Studies in dose-time-volume relationships in bladder and tongue radium implants. The clinical results of 26 tongue and 31 bladder radium implants were analysed in terms of proposed dose specification parameters that describe the dose-time-volume relationships of the implant. Tongue cases that recurred within two years were mostly those with a relatively short treatment time and in which a relatively large dose reduction factor had to be applied. The dose-time factor did not differ significantly in the groups of bladder implants having different clinical results. A higher incidence of necrosis was noted in bladder cases. This was associated with a significantly higher mean dose and a somewhat greater degree of dose inhomogeneity. Recurrences were generally linked with greater mean dose, target volume and dose inhomogeneity. These unfavourable dose-volume relationships were frequently associated with poor distribution of needles. The reported experimental and clinical findings pertinent to the differential sparing of normal tissues associated with protraction of continuous irradiation are outlined. In the light of these, it is felt that the results of tongue implants could have been improved by omission of the dose-time adjustment factor for treatment time of 3-10 days without undue risk of necrosis. However, bladder results could have been improved by attainment of a better implantation technique while keeping the treatment time within 6-8 days in view of the lower tolerance.


Acute transient radiation hepatitis following whole abdominal irradiation. Sporadic cases or radiation hepatitis have been reported following doses above 3500 rad delivered in 3-4 weeks to the liver. The authors report their experience of radiation hepatitis in two out of 117 consecutive lymphoma cases treated with total abdominal irradiation. These two patients developed clinically overt manifestations which lasted for a short period of time and fully recovered. The dose delivered to the whole liver was 3000 rad in six weeks, but in one an additional 1000 rad in five fractions were delivered to the left lobe in an attempt to boost the dose to the central axis lymphatic system up to 4000 rad. The low incidence of radiation hepatitis and its reversible course, when 3000 rad in six weeks are delivered to the whole liver, is emphasised.


"Early" and "late" breast cancer: a unified concept for treatment. Most women with "early" breast cancer have distant metastases by the time the primary growth comes to diagnosis. This observation is based upon the fact that these frequently appear despite successful removal of the primary growth, and given that they originate from the now no longer present tumour, the inescapable conclusion is that dissemination must have taken place prior to initial treatment. Failure to appreciate this rather obvious point results from shortcomings in available diagnostic technology, and inadequate usage of that which is available. Whether detected early or late, treatment of this disseminated cancer poses a common problem, and the various systemic methods are reviewed. Androgens, oestrogens, progestogens and single drug chemotherapy can, from time to time, produce useful results. By careful selection of patients with appropriate metastatic patterns, these methods may yield improved response rates up to 50% but, by and large, experience remains disappointing with across the board representative figures of perhaps 25% response being commonplace. Additionally, these methods are not without their side effects which can be distressing, and indeed on occasion life-threatening. Their short-comings have led to the development of cyclical combination chemotherapy as here reported. Cyclophosphamide, vincristine, 5-fluorouracil and methotrexate are administered for five consecutive days per month. The results obtained in 100 patients treated with this technique are compared with the authors' previous  experience with norethisterone acetate and hypophysectomy. Whether the results are considered in total or broken down into prognostic categories such as predominant metastatic pattern, disease-free interval, or age, combination chemotherapy has a clear advantage over other techniques. Whilst this experience does not constitute a randomised trial, it is considered that the results are so superior to previous treatment techniques as to render such a study unnecessary or even unethical. It is proposed that combination chemotherapy should constitute the first line of treatment for overt advanced breast cancer. It is further proposed that its role should be explored at an earlier stage in the treatment of breast cancer. Before this can take place however, treatment must be made less demanding and less toxic. Further research is underway with these aims in mind.


Shunt blockage in hydrocephalic children: the use of the valvogram. Shunt blockage in valve-dependent hydrocephalic children is not always recognised, as symptoms may be non-specific and signs inconclusive. Valvography is a simple, easily interpreted technique for the investigation of shunt patency in children with Spitz Holter values in the shunt system. The technique affords a simple, rapid method of demonstrating patency at the cardiac end of the shunt. Fifty-one valvograms have been performed in 36 children. In 25 obstruction of the lower end was demonstrated. The unreliability of some associated signs is demonstrated. No serious complications have been observed and the technique has proved an invaluable addition to the practical management of these children.


Transitional cell carcinoma of the kidney. Transitional cell carcinoma is an uncommon disease of the renal pelvis, the diagnosis of which depends largely upon radiological investigation. Thirty-eight such tumours in 37 patients have been reviewed to establish the examination of choice. High-dose excretion urography, tailored to the presenting problems, is the primary investigation and the results fall into five main groups. Each presents different differential diagnostic problems. Discrete filling defects within the pyelogram (group I) may be overlooked, but, when seen, can be diagnosed on urography alone. Filling defects with dilated calyces (group II) are easily seen and readily diagnosed. Calyceal obliteration (group III) presents more difficulty in diagnosis and may require retrograde pyelography and selective renal angiography. Hydronephrosis with renal enlargement (group IV) is easily confused with uncomplicated primary pelvic hydronephrosis and will usually require antegrade pyelography for diagnosis. Reduced function without renal enlargement (group V) cannot be diagnosed on excretion urography and requires both retrograde pyeloureterography and selective renal angiography.


Pyonephrosis.

Pyonephrosis. The clinical and radiological features of pyonephrosis are reviewed, based on a consecutive series of 40 cases. There were 32 female and eight male patients, with a peak incidence in the 50-59 year age group. In 63% of cases the right kidney was involved. Almost all patients complained of loin pain and 48% had lower urinary tract symptoms. In 58% of cases a renal mass was palpable. An anaemia, pyuria and elevated blood sedimentation rate were usual. Plain films of the abdomen revealed enlargement of the outline of the involved kidney in 75%, ipsilateral absence of the psoas shadow in  63% and urinary tract calculi in 60%. At high-dose excretion urography a nephrogram was obtained in 58% of cases and a pyelogram produced in 34%. No single clinical or radiological entity emerged, there being an unbroken spectrum of disease ranging from infected hydronephrosis to xanthogranulomatous pyelonephritis. There is an increasing incidence of calculi, loss of the renal and psoas outlines and reduced renal function with increasing chronicity of disease. High-dose excretion urography is the investigation of choice since  not only  may the diagnosis be established but also there precise pathological state of the involved kidney. Further radiological investigation is infrequently required.


The incidence and importance of renal duplication. The excretory urograms performed on 1716 children and 3480 adults have been examined to find the incidence and complications of renal duplication. Ninety-five patients with duplication were found, unilateral in 79 and bilateral in 16 patients. It was equally common on each side and twice as common in females as in males. Non-duplex kidneys had a mean of 9.4 calyces and duplex kidneys had a mean 3.7 upper and 7-6 calyces in lower moieties. In patients without renal disease and with unilateral duplication the two kidneys were equal in size in 39%, and the duplex was smaller in  10%. Twenty-seven per cent of the duplex kidneys examined showed evidence of disease compared to 3% of the non-duplex kidneys-a significant difference (P less than 0-001). Saddle reflux is the only abnormality unique to duplication and was seen in one patient. Extravesical ectopic ureter and ureterocoeles are known to be associated with renal duplication, but in this series ureterocoeles were found only on the non-duplex side. The duplex kidney in children is more susceptible to reflux than is the non-duplex kidney, and this leads to both ureteric and pelvi-calyceal dilation, and to chronic pyelonephritis in the duplex side in those children who develop urinary tract infections. Chronic pyelonephritis was found in 22% of patients under 15, significantly more often than in adults (P less than 0-001), although the incidence of duplication was unchanged. It is concluded that there is no real increase in the number of children with duplex kidneys having urinary tract infections, and the vast majority of duplex kidneys do not become diseased.


Urinary tract changes in obstetric vesico-vaginal fistulae: a report of 216 cases studied by intravenous urography. Intravenous urographies carried out routinely on 216 cases of vesico-vaginal fistulae were reviewed. All the patients had suffered from urinary incontinence following obstructed labour for periods varying from immediate post-partum period to as long as 35 years with the majority (48%) presenting in the first year of the disease. One hundred and eleven patients (51-4%) showed no urinary tract abnormality. Calyceal abnormality was graded from 1-5 in ascending order of severity. The most frequent abnormality was Grade 1 (or minimal calyceal blunting) found in 75 (71%) of 105 cases showing lesions. Ten patients had non-functioning kidneys. There was no correlation of severity of calyceal grading with duration of the disease. Other notable changes were hydroureter in 75 (34%), medial deviation of the terminal ureters in 21 (9-7%) and bladder calculi in four. The study reveals a high risk of morbidity to the kidneys in patients with vesico-vaginal fistulae and the predominant role of fibrous itssue in tis genesis is postulated.


The radiology of the intrauterine contraceptive device. Some intrauterine devices are of low radiographic density and require careful technique for their demonstration. The main indications for radiology are to exclude deformity, which reduces the loop's efficiency, perforation of the uterus, or expulsion of the loop.


Two radiological observations on chest radiographs of children. A. The frequency with which a ring shadow of the anterior bronchus could be clearly seen was investigated. The annual radiographs of the same normal children studied in another paper (Simon and Rona, 1976) were examined to see how often a small 3-5 mm ring shadow lying laterally near the upper part of the hilum could be clearly seen. This was the ring shadow most frequently seen and appears to be due to the anterior bronchus seen end on. B. In some children vessel size in the upper lobes is the same as that in the lower lobes. This tends to change to the adult pattern as the child grows older.


