Dominant slowly progressive macular dystrophy. Twenty-three members of one white family were studied for a new form of dominant slowly progressive macular dystrophy in which visual acuity remained good until the seventh decade. Ten patients had positive signs of this entity. Eight patients had possible early forms. Five had no signs. Several patients had visual acuity fluctuations, documented by their ophthalmologists who saw associated pigment epithelial alterations in some cases. Obvious macular changes included perifoveal pigment epithelial atrophy, posterior pole flecks, and fundus lesions resembling an atrophic form of senile macular degeneration. We suggest a possible hereditary predisposition to senile macular degeneration in our patients.


Relationship of iris nevi to malignant melanoma of the uvea. To test the hypothesis that there is an increased number of iris nevi in eyes with a posterior uveal melanoma, we performed slit-lamp examinations on 50 patients with choroidal or ciliary body melanomas to note the presence and number of iris nevi in both eyes. We compared these patients to 50 age-matched control subjects who had cataracts. No relationship was found between the number of iris nevi and posterior uveal melanoma.


Giant papillary conjunctivitis in contact lens wearers. A syndrome that occurred in both hard and soft contact lens wearers was characterized by increased mucus, itching, decreased lens tolerance, and giant papillae in the upper tarsal conjunctiva. It developed in as few as three weeks with soft lens wearers but also occurred after months or even years of successful wear. The histology was characterized by basophils, eosinophils, and mast cells in the epithelium, and these cells as well as increased numbers of lymphocytes, plasma cells, and polymorphonuclear leukocytes in the stroma. The syndrome may be immunologic in origin with deposits on the lenses as the antigen, and the syndrome may be a major cause of difficulty in wearing contact lenses once they have been successfully fit.


Familial aniridia with preserved ocular function. Of 76 members of a large pedigree with familial aniridia, 61% of the 38 affected patients had visual acuity of 6/9 (20/30) or better and only 5% had acuity of 6/60 (20/200) or worse. Cataracts were present in 18% of affected patients; glaucoma in 13%; and strabismus in 34%. Sixteen percent of affected patients had strabismic amblyopia. No patient had nystagmus or corneal pannus. The good visual acuity in this family, as compared to that in others, indicates that the absence of iris tissue alone cannot account for the severe visual problems usually associated with aniridia.


A soluble sustained-release ophthalmic delivery unit. Four studies carried out in normal volunteers assessed the characteristics and acceptability of the matrix of a soluble sustained-release delivery system. Fourteen volunteers in the first study received crossover single applications of a rod- and oval-shaped soluble unit at 8 AM. Fifteen normal volunteers in the second study received soluble units at 9 PM in the inferior cul-de-sac. During the crossover phase, the units were placed into the superior cul-de-sac rather than the inferior cul-de-sac. In the third study, 15 normal volunteers received a rod-shaped unit in one eye and an oval-shaped insert in the opposite eye nightly for five successive nights. In Study 4, 24 normal volunteers subdivided into four groups of 12 eyes received an 18-mg rod, 24-mg rod, 18 mg-oval, or 24-mg oval unit at 9 PM. We concluded that the disappearance rate of these soluble units from the conjunctival sac depended on the size rather than shape and was not influenced by sleep. The soluble units were well tolerated.


Vogt-Koyanagi-Harada syndrome.

Vogt-Koyanagi-Harada syndrome. We studied 51 patients who developed Vogt-Koyanagi-Harada (V-K-H) syndrome after corticosteroid therapy. The final visual acuity was better than 6/15 (20/50) in 50%, and less than 6/60 (20/200) in 25% of the patients. The severity and extraocular manifestations of this disease also appeared to be less than observed in patients before the clinical use of corticosteroids. Corticosteroid therapy probably altered the clinical picture in this disease, although other possibilities, including a skewed patient population, may account for these differences.


A histologic study of regional choroidal dystrophy. Light and electron microscopy studies of eyes removed from an 84-year-old man after death indicated a normal optic nerve despite severe peripapillary choroidal atrophy. In the area of atrophy, the choriocapillaris, retinal pigment epithelium, and photoreceptors were absent and there was a marked decrease in choroidal arteries and veins. Bruch's membrane was intact except for several breaks in the peripapillary region. Müller cells, in the region of atrophy, produced an aberrant, thick basement membrane either in the outer layers of the neurosensory retina or directly applied to Bruch's membrane. On the basis of this study, we postulate that the primary abnormality in this disease is of the choroidal vasculature.


Oculomotor disturbances associated with 5-fluorouracil chemotherapy. Two patients treated with 5-fluorouracil (5-FU) for disseminated adenocarcinoma of the colon developed cerebellar dysfunction typical of 5-FU neurotoxicity. The neurotoxicity was associated with oculomotor disturbances expressed primarily as weakness of convergence and divergence. Detailed postmortem examination of one patient revealed no anatomical abnormalities of the central nervous system. The ocular motor disturbances are probably an expression of regional 5-FU neurotoxicity primarily affecting the brain stem.


Corneal opacification occurring after phacoemulsification and phacofragmentation. Four patients developed progressive corneal opacification five to eight months after ultrasonic cataract extraction. Transmission electron microscopy was performed in all patients. Scanning electron microscopy, performed in only one patient, showed radiating folds of Descemet's membrane with pits on its posterior surface as well as focal traumatic disruption probably caused by probe contact. Bullous keratopathy was present in one patient. Two other patients had folds of Descemet's membrane and a thin retrocorneal fibrous layer. All four tumor specimens showed secondary epithelial and stromal changes. The common denominator was the total or partial absence of endothelium or marked alterations of its remnants.


Phacocryolysis and phacoemulsification.

Phacocryolysis and phacoemulsification. The effect of rapid freezing and thawing was tested in vitro on 100 human hard nuclear cataracts before ultrasonic emulsification. After phacocryolysis the interspace between lens fibers increased, and the normally closely packed fibers appeared to loosen. This seemed to soften the hard cataract, thereby facilitating ultrasonic emulsification.


Intraocular fibrous proliferation as an incisional complication in pars plana vitrectomy. We enucleated an eye of a 39-year-old white man four weeks after partial pars plana vitrectomy was carried out for removal of an amagnetic foreign body which failed. Vitreous clouding complicated the perforating injury. Histological findings included massive ingrowth of fibrous tissue into the vitreous space and along preretinal planes, total retinal detachment with degenerations, and localized proliferations of the pigmentary epithelium. All proliferations originated at the site of the sclerotomy incision.


Ultrastructure of epiretinal membrane removed by pars plana vitreoretinal surgery. Electron microscopic study of an epiretinal membrane obtained from a 69-year-old black woman during pars plana vitreoretinal surgery with vitreous hemorrhage complicating a retinal vein obstruction revealed extensive proliferations of fibrous astrocytes that had secreted fibrillar and basement-membrane collagens. Hemosiderin-containing macrophages were also found. Neovascular elements were present and appeared identical to normal retinal capillaries.


Pigmented preretinal membranes.

Pigmented preretinal membranes. Continuous growth and an increase in pigmentation of a preretinal membrane occurred in a 46-year-old woman after a scleral buckling procedure for rhegmatogenous retinal detachment. Ten additional patients had pigmented preretinal membranes in eyes treated for rhegmatogenous retinal detachment. Although we made no attempts to determine the incidence of pigmented preretinal membrane formation in eyes with retinal detachments, these 11 cases, in a consecutive series of 500 eyes treated for rhegmatogenous retinal detachment, indicated that the development of pigmented preretinal membranes is not uncommon. Our clinical observations supported recent experimental findings implicating retinal pigment epithelial cells as a cause of preretinal membrane formation.


Follow-up study in eyes with choroidal neovascularization caused by presumed ocular histoplasmosis. Sixty-four eyes of 60 patients with ocular histoplasmosis, and choroidal neovascularization documented by fluorescein angiography, and not treated with photocoagulation, were followed for an average of 29 months. The primary determinant of visual outcome was the proximity of the neovascular membrane to the fovea. Sixty-four percent of eyes with membranes 0.25 disk diameter or greater from the fovea had a final visual acuity of 6/12 (20/40) or better, and 71% of such eyes maintained or improved initial visual acuity. All eyes with subfoveal neovascularization had a poor visual result. Other factors related to visual prognosis included initial visual acuity, size of the neovascular membrane, size of sensory retinal detachment, and presence of hemorrhage.


Geographic dark posterior fundus patches. Nine cases of a newly recognized, probably not uncommon, anomaly of the retinal pigment epithelium have been observed over a four-year period. The lesions occur predominantly in black subjects. Some degree of hemoglobinopathy was present in all the black patients with geographic dark posterior fundus patches. Almost all of the patients were young (6 to 26 years old) but two were 50 years of age. In three patients the patches grew larger. They did not interfere with vision or visual fields and did not appear to be involved with vitreous abnormalities. Fluorescein angiography was normal. In three patients, an electroretinogram gave subnormal results to all stimulus intensities; it was normal in one patient.


X-chromosone-linked juvenile retinoschisis with hemorrhagic retinal cyst. A 6-year-old boy with X-chromosome-linked juvenile retinoschisis had a large blood-filled retinal cyst surrounded by a rim of exudate which had infiltrated the macula. Spontaneous clearing of the blood and exudate was associated with improvement in vision.


A tentative mechanism for inferior punctate keratopathy. We analyzed the blinking motions of ten patients with inferior punctate keratopathy and ten normal subjects by means of time-lapse motion pictures. We also determined the frequency of blinking during one-minute intervals for each individual. Four types of blinking were distinguished: complete, incomplete, twitch, and forced blink. The average blinking frequency was about the same for both groups: 16 to 17 blinks per minute. The relative proportion of complete blinks, however, was much lower in patients with inferior punctate keratopathy than in normal subjects. The impaired blinking motion may be responsible for the punctate staining of the inferior corneal epithelium by producing exposure and inadequacies in the tear film. For this reason, these patients may benefit from blink training, application of tear substitutes, or soft contact lenses more than from the customary prescription of topical cortisone eyedrops.


