Do the right children have necropsies?. Analysis of selected determinants. An analysis of the frequency of post-mortem examinations was conducted in the paediatric age group. Among the factors found to influence necropsy rates were (i) age at death, the frequency of necropsy decreasing with age; (ii) cause of death, necropsy frequency varying with major diagnostic groups; (iii) investigation conducted before death, necropsy frequency decreasing when the clinical picture was ill-defined; and (iv) place of death, necropsy being less frequent when death occurred outside hospital. These findings imply (a) that necropsy practices may be governed by habit and convenience as well as by desire to complete the clinical picture, and (b) that more equitable balances in such practices should be sought if there is to be improvement in the quality of mortality data.


Changes in plasma nephelometry after oral fat loading in children with normal and abnormal small intestinal morphology. A standardized oral fat load has been given to 66 children having duodenal or jejunal biopsy, and to 10 children presumed normal. The rise in plasma light scattering intensity (LSI) measured by nephelometry between the fasting and 2-hour postload level (0-2 hour) showed good correlation with the small intestinal morphology in patients suspected of having coeliac disease. In those who had had recurrent diarrhoea and gastroenteritis, the fat load test did not predict small intestinal morphology. Serial studies in 5 treated patients with malabsorption showed increase in the 0-to 2-hour LSI, with corresponding improvement of small intestinal morphology and clinical state.


Asymptomatic type II hyperprolinaemia associated with hyperglycinaemia in three sibs. Three clinically normal sibs were discovered to have type II hyperprolinaemia in a routine serum amino acid screening programme in Sicily. In addition to the basic biochemical features of type II hyperprolinaemia, all 3 children had marked hyperglycinaemia, whereas their parents had both normal blood proline and glycine concentrations. Clinical normality in individuals with hyperprolinaemia may suggest that these two metabolic disorders (types I and II) are benign entities. Furthermore, the absence of clinical abnormality in these sibs, despite the presence of marked hyperprolinaemia and hyperglycinaemia, may suggest that neither of these findings alone causes brain damage. The hyperglycinaemia in these sibs is unexplained and is an unusual if not unique finding in association with hyperprolinaemia.


Herediatary anhidrotic ectodermal dysplasia. Studies in a Nigerian famil. Studies in a Nigerian family with hereditary anhidrous ectodermal dysplasia are reported. Microscopical examinations of finger tips for sweat pores were diagnostic in phenotypes, and it is suggested that this simple nonsurgical procedure is a preferred alternative to skin biopsies in the diagnosis of the syndrome. The clinical implications of a tropical environment for the syndrome, as well as the factors that may favour maintenance of the gene in such an environment are discussed.


Perifollicular fibromatosis cutis with polyps of the colon--a cutaneo-intestinal syndrome sui generis. In the present study, a peculiar fibromatosis cutis in two siblings has been reported the dermatosis being characterized by innumerable perifollicular fibromas on face, neck and trunk as well as multiple fibromata pendulantia. Since the father allegedly had skin lesions resembling those of his two affected children, an inherited condition is assumed for the disease manifesting itself rather late in age. In the female patient, several adenomatous colon polyps one being transformed into carcinoma were found. Since the association of distinct epithelial and mesenchymal tumours of the skin and the cranial bones with multiple colon polyps is typical for Gardner's syndrome, we have discussed in detail the possiblity of an unknown variant of it. On the other hand, most features of Gardner's syndrome (cutaneous and subcutaneous epidermoid cysts, desmoid tumours, generalized osteomas, a marked multitude of colon polyps, early manifestation of skin and bone changes) were absent in both cases whereas, to our knowledge, in Gardner's syndrome perifollicular fibromas have never been seen. Since perifollicular fibromas are organoid tumours of the mesenchymal hair sheath being clearly defined both clinically and histologically, they must not be confused with the equally well characterized cutaneous tumours of Gardner's syndrome. We are prone to assume that the (irregular?) ASSOCAITION OF MULTIPLE PERIFOLLICULAR FIBROMAS AND COLON POLYPS Represents a distinct nosological entity neither identical with Gardner's syndrome nor with any other known dermo-intestinal syndrome. Thus, perifollicular fibromatosis should alert the dermatologist to consider periodic thorough examination for intestinal polyps the more as they may change into malignant growth.


Lymphocyte stimulation in the cellular inflammatory reaction of some human skin tumours. By labelling dermal infiltrate cells with H3-thymidine, two types of skin tumours can be distinguished: one type with many labelled cells in the infiltrate (H3-thymidine labelling index, H3-I), the other with few labelled cells. Type I includes malignant melanoma (H3-I = 2.2%) and hemangioendothelioma (2.8%). Type II includes metastases of malignant melanoma (1%), squamous cell carcinoma (1.1%), basel cell epithelioma (0.5%), nevus cell nevus (0.6%), and nevoid lentigo (0.4). The number of labelled cells in the cellular reaction of Type II tumours does not differ significantly from that in normal human corium (0.75%), though there may be a dense cellular reaction. DNA-synthesizing cells were classified with the aid of characteristical stainings and histochemical methods. A vast majority of them were found to be lymphocytes. Our research underlines the special importance of cellular inflammatory reaction, i.e. cellular immunity, im malignant melanoma and probably in hemangioendothelioma.


Histophysiology of mast cells in skin and other organs. Our observations demonstrate an intimate relationship between peripheral nerve fibers and mast cells. In addition, mast cells in various organs influence both the small blood vessels and the organ parenchyma cells. These relations are interpreted in the sence of a neuro-hormonale feedback-system.


Contact radiotherapy of cutaneous hemangiomas: therapeutic effects and radiation sequelae in 818 patients. The paper presents statistical data on the therapeutic effects and radiation sequelae following Chaoul contact therapy of 818 cutaneous hemangiomas treated between 1938 and 1952. 73.3% of all irradiated hemangiomas showed initial improvement but complete involution with an excellent cosmetic result was observed in only 50% of lesions 5 years after treatment. During the same period of time, more than one-third of all patients developed mild to moderate cutaneous radiation sequelae (hyper- or hypopigmentation and telangiectases, rarely atrophy). The high incidence of late radiation effects is probably relation to the high total doses administered in this series of patients, the very short intervals between treatments and the age of the patients. Other radiation radiation hazards are also discussed. Since large studies have proven conclusively that spontaneous involution occurs in 95% of hemangiomas after several years, indications for radiotherapy of hemangiomas are extremely limited.


Human skin proteases: separation and characterization of two alkaline proteases, one splitting trypsin and the other chymotrypsin substrates. Two alkaline proteases, one splitting preferentially the substrates of chymotrypsin (ATEE) and the other one those of trypsin (BAEE), were separated and partially purified by chromatographic means from human skin extract made in a buffer containing 1.07 mol/1 KC1. The proteins soluble in dilute buffer were removed by a prior extraction. The enzymes could be separated effectively only in the presence of KC1 at a high conc-ntration since large molecular size aggregates or polymers were formed in solutions of low ionic strength. In the presence of 2 mol/1 KC1 the molecular size of the BAEE-hydrolysing enzyme was 120000 and that of the ATEE-hydrolysing enzyme 30000. The ATEE-hydrolysing enzyme was purified by Sephadex G-100 gel filtration and DEAE-cellulose chromatography about 250 fold. It also hydrolysed esters of tryptophane and phenylalanine as well as casein with optimum pH 7.8--8.2. The enzyme was inhibited effectively by LBTI, SBTI and partially by trasylol, TPCK and TLCK, but not by E-600 and SH-modifers. The hydrolysis of ATEE was doubled in the presence of 1 mol/lKCl, NaCl, KBr or NaBr but that of casein was inhibited to some extent. Human serum and alpha-1-antitrypsin inhibited this enzyme but not C1-inactivator. alpha-2-Macroglobulin did not protect if from inhibition by SBTI. The BAEE-hydrolysing enzyme was purified by Sephadex G-100 gel filtration and hydroxylapatite chromatography about 30 fold. It also split other esters of substituted basic amino acids as well as BAPA and histone proteins with optimum pH 7.5--8.2. It was inhibited by Trasylol and TLCK, but not by LBTI, SBTI, OMTI, TPCK, E-600, SH-modifiers, human serum, C1-inactivator or alpha-1-antitrypsin. Neither of these enzymes is exactly similar to any one of the enzymes so far separated from human tissues or fluids.


Investigative studies of the dermatitis caused by the larva of the brown-tail moth (Euproctis chrysorrhoea Linn.) I. Clinical and experimental findings. A description is given of both naturally occurring and experimentaly produced brown-tail moth caterpillar dermatitis. Epicutaneous test reactions were studied in a group of 45 persons, utilizing different setae preparations obtained from Euproctis chrysorrhoea L. About 70% of the individuals developed marked reactions upon contact with untreated nettling hairs. The early skin lesions were as a rule erythematous and wheal-like in character (urticarial), gradually becoming more infiltrated and developing into erythematous papules or vesicles. Treatment of the nettling hairs either by heating or saline extraction resulted in a partial loss only of their skin irritating properties; heat treatment being slightly more effective in this respect. Intracutaneous tests with a sline extract of nettling hairs elicited positive skin reactions in all individuals tested. Biochemical analysis of the crude extract revealed the presence of a potent esterolytic enzyme. Apart from their skin irritating action, the nettling hairs were found capable to induce the formation of spherocytes when mixed in vitro with human erythrocytes. The relevance of this phenomenon is discussed. On the basis of our findings and those of other it is suggested that the action of the nettling hairs upon the human skin is dependent both on a toxic and mechanical traumatic principle.


Isolation of single cell nuclei from human epidermis for cytophotometric DNA--measurements. Diluted acetic acid was applied to dissociate human epidermis into its constituents. A simple procedure to gain isolated single cells for cytophometric determination of their nuclear DNA content is described. The method is suited for single cell cytophotometric measurements and for cytofluorimetric flow systems likewise. The losses of Feulgen--stainable nuclear DNA during preparation were studied in dependence on the incubation time of the cells in acetic acid. The kinetics of extraction of nuclear DNA by diluted acetic acid follow a reaction of the first order. It was possible therefore to formulate a simple mathematical correaction for the losses during the isolation of epidermal cells. Avoiding the disadvantage of cut nuclei in histological sections the method is used to study the DNA histograms of resting, regenerating and pathologically altered human epidermis.


