Slowing of active labor associated with internal fetal monitoring. Active labor progress is generally believed to be linear. By using an ultrasonic cervimeter, which continuously records dilatation of the uterine cervix, acute decreases in active-phase dilatation followed by less rapid recoveries are found to be associated with intravaginal obstetric manipulations. These findings support the concepts that active labor may be nonlinear and regression in cervical dilatation is a real phenomenon.


Ovarian hemorrhage complicating warfarin sodium anticoagulant therapy. Three cases of women in the reproductive age group who received warfarin sodium therapy for pulmonary embolism are presented. The therapy was complicated by rupture of ovarian cysts with intraperitoneal hemorrhage necessitating exploratory laparatomy. The possibility of intraperitoneal hemorrhage must be considered in patients who present with abdominal pain and a history of anticoagulant therapy. Lack of awareness of the complication may result in delay in making a correct diagnosis and instituting appropriate therapy.


Puerperal infection in the antibiotic era. Developments in etiology and treatment of puerperal infection in the last 20 years are reviewed. Emphasis is placed upon predisposing factors, microbiology and antibiotics, unusual sources of severe infection, special complications, and prophylactic antibiotics.


Immunotherapy and chemotherapy of gynecologic cancers. Recurrent cervical, ovarian, and breast cancers have been treated with immunochemotherapy. Optimum chemotherapeutic agents have been determined by direct and indirect methods of sensitivity determination. The Hellström assay has been used for lymphocyte-tumor recognition and for cytotoxicity assays. Vaccines developed in this laboratory, consisting of autologous and allogeneic tumor-associated antigens, combined with BCG, have been used in immunotherapy. Objective tumor regression and notable clinical improvements have been observed. Forty-five advanced cases, including recurrent cancers of the cervix and ovary, along with sarcomas, breast malignancies, and melanomas, have been treated: 16 patients have died of their disease and 29 patients have survived for 6 months to 1 1/2 years. Some of these have shown either regression, total disappearance, or stabilization of their disease process. While the results of these preliminary studies are encouraging, the as yet unknown potential of this modality cannot be expected until it is applied earlier, at a time when residual tumor cells are minimal.


Fetal membrane dynamics.

Fetal membrane dynamics. The validity of the concepts of exchange and net flow and of the method used to measure them was proved by utilizing a standard artificial membrane. The exchange rates across the amniochorion of D- and L-isomers of various amino acids have been measured. They do not differ. Rates of exchange of water, glucose, and mannitol across the umbilical cord were determined and were noted to be considerably slower than the rates for these substances across the amniochorion.


Rate of transport of radioactive ovum models through the oviducts of individual rabbits. The transport of radioactive ovum models of 100, 200, 400, 800, and 1,000 mu diameter through the oviducts was measured. Four surrogates of a given size were transferred into each oviduct 6 hours after injection of human chorionic gonadotropin (HCG). The surrogates were located in the oviducts 24, 48, 60, 66, and 72 hours after HCG injection with a collimated end-window Geiger-Mueller tube. Thus the time-course of the transport of each surrogate, from ampulla to uterus in the same animal, was plotted. The time-course of surrogate transport was directly related to surrogate size. Our data suggest that normal tubal patency and ovum transport function can be tested by introducing radioactive ovum surrogates of appropriate size into the oviducts and monitoring their time of arrival at the uterus.


The significance of urinary free cortisol and progesterone in normal and anencephalic pregnancy. Urinary free cortisol and progesterone were determined by radioimmunoassay in 18 normal and 16 anencephalic pregnancies and urinary free cortisol levels in 9 nonpregnant women. In normal pregnancy the urinary free cortisol (46.89 +/- 34.02 mug per 24 hours) was significantly higher (P less than 0.001) than that found with anencephaly (17.19 +/- 13.20 mug per 24 hours) and 2 1/2 times (P less than 0.001) the nonpregnant value (18.47 +/- 5.44 mug per 24 hours). In 12 of the anencephalic pregnancies, urinary free cortisol levels (11.05 +/- 5.56 mug per 24 hours) were significantly lower than in nonpregnant women (P less than 0.001). Urinary progesterone levels in normal pregnancy (15.57 +/- 9.66 mug per 24 hours) and anencephaly (18.54 +/- 12.69 mug per 24 hours) were comparable. The cortisol excretion values associated with anencephaly indicate that the normal fetus contributes substantially to the maternal plasma cortisol pool. Urinary free cortisol determinations may be a useful index of fetal adrenal dysfunction.


Coagulation changes in eclampsia: their frequency and pathogenesis. The maternal coagulation mechanism has been investigated in an effort to identify its role, if any, in the pathogenesis of eclampsia. Thrombocytopenia was identified in 28 of 95 cases (29 per cent), a prolonged thrombin time in 19 of 38 (50 per cent), abnormally elevated serum fibrinogen-fibrin degradation products in two of 65 (3 per cent), and circulating fibrin monomer in one out of 20 (5 per cent). Overt hemolysis was rare (2 per cent). Thus the pattern as well as the degree of change in the maternal coagulation mechanism differed remarkably from that typical of severe abruptio placentae and of prolonged retention of a dead fetus, the classic obstetric models of fast and slow disseminated intravascular coagulation. It is concluded that the coagulation changes when present in eclampsia are effect rather than cause. Moreover, the changes may evolve primarily from platelet adherence at sites of vascular endothelial damage as the consequence of segmental vasospasm and vasodilatation rather than be triggered by the escape of thromboplastin from the placenta into the maternal circulation.


Effects of local anesthetic agents on the uterine vasculatures and myometrium. Intravascular procaine, lidocaine, mepivacaine, and bupivacaine decrease blood flow to the placental and nonplacental vascular beds of gravid ewes by stimulating vasoconstriction and myometrial contractility. These effects appear to be direct ones since they are not affected by alpha-adrenergic blockade. Dose-response curves determined in nonpregnant ewes indicate that significant decreases in blood flow may occur at arterial blood concentrations encountered clinically. It is proposed that reduced placental blood flow is the cause of fetal bradycardia following paracervical block anesthesia. The implications of these findings in obstetric anesthesia are discussed.


Elective cesarean hysterectomy: a 5 year comparison with cesarean section. Elective cesarean sections performed on the obstetric service at the University of Arkansas Medical Center were reviewed for the period January 1, 1970, through December 31, 1974. The purpose of the review was to compare operative and postoperative complications of cesarean section, cesarean section and tubal ligation, and cesarean section and elective hysterectomy. A total of 1,255 cesarean sections were performed of which 207 (17 per cent) were associated with tubal ligation and 242 (18 per cent) with hysterectomy. Elective cesarean hysterectomies were performed for elective sterilization (68 per cent), for medically indicated sterilizations (11 per cent), or for definitive treatment of uterine pathology(21 per cent). All cesarean sections were obstetrically indicated with the exception of 34 primary cesarean hysterectomies performed as definitive treatment of carcinoma in situ of the cervix. The operative procedures were compared in regard to the following characteristics or complications: operating time; incidence of blood transfusions, urinary tract injuries, postoperative bleeding, febrile morbidity, and other postoperative complications; and postoperative hospital days.


Cell kinetics and programmed chemotherapy for gynecologic cancer. I. Squamous-cell carcinoma. The results of current investigation into cellular kinetics of both normal and abnormal human genital tissue have stimulated interest in programming chemotherapeutic drug regimens for the treatment of genital cancer. This report outlines the results of cell kinetic studies of normal and abnormal squamous epithelium of the female genital tract and presents preliminary results of a regimen utilizing methotrexate, hydroxyurea, and vincristine in patients with far-advanced squamous-cell cancer of the vulva, vagina, and cervix. A total of 92 patients have received 444 courses of programmed chemotherapy by either pelvic intra-arterial infusion or systemic administration of the drugs. Our results are presented and the theoretical basis of the research is discussed.


Cytology and colposcopy in the diagnosis and management of preclinical carcinoma of the cervix uteri: a learning experience. This report presents a learning experience in the use of colposcopy in the management of 254 patients consecutively and personally studied in whom one or more Papanicolaou smears suggested a cervical intraepithelial neoplasia or early invasive carcinoma. The accuracy of cytology in predicting the degree of cervical intraepithelial neoplasia and early invasive carcinoma, within the limits of confidence of the laboratory, was 84.5 per cent. The accuracy of the colposcopic impression, within the limits of confidence, was 83.5 per cent. When only those lesions that could be satisfactorily examined were considered, the accuracy of the colposcopic interpretation within the limits of confidence was found to be 96.4 per cent. Neoplastic lesions limited to the ectocervix, and lesions that extended from the ectocervix into the lower portion of the endocervical canal and lesions limited to the canal were significantly related to the age of the patient. Of the total group of 254 patients examined, 45 patients (17.7 per cent) were subjected to a diagnostic cone biopsy.


One hundred consecutive pars plana vitrectomies using the vitrophage. One hundred consecutive eyes underwent vitrectomy with the disposable vitrophage via a pars plana approach. Eyes were divided into two main categories based on opacity location-in the anterior or posterior segment. Patients with posterior segment opacities had diabetic retinopathy, nondiabetic vitreous hemorrhages, retinal detachments associated with vitreous hemorrhage, bands, or membranes, and intraocular foreign bodies or silicone oil. Patients with anterior segment opacities were treated for pupillary membranes resulting from surgical trauma or perforating injuries, and for complications following cataract extraction, such as capsule breakage and vitreous loss. Postoperatively, visual acuity improved in 68% of eyes with posterior segment opacities and in 85% of eyes with anterior segment opacities. Overall, visual acuity was 20/300 or better in 45% of eyes. There were only two intraoperative retinal tears and one postoperative rhegmatogenous retinal detachment.


Visual loss after cardiopulmonary bypass. Ten cases of visual loss ranging from total blindness to a brief period of transient ischemic attacks occurred after cardiopulmonary bypass. Brain scan studies indicated occipital cortical infarction as the cause. Thrombosis, embolization, and selective laminar cortical necrosis due to cerebral anoxia were possible mechanisms.


