Ability to perform prolonged physical exercise in dogs after chronic treatment with thyroxine. Treatment of dogs with L-thyroxine (T4) for 7 or 21 days had no influence on their body temperature, blood LA and NA concentrations and muscle glycogen content at rest. Only blood FFA and glucose concentrations were significantly higher than those before T4 administration. During exercise performed by T4-treated dogs considerably higher increases in rectal temperature as well as in blood FFA and LA concentrations were found in comparison with control runs. Plasma NA level at the end of exercise was significantly lower in T4-injected dogs than in controls, and blood glucose and muscle glycogen content were similarly decreased in spite of much shorter time of exercise until exhaustion in T4-treated dogs. As a result of the described metabolic and temperature alterations ability of T4-treated dogs to perform prolonged physical exercise was markedly reduced.


Discharge pattern of single neuronal units in cortical projection area of vagus nerve during successive episodes of hypoxia. For an analysis of discharge pattern of single neuronal units in the cortical projection area of the vagus nerve during successive episodes of hypoxia their action potentials were recorded extracellularly. Changes in the discharge pattern were assessed by means of histograms of interimpulse intervals. It was found that the reaction of neurons to repeated exposure to hypoxia includes: a) increased frequency of discharges, b) decreased activity, or c) habituation, i.e. reduction in the degree of neuronal activity changes during successive exposures to hypoxia.


The effects of unilateral brief-interval ECT on memory. One hundred and three patients treated for endogenous depression with unilateral, non-dominant ECT, half with two, half with four treatments weekly, were examined to determine the effect of the treatment on memory functions. Th first-mentioned group was studied with double-blind technique in connection with an earlier study while the latter group was investigated under open conditions. Tests were made before the first treatment, after the sixth treatment, and after the final treatment (the Wechsler Memory Scale Forms I and II) and at the same times, ratings were made of the depressive state. No significant differences were found between the results of the two groups either with regard to the total results or the sub-test results in WMS. This was true for changes between and the first and the sixth treatment and between the first and the final treatment. On the whole, both groups showed improved results during the course of treatment; a memory reduction to an equal degree in both groups evident before treatment, and thus due to the depression, was eliminated concurrently with the improvement in the depressive condition. With reference to delayed reproduction  a comparison made after the sixth treatment showed that the high-frequency treatment group scored significantly higher than the other group. This can only be ascribed to a better therapeutic effect resulting from accelerated treatment. Likewise these improved therapeutic results in the high-frequency treatment group must be responsible for the fact that this group does not show poorer test results than the group treated at the customary frequency-rate in spite of an expected deteriorating effect of accelerated treatment on memory functions and in spite of a larger number of treatments per series in this group. Neither in the higher nor in the lower frequency treatment group were any age-related variations in memory found.


Lipid composition of plasma obtained from various parts of the vascular system of the rabbit. Lipid concentrations were compared in the arterial blood, peripheral venous blood (pinna), and blood from the portal vein, hepatic vein, inferior caval vine and both renal veins (right and left). Greatest differences were found between the arterial blood and venous blood from a peripheral vein and hepatic vein. For assessment of the degree of lipid assimilation by the peripheral tissues simultaneous determination of triglycerides and non-esterified fatty acid concentrations in arterial blood and peripheral venous blood was found to be most useful. Liver ability of lipid synthesis can be measured on the basis of difference in the concentrations of cholesterol, non-esterified fatty acids and phospholipids in the arterial and venous blood leaving the liver. Blood passage through the kidneys had no influence on changes in the lipid concentration.


The absorption of epsilon-(gamma-L-glutamyl)-L-lysine in different parts of the gastrointestinal tract in the rat. A study was made on the absorption of epsilon-(yamma-L-glutamyl)-L-lysine (GL) from the small intestine and caecum of the rat. Under the experimental condition (incubation at 37 degrees for 60 min), GL was absorbed from the small intestine by an active transport mechanism and from the caecum by passive diffusion. L-lysine had no effect on the rate of absorption of GL which may suggest the existence of independent mechanisms of absorption of these two compounds in the small intestine of the rat.


Self-mutilation in antisocial personality (disorder). In the present study, attempts were made to clarify the characteristics and the background information of persons with antisocial personality (disorder) who had resorted to slashings. These were compared with controls with a similar personality disorder who had not resorted to slashings. It appeared that the former had been more often prone to repeated outbursts of rage or fighting, drug abuse, and even other forms of self-destruction as well as tattooing in prison. They had more often had an alcoholic father. Moreover, they were more withdrawn, anxious and had a tendency to blame their environment. They had more often made efforts to get out of the restricted milieu of prison to the prison's psychiatric department  and experienced the confined space of the prison as oppressive. They resorted to slashing usually in prisons and it seemed that the restricted environment with an absence of sufficient stimuli was crucial in triggering self-mutilation.


Changes in blood catecholamine levels in neonatal and growing lambs. Changes in the palsma catecholamine (A and NA) and FFA concentrations were followed in 12 lambs from birth to 6 months of age. At birth plasma A, NA and FFA levels were higher than those at 6 months of age. Within first 3 days of life plasma A concentration markedly increased, and that of NA decreased, but on the 10th day of age both catecholamines returned to the levels found after first suckling. At this time significant decline in plasma FFA level occured. Later on up to 100 days blood A did not change, whereas NA stabilized on a relatively high level, which resulted in a marked increase of total catecholamine concentration and in a high NA/A ratio. The weaning stress caused a marked increase in blood total catecholamine and FFA levels. No relationship between plasma catecholamine and FFA levels was found during the whole period of growth considered.


A method for testing differences in morbidity risk for affective psychoses. A modified method for testing differences between two proportions  is described and its use for testing differences in the morbidity risk for affective psychoses is discussed. The method is based upon the u test for comparisonof two proportions. An example of the application of the method to study sex differences in morbidity risk for affective psychoses in parents of probands with unipolar depression and manic-depressive psychosis presented.


Classification of the MMPI profiles of two alcoholic groups. Ninety-two per cent of the MMPI CODES OF 60 ALCOHOLICS IN THE Link Society and institutional groups of the present study were classified  according to a mixed typological-dimensional model. The study applied reciprocal two-digit high-point codes and also five different spiked codes and two different codes which include more than two scales in predominant position. Related codes suggesting different diagnostic descriptions were, however, separated from each other. The present study also used new interpretations of some MMPI scales, detailed descriptions of the other scales and applied some critically examined measurements of certain authors. Of special interest is a detailed interpretation of codes opathic deviate) scale as a measurement of hysterical personality. The above methods gave a more exact identification of the MMPI codes than a previous study of the present author and suggest that it is possible to give a more refined description of different personality disorders in particular but also of other psycho-pathological and behavioural characteristics of the alcoholic patients in the Link Society and institutional groups. The different typal dimensions measured by the MMPI high-point codes seem to be of theoretical value but also seem to be useful for a more differentiated and adequate treatment of alcoholics. In further corroborative studies there is a need for more case history descriptions in order to correct for local departures. It is also possible that these descriptions may aid in giving a clearer identification of the codes, including scale 5, not classified in the present study.


The effect of triiodothyronine (T3) on calorigenic and thermoregulatory responses to noradrenaline in the rabbit. Calorigenic action of NA administered to conscious rabbits was potentiated by the prior injection of triiodothyronine (T3). The increased NA-induced heat production in these rabbits, accompanied by higher increases in body temperature in spite of improved heat elimination, can be at least partly attributed to more intensive lipid mobilization and utilization. A considerable hyperglycemic effect of NA was found both in the control-untreated and T3-treated rabbits.


Mantle treatment of Hodgkin's disease. Results and side effects. Eighty-seven patients were treated with the mantle technique for Hodgkin's disease. Usually 40 Gy in 27 fractions in two series over 71 days were given. A local recurrence was diagnosed in 3 of 87 patients. An analysis of radiation reactions of the lung tissue, heart and pericardium, and spinal cord is reported. It is recommended to give mantle treatment for Hodgkin's disease over a relatively long period of time such as in split-course in two series.


Biopsy of the nasopharynx as a staging procedure in Hodgkin's disease. Biopsy of the nasopharynx was perfomred in 45 patients with Hodgkin's disease as part of the pretherapeutic staging. Seven of the 45 (16%) had microscopic abnormalities in the nasopharynx compatible with Hodgkin's disease. Such abnormalities occurred even in the absence of local ENT-symptoms or signs, and they could not be predicted from the microscopic type of lymph node biopsy, stage of disease or general presentation. A generous biopsy of the nasopharynx is recommended to be included in the staging procedures in Hodgkin's disease.


Effect of chemical protectors on the response of the intestine to roentgen or fission neutron irradiation. The monosodium salt S-1-(2-hydroxy-3-amino) propylphosphorothioic acid (WR-77913) and S-2-amino ethylisothiuronium-Br-HBr (AET) were tested for protective effects against 4 MeV roentgen irradiation and fission neutrons in the mouse intestine. The parameters tested were intestinal crypt survival, lethality and intestinal crypt cellularity. The results showed both compounds to be good protectors in animals. The crypt survival curve for roentgen-irradiated mice treated with AET was parallel to that of the untreated group and was displaced to the right by 4.88 Gy (488 rad). Protection from neutron irradiation was less effective with a displacement of only 0.69 Gy (69 rad). Pretreatment with WR-77913 increased the slope of the crypt survival curve in roentgen-irradiated mice. This was also seen to a much less extent in neutron-irradiated animals. The displacements of the curves (at 50 per cent crypt survival) were found to be 5.15 and 1.02 Gy (515 and 102 rad) for roentgen and neutron irradiation, respectively. The lethality experiments showed a dose modification factor (DMF) of 1.42 for both drug-tested groups of roentgen-irradiated mice. The dose modification factors for fission neutron irradiated mice were 1.48 and 1.2 for WR-77913 and AET-treated mice, respectively. The effect of these protectors of crypt cellularity is also discussed.


