Macrocytic anemia, thrombocytosis and nonlobulated megakaryocytes: the 5q-syndrome, a distinct entity. The clinical, hematologic and histologic characteristics of six patients with refractory anemia with deletion of the long arm of chromosome No. 5 are described. These patients had a distinct hematologic picture with macrocytic anemia of mild to moderate severity, normal to low leukocyte count and increased platelet count. The long arm of chromosome No. 5 was deleted in the majority of bone marrow metaphases. The main cause of anemia was underproduction with decreased erythroid precursors in the bone marrow and no increase in peripheral blood reticulocytes. Two of five patients responded transiently to the administration of androgens. In vitro evaluation of the bone marrow growth pattern in semisolid agar culture system was performed in three patients and was found to be normal and distinct from that in patients with preleukemia. In a follow up of up to five years, no patient had changed hematologically and in none had leukemia developed. The 5q-syndrome is a distinct hematologic entity and probably more common than hitherto realized. This diagnosis may have therapeutic and prognostic implications.


Systolic time intervals in hypothyroidism: end organ function as a reflection of clinical status. Systolic time intervals (STI) were determined in 14 hypothyroid patients who did not have congestive heart failure or atrial fibrillation, and who were not taking cardiotropic drugs. Compared to normals, there was a significant decrease in the left ventricular ejection time (LVET) and there were significant increases in the pre-ejection period (PEP) and the PEP/LVET ratio. The prolongation of the PEP primarily reflected lengthening of the isovolumic contraction time. Serial recordings during thyroxine therapy in seven patients showed consistent changes in STI toward normal values. These results in hypothyroid patients complement our earlier data in hyperthyroid patients; they indicate that STI's are a sensitive measure of the heart as an end organ over the entire range of thyroid hormonal activity.


The relation between aerobic fecal and oropharyngeal microflora in hospitalized patients. The aerobic fecal and oropharyngeal bacterial flora was examined in 75 patients hospitalized, but not given antibiotics; in 70 patients given antibiotics during hospitalization and in 25 nonhospitalized controls. In all subjects, when first examined, normal throat flora were predominant. At the end of 21 days, however, a gram-negative bacilli became predominant in 17 (22.7%) of the Hospital Group and 33 (47.1%) of the Antibiotic Group. Newly appearing genera of gram-negative bacilli in the pharynx were almost always represented those present in the fecal flora. The Hospital Group all had recognizable components of the normal oropharyngeal flora present at 21 days, but 12 (17.1%) of the Antibiotic Group had no demonstrable normal oropharyngeal flora at 21 days. The findings suggest that hospitalization alone can be associated with the appearance of gram-negative bacilli in the oropharynx, and that the intestinal tract is their most likely point of origin.


Endotoxin shock in the beagle dog.

Endotoxin shock in the beagle dog. The hemodynamic and metabolic responses to endotoxemia were assessed in seven splenectomized, chronically instrumented, conscious but lightly sedated beagle dogs. Measurements included: cardiac output (CO), right and left atrial pressures (RAP, LAP), systemic and pulmonary arterial pressures (SAP, PAP), and heart rate (HR). Arterial blood samples were measured for blood gas tensions, pH, lactate, and pyruvate. After a brief control period, 1 mg/kg endotoxin (Difco 026:B6) was given as an intravenous bolus. Two hours later, each animal was treated with low-molecular weight dextran (LMDX), 2 ml/kg/min for 15 minutes. Endotoxin initially produced a precipitate decline in CO, HR, RAP, LAP, and SAP with concurrent pulmonary hypertension; both pulmonary and systemic vascular resistance increased significantly, then declined to control values as the animal partially recovered. A progressive metabolic acidosis with excess lactate accumulation developed. LMDX produced a significant increase in CO, SAP, PAP, and LAP with a decrease in HR; RAP increased slightly. With hydration, hemodilution was noted along with relief of the metabolic acidosis and the oxygen debt. We conclude (1) neither pulmonary nor systemic vasconstriction persisted in the shocked dog, (2) the response of the pulmonary and systemic vascular beds to endotoxin was qualitatively similar, and (3) oncotic fluid therapy appeared to restore the hemodynamic and metabolic parameters to preshock values.