Surgical treatment of true Brown's syndrome. In 1950 H. W. Brown reported the superior oblique tendon sheath syndrome and cut the sheath as treatment for the condition. My results (as well as those of other surgeons) with similar surgery have been disappointing. Consequently, I carried out different operations consisting of Z tenotomy of superior oblique tendon in nine patients, split tendon lengthening in two patients, complete tenotomy in 16 patients, and a tenectomy in two patients. One of the latter was done on a patient after an unsatisfactory tenotomy where I missed the tendon. Tenotomy of the superior oblique tendon gave the best results. Experiments with the superior oblique tendon in cadavers several hours after death showed that after cutting the tendon just medial to the superior rectus muscle, the cut end of the tendon moved medially only about 8 to 10 mm due to restrictions of the capsular attachments to the trochlea. The cause of "true" Brown's syndrome is a tight tendon, and a safe and effective surgical treatment consists of cutting it just medial to the superior rectus muscle.


Saccadic velocity measurements in internuclear ophthalmoplegia. Five patients with internuclear ophthalmoplegia had horizontal saccades measured by electro-oculography. In all patients, abduction saccadic velocities were normal while adduction saccades were slowed either binocularly or monocularly. In one patient, adduction saccades were reduced in velocity, even though full adduction was present. Saccadic velocity measurements may be helpful in diagnosing internuclear ophthalmoplegia, especially in the early or subclinical case. As bilateral internuclear ophthalmoplegia frequently suggests multiple sclerosis, prolonged examination with more sophisticated and difficult diagnostic tests is avoided.


Familial nanophthalmos.

Familial nanophthalmos. Four members of one sibship had microphthalmos with fundi having an irregular "rippled* appearance with alternating light and dark red coloration. Fluorescein angiography revealed patchy choriocapillaris perfusion with unusually rapid diffusion into the retina. Genealogic and geographic data strongly suggest autosomal-recessive inheritance. Only one patient developed glaucoma. The unique combination of abnormalities in this family suggests that a new recessive mutation may be responsible.


Corneal distribution of subconjunctival antibiotics. Radioactive carbon-labeled penicillin G, chloramphenicol, or gentamicin were injected subconjunctivally into rabbit eyes. The distribution of antibiotics throughout the cornea was determined in relation to the injection site; aqueous humor levels were also measured. For chloramphenicol, the highest drug concentrations in the cornea were adjacent to the injection site; levels decreased as the distance from the injection site increased. For penicillin G and gentamicin, highest corneal levels were adjacent to the injection site. Levels were lowest in the central cornea but increased in the peripheral cornea, 180 degrees opposite the injection site. For all antibiotics, therapeutic levels were reached throughout the cornea irrespective of the injection site. Corneal values for all drugs were consistently higher than aqueous humor values. These results suggest that in the treatment of corneal ulcers the choice of subconjunctival injection site is not important.


Specular microscopy of human corneal endothelium in vivo. A clinical specular microscope used in the routine examination fo the corneal endothelium of 40 patients at high magnification, without inconvenience or discomfort to the patients, detected endothelial damage or disease that was not seen by slit-lamp examination. A statistically significant decrease (P less than .001) in the number of central endothelial cells with age was documented.


Surface ultrastructure in alkali-burned rabbit corneas. The scanning electron microscope was used to follow morphologic events after alkali burn of rabbit corneas. Immediately after a burn there was extensive destruction and shrinkage of the epithelial cells. In subsequent healing, the regenerated superficial cells were morphologically abnormal and possed multiloculated cysts; three months later the normal polygonal packing of cells was not observed. Although the shape of these cells was irregular, microprojections were present on the cell surface. Basal cells were usually observed at the edge of an epithelial defect, an area where the epithelium was easily detached from the basement membrane. In long-standing epithelial defects, the basement membrane became eroded in a spot-like manner after about two weeks. Eventually, when a frank stromal ulcer had formed, bundles of collagen fibrils were visible in a meshwork-like fashion. These changes did not seem to be caused by the direct action of alkali but rather by latent secondary factors that took days or weeks to activate.


Disinsertion of the aponeurosis of the levator palpebrae superioris muscle after cataract extraction. Surgical exploration of the upper eyelid was undertaken in two patients who developed blepharoptosis after cataract extraction. Disinsertion of the aponeurosis of the levator palpebrae superioris muscle from its epitarsal attachments was discovered and repaired in each patient to correct the blepharoptosis.


Increased intraocular pressure after third ventricle injections of prostaglandin E1 and arachidonic acid. Prostaglandin E1 administered into the third ventricle of rabbits produced increased intraocular pressure and body temperature. Similar responses were observed after third ventricle instillation of arachidonic acid, a precursor of prostaglandin E2. Increase of body temperature occurred with lower doses of prostaglandin E1 and arachidonic acid while the intraocular pressure response required larger amounts of these drugs. Pretreatment with aspirin rectal suppositories had no effect on the third ventricle responses induced by prostaglandin E1. Aspirin pretreatment before third ventricle instillation of arachidonic acid blocked the increases of intraocular pressure and temperature.


Hemorrhage into the lens as a complication of glaucoma surgery. Intralenticular hemorrhage is a rare complication of glaucoma surgery. In a 45-year-old man, the intralenticular blood caused loss of the red reflex from the fundus postoperatively. Clinically, hemorrhage into the lens has usually been misdiagnosed initially as a hyphema.


Prisms for inspection of a seesaw nystagmus. Two eyes may be simultaneously viewed one above the other by using an arrangement of two prisms with their bases arranged to the right and to the left. When these prisms are placed in front of the glabella and tilted slightly clockwise it is possible to view both eyes simultaneously and appreciate the seesaw motion of a nystagmus.


Comprehensive evaluation of basic living skills. In this paper a rationale is established for an evaluation of basic living skills for chronic psychiatric patients living in mental institutions, and a comprehensive evaluation is presented. The advantages of this battery of tests over currently used activities of daily living scales are: it is specifically designed for psychiatric patients, it tests a wide range of skills, the items are graded in complexity, it can be administered in full or in part, and it has a scoring system and a summary that indicates the patient's functional status. The information gained from the evaluation improves staff communication about patient care and aids in the planning of the patient's future placement or treatment situation.


Cosmetic  prosthesis for traumatic defect of the leg. The procedure described above requires two clinic visits: the initial visit for measuring and casting; the second visit for fitting, additional contouring, if necessary, and delivering the prosthesis to the patient. This prosthesis fits into the defect and is kept in place by wearing a support sock. There is minimal chance of slipping since it conforms to the defect and is also extremely light-weight. The prosthesis is confortable and allows the child to sit, kneel, and run without difficulty.


Adolescent role assessment.

Adolescent role assessment. Adolescence is a complex period when children are expected to shed their dependencies and achieve a level of independence as adults. Frequently, adult independence is achieved through the occupational role where individuals recognize personal assets and liabilities and participate cooperatively in the society. The decision-making process that guides adolescents in the search for an occupational role is occupational choice. This paper traces the development of skills necessary for the occupational choice process. An instrument is presented that attempts to identify deficiencies in the occupational choice process and to provide content for occupational therapy intervention. Its usefulness in screening deviant adolescents in order to identify those who may be at high risk in the occupational choice process is discussed.


Hand skill measurement: a gauge for treatment. Objective measurements of performance are vital with the increasing necessity to justify the need for occupational therapy services, and to conduct studies that measure the effectiveness of treatment procedures. This paper reports on a measurement of hand skill that was standardized by comparing hand skill performance among the able-bodied, or normal, population. The performance on this test o patients with various types of disabilities and the implications for treatment are discussed. For the paraplegic, the hand skill test indicates the need for occupational therapy services; for the quadriplegic, the test measures the effectiveness of functional orthotic devices; and for the hemiplegic, the hand skill test determines the potential for success in one aspect of self-care, dressing.


Theoretical and clinical approaches to the treatment of adolescent drug addiction. Psychologists, social workers, addiction specialists, and occupational therapists often find themselves faced with clients who not only are addicted but also have personal, family, and social problems. These combined problems make the drug-abusing client an extremely difficult one to work with. Occupational therapists have a particular challenge in that they must not only understand and analyze their clients' occupational behavior but also their needs as addicts. This paper describes an approach to adolescent addiction that presents a clinical and theoretical consideration that could be helpful to professionals who work with addicted or drug-abusing clients. In the approach a fusion must be made between the client and the therapist or treatment program. The fusion is temporary but long enough to provide opportunities for clients to work through their feelings of anger, aggression, and sadism, as well as their ego and superego problems. To understand all aspects of their use of drugs, an easily memorized two-dimensional scheme is drawn by the client and therapist together and is used to formulate a treatment plan. Separation from the therapist or program is an essential part of treatment. At this time the client is given the kind of emotional support required to establish new relationships.


Comprehensive occupational therapy evaluation scale. This paper presents the Comprehensive Occupational Therapy Evaluation Scale (COTE Scale) for use by occupational therapists in short-term, acute-care psychiatric facilities. The scale defines 25 behaviors that occur in and are particularly relevant to the practice of occupational therapy. The scale is used as an initial evaluation, as a record of patient progress, and as a means of communicating the evaluation, progress, and treatment to other hospital departments. Ratings of patients that indicate improvement and readiness for discharge are supported by the evaluations of other disciplines.


The influence of aspirin and indomethacin on the platelet contractile wave. Recent evidence suggests that a short-lived product of prostaglandin biosynthesis produced on the addition of arachidonic acid to platelet microsomes is involved in physiologic platelet aggregation and mediates the release reaction by producing the platelet contractile wave. An important corollary of this hypothesis is that aspirin and indomethacin, inhibitors of prostaglandin synthesis, should block the platelet contractile process produced by agents which can initiate platelet aggregation. The present study tested this hypothesis and found that aspirin and indomethacin were, indeed, potent inhibitors of the platelet contractile wave stimulated by collagen and epinephrine, but largely failed to inhibit internal transformation induced by thrombin and ADP. The findings confirm the hypothesis that a prostaglandin produced endogenously by platelets initiates platelet contraction and suggests that ADP and thrombin have the ability to stimulate the platelet contractile apparatus by an alternate mechanism not dependent on prostaglandin synthesis.