Build-up effects at air cavities measured with thin thermoluminescent dosimeters. The build-up and build-down situation around air cavities of various size in a polystyrene phantom was evaluated by measurements with LiF-Teflon disks with a thickness of about 1.6 X 10(-2) kg/m2. The measurements demonstrate that when irradiating with two opposed beams the surface dose at the cavity (depth 39 mm) is 74% of the maximum dose for 60 Co, 77% for 6 MV and 87% for 42 MV roentgen radiation.


Late effects on rabbit brain morphology and monoamine metabolites produced by 60C0-irradiation. Twenty-three rabbits were exposed with 60Co irradiation over the skull. Nineteen of the animals received 29.6 Gy over the right hemisphere and 4 animals received 20 Gy over both hemispheres. Six months after the exposure the cncentrations of 5-hydroxyindolacetic acid (5-HIAA) and homovanillic acid (HVA) in seven different brain regions were assayed. No significant differences in the levels of these monoamine metabolites as compared to nonirradiated control animals were found. In contrast to discrete biochemical changes, a relatively marked parenchymal destruction was demonstrated by means of light microscopy, microangiography and scanning electron microscopy of the vessels, which exhibited telangiectases, fibrinoid necroses and thrombosis due to the late effects of irradiation.


Blurring quality in spiral tomography.

Blurring quality in spiral tomography. In view of the close relationship which exists between image aberrations and the form of the transfer function, the transfer functions of some different types of spiral tomographic movements have been calculated numerically. The results allow prediction of a type of spiral movement which yields blurring of favourable quality. The validity  of this approach has been demonstrated experimentally, by comparing the blurring characteristics of tomographs with single and multiple circular movements. When the radii of the circles in the latter case are chosen with reference to the form of the transfer function, a marked improvement in blurring quality is apparent.


[Morphological and cytokinetic studies of the arterial wall following x-ray irradiation. I. Results with 3000 rad. focal irradiation dose in rabbits]. The arterial wall (abdominal aorta, splenic artery) has been investigated after irradiation with 3000 rad (3 X 1000 rad within 3 weeks) in rabbits. In addition to light microscopic techniques semi-thin sections, electron microscopic sections, permeability staining and autoradiographic techniques have been applied. These studies revealed typical lesions in the media (elastic degeneration, cellular proliferation of the smooth muscle cells) and lesions of the endothelial cells using ultrastructural techniques especially. The intima showed an increasing permeability in the irradiated area, while autoradiographically a higher mitotic activity in the media was demonstrable. The results are discussed in the light of similar atherosclerotic and X-ray induced lesions of human blood vessels.


The tuberositas tibiae and extension in the knee joint. In all 56 tibiae from Lapps and 56 from Norwegians have been studied. These ethnic groups represent different weight bearing situations. Variables dealing with the extension in the knee joint are dealth with. The bone is mainly studied in the AP and the ML planes. The material is analyzed statistically. The distribution form is examined and the deviations from normality are found to be moderate. Chiefly positive skewness occurs. Platykurtosis is found equally often as leptokurtosis. The deviations from a standard normal distribution are not supposed to affect the results significantly. There is a non-systematic pattern of distribution. The variability is generally lower in Lapps than in Norwegians. The variability is about the same in linear and angular variables and in indices. In linear variables females and Lapps show lower mean values than males and Norwegians, respectively. Lapps show the largest indices. In linear variables, contrary to in angular variables and indices, the sex differences exceed the differences between the ethnic groups. As a rule sex differences are largest in Lapps. The variations of the tuberositas tibiae are supposed to be in particular the results of muscular forces in bone remodeling. The relationship between the habitual knee position and extension is discussed.


Auditory frequency generalization with differing extinction influences in normal and prefrontal dogs trained in instrumental alimentary reflexes. Following criterion of 90 percent correct responses to a 1,000-Hz tone on a 50 percent reinforcement schedule, 8 of 12 dogs were subjected to lesions of the medial or lateral prefrontal cortex. Three types of auditory frequency generalization tests followed separated by a period of reacquisition of the instrumental response. A sampling procedure of generalization assessment, wherein a block of test trials was contained within 15 partially reinforced trials and repeated over 16 days, revealed complete generalization in the medials and rapid, but discriminative responding in the laterals. The second generalization test was conducted in complete extinction over 5 days. The medials yielded discriminative performance and least overall resistance to extinction, while the laterals showed a higher amount of frequency control and minimal extinction effects. Go-no go differentiation training preceeded the last generalization test [CS(+) = 1,000 Hz; CS(-) = 600 Hz], resulting in retarded acquisition in the laterals and easiest acquisition in the medials. The last generalization test suggested that all groups were comparable, with some trend toward more rapid extinction in the medial dogs. Collectively, the data indicated that performance was determined by the interacting functions between the specific lesions and the density of reinforcement present in the testing procedure.


Hippocampal theta activity in the acute pretrigeminal cat. In five cats with a pretrigeminal brainstem transection ocular behavior and cortical and hippocampal EEG activity were recorded. The ECoG desynchronization was usually accompanied by clear hippocampal theta activity. The episodes of ECoG desynchronization and hippocampal theta activity lasted in some cases for several hours. Visual stimuli evoked two types of hippocampal EEG response: (I) increase of regularity and frequency of theta activity (II) EEG desynchronization. The intensity of these responses was positively correlated with the intensity of ocular and ECoG components of the orienting reflex (the most conspicuous phenomenon being their habituation with stimulus repetition). Electrical stimulation of the midbrain reticular formation evoked theta activity of a frequency proportional to stimulus voltage; for maintaining it constant stimulus strength had to be elevated gradually. Depriving the brain of influences from the lower brainstem does not influence qualitatively the function of reticulo-septo-hippocampal system.


Contact with estrus female as a reward for instrumental response in a growing male rat from the 3rd up to the 14th week of life. The bar-press response reinforced by the contact with estrus female was investigated in growing male rats. The bar-press latency as well as the subjects' behavior changed distinctly in the course of the study with the increase of experience and maturation of the subjects. Some behavioral items such as, nasogenital contact, climbing on the head, and running around showed gradual increase during succeeding weeks of life, parallelly to the decrease of the sitting under female, and crawling under female. A gradual shortening of the bar-press latencies was observed from the 4th to the 11th week of life succeeded by a prolongation from the 11th to the 14th week. On the basis of the changes in bar-press latencies as well as of the analysis of the subjects' behavior it is suggested that the young male rat between the 4th and 7th week of life comes under an increasing influence of sexual motivation.


The foraging behavior of the ant Myrmica laevinodis nyl. The foraging territory is not divided among particular foragers, at least in the young, small families of M. laevinodis. The same individuals may be observed repeatedly only at the aphides over a period of several days, which may be explained by a transient memorizing of the source of attractive food. Along with the faculty of these ants to inform their nestmates of the food source, a certain continuity in care of the aphides is ensured. Various forms of behavior among particular foragers coming in contact with the trophy exceeding their strength were noted. The less time the ant hesitates before to the nest, the sooner and more efficiently it recruits helpers and the smaller is its dependence on its own odor trails when moving on the terrain. Since there exist transitory forms between diametrically opposite manifestations of such behavior, possibly the process of individual acquirement of capabilities necessary for fulfilling foraging function occurs.


The selection of shelter place by the house cricket. The stimuli acting upon the choice of shelter and resting place by the house cricket, Acheta domesticus (L.) were analysed. The places of preference in different types of terraria as well as the choice of tubes of different diameter and of various light conditions were investigated. Acheta domesticus avoids open and illuminated space in its choice of resting place. It prefers dark places, enclosed by walls, like a clefts or boxes. The influence of the conditions of environment configuration at the larval period of the crickets' development upon their subsequent preference as to rest place, has not been stated. Neither was this influence observed on their behavioural reactions as connected with the former. Crickets attain their ethological praeferendum of resting site owing to their innate photo- and thigmo-kinesis which are supplemented by hygrophilia and thermophilia. The influence of the group effect on the cricket's individual rate of development was confirmed.


Frontal lobe system maturational lag in juvenile delinquents shown in narratives test. The aim of the present study was to test the hypothesis that a brief clinical test of frontal lobe system (FLS) maturity levels, designated as Stages I, II, III, IV, can differentiate between three experimental groups (all of age 9-16): normal Ss, Ss with emotional problems, and juvenile delinquents. The stages represent 1) disjointedness of activities; 2) inability to switch the principle of action of an ongoing activity appropriately; 3) planning, and 4) ability to switch the principle of action of an ongoing activity and to re-program it appropriately in accordance with new circumstances. By means of a blindly performed brief form analysis of action patterns expressed through narratives, it was shown that 70% of the normal Ss attained stage IV, but only 47% of the delinquent Ss did so. These findings support the previously proposed new conceptual model about ethical action behavior in general (Pontius, 1972) and in particular with regard to a subgroup of juvenile delinquents who reveal signs of a neuro-physiological dysfunction, probably a maturational lag of the FLS. In the present sample, this appears to be especially revealed in the specific inability to switch in a flexible manner the principle or plan of action of an ongoing activity according to new circumstances, resorting to re-programming. Such specific inability calls for specific classification as such, thereby enabling the formulation of specific remedial efforts, which are discussed.


Prognosis of acute poststreptococcal glomerulonephritis in childhood: prospective study and review of the literature. Serial, clinical, clinicopathologic and histologic studies performed simultaneously following onset of PS-AGN in children for a period of up to 144 months revealed no evidence of progression to chronic glomerulonephritis. Although acute morphologic changes were more severe in renal tissue obtained from patients with AGN following streptococcal upper respiratory infection than following pyoderma, the acute manifestations in both groups subsided 6 to 12 weeks after onset. Cumulative morphologic healing occurred in 20% of patients at 24 months, in 43% at 48 months after onset of PS-AGN; 1 patient who was unhealed  at 49 months was lost to follow-up. In 2 patients (6%), acute histologic exacerbations without clinical signs occurred within 24 months after onset. Subsequent healing was documented histologically. Addis counts remained abnormal in a high percentage of patients throughout the 12 years of observation and did not correlate with the histologic findings of renal biopsy tissue. The occasional demonstration of renal vascular disease and/or hypertension may merely reflect the early development of spontaneous essential hypertension although the possibility of a relationship to the previous attack of PS-AGN is intriguing. This question cannot be answered at this time. Renal biopsy studies are more dependable than Addis counts in assessing the course of PS-AGN. The significance of persistence of immunofluorescent and/or electron microscopic changes (subepithelial dense deposits) many years after onset in 58% of 12 patients studied, at a time when a majority of patients (84%) revealed healing by light microscopy, remains to be assessed.


