resulving power, probably the sustained channels which have been studied psychophysically and neurophysiologically by others.


Measurement of visual preferences in cats. A technique is described for measuring visual preferences in cats. The method involves a self-presentation paradigm, but provides strict control of the visual field and orientation of contours in the field. Two procedures are presented: a single-choice design and a multiple-choice design, both of which use duration of self-produced exposure as the dependent measure. Although both procedures may serve as indices of preference order, the multiple-choice method is preferable for measuring preference strength. The application of the technique as a behaviorual index of the effects of early environmental manipulation is suggested. Preliminary data from two normal cats indicate that, although homogeneous illumination is reinforcing, the presence of features, especially oriented contours, appears to increase the 'interest' value of the presentation.


A behavioural technique for the rapid assessment of the visual capabilities of kittens. A behavioural method is described for the measurement of various visual spatial acuities in kittens as young as thirty days of age. Expamples are given of applications of the technique to measurement of the visual acuity for gratings in normal kittens as well as to studies of the time course of behavioural recovery from the effects of early monocular visual deprivation.


Global processes in stereopsis: some comments on Ramachandran and Nelson (1976). The use of the term 'global in the context of stereopsis is discussed. It is concluded that different meanings of this term need to be kept carefully distinguished at all times. The discussion centres around a series of demonstrations introduced by Ramachandran and Nelson, and interpretations are offered for these demonstrations in terms of spatial-frequency-tuned stereopsis channels.


Judgemental criteria and the perception of structure. We repudiate Dodwell's claim that his relational model is predictively more accurate than our Garner-based treatment of AT. We claim instead, that his case is based on a fundamental misunderstanding of the essentials of Garner's complex thesis, together with a misreading of our own report. Rather than accept his notion of a single continuum of salience as providing for the genesis of structure, we argue instead that his 'single' continuum' compounds and confounds at least two continua which may be understood only where the criteria of judgement are made explicit.


A halo visual illusion.

A halo visual illusion. A visual illusion consisting of transparent halos extending beyond the boundaries of rotating discs is reported. The effect can be obtained by rotating a variety of black-and-white discs at moderate speeds. It is not due solely to rods, as opposed to cones, and does not appear to be explainable in terms of intermittent stimulation of portions of visual fields of fixed visual angle.


[Problems in practical management of essential hypertension]. A study of 100 men with arterial hypertension showed that: 1) hypertension was predominantly moderate with 14% index of placebo reactivity; 2) only 3 patients had a surgically curable etiologic factor; 3) frequent associated findings were hereditary factors (60%), overweight and metabolic disorders (30 to 40%). Such results suggest that: a) hypertension could be treated, in the majority of patients, without preliminary etiologic investigations and, b) non invasive hemodynamics techniques are required to evaluate arterial and cardiac lesions which are the dominant factors in the prognosis.


[Clinical and diabetic research of the artificial extracorporeal pancreas]. With the external artificial pancreas used by the authors, blood glucose is continuously controlled by insulin delivered through an IV infusion and adjusted to two parameters: instantaneous blood glucose levels and increasing or decreasing patterns of blood glucose. The artificial pancreas can be used to treat acute diabetic disorders an to evaluate insulin needs. Furthermore, exogenous insulin homeostasis can be studied: the delay to reach an insulin effect is 18 mm +/- 2 and it remains within 28 mm +/- 2 after the infusion has been stopped; fractional insulin needs are evaluated. From these data, it appears that the efficiency of exogenous insulin exhibits a circadian rhythm.


[Congenital pulmonary lymphangiectasis. One new case with complete blockage of the return venous pulmonary circulation and marked interstitial emphysema]. In this unusual case of bilateral congenital pulmonary lymphangiectasia with complete block of pulmonary venous return, the radiological diagnosis was made difficult by the association of the lymphangiectasia with bilateral interstitial emphysema. Routine dissection of the heart, considered to be normal since the cardio-thoracic index was only 0.45, relealed the true cause of death. The heart was the site of extreme hypoplasia of the left heart with complete mitral and aortic atresia. The ostium secundum being completely closed, the left atrium, after receiving the pulmonary veins, was completely blocked. It communicated neither with the right atrium, nor with the non-existent left ventricule.


