Prospective study of angiotensin II response to positional change in pregnancy-induced hypertension. The response of endogenous angiotensin II levels to positional change, lateral to supine recumbency, was investigated in a prospective study of 55 primigravid patients during the last half of pregnancy. Blood samples were obtained in the lateral and supine recumbent positions. The mean supine angiotensin II level was significantly higher between 29 and 34 weeks' gestation in those patients destined to develop pregnancy-induced hypertension than in those who remained normotensive (P less than 0.05). As gestation advanced, the mean per cent relative change of angiotensin II from the lateral to the supine position altered from negative to positive in those patients destined to develop pregnancy-induced hypertension, whereas it remained negative in those patients who remained normotensive. These findings are discussed in relation to pathophysiologic alterations in the development of pregnancy-induced hypertension.


The prognostic value of serum human placental lactogen determinations in early pregnancy. Serial serum human placental lactogen (S-HPL) determinations were done in early pregnancy on 85 high-risk cases. Normal S-HPL values with a normal ultrasonogram had a 94.8 per cent successful outcome of pregnancy. Low S-HPL values were often accompanied by an abnormal or equivocal ultrasonogram (29.6 per cent). The fetal loss in patients with low S-HPL values and a normal ultrasonogram was 36.8 per cent.


The estimation of fetal weight by computer-assisted analysis. The need for a quick and easy method for estimating fetal weight in utero has been clearly established. Estimates by abdominal palpation and fetal hormone production have proved to be of limited value. Eight-five patients, ranging from 17 to 41 weeks' gestation, were ultrasonically scanned within 48 hours of delivery. Statistical analysis and multiple multivariant linear regressions were performed employing the BMD statistical packages. Our results show that birth weight is a logarithmic function of fetal body parameters and that the abdominal circumference has the single best correlation with the log10 birth weight. Our best linear regression with the use of two fetal dimensions (abdominal circumference and biparietal diameter) had a standard deviation of 106 grams per kilogram fetal weight. Since this derived formula is very cumbersome to manipulate, tables have been prepared with computer assistance to read the estimated fetal weight directly. Prospective estimates in 32 cases of both normal and pathologic gestations have proved to be within our expected accuracy.


Placental transfer of a large angiotensin fragment in the guinea pig. Angiotensin II (AII) levels are usually higher in the fetal than in the maternal circulations. Radioiodinated AII has been used to establish whether or not this hormone crosses the placenta from the fetus to the mother in the pregnant guinea pig. No intact radioiodinated AII was found to have crossed in any of 13 experiments. A single radioiodinated AII fragment was found in 10 of these experiments. This ran as (des-(Asp1 Arg2 Val3)) in one solvent, but this could not be confirmed when a different solvent was used. The results support the hypothesis, previously based on indirect evidence, that AII does not cross the placenta.


Trabeculectomy and postoperative ocular hypertension in secondary angle-closure glaucoma. I performed trabeculectomies to reduce the introacular pressure to 20 mm Hg or lower, in 56 eyes with medically uncontrollable primary open-angle glaucoma or secondary angle-closure glaucoma. In the former group, I achieved success in 85% of cases, 65% without further antiglaucomatous therapy. In the latter group, 59% obtained a successful result, 41% without additional treatment. The readings of applanation tonometry on the first postsurgical day were compared to those obtained after one year. Although approximately 50% of eyes in both glaucoma categories had an initially elevated pressure after trabeculectomy, it decreased steadily in most of those with primary open-angle glaucoma. In the secondary angle closure glaucoma population, this immediate postoperative ocular hypertension was significantly correlated with eventual failure of the operation.


Pars plana lens removal with vitrectomy. We used a modification of lens removal by phacofragmentation in conjunction with posterior vitrectomy without any serious complications in over 200 procedures. This modification allowed removal of hardened nuclear sclerotic lenses and reduced the time required for lens removal.


Detection, removal, and effect of unpolymerized methylmethacrylate in intraocular lenses. Gas-liquid chromatography, infrared spectroscopy, or Raman spectroscopy were used to determine the level of monomer in intraocular lenses and in the preforms used in each step of the manufacturing process. Heating, lathing, molding, and grinding caused an increase in monomer content, presumably the result of depolymerization. The tendency of methylmethacrylate to volatilize, repolymerize, or dissolve precludes high monomer contents from persisting in intraocular lenses. Vacuum ovens or water baths significantly reduced the monomer content to levels of 0.5% or less. Lenses with a monomer content higher than that found in currently available commercial lenses had no effect on rabbit kidney cell cultures. Lens fragments with a similarly elevated monomer content were indistinguishable from lenses with a low monomer content in rabbit eyes. According to these data, monomer does not appear to be a toxic agent in currently available intraocular lenses.


Hemorrhagic peripapillary lesions in presumed ocular histoplasmosis. Eight eyes of five patients with hemorrhagic peripapillary histoplasmosis demonstrated prolonged symptomatic periods and recurrent bleeding episodes, although final visual acuity was equal to or better than 6/12 (20/40) in five eyes (63%). Fluorescein angiography demonstrated new subretinal neovascular growth at the margins of atrophic scars. In the late stages additional retinal pigment epithelium was lost and a white subretinal mass developed adjacent to the atrophic zone. Argon laser photocoagulation was used in two cases to destroy this neovascular tissue, but caused a permanent arcuate defect in one.


Benzalkonium chloride toxicity to the human cornea. A 36-year-old woman fitted with a soft contact lens after an uneventful extracapsular cataract extraction was wearing her aphakic lens successfully until she switched her lens-soaking solution to an isotonic solution of boric acid, potassium chloride, and sodium carbonate preserved with benzalkonium chloride and edetic acid. After three days her eye became inflamed and vision decreased. No endothelial damage was apparent and the anterior chamber showed 2+ cell and flare reaction. Three weeks after removal of the lens and fitting with an aphakic lens visual acuity was 6/9 (20/30). Study of the preservative by a semiquantitative dilution method together with the clinical evidence in this case proved the cytotoxic effect of benzolkonium chloride when used to sterilize soft contact lenses.


Early argon laser photocoagulation of presumed histoplasma maculopathy. In this study, 66 patients with presumed ocular histplasmic maculopathy and in whom the edge of the neovascular membrane was at least 200 micron from the center of the fovea were selected for treatment with argon laser photocoagulation. They were divided into three groups depending on the time elapsed between the beginning of symptoms and treatment with argon laser photocoagulation. The size of the neovascular membrane, the distance from the center of the fovea, and the presence of hemorrhage in the foveal area were also noted. We found that the most important prognostic factor for best final visual acuity was the interval of time between onset of symptoms and treatment. The study showed that 73.3% (22 of 30) of patients with symptoms of short duration (four weeks or less) compared with 17.6% of those with symptoms of long duration (16 weeks or more) retained 6/15 (20/50) or better final visual acuity following argon laser photocoagulation treatment.


Retinal breaks secondary to vascular accidents. Seven retinal breaks occuring after occlusion of a major retinal arterial or venous branch were found in the eyes of six patients. Five holes were in the midretina, in a nonperfused avascular area corresponding to the sector affected by the vascular accident. One was a macular hole, and one a horseshoe tear outside the area involved in the vascular occlusion caused by traction of vitreous on a tuft of neovascular tissue. Five of the holes may have been caused by a kind of sequestration of the retina secondary to vascular insufficiency.


Malignant melanoma of the choroid associated with spontaneous expulsive choroidal hemorrhage. A 79-year-old man initially had a perforated corneal ulcer of his blind right eye. The next day a spontaneous expulsive choroidal hemorrhage occurred just before scheduled enucleation. Histopathologic examination of the enucleated eye revealed a severe necrosis of several posterior ciliary arteries in the expulsive choroidal hemorrhage, as well as a large occult spindle B malignant melanoma of the choroid. The necrosis of the posterior ciliary arteries may have been the cause of the choroidal hemorrhage. The finding of an occult malignant melanoma may be more than a chance occurrence of two unrelated events, inasmuch as both are associated with necrosis of the posterior ciliary arteries.


Necrotizing vaso-occlusive retinitis.

Necrotizing vaso-occlusive retinitis. We studied two adult patients with fulminating, necrotizing vaso-occlusive retinitis, and documented the progressive course of retinal necrosis, vitreoretinal interface contraction, and consequent retinal detachment. The systemic criteria for Behçet's disease were present in one patient, and partially fulfilled in the second.


Congenital retinal arterial loops and vitreous hemorrhage. In two adolescents, mild vitreous hemorrhage occurred from the area of retinal arterial loops near the optic nerve. In both cases the hemorrhage cleared without further complications. This vascular malformation may be associated with secondary complications more frequently than has previously been reported.


The eye in the partial trisomy 2q syndrome. Mandibulofacial dysostosis, mental retardation, skeletal, genital, and ocular malformations occurred in a family with partial trisomy of the long arm of chromosome 2. Translocations of chromatin material from the long arm of chromosome 2 to the short arm of chromosome 9 was balanced in the female carriers of the pedigree but was unbalanced among the males. Ocular signs in the males included uveal coloboma, anterior chamber angle anomalies as in Ringer's syndrome, congenital glaucoma with dislocated lens, exotropia, and blepharoconjunctivitis. These findings were related to an inherited malformation syndrome.


The retinal manifestations of Rocky Mountain spotted fever. The prominent ophthalmoscopic features in a 9-year-old white girl with Rocky Mountain spotted fever consisted of papilledema, cotton-wool spots, and dilated, tortuous retinal veins. Fluorescein angigography showed focal areas of capillary nonperfusion with blocked retinal and choroidal fluorescence at the cotton-wool spots. We observed perivascular staining adjacent to the infarcted areas. In addition to hyperfluorescence of the optic disks, late phase photographs demonstrated prolonged retention of intravascular fluorescein indicating obstruction to venous outflow.


Mydriasis from Datura wrightii.

Mydriasis from Datura wrightii. A 4-year-old girl had painless, uniocular mydriasis after picking flowers. Pharmacologic testing with 1% pilocarpine confirmed the probability that an atropine-like agent had been instilled in the affected eye. The flowers were identified as Datura wrightii and contained scopolamine, hyoscyamine, and atropine on thin-layer chromatography.