The pregnant adolescent--a group approach. This paper has described the groups for pregnant teenagers developed in the Rochester Adolescent Maternity Project. One and one-half year's experience with these groups has allowed the authors time to begin their study of groups and to write a descriptive paper of their evolution. The groups' development goes on while the leaders continue their own theoretical study of groups at this writing. Groups for pregnant adolescents have ranged from group therapy sessions to structured groups where only didactic material is presented. The literature is somewhat limited in its discussion of types of groups and especially in describing group process. This paper differs from others in that both group structure and process, based on the group objectives, are discussed. Information on approaches beneficial to the adolescent have been included. The goals of the group are to help the teenagers work through the developmental tasks of adolescence and pregnancy and to prepare them for the labor, delivery, and initial parenthood experience. Group structure is based on the intent to engage teenagers in resolution of these tasks in order to be prepared at a variety of levels, i.e. cognitive, emotional, etc., for labor, delivery, and parenthood. Co-leadership of the groups and an unstructured format facilitate the movement of the group toward accomplishment of its objectives. Group content issues were explored and techniques developed to handle these issues were suggested. Included were the following: 1. Commitment to the group by the members is assisted by the structure set for the group and the leaders' active outreach to members. 2. Descriptions of emotions and thoughts are made in concrete rather than abstract terms because of the developmental status of the teenagers. 3. Expression of personal feelings, often difficult for teenagers, is aided by the use of a projective technique. 4. Transition from leader-oriented to group-directed discussion is made possible by the group leaders gradually changing their leadership from one of direct interaction to one of facilitating discussion. 5. Polarization of the group in a negative or positive direction is prevented through the use of a neutral group member or active intervention by the group leaders taking on a neltral role. 6. Control, an issue of pregnancy and adolescence, is dealt with on interactional, educational, and emotional levels. 7. Termination is determined by the stage of the group "work" and is identified and facilitated by the group leaders. Research questions needed to document the effectiveness of the group approach to the pregnant adolescent were addressed.


Age and sex differences in self-perception as related to ideal trait selections. Self-perception differences of sixth- and twelfth-grade subjects were measured with the Tennessee Self Concept Scale, and the youngsters' choices of an ideal personality trait were studied. Findings indicate that some age and sex differences in self-regard are statistically significant and that both younger and older girls seem to perceive themselves more favorably than do boys of the same ages. Boys as a group tend to select competence, and girls virtue as the traits they most admire, but the choice of an ideal personality characteristic apparently is unrelated to one's level of self-esteem.


Geriatrics in relation to the social and behavioural sciences. Social and behavioural gerontology is the scientific study of how men and women adapt to their environment as they grow older. It is a multidisciplinary area, comprising subjects each of which asserts an existence in its own right, as a scientific enterprise, apart from other subjects in the area, and apart from geriatrics. Social and behavioural gerontology, however, forms part of the total context within which geriatrics gets its meaning and value. Geriatrics, in turn, affects these other adjacent disciplines. Social and behavioural gerontology could help in a general way by putting geriatrics into this wide perspective and thus demonstrating the wider issues that might otherwise be neglected in the busy round of geriatric care. Social and behavioural gerontology could also help in numerous particular ways such as: the collection of normative data; improved conceptual analysis; better methods of observation, experimentation, measurement and data analysis; the integration of social and behavioural case-work with clinical geriatrics for both treatment and training purposes; improved techniques of social and behavioural assessment; improvements in communication; better social attitldes; increased self-help and understanding of the role of the elderly in society; more effective consumer behaviour; and more effective social policies incorporating long-range, broad-spectrum preventive measures.


Steady-state kinetics of digoxin in the elderly. Renal clearance of digoxin and creatinine was determined simultaneously on 30 occasions in 28 elderly in-patients on maintenance digoxin therapy. The mean ratio of digoxin to creatinine clearance was 1.04 (+/- S.E.M. 0.08). Multiple 24-hour urinary excretions of digoxin were measured in 10 patients on digoxin on a dose of 0.25 mg/day, four on 0.125 mg/day, and six on 0.0625 mg/day. Mean urinary excretion was 42% of dose per day. Calculated "net biliary clearance" averaged 18 ml/min. Knowledge of the magnitude of renal and net biliary clearance, together with assumed values for fractional absorption allows a relationship between serum digoxin levels and creatinine clearance to be calculated for each dose level. There was reasonable agreement between observed and expected serum digoxin levels in 41 elderly patients in whom creatinine clearance was measured, and in 106 in whom glomerular filtration rate was estimated from serum urea and creatinine concentrations. Quantitation of the kinetics of digoxin in the elderly can make maintenance therapy more rational and therefore safer and more effectove.


Causes of high free-thyroxine index values in sick euthyroid elderly patients. Modest elevation of the free-thyroxine index occurs in many apparently euthyroid elderly in-patients. The present study investigated the possible relevance of drug side-effects to this problem. It appears that such side-effects associated with the use of L-Dopa, digoxin and co-trimoxazole account for a substantial proportion of the observed elevated free-thyroxine index results.


Electors not liable for jury service as a sampling frame for the elderly. Data from 449 persons aged over 65 who had been respondents to a population-based survey and 96 non-respondents aged over 65 were studied to compare those who had declared their age at electoral registration with those who had not. It was found that only 75% (79% of respondents and 57% of non-respondents) had declared their age. In an analysis of 16 variables among the respondents, a statistically significant difference for social class among males was found in that relatively fewer from Social Classes IV and V had declared their age. As an administrative instrument for estimating the size of the elderly population, the list of those marked as not liable for Jury Service on the electoral roll is clearly inadequate, giving an underestimate of about 25%. This could possibly be improved upon by better design of the electoral return form.


Observer variation in the clinical assessment of stroke. Clinical assessments have to be used in epidemiological studies in the absence of more objective means of establishing diagnosis or recording events in the natural history of disease. This requires the standardization of definition, technique and interpretation as a means of reducing observer variability in clinical examination. The methods used to reduce the observer variation in the clinical assessment of stroke patients are described and results are presented which demonstrate the degree to which this was achieved.


The characteristics of old people receiving and needing domiciliary services: the relevance of psychiatric diagnosis. A sample of 447 people aged 65 years and over, randomly selected from electoral rolls, were visited in their homes, independently, by a medical social worker and a psychiatrist. Twelve per cent were receiving domiciliary services from the Local Authority and a further 20% were considered to require them. The types of services received and recommended are described and the medical, social and psychiatric services of those receiving services, in need of them, and the remainder are compared. The high priority for the support of persons with chronic brain syndrome and their relatives is emphasized. Functional psychiatric symptoms were found by the psychiatrist, in a high proportion of those considered by the medical social worker to need services. Psychiatric assessment and treatment which might reduce the need for social services in some cases, would be greatly assisted by the development of a reliable screening device for the use of the primary care team.


Does the pro-inflammatory factor in lymphocytes (LpIF) explain the role of these cells in acute inflammation? Lymphocytes produce a pro-inflammatory factor, which modulates the development of acute inflammation. Injection of lymphocytes or products, obtained from either rats, dogs or rabbits, caused a restoration of inflammatory responses in leukopenic rats which are hyporeactive to various inflammatory stimuli. In vitro incubation of viable lymphocytes with homologous and heterologous anti-lymphocyte sera abolished the ability of the cells to restore the inhibited inflammatory reactions.


Role of cellular density, in vitro, in anti-tumor activity of CFA-treated and immunized cells. Incorporation of tritiated deoxythymidine (3HdT) into DNA was used to measure growth, in vitro, of P815 tumor cells admixed with spleen and peritoneal effector cells. At a high tumor cell density ((1x10(5) cells per dish), using anti-theta and anti-macrophage sera, T-cells and macrophages from the peritoneum of immunized mice could be identified as cells possessing anti-tumor activity. A nonspecific inhibition by normal effector cells, which occurred at the high tumor cell density, did not occur at a lower tumor cell density (1x10(4) cells per dish). Therefore, the effects of immunization and Freund's adjuvant treatment on the anti-tumor activity of effector cells were determined more accurately when normal cells were no longer inhibitory. Thus, experimental variables dealing with cellular density (cells/mm2 of the culture vessel surface) and effector:tumor cell ratios play an important role in the anti-proliferative capacity of effector cells.


Platelets, prostaglandins and inflammation. In exudates of implanted sponges in rats, made thrombocytopenic by the administration of anti-platelet serum, there are significant reductions in the platelet and leucocyte counts and of the content of prostaglandin-like activity. It is concluded that platelets migrate into the developing sponge exudates, are the source of the prostaglandins and interact with complement to cause leucocyte migration. In normal animals the administration of indomethacin and sodium salicylate cause similar effects to thrombocytopenia whereas the injection of human plasma fraction affects only the leucocyte migration. One of the sites of the anti-inflammatory action of conventional non-steroidal drugs may be concerned with the migration of platelets into inflammatory lesions.


The modulation of enhanced vascular permeability by prostaglandins through alterations in blood flow (hyperemia). The enhanced vascular permeability induced by histamine or bradykinin in the skin of the guinea-pig and rabbit was significantly augmented by small amounts of prostaglandins of the E type. When injected alone these prostaglandins had little effect on vascular permeability. Furthermore, E type prostaglandins were found to be more potent at inducing hyperemia than either histamine or bradykinin. Prostaglandin F2alpha did not enhance the vascular permeability induced by histamine or bradykinin nor did it produce hyperemia in the skin. In the rat, prostaglandins alone enhanced vascular permeability but they also increased the effect of histamine, serotonin and bradykinin. Using 85Sr-microspheres to measure blood flow a correlation was found between the degree of hyperemia produced by prostaglandins and the degree to which they augmented enhanced vascular permeability due to histamine, serotonin or bradykinin. Prostaglandins therefore can directly mimic the hyperemia of the inflammatory process and can also modulate the changes in vascular permeability caused by other mediators of inflammation.