[Automated evaluation and analysis of isotopic heart function tests with minimal cardiac transit times]. The clinical evaluation of cardiac function by non-invasive means with the help of radioactive isotopes registering minimal cardiac transit times (MTTs) is increasingly employed in routine diagnosis. In order to economise on work load and time expenditure and for the purpose of an objective and complete evaluation of data, automatic data processing is desirable. This paper describes a program that consists of 4 sections: 1. examination 2. generation of data 3. processing of data 4. evaluation of data. The program permits a nearly total automated data generation, analysis, calculation, classification, final clinical evaluation and the automated production of a medical report. This greatly reduces the time spent per examination to approximately 5 minutes. The automated evaluation of the data is based on clinical experience with  approximately 3.500 measurements in patients with the most frequent cardiac diseases. The result is an objective statement of causes of MTT changes and is highly useful for medical routine application. The control and the final inclusion of the findings into the spectrum of other clinical results remains the subject of the physician's judgement. The advantage of the method is the evaluation of all cardiac segments. This pertains to the evaluation of both atria and both ventricles, as well as of the entire central circulation with and without participation of the lung.


A simple and rapid non-invasive radioisotope method to determine ventricular ejection fractions and cardiopulmonary transit times. Ejection fractions and cardiopulmonary transit times were measured in 20 hospital patients by means of intravenously injected 99mTc-radiocardiography. Time activity curves from the regions of the whole heart, superior vena cava, right atrium, right ventricle, right lung, left atrium and left ventricle were drawn and analyzed by using the modified gamma function fitting method. The comparison between the ejection fractions determined from the whole heart curves and those from the ventricular curves shows a correlation coefficient of 0.93 for the right ventricle and of 0.90 for the left, although there was a systematic difference between the determinations. The analysis of the single ventricular curves gave about 10% higher values than those obtained from the whole heart curves. The cardiopulmonary parameters measured from the whole heart curves for 16 normal subjects the following results gave: right ventricular ejection fraction=0.57+/-0.08 left ventricular ejection fraction=0.62+/-0.08 pulmonary mean transit time=6.1+/-1.1 heart-beats intracardiac mean transit time=10.5+/-1.8 heart-beats right/left ventricular volume=1.10+/-0.09 These values agree closely with the data accumulated using more elaborate methods. The method presented here is simple to perform, it is non-invasive, time-saving, inexpensive, easy to analyze and suitable for exercising subjects and for bed-side measurements. Data assembly and analysis are easily automated so that results are obtainable immediately after measurements.


[Negative and positive imaging of myocardial infarct]. In 41 patients myocardial scintigrams were performed using 2 mCi 201T1 and 15 mCi 99mTc-diphosphate. 9 healthy persons showed no myocardial imaging with 99mTc-diphosphate and normal 201T1 scintigrams. Transmural infarctions could be documented by both isotopes, excepted lateral and apical infarctions which could only be shown by means of 99mTc-diphosphate. Non-transmural infarctions could not be identified, myocardial scars however--as was to be expected--showed only activity defects within the 201T1 scintigrams without corresponding images in the 99mTc-diphosphate scans. One patient with severe coronary heart disease showed diffuse diphosphate uptake all over the myocardium with  normal 201T1 scintigram. The combined myocardial scintigraphy provides a better diagnosis, enabling an improved localisation of infarction and avoiding misinterpretations.


Plasma renin activity in patients with ischaemic heart disease. Plasma renin activity (PRA) stimulated by upright posture was measured in  300 men aged 45-64 years using a radioimmunoassay of angiotensin-I. The examined subjects were normotensive or patients with benign essential hypertension and were divided into 6 groups according to the absence of manifest atherosclerosis, the presence of definite angina pectoris or a history of myocardial infarction. Each group contained 50 unselected subjects, with a comparable mean age. Significant differences in mean PRA were found between corresponding groups of hypertensives and normotensives, the values in hypertensives being lower. The percentage of low renin values was higher in hypertensives with ischaemic heart disease than in other groups. It is suggested that this finding might be explained by functional disturbances in the kidneys in hypertensives with ischaemic heart disease.