Serum IgE-concentrations in patients with contact sensitization. In 123 patients with contact sensitization (cs), of whom 23 had positive histories of atopy and/or positive prick tests (csa), the serum IgE-concentrations were determined and the following results were obtained: 1. A remarkable dispersal of IgE-concentrations was noted in cs--patients (1-3080 U/ml); 12% of them displayed IgE-concentrations of more than 1000 U/ml, even though they had no histories of clinical manifestations of atopy, liver of kidney diseases, or parasitic infestations. Their mean IgE-value of 396 U/ml +/- 60 differed considerably from the one of a comparable control group of healthy individuals. No statistically significant differences were noted between the IgE-levels, the age of our patients, the type and number of contact allergens, and the duration of skin lesions. 2. On an average, there were higher IgE-levels noted in cases of acute and extensive skin lesions than in cases of subacute to chronic, localised skin lesions. Controls of the serum IgE-concentrations and histologic examinations by means of immunofluorescence suggested that, depending on the individual patient, skin lesions might lead to an (unspecific?)activation of IgE-synthesising round cells. 3. In csa-patients with sensitization to metal, the skin lesions were of localised subacute to chronic character, while skin lesions of acute and extensive character were exceptional (5.9%).


The skin in magnesium-deficient rats.

The skin in magnesium-deficient rats. The cutaneous vasodilatation occuring in the early stages of dietary deficiency of magnesium has been investigated in rats. While the time of onset of erythema varies in proportion to the weight of the animal, the duration is not related to weight. In severe states of vasodilatation, the skin is thickened and infiltrated with mononuclear cells, apparently derived from the blood. Intact sympathetic and sensory innervation are not necessary for the development of vasodilatation in the skin. Neither can the genesis of the erythema be attributed to degranulation of mast cells. From consideration of this and other investigations, it is concluded that the cutaneous abnormalities of magnesium-deficient rats cannot be due directly to hypomagnesaemia.


The effect of electrical epilation on the bear hair of women with idopathic hirsutism. The influence of epilation by means of diathermy and galvanic current on the hair roots in the beard region of 11 women with idiopathic hirsutism has been investigated. The hair-roots could be destructed by both methods. Various differences were found between the two methods: 1. After 10 weeks, the hair density in the field treated by diathermy was lower than that in the corresponding field treated with galvanic current. However, the time required for total destruction of all hair roots was found to be the same for both methods. 2. The diameter of the hairs growing again after diathermy was found to be less than that after galvanic current, while the proportion of dysplastic/dystrophic hairs was significantly greater.


[Manometric study of esophageal involvement in progressive systemic sclerosis (author's transl)]. In 15 patients with progressive systemic sclerosis esophageal function was examined radiologically and by manometry. Only one third of the patients had experienced dysphagia, while radiologically esophageal motility was abnormal in 8 patients (55%) and by manometry even in 11 patients (73%). Therefore the absence of symptoms does not exclude extensive involvement of the esophagus. Furthermore the manometric results indicate that involvement of the esophagus in the edematous-indurative stage of scleroderma should be suspected more frequently than assumed generally on the base of radiological studies alone.


Comparative study on the 3H-thymidine index of dorsal epidermis, buccal mucosa, and seminal vesicles in senile male rats. To supplement previous investigations on endogenous fluctuations of DNA synthesis in male rat dorsal epidermis, buccal mucosa and seminal vesicle epithelium from birth to sexual maturity, the labelling indices (L.I.) of these tissues in senile male rats from the same breed, studied under analogous experimental conditions, were evaluated as well as compared to the data obtained from rats in puberal and early mature age. In the dorsal epidermis and buccal mucosa of the old animals the medium L.I. were found to be at about the same level as those measured after puberty. In the aged seminal vesicle epithelium the medium L.I. was found to be decreased. The maintenance of epidermal and buccal DNA synthesis in senile rats as well as the results of previous studies with male rats subjected to castration or long-term administration of cyproteron acetate furnish evidence that a deficiency of testosteron does not diminish the rate of DNA synthesis in epidermis and buccal mucosa. However, from the decreased L.I. in seminal vesicle epithelium a reduced blood level or stimulating capacity, respectively, of testosteron in senile rats can be concluded. Furthermore, withdrawal of testosteron by orchidectomy or administration of cyproteron acetate is appropriate to suppress significantly the proliferative activity of seminal vesicles epithelium.


Statistical association between psoriasis and diabetes: further results. In a group of 200 psoriatic patients from the area of Umbria, Italy, diabetes mellitus occurred in a statistically highly significant association with psoriasis. Similar observations were made earlier in a series of 600 patients. The above correlation also occurred significantly more frequently in patients under 50 years and in male patients. Previous and present experience also demonstrate that psoriasis is statistically correlated with heredity for diabetes and obesity. The possible biological basis of psoriasis/diabetes association are tentatively outlined.


Peripilar keratin casts: a study with the scanning electron microscope. Two cases of Peripilar keratin casts are presented and the results of a Scanning EM investigation are discussed. The surface of the casts is very irregular and disordered. In the underlying structure of the casts the characteristic image of a "sponge" is observed. The cuticle of the hair beneath is slightly flaky, showing fissures. The hair surface facing the peripilar casts is normal.


Degradation of deoxyribonucleic acid by guinea pig epidermal extracts. The capability of guinea pig epidermal extracts to hydrolyze deoxyribonucleic acid has been studied. The results of investigation by gel filtration on Sephadex G-75 column and by viscometry on the mode of hydrolysis of deoxyribonucleic acid by epidermal extracts revealed that deoxyribonucleic acid was degraded by both endonuclease and exonuclease activities. The exhaustive digestion by epidermal extracts yielded the complete degradation of deoxyribonucleic acid to mononucleosides or further metabolites. The enzyme systems involved in the deoxyribonucleic acid degradation include at least an endonuclease, an exonuclease and a phosphatase.


D-penicillamine in dermatology: influence on enzymatic activities of human skin in vitro. By in vitro assay, 6 important enzymatic activities of human skin homogenates were determined following an incubation with D-penicillamine in concentrations between 10(-4) and 10 mg/ml, i.e. 67 X 10(-5) and 67 mM/l. The following enzymatic activities were recorded: lactate dehydrogenase (LDH), glucose-6-phosphate dehydrogenase (G-6-PDH), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), alkaline phosphatase (AP), acid phosphatase (AcP), and "leucine aminopeptidase" (LAP). A dose-dependent activation by D-penicillamine occurred in the case of G-6-PDH- and AcP-activities, a dose-dependent inhibition by D-penicillamine was found with AP- and GAPDH-activities. LDH- and LAP-activities remained unchanged in the presence of D-penicillamine in concentrations up to 10 mg/ml (67 mM/l). From the data of pharmacokinetic studies in rats it may be concluded that concentrations of D-penicillamine which influence enzymatic activities may easily be reached in vivo, under the conditions of treating rheumatoid arthritis and Morbus Wilson. The biochemical actions of D-penicillamine are briefly discussed with secial regard to dermatological therapy and dermatological unwanted side-effects.


Predisposing factors of the skin surface in persons with impetigo contagiosa. The following report describes the results of biochemical and physiological examinations in 32 persons, who had suffered from impetigo contagiosa in the last 2 years, as well as 21 control persons of the same age and sex. The examination of the skin surface of the patient group, when compared with the corresponding control group, showed the following significant results: 1. an increase in the percentage of free cholesterol in skin surface lipids possibly as a result of an increased cell turnover in the epidermis, 2. a decrease in reducing substances as revealed by the ferricyanide and the phenolsulfuric acid methods in the so called water solubles, 3. a decrease in the alkali resistance of the skin possibly as a result of a decreased barrier function of the stratum corneum. It is most likely that these results indicate predisposing factors, localized in the epidermis, for impetigo contagiosa.


Particulates in domestic premises. II. Ambient levels and indoor-outdoor relationships. Three indoor environments, two residential and on institutional, were monitored for particulate and gaseous air pollutants over a one-year period. Inside air particulate levels decreased at night and under conditions of no household activity. Different homes showed different time lags in correlating inside vs outside particle counts. Indoor particle count reduction correlated to rate of air flow through the precipitator. The standard, portable household vacuum cleaner produced about a 100% increase in counts of particles measuring 1.0 mum and larger, as compared to a 50% increase produced by the central vacuum system. Particulates that were smaller than 1.0 mum were not substantially affected by smoking. The indoor gaseous pollutants showed very low maximum levels.


Pneumoconiosis among the activated-carbon workers. The prevalence of respiratory symptoms and chest radiographic and spirometric abnormalities was assessed among 397 employees of an activated carbon plant. Definite radiographic findings of pneumoconiosis, consisting of p-type, rounded opacities in the lower lung fields without firbosis or coalescence, were present in 9.6% of men and were related to cumulative dust exposure. Lesser degrees of radiographic abnormality suggesting pneumoconiosis were present in 11% of men and 2% of women. Spirometric values were substantially lower in blacks than in whites. However, cumulative dust exposure was not an important determinant of pulmonary function in either race. Review of lung biopsy speciments that had been obtained previously in two employees revealed extensive carbon depositiion but minimal associated fibrosis. Prolonged inhalation of activated carbon dust leads to pulmonary deposition of carbon and raciographic signs of pneumoconiosis; such deposition has little, if any, effect on respiratory symptoms or pulmonary function.


Erythrocyte protoporphyrin test for occupational lead exposure. Determination of erythrocyte protoporphyrin levels was performed in workers who are occupationally exposed to lead. The level of erythrocyte protoporphyrin was easily measured with microsamples of blood by utilizing a fluorescent assay. The log of erythrocyte protoporphyrin level was closely correlated to blood lead level (r = .72) in lead-exposed workers. The erythrocyte protoporphyrin test is especially useful in the detection of mild increases in blood lead concentration under conditions of occupational exposure.


Edwardsiella tarda infections in Florida racoons, Procyon lotor. Edwardsiella tarda was isolated from the large intestine of seven (17%) of 42 racoons from Florida. The rate varied from 12% in South Florida to 25% in North Florida. In addition, 52% of the racoons examined were carrying Salmonella, with numerous serotypes represented.