Prostaglandin endoperoxides, serotonin and the superfused rabbit aorta: possible pitfalls in the bio-assay of rabbit aorta contracting substance (RCS). The specificity of the isolated rabbit aorta for identification and assay of prostaglandin endoperoxides, formed during aggregation of platelet rich plasma (PRP) from rats, was investigated in the superfused organ cascade. The use of cumulative dose-response curves in this design is quicker than conventional step-wise dosing while delivering identical results. On the rabbit aorta, in contrast to the rat fundus strip, methysergide is too weak an antagonist to rule out responses due to 5-HT. After pretreatment with phenoxybenzamine, in the presence of methysergide, the rabbit aorta retains its sensitivity towards oxygenated fatty acids, while being virtually unreactive towards 5-HT. The prostaglandin endoperoxide PGH2 is more potent than prostaglandin E2 when assayed on the rabbit aorta, while on the rat fundus the situation is reversed. Combining the rabbit aorta and rat fundus strip with pre-filtration on Amberlite XAD-2 columns showed that during collagen induced aggregation rat PRP generated both a labile RCS-most probably a prostaglandin endoperoxide- and a lipophylic prostaglandin-like material, along with 5-HT.


Smooth muscle sensitization induced by vinblastine. At the optimal concentration of 10 mg/l, vinblastine increases the submaximal contractions of the isolated guinea-pig ileum induced by the following agonists: acetylcholine, histamine, nicotine, angiotensine, prostaglandins E1 and F2alpha (but not serotonine). It also increases the contractions induced by transmural electrical stimulations of the guinea-pig ileum and reverses the inhibitory effect of non-steroidal anti-inflammatory drugs on these electrically-induced contractions.


The antiphlogistic, antinociceptive and antipyretic properties of fenclorac. Fenclorac (a,m-dichloro-p-cyclohexlphenylacetic acid, diethylammonium salt) is a potent nonsteroidal anti-inflammatory agent with significant analgesic and antipyretic activity. Fenclorac had an ED50 of 7.9 mg/kg in the carrageenan paw edema assay and had a duration of action of 18-22 hours. Comparative tests in the carrageenan paw edema assay in the rat indicated that the potency of fenclorac was 13 times that of aspirin, 3.4 times phenylbutazone, 3 times ibuprofen and 0.3 times indomethacin. Fenclorac was less potent than indomethacin, but more potent than phenylbutazone or aspirin in treatment of developing or established adjuvant arthritis. The anti-inflammatory effectiveness of fenclorac did not depend upon the integrity of the adrenopituitary axis and was not affected by the route of administration or sex of the test animal. Fenclorac was 77 times more potent than aspirin and more than twice as potent as indomethacin in reducing fever in rats rendered hyperthermic with brewer's yeast. Fenclorac did not affect normal body temperatures. Fenclorac did not interfere with cellular immune mechanisms as measured by its lack of effectiveness in experimental allergic encephalomyelitis. Antinociceptive testing indicated that fenclorac had peripheral but not central analgesic activity. Fenclorac had an acute oral LD50 in rats and mice of 285 and 430 mg/kg, respectively. The acute gastric lesion UD50 for fenclorac was 7 mg/kg in the fasted rat. Studies using 51Cr-tagged erythrocytes indicated that fenclorac did not produce significant fecal blood loss in the rat at twice the therapeutic ED50 dose for up to 12 days after dosing. Extensive and prolonged fecal blood loss was observed with a corresponding dose of indomethacin for up to nine days after administration. Comparison of the anti-inflammatory pharmacology, Therapeutic Ratio and the data obtained from the 51Cr-fecal blood loss studies indicated that fenclorac was well tolerated after acute or subacute administration to the rat.


Anti-inflammatory activity of isoxicam in combination with aspirin or D-propoxyphene. Unlike several arylacetic acid derivatives (indomethacin, fenoprofen, ibuprofen, flurbiprofen and naproxen), the anti-arthritic activity of isoxicam is not reduced in the adjuvant-induced polyarthritis assay by the concomitant administration of aspirin or D-propoxyphene.


Inspiration inhibiting effect of etorphine-derivatives. The inspiration inhibiting vagal reflex as elicited in rabbits by tracheal occlusion in inspiratory position, is strongly increased by etorphine and its derivatives, the 19-isoamylderivative benig of outstanding activity.


Molybdenum toxicity: interactions between copper, molybdenum and sulphate. Molybdenum toxicity and the interactions between copper, molybdenum and sulphate are reviewed. The main signs of molybdenum poisoning are poor growth and anaemia (rat, chick, rabbit, cattle and sheep), anorexia (rat), diarrhoea and achromotrichia (cattle and sheep), joint and bone deformities (rat, rabbit, cattle), central nervous system degeneration and loss of crimp in wool (sheep). The following topics are discussed: (1) The effect of sulphate and sulphur compounds on molybdenum toxicity. (2) The effect of molybdenum on tissue copper levels. (3) The effect of molybdenum on the distribution of copper in plasma. (4) The effect of molybdenum on uptake and excretion of copper. (5) The possible existence of copper(II) molybdate in vivo. (6) The influence of molybdenum on sulphide production by ruminal micro-organisms. (7) Competition between molybdenum and sulphate in intestinal transport. (8) Interaction of sulphur with copper in vivo. (9) The possible involvement of molybdenum in gout and multiple sclerosis in humans.


A preliminary investigation of the organic chemical emissions from green sand pyrolysis. Condensable effluents from the thermal decomposition of a typical green sand foundry mold were investigated for the presence of emissions that could present health hazards in a foundry atmosphere. The benzene-soluble fraction extracted from the condensate was analyzed by gas chromatography/mass spectrometry. Over 200 compounds were observed on the chromatograms and benzo(a)pyrene, benzo(e)pyrene and perylene were identified. The concentrations of these materials were not determined, but their presence in foundry atmospheres represents in area of potential concern for health welfare.


The interpretation and applicati-n of OSHA carcinogen standards for laboratory operations. A safety protocol implemented at the Los Alamos Scientific Laboratory for a project involving 14 chemical carcinogens is described. Specific topics pertaining to facilities, personnel practice, laboratory operations, decontamination and disposal are discussed within the context of regulations issued by the Occupational Safety and Health Administration.


The toxicity of chloroform as determined by single and repeated exposure of laboratory animals. The acute and chronic toxicity of chloroform has been studied in laboratory animals. An acute oral LD50 of 2.0 (1.0-3.8) g/kg was determined for male rats. When applied to the skin of rabbits, chloroform produced slight to moderate irritation and delayed healing of abraded sking. Absorption of chloroform through the skin of rabbits was apparent but absorption is not expected to present a practical acute hazard. Liquid chloroform produced slight injury to the eyes of rabbits which took over a week to heal. Repeated 1-hour exposures five days per week for six months to either 85.50 or 25 ppm of the vapor of chloroform resulted in adverse effects in all or some species studied: rats, rabbits, guinea pigs and dogs. The effects at 25 ppm were slight and reversible. Rats exposed to 25 ppm for 4.2 or 1 hour/day for 6 months were not adversely affected. Based on experimental data and published reports on human experience as well as industrial experience with carbon tetrachloride, the authors suggest that when worker's exposures can be expected to be repeated and prolonged, the exposure concentrations be maintained below 25 ppm vapor and that the time weighted average not exceed 10 ppm.


Experimental evaluation of the clearance of 3,4-benzo(a)pyrene in association with talc from hamster lungs. B(a)P was administered intratracheally either alone or in association with 3 mg or 9 mg of talc, to Syrian golden hamsters. The clearance rate of the polycyclic hydrocarbon from the lungs was measured at regular intervals. It was found that talc was an effective factor in depressing the clearance of carcinogen from the lung tissue.


[Allergens of domestic dust. III. Comparison of the cutaneous responses to an extract of total dust, to an extract of D. pteronyssinus and to an extract of dissacharinized dust]. A study of the coefficient of correlation has been made, based on cutaneous response and by intradermal means, between household dust from Barcelona diluted to a strength of 1/1,000 and an extract of D. Pteronyssinus and its medium of culture, diluted to a strength of 1/1,000,000. This study was effected to a group of thirty-three children with allergic asthma, sensitive to household dust, with a resultant value of r = 0.94 (p less than 0.001). In the same way, thirty-six children with the same characteristics, the correlations between the same extracts and an extract of dust without mites has been studied. Using Spiekma's technic, this dust was obtained through successive sifts gathered in a case under the inferior sifter. Of the mentioned dust, two equal fractions were made, one to confirm the absence of mites (Spiekma's technique) and the other to realize the extract, preparing the dilutions 1/1,000 and 1/1,000,000. With the dilution 1/1,000, the value is r = 1 (p less than 0.001) for the domestic dust and of r = 0.94 (p less than 0.001) for the D. Pteronyssinus. In sixteen of the above mentioned children, the study was repeated with the same extract, using the dilution of 1/1,000,000, and the values obtained were of r for household dust of 0.004 (p less than 0.55) and for D. Pteronyssinus of 0.016 (p less than 0.55). In twenty-one of these children, unmited dust and the extract of the way of cultivation (9 parts of human skin scales and 1 part of Sacharomyces) was compared, both diluted to 1/1,000. The value obtained was of r = 0.89 (p less than 0.001). Taking these results into consideration, it seems that D. Pteronyssinus is the most powerful allergene of dust, but the possible role of fecal pellets, product of mite excretion and of human skin scales should be considered as minor allergenes. The human skin scales emphasize their role in this case, and even though good correlation is obtained, we need to use concentrations a thousand times bigger than the D. Pteronyssinus. One can think of it being the same antigen, but the study made previously between uncultivated mites in human skin scales and these in concentrations of the same potence, has been of 0.31, which leads us to think that it is not the same antigene. Finally we consider that in some conditions, it is possible that other antigenes participate in the genesis of dust allergic (fecal pellets, human skin scales), but the antigenic power is very low.