Comparison of 131I-tetracycline and 67Ga-citrate as abscess localizing agents. Previous studies have shown that radiolabeled tetracyclines tend to accumulate in infarcts and necrotic tumors. These results suggested that radiolabeled tetracyclines might also accumulate in necrotic abscesses or areas of inflammation. In order to develop a better abscess scanning agent, we compared the efficiency of 131I-tetracycline with 67Ga-citrate in labeling experimentally induced staphylococcal aureus abscesses in rats 24 and 72 hours after injection. In addition to evaluating 131I-tetracycline as an abscess scanning agent, we hoped to obtain data which might clarify the controversy regarding early versus late gallium scanning in suspected infection. 131I-tetracycline was chosen over 99mTc-tetracycline because the longer half-life of 131I would allow 72 hour imaging. Absolute concentrations of gallium in the abscess contents and in the surrounding areas of inflammation were significantly greater than the concentration of 131I-tetracycline at both 24 and 72 hours. With the exception of blood, muscle, and bone, the abscess-to-tissue activity ratios for gallium and 131I-tetracycline were similar; however, the ratio of gallium activity in the inflammed tissue to other tissues was greater than that of 131I-tetracycline for every tissue examined at both time periods. The data suggest that 131I-tetracycline has little potential as a general abscess scanning agent. The gallium tissue concentrations and tissue ratios suggest that abscesses which can be imaged at 72 hours can probably be imaged at 24 hours, thus allowing earlier initiation of appropriate therapy. Because of the higher lesion-to-blood ratio at 72 hours, a 72-hour scan would appear to be indicated before a scan is interpreted as normal.


[Performance and clinical usefulness of the 14CO2-glycocholate-breath-test]. 14C-glycocholate breath-tests were performed in 22 clinical patients without gastointestinal disorders, in 11 cases with M. Crohn of the ileum and in 8 patients, in whom an intestinal overgrowth with bacteria was suspected. Additional to the usual discontinuous measurement of the specific activity of 14CO2 the exhaled amount of CO2 and 14CO2 and 14C-serum activity were determined. No advantage was found in the determination of the latter; for 1. discontinuous measurement of the specific activity of 14CO2 was sufficient for detecting disturbed enterohepatic bile-salt circulation; and 2. measurement of 14C-serum-activity or 14C-activity in cholic acids or protein were of no help in differentiating between bacterial overgrowth and diseases of the ileum. There remained doubts regarding the clinical usefulness of the test. Low specificity and many positive tests in patients without corresponding symptoms require that therapeutical procedures in such patients are initiated with some reserve.


A new radiopharmaceutical for gallbladder studies: 99mTc-Sn-LIDA complex. A simple method for the preparation of 99mTc-Sn-LIDA complex is described. Organ distribution and blood clearance studies in animals are reported. This complex has also been used successfully in more than 50 patients for assessing gallbladder function.


As bone marrow scintigraphy in patients treated with chemotherapy and/or radiotherapy. Bone marrow scintigraphy after the application of indium 111In was compared with the results of bone marrow puncture in 18 patients with Hodgkin's disease treated with radiotherapy and/or chemotherapy. Agreement was found in 85% of the cases. When the results of bone marrow puncture were compared with the general state of haemopoiesis estimated scintigraphically agreement was found in only 65%. Bone marrow scintigraphy gives a more detailed knowledge of the general state of haemopoiesis and serves as a guide for the control of therapy with cytostatics and/or irradiation.


Structural abnormalities in COPD.

