Decreased heat-labile opsonic activity and complement levels associated with evidence of C3 breakdown products in infected pleural effusions. Heat-labile opsonic activity was measured simultaneously in serum and pleural fluid of patients with transudates, infectious exudates (with positive or negative bacterial culture) and neoplastic exudates, using two different complement-dependent phagocytic tests: the killing of Staphylococcus aureus Wood 46 variant strain (K50 opsonic titers) and the assessment of ingestion rate of endotoxin-coated paraffin particles (Oil Red 0 uptake test). K50 opsonic titers were lower in culture-positive pleural effusions as compared to culture-negative (P < 0.002) or neoplastic effusions (P < 0.002). These results were corroborated by the Oil Red 0 uptake test. The data obtained with the two assays showed a significant correlation (P < 0.001). The hemolytic activity of complement (CH50) as well as the levels of C3 breakdown product, C3d, were measured in the same sera and pleural fluid samples and in an additional group of patients with pleural effusions of the same etiology. Effusions with positive cultures showed lower CH50 values (P < 0.01) and higher C3d values (P < 0.05) when compared to culture-negative pleural fluids. Finally, evidence for immune complexes in pleural effusions and sera was looked for by determination of Clq binding activity. Levels were higher in culture-positive effusions when compared to culture-negative fluids (P = 0.005).K50 opsonic titers showed a positive correlation with CH50 values (P < 0.001) for all fluids tested. Similarly Clq binding activity correlated with C3d levels in effusions of infectious origin (P = 0.05). Recovery experiments using the various bacterial species isolated from culture-positive pleural effusions showed evidence of complement inactivation upon incubation with pooled sera at concentrations of 10(7)-10(8) microorganisms/ml. These results indicate that one important reason for bacterial persistence in empyema may be decreased opsonization secondary to local consumption of complement.


Elevated 1,25-dihydroxyvitamin D plasma levels in normal human pregnancy and lactation. Plasma 1,25-dihydroxyvitamin D levels are elevated in early pregnancy and continue to increase throughout pregnancy. They remain elevated postpartum in lactating women. The elevated levels probably represent a physiological response to increased calcium requirements.


Diabetes mellitus and genetic prediabetes. Decreased replicative capacity of cultured skin fibroblasts. The idea that the gene(s) that cause diabetes mellitus can be expressed in extrapancreatic cells has been examined by tissue culture techniques. Skin biopsies were obtained from 25 normal subjects (N), 26 overt diabetics (D), 16 of juvenile onset (JOD) and 9 of maturity onset (MOD), and 21 subjects genetically predisposed to diabetes (P) on the basis of maturity-onset diabetes in both parents. Each biopsy was subdivided, multiple skin fragments were explanted in vitro, and several parameters of cellular outgrowth were monitored in primary and secondary cultures until cell division ceased because of senescence. In general, the rank order of growth vigor was N greater than P greater than D although differences were often marginal and statistically significant between N and JOD and(or) MOD. Outgrowth of epithelial cells was more vigorous in N explants in early stages, but later, JOD and MOD cells grew better than those of N. Outgrowth of fibroblast cells from N explants was more vigorous both at early and later stages and required less time to achieve maximum percent outgrowth. In secondary cultures, N cells grew faster than the other three groups so that fewer days elapsed between subcultures but significant differences were only seen between N and one or two of the other groups over some of the first seven subcultures. The onset of cellular senescence occurred earlier in P and JOD cultures both in mean population doublings and calendar time. N cultures had a higher percent surviving clones after picking than MOD, and a shorter recloning time than clones of JOD. The replicative life-spans of cultures (mean population doublings +/- SE) were N = 52.54 +/- 2.24, P = 47.84 +/- 2.43, JOD = 47.12 +/- 2.99, and MOD = 46.40 +/- 4.04, but differences did not reach significance for N vs the other three groups. The data demonstrate that cellular growth is impaired in both JOD and MOD types of cultures and to a generally lesser extent in P cultures. This is consistent with intrinsic genetic defects but the possibility that persistent deleterious effects of in vivo pathophysiology contribute alone or in combination cannot be ruled out. Therefore, the diabetic defect(s) can be expressed in extrapancreatic cells of mesenchymal origin. This system should prove useful in exploring the interplay between genetic and environmental factors in diabetes, the mechanisms(s) of hyperglycemia and other metabolic derangements, and the propensity that affected individuals have to develop degenerative diseases.


Glucose production in pregnant women at term gestation. Sources of glucose for human fetus. The effects of pregnancy and diabetes on systemic glucose production rates and the sources of glucose for the human fetus in utero were evaluated in five normal, four gestationally diabetic, and one insulin-dependent diabetic subject undergoing elective caesarean section at term gestation. Five normal nonpregnant women were studied for comparison. Systemic glucose production rates were measured with stable tracer [1-(13)C]glucose according to the prime-constant rate infusion technique. Even though the plasma glucose concentration during normal pregnancy had declined as compared with the nonpregnant subjects (P < 0.0005), the systemic glucose production rate was 16% greater, a rate sufficient to provide the glucose requirement of the fetus at term gestation. The decline in glucose concentration could be the result of an increase in apparent volume of distribution of glucose. Systemic glucose production rates in well-controlled, gestationally diabetic subjects were similar to those in normal pregnant subjects (2.07+/-0.53 vs. 2.42+/-0.51 mg/kg.min). The sources of glucose for the human fetus at term gestation were evaluated by comparing (a) natural variation in (13)C:(12)C ratio of plasma glucose and (b) enriched (13)C:(12)C ratio of plasma glucose during [1-(13)C]glucose infusion in maternal and fetal blood at delivery in both normal and diabetic subjects. These data showed that the fetal glucose pool was in equilibrium with the maternal glucose pool in both normal and diabetic subjects, indicating that a brief maternal fast did not initiate systemic glucose production in human fetus. A materno-fetal gradient was observed for betahydroxybutyrate.


Reflex inhibition of renal sympathetic nerve activity during myocardial ischemia mediated by left ventricular receptors with vagal afferents in dogs. The major goal of this investigation was to determine if activation of cardiac receptors during coronary artery occlusion could inhibit efferent renal sympathetic nerve activity. In nine chloralose anesthetized dogs with only carotid (n = 3) or with sinoaortic (n = 6) baroreceptors operative, anterior descending coronary artery (LAD) occlusion resulted in a small decrease in mean arterial pressure (-9.8+/-5.1 mm Hg, NS) and in a significant (P < 0.05) increase in renal nerve activity (24.0+/-4.1%). In these dogs, circumflex coronary artery (Cx) occlusion resulted in greater hypotension (-18.4+/-4.0 mm Hg), and yet no change (1.1+/-9%) in renal nerve activity was noted. Changes in left atrial pressure during LAD and Cx occlusion were not different. In seven dogs with carotid sinus denervation, coronary occlusions resulted in decreases both in arterial pressure and in renal nerve activity which were consistently greater during Cx occlusion. The responses to coronary occlusion in six dogs after sinoaortic deafferentation were similar to those observed with only carotid sinuses denervated. In all experiments, vagotomy abolished the difference in the blood pressure responses and the decreases in renal sympathetic nerve activity during Cx occlusion. Vagotomy also abolished the decrease in nerve activity during LAD occlusion in dogs with carotid or sinoaortic denervation. These data show that Cx occlusion and, to a lesser degree, LAD occlusion resulted in reflex withdrawal of renal sympathetic nerve activity mediated by left ventricular receptors with vagal afferents. The reflex withdrawal of renal nerve activity during Cx occlusion occurred in spite of hypotension and the presence of functioning sinoaortic baroreceptors.


Simulated hyperglycemic hyperosmolar syndrome. Impaired insulin and epinephrine effects upon lipolysis in the isolated rat fat cell. These investigations were designed to evaluate the effect of excess glucose and sodium chloride on lipolysis in the isolated adipocyte under normal and modelled pathological conditions simulating the hyperglycemic hyperosmolar syndrome. Isolated rat fat cells were incubated in the presence of various combinations of sodium chloride, glucose, epinephrine, and insulin. Lipolysis was measured as glycerol and free fatty acid release, and total medium osmolarity as milliosmoles per liter by freezing point depression. Basal lipolysis was unaffected by changes in osmolarity with sodium chloride, but glucose and glucose plus sodium chloride increased basal glycerol release. Increasing osmolarity with sodium chloride diminished the lipolytic response to epinephrine. Increasing osmolarity with glucose augmented the lipolytic response to epinephrine up to a total medium osmolarity of 550 mosmol. Higher osmolarities produced with glucose suppressed the epinephrine-induced lipolytic response.When the hyperglycemic hyperosmolar syndrome was simulated with 100 mM glucose and 50 mM sodium chloride (total osmolarity = 460 mosmol) the epinephrine-stimulated lipolysis dose-response curve in the isolated fat cell was shifted to the right. Furthermore, in the presence of 100 mM glucose + 50 mM sodium chloride, physiological concentrations of insulin were less effective in opposing epinephrine-stimulated lipolysis. In the presence of 50 mM glucose and 25 mM sodium chloride (total osmolarity = 370 mosmol) epinephrine-stimulated lipolysis measured as free fatty acid release was decreased by 50%. Under conditions simulating the hyperglycemic hyperosmolar syndrome in the isolated rat adipocyte, altered lipolysis reflects impaired effectiveness of both insulin and epinephrine as antilipolytic and lipolytic hormones, respectively. Furthermore, the attenuated response to both hormones appears to be primarily a function of extracellular solute composition. The lack of ketosis is the result of diminished release of free fatty acids from peripheral adipose cells.