Luxation of the globe in Engelmann's disease. A 35-year-old woman with Engelmann's disease and systemic lupus erythematosus developed spontaneous luxation of the globe and glaucoma. Radiological studies demonstrated increased sclerosis of the orbital bones and decreased orbital volumes, the probable cause of the luxation and the glaucoma. The glaucoma was controlled with pilocarpine eyedrops and the luxation spontaneously reduced. The systemic administration of corticosteroids for the control of Engelmann's disease and systemic lupus erythematosus may have been a contributory factor in the etiology and management of glaucoma.


Vascular tufts of pupillary margin of iris. A 71-year-old woman complained of "smoky" vision, which was found to be caused by a hyphema with blood dripping from a vascular tuft located in the 12 o'clock meridian of the iris. Fluorescein angiography delineated vascular tufts and argon laser photocoagulation eradicated one of the tufts that bled. Histopathologic studies of iris obtained at the time of cataract extraction showed an aggregate of small vessels at the pupillary margin. Most patients with vascular tufts of the pupillary margin have no systemic disease but they are also observed in diabetes mellitus and myotonic dystrophy.


Solitary iris nevus associated with peripheral anterior synechiae and iris endothelialization. Two middle-aged patients developed pigmented intrastromal iris nevi and an associated loss of the surrounding iris stromal markings suggestive of a surface iris membrane. Because of the fear of malignant melanoma with superficial growth, we excised the lesions. Histopathologic examination of the specimens revealed that the pigmented lesions were benign iris nevi and that the surrounding membrane was caused by endothelial cell growth onto the iris from peripheral anterior synechiae. These synechiae occurred anterior to Schwalbe's line in the same sector as the nevi and had been noted preoperatively at gonioscopic examination, but their diagnostic significance was not appreciated.


Cryotherapy in phthiriasis palpebrarum.

Cryotherapy in phthiriasis palpebrarum. A 5-year-old white girl had phthiriasis palpebrarum of both upper eyelids. Excellent cooperation by the patient permitted the destruction of adult lice and the nits by cryoapplication under the slit lamp. Cryotherapy seems to be a promising method of treating phthiriasis palpebrarum in a single office visit.


Ectopic lymph node of the orbit simulating a lacrimal gland tumor. A 47-year-old woman had a tumor in the lacrimal gland region of the orbit for 20 years which was histologically diagnosed as a large lymph node. The ectopic lymph node was probably congenital.


Traumatic eye and intracranial air-movement from a subconjunctival to an intracranial position. In a 12-year-old boy, air accidentally introduced subconjunctivally from the pointed tip of an air compressor hose, moved to an intracranial position over the sella turcica as demonstrated by x-ray films. The globe and a portion of the optic nerve were also outlined by air contrast. A minor corneal abrasion and traumatic iritis cleared promptly and no fractures or other damage occurred.


A binocular perimeter.

A binocular perimeter. A newly designed visual field testing instrument may be used either binocularly, as a quick screening test, or uniocularly, for plotting field defects. During binocular testing, the patient views a single target light at various points in the binocular central field. The eyepieces through which the patient looks and which contain weak prisms induce an artificial diplopia, and the patient sees two target lights. If the patient responds that he sees only one, then a field defect is present in one eye. Further analysis of the fields is then tested uniocularly. The instrument is simply constructed, yet should provide the means for assessing visual fields quickly and accurately.


Tangent screen perimetry using twin test objects. A T-shaped carrier with twin test objects is an inexpensive efficient visual field screening device which facilitated identification of a nasal steppe, a paracentral scotoma, an enlarged blind spot, an arcuate scotoma, macular sparing, or hemianopic defects.


A stable base for an operating microscope. We developed a 1/4-inch mild steel plate underbase with reinforced steel angles and three-inch diameter casters for our nonmotorized operating microscope floorstand. When fully weighted with an automatic focus zoom microscope head, a stereoscopic assistant scope, and a television camera, the unit proved stable and safe. It can be moved more easily than the existing floorstand.


Peripheral area-intensity interaction in scotopic visual reaction time. Two observers performed simple reaction-time responses to peripheral stimuli of varying intensity (-2.5 to +1.0 log td) and angular subtense (10 to 210 min). The area-intensity combinations that produced each of three scotopic reaction-time criteria were calculated. Analysis of these combinations showed that the area-intensity reciprocity could not be predicted by traditional theories of spatial summation. Like earlier findings for peripheral photopic reaction-time criteria, the results indicated that for small stimulus sizes, area has a greater effect than intensity in determining the scotopic reaction-time responses.


Lens correction of infantile myopia in identical twins: a case report. Spectacles were prescribed for 5-year-old identical twins with similar high, uncorrected, isometropic myopia. One received the full correction, and the other was undercorrected by 4 D. The fully corrected subject was a constant esotrope at distance and near; the undercorrected subject exhibited exotropia at near only. Evaluations over a 5-month period indicated that the full correction was the treatment of choice.


Differential diagnosis of an iris melanoma: a case report. A large, inferior-sector melanoma occupying about one-fifth of the iris area in a 65-year-old white man is described. Pigmented lesions of the iris (freckles, nevi, and benign and malignant melanomas) and their signs are reviewed. The iris lesion shows signs of being both malignant and benign. Periodic monitoring of the defect is being continued.


Astigmatism in Zuni and Navajo indians.

Astigmatism in Zuni and Navajo indians. Data provided by a practicing optometrist in Gallup, New Mexico indicate a greater than expected frequency of astigmatism among first- and second-grade Zuni and Navajo Indian children. Zuni children displayed a greater frequency of high astigmatism (3.00 D) than Navajo children. In an effort to understand the etiology of this prevalence of high astigmatism, a study of corneal astigmatism in 22 Zuni families was undertaken. The results suggest both genetic and environmental causes. A very high frequency of albinism was also observed among the Zuni.


Results with the Bausch and Lomb F3 series Soflens contact lens. We wanted to determine whether the Bausch and Lomb F3 series Soflens contact lens increases the number of patients who can successfully wear Soflenses. Thirty-two patients (64 eyes) who could not successfully wear 12.5-mm-diameter B, F, J, or N series Soflenses were fitted with the 13.6-mm-diameter F3 series lenses. For 40 of the 64 eyes, the F3 series lenses were successfully worn. Use of this lens series clearly increased the number of patients who could be fitted with Bausch and Lomb Soflens contact lenses. For many patients, this flatter, larger lens centered better and improved vision and comfort compared with the best-fitting Soflens of the 12.5-mm-diameter series.


Neuro-optometry: an evolving specialty clinic. Neuro-optometry is evolving as an optometric clinical specialty focusing on neurological dysfunctions of the visual system. Initially, we focused upon abnormalities of ocular movements, and our investigations have now broadened to include static and dynamic measurements of eye movements, accommodation, and the pupil. We feel the clinic serves three fundamental purposes: (1) to provide service to the patient, (2) to perform clinical research, and (3) to broaden the scope of the students' clinical experience. Operation of the clinic, technical methods of measurement, the testing protocol, and examples of interesting clinical recordings are described.


Focal mesangial proliferative glomerulonephritis in the rat caused by habu snake venom. A morphologic study. A new model of focal mesangial proliferative glomerulonephritis in the rat has been produced by intravenous habu snake venom. Glomerulonephritis developed in 70% of rats surviving the first 6 hours after venom administration. The earliest ultrastructural change (10 minutes after venom) was the presence of loose platelet aggregates and free granules in the capillary lumen and mesangium. This was followed by dissolution of the matrix and endothelial damage. Between 4 and 24 hours, a characteristic focal and segmental ballooned lesion of glomerular capillaries developed. In these lesions, from 3 days onwards a segmental mesangial proliferation occurred, which persisted until sacrifice at 21 days.


The effect of ethchlorvynol on pulmonary ultrastructure in dogs. The ultrastructure of alveolar septae in dogs is investigated at times ranging from 30 seconds to 60 minutes after intravenous injection of ethchlorvynol (Placidyl). Pulmonary edematous fluid first appears in alveolar spaces 5 minutes after injection and becomes progressively more prominent with increasing time. Alveolar septae are initially somewhat fibrotic, and subsequently, most interstitial spaces become swollen and hydrated. Vesicles in endothelial cells increase with postinjectional time, and they seem to form channels or pores interconnecting capillaries and interstitial spaces. Similar vesicles in epithelial cells (Type 1) show an increase after 30 minutes, and they also seem to form channels or pores interconnecting interstitial spaces and the alveolus. Vesicles, whether in endothelial or epithelial cells, contain a flocculent filamentous material similar to plasma protein and the filamentous proteinaceous material in edematous fluid in alveolar spaces. Ethchlorvynol injection rapidly induces a non-hemodynamic form of pulmonary edema. Since cell junctions of both endothelial and epithelial cells remained intact, it is proposed that transalveolar transport of edematous proteinaceous fluid is mediated by means of endothelial and epithelial vesicles.


Changes in bone and bone marrow of rabbits bearing the VX-2 carcinoma. A comparison of local and distant effects. The VX-2 carcinoma in 32 New Zealand white rabbits was studied morphologically with respect to the osseous effects induced by the innoculation and subsequent growth of tumour in the soft tissues over periods ranging from 1 to 5 weeks. Although more severe changes were noted in bones of tumor-bearing than in non-tumor-bearing limbs, effects could be seen in both experimental situations. Severe bone marrow hyperplasia was noted consistently in tumor-bearing animals. A marked increase in numbers of osteoclasts over control rabbit bones was observed along the surface of bones near and distant from the tumor. Resorptive changes were also noted in the cortex of tumor-bearing rabbits. The increase in osteoclast numbers was related chronologically to the development of hypercalcemia and was proportional to the degree of hypercalcemia at the time the animals died. The number of osteoclasts was inversely proportional to the serum creatinine. A diminution of osteoclast numbers was noted in the latter stages of the disease. These changes may be the morphologic expression of humoral hypercalcemia accompanying the VX-2 carcinoma.