Structural abnormalities in COPD. Emphysema is classified by macroscopic examination of inflated lung sections as proximal acinar, panacinar, distal acinar, and/or paracicatricial. Alveolar fenestrations, the earliest morphologic expression of alveolar wall damage, may be defined with the aid of a dissecting or scanning electron microscope. In bronchial obstructive disease, lesions of both the large and small airways contribute to respiratory impairment. The structural changes of chronic bronchitis are, for practical purposes, always associated with severe emphysematous disease. Thus, it is mandatory for the morphologist who evaluates lung specimens for COPD to pay detailed attention to the acinar pattern of destruction of inflated emphysematous lungs as well as to the gross and microscopic pathology of large and small airways. These structural changes should then be correlated with clinical parameters relative to age, sex, air pollutants, cigarette smoking allergy, and hereditary deficiencies of antiproteolytic enzymes.


Air pollution and COPD.

Air pollution and COPD. Air pollution referable to increased ambient levels of sulfur dioxide and suspended particulates is associated with increased episodes of acute bronchitis and is also causally related to some cases of chronic bronchitis. Oxidant air pollution is associated with abnormalities of pulmonary function in children and is a major contributory factor in COP, especially bronchitis, in some areas of the United States. The relationship of nitrogen dioxide atmospheric contamination to COPD is still controversial. In our opinion, the epidemiologic studies conducted to date have been inadequate and further elucidation is indicated. Cadmium fumes and compounds have been found to be instrumental in the development of some cases of chronic bronchitis and emphysema in Sweden. This association is unproved in the United States and warrants a thorough clinical and epidemiologic evaluation.


Management of COPD: a physiologic approach. The main goal of therapy for COPD is to improve the patient's quality of life. A rational approach to therapy requires improvement in pulmonary gas exchange by identification of the type or types of COPD present and tailoring of the therapeutic regimen to the severity and mechanism of obstruction. Other measures can be used to improve tissue oxygenation, including oxygen supplementation, maintenance of cardiac output and tissue perfusion, and reduction of metabolic demands. Complications of COPD are as important as the disease itself in terms of disability and require aggressive therapy.


Pulmonary rehabilitation of the patient with COPD. The basic aims in managing COPD are to minimize hypoxia and to improve the ventilation-perfusion relationship. A progressive daily walking exercise program together with pulmonary physiotherapy, creative or occupational therapy, and respiratory therapy to improve bronchial hygiene is advocated. The main benefits of this program, in addition to improved emotional and sociologic status, are increased exercise tolerance, reduced dyspnea (work of breathing), and reduced oxygen requirements.


Evaluation of the bleeding patient.

Evaluation of the bleeding patient. The evaluation of the bleeding patient starts with the integration of data from the history and physical examination. From this results either one probable explanation that can easily be substatniated by laboratory studies or, as more commonly occurs in practice, several possibilities that are reasonable and must be investigated by more extensive laboratory tests. In either event, the initial laboratory evaluation usually includes examination of the peripheral blood and measurement of the platelet count, bleeding time, prothrombin time, partial thromboplastin time, and thrombin time. More specific laboratory tests are then performed if indicated.


Intravascular coagulation and fibrinolysis. Intravascular coagulation occurs as a sequela of many diverse conditions and may vary greatly in clinical and laboratory manifestations. The essence of the problem is that plasma is converted to serum in the circulation. As a result, both hemorrhagic and thrombotic events may occur. Platelet count and fibrinogen determination are the most important diagnostic tests. If values are abnormal, tests for fibrin (fibrinogen) degradation products are indicated. The first step in management is to identify and attempt to eliminate the underlying cause. Heparin therapy should be considered, particularly when clotting and severe fibrinolysis are both present. Replacement of clotting factors may be considered, but its value is a matter of debate.


Fever of unknown origin: the value of abdominal exploration. The decision to perform exploratory laparatomy in search of the cause of prolonged fever should not be made hastily. The operation is not benign, and before the patient is subjected to it, a meticulous medical evaluation should be made. A number of recently developed diagnostic techniques are invaluable aids to the physician challenged by this diagnostic dilemma.


Fever: genuine or factitious?