Standard of the descending (basal) pulmonary artery in children from the routine chest radiograph. The right and left basal artery have been measured in serial radiographs taken annually for 3 years or more, in 48 boys and 45 girls, all clinically normal. Centiles were constructed from 5 to 15 year old children. A study of the gain in size revealed a growth spurt during the pubertal period corresponding to that seen with height or weight gain. Correlations were found between right basal artery size (RBA), height and weight. Between 22 and 40% of the RBA diameter can be explained by these two metric traits. Multiple regression equations were therefore constructed to predict the diameter of the artery from a knowledge of the height and weight of the person. It is suggested that these can be of help especially in borderline cases when the size of the basal artery falls between the 90th and 97th centile. A study of 14 patients with a diagnosis of pulmonary hypertension or increased blood flow or both were plotted on one of these charts. In 11 the RBA was above the 97th centile. In three who had high pulmonary artery pressure. the RBA was of normal width and they may well have been near or in the Eisenmenger situation. The limiation in that situation was underlined.


The prevalence of gallbladder disease in patients with ileostomy. The prevalence of gallstones has been examined in an unselected group of ileostomy patients who had undergone surgery for ulcerative colitis. In this group 11 of 55 patients were found to have gallbladder disease which is an overall incidence of 20%. This is considerably higher than that found in a control population in the same area.


The plain abdominal radiograph in pneumatosis coli. The clinical features and plain film findings in 14 patients with pneumatosis coli are described. Nine had oxygen treatment. The plain radiographic appearances are analysed and their value in diagnosis is presented. It is concluded that the plain abdominal radiograph is a simple and effective way of monitoring the progress of patients undergoing oxygen therapy.


Acute arterial occlusions.

Acute arterial occlusions. Aside from a ruptured aneurysm or an acute myocardial infarction, acute arterial occlusion is one of the most pressing of the nontraumatic situations facing the physician. Administration of sodium bicarbonate, papaverine, and heparin will often provide the extra few hours needed to get the patient into the hands of a vascular surgeon for surgical removal of the occlusion. Occasionally, one finds a candidate for the use of streptokinase. Regardless of the mode of therapy chosen, post-treatment angiograms are very important, for they often elucidate atherosclerotic lesions amenable to elective reconstructive surgery.


The diagnosis of pulmonary embolism.

The diagnosis of pulmonary embolism. Objective documentation of pulmonary embolism is an essential prerequisite for appropriate treatment (Figure 7). A chest film, as well as measurement of arterial blood gases, should be obtained immediately, and if the lung fields are essentially normal, a lung scan should then be performed. If the scan shows a definite perfusion defect characteristic of embolism, this provides sufficient evidence to establish a diagnosis of pulmonary embolism. The presence of hypoxemia with a low arterial pO2, further confirms the suspicion of a ventilation-perfusion abnormality, and anticoagulant therapy with heparin should be initiated immediately. Should the chest film show abnormalities in the same anatomic areas in which perfusion defects are present on the scan, further investigation by pulmonary arteriography is required to substantiate the diagnosis. The use of pulmonary angiography for documentation of pulmonary embolism is also indicated at the outset when certain specific disorders that confuse scan interpretation are also present-chronic obstructive lung disease, emphysema, asthma, congestive cardiac failure. Assessment of the arterial blood oxygenation simultaneously with the estimated occlusion and the hemodynamic data can be used as a prognostic index as therapy progresses.


Social class and group therapy in a working class population. In a clinic in which the assignment of patients to therapy was demonstrated as not affected by social class and in which no patient was excluded as unsuitable, 45% of those referred to group therapy stayed 2 or more years. The only category that consistently correlated with not remaining in treatment was that of unemployment. When unemployed persons were included there appeared to be a significant correlation between a stay of  2 or more years and social class. When only employed persons were considered, this significance disappeared.


Citizen participation in the decision-making activities of formal social service agencies: an unreasonable goal? In the past, attempts by social service agencies to include nonprofessional area residents in program planning and policy-making activities have met with little success. Such failures may be due in part to mistrust and a feeling that the agencies and their programs have little relevance to the problems faced by most people. Perhaps an alternative way of developing resident participation in community action programs would be to move the planning and decision-making process away from the trained experts associated with formal institutions to the residents within the neighborhoods themselves. The people living within a defined community would decide which problems they wish to address, and then use resources available within the community to solve them.


Predictors of the duration of therapy for clients in the community mental health system. Single and multiple correlates for premature termination and duration of treatment were examined for 13,450 clients seem in 17 community mental health facilities. Predictor variables included seven demographic characteristics of clients and five characteristics of service (type of personnel seeing clients, assignment to in- or outpatient programs, diagnosis rendered, assignment to therapy or diagnostic services, and assignment to individual therapy or other services. Results indicated that clients who are members of ethnic groups, who have low educational backgrounds, who are seen by paraprofessional staff, and who are assigned for diagnostic services quickly terminate at community mental health facilities.


Training crisis intervention specialists and peer group counselors as therapeutic agents in the gay community. This paper describes the development of a training program to provide unique services to homosexuals in crisis. The focus of the program was on the utilization of gay nonprofessionals as therapeutic agents in specific crisis situations and the development of a follow-up program to prevent future crises. Emphasis was placed on many aspects of the social milieu to provide comprehensive community intervention.


The role of folk healers in community mental health services. This paper deals with the relationship between sociocultural factors and psychopathology in Hispanic groups in a disadvantaged urban area. The data were drawn from a 6-year collaborative undertaking between the Lincoln Community Mental Health Center and two local spiritualistic centers in the Southeast Bronx, New York. Comparisons are offered between classical mental health personnel and indigenous folk healers with emphasis on terminology, means of communication, and diagnosis techniques, as well as the utilization of social behavior and moral values. Relevant inferences are drawn regarding the broader relationship between religion and psychiatry. The importance of understanding of utilization of local folk resources in the planning and implementation of mental health services in urban ghettos is documented.


Decentralization of forensic services.

Decentralization of forensic services. Decentralization of mental health services to persons in contact with the criminal justice system is essential in the application of community mental health concepts. This is feasible considering the levels of "dangerousness" of such persons, costs of the typical isolated central facility, and implications of the Supreme Court decision Jackson v. Indiana (406 U.S. 715, 1972). In Tennessee, reform began with legal review of unit records, pretrial screening in mental health centers, revision of state law, liaison with the Tennessee Board of Pardons and Paroles, and use of consultant staff. The results are positive wherever decentralization of services has been maintained.


Behavior therapy techniques as a fulfillment of community mental health ideology. Due to value orientations, lack of knowledge, or exposure, the behavioral approach has been avoided by many professionals in the community mental health field. This is unfortunate, because many concepts of behavior analysis are identical to some of the guiding principles of the community mental health movement. Furthermore, the methods derived from a behavioral framework can help implement the community mental health idiology. This paper identifies possible linkages in the areas of treatment, client population, and evaluation.


Computer processing of oxygen dissociation curves. Oxygen dissociation curves (ODC) plotted by a semi-automatic analyzer are subsequently processed by a digital computer. This computer processing provides a complete determination of the ODC, hence offering more information than the single P50 generally used. The programs consist of three successive modules each with a higher degree of sophistication in the processing. The mass handling of the curves is also described.


Computerized tomography using a modified orthogonal tangent correction algorithm. A modified orthogonal tangent correction algorithm is presented for computerized tomography. The algorithm uses four X-rays scans spaced 45 degrees apart, to reconstruct a transverse axial image. The reconstruction procedure is interative in which image matrix elements are corrected by alternately matching the two sets of orthogonal scan data. The algorithm has been applied to phantom data as well as to video recorded fluoroscopic data.


A method of computing drug distribution in plasma using stepwise association constants: clofibrate acid as an illustrative example. A program is described to compute the distribution of ligand among various complexes of ligand and protein using stepwise association constants. The key input data consists of stepwise association constants and the concentration of macromolecule and various concentrations of ligand. The key output data consists of the concentration of free drug and protein and the concentration of the various complexes.


CHRONOS: a data base management package for physicians and researchers. This paper describes a general data base management package defined for medical applications. CHRONOS is a user-oriented system which has been designed for physicians to get periodical reports and for researchers to prepare statistical treatments. The basic principles of the data base and program organization are described: many possibilities are offered for data acquisition and specific efforts have been made in order to analyze easily the evolution of patients. Several medical applications are now operational with CHRONOS in fields as different as psychiatry and nephrology.


A DATA MANAGER for the health information system Berlin. The needs for permanently changing the logical and physical structure of a medical datebase during the development of a health information system have initiated the project of implementing a DATA MANAGER. The concept of the DATA MANAGER covers facilities for the development of the logical data structure model including documentation of the model and programming support for application programs accessing the health information system (HIS) database. The outstanding facilities of the INTERLISP system have been found to be appropriate for writing the DATA MANAGER. A first data structure model, on which the DATA MANAGER will operate, is roughly outlined.


A data structure model for a health information system. The Ministry of Health and Environmental Control of Berlin is developing a Health Information System (HIS) on the basis of a multi-satellite network system, comprising a central, regional, local and functional unit level. The main part of this paper describes the conceptual structure of the Common Data Base (CDB) of HIS with special regard to the patient-oriented medical information originating from the various institutions of the health care system. This structure comprises the following five levels: 1. PATIENT 2. PROBLEM 3. CASE 4. EVENT 5. ACT Each of the levels represents a node in the structure model. A node is an entity with a set of "local properties" being specified for each level, referring to selected data on inferior levels. The structures of these five levels are described in detail. In the last part, so-called "data-manipulation procedures" are treated. These are descriptions covering any data manipulation and represent the basis of data integrity through system controlled transaction with the data base.


A computer system for handling data from bacterial sensitivity testing. A computer system for handling data collected from antibiotic sensitivity testing of clinical bacterial isolates is described. The system allows a rapid handling of the information collected, supplying the ward and laboratory with cummulative data on each patient. The bacteriologist and the clinician are thus suitably armed when creating a rational antibiotic therapy.


A program for fitting of hypnograms and other biological data by orthogonal polynomials. Many biological phenomenon are nonlinear and poorly approximated by linear regression. The program POLFIT calculates curvilinear regressions by fitting of orthogonal polynomials. This program, as well as two supporting programs (CORREC: disk storage, and CALCML: calculation of cumulated values of series of observations), was primarily designed for the study of the temporal organization of sleep components. They can be used as well for any other kind of biological data.


