Pulmonary arterial compression syndrome caused by false aneurysm of left ventricular outflow tract. A 29 year old man experienced exertional dyspnea and coughing 3 1/2 years after insertion of a Brauwald-Cutter aortic valve prosthesis. Clinical examination suggested pulmonary arterial hypertension, and cardiac catheterization revealed a saccular lesion apparently arising from the left ventricular outflow tract and producing compression of the right pulmonary artery. Origin from the left ventricular outflow tract just under the aortic ring was confirmed at operation. The lesion apparently arose from an anular excavation related to previous endocarditis with abscess formation. Reported cases of similar aneurysmal lesions are briefly reviewed, and other known causes of the pulmonary arterial compression syndrome are discussed.


Independence of the effects of cholesterol and degree of saturation of the fat in the diet on serum cholesterol in man. The effect on the fasting serum lipid levels of adding daily 291 mg of cholesterol to diets containing 3 mg of cholesterol and equal fat content, but different fatty acid composition, was tested on 12 young men. The saturated diet provided 97 g/day of a staurated oil made up of 2 parts of palm oil and 1 part of coconut oil. The polyunsatured diet provided 97 g/day of safflower oil. The cholesterol was dissolved in 40 g of either oil incorporated into a spread. A similar spread, devoid of cholesterol, was fed during the cholesterol free periods. Duration of dietary periods was 14 days. Addition of cholesterol produced a mean elevation of serum cholesterol of 9 mg/dl (SE +/- 2.1) in the presence of the saturated diet, and of 8 mg/dl (SE +/- 1.6) in the presence of the polyunsaturated diet. Both cholesterol elevations were significant (P less than 0.01) but not significantly different from each other. Substitution of the saturated diet for the polyunsatured diet caused a significant elevation of serum cholesterol which was the same when the substitution was made in the presence or in the absence of added dietary cholesterol.


Effect of anti-insulin serum on the hepatic lipid metabolism of BHE rats. The effects of daily injections of anti-insulin serum (AIS) on the hepatic synthesis of lipids was studied in young male BHE rats after 3 weeks of feeding either a 45% carbohydrate 40% protein diet, a 65% sucrose diet, or a 65% protein diet. One-half of the animals in each diet group received injections daily with AIS, and the remaining animals in each group received injections with isotonic saline solution. After 3 weeks the animals were killed, and levels of serum insulin cholesterol, and triglycerides were determined as were the levels of liver lipid, cholesterol, fatty acid synthetase, and the conversion of acetate 14C to cholesterol 14C. AIS treatment lowered serum insulin levels, serum triglyceride levels, caloric intake, weight gain, liver weight, acetate 14C incorporation into cholesterol 14C, and the percentage of liver lipid that was cholesterol. Diet affected serum and liver lipid levels, fatty acid synthetase activity, and the incorporation of acetate 14C into cholesterol 14C. The results of this study show that the lipogenic characteristic of the BHE rat is diet dependent, but that this characteristic can be modified to a limited extent by AIS treatment. Further, the results also suggest that the hyperlipemic characteristic of these rats may be independent of the hyperinsulinemic characteristic.


Relationships between cigarette smoking, oral contraceptives, and plasma vitamins A, E, C, and plasma triglycerides and cholesterol. Plasma vitamins A, E, and C, plasma triglycerides and cholesterol, and leukocyte vitamin C were examined in young healthy adult females who were cigarette and/or oral contraceptive users. It was found that cigarette smoking slightly increased the levels of vitamin A, triglycerides, and cholesterol while oral contraceptives significantly increased these plasma lipids. The effects of cigarette smoking and oral contraceptives on these substances were additive. Neither cigarette smoking nor oral contraceptives had any significant effect on plasma vitamins E and C. Oral contraceptives slightly decreased the level of leukocyte vitamin C in the cigarette smokers. Cigarette smoking did not impart and acute effect on these parameters.


Two types of nutritional rickets in infants. In 100 infants with nutritional rickets, i.e., responsive to vitamin D therapy, we found a close inverse relationship between serum phosphorus, on the one hand, and serum alkaline phosphatase and the presence of radiological signs of rickets, on the other. There was no correlation between serum calcium and the severity of bone lesions. It is concluded that hypophosphatemia but not hypocalcemia is typical of rickets. Since hypophosphatemia and rickets can be produced experimentally by phosphate deficiency alone, we suggest our infants can be divided into two groups, one with true vitamin D deficiency that leads to hypocalcemia and no or mild bone lesions, and one with primary phosphate deficiency, resulting perhaps from a defect in phosphate transport, which leads to rickets and hypophosphatemia.


Physical and intellectual development in Philippine children fed five different dietary staples. Assessments of dietary intake, intelligence, physical growth, and clinical signs of malnutrition were made on 600 children from five Philippine communities. Five boys and five girls each at ages 8,9, and 10 from poor and less poor families drawn from town and rural schools in each community were examined. Dietary staples were rice, fish, corn, coconuts, and sweet potatoes, respectively, at the five sites. Analyses of variance indicated marked differences among communities in nutrient intake based on 24-hr recall, in intellectual and anthropometric measures and in clinical signs of malnutrition. There were few significant F ratios for urban-rural residence, socioeconomic status, sec, or age. There were positive correlations of approximately 0.20 between intake of calories and carbohydrates and intelligence; between calories and carbohydrates and anthropometric measures; and between intelligence and anthropometric measures. Clinical signs in the eye and on the skin showed low correlations of about-0.20 with dietary intake of protein, fat, thiamin, and riboflavin but not with vitamin A. In all communities energy intake was low reflecting limited fat consumption. Where rice or corn was the staple, thiamin and riboflavin were also frequent deficiencies; with fish, ascorbic acid; with sweet potatoes and coconuts, calcium, riboflavin, and thiamin. A very high incidence of eye changes, suggestive of a vitamin A deficiency, was found even where vitamin A intake seemed adequate.


Morphological effects of vitamin D and its analogs on bone. Recent studies employing analogs of vitamin D in the treatment of clinical and experimental renal osteodystrophy indicate remarkable healing of morphological and biochemical skeletal lesions. After short periods of therapy, 25-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol normalizes most of the histological abnormalities of the human uremic skeleton and significantly suppresses elevated levels of circulating immunoreactive parathyroid hormone. 25-Hydroxycholecalciferol appears to stimulate individual osteoblastic activity but does not increase the number of bone forming cells. Accumulated evidence suggests a direct effect of vitamin D and its metabolites on uremic bone.


Vitamin D deficiency and rickets.

Vitamin D deficiency and rickets. Classical experimental rickets in the rat is a dual deficiency, resulting from both phosphate and vitamin D deficiency, with many of the features of rickets reproducible by simple phosphorus deficiency. Simple vitamin D deficiency differs markedly from experimental rickets, with only the absence of the vitamin D-dependent calcium-binding proteins common to both situations. The expression at the bone level of vitamin D deficiency differs in the two conditions, with rickets leading to profound structural and metabolic changes, whereas simple vitamin deficiency primarily compromises the regulatory function of bone, without obvious structural alterations. It is proposed that human nutritional rickets is the result of a nutritional vitamin D deficiency that aggravates the expression of a pre-existing metabolic defect in phosphate transport. Simple nutritional vitamin D deficiency, unaccompanied by rickets, may occur, but probably has always been rare.


Pantothenic acid, coenzyme A, and human chronic ulcerative and granulomatous colitis. To investigate further an apparent relationship between chronic ulcerative and granulomatous colitis and pantothenic acid deficiency, colonic tissues obtained at the time of colectomy in 29 patients with these disorders were assayed for pantothenic acid and for coenzyme A (CoA) activity. For comparison, normal colonic tissues free of pathological lesions were obtained from 31 patients having colectomy for carcinoma or diverticulitis. Plasma, red blood cells, and colonic mucosa were assayed microbiologically for free and total pantothenic acid. The activity of CoA in colonic mucosa was determined by assaying the acetylation of sulfanilamide. Concentrations of free, bound, and total pantothenic acid in blood and in colonic mucosa did not differ between the two groups of patients. Bound pantothenic acid increased linearly with total pantothenic acid. Colonic mucosa concentrated free pantothenic acid to about 50 times the level of blood, and pantothenic acid in red cells was similar to the concentration in plasma. Compared to normal gut mucosa, CoA activity was markedly low in mucosa from patients with chronic ulcerative or granulomatous disease despite the presence of normal amounts of free and bound pantothenic acid. A block in the conversion of bound pantothenic acid to CoA in diseased mucosa is suggested.


Acute effect of ascorbic acid infusion on carbohydrate tolerance. Large doses (1 to 2g/3 hr) of ascorbic acid were administered intravenously to normal weight and obese, nondiabetic subjects. Glucose tolerance and fasting plasma glucose levels were unaffected, despite a 3- to 8-fold rise in plasma concentrations of the vitamin. Infusion of ascorbic acid did not alter fasting serum insulin levels in normal subjects, but was associated with lower concentrations of hormone during an intravenous glucose tolerance test. Plasma glucose, serum insulin, growth hormone, and glucagon levels in obese subjects remained unchanged during the ascorbic acid infusion.


Plasma amino acids and nitrogen retention of human subjects who consumed isonitrogenous diets containing rice and wheat or their constituent amino acids with and without additional lysine. Six diets furnished 6.0 g of nitrogen to adult human subjects as follows: a combination of rice and wheat; mixtures in which either 100 or 50% of the amino acids in rice and wheat were replaced by their constituent amino acids; and similar diets in which lysine was increased from 1.2 to 1.8 g. Nitrogen retention was greater (P less than 0.01) and concentrations of several amino acids in plasma were lower when the cereals were supplemented with lysine than when all other diets were fed. Data obtained with mixtures of amino acids apparently cannot always be used interchangeably with that from cereal-based diets, even when amino acid content is the same. Changes in plasma amino acids are a useful indicator of utilization of dietary amono acids when nitrogen balance also is determined.