Subconjunctival dislocation of intraocular lens implant. Eight weeks after intracapsular cataract extraction with implantation of a Binkhorst iris-clip lens joined with a suture to a peripheral iridectomy at the 12 o'clock position, a 52-year-old woman struck the right side of her head. The corneoscleral wound ruptured for three fourths of its length and the artificial lens was located in the subconjunctiva in the superior-nasal quadrant of the eye. The lens was removed, the iris reposited, and the anterior chamber reformed, and the wound resutured. Her vision was 6/12 (20/40) at the time of discharge.


A visual tracking machine.

A visual tracking machine. The Visual Tracking Machine is an easily constructed device used for perceptual training with adults and children-with the following diagnoses: cerebral vascular accident, traumatic head injury, cerebral palsy, mental retardation, and spina bifida. It offers activities for the following purpose: development of visual attention and eyemotility, stimulation to cross the midline, compensation iraining for homonymous hemianopsia, one-side neglect, eye-hand coordination, and motor planning. The machine features control over smoothness, speed, and direction of movement of a visual stimulus, eliminates a potentially distracting background, spans the whole visual field, motivates the patient by offering the opportunity for many challenging games, and offers variability in task difficulty. It is sturdily built, relies only on manual power, and is not prone to mechanical breakdown. Used successfully during a one-year trial period, it appears to be a potentially useful adjunct to perceptual training programs. A description of its construction and materials needed are included. Other devices promoting tracking are reviewed in terms of function, source, and availability.


Training the deaf-blind child.

Training the deaf-blind child. The literature pertaining to deaf-blind persons was reviewed to acquaint occupational therapists with the needs of this population and to delineate their role in the habilitation of these persons. Two examples of the occupational therapy role in programming for deaf-blind children were described. In the late 1960s, occupational therapists were needed in small numbers, therapists who could work intensively in specific programs for deaf-blind children; in the late 1970s, a much greater number will be needed to provide services to small numbers of deaf-blind persons of all ages who will be attending the same schools, clinics, sheltered workshops, and group living facilities as will other handicapped persons.


Visual functions of the elderly.

Visual functions of the elderly. This review of the literature describes the limitations in visual functions that affect the elderly's ability to accomplish the tasks of daily living. Decline in accommodation for near vision begins as early as 10 years of age, while visual acuity begins to diminish at 18 years of age. These and other limitations are the result of normal age-related physiological changes in the mechanisms underlying visual function. In order to compensate for the visual limitations of the elderly, environmental modifications are recommended. The planners of institutional and other environments need to consider architectural features that allow optimal visual performance and, thereby, encourage safe mobility. Adaptations are suggested to assist the elderly in the accomplishment of daily living tasks.


Dichotic listening performance in learning-disabled children. A dichotic listening test was administered to 114 learning-disabled children aged 6 to 10 years and the ratio of correct right ear responses to correct left ear responses was computed. Three subgroups were formed: those with a low right-left ear ratio, those with an average ratio, and those with a high ratio. The groups were given a battery of sensory integrative, postural-ocular, auditory-language, and academic tests. Mean scores were computed for each group. All three groups were considerably lower in their overall accuracy of response to the dichotic listening test than was a normative sample. The groups with low right-left ear ratios were less likely to have a somatosensory disorder than the other two groups, but they were more apt to have a language problem. There was a much larger percentage of children with very high right-left ratios (right ear very "superior" to left ear) than would be expected in a random population.


Tactile-sensitive behavior in hyperactive and nonhyperactive children. The Tactile Sensitivity Behavioral Responses Checklist was used to rate behavioral responses that demonstrate tactile defensiveness by children being administered the Southern California Kinesthesia and Tactile Perception Test battery. Hypothesizing that a group of five-year-old boys with hyperactive behaviors would have greater frequencies of tactile-sensitive behaviors than a group of nonhyperactive boys, and that tactile sensitivity would be negatively correlated with tactile discrimination, videotapes of 15 hyperactive and 25 nonhyperative boys being administered the test battery were rated on the checklist. Using the Mann-Whitney U test to compare each group for behavioral response, significant results at the .05 level were reached between groups for seven out of nine categories. A significant negative correlation between tactile sensitivity and tactile discrimination was reached for those children who completed the test battery. These findings support the research hypotheses and provide a more objective data base for recognizing and further researching tactile sensitivity.


Prevention by chlorpromazine of ischemic liver cell death. Ischemic liver tissue was produced by clamping the portal venous and hepatic arterial blood supply to the left lateral and median lobes of rat liver. If, after 2 to 3 hours of ischemia, reflow to the liver was established by removing the clamp, two-thirds or more of the liver cells were histologically dead 24 hours later. Pretreatment with chlorpromazine (20 mg/kg) 30 minutes before inducing ischemia for up to 3 hours virtually completely prevented this ischemic cell death. If the animals were kept alive for an additional 24 hours with no further treatment, the extent of liver cell necrosis at 48 hours was still markedly less than that seen in the untreated ischemic controls. Administration of chlorpromazine after induction of ischemia and immediately prior to the onset of reflow reduced but did not completely prevent ischemic cell death as determined at 24 hours. This protective action of chlorpromazine was confirmed by the ability of the treated animals to regenerate cellular ATP levels after 3 hours of ischemia. In addition, chlorpromazine was shown to significantly reduce the increases in total liver cell and mitochondrial calcium ion contents that accompany the return of blood flow to irreversibly injured liver cells. The protective effect of chlorpromazine could not be attributed to any effect either on the rate or extent to which the liver cells became ischemic or on the perfusion patterns following release of the obstruction, and it is concluded that the action of chlorpromazine must be on some component(s) of the reaction of the cells to the ischemia itself. The possible basis of this action is discussed.


Kinetics of regression of epidermal hyperplasia in the the skin of mice following abrasion. Previously, we reported the kinetics of epidermal production during the early phase of epidermal regeneration following abrasion in the skin of mice. We pointed out that following abrasion, epidermal regeneration is characterized by the production of a marked epidermal hyperplasia resulting in a massive overproduction of epidermis, amounting to over a fourfold increase in epidermal wet weight compared to normal. The purpose of this report is to present the kinetics of reduction of epidermal mass following the production of the epidermal hyperplasia as the epidermis returns to its normal thickness during the period of regression. After an almost six times increase in epidermal wet weight per unit area at 5 days after abrasion, epidermal wet weight per unit area begins to decrease gradually, approaching normal levels by 21 days. The gradual decline in epidermal wet weight is associated with a concomitant decrease in the number of nucleated epidermal cell layers, total and suprabasal nuclei per millimeter of interfollicular epidermis, and in the number of mitoses per 1000 nuclei.


Morphometric analysis of hypertension-induced hypertrophy of rat thoracic aorta. The response of the intima-media of the thoracic aorta to 1 to 4 weeks of two-kidney renal hypertension in the rat has been analyzed by morphometric techniques at light and electron microscopic levels. The increased thickness of the aorta that ensues is the result of an increase in the size but not the number of smooth muscle cell layers. The volume fractions of intima occupied by endothelium (26%), internal elastic lamina (37%), and subendothelial space (37%) in normotensive animals are not significantly altered by the hypertension. The percent increases in muscle cross-sectional area is greatest (58 to 60%) in the two innermost layers (M1 and M2). M1 is composed of nearly equal compartments of smooth muscle cells and interstitial space that expand 69% and 50%, respectively, with hypertension. Analysis of the subcellular constituents of the M1 smooth muscle cells indicates that significant changes in absolute volume include increases of caveolae (45%), myofibrils (59%), mitochondria (81%), glycogen (163%), and rough endoplasmic reticulum (221%). Factors contributing to these alterations are discussed.


The pulmonary vascular pathology of experimental radiation pneumonitis. Dogs exposed by inhalation to an aerosol of fused aluminosilicate particles containing the radionuclide yttrium 90 developed radiation pneumonitis. The aerosol had a mean aerodynamic diameter of 0.8 to 1.2 mu with a sigma(g) of 1.6 to 1.9. The 36 dogs included in this report received initial lung burdens of 590 to 5200 muCi (90)Y/kg body weight and died at 7.5 to 237 days after exposure with total cumulative radiation doses to lung of 9300 to 70,000 rads. Vascular lesions in the lungs were marked. Early changes included edema of vessel walls with leukocytic infiltration, dilation of perivascular lymphatic channels, and occasional periarterial lymphangiectasia. Splitting and reduplication of the elastica were occasionally visible. The most striking inflammatory vascular changes were vasculitis and fibrinoid necrosis, which involved bronchial and pulmonary vessels at some-what different times. Such lesions were often segmental and included fibrinoid necrosis and a variable leukocytic infiltrate in and around the actively involved lesions. Vasculitis was most commonly seen in small muscular arterioles, but veins and venules also occasionally exhibited similar inflammatory lesions. Progressive vascular inflammation led to extensive intimal proliferative lesions and fibromuscular hypertrophy with eventual fibrous accumulation around blood vessels, obliterative intimal and medial thickening, and luminal narrowing. Such changes eventually formed the morphologic basis for increased pulmonary vascular resistance and the development of cardiac dilation and hypertrophy reflecting pulmonary hypertension.


Child abuse and neglect: the rights of parents and the needs of their children. The trends in treatment and in legal decisions with respect to custody of abused and neglected children are reviewed. Parental rights, including a familial right to treatment, are discussed in terms of the needs of children for their parents and for a safe home environment. It is argued that the critical point for the assertion of parents' rights is not the ultimate custody hearing but the initial decision to remove the child from its home.


Patterns of coping in families of psychotic children. The nature of family adaptation to severely and chronically disabling cognitive and behavioral conditions is considered. The relationship between atypical development and family response is examined to derive basic concepts--parents' perceptions of their child's unusual characteristics, effects on social relationships, etc.--and suggest strategies for intervention and research.


Paranatal influences on maternal-infant attachment. This paper reviews recent literature relating to effects on mother-infant attachment of events during pregnancy, birth, and the post-partum period. It is suggested that, for the sake of the physical and emotional well-being of child and mother, medical and technological interventions be held to a minimum during this time. Recommendations are made for the restructuring of routine professional practice.


Maternal drinking and the outcome of pregnancy: implications for child mental health. Research since identification in 1973 of the fetal alcohol syndrome indicates that offspring of alcoholic women who drink heavily during pregnancy are at high risk for physical and mental deficiencies, and that even "social drinking" during pregnancy may have detrimental effects on birthweight and behavior of infants. While further research and remediation efforts are needed, primary prevention and active intervention in counseling and obstetrical clinics seem clearly and urgently called for.


