Hair root versus red cell individual phenotype in Sardinian heterozygotes for G6PD deficiency (Mediterranean type). G6PD activity was assayed in 20 Sardinian heterozygotes for G6PD deficiency and related to that of LDH and MDH. One of these heterozygotes showed a deficient phenotype in all her follicles, while the remaining 19 had different proportions of deficient, intermediate, and normal follicles. This is in accordance with a previous estimate. Because of the broad fiducial limits at the 5% level and because of some developmental considerations, this value cannot be interpreted as indicative of the number of primordial cells for scalp epidermis at the time of X-chromosome inactivation, as previously stated. The assay of single hair follicles is, however, a very valuable tool for establishing the role of cell selection in the same or in a different tissue, like peripheral blood.


The physicochemical properties of hair in the BIDS syndrome. The physicochemical properties of hair from a new recessive syndrome associated with brittle hair, intellectual impairment, decreased fertility, and short stature have been studied. Electrophoresis of the SCM-structural proteins showed that the alpha polypeptides appeared normal, but the matrix component was markedly reduced. This was confirmed by finding a normal alpha X-ray diffraction pattern but a reduced 1/2 cystine content of hair and an abnormal stress-strain curve. Electron-microscopic studies revealed extreme disorganization of the filaments which most likely resulted from the absence of normal cross-linking. Nails, which contain structural proteins similar to hair, also showed the abnormality. Since the matrix component seen by electrophoresis consists of more than one component the defect cannot be explained as a single structural gene abnormality.


Hospital formularies: organizational aspects and supplementary components. The organizational aspects and supplementary components of 44 formularies in teaching hospitals of 500 beds or more were compared. The aspects of formularies studied included prescribing regulations and technical aids, economic considerations, information on pharmacy services and procedures, information regarding drug products, hospital regulations, and format and readability. Many inconsistencies were found in the organization of the formularies and in the types of supplementary sections they included. It is suggested that the formulary has not been employed effectively as a document for transmitting drug information and hospital regulations.


State-of-the-art of drug usage review.

State-of-the-art of drug usage review. Drug usage review (DUR) studies reported in 16 medical, allied health and pharmaceutical journals from 1970 to 1975 are analyzed. The studies cited included systematic data collection of prescription orders and an evaluation of these orders on at least one of the following: daily dose, length of therapy or quantity dispensed, or appropriateness of the drug itself. Gaps in both content and methodology of the DUR programs were discovered, and methods for improving future studies are discussed.


Development of patient medication instruction cards. The development of patient medication instruction cards for use in patient education is described. Writing of the cards, their use in practice and predischarge teaching are discussed.


The Federal Drug and Devices Act and the Drug Safety Amendments of 1976. The proposed Federal Drug and Devices Act and the Drug Safety Amendments of 1976 are discussed, including their potential impact on pharmacists.


Tardive dyskinesia with low-dose, short-term neuroleptic therapy. The development, treatment, and outcome of a case of tardive dyskinesia following short-term, low-dose neuroleptic therapy is described. Thirty weeks of treatment with haloperidol, in doses never exceeding 10 mg daily, produced tardive dyskinesia symptomatology. Upon discontinuing haloperidol, the symptoms decreased significantly in severity within the first four weeks and disappeared completely within 12.5 weeks. This case is compared with the classical description of tardive dyskinesia symptomatology, etiology, response to treatment and degree of reversibility. Atypical features are explained and clinical implications of the case are offered.


Pulmonary aspergilloma. A rational approach to treatment. A prospective study of 15 patients with pulmonary aspergilloma was undertaken over an 11 year period. Serious underlying diseases, particularly chronic obstructive pulmonary disease and alcoholic cirrhosis, were present in 12 of them. Eight of 15 patients whose clinical and roentgenographic course was followed for an average of 50 months, received no specific therapy. There were four deaths in this group, none attributable to aspergilloma. The aspergilloma had lysed spontaneously in two, decreased in size in one and was unchanged in one. In the four surviving patients who had no treatment, the aspergilloma lysed spontaneously in one, remained unchanged in two and increased in size in one. Of the seven patients who were treated medically or surgically, three died. Among the seven deaths (untreated and treated patients combined), six were clearly related to underlying disease. The prognosis of aspergilloma is related primarily to the nature and severity of the underlying disease(s). Contrary to the conclusions of previous reports, the experience in our series of patients suggests that routine surgical excision of aspergilloma is not indicated.


Intravascular coagulation associated with the adult respiratory distress syndrome. In seven of 30 consecutive patients with the adult respiratory distress syndrome, disseminated intravascular coagulation (DIC) developed. Increasing respiratory dysfunction characterized by decreased effective static compliance and increased hypoxemia coincided with the development of DIC. Patients in whom DIC developed were characterized by a high incidence of bleeding, gangrene of the extremities, renal dysfunction, mortality and autopsy evidence of fibrin microthrombi in the lungs, kidney and skin. In 12 of 23 patients who did not meet the criteria for DIC, the platelet count decreased by at least 50 per cent of the initial values at some time during their illness. Fibrin microthrombi were found in the lungs in the majority of the patients subjected to autopsy. These data support the concept that depostion of platelet on damaged pulmonary capillary endothelium may be more common in the adult respiratory distress syndrome than the DIC syndrome.


Diagnosis and evaluation of patients with an enlarged sella turcica. A prospective analysis of the roentgenographic and laboratory parameters in 100 patients with an enlarged sella turcica was made. Seventy-five patients had no visual symptoms: 27 had primary intrasellar tumor; 25 had the empty sella syndrome: 13 had an extrasellar process; and in 10, no final diagnosis was made because air study was omitted. However, these patients remained asymptomatic for up to three years. Eighteen of the patients with a primary intrasellar tumor had symptomatic pituitary dysfunction; nine were asymptomatic. Five of 14 patients studied had elevated plasmaproa prolactin levels. of the 25 patients with the empty sella syndrome and the 10 patients in whom no final diagnosis was made, none had any clinical endocrine or visual abnormalities, although in 10 of these 35 patients, results of laboratory studies were compatible with pituitary dysfunction. In these cases, air study was necessary to differentiate a clinically silent pituitary tumor from the empty sella syndrome. This emphasizes the high incidence of the empty sella syndrome in patients with enlarged sella, and also confirms the high incidence of hyperprolactinemia in patients with pituitary tumors.


The effect of anti-inflammatory agents and inflammation on granulocyte adherence. Evidence for regulation by plasma factors. Significant inhibition of granulocyte adherence to nylon fiber columns followed the administration of alcohol, aspirin, sodium salicylate, acetaminophen, indomethacin, phenylbutazone, colchicine or prednisone to normal subjects. The addition of salicylates and glucocorticoids to blood in vitro had no effect on adherence, but plasma from volunteer subjects treated with either drug contained a factor which inhibited the adherence of normal granulocytes. The factor is heat stable, nondialyzable and not present in serum; it produces a linear dose response in normal cells. When mixed with the adherence-increasing factor found in inflammatory diseases, it neutralizes the augmenting effect and normal granulocyte adherence results. The effect of anti-inflammatory therapy on inflammatory disease was studied in aspirin-treated patients with rheumatoid arthritis. Their granulocyte adherence fell into two categories based on the clinical control of their disease; patients in good control had only slightly increased granulocyte adherence, but those in poor control had an average adherence more than twice normal. Mean blood aspirin levels were equivalent for the two groups (11.0 mg/100 ml for the well controlled and 13.4 mg/100 ml for those poorly controlled). Thus, clinical response to anti-inflammatory therapy correlates well with granulocyte adherence, not with aspirin levels. The potential pathogenetic role of adherence-modifying factors in inflammatory diseases remains to be determined.


A nationwide outbreak of Reye's Syndrome. Its epidemiologic relationship of influenza B. Between December 15 and June 30, 1974, 379 cases of confirmed Reye's syndrome were reported to the Center for Disease Control. Of these, 316 occurred during February and March 1974. A simultaneous surveillance system for influenza B indicated that this clustering of cases of Reye's syndrome correlated both temporally and geographically with influenza B outbreaks. The incidence of Reye's syndrome was higher in rural than in urban centers. Epidemiologically, two groups of cases of Reye's syndrome emerge: those which occur in older children (median age 11 years), cluster in time and geographic region, and are associated with antecedent influenza B infection; and those which occur sporadically thoughout the year, are isolated in occurrence, occur in younger children (median age 6 years), and are associated with a wide variety of antecedent viral illnesses.


Visceral fungal infections due to Petriellidium boydii (allescheria boydii). In vitro drug sensitivity studies. Four patients with visceral infections due to the fungus Petriellidium boydii, who were recently hospitalized in our institutions, are described. Three of the patients were compromised hosts; in the fourth patient, infection occurred after trauma. All had received prior steroid and antibiotic therapy. Studies of patients with mycetoma or secondary infection of a pulmonary cavity due to this organism and of patients with visceral infections are reviewed. Because of histologic similarities to Aspergillus species, infections due to P. boydii may have been misdiagnosed in the past if the infecting fungus was not isolated in culture. The fungus has been shown to be resistant in vitro to currently available antifungal agents. Resistance to amphotericin and 5-fluorocytosine is demonstrated in our studies. There are few reports of successful chemotherapy of any manifestation of this infection, and no such reports of visceral disease. We demonstrate in vitro sensitivity of isolates in our cases and in others to micronazole, a new antimicrobial agent; this drug may be indicated for treatment of disease due to P. boydii.


Atrial pacing in patients with sinus node dysfunction. Sinus nod recovery time (SNRT) at paced atrial rates of 100 (SNRT100) and 120 (SNRT120) beats/min, atrial effective refractory periods at spontaneous heart rates (AERP) and at paced rates of 100 (AERP100) and 120 (AERP120) beats/min, and premature atrial stimulation were among the studies in evaluating 33 patients with symptomatic sinus node disease and 42 normal subjects. Although mean SNRT100 and SNRT120 were statistically significantly greater in patients than in control subjects, there was a significant overlap between patient and control groups, and SNRT100 or SNRT120 was associated with a 30.3 per cent false-negative and 5 per cent false-positive incidence. Correction for heart rate (SNRT-spontaneous cycle length) failed to improve the sensitivity or specificity of this test. There was no significant difference in mean AERP, AERP100 or AERP120, or in sinoatrial conduction time in patients compared with control subjects. Analyses of curves derived from plots of test and return cycles showed abnormal curves in only five of the 24 patients studied by progressively premature atrial stimulation. Two of these five patients showed normal zone I and II phenomena followed by a progressive linear increase in the return cycle that was thought to be due to abnormal refractoriness of the perinodal fibers.