Aortic intimal injury in rabbits. An evaluation of a threshold limit. Sixty-one rabbits were exposed to carbon monoxide, and aortae were then examined by light microscopy and transmission and scanning electron microscopy. The CO concentration in ambient air and the exposure time were varied to estimate the threshold limit for CO-induced focal intimal edema. A significantly higher incidence (P less than .0001) of focal intimal changes was present in rabbits exposed to 180 ppm of CO for four hours or more than in rabbits given a shorter or weaker exposure. The present study, as well as recent reports on the effect of low-level CO exposure on the cardiovascular system, suggests that the CO content in tobacco smoke and in heavily polluted atmospheric air may be deleterious to the arterial wall and enhance atherogenesis. A reevaluation of the recommended threshold limit for industrial CO exposure is proposed.


Human pesticide poisonings by a fat-soluble organophosphate insecticide. In five cases of dichlofenthion poisoning due to suicidal ingestions, unusual toxicologic features were encountered. Initial symptoms were mild or delayed and severe cholinergic crises did not appear until 40 to 48 hours after ingestion. Two patients died, and in the three survivors, cholinesterase symptoms persisted for five to 48 days. An almost total inhibiton of both cholinesterase enzymes continued in one patient for 66 days, and prolonged antidotal therapy was required. Residues of the intact  pesticide were detected in fat after 54 days in one patient, and in the blood for 75 days in another patient. The partition coefficient of dichlofenthion in fat was 20 times greater than parathion, and exceeded only by leptophos. Considering the chemical and toxicologic properties of this compound, we postulated that the mechanism of protracted intoxication is a slow release from adipose reservoirs.


Left ventricular performance after acute myocardial infarction. Sectrum of functional abnormalities and importance of wall motion disturbances during convalescent phase. Seventeen patients underwent catheterization of the right and left sides of the heart and left ventricular (LV) angiography three to six weeks after acute myocardial infarction. Fourteen of 17 patients had abnormal LV function. Three patients had altered LV diastolic properties; five patients had abnormalities of diastolic properties and of systolic function; and six patients had abnormal systolic function, but diastolic function could not be assessed. Thirteen of the 14 patients with abnormal LV function had LV wall motion abnormalities, which were quantitatively related to impaired LV systolic function.


Staphylococcal endocarditis in drug users. Clinical and microbiologic aspects. Forty patients had staphylococcal endocarditis and a history of parenteral drug abuse. Clinical and microbiologic features of their cases were evaluated. None of our patients were known to have had preexisting valvular disease. The tricuspid valve lesions and their pulmonary complications were the predominant findings. Systemic complications in the form of meningitis, glomerulonephritis, empyema, arthritis, and nosocomial Gram-negative septicemia occurred in 33% of our patients. Of interest was the high incidence of reactions to therapy especially with methicillin sodium, which occurred in 30% of patients. Correlation of phage type and group with the antibiotic sensitivities of individual staphylococci showed that group 3 and phage types 6, 42E, 54, and 75 were much more resistant to penicillin than other groups and types. The clinical outcome did not relate to phage type and group or to antibiotic sensitivity of the organism.


A study of 57 cases of actinomycosis over a 36-year period. A diagnostic 'failure' with good prognosis after treatment. Actinomycosis continues to elude the clinician. In only four of 57 patients seen at the University of Iowa Hospitals (and in none of 12 since 1958) the disease was correctly diagnosed on admission. The disease is more common in men, but has no seasonal or occupational predilection. A normal inhabitant of the mouth, Actinomyces israelii acts as an opportunistic infection, usually in association with bacterial invasion. It tends to follow a break in normal mucosal barriers. Fistula and palpable mass are the physical hallmarks, with pain and fever the most frequent symptoms. Definitive identification requires anaerobic culture. Chances for cure are excellent with lengthy antibiotic administration.


Treatment of massive obesity with rice/reduction diet program. An analysis of 106 patients with at least a 45-kg weight loss. One hundred six massively obese patients, who each lost at least 45 kg, were treated as outpatients with the rice/reduction diet, exercise, and motivational enhancement under daily supervision. Average weight loss was 63.9 kg. Forty-three patients achieved normal weight. Men lost weight at a greater rate than women. Concomitant with weight reduction, there were significant decrements in blood pressure; fasting and two-hour postprandial blood glucose, serum triglyceride, and serum uric acid levels, and heart-chest ratio as evidenced on chest x-ray film. Electrocardiographic and retinal venous changes improved. Serum cholesterol level did not change significantly. This study demonstrates that massively obese persons can achieve marked weight reduction, even normalization of weight, without hospitalization, surgery, or pharmacologic intervention. Accompanying cardiovascular risk factors show great decrements concomitant with weight loss.


Transient red blood cell aplasia in association with viral hepatitis. Occurrence four years apart in siblings. Transient pure red blood cell aplasia was verified during the course of viral hepatitis in two siblings whose illnesses occurred four years apart. The duration and course of the anemia was very similar in the two subjects, and in both the hepatitis progressed to a chronic active form. Autoimmune phenomena were prominent in one patient and suggested in the other, but a cytotoxic antibody to erythroblasts could not be demonstrated in the one patient in whom it was sought. The unique occurrence of such a syndrome in siblings, widely separated in time, suggests the possibility of a genetic predisposition governing the unusual response to a common illness.


The uptake and assimilation of sulphate by Thiobacillus ferrooxidans. Sulphate was rapidly bound by cell suspensions of Thiobacillus ferrooxidans. The binding was depressed by tetrathionate but was unaffected by Group VI anions, cysteine or methionine. Increasing uptake of sulphate was observed in cell suspensions incubated in the presence of ferrous iron. The bulk of 35S-sulphate was removed from the organisms by washing with dilute sulphuric acid and the remaining label was incorporated into cold trichloroacetic acid-soluble compounds. 35S-labelled adenosine 5'-sulphatophosphate was produced from ATP and 35S-sulphate by cell suspensions and in cell-free extracts. There was no evidence for the production of adenosine 3'-phosphate 5'-sulphatophosphate assayed by a very sensitive bioluminescence method.


Regulation of the pyruvate kinase from Alcaligenes eutrophus H 16 in vitro and in vivo. The biosynthesis of the enzyme pyruvate kinase (E.C. 2.7.1.40) of Alcaligenes eutrophus (Hydrogenomonas eutropha) H 16 was influenced by the carbon and energy source. After growth on gluconate the specific enzyme activity was high while acetate grown cells exhibited lower activities (340 and 55 mumoles/min-g protein, respectively). The pyruvate kinase from autotrophically grown cells was purified 110-fold. The enzyme was characterized by homotropic cooperative interactions with the substrate phosphoenolpyruvate, the activators AMP, ribose 5-phosphate, glucose-6-phosphate and the inhibitor ortho-phosphate. In addition to phosphate ATP caused inhibition but in this case nonsigmoidal kinetics was obtained. The half maximal substrate saturation constant S0.5 for phosphoenolpyruvate in the absence of any effectors was 0.12 mM, in the presence of 1 mM ribose-5-phosphate 0.07 mM, and with 9 mM phosphate 0.67 mM. The corresponding Hill values were 0.96, 1.1 and 2.75. The ADP saturation curve was hyperbolic even in the presence of the effectors, the Km value was 0.14 mM ADP. When the known intracellular metabolite concentrations in A. eutrophus H 16 were compared with the regulatory sensitivity of the enzyme, it appeared that under the conditions in vivo the inhibition by ATP was more important than the regulation by the allosteric effectors.


[Effect of blue and red light on the synthesis of ribosomal RNA in Chlorella]. In autotrophic cultures of Chlorella pyrenoidosa (strain 211-8b) incorporation of tritiated guanosine and uridine into ribosomal RNA is stimulated by light. Blue light of wavelengths around 457 nm is considerably more effective than red light around 679 nm (5-10(-10) Einstein cm-2 sec-1 for both). This effect can be demonstrated for young daughter cells (at the end of the dark period) and for older cells (at the end of the light period). It is shown to depend on a regulation of rRNA-synthesis. The blue light dependent enhancement of incorporation is more pronounced in the cytoplasmic rRNA (25 and 18 s) than in the chloroplast rRNA (23 and 16 s). Blue light of low intensity (1-10(-10) Einstein cm-2 sec-1) has nearly the same effectivity as the fivefold intensity, whereas red light of equal quantum fluxes enhances incorporation only slightly compared with the dark control. The blue light dependent enhancement of rRNA-synthesis continues in the following darkness in contrary to that caused by red light. This enhancement is also found in DCMU-poisened cultures. In contrast to this, is red light in presence of DCMU, incorporation into rRNA is nearly the same as in dark. It is concluded that the regulation of rRNA-synthesis in red light is closely connected to complete photosynthesis, while in blue light an additional regulation takes place independent of photosynthesis.


Cryptomonad biliprotein: phycocyanin-645 from a Chroomonas species. The properties of phycocyanin-645 from the fresh water cryptomonad Chroomonas spec. were investigated after the pigment was isolated and purified by a combination of differential ammonium sulphate fractionation, gel filtration chromatography and ammonium sulphate gradient elution. Phycocyanin-645 is characterized by absorption maxima at 645 nm, 584 nm, 369 nm, 275 nm and shoulders at 340 nm and 620 nm. The CD spectrum has a negative maximum at 645 nm and a positive maximum at 584 nm with a shoulder at 610 nm. The fluorescence emission spectrum is asymmetrical and shows a maximum at 660 nm and a shoulder at approximately 715 nm. The molecular weight of the native phycocyanin-645, estimated by gel filtration, is 45000 for all multiple pigment forms below. Phycocyanin-645 is heterogeneous as revealed by isoelectric focusing with pIs at 7.03, 6.17, 5.75, 5.25 and 4.88, respectively, the main bands lying at pI 7.03 and pI 6.17. This was confirmed by polyacrylamide gel electrophoresis; five pigment compoents differing in mobility were found. We propose the term "multiple pigment forms" for these five phycocyanin-645 modifications. Calibrated SDS gel electrophoresis shows phycocyanin-645 to consist of three subunits, two light chains (alpha1, alpha2), having molecular weights of 9200 and 10400, respectively, and one heavy chain (beta), having a molecular weight of 15 500. Suggesting a 1:1:2 ratio between the subunits, the quaternary structure of the pigment molecule is alpha1beta--alpha2beta1.