Disruption of the Golgi zone and inhibition of the conversion of proparathyroid hormone to parathyroid hormone in human parathyroid tissue by tris(hydroxymethyl)aminomethane. Tris(hydroxymethyl)aminomethane (Tris, Tromethamine, THAM) and other non-amphoteric amines were previously reported to inhibit the conversion of proparathyroid hormone to parathyroid hormone in bovine parathyroid glands incubated in vitro. This inhibition correlated with a striking dilation of the Golgi complex. This work has now been extended to normal, hyperplastic, and adenomatous parathyroid glands from human subjects. The tissues were incubated for up to 3 hours with 3H-leucine in physiologic solutions (control) or in the same solutions containing 50 mM Tris. In one case, diethylamine also was tested. Electron microscopy revealed that the amines produced a dilation of the Golgi complex and swelling of vesicles, predominantly in the region of the Golgi zone. Other organelles were normal in appearance. During the same period, Tris reduced by sixfold the ratio of the parathyroid hormone to proparathyroid hormone, from a control value of 2:1 to 1:3. It was apparent that Tris exerted the same biochemical and morphologic actions in human parathyroid tissues as it was previously shown to do in bovine glands. These studies support the concept that the Golgi zone is that region in the parathyroid gland in which proparathyroid hormone to parathyroid hormone conversion is initiated and that Tris inhibits this conversion through disruption of the converting site.


Metaplasia of smooth muscle cells into juxtaglomerular cells in the juxtaglomerular apparatus, arteries, and arterioles of the ischemic (endocrine) kidney. An ultrastructural-cytochemical and autoradiographic study. Partial ligation of the aorta between the renal arteries induces marked atrophy of the cortical tubules of the left (endocrine) kidney with a remarkable increase in the number and granularity of hypersecretory juxtaglomerular cells (JGC), which are found not only at the glomerular pole of arterioles but also in the walls of arteries and arterioles far removed from the glomerulus. Typical vascular smooth muscle cells (SMC), in which secretory granules appear, show a concomitant development of their Golgi complex and rough endoplasmic reticulum, with a gradual decrease in the number of their filaments. Microtubules also appear in the Golgi area. Thiery's periodic acid-thiocarbohydrazide-silver proteinate technique demonstrates that in these "intermediate" cells, as in mature JGC, the amount of glycogen is greater than in SMC. The newly-developed secretory granules of intermediate cells are stained by phosphotungstic acid at a low pH, as are the mature granules of JGC, an indication that both types contain glycoproteins. Light and electron microscopic autoradiography reveal that both JGC and "intermediate" cells of the vascular wall do not incorporate radioactive thymidine (injected during the 10-day observation period). Thus, they develop by metaplasia of preexistent SMC. In control kidneys, radioactive thymidine is practically never incorporated into the nuclei of SMC but is found in a few glomerular and tubular cells of all zones except the papilla.The endocrine kidney shows virtually no reactive nuclei in vascular SMC, glomeruli, or tubular cells of the outer cortex. Thymidine is incorporated into practically all nuclei of the straight portion of proximal tubules and into about half the nuclei of all medullary tubular cells including the papilla.


Ultrastructural evaluation of parathyroid glands and thyroid C cells of cattle fed Solanum malacoxylon. Fine structural alterations of thyroid C cells and parathyroid chief cells were evaluated after feeding dried leaves of the calcinogenic plant, Solanum malacoxylon, to cattle for 1, 6 and 32 days. Thyroid C cells initially were degranulated in response to the hypercalcemia, and parathyroid chief cells accumulated secretory granules. There was hypertrophy of thyroid C cells with well-developed secretory organelles but few secretory granules in the  cytoplasm after 6 days of feeding S. malacoxylon. Inactive chief cells with dispersed profiles of endoplasmic reticulum and increased lysosomal bodies predominated in the parathyroid glands. Multiple foci of soft tissue mineralization were present in the heart, lung, and kidney. Thyroid C cells underwent hypertrophy and hyperplasia after 32 days of S. malacoxylon, and parathyroid chief cells were inactive or atrophic in response to the long-term hypercalcemia. Severe soft tissue mineralization was present throughout the cardiovascular system, lung, kidney, and spleen. These ultrastructural changes in thyroid C cells and parathyroid chief cells plus the widespread soft tissue mineralization observed after feeding cattle small amounts of S. malacoxylon are consistent with the recent evidence that leaves of this plant are a potent source of the active metabolite, 1,25-dihydroxycholecalciferol, of vitamin D.


3-methylindole-induced pulmonary injury in goats. Ruminal administration of 3-methylindole in goats severe pulmonary edema and respiratory distress. Electron microscopic studies of lungs reveal extensive degeneration and necrosis of alveolar membranous pneumocytes and bronchiolar epithelium. The necrosis of the pneumocytes is followed by proliferation of granular pneumocytes, which repopulate the alveolar basal lamina scaffold. 3-Methylindole may also induce proliferation of smooth endoplasmic reticulum in the remaining membranous pneumocytes and nonciliated columnar cells, indicating that these two cell types are involved in the xenobiotic function of the lung. The results suggest that 3-methylindole in cigarette smoke may play an important role in the pathogenesis of small airway disease and emphysema, and that patients with severe liver diseases or portocaval shunt may be predisposed to diffuse alveolar damage by 3-methylindole produced in the intestinal tract.


Dynamic properties of human motor units in the Hoffmann--reflex and M response. The dynamic properties of motor units involved in unrestrained H-reflexes and M responses have been studied in seven normal adult males. A linear relationship was observed between the peak to peak EMG of the M response and its twitch tension. Linear relationships were also noted between the EMG and peak displacement, velocity, and acceleration of the evoked muscle twitch for both the H-reflex and the M response. Contraction times for motor units recruited in the H-reflex were longer than those for the M response at low levels of motor unit recruitment. For both responses, however, the contraction times (time to peak force) were markedly shorter than those reported for isometric conditions. Differences were also noted between the H-reflex and M response in the absolute values of the tension to EMG ratio. These differences, together with the longer contraction times for the H-reflex, are quite consistent with the view that different motor unit subpopulations are recruited in the early stages of the two responses. The results and their interpretation, in terms of differential motor unit recruitment, generally confirm the conclusions of studies in which isometric twitch contractions have been investigated.


The effect of alcohol and smoking on testosterone function and aggression in chronic alcoholics. Forty alcoholics without other significant medical or psychiatric problems were studied on a research ward for two weeks. All subjects abstained from alcohol and cigarettes during the first week; 30 randomly selected subjects were permitted unlimited alcohol and/or cigarettes during the second week. Plasma testosterone levels were normal during the first week but decreased rapidly and significantly in those subjects allowed alcohol. A variety of measures of affect failed to show a significant correlation between hostility/aggression and plasma testosterone levels or alcohol ingestion.


Illustrious psychiatric administrators.

Illustrious psychiatric administrators. The authors found several common themes in intensive interviews with 20 prominent psychiatric administrators. The decision to go into administrative work resulted from strong interest in public service, frustration in other roles, and/or situational factors. Administration was learned by doing and by interaction with colleagues in the field or other knowledgeable individuals. The job of administrator is often perceived as stressful, but it offers rewards such as increased autonomy, opportunities for self-growth, prestige, and the potential for a broader contribution to mental health.


Trends in the frequency of schizophrenia by different diagnostic criteria. The authors report results of rediagnoses of 128 cases from two decades (1932-1941 and 1947-1956) by clinicians using the Research Diagnostic Criteria as guidelines and compare these results to rediagnoses by clinicians in a previous study using more general guidelines. Although hospital records indicated an increased frequency of schizophrenia over the two decades, the rediagnosticians found no change or a decrease. Severity of symptoms did not change during the two decades, but patients in the second decade showed more borderline symptoms, leading to more diagnostic disagreement. The authors conclude that changes in diagnostic criteria and pateints' conditions influence admission trends for schizophrenia.


Psychiatry in crisis.

Psychiatry in crisis. Psychiatry today faces sociopolitical, economic, and philosophical pressures that threaten its existence as a valued medical specialty. Recent legislation that decreases the numbers of foreign medical graduates eligible to practice in the United States, increases the numbers of community mental health centers and types of services they offer, and limits federal support of psychiatric education will affect the future of psychiatry as a profession and discipline. Forthcoming legislation and federal health policies will be related to the ability of the profession to demonstrate its unique role in the provision of mental health and health services. The authors offer suggestions for the education of the American public regarding the important role of psychiatry in America's health and mental health care system.


Sexual dysfunctions and psychoanalysis.

Sexual dysfunctions and psychoanalysis. The authors examine the major factors involved in recent changes in the social standards and attitudes related to homosexuality. The principal influences investigated include the misconstrued emphasis given to the humanist ideology, which properly stresses the dignity of the individual; the social sciences' relativization of the cultural norms defining homosexuality; the influence of the mass media in disseminating these perspectives and thereby tending to create an acceptable image of homosexuality, and the tendency of all these changes to result in a substantial increase in public acceptance and tolerance of homosexuality. The authors suggest that this trend in public opinion has begun to isolate psychoanalytic knowledge, to reduce its status and acceptability among the public, and to replace it with popular views concerning the meaning of sexual dysfunctions.


Evaluating antianxiety agents in humans: experimental paradigms. Conventional clinical trials using parallel groups are relatively insensitive to the effects of psychotropic drugs, especially antianxiety agents. Experimental paradigms based on the single organism research strategy offer an alternative. A free operant avoidance procedure clearly distinguished representative psychotropic compounds, including diazepam and pentobarbital, in normal subjects, and a multiple crossover procedure clearly detected antianxiety effects of diazepam in 11 psychoneurotic patients and antipsychotic effects of chlordiazepoxide in individual schizophrenic patients. Such procedures may serve to evaluate the effectiveness of therapeutic interventions in clinical practice as well as in research.


Dysmorphophobia: symptom or disease?

Dysmorphophobia: symptom or disease? Although dysmorphophobia, a subjective feeling of ugliness in a person of normal appearance, constitutes a distinctive symptom cluster occasionally seen in patients requesting cosmetic surgery, it is not included in current major psychiatric diagnostic systems. Patients with dysmorphophobia are usually young and perfectionistic and have both schizoid and narcissistic traits. The authors present two representative case histories and suggest that study of more patients with dysmorphophobia is needed to determine whether it is a symptom of an underlying disease or is itself a separate disease entity.