Characteristics of volume reabsorption in rabbit superficial and juxtamedullary proximal convoluted tubules. Segments of superficial and juxtamedullary proximal convoluted tubules of the rabbit were perfused in vitro to examine the mechanisms responsible for net volume reabsorption. The very early postglomerular segments were not studied. Fluid reabsorptive rates and transepithelial potential differences were compared under various conditions: (a) with perfusate that simulated glomerular filtrate; (b) with perfusate that lacked glucose, amino acids, and acetate and that had HCO(3) and Cl concentrations of 5 and 140 mM, respectively; (c) with perfusate that lacked glucose, amino acids, and acetate but with 20 meq of NaHCO(3) replaced with 20 meq of Na cyclamate; (d) with the same perfusate as in b but in the presence of ouabain in the bath; (e) with ultrafiltrate of rabbit serum titrated with HCl to final HCO(3) and Cl concentrations of 2 and 134 mM, respectively. Tubules were perfused with this titrated ultrafiltrate at 37 degrees C, 21 degrees C, and in the presence of 0.1 mM ouabain in the bath. Bath fluid in all experiments was regular rabbit serum. Under conditions a and b superficial proximal convoluted tubule (SFPCT) and juxtamedullary proximal convoluted tubule (JMPCT) behaved similarly with the exception that SFPCT exhibited a lumen-positive and JMPCT a lumen-negative electrical potential under condition b. However, under condition c SFPCT failed to exhibit net volume reabsorption, whereas reabsorption in JMPCT continued unchanged. Ouabain did not affect volume reabsorption in SFPCT under condition d, whereas neither ouabain nor hypothermia affected SFPCT under condition e. In contrast, ouabain and hypothermia totally inhibited volume reabsorption in JMPCT under conditions d and e. These studies document heterogeneous mechanisms responsible for volume reabsorption in the major portions of SFPCT and JMPCT with passive forces predominating in SFPCT and active forces in JMPCT.


Quantitative assessment of polymerized and depolymerized platelet microtubules. Changes caused by aggregating agents. The equilibrium between assembled and disassembled microtubules was studied in human platelets exposed to aggregating agents. Soluble and insoluble tubulin were "frozen" by addition of a glycerol-dimethyl sulfoxide-containing medium. The two pools were estimated by measuring the colchicine binding activities of total and polymerized tubulin. Resting platelets were found to contain an average of 56.2 mug tubulin/1 x 10(9) cells of which 56.7% was in polymerized form. Platelet aggregation induced by thrombin, ADP, epinephrine, or collagen produced a transient decrease in the pool of polymerized tubulin which was evident within 15 s after addition of the aggregating agent. A return to base-line values occurred within 1-4 min depending upon the specific aggregating agent used. Neither secretory release nor aggregation of platelets were found to be prerequisites for the temporary disturbance of the equilibrium between soluble and polymerized tubulin. With thrombin as the aggregating agent a clear threshold concentration could be demonstrated above with a dose-dependent dissociation response of microtubules was evident. We conclude that microtubules exist in a dynamic equilibrium between polymerized and depolymerized forms in human platelets, which is transiently disturbed by their interaction with aggregating agents.


The dynamics of ammonia metabolism in man. Effects of liver disease and hyperammonemia. The cyclotron-produced radionuclide, 13N, was used to label ammonia and to study its metabolism in a group of 5 normal subjects and 17 patients with liver disease, including 5 with portacaval shunts and 11 with encephalopathy. Arterial ammonia levels were 52-264 micron. The rate of ammonia clearance from the vascular compartment (metabolism) was a linear function of its arterial concentration: mumol/min = 4.71 [NH3]a + 3.76, r = +0.85, P less than 0.005. Quantitative body scans showed that 7.4 +/- 0.3% of the isotope was metabolized by the brain. The brain ammonia utilization rate, calculated from brain and blood activities, was a function of the arterial ammonia concentration: mumol/min per whole brain = 0.375 [NH3]a - 3.6, r = +0.93, P less than 0.005. Assuming that cerebral blood flow and brain weights were normal, 47 +/- 3% of the ammonia was extracted from arterial blood during a single pass through the normal brains. Ammonia uptake was greatest in gray matter. The ammonia utilization reaction(s) appears to take place in a compartment, perhaps in astrocytes, that includes less than 20% of all brain ammonia. In the 11 nonencephalopathic subjects the [NH3]a was 100 +/- 8 micron and the brain ammonia utilization rate was 32 +/- 3 mumol/min per whole brain; in the 11 encephalopathic subjects these were respectively elevated to 149 +/- 18 micron (P less than 0.01), and 53 +/- 7 mumol/min per whole brain (P less than 0.01). In normal subjects, approximately equal to 50% of the arterial ammonia was metabolized by skeletal muscle. In patients with portal-systemic shunting, muscle may become the most important organ for ammonia detoxification. Muscle atrophy may thereby contribute to the development of hyperammonemic encephalopathy with an associated increase in the brain ammonia utilization rate.


Synthesis and secretion of corticosteroid-binding globulin by rat liver. A source of heterogeneity of hepatic corticosteroid-binders. Classical glucocorticoid receptors (type II) have a high affinity for synthetic and natural glucocorticoids. We have previously demonstrated an additional binding site in kidney cytosol (type III) which has a high affinity for corticosterone but a low affinity for dexamethasone. In many ways, this binder resembles plasma corticosteroid-binding globulin (CBG). The first goal of this study was to determine the organ distribution of the type III binding sites. Cytosol was prepared from isolated cells to avoid plasma contamination. Of the tissues examined, type III sites were found only in liver and kidney; sites were absent from thymocytes, IM-9 lymphocytes, adipocytes, and bone cells. The second goal of this study was to ascertain whether CBG is synthesized in liver and kidney. Liver and kidney slices were incubated in vitro and the concentration of type III sites was seen to rise in hepatic cytosol and incubating medium but not kidney. To verify the impression that liver was synthesizing and secreting CBG, the following experiments were performed: (a) To demonstrate that type III sites were CBG, steroid-binding profiles and migration on polyacrylamide gel electrophoresis were shown to be identical for hepatic type III sites and serum. (b) To indicate that the rise in type III sites was dependent on protein synthesis, it was shown that cycloheximide blocked the appearance of new type III sites. (c) To establish that the type III sites were being secreted, in situ liver perfusion experiments showed time-dependent release of new sites into the perfusate. In conclusion, liver synthesizes and secretes type III sites, a finding previously suspected but never proved. The presence of type III sites in kidney remains to be explained.


Circulating immune complexes in Lyme arthritis. Detection by the 125I-C1q binding, C1q solid phase, and Raji cell assays. We have found immunoglobulin (Ig) G-containing material consistent with immune complexes in the sera of patients with Lyme arthritis. It was detected in 29 of 55 sera (55%) from 31 patients by at least one of three assays: (125)I-C1q binding, C1q solid phase, or Raji cell. The presence of reactive material correlated with clinical aspects of disease activity; it was found early in the illness, was most prominent in sera from the sickest patients, was infrequent during remissions, and often fluctuated in parallel with changes in clinical status. The results in the two C1q assays showed a strong positive correlation (P<0.001). They were each elevated in 45% of the sera and were usually concordant (85%). In contrast, the Raji cell assay was less frequently positive and often discordant with the C1q assays. In sucrose density gradients, putative circulating immune complexes sedimented near 19S; they, too, were detected best by the two assays based on C1q binding. An additional 7S component was found in some sera by the (125)I-C1q binding assay. Serum complement was often above the range of normal in patients with mild disease and normal in patients with severe disease but did not correlate significantly with levels of circulating immune complexes. IgM and IgG rheumatoid factors were not detectable. These findings support a role for immune complexes in the pathogenesis of Lyme arthritis. Their measurement, by either the (125)I-C1q binding assay or by the C1q solid phase assay, often provides a sensitive index of disease activity. Moreover, the complexes are likely sources of disease-related antigens for further study of this new disorder.


Reduced fibrinogen survival in diabetes mellitus. A reversible phenomenon. Fibrinogen survival and turnover were examined in 15 adult-onset diabetic patients. (125)I-labeled fibrinogen was prepared from each patient during the period of poor carbohydrate control, or hyperglycemic period, and fibrinogen survival determined. Improved control was established in each patient and during this euglycemic period, fibrinogen survival was determined simultaneously with (125)I-fibrinogen saved from the hyperglycemic period and (131)I-labeled fibrinogen prepared from the patient during the euglycemic period. The results confirm reduced fibrinogen survival in hyperglycemic diabetic patients and demonstrate reversal of the fibrinogen abnormality when euglycemia is achieved. The results of the double-label experiments in the euglycemic period suggest that the fibrinogen molecule is not altered functionally and that an abnormal plasma or vascular environment is a more likely basis for reduced fibrinogen survival during hyperglycemia. Electrophoretic and chromatographic experiments demonstrated no gross chemical differences between the fibrinogens prepared from the hyperglycemic and euglycemic periods and normal fibrinogen. Fibrinogen survival gave a better correlation with serial glucose measurements than with correction of hemoglobin A(Ic) levels indicating that the reduced fibrinogen survival noted in diabetics is a rapidly reversible phenomenon. During the hyperglycemic period, pharmacological intervention with aspirin and dipyrimadole was attempted to examine the role of platelets in reduced fibrinogen survival. No significant change in fibrinogen survival was observed. Heparin infusion during hyperglycemia normalized the fibrinogen kinetics of hyperglycemic diabetic patients, suggesting that reduced fibrinogen survival during hyperglycemia is secondary to an effect on thrombin or one of its antagonists.


Osteomalacia and hyperparathyroid bone disease in patients with nephrotic syndrome. Patients with nephrotic syndrome have low blood levels of 25 hydroxyvitamin D (25-OH-D) most probably because of losses in urine, and a vitamin D-deficient state may ensue. The biological consequences of this phenomenon on target organs of vitamin D are not known. This study evaluates one of these target organs, the bone. Because renal failure is associated with bone disease, we studied six patients with nephrotic syndrome and normal renal function. The glomerular filtration rate was 113+/-2.1 (SE) ml/min; serum albumin, 2.3+/-27 g/dl; and proteinuria ranged between 3.5 and 14.7 g/24 h. Blood levels of 25-OH-D, total and ionized calcium and carboxy-terminal fragment of immunoreactive parathyroid hormone were measured, and morphometric analysis of bone histology was made in iliac crest biopsies obtained after double tetracycline labeling. Blood 25-OH-D was low in all patients (3.2-5.1 ng/ml; normal, 21.8+/-2.3 ng/ml). Blood levels of both total (8.1+/-0.12 mg/dl) and ionized (3.8+/-0.21 mg/dl) calcium were lower than normal and three patients had true hypocalcemia. Blood immuno-reactive parathyroid hormone levels were elevated in all. Volumetric density of osteoid was significantly increased in three out of six patients and the fraction of mineralizing osteoid seams was decreased in all. Evidence for an increase in active lacunae (bone-osteoclast interface) occurred in three out of six patients and in inactive (Howship's lacunae) bone resorption in six out of six. The data indicate that the loss of 25-OH-D in urine of patients with nephrotic syndrome and normal renal function may result in a decrease of blood levels of ionized calcium, secondary hyperparathyroidism and enhanced bone resorption. In addition, the vitamin D-deficient state causes osteomalacia as evidenced by defective mineralization and increased osteoid volume.