Echocardiographic study of left ventricular posterior wall motion in angina pectoris. Echocardiographic study of left ventricular posterior wall motion was performed on 22 healthy subjects, on 7 cardiac patients without angina, and on 12 patients with angina pectoris, at rest and during supine exercise on a bicycle ergometer. Resting values did not differ significantly between patients with angina and control subjects. During submaximal ergometric exercise, the systolic excursion of the left ventricular posterior wall as well as the maximal systolic and diastolic velocities increased considerably in all groups. The degree of the changes was essentially similar in patients with angina and in healthy subjects. During chest pain, however, all three parameters of posterior wall motion decreased markedly, especially the systolic excursion, which fell well below the resting level. This phenomenon is attributed to the reduction of the work of the heart during chest pain.


Haemodynamics and myocardial metabolism in patients with obliterative coronary arteriosclerosis and tachycardia induced by pacing. Fifty-three men with significant obliterative arteriosclerosis of coronary arteries were examined at rest, during and after pacing. Pacing induced both angina pectoris and depression of the ST segment in 38% of the patients; either angina pectoris or depression of ST segment, in 32% of the patients; the remaining 30% of patients were without symptoms or ECG signs of coronary insufficiency. Haemodynamic findings at rest, or during and after cessation of pacing were not different between these groups. Pacing increased heart rate, cardiac index remained unchanged, the stroke volume decreased, the left ventricular ejection time shortened. In both systemic and pulmonary arteries the systolic pressures decreased, the diastolic and mean pressures rose. The left ventricular end-diastolic pressure decreased. In 28 of the patients the myocardial metabolism was investigated. A close correlation was found between positive symptoms and ECG signs of myocardial ischaemia on the one hand, and metabolic signs on the other hand. Absence of angina pectoris and depressions of the ST segment during pacing does not exclude the presence of metabolic signs of ischaemia; an opposite finding is about three times less frequent. The study offers objective information about haemodynamics and myocardial metabolism before, during and after pacing, and represents an attempt of a simple classification of symptoms and signs of induced ischaemia.


Cardiac lesions in nonspecific aorto-arteritis. Cardiac conditions were examined in 48 patients with nonspecific aorto-arteritis. The authors assume that nonspecific aorto-arteritis may be accompanied by lesions, although usually moderate, of the valvular apparatus. Such defects, even moderate ones, are accessible to intravital diagnosis based on auscultation findings. Additional study is required for resolving whether such valvular defects are manifestations of the primary disease or sequelae of nonspecific aorto-arteritis combined with a rheumatic affliction. The most frequent form of cardiac lesion, however, is myocardial hypertrophy resulting from systemic hypertension. Signs of coronary insufficiency may signalize coronaritis and result from relative coronary insufficiency. Besides, there also occur symptoms of myocardial dystrophy, which in some patients may be caused by thyrotoxicosis, occasionally encountered in patients with nonspecific aorto-arteritis.


Influence of nutritional status and tobacco smoking on the development of atherosclerosis in male manual and brain workers. Atherosclerotic changes in the aorta and coronary arteries (stained with Sudan IV) were appraised by a visual planimetric method. The material had been obtained in a WHO-sponsored epidemiological study of atherosclerosis, carried out in Tallin, Riga, Kharkov, Ryazan, and Yalta. The authors examined vessels obtained from 430 practically healthy men of various nutritional status, deceased when aged 40-69 years. The influence of tobacco smoking was investigated by analyses of vessels obtained from 313 men -- heavy smokers, and 82 non-smokers, deceased when aged 30--69 years. The results obtained justify the conclusion that the accelerating effects of over-nourishment and tobacco smoking on the development of coronary vascular atherosclerosis were much more pronounced in male brain-workers than in male manual workers.


The action of arterial hypertension on lipid and lipoprotein metabolism. I. Salt, adrenal-regeneration and renal (Goldblatt) hypertension. The purpose of the investigation was to study the alterations in the lipid and lipoprotein content in the blood serum, the liver and the aortic wall of rats with experimentally induced salt, renal (Goldblatt) and adrenal-regeneration hypertension. The experiments were carried out on 59 Wistar rats (25 normotensive controls). It was established that both the serum and the liver lipid patterns vary in the three experimental models of hypertension. Thus, while in salt-induced hypertension no hyperlipidaemia and hyperlipoproteinaemia were established, in renal hypertension the serum lipid and lipoprotein levels were significantly increased in comparison to the controls. The cholesterol content in the liver was increased in all the three models of hypertension. The remaining lipid fractions were within normal ranges or a little decreased in salt-induced hypertension, while in renal and adrenal-regeneration hypertension their quantity was significantly increased. A two weeks' treatment with hypotensive prostaglandin E1 diminished the lipid and lipoprotein contents in the liver of rats with adrenal-regeneration hypertension, only cholesterol remaining unaltered. The blood serum level of free fatty acids increased in all the three models of experimental hypertension, as did the cholesterol and beta-lipoprotein level in the aortic wall. The alterations in lipid and lipoprotein metabolism established in this study are regarded as specific for the hypertensive process itself, since no histological alterations characteristic of atherosclerosis were observed.


Mild hypertension at young age--a long-- term follow--up. Out of a group of persons who had had mild hypertension (170/100 mmHg) at the age of 14--29 in the years 1952--1954, 72% were re-examined after 20 years. A surprisingly large part of them (36.3%) had a normal blood pressure even without any treatment during last 15 years. In 43.4%, the hypertension is now stabilized, and in 20.3% a progression of hypertension was found. The prognosis of a mild juvenile hypertension is significantly related to the family history of hypertension, the longevity of parents, and to the initial level of blood pressure.


Prevalence of hypertension in children and adolescents. The children in the population of the district of Prague 4 were screened for the prevalence of hypertension. From the age group 6--11 years (1st--5th forms), a representative sample was selected, comprising 2 152 children; of the age group 12--19 years (6th--9th forms and adolescents), 90% of the population (11 323 individuals) were examined. The arbitrarily set criteria of hypertension 130/80 mmHg in the children aged 6--11 years and 135/80 mmHg in those aged 12--19 years, were found acceptable for identification of potential hypertonics. In the population examined, such or higher pressures were found in 0.5--3.4% of the subjects examined. By thorough clinical and laboratory examinations of children aged 11--15 years with elevated blood pressures the participation of secondary hypertension was determined. In comparison with a control group, these children exhibited statistically significantly more frequent diseases, obesity, and faulty regimen of living, as well as hypertension in their parents.


Light and electron microscopy of laser microirradiated nucleoli and nucleoplasm in tissue culture cells. This manuscript describes in precise detail the ultrastructural alterations produced as a result of laser micoirradiation of nucleoli and nucleoplasm of tissue culture cells. Because of the general difficulty of single cell recovery, flat embedding, and serial sectioning, very few studies have ever been conducted on microbeam irradiated cells; yet the use of the microbeam technique has become widespread in functional studies of the nucleus. The results presented here demonstrate two classes of lesion material: small spherical electron dense bodies 0.05-0.02 mum in diameter and a larger, more irregular electron dense material up to 1 mum in length. The occurrence of these different types of lesion materials is described in control irradiated nucleoli and nucleoplasm, irradiated nucleoli and nucleoplasm in quinacrine treated cells, irradiated nucleoli and nucleoplasm in actinomycin D treated cells, and irradiated nucleoli and nucleoplasm in combined actinomycin D and quinacrine treated cells. In all the cells in which actinomycin D was employed, nucleoli were selectively irradiated in either their granular or fibrillar zones. The results of the ultrastructural studies are discussed in light of earlier functional studies.


Auditory vocabulary of the right hemisphere following brain bisection or hemidecortication. Unilateral scores of two commissurotomy and three (one left and two right) hemispherectomy patients were obtained on standardized auditory language comprehension tests which use pointing responses to a pictorial array. Unilateral performance by the commissurotomy patients was achieved by restricting the pictorial array to one visual half field, using a novel contact lens system which permits ocular scanning of the lateralized stimulus and self-monitoring of task performance. Using the Peabody and Ammons Picture Vocabulary Tests, the auditory vocabulary in the disconnected or isolated right hemispheres was found to be equivalent to that of normal subjects of ages 8:1 to 16:3 with a mean of 11:7 (eleven years and 7 months old). At the same time, standardized aphasia tests showed that the picture vocabulary in the right hemispheres is similar to that of a heterogeneous population of aphasics, even though the right hemispheres did not behave quite like any classical aphasic diagnostic group. No significant differences were found between right hemisphere comprehension of object vs. action names. Results indicated that vocabulary as a function of word frequency followed the  same pattern in the right and left hemisphere although the right hemisphere was consistently lower. This parallel between the two hemispheres was conjectured to reflect some similar or even shared lexical structures in the two hemispheres. Together with other data on the performance of the right hemisphere on the Token Test (Zaidel, 1976), the results suggest a complex model of the development of language laterality in the brain, in which some, but not all, auditory language functions continue to develop in the right hemisphere past what is generally regarded as the critical period for language acquistion. In general, auditory language comprehension is better characterized as that of an "average aphasic" than that of a child of a specific age.


Constructional apraxia in patients with discrete missile wounds of the brain. Sixty patients with missile wounds confined to one of the four quadrants of the brain were investigated. All patients had neurosurgical verification of the limits of their lesions. The incidence and severity of constructional apraxia was studied using the WAIS Block Design and Object Assembly subtests, and the Bender Gestalt Test. A uniformly significant caudality effect was obtained with more posteriorly localized lesions resulting in more severe constructional apraxia. A significant laterality effect was obtained on two of three criterion measures with uniformly inferior performance by patients with right hemisphere lesions. The magnitude of the laterality effect, however, was less than that of the caudality effect for all criterion variables. The degree of severity of constructional apraxia in patients with right posterior lesions was uniformly greater than that of patients with other quadrant loci. The incidence of constructional apraxia in the four quadrants varied as expected with the left anterior lesion sample showing very little evidence of constructional apraxia, while the right posterior sample showed a high incidence of such deficits. The absolute incidence of significant constructional apraxia in all samples was suprisingly low. This finding might be partially accounted for by the age and general good health of the subjects studied, the relative absence of general cognitive impairment in the majority of subjects, and the discrete nature of the lesions.