Local characteristics of the normal and asynergic left ventricle in man. The significance of ventricular asynergy in determining medical prognosis and surgical risk in patients with coronary artery disease and its delineation by ventriculography have been of increasing interest. To determine the underlying histopathologic and electrographic features of left ventricular asynergy, 39 patients undergoing open heart surgery were studied. Thirty-six histopathologic specimens were obtained in 31 patients (26 as transmural needle biopsies and 10 as aneurysm resections). In four normally contracting areas and 12 hypokinetic areas, neither fibrosis nor early changes of myocardial damage was evident. In contrast, of eight akinetic areas there was more than 50 per cent muscle loss in four and from 30 to 35 per cent muscle loss in three, in only one area was there less than 10 per cent muscle loss. Of 12 dyskinetic zones there was more than 75 per cent muscle loss in 10 zones, 35 per cent in one and no pathologic abnormalities in one. Epicardial electrograms were obtained from 35 areas in 29 patients. Of 10 normally contracting ventricles, in one, pathologic Q waves were demonstrated only over the inferior area. Progressive increases in the severity of asynergy were associated with a progressive increase in frequency of initial abnormal Q waves. In only one of nine hypokinetic areas were epicardial Q waves exhibited, but they were present in six of 10 akinetic and five of six dyskinetic areas. Both histopathologic and electrographic data were available from 20 asynergic areas in 16 patients. Initial epicardial R waves were associated with normal biopsy specimens in seven of eight hypokinetic areas. Of seven akinetic areas, initial R waves were associated with 30 to 35 per cent muscle loss in three; of four areas with initial Q waves, there was a 35 per cent muscle loss in one and more than 50 per cent muscle loss in three. Similarly, of five dyskinetic segments, a QS pattern was associated with more than 75 per cent fibrosis in four. In one dyskinetic area there was an intial R wave in association with a normal appearing biopsy specimen. In summary, a good correlation exists between the severity of asynergy by ventriculography, the degree of muscle loss and the presence of epicardial Q waves. However, a significant amount of histologically and electrographically normal myocardium may be present even in severely asynergic areas.


Pulmonary hypertension and foreign body granulomas in intravenous drug abusers. Documentation by cardiac catheterization and lung biopsy. In this report we confirm the presence of pulmonary hypertension by cardiac catheterization in four intravenous drug abusers with biopsy-documented foreign body granulomas in the pulmonary vessels and interstitium. Each patient had a history of intravenous injections of alpha-sympathomimetic agents obtained from nasal inhalers. There agents may have contributed to the disease by constricting small vessels when simultaneously injected foreign bodies were passing through the vasculature of the lung. The severity of the pulmonary hypertension correlated well with the decrease in single breath diffusing capacity in each case. Pulmonary hypertension may contribute significantly to the increased morbidity and mortality observed in intravenous drug users.


Influenza A viral infection associated with acute renal failure. The clinical and laboratory findings in four cases of acute renal failure following the onset of influenza A viral infection (Port Chalmers/1/73) are presented. Although the pathophysiologic mechanisms affecting the kidney in these cases varied, the ensuing renal failure in each patient was severe. Findings suggestive of acute myoglobinuria developed in one patient, and disseminated intravascular coagulation (DIC) occurred in another. The role of viruses in the pathogenesis of renal disease is reviewed. Despite inconclusive evidence that the influenza virus can cause human renal disease, the secondary pathways that can be triggered by viral infections may be even more significant in producing various degrees of renal dysfunction. The occurrence of renal failure during an episode of influenza represents a serious complication which may influence significantly the morbidity and mortality of patients with this viral infection.


Hypertension associated with early stage kidney disease. Complementary roles of circulating renin, the body sodium/volume state and duration of hypertension. Interrelations among blood pressure, exchangeable sodium, blood volume and plasma renin activity were studied in 40 normal subjects and in 40 patients with early stage kidney disease (mean plasma creatinine, 2 mg/100 ml). Findings in eight normotensive patients did not differ significantly from those in normal subjects. However, 32 hypertensive patients showed increases (p less than 0.05) in mean exchangeable sodium and in the products of the logarithm of plasma renin activity and exchangeable sodium or blood volume. In normal subjects, blood pressure did not correlate with any of the parameters measured. In the patients, it correlated significantly (p less than 0.05) with duration of hypertension (r = 0.70), exchangeable sodium (r = 0.34) and with sodium-renin (r = 0.38) or volume-renin (r = 0.30) products, but not with blood volume or circulating renin individually. Multiple regression analysis with blood pressure as a dependent variable, and duration of hypertension and the sodium-renin or volume-renin products as independent variables, revealed correlation coefficients of 0.77 and 0.76, respectively. These findings suggest that hypertension accompanying early stage kidney disease may depend at least partly on subtle abnormalities in the sodium volume-renin feedback mechanism as well as on a factor related to the duration of preexisting hypertension.


Elevation of serum lipid levels during diuretic therapy of hypertension. In a study attempting to improve coronary risk status, serum cholesterol and triglyceride levels were measured before and during treatment of 74 patients with mild primary hypertension. In 35 patients there was a satisfactory reduction in elevated blood pressure levels with diet therapy alone. In the remaining 39 patients a diuretic drug was required in addition to the diet. Diet therapy alone was followed by a decrease of 11 mg/100 ml in mean serum cholesterol (p less than 0.01 versus pretreatment value) and no change in serum triglyceride. The sue of diuretics was accompanied by an average increase of 11 mg/100 ml in serum cholesterol and of 34 mg/100 ml in serum triglyceride (p less than 0.01 versus pretreatment level for  both). In a subgroup of 21 patients with greatest elevations in lipid levels during the administration of diuretics, little improvement in coronary risk status occurred because the increase in serum cholesterol balanced the decrease in systolic blood pressure, according to Framingham risk tables. If the level of serum lipids is a factor in the pathogenesis of coronary atherosclerosis then the observed effect of diuretic drugs to elevate serum cholesterol and triglyceride levels may explain, in part, the continuing high rate of occurrence of myocardial infarction during the treatment of hypertension.


Spinner films for reticulocyte counts.

Spinner films for reticulocyte counts. The widely practiced method for performing a reticulocyte count includes counting 1000 normal erythrocytes while searching for a relatively small population of reticulocytes. A method is presented using a spinner reticulocyte preparation which avoids the need to count the normal erythrocytes, thereby eliminating most of the tedium from the test. The accuracy and reproducibility of this new method, as compared to the currently practiced method, is presented, along with the results of an on-line comparison.


Career planning of medical laboratory science students. The purpose of this study was to determine the most influential people in the career choices of medical laboratory science students. Methods of investigation used by these students were also explored. A questionnaire survey indicated that students were influenced more by professionals in the field, and that high-school guidance counselors were unable to furnish current and accurate information for decision making. Results of the study have implications for improvements in all areas of guidance. Based on the findings, the best interests of the students are served when both guidance counselors and professionals in the medical laboratory science field provide students with understanding, encouragement, and factual information.


Leukemic reticuloendotheliosis: a medical technologist's diagnosis. Leukemic reticuloendotheliosis (LRE) or "hairy cell leukemia" is a unique form of leukemia which possesses features of both a chronic and acute leukemia. Its characteristic morphology, clinical diagnosis, and treatment are discussed. A high index of suspicion should make this entity easily diagnosed by the medical technologist.


Technique of handling neonatal blood samples for zinc analysis. Short segments of Chemfluor flexible Teflon tubing (2.38 mm ID) previously coated with sodium heparin (1,000 units/ml) serve as ideal containers in which blood from neonates can be collected for zinc analysis. The ends of the tube are plugged with Teflon TFE round beading so that the sample comes in contact only with Teflon and the risk of contamination is minimized. The heparin coating facilitates easy collection of the sample and separation of plasma by centrifugation. It does not contribute zinc to the specimen.


Revised laboratory manual helps solve problems. This paper describes a project to design a laboratory manual which could be easily understood and used by both those who work in and those who utilize the laboratory in a large teaching hospital complex. Results indicated increased employee knowledge of laboratory policies and procedures, and an improved relationship between patient units and the laboratory.


Parametrial phlebectasia: a clinical-pathologic entity. A unique group of patients, representing 110 consecutive abdominal hysterectomies wherein parametrial varicosities were associated with pelvic transudate, mild uterine engorgement, cervical engorgement, and ovarian cystic enlargement, were studied conjointly by the pathologist and surgeon. A diagnosis of pathologic phlebectasia was assigned after appropriate criteria were applied. Speculation regarding pathogenesis and descriptions of results of therapy are given.


Intensive care of the pregnant diabetic. Over the last 2 years at Metropolitan Hospital Medical Center 245 diabetic women have been seen on the obstetric service. This complication of pregnancy comprises 7.9 per cent of 3,076 deliveries, resulting in an over-all uncorrected perinatal mortality rate of 2.9 per cent. We believe that early detection and strict rigid control of diabetes is the key to improved perinatal outcome. This article presents the classification, diagnosis, and management which have led to these results.


Effects of large doses of estrogen on prolactin and growth hormone release. The effects of large doses of estrogen on prolactin (PRL) release were assessed. Circulating PRL levels in response to intravenous infusion of 17 beta-estradiol (E2), at a rate of 50 mug per hour for 4 hours, were studied in 10 subjects, and a chronic administration of ethinyl estradiol (EE) at a dose of 400 mug per day, for 1 week, was evaluated in five hypogonadal subjects. There was a significant depression of serum level of PRL during the E2 infusion and a significant increase in PRL release after discontinuation of the infusion. The chronic treatment of large doses of EE induced a more rapid (within 36 hours) and a significantly greater elevation of PRL levels at the end of 1 week treatment than those found during smaller doses of EE administration, as reported previously. These data suggest that acute treatment of estrogen may have a biphasic action on the pituitary PRL section and that the augmentatory effect of estrogen on PRL secretion is dose-dependent in human beings.