Newborn dopamine-beta-hydroxylase, minor physical anomalies, and infant temperament. The authors examined newborn anomaly scores for 193 normal infants in relation to obstetrical history, newborn dopamine-beta-hydroxylase (DBH), and 5-month (N=185) and 1-year (N=123) infant behavior, determined by a questionnaire completed by their mothers. There was no significant relationship between anomaly score and obstetrical history or 5-month infant temperament; low significant correlations were found between newborn DBH and 1) infant irritability and unsociable response and 2) 1-year anomaly scores and reported activity levels. The authors discuss the possible importance of these findings.


Primary and secondary benefits from treatment for alcoholism. The authors recorded diagnoses and total number of sick days for 148 men before and after treatment for alcoholism in a Navy alcoholic rehabilitation center. Over a 4-year period (2 years before and 2 years after treatment), there was a reduction of sick days for each man and a reduction of alcohol-and nonalcohol-related complaints. The authors stress the importance of valid evaluation criteria for alcohol rehabilitation programs.


Auditory evoked potentials and selective attention in formerly hyperactive adolescent boys. Although many of the prominent symptoms of minimal brain dysfunction (MBD) subside during pubescence, adolescents who had MBD during childhood may have persistent neuropsychological dysfunctions. The authors studied the auditory average cortical evoked potentials and behavioral responses of 9 formerly hyperactive adolescent boys and 9 matched control subjects who performed a selective attention task. Experimental subjects showed indications of impairment on both electrophysiological and behavioral measures of selective attention. Although the findings are consistent with a neurodevelopmental lag interpretation of MBD, they may also imply a persistent dysfunction related to the frontal association cortex.


Borderline rage and the therapist's reponse. Borderline patients often engender feelings ranging from apathy to rage in therapists. The author views the borderline patient's rage as defensive against fear of total negation resulting from projective identification with hostile part objects. The therapist's withdrawal or anger parallels the patient's projection of affect. Countertransference offers the potential for understanding a patient's terror, but therapists may become fixed in identifications that distort their understanding. Clarity often comes slowly as the therapist directs attention to his/her own affective state in order to understand the patient's vulnerability.


Collaboration between Ohio psychiatrists and the legislature to update commitment laws. The author describes how the Ohio Psychiatric Association (OPA) worked with the state legislature to ensure that the revision of Ohio's laws regarding involuntary commitment of the mentally ill reflected what psychiatrists felt to be in the best interests of patients. The OPA was successful in changing the definition of "persons subject to hospitalization by court order," in abolishing suggested 90-day and 180-day limits on the hospitalization of certain kinds of patients, in supporting the participation of psychologists in the admission process after the presence of a medical examiner had been affirmed, and in protecting the confidentiality of private patients' records.


The prevention of tardive dyskinesia.

The prevention of tardive dyskinesia. The publication of numerous articles on tardive dyskinesia has had little effect on the excessive use of neurolepic drugs in psychiatric populations. If current prescribing patterns are not drastically changed, larger numbers of patients will be afflicted by conspicuous, sometimes disabling neurological side effects. The risk of permanent neurological disorder can be minimized by monitoring side effects and systematically reducing drug doses in hospitals, outpatient centers, and private practice. However, one should not underestimate the difficulty in implementing such a program in facilities that rely heavily on chemotherapy.


Clinical research techniques in tardive dyskinesia. The authors have developed standardized assessment and control techniques designed to provide objective measures of tardive dyskinesia in patients progressing through an experimental treatment program. Standardized videotaping is carried out and blind ratings on the Abnormal Involuntary Movement Scale are made by a team of psychiatrists and neurologists. Other assessments include several measurements of vocal function and a quantitative acceleration profile standardized on normal subjects. Such measures allow quantifiable determination of response to drug treatment and may provide clues to the etiology and definition of the dyskinetic syndrome.


Effects of dopamine agonists in tardive dyskinesia. The authors used a combined behavioral and neuroendocrinological strategy to investigate the relevance of abnormalities in the brain dopaminergic systems to the pathophysiology of tardive dyskinesia by assessing the effects of apomorphine, a directly acting dopamine agonist, and d-amphetamine, an indirectly acting dopamine agonist, in patients with tardive dyskinesia. Administration of I.V. d-amphetamine increased dyskinetic movements in most patients with tardive dyskinesia, a finding consistent with the dopaminergic hypothesis. Contrary to predictions based on animal models, apomorphine did not increase dyskinetic movements in these patients but instead substantially reduced dyskinesia in some patients. Patients with tardive dyskinesia did not have a greater drop in serum prolactin or a greater rise in serum growth hormone after apomorphine than normal or chronic schizophrenic subjects without tardive dyskinesia.


Cholinergic influences in tardive dyskinesia. The authors conducted placebo-controlled double-blind studies of physostigmine, choline, and deanol in 12 patients with tardive dyskinesia. Physostigmine and choline both had a positive therapeutic effect on tardive dyskinesia, but the authors note that interpretation of these results is not entirely clear because they found that the sedation effect of physostigmine may nonspecifically reduce the intensity of tardive dyskinesia symptoms. Deanol was not found to be effective in this group of patients; the authors suggest that this drug should not be assumed to be generally effective unless effectiveness is verified by a large placebo-controlled double-blind study.


Electrophysiological (H-reflex) studies of patients with tardive dyskinesia. The authors studied the H-reflex recovery curves of 31 schizophrenic patients with tardive dyskinesia in response to acute administrations of apomorphine, amphetamine, or physostigmine and compared them with curves of chronic schizophrenic patients without tardive dyskinesia and normal volunteers. Their most unexpected finding was the absence of an H-reflex in 9 of the 31 patients with tardive dyskinesia. They also found a relationship between severity of tardive dyskinesia and the value of the facilitatory peak Hchi: patients with more severe tardive dyskinesia symptoms had significantly higher values for Hchi.


The relationship between parkinsonism and tardive dyskinesia. The author analyzes parkinsonism and hyperkinesia in psychiatric patients with tardive dyskinesia before and during treatment with alpha-methyl-p-tyrosine (AMPT, a dopamine antagonist), biperiden (an acetylcholine antagonist), and baclofen (a GABA agonist); and in patients with paralysis agitans and L-dopa-induced hyperkinesia. AMPT and baclofen had similar influences on oral dyskinesia, resulting in reduced frequency, unchanged or slightly reduced amplitude, and increased duration of each movement. The author concludes that: 1) reduced dopaminergic activity may be the primary pathogenetic background for tardive dyskinesia; 2) dopaminergic hypersensitivity and/or cholinergic hypofunction is necessary before hyperkinesia breaks through; and 3) the neurotoxic effects of neuroleptics may be associated with age-dependent changes in nigrostriatal regions representing oral innervation.


Relationship between age and tricyclic antidepressant plasma levels. Older depressed patients treated with imipramine or amitriptyline developed higher steady-state plasma levels of imipramine, desipramine, and amitriptyline. In imipramine-treated patients this finding was associated with a decreased rate of drug elimination from plasma. These findings provide at least a partial explanation for the increased susceptibility of the older patient to tricyclic antidepressant side effects and also provide a pharmacological rationale for use of lower dosages in this age group.


Anhedonia and schizophrenia.

Anhedonia and schizophrenia. The authors administered semi-structured interviews to 187 psychiatric inpatients to determine the role of anhedonia in schizophrenia. The interviews were taperecorded and then given blind ratings for anhedonia on a 7-point scale. Schizophrenic patients had significantly more anhedonia than nonschizophrenics, although many of the latter group had anhedonic tendencies. Most of the difference between the groups resulted from high anhedonia scores for chronic schizophrenics; less anhedonia was found in the acute schizophrenic patients. The data indicate that anhedonia is not necessary or unique to schizophrenia but is a prominent factor in chronic schizophrenia.


Social adjustment profiles of female drivers involved in fatal and nonfatal accidents. Previous research by the authors has shown that male drivers involved in fatal and nonfatal accidents can be differentiated from the general population on the basis of background, behavior, and social adjustment. The results of the present study suggest that female drivers involved in serious crashes do not differ from the overall female driving population.


The geographic and functional distribution of black physicians: some research and policy considerations. Studies of the geographic and functional distribution of physicians rarely include race of the physicians as a study variable. For black physicians, there are some rather strong justifications for doing just that: 1) their services are directed almost exclusively to black and often medically underserved communities; 2) recent efforts to reduce constraints to medical education based on race, sex, ethnicity, and income have resulted in a substantial increase in the proportion of black medical students; 3) inferring about black physicians from information on the general population of physicians given the differences in biographical and experimental characteristics is tenuous at best. Hence, an adequate information base and focused conceptualization on the educational and career patterns of black physicians are indicated. At the policy level there is a need to clarify the relationship between equity in educational (and career) opportunity and efforts to redistribute physicians.


Studies of ambulance patients with ischemic heart disease. 1. The outcome of pre-hospital life-threatening arrhythmias in patients receiving electrocardiographic telemetry and therapeutic interventions. Patient delay in seeking medical assistance for acute ischemic heart disease and the incidence of potentially life-threatening arrhythmias en route to the hospital were examined in a 22-month community trial of ambulance telemetry. Of 7,654 patients transported, 179 who had electrocardiograms (ECGS) transmitted were found to have had acute MIs or acute myocardial ischemic events. Fifty per cent of these patients summoned an ambulance within 30 minutes and 72 per cent within two hours after the onset of acute symptoms. Fifty-eight patients had potentially life-threatening arrhythmias. Interventions with drugs and/or defibrillation was required in 22 patients with or without cardiopulmonary resuscitation (CPR); intervention with CPR alone was required in six patients. Twelve of these 28 patients survived through hospital admission and six were alive at three months. The relatively low outcome/input ratio of this experience necessitates re-evaluation of the epidemiological characteristics and patient selection criteria in populations considered for telemetry.


Studies of ambulance patients with ischemic heart disease. 11. Selection of patients for ambulance telemetry. One hundred eighty-two of 1,928 patients (9.4 per cent) transported by ambulance during a six-month period in Baltimore had ECGs transmitted. Review of the remaining 1,746 records by two cardiologists indicated that an additional 113 patients should have had their ECGs transmitted because of life-threatening conditions. Of patients with acute ischemic heart disease, 47 had ECG monitoring and 24 did not. There were 22 per cent more Killip 111/1V patients with a 19 per cent higher mortality at three months among the "non-transmitted" patients as compared to the "transmitted" patients, controlling for all other relevant variables. Critical presentations inappropriately affect ambulance staffs' selection of patients for monitoring.