Consultation on a pediatric surgical ward: creating an empathic climate. Meaningful consultation to a pediatric surgical service must occur within an emotional climate that supports the consultative process. This paper examines the intangible qualities inherent in such a milieu and the consultant's role in structuring an atmosphere in which one's consultative skills can be utilized effectively.


Problem-solving strategies in consultation. Techniques for overcoming common stumbling blocks in consultation are outlined, and the advantages to consultants of viewing consultation as a mutual problem-solving process are discussed. It is suggested that the consultant-in-training can achieve confidence in this approach only through experiencing the relationship from the other side by gaining first-hand understanding of the situation of the consultee. Strategies towards this end are offered.


Intraethnic violence in a Hawaii school: a mental health consultation experience. This paper explores the dynamics of a violent confrontation between local-born and immigrant Filipino students in a Hawaii high school. Social and psychological issues underlying the incident are considered, and pragmatic aspects of mental health consultation during a crisis situation in a school setting are discussed.


Federal day care standards: rationale and recommendations. Day care for young children is an increasingly popular and needed resource. However, there is no consistent federal policy for assuring quality. This paper argues that fiscal and monitoring responsibilities should be based in a federal agency committed to children and families, and standards should be explicit, enforceable, and economically realistic.


Conflict and detente between social issues and clinical practice. The "dual nature" of the mental health profession--embodied in the differences between advocates of social and clinical approaches to people's problems--is considered. It is suggested that the situation reflects realities of the world we live in, and that it contains both dilemma and opportunity. Areas in which social advocacy and clinical expertise have complemented each other are illustrated, and possibilities for constructive and creative conflict are suggested.


The nature of the symbiotic bond between mother and schizophrenic. Based on objectively scored TAT stories and interviews measuring five aspects of symbiotic relationships, a group of schizophrenics and their mothers showed more evidence of being enmeshed in such a relationship than did both non-schizophrenic mental patients and a group of normals and their mothers.


A family therapy outcome study in an inpatient setting. A small sample of adolescents hospitalized in a public mental health facility received family therapy while a control group received individual therapy. Follow-up at three months indicated that those treated in family therapy returned to functioning more rapidly and were rehospitalized less frequently than adolescent patients in individual therapy. Directions for further study are suggested


New procedure for evaluation of normal and abnormal gait. In this paper a new procedure is presented that permits a quantitative clinical evaluation of an important aspect of human locomotion. It involves a spatio-temporal representation of the evolution of the group reaction vector (sagittal plane) for a single hind limb during the stance phase of a step. This representation is provided directly on line by use of a computer. Some preliminary results are presented for normal subjects and for patients with a variety of motor disorders.


The Cajuns of Southern Alabama: morphology and serology. A survey was conducted of 324 members of the Cajun isolate of Southern Alabama. Tradition and appearance suggest that this population of about 3,000 are not entirely White, Black, or Indian but constitute a triracial community somewhat reproductively isolated and inbred. The earliest American settlement in the area, along the banks of the Mobile and Tombigbee Rivers, lay between Spaniards to the South and Indian tribes on the other sides: Creek, Choctaw, and Cherokee. Physical measurements are reported for 71 adults, plus color of skin, eyes, and hair. X-rays were taken of wrist and ankle bones of some 253 children. Red blood samples were typed on adults and children, and haptoglobin, Gm, and Gc types were determined from serum. History and physical examinations were also made. Physical measurements and observations suggest predominantly White ancestry, and D2 analysis confirms this, with least similarity to Indians. Analysis of serological traits implies almost 70% White, almost 30% Black, and very little Indians genes. Few defects of clear genetic etiology were discovered. Growth patterns judged from X-rays appeared normal. All genetic loci testable were in Hardy-Weinberg equilibrium except Gc. While history and some common surnames suggest endogamy in the past, the medical and serological findings, plus some additional surnames, indicate that the isolate has already been largely diluted or dissolved.


Palmar flexion creases and dermatoglyphics among diabetic patients. Palmar dermatoglyphics and flexion creases of 108 male and 65 female patients diagnosed as having diabetes mellitus have been analysed. The control population consists of 536 males and 234 females from the same population. Palmar flexion creases were analysed according to the method suggested by Bali and Chaube ('71). The flexion creases of diabetic patients and the control population are significantly different. The differences between main line formulae in diabetes and controls are significant among males. The differences between C-line types of patients and controls are significant among both sexes. Axial triradii are significant among female patients and controls. The patterns in the interdigital areas IV and II are significantly lower among male and female patients respectively from their controls.


Cribra orbitalia, a possible sign of anemia in early historic native populations of the British Columbia Coast. Excavated and museum skeletons of the postcontact period revealed cribra orbitalia in four native ethnolinguistic divisions of the British Columbia coast, Haida, Kwakiutl, Nootka, and Coast Salish. Affected skulls were distributed among 25 of 35 localities, indicating widespread occurrence in a mainly heterogeneous population. Manifestations were similar to porotic hyperostosis, and additional lesions in the sample tend to support the concept that cribra orbitalia is related to anemia. Both inherited and acquired disorders may have been involved in the etiology. A uniquely high incidence of 52.9% occurred in immature of the Haida, a relatively homogeneous population. However, marked variability in expression by age group and by sex in the total sample is suggestive of iron-deficiency anemia. The data and historical information parallel modern expectations of susceptibility. Among 454 skulls, criba orbitalia occurred in 32.7% of growing children and adolescents, 19% of infants and toddlers, 13.3% of adult females, and 4.8% of adult males. Postcontact disruptions and disease may have figured in promoting iron-deficiency anemia, but noted precontact occurrences may also have been due to the disorder.


The dichotomous pattern of craniofacial expansion during aging. The craniofacial skeleton expands during adult life and previous investigations have demonstrated non-uniformity in continuing growth. This report confirms the fact that sella turcica, frontal sinus and the skull tables remodel at a rate per unit time which is twice the amount of the anterios and posterior skull diameter. The dual enlargement pattern occurs in both male and females and has been observed longitudinally from the third through the eighth decades of life. Though associations in the continuing growth process of separate anatomical parts throughout the human skeleton remain obscure, the degree to which components vary within the craniofacial system is now clearly evident.


Chemical and physical methods in dating human skeletal remains. Chemical and physical methods for dating skeletal remains were examined. Benzidine reaction, ultra-violet fluorescence, specific gravity and supersonic conductivity were carried out on 71 dated skeletal findings distributed over the span of the last 3,5000 years. Results given by benzidine reaction and ultra-violet fluorescence basically coincide, and positive readings were obtained up to about 200-350 years. Values, measured in specific gravity and supersonic conductivity testing show a parallel trend, pointing out a clear difference between samples of the three first centuries and the ones belonging to more ancient periods examined.


Palmar creases in population studies.

Palmar creases in population studies. Three strictly endogamous groups of Indian, Brahmin, Bhangi, and Punjabi Khattri, were analyzed to test the authenticity of palmar flexion creases as a criterion of human classification, according to the method of Bali and Chaube ('71), which has certain advantages over the existing classification. The significant frequency variation of palmar creases among different Indian populations and the bisexual and bimanual differences in the frequencies of different crease types indicate a regular distribution trend of the trait.


A descriptive and comparative study of the deciduous dentition of prehistoric Ohio Valley Amerindians. The deciduous dentition of 58 individuals from groups of prehistoric Ohio Valley Amerindians (2,000 B.C.-1,600 A.D.) was measured for antero-posterior and bucco-lingual dimensions and scored for morphological characteristics and macroscopic pathology. Only five dimensions of the posterior teeth and the frequency of severe linear enamel hypoplasia showed significant differences in the groups. In all cases focal agriculturalists exhibited smaller teeth and a higher frequency of severe linear enamel hypoplasia. These findings are explained as the result of changing diet and food preparation techniques, and/or sampling bias in the earlier burial cult groups where primarily higher status individuals may be the representatives. Comparison of metric and morphological characteristics of the deciduous dentition in the prehistoric Amerindians and roughly contemporaneous European groups indicates morphological characteristics are the better means of discrimination.


Fluctuating dental asymmetry: variation among skeletal populations. Recent investigations have shown that nongenetic, environmental factors can adversely affect dental growth and produce bilateral asymmetries in tooth size. When asymmetries do not favor either side, i.e., absence of directional asymmetry, the condition is termed fluctuating asymmetry. Fluctuating asymmetry of the mesiodistal and buccolingual dimensions of the total permanent dentition was compared among human skeletal populations which differ socio-economically and nutritionally. Odontometric data were collected from prehistoric hunters (Indian Knoll site), later aboriginal farming groups (Campbell and Larson sites), and a modern cadaver population (Hamann-Todd). The magnitude of asymmetry is expressed by the familiar correlation coefficient, r. The proportion, then, of intra-individual variation due to fluctuating asymmetry is equal to 1-r.


ABO-typing of ancient skeletons from Israel. Sixty-eight ancient skeletons, unearthed at Jerusalem and En Gedi and, according to the archeological data belonging to Jewish residents of these places from about 1,600 to 2,000 years ago, were ABO-typed by means of the hemagglutination-inhibition test. The blood groups of 13 skeletons were undiagnosable and the remaining 55 showed the following distribution: 30.91% A-group, 14.54% B-group, 50.91% AB-group and 3.64% O-group. According to these findings, the population to which these skeletons belonged must have had a high frequency of genes IA and IB, and a low occurrence of O blood group and its related IO gene.


Congruence of distance matrices based on cranial discrete traits, cranial measurements, and linguistic-geographic criteria in five Alaskan populations. Biological distances (C.A.B. Smith's Measure of Divergence) based on 25 nonmetric skull variants have been compared with distances (Mahalanobis' D2) based on cranial measurements of four Eskimo populations representing the Yupik subdivision of the Eskaleut linguistic stock, and one Aleut population. The ranking of Measures of Divergence (pooled-sex samples) for ten pairwise comparisons is significantly correlated (Spearman's rs) with both the male and female rankings of the F-values of D2. In addition, the non-metric distances showed stronger concordance than the metric distances with a hierarchy based on linguistic and geographical affinities. These findings indicate that, depending upon the particular battery of variants used, discrete traits provide valid taxonomical information in the study of extinct human populations.