Liver cancer deaths in the continental USA from 1930 to 1972. Since 1944 the general U.S. population has been absorbing organochlorine pesticides, which have recently been largely banned because of a concern that they would cause or contribute to the production of liver cancer. This survey is related to the quantities of these pesticides used and the incidence of liver cancer deaths in the U.S. from 1930 to 1972.


Respiratory cartridge efficiency studies: VIII. summary and conclusions. The theory of solvent vapor adsorption of activated carbon is reviewed. Calculated and experimental cartridge service life values are compared using various breathing rates, relative humidities, concentrations and solvent vapors. Cartridge service life (the 10% breakthrough time) can be estimated from the emperical expression: t 10% = 2.4 X 10(6) WC (A + BT)/C 2/3 MQ Carbon weight (wc), relative solvent volatility (a, b and t) concentration (C), molecular weight (M) and breathing rate (Q) all play a vital role in cartridge performance predictions.


Respiratory function and symptoms: an environmental-epidemiological study of rubber workers exposed to a phenolformaldehyde type resin. Rubber workers exposed to a hexamethylenetetramine-resorcinol (HR) adhesive system reported an excess of acute symptoms and significant reductions in expiratory flow rates at low lung volumes. Smokers exhibited greater reductions in flow rates than nonsmokers. The greatest reductions in ventilatory capacity were associated with HR exposure. There was a moderate association of reduced flow rates with respirable particulate in the HR exposed workers only.


Aerosol production by irrigation equipment used for land application of wastewater. Aerosol production from sprays of four irrigation systems used for upland application of wastewater was studied over a range of operating and meteorological conditions by sampling particles from evaporated tracer droplets. Most aerosol-forming droplets were less than 100 mum in diameter with median number diameters from 1 to 3 mum and median mass diameters appreciably larger. More than 10(10) respirable sized particles were produced per minute by single nozzles. Actual wastewater sprays were similar. Diffusion calculations indicate decreases in concentration of 1 to 2 orders of magnitude in 1 km.


Use of a filter disc micro-sampling atomic absorption method for blood lead level screening. The filter-paper disc method using capillary blood was compared with the Delves techniques using venous blood. For routine screening, the filter-paper disc method was found to yield rapid and reasonable results and, in addition, to be relatively inexpensive. The method was used to screen the blood lead level of over 1000 children in pediatric hospitals of four major cities in Canada. Results of the survey are discussed with regard to sampling technique, analytical technique, and the statistical analysis.


Evaluation of hoods for low volume-high velocity exhaust systems. Current practice in the design of exhaust hoods for low volume-high velocity exhaust systems is empirical and evaluation of performance is conducted at the completed installation. A procedure is described for laboratory evaluation of prototype hoods using a simulator in conjunction with a tracer aerosol.


Polysaccharides in lung alveoli.

Polysaccharides in lung alveoli. Rat lung alveolar surfaces and contents were studied after using concanavalin A as a bifunctional agent to link exposed sugars to horseradish peroxidase, in accordance with a technique developed by Bernhard and Avrameas ('71). The Graham and Karnovsky ('69) diaminobenzidine procedure then was used to provide and electron-dense reaction product so as to define the distribution of complex carbohydrates in alveoli. A layer of very dense raction product was intimately associated with the outer leaflets of the luminal plasma membranes of type I and II pneumocytes. Masses of generally less dense reaction product extended irregularly into the alveolar coated by reaction product. When highly ordered tubular myelin bodies were seen, the reaction product filled all the "gutters" created by the intersentions of the membranes. Reasons are presented for believing that the intrinsic periodicity of the tubular myelin may be created and maintained by the domains ol technique. The distribution of autologous albumin, demonstrated by antibody staining by Bignon et al. ('75), apparently coincides with the carbohydrate pattern, suggesting both may be associated as a glycoprotein. The ultimate relationships between carbohydrate moieties and phospholipid membrane systems proved to be of such complexity that we believe it justifiable to think that they also may be truly complexed together.


The features of sperm maturation in the epididymis of a marsupial, the brushtailed possum Trichosurus vulpecula. Possum spermatozoa undergo a distinctive process of maturation in the epididymis, as shown by change in the properties of the sperm surface, by modification of their morphology and by their increasing capacity for progressive motility. Modification of the sperm surface over the head and tail is demonstrated by the different affinities of sperm from successive regions of the epididymis for FITC-conjugated wheat germ agglutinin and concanavalin A, and for cationic ferric oxide colloidal particles. Changes in sperm head morphology are caused by (1) a dramatic reshaping and consolidation of the acrosome in which excess plasma membrane overlying it is sloughed as a cluster of vesicles, (2) a reorientation of the nucleus almost parallel to the axis of the tail and (3) distal movement of the droplet from its initial envelopment of the nucleus to an eccentric position on the anterior segment of the midpiece. Spermatozoa released from the testis and caput epididymidis are essentially immotile or exhibit only lazy uncoordinated movements, whereas many from the corpus and most from the more distal regions of the epididymis display an energetic, progressive motility imparted by a rapid and stiff tail beat of narrow arc. This maturation of the capacity for motility is accompanied by an enhanced stability of the dense fibers and sheath, which became more resistant to the disruptive action of SDS and DTT, and by changes in the ultrastructure of the sperm tail. These include modification of the matrix of the mitochondria and also an unusual differentation of the midpiece into two distinct segments. The anterior segment is defined by profuse peri-mitochondrial stacks of membranes which developed as spermatozoa pass through the epididymis. These membranes, although prominent in mature spermatozoa fixed in situ, appear sparse and disorganised in spermatozoa fixed after 15 to 30  minutes of active motility in physiological medium, suggesting their possible utilisation in motile spermatozoa. The posterior segment is characterised by a thick peri-mitochondrial cytoplasmic sleeve, by spirally arranged parallel fibrous bands immediately beneath the plasma membrane and, subsequently, as spermatozoa pass into the lower corpus epididymidis, by rows of flask-shaped surface invaginations which develop between the spiral bands. Despite broad similarities in the features of sperm maturation in this marsupial and in eutherian mammals, there are distinct differencesin the structural organisation of their spermatozoa, particularly in the pserm head. Until more is known of the details of fertilisation in marsupials the significance of these differences will remain unclear.


Perspectives of clinical students on training in community mental health and community psychology. Three hundred eighty-five advanced doctoral students from 102 training programs in clinical, clinical--community, and community psychology participated in as assessment of their training in community psychology/community mental health (CP/CMH). Significant findings included: (a) 66% consider training in CP/CMH as very helpful to their career goals, (b) 54% are very much interested in post-doctoral training in CP/CMH, and (c) 62% consider the training in CP/CMH available in their graduate programs below adequate. Respondents rated the coverage and adequacy of coverage of 30 CP/CMH-related topics. Only four topics were reported by 50% or more of the respondents as having been covered. For the 30 topics, reported adequacy of coverage ranged from 40% to 67%; the percentage of respondents who considered coverage inadequate ranged from 18% to 56%.


Community mental health ideology and activity interests. Sixty mental health professionals completed two scales: the Community Mental Health Ideology Scale (CMHI), and a scale rating the importance of, and personal interest in, a range of mental health activities. The overall mean CMHI score was comparable to that of clinical psychologists surveyed in the original CMHI study. CMHI scores correlated significantly with subjects' ratings of the importance for the general community to provide a range of services other than direct rehabilitative services. Ratings of the importance for community mental health centers to provide mental health planning and development, and activities directed at general community and social problems, also correlated significantly with CMHI scores. Additionally, CMHI scores were related to personal interest in participating in a broad range of mental health activities. The results contribute to the construct validity of the CMHI and support the notion that community mental health ideology relates to actual mental health activity interest.


Perceptions of community life which distinguish between participants and nonparticipants in a neighborhood self-help organization. Questionnaire, Edwards-Kirkpatrick scale, and semantic differential techniques were used to provide converging measures of psychosocial factors affecting participation in a community self-help organization. This group is attempting to maintain the racially mixed residential character of a neighborhood located in a zone of transition between large tracts of project housing and an area of stores, apartment buildings, and offices on the edge of a southern center city. Results indicate that a complexly integrated set of attitudes toward the area as a place to live, one's neighbors as active and potent yet stable people, and the future as a promising and secure time of life seems to determine attitudes toward and participation in the community organization.


Effect of secretin, glucagon and duodenal acidification on bombesin-induced hypergastrinemia in man. The action of duodenal acidification, of continuous I.V. infusion of secretin and glucagon and of a one bolus I.V. administration of secretin and glucagon at maximal doses on BBS-induced gastrin secretion has been studied in a group of 18 healthy subjects. Continuous infusion of secretin and glucagon and the acidification of the duodenum did not alter significantly the levels of gastrin stimulated by BBS. Secretin and glucagon administered by a single I.V. bolus paritially inhibit the effect of BBS on gastrin levels. On the basis of these results it is not possible to affirm or to exclude the possibility that BBS is a hormone physiologically present in man.


Canine exocrine pancreatic secretory changes induced by calcium or ethanol plus calcium intraduodenal infusion. In dogs provided with chronic gastric and pancreatic fistulas (Thomas cannula), an 80-minute intraduodenal CaCl2 (0.6 mM/kg.) infusion against a background of secretin perfusion (GIH, 1.0 CU/kg./hr.) elicits a complex "pancreon" response consisting of both excitatory and inhibitory effects on the protein and alkaline components, respectively, of pancreatic secretion. It is postulated that these pancreatic secretion changes are the result of the interplay of released CCK and calcitonin. The lack of pancreatic secretion modifications when ethanol (0.7 mg./kg.) was added to the intraduodenal CaCl2 infusion suggests that the former counteracts the effects of the latter on the nerves and/or the endocrine cells of the gut. Ca++ concentration and output in pancreatic secretion did not change significantly either with the intraduodenal CaCl2 alone or associated with ethanol. Fasting blood Ca++ levels were not modified either by the secretin perfusion or by the intraduodenal CaCl2 infusion, either given alone or associated with ethanol.


Histologic and ultrastructural studies of canine pancreas fed an elemental diet. A clinically available elemental diet (Vivonex-100) has been fed to healthy mongrel dogs. Compared to a regular chow diet and regulated so as to maintain a stable weight, no changes were noted on light or electron microscopy and six months' maintenance. Extrapolating, the pancreas shows no evidence of a "resting state" according to this data.