Five year follow-up of a smoking withdrawal clinic population. Eight hundred volunteers who attended smoking clinics at Roswell Park Memorial Institute from 1964-1965 were followed up five years later to ascertain their current smoking status. From three waves of a mailed questionnaire, plus a telephone campaign, we obtained 559 usable responses. The relationship between smoking status at the five-year follow-up and clinic protocols and selected social and psychological characteristics as determined during the clinics were examined. Of those individuals contacted five years after the clinic, 17.8 per cent were not smoking. Variations in clinic protocol in terms of drugs and education methods had no relation to long-term smoking withdrawal. Several social and psychological variables, however, were related to smoking behavior five years after the clinics. Non-smokers were more likely than smokers to be males, to be older, to have smoked less before the clinic, to have started smoking at a later age, to have a milieu that was supportive of their stopping, and to have fewer indices of neurosis and fewer psychosomatic symptoms.


Expired air carbon monoxide and serum thiocyanate as objective measures of cigarette exposure. Expired air carbon monoxide (CO) and serum thiocyanate (SCN) were used to asses exposure to cigarettes in 139 middle-aged men. Subjects who reported smoking cigarettes generally had CO levels exceeding 8ppm and SCN levels exceeding 100umol/L; non-smokers had lower levels. For both tests the mean concentration among men smoking more than one pack daily was three times that of non-smokers. The is a high correlation between the two tests (r=.571 for smokers), an association that was largely independent of the smaller correlations between either test and reported smoking frequency (r=.476 for CO; r=.479 for SCN). The ability to distinguish between individuals who reported "typical" smoking habits and non-smokers was best when the CO and SCN analyses were used together to take advantage of their separate sources of variance; it was 99 per cent when the two tests were mutually concordant (91 per cent of cases). The CO and SCN measurements allowed 16 individuals who reported light smoking habits to be categorized into high and low presumptive tobacco exposure groups. The two tests are inexpensive and suitable for use in epidemiologic and health care delivery programs.


The nature of a cytopathogenic material present in amebae of the genus Naegleria. The Naegleria ameba cytopathogenic material (NACM) obtained from free-living and/or pathogenic amebae has been partially isolated and characterized. The evidence indicates that the material is a protein or has a protein component, and is in the estimated molecular weight range of 50,000 daltons. The partially isolated NACM, like its counterpart in the amebic lysates, is capable of sustaining itself in tissue cultures at a temperature which otherwise would inactivate it, and in serial passages through multiple dilutions. No distinctions between the NACMs from amebae of different Naegleria species or strains have been found in the biological response to the various treatments studied.


Mesocercaria in the skin of man in Louisiana. Two areas of intradermal swelling removed from the upper thigh and iliac crest of a 43-year-old man in Louisiana were each found to contain a larval trematode about 0.5 mm in length. Based on morphology reconstructed from serial sections, the two worms were identified as a mesocercaria of an undescribed species belonging to the subfamily Alariinae.


Prevalence and morbidity of Schistosoma haematobium in Egyptian children. A controlled study. The prevalence and morbidity of schistosomiasis haematobium were studied in three geographically different villages in Giza governorate in Egypt. The survey included 786 children ranging in age from 6 months to 10 years. There was a marked variation in the prevalence of infection in the three areas, correlated with the socioeconomic standards and sanitary habits, emphasizing their role in the spread of the disease. The youngest child infected was a 14-month-old boy, while the peak of prevalence of infection was in children 8 to 10 years old. The intensity of infection, as indicated by the heaviness of urinary egg output (mean of 3 successive days), was unrelated to the degree of prevalence in the area concerned. On the other hand, such intensity of infection correlated well with the severity of the clinical picture. Immediate skin-test reactivity was related to the intensity of infection, though unreliable as a single diagnostic test in children. Delayed reactivity was less sensitive. Stool examination showed a higher prevalence of other helminthic infections in schistosome-infected children aged 6 to 10 years than in uninfected children. The impact of schistosomiasis on the general health of children as shown by the anthropometric measurements was mild, except in heavily infected children in whom it was significant. The study focused on the overshadowed young age period when infection can be radically cured and even easily avoided. The data point to the importance of considering the intensity of infection, and not the prevalence, in weighing the need for therapy against its toxic effects in children, or in discussing the priorities of treatment in an endemic area.


Prevalence and intensity of Schistosoma haematobium and S. mansoni infection in Qalyub, Egypt. We report the preliminary findings of a comprehensive schistosomiasis survey in the Qalyub region of the Nile Delta. A systematic sample of households in eight villages was studied, and 8,712 individuals submitted stool and urine specimens for parasitologic examinations. The prevalence of Schistosoma mansoni infection (40.5%) was much higher than that reported previously in this area, and the prevalence of S. haematobium (27%) was much lower. The geometric mean egg output for both parasites was surprisingly low. The apparent increase in S. mansoni infection may be largely due to the use of a very sensitive parasitologic technique, but the decrease in S. haematobium prevalence is unexplained. Preliminary results of snail surveys, however, indicate a profound decrease in the population levels of Bulinus species, a phenomenon which may be related to ecological changes since construction of the Aswan High Dam.


Proteolytic, antigenic and immunogenic properties of Schistosoma mansoni cercarial secretion material. Schistosoma mansoni cercariae secrete preacetabular gland material in association with skin penetration. The material is heterogeneous and contains proteolytic enzyme(s) which comprise a small proportion of the total protein. We have immunized mice with cercarial secretion material in several protocols designed to induce a variety of antibody responses. The cercarial secretion material is sufficiently immunogenic to induce precipitating and reaginic antibody production. The antibodies obtained were not of the necessary quantity and/or quality to afford protection from a challenge infection.


Inhibition of the immune response to whooping cough and tetanus vaccines by malaria infection, and the effect of pertussis adjuvant. Plasmodium yoelii infection of mice depressed their capacity to build up humoral immune response to diphteria vaccine and protective immunity against tetanus toxin. This immunodepression was overcome by Freund's complete adjuvant or killed pertussis bacilli (whooping cough vaccine). These results suggest that vaccines should be given in association in malaria endemic area.


Fibrinogen metabolism and disseminated intravascular coagulation in dengue hemorrhagic fever. In 29 patients with dengue hemorrhagic fever (DHF), 12 with grade 2 and 17 with grades 3 and 4, fibrinogen metabolism was studied by using 125I-fibrinogen; 11 of these patients were studied during shock. Hemostatic studies were also performed to search for evidence of disseminated intravascular coagulation (DIC). Increased intravascular coagulation, as judged by rapid T1/2 of 125I-fibrinogen, as well as evidence of DIC by hemostatic patients with DHF grade 2 had rapid T1/2 and only 17% had DIC. Of the 11 patients studied during shock, 91% had both rapid T1/2 and evidence of DIC, whereas 63% of the 18 patients without shock had rapid T1/2 and only 11% of this latter group had DIC. A correlation between the increased fibrinogen consumption as judged by rapid T1/2 of 125I-fibrinogen, DIC, clinical severity, and shock was demonstrated. The role of DIC in the pathogenesis of DHF is discussed, and heparin is suggested for patients with prolonged shock and severe acidosis when DIC becomes clinically apparent.


Single inoculation immune hamster sera for typing California group arboviruses by the complement-fixation test. Eight reference California group viruses of North America were typed using sera of immune hamsters bled 21 days after a single inoculation. The complement-fixation test reactions were relatively specific, although only 2-fold differences were observed reciprocally with the closely-related La Crosse and snowshoe hare viruses. Hamster serum taken 10 days post inoculation was more specific than a 21-day serum. Sepcificity after second inoculation was lost with some antigens. Jamestown Canyon and South River viruses were identical by complement-fixation test and showed minor differences in the plaque reduction neutralization test.


Sterility introduced by release of genetically altered males to a domestic population of Aedes aegypti at the Kenya coast. The release of males heterozygous for one or two sex-linked translocations was effective in introducing a high level of sterility into a domestic population of Aedes aegypti at a Rabai village. The effect of the releases continued for several weeks after the release period.


Efficacy of various drugs for treatment of giardiasis. A comparative study. A total of 172 patients with giardiasis were treated with four of the drugs most commonly used for this infection. All drugs were used in their usual posologic schedules. The cure rates achieved with furazolidone, nimorazole, metronidazole, and tinidazole were; respectively, 72%, 94%, 87%, and 97%, while in a control group given no medication stools of only 35% of the patients became negative. Side effects were of minor importance in patients treated with nimorazole and metronidazole, and were somewhat more frequent and severe in those treated with furazolidone. Tinidazole produced no side effects.


Oral infection of mice with trophozoites of Giardia muris. Giardia muris has been maintained for years in the mouse by administering by gavage 10,000 trophozoites taken from the small intestine of infected mice. Despite the growth of numerous protozoa in the intestine, absorption of tetracycline hydrochloride in infected mice was not changed to a statistically significant extent, as blood drug levels increased only slightly: behavior was similarly unaffected. Reasons for the apparent lack of virulence of this strain are discussed.


Ectopic ascariasis: report of a case with adult worms in the kidney. Six adult Ascaris lumbricoides were found in the pelvis and calyces of the left kidney of a 25-year-old woman in Mexico. Prior to death three worms had emerged from a subcutaneous abscess which at autopsy was found to communicate with the colon through fistulas to the upper ureter above an occluding calculus, and from the renal capsule to the skin near the left iliac crest.


Microfilarial granuloma of the breast in a patient with tropical pulmonary eosinophilia. Microfilariae found in a breast nodule of a patient with tropical pulmonary eosinophilia were identified as Wuchereria bancrofti, confirming that the tropical pulmonary eosinophilia syndrome may be associated with infections caused by this species of filarial worm.


Malignant duodenocolic fistulas.