Variations in the anterior patellar groove of the human femur. An analysis of the anterior patellar groove of the human femur shows considerable variation in its medial and lateral spects. The groove itself, measured by the angle it encloses, shows considerably less variation than its individual components. The suggested functional relationship between bicondylar angle and lateral elevation of the patellar groove does not obtain for this sample.


Insulin and growth hormone in lean and obese pigs. Plasma glucose, immunoreactive insulin (IRI), and growth hormone (GH) were determined in fasted lean and genetically obese pigs at 1, 3, and 6 mo of age. Rate of glucose clearance and plasma IRI and GH response in provocative stimulation were also measured. Fasting glucose was similar in lean and obese pigs, whereas glucose clearance rate was more rapid in lean pigs. Obese pigs were not hyperinsulinemic but had lower plasma GH than lean pigs. At 1 mo of age, both lean and obese pigs had higher plasma IRI and GH as compared to 3 and 6 mo. Glucose infusion produced increases in plasma IRI at 1, 3, and 6 mo, respectively, with the greatest increases at 6 mo. Plasma IRI peaked at the same level in both pig types at a given age; but due to a more prolonged response in obese pigs, the overall IRI response to glucose infusion was greater in obese pigs. Arginine infusion caused much smaller IRI responses than glucose, but the response of obese pigs was significantly greater than that of lean pigs. Both provocative stimuli caused increases in plasma GH. The GH response to glucose infusion in obese pigs was considerably less than in lean pigs. These observations suggest mild insulin insensitivity and a reduced GH secretory potential in the obese as compared to lean pigs.


Protein degradation in muscle: response to feeding and fasting in growing rats. Degradation rates of muscle proteins were determined in young rats allowed access to standard rat chow 12 h/day. degradation was assessed by determination of 3-methylhistidine (3MH) excretion rates. 3MH is a nonreutilized amino acid produced almost exclusively within the actin and myosin of skeletal and cardiac muscle. Because plasma levels of 3MH are low and renal clearance is high, excretion reflects myofibrillar degradative rates. Excretion of 3MH was determined for 4-h periods beginning 12 and 20 h after initiation of feeding and after 24-and 48-h fasts. Excretion of 3MH per 4-h period increased with time after the last feeding. Because creatinine excretion is a function of muscle mass dividing 3MH excretion by creatinine excretion represents myofibrillar degradation per unit muscle mass, the fractional degradative rate. Degradation rates rose from 4.6 to 14.5%/day between 12 and 16 and 60 and 64 h after the beginning of the last meal. These results support the presence of a diurnal pattern of protein degradation as well as increased muscle degradation during starvation.


Effect of burn trauma on glucose turnover, oxidation, and recycling in guinea pigs. The simultaneous primed-constant infusion of [6-3H]- and [U-14C]glucose was used to determine the effect of burn injury on glucose turnover, oxidation, and recycling in guinea pigs. Eleven burned animals survived more than 72 h (survivors), whereas five died between 60 and 72 h postburn. All of the controls (n = 9) survived more than 72 h. At 48 h postburn, glucose turnover in the burned survivors was elevated 40% above that in control animals. A greater portion of the burned survivors' turnover was due to recycling and less was directed towards oxidation. The nonsurvivors had both a significantly depressed rate of appearance of glucose and an increased glucose clearance rate. Consequently, they were profoundly hypoglycemic and had a low rate of glucose oxidation. The alterations in glucose kinetics and oxidation apparent after burn did not reflect an inability of burned animals to oxidize exogenously infused glucose, however, because of 2-h infusion of 55 mumol/kg-min of unlabeled glucose doubled glucose oxidation in the burned survivors and tripled it in the nonsurvivors.


Mechanism of triiodothyronine-induced creatinuria in the rat. Mechanism of triiodothyronine (T3)-induced creatinuria was studied in rats after a single injection of T3 (100 microgram/100 g per s). Urinary creatine excretion increased markedly during the 1st day after T3 injection. Peak of creatinuria was observed during the 2nd day after T3 injection. Excretions of nonprotein nitrogen and potassium were not different between control and T3-injected animals throughout the experimental period. Creatine reabsorption in the kidney was not influenced by T3 treatment. Radioactive creatines in both plasma and urine after [14C]creatine injection were higher in T3-injected animals than in controls, whereas the uptake of radioactive creatine by muscle was lower in the former. Creatine content in muscles decreased significantly 48 h after T3 injection. Moreover, T3 increased a fraction derived from muscle in urinary creatine, but it did not influence that derived from creatine synthesized de novo. These results suggest that both decreased creatine uptake by muscle and increased release of creatine from muscle play important roles in T3-induced creatinuria.


Effect of volume expansion with NaCl or NaHCO3 on nephron fluid and Cl transport. To assess the influence of plasma anions on nephron fluid and chloride transport following volume expansion (VE), rats were studied by micropuncture technique during hydropenia and after VE with NaCl (CVE) or NaHCO3 (BVE). VE with either solution produced increments in plasma volume, SNGFR, and fractional sodium excretion (FENa), and decrements in proximal and distal TF/P inulin ratio which were not different. The proximal transepithelial chloride ratio decreased similarly in CVE (from 1.34 to 1.16) and BVE (from 1.32 to 1.17). Following VE, proximal fractional Cl reabsorption decreased similarly in both CVE (-5.9%) and BVE (-7.4%). Early distal fractional Cl reabsorption also was decreased in CVE (-12%) but not in BVE (-1%). Fractional chloride excretion increased in CVE but not in BVE. Therefore, following VE plasma anion composition did not significantly modify either fluid reabsorption in proximal tubule or loop of Henle or urinary Na excretion. The fraction of sodium reabsorbed with chloride in the proximal tubule increased, and Cl conservation, primarily within the loop of Henle, can be maintained despite marked natriuresis.


Renal handling of the polar DDT metabolite DDA (2,2-bis[p-chlorophenyl] acetic acid) by marine fish. The renal handling of 2,2-bis(p-chlorophenyl) acetic acid (DDA) was examined in the isolated tubules of the winter flounder (Pseudopleuronectes americanus) in vitro in conjunction with clearance studies in the flounder and in the aglomerular goosefish (Lophius americanus). In vitro, both uptake studies and autoradiography showed extensive energy-dependent accumulation within the cytoplasm of tubular cells and the tubular lumen. The uptake was strongly inhibited by p-aminohippurate and chlorophenol red. A second component of uptake was insensitive to metabolic inhibitors or organic acids and represented tissue binding. In vivo, both species showed net secretion which was inhibited by probenecid. Comparison of DDT and DDA distribution and excretion emphasized the importance of the greater water solubility of DDA and of its secretory transport, since DDA was excreted at over 200 times the rate of DDT. Liver, kidney, and bile also showed elevated DDA tissue-to-plasma ratios. Thus, the organic acid system mediates the accumulation and excretion of DDA in these fish.


Renal tubular transport of prostaglandins: inhibition by probenecid and indomethacin. With use of the Sperber technique in chickens, labeled prostaglandin E2 and F2alpha were infused and resulted in renal tubular excretion of the label into the urine. A labeled metabolite, 12,14-dihydro,15-keto-PGF2alpha, was infused exogenously and this label was also excreted by active tubular transport. Tubular excretion of the label from PGE2, PGF2alpha, and 13,14-dihydro,15-keto-PGF2alpha was inhibited by probenecid, indomethacin, and PAH. The PAH was 10 times weaker as an inhibitor than probenecid and indomethacin. These results indicate that the prostaglandins are actively transported across the renal tubule by the classic anionic transport system which transports PAH. Since the transport of the prostaglandins is blocked by nonsteroidal anti-inflammatory agents such as indomethacin, the anti-inflammatory action of indomethacin may be produced not only by the inhibition of prostaglandin synthesis but also by restriction of the distribution of endogenous prostaglnadins. Thin-layer chromatography of an ethyl acetate extract of urine collected during infusion of [3H]PGF2alpha revealed three discrete radioactive peaks, one of which corresponded to authentic PGF2alpha. This signified tubular excretion of PGF2alpha. One metabolite in the ethyl acetate extract was found to be of renal origin.


Renal excretion of phosphate and calcium in parathyroidectomized starlings. Renal excretion patterns of calcium, phosphate, sodium, and potassium were studied in parathyroidectomized (PTX) and parathyroid extract (PTE)-injected PTX starlings. Sturnus vulgaris. Anesthetized birds (Equi-Thesin or Dial) were infused intravenously with 2.5% mannitol containing [14C]inulin. PTX caused significant hypocalcemia, hyperphosphatemia, increased relative calcium clearance (CCa/CIn), and decreased relative clearances of phosphate and potassium, but did not change the clearance of sodium. Glomerular filtration rate (GFR=CIn) and urine flow remained unchanged up to 2 h after PTX. PTE administration 3 h after PTX returned serum calcium and phosphate values to control levels and caused a transient (10-min) increase in GFR. Following PTE, the relative clearances of phosphate, sodium- and potassium increased, while that of calcium decreased significantly relative to the PTX levels. PTE caused net tubular secretion of phosphate, decreased tubular reabsorption of sodium and potassium (sometimes potassium secretion), and a return of excretion of calcium to control levels. These studies indicate that the parathyroid role in calcium and phosphate homeostasis in starlings is predominantly on the kidney.


Phosphate transport in superficial and deep nephrons in phosphate-loaded rats. We tested the hypothesis that greater phosphate delivery from deep nephrons than from superficial nephrons contributes to the addition of phosphate to the collecting system during phosphate loading. In the first group of eight anesthetized Munich-Wistar rats infused with phosphate and parathyroid hormone (PTH), fractional delivery of phosphate (FDP%) from superficial distal tubules was 56 +/- 6%, significantly less than the amount appearing in the urine, 67 +/- 6% (P less than 0.01). In the second group of six rats, we determined whether this addition of phosphate could be accounted for by a higher FDP% from the deep nephrons. Free-flow micropuncture collections were taken from deep nephrons (ascending limb of the loop of Henle in the papilla), superficial nephrons (distal tubules in the cortex), and urine (duct of Bellini). The FDP% to the ascending limb of the loop of Henle in deep nephrons was 78 +/- 10%, significantly greater than to the distal convoluted tubules in superficial nephrons, 51 +/- 6% (P less than 0.005), and the fractional excretion of phosphate in urine, 72 +/- 10% (P less than 0.05). Although a difference between FDP% in superficial and deep nephrons due to reabsorption in the ascending limb of the loop of Henle cannot be ruled out from the present data, other studies indicate that this interpretation is unlikely. We conclude that greater phosphate delivery by deep nephrons contributes to the addition of phosphate to the collecting system of phosphate-loaded rats.