Urinary creatinine excretion and lean body mass. In a group of 34 adult and child subjects a high correlation (r = 0.988) was found between lean body mass, as determined by potassium-40 counting, and urinary creatinine excretion. The effect of technical errors was reduced by averaging the results of two or three 40K assays on each subject, and by making consecutive 3-day collections of urine. It appears that one can make a reasonable estimate of lean body mass from urinary creatinine excretion.


Plasma and urinary amino acids and selected sulfur metabolites in young men fed a diet devoid of methionine and cystine. A preliminary investigation was conducted to explore the use of plasma methionine and cystine for determining human sulfur amino acid requirements. Measurements of urinary methionine, cystine, taurine, and inorganic sulfate were included. After a 3-day control period, three young men were fed for 8 days a diet containing a purified -l-amino acid mixture, patterned after egg protein but devoid of methionine and cystine. Fasting plasma methionine and cystine levels showed little decrease during the 8-day period. Urinary cystine and taurine responses were inconsistent among the subjects. Urinary methionine and inorganic sulfate levels decreased markedly within a few days after feeding of the experimental diet, and may be useful criteria for determining human sulfur amino acid requirements.


Vitamin A absorption in ascariasis.

Vitamin A absorption in ascariasis. Vitamin A absorption was studied in a group of 28 adult patients with ascariasis and 12 healthy adult controls, using a simplified vitamin A absorption test. In over 70% of the patients with ascariasis malabsorption of vitamin A was demonstrated. Stool egg counts for ascaris were not related to the degree of vitamin A malabsorption. Of the 23 patients in whom a D-xylose absorption test was performed, seven showed excretion less than 20% in 5 hr. Immediately after expulsion of the worms, vitamin A absorption improved in 13 out of 14 patients tested (in nine to normal level). The results of this study suggest that ascariasis in populations on marginal intakes of vitamin A and its precursors is an important contributing factor in producing clinical vitamin A deficiency.


Adequacy of vitamin B6 supplementation during pregnancy: a prospective study. This prospective study assesses the effect of 2.5, 4, and 10 mg of pyridoxine supplementation during pregnancy on maternal and fetal plasma levels of pyridoxal 5'-phosphate (PLP) and on the degree of coenzyme saturation (activation factor) of aspartate aminotransferase and alanine aminotransferase (alphaEGOT and alphaEGPT) in maternal erythrocytes. More than 4 mg of pyridoxine supplementation daily was required for most pregnancies to maintain maternal plasma PLP levels within the range observed during the first trimester and in the nonpregnant state. The plasma PLP concentrations in maternal and cord blood were highly correlated and indicated a dependence of fetal vitamin B6 nutrition on maternal circulating PLP. Measurements of alphaEGOT and alphaEGPT were not as reproducible as plasma PLP assays and were less sensitive and quantitative indicators. In the majority of subjects, the changes in alphaEGOT and alphaEGPT with time correlated poorly with the changes in plasma PLP. However, when the data were analyzed without regard for their dependence on time, they demonstrated a negative, linear correlation between alphaEGOT and log plasma PLP and between alphaEGPT and log plasma PLP for the group on 2.5 mg of pyridoxine and for all the subjects combined. Finally, the dietary records showed that most of the subjects consumed less than 2 mg of vitamin B6 daily from their food. The results indicate that the current Recommended Dietary Allowance for vitamin B6 during pregnancy (2.5 mg) is too low and that supplementation of this vitamin in an amount more than 4 mg daily is recommended.


Daily nutritional intake and serum lipid levels. The Tecumseh study. To determine the influence of diet on serum cholesterol and triglyceride levels among adults, 24-hr dietary recall interviews were conducted among 957 men and 1,082 women resident in the community of Tecumseh, Michigan. Trained interviewers obtained detailed description of all foods consumed during 24 hr before venipuncture for lipid determination. Using a list of nutritional composition of 2,706 foods prepared from standard references, nutritionists determined quantities of all nutrients common to the American diet which were consumed by each participant according to a 24-hr diet record. For analysis, men and women were grouped into lower middle, and upper tertiles according to serum cholesterol and triglyceride levels. The mean daily consumption of each dietary component was virtually identical in all tertiles for men and women but differed between sexes. Cholesterol and triglyceride levels were unrelated to quality, quantity, or proportions of fat, carbohydrate, or protein consumed in the 24-hr recall period.


Bacteria, diet, and large bowel cancer.

Bacteria, diet, and large bowel cancer. The influence of various dietary supplements on the fecal bacteria was studied. Substances were chosen for study because they were known to influence body metabolism or had been implicated in the various hypotheses as the cause of large bowel cancer. No alteration in the fecal flora was demonstrated. The implications of these findings are discussed in the light of other investigations with special reference to our theory concerning the cause of large bowel cancer.


Colon cancer and diet, with special reference to intakes of fat and fiber. Colon cancer, rare in the past, and in developing populations, currently accounts for 2 to 4% of all deaths in Western populations. Evidence suggests the primary cause to be changes in diet, which affect the bowel milieu intérieur. It is possible that in sophisticated populations, the higher concentrations of fecal bile acids and sterols, and longer transit time, favor the production of potentially carcinogenic metabolites. Of secular changes in diet, evidence suggests that the following may have etiological importance: 1) the fall in  intake of fiber-containing foods with its effects on bowel physiology, and 2) the decreased fiber but increased fat intakes, in their respective capacities to raise concentrations of fecal bile acids, sterols, and other noxious substances. For possible prophylaxis against colon cancer, recommendations for a lower fat intake, or a higher intake of fiber-containing foods (apart from fiber ingestion from bran) are extremely unlikely to be adopted. For future research, western populations with considerably lower than average mortality rates, e.g., Seventh Day Adventists, Mormons, the rural Finnish population, as well as developing populations, demand intensive study. Also requiring elucidation are the respective roles of diet and of genetic constitution on concentrations of fecal bile acids, etc., and on transit time, in prone and nonprone populations.


The reproducibility of dietary intake data in a prospective study of gastrointestinal cancer. To test the reproducibility of the dietary questionnaire used in the Japan-Hawaii Cancer Study and to measure the consistency of dietary patterns over time, 109 men were reinterviewed with the same questionnaire after a 6-month interval and 111 men were reinterviewed after a 2-year interval. The responses for intake of the 33 food items in the questionnaire were fairly reproducible. Food items with substantial correlation coefficients in both groups of men tended to be consumed on a more habitual basis. This finding suggests that if habitually consumed foods are linked to specific cancers, it is less likely that such associations occur by chance. This is of particular importance because when many food items are considered in a dietary study, chance association between a specific food and cancer is not an infrequent event.


The effect of dietary fiber supplementation in man. I. Modification of eating habits. Six subjects were studied for an 8-week period that consisted of a 3-week control period, followed by a 3-week period during which their daily diets were supplemented with 3 oz of a  high fiber breakfast food, All-bran, and a final 2 weeks on their regular diet. Daily diet records of food intake were recorded and analyzed for seven dietary constituents; carbohydrates, proteins, fats, cholesterol, fiber, alcohol, and total calories. The most significant change in eating behavior due to the fiber food supplementation was a decrease in eating eggs, butter, and breakfast meats. These foods were most often replaced because all six subjects chose to eat the major portion of All-bran during breakfast. An increase in milk and fruit also occurred during the supplemented feeding. These particular foods were added to make All-bran more palatable and served to increase carbohydrate and protein intake. Five subjects added the supplement to the between meal-time intake and thus caused an increase in total daily caloric intake. At lunch and dinner few foods were altered with no particular pattern of substitution. Notwithstanding the knowledge that increased fiber content may have beneficial effects, none of the subjects modified his eating behavior to include even 1 oz of a high fiber food daily after the experimental period was concluded. Thus behavior modification by forced diet intake of a high fiber breakfast food resulted in definite diet pattern changes that did not persist following the experimental period.


Changes in fecal composition and colonic function due to cereal fiber. The effect on colonic function of adding wheat fiber for 3 weeks to the metabolically-controlled diets of six healthy volunteers has been studied. Increasing dietary fiber intake from 17 to 45 g/day increased fecal weight from 79 +/- 6.6 g/day to 228 +/- 29.9 g/day and shortened mean transit time, measured by a continuous marker method, from 57.8 +/- 8.3 hr to 40.3 +/- 8.9 hr. The increase in fecal weight was largely due to water. Fiber caused a dilution of fecal marker and an increase in fecal fat, nitrogen, and calcium output. Fecal sodium, potassium, and chloride showed only small changes but volatile fatty acid output increased significantly without concentrations changing. Fecal bile acid output increased from 199 +/- 46 mg/day to 279 +/- 46 mg/day. These changes are discussed in light of current views of the role of dietary fiber in protecting against colon cancer.


The effect on intestinal transit and the feces of raw and cooked bran in different doses. Ten healthy male subjects on a low fiber diet were given two doses of raw wheat bran (12 and 20 g/day) and two doses of cooked bran (13.2 and 22 g/day). Both doses of raw bran increased fecal dry weight but only the higher dose decreased transit time and increased stool volume. Individual stool size was increased only by raw bran 12g/day. Neither bran influenced fecal wet weight or stool frequency. This study suggests that the cereal manufacturing process alters wheat bran so that cooked bran has less effect on the intestine than does a comparable amount of raw bran.


Limulus amebocyte lysate test in neonates. The limulus amebocyte lysate test for endotoxin was done on samples of blood from 22 well babies and 33 neonates in an intensive-care nursery. The objective was to determine whether falsely positive test results occurred in samples from newborn infants during acquisition of usual bowel flora. One neonate had a transiently positive limulus amebocyte lysate test; he had clinical signs of spesis, but no bacteremia could be documented. Unlike the nitroblue tetrazolium test, the limulus amebocyte lysate test does not appear to be regularly positive in neonates. The sensitivity of the test in detection of endotoxemia associated with gram-negative spesis in the neonate remains to be determined in a large prospective study.


