Cellular hypertrophy and renal function during compensatory renal growth. Simultaneous measurements of biochemical and physiological events of compensatory renal hypertrophy were made in groups of white Spartan rats. Thirty hours following right unilateral nephrectomy, the left kidney had an increased rate of renal plasma flow, glomerular filtration rate, and potassium excretion when compared to sham-nephrectomized rats. Kidney cells were also hypertrophied as evidenced by an increase in the ratio of ribonucleic to deoxyribonucleic acid. The effects of a single injection of cycloheximide and actinomycin D on compensatory growth were studied. Both drugs prevented the rise in glomerular filtration rate and renal plasma flow 30 h postnephrectomy while having no inhibitory effect on cell hypertrophy. The maintenance of nephrectomized rats on a low-sodium diet also interfered with the physiological components of the response while having no effect on ribonucleic or deoxyribonucleic acid. These suggest that the physiological and biochemical aspects of compensatory renal hypertrophy may be under separate control systems.


Intracellular potassium activities in Amphiuma small intestine. Intracellular potassium activity (aKi) has been determined in absorptive cells lining the villi of isolated, stripped proximal segments of Amphiuma small intestine. With single-barreled liquid ion-exchanger microelectrodes aKi = 41.6 +/- 1.5 mM in normal chloride buffer; with double-barreled microelectrodes constructed by a new method aKi = 38.5 +/- 2.4 mM. Also, by the latter approach aKi = 41.1 +/- 2.1 mM in buffer in which potassium was elevated to 5 meq/liter and aKi = 44.2 +/- 1.3 mM in sulfate buffer with the same bath potassium concentration. Since the calculated potassium equilibrium potential exceeds the membrane potential this ion is accumulated by the intestinal absorptive cell. A major portion of cellular potassium is bound or compartmentalized since the intracellular potassium activity coefficient is very low. A layer exists near the villi in which the potassium activity exceeds that in the bath buffer solution.


Ischemia in isolated interventricular septa: mechanical events. Isolated blood-perfused rabbit interventricular septa were adapted for studies of global ischemia by enclosure in a constant-humidity nitrogen atmosphere. During ischemia, developed tension (DT) and maximal rate of relaxation (-dP/dt) declined monoexponentially, lambda = 0.39 min-1 at 37 degrees C and 72 beats/min with a Q10 of 1.4 for DT and a Q10 of 1.9 for -dP/dt. After a 60- to 90-s delay the maximal rate of tension development (+dP/dt) declined at the same rate as DT. Time-to-peak tension (TPT) shortened immediately with ischemia but action potential duration shortened after 60-90 s. Calcium at a concentration of 5 mM slowed the rate of decline of +dP/dt to lambda = 0.26 min-1. Upon reperfusion after 10 min of ischemia the rates of recovery of DT, +dP/dt, and -dP/dt were similar, lambda = 0.21-0.23 min-1, and were not temperature dependent. The magnitude of recovery was 10-17% less at 37 degrees C than 28 degrees C. Potassium at a concentration of 10 mM did not alter the rate of decline of mechanical function, but significantly (P less than 0.01) increased the magnitude of mechanical recovery. The results suggest depletion and/or repletion of single compartments as the rate-limiting steps in ischemia and reperfusion.


Lower esophageal sphincter pressures and serum gastrin levels after cholinergic stimulation. To define the role of gastrin, if any, in the response of the lower esophageal sphincter (LES) to bethanechol, serum gastrin determinations and LES pressure measurements were made in controls, patients with vagotomy and antrectomy (V&A), and patients with vagotomy and pyloroplasty (V&P). Despite significant differences in mean basal serum gastrin levels no differences were found in mean resting LES pressures among these groups. In controls significant increases in LES pressure occurred after subcutaneous bethanechol, but serum gastrin levels did not change from basal values. Subcutaneous injections of bethanechol produced significantly greater increases in LES pressures in V&P patients than in V&A patients. Serum gastrin levels did not change in either group; however, background serum gastrin concentrations were significantly greater for V&P patients than V&A patients throughout the study. Intravenous infusion of human gastrin I heptadecapeptide in controls significantly increased sphincter responses to bethanechol. Thus, these studies provide evidence to suggest that the LES response to bethanechol is affected by background serum gastrin levels.


Postsplenectomy blood values, marrow cytology, erythrocyte life-span, and sequestration in mice. Studies in mice indicated that splenectomy influenced neither the erythrocyte and leukocyte total and differential values nor the erythrocyte survival. The right femoral marrow erythrocyte and nucleated cell counts were also not altered by splenectomy, and compensation for the important splenic contribution to erythropoiesis was in the form of marrow erythroid hyperplasia with a drop in the myeloid:erythroid ratio from 2.79:1.00 in intact mice to 1.44:1.00 in splenectomized mice. The spleen was the most important site for the sequestration of erythrocytes as monitored by tissue localization of 51Cr-labeled erythrocytes, and this function was assumed by the liver in splenectomized mice by almost doubling its activity. The total residual body count was, however, significantly decreased (P less than 0.01) by splenectomy.


Effect of ammonia via prepyriform cortex on regulation of food intake in the rat. Studies were made on whether ammonia, which is an obligatory intermediate of amino acid metabolism, depresses the food intake of rats fed a low-casein (basal) diet containing imbalanced amino acid mixtures (imbalanced diets). Bilateral lesions in the prepyriform cortex caused normalization of food intake of rats fed amino acid-imbalanced diets, confirming the work of Leung and Rogers (Am. J. Physiol. 221:929-935, 1971). Unlike normal rats, animals with prepyriform cortical lesions consumed as much of a diet containing 3% NH4Cl as they did of the basal diet. However, like normal rats, they rejected a diet containing a mixture of keto acids. Unilateral injection of NH4Cl into prepyriform cortical areas reduced the food intake to a greater extent than injection of NaCl into these areas or injection of NH4Cl into other parts of the brain. These results suggest that ammonium ions influence the appetite through their effect on prepyriform cortical areas.


Effect of angiotensin II antagonist infusion on autoregulation of renal blood flow. The role of the renin-angiotensin system in the autoregulation of renal blood flow was examined in the anesthetized dog. The angiotensin II antagonist, [1-sarcosine, 8-isoleucine]angiotensin II, was continuously infused into the renal artery at rates of 1 and 3 mug/min, and renin secretion rate and intrarenal distribution of blood flow as well as total renal blood flow were measured during acute reductions in renal perfusion pressure within and below the range of autoregulation. Renal autoregulation and redistribution of blood flow by pressure reduction were not disturbed by the angiotensin II antagonist. This result does not provide any evidence for a primary role of the renin-angiotensin system in renal autoregulation. Redistribution of blood flow by pressure reduction occurred independently of the renin-angiotensin system. It might depend on the differences in the resting tone among the zones.


Cardiac responses to stimulation of thoracic afferents in the primate and canine. Excitatory cardiovascular responses to electrically stimulated upper thoracic sympathetic afferent nerves were observed in halothane-anesthetized mongrel dogs and monkeys. The central end of the transected ventral limb of the left ansa subclavia was stimulated before and after several types of denervation. Significant increases in right and left ventricular maximum systolic pressures, systolic and diastolic systemic blood pressures, and aortic flow were observed. The carotid sinuses were denervated bilaterally and stimulation of the ansa was repeated. The cardiovascular responses to stimulation of the ventral ansa after carotid sinus denervation were greater in magnitude than those observed prior to denervation. This carotid sinus modulation of cardiovascular responses was observed in dogs and monkeys. Cardiovascular responses to stimulation of the ventral ansa after bilateral vagotomy were significantly less than the responses observed after carotid sinus denervation prior to vagotomy. However, the responses after vagotomy were statistically identical to responses obtained while stimulating the ventral ansa when the carotid sinuses and vagi remained intact.


Renin-angiotensin system in spontaneously hypertensive rats. Plasma and kidney renin activities (PRA, KRA) were determined in male spontaneously hypertensive rats (SHR), the inbred strain of F27-30. Blood samples of 0.5 ml for PRA determination were obtained through a cannula inserted into the abdominal aorta without anesthesia to minimize renin release from the kidney. The PRA was 30 wk. The KRA of SHR at age 10, 20, and 30 wk was also lower, confirming a previous report. At 5 wk of age, KRA was slightly higher than that of normal controls. At 50 wk of age, PRA and KRA were significantly lower in SHR (F25) from a random-bred colony than in normal Donryu rats. It is suggested that the renin-angiotensin system is suppressed in SHR as a compensatory reaction against blood pressure elevation.


Renin response and angiotensinogen control during graded hemorrhage and shock in the dog. Hemorrhage and hemorrhagic hypotension have been shown to be potent stimulators of renin release. However, the relationship between angiotensinogen consumption and angiotensinogen production has yet to be completely defined during this type of circulatory stress. Peripheral renin activity increased progressively as the blood pressure was decreased stepwise by hemorrhage to 50 mmHg and remained elevated throughout the shock phase of the experiment. Angiotensinogen did not change from control (809 ng/ml) throughout hemorrhabic hypotension and shock. During hemorrhagic hypotension, with the infusion of the angiotensin antagonist, [1-sarcosine, 8-alanine]angiotensin II, angiotensinogen concentration fell progressively from 693 to 208 ng/ml at 50 mmHg. Intravenous angiotensin II infused continuously after the mean blood pressure reached 50 mmHg significantly elevated plasma angiotensinogen concentration. In conclusion, during hemorrhagic hypotension and shock, the kidney and the liver appeared capable of maintaining elevated plasma renin activity and adequate plasma renin substrate, angiotensinogen, respectively. The mechanism responsible for the maintenance of plasma angiotensinogen is suggested to involve a positive-feedback effect of angiotensin II on the liver.