Ultrastructural cytochemistry of the ischemic (endocrine) kidney. Partial ligation of the aorta between the renal arteries induces marked atrophy of the cortical tubules (including the macula densa) of the left (endocrine) kidney with a remarkable increase in the number and granularity of hypersecretory juxtaglomerular granulated cells (JGC) which are found not only at the glomerular pole of arterioles but also in the walls of arteries and arterioles far removed from the glomerulus. Staining of fine sections of Araldite-embedded endocrine kidneys according to the periodic acid-thiocarbohydrazide-silver proteinate technique of Thiery reveals abundant glycogen in the JGC and less in the blood vessels and tubules. Juxtaglomerular granules are argentaphobic, but their rim is positively stained when ultrathin sections of glutaraldehyde-fixed, glycol methacrylate-embedded kidneys are exposed to phosphotungstic acid at a low pH. A positive reaction is also shown by the cell coat and lysosomes of JGC as well as by the thickened basal lamina, cell coat, cytosomes, and cytosegresomes of the atrophic tubules. Atrophy is most pronounced in the proximal convoluted tubules, which lose their apical microvilli, their basal infoldings and the majority of their mitochondria and cytosomes.


Inflammatory sequences in acute pulmonary radiation injury. The histopathologic events in the developing acute pulmonary inflammatory reaction to inhaled particles of Yttrium 90 are detailed. In animals that died or were sacrificed during the first year after inhalation exposure, microscopic findings of acute inflammation predominated and included vascular congestion; stasis, focal hemorrhage; edema; various inflammatory cell infiltrates; cytolysis and desquamation of bronchiolar and alveolar epithelium followed by regeneration; vascular injury and repair; and the eventual development of pulmonary fibrosis. Accumulation of alveolar fibrin deposits was an additional characteristic, though not a constant feature of the early stages of radiation pneumonitis. In addition to the direct effects of radiation on pulmonary cell populations, the histopathologic findings were suggestive of diverse activation of various cellular and humoral mediation systems in their pathogenesis. The potential interrelationships of systems responsible for increased vascular permeability, coagulation and fibrinolysis, chemotaxis, and direct cellular injury were discussed and related to the pathogenesis of the microscopic findings characteristic of early pulmonary radiation injury.


The Chediak-Higashi (beige) mutation in two mouse strains. Allelism and similarity in lysosomal dysfunction. A mutation called beige, with a phenotype similar to that of the human Chediak-Higashi syndrome, has occurred independently in two inbred strains of mice. Beige-J (bgj) occurred as a spontaneous mutation in the C57B1/6J strain and beige (bg) was radiation-induced in mice of heterogenous background which were then inbred as strain SB/Le (bg/bg), the subject of the present study. As in the previously characterized C57Bl/6J beige-J mutant, there is a correlation between abnormal lysosome structure and defective lysosome function in SB/Le beige mice. They secrete much less than normal amounts of lysosomal enzymes from proximal tubule cells and, hence, have increased lysosomal enzyme activity in kidney. In addition, after treatment of either beige strain with androgen, numerous giant beta-glucuronidase-containing lysosomes are present in kidney proximal tubule cells near the corticomedullary border. By directly measuring the rate of beta-glucuronidase synthesis in androgen-treated SB/Le beige mouse kidney, it was shown that the greater accumulation of this lysosomal enzyme in proximal tubule cells was not due to an increase in its rate of synthesis. Genetic analysis of the beige mutations in the two mutant strains demonstrated that both mutant genes are recessive and, in fact, are allelic. The results suggest that both beige strains are defective in intracellular motility of lysosomes and/or their fusion with cellular membranes, and that both mutant strains are suitable experimental models for the human Chediak-Higashi syndrome.


A light and electron microscopic analysis of gentamicin nephrotoxicity in rats. The sequence of proximal tubular damage and repair after gentamicin sulfate administration was studied by light and electron microscopy in Fischer 344 rats. The drug was administered at a dose of 40 mg/kg for up to 14 days. Although epithelial destruction was progressive with time, the extent and degree of tubular damage varied among animals at each interval. Tubule regeneration began to occur by the tenth day despite continued drug administration. Regenerating cells appeared to originate from residual epithelial cells in areas of tubular damage. The morphologically immature regenerating cells are apparently metabolically immature as well and appear not to be susceptible to toxic effects of the drug. Tubules were repopulated by 3 days following cessation of gentamicin administration. Except for foci of tubular atrophy and interstitial fibrosis, cortical tissues were comparable to controls ultrastructurally at the end of 31 days.


The genetics of shovel shape in maxillary central incisors in man. From dental casts of 94 parent-offspring and 127 full-sib pairs, sampled from two Chilean populations, shovelling indices are computed to measure the degree of shovelling of maxillary central incisors quantitatively. Genetic correlations are computed to determine the role of genetic factors in explaining the variation in this trait. Assuming only hereditary factors to be responsible for the transmission of shovel shape, 68% of total variability is ascribed to the additive effect of genes.


Relationship of body composition to somatotype. The purpose of this study is to determine the relationship in college-aged women between somatotype using both Sheldon's ('69) and Heath and Carter's ('67) procedures, and body composition, as measured by whole-body 40K counting and body density. Sheldon's endomorphy is closely associated with height and weight; Heath and Carter's first component is significantly related to weight and body fatness. Lean body mass (LBM) as a weight or as a percent is not closely related to Sheldon's mesomorphy or Heath and Carter's second component. However, when LBM and height are used as independent variables to estimate somatotype, both variables are significantly related to  Heath and Carter's second component, accounting for 61% of the variance. Thus Heath and Carter's second component is significantly associated with LBM for a given body height. Most of the variation in Sheldon's ectomorphy and Heath and Carter's third component can be accounted for by weight and height. Sheldon's somatotype for all three components is not as closely related to body composition as Heath-Carter's. Body composition, as measured by either 40K counting or body density, is found to be important in accounting for variation in Heath and Carter's first and second components.


The frequency of middle phalangeal hair in Saudi Arabia. Middle phalangeal hair was found to be present in 71% if Saudi Arabian males. For those exhibiting this trait, the frequency of combinations of digits with hair was similar to the frequency in other populations.


Newborn Brain: Body weight ratios.

Newborn Brain: Body weight ratios. Newborn brain:body weight ratios are generally considered to be constant in man. In autopsy studies many factors influence the measured weight of the brain, and therefore the conclusions based on such observations, including the gestational age of the material, the presence or absence of intrauterine growth retardation, and the cause of death. In this study these influences have been eliminated by careful selection of normally grown fullterm newborns not subject to the factors influencing brain weight. Using double logarithmic plots, brain size in fullterm newborns is found to be related to the 0.64 power of birth weight. There is a negative correlation between relative brain size and increasing fullterm birth size in man.


The interaction between nonmetric and metric cranial variation. Cranial discrete or 'epigenetic" traits have been analyzed for interrelationships with measurements of the skull in a sample of American Negro males. Univariate t and multivariate T2 tests are used. It has been the previous consensus view that nonmetric and metric characters are unrelated. Statistically significant associations between the total of 50 discrete and 23 metrical characters, however, are much more frequent than would be expected through random distribution. Multivariate analysis supplements simpler statistics by synthesizing patterns of variation within regions of the skull, identifying many interrelations of skull size and shape with discrete traits. A low but observable general influence is exerted upon nonmetric morphology by metrical variation of the human skull (or vice versa).


Local cold exposure of Andean Indians during normal and simulated activities. Thermal resonses of Andean Indians were measured during several customary tasks associated with cold exposure in the highlands of southern Peru. These included surface temperature measurements of women while they washed clothing in the river and similar measurements of men while they constructed a diversion channel in the same river. A third test measured the effects of alcohol consumption on body temperatures during light activity. Women maintained slightly warmer hand than foot temperatures. Men maintained nearly equal hand and foot temperatures during the exposure period. Among male subjects the foot rewarmed at a faster rate than the hand. The results from the field studies compared favorably with results from earlier laboratory exposure tests. Comparisons between the river water exposure tests for males and females showed a consistent pattern where females maintained warmer hand and foot temperatures than males. These findings were in accord with previous laboratory studies among Quechua Indians and with the findings reported for other ethnic groups who experience natural cold stress. Alcohol ingestion appeared to have minimal effect in mitigating cold stress response during light activity. This finding was counter to earlier laboratory tests of resting subjects.


Finding from Asia, Australia, Europe, and North Amercia on secular change in mean height of children, youths, and young adults. Studies conducted during the past century in Australia, Canada, Japan, Norway and the United States indicate that the magnitude of secular increase in mean height rose with advancing age from childhood to mid-adolescence. Comparisons for a period approximating two-thirds of a century yield average increases in mean height of 12.2 cm for female youths age 12 years, and 12.5 cm for male youths age 14 years; for the same calendar span, the amount of secular increase in mean height declines from mid-adolescence to early adulthood. Comparisons of Belgian females, spanning a period approximating 130 years, yield increases in mean height of 18.1 cm at age 12 years, 11.9 cm at age 16 years, and 3.7 cm in early adulthood. For a period of 90 years, increases obtained on United States White males are 14.8 cm at age 14 years, 8.8 cm at age 17 years, and 5.3 cm in early adulthood. These and other displayed findings show clearly that the search for causes of secular change should take particular account of a phenomenon widespread among human populations, i.e., the phenomenon of childhood and early adolescent growth in body height proceeding at a faster pace in recent decades than about a century ago.


Influence of physical activity on stability of somatotypes in boys. The purpose of this study is to examine the stability of somatotypes of boys with different activity levels followed longitudinally for eight years. Thirty-nine boys ated 11 were somatotyped annually (until 18 years) using the Heath-Carter  anthropometric rating method. Three sub-groups were formed according to their levels of systematic physical activity designated High, Moderate, and Low Activity. There were no differences in somatochart distributions of the Total Group, but there were considerable individual changes which cancelled each other in group comparisons. All boys changed their somatotype ratings at least once and 67% changed in component dominance. The inter-age correlations for the components were generally of poor prediction value, and the somatotype migratory distances showed considerable variation. The Total Group means differed on three components and this was attributed to differences within the Moderate Activity Group, the only sub-groups to differ. It was concluded that changes occur in somatotypes of adolescent boys, but the influence of physical activity on the changes is inconclusive.


The genetic structure of finland.

The genetic structure of finland. The Finnish gene pool derives primarily from a relatively homogeneous Finno-Ugric population established during the Iron Age (100 B.C.-800 A.D.) in the southwest and southeast of Finland. Gene flow from Sweden to the southwest coastal areas, dating from prehistoric times, as well as the patterns of settlement and migration throughout Finland during the past 1000 years, appear to have been the major biosocial factors underlying the genetic structure of the contemporary population. Analysis of genetic variation and covariation at nine polymorphic loci in a large random sample of rural Finns, partitioned into either 8 countries or 27 geographic districts, showed that all of the essential features of the genetic structure suggested by the archaeological and historical data could be distinguished. Procedures for obtaining inference on the genetic structure of such a population are reviewed, including coefficients of similarity and (genetic) distance among subpopulations, the relation between linear or planar geographic structure and genetic covariation, and the methods for describing allelic differentiation. Bias resulting from the inappropriate assumption of a simple phylogenetic model can be substantial, expecially for the analysis of isolation by distance; procedures for avoiding misleading inference on the genetic structure are demonstrated.