The prevalence of cervical cancer screening iin the United States in 1970. The Papanicolaou smear history of 6,752 ever-married women under 45 years old residing in the United States, was obtained by the 1970 National Fertility Study, conducted by the Office of Population Research at Princeton University. An epidemiologic analysis of these data is presented, and women who had never had a Papanicolaou smear, those who had had a smear more than 12 months before interview, and those who had had a smear during the previous 12 months are described.


Amniocentesis for antenatal diagnosis. Review of problems and outcomes in a large series. The results of amniocentesis for diagnostic genetic studies on 242 patients are presented in detail. These suggest that obtaining fluid free from contaminating red blood cells is important to successful cell culture. The data also suggest that it is technically more difficult to obtain such fluid tham might be expected, despite the use of ultrasonic localization and experienced operators. Nevertheless, 97 per cent of patients who elect to complete antenatal diagnosis will ultimately obtain the information sought, in time to intervene medically if desired. Moreover, the act of obtaining this information is shown to be without significant risk to the ultimate outcome of pregnancy.


Studies on blood pressure during pregnancy. I. Influence of parity and age. Routine prenatal visit blood pressure measurements were used to examine the differences in blood pressure by age and parity in a cohort of 6,662 white gravidas. Both age and parity were observed to have significant effects on blood pressure during pregnancy. For a given age, nulliparas were observed to have higher mean blood pressures than parous gravidas, irrespective of the inclusion or exclusion of gravidas who were diagnosed to have hypertensive disorders during their pregnancies.


The susceptibility of the postpartum and postabortal cervix and uterine cavity to infection with attenuated rubella virus. To determine the susceptibility of the postpartum and postabortal genital tract to infection with attenuated rubella virus, 30 patients with negative hemagglutination inhibition (HI) titers were studied. Following inoculation with Cendehill or RA 27/3 vaccine, viral cultures of the cervix and uterine cavity were obtained with blood specimens to evaluate serologic conversion. Attenuated rubella virus was not isolated in any patient; seropositive conversion was achieved in 24 women. The significance of these findings related to wild rubella virus infection is discussed.


Effect of length of gestation on maternal cellular immunity to human trophoblast antigens. Maternal lymphocyte reactivity to human trophoblast antigens was studied in placentas of gestational ages 8 to 14 weeks and 32 to 34 weeks, respectively. Significant trophoblast lysis became apparent after 24 hours' incubation in the latter case compared with a time lag of 72 hours in the terminated gestations. Maternal cellular immunity, therefore, was not detected during the first 3 1/2 months of pregnancy, but was detectable by the time of parturition. The possible significance is discussed with respect to the antigenic stimulus and survival of the fetal allograft.


Computer interpreted fetal electroencephalogram. I. Relative frequency of patterns. Fetal electroencephalography (FEEG) is a clinical research technique for monitoring the electrical activity of the fetal brain during labor. Because of the massive volume of data, it has not previously been practicable to quantify the frequency of occurrence of the various patterns by visual analysis. With the use of a computer program, which has been shown to be consistent with visual interpretations, records for 11 fetuses, known to be neurologically normal at 1 year of age, were analyzed. Adequate FEEG had been recorded 73.6 per cent of the time during which the fetuses were monitored. In 10,511 10 second epochs of adequate FEEG, the Mixed pattern was found to be dominant, with a relative frequency of 41.2 per cent. The relative frequencies of Trace Alternant and High Voltage Slow activity were 32.3 per cent and 21.5 per cent, respectively. Low Voltage Irregular, Voltage Depression, and Isoelectricity occurred infrequently, accounting for approximately 4.6 per cent of the epochs. The relative frequencies of the various patterns were stable from the onset of monitoring of FEEG through neonatal EEG obtained in the delivery room. These data will form the basis for subsequent studies of FEEG changes associated with various endogenous and exogenous factors.


Computer interpreted fetal electroencephalogram. II. Patterns in infants who were neurologically abnormal at 1 year of age. A computer program for pattern recognition of fetal electroencephalogram has been used to analyze the records of nine fetuses, known to be neurologically abnormal at 1 year of age. In 4,913 10 second epochs of adequate FEEG, Low Voltage Irregular (LVI) accounted for 17.8 per cent, Mixed activity (MIX) for 30.5 per cent, High Voltage Slow (HVS) for 18.1 per cent, and Trace Alternant (T/A) for 33.2 per cent of the epochs. The numbers of observed FEEG patterns in these abnormal cases appear to be significantly different from those in 11 normal cases (p less than 0.001)3. Specifically, the relative frequency of LVI was found to be increased in the abnormal cases (p congruent to 0.05). Moreover, LVI was significantly associated with visually interpreted prolonged voltage suppression (p less than 0.025) and lowered one-minute Apgar score (p congruent to 0.025). Using discriminant function analysis for LVI, MIX, HVS, and T/A patterns from FEEG recorded during labor, 10 of 11 infants were correctly classified as being neurologically normal at one year of age and 6 of 9 infants were correctly classified as being neurologically abnormal at 1 year of age. These studies confirm previous associations based on visual analysis of FEEG and suggest that the relative frequencies of FEEG patterns may be useful in the prediction of neurologic outcome 1 year later.


Breathing movements in the human fetus.

Breathing movements in the human fetus. Simultaneous observations of the movements of opposite sides of the human fetal trunk were made by an ultrasonic device. Rhythmical excursions that were in time but out of phase were recorded from the lateral chest walls. These movements are considered to be the result of changes in the shape of the chest and are consistent with breathing movements. Large excursions of the antior abdominal wall compared to the chest movements suggest that the diaphragm shares in the breathing movement.


A proposed system whereby a (colcemid-induced) S2 phase is responsible for the tetraploidy found in cultured human amniotic fluid cells. The results of this study, using cultured amniotic fluid cells (AFC) and colcemid, together with results of several other investigators who worked with colcemid and DNA synthesis, have led to the proposal of a hypothesis suggesting a mechanism by which tetraploidy may be induced. Data from this study of 24,455 mitotic spreads indicate increased concentrations of colcemid, as well as extended exposure times, results in a higher incidence of tetraploidy in cultured AFC, with no concomitant increase in the unexposed control cells.


Decreasing postpartum sexual abstinence time. Postpartum sexual abstinence time can be safely shortened for most patients when episiotomy repair is done meticulously with fine PGA suture on small needles. The time preferred by patients for resumption of intercourse seems to be between the second and third postpartum week. We have seen no ill effects from this, and we feel that sexual intercourse at these early dates does not influence the healing of the episiotomy in any way.


Abnormal cervical cytology in the teen-ager: a continuing problem. Abnormal cervical cytology is being discovered in an alarming number of sexually active teen-agers. Over an 18 month period, cytology consistent with mild dysplasia or worse was noted in 188 of 2,655 teen-agers screened. This represents a rate of 70.8 per thousand. Colposcopically directed biopsies in 65 patients revealed 15 cases of severe dysplasia-carcinoma in situ. Cryosurgery was the principle method of treatment and, combined with colposcopy, is a safe and effective means of managing these patients.


Virucidal effect of certain chemical contraceptives on Type 2 herpesvirus. The virucidal effect of several chemical contraceptives was investigated and the findings are rrported. The supension of Type 2 herpes simplex virus, containing 10(6) to 10(7) tissue culture infectious doses per 0.1 ml., was inactivated on exposure to five different chemical contraceptives. For quantitative estimates of virucidal effect, 10 per cent solutions of these chemical contraceptives were tested with an exposure time of 10 minutes at room temperature. The methods for determination of residual infectivity included both virus assays in cultures of Vero cells and human embryo fibroblasts, as well as the intracranial inoculation of mice. Virus infectivity decreased 1,000- to 10,000-fold after contact with chemical contraceptives, indicating a substantial virucidal effect.


Plasma testosterone and dihydrotestosterone in ovulatory and anovulatory cycles. Daily plasma testosterone (T) and dihydrotestosterone (DHT) as well as plasma lueteinizing hormone, plasma estradiol (E2) and plasma progestrone (P) were measured by radioimmunoassay in seven ovulatory cycles and in three anovulatory cycles. In ovulatory cycles, plasma T ranged from 110 to 637 pg. per milliliter, while plasma DNT ranged from 10 to 246 pg. per milliliter. There is an increase in the mean plasma T during the early follicular phase of the cycle with a fall on the day of ovulation. Plasma T levels rise again during the early luteal phase and drop during the late luteal phase of the cycle. Plasma E2 rises during the follicular phase with a preovulatory surge followed by a drop after ovulation and a subsequent secondary rise. Plasma P was less than 1 ng. per milliliter during the follicular phase and increased to above 5 ng. per milliliter after ovulation, reaching levels of 20 to 25 ng. per milliliter during the luteal phase. In anovulatory cycles, there is random fluctuation with no well-defined patterns. Plasma P remained below 1 ng. per milliliter throughout the cycle. The finding of maximum T levels prior to midcycle may reflect increased T production by the ovaries in response to increasing levels of follicle-stimulating hormone. There is little fluctuation in the levels of T during the menstrual cycle. These findings obviate the need for multiple plasma T estimations in the assessment of women with hirsutism, polycystic ovarian disease, and the testicular feminization syndrome.


Three-day therapy of vulvovaginal candidiasis with econazole: a multicentric study comprising 996 cases. Within the scope of three open multicentric studies, effect and tolerability of 150 mg. econazole vaginal suppositories were tested in a total of 996 women, 13 to 74 years old (mean age, 29 years). Vaginal candidiasis had been mycologically demonstrated in every patient prior to therapy, and the total cure rate of 93.4 per cent in Studies I and II (880 patients) was also mycologically confirmed. The tolerability was tested by checking of 30 laboratory variables before and after the treatment of 116 patients (Study III); no therapy-related adverse changes were recorded. Connections between therapeutic results, age distribution, initial hormonal situation, and conception of the therapy are pointed out.


Familial allergic seminal vulvovaginitis. Vulvovaginal reactions to seminal fluid occurred in all four women in a family. The reactions consisted of stinging, burning, and pain in the vagina, starting during coitus or immediately after ejaculation, and persisting for 2 to 72 hours. The vagina and vulva were red and swollen, with urticaria on the labia. Although skin tests showed a positive reaction in two of three women tested, no sperm agglutination antibody was detected. Benadryl was effective in preventing the development of vulvovaginal reactions completely in one woman and partially in two others.