Failure to abolish reactive hyperemia by indomethacin in denervated kidneys of rabbits. The effect of indomethacin (10 mg/kg) on the distribution of cortical blood flow during postocclusive reactive hyperemia was evaluated in denervated kidneys of anesthetized rabbits by the radioactive microsphere technique. Renal denervation caused a slight but not significant increase in renal blood flow with no remarkable alteration in the distribution of cortical blood flow. After release of 1-min occlusion of the renal artery, hyperemic responses developed with a fractional flow redistribution toward the inner cortex. The absolute perfusion rate increased in the inner cortex but did not significantly change in the outer cortex. Indomethacin produced a decrease in renal blood flow despite elevated blood pressure. Even in the indomethacin-treated animals, postocclusive reactive hyperemia appeared concomitantly with the fractional flow redistribution to the inner cortex. The percentage repayment by reactive hyperemia of ischemia during the artery clamping was not significantly different before and after indomethacin administration. The findings indicate that indomethacin did not significantly affect the postocclusive vascular response in denervated kidneys of rabbits, thereby giving evidence against the role of prostaglandins as mediators of reactive hyperemia.


Reflex suppression of renin release by ventricular receptors with vagal afferents. Intracoronary injection of veratrum alkaloids is known to stimulate ventricular receptors with vagal afferents resulting in bradycardia and hypotension. This study examined the role of veratrum-sensitive ventricular receptors in the control of renin secretion in eight chloralose-anesthetized dogs. Hemorrhage of 10% caused renin release to increase significantly from a control of 778 to 1,971 ng/min. Arterial pressure and renal blood flow did not change significantly. The augmented release of renin during volume depletion was virtually abolished by injection of cryptenamine (2 microgram/kg) into the main left coronary artery, falling from 1,971 to 269 ng/min by 4 min after the cryptenamine injection. Blood pressure decreased significantly from 130 mmHg before to 111 mmHg after injection. Renal blood flow did not change significantly. This reflex suppression of renin release by excitation of ventricular receptors was abolished by vagotomy. These data indicate that ventricular receptors with vagal afferents participate in the reflex control of renin release.


Intraperitoneal pressure in formation and reabsorption of ascites in cats. The rate of ascites formation or reabsorption was recorded in anesthetized cats using the technique of intraperitoneal plethysmography. Hepatic venous pressure was increased using an extracorporeal circuit to drain effluent blood from the liver. When the intraperitoneal pressure was set to zero, elevation of hepatic venous pressure increased portal pressure and produced a constant rate of ascites formation. However, equivalent increments of portal pressure without elevation of hepatic venous pressure did not cause ascites formation, indicating that the liver was the source of ascites when hepatic venous pressure was increased. The rate of ascites formation was proportional to hepatic venous pressure, but elevation of the intraperitoneal pressure reduced the transsinusoidal pressure gradient responsible for fluid filtration from the liver. Although this reduced the rate of ascites formation, a secondary effect partly opposed this reduction in filtration rate. From this study and from previous work, there are now quantitative data showing that the intraperitoneal pressure is an important factor which accelerates the rate of reabsorption and decreases the rate of formation of ascites to bring these processes into equilibrium.


Effects of Ca2+ and catecholamines on the guinea pig atrium action potential plateau. The activation process in isolated electrically driven guinea pig atria was studied by means of simultaneous microelectrode and tension recording. Reducing external calcium from 2.5 to 1.25 mM prolonged the plateau but further reduction of calcium shortened it. Progressively increasing doses of the calcium antagonist D600 (up to 1.4 micrometer), however, monotonically decreased plateau duration. Either protocol monotonically decreased steady-state tension, but with markedly different effects on the restitution relation. Epinephrine, and to a lesser extent isoproterenol, restored plateau duration after exposure to either a calcium-free or D600-containing solution, but only the isoproterenol effect was propranolol sensitive. Addition of calcium chelators enhanced rather than prevented the effect of epinephrine on plateau duration in a calcium-free solution, extending the plateau duration to more than 3 times normal in some cases. These results are explained in terms of two opposing effects of a change in calcium concentration on plateau formation, one action being through the slow inward current and the second through a shift in a calcium dependence of the inward-rectifying, potassium conductance system.


Differential sensitivity to neurotransmitters in denervated canine sinus node. This investigation determined the chronotropic effects of norepinephrine and acetylcholine (ACh) administered selectively into the canine sinus node artery after cardiac denervation. In 42 dogs the cervical vagi were isolated, the heart was exposed, and vagal stimulations were performed before and after sham procedure or extrinsic cardiac parasympathectomy. Four additional dogs underwent bilateral stellectomy. The dogs were reanesthetized 4-23 days later, and blood pressure, heart rate, ECG, and local cardiac electrograms were recorded. The vagi were again stimulated and the effectiveness of the parasympathectomy was verified in 11 of the dogs. On selective perfusion of the sinus node with 0.001- to 1-microgram doses of ACh, the sinus bradycardias of the parasympathectomized and the sham-operated dogs were not significantly different. The responses to norepinephrine (0.01 and 0.1 microgram/ml) administered via the same route in the stellectomized dogs were significantly greater than those in the sham-operated dogs, thus verifying this technique for the assessment of sinus node sensitivity to neurotrasmitters. We conclude that extrinsic denervation of the canine sinus node leads to development of a differential response between adrenergic and cholinergic neurotransmitters. These differential sensitivities may be important when considering the pharmacological responses and electrical stability of the denervated and/or transplanted heart.


Transmural metabolic gradients in the normal dog left ventricle: effect of right atrial pacing. The effects of atrial pacing on tissue metabolite levels known to be sensitive to ischemia were examined. Anesthetized dogs were thoracotomized and a pacing electrode was sutured to the right atrium. Pacing at rates of 200 or 250 beats/min (10 animals per group) was performed for 15 min after base-line hemodynamic data had been obtained. At the end of the pacing period, a transmural biopsy was taken, frozen in liquid nitrogen, and sectioned into subepicardial, midmyocardial, and subendocardial layers. ATP, phosphocreatine, lactate, and glycogen were extracted and analyzed. Significant (P less than 0.001) transmural gradients of each of these metabolites existed in the control group. Pacing had no significant (P greater than 0.2) effect on any metabolite from layer to layer at 200 or 250 beats/min. However, indices of heart work (i.e., contractility (dP/dt), stroke work, and stroke volume) demonstrated significant reductions (P less than 0.01) due to pacing, while circumflex artery blood flow increased more than twofold (P less than 0.001) at the highest rate. These data suggest that physiologic autoregulation occurred during pacing and protected the subendocardium from stress-induced ischemic insult.


Chronotropic response of spontaneously beating rabbit atria to hyperosmotic media. Spontaneously beating rabbit atria responded to hyperosmotic Tyrode bathing media with an increase in rate, force of contraction, and passive tension dependent on the level of osmolality and the osmotic agent employed. The positive chronotropic response reached a maximum within a few minutes and then declined to a lower, maintained plateau level. The plateau change in rate was similar whether the osmotic agent added to Tyrode solution was sucrose, mannitol or NaCl. For these agents, the response increased linearly with osmotic pressure of the bathing media from 300 to 500 mosmol/kg H2O, then progressively decreased approaching zero (plateau rate = control) at about 700 mosmol/kg H2O. The chronotropic response to urea in Tyrode solution, though less than for the other three agents, progressively increased over the entire range of osmolalities tested (from 300 to 700 mosmol/kg H2O). The inotropic response was positive for all agents from 300 to 600 mosmol/kg H2O. Passive tension of atria increased with added NaCl, sucrose, or mannitol, but not with urea. Propranolol did not alter the atrial response to hyperosmolality. Thus, we find that the chronotropic response of atria to hyperosmolar solutions is positive over a wide range of agents and osmolalities, in contrast to earlier reports of a direct negative chronotropic effect.


Effect of methylcellulose injection on murine hematopoiesis. This study was designed to determine the effect of methylcellulose (MC)-induced reticuloendothelial (RE) hypertrophy on neutrophils and hematopoietic stem cells and to contrast its overall hematologic effect in the mouse to the more frequently studied rat model. Mice were given MC 3 times/wk and studies were done at 2, 3, and 4 wk, with maximal hematologic change by 2 wk. A stable, but incompletely compensated hemolytic anemia developed which was accompanied by a significant shift of erythropoiesis from marrow to spleen. Thrombocytopenia developed as did neutrophilia, accompanied by an increased number of marrow neutrophil precursors. Extramedullary hematopoiesis was observed in the liver. The number of cells forming spleen colonies in irradiated recipients increased in the spleen but not in marrow. The number of cells producing granulocyte and macrophage colonies in semisolid media increased in spleen and marrow. Splenectomized mice, treated with MC, developed changes very similar to intact mice. Thus, it appears that all three major hematopoietic lines may be destroyed by the MC-hypertrophied RE system. The mouse differs from the rat in its hematologic response to MC by destroying cells in organs other than the spleen, by increasing neutrophil production, by developing hepatic hematopoiesis, and by developing all changes more rapidly.


Metabolism of adenine nucleotides in the cultured fetal mouse heart. Intact beating fetal mouse hearts in organ culture were deprived of oxygen and glucose for up to 4 h, resulting in loss of beating, an 80% fall in ATP, reduction of energy charge from 0.85 to 0.48, and doubling of total nucleoside concentration. Radiolabeled adenine nucleotides were degraded to hypoxanthine and inosine, which were lost from the hearts into the medium during the deprivation period. Adenosine and adenine also appeared in the medium when adenosine deaminase was inhibited. After 24 h of O2 and glucose resupply, ATP returned to 60% of control, and energy charge rose to 0.76. Labeled nucleosides and bases remaining in the heart or exogenous labeled adenine were utilized to resynthesize ATP. [14C]glycine was rapidly taken up by recovering hearts but was not used for de novo adenine nucleotide synthesis. Ability to recover ATP and spontaneous contraction appear related to residual nucleotide and nucleoside content rather than to energy charge.