Postpsychotic state, convalescent environment, and therapeutic relationship in schizophrenic outcome. The authors evaluated the following variables in the 2-3-year outcomes of 30 schizophrenic patients: the acute/chronic dichotomy, the presence of a postpsychotic regressive state, the quality of the convalescent environment, and the formation of a therapeutic relationship. They found that the presence of a postpsychotic regressive state was not associated with either good or poor short-term outcome; that the diagnosis of acute schizophrenia was almost invariably followed by good outcome, but a diagnosis of chronic schizophrenia had little predictive value; and that a favorable convalescent environment and the presence of a therapeutic relationship were signigicantly associated with good outcome.


Strategies and risks in psychotherapy with bilingual patients: the phenomenon of language independence. The presence of two separate languages, each with its own lexical, syntactic, semantic, and ideational components, can complicate psychotherapy with proficient bilingual patients. If only one language is used in therapy, some aspects of the patients emotional experience may be unavailable to treatment; if both languages are used, the patient may use language switching as a form of resistance to affectively charged material. The authors suggest that monolingual therapists should carefully assess the degree of language independence in bilinguals in order to minimize its impact on therapy. They conclude that study of bilingual patients may provide important insights into the nature of the therapeutic process.


Patient privacy and confidentiality at mental health centers. The authors studied potential violations by mental health centers of individuals' rights to privacy and confidentiality by sending questionnaires to state directors of mental health programs and to mental health centers in all the 50 United States and its teritories. The questionnaires assessed the extent to which information that could identify a patient is reported to state offices; it also addressed issues of mental health center discretion in reporting information, the life span of patient files, and the access of outside  agencies to mental health center files. The authors conclude that legislative action prohibiting the reporting of identifying information appears desirable.


Patients' perceptions of the therapeutic relationship and group therapy outcome. The authors review the empirical literature examining the hypothesized relationship between the patient's perception of the therapeutic relationship and treatment outcome in group therapy and describe studies of both inpatient and outpatient group therapy. Their review indicates that, in contrast to the overwhelming evidence in support of the perceived relationship-outcome hypothesis in individual psychotherapy, there is no persuasive evidence in favor of the proposed relationship between the therapist-patient relationship and the efficacy of group treatment. The authors discuss the clinical and theoretical differences between individual and group therapy that would contribute to this result.


In search of the true amok: amok as viewed with the Malay culture. In an attempt to discover how the phenomenon of amok is viewed within its indigenous culture, the authors studied and interviewed 21 subjects in West Malaysia who were labeled as amok. This investigation showed that both the subjects and the Malay culture view amok as psychopathology, that amok cases are disposed of in line with this view, and that the behavior of the amok person conforms to social expectations of the phenomenon. Despite cultural proscriptions, however, the act is purposive and motivated and is subtly sanctioned by Malay society.


Cancer, emotions and mental illness: the present state of understanding. The authors review recent and current literature on the relationship between psychological factors and cancer. They discuss the roles of predisposing personality patterns and emotional stress in the development, site, and course of cancer; the influence of awareness of terminal illness on the behavior of cancer patients; and the management of psychiatric symptoms in these patients.


Studies of adoptees from psychiatrically disturbed biological parents. III. Medical symptoms and illnesses in childhood and adolescence. Analysis of data gathered from interviews with adoptive parents supports the hypothesis that female adoptees of antisocial biological backgrounds might have higher percentages of somatic symptoms. The authors compared female adoptees of antisocial parentage with male and female controls, male adoptees of antisocial parentage, and male and female adoptees whose biological parents had other psychiatric conditions. They stress the importance of this hypothesis in the diagnosis and management of childhood and adolescent "medical" and behavioral problems.


Male transsexuals in the homosexual subculture. The author describes 20 male transsexuals who differ from most discussed in professional studies and from those in media portrayals in that they live in the male homosexual subculture. Furthermore, interviews with these individuals indicated that transsexuals are no more sexually or socially homogeneous than heterosexuals or homosexuals. In general, these men entered the homosexual subculture in their teens; they knew they were not heterosexual and therefore assumed they must be homosexual. As their gender identity crystallized, homosexual activity became repugnant and they rejected and were rejected by male homosexuals. Being unable to attract heterosexual men, they sought bisexual partners in a futile effort to confirm their identity as females. The author suggests that in addition to efforts to help transsexuals shift their gender identity, psychiatrists should emphasize prevention of this psychopathologic symptom.


Problems in the differential diagnosis of narcolepsy versus schizophrenia. The authors discuss the problems of accurately diagnosing narcolepsy when patients manifest the auxiliary symptoms of this disorder, i.e., cataplexy, hypnagogic hallucinations, and sleep paralysis, which conclude that misdiagnosis of narcolepsy can be avoided if clinicians are aware that this illness can simulate a psychiatric disorder and if they give careful attention to the histroy of the patient's illness.


Characteristics of "erotic" practitioners. Using the responses of 460 physicians to a questionnaire survey regarding sexual contact with patients (1), the authors attempt to statistically differentiate two groups--erotic practitioners and nonerotic practitioners. Analysis of data suggests that the freer a physician is with nonerotic contact with patients, the more statistically likely he is to engage in erotic contact.


The why of fragging.

The why of fragging. The author studied 28 men convicted and confined for use of explosives in assaults on superior officers during the Viet Nam war. There were several predominant characteristics in this group, including deprivation and/or brutality in family backgrounds, poor self-image, lack of critical self-observation, the use of externalization, and feelings of insecurity or vulnerability. Drug use joined with these and several other factors related to the situation of these men in Viet Nam in a lethal combination that led to the perpetration of an indirect assault with an explosive device on a figure perceived as powerful and threatening.


Occurence of psychiatric disorder in a county jail population. The authors report on a year's experience in providing psychiatric services in a county jail setting. Of 545 inmates evaluated, 22% were diagnosed as psychotic and 23% had a history of long-term or multiple hospitalizations. The authors discuss the implications of these data in terms of the problem of providing adequate psychiatric care for such a population.


The cessation of marital intercourse.

The cessation of marital intercourse. The authors found that marital coitus had ceased for a definable period (median=8 weeks) in one-third of a sample of 144 men and 221 women who were relatively young and had been married an average of 11 years. An analysis of factors related to the social background and marital relationship of the respondents indicated that the cessation behavior of men is more highly predictable than that of women and that antecedents of this behavior differ markedly between the sexes. The authors suggest that, even among relatively young couples, marital intercourse is discontinous and problematic.


Digit-symbol performance in methadone-treated ex-heroin addicts. The digit-symbol substituion task (DSST) of the WAIS was given to working (MW) and nonworking (MNW) patients on high-dose methadone maintenance and to two comparison groups to assess the function of attention in these patients. Mean DSST scores were significantly lower for the MNW group than for the other three groups, which did not differ. However, the scores for the MNW group were within the normal range. DSST scores and lenght of methadon treatment (range: 11 months to 8 years) were positively correlated, providing no evidence of deterioration with increasing duration of treatment.


Portable electromyograph monitoring of unilateral ECT. The authors describe a portable electromyograph (EMG) designed for use in monitoring unilateral ECT. Administration of muscle relaxants in conjunction with ECT often makes it difficult to determine that an adequate response has been elicited. The authors feel that this adaptation of the EMG provides a useful and easy means of monitoring the presence, bilateralism, and length of the seizure.


The treatment of pathological panic states with propranolol. The authors report on the effects of propranolol, a beta-adrenergic blocking agent, on 10 patients with pathological panic states. Propranolol was effective in treating acute pathological panic, but modest doses of the drug administered for brief periods of time did not alleviate chronic panic attacks associated with agoraphobia. The drug suppressed panic associated with depressive syndromes but did not affect the depression and had no clear effect on anticipatory anxiety. The authors suggest that further study of these findings may clarify other clinical problems.


Delinquency, psychomotor epileptic symptoms and paranoid ideation: a triad. In a retrospective chart-review study, the author found psychomotor epileptic symptoms in 6% (N=18) of children referred to a juvenile court over a 2-year period. Abnormalities appeared in 11 of the 14 available EEGs, but temporal lobe foci were noted in only 3 cases. Of these 18 children, 16 experienced paranoid symptoms that led to aggressive behavior. The incidence of offenses against persons was 50% in this sample, compared to 2--3% in the population of children referred to the juvenile court. The author suggests that psychomotor epilepsy may be far more common among delinquent children than has been reported previously and should therefore be included in the differential diagnosis of court-referred children.


Effects of legal pressure on prognosis for treatment of drug dependence. The authors found that four measures of legal pressure were either unrelated or negatively related to retention and outcome in five drug abuse treatment modalities. This suggests that nonvolunteer clients are likely to be insufficiently motivated to benefit fully from treatment and their presence may adversely affect staff morale and prognosis of volunteer clients. The authors recommend that legal pressure not be used as a basis for assigning applicants to treatment modalities and suggest that treatment outcome might be improved by procedures that 1) deal clinically with motivational differences between volunteers and nonvolunteers, 2) establish stricter motivational criteria for admitting nonvolunteers, or 3) encourage enforcement of existing sanctions against violations of stipulations to treatment.


The effect of lithium on impulsive aggressive behavior in man. The authors conducted a double-blind, placebo-controlled study of the effect of lithium on aggressive behavior. The 66 subjects, who were prisoners in a medium security institution, ranged in age from 16 to 24 years, were physically healthy and nonpsychotic, and had histories of chronic impulsive aggressive behavior. Subjects received lithium or placebo daily for up to 3 months. There was a significant reduction in aggressive behavior in the lithium group as measured by a decrease in infractions involving violence. The authors suggest that lithium can have a clinically useful effect upon impulsive aggressive behavior when this behavior is not associated with psychosis.


An interpersonal approach to hysteria.

An interpersonal approach to hysteria. The author defines hysteria in terms of specific observable classes of interpersonal behaviors and examines the impact of these behaviors on the receiver. The hysteric communicates frailty and helplessness, thus structuring the interpersonal environment to ensure attention and inhibit aggression. The development of these roles is shown in histories of female hysterics, who were selectively reinforced for frailty, seductiveness, and passivity as children. The major classes of symptoms shown by adult hysterics--conversion symptoms and dissociative reactions--reflect these interpersonal roles. The author concludes that hysteria is a relatively specific interpersonal style that results from cultural, social, and interpersonal influences.