Halococcus morrhuae: a sulfated heteropolysaccharide as the structural component of the bacterial cell wall. The qualitative and quantitative composition of purifed cell wall of Halococcus morrhuae CCM 859 was determined. Glucose, mannose, galactose; glucuronic and galacturonic acids; glucosamine, galactosamine, gulosaminuronic acid; acetate, glycine and sulfate are found as major constituents. The amino sugars are N-acetylated. It was not possible to fractionate the cell wall in chemically different polymers. Evidence is presented that the major cell wall polymer of this strain is a complex heterolgycan which seems, like the peptidoglycan of most bacteria, to be responsible for the rigidity and stability of the cell wall. In addition it could be proved that this heteroglycan is sulfated and therefore differs considerably from previously described bacterial cell wall polymers.


Oxidation of formaldehyde by alcohol oxidase of Candida boidinii. A fromaldehyde oxidase activity was found in cellfree extracts of methanol-grown yeast Candida boidinii. Loss of alcohol oxidase activity in a mutant, 48, led to loss of the formaldehyde oxidase activity, indicating that the same enzyme is probably responsible for both activities. This could be demonstrated with the purified alcohol oxidase which oxidizes, besides lower primary alcohols, formaldehyde to formate. The Km value for formaldehyde is 5.7 mM. It seems that alcohol oxidase is not implicated in formaldehyde oxidation in vivo.


[Quantitative morphology studies on the development of body mass and various muscle groups in intensively reared rabbits]. Development of body mass and the mass of thigh, back and loins musculature was examined at 4, 8, 10 and 12 weeks in 51 California hybrids and 49 New Zealand White hybrids. Body mass development was practically identical in these rabbits. Peak growth rate of the characteristics studied occurred at 2-3 months of age in the California hybrids, but at a variable time in the New Zealand White. Age was less important than body mass in the development of criteria of productivity.


[Course of the parasite phase of development of Trichostrongylus axei (Cobbold, 1879) Railliet et Henry, 1909, in the domestic rabbit]. Rabbits of the New Zealand White and Small Chinchilla breeds were each infected at 3-4 months of age with 4-10 thousand invasive trichostrongyle larvae. Prepatent period of the infection was 22-32 days. Third-stage larvae were present up to the 6th day of infection, fourth-stage from the 8th day, fifth-stage from the 14th day and sexually mature trichostrongyles on the 18th day. The period of patency of the infection lasted for over a year, but only small numbers of eggs were passed in faeces, and food intake was not affected. Between 14 and 44% of the third-stage larvae developed into sexually mature nematodes, regardless of infection dose or duration of infection.


[Course of Trichostrongylus retortaeformis (Zeder, 1800) Looss, 1905, infestation in the domestic rabbit (Oryctolagus cuniculus)]. Fifty Havanna, Small Chinchilla and crossbred rabbits were each infected at 3 to 4 months of age with a single dose of 5-20 thousand third-stage larvae of the trichostrongyle. After infection with 10 thousand larvae, third-stage larvae were present on the 1st and 2nd days, fourth-stage on the 4th-6th days, fifth-stage on the 7th and 8th days and sexually mature trichostrongyles on the 8th-10th days. Only a small proportion of third-stage and fourth-stage larvae failed to develop into sexually mature neamtodes. Prepatent period of infection was 9-10 days; patency lasted from a few weeks to 2-3 months. Single infection with 5000-7000 invasive larvae produced no clinical signs. A dose of 10 thousand larvae produced diarrhoea even during the prepatent period, and this was accompanied by expulsion of a considerable part of the parasite population. Infection with 20 thousand larvae produced a loss of weight in the experimental rabbits.


[Vaccination of sows with the "Dessau" Salmonella-cholerae-suis adsorbate vaccine]. Experiments on the immunization of sows were conducted on six premises. The results justify immunization of breeding animals as part of a control programme for salmonellosis in pigs.


[Occurrence of chlormequat (CCC) in wheat straw and its excretion in milk following feeding of straw pellets containing chlormequat]. When the herbicide chlormequat (chlorocholine chloride or CCC) was correctly used at 2 kg per hectare at the five-leaf stage of growth, the residues in wheat straw did not exceed 3 ppm. Such residual amounts remained unchanged after storage and pelleting. However, the feeding of contaminated straw pellets to cows did not result in contaimination of the milk detectable by a method which was capable of determining concentrations down to 0.05 ppm.


[Lactic acid content of blood plasma in domestic swine of various breeds during physical exertion]. Lactic acid was determined by an enzymic method in plasma samples taken from 20 pigs of the German Edelschwein, German Landrace, German Saddleback and Edelschwein/Landrace crosses before, during and after being made to run on a band moving at 1.3 metres/second for ten minutes, at 10 degrees C and relative humidity of 65-75%. A special method was used to assess the degree of exertion. The lactic acid curve showed that Edelschwein and German Saddlebacks had a low regulatory capacity while German Landrace and the crossbred pigs had a large capacity. For assessing differences attributable to individuals or to breeds, the occurrence of the maximum lactic acid concentration during or after exercise was of special significance.


[ Glucose concentration in blood during exertion. 5. Use of the total distribution of blood glucose values during physical exercise or the estimation of response to exertion in various breeds of swine]. Blood glucose was determined by an enzymic method in 56 pigs of the German Edelschwein, German Landrace, German Saddleback breeds and Edelschwein/Landrace crosses before, during and after exercise on a belt moving at 1.3 metres/second for ten minutes, at 10 degrees C (winter) or 22-34 degrees C (summer) and relative humidity of 65-75%. Total plasma glucose was calculated from the plasma volume. Total scatter of values for blood glucose concentration and total plasma glucose was greater in Edelschwein and Saddlebacks than in Landrace and the crossbred pigs. There was a close and significant relationship between individual regulatory capacity and breed. The total scatter of blood glucose values was greater in winter than in summer.


[Effect of the type of management and training on heart rate, rectal temperature and respiration rate of domestic swine during physical exertion]. 29 pigs (meat type of German Landrace) were kept in groups in a confined space (0.48 m2 a head; group E), in a normal area (1.2 m2 a head; group N) or in a normal area plus daily exercise (group L). After having been kept under these conditions for specified periods, the pigs were made to run on a band moving at 1.1 metres a second for 2 km. During exercise the heart rate increased to 275 beats a minute in group E and only 180 in group L. In group L the recovery pulse rate was greater and the absolute and relative heart weight smaller than in group L; rectal temperature after exercise was also higher than in group L. Values for group N lay between those of groups E and L. The relationship of respiration rate to rectal temperature after exercise was greater in group L than in groups E and N. Physical fitness of groups E and N was inferior to that of group L.


[Mineral content of various tissues in cattle. 4. Studies on dry matter, Ca, Mg, Na and K concentration in mucous membrane and muscle layer of various bovine gastrointestinal sections]. Samples of the following parts of the gastrointestinal tract were collected from 20 slaughter cattle: - oesophagus, reticulum, omasum, rumen, abomasum, duodenum, jejunum, ileum, colon (beginning and end). There were considerable differences in mineral content, related to the differing functions of each part. Forestomach mucosa contained high concentrations of Ca and Mg, attributable to accumulation and separation of mineral salts. In the three segments of small intestine there was generally more Mg than Ca, with high concentrations of Na and K. The tabulated results are intended to provide a basis for comparison with pathological states.


[Alkaline phosphatase activity in blood serum, bile and urine of cattle and calves]. Mean values and the range of values for alkaline phosphatase activity in serum (expressed in units) were: - calves 909 (413-1445), bulls 325 (179-543) and cattle 131 (72 to 162). Differences between these groups were statistically significant. Values for bile were: - calves 416 (116-882), cattle 546 (145-1203), bulls 738 (108-1438) enzyme units; here there were no significant differences. Activity of the enzyme in urine was very low, mean values being 0.77 in calves, 0.39 in cattle and 1.69 in bulls; the differences between groups were statistically significant.


[Influence of the cecum, in geese fed diets containing urea, on N-metabolism and digestibility of nutrients and on urea concentration in excrements and blood]. Balance experiments were performed on six normal young geese and on six geese with a ligated caecum. The ration consisted of 43.25% barley, 30% sugar beet slices, 20% cellulose, 1.4% maize germ oil, 3% mineral mixture, 1% concentrate of vitamins and growth factors, 1.25% urea and 0.1% lysine. Daily nitrogen balance was similar in the two groups (average 1051 mg in the controls and 1090 mg in the experimental birds). Crude protein digestibility was 82.4 +/- 1.1% in the controls and 84.9 +/- 1% in the experimental birds (a significant difference). The bacterial flora of the caecum seemed to have no effect on crude fibre breakdown. Digestibility was quite low, averaging 5.7% in controls and 4.6% in experimental birds. The proportion of urea discharged in excreta was 50% in controls and 55.7% in experimental birds. Blood urea veraged 21.7 mg/100 g in controls and 22.8 mg in experimental birds (insignificant difference).


[Experimental studies on allergenic effect of Mycobacterium intracellulare in cattle]. Mycobacterium intracellulare, isolated from sawdust used as litter, was inoculated into 25 bullocks. Six developed a doubtful reaction to mammalian tuberculin and the remainder stayed negative. With avian tuberculin, 8 became positive, 10 doubtful and 7 remained negative. Using the interpretation key described by Goetze, Lauterbach and Nassal, the reactions were shown to be para-allergic. At slaughter there was no evidence of tuberculous lesions.


[Hyperthermia in the rabbit. I. Studies on influencing circulation with exogenic hyperthermia]. Increasing the environmental temperature to 35 degrees C produced hyperthermia in 11 female rabbits, 80-90 days old. At the onset of hyperthermia the heart rate increased, but there was no further change after about two hours (range 1-3 hours); it remained constant at an increased rate until the end of the experiment. Blood pressure fell at first, but it had increased again after 90 minutes, and underwent no further change during the experiment. The mechanism of these circulatory changes were discussed in relation to the neutral control of body temperature regulation.