Resting skeletal muscle membrane potential as an index of uremic toxicity. A proposed new method to assess adequacy of hemodialysis. Electrochemical disturbances of skeletal muscle cells in untreated uremia are characterized by an increase in the intracellular sodium and chloride content, a decrease in intracellular potassium, and a low resting membrane potential. In this study, we have reexamined the foregoing and, in addition, have examined the effects of hemodialysis. Three groups of patients were studied. In the first group of 22 uncomplicated uremic patients, whose creatinine clearance (Ccr) ranged from 2 to 12 cm(3)/min per 1.73 m(2), resting transmembrane potential difference (Em) of skeletal muscle cells was measured. In each of the nine patients whose Ccr ranged between 6.3 and 12 cm(3)/min, the Em was normal (i.e., -90.8+/-0.9 mV, mean+/-SEM). However, as Ccr dropped below 6.3 cm/min, the Em became progressively reduced and assumed a linear relationship with the Ccr. In the second study, nine individuals with end-stage renal disease, whose mean Ccr was 4.3 cm(3)/min, underwent measurement of Em and intracellular electrolyte concentration before and after 7 wk of hemodialysis. Before dialysis, the Em was -78.5+/-2.1 mV, intracellular sodium and chloride were elevated, and the intracellular potassium was reduced. After 7 wk of hemodialysis the Em rose to -87.8+/-1.3 mV, and the intracellular sodium, chloride, and potassium became normal. In the third study, seven patients who were stable on 6-h thrice-weekly dialysis were studied before and after reduction of dialysis to 6 h twice weekly. In those individuals whose Em remained normal after 6 wk, dialysis time was reduced further. On thrice-weekly dialysis the Em was -91.2+/-1.0 mV. With reduced dialysis, the Em fell to -80.1+/-0.8 mV (P < 0.001). In each case, the Em became abnormal before significant signs or symptoms of uremia were noted. These findings demonstrate that end-stage renal disease is associated with serious electrochemical changes in the muscle cell which are reversed by hemodialysis and recur when dialysis time is reduced. Thus, serial observations of muscle Em may be a potentially powerful tool to assess adequacy of dialysis therapy.


Stimulation by triiodothyronine of the in vitro uptake of sugars by rat thymocytes. Studies were conducted to ascertain the in vitro effect of 3,5,3'-triiodothyronine (T(3)) on the accumulation of the glucose analogue, 2-deoxyglucose (2-DG), by thymocytes freshly isolated from weanling rats. At a concentration of 1 muM, T(3) stimulated the 15-min uptake of (3)H-2-DG after cells had been exposed to T(3) for only 30 min. Significant stimulation of 2-DG accumulation was produced by 1 nM T(3), with increasing stimulation at doses ranging up to 10 muM. T(3) did not alter the fraction of accumulated 2-DG that was phosphorylated, and kinetic studies indicated that its effect was associated with a significant increase in the apparent V(max) of 2-DG accumulation, but not the apparent K(m). T(3) also enhanced the accumulation by thymocytes of the nonmetabolized glucose analogue, 3-O-methylglucose (3-O-MG), an effect that was evidently the result of an increase in 3-O-MG transport into the cell, because it was seen in cells incubated with (3)H-3-O-MG for only 30 s. The proportionate increase in 2-DG accumulation produced by T(3) was not altered by preincubating cells with concentrations of puromycin or cycloheximide sufficient to reduce [(3)H]-leucine incorporation by 95%, and T(3) over a period of >2 h had no effect on [(3)H]leucine incorporation itself. These results indicate that T(3) stimulates the uptake of sugars in rat thymocytes in vitro by an effect on their inward transport. The promptness of the effect and its failure to be inhibited during profound inhibition of protein synthesis further indicate that this effect of T(3) is not mediated through a nuclear-dependent mechanism. Rather, the properties of this response, and of the increases in amino acid and 2-DG accumulation produced by T(3) in other tissue preparations, strongly suggest that these effects of T(3) are mediated at the level of cell membrane.


The role of sulfhydryl groups on the impaired hepatic 3',3,5-triiodothyronine generation from thyroxine in the hypothyroid, starved, fetal, and neonatal rodent. The role of nonprotein sulfhydryl groups (NPSH) in the decreased in vitro hepatic 3',3,5-triiodothyronine (T(3)) generation from thyroxine (T(4)) in the starved, hypothyroid, fetal and 1- to 4-d-old neonatal rat and dwarf mouse was assessed. NPSH were measured in fresh 25% liver homogenates prepared in 0.1 M PO(4)/10 mM EDTA buffer. As compared with values in adult male rats, NPSH concentration was decreased in the 2-d-starved (1.1+/-0.04 (mean+/-SE) vs. 2.2+/-0.15 mmol/250 g wet liver weight, P < 0.001), fetal (1.0+/-0.04 vs. 3.2+/-0.08, P < 0.001), 1-d-old neonatal (1.1+/-0.03 vs. 2.1+/-0.04, P < 0.001), and hypothyroid (thyroidectomized 60 d) (1.4+/-0.06 vs. 2.2+/-0.15 P < 0.001) rat. NPSH were also decreased in the hypothyroid, hypopituitary dwarf mouse as compared with values in their normal litter mates (1.3+/-0.03 vs. 2.0+/-0.2, P < 0.01). Chronic administration of T(3) (0.5 mug/100 g body wt per d) markedly increased hepatic T(3) generation from T(4) in the thyroidectomized rat and in the dwarf mouse to values similar to those observed in the normal rodent without affecting NPSH concentration. In contrast, T(3) administration to the starved rat did not alter either hepatic T(3) generation from T(4) or NPSH. Reduced glutathione concentration was also markedly decreased in the starved rat (fed; 1.05+/-0.075 mmol/250 g wet tissue vs. starved 0.38+/-0.02, P < 0.001). Dithiothreitol (DTT), a thiol reducing agent, increased hepatic T(3) generation from T(4) in the normal adult male rat by 45+/-5% in six experiments. When compared to DTT-stimulated control homogenates, the addition of DTT completely restored hepatic T(3) generation in starved rats, partially restored T(3) generation in 1- and 4-d-old neonates, but had little or no effect in the fetal and hypothyroid rat and dwarf mouse. Liver homogenates stored for 6 mo at -20 degrees C lost their capacity to generate T(3) from T(4). NPSH concentrations in the frozen homogenates decreased progressively with increasing storage and were absent by 6 mo. 5'-Deiodinase activity correlated with NPSH concentration in the stored homogenates (r = 0.95, P < 0.005). Addition of DTT partially restored hepatic T(3) generation in the frozen homogenate. It is concluded that NPSH are important for the action of the liver 5'-deiodinase. The decreased hepatic T(3) generation in the starved rat is associated with decreased NPSH but not with a decrease in the absolute quantity of 5'-deiodinase because provision of sulfhydryl groups restored hepatic T(3) generation to normal. In contrast, the decreased hepatic T(3) generation in the adult hypothyroid rodent and in the fetal rat is probably due to a decrease in the enzyme concentration per se. In the 1- and 4-d neonatal rat, the decrease in hepatic T(3) generation is secondary to a decrease in NPSH and the deiodinating enzyme.


Identical biological effects of pancreatic glucagon and a purified moiety of canine gastric immunoreactive glucagon. Because in the dog, the gastric fundus contains the largest amount of glucagon immunoreactivity (IRG), the IRG of mucosal scrapes of 105 canine stomachs was extracted by acid-ethanol and then precipitated by ether-ethanol. The IRG recovered was measured by antisera 30K, specific for glucagon and K-4023, which cross-reacts with glucagon-like immunoreactivity. Extracts of mucosa of stomach fundus were further purified by gel filtration on Bio-Gel P-30 in 3M acetic acid. One pooled fraction corresponding to marker pancreatic glucagon in its elution volume was then gel-filtered on Bio-Gel P-30 in 0.05 M NH(4)HCO(3) and yielded one IRG peak, which, however, showed three immunoreactive components on polyacrylamide disc gel electrophoresis in urea. In addition, antiserum K-4023 reacted more strongly with that peak than antiserum 30K indicating the presence of glucagon-like immunoreactivity in this fraction. Subsequent ion-exchange column chromatography on DEAE-Sephadex A-25 and then CM-Bio-Gel A allowed purification to a single protein band on disc gel electrophoresis reacting equally to both antisera 30K and K-4023. 1.5 mug of purified gastric glucagon was obtained and its biological effects were compared to those of pancreatic glucagon in isolated rat hepatocytes. When immuno-equivalent amounts (300-2,500 pg/ml) of either type of glucagon were used, the same biological responses with respect to glycogenolysis and gluconeogenesis as well as urea, lactate, and pyruvate production were observed. Liver cyclic AMP was also raised to the same extent by either one of these hormones. We conclude that this moiety of gastric IRG is apparently identical to pancreatic glucagon because (a) their molecular weights, elution properties in ion exchange chromatography, and their electrophoretic mobility are indistinguishable and (b) both hormones elicited identical biological effects in isolated rat hepatocytes.


Medical careers in pathology, 1977.

Medical careers in pathology, 1977. A survey has been made, mainly covering the second half of 1977, of career grade posts and senior training posts in pathology in the United Kingdom. The survey included all disciplines of pathology and all types of employment--National Health Service, medical school, and many others. The survey also examined the number of applicants for advertised posts and the number of posts left vacant. There were variations between disciplines and between regions; microbiology and Northern Ireland had most failures in filling posts. Overall about 3% of career grade posts, and 15% of training grade posts, were left unfilled.


Relationship of air temperature to various chemical, haematological, and haemostatic variables. Results for biochemical and haematological variables have been correlated with data on atmospheric temperature in order to identify possible mechanisms through which low environmental temperature may increase mortality from myocardial infarction and cerebrovascular disease. With the exception of cholesterol, there were no associations in the case of several clinical chemistry variables, or of haemoglobin and related indices. With varying degrees of consistency among the sex and age groups studied, temperature was positively correlated with factor VII, antithrombin III, and cholesterol, and negatively correlated with fibrinolytic activity. The correlations were all low but may offer some clues to mechanisms whereby air temperature influences ischaemic heart and cerebrovascular disease mortality.