Pulmonary infection with Allescheria boydii. Allescheria boydii, the most common fungus isolated from North American maduromycosis, is a well-described pathogen. Reports of its isolation from sites other than the extremities are rare. Only ten cases of pulmonary infection are recorded in the literature. Of these, two are primary infections, and eight are secondary. An eleventh case is reported. Although there are some elements in the patient's history that indicate that this infection is secondary, the authors regard the infection a primary one. A pathologic and microbiologic compendium of all 11 cases is presented.


Isolation of the uterotonic principle from Leonurus artemisia, the Chinese motherwort. A search in ancient Chinese medicinal literature and modern phytochemical references indicates that the therapeutic value of Leonurus artemisia (I-mu ts'ao, the Chinese motherwort) might reside in a uterotonic principle present in leaves. Leonurine (4-guanidino-n-butyl syringate) was isolated from fresh and dry leaves of Leonurus artemisia. The uterotonic effect of leonurine was demonstrated in rat uterus in vitro. Results from this study suggest that functional phytochemistry based on ethnobotanical experience could lead to development of new and effective drugs from Chinese medicine.


The involvement of medullary reticular formation in the hypotensive effect of extracts from seeds of Cassia tora. In pentobarbital anesthetized rats, the medial portion of the medullary reticular formation has been identified to be directly involved in the hypotensive effect of extracts from the seeds of Cassia tora. This conclusion was drawn from the observed decrease in arterial blood pressure following local injection of extracts of this herb into this reticular site and from its inability to promote hypotension when the same reticular site has been electrolytically lesioned. The role of the medullary reticular formation in the Cassia tora-induced hypotension was suggested to be one which modulates the basic cardiovascular reflexes, favoring a decrease in vasomotor tone.


The influence of acupuncture stimulation on plasma levels of LH, FSH, progesterone and estradiol in normally ovulating women. This is the first attempt to elucidate the direct effect of acupuncture stimulation on plasma levels of LH, FSH, progesterone and esterone and estradiol in normally ovulating women. Four loci, which are known from experience to relate closely to female reproductive organs, were needled with electric stimulation and the responses to synthetic LH-RH with and without acupuncture stimulation were also analyzed in the same cases. Plasma hormone levels were measured by specific radioimmunoassay. All cases showed normal responses to LH-RH corresponding to the day of the menstrual cycle. During the initial part of stimulation, both progesterone and estradiol levels rose in follicular cases and declined in luteal cases. Plasma LH levels declined and FSH showed no change at this time. The analysis of plasma LH responses to LH-RH under acupuncture stimulation revealed extraordinary re-elevation in some cases. It is suggested that properly performed acupuncture stimulation might affect the female endocrine function.


Isoelectric focusing of alkaline phosphatase isoenzymes in polyacrylamide gels. Use of Triton X-100 and improved staining technic. The examination of alkaline phosphatase isoenzymes by means of isoelectric focusing in polyacrylamide gel rods using the apparatus and focusing method of Righetti and Drysdale is discussed. A simultaneous coupling procedure using alpha-naphthyl phosphate and fast blue salt R in 2-amino-2-methyl-1,3-propanediol buffer, pH 9.68, containing MgCl2 and ZnSO4 proved sensitive for developing the enzyme bands. Also discussed are the effects seen with the incorporation of Triton X100 into the gel and sample mixtures. Enzyme, which remained at the top of the gel without using this detergent, entered the gel easily with the addition of Triton X-100 into the application solution. Incorporation of Triton into the gel matrix resulted in some enzyme band patterns that showed distinct differences from gels containing no Triton.


Variations of cholesterol and total lipid concentrations in sera of healthy young men. Differentiating analytic error from biologic variability. Three major sources of variation affecting serum cholesterol and serum total lipid concentration values were studied in a group of healthy men. The first source of variation, analytic error, was separated into pre-instrumental and instrumental components. The pre-instrumental component, which consisted of all uncertainties occurring from the instant of venipuncture to the entrance of the sample into the instrument, was statistically significant for total lipids. The second major source of variation-preparation of the subject-was evaluated for four major stresses: diet, exercise, posture prior to venipuncture, and duration of tourniquet application. Diet affected total lipids, while the specifics of posture and tourniquet application were statistically significant for both serum cholesterol and total lipids. The third source of variation considered was the within-day and the day-to-day changes. Within-day changes were divided into within-hour and hour-to-hour effects. Day-to-day changes occurred over a two-week period. The magnitude and statistical significance of the changes were evaluated using an ANOVA model. The C.V.'s of day-to-day changes for cholesterol and total lipids (biologic) were 5.3% and 10.2%, respectively while the hour-to-hour within-day C.V.'s were 3.8% for cholesterol and 10.4% for serum total lipids. In all cases the biologic variation was in far excess of the analytic variation. The significance of these factors affecting intraindividual variation in healthy subject is discussed.


Acupuncture treatment of drug dependence in Pakistan. Wen's technique of electro-acupuncture was used successfully for treatment of withdrawal symptoms of 19 drug abusers. The drug common to all was opium (eating as well as smoking). Other drugs were amphetamine, methaqualone (mandrax) and barbiturates by mouth and cannabis (charas) smoking. The sample of the study is too small to draw statistical conclusions, but it is worth stating that all the cases showed a definite response to electro-acupuncture and that their withdrawal symptoms, especially those of opium, were controlled within 30 minutes of the application. The need for subsequent treatment varied, but all patients were symptom free and chemical free on the 6th-8th day of treatment. Thus, the period of active treatment was much shorter than that with codeine substitution therapy. It appears obvious that electro-acupuncture is an effective, simple and more economical method for the detoxification of opiate dependents.


Prostatic acid phosphatase. Current assessment in vaginal fluid of alleged rape victims. Although elevated prostatic acid phosphatase activity (ACP) in vaginal fluid is compatible with recent coitus, the finding of spermatozoa in vaginal fluid is usually considered the diagnostic indicator for semen. When 80 alleged rape cases during an 18-month period were reviewed and the results of cytologic examination for the presence of spermatozoa compared with quantitative ACP determinations, the latter appeared to be a more reliable and sensitive indicator of semen. The normal range of ACP in semen, as well as persistence of ACP in vaginal fluid, was also defined. It is concluded that vaginal fluid ACP is a reliable and sensitive method for identification of semen. Furthermore, the results confirm that quantitative ACP determination of vaginal fluid specimens may substantiate the allegation of rape with respect to time.


Reduced erythrocytic deformability in megaloblastic anemia. Ten patients with megaloblastic anemia had erythrocytes with reduced deformability. The mean half-life for erythrocyte filtration was 9.89 minutes in these patients, compared with 5,20 minutes in controls. The half-life was inversely related to the hemoglobin concentration. After adequate vitamin replacement therapy filtrability improved significantly. Two patients had thromboembolic disease, It is proposed that the reduced erythrocytic deformability reflects membrane rigidity that might ultimately lead to hemolysis.


Fibrinogen heterogeneity in cancer, in occlusive vascular disease, and after surgical procedures. Electrophoresis in 3.5% polyacrylamide gel was used to determine the patterns of fibrinogen heterogeneity in healthy subjects, in postoperative patients and in patients with cancer or occlusive vascular disease. Two major and one minor fibrinogen fractions, differing in molecular weight, were identified, and their concentrations in blood determined. The high-molecular-weight (HWM) fraction was found in greatest concentration after operation, during the period of hyperfibrinogenemia, whereas no simultaneous increase of lower-molecular-weight (LMW and LMW') fractions occurred, suggesting that these were derivatives of HMW ("native") fibrinogen. No correlation between the concentrations of the LMW and LMW' fractions and fibrinolytic activity was found, suggesting that direct degradation of HMW fibrinogen by plasmin was unlikely. The high fibrinogen level in cancer patients was related to increased concentrations of HMW and LMW fractions, whereas in the vascular-disease patients it was due exclusively to increased concentrations of LMW and LMW' fibrinogen. Serial observations indicated little fluctuation in the concentration of these fractions, indicating a persistently accelerated rate of conversion of HMW to LMW and LMW' fibrinogen in occlusive vascular disease. Possible pathogenic implications are discussed.


Oxalosis. An unusual cause of myelophthisis in childhood. In a child with renal failure and oliguria due to hyperoxaluria myelophthisis developed as a result of extensive bone-marrow replacement with calcium oxalate crystals and an accompanying fibrous proliferations. The histopathology associated with this metabolic disorder was demonstrated in posterior iliac crest bone-marrow trephine biopsies, renal biopsies, and nephrectomy specimens. Crystals were demonstrated in biopsy specimens of transplanted kidneys within six weeks following renal transplantation.


Primary Kaposi's sarcoma of lymph nods.

Primary Kaposi's sarcoma of lymph nods. An example of Kaposi's sarcoma with primary involvement of lymph nodes is reported. The patient, a woman, was admitted because of generalized lymphadenopathy and anemia. She was also known to have congestive heart failure of rheumatic origin. SMA-12 screening disclosed hypercalcemia on several occasions during her hospitalization. Levels of circulating parathormone and prostaglandins E2 and F were markedly increased. Total bone scan was negative for involvement by tumor. Electronmicroscopic examination of an involved lymph node disclosed secretory bodies in the cytoplasm of malignant cells and other cells, with clear indication of endothelial origin. The rarity of Kaposi's sarcoma with primary lymph nodal involvement in the United States is discussed. So far as is known by the authors, no example of Kaposi's sarcoma has been associated with hypercalcemia due to ectopic endocrine production.


Observed child restraint use in automobiles. Visual observations were made on restraint use in occupants of 5,050 automobiles containing at least one passenger less than 10 years of age, and short interviews were conducted with the drivers. Ninety-three percent of passengers less than 10 years old were not restained. Eighty-nine percent of passengers 10 or older and 78% of the drivers were not restained. Sixteen percent of child motor vehicle restraint devices observed were not used, and 73% of those in use were not used correctly. Use of such devices declined sharply after age 1. Although child passengers were more likely to be restained if the driver was restrained, more than 75% of the children were not restrained when the driver was, even if the driver was the child's parent.