Malignant duodenocolic fistulas. Five cases of malignant duodenocolic fistula seen at the Massachusetts General Hospital in the past thirty years are reviewed. Rarely encountered, these lesions are characterized by diarrhea, weight loss, abdominal pain, anemia, and sometimes feculent vomiting. Barium enemas are more likely to demonstrate the fistula tract than upper gastrointestinal series. Nutritional deficiencies may be profound, and the use of preoperative hyperalimentation is encouraged. Operations that accomplish only bypass of the fistula are of minimal palliative value, and the fistula should be divided or resected if possible. When feasible, wide resection is the procedure of choice, and a fourteen year survival is reported after this operation.


Operative complications of abdominal vagotomy. To assess the incidence of operative complications, mortality, and accuracy of vagotomy in transabdominal vagotomy, 733 cases were reviewed. Statistics are compared with those of other authors. A loose comparison of patients operated on by resident surgeons versus those operated on by attending surgeons is also made. Our preference for immediate microscopic examination of vagotomy specimens is stressed. One unusual complication is described.


Gallium 67 citrate scanning in the diagnosis of intraabdominal abscess. Fifty-one consecutive gallium scans in fifty patients with suspected intraabdominal abscess are reviewed. There were twelve true-positive, seven false-positive, twenty-nine true-negative, and two false-negative scans. Accumulation of gallium in the colon and in areas of healing and repair caused soem interpretive difficulty. Despite a significant number of false-positive results, we believe that gallium scanning is a valuable diagnostic tool. Careful attention to technic and cautious interpretation should significantly reduce false-positive and false-negative scans.


Familial retrocecal appendicitis.

Familial retrocecal appendicitis. A family pedigree containing sixteen individuals with acute appendicitis is presented. In all but one the position of the appendix was retrocecal. In two other members explored for abdominal pain wherein acute appendicitis was not the cause, the appendix was also found to be retrocecal. The anatomic retrocecal location of the appendix in this pedigree shows a degree of uniformity that implies a common predisposing factor inherited as a simple, dominant unit-character.


Phytobezoar: a recurring abdominal problem. Phytobezoars often follow gastric surgery for peptic ulcer disease. Billroth I resections have a high incidence of gastric bezoars, especially if accompanied by vagotomy. The larger opening of a Billroth II resection may result in intestinal bezoars with obstruction in the narrow terminal ileum. Gastric bezoars can be treated with enzymes or can be broken up by endoscopy; only rarely is operative removal required. Intestinal bezoars can be treated by long-tube and enzyme instillation but usually require laparotomy. If possible, the bolus should be milked into the cecum, but enterotomy or even resection may be required. Prevention is the best treatment and can be carried out by instructing patients who have had gastric surgery to avoid the fibrous portion of oranges and grapefruit and to avoid persimmons.


A community-wide experience with jejunoileal bypass for obesity. The records of seventy-nine patients who had jejunoileal bypass operations for morbid obesity were reviewed. The data represent the entire experience of surgeons in the Louisville, Kentucky metropolitan area for the period studied. Retrospective evaluations of criteria for selecting patients for bypass operation, type of shunt done, and clinical results were recorded. Sixty-eight patients (86 per cent) weighed more than 100 pounds over ideal weight. Operative mortality was 5 per cent. Only 31 patients (47 per cent) were judged as having satisfactory results. Two patients died of hepatic failure and five required restoration of intestinal continuity. Comparison of this community experience with published data supports the concept that these operations are best confined to those institutions where there is special interest in the full range of medical and surgical care of obese patients.


Surgical treatment of the celiac axis compression syndrome. Six patients with symptomatic celiac axis compression syndrome are reported on. Four were treated surgically with arterial reconstruction. None of these four patients was benefited more than temporarily by the corrective surgery. One patient had an abdominal exploration and highly selective vagotomy unrelated to the celiac axis and is symptom-free ten months after surgery. One patient had no surgery and remains symptomatic. Angiographic evaluation in all patients demonstrated that despite high grade stenosis of the celiac axis, there was no radiographically discernible reduction in constrast flow to the celiac axis because of well developed collaterals from the superior mesenteric artery. These results indicate that compression of the celiac axis may be merely an incidental angiographic finding, so this syndrome needs cautious evaluation.


The healing of below-knee amputations: a comparison of soft and plaster dressing. To evaluate the effect of wound dressing upon wound healing, fifty-one patients undergoing below-knee amputation using a long posterior myocutaneous flap technic were randomly allocated into a soft or plaster dressing group. Neither wound dressing technic proved superior, as wounds healed in 85.2 per cent of the plaster dressing group and 83.3 per cent of the soft dressing group.


The relative merits of temporary gastrostomy and nasogastric suction of the stomach. Nasogastric suction is usually employed for gastric decompression because of its ease of application. However, it is associated with greater discomfort and more complications than temporary gastrostomy, especially in the young, the elderly, those who smoke, and those in whom prolonged decompression is necessary.


Carcinoma of the colon in the adolescent: a report of survival and an analysis of the literature. A case of adenocarcinoma of the transverse colon in a fourteen year old girl is presented. Five years after radical resection of this Dukes' C2 lesion, the patient is alive and well without recurrent disease. The incidence of large bowel carcinoma in adolescents remains low, but there is an increasing tendency toward neoplasia in younger patients. Factors that affect patient survival included late stage at presentation, delay in treatment, paucity of symptoms, and a higher incidence of tumors of the transverse colon. An increased incidence of colloid carcinoma is noted. The etiology and pathogenesis of large bowel cancer as it pertains to childhood are reviewed.


Stenosis after stapler anastomosis.

Stenosis after stapler anastomosis. Two cases of anastomotic stenosis after the use of the GIA Auto Suture Stapler are presented as examples of the potential problem that does exist in using this instrument. Possible causes and a suggestion for eliminating this complication have been outlined.


A simple guideline to facilitate axial alignment of vascular grafts. The proper orientation of vascular prostheses is essential for successful performance of vascular reconstructions. To prevent axial rotation of grafts, particularly in long tunnels such as in the axillo-femoral or subsartorial position, vascular prostheses with a simple guideline incorporated within their fibers were employed. The advantages of these grafts are discussed.


A practical method of autotransfusion in the emergency center. A new mobile autotransfusion device, modified for use in the Emergency Center, is described. Preliminary usage in thirty trauma patients who underwent autotransfusion of 60 units of blood indicated the device was simple to utilize, efficacious, inexpensive, cost-effective, and safe.


Anaesthesia and blood loss in total hip replacement. Twenty-seven consecutive patients scheduled for total hip replacement were randomly divided into three groups. The first group had their operations under epidural analgesia, the second whilst breathing halothane spontaneously and patients in the third group were anaesthetised using a modified neuroleptoanaesthetic (NLA) technique. Blood lost during the operation was measured by a colorimetric technique. Closed suction drains were used and all blood lost after the operation collected for measurement. Deliberate hypotensive techniques were not employed. The mean operative blood loss of patients who had their operations under epidural anaesthesia was significantly less than that of patients in the other two groups, being 341-6 +/- 59-1 ml (s.e.m.) for the epidural group, 648-4 +/- 58-3 ml (s.e.m.) for the halothane group and 744 +/- 98-9 ml (s.e.m.) for the NLA group. There was no significant difference in the amounts of blood collected by closed suction drainage in any of the three groups and the mean values for total overall blood loss incurred by procedure were 734-1 +/- 40-7 ml (s.e.m.) for the epidural group, 986-3 +/- 94-9 ml (s.e.m.) for the halothane group and 1168-4 +/- 126 ml (s.e.m.) for the NLA group. In this series only 3 of 10 patients (30%) who had their operation under epidural anaesthesia required transfusion with whole blood, compared with 7 of 9 (78%) in the halothane group, and 7 of 8 (87-5%) in the neuroleptoanalgesia group. From this series it is evident that the need for transfusion of whole blood in total hip replacement can be significantly reduced by the use of epidural analgesia.


Femoral artery pressure monitoring. Use of the Seldinger technique. A case of bilateral femoral arterial occlusion following the Seldinger technique of arterial puncture for monitoring blood pressure is described. Sixty patients were closely studied for possible complications of this technique, using pedal blood pressure, and skin temperature to supplement clinical observation. Despite the occasional complications which are described we consider this to be a safe and valuable technique in selected circumstances.


The use of sodium nitroprusside in children. The hypotensive response to sodium nitroprusside was investigated in 30 children, age range 5-15 years, weight range 14-60 kg, who were undergoing spinal surgery for kyphoscoliosis. It was possible to achieve a constant level of satisfactory hypotension within the range 70-80 mmHg systolic arterial pressure using sodium nitroprusside infused at a rate of 10 microng/kg/minute and no serious side effects were experienced at this dose rate.


Forced expiratory flow-volume relationships. Changes after upper abdominal surgery. Forced expiratory flow-volume relationships have been used to investigate changes in lung mechanics caused by upper abdominal operations. The slope of the 'effort independent' portion of the flow-volume curve increases after operation, suggesting that restriction of respiratory movement is associated with an increase in lung recoil.


Treatment of porcine malignant hyperpyrexia. The successful use of dantrolene in the Pietrain pig. The effect of dantrolene on porcine malignant hyperthermia in the Pietrain pig was studied. Five out of six pigs were successfully treated with dantrolene and the alkaline solvent was found to have no therapeutic effect.


Measurement of neuromuscular blockade in man. A simple modification of a clinical pressure transducer. A simple modification of a clinical blood pressure transducer is described, which permits it to be used for the quantitative estimation of neuromuscular blockade in man. The instrument remains available for other pressure measurements since only the plastic dome is modified.


The immediate care of cases of poisoning. The immediate management of poisoned patients has been discussed with regard to supportive and specific treatment. Details are given of the information services available in the United Kingdom.


Continuous epidural analgesia in the obstetric patient: a feasibility study using a mechanical infusion pump. Eleven patients in uncomplicated labour received a continuous infusion of 0-125 or 0-25% bupivacaine solutions into the epidural space, using a simple rotary pump. Maternal and umbilical cord venous plasma bupivacaine levels were measured and were found to be within safe limits for mother and baby. Incidence of complications were noted.