Sexual experimentation and pregnancy in young black adolescents. Young black adolescents (13 to 16 years of age) and their parents were interviewed and psychological tests were administered. They were divided into three groups; (1) abortion group, (2) pregnancy to term group, and (3) a control group of never-pregnant adolescents matched by age and socioeconomic status. We focus the present report on their performance in school and educational goals, sexual experimentation to intercourse, their use of contraceptives, theirs and their parents' attitudes toward abortion, their reaction to their pregnancy in the two pregnant groups, and their attitudes in choosing for or against abortion.


A prerecorded program for the Ball pelvimetry technique. Pelvimetry can be simplified by a recently devised computer program. The program can be used with any of several advanced programmable pocket or desk-top calculators. This approach is more accurate than either the nomogram or the slide rule, and demands much less time and attention.


Sonar biparietal diameter. I. Analysis of percentile growth differences in two normal populations using same methodology. BPD measurements were obtained from 107 white and 91 black normal gravid women, with established dates, between weeks 16 to 40 of pregnancy. The sonar methodology used is uniform, employing nonpersistent image scanning with electronic calipers. It is noted that the BPD percentile growth patterns derived from these racially different fetuses are alike. Similarly, the fetal age distributions corresponding to white vs. black fetal BPD's show minor differences. From a clinical standpoint, therefore, one percentile curve is constructed for both populations. It is concluded that the BPD differences observed in the currently used growth curves, reported by different investigators, are related to nonuniformity in sonar BPD methodology.


Sonar biparietal diameter. II. Predictive of three fetal growth patterns leading to a closer assessment of gestational age and neonatal weight. Serial BPD readings were obtained from 142 normal parturients, with established dates, between 20 to 40 weeks of pregnancy. It is noted that fetal BPD's can be separated into one of three percentile rankings: large (i.e. above the seventy-fifth percentile), average (i.e. twenty-fifth to seventy-fifth percentile), and small (i.e. below the twenty-fifth percentile). In addition, it is shown that, under normal conditions, fetuses intially placed in any one of these cephalic levels will continue to grow within the confines of the same percentile range. This biologic phenomenon has not been previously reported in human fetal growth. It is important because it leads to a closer prediction of fetal age and a better assessment of neonatal weight and outcome.


Current practices in antepartum and intrapartum fetal monitoring. Survey forms were sent to 360 Ob./Gyn, residency programs in the United States and Canada with responses from 279 concerning usage of various types of fetal monitoring. The results are presented and discussed.


Microcirculation of the rat placenta. Scanning and transmission electron microscopic observations on fetal blood vessels. The fetal circulation of normal rat placenta was studied by parallel examination with the scanning electron microscope (SEM) and the transmission electron microscope (TEM). By examining casts of vessels injected with latex and prepared by corrosion in hypochlorite solutions, the fetal arteries, veins, and capillaries of the placenta could be traced in the scanning electron microscope and, in addition, the ultrastructural details of microcirculation and luminal surfaces could be studied. Cast specimens showed fetal arteries entering the center of the placenta and branching into long, thin vessels which traversed almost the entire thickness of the placenta before dividing into a markedly tortuous capillary network. The smooth-surfaced capillary vessels located at the arteriolar end flowed into a much less tortuous prevenous capillary network which conducted the blood into collecting venules and veins. Placental blood vessels examined by the TEM provided evidence that details observed by the SEM were accurate for the ultrastructural appearance of fetal arteries, capillaries, and veins.


Cesarean section in present-day obstetrics. Presidential address. Two thousand five hundred and sixty-three cesarean sections performed at Charlotte Memorial Hospital during 1963 through the first six months of 1975 were reviewed. The cesarean section rate was 6 per cent. The results of two earlier studies, starting with the opening of the hospital in 1940, were compared. The total number of cesarean sections from 1940 through 1975 was 3,717. The present study shows that significant improvement has been made in reducing cesarean section deaths, morbidity, and complications, as well as fetal deaths. There have been no maternal deaths in the last 2,225 cesarean sections. Questionnaire returns from 50 representative medical schools and obstetricians throughout the United States discuss the increased cesarean section rate, the reasons for the increase, and the predicted cesarean section incidence of the future.


Accurate amniotic fluid bilirubin analysis from the "bloody tap". A preliminary report. The quantitation of bilirubin in amniotic fluid is of paramount importance in prognosticating the severity of Rh isoimmunization. Amniotic fluid contaminated by maternal blood can result in erroneous results when direct spectrophotemetric analysis is performed on such fluid. The technique and results of a one-step chloroform extraction performed on "bloody" amniotic fluid is presented. Results confirm that chloroform extraction yields more accurate clinical information in regard to Rh isoimmunized patients in whom a "bloody tap" is obtained.


The individual at high risk for endometrial carcinoma. Epidemiologic studies can help us recognize high-risk factors in endometrial carcinoma. The definition of high-risk factors, especially at the menopause,can lead to prophylactic measures that may aid in the control of this disease. This recognition of the high-risk patient in the perimenopausal years may be aided by aspiration curettage of ambulatory women, for such a strategy of surveillance is practical and efficient. Increasing acceptance of hormone sensitivity in neoplastic abnormality of the endometrium can also influence us in identifying the patient at risk.


Cancer risk in diethylstilbestrol-exposed offspring. The occurrence of columnar epithelium in the vagina (vaginal adenosis) in young women with intrauterine exposure to diethylstilbestrol (DES) during the first trimester of pregnancy was observed in 231 patients (82 per cent of 280 cases who underwent colposcopic study). Extension of columnar epithelium onto the portio of the cervix was present in the remaining 18 per cent of the cases. Abnormal colposcopic findings were present in the transformation zone in 96 per cent of the patients with vaginal adenosis. Directed biopsy revealed four cases of vaginal and/or cervical squamous carcinoma in situ (CIS), two cases of severe dysplasia, five cases of moderate, and 29 cases of mild dysplasia. The prevalence of CIS in DES-exposed girls (1.4 per cent) was nearly five times the prevalence rate of CIS in a control group of 5,808 DES-unexposed women (0.44 per cent). This finding correlates well with the hypothesis that the genesis of squamous intraepithelial neoplasia is specifically related to the extent and surface area of the vaginal transformation zone. An unusual case of invasive squamous carcinoma in a DES-exposed young girl is presented, which represents the initial observation of this association to date.


A comparison of oral prostaglandin E2 and intravenous oxytocin for induction of labor in normal and high-risk pregnancies. The efficacy of oral prostaglandin E2 (PGE2) for induction of labor has been compared to that of intravenous oxytocin. There were 49 patients in each series. The over-all success rate with PGE2 is 82 per cent; with oxytocin, 65 per cent. PGE2 is at least as effective as oxytocin regardless of Bishop score or gravidity. There was no difference in the duration of labor in successful inductions with PGE2 or oxytocin. Nausea and diarrhea are more common with PGE2 but in only one case was this severe enough to warrent discontinuing the medication. One case of uterine hypertonus occurred in each series. No serious harmful effects on mother or fetus were noted with PGE2. These data support the concept that oral PGE2 administration is a safe and effective alternative to intravenous oxytocin for induction of labor in normal and high-risk pregnancies.


A standard of fetal growth for the United States of America. The appropriate interpretation of monitored fetal growth throughout pregnancy in individual patients and populations is dependent upon the availability of adequate standards. There is no adequate standard of fetal weight throughout pregnancy that is suitable for patients in the U.S.A. To determine such a standard for infants delivered at about sea level the 10th, 25th, 50th, 75th, and 90th percentiles of fetal weight for each menstrual week of gestation were calculated from 430 fetuses at 8 to 20 menstrual weeks' gestation aborted with prostaglandins and from 30,772 liveborn infants delivered of patients at 21 to 44 menstrual weeks' gestation. Median fetal crown-to-rump lengths and crown-to-heel lengths were derived from measurements of 496 aborted fetuses of 8 to 21 weeks' gestation. Fetal weight correction factors for parity, race (socioeconomic status), and fetal sex were calculated. The derived fetal growth curves are useful for clinical, public health, and investigational purposes.


A new look at pelvic relaxation.

A new look at pelvic relaxation. The concept is presented that most cystoceles and/or urethroceles result from insolated defects in the connective tissue supports of the anterior quadrant of the pelvis. Four areas in which defects have been found to occur are identified. Sixty patients are presented who were found to have isolated defects in the endopelvic fascia at the lateral sidewall of the pelvis with significant cystourethroceles and stress urinary incontinence. The surgical treatment consisted only of a direct approach to and closure of the isolated defect. The operative results at 3 to 48 months were excellent in 91.7 per cent, improved in 5 per cent, and failed in 3.3 per cent. Discussion is offered of the possibility of the study of the pelvic floor from the viewpoint of a mechanical engineer.


Corynebacterium vaginale (Haemophilus vaginalis) in women with leukorrhea. Corynebacterium vaginale was recovered from vaginal-cervical swab specimens in 164 of 288 women with leukorrhea and in four of 30 women without signs or symptoms of lower genital tract infection. The amount and character of the leukorrhea observed in association with C. vaginale infection were variable; in typical cases the discharge had the appearance of a thin paste. In a series of 100 patients studied to determine the apparent causes of leukorrhea, noninfectious causes were inferred in seven patients and no cause ascertained in six. Candida or other yeasts, C. vaginale, and Trichomonas vaginalis were identified alone or in combination in 87 patients; 53 had yeasts, 35 had C. vaginale, and 15 had T. vaginalis.


Gonadoblastoma: clinicopathologic correlation in six patients. Six patients with a total of nine gonadoblastomas are presented; three--and possibly a fourth--had dysgerminomatous overgrowth which was massive in two patients. Calcification detected by abdominal films was present in three sufficient for preoperative diagnosis. All patients were found to have a Y stem line on peripheral leukocyte chromosome cultures except one patient, who had a 46 XX/45 XO karyotype. She was found to have Y chromatin bodies in the germ cells of her tumor which was in a normal ovary found at exploration for an ectopic pregnancy. Three were found in virilized phenotypic females investigated for amenorrhea, and two for therapy of pelvic masses due to dysgerminomatous overgrowth. Y chromatin studies are reported on gonadal tissue.