Determination of antithrombin activity by an amidolytic and a clotting procedure. Plasma antithrombin activity was measured using an amidolytic method (substrate Chromozym TH) and a clotting method. The mean antithrombin values found in 76 hospital outpatients were 9.4 micronmol/min/ml with the amidolytic procedure and 100.1% of antithrombin activity with the clotting procedure. The two methods correlate fairly well (r = 0.85, P less than 0.01) and show satisfactory reproducibility. Coefficients of variation of 5.9% and 8.8% were obtained respectively with the amidolytic and the clotting procedures. In the presence of very high levels of fibrinogen degradation products, falsely elevated antithrombin activity levels were observed with the clotting procedure but the amidolytic method is essentially unaffected. It is concluded that both methods are suitable for determining antithrombin activity but a well-standardised amidolytic procedure has advantages.


Neutrophil cytochemistry in bacterial infection. A new cytochemical technique, sensitive to altered lysosomal membrane permeability of blood neutrophils, has been evaluated as a screening test for bacterial infection. This technique, for the lysosomal enzymes acid phosphatase and chloroacetate esterase, was compared with the neutrophil alkaline phosphatase and nitroblue tetrazolium tests. The mean score for each method was significantly higher in infected patients than in normal controls. There was, however, considerable overlap of individual scores between infected patients and ill, but uninfected, patients. This overlap limits the diagnostic value of existing cytochemical screening methods.


Fatal anaphylaxis in systemic mastocytosis. A 42-year-old woman died after an episode of anaphylaxis associated with a raised serum histamine level. A diagnosis of systemic mastocytosis was established, with lymphadenopathy and hepatosplenomegaly, not associated with the usually pre-existing skin lesions of urticaria pigmentosa.


Cytohormonal patterns in mature and pre-term babies. Comparison of cytohormonal patterns in full-term and pre-term babies of both sexes showed significant differences. At birth, irrespective of gestational age, both groups had high oestrogen levels, reflecting the maternal hormonal environment, but whereas the mature neonates were capable of metabolising and excreting the excess hormone within the first week of life, the pre-term infants took much longer to do so. It is thought that immaturity or impairment of liver function is at least partially responsible for this finding.


Yellow bodies in superficial and deep lymph nodes. The prevalence of yellow bodies was studied in superficial and deep lymph nodes in material from 46 necropsies. They were found in 22.8% of the 359 lymph nodes collected, ranging from 35.6% of the mesenteric to 11.1% of mediastinal lymph nodes, and were significantly more prevalent in deep abdominal than in superficial groups. Sets of lymph nodes from individuals tended to show an 'all or none' variation in the proportion of nodes that contained yellow bodies, but the presence of the bodies was not significantly related to age, sex, or disease.


Interpretation of serum total calcium: effects of adjustment for albumin concentration on frequency of abnormal values and on detection of change in the individual. Serum total calcium was measured in 1693 patients during a four-month period. We examined the effects of adjustment for albumin concentration on the interpretation of single measurements of serum total calcium and on the variation of series of measurements in individual patients. Markedly abnormal total calcium concentrations--2.75 mmol/l (11.0 mg/100 ml) or more, or 2.00 mmol/l (8.0 mg/100 ml) or less--were found in 115 patients, but only 24 (21%) remained markedly abnormal after adjustment for albumin. Three patients, two with malignant disease and one with primary hyperparathyroidism, had significant hypercalcaemia which was masked by hypoalbuminaemia. The serum total calcium measured on a subsequent occasion had changed 0.15 mmol/l (0.6 mg/100 ml) or more in 60 patients, but after adjustment for albumin this number was reduced to 27 (45%). The within-person standard deviation for serum total calcium was calculated in 26 patients with normal mean adjusted calcium concentrations who had had six or more sequential measurements. The mean standard deviation was 0.148 mmol/1 (0.59 mg/100 ml) and, after adjustment for albumin, this was reduced to 0.100 mmol/1 (0.40 mg/100 ml). We conclude that adjustment of serum total calcium concentration for albumin is essential to detect abnormal values and to assess changes in a value.


Distribution in clinical material and identification of Pseudomonas maltophilia. During the 10-year period ending March 1976, 128 (8.5%) of 1506 strains of Gram-negative non-fermentative bacteria submitted to the National Collection of Type Cultures for computer-assisted identification have been strains of Pseudomonas maltophilia. These figures suggest that Ps. maltophilia is both a relatively common species in clinical material in the United Kingdom and also that many laboratories experience difficulty in identifying this species. We report the sources from which our strains were isolated and also characteristics of the species by which it may be recognised. The clinical significance of Ps maltophilia is discussed and also the susceptibility of this species to certain antimicrobial agents.


Flavobacterium odoratum: a species resistant to a wide range of antimicrobial agents. During the period 1966-77, 24 strains of Flavobacterium odoratum were identified from among strains of Gram-negative, non-fermentative bacteria submitted to the National Collection of Type Cultures for computer-assisted identification. The F. odoratum strains showed resistance to therapeutic levels of gentamicin, tobramycin, amikacin, and carbenicillin as well as to several other antimicrobial agents generally useful in the treatment of infections caused by Gram-negative, non-fermentative bacteria. Two strains isolated from amputation stumps and another three strains isolated in significant numbers from urine specimens were possibly opportunist pathogens. The biochemical characteristics of the 24 strains, the proposed neotype strain of F. odoratum, and three strains representative of a group, referred to at the Center for Disease Control, Atlanta as group M-4f, were compared with those of biochemically similar species which may be isolated from clinical material.


Unusual increases in serum lactate dehydrogenase isoenzyme-5 activity caused by severe congestive cardiac failure: two case reports. Two cases of congestive cardiac failure had unusually high activities of serum lactate dehydrogenase and lactate dehydrogenase isoenzyme-5. Values for isoenzyme-5 exceeding 87% of the total serum activity, and increases of 228- to 380-fold of the upper reference limit, are very uncommon.


A histological study of the effect of chronic gastritis on gastrin cell distribution in the human stomach. To determine the effect of varying degrees of gastritis on the distribution of immuno-reactive gastrin cells 38 partial gastrectomy specimens have been studied. Routinely stained histological sections of mucosa were compared with serial and adjacent sections stained by specific immunohistochemistry using peroxidase and fluorescent techniques. While chronic superficial gastritis had no obvious effect, mild atrophic gastritis was associated with an uneven distribution of gastrin cells which became more marked with increasing severity of gastritis. In the region of intestinal metaplasia gastrin cells were almost totally absent. Small numbers of gastrin cells were found within areas of pseudopyloric metaplasia in the fundus, a region where those cells are not normally seen. Similarly, gastrin cells were detected within regenerative gastric polypi in both antrum and fundus.


Failure to demonstrate specificity of the morphological and histochemical changes in mucosa adjacent to colonic carcinoma (transitional mucosa). Characteristic morphological and histochemical changes in mucosa adjacent to colorectal adenocarcinomas have been described. It has been suggested that this type of mucosa, labelled transitional mucosa (TM) because of its specific association with colorectal adenocarcinoma, is indicative of a premalignant change. In an investigation of mucosa adjacent to anal tumours extending into the rectum and mucosa from solitary ulcer syndrome and colostomies the mucosal alterations described in TM could be demonstrated. Thus TM is not specifically related to colorectal adenocarcinoma and probably arises as a secondary phenomenon. The claim that TM represents a premalignant change cannot be substantiated.


Gas-liquid chromatographic measurement of lignocaine in small samples of canine myocardium after enzymatic digestion. A method is described whereby lignocaine can be measured in small samples of canine myocardium. A proteolytic enzyme is used to digest the tissue, and the drug, together with an internal standard, is subsequently extracted into an organic solvent and measured by gas-liquid chromatography. The method is reproducible using tissue samples as small as 50 mg and appears to be suitable for the measurement of a number of drugs in small samples of tissue.


Central nuclear counts in muscle fibres before and during treatment in hypothyroid myopathy. Serial percutaneous needle muscle biopsies of vastus lateralis were studied in 10 patients who had varying degrees of hypothyroid myopathy. The biopsies were taken before and during treatment with l-thyroxine. Before treatment the most severely clinically affected patients showed type II muscle fibre atrophy and loss, together with increased central nuclear counts preferentially affecting the type II muscle fibre. Both the type II muscle fibre atrophy and loss and the increased central nuclear counts tended to return towards normal values during treatment with l-thyroxine. The severity of myopathic symptoms before and during treatment correlated with the biochemical evidence of hypothyroidism, a type II fibre atrophy, and increased central nuclear counts. The severity of myopathic signs before and during treatment was correlated with both a type II fibre atrophy and loss and increased central nuclear counts. There was no evidence that the myopathic signs before and during treatment were related to the biochemical parameters of hypothyroidism, except the level of thyroid stimulating hormone. It is suggested that sequential studies of muscle fibre percentages, diameters, and central nuclear counts may provide an additional method of assessing the response to treatment in hypothyroid and possibly other types of myopathy. When increased central nuclear counts are confined to a specific muscle fibre type, this may suggest a hitherto unsuspected specificity of muscle fibre damage.


Hypercalcaemia due to hyperparathyroidism in a patient with chronic renal failure and renal carcinoma. A 65-year-old woman with a history of a left heminephrectomy for renal carcinoma developed hypercalcaemia 11 years after the operation. The same kidney was found to contain a recurrent renal carcinoma. After the radical nephrectomy of the left kidney, hypercalcaemia remitted but reappeared 11 months later. The right kidney was small but functioned at a level of creatinine clearance of 10--15 ml/min. Metastatic work-up was negative, and secondary causes of hypercalcaemia were excluded. A neck exploration revealed a parathyroid adenoma. With parathyroid resection the serum calcium declined to normal, and the risk of hypercalcaemic nephropathy in the remaining kidney was precluded.


Plasma binding capacity for 25-hydroxy-vitamin D in the elderly. Plasma 25-hydroxy-vitamin D (25-OHD) concentrations and 25-OHD binding capacities were measured in 14 elderly patients and in 14 young controls. Both 25-OHD concentrations and 25-OHD binding capacities were reduced in the elderly. In neither group, however, was there a significant correlation between 25-OHD binding capacities and 25-OHD concentrations. Thus, although 25-OHD binding capacities are reduced in sick old people this does not account for the low 25-OHD concentrations often found in this group.