Methods of conserving carbon dioxide in artificially ventilated patients:  a clinical investigation. A technique is described for maintaining the PaCO2 within, or close to, the normal range in patients hyperventilated using the Mapleson D Circuit or the Circle system with the soda-lime excluded. Control is achieved by limiting the fresh gas inflow to 4-5 litres/minute.


Effect of buprenorphine on the ventilatory response to carbon dioxide. Buprenorphine is a potent synthetic opioid-partial antagonist analgesic drug currently under clinical trial. When administered intravenously to human volunteers buprenorphine produced a significant depression of the ventilatory response to carbon dioxide stimulus for a period in excess of six hours.


Technical considerations in the use of the membrane oxygenator (Lande'-Edwards) for open heart surgery. Experience has shown that successful cardio-pulmonary bypass depends upon an efficient oxygenator which causes minimum blood damage. Experience with 1,600 Lande'-Edwards membrane oxygenators in more than 1,000 patients has led to the development of a simple and safe routine for their use in open heart surgery. The circuitry, method of preparation for perfusion, and management of perfusion are described in detail.


Post-operative flow-volume loops.

Post-operative flow-volume loops. A study of flow-volume curves pre- and post-operatively demonstrated a marked difference between bronchitic and non-bronchitic patients. All bronchitic patients showed lower flow rates at low lung volumes post-operatively, when compared with their pre-operative values. Non-bronchitic patients all had higher flow rates for the same comparison.


Post operative pulmonary compliance.

Post operative pulmonary compliance. Lung compliance was studied pre-operatively and post-operatively in a group of patients having abdominal surgery. Lung compliance was shown to be markedly reduced post-operatively especially in the patients with chronic bronchitis.


Ketamine and paediatric radiotherapy.

Ketamine and paediatric radiotherapy. Two hundred and seventy-two ketamine anesthetics have been given to sixteen children undergoing radiotherapy. Satisfactory conditions were provided in every case and the incidence of complications was low. At the present time ketamine would appear to be the most satisfactory agent in thos children who require sedation in order to undergo radiotherapy.


Flow through venous cannulae.

Flow through venous cannulae. Fluid flow through modern cannulae is not simple and cannot be expressed in classical terms. Progressively increasing the length of a cannula diminishes flow predictably but altering the bore of the cannula does not give a fourth power improvement in flow but rather a linear one. A reasonable working value for the relative viscosity  of ACD blood in infusions would seem to be 2-6 below about 125 ml/minute flow (saline). The decline in relative viscosity above this may be caused by turbulence in the saline flow.


Postoperative arterial hypoxaemia.

Postoperative arterial hypoxaemia. Postoperative arterial oxygen tension was measured in a group of patients. Unacceptably low levels were found in 32% of the patients and this hypoxaemia persisted in some cases for three days. The results enforce the principle that some patients whould be given prolonged oxygen therapy and this should cease only when blood gas analysis demonstrate the patients ability to maintain a safe PaO2 breathing air.


Radiological lung volume in surgical patients. Radiological total lung capacity (T.L.C.) was measured preoperatively and postoperatively in a group of patients. A decrease in T.L.C. postoperatively in patients who smoke was demonstrated. The use of radiological T.L.C. in the study of postoperative respiratory dysfunction is suggested.


Efficacy of high volume low pressure cuffs in preventing aspiration. The incidence of aspiration in patients with indwelling high volume, low pressure cuff endotracheal and tracheostomy tubes was assessed. A simple technique to routinely determine the correct inflation pressure of cuffs is recommended.


Comparative histochemical study of the succinic dehydrogenase (SDH) activity in the respiratory muscles of an air-breathing siluroid fish, Clarias batrachus (Linn.). 1. Funcitonal morphology including origin, insertion, innervation and action of the respiratory muscles in relation to the respiratory pumps and the movement of barbels and gill filaments have been studied in a fresh-water air-breathing siluroid fish, Clarias batrachus (Linn.). 2. Cytochemical studies were made on the succinic dehydrogenase (SDH) activity of:--Abductor hyomandibularis, Adductor arcus palatini, Adductor hyomandibularis, Adductor mandibularis, Intermandibularis anterior and posterior, Interhyoideus, and Rectus cervicis (all concerned with buccal pressure pump), Adductor operculi, Dilator operculi, Levator operculi, Inferior hyohyoideus, Superior hyohyoieus (all concerned with opercular suction pumps), Extensor tentaculi, Protractor tentaculi, Retractor tentaculi (movement of barbels), adductor and abductor muscle sheets of the Constrictor branchialis (movement of gill filaments). 3. The intensity of SDH reaction reveals that except the Adductor mandibularis, Intermandibularis anterior and the Protractor tentaculi all muscles are made up of red as well as white muscle fibers. 4. The muscle innervated by the branches of Vth (trigeminal) nerve is dominated by white fibres, whereas those innervated by the branches of VIIth (facialis) contain more red muscle fibres. 5. The Retractor tentaculi (concerned with the movement of maxillary barbel) consists of superficial white fibers and its interior deeper part is dominanted by red and intermediate muscle fibres. 6. The adductor muscle sheet of the Constrictor branchialis is made up of red fibres, whereas the abductor muscle sheet is entirely made up of white muscle fibres.


Postnatal enzymorphology of the albino-rat kidney. In the present attempt, kidney from newly born albino-rat litters has been examined for few enzymes. Those selected for the study include, alkaline phosphatase, acid phosphatase; adenosine monophosphatase, nonspecific osterase and leucine amino peptidase. All the enzymes were observed exhibiting strong positive reactions except moderate acid phosphatase. Furthermore, a comparison of relative enzyme activities with adult rat kidney has been made. Variations in the distribution and intensity of reactions this observed have been discussed in relation to the hypothesis that redistribution of enzymes occurs as the animal becomes older. Functional role of these enzymes in the young kidney have also been discussed.


Connective tissue fibers in the liver of squirrel, after carbon tetrachloride poisoning. A histochemical study. Attempt has been made to study histochemically the disposition of connective tissue fibrils in the liver of common ground squirrel, Funambulus pennanti in cirrhotic and necrotic conditions caused by carbon tetrachloride treatment. Evidence has been put forward to show that no reticulin remains in the liver during these conditions. However the percentage of elastin and collagen increases with a change in arrangement. Probable causes of this topographical change in localization are discussed comparing the results with controls.


Submassive necrosis of liver of Channa gachua, a fresh water fish during experimental alloxan diabetes. An extensive change in the liver architecture leading to submassive necrosis has been observed in Channa gachua toxicated with alloxan. An intramuscular dosage of 10 mg/kg of the toxicant mobilized liver glycogen after 4 h of application leading to hyperglycaemia of blood. The serial changes occurring in the liver have been discussed at intervals of 24, 48, 96 and 100 h, when the fish reached to comasate condition and finally died.


Branching of the coeliac artery in some domestic birds. iii. A comparison of the pattern of the coeliac artery in three breeds of the domestic fowl (Gallus gallus f. domestica). The authors examined the pattern of the coeliac artery and its branches in 100 females of the domestic fowl of three breeds: White Leghorn (33 females), Brown Leghorn (34 females) and White Plymouth (33 females). The arterial pattern was injected by red-dyed latex. An exact analysis of the pattern of branches of the coeliac artery in the individual breeds was made, the individual signs were compared and the level of statistical significance in the differen breed-related findings was determined. On the basis of study of the material it is possible to state that: a) There exist certain differences in the pattern of branches of the coeliac artery in various breeds of the domestic fowl.  b) These differences comprise especially the way of origin of the A. proventricularis dorsalis, the origin of spleen arteries, the existence of the accessory arteries for the gall bladder, bile ducts and the duodenum, the origin of the Aa. ileocaecales and the way of branching of the A. gastrica sin. c) It will be possible to compare the pattern of the coeliac artery in various species of birds no sooner than the breed-related differences are determined.


Regional and age associated changes in the umbilical artery of goat. The umbilical arteries from 42 goate ranging between 1 day to over 6 years of age have been studied serially throughout their length. The histomorphology at the point of its origin and the progressive changes in the artery during its course towards its termination as well as with age have been discussed.


[The chondrocranium in sheep and goat. I. (author's transl)]. The morphogenesis of primordial cranium was studied in 12 merino-sheep fetuses (between 25th and 67th day of development) and in 10 goat fetuses (between 24th and 52nd day of development). On the base of histological sections a reconstructional model of the nasal capsule was made.from a 67-day old sheep fetus. In the work, the stages of chondrocranial development in both the two small ruminats were indicated, and the main differences in the construction of chondrocranium in sheep and goat, are like wise shown.


The fine structure of human digital arterio-venous anastomoses (Hoyer-Grosser's organs). Hoyer-Grosser's organs were studied in human digital biopsies. The fine structure of both the supplying arteries and collecting veins was found to be inconspicuous. Endothelial cells in the AV canals form a continuous layer. They are characterized by their rich content of specific organelles (Weibel-Palade bodies), especially in the venous segments. The epitheloid zone is composed of a variety of ramified smooth muscle cells (RSM). These appear either dense, when well provided with bundles of myofilaments, or clear, when including only a few myofilaments. The nuclei of dense RSM show condensed chromatin, while those of clear RSM are larger with loose chromatin texture. In addition, all transitional forms occur. Cell organelles are rarely seen within all types of RSM. The cytoplasmic processes reach other as well as endothelial cells. The preservation of our material did not allow observation of specialized membrane contacts in these zones. All RSM are invested with a regular basal lamina and well provided with surface vesicles. Profiles of free basal lamina material and faint collagen (argyrophil) fibers are seen in the wide intercellular spaces. RSM poor in myofilaments are interpreted to represent "epitheloid cells" of light microscopy. Their number constantly decreases from the arterial segment of the AV canal to the venous segment. Here the cytoplasmic processes of RSM become less pronounced and the wall of the anastomotic segment continuously changes to that of the collecting vein. Dense RSM rich in myofilaments are compared with pacemaker cells found inthe ureter. Both internal and external elastic membranes are absent in AV canals. A dense network of unmyelinated nerve fibers is found in the adventitial layer of the AV canal, especially in its arterial segment. The axons branch out from small dermal nerves which also contain two or three myelinated axons. The myelin sheaths terminate where the axons reach the adventitia of the AV canals. Axon varicosities filled with mitochondria are thought to be terminals of myelinated axons and are interpreted as receptory. Axon varicosities with synaptic-type vesicles are assumed to be terminals of sympathetic and para sympathetic fibers. All axon profiles are confined to the adventitial layer of the anastomotic segment.