Clinical experience with the copper-7 intrauterine contraceptive device. A preliminary report. There have been 203 copper-7 IUD insertions performed in 199 women. The data from 2,230 woman-months of use have been analyzed and compared with other published reports. The copper-7 IUD was an acceptable contraceptive method in regard to effectiveness, continuation, and lack of serious complications.


A composite vaginal vault suspension using fascia lata. A description of a composite procedure is offered as a further effort to have a safe, relatively easy, and dependable surgical operation for complete vaginal prolapse in the sexually active woman. The fact is generally accepted that the combination vaginal and surgical approach done at the same sitting gives a better chance for cure where either single approach has proved to be less dependable. Nothing startling new is claimed, but the selection of the homologous fascia lata as the suspending material used technically in a simple, safe manner is outlined. Twelve patients have had this procedure done in the past 4 years with no recurrence of the prolapsed vault and no complaint of dyspareunia by either partner. One patient has had recurrent enterocele even though effort had been made to prevent this. There has been no death in this series.


The critical control of progesterone levels and pregnancy by antiprogesterone. Circulating plasma progesterone (P) has been quantitatively controlled in the rat "model" through highly specific binding by treatment with anti-P (A-P). Knowing the constant, which characterizes the binding of P to A-P in plasma, sequential assays of circulating A-P and A-P bound total P (Pt) revealed the levels of the biologically active unbound P (Pu). The studies showed that at different stages of gestation the mechanisms through which A-P reduces Pu and terminates pregnancy are the same. However, the doses of AP which effectively reduce Pu and also the critical levels of Pu at which pregnancy terminates are different. The moderate and transient physiologic P-withdrawal (Pw) at midterm permits the continuation of normal gestation, but pregnancy is terminated by a drastic and sustained reduction in Pu. In contrast, when Pu is only slightly and briefly reduced below physiologic levels, pregnancy continues and only retarded conceptus growth signals that Pw occurred. Apparently Pw has to be controlled and measured with "razor's-edge" precision to fully expose and define the regulatory significance of this steroid in the maintenance and termination of pregnancy. Short of this precision, the key regulator of the pregnant uterus will remain buried, as it has been during 40 years, in controversial findings.


Obstetrician-gynecologists are primary physicians to women. I. Practice patterns of Michigan obstetrician-gynecologists. Michigan obstetrician-gynecologists were asked to complete questionnaires designed to determine what kinds of medical services they provide their patients. The questionnaires completed by 369 doctors, who had graduated from medical school between 1930 and 1964 and who are in active practice, form the basis of this report. More than 50% treat common non-obstetric-gynecologic disorders in their own patients and smaller numbers treat more serious medical conditions. This study confirms a previous one, derived from information obtained from patients, that obstetricians-gynecologists serve as primary physicians to women, not exclusively as specialist-consultants.


Plasma levels of fractionated estrogens and pituitary hormones in endometrial carcinoma. Plasma levels of estrone (E1), estradiol-17beta (E2), and estriol (E3), as well as follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin were measured in 30 control subjects and in 20 postmenopausal patients with adenocarcinoma of the endometrium. Within the sensitivity of the assay (5 to 10 pg.), no E3 was found. Mean levels of E1 and E2 in the patients with carcinoma (42.64+/-3.8 (S.E.M.) and 17.3+/-1.7 (S.E.M.) pg. per mililiter) were significantly higher than those measured in the control subjects (E1=26.97+/-2.4 (S.E.M.) pg. per mililiter, p less than 0.001; E2=12.08+/-1.2 (S.E.M.) pg. per milliliter, p less than 0.02). Effects of age, diabetic status, and obesity were taken into consideration. Significant differences in FSH and marginally significant differences in prolactin levels were observed between the two groups. Mean levels of FSH, LH, and prolactin in the control group and the group with adenocarcinoma, respectively, were as follows: FSH=152.3+/-7.0 (S.E.M.) versus 98.1+/-8.9 (S.E.M.) mI.U. per milliliter, p less than 0.001; LH=64.7+/-3.1 (S.E.M.) versus 66.5+/-5.2 mI.U. per milliliter, difference not significant; and prolactin=14.3+/-0.9 (S.E.M.) versus 17.8+/1.7 (S.E.M.) ng. per milliliter, p less than 0.06. These results, as well as previously reported alterations in human growth hormone secretion, suggest aberrations in hypothalamic function in endometrial carcinoma.


Untreated endocervical gonorrhea and endometritis following elective abortion. A matched-pair analysis of 228 cases of endometritis occurring over a two-year period in 4,823 elective abortion patients was carried out. Patients with postabortal endometritis were matched with control subjects for age, parity, race, pay status, time of abortion, and type of abortion procedure. The prevalence of endocervical gonorrhea was 2.7% in the entire group seeking abortion, with 14.7% of patients with gonorrhea subsequently developing endometritis. The matched-pair analysis detected a threefold increased risk for endometritis in patients with untreated gonoccocal endocervicitis when compared with control subjects (p less than 0.05). The significance of these findings to centers performing abortions is discussed.


Amylases of the genital tract. I. Isoamylases of genital tract tissue homogenates and peritoneal fluid. Homogenates of tissue from the female genital tract contain isoamylases which are, to a certain extent, electrophoretically distinguishable from the pancreatic and salivary isoamylases. In healthy  nonpregnant women, high levels of activity of genital isoamylases were found in tissue homogenates of cervical and Fallopian tube mucosa, whereas activity was weak or absent in homogenates of endometrium. The isoamylases of the cervical mucosa had an electrophoretic migration rate toward the anode identical to that of the salivary main fraction, whereas the isoamylases of the Fallopian tube migrated faster. Specific genital isoamylase activities were also demonstrable in peritoneal fluid collected from the cul-de-sac. During the menstrual cycle, these activities showed a midcycle peak. In pregnant women, the levels of activity of the genital isoamylases in peritoneal fluid were lower than in nonpregnant women. In homogenates of the male accessory genital glands, the isoamylases specific for the genital tract were present in minute amounts. The isoamylases specific for the genital tract were not detectable in serum in either sex.


Amylases of the genital tract. II. Peritoneal fluid isoamylases in acute salpingitis. The activities of the specific genital isoamylases in peritoneal fluid were diminished or absent in acute salpingitis. The decrease was proportional to the severity of the tubal inflammatory reactions but could not be related to a closure of the abdominal tubal ostia. In women with infections of the lower genital tract in whom the Fallopian tubes were normal at laparoscopy, the peritoneal fluid isoamylase activities were as high as in healthy women. Determination of the activities of specific genital isoamylases in peritoneal fluid obtained by cul-de-sac puncture would seem to constitute a specific diagnostic method for acute salpingitis.


Fertility in women with gonadal dysgenesis. A successful pregnancy in a patient with a 45,X/47,XXX karyotype who had premature menopause is described. Review of the literature revealed an additional 24 cases of fertility in women with gonadal dysgenesis associated with a 45,X chromosomal line. Their reproductive history showed a total of 58 pregnancies. However, abortion, stillbirth, and abnormal progeny, including five with chromosomal errors, were common. Therefore, such patients should be advised regarding their reduced fertility potential and the possibility of abnormal offspring.


Maternal cardiovascular dynamics. VII. Intrapartum blood volume changes. Blood volume was measured in 75 normal pregnant women at term and serially at 10 and 60 minutes and on Days 1 and 3 post partum in women delivered vaginally and on Days 1, 3, and 5 in women who underwent cesarean section. The mean blood volume at term was 5.95 L. and 83.3 c.c. per kilogram, an increase of 44 and 16%, respectively, over nonpregnant values. The increment appeared to be related to lean body mass and the weight of the neonate alone and to the combined weights of the neonate and placenta, but the wide range of values precluded statistical significance. The blood volume loss at 60 minutes post partum was 610 c.c. (10.2%) for patients delivered vaginally and 1,030 c.c. (17.4%) for those delivered by cesarean section. The blood volume showed a steady decline to Day 3 post partum in the vaginal delivery group, whereas it remained fairly stable from 60 minutes to Day 5 post partum in the surgically delivered group. Remarkably, the volume had declined by the amount, 16.2%, in both groups on the third postpartum day. On the other hand, the hematocrit showed a rise of 5.2% in the former group and a decline of 5.8% in the latter. A remarkable tolerance for blood loss at delivery was demonstrated. A more realistic definition of postpartum hemorrhage is strongly recommended.


Serum human chorionic gonadotropin levels throughout normal pregnancy. Human chorionic gonadotropin (hCG) levels were measured in the sera of 443 pregnant women by the beta-hCG radioimmunoassay in order to determine if the third-trimester secondary peak in hCG levels observed by less specific immunoassays was due to cross-reacting substances. hCG was detected as early as six days after presumed conception and peaked between 56 and 68 days, with a nadir at 18 weeks. No secondary rise in hCG levels was demonstrated, indicating that the nonspecific hCG immunoassays give spuriously high values for hCG during the last trimester of pregnancy.


Uterine activity in the multiparous patient. There were 149 parous patients with normal cervical dilatation patterns studied. The purpose was to quantitate and characterize uterine activity in a group of multiparous patients with normal labor using our present on-line method and to evaluate our method against pervious work done on uterine activity. A mean total of 5,299 uterine activity units (UAU) was required to progress from 4 cm. through delivery. In the patients receiving oxytocin 5,907 UAU were required and 4,498 UAU for those not receiving oxytocin. Of the total uterine work from 4 cm. to delivery, 49.4% was required to progress from 4 to 6 cm. 38.7% to progress from 6 to 10 cm., and 11.9% for the second stage. This study establishes in a quantitative way, using on-line methods, the patterns of uterine activity expended by the parous patient in normal labor and can be compared to previous off-line and manual evaluations. These data can be compared with the on-line observations previously made in a primiparous group, and will be fundamental to automated evaluations including definitions of abnormal labor.


Maternal deaths in Texas, 1969 to 1973. A report of 501 consecutive maternal deaths from the Texas Medical Association's Committee on Maternal Health. The Texas Medical Association's Committee on Maternal Health reports its experience with 501 consecutive maternal deaths. The committee structure and procedures are explained. Demographic and pathologic data are presented and discussed. The defects which allowed complications to proceed to death are analyzed and recommendations are made to reduce the number of these deaths.