An evaluation of simultaneously administered free and intrinsic factor bound radioactive cyanocobalamin in the diagnosis of pernicious anaemia in the elderly. The definitive diagnosis of pernicious anaemia (PA) in the elderly is by no means always straightforward, particularly when inappropriate medication has been introduced before the institution of specific investigatory procedures. A detailed haematological study was carried out on 301 patients aged 60-95 with a serum B(12) concentration at the laboratory's lower level of normal of 150 ng per litre (Euglena gracilis assay). The diagnosis of PA was based on strict predetermined haematological criteria. All patients were subsequently studied by the simultaneous oral administration of the dual isotopes (57)Co-labelled B(12) bound to intrinsic factor and free (58)Co-labelled B(12) (Dicopac test), and urine was collected over 24 hours after an intramuscular dose of 1 mg nonradioactive B(12) for estimation of the (57)Co/(58)Co B(12) ratio; 255 patients satisfied all criteria for final analysis. The Radiochemical Centre, Amersham suggests an upper limit of the normal range for the (57)Co/(58)Co ratio of 1.3 with a lower limit for PA of 2.0. We were unable to show a sharp borderline in the (57)Co/(58)Co B(12) ratio between those patients shown by other criteria to have PA and those who do not have PA; 34% of the 71 established patients had a ratio below 2.0. From our series a ratio borderline drawn at 1.4 gave only one false negative (1.4% of the PA group). Of the 175 non-PA cases, nine (5%) gave false positive results; four of these had (58)Co excretion levels high enough to make misdiagnosis unlikely. In a proportion of patients the (57)Co/(58)Co B(12) ratio was estimated at regular intervals for 36-hour periods. Maximum accuracy of isotope measurement on a single specimen was obtained 8-20 hours after isotope dosing. The Dicopac investigation is a useful simple screening test in the differential diagnosis of patients with a megaloblastic bone marrow and combined low serum B(12) and folate concentrations. When carried out by the standard technique, the degree of discrimination between normal and abnormal ratios is of limited diagnostic significance in one-third of patients.


Quality control trials of prothrombin time: an assessment of the performance in serial studies. A series of collaborative exercises on the one-stage prothrombin time test involving hospitals in Britain and overseas was performed between 1972 and 1977. The British Comparative Thromboplastin (BCT) and the lyophilised test plasmas were issued from the National (UK) Reference Laboratory for Anticoagulant Reagents and Control. Participants were asked to test the plasma samples with the BCT using the recommended technique. Variability of performance was assessed by the 'index of reliability' based on the plasma variance and error variance within each exercise. The results show that hospitals have attained higher precision in the later trials.


'On line' data handling in a routine haematology department. The use of a ;stand alone' mini computer, on line, data acquisition system is described utilising a microprocessor as an adjunct to the main central processor to increase data transmission rates. Visual display units (VDU) provide on line flexibility of data input. The system acquires, on line, the Coulter S generated parameters together with the associated patient identification data and other requested tests. Erythrocyte sedimentation rate, platelet count, and B12 and folate results are fed in at will via the VDUs, using rapid entry subroutines. Percentage differential white cell count results and the absolute leucocyte count are calculated by the microprocessor, on line input being facilitated by remote keyboards associated with the VDUs. Total editing of all requests and results is available on all ;current' (unfiled) reports via the VDUs, and this facility includes the entry of film appearances using plus symbols and predetermined comments available against a code number. This editing function is also used to enter all other results that can be made available on the computer-printed report form. The computer system also provides quality control data, immediate printout of Coulter S results outside given limits, cumulative filing for all routine and designated ;priority' results, and a daily alphabetical listing of all patients from whom specimens have been examined together with full blood count, ESR, and platelet results on specimens examined that day.


Eosinophilic leukaemia: morphological, cytochemical, and electron microscopic studies. The eosinophils of a patient with eosinophilic leukaemia were studied with 13 different cytochemical methods using light and electron microscopy. Apart from the 'left shift' of the eosinophils in bone marrow and peripheral blood, the following morphological changes were noted: uncoordinated maturation of the nucleus and cytoplasm, changes in size of the specific granules, and hypogranulation to such an extent that some of the cells bore only very few granules. The cytochemical studies showed a strongly positive periodic acid Schiff reaction in the eosinophils, caused by a high content of glycogen, and a relatively strong positive acid-phosphatase reaction. These cells were also tested for aryl sulphatase and coenzyme Q. Electron microscopy confirmed the presence of a high-content glycogen and a strong acid phosphatase response in the cells. Peroxidase reaction, detected in electron microscopy as well, enabled us to trace the maturation of the eosinophil cell line.


Evaluation of an indirect haemagglutination kit for the rapid serological diagnosis of Mycoplasma pneumoniae infections. A recently introduced indirect haemagglutination kit for the detection of Mycoplasma pneumoniae antibodies is compared with the standard method complement fixation. It is concluded that the kit provides a rapid, simple, and moderately sensitive means of detecting antibodies and, in some cases, enables these to be detected in the early, acute stage of infection.


Urinary infection with coagulase-negative staphylococci in a teaching hospital. In the eight-month period of study of all urine samples processed in our routine laboratory, only 85 out of 12 152 specimens yielded a bacteriologically significant growth of either Staphylococcus epidermidis or micrococci. Their growth on MacConkey medium was strictly comparable to that on cysteine lactose electrolyte-deficient (CLED) media. Most micrococci isolated were from urine samples of non hospitalised women patients, were resistant to a novobiocin (5 micrograms) disc, and belonged to Baird Parker type 3. Staph. epidermidis came mainly from postoperative surgical in-patients. Their antibiotic sensitivity patterns are variable whereas micrococci are fully sensitive to all urinary antibiotics. We agree that the use of a novobiocin (5 micrograms) disc for provisional identification of micrococci and Staph. epidermidis is simple and practical for a busy routine diagnostic laboratory. The use of more extensive systems to biotype these organisms in a routine laboratory is not practical and not relevant to patient management.


Comprehension of transitive and intransitive phrases by autistic, retarded, and normal children. Autistic children were compared with retarded and normal control groups in a verbal comprehension task. Subjects were asked to select from four pictures the one that illustrated a two-word intransitive or three-word transitive phrase which was described verbally. Distractor pictures differed from the target picture by one, two, or all three features. Autistic children were poorer in performance than the control groups; however, the hierarchy of difficulty of discrimination was common to all three groups, with transitive phrases more difficult than intransitive phrases. Word type did not affect comprehension for the autistic children, although control children evidenced most difficulty with the verb or middle word. Results are interpreted as supporting the hypothesis that a severe and global language disorder is characteristic of autism.


Spectral noise and vocal roughness relationships in adults with laryngeal pathology. Twenty adult males, presenting laryngeal pathology, each produced five vowels and two sentences for tape recording. Individual recordings were then rated for roughness on a 5-point equal-appearing intervals scale. Each vowel production was also analyzed spectrographically. High, positive correlations (multiple r) were obtained between vowel spectral noise measures (dB SPL) and median roughness ratings for the vowels and sentences. The findings, similar to those previously reported for subjects without pathology, suggest that the relationships shown are independent of laryngeal health. Vowel spectral noise measures appear to provide a useful quantitative index of vocal roughness in vowels and connected speech.


Phonetically mediated recall in the phonetically disordered child. Children with phonology disorders frequently show reduced performance in short-term recall, inviting the assumption that impairment of memory may cause or help to cause the speech disorder. Ten children with marked phonology disorders were compared to 10 correctly speaking children on a test of short-term memory for sets of pictures whose names rhymed or did not rhyme. The phonologically disordered children performed significantly worse than those with correct speech and provided less evidence of phonetic mediation, a process commonly associated with enhanced levels of recall. Attention is drawn to the possibility that the disorder of phonology operated indirectly to reduce the efficiency of memory, though the question is complicated.


Language performance of stuttering and nonstuttering children. This study investigated the syntactic and semantic language performance of typically dysfluent nonstuttering children, stuttering children, and highly dysfluent nonstuttering children. The three groups of children did not differ on Developmental Sentence Analysis scores. The stuttering and highly dysfluent nonstuttering children obtained significantly lower receptive vocabulary scores, made significantly more grammatical errors, and obtained significantly higher incorrect response scores on the semantic tasks.


Research trends in the field of speech and hearing. Topics of research in the field of speech and hearing were identified and compared over a 21-yr  period (1954--1974). These topics were identidied by a key-word analysis of approximately 8200 titles consisting of articles in national and international journals, and of theses and dissertations presented in the state of Ohio. Results of this analysis have pinpointed certain research trends in the field of speech and hearing. Attention to certain topics has either declined, increased, or reached a peak during the 21-yr period, while interest in some topics has been consistently maintained throughout the years. The information reported provides a perspective from which to view contributions made by researchers in the field of speech and during the last two decades.


Treatment of dysarthria: a case report.

Treatment of dysarthria: a case report. There is little information available to the speech clinician on management of dysarthria. This article presents the rationale, procedural outline, and results of an approach to communication training for one dysarthic subject in view of suggestions made by Darley et al. (1975).


Children's auditory assembly of present progressive and past tense sentences. Auditory assembly performance of kindergarten-age children was studied using either present progressive or past tense sentences. Thirty children enrolled in kindergarten repeated six past tense sentences and six present tense sentences. Sentence length was systematically increased from six to 11 words. All responses were tape recorded and analyzed according to total errors, error types, word position, word type, and semantic information. Results indicated significantly more omission errors than substitution, nouns and verbs were best retained, and error rates increased linearly through the nine-word sentences with a greater number of errors occurring in the 10- and 11-word sentences. In addition, there was no significant difference in ability to assemble past or present progressive tense sentences. Finally, in contrast to preschool children, kindergarten-age children retained key items (noun, verb, and object) during assembly performance of all 12 sentences.


Judgments by children and adults regarding communication skills of esophageal speakers. The intelligibility and acceptability of esophageal speech were judged by a group of children and a group of adults. Eight esophageal speakers demonstrating a range of speech proficiency and differing vocal characteristics were videotaped reading a children's story. These recordings were played to child and adult judges. Data were analyzed to provide information about within-group and between-group comparisons. Findings indicated that children achieved higher intelligibility scores and employed different values than did adults when listening to esophageal speech.