Double stopcock technique for blood sampling from umbilical artery catheters. Umbilical artery catheters have an established place in neonatal intensive care. A double stopcock technique is described for sampling blood from umbilical catheters. This method improves accuracy in blood withdrawal, avoids contamination of samples, and reduces blood loss to a minimum.


The role of urine sugar in diabetic management. The concentration of reducing sugar in the urine is commonly used in the management of diabetes in children. Supplemental doses of regular insulin are administered in response to the concentration of urine sugar according to a protocol termed the "sliding scale." This practice assumes that the concentration of sugar in urine is a good indicator of the plasma glucose concentration. This assumption was tested by comparing urine sugar concentrations in first and second voided urines with the plasma glucose concentrations in 220 children with diabetes. The correlation was good (r = .92) for both the first and second voided urine specimens. Thus, urine sugar concentrations in general define the  level of plasma glucose. The large standard deviation of the plasma glucose at each concentration of urine sugar, however, limits the usefulness of urine sugar as an accurate reflection of the coincident plasma glucose concentration. The urine sugar concentration, although useful for the general management of diabetes, provides significant risk when used to guide frequent adjustments in insulin administration. Therefore, the "sliding scale" should not be used in the treatment of children with diabetes.


A spinal arteriovenous malformation with hereditary cutaneous hemangiomas. A 16-month-old girl with cutaneomeningospinal angiomatosis became paraplegic because of the intraspinal arteriovenous malformation. Since skin hemangiomas occurred in three successive generations of the girl's family, this may represent the first inherited case of this condition. In children with signs of a spinal space-occupying lesion, the presence of a skin hemangioma, especially if it is in a corresponding dermatome, could be the clue to early diagnosis of a spinal angioma.


Unusual manifestations of Henoch-Schönlein syndrome. Henoch-Schönlein syndrome represents a diagnostic challenge when the abdominal and/or joint manifestations precede the cutaneous lesions. Laparotomy is often performed unnecessarily. We describe a patient whose abdominal symptoms antedated the appearance of cutaneous lesions by three months. Gastrointestinal blood loss, thrombocytosis, hypoproteinemia, and the roentgenographic appearance of the small intestine suggested the correct diagnosis. His course was further complicated by hypertension associated with elevated plasma renin levels without evidence of nephritis. Joint manifestations were mild and transient as were testicular pain and swelling.


Hyperdibasicaminoaciduria and hyperammonemia in familial protein intolerance. A 3-year-old boy with hyperdibasicaminoaciduria and hyperammonemia showed characteristics of familial protein intolerance (FPI). Oral loading tests of lysine and arginine disclosed a remarkably reduced capability for intestinal absorption of these amino acids. Because urinary excretion and renal clearance of dibasic amino acids were only moderately elevated in the patient, the conspicuously decreased serum concentration of lysine, arginine, and ornithine was attributed to the defect in internal absorption. A possible explanation for elevated blood ammonia levels in FPI is that it is due to a deficiency of arginine and ornithine in the urea cycle that in turn results from a severe impairment in absorption of the amino acids by the gut mucosa.


Severe renal dysgenesis produced by a dominant gene. A woman with the autosomal dominant syndrome of preauricular pits, cervical fistulae, and partial deafness gave birth to two children with preauricular pits and severe renal dysgenesis. The facies had some features of the Potter facies of renal agenesis. One child died soon after birth because of pneumothorax and immature development of the lungs. We suggest that all infants with renal agenesis or dysgenesis be examined for preauricular pits because of the high recurrence risk of renal anomalies in families with this syndrome.


Bulging fontanelle as presenting sign in cystic fibrosis. Vitamin A metabolism and effect on cerebrospinal fluid pressure. A 51/2-month-old infant had the single problem of a bulging fontanelle. A diagnosis of cystic fibrosis with secondary hypovitaminosis A was made by the findings of high sweat chloride values and a low serum carotene level. A greatly accelerated rate of weight gain following the addition of pancreatic enzyme supplements confirmed the presence of malabsorption. The infant developed characteristic fibrosis pulmonary disease at 20 months of age. Animal studies have shown vitamin A deficiency to be associated with increased cerebrospinal fluid (CSF) pressure, diminished absorption of CSF, and pathological findings of thickening and infiltration with mucopolysaccharides of the dura mater around the arachnoid villi.


Treating Pseudomonas cepacia meningitis with trimethoprim-sulfamethoxazole. An infant with neonatal meningitis caused by Pseudomonas cepacia responded promptly to treatment with trimethoprim-sulfamethoxazole (Bactrim) after other abtibiotics had failed. Pseudomonas cepacia has proven to be resistant to most of the commonly used antibiotics.


Electrosurgical advances in upper gastrointestinal endoscopy. Because of rapid technological advances in endoscopic instrumentation, electrosurgical polypectomy and electrocoagulation has become a reality in the upper gastrointestinal tract. Twenty gastric polyps and three duodenal polyps have been removed. Six additional hyperplastic gastric polyps were electrodesiccated. Nine gastric ulcers, four duodenal ulcers, one hemorrhagic gastritis, one gastric varix and three Mallory-Weiss tears were successfully electrocoagulated. One duodenal ulcer and one Mallory-Weiss tear was unsuccessfully electrocoagulated. No morbidity nor mortality occurred as a result of electrosurgical polypectomy or electrocoagulation.


The radiological differentiation between ulcerative and granulomatous colitis by double contrast radiology. The purpose of this report is to illustrate the value of the double contrast technic for the detection of early changes of colitis and for the differentiation between ulcerative and granulomatous colitis. Fifty consecutive patients with radiologically-diagnosed nonspecific colitis are included and the radiographs, endoscopic and pathologic reports and photographs were reviewed. On radiological grounds ulcerative colitis were diagnosed in 23 patients and granulomatous colitis in 27 patients. There were no radiologically indeterminate cases. Follow-up information was obtained by colectomy in nine patients, colonoscopy in nine patients and sigmoidoscopy in the remainder. In no case did the endoscopic or pathologic diagnosis conflict with the radiological diagnosis. With the double contrast technic, very fine mucosal detail can be seen including features such as granular mucosa, "aphthoid" ulcers and discontinuous disease which are not demonstrable by the conventional single contrast barium enema. This detailed mapping of the nature and extent of disease facilitates the differential diagnosis between ulcerative and granulomatous colitis.


A comparison of basal and stimulated gastric acid and duodenal bicarbonate in patients with and without duodenal ulcer disease. Basal gastric secretion and the maximum response to pentagastrin and basal secretion into the duodenumand its near-maximum response to secretin were measured in 20 control subjects and ten patients with duodenal ulcer disease. In control subjects the volumes of stimulated gastric and duodenal secretions were significantly correlated. In patients with duodenal ulcer, there were no significant correlations between basal gastric and duodenal secretion but after stimulation both volumes and outputs (but not concnetrations) of gastric and duodenal secretions were significantly correlated. The bicarbonate secretory capacity in patients with duodenal ulcer was not only normal but was also comparable to the gastric acid secretory capacity. The basal bicarbonate content of the duodenal aspirate, however, in patients with duodenal ulcer was only half that in control subjects, perhaps another example of inadequate entry of bicarbonate into the duodenum in patients with duodenal ulcer in spite of the normal bicarbonate secretory capacity.


Tuberculous peritonitis. Low ascitic fluid glucose concentration as a diagnostic aid. Five Vietnamese patients with tuberculous peritonitis are described. Fever, x-ray evidence of pulmonary tuberculosis, or positive PPD skin tests were absent in several patients. The diagnosis was considered only when routine paracentesis demonstrated ascitic fluids with increased protein concentrations and lymphocytic pleocytosis. Ascitic fluid glucose concentrations were less than 30 mg./100 cc. in three of five patients.


Electromyographic study of the postoperative function of duodenal papilla. Does the endoscopic sphincterotomy of the ampulla of Vater destroy the bile flow mechanism? Endoscopic sphincterotomy of the ampulla of Vater was performed in seven patients suffering from gallstones in the common bile duct and/or bile flow stasis. After this procedure, spontaneous delivery of gallstones occurred in two cases and a gallstone was extracted by our basket-tipped catheter in two cases. The electromyogram of the sphincter of Oddi after endoscopic sphincterotomy showed the similar patterns and rhythms to those before this procedure. Thus, the function (bile flow mechanism) of the sphincter was not destroyed by this procedure. Morphologic and physiologic data, therefore, lead to the conclusion that endoscopic sphincterotomy is a safe and useful procedure.


Hepatic paraplegia.

Hepatic paraplegia. A 53-year old cirrhotic patient is presented with spastic paraplegia as a sequel of chronic hepatic encephalopathy accompanying a spontaneous portasystemic anastomosis. We describe the clinical picture with the investigation, followed by a brief discussion on this rare syndrome.


Eosinophilic cholecystitis.

Eosinophilic cholecystitis. A somewhat obese, 40-year old female presented with a classic history of gallbladder disease and a peripheral eosinophilia of 14% without an allergic history. A nonvisualizing oral cholecystogram was followed by an uneventful cholecystectomy. Pathological examination revealed a calculus in the cystic duct and a pure transmural eosinophilic infiltrate of the gallbladder wall. Postoperatively the peripheral eosinophilia returned to normal. Biopsies of the small bowel one year later showed focal mucosal eosinophilia when the patient had recurrent abdominal pain, diarrhea and peripheral eosinophilia. Eosinophilic cholecystitis may represent a descrete entity in search of an etiology or involvement of the biliary tract by eosinophilic gastroenteritis.