The cnemic index: a criktique.

The cnemic index: a criktique. The accuracy of the cnemic index is questioned. Excessive random variation is found to be present in the datum for this index, the nutrient foramen. It is suggested that the index be taken at a fixed location on the tibial shaft. A new index, the cnemic index (one-third), is proposed.


P.T.C. tasting among three Indian groups of Nicaragua. Ninety-six Miskito, 85 Sumo and 79 Rama Indians were tested for P.T.C. taste ability according to a modification of Harris and Kalmus' sorting technique. Miskito's "non-taster" high frequency approach values reported for some highly inbred Central and South American Indian populations, while Rama's and Sumo's figures appear in aggrement with values reported for other relatively pure Amerindians.


Advanced weathering cracks as an improvement on split-line preparations for analysis of structural orientation in compact bone. Weathering cracks have been demonstrated to be equivalent to split-lines in compact bone. The amount of cracking becomes more extensive with time. Advanced weathering cracks have the potential for giving more complete information on orientation patterns than split-lines. They can also be superior in accuracy and objectivity of results obtained, in preserving the original condition of the bone, and in elimination of much of the work involved in making split-line preparations.


Dietary regulation of liver and muscle transport of amino acid. Distribution ratios (intracellular concn/extracellular concn) of alpha-amino isobutyric acid (AIB) after intravenous injection were determined in fed, 12-h, 1-day, and 5-day starved rats. Progressive increases (over fourfold) in the distribution ratios of AIB in the liver and progressive decreases (over threefold) in the gastrocnemius muscle occurred within these periods. On full day of protein deprivation was without effect on AIB distribution ratios, but after 5 days it produced an increased distribution ratio of AIB in the liver (twofold), without affecting that of the muscle. A sudden increase in hepatic glucose output, induced by phlorizin, was followed by an increase in the liver distribution ratio of AIB. In starvation the increase in plasma concentration of glucagon and decrease in insulin level preceded the changes in AIB distribution ratios; in protein deprivation there was no change in plasma concentrations of these hormones. It is concluded that caloric restriction profoundly affects amino acid transport by the liver and by the skeletal muscle. These transport changes would enhance the availability of substrates for increased gluconeogenesis during starvation.


Colonic absorption of bacterially synthesized vitamin K2 in the rat. Colonic absorption of bacterially synthesized vitamin K2 ([3H]menaquinone-9) was studied with everted rat colonic sacs in vitro. The mean +/- SE rate of absorption of the vitamin by the colon was 20 +/- 1.45 pmol/min per 100 mg tissue at 300 nM mucosal concentration of the vitamin. The rate of absorption did not change (P greater than 0.10) with the addition of 2,4-dinitrophenol, Na azide, or KCN to the mucosal incubation medium. No evidence for transmural transport of the vitamin was detectable. When the concentration of the vitamin was increased in a stepwise fashion up to 900 nM, the absorption rate remained linear with respect to the mucosal fluid concentration (r = 0.98). Autoradiography indicated that the vitamin accumulated in the mucosal and submucosal layers of the large bowel. Absorption of the vitamin by the large bowel takes place via a passive, nonsaturable process that shows no evidence of energy dependence or carrier mediation. It was concluded that vitamin K2 (bacterial origin) is absorbable by the rat colon in amounts sufficient to meet the daily requirement of the animal and may explain the lack of bleeding problems in the face of episodic lack of dietary vitamin K.


Low Na+ effects on PAH transport and permeabilities in isolated snake renal tubules. Effects of low sodium concentrations on p-aminohippurate (PAH) transport by isolated, perfused snake (Thamnophis spp.) distal-proximal renal tubules were studied. Replacement of sodium in bath with choline led to significant depression of net PAH transport from bath to lumen in less than 10 min and to maximum depression (to 25-30% of control) in about 30 min, but transport still occurred against concentration gradient. In absence of sodium, PAH concentration in cell water was markedly depressed, but was still slightly greater than that in bath or lumen. Apparent permeability of peritubular membrane, determined from PAH efflux from tubules with oil-filled lumens, averaged about 0.5 X 10(-5) cm s-1 in 150 mM sodium and about 1.1 X 10(-5) cm s-1 in sodium-free medium. Data suggest that both decreased rate of active transport and increased apparent permeability of peritubular membrane contribute to depression of net transepithelial PAH transport and cell water PAH concentration in sodium-free medium. When sodium was restored to bath, net PAH transport nearly tripled in 15 min. Reduction of bath sodium concentration to one-half control or perfusion with sodium-free medium in lumen and control medium in bath had no effect on net PAH transport.


Basis for phase relations between baroreceptor and sympathetic nervous discharge. The phase relations between the cardiac cycle and sympathetic nervous discharge (SND) were studied with an average-response computer in the anesthetized cat. Maximum SND occurred during early diastole at heart rates between 3 and 4 beats/s. Dramatic shifts in the phase relations between SND and the cardiac cycle accompanied the decrease in heart rate produced by stimulation of the distal end of the cut right vagus nerve. The point of maximum SND was shifted from early diastole to near peak systole and then into the late diastolic phase of the preceding cardiac cycle as heart rate was progressively lowered to 2 beats/s. These observations indicate that synchronization of SND during each cardiac cycle is not the simple consequence of the waxing and waning of baroreceptor nerve activity. Rather, 1:1 locking of bursts of SND to the cardiac cycle is explained on the basis of entrainment by the baroreceptor reflexes of a sympathetic rhythm of central origin. An inhibitory-phasing hypothesis is proposed to account for entrainment. In addition, two components (spinal and brainstem) of sympathoinhibition associated with the pulse-synchronous discharge of the carotid sinus nerve were revealed when the 1:1 relationship between bursts of SND and the cardiac cycle was disrupted at heart rates below 2 beats/s.


Reflex effects of thermal stimulation on sympathetic nerve activity to skin and kidney. Effects of peripheral and central thermoreceptor reflexes on sympathetic nerve activity to the skin (SkNA) and kidney (RNA) were compared in anesthetized cats. Sudden warming of the skin produced a rapid increase of RNA, wheras sudden cooling produced a rapid increase of SkNA. When the bath temperature (TB) was 17.6, 29.7, and 41.9 degrees C, the normalized SkNA was 100, 82, and 48%, while the normalized RNA was 81, 90, and 100%, respectively. Similarly, under open baroceptor loop conditions, SkNA changed inversely with TB, while RNA changed proportionally to TB. Changes in the temperature of the whole brain including hypothalamus (Thy) modified the amplitude of grouped RNA and SkNA synchronously with the cardiac cycle. At TB of 32.4 degrees C, when Thy was altered in a range of 30-42 degrees C, SkNA reached a maximum level at a Thy of 38.4 degrees C, whereas RNA reached a maximum above 42 degrees C. In a Thy range of 38-42 degrees C, the slopes of the Thy-SkNA curve and Thy-RNA curve were 30 and +4%/degrees C, respectively. At Thy below 38 degrees C, SkNA and RNA changed in parallel with Thy. Continuous cooling of the skin modified the slope of the TB-SkNA curve, but a small change of Thy caused a shift of the TB-SkNA curve.


Effects of time on volume and distribution of coronary collateral flow. Changes in the volume and distribution of collateral blood flow were studied during the 1st h after coronary occlusion in nine open-chest dogs. Labeled microspheres (7-10 mum) were injected into the left atrium prior to and 20 s, 5 min, and 60 min after acute occlusion of the midcircumflex coronary artery so that myocardial perfusion to small segments of the entire left ventricle could be measured. The segmental perfusions were classified as normally perfused, severely hypoperfused, moderately hypoperfused, and borderline hypoperfused. Standard hemodynamic measurements were obtained and relative coronary vascular resistance to the normally perfused and hypoperfused zones was calculated. The principal conclusions of the study are as follows: 1) during the 1st h after coronary occlusion the collateral flow to the hypoperfused myocardium increases substantially; 2) the increase in collateral flow is distributed fairly evenly to various hypoperfused zones and is associated with a marked decrease in coronary vascular resistance; and 3) as a result of this influx in collateral flow the size of the hypoperfused area decreases and the relative proportion of severely hypoperfused segments within the hypoperfused area decreases.


Response to parathyroid hormone in defined segments of proximal tubule. Previous investigations have suggested that there is a functional heterogeneity along the length of the proximal convoluted tubule. This study was designed to confirm and extend these suggestions by examining the intrinsic absorption of fluid and the effect of parathyroid hormone (PTH) on net fluid absorption in isolated, anatomically defined segments of rabbit superficial proximal tubules. The EPCT (early proximal convoluted tubule), LPCT (late proximal convoluted tubule), and PR (pars recta) segments were studied under controlled conditions by the isolated perfused tubule technique. In 23 EPCT, base-line fluid absorption was 1.38 +/- 0.04 (SE), a rate significantly higher than those of 11 LPCT (0.62 +/- 0.02; P less than 0.001) and 12 PR (0.52 +/- 0.03 nl mm-1 min-1, P less than 0.001) segments. In 10 EPCT, mean control fluid absorption was 1.31 +/- 0.04 nl mm-1 min-1; addition of PTH resulted in a decrease to 0.95 +/- 0.05 nl mm-1 min-1 (P less than 0.001); and, after removal of PTH, fluid absorption increased (P less than 0.001). Parathyroid hormone had no effect on either seven LPCT segments or six PR segments. These results demonstrate differences in intrinsic capacity to absorb fluid by anatomically defined segments of the rabbit proximal tubule. This functional heterogeneity is further supported by the observed differential response to PTH by the various anatomic segments of the proximal tubule.