Presence and persistence of depressive symptoms in patient and community populations. The authors used a questionnaire to assess presence and persistence of 16 depression-associated symptoms in two inpatient groups and a random community sample. Nondepressed inpatients were more likely than the community population to experience psychological symptoms of depression, but persistence of the symptoms was the same for both groups. In contrast, significantly more depressed patients than community respondents indicated presence for all but 2 symptoms and persistence for all but 1. Thus persistence of symptoms may be more specific to depression than mere presence.


Clinical depression among narcotic addicts maintained on methadone in the community. In a study of 106 predominantly young, lower-social-class men participating in a methadone maintenance program, the authors found that about one-third were moderately to severely depressed as assessed on standard rating scales of depression. The depressive symptoms were associated with a decrease in social functioning, increase in stress in the past 6 months, and a history of alcohol abuse. Because the combination of depression and drug addiction creates a high risk for suicide, depressive symptoms require early detection and treatment. The authors point to the need for more research on treatment approaches, particularly the use of psychotropic drugs.


Rate of psychiatric morbidity in a metropolitan county jail population. The author describes social-psychiatric characteristics of 122 jail inmates examined while awaiting trail, 80% of them on felony charges. The estimated overall rate of psychiatric illness was 4.6%. The patient sample was significantly older and contained significantly more minority group men than the jail population as a whole. Thirty-six percent of the patients diagnosed as schizophrenic were arrested on misdemeanor charges. Drug dependency was diagnosed in 51% of the men but in only 15% of the women. Psychosis was diagnosed more frequently and alcoholism, anxiety neurosis, and antisocial personality less frequently than in studies of prison populations using similar diagnostic criteria.


The psychotherapist and informed consent. The authors points out that psychotherapists are being increasingly required by law to function as instruments of social control. He believes it is incumbent on therapists to employ full and informed consent procedures with their patients in regard to the effects of providing psychiatric information to potential employers, insurance carriers, and other third parties.


Patients' expectations of therapeutic improvement and their outcomes. The authors studied the relationship between patients' expectations of therapeutic improvement and their actual outcomes after 8 and 12 months of group psychotherapy. Using patients' self-evaluations and assessments by therapists and independent judges, they found a positive relationship between expectations and outcomes only when assessments were derived from patients. The authors discuss the possibility of a continuing expectational set in patients toward psychotherapy.


Attitudes of psychiatric residents toward payment of psychotherapy fees. A preliminary exploration of psychiatric residents' thinking on the subject of psychotherapy fees revealed a pattern of inconsistencies in attitudes and a divergence between attitudes and practice. The author discusses these findings in the light of theoretical considerations and the effect of such attitudes on clinic administration and patient treatment. He emphasizes education about and discussion of fees as important aspects of residency training.


Inspiration of psychotherapists by patients. Many patients possess such exemplary traits and virtues that their psychotherapists are inspired to emulate them. This process can benefit the clinician and reinforce the therapeutic alliance, rapport, and the spirit of reciprocity; however, it can also arouse responses by the clinician that are therapeutically detrimental. Awareness of this hazard can enable the clinican to avert it and enhance the benefits provided by the patient's outstanding strengths.


Patient and staff reactions to a strike by essential hospital employees. The authors sampled the feelings and attitudes of patients and staff toward an 8-day strike by 2,500 health care employees of a metropolitan hospital. The strike had a major impact, and most respondents felt angry at one of the parties of the strike. Sympathies toward the strikers and the hospital management were equally divided.


Mania and schizo-affective disorder, main type: a comparison. The authors report data gathered from a consecutive sample of 88 psychiatric inpatients who were diagnosed as having either manic disorder or schizo-affective disorder, manic type, according to Research Diagnostic Criteria (1) similar to those proposed for DSM-III. There were no differences between diagnostic groups on clinical psychopathological or demographic variables, individual or family history, or treatment response.


Bilinguals in psychotherapy: language as an emotional barrier. The English-speaking clinician frequently evaluates and treats patients whose mother tongue is not English. This paper summarizes some of the evidence supporting an emotional-detachment effect associated with speaking in a second language and describes its implications for the psychotherapy of this population.


Psychotherapy of the chronically suicidal patient. A major issue in the psychotherapy of the chronically suicidal is the patient's avoidance of his responsibility. If the patient is not helped to recognize this avoidance, the therapist's efforts may be consigned to future attempts to either assume responsibility for the patient or to rescue him.


Psychiatric problems within the satellite-extended families of Turkey. The many Turkish villagers who now migrate to large Turkish cities or enter the European labor force try to create models of the extended families they leave behind. Their satellite families necessarily drift away from tradition, however, in the direction of greater independence. This process often triggers psychiatric symptom formation.


Sex role psychodynamics in psychotherapy supervision. Supervision of the female psychotherapy neophyte is discussed in relation to sex role-exacerbated ambivalence toward the transition from classroom passive-dependency to self-reliance as a professional clinician. Supervisors are alerted to hostile-dependent strategies, such as seductive flattery, that serve immediate ego-protective needs but ultimately block the attainment of fuller professional functioning.


Survivor themes in the supervision of psychotherapy. Some themes of survivorhood are discussed in relation to their effects on the supervisory process. The focus of this paper is on the intrusive themes of survivor shame, survivor rage, and survivor panic. Three illustrative case examples are presented.


The hard-of-hearing psychotherapist.

The hard-of-hearing psychotherapist. The hard-of-hearing psychotherapist is faced with special problems not faced by other therapists. This paper discusses these in a framework of reality, transference, and countertransference difficulties. Possible solutions are offered. The need of the therapist to work through his own feelings about his hearing deficit is discussed.


Copsychotherapy of the individual patient: indications and operative factors. The study analyzes the treatment by copsychotherapy of 56 individual patients carried out by a male-female therapist pair. The therapeutic contributions of the female cotherapist are scored (from evidence in the process notes) in terms of thirteen factors, and are listed in order of importance. Her contributions are greatest in the treatment of borderline psychotic personality disorders.


The question of neutrality in psychotherapy. The question of neutrality in psychotherapy is considered in the light of original historical psychoanalytic attitudes, and present usual practices. A disparity between what is reported and what is done is examined, and explanations for its existence are put forward.


Sadism revisited.

Sadism revisited. Sadism has been for a long time, among psychoanalytic and other writers, the subject of extensive theorizing and controversy. This paper takes a fresh look at the many dimensions (sexual, characterological, neurotic, psychotic, neurological) of this old aberrations.


The practice of dynamic pscyhotherapy in a circumscribed community. The paper describes the changes produced in the practice of dynamic psychotherapy when conducted within a circumscribed region. The authors discuss changes in anonymity, roles, and transference relationships for both therapist and patient. The paper demonstrates these effects on the therapist's professional training, his practice, and his family.


The collapsing perimeter. A commentary on life, death, and death-in-life. The individual is encased in an existential, phenomenological space that has the capacity to contract or expand, to isolate itself, or to join with others. An analysis is provided of how this individual space capsule functions under varying circumstances, such as depression, schizophrenia, sociopathy, divorce, child-battery, aging, death, overpopulation, cultural disruption, and execution.


Obsessive-compulsive neurosis after viewing the fetus during therapeutic abortion. A case of obsessive-compulsive neurosis which developed in a young woman after she had viewed the fetus expelled during a therapeutic abortion with hypertonic saline is reported. The treatment, involving both psychodynamic psychotherapy and behavior therapy, illustrates the use and possible interaction of these therapies in the same patient.


Family planning services for persons handicapped by mental retardation. The National Children's Center, Inc., and Planned Parenthood of Metropolitan Washington joined in organizing a special family planning service for persons handicapped with mental retardation. The limited utilization, despite considerable community recruitment efforts, and the few problems encountered with patients served suggest that handicapped individuals can be seen at lower cost and at greater efficiency in regularly scheduled clinics, provided staff are attuned to their special needs. Informal interviews with residential center and clinic staff, with parents, and with clients confirm the need for (a) strengthening in-service training in sex education and contraception to prepare potential clients for more effective use of family planning services; (b) counseling with parents who place a high priority on training for independent community living but are reluctant to face the sexuality of their dependent offspring; and (c) increasing community awareness of the legitimate needs and rights of hard-to-reach handicapped persons in preventing unwanted pregnancies.


A comparison of suicide and non-suicide deaths involving psychotropic drugs in four major U.S. cities. By use of a standard reporting form, extensive data were gathered on 651 deaths involving psychotropic drugs and recorded with the Coroner's or Medical Examiner's Office in each of four major U.S. cities. Thirty-six per cent of these deaths were listed as "Definitely Suicide" and 44% were listed as "Non-Suicide." A comparison was made of the age, sex, race, occupational category, and type of drug involved for each of these two groups, by city. In general, the Suicide group tended to be older, from higher occupational levels, and more often female. Blacks were under-represented among the Suicides but over-represented among the Non-Suicides. Suicide deaths tended to be associated with barbiturates, analgesics, and/or sedatives, while the Non-Suicides usually died from an accidental abuse of narcotics, usually heroin. These findings tended to be similar for each city, although some inter-city differences were noted.


A study of volunteer ambulance squads.

A study of volunteer ambulance squads. A study of all 37 ambulance squads in two Pennsylvania counties (Lehigh and Northampton), an area known to be served largely by volunteer units, was carried out by personal on-site interviews in 1973. The objectives were to determine the structure and functions of the squads and to devise some preliminary estimates of effectiveness as a base for regional planning. Topics examined include population and geographic area served, numbers and training of personnel, vehicles, equipment, record keeping, finances, communications capabilities, and squad organization. The 34 volunteer squads were found to vary greatly in resources and sophistication. The rural squads in particular tended to be underfinanced, to have low call loads and a delayed response to calls. In some squads personnel were inadequate in numbers and training. The advantages and disadvantages of maintaining volunteer services in rural areas are discussed and some possible approaches to the problem of providing high-quality services in rural areas outlined.