Severe dysplasia and carcinoma in situ of the vagina. Papanicolaou smears for early detection of carcinoma in situ of the cervix has been a well-recognized method of screening patients for over 30 years. The necessity for Papanicolaou smears following hysterectomy, especially for benign disease, has been a controversial subject. Twenty-two cases of carcinoma in situ of the vagina, over a period of 18 years, at the Huntington Memorial Hospital in Pasadena, California, are presented. Ninety-five percent of the lesions were first suspected by use of the Papanicolaou smears. Approximately half of previous hysterectomies were performed for benign disease. The various methods of treatment employed and the complications in these patients are discussed.


Aspects of folate metabolism in lactating women studied after ingestion of 14C-methylfolate. Radioactive methylfolate (14C-5CH3H4PteGlu) (10-14 microgram/kg) was fed to four lactating women presenting with breast abscesses necessitating cessation of lactation. The appearance of radiofolate in milk, plasma and urine over the next 24 hours was investigated. In spite of a minimal postabsorption rise of plasma biofolate, plasma radiofolate (including a dialysis-resistant (bound) fraction) increased steadily to 1.26 to 5.11 microgram/l at 24 hours. Urinary radiofolate excretion was considerable. Total milk biofolate rose significantly by 15 to 28 microgram/l, in contrast with a much smaller radiofolate fraction (1.95-3.88 microgram/l) which at 24 hours was comparable with that of plasma. Milk radiofolate included a dialysis-resistant fraction rising to 0.75 to 1.15 microgram/l at 24 hours. On chromatography (Sephadex-DEAE-A50) plasma, urine and milk showed a nonbound radiofolate peak suggestive of 10-CHO.H4PteGlu. This folate may originate predominantly from the apocrine mammary glands. The in vitro labelled radiofolate milk binder could not be identified chromatographically, but it was shown that the in vitro milk binders of PteGlu and 5CH3H4PteGlu could be separated chromatographically.


Does adoption affect subsequent fertility? A hypothesis derived from the old wives' tale that adoption increases subsequent fertility was tested by analysis of follow-up data obtained from 895 couples who were "at risk" of pregnancy and of adoption after they had registered in the Stanford Infertility Clinic between 1963 and 1977. Of the 767 couples who did not adopt, 329 later conceived; of the 128 who did adopt, 41 later conceived. Simple comparison of the percentages or, indeed, of the life tables suggests reduced fertility after adoption. However, this is probably a spurious effect related to a number of factors which differ between two groups. These differences were controlled in the statistical analysis by methods which take into account the length of time each couple was at risk of either conception or adoption and the presence or absence of explanatory variables. The relative risk of conception estimated by the Cox model was not significantly different from 1 and the Mantel-Haenszel statistic (m = 0.208) indicates no significant difference in subsequent conception rates between adoptive and not-adoptive couples. The same methods were used to control for seven covariates, including age and duration of infertility, which could affect conception rates. In each instance, the estimate of relative risk of conception for adoptive versus not-adoptive couples was not significantly different from 1. Therefore, our data do not support the hypothesis that adoption affects subsequent fertility.


Bilateral internal iliac artery ligation in cervical pregnancy: conservation of reproductive function. Like other forms of ectopic gestation, cervical pregnancy is a serious complication with potentially life-threatening consequences. Excessive bleeding almost invariably follows an attempt to evacuate this rare ectopic pregnancy. In most reported cases, hysterectomy has been required to control the severe hemorrhage. This paper reports for the first time the successful conservative management of cervical pregnancy in two patients by bilateral internal iliac artery ligation alone. Early recognition of the cervical pregnancy and prompt internal iliac artery ligation are stressed.