Influence of fasting on lung oxygen consumption and respiratory quotient. We measured the oxygen consumption (QO2) of lung slices from rats and rabbits and the respiratory quotient (RQ) of lung slices from fed and fasted rats. The QO2 of lung slices is lowered within 24 h after the onset of food deprivation; this decrease in QO2 lasts during at least 2 additional days of fasting and is not eliminated by addition of glucose to the reaction medium. In fed rats the RQ of lung slices after 30 min of incubation without glucose is 0.75 +/- 0.01 (mean +/- SE) and 0.96 +/- 0.02 with glucose present. Fasting for 72 h lowers the RQ of lung slices after 30 min of incubation without glucose to 0.68 +/- 0.03; addition of glucose raises the RQ of lung slices from 72-h-fasted rats to 0.76 +/- 0.02. We conclude that fasting depresses lung oxidative metabolism. In the fed rat glucose is a major substrate for oxidative processes but in the fasting rat the oxidation of glucose is impaired and lipids are an important source of lung energy.


Influence of thyroxine on adult rat lung oxygen consumption and ultrastructure. We studied the oxygen consumption (QO2) of lung slices and the ultrastructure of the pulmonary granular pneumocyte in rats whose level of circulating thyroxine was altered. Rats given thyroxine for 6 days (1.0 mg-kg-1-day-1) and sacrificed on the 7th day had a serum thyroxine level of 18.9 +/- 2.7 mug/100 ml (mean +/- SD); rats given diluent alone for 6 days had a serum thyroxine level of 4.67 +/- 0.53 mug/100 ml. Rats subjected to a sham thyroidectomy has a serum thyroxine level of 7.27 +/- 1.47 mug/100 ml, whereas rats subjected to thyroidectomy had a serum thyroxine level of 1.13 +/- 0.55 mug/100 ml when sacrificed. The QO2 of lung slices from rats with high levels of circulating thyroxine was significantly greater than that of rats that received diluent alone. The QO2 of slices from rats whose thyroid glands were excised was significantly lower than the QO2 of slices from sham-operated rats. We did not find quantitative ultrastructural differences in granular pneumocyte mitochondria and lamellar bodies of rats given thyroxine compared to rats given diluent or between rats subjected to sham thyroidectomy compared to rats whose thyroid glands were removed.


Effects of vasoconstrictors on intestinal vascular resistance and oxygen extraction. To delineate the mechanism through which vasoactive compounds alter intestinal oxygen consumption and to determine the pharmacological nature of the receptors involved, we quantitated the effects of vasoconstrictors on arteriovenous oxygen difference and on vascular resistance in isolated constant-flow perfused canine small bowel. Norepinephrine (NE) and sympathetic stimulation (SS) increased vascular resistance and depressed O2 extraction. These effects were not altered by beta-blockade, but were abolished by alpha-blockade. Since capillary filtration coefficients at constant-pressure perfusion and 86Rb extraction at constant flow are reported to diminish during NE and SS, it follows that these agents reduce O2 extraction by an alpha-adrenergic closure of precapillary sphincters. Vasopressin had similar effects which were not affected by adrenergic blocking agents. Epinephrine (Epi) in high doses or after propranolol produced the same effects as NE and SS. By contrast, Epi in low doses increased O2 and 86Rb extraction. This response to low doses of Epi was not affected by phentolamine, but was reversed by propranolol. We conclude that Epi in high doses or after propranolol depresses intestinal O2 extraction by the same mechanism as NE and SS, but the mechanism through which Epi increases intestinal O2 extraction is unclear.


Renin-angiotensin-aldosterone system in experimental renal hypertension in the rabbit. Hypertension was produced in 25 rabbits by constricting the right renal artery and leaving the opposite kidney intact (two-kidney hypertension). After 30 days mean arterial pressure and plasma renin activity (PRA) were significantly elevated (P less than 0.01), and arterial pressure was correlated with PRA (r = 0.551, P less than 0.01); however, not all hypertensive rabbits had elevated PRA, and in animals in which sodium balance was monitored, only rabbits in negative sodium balance had increased levels of PRA. To investigate the role of angiotensin II (A-II) in the hypertension, [1-sarcosine,8-alanine]angiotensin II was infused at 6 mug/kg per min for 30 min in anesthetized hypertensive animals (n = 25). For the group, arterial pressure fell significantly (P less than 0.01), but several animals with minimal hypertension failed to give a depressor response. The declines in arterial pressure were highly correlated with PRA (r = 0.853, P less than 0.01). Aldosterone secretion in hypertensive animals was correlated with PRA (r = 0.851, P less than 0.01). Thus, two-kidney hypertension in the rabbit persists with normal PRA, but during periods of spontaneous sodium depletion, A-II plays a role in the maintenance of the hypertension.


Effects of altering O2 delivery on VO2 of isolated, working muscle. Maximal oxygen consumption (VO2 max) and muscle blood flow (Q max) were measured in an isolated gracilis muscle preparation before and after alteration in perfusion pressure (BP), arterial oxygen saturation (SaO2), and hemoglobin concentration (Hb). Q varied directly with BP and inversely with Hb (viscosity) but was unaffected by changes in arterial SaO2. VO2 max varied directly with oxygen delivery under all conditions. These results indicate that VO2 max is normally limited by oxygen delivery rather than any intrinsic limiting of oxygen consumption of the muscle.


Sympathetic control of Na, K transport in perfused submaxillary main duct of rat. The effect of stimulating the sympathetic innervation to rat submaxillary gland on ductal transport of Na, K, and water and on transepithelial PD was tested in the main excretory duct during perfusion through its lumen. Stimulation of the sympathetic nerve, supramaximally, caused a decrease of 30-40% in net flux of Na from, and of K to, the lumen in ducts perfused with medium containing Na and K in isotonic concentrations. Net flux of water was unaffected. Transductal PD decreased by about 30% during supramaximal stimulation. Changes in PD and net cation fluxes were reversible. These effects of supramaximal stimulation of the sympathetics on ductal transport resemble those reported to occur after large doses of isoproterenol and suggest an adrenergic secretomotor innervation to the ducts. However, changes in PD evoked by supramaximal stimulation of the sympathetic nerve could not be suppressed with propranolol, but were with phenoxybenzamine, indicating that alpha-adrenergic receptors are primarily involved in mediating at least the electrical responses of duct cells to sympathetic nerve stimulation.


Primate gastric circulation: effects of catecholamines and adrenergic blockade. The effects of intra-arterial injections and infusions of epinephrine, norepinephrine, and isoproterenol on gastric blood flow were studied in anesthetized baboons. Blood flow was measured electromagnetically before and after adrenergic blockade. The results for injected epinephrine and norepinephrine indicate these agents to be pure vasoconstrictors in the primate gastric circulation, and this response is attenuated by alpha-adrenergic blockade with phenoxybenzamine. Isoproterenol is a pure vasodilator, and its response is attenuated following beta-adrenergic blockade with propranolol. Intra-arterial infusions of epinephrine and norepinephrine (.05 mug kg-1 min-1) resulted in sustained vasoconstriction with no evidence of autoregulatory escape and no postinfusion "over-shoot." This study suggests that epinephrine and norepinephrine might provide alternatives to vasopressin as a vasoconstrictor for the control of upper gastrointestinal bleeding.


Acetate as a metabolic substrate in the fetal lamb. Fetal acetate metabolsim was studied in chronically catheterized fetal lambs of 110-141 days' gestation. Acetate concentration was measured enzymatically in whole blood drawn simultaneously from maternal and fetal pre- and postplacental vessels. The oxygen content of the fetal blood samples was also measured. Fetal umbilical venous acetate concentration was found to be proportional to the maternal arterial acetate concentration and had a mean value of 0.366 mM. Fetal blood acetate increased significantly, by a mean of 0.081 mM, during circulation through the placenta. This increase was proportional to both the maternal acetate concentration and the concentration gradient of acetate across the placenta. The mean maternal arterial acetate concentration was 1.153 mM. Maternal blood lost significant amounts of acetate, 0.112 mM, during circulation through the uterus and appeared to be the source of the acetate being gained by the fetus. It is estimated that a total of 23 mmol of acetate/kg of fetal weight is being taken up by the fetus each day, providing it with 0.560 g of carbon/kg. Comparisons of acetate uptake with fetal oxygen uptake indicate 10% of the daily fetal oxygen consumption would be required to completely oxidize the acetate being gained by the fetus.


Effects of age and fasting on gluconeogenesis from glycerol in dogs. The extent of gluconeogenesis from glycerol was examined in pups and adult dogs. With use of the SAAM-26 program, a four compartment model was formulated from tracer data to calculate the kinetics of the glycerol:glucose system. In the postabsorptive state gluconeogenesis from glycerol declines with age: 13.8% of glucose carbon originated from glycerol in 0- to 4-day-old pups, 6% in adults. Approximately 50% of glycerol carbon is converted to glucose carbon independent of age. During fasting, a) the percentage of glucose carbon arising from glycerol carbon increased to 13.3% and 10.3% in adult dogs and pups 5-19 days old, respectively, in younger pups it declined to 3.4%; b) glycerol production increased in adults, but decreased in the youngest pups; c) glucose production and utilization decreased at all ages, and a smaller percentage of glycerol carbon was converted to glucose carbon, especially in the youngest pups. Thus in neonates fasting decreases gluconeogenesis from glycerol.


Characterization of midbrain component of the trigger for arousal from hibernation. The ability of the midbrain reticular formation (MRF) to trigger arousal from hibernation and to change body temperature (Tb) during euthermia was tested in golden-mantled ground squirrels (Citellus lateralis). During hibernation (ambient temperature 5-6 degrees C) microinjections of cholinomimetic compounds (acetylcholine and carbachol) triggered full arousal or produced transient increases in Tb in 15 out of 19 tests; MRF microinjections of norepinephrine (NE) and 5-hydroxytryptamine (5-HT), at the same concentrations that produced full arousal when microinjected into the preoptic/anterior hypothalamus (PO/AH) area in previous experiments, has no effect on Tb in 13 out of 16 tests. In experiments on euthermic ground squirrels tested at an ambient temperature of 25 degrees C, MRF microinjections of acetylcholine raised Tb, whereas the monoamines had no significant effects. These results show that cholinoceptive neurons in the MRF can trigger arousal from hibernation and increase Tb during euthermia. The failure of NE and 5-HT to produce any significant effects at the same doses that were reported to be effective in the PO/AH indicates that the functional organization of the MRF portion of the arousal mechanism is different from that reported for the PO/AH.