Dependence of reactive hyperemia in skeletal muscle on oxygen tension. Red blood cell velocity was measured in capillaries of the rabbit tenuissimus muscle during exposure to a low-oxygen-tension (PO2 = 5 mmHg) and a high-oxygen-tension (room-air PO2 = 150 mmHg) suffusion solution. Control capillary red blood cell velocity was significantly reduced (44%) by elevating the suffusion solution PO2 from 5 to 150 mmHg. The reactive hyperemias that occurred after a 120-s aortic occlusion under these two conditions were compared. The mean RBC velocity during the hyperemia in the 1st min following the removal of occlusion was significantly reduced by increasing oxygen tension, as was the duration of the hyperemia. Peak capillary red blood cell velocities in the hyperemic phase during exposures to low and high PO2 were not significantly different. It can be concluded from this study that although oxygen tension does affect postocclusive reactive hyperemia, other factors such as myogenically induced vascular relaxation also contribute to the production of this phenomenon.


Relationship between colloid osmotic pressure and plasma protein concentration in the dog. This study was done to establish the correct relationship between protein concentration and plasma colloid osmotic pressure in the dog and to determine the possible influence of the relative albumin and globulin content (A:G ratio). Plasma samples from dogs, rats, and humans were evaluated for total protein concentration, globulin concentration, and colloid osmotic pressure. Samples were concentrated and diluted by ultrafiltration to provide a range of total protein concentrations from 1 to 12 g/dl. Rat and human plasma samples had A:G ratios of 1.4 and 2.1, respectively, and the relationship between protein concentration and colloid osmotic pressure was in agreement with the Landis-Pappenheimer equation. In contrast, dog plasma samples consistently exhibited lower colloid osmotic pressures for any given protein concentration. Two forms of empirical equations were derived to relate these parameters in the dog. Dog plasma samples had higher concentrations of globulin and the A:G ratio averaged 0.59 +/- 0.35 SD. There was a significant relationship between the A:G ratio and the plasma colloid osmotic pressure. Analysis of the possible effect of this altered relationship on glomerular filtration dynamics predicted that efferent plasma colloid osmotic pressure was not specifically affected and was dependent only on the filtration fraction and the plasma colloid osmotic pressure.


Formation of adenosine nucleotide derivatives in isolated hog carotid artery strips. Media strips of hog carotid artery formed hypoxanthine and inosine during incubation under conditions of normoxia (95% O2, 5% CO2). During anoxia (95% N2, 5% CO2), hypoxanthine increased fivefold and inosine twofold. Stimulation with 124 mM K+ resulted in a twofold increase in hypoxanthine and a threefold increase in inosine. Concurrent with the increase in the concentrations of purine derivatives was a decrease in tissue ATP. Although significant amounts of adenosine were not detected in the medium of incubating artery strips, the following evidence suggests adenosine was formed and rapidly deaminated to inosine: 1) Exogenous adenosine added to the medium of incubating strips was rapidly deaminated to inosine. 2) Exogenous 5'-AMP concentration decreased, whereas adenosine and, subsequently, inosine levels increased during incubation of artery strips. The reaction was specific for 5'-AMP and the data suggest that AMP is dephosphorylated to adenosine. 3) The specific activity of exogenous [U-14C]adenosine added to the medium of incubated strips decreased after 15 min. It is concluded that adenosine is formed in isolated artery strips but is rapidly deaminated to inosine.


Inhibition of fibrin-platelet interactions by fibrinogen-degradation fragment D. Homogenized fibrin induced platelet aggregation and the release of serotonin from human platelets. Fragment D, purified from a plasmin digest of human fibrinogen, inhibited these platelet-fibrin interactions. Using a radiolabeled fragment D, it was possible to demonstrate saturable binding of fragment D to fibrin. Nonlabeled fragment D competed with the radiolabeled fragment D for binding to fibrin. Furthermore, the binding of fragment D to fibrin paralleled its ability to inhibit the fibrin-induced release of platelet serotonin. It is postulated that the inhibitory effect of fragment D on fibrin activation of platelets is due to the binding of fragment D to fibrin. The bound fragment D may cover up or block sites on fibrin that are involved in fibrin-platelet interactions. This would then result in inhibition of the fibrin-induced platelet aggregation and release of platelet serotonin.


A microscope-television system for studying flow velocity in human skin capillaries. A noninvasive technique for studying blood flow dynamics in human skin capillaries is described. A light microscope combined with a closed-circuit TV system was used to monitor and record capillary blood flow velocity on video tape. Arterial pulsations were recorded plethysmographically and converted into video signals by modulating the position of a square, white area in the televised scene. Twelve healthy subjects were studied. The mean (+/- SD) resting capillary blood flow velocity was 0.65 +/- 0.3 mm/s at an average skin temperature of 30.4 +/- 2.3 degrees C. Spontaneous fluctuations at a frequency of 6-10 cycles/min were observed in most subjects. A well-pronounced flow pulsatile component could be demonstrated in all capillaries studied. The technique can be used in clinical practice for studying the physiology and pathophysiology of cutaneous microcirculation in man. It can be expected that the method may become an important diagnostic tool in diseases that involve disturbances of the microcirculation, such as diabetes, hypertension, and atherosclerosis.


Improved signal processor for the ultrasonic dimension gauge. Inexpensive modifications and additions to improve the performance of a widely used ultrasonic dimension gauge are presented in detail. These include a pulse width demodulator, averaging peak detector, and improved signal processing circuits. Benefits of the modifications are improved frequency response (to 1 kHz), lowered drift, increased sensitivity (to 128 mV/mm), rational gain calibration, calibrated zero suppression, and improved recovery from signal dropout. The modifications result in the ability to take the derivatives of ventricular wall motion with greater reliability.


Organizational determinants of subjective contour: the subjective Necker cube. With specially arranged inducing elements on a white surface of uniform luminosity, a phenomenally complete Necker cube can be seen in any array where only the 'corners' of the cube are physically represented. The subjectively seen bars of the cube disappear when the inducing 'discs' are seen as 'holes' in an interposing surface, through which the corners of a partially occluded cube are viewed. Illusory brightness effects are also observed in connection with the different organizations of this ambiguous figure.


Ohio drinking water source and cancer rates. The 88 counties of Ohio were classified as either ground water or surface water counties based on the source of the drinking water used by a majority of the county residents included in the 1963 U.S. Public Health Service Inventory of Municipal Water Facilities. Average cancer mortality rates for surface and ground water counties were compared using analysis of covariance. Mortality rates for stomach, bladder, and all malignant neoplasms were higher for white males in counties served by surface water supplies than in counties served by ground water supplies. Mortality rates for stomach neoplasms were higher for white females in surface water counties. These differences in mortality rates were not attributable to other factors known to be associated with cancer death rates including urbanization, median income, population size, manufacturing activity, and agriculture-forestry-fishery activity.


Pro Bono Publico--a century later.

Pro Bono Publico--a century later. From the introduction of Pro Bono Publico smoking tobacco in Durham, NC a century ago, the production of tobacco products has become a vital part of the state's economy. How this may relate to the smoking behavior, and consequently to the health of its residents is assessed from smoking patterns of adult residents of a rural area of Durham County. Male smoking rates are considerably higher than U.S. estimates whereas female rates are lower. The national trend of increasing incidence of lung cancer can be expected to continue in North Carolina and may be even greater due to the high rate of smoking.


Screening for gonorrhea and syphilis in the gay baths--Denver, Colorado. During 33 screening sessions in Denver gay steambaths, 48 of 419 (11.5 per cent) men were found to have asymptomatic gonorrhea and six (1.4 per cent) had early latent syphilis. Questionnaires were administered to 160 men who reported a mean of 7.9 different male sex contacts per month. Female sex contacts were also reported by 30 per cent. The respondents used the baths an average of 2.2 times per month, having an average of 2.7 different sex contacts per visit, 84 per cent of whom were not previously known to the respondent. Gay steambaths are productive locations for detecting asymptomatic gonorrhea and syphilis.


A pitfall in sampling medical visits.

A pitfall in sampling medical visits. Samples of outpatient visits often must be used to identify users of a health facility with a given chronic condition. Such samples can lead to biases, however, because patients with more frequent visits are overrepresented. These biases can be avoided by a weighting procedure in which each sampled visit is weighted inversely to the number of clinic visits made by that patient during the sample period. This procedure proved critical in estimating the number and characteristics of hypertensive patients seen in the medical clinic of a teaching hospital. The unweighted estimate of the number of hypertensives was 7,373 patients, more than three times the weighted estimate of 2,250. Similarly,, the number of visits per year by these patients would be overestimated by almost 50 per cent without weighting. The estimated proportion of hypertensives still under treatment after 18 months was 68 per cent without weighting, compared to 51 per cent with weighting. Thus biases from failure to weight may be substantial. Analogous biases and solutions apply to other sampling problems in health services research.


The 4 score: an index for predicting a patient's non-medical hospital days. Three hundred sixty-three patients representing two groups of consecutive medical admissions to a large city hospital were evaluated on admission to determine what factors might predict "non-medical" or social stay. Periodic follow-up determined when patients were ready for discharge and when their social stay began. A composite index, the 4-Score, was derived as a simple indicator of risk for subsequent social stay; it is defined as the number of positive answers to the questions: 1) Is the patient 80 years old or more? 2) Will the patient have to live somewhere new at discharge? 3) Is there any disorientation? AND 4) If so, is the disorientation chronic? Eighteen per cent of the total inpatient hospital days of this group of patients could be attributed to social stay. The 56 patients with a 4-Score of two or more on admission had on average a week each of social stay while the 307 patients with a score of less than two averaged only one social day each.


Affecting the supply of rural physicians. A model describing physician supply and distribution is described. Two surveys obtained information to examine elements of the model. The first survey identified a group of primary care physicians that had considered rural locations but ultimately selected an urban location. This sub-group, 29 per cent of the primary care supply pool, received a follow-up survey to provide more information about how they made their choice. About one-half of them finally chose on the basis of factors other than metropolitan/non-metropolitan considerations. For this half, some of the factors that entered into the decision were the availability of physician specialists, nearby hospital facilities, and access to medical school programs. Such factors could be affected by future policy decisions, but the cost is unknown. Even if such policy decisions were made, and appropriate programs instituted, the results would probably not solve the problem of disproportionate physician distribution. The most likely-to-succeed approach to increasing the number of rural physicians remains that of increasing the number of entrants to medical school with a rural background.