Some aspects of human and canine macroscopic pancreas innervation. Both vagus nerves and the celiac ganglion complex are the main source of the pancreatic gland innervation. In both man and dog there is a distinct difference in the number of fibers ending in the different segments of the gland. In the former, the macroscopic innervation is primarily concentrated in the pancreas head and isthmus. In the latter most of the nerves enter through the upper part of the right limb (uncinate process). Both vagus nerves send direct fibers to the gland but in most of the nerves, that course in general along the different branches of the celiac and mesenteric arteries, the parasympathetic and adrenergic fibers are intermingled. The anterior hepatic plexus, continued down by the gastroduodenal, completes a nervous circle, at the lower edge of the pancreas, with the branches arising from the splenic plexus. In human pancreas most of the nerves, with the exception of the branches given off by the gastroduodenal network, enter the gland by its periphery, either through its superior or inferior border. The gastroduodenal plexus is the pathway for the duodenopancreatic and the duodenogastric arc reflexes and for the "pancreatic type" of pain triggered by some posterior penetrating duodenal ulcers.


Ampicillin-associated colitis.

Ampicillin-associated colitis. Pseudomembraneous colitis has been increasingly observed after therapy with several antibiotics including ampicillin. This report describes the clinical and pathologic features of a patient who developed pseudomembraneous colitis while receiving ampicillin. The strikingly characteristic nature of these lesions is discussed and early diagnosis in the prevention of a potentially hazardous disorder is emphasized.


Amebic peritonitis.

Amebic peritonitis. A total of 18 patients with amebic peritonitis were studied. Fourteen of these cases were due to rupture of amebic liver abscess into the peritoneum and the remaining cases were due to perforation of amebic colitis. No initial suspicion of amebic etiology was made in more than half of the cases. In the group of ruptured liver abscesses, nearly half of the patients showed right lower lung syndrome. The diagnosis in 13 of 14 cases of rupture of liver abscess was confirmed on aspiration. Patients with ruptured amebic liver abcess were of two types: 1. Diffuse type with diffuse signs, shorter duration of illness and poor prognosis. 2. Localized type with longer duration of illness, marked signs of peritonitis and better prognosis. Once the diagnosis of peritonitis was made, the management was surgical. Conservative treatment was tried only in cases with signs of localization. The mortality rate had been 33% in amebic liver abscess rupturing into the peritoneum and 75% in perforation of the intestine. A high index of suspicion of amebiasis in patients with an acute abdomen and institution of early treatment are recommended to help in reducing this mortality. Amebic liver abscess and amebic dysentery should be treated energetically to avoid this fatal complication and surgical intervention whenever indicated should not be delayed.


Intestinal perforation in adults due to ingested opaque foreign bodies. Accidental foreign body ingestion occasionally occurs in adults and is especially likely in those wearing dentures. While most foreign bodies pass readily through the gastrointestinal tract, complications such perforation, abscess, obstruction and hemorrhage occasionally occur. Radiography may be of help in detecting and localizing these foreign bodies and in determining complications caused by them.


Primary torsion of the greater omentum mimicking duodenal ulcer. The diagnosis of primary torsion of the omentum is a diagnostic enigma and is made almost exclusively at laparotomy. The difficulty is enhanced when the patient has a chronic problem mimicking a specific entity, e.g. peptic ulcer disease. The case presented is an example of this situation. The patient's history and acute presentation were compatible with chronic peptic ulcer disease with acute perforation. At laparotomy, the findings of torsion of the right lower omentum with infarction, along with marked scarring of the remainder of the greater omentum explained the clinical picture. Torsion of the greater omentum, therefore, must be added to the list of differential diagnoses when one is considering peptic ulcer disease.


Alcohol consumption and nonfatal myocardial infarction. A study of the relathonship between alcohol consumption and nonfatal myocardial infarction, involving 399 cases and 2486 reference subjects, indicated absence of any major overall association (rate ratio point estimate of 0.9 with 95% confidence limits of 0.6 and 1.2), but there was some evidence of a lower rate in subjects consuming six or more drinks per day (rate ratio point estimate of 0.6 with 95% confidence limits of 0.3 and 1.1). Confounding by several potential confounders was controlled by stratification according to a confounder-summarizing score.


Stratification by a multivariate confounder score. The complexity and inefficiency of multiple cross-classification as a means of controlling confounding in etiologic research may be avoided upon summarizing the pattern of confounding factors for each subject in terms of a multivariate score. The control of confounding may be based on stratification by the score, with stratum-specific contingency tables obtained and analyzed in the usual manner.


Multivariate analysis of risk of perinatal telencephalic leucoencephalopathy. The hospital and autopsy records of 40 infants who died with perinatal telencephalic leucoencephalopathy (PTL) (hypertrophic astrocytes and amphophilic globules in telencephalic white matter) were compared to those of 76 control infants who had no white matter abnormality. A linear discromination procedure, which takes into account multiple confounding factors, was used to estimate risk ratios. PTL was found more commonly in infants who (a) had bacteria isolated from blood at autopsy, (b) received intravenous glucose and water for more than one day, or (c) received kanamycin or streptomycin. Infants were at reduced risk if they received penicillin, atropine, mercurhydrin or a transfusion of whole blood. It is hypothesized that endotoxin from bacteremia adversely affects developing white matter and that the other risk factors of PTL are markers of, or contributors to, increased risk of gram negative infection. No evidence was found for antibiotic-endotoxin interaction. The factors that are associated with reduced risk of PTL may be markers of, or contributors to reduced risk of gram negative infection.


Childhood polymyositis: a case-control study. A case-control epidemiologic study of childhood polymyositis is presented. Parents of 42 cases of childhood polymyositis were interviewed along with parents of controls matched for sex and age. Extensive review of past medical history, animal exposure history, residential and family history, and immunization history failed to reveal any significant differences between the two groups. The only suggestive difference was exposure to bacteriologically confirmed streptococcal diseases in 20 cases as compared to 13 controls.


Nursery outbreak of peritonitis with pneumoperitoneum probably caused by thermometer-induced rectal perforation. Between June 16 and October 9, 1974, 9 neonates at a small, community hospital were stricken with an unusual, serious illness manifested by peritonitis and pneumoperitoneum; 3 died. Although the illness was initially thought to be necrotizing entercolitis, clinical, laboratory, and epidemiologic evidence strongly suggested that it was instead the result of gastrointestinal perforation. in case-control studies employing 3 different conposure to a particular nurses' aide. Other studies including a comparison of expected and actual exposures of ill infants to nursery personnel further linked this nurses' aide to illness. Since rectal temperature-taking was the only procedure possibly predisposing to gastrointestinal perforation that was routinely practiced in the nursery, it was hypothesized that the illness might be the result of rectal perforations. In order that rectal temperature-taking technique could be observed, each nurse and nurses' aide on the OB-GYN service was asked to take part in a general practical examination of nursing skills on a life-like baby doll. The mean and median depths to which nursing personnel inserted the thermometer exceeded the maximum depth recommended to prevent perforation. The nurses' aide epidemiologically associated with illness inserted the thermometer to almost twice the maximum recommended depth-farther than all the personnel who worked primarily in the nursery. After this nurses' aide was removed from the nursery and axillary temperature-taking replaced rectal temperature-taking as the nursery routine, the outbreak ceased.


A community outbreak of scabies.

A community outbreak of scabies. An elementary school in Broward County, Florida, reported an outbreak of scabies in January and February 1975. Investigation identified 23 cases of scabies in schoolchildren, with at least two cases in each grade. The first case had appeared as early as July 1974, but most occurred after December. There was little contact between students in different grades; most transmission was found to have taken place within families and in the community. An additional 28 cases were found in families and contacts; altogether, 51 cases in 24 families were identified on clinical or historical grounds. Infestation was more frequent in children who exchanged clothes with friends or relatives and in those who, on occasion, spent the night with other children.


Canine bladder cancer: epidemiologic features. A retrospective study of medical records from 13 veterinary university hospital clinics yielded 114 dogs with microscopically confirmed primary malignancy of the bladder. When matched to controls, there was no increased frequency to suggest an association of urogenital tumors or anomalies with neoplasms of the bladder. The majority of tumors seen in this study were transitional cell carcinomas. Four breeds were identified with excessive risk for bladder cancer and may serve as models for further research into genetic determinants, such as abnormal tryptophan metabolism. The epidemiologic features of canine bladder cancer were compared with the disease in man. An excess among female dogs may be the result of less frequent urination as compared to male dogs. Assuming an etiology from urine-borne carcinogens applies to spontaneously occurring bladder cancer in dogs, then monitoring the frequency of occurrence of canine bladder cancer may provide an early warning of emerging environmental hazards to man.


Viremia in young herons and ibis infected with Venezuelan encephalitis virus. Fifty-seven of 61 nestling, 8- to 30-day-old herons of three species (Black-crowned Night Heron, Great Egret, and Snowy Egret), developed viremia lasting one to three days following subcutaneous inoculation with small doses of endemic or epidemic strains of Venezuelan encephalitis virus from Mexico, Guatemala or Venezuela. Two epidemic strains from Guatemala or Venezuela stimulated levels of viremia similar to those following infection with enzootic strains. Great Egrets, Striated and Boat-billed Herons and Scarlet Ibis older than 30 days of age developed viremias of lower levels and shorter durtions than did young birds. Marked differences in levles of viremia were not observed among Black-crowned Night Herons, Great Egrets, or Snowy Egrets. Over 50% of viremic blood samples from herons 8-30 days of age contained 1000 or more chick embryo cell culture plaque forming units of Venezuelan encephalitis per ml, levels sufficient to infect some vector species mosquitoes.


A prophylactic transfusion program for children with sickle cell anemia complicated by CNS infarction. CNS infarction is a devastating complication in sickle cell anemia. Episodes are frequently repetitive and often result in permanent neurologic abnormalities. In an attempt to prevent such recurrences a periodic transfusion program was begun at the Children's Hospital of Michigan in 1969. Twenty-one children currently on the program receive buffy-coat poor transfusions on an out-patient basis every 3 weeks. Of 15 who have been on the program for periods of from 9 months to 5 3/4 years, none have had progression of neurologic abnormalities, and several have had definite improvement in neurologic function. One child who was not brought in regularly had recurrent CNS infarction. The only recognized complication has been one instance of serum hepatitis. While such a transfusion program is not without risk, it seems an effective way of preventing progression of neurologic abnormalities resulting from recurrent CNS infarction in sickle cell anemia.