Protein composition of lung fluids in acute alloxan edema in dogs. In 11 anesthetized dogs with acute alloxan-induced pulmonary edema, we measured the protein composition of 1-mul samples of plasma, free interstitial fluid, alveolar fluid, and airway fluid. We obtained plasma and airway fluid at regular intervals as edema developed. We sampled alveolar fluid by pleural micropuncture in the unfrozen, excised lung and free interstitial fluid from perivascular cuffs in the frozen, excised lung. The average (+/- 1 SD) total protein concentration of plasma was 4.9 +/- 0.6, airway fluid 4.4 +/- 0.7, free interstitial fluid 4.9 +/- 0.7, and alveolar fluid 5.2 +/- 0.8 g/100 ml. The average fractions of albumin were 0.42 +/- 0.05, 0.50 +/- 0.05, 0.49 +/- 0.06, and 0.49 +/- 0.07, respectively. By paired analysis, the protein concentration of interstitial fluid was not significantly different from alveolar fluid. The protein concentration of airway fluid was significantly less than that in interstitial and alveolar fluid. The albumin fraction of the three lung fluids was identical but significantly different from plasma. We conclude that in alloxan-induced pulmonary edema the lung fluids contain high concentrations of protein and the alveolar epithelial membrane becomes freely permeable to protein molecules.


Modification of in vivo lacrimal gland secretion by 2,4-dinitrophenol. Mecholyl-stimulated flow from the excretory duct of the rabbit lacrimal gland in vivo was recorded continuously and samples of Mecholyl-stimulated fluid were collected before, during, and after 30 min of local intra-arterial infusion of 2,4-dinitrophenol (DNP). Compared with the control period, Mecholyl-stimulated flow during the DNP infusion was 60-70% less; [K+] was the same and [Na+] and [Cl-] were higher in the Mecholyl-stimulated fluid. The changes that occurred during the DNP infusion were not produced by infusion of the solvent (NaHCO3) or an acid with similar pK (para-aminohippuric acid) nor were the changes related to any effect of DNP on the general circulation. The magnitude of the changes during the DNP infusion increased as the dose of DNP increased and the inhibition of flow changes in [Na+] and [Cl-] during the DNP infusion were reversible. The results are compatible with the hypothesis that stimulation by Mecholyl involves oxidative metabolsim at the duct level but they do not exclude the possibility that oxidative metabolism may also be involved in formation of the primary fluid at the acinar level.


Effect of exercise on hormone-sensitive lipase activity in rat adipocytes. Hormone-sensitive lipase activity was measured in adipocytes of rats subjected to a 12-wk program of treadmill running. Enzyme activity in the runners sacrificed immediately after exercise increased 2.5-fold (P less than 0.001) in tissue exposed to epinephrine and threefold (P less than 0.001) in tissue not exposed to epinephrine, when the results were expressed per gram of adipose tissue. Increases of almost the same magnitude were observed in runners sacrificed 24 h after their last bout of work. These significant increases in enzyme activity, however, were the result of a significant reduction in the size of cells in the epididymal fat pads of the exercisers compared with those of the freely eating sedentary animals (68.7 +/- 2.7 mum vs. 82.0 +/- 2.7 mum; P less than 0.01). When the results were expressed on a per-cell basis, therefore, hormone-sensitive lipase activity, assayed in the presence or absence of epinephrine, was unaffected by the exercise program. These results provide evidence that the lipolytic capacity of adipocytes of normal, untrained rats is sufficiently large to meet the increased demand for free fatty acids imposed by the exercise program without the need for an adaptive increase in enzyme activity.


Gastroduodenal motor gradients in the dog after pyloroplasty. Circular muscle contractile activity of the antrum and duodenum and gastric emptying of a liquid test meal were investigated in unanesthetized dogs in which the gastroduodenal junction (GDJ) was altered (Heineke-Mikulicz pyloroplasty). After pyloroplasty, antralization (antral-like contractions occurring in the first portion of the duodenum) was observed during the digestive state. Antralization replaced the normal periods of inhibition that separate periods of duodenal contractions during the interdigestive burst. Bethanechol (0.1 mg/kg sc) and metoclopramide (2.0 mg/kg iv) were capable of stimulating interdigestive contractile activity in the altered GDJ. Pentagastrin (1.0 mug/min iv) produced a differential stimulation on the antrum without appreciably affecting duodenal contractile activity. Pyloroplasty also enhanced the emptying of a 300-ml citrate-fat liquid test meal. An intact hypomuscular segment between the antrum and duodenum is important for normal coordinated contractile activity between the antrum and the duodenum and for the normal gastric emptying of liquids.


Effect of magnesium on rat nephron sodium reabsorption: a segmental analysis. To evaluate the effect of hypermagnesemia on distal nephron sodium reabsorption, renal clearance, micropuncture, microinjection, and electrophysiological studies were performed in the anesthetized rat before and after intravenous administration of MgCl2, MgSO4, and Na2SO4. Along the proximal tubule, MgCl2 caused a 21% decrease and MgSO4 a 17% decrease in fractional sodium reabsorption, while only a 4% decrease was observed with Na2SO4. In the loop segment, the decrease in fractional sodium reabsorption was 7% with MgCl2, 15% with MgSO4, and 12% with Na2SO4. In the distal tubule and collecting duct, MgCl2 and MgSO4 had no effect on fractional sodium reabsorption, whereas Na2SO4 significntaly depressed sodium reabsorption to a greater extent in the collecting duct than in the distal tubule. Microinjection studies, however, showed that both MgSO4 and Na2SO4 depressed lumen-to-plasma sodium movement across the collecting duct. Early and late distal tubular transepithelial potential difference was unaffected by MgCl2, whereas it was increased by both MgSO4 and Na2SO4. The decrease in sodium reabsorption along the distal tubule and collecting duct produced by Na2SO4 and probably MgSO4 may relate to the increased transepithelial electrochemical gradient for sodium transport produced by the poorly reabsorbable sulfate anion.


Effects of temperature on cardiac transmembrane potentials in hibernation. Resting and action potential parameters were measured from papillary muscle isolated from hibernating and control hamsters and from rats. The temperature range of the study was 12-38 degrees C. The decrease in resting membrane potential (Em) with decreasing temperature was significantly less in the hibernation preparations (HH), down to 20 degrees C, than in either the control hamsters or rats. Below 20 degrees C the declines in Em of all preparations were indistinguishable. Action potential magnitude was adequately maintained in HH to 12 degrees C while both control hamster and rat action potentials declined markedly as temperatures were reduced. Both types of hamster preparations showed greatly prolonged action potentials with reduced temperatures as contrasted to a limited prolongation of rat action potentials. The data are suggestive of a membrane modication in hibernation.


Evidence for an intrarenal beta receptor in control of renin release. Infusion of isoproterenol intravenously in normal dogs at rates of 0.10 or 0.018 mug/min per kg body wt increased renin secretion; at the lower infusion rate arterial pressure (AP) and renal blood flow (RBF) were unchanged. Isoproterenol was also infused into the renal artery in normal dogs at 0.10 mug/min per kg; renin secretion increased in association with an increase in RBF but AP was unchanged. Plasma K concentration was consistently decreased in all three of the above experiments and because hypokalemia is known to increase renin release isoproterenol was not infused intrarenally at the lower rate; the decrease in plasma K level precluded relating the entire response in renin release to isoproterenol. Intrarenal infusion of propranolol at 0.05 mg/kg per h in Na-depleted dogs decreased renin secretion whereas intravenous infusion at the same dose failed to alter renin release. Intrarenal infusion of propranolol at this rate in Na-depleted dogs with a denervated, nonfiltering kidney also decreased renin release. In contrast, intrarenal infusion of phentolamine or phenoxybenzamine in normal dogs failed to alter renin secretion in doses that blocked alpha-adrenergic receptors. These experiments provide strong evidence for an intrarenal beta-adrenergic receptor that mediates renin release, and it seems likely from the experiment in the denervated, nonfiltering kidney that the receptor is located in the juxtaglomerular cells.


Factors influencing left ventricular shortening in isolated canine heart. To assess in the intact ventricle the steady-state influence of several mechanical variables on the extent of left ventricular midwall circumferential shortening, a pressure servo system was utilized in isolated canine hearts. The system permits continuous monitoring of ventricular volume and control of diastolic and systolic pressures. After determination of the diastolic volume at zero filling pressure (V0), a series of variably preloaded or afterloaded contractions were generated including the isovolumic state. Contractile state was manipulated in a positive (calcium, 12-18 mg/100 ml; norepinephrine, 0.4-1.4 mug/min) or negative (propranolol, 0.12-0.50 mg/min) direction. Force and length terms derived for a thick-walled sphere were expressed per cross-sectional area of muscle and length, respectively, calculated at V0. For any preload, an inverse linear (r greater than 0.96) force-shortening relation was obtained, and each line was identified by its slope and isovolumic load (sigma0). Both slope and sigma0 increased with positive inotropic agents (vis-a-vis propranolol) or increments in preload. Thus, in the intact ventricle an inverse linear relation characterizes the force-shortening relation with the amount of shortening determined by initial fiber length, afterload, and the contractile state of the myocardium.


Natriuresis induced by intracarotid infusion of hypertonic NaCl. The intracarotid infusion of hypertonic sodium chloride in anesthetized dogs pretreated with vasopressin and mineralocorticoid resulted in an increase in sodium excretion as well as an increase in the percent of the filtered load of sodium excreted. This increase was not due to changes in renal hemodynamics or arterial blood pressure. The change in fractional sodium excretion was approximately 1%. Intracarotid infusion of isotonic sodium chloride did not result in a natriuretic response. The intracarotid infusion of hyperosmotic glucose did not evoke an increase in sodium excretion. Femoral vein infusions of hypertonic sodium chloride failed to evoke any natriuretic response. These data indicate that a sodium-sensing mechanism may exist in the brain that can alter the renal handling of sodium. The efferent mechanism of the response is discussed.