The occurrence of visual neglect in patients with unilateral cerebral disease. Visual neglect for the contralateral space has been reported to occur more frequently and more severely following right than left brain damage. The present study sought to determine whether this hemispheric difference is task dependent, i.e. is maximal for tests demanding a thorough exploration and minimal for tests leaving space scanning to the patient's initiative. The findings supported this hypothesis. When the occurrence of neglect was assessed by means of a copying drawings test omissions of details contralateral to the involved hemisphere were found only in the right brain-damaged patient. When the patient was required to bisect a line or to choose the correct response among the alternatives of the Raven test, a tendency for preferring the homolateral hemi-space was also shown by left brain-damaged patients, although it was much more marked in the right-sided group. When patients were asked to insert balls in the holes of a board, both hemispheric groups showed a preference for the homolateral space. The incidence of constructional apraxia was evaluation in the same hemispheric groups and found not to be significantly different.


Effects of unilateral hemispheric lesions on two types of optico-geometric illusions. Two optico-geometrical illusions--the Müller-Lyer (ML) and the Ponzo (P) illusion--have been studied in normal subjects and in patients with unilateral cortical lesions. Patients with left-sided lesions have stronger illusions than normal subjects, the increase being significant only for the ML illusion. In the case of right-sided lesions, the P illusion is weakened while the ML illusion is equivalent to that of control subjects. The findings are discussed in relation to the mode of apprehension of information.


Iconic recognition of musical symbols in the lateral visual fields. Subjects with formal musical training were tested tachistoscopically in order to obtain thresholds for recognizing single notes a staff, presented successively to the lateral visual fields. They were also tested on backward visual making of the same stimuli to determine the interstimllus interval needed to escape the masking effect (critical ISI). Response requirements in threshold and ISI conditions were nonverbal (depressing an organ key), or verbal (indicating the stimulus by name). Recognition threshold for notes were lower in the right visual field than in the left, and verbal responses were easier than manual responses in the threshold condition. However, critical ISIs were lower in the left field than in the right, and ISIs from the left visual field were lower with manual responses than with verbal responses. These findings support the idea that (a) threshold and ISI represent separate levels of perceptual processing, and (b) in trained subjects, the ability to recognize musical symbols may be governed by the left hemisphere, while the information-processing stage of iconic storage may occur in the right hemisphere.


The nature of comprehension errors in Broca's conduction and Wernicke's aphasics. The purpose of the study was to ascertain if Broca's aphasics have a comprehension defect which is dependent on syntactic relationships, to ascertain how this comprehension defect, if present, is different from that seen in Wernicke's and conduction aphasias. Twenty-six aphasic patients (nine Broca's eight conduction, nine Wernicke's) and eight controls were given a test which helped differentiate comprehension errors caused by syntactic incompetence from those caused by lexical incompetence. Wenicke's aphasics made significantly more lexical errors than each of the other groups. There were no significant differences between the lexical errors made by the other groups (Broca's, conduction, and control. There were no significant differences between Broca's and conduction aphasics, however both these groups made more syntactic errors than the controls.


Left-handedness and cognitive deficit.

Left-handedness and cognitive deficit. Intellectual and performance measures were taken on 7688 school children tested on three behavioral measures of handedness and one measure of eyedness. Test results were compared against all combinations of handedness and eyedness and against a measure of socio-economic level. No relationships of any kind were found. Comparisons of the present results are made against 33 studies concerned with possible deficits associated with left-handedness. The results of the present study combined with a review of the majority of studies on deficit and handedness strongly suggest that the hypothesis of no difference in intellectual and cognitive performance between right- and left-handed subjects can be accepted as true.


Memory changes after unilateral electroconvulsive therapy with different electrode positions. In the course of a series into the effects of unilateral electroconvulsive therapy on memory functions,double-blind cross-over intraindividual comparison were performed after the second and third treatment in patients suffering from depressive syndrome. The main aim of the project, which is still in course, was to explore the possibility of a further reduction of the side-effects of this antidepressant method. Three separate comparisons were performed between unilateral nondominant temporo-parietal ECT and (a) unilateral dominant temporo-parietal ECT, (b) unilateral non-dominant fronto-parietal ECT, (c) unilateral non-dominant fronto-fronto ECT (Figure 1). The treatments were given under total anaesthesia and with subtotal muscle relaxation. Four memory tests were administered three hours after the second and the third ECT, the treatment methods being allocated at random. The 30 Word-Pair Test is mixed audio-visual recall verbal test. The 30 Figure Test is mainly visual recognition test with items which can be easily verbally patterned. Further, two visual recognition tests, the 30 Face Test and the 30 Geometrical Figure Test, composed of not easily verbalized items were administered. For each test, three memory scores were obtained, immediate memory score (IMS, immediately after the presentation of the items, three hours after ECT), delayed memory score (DMS, three hours after IMS) and their differenc, forgetting score (FS). IMS is considered to be a function of the hypothetical memory variable, learning, and FS a function of the variable retention. DMS is related to both learning and retention. When non-dominant and dominant temporo-parietal ECT are compared, there are, after non-dominant ECT, significantly lower IMS and DMS in the 30 Face Test but only lower IMS in the 30 Geometrical Figure Test. The difference in DMS for the 30 Word-Pair Test is in the opposite direction (Figure 2). In the comparison between non-dominant temporo-parietal vs non-dominant fronto-frontal ECT, a slightly, non-significant, lower IMS in the 30 Face Test is apparent (Figure 4). Other important trends are not found in any of the studies (Figures 2-4). The results show that differential effects are obtained with different memory material when dominant and non-dominant electrode positions are used in unilateral ECT. The results are discussed in relation to the question whether high level perceptive function or memory is involved in the encoding-storage of complex non-verbal material in the non-dominant hemisphere.


A behavioral manifestation of the development of interhemispheric transfer of learning in children. Two hundred and fifty normal, right-handed children ranging from aged 5 to 15 were administered measures of grip strength, finger-tapping speed and the Tactual Performance Test. In order to assess the development of manual preference, analysis for each of the measures were performed on the left hand score as a percentage of the right hand score. Small age-related trends were found for the pure motor measures of speed and strength. In the case of the TPT, a clear age-related practice effect was found. The results were discussed in terms of the development of hemispheric cooperation.


Open multicentre clinical trial of diftalone in osteoarthrosis. An open, multicentre trial was carried out in 140 patients with coxarthroxis and/or gonarthrosis to assess the effectiveness of treatment with diftalone. The trial lasted 4 weeks with a drug dosage decreasing from 1000 mg (Week 1) to 750 mg (Week 2), and to 500 mg (Weeks 3 and 4). In almost all of the objective and subjective assessments used for the measurement of effectiveness there was a statistically significant improvement with treatment, which was dose related, the greatest improvement being seen during the first week. Tolerance of treatment was assessed as good in the majority of patients and again, side-effects appeared to be dose related.


A single-blind comparative study of once daily dothiepin ("Prothiaden") and divided daily doses of amitriptyline. Forty-eight patients took part in a single-blind clinical trial comparing a once daily dose of dothiepin (75 mg) and 25 mg 3-times a day  of amitriptyline. The results showed that dothiepin caused a greater improvement than amitriptyline after 4 weeks of treatment as judged by depression scores, total scores and global assessments. The  incidence of side-effects was less with dothiepin and in those patients who actually reported side-effects the severity was much less with dothiepin than with amitriptyline.


An open, multicentre study of acebutolol in hypertension. Four hundred and twenty-seven hypertensive patients in the United Kingdom have so far been admitted to two on-going open multicentre trials, and have been treated with acebutolol for periods ranging from 1 to 6 months. Oral dosages were within the range of 100 mg to 1200 mg/day in divided doses and were increased or decreased to suit individual requirements. The data on 366 patients completing more than 1 month's treatment were analysed. A high significant reduction in mean diastolic pressure was observed. This reduction was progressive up to 6-month's treatment and was the more marked as pre-treatment values were higher. There was a highly significant correlation between pre-treatment mean diastolic pressure and mean fall of diastolic pressure at 6-months' treatment. There was also a highly sigificant association between initial values and response, and between duration of treatment and response. The higher the pre-treatment value, the less likely was non-response. Response also increased as treatment duration increased. Although asthmatic patients were not excluded, only 2 of the 427 patients included in the present study had to discontinue treatment because of the occurrence of airways obstruction; only 1 of these patients had experienced asthma previously.


A study on the properties of mitochondria from rat kidney cortex and red medulla. Mitochondria of rat kidney red medulla form a single band (rho = 1.163) on a sucrose gradient, while mitochondria of the cortex form bands in 2 density regions, namely ca. 66% (M1) at rho = 1.173 and ca. 33% (M2) at rho = 1.163. The mitochondria of the red medulla contain more cytochrome a, more cytochrome b, and less cytochrome c, compared to the M1 population which predominates in cortex. Mitochondria from the red medulla show higher rates of Pi incorporation into total organically bound phosphorus in the presence of ADP, Pi, and oxidizable substrate than do mitochondria from cortex. However, in absence of added oxidizable substrate the reverse is observed, indicating that isolated cortex mitochondria contain more endogenous substrate. The superiority of the red medulla organelles in phosphorylation in the presence of substrate persists in preparations made according to LOWENSTEINS [3] procedure (shortened isolation time, removal of lysosomal enzymes by digitonin treatment). This shows that the observed differences are not artifacts due to different degrees of damage to the organelles by lysosomal attack.