[Evaluation of the ability to regulate blood volume under standardized motoric stress]. Sixteen German Landrace pigs of the meat type were kept in individual cages (0.47 m2 floor area each) or in two pens of four pigs providing 1.05 m2 per animal, under otherwise identical conditions for 45 days, commending at a body weight of 45 kg. Plasma volume and plasma glucose were determined before, during and after the pigs made to run on a band moving at 1 m/s for 20 minutes at 24 degrees C. Changes in plasma volume were studied from the total scatter of values (total area covered by the curve of values). This made it possible to quantify individual regulatory capacity and the influence of management. Close confinement in an individual cage reduced the regulatory capacity of the plasma volume by 3.5 to 4 times. There were significant qualitative and quantitative relationships between intravascular fluid volume and intravascular glucose or glucose concentration.


[Metabolism and hematology studies of intensively raised fattened lambs under various feeding and management conditions. 1. The effect of various feeding methods on the blood picture, serum mineral and bilirubin concentration, and vitamin A concentration in the liver]. Calcium, phosphorus, magnesium and bilirubin content, blood picture and liver vitamin A were determined in six groups of lambs fattened on different rations, in comparison with a control group. The results are presented in graphs and tables. There was no clear difference between the various groups, in the criteria examined.


[Metabolism and hematology studies of intensively raised fattened lambs under various feeding and management conditions. 2. The effect of various management methods on the blood picture, serum mineral and bilirubin concentration and vitamin A concentration in the liver]. Calcium, phosphorus, magnesium and bilirubin content, blood picture and liver vitamin A were studied in four groups of intensively fattened lambs kept under different conditions of management, in comparison with a control group. Results are shown in graphs and tables, Group-specific differences were found in some of the parameters examined: - Ca, P, erythrocytes, leucocytes, vitamin A.


[Metabolism and hematology studies of intensively raised fattened lambs under various feeding and management conditions. 3. The effect of weaning age under various management conditions on the blood picture, serum mineral and bilirubin concentration and vitamin A concentration in the liver]. Calcium, phosphorus, magnesium and bilirubin, blood picture and liver vitamin A were studied in six groups of lambs weaned at various ages and fattened under four types of management, in comparison with a control group. Results are shown in graphs and tables, with a comparison with conventionally fattened lambs. Age at weaning had no demonstrable effect on the parameters investigated.


Erythrocyte soluble catechol-O-methyl transferase activity in primary affective disorder. A clinical and genetic study. Erythrocyte catechol-O-methyl transferase (COMT) activity was studied in 53 patients with primary affective disorders and 38 controls and in selected relatives. Patients with affective disorders tended to have higher activity levels than normals, after correcting for sex differences. The COMT activity was positively correlated between relatives and is heritable. Within families, elevation of COMT activity distingushed healthy relatives from probands and ill relatives. This suggests that COMT activity elevation and affective illness do not show independent assortment and implies that COMT activity identifies genetic vulnerability to affective order.


Bias against genetic hypotheses in adoption studies. Genetic factors are implicated in the cause of psychopathological disorders whenever the incidence of disorder is greater among the adopted-away offspring of affected parents than among those of control (unaffected) parents. The lack of information about most parents who give their children up for adoption could result in the inclusion of a substantial number of high-risk parents in the control groups. This could bias an adoption study against a genetic hypothesis. The Minnesota Multiphasic Personality inventory scores of two groups of pregnant unwed mothers were compared to those of two other groups: married pregnant women and 18-year-old women. Comparisons disclosed that the unwed mothers had significant elevations on five to the nine clinical scales. Elevations on psychopathic deviancy and schizophrenia were particularly substantial. These results indicate a requirement to select control group parents who are representative of the general population.


Biogenic amines and depression. Biochemical and pharmacological separation of two types of depression. Recent research findings indicate that depressive disorders may be divided into two groups, A and B, using specific biochemical and pharmacological criteria. It is suggested that in the A group there is a disorder of norepinephrine systems are not altered. Further, there is the possibility that B types patients have disorder of serotonin, but not norepinephrine or dopamine systems. This biochemical heterogeneity of human depression has implications for both investigators and clinicians, and may account for disparate findings in biological studies of patients with affective disorders.


Grandsons of alcoholics. A test of sex-linked transmission of alcohol abuse. To test the hypothesis of a sex-linked factor influencing the occurrence of alcoholism and alcohol abuse, alcoholism or abuse rates were compared for 136 sons of the sons vs 134 sons of the daughters of 75 alcoholics. No substantial difference between the groups of grandsons was found in frequency of officially registered alcoholism or alcohol abuse, or both, which suggests no sex-linked factor is involved. The total sample was also used to calculate the risk of such registration for the grandson; the rate of registration by the grandsons' fifth decade of life was 43%, approximately three times that of the general male population, and even higher than the equivalent rate in brothers of alcoholics. This result is incompatible with an assumption of a recessive gene being involved in the occurrence of alcoholism, though it fits with the assumption of a dominant gene.


Alcoholism as a mental health problem of Native Americans. A review of the literature. Alcoholism among North American Indians and Eskimos is generally considered a major public health and community mental health problem, and increasingly so.  All too often alcoholism and alcoholic (and the simple avoidance of these terms) are used indiscriminantly, obscuring important avenues for serious consideration. A major consideration is the extent to which the heavy drinking so common among indian men corresponds to "alcoholism" in the dominant culture. Considerations of culture stress (deculturative and acculturative) and cultural intoxication-permitting factors are essential in any dynamic formulation of Native Americans' problem drinking. A crucial individual motive is that drunkenness can provide short-cut gratification by providing fantasy solutions to culture-bound problems.


Alcohol's effect on some formal aspects of verbal social communication. The effects of alcohol on formal aspects of social communication were studied by scoring transcripts of verbal discussions between dyads in alcohol and placebo sessions. At a low dose (3.83 to 1.0 ml/kg), alcohol significantly (P Less than .01) increased the amount of and overlap in communications, and tended to decrease subjects' acknowledgement of their partners' statements. At a high dose (1.5 ml/kg), the rate of overlap in speech was additionally increased, but there was a leveling off or reversal of the drug's effect on amount of communication. The subjects' blood alcohol levels were not related to the drug's effect.


Sex of siblings of male alcoholics.

Sex of siblings of male alcoholics. Research conducted with general population samples has demonstrated the importance of sex of siblings in the formation of sex-role identification and in the development of sex-role conflict. Information on early family structure was collected from 207 white male alcoholic inpatients. Among those reared in intact families with at least two older siblings, 65 had a second-older brother. This difference cannot be explained by variation in family size, differential sex ratios in birth rates, or greater availability of women in the sibships of the alcoholics. It is consistent with a model that postulates that alcoholism in men may express dependency conflict associated with sex-role identify problems.


Dreaming sleep attacks and desynchronized sleep enhancement. Report of a case of brain stem signs. When central neurologic signs were localized to the vestibular region of the brain stem and cerebellum, a 54-year-old man experienced frequent awakenings from nocturnal sleep and daytime sleep attacks with hallucinosis. Sleep attacks were characterized by lid fluttering and closure, upward turning of the eyes, rapid eye movements, myoclonic twitching of all extremities, and loss of consciousness, lasting one or two minutes and aborted by strong sensory stimulation. At their termination, reports of hallucinoid imagery were given. In a sleep record of 6.5 hours, there were 2.2 hours awake (34%), 4.3 hours desynchronized sleep (66%), and a complete absence of synchronized sleep. Reports of hallucinoid imagery were given after awakenings from desynchronized sleep. The findings support the hypotheses that desynchronized sleep is normally under brain stem control and that some types of narcolepsy may be pathophysiologically related to desynchronized sleep.


Stuttering, dichotic listening, and cerebral dominance. Fully right-sided stutterers (35) and fully right-sided nonstutterers (35) had a dichotic listening task to test hypotheses that stutterers have incomplete cerebral lateralization or reversed lateralization of speech function, or both. An assumption of the procedure is that a right-ear preference indicates left-cerebral dominance for speech. Six stutterers and no nonstutterers showed a reversal, ie, a left-ear preference. As a group, the remaining stutterers who showed no such reversal were the same as nonstutterers in the magnitiude of the right-ear preference. This suggests that a subset of stutterers may have an anomaly in the lateralization of speech functions. A nonsignificant tendency emerged for stutterers to show smaller between-ear differences on the test, consistent with the hypothesis that stutterers have less or incomplete lateralization of speech function than nonstutterers.


Intrusive and repetitive thoughts after experimental stress. A summary. Clinical research indicates a tendency to compulsive repetitions of traumatic experiences. Such phenomena have not been studied experimentally and so the generality of the tendency has been uncertain. With development of operational definitions and content analysis techniques, it was possible to quantity and examine intrusive and stimulus-repetitive thought in a series of experiments with controlled variations in subject selection, stimuli, demand set, and context. Comparison of data across experiments indicates a tendency toward intrusive and stimulus-repetitive thought that is not restricted to "traumas" or a few predisposed individuals. Intrusive and repetitive thought appears to be a general stress-response tendency seen in a large proportion of persons after even mild to moderately stressful events. It is concluded that the intrusive repetitions observed clinically are extreme forms of this general stress-response tendency.


Some myths about "mental illness".

Some myths about "mental illness". Radical psychiatrists and others assert that mental illness is a myth. The opening and closing portions of the article deal with the impact such an argument has had in law and psychiatry. The body of the article discusses the five following versions of the myth argument prevalent in radical psychiatry: (1) that there is no such thing as mental illness; (2) that those called "mentally ill" are really as rational as everyone else, only with different aims, that the only reasons anyone ever thought differently was (3) because of unsophisticated category mistakes or (4) because of an adherence to the epistemology of a sick society; and (5) that the phrase "mental illness" is used to mask value judgments about others' behavior in pseudoscientific respectability. Reasons are given for rejecting each of these versions of the argument that mental illness is a myth.


The position of psychiatry in the understanding of human disease. The article discusses psychiatry and the concept of disease. This is approached by first reviewing generic attributes of the concept and how it has come to be used in contemporary medicine. Psychiatry's time-honored concern with alterations in social behavior is analyzed in the light of the generic attributes of disease. A holistic and adaptational perspective toward disease is discussed, and in particular, how psychiatry stands in relation to such a perspective. Alternative paradigms for ordering behavioral changes that can be implicated in disease are suggested. In adopting such a perspective, and rigorously exploring how disease and behavior interrelate, psychiatry becomes one of the disciplines that examines fundamental questions about man and social adaptation.