Calcium homeostasis during hypertonic volume expansion in the hypothyroid rat. The clearance characteristics of calcium and the relationship of coupled Na+ and Ca++ renal transport were evaluated in the hypothyroid rat (TX) during volume expansion with 1.5% saline. Despite similar hydropenic plasma calcium, after 11 ml/100 g body wt of infusion volume, the plasma calcium was significantly lower in the TX group (TX, 6.1 +/- 0.2; TI, 7.0 +/- 0.1; P less than .001). With continued infusion, plasma calcium in the TX group continued to drop to 5.3 +/- 0.3 while in the control rats (TI group) it rose to 8.0 +/- 0.1. This marked hypocalcemia in the TX group could not be explained by urinary losses of calcium, hemodilution, deficient parathyroid response, or changes in ultrafilterable plasma calcium. The higher fractional calcium excretion found in the TX group paralleled the higher fractional sodium excretion, and the coupling between calcium and sodium excretion was preserved in hypothyroidism under these conditions. Our results indicate an abnormal calcium homeostasis in the hypothyroid rat. The data do not support a renal cause for this disturbance but are consistent with the view that mobilization of calcium from the bone is sluggish in hypothyroidism during volume expansion.


Mechanics of canine iliac artery smooth muscle in vitro. Transmural pressure and external diameter were continuously recorded from intact segments of canine iliac artery and used to determine wall responses to maximal smooth muscle (SM) activation by norepinephrine (NE). Three different approaches were used:a) step inflations from low pressure following NE, B) slow, continuous inflation from low pressure following NE, and c) direct isometric and isobaric responses to NE. Passive pressure-diameter data were determined. The results show that active wall stress and diameter responses to NE determined using direct isometric and isobaric responses and from slow inflation responses (less than 1 mmHg/s) were not significantly different. Pressure-diameter and stress-strain curves determined using continuous (0.2 mmHg/s) and step pressure inflations after NE were not signficantly different. Pressure-diameter curves obtained at different inflation rates were not those expected from a simple viscoelastic material. The results suggest that slow inflation of iliac arteries with activated SM is a reasonable method for assessing contractile properties of SM. Furthermore, they also suggest that activation of iliac artery SM at high contractile element length (L greater than Lo) does not produce attenuated constriction responses.


Tracer experiment design for unique identification of nonlinear physiological systems. The design of tracer kinetic experiments, the purpose of which is to elucidate uniquely the internal couplings of a nonlinear dynamic system, is considered for a practical class of models of physiological systems. The extent of information about the real system contained in tracer kinetic data is a central issue. Criteria for determining whether nonlinear model parameters can be estimated from small-signal, "linearizing" tracer experiments are developed and illustrated by examples. The concept of "structural identifiability" is employed in this analysis to determine which model parameters can be and which cannot be determined "uniquely" from given input-output data; a step-by-step procedure based on an extension of this concept is presented for adapting the overall approach to the experimental design problem. Estimation of unmeasurable endogenous inputs and system state variables, problems that are intimately related to parameter estimation for physiological systems, are also considered.


Origin of great cardiac vein and coronary sinus drainage within the left ventricle. The relative contributions of left anterior descending (LAD) and left circumflex (LC) arterial inflow to blood sampled at various points within the great cardiac vein (GCV) and coronary sinus (CS) have been investigated in open-chest dogs. Dissolved helium (He) and hydrogen (H2) were infused into external circuits perfusing the LAD and LC, respectively, and their steady-state concentrations were measured chromatographically at various points within the GCV and CS. Under basal conditions GCV H2 averaged only 5% of mid-CS H2 and did not change greatly during alterations of preload and afterload or during selective LAD or LC obstruction and vasodilation. The relationship of mid-CS He to GCV. He was more variable under basal conditions and changed noticeably during selective changes in LAD or LC inflow. Appreciable amounts of He were present consistently in left marginal vein drainage. We conclude that: 1) GCV blood is remarkably free of LC inflow in both normal and abnormal physiological states; 2) the origin of mid-CS blood is more variable, both from animal to animal and in individual animals before and after interventions; 3) a portion of LAD drainage normally reaches the CS through circumflex venous branches rather than the GCV.


Neurons intrinsic to arterioles initiate postcontraction vasodilation. Ganglion cells exist in muscle arterioles. To determine the role of these intrinsic neurons in postcontraction vasodilation, isolated dog gracilis muscles were studied. A single twitch elicited vasodilation, but no vasodilator metabolites appeared in the venous effluent. Contraction at 2/s lowered resistance within 1 s whereas dilator metabolites were not demonstrable in the effluent until 15-20 s. During contraction the magnitude and time course of vasodilation were the same during constant and variable flow, and at various values of PaO2 and PVO2. In contrast, resistance was strongly correlated with flow and PO2 during recovery. Some resting muscles were perfused with venous blood from contracting donors. The rate of metabolic vasodilation in recipient muscles was about 10 times less than the rate of vasodilation in the donors. Lidocaine and procaine blocked postcontraction vasodilation but did not influence postocclusion vasodilation, metabolic vasodialtion, or autoregulation. The degree of block was the same in acutely and chronically denervated muscles. The effect of local anesthetics could not be accounted for by properties of skeletal or vascular smooth muscles. 1) intrinsic neurons initiate postcontraction vasodilation; 2) metabolites account for sustained vasodilation during recovery.


Intracellular concentrations of the salt gland of the herring gull Larus argentatus. Attempts were made to measure intra- and extracellular concentrations in secreting and inactive salt gland tissue of the herring gull. 14C-labeled polyethylene glycol (mol wt 4,000) was used as a marker for extracellular fluid. Fluid separated by centrifugation at 36,000 g appeared by three independent criteria to represent primarily extracellular fluid. It could not, however, be fully ascertained if this fluid was mixed with a small amount of intracellular fluid. Therefore, intracellular concentrations were calculated from the concentrations in centrifuged fluid as well as from plasma concentrations. By either method it was found that secreting and inactive glands showed no difference in extracellular and intracellular fluid concentrations of Na, K, Cl and Ca. Secreting glands had lower intracellular water content and a higher intracellular Mg concentration than inactive glands. The absence of evidence for intracellular accumulation of Na and Cl ions in secreting glands suggests that active ion transport takes place across the apical rather than the basal and lateral membranes in spite of the fact that Na-K-activated ATPase is associated with the extensive infoldings of these plasma membranes.


Nonshivering thermogenesis induced by repetitive hypothalamic cooling in the rat. The effect of prolonged and repetitive cooling of the preoptic/anterior hypothalamic area on the sensitivity to the metabolic effect of noradrenaline and on the resistance to cold exposure was studied in the white rat. The preoptic area of 18 unanesthetized animals was cooled 9 h/day 5 days/wk, for a total of 80-150 h. One hour after a noradrenaline test injection (0.4 mg/kg), the experimental animals in which the preoptic area had been cooled to about 24 degrees C increased oxygen uptake by 81%, whereas those in which the preoptic area had been cooled to about 28 degrees C increased oxygen uptake by 48% (the control animals by only 37%). Despite their increased capacity for nonshivering thermogenesis, the experimental animals did not tolerate cold exposure (-10 degrees C) better than the controls. This development of nonshivering thermogenesis is thought to have been mediated by the hypothalamic temperature-sensitive neurons, and the possibility that it could explain the shift from shivering to nonshivering thermogenesis seen during adaptation to cold is discussed.


Fluoride renal clearance: a pH-dependent event. The renal clearance of fluoride (CF) was studied in pentobarbital-anesthetized rats. Urine flow rate and chloride clearance, previously thought to be the main determinants of CF, were readily dissociated from CF. Neither the clearance of sodium nor the excretion of potassium correlated consistently with CF. In experiments designed to manipulate urinary pH, viz., the administration of NaHCO3 or NH4Cl, acetazolamide, and mannitol, CF correlated closely with urinary pH. At a urinary pH of 5.0-k96, CF/GFR averaged less than 5%, while at a urinary pH of approximately 7.6, mean CF/GFR exceeded 65%. The data suggest that 35-45% of the filtered fluoride is reabsorbed in the proximal tubule, regardless of the final urinary pH, while in acidosis the majority of fluoride reabsorption occurs in the distal nephron. The results suggest that the tubular reabsorption of fluoride is inversely related to tubular fluid pH. Fluoride reabsorption seems to occur by nonionic diffusion, apparently as hydrogen fluoride. Depending on local pH gradients, it may occur along the entire nephron.


Site of kininogenase secretion in the dog nephron. We determined the site of kininogenase secretion in the nephron by performing stop-flow studies in dogs. Kininogenase activity, inulin, sodium, and potassium were measured in the same fractions. The highest kininogenase concentration was found in the fractions with the lowest sodium concentration corresponding to urine samples that must have been trapped in the distal nephron. Kininogenases in these urine fractions were 5-17 times higher than in fractions from the proximal nephron or from the free-flow sample. The ratio of kininogenase increase to inulin increase was always higher than 3.0, thus indicating that the increase in kininogenase concentration was mainly due to secretion and not to water reabsorption. When a peak of potassium was present, it occurred 1-2 ml before the peak of kininogenases. We concluded that kininogenases are secreted into the urine at the level of the distal nephron by either the tubule itself or by a specialized structure located at this part of the nephron, such as the macula densa.


Distribution of renal blood flow in dogs with congestive heart failure. Studies were performed to determine whether the intrarenal distribution of cortical blood flow is altered in congestive heart failure. Utilizing the radioactive microsphere method, we studied eight dogs that developed congestive heart failure secondary to the construction of an aortocaval fistula. They had marked reduction in total renal blood flow not accompanied by intracortical redistribution of blood flow. All dogs had developed edema and/or ascites, and gained a mean of 3.4 kg; glomerular filtration rate, hematocrit, and urinary sodium excretion fell significantly. Renal vascular resistance increased; mean blood pressure and filtration fraction were unchanged. Furosemide was administered to a second group of nine fistula dogs. The drug produced a marked natriuresis associated with a decrease in outer cortical blood flow (zone 1) and an increase in midcortical zones 2 and 3; no change was observed in zone 4. We conclude: 1) chronic salt retention occurs in high-output heart failure in the absence of redistribution of renal cortical blood flow, and 2) the effect of furosemide on intrarenal hemodynamics of dogs with heart failure is similar to that seen in normal animals.


The psychological treatment of personality disorder. The author presents three case reports of individuals with personality disorder, none of whom demonstrated significant ability for transitional relatedness before therapy. In therapy, he conceptualized for the two adult patients the importance of their inability to experience in the transitional mode; he offered concrete potential transitional objects to the one child patient. The therapeutic results were good.