Axonal guidance during embryogenesis and regeneration in the spinal cord of the newt: the blueprint hypothesis of neuronal pathway patterning. In our previous studies on studies on spinal cord regeneration in the adult lizard and the newt, we observed that the radial processes of the regenerating ependyma form between them channels which are subsequently invaded by growing neurites. In the present study we compare embryogenesis of the newt spinal cord with regeneration in the adult. Except for minor differences, we observed that the germinal neuroepithelium of the embryo and larva patterns the longitudinal neural tracts in a similar manner. With these facts in mind we propose the blueprint hypothesis which asserts that inherent in the primitive germinal neuroepithelium and its derivative primitive glia is the pattern of the primary neuronal pathways which is expressed in neurogenesis as formed channels or spaces between the processes of the epithelial cells, the surfaces of which contain trace pathways which the growing neurites follow toward their destination. The trace pathways are envisoned as mechanical-chemical itineraries which the neurities follow according to their individual affinities. The hypothesis is compared to extant theories and the limitations in central nervous regeneration of vertebrates is compared.


The distribution and size of ganglion cells in the regina of the pigmented rabbit: a quantitative analysis. The distribution and soma diameters of retinal ganglion cells have been examined in whole mounted retinae of pigmented rabbits. Maps of the distribution of ganglion cells confirmed several features of earlier descriptions, but generally showed lower density values and yielded lower total ganglion cell counts (250,000-270,000). The maximum ganglion cell density encountered in each retina and its retinal location both varied between rabbits. As previously reported, the dominant feature of the rabbit's retina is a strongly developed visual streak (Hughes, '71) but some evidence of an area centralis-like specialization was found. This appears not as the area of peak gangion cell density, but as a concentration of large (greater than or equal to 20 micron in diameter) ganglion cells at the temporal end of the visual streak, 2-3 mm from the temporal margin of the retina. In one rabbit in which the optic tract was sectioned five months previously, the density distribution of large retinal ganglion cells in the retinae has been mapped. These maps indicate that the nasotemporal division for large ganglion cells in the rabbit retina is approximately centered on the area of their maximum density. It has previously been reported that in the cat the area centralis is characterized by an aggregation of smaller diameter ganglion cells of a particular functional type (Stone, '65, '78). It is possible that areas of retinal which subserve area centralis-like functions are represented not simply by localized increases in ganglion cell density, but by changes in the relative proportions of ganglion cell types, which are reflected in the changing relative densities of ganglion cell soma diameter groups.


Preservation of binocularity after monocular deprivation in the striate cortex of kittens treated with 6-hydroxydopamine. The results of single unit recordings from Area 17 of monocularly deprived kittens were compared with similar ones from littermates who had been monocularly lid-sutured for the same period of time, but who had in addition been given intraventricular injections of 6-hydroxydopamine (6-OHDA) to deplete brain catecholamines. This visual cortices of all catecholamine-depleted kittens showed high proportions of binocular neurons, in contrast to the control group, a majority of whose visual cortical neurons were driven exclusively by the non-deprived eye. Preservation of binocularity in 6-OHDA-treated kittens was dose-related. Even after a 1 to 2-week period of lidsuture which reduced binocularity to 20% in controls, normal proportions of binocular neurons (greater than 75%) were preserved if the cumulative dose had been 10 mg 6-OHDA or more. The density of single neurons sampled from electrode tracks through the cortex of drug-treated kittens was high and did not differ significantly from controls. Neurons were isolated every 100 micron on the average. There was some indication that the drug's effect in preventing an ocular dominance shift disappears by six weeks following cessation of 6-OHDA treatment. This reversal of the physiological effects in cortex is preceded by recovery from the behavioral manifestations of 6-OHDA treatments. Binocularity was only slightly increased in a kitten who received large doses of 6-OHDA after a period of monocular deprivation. This observation, together with control recordings from normal kittens and adults treated with 6-OHDA, indicates that the direct effects of 6-OHDA on cortical neurons' response properties play a minor role in comparison to its effects in reducing the sensitivity of the cortex to monocular deprivation. The overwhelming majority of cortical neurons in 6-OHDA-treated kittens remained normal in receptive field properties after a period of monocular deprivation. These data support the hypothesis that catecholamines are required for the maintenance of visual cortical plasticity during the critical period.


Behavioral and electrophysiological effects of unilateral optic tract section in ordinary and Siamese cats. In ordinary cats, section of one optic tract produced a complete contralateral hemianopsia in both eyes. Single-unit recordings showed a normal representation of the contralateral nasal retina and ipsilateral temporal retina in the SC on the side of the intact optic tract. In addition, in the rostral portion of this SC there was a representation of a small portion of the contralateral temporal retina. This portion was apposed to the vertical meridian and its width was at most 6 degrees. In the anterior half of the SC on the side of the optic tract section, despite the interruption of any direct optic input, there was an extensive representation of the ipsilateral nasal retina and the contralateral temporal retina. This indirect visual input to the SC ipsilateral to the optic tract section was absent in a cat with a section of the forebrain commissures. In Boston Siamese cats, section of one optic tract led to a virtually complete blindness in the eye contralateral to the section, whereas the other eye retained a full visual field, although the responsiveness of the temporal retina beyond 20 degrees from the vertical meridian was reduced. Similarly, the nasal hemiretina and most of the temporal hemiretina on the side of the section were represented in the opposite SC, whereas stimulation of the eye contralateral to the section could not drive SC units. There was some evidence that the visual field of the eye on the side of the section could at least in part be represented in the SC on the same side. The findings indicate that the crossed projections from temporal hemiretina in the ordinary cat, and the uncrossed projections from temporal hemiretina in the Siamese cat are insufficient by themselves to sustain visual orientation and to drive SC neurons. Each half of the visual field in the ordinary cat, and the field of each eye in the Siamese cat, can be represented in the ipsilateral SC via across-the-midline, indirect connections.


Facial thermal input to the trigeminal spinal nucleus of rabbits and rats. In rabbits and rats under urethane anesthesia, a systematic survey was made of the caudal trigeminal nucleus, using glass coated tungsten microelectrodes. This revealed many neurons in the marginal layer sensitive either to warming or cooling the facial skin. The majority of these neurons were specifically temperature sensitive. In rats, a somatotopic arrangement of cold receptive fields was evident within the marginal layer of the trigeminal nucleus, with the ophthalmic division of the trigeminal nerve represented most laterally, the mandibular most medially and the maxillary division represented over most of the recording region. This arrangement is similar to the mediolateral distribution seen in cats. In rabbits, the distribution was less rigorous but the ophthalmic division tended to be represented caudally and the mandibular division rostrally. The maxillary division was represented over most of the recording region. All receptive fields were ipsilateral and showed spatial convergence of input. Both rabbits and rats possessed a concentration of thermal receptive-fields around the nose, whisker pad and mouth. At steady skin temperatures, marginal units gave bell-shaped intensity functions which were very similar to those reported for the cold and warm receptors. With rapid changes of temperature, neurons responded with a dynamic outburst which corresponded to the equivalent receptor response.


Two modes of cutaneous reinnervation following peripheral nerve injury. The return of sensation to the foot following sciatic nerve crush injury was analyzed behaviorally and electrophysiologically in the rat. Functional recovery begins within four days. Its early phase is accounted for by expansion of the functional distribution of intact neighboring fibers of the saphenous n. It occurs even if the sciatic n. is ligated, and it disappears with section of the saphenous n. Accompanying this functional expansion we began to encounter in electrophysiological recordings from the saphenous n., fibers with unusually large receptive fields (RF's) extending onto the plantar surface of the foot, well beyond their limits in intact rats. All of the expanded RF's were high threshold mechanoreceptors. On about the twentieth day after crushing, the regenerating sciatic n. began to make a functional contribution. This was seen by return of sensation to zones not invaded by the saphenous n. and by the onset of sensation in rats in which the saphenous n. had previously been ligated. With return of the sciatic n. the expanded distribution of the saphenous n. went back to its original boundaries. Correspondingly, we could no longer find expanded saphenous n. RF's. We conclude that cutaneous reinnervation begins with the collateral expansion of high threshold afferents from intact neighboring nerves. This alien innervation is later replaced upon regeneration of the original nerve.


Sympathetic neurons in the cat spinal cord projecting to the stellate ganglion. Horseradish peroxidase (HRP) was injected into the stellate ganglia of anesthetized cats. After a 2-day survival time the spinal cord was processed for the HRP reaction to study the distribution of the preganglionic neurons which project to the stellate ganglia. HRP-labeled neurons in the cord were located exclusively on the side ipsilateral to the injected stellate ganglia and were concentrated in four distinct areas: (1) intermediolateral cell column (78.2%), (2) lateral funiculus (18.5%), (3) intercalated area and (4) central autonomic area (3.3%) for the latter 2 areas). Their distribution pattern in the very rostral pole of the thoracic sympathetic preganglionic cell column was different from the typical thoracic pattern in that a greater proportion of the cells were located in the lateral funiculus, and a few labeled cells were observed in the ventral horn. Longitudinally, a wide range (C8-T8) of spinal cord levels projected to the stellate ganglia, with a peak at the T2 level. These observations infer that a large population of axonal processes of sympathetic preganglionic neurons traveled several segments of the spinal cord through an intraspinal pathway before exiting a particular ventral root.


Topographic projections of the retina and optic tectum upon the ventral lateral geniculate nucleus in the chick. The topographic projections of the retina upon the optic tectum and ventral lateral geniculate nucleus (GLv) of the chick were investigated by making small intraretinal injections of 3H-proline. The retinotectal projection pattern was similar to that described for the pigeon. The retinal projection to the GLv was also topographic and was restricted to the outermost lamina of the nucleus. The anteroposterior retinal axis was reversed in the GLv relative to its orientation in the tectum but the superoinferior axis was oriented identically in both. Furthermore, the posterior retina had an enlarged area of projection in the GLv similar to the enlarged area of retinotectal projection for the "red field" found in pigeons. The tectogeniculate projection was topographic and was confined to the outermost geniculate lamina. The second-order retinotopic map made by the tectogeniculate projections was in register with the retinogeniculate projection. Although the retinal and tectal projection areas were coextensive in the outermost geniculate lamina, the grain density distributions peaked at different points along a radial path through the geniculate laminae. Injections of HRP into the optic tectum led to very light retrograde labeling of a small population of GLv cells topographically corresponding to the tectogeniculate projection zone of the injection site. The data suggest that the chick GLv is comparable to the GLv of other non-primate mammals.


The cochlear nuclei of some turtles.