The participation of the renal tubules to the metabolism of insulin. The role of renal tubules was explored by two kinds of experiments: (1) inhibition of the tubular reabsorption of insulin by induced polyuria; (2) suppression of insulin filtration by ureter clamping; 1. Anaesthetized dogs maintained in normoglycaemia by glucose compensation were infused with crystalline and 125I-insulins. Polyuria was induced by: (1) saline-bicarbonate infusion; (2) furosemide with saline-bicarbonate infusion to replace urine losses; (3) massive infusion of mannitol. Inulin and paraminohippuric acid were used to estimate the glomerular filtration rate and the renal plasma flow. The permeability of the glomerular wall (pore radius and total area of the pores per unit of path length) was determined by measuring the sieving curve of 131I-polyvinyl-pyrrolidone fractions during basal and treatment periods. Mannitol infusion was able to bring the insulin/inulin clearance ratio up the values of the sieving coefficient of insulin (insulin filtration rate) without modifying the permeability of the glomerular wall; saline infusion displayed a similar effect; furosemide, only a minute one although it induced a more marked polyuria. 2. Clamping of the left ureter was performed on dogs with catheters inserted into the artery, the left renal vein, the pelvis and a renal lymphatic vessel. Almost complete suppression of the glomerular filtration was achieved. It slightly increased the high insulinic concentration of the renal lymph, entailed a 1/3 decrease in the extraction ratio of insulin and reduced by half its renal clearance. In conclusion, the tubules participate to the catabolism of insulin by two different mechanisms: (1) an uptake from the tubular fluid which can be inhibited by diuretics exerting their main action on the proximal tubules; (2) a direct catabolism from the interstitial fluid resulting from the large permeability of the peritubular capillaries to insulin.


Specificity of sugar transport across the brush border of the rat proximal tubule. By chemical and electrical measurements the transport of 25 sugars in the proximal tubule of the rat kidney was investigated. The data gained reveal the following structural requirements for the D-glucose transport system in the renal brush border: A free OH in the D-gluco-configuration on C atom 2 is most important - OH in equatorial position of the chair Cl conformation -. A free OH on C-3 in the equatorial configuration is also essential. If the OH on C-4 turns from the equatorial to the axial configuration the transport is 50% reduced. The OH on C-6 may be missing if otherwise the D-glucose configuration is unchanged. But if in addition the position of OH in C-4 has changed the transport ceases. Furthermore the presence of a C-6 atom and of a ring structure is necessary.


Tubular adaptation of inorganic phosphate (Pi) transport in response to variations in dietary Pi in rats. The renal response to variations in the dietary intake of inorganic phosphate (Pi) has been studied in intact and thyroparathyroidectomized (TPTX) rats. The results show that the renal tubule can markedly vary its capacity to transport Pi according to homeostatic requirements: the lower the prior dietary intake, the higher the capacity of the tubule to reabsorb Pi. This adaptive response also occurs in TPTX rats. It is observed as early as three days after varying the dietary intake of Pi. This diet-induced difference in the tubular transport capacity for Pi can be seen in the presence of identical plasma Ca and urinary pH and also during marked expansion of extracellular volume. Comparison between Pi intake and thyroparathyroidectomy indicates that the fractional excretion of Pi measured at similar [Pi] Pl. can vary more than 100 times according to the prior dietary intake, whereas the removal of the thyroparathyroid glands brings about only a change of 2-4 times in this parameter. Free-flow micropunctures done in sham-operated rats pair-fed diets containing either 0.2 or 1.8 g/100 g P show a difference in Pi handling along the early proximal and distal tubule. However the most striking alteration seems to take place along the terminal nephron where an apparent net secretion of Pi would occur in the rats fed the high Pi diet. In conclusion the renal tubule adapts its transport capacity for Pi according to the supply of Pi in the diet. This involves a PTH-independent mechanism of great adaptive capability.


Acute and reversible inhibition of tubuloglomerular feedback mediated afferent vasoconstriction by the calcium-antagonist verapamil. In order to analyze the role of afferent vasomotor activity in mediating tubuloglomerular feedback response, we studied the effect of the intravenously applied Ca++ antagonist Verapamil on proximal stop flow pressure (SFP). In Wistar rats SFP was recorded continuously upstream of a solid paraffin block under either zero or 50 nl/min loop perfusion rate with artificial tubular fluid. The latter elicits maximal feedback response. Similar experiments were performed on heminephrectomized rats which are known to exhibit a highly sensitive feedback response. Verapamil given as a single dose (0.05-0.15 mg/kg b.w., i.v.) resulted in a transient decrease of mean arterial blood pressure of about 10 to 20 mmHg (1 to 3 min), SFP was unaltered during zero loop perfusion. Verapamil applied during a feedback stimulated SFP decrease (50 nl/min loop perfusion) caused restoration of normal SFP for 6 to 10 min indicating an acute and reversible interference of this drug with feedback regulation. Reversal of feedback response was complete in both groups of rats irrespective of the large difference in their feedback sensitivity. Thus: 1. The Ca++ antagonist is a complete inhibitor of feedback mediated SFP changes, 2. decreased SFP during high loop perfusion rate could be titrated back to normal by continuous infusion of Verapamil (dose 0.04 mg/kg-min), 3. Furthermore, feedback regulation of SFP could be prevented by infusion of the drug just prior to increasing loop perfusion rate.


Phosphate activation of glutaminase in sonicated mitochondria of normal and acidotic rat kidneys. Glutaminase activity was assayed in homogenates and mitochondria of kidneys from normal and acidotic rats. These preparations were also subjected to ultrasonic disintegration and the enzyme was assayed in the pellets and supernatants resulting from ultracentrifugation. Glutaminase activity was recovered mainly in the mitochondrial fraction of unsonicated tissue. Sonication released some of the glutaminase from the mitochondria. The increase in glutaminase activity due to the addition of phosphate was greater for the enzyme released from the mitochondria by sonication than for the enzyme recovered in the mitochondrial pellet after centrifugation. Acidosis did not significantly alter glutaminase activity when assayed in Tris buffer. However, when phosphate was present in the incubation medium acidosis increased glutaminase activity whether or not it remained attached to the mitochondrial membrane during sonication. The data indicates that there is more than one isoenzyme of glutaminase in kidney mitochondria and that the sensitivities of these isoenzymes to phosphate are not identical.


Direct quantitation of amino acid transport and metabolism in segments of individual nephrons. A new approach to amino acid transport in kidney is described which may be useful for study of renal transport in general. The amino acid is given in threshold and above threshold loads along with inulin as a glomerular filtrate marker. The kidney is quickly frozen at --60 degrees. Frozen 16 mum sections are dried at --40 degrees, and identified parts of single nephrons are analyzed for amino acid given, certain metabolites and inulin. The relationship of amino acid to inulin along the tubule is used to indicate changes relative to the glomerular filtrate. With either aspartate or glutamate loads, both amino acids accumulate to high levels in segments in which transport is believed to take place (proximal convoluted and straight tubules). Glutamine also accumulates to a high degree, but only in the proximal straight tubule.


Different renal oxidation rates of intramolecular carbon atoms in lactate and pyruvate. In order to get more detailed information on the different renal modes of utilization of individual intramolecular carbon atoms, formation rates of 14CO2 and metabolic products from single-carbon labelled exogenous substrates have been studied in isolated tubular fragments from rat kidney cortex. The results showed that carboxyl groups from acetate, lactate, and pyruvate were converted to CO2 at a much higher rate than substrate-2-C or 3-C. This effect was not due to a physico-chemical splitting. The corresponding C-2 or C-3-atoms were incorporated into newly formed glucose to a higher extent than carboxyl groups. Apparently, the maximum chance to be converted to CO2 for an intramolecular carbon of an exogenous substrate lies at the stereospecific site of action of decarboxylating enzymes. With rising distance from this point the probability to be built into glucose (i.e. to escape the oxidative pathway) increases. Due to the different share of the intramolecular substrate carbon (in the total CO2 formation) without the use of single-carbon labelled substrates one cannot calculate the oxygen requirements for an observed 14CO2 formation.


Molecular specificity of tubular amino acid reabsorption. The specificity of tubular reabsorption of L-arginine and L-methionine was investigated by continuous microperfusion of single proximal convolutions of the rat kidney. The following observations were made: 1) L-arginine reabsorption form the tubular lumen is saturable and can be inhibited by cycloleucine and some L-arginine derivatives with the following structure: -OOC -- CH (N+H3) -- (CH2)x -- N+H (R1) -- R2 The optimal value of x is 3 to 4. The methylene group adjacent to the nitrogen can be replaced by an oxygen atom. The radicals R1 and R2 have to permit ionization of the vicinal nitrogen. L-cysteine, L-homoserine, and diaminodicarboxylic acids do not inhibit L-arginine reabsorption. 2) L-methionine reabsorption is mainly a saturable process (Vmax = 2.5 x 10-(11) mol/cm/sec; Km = 6.1 mM). Passive diffusion does not play an important role (permeability coefficient = 2.45 x 10(-7) cm2/sec. 3) D-methionine also uses this saturable system for reabsorption. However, the affinity in this case is much smaller (Km = 23 mM). 4) L-phenylalanine, L-iso-leucine, L-ethionine, and cycloleucine seem to share this mechanism with L-methionine. In addition, the autoradiographic method was employed to determine on which side of the tubular cell competition of L-arginine and L-lysine for reabsorption occurs. Good evidence was obtained that the specific receptor for these two amino acids is located at the luminal membrane.