Possible response of acute psychosis in hepatic encephalopathy to levodopa. A favorable response to levodopa in two episodes of hepatic encephalopathy, the latter presenting as acute psychosis, is described in a patient with Budd-Chiari syndrome.


Superior mesenteric artery syndrome simulating acute pancreatitis: a case report. A case of infrapapillary duodenal obstruction secondary to the superior mesenteric artery syndrome is reported. The clinical picture and laboratory data simulated acute pancreatitis but no evidence of pancreatic disease was noted at surgical exploration. A review of the causative factors and treatment of the superior mesenteric artery syndrome is presented along with the differential diagnosis of infrapapillary duodenal obstruction.


An unusual clinical presentation of pancreatic carcinoma: Duodenal obstruction in the absence of jaundice. A case of pancreatic carcinoma, presenting with the uncommon initial manifestation of vomiting secondary to duodenal obstruction without jaundice, is reported. A review of 72 consecutive biopsy-proven cases of pancreatic carcinoma admitted to our institution in the past five years revealed an 8.3% incidence of this unusual primary complaint. Although infrequently reported previously, pancreatic carcinoma should be considered in the differential diagnosis of gastric outlet obstruction in the absence of jaundice. The classic triad of progressive jaundice, weight loss and abdominal pain suggests carcinoma of the head of the pancreas. Emesis, secondary to high grade duodenal obstruction in the absence of jaundice, is an infrequent clinical presentation. The case described is illustrative of widespread pancreatic carcinoma that remained silent until obstruction developed.


Duodenal tuberculosis as seen by duodenoscopy. A case of tuberculous stricture of the third part of the duodenum was detected by duodenoscopy. Endoscopic biopsy, however, failed to reveal the histological diagnosis. The possible role of endoscopic follow-up of tubercular strictures is indicated.


The radiology corner: Longitudinal fistulous tract of the colon and a perianal fistula in diverticulitis. Diverticular disease may mimic many of the symptoms and signs of Crohn's disease. The presence, however, of perirectal involvement and a longitudinal fistula greater than 10 cm. in the wall of the colon are two unusual features of diverticular disease. Discussed herein is a patient who presented with both of these complications.


Inhibition of murine granulopoiesis in vitro by dexamethasone. The effect of dexamethasone on mouse bone marrow granulocyte-monocyte precursor cells (CFU-C) was studied in vitro. Dexamethasone inhibited colony formation in the presence of maximally stimulating concentrations of colony-stimulating activity. A mean colony reduction of 55% occurred at 10(-9) M dexamethasone and inhibition was observed at concentrations as low as 10(-12)M. The dexamethasone suppression could be abrogated by progesterone. These studies provide evidence that the committed granulocyte-monocyte stem cell has a glucocorticoid receptor mechanism that when activated results in inhibition of cellular proliferation in vitro.


Staging laparotomy and splenectomy: treatment and complications of Hodgkin's disease in children. Twenty-five cases of hodgkin's Disease (15 males and 10 females) aged 5 to 17 years were studied from April 1970 to July 1976 (75 month period). Histology revealed that 2 had lymphocytic predominance, 12 had nodular sclerosis, and 11 had mixed cellularity. Pathologic staging revealed that 3 were IA, 1 IB, 5 IIA, 4IIB, 6IIIA, and 6 IIIB. Laparotomy altered the staging in 12 patients (9 were staging up and 3 down). All but 2 patients received extended field radiation, and 5 had recurrence of disease and were treated with combination chemotherapy. Twenty-three are alive without evidence of disease (21-75 months), and the 2 deaths were not due to Hodgkin's Disease but to hemobilia (postliver biopsy) and penumococcal septicemia, purpura fulminans, and disseminated intravascular coagulation (14 months postsplenectomy). Other complications included 2 patients with intestinal obstruction, 1 with postoperative subphrenic abscess, and 1 with streptococcal septicemia and polyarthritis. Nineteen patients received continuous penicillin prophylaxis postoperatively and the 2 with serious infections were amongst the 6 who had not received penicillin or whose penicillin had been discontinued at the time of infection. It is concluded that laparotomy and splenectomy in children is essential for accurate staging but carries significant risk, and continuous penicillin prophylaxis is recommended.


Effect of sialidase on the viability of erythrocytes in circulation. Sialic acid has been detected on the erythrocyte surface of a number of different species of animals. The objective of this investigation was to determine the physiological significance of these sialyl residues to the viability of erythrocytes in circulation. Methods have been described for the determination of total sialic acid on red blood cells and the conditions under which it may be released with sialidase. Chicken, dog, goat, and rabbit were chosen for these studies because of the differences in the amount (3 X 10(6) - 72 X 10(6) resides per erythrocyte), and type (N-acetyl-or N-glycolyl-neuraminic acids) of sialic acid found on the surface of their erythrocytes. Radioactive tagging with Na251CrO4 was used to monitor the effect of sialidase on the viability of erythrocytes upon autologous transfusion. By the two criteria used to assess the viability of erythrocytes-the percentage of erythrocytes surviving 24 hr after the autologous transfusion, and the half-life of those red blood cells in circulation that survive the first 24 h after the autologous transfusion, and the half-life of those red blood cells in circulation that survive the first 24 hr-it is apparent that the presence of sialic acid on the cell surface is crucial for the survival of nonnucleated mammalian erythrocytes. The loss of viability of dog erythrocytes can be elicited by the removal of approximately 10% of the total sialic acid. In marked contrast to the behavior of mammalian erythrocytes, sialidase-treated chicken erythrocytes appear to retain their viability in circulation.


Two new glucose 6-phosphate dehydrogenase variants associated with congenital nonspherocytic hemolytic anemia found in Japan: GD(-) Tokushima and GD(-) Tokyo. Two new variants of glucose 6-phosphate dehydrogenase (G6PD) deficiency associated with chronic nonspherocytic hemolytic anemia were discovered in Japan. Gd(-) Tokushima was found in a 17-years-old male whose erythrocytes contained 4.4% of normal enzyme activity. Partially purified enzyme revealed a main band of normal electrophoretic mobility with additional two minor bands of different mobility; normal Km G6P, and Km NADP five-to sixfold higher than normal; normal utilization of 2-deoxy-G6P, galactose-6P, and deamino-NADP; marked thermal instability; a normal pH curve; and normal Ki NADPH. The hemolytic anemia was moderate to severe. Gd(-) Tokyo was characterized from a 15-year-old male who had chronic nonspherocytic hemolytic anemia of mild degree. The erythrocytes contained 3% of normal enzyme activity, and partially purified enzyme revealed slow electrophoretic mobility (90% of normal for both a tris-hydrochloride buffer system and a tris-EDTA-borate buffer system, and 70% of normal for a phosphate buffer system); normal Km G6P and Km NADP; normal utilization of 2-deoxy-G6P, galactose-6P, and deamino-NADP; greatly increased thermal instability; a normal pH curve; and normal Ki NADPH. These two variants are clearly different from hitherto described G6PD variants, including the Japanese variants Gd(-) Heian and Gd(-) Kyoto. The mothers of both Gd(-) Tokushima and Gd(-) Tokoyo were found to be heterozygote by an ascorbate-cyanide test.


Erthropoietic precursors in mice with phenylhydrazine-induced anemia. Using a methylcellulose cell culture technique, we studied the serial changes in erythropoietic precursors in the femur, spleen, and blood of mice under erythropoietic stimuli. Phenylhdrazine hydrochloride, in the dosage of 60 mg/kg, was injected into mice subcutaneously on days 0, 1, and 3, and mice were sacrified on days 0, 2, 4, 7, and 10 for assessment of erythropoietic precursors. Significant changes were observed for all hemopoietic organs in the number of erythrocytic burst-forming units (BFU-E) and erythrocytic colony-forming units (CFU-E). Only BFU-E were present in blood, and their maximal increase was noted on day 2. While marrow BFU-E continuously decreased, maximal increase of CFU-E noted on day 4. Splenic BFU-E and CFU-E increased until day 4 and declined subsequently. These observations suggest the presence of significant migration of BFU-E in mice under erythropoietic stimuli and stress the importance of studies on all hemopoietic organs in the assessment of murine hemopoiesis.


Specific radioimmunochemical identification and quantitation of hemoglobins A2 and F. Hyperimmune antisera to chromatographically purified hemoglobins F and A2 were produced in rabbits and made specific for the immunogen by adsorption with normal human hemoglobin A conjugated to cyanogen bromide-activated agarose. A radioimmunoassay was established that permitted identification and quantitation of each of these two minor hemoglobins in hemolysates containing other hemoglobin components. The quantities of hemoglobins A2 and/or F present in hemolysates of individuals with beta-thalassemia, sickle cell anemia, Hb-C disease, and other hematological disorders were determined immunochemically, and the results were commpared to values obtained by microcolumn chromatography for the measurement of Hb-A2 or with the alkali denaturation technique in quantitating Hb-F. The immunoassay procedure has a greater sensitivity than other commonly employed techniques and can detect as little as 0.05 mug of these hemoglobins.


Predictive value of cross-matching for transfusion of platelet concentrates to alloimmunized recipients. Compatibility tests in which donor platelets were tested with recipient sera were performed retroactively after 64 transfusions of platelets from 59 unrelated donors to 10 alloimmunized patients. Techniques used were serotonin release, aggregometry, platelet factor 3 release, and lymphocytotoxicity, each of which has been advocated as a means of testing donor-recipient platelet compatibility. Although "false positive" reactions were few (positive crossmatch but satisfactory transfusion response), "false negative" reactions (negative crossmatch but poor transfusion response) were unacceptably high (43% by lymphocytotoxicity, 60% by serotonin release, 76% by platelet factor 3 release, and 83% by aggregometry). We conclude that current methods of detecting isosensitization to platelet alloantigens are less satisfactory than HLA phenotyping in selecting unrelated platelet donors for an alloimmunized patient population.