A new, more sensitive tube test for pregnancy evaluated with a selected hospital population. A new tube test for pregnancy, having a sensitivity of 0.5 I.U. of human chorionic gonadotropin per milliliter, was evaluated, along with two other commercially available kits, in a hospital patient population. Of 586 patients in the study, 302 were in nonobstetric services and many were acutely ill. Approximately one fourth of the women were age 40 or older. The medical records of 66% of the patients were retrieved to obtain information on the drugs administered prior to pregnancy testing. A small number of problems did occur in the pregnancy test procedures. Inconclusive results were recorded for both pregnant and nonpregnant patients and could not be correlated with disease states and/or medications. The importance of a reagent control for tube test procedures is discussed.


Screening for detecting twin pregnancy.

Screening for detecting twin pregnancy. Estimation of HPL during the twenty-ninths to the thirtieth week of pregnancy is a simple and safe method for detecting twins. Nine out of 10 pregnant women have a value below 5.0 mug per milliliter, which excludes the suspicion of twins. In the remaining women with higher values the diagnosis can be confirmed or excluded by ultrasound or x-ray.


Nonstressed fetal heart rate monitoring in the antepartum period. The role of nonstressed monitoring of the fetal heart rate (HR) in determining fetal well-being during the antepartum period was assessed in 125 high-risk patients. Observations on HR, variability, and HR response to fetal movement (FM) and uterine contractions (UC) over a 30 minute period were made with an external microphone and tocotransducer. A total of 625 tests were performed; the earliest gestation tested was 28 weeks, and the latest was 46 weeks. A reactive pattern (variability greater than 6 b.p.m. and accelerations with FM) appears to be a reliable indicator of fetal well-being. All the 51 fetuses exhibiting this pattern survived. This group also had the lowest incidence of neonatal complications. On the other hand, of the babies who failed to show variability greater than 6 b.p.m. or accelerations with FM (nonreactive pattern), 40% died in the perinatal period. Thirty-five patients showed features of both a reactive and nonreactive pattern (combined pattern). Poor outcome in this group was confined to those in whom the majority of the pattern was nonreactive. An undulating HR pattern with virtually absent variability (sinusoidal pattern) was found in 20 Rh-sensitized fetuses, 50% of whom died in the perinatal period. Bradycardia and tachycardia were not found to be reliable signs of fetal distress antepartum. Of the 12 fetuses who died during observation, six showed late decelerations with spontaneous UC but all showed diminished variability. The close correlation between nonstressed patterns and neonatal outcome demonstrated by this preliminary study warrants further use of this technique for fetal evaluation.


Serum levels of human placental lactogen and human chorionic gonadotropin in early pregnancy: a maturational index of the placenta. Between weeks 10 and 20 of gestation, there are rapid and opposing changes in blood levels of two hormones produced by the syncytiotrophoblast; hPL increases and hCG decreases. In this study, the relationship between these two changing hormone levels was examined, rather than the serum concentrations themselves, as a potential test for placental maturation. The relationship between the hCG and hPL concentrations and GA determined in a selected group of patients was described by the following equation: GA (in days)=97.3 + 24.8 ln [hPL]-14.5 LN [HCG]. The endocrine evaluation of placental maturation by comparison of [hCG] and [hPL] in early pregnancy shows promise as a simple, safe, and inexpensive clinical tool for GA assessment.


Combined obstetric and pediatric approach to prevent meconium aspiration syndrome. Routine intrapartum pharyngeal suctioning with a DeLee catheter of infants with meconium staining has significantly reduced the incidence and severity of meconium aspiration syndrome (MAS). There have been no adverse sequelae to this procedure, which is carried out while the infant's head is on the perineum, prior to the onset of respirations. Routine suctioning of the trachea under direct vision after delivery is rarely necessary but should be done if meconium is visualized at the vocal cords. Tracheobronchial lavage with saline may add to the respiratory morbidity. No deaths or severe cases of MAS have occurred since institution of the obstetric suctioning procedure.


Scalp abscess: a complication of the spiral fetal electrode. During the period from September, 1974, to January, 1975, we performed 276 deliveries, of which 54% were internally monitored with a spiral type of fetal electrode. Eight of the infants monitored (incidence, 5.4%) developed scalp abscesses. We had had no previous complications associated with the electrodes. An intensive investigation was conducted to detect the causative factor(s) of the fetal scalp infections. Case histories of the mothers and infants were scrutinized, instruments were examined, the environment and techniques were analyzed. A survey of maternal and infant complications during the period from September, 1973, to August, 1974, served as control. The findings indicated that a different type of coil electrode had been substituted for the brand we had used previously. The new coil electrode had a barb at the tip, presumably to prevent its falling out of the scalp. We discontinued the use of the coil which had become suspect and returned to the type we had used previously. We have not had another incidence of fetal scalp infection associated with intrapartum monitoring.


Adverse effect of amniofetography on fetal thyroid function. Amniofetography is a valuable tool for the diagnosis of fetal malformations. This technique is being used routinely in pregnancies carrying a high risk of external fetal malformations. There are very few published data concerning the effect of radiopaque dyes, containing large amounts of iodide, on fetal thyroid function. We have performed serial determinations of serum thyrotropin and thyroxine in seven newborn infants to assess the effect of amniofetogrpahy on fetal thyroid function. This work demonstrates that amniofetography induces a transient impairment of fetal thyroid function.


Eye movements during reading: case reports. Since the time of Javal, it has been well established that normal reading eye movement patterns have 3 principal components: (1) small saccades that move the eyes from word to word, (2) large saccades that return the eyes to the beginning of the next line, and (3) fixation pauses between each saccade for information processing. We discuss the vision analysis results and show the quantitative reading eye movement records, measured with the infrared photoelectric method, of 5 patients examined in the Neuro-optometry Clinic. The reading records showed a wide variety of behavior: 1 patient performed normal reading movements, 1 "slow reader" manifested an excessive number of fixations as well as extended fixational durations, another "slow" reader only exhibited an excessive number of fixations, a patient with dyslexia performed backward reading movements, and 1 patient exhibited nystagmus superimposed upon the reading pattern.


An interpretation of the drop ball test in terms of a statistical model for fracture. Some well known statistical models for fracture were applied to the problem of impact of glass ophthalmic lenses. Parameters for a flaw distribution function were chosen to fit some previously published results of drop ball testing. The concept of an impact-resistant lens was reformulated in terms of minimizing the most severe flaws. Formulas were derived for the detection parameter, a convenient measure of the ability of any mechanical test to identify those lenses with the worst flaws. It was shown that the fraction of such lenses identified by the drop ball test is very small. As a side note, it was found that it is not significantly more difficult to expose "bad" lenses when they are tested in plastic bags. A method of obtaining useful information from the results of drop ball testing was outlined.


The management view of the future of occupational therapy in mental health. The dramatic changes in the field of mental health and their impact over the past ten years are reviewed in this article. The community mental health movement, the decline of the state hospital, court decisions, and new laws have resulted in a new atmosphere in psychiatric practice. The future role of the state hospital is examined, particularly in view of the scandalous situation of the long-term chronic patient. Some clear implications for the field of occupational therapy are drawn from this background. Challenges are given in the areas of training and research, innovative programming, management, and for the professional association.


Image motion on the retina.

Image motion on the retina. It is shown that angular image motion depends on the refractive state and geometry of the eye, as well as the object angular motion. Results valid for small angles are derived, and a model test is described.


An educational strategy for occupational therapy community service. In response to the increasing trend toward community health care, a model of training that prepares students for community practice was incorporated into the occupational therapy curriculum at the University of Southern California. During academic training students are placed in a part-time community assignment where no occupational therapy services are offered. Training students for the role of community health specialist produces a dilemma for curriculum design. A balance must be achieved between providing traditional clinical content and providing the knowledge and expertise necessary for community practice. However, this training is considered necessary for maintaining the viability of the profession in a changing health system. Significantly, during the four-year period using this model, many graduates have sought employment in "nontraditional" community roles.


A planning group for psychiatric outpatients. Planning leisure time successfully can contribute to a patient's ability to function in the spheres of work and family as well. A leisure-time planning group for psychiatric out-patients is described in this article and includes the treatment principles upon which the group is based, the format of the sessions, and the goal-setting techniques employed. A concrete, highly structured, and self-actualizing approach was used to help patients discover and develop their interests. Members often encountered similar problems in their attempts to plan leisure time despite their varied backgrounds and skills in planning, which led to the use of specific approaches in dealing with these common problems, and also suggested a wider application for the Planning Group.


A hypothesis for the formation of vertical corneal striae as observed in the wearing of softlens contact lenses and in keratoconus. It is postulated that vertical striae are created in the central corneal area by way of mild edema in the posterior layers, which causes a buckling in the shorter, thinner vertical meridia.


A quarterway house for adult psychiatric patients. An intermediate step between living on a hospital ward and living in the community was considered necessary for many acute and chronic patients preparing to leave Harlem Valley Psychiatric Center in New York. A quarterway house program was initiated to help patients acquire the skills and coping mechanisms they could not easily acquire on a ward setting, but which they would need to meet the demands of living in the community. The quarterway house program described may offer ideas to others who are attempting to help patients prepare for living outside a state hospital.


Drug-induced myopia: a case report.

Drug-induced myopia: a case report. A case report is presented in which an acute, transient myopia of 3 diopters is induced by Hygroton (chlorthalidone), a monosulfamyl diuretic and antihypertensive drug.


A field work experience in mental retardation. A graduate student specializing in mental retardation found few pertinent electives as well as little opportunity for field work experience. A special arrangement was made for appropriate field work experiences in three types of settings--a large residential institution, school programs, and nursing care facilities. There was little time to view client changes, and rapport with patients and staff was difficult to develop. The advantages included more time with her supervisor, more exposure to organizational and administrative duties, and more exposure to a variety of settings and to the professional roles of numerous therapists. More such field work experiences should be developed to encourage new therapists to choose mental retardation as a specialty.


Management of intractable diplopia in small angle, non-fusing squint. A treatment method is presented for eliminating perception of diplopia in patients with intractable diplopia and horror fusionis. Treatment emphasizes creating awareness of singleness in the periphery. Two cases are described.