Psychosurgery: some current observations. The term "psychosurgery" encompasses a wide variety of different neurosurgical procedures applied in the treatment of behavioral and psychiatric disorders. Arguments about the effectiveness and ethicality of psychosurgery are often based on studies using outdated procedures or inappropriate patient populations. The debate over psychosurgery is also obscured by the frequent confusion between its use in classical psychiatric syndromes and in such controversial areas as aggression or violent behavior associated with temporal lobe epilepsy. The author believes that such factors need to be clarified so that practitioners can choose a personal position based on sound medical fact.


Therapy groups for women.

Therapy groups for women. The author describes her experiences with two all-female psychotherapy groups, comparing these groups with both mixed-sex and consciousness-raising groups. Problems included a tendency of group members to drop out when dependency on the group became too intense and a lack of referrals to replace these dropouts, with resulting decreases in group size. The special strengths of such groups include the opportunity to concentrate on issues relevant to women, the possibility for development of a support system, the lack of sex-role divisions of labor, and the increased respect of members for other women and for themselves.


A psychiatric study of patients referred with a diagnosis of hypoglycemia. Five-hour oral glucose tolerance tests (GTTs) differentiated 30 volunteer patients who considered themselves hypoglycemic into three major groups: those who had reactive hypoglycemia, those who were normal, and those who had diabetes. Clinical psychiatric evaluation and Minnesota Multiphasic Personality Inventory testing revealed that half of the 30 patients were experiencing a current psychiatric disorder, usually depression. Hysterical personality traits were also noted in many of the patients. The idea that reactive hypoglycemic patients have specific personality characteristics was not substantiated by the authors' data. They hypothesize that some patients with psychiatric illness may have their symptoms erroneously attributed to incidental GTT findings.


Disaster at Buffalo Creek. Family and character change at Buffalo Creek. Psychiatric evaluation teams used observations of family interaction and psychoanalytically oriented individual interviews to study the psychological aftereffects of the 1972 Buffalo Creek disaster, a tidal wave of sludge and black water released by the collapse of a slag waste dam. Traumatic neurotic reactions were found in 80% of the survivors. Underlying the clinical picture were unresolved grief, survivor shame, and feelings of impotent rage and hopelessness. These clinical findings had persisted for the two years since the flood, and a definite symptom complex labeled the "Buffalo Creek syndrome" was pervasive. The methods used by the survivors to cope with the overwhelming impact of the disaster--first-order defenses, undoing, psychological conservatism, and dehumanization--actually preserved their symptoms and caused disabling character changes.


Disaster at Buffalo Creek. From chaos to responsibility. The litigation initiated by the 625 survivors of the Buffalo Creek flood who refused to settle with the coal company claims office was a landmark case. For the first time, individuals who were not present at the scene of a disaster were allowed to recover for mental injuries. Psychic impairment, the term coined for these injuries, was found in virtually all of the survivor-plaintiffs. In an out of court settlement, the survivors were awarded $13.5 million, $6 million of which was distributed on the basis of a point system as compensation for the psychological damages.


Disaster at Buffalo Creek. Loss of communality at Buffalo Creek. The survivors of the Buffalo Creek disaster suffered both individual and collective trauma, the latter being reflected in their loss of communality. Human relationships in this community had been derived from traditional bonds of kinship and neighborliness. When forced to give up these long-standing ties with familiar places and people, the survivors experienced demoralization, disorientation, and loss of connection. Stripped of the support they had received from their community, they became apathetic and seemed to have forgotten how to care for one another. This was apparently a community that was stronger than the sum of its parts, and these parts--the survivors of the Buffalo Creek flood--are now having great difficulty finding the personal resources to replace the energy and direction they had once found in their community.


Disaster at Buffalo Creek. Discussion of the Buffalo Creek disaster: the course of psychic trauma. The specific contribution of the psychiatrist to the team study of the human disaster at Buffalo Creek focuses on the course of psychic trauma. The initial violent intrusion by the flood waters was followed by a second phase of the traumatic cycle, the physical dislocation of the survivors, with disruption of their "ground" and "surround." During this long subsequent period the level of trauma did not recede but kept rising, although at a slower pace. Distant effects of the trauma may succeed the more immediate ones. The finite psychic space of the survivors is encroached upon by traumatic memories for an indefinite period of time, leaving fewer resources available for normal effective living. The absorption and merging of traumatic stimuli into a traumatophilia poses still another potential problem. The unprecedented legal decision as to the linear effects of psychic trauma on a succession of connected individuals will need further interdisciplinary clarification.


Carbon monoxide encephalopathy: need for appropriate treatment. The authors describe severe psychiatric and neurological sequelae in a patient who suffered carbon monoxide poisoning as a result of a suicide attempt. A review of the literature revealed that 15 to 40% of survivors of carbon monoxide poisoning develop neuropsychiatric symptoms, often following a period of apparent recovery. The authors advocate an aggressive treatment approach to carbon monoxide poisoning, emphasize the diagnostic value of extensive laboratory testing, and suggest that 2 to 4 weeks of bedrest may prevent delayed neuropsychiatric sequelae.


Consultation-liaison psychiatry: current responsibilities. The authors describe their experiences as consultation-liaison psychiatrists in two general teaching hospitals. Current medical house staff members appear to be more aware of the importance of psychosocial issues in patient care than were interns and residents in the past. Consultation-liaison teaching may now focus on the application of this psychologic awareness to patient management, the correct use of psychotropic drugs, and the differentiation of delirium from functional psychoses.


The role of the chief resident: expectations and reality. The job expectations of 35 incoming chief residents were tested by questionnaire when they attended a weekend workshop on leadership and were reexamined after they has had six months' experience on their jobs. Such personal qualities as a sense of humor and persistence and such administrative skills as the ability to exercise authority and set objectives significantly increased in importance six months after these residents began work. The authors recommend educational programs in administration for chief residents.


The effect of haloperidol on stuttering. Haloperidol was compared with placebo in the treatment of 8 young adult stutterers in a double-blind crossover study involving 6 sequential observations over periods of 6 or 12 weeks. The drug was found to have a significant effect on the percentage of time subjects were dysfluent but not on the number of dysfluencies per minute. The authors discuss possible reasons for this finding.


An evaluation of detoxification as an initial step in the treatment of heroin addiction. Of 802 voluntary patients admitted to the detoxification unit of a comprehensive treatment system, 69% completed detoxification but only 9.6% of thest patients sought long-term treatment. The demographic profile of detoxification patients differed somewhat from that of patients in long-term treatment. The authors suggest that new approaches, including legal pressure, are needed to induce detoxification patients to accept prolonged therapy.


The use of problem-oriented medical records in community mental health centers. The authors' questionnaire survey of 147 community mental health centers revealed that 36 (24%) were using problem-oriented medical records (POMR), 34 (23%) planned to use them, 23 (16%) were uncertain and 54 (37%) had no considered using them. According to the responses of centers that were using POMR and the authors' experience, the advantages of POMR in psychiatry are similar to their advantages in other specialties, and the difficulties in implementing this system are related to the definition of "problems."


Orgone (Reichian) therapy in tension headache. Orgone (Reichian) therapy, which utilizes a unique physical approach in addition to standard character-analysis, is illustrated in cases of muscle contraction (tension) headache. It offers a more direct technique for attacking the muscular tension (somatic armor) while undermining the psychic defenses.


Teaching dynamic psychotherapy by observation. Experience with a seminar demonstrating psychotherapy, interviews with 12 of the treated patients, and a survey of 23 residents have shown the value of this teaching method and its effect on the participants. Generally the patients felt helped and residents were enthusiastic. The teaching format has many valuable features--most important being the inclusion of a faculty-observer.


Communication and reality in the Capgras syndrome. The study of a case of Capgras syndrome with striking clinical features illuminates the reality elements, affective conflicts, and cognitive processes that go into forming this specific delusion; and raises questions about the nosologic uniqueness of the entity. The meaning of the syndrome as a communication about an altered reality is highlighted.


Strategies and techniques of family therapy. A conceptual model of the strategies and techniques of family therapy is presented. Attention is drawn to the complex relationships between the family therapist's manner of relating, the strategies and techniques which he or she employs, the presenting problem or problems, the particular characteristics of the family, and the development phase of the family therapy process.


Psychotherapy with patients from lower socioeconomic groups. Patients of lower socioeconomic status are only infrequently considered for individual psychodynamic psychotherapy even where cost is not a factor. Reasons for this bias are examined and suggestions are made for correcting such inadvertent discrimination.


Meditation and consciousness: an Asian approach to mental health. According to Abhidhamma, a classical Asian phenomenology of consciousness, through meditation a set of "healthy" mental properties reciprocally inhibits an "unhealthy" set. In light of Abhidhamma and empirical findings, applications of meditation are suggested for inducing an optimal mode of responsiveness to environmental demands, and as a complementary adjunct to psychotherapy.


Learning theory and gestalt therapy.

Learning theory and gestalt therapy. This article discusses the theory and operations of Gestalt Therapy from the viewpoint of learning theory. General comparative issues are elaborated as well as the concepts of introjection, retroflextion, confluence, and projection. Principles and techniques of Gestalt Therapy are discussed in terms of learning theory paradigm. Practical implications of the various Gestalt techniques are presented.


"Joining techniques" in the treatment of resistant children and adolescents. Several clinical vignettes illustrate types of resistive children and adolescents: the shrugger, the silent child, the rose-colored-glass child, the mistrustful adolescent, the cheater and rule changer, the thrower. Several joining techniques are demonstrated such as hypervaluing, tutoring the therapist, ordering, and mirroring. Limited anxiety enhanced ego strength, and facilitated therapy result. Neal Miller's conflict model provides a theoretical framework for the approach.


Selective group approaches with psychotic patients in hospital settings. This paper stresses the group treatment of psychotics, with special reference to the schizophrenic. It includes interrelated groups structured on a graded scale and differentiated by the degree of its members' regressive levels of fixation. The patients' emotional and functional capacities decide suitability and selection. This group system simplifies criteria for composition, techniques, and the therapist's role.


An evaluation of selected federal categorical health programs for the poor. We examine evidence regarding the impact of several categorical federal health service programs--neighborhood health centers, maternal and infant care projects, and children and youth projects--on access to and quality of health care for the poor. We conclude that, although conclusive evidence of improved access and quality are lacking, suggestive evidence of improved quality exists. It is difficult to utilize legislative objectives as guidelines for evaluating the success of a federal program; it is also difficult to obtain solid data supporting the effectiveness or ineffectiveness of health care in general, and of other government programs. These difficulties are discussed.