The cochlear nuclei of some turtles. Histological sections of the brains of eight species of turtles representing six different families were studied in order to delineate the cochlear nuclei. In addition, the posterior eighth cranial nerve root and its ganglion were sectioned in 15 specimens of Kinosternon leucostomum, and the distribution of the degenerated nerve fibers and terminals was determined. Two primary and one probably secondary nuclei were demonstrated by the terminal degeneration pattern of the cochlear fibers. A spherical nucleus angularis and an elongated nuclus magnocellularis together form a column of primary cochlear nuclei in the dorsal alar lamina of the medulla. Heavy terminal degeneration is seen associated with these cells following transection of the posterior eighth nerve and ganglion. Nucleus magnocellularis is probably homologous with the nucleus magnocellularis medialis of lizards and crocodiles, and has been described in turtles as nucleus dorsalis magnocellularis by previous authors. A probably secondary cochlear nucleus, nucleus laminaris, lies just ventral to the nucleus magnocellularis. It is associated with the nucleus magnocellularis throughout its length but is shorter. Nucleus laminaris remains free of terminal degeneration after destruction of the posterior eighth nerve and ganglion. The cochlear nuclei of other turtle species were very similar to those of Kinosternon leucostomum.


The lateral cervical nucleus in the cat: anatomic organization of cervicothalamic neurons. The morphology of the lateral cervical nucleus (LCN) and the organization of the cervicothalamic projection neurons were studied in cats which had received thalamic injections of horseradish peroxidase (HRP). The boundaries of the LCN were defined following very large thalamic (HRP injections. Roughly 92-97% of LCN cells project contralaterally to thalamus; an additional 1.5% project ipsillaterally. Computer-assisted measurements of perikaryal areas demonstrated that there are two sizes of LCN cells, large (175-900 micrometer 2) and small (less than 175 micrometer 2); the small cells are localized in the medial third of the LCN. LCN cells which are not labeled after large thalamic HRP injections are predomininantly small, medially-located neurons. Small HRP injections into physiologically identified regions of ventroposterior thalamus demonstrated that cervicothalamic neurons are organized in a topography consistent with that observed physiologically in the LCN (Craig and Tapper, '78). Dorsolateral LCN cells are retrogradely labeled from nucleus ventroposterolateralis, pars lateralis (VPL1), ventromedial LCN cells are labeled from pars medialis (VPL m), and a few medial cells are labeled from nucleus ventroposteromedialis (VPM). A few cells in the medial portion of the LCN are also labeled from each part of ventroposterior thalamus. Some interspersion was observed even in the cases with the most well-restricted labeling. We conclude that the LCN maintains a basic somatotographic organization with an inherent variability, certain aspects of which are consistently demonstrable both physiologically and anatomically. Evidence was also obtained suggestive of a rostrocaudal inversion in the cervicothalamic projection. The cervicothalamic projection, the differentiation of the medial LCN subpopulation, and the possible redefinition of the LCN are discussed in light of these results.


Retinal synaptic arrays: continuing development in the adult goldfish. We report a light- and electron-microscopic examination of the inner plexiform layer of the central retina of young (c. 1 year) and old (3-4 year) goldfish. There were no new neurons added to this region during the growth period. Nonetheless, there were substantially more synapses (per cell, per mm2, or per degree 2) in the older retinas. This result is discussed in the contexts of retina function and neural development.


Localization of neurons in the rat superior cervical ganglion that project into different postganglionic trunks. Horseradish peroxidase (HRP) was used to determine whether neurons in the rat superior cervical ganglion (SCG) are localized in regions of the ganglion as a function of the postganglionic trunk they utilize. In separate experiments, each of the two major postganglionic trunks was cut 1-3 mm from the SCG and solid HRP was applied to the cut end proximal to the ganglion. The results demonstrated that the cell bodies of neurons whose axons project out the internal carotid nerve (ICN) were located primarily in the rostral part of the ganglion.  Cell bodies of neurons whose axons project out the external carotid nerve (ECN) were located primarily in the caudal part. The total percentages of neuronc with axons in the ICN and ECN were about 35% and 45%, respectively. When HRP was applied to both these trunks, 73% of the neurons in the SCG were labeled. In the caudal portion of the ganglion, an additional group of neurons was observed whose axons project into the cervical sympathetic trunk. Control studies indicated that the neuronal labeling observed in our experiments was due to retrograde axonal transport rather than the direct uptake of HRP by neuronal cell bodies. Thus, neuronal subpopulations exist in specific regions of the rat SCG. The significance of these results to biochemical and electrophysiological studies is discussed.


Gated cardiac scanning: canine studies.

Gated cardiac scanning: canine studies. Retrospective electrocardiograph gating of data from a rotating detector fan beam computed tomography system was employed to produce end systolic and end diastolic images of the beating heart in a series of normal and experimentally infarcted canines. The gating window was typically less than 20% of the cardiac cycle, and the gated images showed superior spatial resolution compared with ungated images of the same cross section. Comparison of the scans of the normal and of the infarcted animals shows abnormal contrast enhancement of the myocardium in the region of the infarct, and the gating studies demonstrate dyskinetic behavior of the infarct zone.


Computed tomography of the thorax and standard radiographic evaluation of the chest: a comparative study. Comparison of standard radiographic evaluation of the chest with computed tomography (CT) was carried out in 109 patients who were examined on a prototype EMI CT5000 scanner. Forty-eight patients had lung problems, and 61 were evaluated because of a mediastinal mass or widening, or for the detection of an occult thymoma in myasthenia gravis. Computed tomography was of value in the staging of bronchogenic carcinoma, particularly in the detection of direct mediastinal and pleural extension, and in evaluating patients with solitary or multiple nodules by detecting additional lesions and calcification. Thymomas not detected on conventional imaging modalities were visualized in 4 of 33 patients with myasthenia gravis or red cell aplasia. One of these was a false positive. In 28 patients with a mediastinal mass or widening on the chest roentgenogram, incremental information was noted on CT in 22. These included a definitive diagnosis of lesions composed of fat, evaluation of the isolated esophagus after colon by bypass surgery,and identification of the cause of paraspinal widening.


In vitro computed tomography of the human placenta. A plastic holding device has been devised to allow in vitro computed tomography of term human placentas. Graded dilutions of iodinated contrast medium have been injected into the fetal placental circulation and into the intervillous space of placental lobules perfused with normal saline solution. Computed tomography in different orientations has imaged Borell's "jets" on the maternal side and cotyledonary vascular "puffs" on the fetal side of the placenta. Attenuation coefficients, before and after injection of contrast medium may be used for quantitative investigation of the physiological placental circulation and possibly for diagnosing placental pathology.


Computed tomography of rabbit V2 carcinoma after intraarterial contrast enhancement. Changes in X-ray attenuation of rabbit V2 carcinoma, as determined by computed tomography (CT) scanning, were assessed following the intraarterial and intravenous administration of a water soluble contrast agent. After intraarterial contrast medium administration, a significant increase in CT attenuation values occurred in both blood and V2 carcinoma, and the attenuation values remained above control values for at least 120 min. A similar, although less pronounced, increase in VA attenuation values occurred following intravenous contrast medium administration. Comparison of V2 CT enhancement values after intraarterial and intravenous administration suggested that tumor enhancement was greater after intraarterial administration.


The use of contrast -- detail -- dose evaluation of image quality in a computed tomographic scanner. Limiting-perception measurements of hole patterns in computed tomography reconstructions of a low-contrast phantom are used to generate contrast -- detail -- dose diagrams for various contrasts, hole diameters, dose, and system modulation transfer functions (MTF). These curves are then divided into MTF-dominated, transition, and noise-dominated regions. The low-contrast perceptibility and image noise are parameterized and compared. A limiting-perception factor is difined and is shown to be nearly independent of contrast, hole diameter, dose, and MTF in the noise-dominated region.


Contrast--detail--dose analysis of six different computed tomographic scanners. Low-contrast visibility of various rotate-translate, rotating detector, and stationary detector computed tomogrphy (CT) scanners is measured at contrasts ranging from 0.3 to 3% using a phantom based on the partial volume of water and polystyrene. The results are plotted on log-log curves, as a function of entrance dose, to provide a family of contrast (C)--detail (d)--dose (D) visibility curves. The transition region, approximately 1 to 10% contrast, depends on modulation transfer function (MTF), contrast, and the dose (noise), while the noise region, less than or equal to 1% contrast, is independent of MTF. The slopes of the curves in the noise region are consistent with a value of -1, as opposed to a theoretically expected value of -3/2 for ideal CT noise. Relative dose efficiency of various scanners is examined by plotting CdD(1/2) versus contrast for both peak dose (Dp) and summation dose (D sigma). The rotating detector systems are shown to be, on the average (at 0.5% contrast), 3.4 (Dp) and 4 (D sigma) times more dose efficient than the stationary array system examined, and 2.4 (Dp) and 3.2 (D sigma) times more efficient than the rotate-translate units examined.


Diagnosis of cranial asymmetries in cerebral arteriovenous malformations. Nine of 29 patients with cerebral arteriovenous malformations exhibited abnormal cranial asymmetries on computed tomography (CT). Two of these patients showed no other abnormalities on their precontrast CT scans. Assessment of cranial asymmetry is recommended in all patients suspected of having an arteriovenous malformation.


Compartment analysis of contrast enhancement in brain infarctions. Contrast enhancement has been studied with computed tomography in 18 patients with brain infarction. Four patients were examined on more than one occasion. A mode of contrast medium administration has been used that results in constant blood iodine concentration during the investigation. The enhancement pattern was analyzed using a compartment model. A fast and a slow component of contrast enhancement was quantified for different parts of the infarct. Correlation with the age of the infarct confirms earlier studies, indicating a maximum enhancement at 2 to 4 weeks after the incidence of the infarct.


Radiation necrosis of the brain: correlation between patterns on computed tomography and dose of radiation. Recurrent symptoms after radiation therapy of a brain tumor are not always the result of regrowth of the neoplasm but may represent radiation necrosis of the brain. Seventeen patients with proven cerebral radionecrosis are included in the present study. In five patients who received 5,000 to 5,500 rads, areas of radiation necrosis of the brain were shown on computed tomography (CT) as low density lesions with no mass effect or contrast enhancement. In 12 patients who received 6,000 to 7,000 rads, radionecrosis was shown on the CT scans either as a localized mass with contrast enhancement or as diffuse low density, isodense, or high density lesions with no mass effect but with occasional enhancement. In all cases, the lesions coincided well with volumes of the brain that received a threshold dose of radiation determined from the isodose reconstruction maps.