Immunization: public health programming through law enforcement. The pre-inoculation program review of the school immunization records in fall, 1974 found that only 60 per cent of the 63,000 children in the Cincinnati primary school system were adequately immunized. Following a program based upon their legal authority to require immunizations, the Board of Health in collaboration with the Board of Education was able to obtain in a two-year effort a 91 per cent immunization level.


Endemic amebiasis in an extended family. Two cousins from a large Spanish-American family were simultaneously diagnosed as having amebic liver abscesses. Survey of 183 extended-family members revealed that 45.7% of 162 had a positive amebiasis indirect hemagglutination test and 12.6% of 111 had cysts or trophozoites of Entamoeba histolytica demonstrated in a single stool examination. A total of five family members had had liver abscesses; two deaths had occurred. In a random sample survey of the remainder of the community, only one person (0.3%) had a positive serologic test. Within the extended family, person-to-person appeared to be the predominant mode of transmission. Water supplies were not contaminated. Both community and extended family homes had the same source of water. Type and source of food supply were not correlated with infection and there was no evidence to implicate an infected food handler. Clustering of seropositivity occurred in homes without indoor toilets. Homes of the extended family were more crowded and significantly fewer of them had indoor toilets. Endemic foci of amebiasis continue to exist in the United States. Follow-up family and other close contacts of persons with amebiasis will frequently identify other cases.


Clinical trials of a new anthelmintic, 4-isothiocyanato-4'-nitrodiphenylamine (C.9333-Go/CGP 4540), for the cure of hookworm infection. A new compound, 4-isothiocyanato-4'-nitrodiphenylamine (C.9333-Go/CGP 4540), was tried in 39 hospitalized patients with hookworm infection, using several treatment schedules. At effective dose schedules (125 mg X 3 given 4-hourly; 250 mg X 3, 8-hourly; 1,000 mg X 3, 12-hourly), the egg reduction was 96% to 100%; the zero egg-counts were confirmed by coproculture for larvae. The compound was very well tolerated. Transient and mild side effects--giddiness, diarrhea and sweating--were observed in only three patients. No toxic effects were seen as judged by serial organ function tests, except a transient and mild asymptomatic elevation of transaminases in one patient.


Strongyloides fülleborni infections in man in Zambia. Rhabditiform larvae, and in two cases eggs, of Strongyloides spp. identified in the stools of Zambian patients were cultured to the free-living adult stage. Free-living adults of S. fülleborni, a parasite common in primates in Africa and Asia, were present in cultures from 13 (9.9%) of 131 cases of strongyloidiasis. In three of these cases, both S. fülleborni and S. stercoralis free-living adults were found.


Enterobius vermicularis in ectopic sites. We document six cases in which tissues were invaded by Enterobius vermicularis. These cases illustrate several mechanisms whereby the worms form granulomata in ectopic sites. In three cases, the worms passed through pre-existing breaches in the intestinal mucosa. In one case, a gravid worm migrated via the female genital tract to ther peritoneal cavity. In two other cases, male worms were found on the outer surface of the intestine, suggesting active penetration of the intestinal wall.


Onchocerciasis: invasion of deep organs by Onchocerca volvulus. Autopsies of two patients with onchocerciasis in the Republic of Zaïre are reported. In one patient elephantiasis who died following diethylcarbamazine therapy there were large numbers of microfilariae of Onchocerca volvulus in the kidney, liver, pancreas, and lung. In the second patient, who also had leprosy and hyperinfection strongyloidiasis, we found an encapsulated adult O. volvulus in the wall of the thoracic aorta.


Some observations on complement fixation in onchocerciasis in Guatemalans. Recent investigations of infections with Onchocerca volvulus in Guatemala presented the opportunity to study some aspects of complement fixation (CF) antibody titers. An extract of adult O. volvulus obtained from nodules excised from patients was used as antigen. Serum was procured from individuals whose intensity of infection was determined by skin snip counts of microfilariae. In general there was an inverse relationship between intensity of infection and CF titers. This correlation was significant in men 40 years and older. The CF titer of women was greater than that of men with the same intensity of infection.


Intracytoplasmic bacteria in Onchocerca volvulus. Ultrastructural studies on Onchocerca volvulus disclosed intracellular organisms within the lateral chords of adult worms and of the larval stages. In the females the organisms were also present in the oogonia, oocytes, developing eggs and microfilariae. The organisms, found within vesicles of host (filarid) membrane and limited to the cytoplasm of infected cells, appeared to have a developmental cycle consisting of three morphologically distinct forms: a small spheroidal form up to 0.3 micronm in size, a bacillary form up to 1.5 micron7 in length and 0.7 micronm in diameter, and a third form, intermediate in size between the former and the latter, characterized by a dense inclusion. The intravesicular location and the developmental cycle consisting of three distinct forms are the two characteristics which suggest that these organisms are more similar to the chlamydiae than to the rickettsiae, in spite of their being transovarially transmitted. The significance of these findings with respect to the host-parasite relationship and pathogenesis of onchocerciasis is presently unknown and will require further study.


Single dose therapy of paragonimiasis with menichlopholan. Menichlopholan, biphenyl compound, in a single dose of 2 mg/kg body weight, gave a 73%-90% cure rate in the treatment of pulmonary infections due to Paragonimus uterobilateralis at two centers in Nigeria. Ninety-five patients were followed up for 4 months, and 58 for 1 year. Side effects of the drug included sweating and body pains, but there was no significnat biochemical or hematological evidence of damage to the internal organs. The advantages of single dose therapy are likely to make menichlopholan the treatment of choice for paragonimiasis in Africa, and probably elsewhere.


A 13-year follow-up of antimony-treated Schistosoma mansoni-infected patients. Thirty consecutive patients who were treated for Schistosoma mansoni infection with antimony sodium dimercaptosuccinate (Astiban) during the 1960s, and who had not visited an endemic area since the treatment, were reexamined 11 to 17 (average 13) years after the last presumed exposure. Seven of them (23%) still had active infections, six being chronic infections of which only one had been treated in an acute stage. None of the patients with chronic S. mansoni infection had signs of changes in liver, gut, or other organs, and all were able to work at full capacity. Living eggs were found in rectal biopsy specimens from all cases, but in only two cases in stool specimens. Serological reactions were positive in three cases and also in two of the egg-negative cases. Skin tests gave immediate positive reactions in 6 of 7 egg-positive and in 11 of 23 egg-negative patients.


Schistosoma mansoni and S. haematobium infections in Egypt. I. Evaluation of techniques for recovery of worms and eggs at necropsy. Four hundred consecutive autopsy cases were examined in Cairo, Egypt. Sixty percent of cases had Schistosoma haematobium eggs in the tissues and 25% also were infected with S. mansoni. Only a quarter of S. haematobium infections were active, while nearly two-thirds of S. mansoni cases remained active. Adult S. haematobium and S. mansoni were effectively recovered from the mesenteric circulation by a combination of perfusion and dissection. Quantitative recovery from the genitourinary system was reasonably complete, although small numbers of worms were missed in the dissection of these organs.


Mycoplasma pneumonia: a study on hospitalized American patients with pneumonia in Vietnam. A prospective study on consecutively hospitalized pneumonia patients showed that 41.5% of 58 patients had a fourfold rise in the complement-fixation titer for Mycoplasma pneumoniae. Viral isolation techniques and serologic tests for influenza A1, A2 and B, parainfluenza 1 and 3, respiratory syncytial virus and the adeno virus group yielded only a single positive isolate for influenza A2. Serologic tests for melioidosis, leptospirosis, scrub, murine and epidemic typhus and psittacosis were all negative. The clinical manifestations were not distinctive for the positive M. pneumoniae patients when compared with the patients having a negative M. pneumoniae complement-fixation test. The symptoms and signs and laboratory and radiologic findings were similar to those described in other reports on primary atypical pneumonia.


Meningococcal meningitis in northern Ghana: epidemiology and control measures. Hospitalized meningococcal meningitis patients in northeastern Ghana during 1972-1973 were studied to provide baseline information about case clustering and age-specific attack rates to guide meningitis control programs. In 1973, group A meningococci were prevalent and 7% of isolates were sulfadiazine-resistant. In contrast to the age distribution of meningococcal meningitis in North and South America, peak attack rates occurred in 10- to 14-year-old Ghanaians. A mass immunization campaign using group A polysaccharide vaccine in heavily populated areas of the Bawku and Nalgerigu districts is recommended.


Smallpox in the Republic of Guinea, West Africa. II. Eradication using mobile teams. Smallpox transmission was interrupted in the Republic of Guinea in January 1969, 13 months after the beginning of the National Smallpox Eradication Program, and after approximately 60% of the population had been mass vaccinated. The eradication strategy was founded on the recent epidemiology of smallpox in Guinea and surrounding countries. Tactics were based on use of mobile teams specifically trained for mass vaccination, assessment, surveillance, and epidemic investigation. Guinea was one of 15 West African countries officially certified by the World Health Organization in 1976 as having eradicated smallpox. Continued vigilance to detect any possible importation is needed and would best be part of a program to improve quarantinable disease surveillance. An acceptable immunity level to smallpox should be maintained in priority groups until worldwide smallpox eradication is achieved.


Clinical and laboratory observations on patients with primary and secondary dengue type 1 infections with hemorrhagic manifestations in Fiji. An extensive epidemic of dengue type 1 infection with a high incidence of hemorrhagic manifestations occurred on the island of Viti Levu, Fiji beginning early in 1975. Previous dengue outbreaks in this population were such that in 1975 two types of dengue patients were observed, one group of patients experienced primary dengue type 1 infection, whereas another experienced their dengue type 1 infection approximately 4 years after a dengue type 2 infection. Clinical and laboratory findings for the two forms of infection were assessed in patients hospitalized for their disease, usually with hemorrhage. With the exception of virologic and serologic findings, no important differences between these two groups were noted with respect to incidence and nature of hemorrhage and other clinical and laboratory findings. Both types of infection sometimes were associated with thrombocytopenia and low serum levels of the C3 component of complement. Virus was more easily isolated from the primary infection patients and the magnitude of their viremia also was higher. No significant differences were noted in a comparison of the ease of virus isolation from serum or plasma.