Tay-Sachs screening: motives for participating and knowledge of genetics and probability. A highly-educated, socially aware group of persons presented themselves for Tay-Sachs screening having learned about it mainly from friends, newspapers, radio, and television but not from physicians or rabbis. After learning that screening was possible and deciding that it is in principle a good idea, and after discussing it with relatives and friends but not with physicians and rabbis, they presented themselves for the test. Although the participants knew that Tay-Sachs is a serious disease and that Jews are vulnerable, few of them knew much about the genetics of the disease, its frequency, or the incidence of the carrier state. This experience of screening for Tay-Sachs carriers suggests the need for physicians to learn the relation of genetics to preventive medicine, and for the public to learn more about the biology of man.


A study of the genetical structure of the Cuban population: red cell and serum biochemical markers. Gene frequencies of several red cell and serum gentic markers were determined in the three main racial groups--whites, mulattoes and Negroes--of the Cuban population. The results were used to estimate the relative contribution of Caucasian and Negro genes to the genetic makeup of these three groups and to calculate the frequencies of these genes in the general Cuban population.


Distribution of complement C3 variants in individuals with cystic fibrosis. The gene frequency for slow and fast electrophoretic variants of complement C3 in Caucasian individuals with cystic fibrosis was similar to the values expected for unaffected controls, thereby ruling out a suspected differential involvement of these phenotypes with the disease. In one family, cystic fibrosis and complement C3 phenotypes segregated independently.


Third component of complement in cystic fibrosis. In a study of C3 levels and phenotypes in 64 cystic fibrosis (CF) patients, 92 CF parents, 64 normal siblings, and 126 healthy controls, significant elevations of mean C3 levels were found in CF patients, their parents, and in one genetic sub-group of their siblins (SS females). C3 concentration in CF patients correlated with the degree of clinical impairment as measured by Shwachman-Kulczycki (S-K) score. No significant differences were found in the prevalences of C3 phenotypes or the S and F gene frequencies among the groups studied.


The Dyggve-Melchior-Clausen syndrome.

The Dyggve-Melchior-Clausen syndrome. Two new cases of Dyggve-Melchior-Clausen syndrome are described; they belong to the fourth family from Lebanon in which this disease has been recognized. There is no genealogical linkage between these four families. A particular feature in these cases is a striking rhizomelic shortness of the arms especially in one case. Clinical and radiological findings, progression of the skeletal changes are studied, along with the review of the cases in the literature. Cytological and biochemical data indicate that the DMC syndrome is not a mucopolysaccharidosis.


Body fat: its relationship to coronary heart disease, blood pressure, lipids and other risk factors measured in a large male population. Obesity is variably considered to be a major contributor to hypertension and hyperlipidemia, and its treatment is recommended in the management of coronary heart disease. Total body fat was measured by tritium dilution in a large male population and its relationship to age, blood pressure, serum lipids, uric acid and the diagnoses of coronary heart disease, hypertension and glucose intolerance was examined. In addition, three commonly used weight: height indices of obesity were correlated with each of these parameters. The correlation of body fat with blood pressure, serum cholesterol and triglycerides, although statistically significant, was of only small magnitude. Mean levels of body fat were not significantly different between patients with coronary disease and control subjects, whereas serum cholesterol and, to a lesser extent, systolic blood pressure were potent risk factors for the disease. It is concluded that obesity is only a minor determinant of blood pressure and lipid level, and that its contribution to coronary heart disease is small or nonexistent.


Plasma arginine vasopressin in the syndrome of antidiuretic hormone excess associated with bronchogenic carcinoma. A study of plasma arginine vasopressin in 17 patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) associated with bronchogenic carcinoma, revealed that the arginine vasopressin levels were distinctly elevated in most. In 14 patients with bronchogenic carcinoma, but without overt SIADH, plasma levels of arginine vasopressin were significantly higher than in normal subjects (p less than 0.001). This, together with the finding of a lower than normal plasma osmolality in this group, suggests that inappropriate ADH excess might be much more common in patients with bronchogenic carcinoma than previously thought. The normal positive correlation between plasma osmolality and plasma arginine vasopressin was found to be reversed in SIADH. Seven of nine patients with overt SIADH, studied after fluid deprivation, showed an increase in plasma arginine vasopressin coincident with an increase in plasma osmolality (r = +0.8, p less than 0.01); in one patient, plasma arginine vasopressin returned to the original level following rehydration. The possibility that this might imply a degree of physiologic control to what is generally considered an autonomous secretion is discussed. It is, however, considered more likely that other factors, including changes in plasma volume and glomerular filtration, might explain the increase in plasma levels of arginine vasopressin.


Candida peritonitis. Report of 22 cases and review of the English literature. Thirty-one patients with Candida isolated from peritoneal fluid were examined. Twenty-two were considered to have Candida peritonitis. The data on these 22 patients, plus 12 additional patients described in the literature, were reviewed. This infection was observed as a complication of peritoneal dialysis, gastrointestinal surgery or perforation of an abdominal viscus. Recent antibiotic administration seemed to be an important predisposing factor. The disease usually remained localized intra-abdominally, although disseminated candidiasis was also noted in three cases. Clinically significant infection could be differentiated from peritoneal contamination with Candida by the presence and persistence of fever, peritoneal signs, peripheral leukocytosis, positive peritoneal cultures for Candida, abnormal films of the abdomen and purulent ascitic fluid. Surgical interventions and removal of infected peritoneal fluid were the cornerstones of therapy. Short-term, low-dose systemic and/or intraperitoneally administered amphotericin B appeared promising in the treatment of unremitting infection. Mortality in treated patients was low and was comparable to that in patients with bacterial peritonitis.


Clinical manifestations of mannosidosis--a longitudinal study. Mannosidosis is a partially defined disorder of glycoprotein metabolism; less than 20 cases have been reported in the literature. In this work, a longitudinal study of five new patients is presented in an attempt to delineate the phenotype and clinical course of this unusual storage disease. The data on our patients and those in the literature indicate that people with mannosidosis appear normal at birth and that their typical phenotype develops by two years of age. This is characterized by a distinctive coarse facies and dysostosis multiplex. Although recurrent infections, hearing loss and mental retardation occur, the course in this storage disorder generally is stable and is compatible with adult life. The diagnosis is confirmed by the presence of a deficiency in alpha-D-mannosidase activity in leukocytes or fibroblasts, by the presence of vacuolated lymphocytes in peripheral blood and foam cells in bone marrow, and an increased excretion of mannose-rich oligosaccharides in urine.


Skin capillary abnormalities as indicators of organ involvement in scleroderma (systemic sclerosis), Raynaud's syndrome and dermatomyositis. Forty-four study patients with scleroderma (systemic sclerosis) (28 patients), Raynaud's syndrome (13 patients) or dermatomyositis (three patients) were observed for skin capillary abnormalities by widefield microscopy and compared with three control groups of 20 subjects each: (1) patients with other rheumatic disease, (2) hospitalized patients with nonrheumatic conditions, and (3) healthy volunteers. The distinctive microvascular pattern (dilated and distorted capillary loops alternating with avascular areas) previously reported in scleroderma and dermatomyositis was observed almost exclusively in the study patients. The severity of capillary abnormalities varied among the diagnostic subgroups, and a positive correlation was found between the degree and extent of abnormal microvascular patterns and multisystem involvement. On this basis, widefield nailfold capillary observations are proposed as a simple, inexpensive, reproducible technic for making an improved early diagnosis and predicting multisystem involvement in scleroderma, Raynaud's syndrome and dermatomyositis, presently a group of loosely associated and overlapping connective tissue disorders which often defy early and precise diagnosis.


Mediastinal irradiation for chronic lymphocytic leukemia. Thirty-one patients with chronic lymphocytic leukemia were treated with mediastinal radiation. In none of the patients was complete remission achieved; either partial remission or clinical improvement was achieved in 52 per cent, but the duration of response was short. The response rate was 77 per cent for the patients receiving a total radiation dose greater than 3,000 rads and 45 per cent for those receiving less than 3,000 rads. Severe life-threatening toxicity was noted in 11 patients and seven of these patients died; two patients died with progressive disease. Severe toxicity was manifested by one or more of the following: bone marrow aplasia, pancytopenia, gram-negative sepsis, generalized herpes zoster and severe esophagitis. Neither the total dose of radiation nor the dose per week correlated withe the severity of reaction or death.


Tuberculous pseudotumors of the liver.

Tuberculous pseudotumors of the liver. A 35 year old man presented with fever, weight loss and adenopathy. The clinical presentation, laboratory studies, liver scan and laparotomy all suggested metastatic carcinoma. Bacteriologic and pathologic studies established a diagnosis of macronodular tuberculosis isolated to the liver. Response to antituberculous drug therapy was rapid. Review of the literature revealed this case to be a rare example of tuberculous pseudotumors of the liver.


Coagulation studies of viral hepatitis occurring during pregnancy. A study of coagulation disorders due to hepatitis A infection occurring during pregnancy was undertaken to determine if the unique coagulation status produced by pregnancy (elevated clotting factors and decreased fibrinolytic activity) was responsible for the increased severity of hepatitis A infections reported for pregnant women from various parts of the world. Of 49 patients studied, 12 (24%) developed hepatic failure and 9 (18%) died. A prolonged prothrombin time and low fibrinogen level were found to be as frequent as previously reported for nonpregnant patients with and without hepatic failure. Thrombocytopenia was less common and a long thrombin time was more common. Although intravascular coagulation was suggested by a lower mean fibrinogen level than expected in late pregnancy, mean platelet counts were similar to controls. The frequency of a positive protamine sulfate paracoagulation test for intravascular coagulation (DIC) was similar to that reported for uncomplicated pregnancy, and was of no prognostic value when performed on admission. We conclude that the severe clinical course of hepatitis during pregnancy in this epidemic was not attributable to a predisposition for DIC. However, once fulminant hepatitis occurred, DIC may have been a clinically significant factor.


Lymphocyte response to phytomitogens in iron deficiency. The lymphocytes of iron-deficient anemic and nonanemic patients have a decreased response to phytomitogens. Treatment of these patients with iron is followed by restoration of the lymphocyte response to normal. These findings indicate an important nonhemoglobin function of iron. Iron deficiency may be a factor in the production or potentiation of immune deficiency.