Pathways to the hospital for the geriatric psychiatric patient in New York and London. This communication examines the pathways of geriatric psychiatric patients in New York and London from the time of onset of a psychiatric episode to hospitalization. Informants of 50 patients in each city were interviewed with a semi-structured interview covering the events and the patient's activities prior to hospitalization. The results show that the time from the onset of the episode to hospitalization is significantly shorter in London than it is in New York. The major portion of this difference is accounted for by the longer time spent London the doctor is significantly more involved in New York between episode onset and initial medical contact. In the decision to hospitalize. In New York the main reason for hospitalization is harmful behavior, while in London it is psychiatric symptoms.


A comparative evaluation of the Scrub and Bass Methods of toothbrushing with flossing as an adjunct (in fifth and sixth graders). The Scrub and Bass Methods of toothbrushing with flossing as an adjunct were evaluated to determine which is most effective in eliminating or reducing plaque and gingivitis in 5th and 6th grade school children. Three hundred and eleven children were randomly selected and placed in five groups (Scrub, Scrub-Floss, Bass, Bass-Floss, Comparison). Four Method groups went through four weeks of daily supervised toothbrushing with four dental hygienists, while the Comparison group received no supervised instructions. There was a marked effect on oral hygiene and gingival conditions at the end of the experimental period in all four groups with no one method superior to another. Peer group intercommunication probably accounts for the improvement in the comparison group.


Lymphocytic choriomeningitis from pet hamster exposure: a local public health experience. Eleven cases of hamster associated lymphocytic choriomeningitis occurred within a space of four months in Jefferson County, Alabama residents. A single Birmingham breeder was the source of the infected hamsters. Ten cases experienced an illness of one to three weeks duration with grippe-like symptoms being most frequent. Complaints of nine cases suggested meningeal involvement, and one was asymptomatic. All patients recovered uneventfully. Frequent hamster contact had occurred in most cases, although three individuals reported infrequent or room exposure to the animals. The holding of hamsters for observation prior to sale, random testing of all breeders' stock, and the distribution of printed information with each hamster sold are suggested as precautions against future outbreaks of this nature.


Patient responses to request for written permission to review medical records. 2,163 patients of 55 physicians in one county, were sent letters asking for their written permission to have their medical records audited by the University of Michigan research team. The overall positive response rate was 64.1% for one county. Differences in response rates were statistically significant among specialties, among diagnoses, and among individual physicians.


Leukemia incidence and ethnicity in Nassau County, New York. The religious distribution of Nassau County resident leukemia cases diagnosed between 1966 and 1974 was studied to see if the elevated incidence of the disease among Jews reported in the 1950s and early 1960s was persisting. The results showed, for both males and females, virtually no difference in attack rates between the Jewish and "other white" populations of the County.


Epidemiologic studies of Reye's syndrome: cases seen in Pittsburgh, October 1973-April 1975. Twenty-seven cases of Reye's syndrome (RS) were admitted over a 19-month period to one urban hospital. All lived in a suburban or rural location and 23 cases occurred during two influenza outbreaks. Two to three months following the last cases of RS, 24 families of RS cases and 21 control families representing neighbors or friends were interviewed for factors which could predispose to RS. Children with RS had an illness immediately preceding the onset of RS more frequently than did controls (p less than .001). No other clinical, familial, or environmental factors distinguished RS children and families from controls. Water samples, collected during the interviews, from 34 homes showed no potential toxins. The geographic pattern of RS cases with localization exclusively to rural areas suggests that an as yet unidentified environmental factor may be related to the development of RS.


Infectious hepatitis in a college football player. The diagnosis of infectious hepatitis was made in a football player at East Carolina University in the 3rd week of fall practice in 1974. Clinical and laboratory evaluation of all persons involved in the program followed. All participants received immune serum globulin. No further cases were identified. Serum chemistry and enzyme levels were determined under uncontrolled conditions. Lactate dehydrogenase and alkaline phosphatase were generally elevated.


Broken necks from diving accidents: a summer epidemic in young men. Four years (1973-1973) of experience in the management of fractured cervical spine from diving accidents is examined with reference to clinical findings, radiology, prognosis, and socioeconomic aspects.


Treatment of myositis ossificans traumatica in athletes. Myositis ossificans traumatica, although it is one of a number of heterotopic bone formation entities, is a specific lesion with a clearly recognized etiology and natural evolutionary pattern. Early conservative treatment with rest, elevation, and immobilization minimizes additional trauma and decreases the likelihood of incapacitating bone formation. Subsequently, active range of motion exercises progressing to resistive exercises usually effect a satisfactory recovery and return to full athletic participation. With this treatment regimen, few athletes will be left with significant functional impairment. However, surgery does have a definite role in the treatment of this condition and is indicated in those athletes who develop a large mass of mature lamellar bone which is painful and is associated with muscle weakness and a significant loss of joint motion. Four patients are presented in which surgery resulted in satisfactory recovery and return to full participation in football.


Isolated tear of the anterior cruciate ligament: 5-year follow-up study. During the period 1967 to 1971, 64 cadets at the United States Military Academy, West Point, New York, had surgical repair for isolated tear of the anterior cruciate ligament. In a 5-year follow-up study to determine the functional impairment, present disability, and reinjury to the knee, 32 of the 64 patients were located and evaluated by radiographic examination and either by interview or by questionnaire. Twenty-two were commissioned to full duty. 23 had attended ranger or airborne school, and 16 had been in combat. Impairment of ordinary activities was noted by 12 and impairment of athletic endeavors by 24; pain by 71%; swelling by 66%; stiffness by 71%; and instability by 94%. Seventeen of the 32 had had a significant reinjury after the repair of the anterior cruciate ligament. Clinically, we can diagnose the isolated tear of the anterior cruciate ligament by four essential ingredients--a pop at time of injury, inability to continue participation, gross swelling of knee, and maximal swelling within 12 hr. The mechanism of injury is usually deceleration and change of direction, not contact with another player. The follow-up study on this small series indicates that the patients have progressive deterioration of the knee.


Surgical management of osteochondritis dissecans of the capitellum. Ten cases of osteochondritis dissecans of the humeral capitellum which were treated surgically are reviewed. All 10 cases were males and involved the dominant side. The ages at surgery ranged from 13 to 17 years. Follow-up ranged from 1 to 7 years. All of the youths had competed in organized athletics, either baseball or football. By position there were three pitchers, two catchers, two infielders, and one outfielder; in addition there were one quarterback and one linebacker. Only one patient presented with locking of the elbow, whereas the others presented with pain and limitation of extension. The locked elbow was explored immediately and the others were explored after immobilization failed to relieve their symptoms. In seven of the joints a loose fragment of the capitellum was found lying either in the joint or in a defect in the capitellum. The fragment had multiple small holes. In three cases there was no loose fragment. In this situation a corticol window was cut above the capitellum. The capitellum was then drilled and bone was grafted from above. Over all, there were one excellent, six good, one fair, and two poor results. There seemed to be little difference between curretting alone or curetting and drilling. The cases with the cartilage intact and bone grafted from above did worse, with one fair and one poor result of three cases. The two poor results required further surgery, which consisted of partial excision of the capitellum. All cases lacked elbow extension before and after surgery, but nine of 10 gained some motion after surgery. Pre- and postoperative x-rays are shown in this report and a brief review of the literature concerning osteochondritis dissecans is presented.


Alkaline reflux gastritis. A study in forty postoperative duodenal ulcer patients. A study to determine the incidence of alkaline reflux gastritis in forty postoperative duodenal ulcer patients has been presented. Since the majority of patients had evidence of gastritis, the precise role that gastritis plays in the production of symptoms is discussed but needs further clarification. It is suggested that the presence of gastritis may only represent an incidental or associated finding in many patients presenting with symptoms presumably characteristics of alkaline reflux gastritis.


Contact cholangiography.

Contact cholangiography. A technic of intraoperative contact cholangiography is described in which a sterile wrapped film is placed behind the mobilized duodenum and common bile duct. In series of 120 cholecystectomies this technic, in conjunction with conventional cholangiography, allowed a low rate of exploration of the common bile duct (15 per cent) and has detected otherwise unsuspected stones in two patients.


The patient's view of the pes anserinus transfer operation for rotatory instability of the knee. A review of 82 patients was performed to ascertain their subjective evaluations of the pes anserinus transfer procedure for rotatory instability of the knee. Analysis demonstrated a slow improvement in symptoms which occurred over a 12-month period. At that time, 62% of the patients had regained 90% of their preinjury confidence in knee stability.


Perforated gastroduodenal ulcers. Factors affecting morbidity and mortality and the role of definitive surgery. Retrospective analysis of twenty-eight patients with perforated gastric ulcers and 141 patients with perforated duodenal ulcer showed that delay in surgery increased operative mortality. Gastrectomy is advocated for gastric ulcers, and definitive ulcer surgery, not plication, for duodenal ulcers.


Methods and rationale for closed treatment of Achilles tendon ruptures. A method of closed treatment of Achilles tendon ruptures by casting, utilizing a long leg cast for 6 weeks and a short leg cast for 4 additional weeks, is presented. An experimental model using rabbits supports the clinical contention that closed approximation and immobilization of Achilles tendons allows tendon healing to progress, at least in the early stages. Observations made on the tendon sheath during early healing attribute a very positive role to it in providing needed blood supply to the tendon. The importance of maintaining a smooth gliding surface as well suggests that the tendon sheath should not be violated by surgical repair on the Achilles tendon.