Type 1 dengue with hemorrhagic disease in Fiji: epidemiologic findings. An explosive epidemic of dengue occurred in Fiji between January and July 1975. All laboratory evidence indicated that type 1 dengue was the only prevalent dengue virus. This type had probably not been in Fiji for 30 years and over 70% of the population was susceptible. Aedes aegypti appeared to be the major vector in urban areas, but circumstantial evidence indicated that Aedes rotumae was a vector in at least one remote area. All forms of the clinical spectrum of dengue were seen and reported in all age groups. Overt clinical symptoms tended to be less frequent among children under age 10 and adults over age 30. Approximately 16% of persons reporting dengue-like illness had some type of bleeding associated with their disease with little difference by age, sex, or ethnic group. Epistaxis and gingival bleeding were the most commonly reported and observed hemorrhagic manifestations, but internal bleeding was reported in about 25% of hemorrhagic cases. The proportion of hemorrhagic cases was the same among primary and secondary dengue-infected persons. These and other epidemiologic observations did not support the hypothesis that the hemorrhagic complications seen with dengue occur only in secondary infections.


Antibodies to arboviruses in northwestern Spain. A survey for antibodies to arboviruses was done in the human population of the north of Spain (provinces of La Coruña, Orense, Pontevedra, Leon, Asturias). Sera were obtained from 701 persons living in the area. The hemagglutination-inhibition (HI) test showed that 16.5% of the population studied had antibodies to group B arboviruses. All sera were negative for group A and Phlebotomus fever group viruses, as well as for Tahyna and Calovo. No evidence of antibody to tick-borne encephalitis viruses was found. Neutralization tests done with several group B viruses on 56 selected sera with HI antibodies confirmed an earlier infection with West Nile and probably one other group B virus not included in the test battery. A high rate of antibody was found in young persons, indicating that epidemic activity occurred between 1961 and 1970 in the area studied.


Immune electron microscopy of arboviruses. Representative members of four arbovirus taxons were studied by immune electron microscopy (IEM) in an attempt to determine whether the technique can be applied to the specific identification of arboviruses. Alphavirus, flavivirus, bunyavirus, and rhabdovirus antigens were prepared by propagation in tissue culture. The viruses were used to titrate homologous antibody and test heterologous antibody in the IEM test. Specific clumping together with visualization of antibody attachment was observed for all homologous systems studied. For the alphaviruses, titers of antibody, as determined by IEM, were comparable with the titers obtained by hemagglutination inhibition. Alphavirus cross-reactions were observed at low antibody dilutions by IEM. However, further dilution of antibody resulted in specific clumping only of homologous virus, allowing specific identification of alphavirus unknowns. For all viruses studied, positive IEM reactions were obtained with homologous grouping ascitic fluids but not with heterologous grouping fluids.


Experimental infection of birds with epidemic Venezuelan encephalitis virus. Sixty-three birds representing 13 species were inoculated with a strain of epidemic Venezuelan encephalitis (VE) virus from the 1971 Texas outbreak. More than 95% of the birds became infected. Mortality which could be attributed to infection with VE virus was very low. Viremia persisted 2-6 days. Peak viremia levels ranged from 10(3.2) to 10(8.2) suckling mouse intracranial 50% lethal doses per milliliter (SMICLD50/ml). Blood virus levels were highest in juvenile Louisiana Herones, adult Robins and adult Mockingbirds and were lowest in juvenile Common Egrets. Most bird species had blood virus levels about 10(5) SMICLD50/ml (high vector infection potential) for 2-3 days. Neutralizing antibody response was more uniform and frequent in herons (95%) than in passerines (56%). The role of birds in the epidemiology of Venezuelan is discussed.


Viremia and antibody response to La Crosse virus in sentinel gray squirrels (Sciuris carolinensis) and chipmunks Tamias striatus). Six isolates of La Crosse (LAC) virus were obtained from sentinel gray squirrels (Sciuris carolinensis) and four from sentinel chipmunks (Tamias striatus) in an endemic area. Viremia titers were measured by plaquing on Vero cells. Antibody responses of the animals were measured by a microneutralization test employing four California group viruses: LAC, snowshoe hare (SSH), trivittatus, and Jamestown Canyon. In both species LAC antibody titers peaked at approximately 21 days and were still detectable in all animals at 256 days post-viremia. In chipmunks, homologous LAC virus antibody levels were consistently higher than heterologous antibody responses throughout the period recorded. However, in squirrels, homologous LAC virus and heterologous SSH virus antibody responses were initially comparable. This heterologous SSH titer rapidly declined while LAC antibody levels remained relatively high. Data indicate that antibody response persists from one summer season to the next. Viremia titers in both species indicate that these two species are capable of infecting Aedes triseriatus, the principal vector of LAC virus. This is the first reported field isolation of LAC virus from the squirrel.


Hepatic amebiasis: diagnostic counterimmunoelectrophoresis and metronidazole (flagyl) therapy. In an ongoing study of obscure fevers in Cairo, Egypt which is presently in its 6th year, 12 cases of hepatic amebiasis have been diagnosed. Three were diagnosed during the period 1971-1974. With the introduction of amebic serologic techniques, particularly counterimmunoelectrophoresis, nine additional cases have been diagnosed in 1975-1976. Of 9 patients treated with metronidazole 6 were rapidly cured, 2 had a recurrence of fever necessitating surgical drainage of the abscess, and 1 died suddenly on the 3rd day of therapy.


Tinidazole treatment of acute amebic dysentery in children. Tinidazole, a recent derivative of the nitroimidazole group of compounds, was able to achieve a cure in 96% of children with acute amebic dysentery when given in three single daily doses of approximately 60 mg/kg of body weight. At a dose of approximately 50 mg/kg the cure rate was only 76%. The drug was well tolerated and completely free from any toxic effects. Tinidazole can confidently be recommended as a very simple and safe form of therapy for amebic dysentery.


Extending the vascular examination by noninvasive means. The Doppler and phleborheographic technics are highly accurate and convenient methods of diagnosing acute deep venous thrombosis, which cannot be detected reliably by clinical examination. Extent of occlusive disease can be more quantitatively estimated by the Doppler method in the peripheral arteries of the limbs and by oculoplethysmography and phonoangiography in the carotid arteries. Noninvasive methods permit screening of patients suspected of arterial or venous disease and provide physicians with an objective means of assessing therapeutic results.


Doppler ultrasound and supraorbital photoplethysmography for noninvasive screening of carotid occlusive disease. Doppler ultrasound and supraorbital photoplethysmography were 95 per cent accurate in identifying or excluding significant carotid obstruction in 156 vessels of seventy-six consecutive patients undergoing arteriography. Plethysmography was more sensitive but less specific than Doppler ultrasound. These technics provide simple, rapid, and accurate detection of significant carotid occlusive disease.


Prospective screening for deep vein thrombosis in high risk patients. In 257 patients undergoing total hip replacement, gastric bypass for morbid obesity, major abdominal surgery, and major leg amputation, Doppler ultrasonic screening revealed only five instances of deep vein thrombosis. The present study suggests that Doppler screening of high risk patients is a useful alternative to routine anticoagulant prophylaxis of venous thromboembolic disease.


A surgical approach to lymphedema.

A surgical approach to lymphedema. An approach to the management of lymphedema of the extremity is described. Current surgical procedures for this condition are evaluated and it is emphasized that no cure for this difficult problem exists. Available data indicate that physiologically designed procedures which attempt to reconstruct lymph flow are unsuccessful. Currently, subcutaneous excision beneath skin flaps is the most desirable procedure.


Horseshoe and pelvic kidneys associated with abdominal aortic aneurysms. Preoperative recognitiion of horseshoe or pelvic kidney with abdominal aortic aneurysm greatly facilitates proper operative care of such patients. Operative management of three reported patients varied significantly, depending on complicated and anomalous blood supply to the kidney.


Femoral tibial-peroneal bypass: the lateral approach and use of glutaraldehyde-tanned umbilical vein. Access to the peroneal artery as well as to the anterior tibial artery can be accomplished by a lateral approach with fibular resection. The technic is described as well as the use of the glutaraldehyde-tanned human umbilical cord vein as a vascular prosthesis. The results using the latter have been extremely gratifying.


A technic for carotid thromboendarterectomy. An exacting technic for carotid thromboendarterectomy is described. Certain anatomic features and pitfalls are discussed along with specific instrumentation. Intraoperative use, insertion, and removal of the inlying carotid shunt are described.


Long-term follow-up of vena caval clips and umbrellas. Fifty-one consecutive cases of inferior vena caval interruption for documented pulmonary embolism are reported. Forty-four patients underwent transabdominal vena caval clipping  using the multichannel Adams-DeWeese clip, and seven critically ill patients were treated with vena caval umbrella. Operative mortality was 4 per cent. Only one patient developed edema attributable to clipping whereas postinterruption stasis sequelae were common after umbrella insertion. Vena cavography at six months and eight years demonstrated 85 per cent patency in the clip group and 16 per cent in the umbrella group.


Diagnosis and management of arterial mural thromboemboli. If ischemic lesions or cerebral dysfunction appear without obvious cause, aneurysm, stenosing, or ulcerative plaques in proximal arteries are suspected. Diagnostic methods are outlined. Treatment by removal of the embolic source is preferred and exclusion of the lesion and bypass is reserved for inacessible lesions or poor operative risks.


Detection of anticoagulation therapy failures in patients with venous thrombosis. Results of ultrasonic monitoring of venous patency and fibrinogen uptake testing were evaluated in ten patients with venous thrombosis receiving heparin therapy. Two propagating venous thromboses were detected 24 to 48 hours before massive pulmonary embolism developed, thus emphasizing the usefulness of these methods for detection of anticoagulation therapy failures.


The clinical use of fibrinolytic agents. Two fibrinolytic drugs, streptokinase and urokinase, have undergone extensive clinical evaluation in the past fifteen years. Current evidence suggests that these agents may become the drugs of choice in the treatment of certain patients with venous thrombosis and pulmonary embolism. The ultimate usefulness of fibrinolytic therapy in the treatment of thrombotic conditions other than venous thrombosis and pulmonary embolism has not yet been determined.