Differences between behavior therapists and psychotherapists. Patient-therapist interaction patterns of three experienced behavior therapists and three matched analytically oriented therapists were compared. Each therapist saw ten patients in short-term individual therapy. The more active behavior therapists dominated the conversation in terms of speech time, more frequently offered explicit advice and instructions, gave more direct information, presented their own value judgments, and exerted greater control over the content of the interaction than did psychotherapists. Although both groups provided a warm and accepting atmosphere, behavior therapists showed higher levels of accurate empathy, interpersonal contact, and therapist self-congruence. Patients viewed behavior therapists as more authoritarian and believed that psychotherapists encourage greater independence. It was concluded that the two therapy approaches to patients were consistent with theoretical models of each.


Value-related effects on psychiatric judgment. This study was done to clarify the role of political bias in forming psychiatric impressions. One hundred two psychiatrists randomly selected from the national register rendered six clinical decisions on the basis of a prepared case history in which the patient's sex and race were systematically varied, and also completed a moral traditionalism scale. The findings highlight the problem of covert psychiatrist bias, but fail to substantiate the contention that such bias inevitably disfavors the relatively disenfranchised.


Good patients and bad. Therapeutic assets and liabilities. This is an extension of an earlier article that identified three utilization styles at an urban mental health center where, apart from a minority of intensive users, casual users, and pseudousers predominate and, combined, characterize the therapeutically passive user. The present article compares center data to added data from the private sector, where the intensive user predominates. Center/private differences are examined, and correlates of differing utilization styles are identified, such as sex, diagnosis, marital/living arrangements, referral source, and social engagement factor. The later is associated with differences not attributable to diagnostic severity of social impairment. The growing division of labor, wherein the privates sector is engaged in intensive psychiatric treatment while the center increasingly operates an emergency/crisis/maintenance service, is shown to reflect a gross public/private maldistribution of therapeutic assets and liabilities.


Marijuana consumption and tolerance to physiological and subjective effects. The relation between marijuana consumption and the development of tolerance was investigated during a 31-day study. Volunteers with a history of moderate or heavy marijuana use were given access to one-gram (2.1% delta9 tetrahydrocannabinol [THC]) marijuana cigarettes during a 21-day smoking period. Both groups tended to increase consumption during this time. Heavy users averaged 5.7 cigarettes per day and indicated a progressive decline in ratings of intoxication and duration of pulse rate effect. Moderate users averaged 3.2 cigarettes per day but showed no changes in either of these reactions during this time. Results suggested that tolerance does not develop to the two most reliable indexes of marijuana intoxication unless heavy doses of delta9 THC are self-administered repeatedly. Also, the tendency to increase consumption during this time is not necessarily associated with the development of tolerance.


Memory functions six to nine months after electroconvulsive therapy. Memory functions after electroconvulsive therapy (ECT) were assessed in 38 former patients who had received bilateral treatment, right unilateral treatment, or hospitalization without ECT six to nine months previously. Results of six different tests of delayed retention and remote memory provided no evidence for persisting memory impairment. Nevertheless, persons who had received bilateral ECT rated their memory as impaired significantly (P less than .05) more often than did persons in the other follow-up groups. Although considerable effort was made to maximize the sensitivity of the memory tests, it is possible that, long after ECT, some impairment of memory remained that was not detected by these tests. Alternatively, it is hypothesized that the impairment of recent and remote memory initially associated with bilateral ECT could cause some persons to become more alert to subsequent memory failures and then to underestimate their memory abilities.


Memory complaint and impairment in the aged. The effect of depression and altered brain function. To clarify the role of memory impairment in the aged as a normal or psychopathological phenomenon, 153 persons 50-years-old and over with varying degrees of depression and altered brain function were compared for their complaints about memory and actual performance on a series of memory tests. It was found that while performance varied with altered brain function, complaint was related to level of depression, regardless of performance. Exaggerated memory complaint was considered one manifestation of a general pattern of discrpant reporting of symptoms by depressed persons, and apparently related to an underlying personality factor. The complaint of superiority of remote over recent memory was not substantiated empirically, but was considered part of the pattern of stereotyped language and attitudes characteristic of depressed persons.


Erotomania or de Clérambault syndrome.

Erotomania or de Clérambault syndrome. De Clérambault focused attention on a syndrome in which a woman has the delusional belief that a man, usually of higher social status and considerably older, is much in love with her. If the patient's romantic ideas shaped private fantasies instead of determined public behavior, there would be little cause for concern. The situation becomes critical when the fantasies are dramatized in real life with an unsuspecting and usually unwilling man cast in the role of the lover. The woman dwells on the feelings she ascribes to her "suitor." Such delusional thinking, resulting from an ego defect and producting bizarre actions, may be shaped largely by feelings of being unloved or even unloveable; a narcissistic blow is overcome by a grandiose fantasy. Cases in which erotomania is prominent are usually diagnosed as paranoid state or paranoid schizophrenia.


The interictal behavior syndrome of temporal lobe epilepsy. A distinct syndrome of interictal behavior changes occurs in many patients with temporal lobe epilepsy. These changes include alterations in sexual behavior, religiosity, and a tendency toward extensive, and in some cases compulsive, writing and drawing. The concomitants of abnormal limbic acitivity therefore include behavior alterations as well as manifest seizures. The demonstration of interictal spike activity in temporal structures provides a pathophysiologic basis for this syndrome. The constellation of behavioral changes may be of great diagnostic value. In addition, it provides an example of a human behavioral syndrome assocaited with dysfunction at specific anatomic loci. The behavior syndrome of temporal lobe epilepsy may prove to be a useful model in studies on the neural substrates for behavior.


Male transsexualism. Confirmation of a hypothesis? Persistent confusion and the grouping together of similar disorders of differing origins confuse the question of genetic influences of male transsexualism. A 27-year-old adopted biological male transsexual was seen for psychiatric referral. At the time of the initial interview, events of her early development were unknown to her, and were elucidated by her adoptive mother. Her history seems to sever the genetic link between parent and child, while maintaining the psychoenvironmental continuity seen in patients who have been diagnosed as having transsexualism.


Studies of virus-specific antigenicity of tumour cells transformed by bovine adenovirus type 3. The present paper deals with the study of immunologic relationship between tumours induced by bovine adenovirus type 3 and the organism of the tumour-bearing hamster. The experiments showed that primarily induced tumours were not virus-specifically antigenic as a result of non-expression of weak TSTA presumably due to the presence of more potent antigens of cellular origin. It was only after repeated passages of tumour cells in vivo or in vitro, as a result of tumour progression, that the loss of potent antigens of cellular origin occurs which contributes to expression of weak virus-specific antigens. The findings obtained can explain unsuccessful attempts at detecting virus-specific antigens in spontaneous tumours. Antigenicity of spontaneous tumour and its immunologic relationship with the organism are probably associated with antigens of cellular origin occurring on cell membrane as a result of malignization rather than with antigens induced by an etiological agent. Consequently, the more profound development of immunological methods for diagnosis, therapy and prophylaxis of oncogenic processes irrespective of their etiology seems to be expedient.


An infallible method for producing ascitic fluid from solid tumours. Notwithstanding all precautions, the methods usually applied for the transformation of solid tumours into the ascitic form, frequently fail. This must certainly be ascribed to the still existing, considerably high intercellular adhesion forces despite the fact that cancer cells generally show lack of adhesiveness due to their higher electrical charge in comparison with normal cells. Hagmar recently stipulated that particularly anionic detergents increase the negative surface charge of tumour cells, while cationic detergents drastically reduce or even reverse this charge. A series of comparative experiments were undertaken by us in order to study the influence of anionic, nonionic and amphoteric detergents on the production of ascitic fluid from macerates of Yoshida sarcoma and fibrosarcoma BUSP. This latter tumour was produced and maintained in our laboratory and resisted to all our attempts to produce the ascitic form. Heparin, in concentrations of 0,2, 0,4 and 1,0 mg/ml, was used as an example of an anionic detergent; Pluronic F-68 and phosphatidylcholine, both in concentrations of 1, 2, and 5 mg/ml, represent a nonionic and an amphoteric detergent, respectively. The obtained results clearly show a most favourable action of the applied surfactants: whereas the controls, in which the detergents were not applied, failed to produce ascitic fluid in, sometimes, considerable percentages (up to 100% in the case of BUSP) of the treated animals, not a single animal remained free of ascite when the injected macerate was pre-treated with the emulsifier. It should here be mentioned, however, that heparin in the highest concentration applied (1 mg/ml) caused lysis of the tumour cells impeding, thus, whatever formations of ascitic fluid.


[Impulse cytophotometric investigations on melanoblastoma (author's transl)]. We investigated 24 patients with melanotic tumours (under them 22 malignant melanoms). The tumour material (31 x by biopsy, 2 x by autopsy) was homogenized and stained with Ethidium bromide after pepsination. The distribution of the DNA content of the tumour cell nuclei was measured by impulse cytophotometry. The criterion for the curves was the height of the 4-c-peak in percentage of the diploid peak. Our material was divided in 3 groups: I. Without metastases. II. Metastases, slowly progressive. III. Metastases, rapidly progressive. Between the groups there were significant differences: the higher the 4-c-peak, the greater the malignancy. In the group III we mostly had tetraploid populations with the maximal peak at 4-c. The course of the disease (as seen by metastasis, effect of chemotherapy, growing in cell culture) runs parallel to the findings of impulse cytophotometry. In one case of melanosis praeblastomatosa circumscripta Dubreuilh we found a pure diploid cell population without peaks at 4-c. For prognosis (not for diagnosis) the impulse cytophotometric investigation of malignant melanoma is more suitable than the histology. In the discussion we expose the connections between proliferation and DNS distribution of cell nuclei in a tetraploid population. The terminology of cell cycle phases is extended to tetraploid populations with new terms (G', S'). In some cases we found stem lines. As shown by repeated impulse cytophotometric investigations a changing of stem lines in the DNA distribution curve is possible (change from hyperdiploid to tetraploid). The impulse cytophotometry is suitable for such investigations on melanomas.