L-alanine accumulation in isolated tubuli from rat kidney cortex. Tubuli were prepared from rat renal cortex by modification of the method adopted from HOWARD and PESCH (J.Biol. Chem. 243, 3105, 1968). At 37 degrees C tubuli showed constant pyruvate consumption and glucose production for more than one hour. Intracellular electrolyte and amino acid concentrations were measured after separating the tubuli from the incubation medium by a layer of silicon oil in 5 seconds. During incubation at 37 degrees C L-alanine was accumulated 2.6 fold in the tubuli, while intracellular Na+ concentration dropped to about 50 mEq/l. At 27 degrees C, when pyruvate consumption and glucose production was reduced to less than half compared with 37 degrees C incubation, the respective gradients were higher. L-alanine accumulation was reduced by 2,4-dinitrophenol, antimycin A, ouabain and p-hydroxymercuribenzoate and was completely abolished by the reversal of the Na+ concentration gradient between extracellular and intracellular spaces. At 4 degrees C, when erergy production in tubuli ceased, L-alanine could be concentrated in the case of a Na+o/Na+i ratio greater than unity but not at a lower ratio. It is concluded that the accumulation of L-alanine is a direct function of the energy provided by the Na+ concentration gradient and is mediated by a postulated carrier, which can be injured by sulfhydryl group reagents like p-hydroxymercuribenzoate.


Renal substrate uptake, oxygen consumption and gluconeogenesis at low temperature. One of the important needs in the surgery of renal transplantation is the long-term preservation of the removed kidney. Up to now, preservation time has been limited to about 72 hours. The viability of the stored organ decreases sharply with prolongation of the preservation over 24 hours. At present, two methods of preservation are widely used: the storage of the organ in a cold electrolyte solution, and the continuous, hypothermic perfusion with albumin or cryoprecipitated plasma [1]. Both methods require a low temperature to reduce the endogenous renal metabolism. Besides the quality of the removed kidney, the type of perfusate and the duration of perfusion, two other factors might influence the viability and later function of the transplanted kidney: the absolute temperature during preservation, and the supply of energy - yielding substrates to the isolated kidney [2,3]. Up to now, the influence of the latter factor on the metabolic performance of the kidney tissue has been studied only in a few investigations [4,5,6,7]. In the following study, we determined the uptake of various energy - yielding substrates, oxygen consumption and gluconeogenesis at various low temperatures in isolated rat kidney tubules.


Energy requirements for metabolic and excretory activities of perfused rat kidney. A ratio 34.5 NA+/O2, or 5.8 Na+/ATP is obtained for the ouabain sensitive sodium pump, which accounts for 50% of sodium transport in the perfused kidney. Na-K-ATP'ase activity accounts for 15% of renal O2 uptake and sodium transport may account for only 30% of renal oxygen uptake. 2. Hydrogen ion secretion requires little extra energy. An increase in respiration produced by increasing the filtered load of potassium was not prevented by ouabain and active potassium secretion produced no detectable increases in oxygen consumption. 3. In general, the rate of oxidation substrates presented individually does not correlate well with the theoretical energy requirement for sodium transport. Exceptions were the low rate of oxidation of glutamine, which is consistent with limited sodium transport, and glucose, where the expected and observed rates of glucose oxidation are in close agreement. 4. The difference between substrates cannot be explained by activity of pyruvate kinase, by pyruvate dehydrogenase activation, by futile cycling between PFK/FDP'ase, or by involvement of the malate-aspartate shuttle.


Inhibition of IAA-induced elongation in Avena coleoptile segments by lead: a physiological and an electron microscopic study. A high resolution growth measuring apparatus was used to demonstrate the inhibition of auxin-induced cell elongation in oat coleoptile segments (Avena sativa L. var Holden) by lead at concentrations ranging from 2 x 10-6 M to 2 x 10-3 M. The inhibition was immediate, having no measurable lag period. Electron micrographs of lead-treated and control segments revealed that in the treated material, lead became localized as electron-dense granules in the cell walls and in vesicles associated with dictyosomes. These granules were found to be lead hydroxide phosphate by electron diffraction techniques. The possible significance of this localization and identification with regard to phosphatase activity is discussed.


Distribution of microtubules during centriole separation in rat kangaroo (Potorous) cells. The distribution of microtubule profiles during separation of the centriole duplexes in prophase of rat kangaroo cells (PTK2W) has been investigated by serial section reconstructions. Separation begins with a reduction of the interphase microtubular network which radiates from the region of the duplex to all parts of the cell. As duplexes separate, microtubular elements appear between the duplexes. However, most microtubular elements extend oblique to the axis of separation rather than aligned along the axis of separation. Few microtubules are seen extending directly between duplexes. Longer profiles are seen as separation continues. Prior to the completion of separation, microtubules coalesce to form a discrete band often juxtaposed on the nuclear membrane. Subsequently, the duplexes reach their final position and nuclear envelope dissolution is initiated.


Immuno-electron microscopic study of the distribution of the S 100 protein in brain glial cells. The distribution of the brain-specific S 100 protein was studied by an immunohistochemical method at the ultrastructural level. The S 100 protein was localized in the plasma membrane of astrocytes, oligodendrocytes and neurons, but not in that of endothelial cells and pericytes. Astrocytic filaments also possessed S 100 activity. The vascular basement membrane lacked traces of S 100.


Nucleic acid and protein differences in Volvox carteri cell types. Nucleic acids in Volvox carteri have different radioactive labelling patterns in the two cell types, reproductive (gonidia) and somatic. Incorporation of 32P into DNA is maximum during gonidial division in both whole spheroids and isolated somatic and reproductive cells. The most active period of radioactive incorporation into the rRNA of gonidia and somatic cells is during spheroid enlargement, after which the terminally differentiated somatic cells show a steady, continuous decline. Incorporation into the gonidial rRNA declines markedly during late stages of gonidial division but increases during daughter spheroid growth. Polyarylamide gel electrophoresis profiles of cellular proteins are distinctive for spheroids at different developmental stages and also for the isolated cell types.


Scanning electron microscopy in nematode-induced giant transfer cells. A study of giant cells induced by the root-knot nematode, Meloidogyne incognita, in roots of Impatiens balsamina was made by scanning electron microscopy. The cytoplasmic contents of giant cells were removed by a procedure based on KOH digestion, to reveal inner wall structure. Wall ingrowths typical of transfer cells are present in giant cells from six days onwards after induction. They develop on walls adjacent to vascular tissues, and their distribution and development was examined. Pit fields contianing plasmodesmata become elaborated in walls between giant cells, but pit fields are lost between giant cells and cells outside them. The distribution of plasmodesmata in pit fields suggests that de novo formation of plasmodesmata occurs in walls between giant cells. Various aspects of giant cell formation and function are discussed and wall ingrowth development is compared in giant cells and normal transfer cells.


The chromosomal distribution of human satellite III DNA during meiosis. In human meiotic cells DNA satellite II is located in the same sites as in mitotic cells, but in prophase the areas are less condensed. This differs from the situation in Plethodon where the sites of heavy satellite DNA are condensed throughout meiotic prophase (MacGregor and Kezer, 1971). The difference may be ascribed to the fact that Plethodon heavy satellite is pericentrically located, whereas few if any of the human satellite sites are actually at centromeres. A second difference is found in sperm, where the Plethodon satellite is located at a single site in the rear of the nucleus, while the satellite regions in mad do not have a common or constant orientation, suggesting that the respective satellites may well be functionally different.


Action of rotenone and related respiratory inhibitors on mammalian cell division. 1 Cell kinetics and biochemical aspects. Inhibitors of mitochondrial respiration, phosphorylation inhibitors, and uncoupling agents have been reported to delay or inhibit mitosis in cultured mammalian cells. Although the molecular mechanism by which mitosis is delayed in the presence of most respiratory inhibitors presumably involves lowered ATP production for mitotic requirements, one respiratory inhibitor, rotenone, was determined to arrest mitosis by an unrelated mechanism. Cell cycle kinetics studies, oxygen consumption measurements, and viscosity assays indicate that rotenone arrests cultured mammalian cells in mitosis by inhibiting spindle microtubule assembly by a mechanism analogous with colchicine, Colecemid and related antimitotic drugs. Amytal, which blocks electron transport at the same site as does rotenone, failed to arrest cell progression at mitosis. Rotenone delayed cell progression in all phases of the cell cycle, apparently as a direct result of respiration inhibition. Thus, rotenone appears to exert a dual function on events of the cell cycle.


Action of rotenone and related respiratory inhibitors on mammalian cell division. 2 Ultrastructural studies. Light and electron microscopic examination of cultured mammalian cells treated with the respiratory inhibitor rotenone revealed that chromosome, spindle, and centriole configurations were virtually identical to that of mitotic cells arrested with Colcemid, a microtubule assembly inhibitor. The chromosomes of cells arrested in mitosis with either drug were grouped in a spherical mass near the cell centre and centrioles failed to opposite mitotic poles. Spindle microtubules were observed in limited numbers near some chromosome kinetochores and the centrioles. The outer portions of the cell cytoplasm were devoid of microtubules. Scanning and transmission electron microscopy revealed that cells did not progress beyond early stages of mitosis in the presence of rotenone or Colcemid. The ultrastructure of cells harvested from cultures grown in amytal was similar to that of untreated cells. These observations suggest that rotenone arrests mitosis in mammalian cells by inhibition of spindle microtubule assembly.


Increased sister chromatid exchange in bone marrow and blood cells from Bloom's syndrome. Bone-marrow cells from a patient with Bloom's syndrome cultured for 48 h in the presence of BudR exhibited a striking increase in the number of sister chromatid exchanges (SCEs) in comparison to that in the marrow cells of a patient with treated polycythemia vera (PV). Thus, it appears that an increased incidence of SCE in Bloom's syndrome occurs in various differentiated types of cells, not just blood lymphocytes, and constitutes the syndrome's most characteristic cytogenetic feature. In contrast, the incidence of SCE was not increased in marrow cells and lymphocytes of the particular PV patient studied here, whose cells did exhibit increased numbers of chromatid and chromosome gaps and breaks, presumably as result of the patient's earlier treatment. An increased frequency of SCE was demonstrated in Bloom's syndrome lymphocytes using both a technique based on BudR incorporation and one based on labeling with tritated deoxycytidine. This observation constitutes evidence against the increase of SCE being due to an unusual reaction to BudR. By conventional cytogenetic techniques, chromosome instability, including chromatid and chromosome breaks, but no homologous chromatid interchanges were also recognized in Bloom's syndrome bone-marrow cells incubated in vitro (without BudR) for either 1.k or 16 h. This observation points to the existence of chromosome instability in vivo.