Red cell values on the first postnatal day during the last 16 weeks of gestation. The hemoglobin concentration, red cell count, hematocrit, reticulocyte count, and red cell size distribution were determined on skin prick blood obtained on the first postnatal day from infants born at various stages of gestation, from week 24 to term. During this period the hemoglobin concentration and hematocrit remained constant, around 19 gm/100 ml and 60%, respectively. The mean corpuscular volume decreased progressively, with a corresponding rise in the red cell count. The reticulocyte count decreased progressively from 9.6% to 3.7% during the period of observation. The red cell size distribution (Price Jones) curve was markedly shifted to the macrocytic side at 24-25 weeks. Thereafter, cells larger than 102 mu3 decreased gradually, while the percentage of smaller cells increased. These observations are not consistent with the hypothesis of a progressive decrease in the supply of oxygen to the fetus during the later stages of gestation, to which the fetus adapts by increasing its hemoglobin concentration.


Thalassemia intermedia caused by heterozygosity for both beta-thalassemia and hemoglobin Saki [beta 14 (A11) Leu replaced by Pro]. The syndrome thalassemia intermedia can be the clinical expression of heterozygosity for different tyes of thalassemia, beta-thalassemia and hereditary persistence of fetal hemoglobin, beta-thalassemia and Hb-Lepore, and in blacks it may even represent a true beta-thalassemia homozygote. This report describes thalassemia intermedia in a white male due to beta-thalassemia and an unstable hemoglobin. Chain-synthesis studies showed an excess of alpha-chain production over beta-chain production in the propositus and his mother but balanced chain synthesis in the clinically normal father, who is heterozygous for the unstable hemoglobin. The unstable hemoglobin was found to be beta14 (A11) Leu leads to Pro, which has previously been described in a clinically normal African woman, and named Hb-Saki. This hemoglobin is not distinguishable from Hb-A on routine electrophoresis at alkaline or acid pH and tests for unstable hemoglobins are necessary for its detection. The increasing list of such hemoglobin variants and previous cases of heterozygosity for beta-thalassemia and unstable hemoglobins are reviewed.


Leukocyte function in familial Mediterranean fever. Neutrophilic leukocytes of patients with familial Mediterranean fever and of normal control subjects were studied in vitro. FMF neutrophils were found to be morphologically normal by light and electron microscopy and to have normal quantities of the lysosomal enzyme lysozyme. FMF cells demonstrated a slight decrease in their ability to migrate randomly in capillary tubes, this was primarily seen in Armenian patients and in those experiencing an acute attack. The leukocytes of these patients functioned normally in regard to their chemotactic and Candida-killing activity.


Combined deficiencies of Factor VIII (AHF) and Factor XI (PTA). Combined deficiencies of Factor VIII and Factor XI associated with moderate degree of bleeding symptoms were found in 3 brothers. Examination of Factor VIII activity and Factor VIII-related antigen revealed that the Factor VIII activity/Factor VIII-related antigen ratio was significantly decreased in their mother and maternal grandmother consistent with the carrier state of hemophilia. Factor XI deficiency was found in 2 siblings, the father, and 2 of his sisters. The paternal grandmother was thought to carry the abnormal Factor X I gene, although her Factor XI level was normal, because of a significant bleeding history. It was concluded that the combined Factor VIII and XI deficiencies in the 3 brothers represent the coincidental inheritance of 2 separate and independent abnormal genes.


Method for determination and element analysis of particulate contamination in injectable solutions. A method for sampling and evaluating the chemical and physical composition of particles in injectable solutions was developed. The technique facilitates detection of the particles' sources and possible medical hazards. Particles exceeding 0.2 mum are collected on a membrane filter sized for direct application in a scanning electron microscope (SEM). The sampling device shortens the distance between filter and solution and minimizes contamination from the filter holder. Following coating of the membrane filter with gold, the particles are counted by screening at a magnification of 5,000 x in the SEM. Both unused membrane filters and filters through which a solution of 0.9% sodium chloride had been passed were analyzed. X-ray analysis of particles on the clean filter revealed silicon, aluminum (artifact from the stud) and calcium. X-ray analysis of the filter after passage of 1 liter normal saline revealed chromium, copper, iron, magnesium, manganese, aluminum (from study), calcium chlorine, sodium and silicon. Recommendations for standard procedures for particle detection in large-volume injectables are given.


Quantitative microchromatographic determination of hemoglobin F in patients with hemoglobins S and/or C. The improved microchromatographic procedure for the detection of Hb-S and/or Hb-C in cord blood at birth (Schroeder et al.: J. Lab Clin Med 86:528-532, 1975) as well as a modification thereof may also be used for the quantitative determination of Hb-F in the presence of Hb-S and/or Hb-C. However, Hb-A interferes and must be absent. The methods use 0.5 X 6 cm columns of CM-cellulose with Tirs or Bis-tris developers and require 2-4 hr to complete. At low percentages of Hb-F, the sharper zone of the Tris method is more easily visible than that of the Bis-tris method, but the latter is a somewhat more rapid procedure. About 300 cases with Hb-S and/or Hb-C have been examined by the microchromatographic procedure. Most of these results (Fmicro) have been compared with data from the determination of Hb-F by one or more of the following methods: alkali denaturation (FAD), conventional DEAE-Sephadex chromatography (FDES), or isoleucine analyses of zones from DEAE-Sephadex chromatography (FIle). The accuracy and precision of the microchromatographic method is estimated to be 5-10%. The microchromatographic methods require much less time than conventional chromatography but more time than alkali denaturation procedures. Compared to the latter, the new methods use whole blood and less blood and permit the physical separation of Hb-F.


Six-month pharmacy technician training program at a community college. A six-month pharmacy technician training program at a community college is discussed. Establishment of the program, recruitment and screening of applicants, and the curriculum are described. Also discussed are the advantages of community college training, the program's pharmacist advisory committee, contracts with hospitals that provide practical experience, reaction of state pharmacy organizations to the program, and the employment record of graduates. It is suggested that short, effective pharmacy technician training programs should be established in community colleges to supply high quality supportive personnel to hospital pharmacies. A national testing and certification program for pharmacy technicians is recommended.


Pharmaceutical services for the cancer patient. Pharmaceutical services for cancer patients in a hospital-tumor institute are described. The duties of the pharmacists discussed are: (1) providing necessary medication including the preparation of chemotherapeutic agents for administration and (2) providing drug information for the oncology specialist, the private physician, the nurse and the patient. As part of the information service, discharged patients and clinic patients are given brief monographs on the chemotherapeutic drugs included in their treatment. Pharmacists attend ward rounds regularly with four different medical services.


Pharmacist as a provider of oncology ambulatory care services. The services provided by a pharmacist to ambulatory oncology patients is described. The pharmacist takes drug histories, monitors drug therapy, gives patient discharge consultations and acts in cooperation with local physicians and the medical staff in providing chemotherapy to cancer patients for home administration. The pharmacist also provides inservice education and acts as a consultant to the medical, nursing and pharmacy staffs.


Pharmaceutical services in a pediatric oncology day hospital. The role of the pharmacist in a treatment center in which pediatric cancer patients receive intensive chemotherapy with a minimum of inhospital admission time is discussed. Functions of the pharmacist include: preparation and dispensing of oral and parenteral medications; monitoring of physicians' orders; maintaining patient profiles; maintaining investigational drug records; providing drug information; and conducting inservice educational programs.


Cost of comprehensive pharmaceutical services in a 45-bed rural hospital. The financial impact of a comprehensive pharmacy program on patient charges and hospital operating costs in a 45-bed community hospital was studied. Data were collected retrospectively for the fiscal year prior to initiating pharmacy services (FY73), the fiscal year during program development (FY74) and the fiscal year following full operations (FY75). The total cost of pharmacy services increased 75% from FY73 to FY75, with the largest dollar increase being in pharmacy salaries. Large increases among other cost items also were noted. The average total cost for pharmacy services increased from $3.28 per patient day in FY73 to $6.04 in FY75 (84%). Total hospital cost per patient day increased by approximately $35 from FY73 to FY75 (5%). The pharmaceutical services fee per dose of medication administered did not change from FY73 to FY75. Patient charges per day for medications and pharmaceutical services increased $0.55 (9.8%) from FY73 to FY75. There was a 55% reduction in the number of items carried in pharmacy inventory from FY73 to FY74 following the initiation of a formulary and a unit dose drug distribution system.


Double-blind evaluation of 5-mum final filtration to reduce postinfusion phlebitis. A double-blind study was conducted to determine the effectiveness of 5-mum final filtration in preventing phlebitis secondary to intravenous fluid administration. An experimental administration set which contained distal portion of the tubing was used for patients randomly assigned to receive filtered intravenous solutions. An identical administration set minus the filter was used in the control group to allow double-blind evaluation of the injection site. Data were collected on 49 patients whose average age was eight years and one month. Most patients had a primary diagnosis of acute lymphocytic or myelocytic leukemia or solid tumor. The patients' injection sites were evaluated daily for clinical findings of phlebitis (erythema, induration, heat, erythematous-streak and discomfort). The incidence of phlebitis was significantly lower (p less than 0.01) in patients receiving filtered intravenous solutions. For the patients in this study, filtration of intravenous fluids with a 5-mum mesh filter appeared to be a feasible and effective means of reducing postinfusion complications.


Use of bioavailability data by practitioners. Part 2: Preliminary report of evaluation skills of pharmacists and physicians. The ability of pharmacists and physicians to interpret and evaluate promotional and clinical bioavailability data was compared to that of a panel of scientists with experience in pharmacokinetics and pharmacology. An examination tested the ability of 18 physicians and 68 pharmacists to: (1) evaluate and make clinical decisions using promotional bioavailability data; (2) demonstrate the basic qualitative and quantitative skills needed to make rational judgments on drug product selection; and (3) distinguish between drugs with real or potential bioavailability problems. On the examination, pharmacists, as a group, scored significantly higher (52%) than physicians (35%), but the panelists scored highest (83%). Hospital pharmacists (61%) scored higher than community pharmacists (42%). Recommendations for future studies of this type are presented.