Scanning electron microscopy of the development of the mesoderm layer in chick embryos. The distribution of mesoderm, the structure of mesoderm cells and relationship between mesoderm and ectoderm were examined by SEM in embryos at stages 3 to 5. The mesoderm was displayed by removal of the endoderm and by fracturing the embryos through mesoderm containing regions. Within the mesoderm layer four zones could be distinguished by their cell shape and arrangement--the primitive streak, a multilayered compact area around the margins of the area pellucida, multilayered and loosely arranged cells near the primitive streak and a flattened monolayer of cells around the advancing lateral and anterior edges of the mesoderm sheet. Secretion of basement membrane by the ectoderm was seen to precede the arrival of mesoderm cells. This suggests that ectoderm alone can synthesize basement membrane without mesodermal contribution.


Population and structure of nerve cells in mouse submandibular ganglion. The anatomy of the mouse submandibular ganglion, and population and fine structure of nerve cells were studied by light and electron microscopy. The submandibular ganglion is a plexus containing up to forty ganglia along the main and the smaller excretory ducts of the  submandibular gland. Measurements of the volume of nerve cell bodies display a pattern of distribution with two main peaks, suggesting the presence of large and small types of the intraganglionic neuron. The large neurons mainly have axo-dendritic synapses in which the postsynaptic element is a small spine-like process, while axo-somatic synapses are more common in the small neurons. In some small neurons nuclear chromatin is unusually conspicuous, and accumulations of vesicles of fairly uniform size occur within the cell body. Decentralized ganglia contain almost no synapses showing the absence of definite interneurons.


Local secretory response by the mouse uterine epithelium to the presence of a blastocyst or a blastocyst-like bead. The ultrastructure of the uterine secretion appearing locally at the site of a blastocyst or a blastocyst-like bead was compared to the ultrastructure of the secretion present in a sterile horn of similarly treated mice. The secretion consisted of a homogeneous substance with small vesicles. The secretion was sparse and only slightly electron dense in a sterile horn, while it was more abundant and denser in a horn with a luminal object. Around a blastocyst, the secretion appeared more dense than it did around a bead, while the small vesicles of the secretion were more frequently occurring around a bead than around a blastocyst. It is concluded that a luminal object like a blastocyst is capable of eliciting a local secretory activity in the uterine epithelium, and it is suggested that this secretion is rich in hydrolytic enzymes.


A stereological approach to the study of neural organogenesis in Xenopus laevis. Stereological methods are applied to the study of structural changes undergone, during neurulation, by the neuroepithelium of early embryos of Xenopus laevis. In light microscopy, we evaluate: the section area of the neuroepithelium, the nucleocytoplasmic ratio, the volume fraction of the intercellular spaces, of the nuclei and of the cytoplasm. In electron microscopy, the volumetric density and the surface ratio of mitochondria as well as the surface density of the endoplasmic reticulum are measured. Occasionally, the data found for Xenopus are compared to those found earlier in a similar study of the chicken embryo.


An electron microscopic study of the developing caudate nucleus in  euthyroid and hypothyroid states. Thyroid hormone exerts a powerful influence on CNS growth and maturation. Hypothyroidism early in life has long been known to cause disturbances in innate behavior, motor performance, severe and frequently irreversible mental retardation. In this deficiency, depressed caudate neurogenesis, cell migration and neuropil development during the rapid period of CNS growth may contribute to the clinical picture of perceptual handicaps often seen in cretins. Light microscopic and Golgi studies of the developing caudate nucleus in thyroid deficiency have been carried out to help attain insights into the mechanisms whereby the extrapyramidal system regulates motor function. The ultrastructural study of caudate nuclear cytogenesis and synaptogenesis in normal and hypothyroid states provides more detailed information for further analysis of the problem. Hypothyroidism was induced from birth by adding prophylthiouracil to the food and drinking water of lactating dams. Linear development of the caudate nucleus of both normal and hypothyroid rats at ages 8, 14, 20, 30 and 42 days was studied by electron microscopy. Thyroid glands were examined by light microscopy to assess the normal and deficient states. Immature cells, primitive processes and synapses were the characteristic features of the 8-day-old normal caudate nucleus. Distinctively wide cisternae of the rough endoplasmic reticulum, loosley packed Golgi apparatus and chromatin clumps throughout the nuclei of the neurons were significant early morphologic variations. The dramatic cytoarchitectural maturation in the 14- and 20-day normal caudate neuropil points to the rapidity of developmental rate. After the growth spurt of the first three weeks a maturational plateau occurs which is characterized by well-formed neuronal cytoplasmic organelles, myelinated and non-myelinated axons, axon terminals, dendrites and their spines, and synapses. Thyroid deficiency causes a marked maturational delay of approximately 7 days in caudate neuronal proliferation, the elaboration of neuronal networks and the attainment of mature synaptic contents and membranes. This delay is evidenced by comparison of the structural similarities between 8-day-old normal and 14-day-old deficient rats; and additional comparisons between the 14-day-old normal and 20-day-old hypothyroid rats. A rapid "catch up" process in fine structural morphogenesis takes place in the period between days 14 and 30 in the deficient animals. Repression of thyroid function does not entirely prevent development of the caudate nucleus but allows a fairly extensive, though critically incomplete degree of maturation. This imperfection is manifested by a decrease in the number of synaptic contacts that persists even after the rapid "catch up" phenomenon of caudate synaptogenesis.


Fine morphological changes in the penicillate nerve endings of human hairy skin during prolonged itching. Morphological changes in cutaneous nerve endings were investigated electron microscopically in patients suffering from certain kinds of urticaria with associated itching and in normal skin in which wheals and local itching were induced either by application of nettle hairs or by intracutaneous injections of a timothy pollen extract. Skin samples were obtained with a high speed dermal punch without anesthesia from the wheal areas. It was found that some subepidermal free nerve endings derived from non-myelinated nerve fibers (penicillate endings) showed accumulations of extra-cytoplasmic glycogen which was localized in the distended spaces between the axolemma, the Schwann cell membrane and the nerve basement membrane. In some cases, the glycogen was found to be so abundant that it occupied most of the cross sectional area of the ending. No morphological changes were observed in the pappilary endings, in nerve endings of the hairs or in the autonomic terminals. The conducting segments of all cutaneous nerve fibers showed normal morphology. The unusual morphological changes that occur in some penicillate nerve endings during the wheal development indicate that these endings are involved in the skin reaction and therefore they may be the specific end organs that are associated with itch, at least in urticaria.


Ultrastructural alterations in neuroepithelial cells of mouse embryos exposed to cytotoxic doses of hydroxyurea. Developing neuroepithelial cells from the cranial region of neural folds were examined at various intervals from 15 minutes to four hours after administration of teratogenic (250 mg/kg) or embryolethal (500 mg/kg) doses of HU to ICR/DUB mice on ninth day of gestation. Thirty percent of surviving fetuses showed extencephaly after the teratogenic dose. The initial ultrastructural change in some neuroepithelial cells occurred within 15 minutes to one hour after treatment with the teratogenic dose and involved a breakdown of polyribosomes into monosomes which were dispersed evenly in the cytosome. At one to two hours, condensation of the cytoplasm and chromatin was observed along with distorted nuclear shape. At two to four hours, cells exhibited extremely condensed cytoplasm and fragmentation of the cells occurred. The affected cells showed pyknotic nuclei and segregation of fibrillar and granular components of the nucleolus. In some nuclei, particularly after treatment with the higher dose of HU, a condensation of the nucleolus was observed. At this stage images were obtained which indicated that neighboring cells phagocytosed the cellular fragments derived from the HU affected cells.


Concanavalin A binding to the epithelial surface of the developing mouse olfactory placode. Concanavalin A (Con A), a lectin binding to mannosyl and glucosyl residues of glycoproteins and glycolipids, was used to study the appearance of carbohydrate-rich cell surface material on the olfactory placode and nasal processes which contribute to formidine was also used in an attempt to correlate changes in labeling index with formation of the olfactory placode and nasal processes. The cell surface of the early frontonasal epithelium binds Con A very little, if at all, but Con A binding was observed when the olfactory placode could be identified as a plate of cuboidal cells that exhibited a reduced labeling index. During the period of formation of the nasal processes, Con A binding was observed on the facial epithelium including the presumptive contact region. There was also a decline in the labeling index throughout primary palate formation. This study provides three criteria by which the olfactory placode can be identified: a morphological change of placode cells to a cuboidal shape, a synthesis or rearrangement of surface coat material that binds Con A, and a reduced labeling index.


Pulmonary circulation--vertebral venous interconnections in the chickens. Injections of India ink colored blood, latex, and plastic followed by study of corrosion casts and dissections were used to determine the interconnections of the vertebral venous system and pulmonary circulation in the chicken. Multiple, minute connections are found to the intercostal veins, small mesenteric veins and others connected to the vertebral venous system. Thus, blood can flow in quantities between the vertebral venous system and the pulmonary circulation depending upon pressure gradients.


The vertebral level of origin of spinal nerves in the rat. Several dissections were performed to determine the level of spinal cord termination and the vertebral level at which the dorsal and ventral roots of spinal nerves C1-S4 emerged from the spinal cord in the rat. These levels of emergence were then compared to the level of exit from the vertebral canal. The dissections demonstrated that the effect of differential growth between spinal cord and vertebral column begins in the lower cervical region and becomes progressively more pronounced throughout thoracic and lumbar levels. The disparity between the vertebral level of emergence of spinal roots from the spinal cord and their level of exit via intervertebral foramina was found to be considerably larger than was previously reported by Greene ('68). It was further noted that the spinal cord terminated at the level of the intervertebral disc between the third and fourth lumbar vertebrae, not between the fourth and fifth lumbar vertebrae as reported by Greene ('68).