Changes in carbohydrate metabolism and endocrine function of remnant pancreas after major pancreatic resection. Changes of glucose tolerance after partial pancreatectomy were divided into three types depending on the extent of resection. When 88 per cent or more of the pancreas was resected, hyperglycemia developed immediately, and when 70 to 88 per cent of the pancreas was resected, diabetes occurred after six weeks or more, but diabetes did not develop at all when less than 70 per cent of the pancreas was removed. The secretion of glucagon was maintained well, but that of insulin was easily impaired after resection of 70 per cent or more of the entire pancreas.


Electrocoagulation as primary therapy for rectal carcinoma. The survival of forty-seven patients with cancer of the rectum treated by electrocoagulation is compared with thirty-seven patients treated by abdominoperineal resection. The one to ten year survival for the electrocoagulationgroup was 48 per cent and the one to eight year survival for the abdominoperineal resection group was 46 per cent. We believe that electrocoagulation when selectively applied has a place in the management of cancer of the rectum.


Ovarian teratomas in children. A thirty-three year experience. During the thirty-three years from 1941 through 1973, forty-two children with ovarian teratomas were seen. The most common complaint was that of abdominal pain and the most common physical finding was palpable lower abdominal mass. Thirty-seven patients had ovarian teratomas with nature tissues only. Of these, two patients have been lost to follow-up and the remainder are alive and well. One patient had teratoma containing mature and immature tissues (embryonic); this patient has remained well since operation. Four patients had malignant teratoma. Of these, two patients are dead due to the tumor and the two are living and well for six and nine years, respectively.


The injury problem in wrestling.

The injury problem in wrestling. This paper presents an over-all view of the injuries associated with intercollegiate and interscholastic wrestling as conducted in the United States. It classifies injuries according to the mechanism of injury in wrestling and analyzes these mechanisms together with recommendations for treatment and prevention of these conditions.


Noninvasive measurement of pulsatile blood volume changes. Its usefulness in peripheral vascular disease. A clinical trial was made of a new noninvasive technic for the measurement of arterial blood volume changes in a limb segment. The instrument employed is small, portable, provides a digital display in cc/min, is readily calibrated, gives reproducible values of the segmental phen be used to screen patients with peripheral vascular disease and to assess postoperative results.


The fate of patients with intermittent claudication managed nonoperatively. Of 100 patients with intermittent claudication, followed an average of six years, a surprising 78 per cent either showed improvement or remained stable regarding the presenting complaint. However, 39 per cent showed evidence of further progression of atherosclerosis. In patients with femoropopliteal occlusion in one leg, almost 40 per cent had occlusion in the one leg, almost 40 per cent had occlusion in the other leg after two to six years. The amputation rate was 7 per cent but six of these seven patients had severe diabetes. This study suggests that we are not causing limb loss by adhering to stringent criteria for bypass grafting. It also suggests that the patient with intermittent claudication without associated grave signs has a better than 50 per cent chance of improving and a better than 60 per cent chance that his disease will not show evidence of significant progression during a five to six year period. Such data should be taken into consideration when patients are considered for arterial reconstruction.


Delayed mastectomy after outpatient breast biopsy. Long-term survival study. Forty-one patients who had outpatient biopsy and delayed mastectomy (most within 3 days) were subjected to long-term survival study. The ten year and longer survival studies revealed no deleterious effects from this procedure. The improved statistics were believed due to operation on lesions considered clinically benign, the short period of delay, and a low incidence of axillary metastasis.


The Post-Mastectomy Rehabilitation Group program. Structure, procedure, and population demography. Memorial Hospital, New York City, clinical section of the Memorial Sloan-Kettering Cancer Center, has developed a Post-Mastectomy Rehabilitation Group (PMRG) which provides a comprehensive structure program to enable the mastectomy patient to regain functional use of her arm and shoulder on the affected side, and to adapt functionally, psychologically, and emotionally to the loss of her breast and the diagnosis of cancer in the shortest time possible. This first segment of an evaluation of the program outlines the PMRG structure and operating procedures and presents basic demographic data (age, type of mastectomy, preoperative activity status) for 863 of the 1,400 mastectomy patients who attended the program since inception in 1970. Additional reports will focus on the physical and psychologic aspects of recovery and readjustment.


Scar contracture after neck dissection. Causes, prevention, and treatment. Every effort should be made to employ neck incisions that allow for the accomplishment of surgical extirpative goals and at the same time provide maximal functional and aesthetic rehabilitation. Incisions parallel to the normal skin tension lines best fulfill these criteria. When vertical incisions are used, they should be anteriorly directed so as to cross the skin crease lines at an acute angle rather than a perpendicular angle. Such incisions perpendicular to the normal skin crease lines usually result in the greatest degree of scar contracture. Significant improvement in both major and minor scar contractures can be achieved with conventional Z-plasty technics to redistribute the skin tension. A wide resection of the subcutaneous cicatrix in such cases is imperative for a successful result.


Management of thyroid nodules in the elderly. Eleven malignant thyroid tumors were found in 100 consecutive patients more than sixty years old having thyroid operations. Based on preoperative findings, these 100 patients could be separated into two groups according to high and low risk for malignancy. Clinical manifestations in the high risk group were presence of a discrete cold thyroid nodule, hoarseness, dysphagia, an enlarging mass, or palpable ipsilateral cervical adenopathy; and in the low risk group, asymptomatic multinodular goiter, diffusely enlarged glands with elevated antithyroid antibody titers, and a family history of goiter. All eleven patients with malignant thyroid tumors were found in the sixty-six patients considered at high risk, whereas no malignant lesions were found in the low risk patients. Six of the malignant thyroid tumors were undifferentiated and in three of these a thyroid nodule had been present for more than fifteen years. There were no operative deaths and only one significant complication, a recurrent laryngeal nerve injury. Thyroidectomy is indicated for elderly patients with thyroid nudules who have features of the high risk group, whereas patients in the low risk group can be safely followed.


Thyroid angiography.

Thyroid angiography. Twelve patients were studied by selective thyroid angiography for the evaluation of solitary thyroid nodule. Under aseptic conditions with local anesthesia a No 7 preshaped catheter was introduced through the femoral artery and guided to the thyrocervical trunk and inferior thyroid artery. Selectively, 2 to 6 cc of the contrast material was injected and a series of radiographs were taken. Striking differences were noticed in vessels in abnormal thyroid gland. In colloid goiter there was no filling of the vessels in the nodule. In fetal adenoma there was unusual branching of the vessels but no arteriovenous communications. In carcinoma, along with increased vascularities and abnormal branching, arteriovenous communications were noted.


Prediction of malignancy in solitary thyroid nodules in a country with endemic goiter. From January 1962 through October 1975, 455 patients with single thyroid nodules were operated on at King Paul Hospital. Malignancy was proved in forty-three patients. The overall incidence of carcinoma was 9.5 per cent. A higher incidence of cancer was found in patients less than ten years of age (40 per cent), between eleven and twenty years of age (20 per cent), and more than sixty-one years of age (17.4 per cent). Malignant nodules were more frequent in males (17.5 per cent) than in females (8.3 per cent). Radioactive iodine scanning does not distinguish benign from malignant nodule. Solitary thyroid nodules require operative excision supplemented with replacement therapy.


Intra-arterial sympathetic blockade in the treatment of clinical frostbite. Regional medical sympathectomy achieved by the intra-arterial injection of reserpine appeared to be of benefit in the treatment of five patients with acute or chronic frostbite injuries. Clinical improvement was associated with a significant increase in arteriographically determined regional perfusion.


Immunotherapy of cancer with "immune" RNA. A preliminary report. A phase I clinical trial of immunotherapy with "Immune" RNA was undertaken fifteen months ago. Twenty-six cancer patients were treated with RNA extracted from the lymphoid organs of sheep immunized with either autologous tumor cells or allogeneic tumor cells of the same histologic type. Eighteen patients had gross disease and eight had minimum residual disease. RNA was administered weekly, intradermally, at doses up to 9 mg/week without any significant local or systemic toxicity. Four patients improved, thirteen achieved stability of disease or possible improvement, seven were treatment failures, and two are indeterminate. Lymphocyte-mediated cytotoxicity to allogeneic tumor target cells of the same histologic type were monitored in eleven patients. In seven patients, cytotoxicity increased after "Immune" RNA therapy; no change was observed in three patients; a decrease was noted in one patient. There appeared to be a possible correlation between cytotoxicity assessed in vitro and clinical response. There is some evidence that these responses may be specific for the particular tumor used to immunize the RNA donor.


Pelvic fractures: an anatomic guide to severity of injury. Review of 100 cases. A series of 100 cases of pelvic fracture secondary to violent trauma were reviewed and divided into two anatomic groups, those with pure anterior arch fractures (57 patients) and those with posterior fractures (43 patients). By this classification, mortality and associated injury are shown to be markedly increased in those patients with posterior fractures. A detailed study of the major complications has shown that a conservative approach to these injuries is probably the safest for the patient. Major blood loss is the rule rather than the exception and restoration of an adequate circulating volume by transfusion should precede operative attempts to control continuing retroperitoneal hemorrhage.


Fatal drug reactions in patients admitted to surgical services. In a defined group of 10,281 generally healthy inpatients admitted to surgical services, two deaths were identified as being due in part to an adverse effect of a drug, for a rate of 0.19 drug-related dealths/1,000 surgical patients (approximate 95 per cent confidence limits, 0.02 to 0.71/1,000). Both deaths occurred in women more than sixty years old and were due to hemorrhage associated with heparin therapy.


Choledochocele of the common bile duct.

Choledochocele of the common bile duct. The eighth report case of choledochocele is described. This lesion is a cyst communicating with the terminal portion of the common bile duct. It is characteristically lined with duodenal mucosa and is probably a form of duplication of the duodenum. The surgical treatment is marsupialization of the cyst to the interior of the duodenum.


Hyperparathyroidism with coexisting hyperthyroidism. Diagnosis of parathyroid disease in patients with hyperthyroidism may be difficult on clinical findings alone. Radiologic examination of the bones suggested the possibility of parathyroid disease in this patient. Confirmation of the diagnosis was made when serum calcium levels remained elevated in spite of adequate antithyroid medication. Measurement of serum parathyroid hormone levels may prove to be of greatest value. Of additional interest is the fact that the patient, before her symptoms became apparent, delivered an infant with congenital hypoparathyroidism.