Computer support of pharmaceutical services for ambulatory patients. A prototype computerized pharmaceutical services support system (CPSSS) is described. CPSSS maintains records on approximately 40,000 patients; 1,300 outpatient prescriptions are dispensed per day. Using Univac hardware and software developed inhouse, CPSSS provides an online drug therapy profile. The prescription label, including auxiliary information, storage and stability guidelines as well as the traditional information, is automatically generated. Prior to medication dispensing, all information is verified by a pharmacist after the computer searches the patient medication profile for 5,400 potential drug-drug, 1,500 drug-disease state, over 100 drug-allergy and 200 drug-laboratory test interactions as well as identifying duplicate pharmacological therapy. Retrospectively, the patient population is described as to sex, age and number of diagnoses. The number of prescriptions per physician also is reported. Twenty drugs represent one-half of the total prescriptions, with 32% of patients taking diuretics and 30% taking tranquilizers. All new prescriptions were prospectively reviewed. Approximately 2% had potential interactions or pharmacological duplication of therapy problems. Approximately 30% of all new prescriptions duplicated exactly an active prescription on file. When a pharmacist initiated physician contact as a result of CPSSS and profile review, physicians changed therapy approximately 73% of the time when informed of duplicate therapy, 27% of the time when informed of potential drug-disease state interactions and 32% of the time when informed of potential drug-drug interactions.


Delegation.

Delegation. The three basic elements of delegation (responsibility, authority and accountability) are discussed with regard to effective management. Major guidelines for effective delegation are noted, including: (1) securing a mutual commitment to responsibilities involved; (2) establishing goals and checkpoints; (3) giving appropriate authority to the delegate; and (4) avoiding by-passing the delegate.


High-pressure liquid chromatographic and spectrophotometric assays for theophylline in biological fluids. The analysis of theophylline and other xanthine derivatives in biological fluids was examined by high-pressure liquid chromatography (HPLC) and spectrophotometric (Schack and Waxler) methods. An HPLC analysis technique involving precipitation of serum proteins using trichloroacetic acid, injection of the supernatant onto a strong cation exchange column and detection using ultraviolet absorbance provides a nonpolluting, micronized, rapid and reasonably sensitive and specific method for measuring serum theophylline concentrations during clinical pharmacokinetic monitoring. Pre-extration of xanthines with chloroform increases the sensitivity and specificity of the assay. Good agreement was found in the assay results between the spectrophotometric and HPLC assays in 23 of 25 patient specimens, but occasional severe interferences were found with the former technique.


Health planning, part 2; The National Health Planning and Resources Development Act of 1974. The National Health Planning and Resources Development Act of 1974 is discussed, with particular reference to national guidelines, Health Sytems Agencies, state planning and development, technical assistance from HEW, and the purpose, plan and state approval of Health Resources Development.


Stability of gentamicin sulfate injection following unit dose repackaging. The potency of gentamicin sulfate following repackaging in disposable syringes were determined by a modification of the agar diffusion bioassay, using a highly gentamicin-resistant strain of Psuedomonas aeruginosa to assay milligram quantities of active drug. Three factors were studied at 30, 60 and 90 days: (1) syringe character (glass vs plastic); (2) temperature (25 C vs 4 C); and (3) volume of aspirated sample. Glass syringes were superior at all time intervals. Storage in plastic for even 30 days resulted in unacceptable loss of potency (greater than 15%) and formation of a brown precipitate. Mass spectrophotometry indicated that this precipitate consisted mainly of esters of phthalic acid (plasticizer) and methylparaben (gentamicin preservative). Temperature had no effect on retained potency. A positive correlation between the percent potency lost and volume of gentamicin aspirated was demonstrated in both glass and plastic.


Reported use of nonprescribed drugs in health maintenance. The reported use of nonprescribed drugs and its relationship to other reported illness and heal-related activities of subscribers within a prepaid comprehensive medical care system were examined. The data analyzed were abstracted from a household survey of 2603 Kaiser Health Plan subscribers. The survey gathered sociodemographic, economic, attitudinal and behavioral information. The health-related information collected included reported symptom experiences, behavior when ill, and customary health and health-related practices. The findings indicate that the use of nonprescribed drugs is a frequent and in some instances, an extensive activity. Some association was found between reported self-medication activities and selected symptom experiences, use of certain health practitioners, prescribed drug use and certain health maintenance activities and perception. It is concluded that use of nonprescribed drugs appeared to be related to other health-related behaviors, but not just randomly. Also, the use of nonprescribed medicine does not appear aberrant from the perspectives of contemporary health care.


Therapeutic equivalency of two lidocaine preparations. Twenty-five volunteers were studied as to the onset and duration of action of two commercial brands of lidocaine. One and two percent concentrations of the preparations were tested intradermally using a double-blind, cross-over protocol. Both needle-drop and electrical stimulation techniques were employed as the source of pain stimulus. Five additional subjects were studied in a dose-ranging study using a placebo and lidocaine concentrations of 0.25%, 0.50%, 0.75% and 1.0%; this experiment was conduced to determine the sensitivity of the experimental methods. Both the needle-drop and electrical stimulation techniques were able to distinguish the 0.25% preparation from placebo and from the other concentrations of 1% and 2%. The two preparations were found to be statistically equivalent at concentrations of 1% and 2% and could be used interchangeably in clinical procedures.


Drug therapy of patients treated in hospitals for duodenal ulcers. Drug therapy in hospitalized patients treated for duodenal ulcer disease was reviewed retrospectively. The information was obtained by the means of a medical audit of patient records indexed by the discharge diagnosis of duodenal ulcers. A total of 485 cases were abstracted. Antacids were found to be the cornerstone of duodenal ulcer drug therapy. Anticholinergic drugs occupied a central role throughout the medical treatment of duodenal ulcers. The investigators identified a need for the dissemination of information concerning the use of anticholinergics in duodenal ulcer patients experiencing the complications of hemorrhage and obstruction.


Evaluation of written reinforcements used in counseling cardiovascular patients. The acceptance and effectiveness of medication cards and booklets for cardiovascular patients were evaluated. Approximately one month after discharge counseling which included the written reinforcements, 22 out of 50 patients discharged from cardiothoracic surgery and cardiovascular medicine units were questioned to assess patient usage of the medication cards/booklets and patient knowledge of their particular drugs. All patients except one indicated that they had read the material after leaving the hospital, and many had read it more than once. The effectiveness of the material was found to be only partially acceptable when general and specific medical questions were asked. The names and uses of most of the drugs taken by the patients were identified correctly.


Comparative evaluation of drug interaction publications--1976. The usefulness of several reference books in the retriveal and application of drug interaction information was evaluated. Each publication was evaluated as to whether it included information that would be necessary to determine if a suspected interaction was actually occurring. Twenty drug combinations which may interact were studied. In addition, the general format and features of each publication were reviewed. The American Pharmaceutical Association's Evaluations of Drug Interactions and Hansten's Drug Interactions were reviewed favorably on all points. Stockley's Drug Interactions and their Mechanisms was considered nearly as complete and certainly as authoritative. Cohen's Drug Interactions: A Handbook for Clinical Use, Gant's Drug Interaction Index: A Survey of Drug Interactions and Hartshorn's Handbook of Drug Interactions, were deemed useful as an added check if an interaction suspected clinically was not included in any of the former group.


Computerized consultation system for selection of antimicrobial therapy. Mycin, a computer-based consultation system which provides to physicians antimicrobial therapy recommendations for patients with bacterial infections, is described. The consultation program arrives at therapeutic decisions using a built-in knowledge base as well as patient data entered by the physician. The system is capable of explaining its recommendations and answering questions about its reasoning process. The system's knowledge can be updated and corrected easily by infectious disease experts. At present the system is operational within a research setting; its routine use in a clinical setting will require further evaluation of its reliability and effectiveness.


Medical Device Amendments of 1976.

Medical Device Amendments of 1976. The Medical Device Amendments of 1976 are discussed with particular reference to the history of device regulation, classification of devices, performance standards, applications for premarket approval and testing protocols.


MLT and MT student performance on a preliminary psychomotor test battery. Psychomotor ability is a neglected component of student clinical evaluation in the laboratory setting. This paper describes development of an experimental psychomotor test battery containing mechanical comprehension, spatial perception, and manual dexterity subscales. A small sample of MLT and MT students constituted the study population used to determine interrelationships among the subscales. Pearson product moment correlations and factor analysis suggest isolation of hand-eye motor and perception-intelligence psychomotor components in the battery. Clinical laboratory implications of the findings are discussed.


1974 Arizona P.A.C.E. participation.

1974 Arizona P.A.C.E. participation. Members of the Arizona State Society for Medical Technology were contacted to ascertain their knowledge of the P.A.C.E. program as well as to obtain release of the transcripts for those who participated during 1974. Observations regarding reported credits were noted. The Analysis of Variance test with Scheffe comparison was utilized to determine if any characteristic accounted for the difference in total continuing education hours reported. It was concluded that residence location, marital status, sex, age, degree level, length of membership in ASMT, years experience, employment extent, place of employment, and number of beds at place of employment had no significant effect on the total hours reported. A significant difference in total hours reported was noted for those individuals who reported either CEU or college credits. A significant difference was also noted in the total hours reported with respect to job description.


Definitions, sources and detection of laboratory error: a review. Laboratory error has been estimated to occur in one to three percent of test results. Previous studies have identified common sources of laboratory-induced error. Methods of quality assurance are suggested to identify such errors and reduce the possibility of their reaching the physician. Present systems for monitoring quality assurance do not adequately detect biological and pharmacological errors.