Robertsonian polymorphism and constitutive heterochromatin distribution in chromosomes of the rainbow trout (Salmo gairdneri). White-blood-cell culture was used to examine the chromosomes of 53 rainbow trout (Salmo gairdneri) from three locations in the  Pacific Northwest of the United States. A Robertsonian chromosome polymorphism is present, resulting in diploid numbers of 60, 59, or 58 in different individuals with 104 chromosome arms. The low level of intraindividual Robertsonian variation, differences in the number of subtelocentric chromosomes between individuals with different chromosome numbers, and frequencies of fish with different chromosome numbers in one population suggest that the interindividual differences are inherited and not somatic. C-banding shows that constitutive heterochromatin is localized near the centromeres and near the secondary constriction one chromosome pair.


The relationship between chromatid interference and the mapping function. A formula for a general mapping function involving only the number of chiasmata between two points on the chromosome and the average excess of four-stranded double exchanges over two-stranded double exchanges is derived. A formula is also given for deriving the proportion of three-stranded double exchanges after any given number of chiasmata; this is related to mapping for linkage with the centromere. It is shown that this proportion tends to a limit of 2/3 after a large number of chiasmata, whether or not chromatid interference is operating.


Variation in the number of genes for rRNA among human acrocentric chromosomes: correlation with frequency of satellite association. Grain counts after hybridization of 125I-rRNA to human chromosomes indicate numerical polymorphism at the rDNA sites. Prephotographing procedures decrease labeling but do not change the proportions of labeled RNA annealed to different chromosomes. A positive correlation was found between the frequency of participation of a given chromosome in satellite associations and its rDNA content by the criterion of grain count. Certain individual chromosomes are clear exceptions to this correlation.


Cigarette smoking and coronary artery disease. A macroscopic and microscopic study. Vascular changes in the coronary arteries and intramyocardial arteries and arteriole were studied in 1,056 men in relation to the effects of cigarette smoking and to age. The analysis was based on both macroscopic and microscopic studies, and the pathologist was unaware of the identity of the cases. The macroscopic study found a greater association with atheroma than a previous study taken from autopsies. The microscopic study found moderate and advanced fibrous intimal thickening of the coronary arteries to be more frequent in smokers and related to the amount or degree of cigarette smoking. The increase in fibrous intimal thickening was greater for intramyocardial arteries than for subepicardial arteries. The most marked difference by smoking habits was found in the myocardial arterioles. Advanced hyaline thickening was found in 90.7 percent of those smoking two or more packs of cigarettes per day, in 48.4 percent of those smoking less than one pack per day, and not in any of those who never smoked regularly.


The relationship between prolapsing mitral leaflet syndrome and angina and normal coronary arteriograms. Patients with a prolapsing mitral leaflet frequently have chest pain while their coronary arteriograms are normal. In this regard, these patients are similar to the group of patients with angina and normal coronary arteriograms. In the present study, clinical, electrocardiographic, cardiac hemodynamic, angiographic, and metabolic findings in 20 patients with a prolapsing mitral leaflet were compared to those of 16 patients with angina and normal coronary arteriograms. Except for the presence of mitral leaflet prolapse and systolic clicks, the findings were similar in both groups. We postulate that prolapsing mitral leaflet is probably related to two different mechanisms. In one the primary pathologic change is in the mitral valve (mainly myxomatous transformation), and the abnormalities of ventricular contraction are secondary to unloading of the heart because of a volume shift into the distended and enlarged mitral leaflets. In the other group, the primary pathologic change is in the myocardium, with secondary prolapse of the mitral valve. The myocardial abnormality itself is probably related to primary underlying myocardial disease or to arteriolar pathologic changes. The latter group has probably the same pathophysiologic abnormality as patients with angina and normal coronary arteriograms.


Paradoxic bronchospasm after inhalation of isoptroterenol. Paradoxic bronchospasm induced by adrenergic aerosols, especially isoproterenol, is a well-known clinical entity. It normally occurs in patients who abuse the use of isoproterenol, but has also been reported in a small group of other patients. This study attempted to identify patients who exhibit paradoxic bronchospasm after administration of aerosolized isoproterenol. Forty-one stable, ambulant asthmatics, whose FEV 1.0 was less than 70 percent of predicted normal were studied. None of the asthmatics had taken isoproterenol for one year prior to evaluation. Baseline pulmonary function tests (FVC,FEV 1.09 MMEFR), blood pressure and ECG rhythm strips were recorded, and repeated at 15, 30, 60 and 120 min after administration of isoproterenol. Twenty-nine of the asthmatic patients had the expected normal response ( delta  FEV 1.09 15 min: + 579; 30 min: + 464; 60 min: + 372; 120 min: + 307 ml: + 44, + 36, + 23 and + 24 percent)  (delta MMEFR, 15 min: + 37; 60 min: + 29; 120 min: + 18L/Min: + 75, + 69, + 47 and + 37 percent). Twelve asthmatic patients (29 percent) had paradoxic bronchospasm (delta FEV 1.09 15 min: - 38; 30 min: - 60; 60 min: - 175; 120 min: - 27 ml; -1, -4, - 10 and  - 4 percent) (delta MMEFR - 15 min: - .5; 30 min: - 3; 60 min: - 9; 120 min: - 2L/min; + 4, - 3, - 6 and - 5 percent, P less than 0.001).


Regional bronchoconstriction in asthma. 133Xenon washout scans following parenteral methacholine. To determine the influence of bronchoconstriction on the distribution of ventilation during an asthma attack, pulmonary clearance of 133xenon was evaluated in four normal and eight asthmatic subjects within three to five minutes after intramuscular injection of methacholine. In asthmatics, administration of 4-10 mg methacholine resulted in a decrease of forced vital capacity of 28.5 +/- 5.1 (SE) percent and a decrease in expiratory flow at 60 percent vital capacity of 44.2 +/- 6.9 percent (P less than 0.001). The cumulative ventilation required to reach 50 percent of the pre-washout radioactivity increased from 3.6 +/- 0.8 to 9.9 +/- 1.6 L after administration of the drug (P less than 0.05). The normal subjects showed no ventilatory effects after receiving 10 mg methacholine. Comparison of clearance of 133xenon from ten areas of lung (each representing approximately 6 percent of the surface area of one lung) showed that all areas were affected to approximately the same extent during drug-induced asthma. These findings suggest that parenteral methacholine is an effective way to demonstrate airway hyperreactivity and that the airway response to methacholine in asthmatics is relatively generalized throughout the lung.


Echocardiographic manifestations of infiltrative cardiomyopathy. A report of seven cases due to amyloid. Echocardiography has been useful in the evaluation of congestive and hypertrophic cardiomyopathies. We present echocardiographic findings in seven patients with infiltrative cardiomyopathy due to amyloid. Cardiac amyloidosis was documented at autopsy in two patients, and the diagnosis was suggested by clinical, echocardiographic, tissue, or hemodynamic findings in the other five. Hemodynamic findings in three patients mimicked constrictive pericarditis; and autopsy was performed on one of the three and showed a normal pericardium. Underlying disorders were multiple myeloma (five patients), ankylosing spondylitis (one patient), and an unknown disorder (one patient). The basic echocardiographic findings in infiltrative cardiomyopathy due to amyloid were (1) symmetrically increased left ventricular wall thickness (in the absence of hypertension or aortic valvular disease), (2) hypokinesia and decreased systolic thickening of the interventricular septum and left ventricular posterior wall, and (3) small to normal size of the left ventricular cavity. Two patients also had small pericardial effusions. Thus, in a patient with congestive heart failure, these echocardiographic findings should suggest infiltrative cardiomyopathy.


Diagnosis of causes for acute respiratory distress by pressure-volume curves. The determination of effective dynamic and static relationships between pressure and volume aided in the diagnosis of pulmonary disease, its course, and the effects of therapy in 22 patients receiving continuous mechanical ventilation. These measurements were made on multiple occasions early in the course of mechanical ventilation and were repeated after any indication of clinical deterioration. Abrupt changes from control measurements provided supportive evidence for the presence of cardiogenic pulmonary edema  in four patients, progressive pneumonia in four patients, bronchoconstriction in four patients, retained secretions in five patients, pneumothorax in two patients, intubation of main-stem bronchus in three patients, and atelectasis in two patients and were useful in evaluating the results of subsequent therapy. These determinations are simple, noninvasive, and can be accomplished within minutes. The equipment needed is the same as that needed for continuous mechanical ventilation.


The clinical spectrum of chronic His bundle block. This report details our total experience with documented chronic His bundle block in 24 patients. Ten patients had second-degree block (eight with 2:1 block and two with type-1 block), and 14 patients had complete heart block. There were 16 women (67 percent) and eight men (33 percent) with ages ranging from 17 to 87 years. Diagnoses were as follows: hypertensive cardiovascular disease, nine patients (38 percent); arteriosclerotic heart disease, six patients (25 percent); aortic valvular disease, three patients (13 percent); primary conduction disease, two patients (8 percent); primary myocardial disease, two patients (8 percent); congenital heart block, one patient (4 percent); and traumatic heart block, one patient (4 percent). Pacing was instituted in 20 patients because of the following; congestive heart failure, seven patients; syncope, seven patients; fatigue, four patients; and recurrent dizziness, two patients. Permanent pacing was indicated within ten days of initial diagnosis in 13 patients, from 20 to 80 days in four patients, and later than 100 days in three patients. An additional two asymptomatic patients were treated with prophylactic pacing.