Massive pulmonary hemorrhage: a rare complication of heparin therapy. A rare complication, massive pulmonary hemorrhage, occurred in two patients who were receiving heparin for pulmonary thromboembolic disease. The site of pulmonary hemorrhage was not found at autopsy. The occurrence of profuse hemoptysis in both patients prior to anticoagulation suggests that this finding may be of value in predicting the risk of pulmonary hemorrhage in a given patient.


Variegate porphyria with unusual neurologic manifestations. A 62-year-old man with variegate porphyria is reported. This is the first case to be described in Greece. Apart from the common features of the disease this patient exhibited sensory loss of the syringomyelic type. Though variegate prophyria with neurologic manifestations is not uncommon syringomyelic type of sensory loss is most unusual.


Involvement of the heart and pericardium in the malignant lymphomas. Seventeen patients with lymphomatous involvement of the heart or pericardium were studied. The series includes eight patients with Hodgkin's disease and nine with non-Hodgkin's lymphoma. All 17 had radiologia evidence of pulmonary, or mediastinal involvement. Cardiac or pericardial disease in seven was apparently due to direct extension of other intrathoracic tumor masses. Cardiac involvement was usually a late manifestation of lymphoma with median onset 20 months after initial diagnosis. Fourteen patients had been treated for stage IV disease prior to the onset of cardiac lymphoma. Only seven of the 17 patients with cardiac involvement were diagnosed antemortem. Four of them are alive without evidence of disease 8 to 68 months after diagnosis and treatment. Because cardiac lymphomas may respond to therapy with prolonged survival, it is imperative that clinicians suspect cardiac or pericardial involvement in lymphoma patients who have radiographic evidence of intrathoracic lesions (especially adjacent to cardiac borders), unexplained tachyarrhythmia or conduction disturbance, evidence of outflow obstruction, or signs and symptoms suggesting pericardial effusion or tamponade.


Altered copper and zinc metabolism in primary hyperparathyroidism. Mean 24-hour urinary excretion of copper and zinc was greater than normal in 17 patients with untreated primary hyperparathyroidism. Mean total serum copper concentration in these patients was slightly greater than the normal mean, whereas mean total zinc concentration was normal. After surgical treatment of hyperparathyroidism there was a transient further increase in urinary copper and zinc concentrations in the 13 patients so studied, with no consistent change in serum copper or zinc concentrations. Five patients were studied for several days after this postoperative peak had passed. Urinary copper and zinc excretion decreased in three in relation to surgical correction of their hyperparthyroidism and remained elevated in one with persistent hypercalcemia. In the fifth patient urinary zinc excretion increased to slightly above the normal range despite successful surgery. These results suggest that changes in urinary excretion of copper and zinc may be useful indicators in the diagnosis and treatment of patients with primary hyperparathyroidism.


Infectious mononucleosis and severe thrombocytopenia. Two patients with infectious mononucleosis who presented with severe thrombocytopenia at diagnosis are described. Anti-platelet antibody was demonstrated in one patient. Both responded well to a short course of prednisone therapy. These cases are of interest in view of their rarity and illustrate the need for screening patients who present with thrombocytopenia for infectious mononucleosis.


Oedipus of Thebes: the myth and its other meanings. Sigmund Freud used the Oedipus myth to represent a crucial part of sexual development. Careful attention to the details of the myth as related by Sophokles points the way to entirely different and fruitful understandings. Myth is seen as an external representation of man's inner life; omens and the gods are viewed in this context. We can then see Oedipus' suffering as inseparable from loss and growth. In his struggle and ambivalence, Oedipus represents that suffering and transcendence for all of us. The myth tells us of the responsibilty, the pain, and the courage which are necessary ingredients in all human growth.


Coexistence of primary endocrine deficiencies: a unique case of male hypergonadism associated with hypoparathyroidism, hypoadrenocorticism, and hypothyroidism. The unique combination of male hypogonadism with hypoparathyroidism, hypoadrenalism, hypothyroidism, diabetes mellitus, and alopecia totalis has been documented in a male patient who has been followed over the past 28 years. In this patient, first seen at the age of six for hypoparathyroidism alone, repeated clinical and laboratory endocrine evaluation detected the sequential development of the additional endocrine deficiencies. The presence of abnormal serum antibodies is consistent with an atuoimmune pathogenesis of this syndrome.


Lupus anticoagulant in myelofibrosis.

Lupus anticoagulant in myelofibrosis. A patient with myelofibrosis who also demonstrates a lupus anticoagulant is reported. The presence of a circulating anticoagulant adds to the list of potential hemorrhagic diatheses in myelofibrosis and also demonstrates myelofibrosis to involve a system that may be separate from the myeloid elements of the bone marrow.


The black slum child and the problem of aggression. The exposure to violence and life-threatening aggression from many sources caused black children from socioeconomically deprived areas to respond in certain adaptive ways. These usually are appropriate for the culture in which the child is raised. Although one response is a paranoidlike reaction, aggression is also displayed directly in an attempt at mastery of the overwhelming frustration and life-threatening aspects of the ghetto. The significance of aggression in the psychotherapeutic relationship, particularly between the white therapist and black child, is discussed, and there is a brief review of the psychoanalytic concept of aggression as it applies to the ghetto child. A case is presented exemplifying these points clinically in a typical black slum child.


Psychoanalytic treatment of the obese person. Part III. This paper is an attempt to clarify some of the issues which face the psychiatrist in his efforts at treating the obese patient through analytic means. A thoroughgoing bias in Western culture impairs the psychiatric and non-psychiatric medical care of the obese person. Inconclusive evidence concerning the causal relation between obesity and chronic disease does not deter this cultural bias from exaggerating the role that obesity is thought to play in disease process. Whatever contribution it makes to physical illness, obesity remains a substantial social disability that is frequently associated with self-hate and feelings of ineffectiveness. Scientific investigations indicate that adiposity is determined by interactions of genetic and environmental influences acting at different levels of complexity within the organism. Hence, the adipocyte itself may influence existing fatness and retard weight reduction. Constitutional factors affecting the hypothalamus may contribute to obesity in certain individuals. Also, cortical effects determine maladaptive eating behavior and excessive adiposity. Poor eating habits which are associated with emotional conflict seem to strongly affect the development and continuance of obesity in most fat persons. The interaction among adipocyte, hypothalamus, and cerebral cortex remains unclear. The various treatments of obesity have been shown to be of little impact in helping overweight persons to sustain weight loss. Diet control, exercise, group psychotherapy, and behavior modification show slight benefit. Recent controlled studies dispute earlier claims that behavior modification is effective in achieving meaningful and lasting weight loss. Claims that intestinal bypass procedures are a useful treatment also require further supporting evidence. Psychoanalytic or intensive sustained psychotherapeutic treatment of the obese person emphasizes exploration of the entire personality. As long-neglected constructive forces are stregthened, weight loss may proceed. Psychoanalytic treatment is not indicated for obesity uncomplicated by neurotic distortions. In the presence of interpersonal problems and personal ineffectiveness, psychoanalysis has real utility. It is not clear that obesity is a major determinant of impaired physical or emotional health. Rather, the medical indictment of obesity seems to stem from the need to justify an intensely negative cultural bias. Casual disregard of this fact and of the complexity involving issues of etiology and treatment may signify inadequate appreciation in the psychoanalyst of the extent to which he participates in this cultural bias. The continuing failure of medical science to devise a means to help fat persons sustain weight loss to any meaningful degree has prevented the development of studies which would show if weight reduction truly does provide uniformly enhanced physical and emotional well-being...


The relationship of family size and spacing to the growth of preschool Mayan children in Guatemala. The height of preschool Mayan children is analyzed with respect to family size and the spacing of their siblings, controlling for parental heights and weights. Data on 643 cases were abstracted from the records of two previous longitudinal studies on the health of children under age five years living in the highlands of Guatemala. Height at age three years is estimated from the linear regression equations fitted for each child to measurements of height repeated at three-month intervals from ages one to four years. Family size is expressed in terms of birth rank, live siblings, and the number of dependent and independent family members. Family spacing is measured as birth intervals, i.e., the number of months between the birth of the index child and his previous and subsequent siblings. Most previous studies have reported that height decreases as family size increases. This study shows that Mayan children from both small and large families are taller than those from middle-sized families. Evidence is presented to support the hypothesis that children in large families are relatively tall because their early-born siblings contribute to the family fortunes. Birth intervals are positively correlated with height. The findings are discussed in terms of their implications for family planning.


Physician management in primary care.

Physician management in primary care. Minimal explicit consensus criteria in the management of patients with four indicator conditions were established by an ad hoc committee of primary care physicians practicing in different locations. These criteria were then applied to the practices of primary care physicians located in a single community by abstracting medical records and obtaining questionnaire data about patients with the indicator conditions. A standardized management score for each physician was used as the dependent variable in stepwise regression analysis with physician/practice and patient/disease characteristics as the candidate independent variables. For all physicians combined, the mean management scores were high, ranging from .78 to .93 for the four conditions. For two of the conditions, care of the normal infant and pregnant woman, the management scores were better for pediatricians and obstetricians respectively than for family physicians. For the other two conditions, adult onset diabetes and congestive heart failure, there were no differences between the management scores of family physicians and internists. Patient/disease characteristics did not contribute significantly to explaining the variation in the standardized management scores.


The effect of antibiotics on mortality from infectious diseases in Sweden and Finland. A study was carried out to determine whether the preexisting decline in mortality rates from infectious diseases accelerated after the introduction of antibiotic and chemotherapeutic drugs. Linear regression curves showed that in Sweden mortality rates declined faster in septicemia, syphilis, and non-memingococcal meningitis after the introduction of these drugs. By contrast, for the ten other infectious diseases studied, (scarlet fever, erysipelas, acute rheumatic fever, puerperal sepsis, meningococcal infection, bronchitis, pneumonia, tuberculosis, typhoid fever, and acute gastroenteritis) no such accelerated decline in mortality could be detected. The findings suggest that antibiotic and chemotherapeutic drugs have not had the dramatic effect of the mortality of infectious diseases popularly attributed to them.