Dimensions of adaptive behavior in institutionalized mentally retarded children and adults: developmental perspective. Factor analyses were performed utilizing the subscale scores of the AAMD Adaptive Behavior Scale, Part One, for 3,354 institutionalized mentally retarded children and adults. Eight different age groups were studied to determine (a) the underlying dimensions of adaptive behavior measured by the scale, (b) similarity of factor structure across ages, (c) whether there were developmental changes revealed by factor scores, and (d) the extent to which the above findings would be related to level of retardation. Three salient factorial dimensions--Personal Self-Sufficiency, Community Self-Sufficiency, and Personal-Social Responsibility--appeared across a wide span of age ranges from childhood through senility. The implication of these factors was discussed in terms of the critical period of development, rate of growth, and maximum level of growth of subjects grouped by level of retardation.


Reassessment of category knowledge in retarded individuals. We investigated retarded individuals' knowledge of conceptual categories as reflected by semantic priming effects. In the first experiment, retarded individuals were shown pairs of pictures, one picture at a time, and asked to name each picture as rapidly and accurately as possible. The pictures in each pair were objects that were either categorically related or unrelated. The major finding was that second pictures in related pairs were named significantly faster than those in unrelated pairs. This reduction in naming-latency, or priming effect, was interpreted as indicating that information about categorical relationships is established in the memory structure of retarded individuals. In the second experiment, subjects were again given the picture-naming task plus two concept-usage tasks designed to test the recognition and verbalization of categorical relationships. Correlational analyses indicated that while performance on both usage tasks varied with intelligence, neither intelligence nor category usage correlated with the magnitude of the priming effect. This suggests that intelligence-related differences in category usage do not result from corresponding differences in conceptual competence but, rather, are related to the ability to use category information that is potentially available.


Studying cognitive development in retarded and nonretarded groups: the role of theory. Stephens and McLaughlin's (1974) report of retarded-nonretarded group differences in performance on Piagetian reasoning tasks was critically examined. The findings were difficult to interpret in relation to major theories of cognition in retarded and nonretarded persons because of problems in the investigators' testing and subject selection procedures and because of an inappropriate use of analysis of covariance. These problems were discussed, their potential impact on the findings examined, and certain guidelines proposed for research of this genre--guidelines designed to sharpen the relationship between experimentation and theory.


Critique of the use of covariance adjustments for CA and MA in comparative studies of retarded and nonretarded persons. Arguments were presented to show that the procedures of covariance adjustments for MA or for MA and CA are unsuited to the analysis of comparative data for retarded and nonretarded persons. Whatever the task and the performance levels of such subjects, the performance measures for both groups must always define a single continuous regression surface. It was proposed that graphical inspection of the regression surface will properly suggest the relative contributions of CA, MA, and IQ to the performance under study. Some of the data of the Temple longitudinal studies were used to illustrate the graphic procedure.


Background music for repetitive task performance of severely retarded individuals. Environmental manipulation in the form of specific tempo background music was used to assist in the habilitation of severely retarded persons. Thirty institutionalized retarded males were tested on a repetitive manual performance task judged to be similar to the type of tasks found in sheltered workshops. Each subject received each of the background treatments noncontingently: no music, slow tempo music, regular tempo music, fast tempo music. The results indicated that the regular tempo of background music facilitated the greatest improvement in performance, suggesting that the effect of music on performance is more complex than the issue of contingent presentation.


Failure effects on outerdirectedness: a failure to replicate. A replication was conducted of part of Turnure and Zigler's (1964) experiment in which they assessed whether outerdirectedness was a function of failure experiences. Thirty nonretarded and 30 retarded children, matched on MA, experienced either failure games administered with positive or negative comments followed by an imitative assessment task or received only the imitation task. The results did not support Zigler's hypothesis concerning the antecedents of outerdirectedness, as no short-term effects of failure were found. The findings refuted Turnure and Zigler's hypothesis that outerdirectedness is a function of situational social reinforcement. Differences in tasks presented, methods of analysis, and/or school populations may have contributed to the lack of correspondence with the Turnure and Zigler findings.


Effectiveness of a learning potential procedure in improving problem-solving skills of retarded and nonretarded children. In this study we sought to determine the effectiveness of learning potential training on improving children's probelm-solving skills on Raven's Coloured Progressive Matrices. A sample of 553 retarded and nonretarded students were pretested, randomly assigned to trained or nontrained groups, and posttested. Analyses of variance on factor scores derived from a varimax rotation of item responses revealed that learning potential training was effective in increasing the ability to reason by analogy of both retarded and nonretarded children. The learning potential procedure provided learning experiences related to reasoning skills that may not have been previously acquired in school.


Attentional model for the effectiveness of fading in training reading- vocabulary with retarded persons. Researchers have shown that a simple reading-vocabulary can be trained by repeatedly pairing picture and word and that fading the picture over trials increases the efficiency of training. An attention hypothesis attributes the effectiveness of fading to an increase in attention to the word caused by the fading out of the picture. In an alternative hypothesis, stimulus change, it is proposed that the mechanism of fading derives from the increased salience of the changing stimuli, so that fading in the word would be as effective as fading out the picture. These competing hypotheses were tested by training 48 nonreading retarded persons (in four equated groups) under the following conditions: fade picture out, fade word in, double fade (picture fades out and word fades in simultaneously), and standard (picture and word paired without fading). Tests of vocabulary-learning showed that the fade picture out and double-fade conditions were equally effective and superior to the standard and fade word in conditions, which were equally ineffective. These findings were inconsistent with the stimulus-change hypothesis, but consistent with a two-look attentional model, based on the Zeaman and House attention theory (1963).


Differences in attitudes toward sex-typed behavior of nonretarded and retarded children. The present study was an initial attempt at understanding gender constancy in retarded children. Stories about retarded or nonretarded boys or girls were given to teachers and caretakers of retarded children and teachers of nonretarded children. The stories described children in four sex-stereotyped activities. Respondents rated each child in the stories on scales of typicality and acceptability. Results indicated that, while nonretarded children were rated as typical when engaging in sex-appropriate, desirable play activities, retarded children were rated as typical when engaging in undesirable activities, regardless of sex appropriateness. Different professional groups appeared to use different criteria when judging the children in the stories.


Vicarious effects on the creative behavior of retarded and nonretarded children. The effects of observing a model's overt display of a creative drawing response and hearing a description of these actions were assessed with 54 retarded and 68 nonretarded children. The modeled creative strategy was designed to be high in the dimension of elaboration. A multivariate research design was employed to assess the target dimension of elaboration, as well as to determine transfer to tasks of varying degrees of similarity to the model's task and to creative dimensions other than elaboration. The overt modeling of a creative strategy was most effective in improving elaboration, although verbal descriptions also aided performance. Retarded children were less able than nonretarded children to discriminate the essential elements of the model's elaboration strategy and displayed less acquisition of the elaboration strategy but showed comparable gradients of transfer.


Relationship among the self-direction, responsibility, and socialization domains of the Adaptive Behavior Scale. The extent of the relationship among the Socialization, Self-Direction, and Responsibility domains of the Revised Adaptive Behavior Scale was investigated. Based upon the scores of 338 mentally retarded institutionalized male and female children and adults, high positive and significant correlations were obtained among these three domains. The relationship was explained in terms of a possible motivational link among the three domains.


Factor structure of the SREB Attendant Opinion Scale. A factor analysis of the SREB (Southern Regional Education Board) Attendant Opinion Scale was performed, based on the responses of 105 subjects. The results were very similar to those reported by the authors of the scale. Four factors were interpreted as relating to job dissatisfaction, maintenance of the rights of residents, belief in making residents conform to moral standards, and authoritarianism. The scale appears to be a promising instrument for evaluating attendants' attitudes.


Evolution of a women's clinic: an alternate system of medical care. Following the Vermont Supreme Court decision, in 1972, invalidating an old statute against abortion, the community watched for change in hospital and medical practice. When none occurred, representatives of health agencies were jointed by feminists and others dissatisfied with existing medical facilities to form the Vermont Women's Health Center. Tensions resulting from differing viewpoints were channeled into the common goal of providing optimal health care involving paramedical personnel as well as gynecologists and other physicians. In 1973, 1,255 abortions were performed. Complications were monitored by the clinic, by the state health department, and by the International Fertility Research Program and were found to compare favorably with rates in larger clinics. Abortion-related visits initially outnumbered others by 2:1 but rapidly fell, indicating acceptance of the clinic for a variety of gynecologic services. After three years, the clinic is solvent, stable, and utilized by a wide range of women, the result of cooperation between the establishment and its critics.


Radical pelvic surgery versus radiation therapy for stage I  carcinoma of the cervix (exclusive of microinvasion). During the period from January 1, 1945, through December 31, 1975, 446 patients with Stage I infiltrative carcinoma of the cervix (exclusive of microinvasion) were evaluated at the University of Michigan Medical Center. Four different study groups with treatment comparisons between radical hysterectomy with pelvic lymph node dissection and full-course radiation therapy are analyzed. The over-all uncorrected five-year survival rate when each form of therapy is evaluated approximates 85 per cent; the corrected five-year survival rate is approximately 90 per cent. When the regional lymph nodes were negative, the five-year survival rate was 96 per cent; when they were positive, the five-year survival rate was 55 per cent. Pathologic variations are evaluated, and basic vital statistics are reported. Thirteen per cent of the patients developed a recurrence within five years, 70 per cent occurring within the first three years. The therapeutic morbidity experienced in both groups of patients is essentially comparable, and the advantages of each form of therapy are presented.


Uterine pressure-flow relationships during early gestation. Placental and myoendometrial pressure-flow relationships were determined in 17 gravid ewes between 29 and 110 gestational days with the use of radioactive-labeled microsphere injections under flow meter guidance. Myoendometrial relationships were consistently curvilinear with convexity toward the flow axis. From 29 to 40 days, caruncular-cotyledonary relationships were similar to myoendometrial ones. After 50 days, the relationship was slightly but significantly curvilinear with convexity toward the pressure axis. From 42 to 50 days, responses were intermediate. The changes in caruncle-cotyledon vascular reactivity correlated with the onset and maturation of interdigitation of fetal and maternal tissues during definitive placentation. A hypothesis for these changes in vascular reactivity is presented.