[Immunotherapy of laryngeal papillomatosis (author's transl)]. 14 children and adults suffering from laryngeal papillomatosis were treated with an inactivated tissue culture virus vaccine. The vaccine was produced from a virus of the papova group isolated out of juvenile laryngeal papillomatosis. In all vaccinated patients, objective regression of tumor mass was observed, mostly without any operative procedure. In 5 patients even with an operation microscope no residula papillomatous tissue could be seen after treatment. In 7 patients with laryngeal papillomas which had been treated for years by repeated surgery, immunotherapy induced regression of 6-12 months duration. Thereafter, recurrences were found which were clinically silent but visible by microscopy. A second vaccination was succesful in 8 of 10 patients. The vaccine treatment showed no side effects.


The fine structure of the parotid gland of the Mongolian gerbil, Meriones meridianus. The parotid gland of the Mongolian gerbil, Meriones meridianus, was examined by the electron microscopy. A peculiar feature of the serous acinar cells in that mature secretory granules have a bipartite substructure consisting of a centrally-located large dense homogeneous core and the peripheral rim of a less dense, fibrillo-granular matrix. The latter is histochemically revealed to be rich in acid mucosubstance while the former may be mainly composed of zymogenic materials because of its dense homogeneous texture. Such a heterogeneity of granule content is detectable in all the materials examined, regardless of fixation and staining methods and of animal age. Another characteristic feature of the gland is observable in the duct cells, which provide the basal hemidesmosomes attached with microfilaments and the network system of agranular cytoplasmic tubules, closely related to the basal plasma membrane. Functional significance of these structures is discussed.


Histological study on the postnatal development and sequence of eruption of the maxillary cheek-teeth of rabbits (Oryctolagus cuniculus). The development and sequence of eruption of the maxillary cheek-teeth of rabbits were studied by histological methods. The presence of three deciduous molars which were replaced by correspondent premolars and of three permanent molars without predecessors was confirmed. The eruption of the maxillary deciduous molars was shown to begin at 4 days postnatally and that of the permanent molar at 9 days, while the eruption of the premolars occurs from 24 days on, replacing the deciduous molars which are exfoliated. The last tooth to erupt is the M3. At 32 days all the permanent cheek-teeth are erupted. The deciduous molars are completely developed at birth, root resorption starting at 4 days. On the first day the premolars are in the bell stage and in the M1 and M2 amelogenesis is taking place. After 27 days the development of the permanent maxillary cheek-teeth is completed. Dentinogenesis, amelogenesis and cementogenesis were observed in all of them.


Ultrastructural alterations in rabbit taste buds induced by prolonged treatment with cycloheximide. Prolonged administration of cycloheximide, an inhibitor of ribosomal protein synthesis, induces degeneration of rabbit taste bud cells: the degenerative changes resemble early changes in denervated taste buds. Our observations show that the pattern of degeneration is quite different in the three cell types of the taste buds. The earliest changes in type II and III cells are an increase in cytoplasmic filaments and extreme dilatation of rough endoplasmic cisternae. Profiles of dead type I and II cells vastly increase in number. Type I cells appear less affected by the drug and the only sign of degeneration was an increase in the number of autophagic vacuoles in their cytoplasm. There was no indication that degenerating type I cells undergo transformation to type II or III cells. These findings support our hypothesis that type I, II and III cells represent distinct cell types and do not undergo transformation to other types in the course of their life span.


The occurrence of brown adipose tissue in perirenal fat in Japanese. 1. In 125 cases of perirenal fat samples derived from human necropsies (from 1 month to 86 years), the occurrence of the brown adipose tissue was examined. Brown fat cells were contained in 72% (90: 125) of the cases. 2. In the infants, all samples contained maximal amounts of brown fat cells: the perirenal fat was composed almost exclusively of brown fat cells: in children and teenagers they began to diminish, and in younger adults further reductions were observed: after the fifth decade conspicuous diminutions occurred. In later decades the brown fat in the perirenal fat was small in amount. 3. This change in the amount of the brown fat tissue undergoes individual variations. In some cases, the brown fat tissue disappeared from perirenal fats in the early stages of life, while in others it persisted to very late stages of life. A man as old as 86 years possessed brown adipose cells in the perirenal fat. 4. Multilocular brown fat cells were classified into the following types: Type 1, fat-depleted cells: Type 2, small-locular cells: Type 3, middle-locular cells: Type 4, large-locular cells: Type 5, monolocular brown fat cells with a thick cytoplasmic rim and pseudomonolocular brown fat cells and Type 6, multilocular brown fat cells rich in cytoplasm. In the infants, all cell types were identified: the small-locular cells were in general scanty in all decades following infancy: in later decades of life, the most common cell types were middle-locular and large-locular cells. The fat-depleted cell is a particular cell type and may occur usually accompanied by multilocular brown fat cells rich in cytoplasm. 5. The fat lobules are composed of a centrally located brown fat cell area and a peripheral layer of monolocular white fat cells, which in the infants was very thin but in the following ages was gradually widened to invade the interior of the lobules. 6. The present findings suggest a continuous replacement of brown fat cells by white fat cells during advancing age. The monolocular brown fat cell with a thick cytoplasmic rim and the pseudomonolocular brown fat cells probably represent transitional forms between multilocular brown fat and monolocular white fat cells. These cell types were found throughout life, suggesting continuous transformation of the brown fat cell into the white fat cell.


Bladder training: its role in evaluating the effect of an antispasticity drug on voiding in patients with neurogenic bladder. Fourteen patients with spinal cord damage were treated with Ba-34647 (Lioresal, Ciba-Geigy), a new antispasticity drug. The treatment was initiated for excessive skeletal muscle spasticity and voiding difficulty. Seven of the patients had been wearing indwelling catheters and seven were catheter-free. The former were given trials at voiding after removal of catheters; the usual assistive methods common to most bladder training regimens were administered. Despite this, the trials were unsuccessful in reducing residual urine to acceptable levels. With addition of therapeutic doses of the drug without the training regimen, voiding trials were also unsuccessful excepting the response of one patient. The drug plus the training regimen was effective in reducing residual urine to acceptable levels in all patients. On discontinuing or decreasing the dosages of the drug, there was gradual but rapid build-up of residual urine despite the active training regimen. Restoration of effective dosage again led to satisfactory voiding function in all patients. The catheter-free group suffered from frequency, nocturia, and bed-wetting owing to excessive residual urine despite the employment of active training regimens. With addition of optimal dosages of Ba-34647, these problems were markedly reduced. They increased with drug discontinuation or dosage decrease and again improved upon restoration of effective doses. Bladder training, including active assistance to the expulsion of urine, is essential to the evaluation of antispasticity drugs for their effect on voiding.


Sequence of electromyographic abnormalities in stroke syndrome. In 20 stroke patients who were examined by repeated electromyography, fibrillation potentials and positive waves were noted as early as seven to ten days after the stroke and gradually disappeared as volitional potentials and spasticity appeared. This sequence of events occurred first in the antigravity muscles, then in their antagonists and finally in the most distal muscles. We hypothesize that the abnormal irritability is a consequence of the loss of the neurotrophic influence on the muscle fiber after the stroke.


Medical education: a required clerkship in rehabilitation and chronic disease. For seven years the University of Rochester Medical School has required a four-week clerkship in rehabilitation and chronic disease as part of the fourth year curriculum. Students have a choice of clerkships ranging from traditional physical medicine and rehabilitation to chronic disease experience in several other specialties. Data have been systematically collected for five years from the students in regard to the following: (1) rating of this clerkship relative to all other required clerkships for educational value; (2) opinion whether the clerkship should continue to be required; (3) value to other students with similar career goals; (4) attitudes towards rehabilitation and changes therein resulting from the clerkship experience; and (5) open-ended comments about the clerkship. Response rate to the questionnaire has been about 80%. The purpose of the questionnaire was to aid in improving the clerkship and to determine the settings where students would respond most positively to a chronic disease experience. Nearly half of the respondents felt the clerkship should continue to be required, and an overwhelming majority felt it would be valuable to students with career interests similar to theirs.


Pneumatic orthosis for paraplegic patients: functional evaluation and prescription considerations. Fourteen paraplegic patients were studied during ambulation training, 11 with pneumatic orthoses and with conventional metal orthoses, and 3 with pneumatic orthoses only. The purposes of the study were to establish whether pneumatic orthoses could be used by paraplegic patients for effective ambulation, whether these devices presented any advantages or disadvantages over conventional orthoses and how their use would affect the expected level of rehabilitation and independence. As far as application, standing up, sitting down and ambulation within a rehabilitation center are concerned, similar skills and levels of independence were obtained with both types of orthoses. Reduced tendency for orthostatic hypotension, availability, light weight and better endurance make the pneumatic orthosis especially suitable for early ambulation training, but several mechanical problems, mainly its inflation with motorized and heavy compressor units, limit its usefulness for community ambulation.


Synergistic tenotomy: effect on chronically denervated slow and fast muscles of rat. A study was conducted with chronically denervated adult female Wistar rats to test the hypothesis that synergistic tenotomy of denervated skeletal muscles does not just retard atrophy but produces an increase in muscle weight. The animals were categorized in three groups-denervated exercised (DE), denervated tenotomized (DT), and denervated-tenotomized-exercised (DTE). Mechanical stretch was induced in the DE group by forcing the animals to stand on their hind legs to reach for food and water. In the DT group, mechanical stretch was induced by tenotomy of two synergists in the gastrocnemius-plantaris-soleus complex of each leg of the rat so that either the soleus or the plantaris was left as the only plantar-flexor of the ankle joint in each leg. Mechanical stretch was induced in the DTE group by forcing the animals to stand after the tenotomy of synergists at eight weeks postdenervation. All animals in the three experimental groups, and in the sedentary control group (D) were sacrificed at nine weeks postdenervation; the soleus and plantaris muscles were removed and evaluated for MW, DW and percent of hydration. The slow muscle (soleus) increased in muscle mass in DT (53%), DE (26%), and DTE (17%). The fast muscle (plantaris) increased in weight in DE (18%) and in DTE (24%), but showed no significant changes in DT. Study results confirm the hypothesis that synergistic tenotomy stimulates an increase in muscle weight rather than merely retarding atrophy, and that this phenomenon can take place in the absence of neuronal influences. It is suggested that the increase in denervated muscle mass stimulated by muscle elongation is not a true work hypertrophy associated with significant changes in protein concentrations but only an adaptation to a new muscle length. The purpose of the adaptational changes is to optimize the overlap of actomyosin bridges in anticipation of forceful muscle contraction.