Preventable hazard of soft lens wear.

Preventable hazard of soft lens wear. Recurrent pseudomonal conjunctivitis, caused by poor soft contact lens care and the use of contaminated saline, is described. This problem can easily be avoided by proper sterilization, with boiling being the method of choice.


National health and optometry: a follow-up study. A stratified probability sample of the Houston, Texas population was interviewed with a previously described questionnaire (Allen, D., and D. Levi, National Health and Optometry--a survey of public attitudes. Am. J. Optom., 52 (4): 291-300, (1975) to assess present opinion of national health care and public awareness of vision care and its role in a national health care system. Of the population surveyed, 72% favored a national health care bill, some 10% lower than reported 1 year previously. A large percentage of the population sampled favored inclusion of vision care. The results are described in terms of demographic trends for those who have received optometric and ophthalmological care.


Validity of the laser refraction technique for meridional measurement. This study assessed the validity of the laser refraction technique for determining the refractive status of a given meridian of the eye. A subjective-to-BVA finding was taken on a total of 75 eyes, and the laser technique was then used to refract each of the 2 principal meridians that had been located by the subjective procedure. Correlations between laser and nonlaser findings indicated that the laser technique is a valid method for meridional refraction. Differential findings for against-the-rule astigmatism are also discussed.


An experimental study of the efficacy of perceptual-motor training. The efficacy of 40 h of perceptual-motor training among a group of culturally disadvantaged kindergarten children was investigated. The training procedures produced a significant improvement in perceptual-motor abilities such that each group was raised to a "non-dysfunctioning" level as evaluated by the Rosner-Richman Perceptual Motor Survey. In terms of the design of this study, the effects observed and the differences obtained cannot be attributed either to maturation or to attendance in school per se.


The effect of hard and soft contact lenses (SoflensTM) on the spherical aberration of the human eye. An attempt was made in this study to determine experimentally the relative effects of hard and soft contact lenses on the spherical aberration of the human eye. Results of this study indicate that there is very little difference in the value of spherical aberration between wearing soft or hard contact lenses.


Visual field expanders.

Visual field expanders. Diminishing telescope systems designed to widen the field of view of patients with tunnel vision are described. Theoretical analysis suggests that telescope systems will greatly improve visual search times and diminish the difficulties of such patients. This can be considered quantitatively, and it is suggested that the optimum amount of minifying power can be calculated by applying established formulations on visual efficiency. The inadequacies of previous designs have inhibited development, and further improvements to bioptic systems may be necessary before the final assessment of the clinical value of these devices can be made.


Clinical management of hydrogel-induced edema. Clinical techniques and guidelines are discussed to manage manifestations of edema induced by hydrogels. Emphasis is on the pathogenesis of folds in Descemet's membrane (striate keratopathy) accompanying vertical striae that have been found to occur horizontally as well as vertically.


Identifying the potential rural optometrist. Rural optometrists were found to differ from urban optometrists in background, environmental attitude, and interest patterns. Attitude toward the urban environment and place of origin were the best predictors of an optometrist's practice location. When "urbanism" and "origin" were scaled and placed in a multiple regression equation to predict practice location, identification of an optometrist's location as rural or urban was highly accurate. Most importantly, scores on the equation were predictive of optometry students' future practice locations. A single cut-off point on the equation correctly identified 79% of students who entered rural or isolated small city practice and 81% of those who entered urban practice. The findings suggest that optometry students most likely to enter rural (or indeed urban) practice can be objectively identified early in, or even prior to, training. Such identification may assist educators in selecting and training optometrists who will deliver vision care to people in areas of greatest need.


Static postural control in children.

Static postural control in children. The purpose of this study was to investigate "static" balance characteristics in four and eight year old children performing six developmental tasks leading to upright stance. The data were evaluated with electromyographic, center of gravity and photographic procedures. The results of the study indicated that the older age group of children demonstrated higher degrees of motor control in all the balance tasks involving upper and/or lower extremity support of the trunk. The eight year old children showed less postural sway, more definitive muscular localizations and smaller degrees of motor activity occurring during the execution of the developmental tasks.


An hepatic osmoreceptor mechanism in the rat: electrophysiological and behavioral studies. Rat liver was perfused with Ringer solution through the portal vein by use of a perfusion system which was designed to switch from standard Ringer solution to hypertonic or hypotonic Ringer solution. Neural responses to the osmotic change in the perfusion solutions were analyzed. They showed that two different types of osmosensitive afferent fibers exist in the hepatic vagus; one is characterized by increasing the frequency of spike discharges responding to higher osmotic pressure, while the other shows the same response to lower osmotic pressure. Behavioral changes caused by hepatic vagotomy were also observed. Though no differences could be detected in routine behavior (e.g., daily intakes of food and water, body-weight increase) between the vagotomized and the sham-operated rats, the former lost the ability to adjust urine concentration immediately in response to osmotic changes in the internal environment. These results provide evidence for the hypothesis that hepatic osmoreceptors exist in the rat.


Failure of NaHCO3 and KHCO3 to inhibit renin in the rat. To evaluate the contribution of chloride to NaCl- and KCl-induced renin inhibition, renin responses to NaCl or NaHCO3 and to KCl or KHCO3 loading were compared in NaCl-deprived rats. Sodium balance in animals drinking isotonic NaHCO3 and NaCl for 9 days did not differ (P greater than 0.40); K+ balance was less positive in NaHCO3-drinking animals (P less than 0.005). Plasma renin activity (PRA) in NaCl-loaded (16.5 ng/ml per h +/- 4.4 SE), but not in NaHCO3-loaded rats (57.2 +/- 9.8), was lower (P less than 0.005) than in NaCl-deprived controls (44.8 +/- 4.7). Renal renin content (RRC) of NaCl but not of NaHCO3-drinking animals was also decreased (P less than 0.02). Both PRA and RRC of KCl- but not of KHCO3-loaded rats (5 meq K+/10 g diet) were lower (P less than 0.01) than in NaCl-deprived controls. After acute intravenous expansion with isotonic NaCl or NaHCO3, increases of plasma volume and plasma K+ did not differ (P greater than 0.05). However, PRA of NaCl-expanded rats (11.8 +/- 3.8) was lower (P less than 0.05) than in NaHCO3-expanded animals (29.7 +/- 8.5). The failure of NaHCO3 and KHCO3 to inhibit renin suggests a role for chloride in mediating the renin responses to Na+ and K+.


Gastric A-cell function in normal dogs.

Gastric A-cell function in normal dogs. Glucagon release from the gastric fundus and pancreas were compared in normal dogs by measuring glucagon in plasma from a major gastroepiploic vein, the superior pancreaticoduodenal vein, and the inferior vena cava. In 32 dogs in the basal state, gastric vein glucagon averaged 97 +/- 40 pg/ml, not significantly different from the 93 +/- 41 pg/ml level in the vena cava. Pancreaticoduodenal vein glucagon averaged 250 +/- 32 pg/ml (P less than 0.001). Intravenous arginine infused in four dogs caused a rise in mean gastric vein glucagon to 210 +/- 33 pg/ml within 3 min, and glucagon remained between 53 and 98 pg/ml above the vena caval level thereafter. In the gastric vein, the rise in glucagon was significantly greater than in the vena cava at 3, 5, and 10 min (P less than 0.05), but was far less than in the pancreaticoduodenal vein where glucagon rose to 1,295 +/- 379 pg/ml at 1.5 min. Evidence of modest gastric glucagon release was observed after the intragastric instillation of arginine, but not during insulin or phloridzin-induced hypoglycemia. It was concluded that in normal dogs under the circumstances studied, the gastric fundus is not a major source of circulating glucagon.


Hemodynamic responses to stellate ganglion stimulation in mongrels and greyhounds. A comparison of the effects of left stellate ganglion stimulation (SGS) on central and aortic hemodynamics has been made in chloralose-anesthetized mongrel (M), and greyhound (GH) dogs. Measurements of aortic pressure and flow, and left ventricular pressure were made during stimulation of the decentralized left SG at different frequencies from 0 to 20 Hz. The increases in aortic pressure and flow with SGS were larger in the GH, especially for low frequencies of stimulation. Stroke volume was increased with SGS in the GH at all stimulation rates, whereas in the M it was unchanged. A greater decrease in left ventricular end-diastolic pressure with SGS was found in the GH. These results suggest that differences exist in both the intrinsic and extrinsic control of cardiac output in the greyhound dog compared to the mongrel. These differences may be in part responsible for the elevated arterial blood pressure in the greyhound compared to the mongrel.


Surgical reduction of adipose tissue in the male Sprague-Dawley rat. The lipostatic theory of regulation of adipose tissue mass was tested by a method for surgical reduction (adipectomy) of 24% of the total body fat of nonobese adult Sprague-Dawley rats, as judged from carcass analyses. The reduction persisted during an observation period of 12 wk without any evidence of altered food intake, weight gain, or compensatory hypertrophy or hyperplasia of adipose tissue compared with sham-operated controls. No changes were found in serum free fatty acids, glycerol, triglycerides, cholesterol, or insulin between adipectomized and control animals, implying an intact quantitative function of the remaining adipose tissue. It is concluded that the size of the adipocytes rather than the number is important for a presumed lipostatic regulation of adipose tissue mass in the adult male Sprague-Dawley rat.


Angiotensin II in antinatriuresis of low-level renal nerve stimulation. Low-level direct renal nerve stimulation increases both renal tubular sodium reabsorption and renal renin secretion rate without changing arterial pressure, glomerular filtration rate, renal blood flow, or intrarenal blood flow distribution. The possibility was considered that intrarenal angiotensin II formation might mediate the antinatriuretic effect by directly enhancing renal tubular sodium reabsorption. Low-level direct renal nerve stimulation was performed in anesthetized saline-loaded dogs before and after intrarenal blockade to angiotensin II with [1-sarcosine, 8-alanine]angiotensin II. The antinatriuretic response to low-level direct renal nerve stimulation was not altered by intrarenal blockade to angiotensin II. Renal renin secretion rate was increased by low-level direct renal nerve stimulation in the absence of changes in systemic or renal hemodynamics. The antinatriuretic effect of low-level direct renal nerve stimulation does not depend on the intrarenal action of angiotensin II.