Utilization of computed tomography scanners and the health planning issue: a process data summary. Studies were made of the computed tomography (CT) scanning process at three hospitals. The data collected, while of interest to hospital administrators and radiologists, are particularly significant in view of the current structure of health planning guuielines. The data show clearly that the utilization potential of a particular CT scanner is a function of patient demand, scan time, the ratio of head to body procedures, and medical practice insofar as contrast medium administration is concerned. This paper summarizes the results of the hospital studies and documents the implications of the data for health planning guidelines.


Data collection for cross-sectional image reconstruction by a moving ring of positron annihilation detectors. A ring of positron annihilation detectors capable of two independent motions in the plane of the ring is considered. It can rotate around its center, and the whole ring may move so that its center traces a circular path. Provided certain parameters are chosen according to given formulas, data collected by such a detector ring can be reorganized (rebinned), in a computationally very inexpensive fashion, so that the data items in each bin are measurements along parallel lines spaced at small equal intervals. Efficient high resolution reconstruction algorithms that assume such data organization can therefore be applied to data collected collected by a moving positron ring detector. The method is demonstrated on a realistic example.


Evidence of CSF enhancement in the spinal subarachnoid space after intravenous contrast medium administration: is intravenous computer assisted myelography possible? Following intravenous injection of iodinated contrast medium, peripheral enhancement of the area inside the spinal canal, is frequently observed by computed tomography. This may be due, at least in part, to enhancement of the cerebrospinal fluid in the spinal subarachnoid space. Our preliminary observations in human patients and in animal experiments are reported. The goal of intravenous computer assisted myelography is worth pursuing.


Communication of right and left perirenal spaces demonstrated by computed tomography. The anatomy of the perirenal space in recent radiologic texts differs from Gerota's initial description. A case of renal trauma is presented in which computed tomography shows communication of extravasated urine from one perirenal space to the other.


Neuroblastoma follow-up by computed tomography. Follow-up by computed tomography (CT) was quite useful in a child with neuroblastoma. Regression of the initial abnormal findings was shown on a second CT scan as reduction of mediastinal mass. Soon thereafter, however, the patient deteriorated clinically. The CT findings demonstrated progression of the mediastinal expansion as well as multiple organ involvement, supplying significant additional information as compared to conventional X-ray films.


Cerebral computed tomography in Reye syndrome. The computed tomography (CT) findings in a case of Reye syndrome are presented. A striking discrepancy between the CT attenuation of infratentorial (elevated values) and supratentorial structures is observed.


Multiple axis image reconstruction from axial transverse data. The technique for alternate axis reconstruction from axial transverse computed tomography data is presented. The utility of the method as an adjunct to diagnosis, radiotherapy treatment planning, and tumor biopsy is discussed. The relative radiation dose and resolution characteristics between this and other methods are compared.


A simple technique for identification of the lower extremity vascular bundle on computed tomography. Drip infusion of contrast medium has been used prior to computed tomography of the lower extremities to define the deep veins of the leg (vascular bundle).


Localization of scanning level in computed tomography of the spine. A simple method for identifying the scanning level in computed tomography (CT) of the spine is described. The method involves exposing a lead lattice grid on a conventional X-ray film and taking a conventional spine film with aluminum markers on the patient's back. The film showing the grid and the markers on the patient's spine is used to localize the CT scans taken with the aluminum markers still on the patient's back.


Rectal thiopental for sedation of children for computed tomography. Rectally administered thiopental was evaluated for sedation in pediatric computed tomography and compared with "cardiac cocktail" sedation. The drug produced sedation as effective as the "cocktail" with easier administration, more rapid onset, and shorter duration of sedation. Although no complications were observed, careful observation for respiratory depression is suggested.


Complications of implantation of synthetic fibers into scalps for "hair" replacement: experience with fourteen cases. Fourteen cases of complications from implantation of acrylic fibers into scalps for correction of male-pattern baldness were studied. The complications were severe enough in all of them to force attempts to remove the fibers, many of which from the nature of their knotted insertion could not be extracted. Thus, immediate complications were encountered and serious, delayed, bad effects are anticipated. Among the early complications already observed are marked edema of the face; hemorrhagic oozing; microbial infection; foreign-body reactions; scarring; acneform comedones and pustules; pain, pruritus, and numbness; and loss of natural hair. Complications in the furture are likely to be progressive sclerosis from irretrievable fragments and knots of the artificial materials and conceivably malignant degeneration of tissues of the scalp. For all of these known and possible bad effects, implantation of present-day synthetic fibers into the scalp must be judged to be a dangerous practice that must be stopped at once.


Uses of the O-to-Z-plasty repair in dermatologic surgery. The mechanics of repairing round and oval wounds by O to Z-plasty and some personal modifications and uses in special circumstances and locations are described. Several schematics and photographs illustrate the technique and clinical results.


A giant hairy pigmented nevus on the face: excision and reconstruction in stages. Reasons for surgical ablation of giant hairy pigmented nevi are stated and surgical techniques of ablation are illustrated and described in a representative case on the face.


Management of hyperhidrosis axillaris.

Management of hyperhidrosis axillaris. To many people, particularly women, hyperhidrosis of the axillae is a personal discomfort and a social handicap. Previously practiced topical and internal medicinal measures and surgical techniques of management are reviewed and a modified surgical technique is described.


Acne keloidalis nuchae: report and treatment of a severe case. Acne keloidalis nuchae (folliculitis keloidalis or dermatitis papillaris capillitii) is a chronic, deep, scarring folliculitis of the nuchal area. Therapeutic measures such as oral and topical antibiotics, intralesional injections of fluorinated adrenocorticosteroids, and radiotherapy are sometimes effective in controlling this condition. A case of refractory acne keloidalis is presented to show the curative possibility of aggressive surgical therapy.


Supervention of a pigmented basal-cell carcinoma upon a nevus sebaceus. A case is reported of a deeply pigmented, pedunculated mass that developed upon a verrucous nevus. Biopsy proved the combined lesion to be a pigmented basal-cell carcinoma upon a nevus sebaceus. The carcinoma was completely contained in the biopsy and the nevus sebaceus it sprang from was ablated by surgical excision. Modern experience and management of such cases are reviewed briefly.


Anaphylaxis to sunflower seed.

Anaphylaxis to sunflower seed. The clinical and immunological investigation of three patients with an acute anaphylaxis after ingesting commercial varieties of sunflower seeds is presented. Specific IgE-mediated hypersensitivity has been demonstrated in all three patients to sunflower seed extract by history, direct skin tests, and positive radioallergosorbent test (RAST) titers. RAST inhibition was positive in two patients tested. Similar tests on controls were negative.


Nasal methacholine challenge. A test for the measurement of nasal reactivity. The aim of this study was to develop a test for the measurement of nasal reactivity. Different concentrations of methacholine were sprayed intranasally, and the nasal secretion and blockage were measured in normal subjects. The simple collection and measurement of secretion was found to be a valuable parameter of mucosal reactivity, while measurement of nasal airway resistance was unreliable, due in part to the presence of secretion in the nasal cavity. The methacholine test had a fairly good reproducibility when the amount of secretion was used as the only parameter. It caused a significantly stronger reaction in women than in men. Patients with perennial rhinitis had a more vigorous response than the controls. It is concluded that the methacholine test may prove useful as a sign of perennial rhinitis and also for the objective evaluation of medication, but further studies are warranted.


The immune response of patients with ragweed hay fever treated with polymerized ragweed antigens. This report describes the immune response of patients with ragweed hay fever treated with polymerized ragweed antigens (PRW). Their IgG antibody responses to crude ragweed extract, antigen E, antigen K, and antigen Ra3 were determined by a solid-phase radioimmunoassay. The results indicate that PRW contains an array of clinically important antigens that are available for immunologic processing and result in an immune response in patients treated with this new form of immunotherapy for ragweed hay fever.


Tartrazine and the prostaglandin system. The effect of tartrazine on prostaglandin production was evaluated in several in vitro systems in order to elucidate the interrelationship between aspirin-sensitive asthma and tartrazine. Unlike the nonsteroidal anti-inflammatory drugs, tartrazine did not inhibit cyclooxygenase activity in sheep seminal vesicles, guinea pig lung microsomes, and human platelets. Tartrazine had no effect on the activation of acyl hydrolase, which is the rate-limiting step in prostaglandin production. The major metabolite of tartrazine, sulfanilic acid, also had no inhibitory effect on the sheep seminal vesicle cyclooxygenase. In view of these findings, if there is a cross-sensitivity between tartrazine and aspirin in aspirin-sensitive asthmatics, it is unlikely to be on the basis of prostaglandin inhibition.


Bronchial responsiveness to inhaled histamine and exercise. Bronchial responsiveness to inhaled histamine and exercise was measured in 19 asthmatics. Histamine aerosol was inhaled to determine the provocative concentration producing a 20% fall in forced expired volume in one second (FEV1) (PC20). Exercise was performed on a treadmill and a cycle ergometer; following each procedure the percent fall in the FEV1 (delta FEV1) and the exercise lability (percent rise in FEV1 plus percent fall in FEV1) were calculated. Delta FEV1 and exercise lability after both forms of exercise were similar. PC20 correlated with delta FEV1 and exercise lability in both forms of exercise; however, the correlation with exercise lability was better. PC20 was more sensitive in demonstrating bronchial hyperresponsiveness. The close correlation between the level of bronchial responsiveness to histamine and exercise supports the view that release of endogenous chemical mediators is an important determinant of exercise-induced asthma. The treadmill exercise and cycle ergometry protocols were equally effective in producing exercise-induced asthma.


An assessment of cardiorespiratory adjustments of asthmatic adults to exercise. The cardiorespiratory adjustments of asthmatic adults to submaximal and maximal workloads were investigated. Cardiorespiratory variables were measured every 2 min during exercise and at the end of maximal physical effort. Exercise-induced asthma (EIA) occurred in all asthmatic subjects while normal subjects maintained normal spirometry. The results suggest that asthmatic adults have no cardiac reserve or oxygen delivery limitations. They work under less efficient ventilatory conditions at submaximal workloads and have a significantly lower functional work capacity. The high degree of correlation between preexercise maximal midexpiratory flow rate (MMF) and maximum O2 consumption (max Vo2) suggests that the smaller airways contribute significantly to the observed abnormalities. We recommend that evaluation of antiasthmatic medications in exercise-induced asthma should take into consideration their effect upon smaller airways and cardiorespiratory variables.