Bone mineralization in the distal forearm of hemiplegic patients. Bone mineral content was measured by single photon absorptiometry using a modified bone densitometer (Packard) with 125I as the source. In 42 hemiplegic subjects, matched for sex and age, the bone density was compared bilaterally on the radius and ulna 2 cm and 4 cm above the wrist. The nonparalyzed side served as a control for the paralyzed side. The results indicate a consistent, general loss of bone mineral on the paralyzed side compared with the nonparalyzed side. The extent of demineralization in females was greater than in male subjects. Right-dominant left-paralyzed patients showed a greater loss of bone density than right-dominant right-paralyzed subjects. The absorption ratio of the paralyzed vs the nonparalyzed sides revealed that there was a 5.3% and 7.4% decrease in the average bone density at 4 and 2 cm above the wrist, respectively. There was a progressive loss of bone mineral content relative to time after the onset of paralysis, amounting to an average of 6.4% approximately three months after the onset of injury. It was estimated that before the onset of paralysis there was an excess of bone mineral on the dominant vs the nondominant side of +5.4% and +3.2% for males and females, respectively.


F-wave conduction velocity in the central segment of the peroneal and tibial nerves. A simple method was devised to measure the F-wave conduction velocity (FWCV) in the central segment (knee to spinal cord) of the peroneal and tibial nerves in contrast to the conventional motor nerve conduction velocity (MNCV) in the distal segment (knee to ankle). In 33 normal subjects, the FWCV in the central segment (56.3 +/- 4.9 meters/sec for peroneal nerve; 54.4 +/- 3.6 meters/sec for tibial nerve) was slightly faster than the MNCV in the distal segment (49.5 +/- 3.8 meters/sec; 46.8 +/- 3.4 meters/sec) as measured in the conventional manner. In 4 of 14 patients with the Guillain-Barrĕ syndrome, the F-wave was absent or slowed in the face of normal MNCV indicating more marked slowing of nerve conduction proximally. The average FWCV (36.8 +/- 13.6 meters/sec; 42.2 +/- 9.3 meters/sec) and MNCV (41.4 +/- 8.0 meters/sec; 39.0 +/- 5.6 meters/sec) were considerably decreased compared to the normal values. The F-wave could not be elicited in the lower extremities in 16 of 19 patients with Charcot-Marie-Tooth disease. The FWCV was normal in 10 patients with multiple sclerosis including 3 with clinical findings suggesting demyelination in the conus medullaris.


Vocational diagnosis through assessment of functional limitations. Diagnosis in rehabilitation counseling requires a relatively precise delineation of client assets and liabilities. This is essential in establishing direction for counseling efforts; it can also aid in evaluating counseling effectiveness by providing a means of grouping cases according to difficulty or types of problems. This paper identifies the disadvantages of present systems of medical and psychiatric diagnoses for these vocational counseling purposes. It discusses some of the methodological issues involved in establishing a new system for recording client problems. The paper also introduces a brief, yet comprehensive inventory of functional limitations which has been developed in the Counseling Psychology Service of the Department of Physical Medicine and Rehabilitation at the University of Minnesota.


Memory functioning in hemiplegics: a neuropsychological analysis of the Wechsler Memory scale. The Wechsler Memory Scale was administered to 60 hemiplegics and 30 amputees who were matched by age, education, and sex. The results indicated that the orientation subtest has diagnostic value in discriminating between left- and right-sided brain damage in patients and that the right hemisphere may play a proportionately larger role for temporal orientation. The mental control and digits backward subtests seem to be measuring a composite of different cortical functions which are not represented equally in both cerebral hemispheres. Optimal performance on these tests requires interhemispheric integration among these cortical functions. Unilateral damage to either side of the brain would interfere with a special part of the composite function subserved by the damaged hemisphere and produce comparable detrimental effects on performance. The logical memory, digits forward, and associate learning subtests measure memory functions which are equipotentially represented in both hemispheres. Damage to either side of the brain would have no effect on the performance of these tasks. In general, the neuropsychological analysis suggests that the Wechsler Memory Scale has diagnostic value in assessing short-term memory impairment in brain damaged patients. However, memory quotient obtained by summing the total subtest scores has very little value in discriminating between left- and right-sided brain lesions.


Vocational adjustment after laryngectomy. The vocational adjustment of 130 persons after laryngectomy was examined by a semistructured questionnaire which elicited responses on 26 measures including vocational plans, work values, remotivation to work, realism, rehabilitation outlook and speech characteristics. Responses were coded according to the Goldberg Scale of Vocational Development with reliabilities ranging between 0.80 and 0.99. Prior to laryngectomy, 30 persons were unemployed or retired, and 100 persons were employed. After laryngectomy, of the 100 employed persons, 51 remained employed, 31 retired, and 18 were too disabled to work. Higher work values, higher remotivation, greater realism, optimistic rehabilitation outlook, previous employment and previous social involvement correlated positively with employment after laryngectomy (p less than 0.05). The continued employment of 50% of laryngectomees compares favorably with that reported in other studies. Persons who developed the basic ability to cope realistically with their disability had the best chance of continuing employment. Persons with an optimistic outlook about the future course of their disease were more likely to return to employment. This group constitutes a productive clientele for vocational rehabilitation.


Hyperthermia: effect on exercise prescription. Ten healthy male university students pedaled a bicycle ergometer (Monark) for three sessions each lasting 30 minutes. Each subject worked at an individually predicted work load corresponding to approximately 40% of maximal aerobic capacity. The same predicted work load was conducted at 24 degrees C, 44 degrees C and 54 degrees C for each subject. For practical purposes, the results reveal approximately a one beat per minute increase in exercise heart rate for each 1 degree C increase in ambient temperature above neutral (24 degrees C). The practice of exercising cardiac patients in hot ambient temperatures which produce potentially hazardous heart rate levels was challenged. Seasonal reevaluation of exercise heart rate prescriptions is of importance. Hopefully, these findings will also be of some importance to various community gymnasiums and to self-motivated joggers.


Pancreatoduodenectomy. Results when the operation is performed infrequently. A series of 13 pancreatoduodenectomies were performed in a medium-sized university hospital by seven different primary surgeons during an eight-year period without an operative death. The incidence of fistula, wound infection, and other major complications compares favorably with other, larger series. All but two of these operations were performed by resident surgeons. The suggestion that one must have a large experience with this operation in order to perform it safely has not been borne out by our experience. We believe that careful preoperative preparation and meticulous operative technique are the primary factors enabling the safe performance of the operation.


Calf blood flow in intermittent claudication. Calf blood flow was correlated with severity of symptoms in 24 patients with intermittent claudication. Calf blood flow was measured (Whitney strain gauge) at three levels of demand--at rest, after exercise ("open"), and after exercise with total vascular occlusion by a tourniquet about the thigh ("closed"). The results showed significant correlation between the patients' reported capacity to walk and measured exercise tolerance on an ergometer (P less than or equal to .01). The coefficients of correlation between exercise tolerance and calf blood flow (resting, postopen or postclosed exercise) or the vascular reserve (difference between postopen and postclosed exercise hyperemia) were not significant. It is concluded that capacity for walking in cases of intermittent claudication is not a reliable index of the calf blood flow. The relationship between these factors would be clearer if the patients pain threshold and calf tissue metabolic activity were known also.


Serum gastrin and secretin levels after the Exalto-Mann-Williamson procedure. The Exalto-Mann-Williamson procedure produces peptic ulceration in nearly 100% of experimental animals but the mechanism is unknown. To investigate the possible hormonal role of the gastric acid hypersecretion seen after this procedure, we investigated preoperative and postoperative serum gastrin and secretin concentrations. There was no significant change in serum gastrin; however, serum secretin concentrations increased to 2 1/2 times the preoperatve value, most likely secondary to the enhanced secretion of gastric acid. These data do not suppport the theory that alterations in circulating secretin or gastrin levels are responsible for the gastric acid hypersecretion following the Exalto-Mann-Williamson operation.


Malignant hyperthermia associated with enflurane anesthesia. Malignant hyperthermia is induced by potent inhalation anesthetics. Enflurane must be added to the list of those anesthetic agents (such as halothane and succinylcholine) that are associated with this condition. The patient in our study was a young woman with no history of prior exposure to general anesthetics, and no family history of complications following administration of anesthetics. The other possible causes of hyperthermia in the patient were investigated and eliminated, and the condition was finally associated with enflurane. Enflurane should not be used in patients with a family history of this rare but often lethal disorder.


Catheterization in anorectal surgery.

Catheterization in anorectal surgery. Urinary retention and catheterization are among the complications involved in anorectal surgery. One hundred patients who underwent hemorrhoidectomies were able to avoid both of these complications due to a combination of operative and postoperative procedures, including the following: (1) meticulous surgical technique; (2) restriction of fluids; (3) adequate doses of narcotics, and (4) preeducation of the patient and nursing staff, which resulted in spontaneous voiding in all of the patients by the morning after the operation, with or without a hot bath.


The physician, the manufacturer, and medical devices. Better communication between physicians and manufacturers of medical devices is becoming increasingly important due to wider usage of these devices, as well as more intense scrutiny by consumer interest groups. Physicians should therefore have more complete knowledge of techniques of new product development. A new product typically passes through at least six stages, as follows: (1) idea conception; (2) merit and feasibility study; (3) design and testing; (4) production preparation; (5) market preparation; and (6) marketing. These steps are completed over a period of several years at an ever increasing cost. We propose that interaction procedures be undertaken so as to enhance direct physician-manufacturer communications in the medical device arena. Some possible techniques of improving these communications include the direct training of physicians and manufacturers in each other's problems, the establishment of hospital engineering groups, the placement of medical consultants in industry, and the active participation in device standards-generating groups and other groups of mutual interest.