Pancreatic duct obstruction by a benign polypoid adenoma of the ampulla of Vater. An unusual presentation of polyp of the ampulla of Vater is described. The patient initially had a chronic relapsing pancreatitis. Pancreatocholangiography revealed a tumor in the main pancreatic duct that proved to be a pedunculated polyp of the ampulla of Vater by operation. Transduodenal excision and sphincteroplasty may cure the lesion and relieve the symptoms of this disease.


Significance of selective arteriographic patterns in the celiac axis and superior mesenteric artery in portal hypertension. Selective celiac and superior mesenteric arteriographies were performed in patients with portal hypertension. An arterioarterial (A-A) shunt between the superior mesenteric artery and the celiac axis via pancreatic arcades was found in fifteen of forty-three patients with associated massive splenomegaly. A mild A-A shunt disappeared after portacaval anastomosis alone, whereas a prominent A-A shunt was reduced but persisted. The persisting A-A shunt disappeared after splenectomy. These findings led us to suggest that the paucity of the blood flow in the common hepatic artery concomitant with increased splenic arterial flow to the massively enlarged spleen may result in a compensatory supply to the liver from the superior mesenteric artery via the shunt.


Motility of gastric tubes.

Motility of gastric tubes. In gastric tubes interposed between small bowel a clear wave pattern was found, differing markedly from the bowl above and below. The gastric tube appears to be not an inert conduit since it continues to exhibit automatic rhythmic contraction. The possibility of slowing intestinal transit by the interposition of an antiperistaltic gastric tube seems to be supported by the demonstration of regular contraction.


The use of drains in subcutaneous surgical procedures. Continuous suction, negative pressure drains serve as an excellent "atmospheric bandage" in subcutaneous surgical procedures while helping to expedite wound healing and impede complications secondary to tissue plane dissection.


Use of the nephrocholedochoscope in vascular surgery. The nephrocholedochoscope designed for inspection of the ductal system of the urinary and bladder tracts has proved to be a useful method for examining the denuded vessel wall after limited blind endarterectomy. This technic is especially helpful in endarterectomy of the common iliac arteries and also has application in surgery of the profunda femoris, renal artery, and internal carotid artery.


A needle holder for vascular and plastic surgery. A needle holder is described that can be oriented to both the long and transverse axes of the hand, can be used with equal facility in either hand, and because of its narrow configuration is less apt to obscure the operative field.


Pentobarbitone premedication for anaesthesia. The influence of the preparation and route of administration on its clinical action. Studies were carried out in the pre-operative period on patients premedicated with 100 mg pentobarbitone given by mouth or by intramuscular injection into the buttock. The injections were given by doctors using a 4 cm needle or by nurses using the needle of their choosing and two preparations were used. One was a freshly prepared aqueous solution and the other the commercially available organic solution (Nembutal) with propylene glycol, alcohol and water as solvents. An unacceptably high incidence of persistent injection site pain occurred after the use of the organic preparation but not with the aqueous solution. Otherwise no difference was detected between the effects of the two preparations. Drugs injected by doctors were, on the whole, more effective as premedicants than those injected by nurses. Oral pentobarbitone was not as effective a premedicant as the intramuscular preparation and its anxiolytic action did not differ from that of the placebo. Relief of apprehension was disappointing with all preparations of 100 mg pentobarbitone and was not as good as with diazepam. This may be attributed to the use of too small doses but larger injection volumes would have caused their own problems.


Plasma pentobarbitone levels. Estimation by gas-liquid chromatography after clinical doses. A simple and relatively quick method of estimating pentobarbitone in plasma samples is reported using an ether extraction and gas-liquid chromatography. Glutethimide was used as the internal standard and proved reliable. Reproducible results were obtained in plasma following 100 mg pentobarbitone given by mouth or intramuscular injection. Evaporation in a heating block at 37 degrees C and storage of samples at -20 degrees C prior to analysis is recommended.


Plasma pentobarbitone levels. Influence of the preparation, route and method of administration. In fit women plasma pentobarbitone was measured by gas-liquid chromatography after 100 mg given by mouth or intramuscular injection in the buttock using aqueous and organic solutions. Differences in plasma levels with the two solutions were not striking. Considerable inter-administrator difference occurred with significantly higher plasma levels when the drug was injected by a doctor using a 4 cm 21 s.w.g. needle as compared with nurses who used no specified injection technique. The oral route gave significantly higher plasma levels than nurse-given injections.


An approach to programmed anaesthesia.

An approach to programmed anaesthesia. This approach to programmed anaesthesia uses a pharmakokinetic model to predict the rate at which halothane must be administered to achieve and maintain a preselected tension within the brain. 'In-course' corrections are also applied to this predictive regime on the basis of variations in the respired minute volume which is taken as an indicator of the depth of anaesthesia. Experimental data on the accuracy of the model and the performance of the corrective control unit are presented.


Anaesthetist in Salalah. Experience in a field surgical team. A tour of 4 months with a static Field Surgical Team supporting military operations is described. Some of the problems of resuscitation and anaesthesia which were encountered are discussed. The anaesthetist's training in intensive care and the management of acute medical problems have a major part to play in a field hospital particularly in an isolated area. The management of coagulation disorders remains a major problem.


Perinatal mortality after epidural analgesia. A retrospective survey has been carried out of 6442 births during 1973-1974 in Cardiff. Lumbar epidural block had been administered to the mothers of 13-7% (885) of the births, the principle indication being relief of pain. In the management of the mother special emphasis was laid upon avoiding aorto-caval compression. The perinatal mortality associated with epidural block (14-8 per 1000) was not significantly different from that after other forms of analgesia (19-2 per 1000). There were less first week deaths in babies weighing less than 2-5 kg after epidural block (0 of 45) than in those who had other methods of pain relief (41 of 414) (P = 0-023). The choice of maternal medication did not influence the perinatal mortality rate of the immature baby, but there is a positive but non-significant, trend in favour of epidural block in the premature baby. This improvement in mortality could simply be related to the increased use of forceps delivery associated with epidural block. A controlled trial of epidural block is therefore indicated in the management of the premature fetus. In babies over 2-5 kg, or, those who were immature, epidural block was not associated with a reduction or increase in perinatal mortality.


Regional hip blockade. A simplified technique for the relief of intractable osteoarthritic pain. A regional anaesthetic technique is described using a blind anatomical approach to the obturator nerve and nerve to quadratus femoris, as a means of alleviating the disabling pain of chronic osteoarthritis of the hip, when arthroplasty is not available.


Chemical lumbar sympathectomy.

Chemical lumbar sympathectomy. The technique of injection and the results of a series of 124 chemical lumbar sympathectomies, performed on 97 patients, are described. Sixty-eight patients, over 60 years of age, had their sympathectomy because of peripheral arteriosclerotic disease. Fifty-two of these patients benefited in terms of pain relief and only one required amputation. Sixteen patients, under 60 years of age, had their sympathectomy because of peripheral arteriosclerotic disease. Ten of these patients benefited but it is recommended that, where possible, other methods of treatment should be used in this younger age group. Thirteen patients, mostly elderly, had their sympathectomy because of diabetic ischaemic disease. Six only of these patients benefited, but it is felt that chemical sympathectomy can be recommended as a way of helping some of these patients who would otherwise have amputation.


Recurrent hallucinations following ketamine. Recurrent hallucinations appeared in an 11-year-old boy during 5 days following ketamine anaesthesia. Previous anaesthesia with ketamine and adequate diazepam supplementation did not produce any such effect. The phenomenon of delayed recurring hallucinations is a rare but dangerous side-effect of ketamine, not unlike LSD flashbacks. The described case lends support to previous reports on the value of diazepam in the prevention of post-ketamine perceptual abnormalities.


Accidental intra-arterial injection of ketamine. A case of accidental intra-arterial injection of ketamine is reported. Necrosis of the skin proximal to the site of injection and transient foot drop followed the injection.


Securing the endotracheal tube. A method for use with the plastic 'Nosworthy' connector. A method of securing the endotracheal tube using a plastic 'Nosworthy' connector and a commercially available 'O' ring is described.


A double-lumen tube connector.

A double-lumen tube connector. A connector for double-lumen tubes, that is simple and safe, is described. There are no separate attachments that may be lost and it is easily dismantled for sterilisation.


A simple mask for nitrous oxide and oxygen analgesia. The construction and use of a disposable mask for post-operative nitrous oxide and oxygen analgesia are described.


An economic power spray.

An economic power spray. A simple adaptation which can be made to enable a manually operated spray to be used and controlled with low-flow oxygen is described.


Anaesthesia in a plastic surgery unit before the Fall of Saigon. The staffing and anaesthetic techniques in use at the Children's Medical Relief International Plastic and Reconstructive Surgery Unit in Saigon between 1972 and 1975 are considered. The special value of the use of spontaneously respired trichloroethylene and halothane with air enriched with oxygen on the draw-over principle is discussed.


Anaesthesia in Africa. The effect of the African cultural background on the practice of anaesthesia. This paper describes the effect of an African cultural background on normal anaesthetic practice. Attitudes of African people to illness, hospital, pain and medicine are explained.


Anaesthesia in a developing country. A review of anaesthesia in Lesotho based on a recent survey. The background to the anaesthesia being practised in Lesotho, a developing country in southern Africa is described. The results of a recent survey covering the anaesthetic apparatus and techniques currently employed in the country's sixteen district hospitals are discussed, and consideration is given to possible anaesthetic developments for the future.