The laboratory rat as a model for hyperthermic syndromes in humans. To assess the lethal effects of work-induced hyperthermia on exercising animals, untrained rats were run to exhaustion at 5 and 20-26 degrees C or restrained at 41.5 degrees C. An exercise-induced core temperature of 40.4 degrees C represented a base line above which mortalities occurred. With increasing core temperature at exhaustion (between 40.4 and 43 degrees C), mortality increased within 24 h. A dose-respones curve with an LD50 equivalent to a core temperature of 41.5 +/- 0.1 degrees C was calculated. Although differences in body weight loss, core temperature at exhaustion, and cooling rate will clearly distinguish between survivors and fatalities, the severity of heat injury as inferred from survival times is best measured by the time versus intensity of hyperthermia in degree-minutes.


Bile acid conjugation in fetal hepatic organ cultures. A new technique has been developed in which mammalian fetal liver can be maintained in organ culture for prolonged periods with intact structure and function. Near-term rat fetal liver explants were incubated in vitro for periods of up to 3 wk with preservation of normal cellular morphology and intercellular (organ) relationships. [14C]cholate was incorporated into tissue and medium conjugates at a constant rate during 21 days in vitro. During a 24-h incubation with radioactively labeled cholic acid, bile acid conjugates accumulated in tissues to a maximum value by 6 h and maintained this value through 24 h. During the same 24-h incubation with [14C]cholate, conjugates were secreted into the medium at a constant rate. Addition of 8 X 10(-4) M taurine to the medium during a 4-day incubation produced a threefold enhancement in the rate of conjugate formation in tissues and medium. Enhanced conjugation in the presence of additional taurine was due almost entirely to increased taurocholate formation and no significant difference was observed in the amount of glycocholate formed. Exposure of explants to 3.6 X 10(-4) M cycloheximide for prolonged periods resulted in inhibition of conjugate formation, but when this concentration of cycloheximide was maintained for only 24 h a significantly (P less than 0.001) increased rate of conjugate formation was observed. The results indicate that metabolic processes in the organ-culture system are in a state of dynamic equilibrium and that morphologic integrity and specific hepatocytic function are maintained after 21 days in vitro. Preferential taurocholate formation was demonstrated in rat fetal liver, and the data suggest that glycine and taurine interact with separate enzymatic systems in bile acid conjugation. The possible mechanisms that mediate the effect of cycloheximide are discussed.


Cycle-length-dependent properties of AV nodal activation in rabbit hearts. Cycle-length-dependent changes in AV nodal cell activation were studied in isolated preparations from rabbit hearts. Transmembrane action potentials were recorded from the node while it was propagating impulses initiated in the atrium with an accelerating train of stimuli. This train consisting of five successive stimuli separated by progressively shorter intervals was uniformly repeated at every 10th basic beat, each time reproducing a sequence of five different increasing AV nodal delays. The AN and NH cells were found to contribute only slightly to the cycle-length-dependent AV nodal delay which developed mainly in the small N zone, located centrally in the AV node. With the increasing delay, the action potentials from this N zone typically dissociated into two components synchronous with late AN and early NH activity, respectively. The amplitude of the first component decreased, wheareas that of the second increased progressively in N cells activated progressively later. No cells were activated at an intermediate time between the two components. This dissociation was not accompanied by changes in the activation pattern of the AV node. The different nodal cells classified according to their response to the accelerating train delineated functional zones corresponding to different anatomic structures. The possible mechanisms which would explain the cycle-length-dependent AV nodal delay are discussed.


Hereditary variation in uric acid transport by avian kidney slices. Uric acid transport in renal cortical slices from a selected line of hyperuricemic chickens was investigated. Slices from the hyperuricemic (HUA) line accumulated less than half as much uric acid as slices from a control (LUA) line when uric acid in the medium varied from 0.01 to 5 mM. Uric acid uptake by both lines increased as the uric acid concentration in the medium was raised from 0.1 to 0.5 mM, but was markedly inhibited in the HUA line at 3-5 mM. Omission of sodium or potassium from the incubation medium inhibited uric acid uptake by slices from both lines. Ouabain inhibited uric acid uptake in the LUA line. The sodium and potassium requirements for initiation of uric acid uptake were higher, and the potassium requirement for maximal uptake was lower, for slices of the HUA line. No genetic differences in potassium or sodium contents of slices were observed when the potassium content of the incubation medium was altered or when the medium contained ouabain. These studies indicate that hereditary hyperuricemia in chickens may be due to a qualitative change in renal uric acid transport which involves the interaction of cations in the transport process.


Parathyroid hormone and renal excretion of phosphate and calcium in normal starlings. The renal handling of calcium, phosphate, sodium, and potassium was studied in normal and parathyroid extract (PTE)-injected starlings, Sturnus vulgaris. The birds were anesthetized with Equi-Thesin and infused intravenously with 2.5% mannitol containing [14C]inulin. Normal starlings actively reabsorb all four of these substances. After intravenous administration of 50 IU PTE/100 g body wt, the relative phosphate clearance (CPO4/CIn) as well as tubular transfer of phosphate (TPO4) increased significantly. Phosphate secretion occurred and usually persisted longer than 2 h. The relative calcium clearance also rose after PTE, but the TCa did not shift. This probably indicates that the tubular transport maximum (Tm) for calcium had been exceeded. The relative clearances of sodium and potassium also increased after PTE; however, only the rise in CNa/CIn was significantly different from the controls. The glomerular filtration rate (CIn) also increased significantly after PTE, but this effect was transient and cannot explain the longer lasting effects of PTE on excretion of phosphate, calcium, or sodium.


Subcellular calcium transport in failing hearts due to calcium deficiency and overload. Mitochondrial and heavy microsomal fractions were isolated from rat hearts perfused for different intervals with Ca2+-free medium, as well as from hearts reperfused with control medium after perfusion with Ca2+-free medium. Contractile failure due to intracellular calcium deficiency produced by perfusing the isolated rat hearts with Ca2+-free medium resulted in a marked decline of calcium binding and uptake activities of the mitochondrial fraction without any effect on the microsomal fraction. On the other hand, inability of the rat hearts to recover their contractile force due to intracellular calcium overload produced by reperfusion for 10 min with control medium after 5-20 min of perfusion with Ca2+-free medium was associated with decreased microsomal calcium-binding and uptake activities and increased mitochondrial calcium-binding and uptake activities. When the hearts perfused with Ca2+-free medium in the presence of low sodium (35 mM) for 5 min were reperfused with control medium, the contractile force recovered completely, and appreciable augmentation in mitochondrial calcium transport or depression in microsomal calcium transport as seen in conditions of intracellular calcium overload did not occur. These results suggest dramatic alterations in calcium-transporting properties of mitochondria and sarcoplasmic reticulum in hearts failing due to intracellular calcium deficiency and calcium overload, respectively.


Single-nephron function and renal oxygen consumption during rapid volume expansion. Isotonic volume expansion reduces net filtrate reabsorption in the proximal tubule while increasing it in Henle's loop. To determine the role oxidative metabolism plays in these processes, experiments were performed on rats initially hydropenic and then rapidly volume expanded with isotonic Ringer solution. Whole-kidney sodium reabsorption, oxygen consumption, and single-nephron function were measured simultaneously. During volume expansion, net renal sodium reabsorption increased concomitantly with a fall in oxygen consumption and a reduction in proximal tubular absolute filtrate reabsorption. The increase in quantity of nonreabsorbed filtrate delivered into the loop of Henle greatly exceeded the amount excreted in the urine. Thus, filtrate reabsorption by the distal nephron segments increased. These data provide evidence that acute volume expansion reduces oxygen-dependent active solute transport in the proximal tubule. The increase noted in distal nephron sodium reabsorption appears nonoxygen dependent, energized by anaerobic glycolysis or occurring passively.


Influence of potassium on renal ammonia production. The influence of potassium homeostasis on ammonia production was investigated with both cortical and medullary slices from rat kidney. Renal cortical slices from rats depleted of potassium by dietary restriction produced 31% more NH3 than slices from pair-fed controls. A high-potassium diet for 1 wk diminished ammonia production in cortical slices by 5% in comparison with rats pair fed a normal diet (161 vs. 169 mumol/90 min per g wet wt; P less than 0.05). Pair feeding did not introduce an experimental artifact, since animals ingesting similar K+ diets showed no difference in NH3 production. In contrast to cortex, NH3 production by outer medullary slices from K+-depleted animals was similar to pair-fed controls. Medulla from potassium-loaded rats exhibited an impressive inhibition in NH3 production averaging 36%. These striking differences between cortex and medulla suggest that specific alterations in potassium homeostasis may influence NH3 production selectively at different tubular sites. In vitro manipulation of K+ homeostasis produced by varying bathing media K+ from 0 to 144 mM, with concomitant changes in intracellular K+ from 30 to 130 mM, had no detectable influence on NH3 production by cortical slices. Hence altered cortical ammoniagenesis is not the direct result of acute changes in extracellular or intracellular cortical fluid K+ or in the transcellular gradient for K+. Although the specific cellular mechanisms whereby K+ alters ammoniagenesis remains undefined, the observation that K+ loading diminishes while K+ depletion enhances NH3 production supports the supposition that K+ and NH3 are linked in a physiologic control system.


Influence of dietary sodium on renin activity and arterial pressure during anesthesia. The effect of pentobarbital anesthesia on plasma renin activity (PRA) and mean arterial pressure (MAP) was studied in chronically catheterized dogs maintained on normal or low-sodium intake. Within 1 min of administration, pentobarbital caused a rapid fall in MAP which was followed by a restoration of MAP toward control within 5 min. Thirty minutes after induction of anesthesia, PRA was unchanged in sodium-replete dogs and elevated two-fold in sodium-depleted dogs. MAP was significantly lowered (20 mmHg) in normal salt dogs and only slightly decreased in low-salt dogs 30 min after pentobarbital. MAP returned to preanesthetic control value in dogs given converting enzyme inhibitor before anesthesia. Surgical stress or cutaneous electrical stimulation causey hexamethonium. These results indicate that change in PRA and MAP of pentobarbital-anesthetized dogs is significantly influenced by the sodium intake of the animal and by the degree of surgical stress.