R34000, a dioxolane imidazole in the therapy for experimental coccidioidomycosis. Comparison with miconazole and econazole. Comparisons were made on the therapeutic influence of three imidazole drugs in experimental lethal coccidioidomycosis of mice. When administered by the intramuscular route, miconazole and a closely related structural analogue, econazole, were effective in preventing death, restricting fungal replication in the lungs, and minimizing the extent of extrapulmonary dissemination. Neither drug was as effective when administered by the oral route as by the intramuscular route. This contrasted sharply with results obtained using R34000, a dioxolane imidazole. It was very highly effective when administered by the oral route and less so by intramuscular injection. All orally treated mice survived a challenge lethal to more than 80 percent of control animals. Plasma or serum concentrations of orally administered R34000 in mice and in man exceeded the minimum inhibitory concentration for a virulent strain of Coccidioides immitis.


Techniques and significance of threshold measurement for cardiac pacing. Relationship to output circuit of cardiac pacemakers. Because it determines the "reserve" of the pacemaker's output circuit, threshold measurement remains the single most important factor that will ultimately ensure successful pacing. In this review, we describe the various techniques and significance of threshold measurement in relation to the property of pacemaker output circuits. There are two basic types of pacing circuits: (1) those with constant current, as in most external (temporary) pulse generators, and (2) those with constant voltage, as in many implantable pulse generators. Current-limited pulse generators have features of both constant-current and constant-voltage circuitry. The current threshold is helpful in determining the integrity of the electrode-tissue interface and reflects the density of the current, which is the prime factor responsible for successful stimulation. Voltage thresholds are useful for information on lead position and integrity, especially when voltage and current are measured simultaneously. Impedance (calculated from voltage and current during stimulation) can be helpful in the diagnosis of lead fractures, insulation breaks, and position problems. Threshold and impedance are entirely unrelated factors, each providing specific and different information about a pacing system. Threshold may also be measured in terms of charge and energy and in relation to the width of the pulse (at a constant impulse amplitude). The concept of safety margins is important when measuring long-term threshold at the time of replacement of a pulse generator. We have analyzed this problem and have attempted to make acceptable recommendations in the absence of clear information in the literature about this subject.


Recovery from inhalation of diquat aerosol. A patient developed high fever, cough, changing consolidations on chest roentgenograms, jaundice, and skin rash following inhalation of diquat aerosol. To our knowledge this is the first report of diquat inhalation and only the second report of aerosol damage from any part of the dipyridyl herbicides.


Development of rib notching after a cava-pulmonary anastomosis. A patient with tetralogy of Fallot and mitral regurgitation developed unilateral rib notching on the right side secondary to a palliative cava-pulmonary anastomosis. After the operation, decreased perfusion of the right upper and middle lobes stimulated the development of collateral vessels from the systemic circulation to the right pulmonary artery. To our knowledge, this is the first time that this has been described.


Echocardiographic detection of bacterial vegetations in a child with a ventricular septal defect. A 13-year-old boy with a small ventricular septal defect was admitted with clinical manifestations of acute endocarditis. Coagulase-positive staphylococci were isolated from the blood. Definitive diagnosis was made by detecting bacterial vegetations in the right ventricle on the echocardiogram. Repeated embolization of these vegetations to the pulmonary circulation led to the death of the patient.


Mucoepidermoid tumor of trachea.

Mucoepidermoid tumor of trachea. Mucoepidermoid carcinoma of the trachea is rare. Its occurence in a 14-year-old boy is reported here. This case illustrates the typical course of tracheal tumors with clinical manifestations of cough, wheezing, and hemoptysis, the intially reported normal chest roentgenogram, and the common failure to diagnose tracheal tumor for several months. Early use of tomographic studies and bronchoscopic examination in any person with recent onset of airway obstruction unresponsive to bronchodilator therapy is recommended.


Bacterial endocarditis in a patient with Marfan's syndrome. A patient with Marfan's syndrome and subacute bacterial endocarditis is presented. Echocardiographic studies demonstrated dilatation of the aortic root, prolapse of the posterior leaflet of the mitral valve, and the appearance of shaggy echoes on the anterior miltral leaflet, of the kind previously described as representing bacterial vegetations.


Pulmonary tuberculosis following successful treatment of pulmonary infection with Mycobacterium kansasii. A case of pulmonary tuberculosis following successful treatment of pulmonary infection with Mycobacterium kansasii is presented. The immunizing effect of an infection with M kansasii and and other nonspecific immune factors are discussed.


Allergic bronchopulmonary aspergillosis with obstruction of the upper respiratory tract. A case of allergic bronchopulmonary aspergillosis is presented. The only symptoms in this 24-year-old woman patient were those of recurrent nasal obstruction, including mucosal ulcerations, edema, and thick secretions within the nose.


Ruptured chordae of the tricuspid valve. The consequence of flow-directed Swan-Ganz catheterization. A case of autopsy-documented ruptured chordae tendineae of the tricuspid valve, secondary to flow-directed Swan-Ganz catheterization of the right side of the heart is presented. A possible mechanism is discussed and safeguards to prevent this complication are suggested.


Changing P wave polarity. Intermittent posterior internodal conduction. Spontaneous changes of P-wave polarity without change in heart rate were noted on the resting electrocardiogram of a patient admitted because of chest pain. Intracardiac and His bundle electrograms were compatible with a sequence of activation from high to low right atrium with both positive and negative P waves in lead aVR. The decrease in the P-His interval with positive P waves in lead aVR is consistent with selective conduction via the posterior internodal pathway.


Local community change for service to children. Child psychiatrists in the United States recognize that there are hindrances and barriers that delay and obstruct the establishment of good psychiatric services for young people. Services are impeded by a number of myths and invalid assumptions as well as by a lack of national purposes to serve children who suffer. There are some things to do, nevertheless. One is education of the public as to children's maltreatment. Others are advocacy on behalf of children's expanding rights, working within establishment channels to eke out needed changes, forming coalitions with activist groups of special interests and pleading, and upgrading our own profession.


Adult-child interaction analysis: methodology and case application. A revised methodology for analyzing adult-child interactions incorporating the use of videotape is presented. Results obtained from the application of this methodology to a successfully treated case of prolonged subsistence on pureed foods demonstrate that it is valid and useful. Objective confirmation of previous subjective clinical impressions and judgments was provided, and previously unnoted behavioral characteristics of mother, child and therapist were revealed. The clinical, research, and training potential of this comprehensive yet unobtrusive methodology is discussed.


Parent-infant interaction in 8-month-olds. Twenty 8-month-olds were observed interacting with their parents in a structured laboratory situation. Their responses to separations from each parent and the entrance of a strange adult were recorded. These events did not result in the predicted intensification of parental preferences. Before and after the "stressors," infants showed slight and equivocal preferences for their mothers over their fathers. Implications are briefly described.


Memo to child care workers on their role in group homes. The child care worker in a group home meets conditions both similar to and different from those of his counterpart in an institutional setting. Specific qualifications are needed to meet these specific problems.


The simulated family as an aid to learning family group treatment. Role-playing by students as "family members" and "therapist" in a simulated family situation provides a stimulating learning experience for the participants and the student audience.


A day school approach to aggressive adolescents. A day school for aggressive adolescents, organized cooperatively by a school system, a youth guidance center, and a state hospital, is providing an effective alternative to institutionalization. Education and therapy are combined in a supportive setting.


Day care in working-class ethnic neighborhoods: implications for social policy. Implications for social service planning are contained in the findings of a survey to determine preferences in day care for children in working-class families of Polish and Italian extraction.


A framework for the therapeutic use of group activities. An understanding of phase development in groups is the basis of this framework for the therapeutic use of program activities for emotionally disturbed children.


Final results of the Nashville Comprehensive Emergency Services project. This demonstration program was originally described in CHILD WELFARE's March 1974 issue. This summary of its results in coordinating the wide variety of services provided for neglected and abused children in a metropolitan area indicates that objectives were met, at a substantial reduction in costs.


Infant approach behavior as related to attachment. The chief purpose of this study was to identify characteristics that distinguish approach as an attachment behavior from approach serving other behavioral systems. Locomotor approaches of 16 male and 10 female white middle-class infants to an attachment figure (the mother) and to a nonattachment figure (the visitor-observer) were examined under naturalistic conditions at home. Observations were made during 4-hour home visits at 3-week intervals; those from 26 to 54 weeks were used. When approach was examined in a free-choice situation and without regard to behavioral context, infants approached the mother proportionally (though slightly) more often than the visitor (p less than .05). In 2 behavioral contexts, however, spontaneous infant approaches were sharply differential to the mother; approaches accompanied by crying and approaches terminating in a pickup appeal were directed almost exclusively to the mother (p less than .0001 for both). Touching upon completion of the approach was not differential, except in the context of a pickup appeal. Object-oriented approaches were more often directed to the visitor than to the mother (p less than .002) and may be either exploratory or affiliative. It is suggested that neither approach nor touching can be assumed to serve the attachment system without consideration of context- both environmental and behavioral.


Development of the perception and production of line forms. Of primary concern to the researcher interested in the development of drawing in children is an understanding of how lines are perceived and produced. The perception of line forms and of the edges and corners of solid forms may be similar in that both lead to the visual experience of contour. Lines, however, unlike the edges of solid objects, can function in 2 ways: they can be perceived or produced as paths or as the boundaries of shapes. The thesis of this article is that, in the drawings of very young children, line is produced as a path before it is produced as a boundary. An explanation for this progression is proposed.


Effects of social comparison on aggression and regression in groups of young children. The influence of negative, equal, and positive social comparison and of nonsocial comparison upon 4- and 5-year-old black children's subsequent aggressive and regressive behavior in 3-member groups was investigated. The group behavior of boys included more physical agression following negative social comparison than the other treatments, and their group behavior also consisted of more nonverbal teasing behavior following the negative comparison treatment than that of the equal and nonsocial comparison groups. When the behavior of the nontarget partners was controlled, children initiated more physical aggression, nonverbal teasing, and regression after experiencing negative social comparison with the partners than after following the other treatments. There was some evidence to support the reciprocal influence of children's aggressive behavior on each other, particularly for boys following imbalanced social comparison treatments.