Diazepam-ketamine anaesthesia for open heart surgery "micro-mini" drip administration technique. Two hundred open heart cases anaesthetized with a combination of diazepam-ketamine using "Micro-Mini" drip administration technique were presented. The results were eminently desirable, and in the opinion of the authors are a notable improvement over other methods for all types of cardiovascular surgery including most advanced heart diseases. The advantages of this anaesthetic method for cardiovascular surgery are as follows: 1. Effects on cardiovascular system are minimal.--2. Respiratory depression is negligible.--3. There is no increase in salivation or muscle tone.--4. Induction and maintenance of anaesthesia are simple and smooth.--5. Anaesthesia can be maintained, using a high concentration of oxygen alone, by a slight increase in rate of ketamine administration whenever necessary.--6. Post-anaesthetic psychotomimetic effects are negligible.--7. Nearly 100% of patients have excellent amnesia.--8. It has a wide margin of safety.--9. This technique has proved highly acceptable to patients and surgeons. We feel ketamine should be used in small dosages continuously administered with either "Micro-Mini" drip infusion or infusion pump. Ketamine given in this fashion should be regarded as an analgesic.


[The effect of different ventilation under anaesthesia upon intracerebral x-ray findings (author's transl)]. In 35 patients carotid angiography was performed under general anaesthesia (Halothane or NLA) under hyper- and hypoventilation conditions. Hyperventilation led to arterial vasoconstriction. The changes in vessel diameter correlated with the difference from hyper- to hypoventilation. Under hypoventilation the veins were filled earlier and better. In case of tumour and in case of insult with angiographically verified blush the pathological vessels were better stained with hyperventilation. Anaesthetics did not influence the X-Ray findings. Patients should be hyperventilated during carotid angiography. Only in certain cases an angiogram under hypoventilation allows a clearer X-Ray interpretation.


[Studies on the palpable intensity of the radial pulse (author's transl)]. Depending on the pressure of the palpating finger the radial pulse may be found differently "large" in spite of unchanged intravasal pulse pressure. In this paper the amplitude of the extravasal volume pulse is examined related to a continually diminished coupling pressure of a foto-electrical pulse detector. First, the amplitudes increase with the declining external pressure, reach a maximum and then diminish again. This is exactly the same course one gets palpating the radial pulse with the finger. The intravasal pressure amplitudes however show at the same time a different kind of course. These differences between extra- and intravasal pulsation usually can be seen in patients with undistrubed circulation. Having a vasoconstriction in the radial artery the course of the extravasal volume pulse-curve appears different and the sensation of the palpating finger, too. In this case the pulse is palpable evenly small. The differences can be explained by the changes in the pressure-builded elastic tension of the arterial wall and the stronger contraction of the vessels muscles in vasconstriction. Thus, the diagnosis vasoconstriction can be made palpating the radial pulse.


[Quantitative morphological investigation of the effect of ether anaesthesia on the kidney of the rat (author's transl)]. In the proximal and distal convoluted segments and the collecting tubule of the kidneys of 24 male albino rats, type Wistar TNO W 70 SPF, the nuclear volume was measured after the animals had been anaesthetized with ether for 15, 40 and 80 min. In contrast to nontreated controls there was a decrease in average nuclear size of 12.6% and 11.1% after 15 and 40 min in the proximal convoluted segment. Changes in nuclear size could not be detected in the distal convoluted segment and in the collecting tubules. While the decrease in the nuclear volume in the proximal convolution is considered to be a direct effect of ether, the enhanced reabsorption of sodium mentioned in other studies could be explained by an alpha-receptor mediated transport effect of the narcotic agent.


[Investigation on the morphokinetic reactions of the rat liver to ether anaesthesia of different length (author's transl)]. The nuclear volumes were measured in the central, intermediate and peripheral zone of the classic liver lobule of adult male albino rats exposed to ether anaesthesia lasting 15, 40 and 80 min. Related to control animals there was a significantly lower nuclear size after a 40 min duration of narcosis and a significant higher volume after 80 min in the central part of the lobule. With a slight but not significant decrease of nuclear volume in the intermediate zone after 15 min and a significant increase after 80 min respectively, the peripheral lobular region constantly showed significantly smaller nuclei. But here, too, a disappearance of decrease was recorded after 80 min. The interpretation of the data is based upon a typical distribution of cell organelles, enzymatic pathways, and metabolites in the different zones of the hepatic lobule. The intensity of reaction and appearance of diminution in nuclear volume, indicating a functional depression and probably accentuated by a circular dependent low O2-tension of tissue, is interpreted in connection with different local concentrations of ether. An improvement of the blood flow by augmental local metabolites and an increased arterial influx presumably support the recovery and favour a concentration-dependent induction of microsomal enzymes in the central part of the lobule especially.


[The synthetic saliva--a supplement to the premedication (author's transl)]. An undesirable side-effect of the anticholinergic drugs used in the premedication is an unpleasent drying of the mouth and pharynx. According to the experience of the authors, this often distressing feeling can be successfully relieved by means of application of synthetic saliva. This is of special importance for patients operated under reginal anaesthesia.


[Volume and pressure changes due to nitrousoxide diffusion in costumary and in low-pressure cuffs of endotracheal tubes (author's transl)]. Changes of volume and pressure due to N2O-diffusion into PVC and Latex cuffs of endotracheal tubes were measured. Endotracheal tubes with a small-volume cuff (Magill and Portex) and one type of a large-volume, low-pressure cuff (Lanz) were examined. Within 48 h significant changes of volume and pressure were registered at different starting volumes and different N2O-concentrations. In the small-volume cuffs of the Portex and Magill tubes very high pressures were always noted; increases of volume were always seen, which were accompanied by increases, in some cases also by decreases of pressure. In the large-volume cuffs of the Lanz tube there were increases of volume and pressure; the measured pressures where however, in a clinical unimportant range. These changes are caused by N2O-diffusion into the cuff, slowed N2-diffusion out of the cuff, prestretching of the cuff membrane by the starting volume and further stretching by N2O diffusing into the cuff. These measurements are of practical clinical significance: This high-pressures due to starting volume and N2O-diffusion in small-volume cuffs explains the higher rate of trauma to the trachea, even after short term intubation, in contrast to the extremely low pressures in large-volume, low-pressure cuffs.


Aims and objectives for postgraduate learning in anaesthesia. This paper describes the statement of aims and objectives of postgraduate training for the Faculty of Anaesthetists of the Royal Australasian College of Surgeons. The objectives of the authors are that after study of this paper, the readers will: (a) Understand the importance of both "stated" and "informal" objectives in teaching and learning. (b) Understand the important terms used in the Faculty of Anaesthetists' Document on objectives. (c) Know the strategies using in writing the Faculty's Document of Objectives.


The role of formal courses in the vocational training of anaesthetists. Some of the factors which influence the conduct and the effectiveness of formal courses are discussed. It is considered that the needs and the aims of the trainees and teachers are especially relevant, but sometimes a difference in priorities exists. It is suggested that there should be careful definition of the needs to be satisfied by the formal course and that the educational body conducting the course and the geographical location of the course should be based on those needs. The role of the course supervisor in the organizer-teacher-trainee communication system is especially important.


Organizing an educational exercise.

Organizing an educational exercise. The satisfactory organization of an educational exercise is dependent on the organizer having a precise understanding of the needs of his students, their present level of knowledge and understanding, the motives which govern their will to learn, and on the organizer's ability to draw together people with intellectual resources capable of satisfying those needs of the students. Both students and tutors must be placed in an environment which encourages communication and interaction and adequate physical resources for teaching must be provided.


Tutor-student interaction in the operating theatre. This paper examines the view that productive teaching in the operating theatre requires a recognition of the unique set of factors which may influence the process of communication. For tutor-student interaction to occur in a productive manner, the tutor's behaviour will need to be modified to suit the demands of the other tasks in which both tutor and student are involved. The particular value of recognizing the role of nonverbal behaviours during interaction is discussed, with the use of specific examples related to the positioning of the tutor and student, and their use of facial expression, the eyes and voice.


Teaching and learning in the operating theatre. The anaesthetist's role during an anaesthetic is one of vigilance. Any interaction between tutor and student in this situation must be structured around the vigilance task. Teaching that recognizes this role may be educationally fruitful and may even improve vigilance. Teaching which disregards this function is less likely to result in learning and may interfere with patient care. Some of the types of teaching that are likely to be appropriate or inappropriate to different phases of an anaesthetic are indicated.


Medical writing.

Medical writing. Attempts to transfer information are often frustrated by errors in English. A few of these are analysed and some suggestions are made for avoiding them.


The use of summary answers as the basis for tutorials. The use of summary answers to a question as an aid to introducing and guiding a tutorial is described using as an example a question about the physiological changes associated with pyrexia. It illustrates a method that involves all the students and develops a logical comprehensive answer that can also be helpful to students preparing for examinations.


Continuing education.

Continuing education. One view of the aims and objectives of continuing education is presented. Problems in the form of educational material and access to present educational opportunities are outlined together with some suggestions for overcoming these problems. Self evaluation is emphasised as an important means of maintaining educational standards rather than "re-licensure". Several new approaches are presented which attempt to increase access and acceptability in continuing education.


The value of anaesthesia training in the first two postgraduate years. The value of an anaesthetic attachment during the first two postgraduate years is considered under three major headings, the value to the recent graduate, the value to the specialty, and the value to the community. The anaesthetic attachment offers all recent graduates an opportunity to perfect practical skills which should from part of the armamentarium of all doctors, and for some there is the option to acquire the ability to administer a safe anaesthetic. Exposure to the specialty at this time is important for recruitment to the specialist ranks.


Acute appendicitis and continuous peritoneal lavage. In a series of 117 patients of all ages who were found to have acute appendicitis with perforation, it was found that continuous peritoneal lavage started immediately after appendicectomy had a significant effect in reducing the morbidity and complication rate of this condition. The treatment lasted on average 18 hours and approximately 40 litres of dialysate were used per patients. Treatment was continued until the effluent was macroscopically clean.