Fever: genuine or factitious? Although patients with factitious fever form a small subgroup of all patients investigated for fever of unknown origin, the diagnosis should be kept in mind. If unsuspected, this phenomenon can lead to a multiplicity of laboratory investigations and misuse of hospital beds, as well as to unnecessary risk to the patient.


Managing cerumen impaction.

Managing cerumen impaction. The external auditory canal is self-cleaning. Excessive cerumen accumulation usually results from misguided attempts to remove wax and may go unnoticed until a hearing loss occurs. Mechanical removal of the wax or use of a ceruminolytic agent to soften it is recommended--irrigation may contaminate the middle ear space.


Angioimmunoblastic lymphadenopathy: common symptoms, uncommon diagnosis. After five months of treatment for what was believed to be tuberculosis, a 49-year-old woman had recurrence of high spiking fever, lymphadenopathy, and malaise along with an intermittent maculopapular rash. Other findings were a positive Coombs test, iron deficiency, elevated gamma globulin levels, polyclonal gammopathy, and hepatosplenomegaly. Biopsy of a cervical lymph node revealed an angioblastic pattern consistent with angioimmunoblastic lymphadenopathy. Review of biopsy material obtained six months previously showed the same changes. Antituberculosis therapy was discontinued, and a regimen of prednisone and iron replacement was begun. The patient did well initially; when symptoms returned, they were controlled by adding azathioprine to the regimen for steroid-sparing effect. However, serologic abnormalities returned and within a few months, symptoms exacerbated; despite intensive medical therapy, the patient died. Angioimmunoblastic lymphadenopathy is a recently recognized disorder with a usually progressive course. No treatment has yet been established as effective, and death usually occurs within one year after diagnosis.


Evaluating renal function: current status of clinical tests. Most tests of renal function assess glomerular function, tubular function, or renal plasma flow. Glomerular function should be determined initially by measuring clearance of endogenous creatinine. Tubular function is best determined clinically by measuring urine concentrating ability of the kidney. At present, no test for measuring renal plasma flow is both accurate and readily available.


How food and fluid affect drug absorption: results of initial studies. The rate and extent of absorption of many drugs may be influenced by the presence of food in the gastrointestinal tract and by the volume of fluid ingested with the dose. In most cases, food appears to inhibit or delay drug absorption. Relatively large fluid volume, on the other hand, appears to enhance absorption.


Definition, differentiation, and classification of COPD. The term "COPD" covers a spectrum of diseases with a common denominator, obstruction to airflow on expiration. Chronic asthma, chronic bronchitis, and pulmonary emphysema are the most prevalent conditions. The signs and symptoms of COPD are similar in all entities. Differential diagnosis may be difficult. Early detection of COPD is important, and tests are available for this purpose. For therapeutic and prognostic reasons it is also important to differentiate, wherever possible, which disease entity is predominant in a particular person. This can be done to a high degree by correlating clinical, radiologic, and physiologic findings. The radiologic manifestations of COPD are multiple, varied, and in many instances nonspecific. The primary radiologic feature in COPD is lung hyperinflation. In advanced disease, radiologic changes are diagnostic and correlate well with physiologic and clinical findings. Frequently, however, the chest film is normal even when clinical and physiologic manifestations indicate advanced disease.


Acute renal failure following copper sulphate intoxication. Eleven out of a series of twenty-nine patients (37-9%) with acute copper sulphate poisoning developed acute renal failure. Intravascular haemolysis appeared to be the chief factor responsible for renal lesions in these patients. Histological lesions observed in the kidney varied from those of mild shock to well established acute tubular necrosis. In one case, granulomatous lesions were seen in response to tubulorrhexis. Renal failure was the chief indication for dialysis in ten patients, whereas one patient was dialysed primarily for removal of copper. Notwithstanding the adequate control of uraemia by dialysis, only six of the eleven patients recovered. Septicaemia was responsible for death in three, hepatic failure in one and methaemoglobinaemia in another. It is postulated that release of copper from haemolysed red cells during acute haemolytic episodes may initiate, or contribute to, the development of renal damage.