Reversal of the anaesthetic action of sodium gamma-hydroxybutyrate. Physostigmine was administered intravenously to 25 patients, anaesthetised with sodium gamma-hydroxybutyrate (GHB), and their emergence from anesthesia was studied. Physostigmine (2 mg) brought about rapid, safe, reliable and sustained awakening after a "latent period" varying from 2-10 minutes (mean 6-2 minutes+/-S.D. 2-2) in 24 patients. In the one patient not awake at 10 minutes, a second dose of physostigmine produced awakening in an additional 8 minutes. No serious side effects were attributable to the physostigmine. This finding may warrant a reconsideration of the place of GHB in anaesthetic practice.


A new blood administration set.

A new blood administration set. A new blood administration set is described. It incorporates an in-line hand pump and a heat exchange coil and has a number of advantages over separate heating coils. The blood warming efficiency of the unit has been measured.


Fine structure of the esophagus lining epithelials cells of the snake Xenodon merremii Wagler, 1824 (Ophidia). The authors studied the ultrastructure of the esophagus lining epithelial cells of the snake Xenodon merremii. The initial shows ciliated wedge shaped cells and goblet cells which are gradually displaced by columnar ones in the posterior third of the organ. Other cellular types, such as basal, argentaffin and argyrophil cells can be found throughout the esophagus mucosa.


Cytologic changes in the pars distalis of male buffalo following emasculation. The effects of emasculation in the pars distalis of the pituitary gland were studied in male buffalo. Following castration, no size or percentage value changes could be noted in the acidophila and thyrotrophs of the pars distalis. The acidophils were found in greater numbers in the peripheral area of the pars distalis as compared to the central area. However, the frequency of thyrotroph distribution was observed to be more so in the central zone. As for the gonadotrophs, a significant increase in the cell size (P less than 0.05) and percentage value (P less than 0.01) was observed in animals castrated by the Burdizzo method. This points to a state of hyperplasia and hypertrophy of the gonadotrophs as a result of this method of emasculation.


The role of reticulo-endothelial cells in hemopoiesis in the adult liver. Form their sinusoidal position in the properly stimulated adult liver, the reticulo-endothelial cell invades the hepatic cords. Here, their cytoplasmic processes come in direct contact with the cytoplasm of the hepatic cells. Ferritin is transferred from cord cells to the reticulo-endothelial cell, initiating extravascular hemopoiesis. As the reticulo-endothelial cell regains an intravascular position, it takes on the characteristics of a proerythroblast. The activity described for the adult liver follows the pattern observed in the fetal liver where proerythroblasts appear within the hepatic sinusoids only after hemopoiesis is established in the adjacent extravascular hepatic cords.


Histomorphological and histochemical studies on the female genitalia of aging goat. I. Lipid histochemistry of ovary. Paraffin sections of ovaries from 24 goats stained by Acetone Sudan Black B method for bound lipids and Copper-Phthalocyanin method for phospholipids revealed at least two categories of interstitial cells containing sudanophilic lipids with phospholipids. First category were those which were assumed to be formed from theca interna cells of atretic follicles. Second category included those originating probably from the granulosa cells of primordial follicles and form a continuous zone under the tunica albuginea. Another zone of interstitial gland cells presumed to be originated from the germinal epithelium has also been recognized under the latter. Appearance of sudanophilic material in relation to atresia of follicles in goat ovary has been reported.


The fine structure of the parathyroid glands of rats with disuse osteoporosis. The parathyroid glands were studied ultrastructurally in two groups of rats: one control group and one group with an immobilized hindleg. The aim was to see whether immobilization has any effect on the fine structural appearance of the parathyroid glands. No morphological differences were recorded between the two groups. Nor were any signs of increased functional activity observed. The results denote that no increased parathyroid activity occurs after immobilization of an extremity in rats.


Tannic acid induced hepatic injury in Clarias batrachus. The effect of intraperitoneal administration of an aqueous solution of tannic acid was examined after different intervals of time. The results showed a gradual and progressive destruction of the liver cells and transformation of its architecture. The histological signs of liver damage appeared 2 hrs after the intoxication. Mild necrosis at periphery was noted even after 1 hour. After 2 hrs hepatocytes were swollen and sinusoids were contracted. These changes became more pronounced after 12 hrs and by 24 hrs extensive centrolobular and perilobular necroses and severe hydropic degeneration of liver cells were observed. Nuclear volume increased at the very first stage of necrosis but after 48 hrs binucleate and multinucleate cells were also visible. The nucleolus was hypertropied and divided into two or more portions after 1 hour. Connective tissue was degnerated after 24 hrs. Hepatic fibrosis was observed after five days of treatment. In all the present experiments vascular lesions and bile duct hyperplasia were the common phenomena.


An autoradiographic study on the localization of 131I-labeled thyroid hormones in the tissues of the pig. Autoradiographic studies on the localization of 131I-labeled thyroxine and triiodothyronine in the various organs and tissues of the pig have been conducted. The isotopes were compared as to the intensity of radioactivity on the basis of the concentration of developed silver grains in the tissues following the respective radioactive hormone injections. In general, for an identical dose of the isotope and with analogous processing procedures, the autoradiographs of most of the tissues after triiodothyronine were relatively more radioactive than after thyroxine. In both the hormone treatments, the tissues from younger pigs were relatively more radioactive than the tissues of older pigs. The various tissormones. Based on differential localization of radioactivity, the pigs excreted more radioiodine through bile, pancreatic and salivary secretions and in urine.


Thyroid follicles in the head-kidney of teleosts. Out of five species of fishes, selected for this investigation, only two have shown the presence of thyroid follicles in their head-kidneys. In Tor tor the thyroid follicles are larger than those of Cyprinus carpio. They are elliptical in shape in T. tor while spherical in C. carpio. The follicular epithelium in T. tor is thick and prominently built while in C. carpio it is weak in its appearance and structure. The colloid of the follicles in both the cases is uniformely homogeneous, non-vacuolated ans acidophilic in nature. The follicles are almost always located in close proximity to the posterior cardinal veins and their branches. It is, for this reason, argued that they might have migrated along these blood vessels. there is no any regular distribution and proper arrangement of these follicles.


Comparative morphology, anatomy and histology of the alimentary canal of an Indian freshwater major carp, Labeo calbasu (Hamilton) during the different life-history stages in relation to food and feeding habits. 1. The early life-history stages of Labeo calcasu (Hamilton) viz., the fries, are zooplankton-feeders (carnivorous). The morphology, anatomy and histology of the alimentary canal during this stage is adapted accordingly. 2. With increase in age, size and body-length, the food and feeding habits of the fish undergo changes from the carnivorous to the herbivorous type (adult) through the omnivorous type (fingerlung). 3. The morphology, anatomy and histology of the alimentary canal gets modified accordingly in the fingerlings and adults.


Effect of hydrocortisone acetate on interrenal cells in the normal and hypophysectomized catfish, Heteropneustes fossilis, (Bloch). The interrenal gland of the Heteropneustes fossilis occupies three fourth area of the kidney and shows two types of cells histologically. The cells are arranged as cortical strands. Hypophysectomy resulted in regressive changes in the interrenal gland, as seen from the significant reduction in the nuclear diameter within fifteen days. A single injection of hydrocortisone brought about further reduction in the size of interrenal cell and the nuclear diameter in the hypophysectomized animals, but not in the intact fish. It is concluded that the amount of hydrocortisone added was sufficient to cause reduced functioning of the interrenal gland in the absence of ACTH.


The fine structure of the placenta of the impala Aepyceros melampus (Lichtenstein, 1812). The ultrastructure of the placenta was investigated at various stages of gestation. The nonplacental areas of the maternal epithelium continue to show considerable secretory activity long after implantation. The placental barrier is of the epithelio-chorial type.


The morpho-histology of the pituitary glands in two freshwater major carps of India, Labeo rohita (Ham.) and Cirrhinus mrigala (Ham.). 1. The pituitary gland in Labeo rohita and Cirrhinus mrigala is a small, pear-shaped, whitish, soft body situated in a cavity -- the sella turcica. The gland is of the lepto-dorso basic type. 2. It consists of the neurohypophysis and adenohypophysis. The latter comprises three lobes viz., the rostral pars distalis, the proximal pars distalis and the pars intermedia. 3. The neurohypophysis branches into the pars distalis, extends into the pars intermedia and ramifies extensively. It is composed of loosely arranged fibres among which are present nuclei of the neurones and a few droplets of neurosecretory material. 4. The rostral pars distalis is antero-dorsal in position and is the smallest portion of the gland. It consists of two types of acidophils a few cyanophils and chromophobes. 5. The proximal pars distalis occupies the central region and is the largest portion of the gland. It comprises two types of acidophils two types of cyanophils and a few chromophobes. 6. The cyanophils of the proximal pars distalis may also contain acidophilic or cyanophilic globules of varying sizes. These globules may be either situated inside the nucleus or on its periphery. 7. The presence of cyanophilic material in the blood sinuses indicates a possible pathway through which the secretory products are conducted into the general circulation. 8. The pars intermedia is the posterior most region of the gland and is large. It is composed of two types of acidophils and a few chromophobes. During the breeding season some of the cyanophils resent in the pars intermedia behave like the gonadotrophs of the proximal pars distalis.


Distribution and density of goblet cells in the middle ear in children. On dissected mucosa stained by the PAS-alcian blue whole-mount method the density and distribution of goblet cells in various parts of the middle ear was determined in 13 children, ranging in age from 9 days to 14 years. Goblet cells, of an irregular distribution, were found in all parts of the middle ear, but in varying density, decreasing in a given sequence from the hypotympanum anteriorly, posteriorly, promontory anteriorly and in the middle, niches of the oval and round windows, epitympanum, antrum, posterior part of the promontory, and mastoid process. During pathological actions, especially tubal occlusion, the goblet-cell density increases in all parts, simultaneously with epithelial metaplasia and new-formation of mucous glands. When the pathological stimulus ceases, the goblet-cell density again falls. In entirely normal infants and in children aged 2-4 years the goblet-cell density was found to be somewhat higher than in normal adults.