Renin-angiotensin-aldosterone system, electrolyte homeostasis and blood pressure in alloxan diabetes. The effect of a chronic glucose osmotic diuresis on electrolyte homeostasis was evaluated in alloxan diabetic rats with urine volumes greater than 150 ml/day and glycosuria of 4 to 10 gm/day. Results were compared with control rats for periods up to 84 days. Sodium and potassium intake and urinary losses were significantly higher in diabetic animals throughout the study periods. Negative Na balance, however, persisted for only four days, and negative K balance for only 18 days. Blood volumes were elevated probably secondary to the osmotic effect of hyperglycemia (serum glucose greater than 600 mg %). Plasma renin activity decreased progressively, in part because of an early decrease in renin substrate at a time when renin concentration was normal. Despite hyperkalemia, mean plasma aldosterone was not increased compared with that in control rats, suggesting diabetic rats had relative hypoaldosteronism. Although three diabetic rats became hypertensive, no significant difference in mean blood pressure was observed between the groups. The results suggest that diabetic rats have losses of Na and K early in their diabetes, following which mechanisms to conserve Na and K are activated preventing further electrolyte depletion despite continuation of the osmotic diuresis. Decreased renin activity with inadequate stimulation of aldosterone would contribute to K conservation. Maintenance of Na balance must be explained by increased Na intake and other renal Na conserving mechanisms.


Vasa previa.

Vasa previa. An active obstetric service can expect to have one perinatal death each year due to vasa previa. Unfortunately, little has been done to improve the diagnosis and treatment of this condition, which presents no risk to the mother but is often fatal to the fetus. The various clinical pictures which can be associated with vasa previa are presented, along with a discussion of the techniques readily available for making the diagnosis: palpation and visualization, amnioscopy, fetal heart monitoring, and various tests for the presence of fetal hemoglobin.


Cephradine in the treatment of infective endocarditis. Ten patients with a mean age of 34.1 years with infective endocarditis (55% of cases due to Staphylococcus aureus) were treated with cephradine. The peak serum levels of cephradine (8-42 microgram/ml) were 3- to 17-fold higher than the minimum inhibitory concentrations of cephradine against pathogenic strains of S aureus (1.2-4 microgram/ml). Patients treated with cephradine became afebrile in 2 to 13 days of therapy, and their white blood cell count returned to a normal level in 3 to 30 days. Cephradine therapy was well tolerated without any incidence of phlebitis. The drug could be administered by three different routes. Cephradine is a useful cephalosporin for treatment of nonenterococcal gram-positive endocarditis in young heroin addicts.


Cholelithiasis in sickle cell anemia: a case for elective cholecystectomy. Ten patients with sickle cell anemia over the age of 10 who had cholecystectomy are reported. All had symptomatic cholecystitis; three had biliary tract obstruction. Transfusions were given preoperatively and with attention to oxygenation and fluid and electrolyte balance. There were few complications, none serious. Based upon the frequency of gallstones over the age of 10, the likelihood of symptoms or serious complications and the apparent ease with which the properly prepared sickle cell patient comes through surgery, we recommend routine cholecystograms in all adolescent and adult sickle cell anemia patients with elective cholecystectomy for those who have stones.


Pregnancy complicated by diabetes mellitus in private practice: a review of ten years. Two hundred private diabetic patients delivered of their infants (202) in a private hospital were evaluated for a 10 year study period (1968 to 1977). There were no maternal deaths. An 88% overall survival rate of viable infants compared favorably with that of other reported series. Analysis of each of the 10 years demonstrated marked changes in management and consequent changes in fetal survival, morbidity, and mortality rates. No neonatal deaths occurred during the last 3 years of the study period and the mortality rate in viable infants was 6.8%. There has been no significant temporal change in the incidence of toxemia or hydramnios. Fifteen stillbirths and ten neonatal deaths were analyzed to identify significant factors or parameters. Attention is directed to sex ratios (male:female) of 3:1 for stillbirths and 3:2 for infants affected with respiratory distress syndrome. Conservative use of accessory testing and antepartum hospitalization was obvious. The question of the necessity for expensive and intensive regimented institutional management is addressed. A minimum management regimen is proposed to be used in conjunction with the private obstetrician's clinical judgment and expertise.


Urinary tract endometriosis: enigmas in diagnosis and management. The diagnosis and management of endometriosis presents several enigmas. This review, of eight patients with endometriosis involving the urinary tract, from three large clinical services in the City of Los Angeles, highlights some very difficult problems. Not only diagnostic errors but also inappropriate conservatism and inadequate surveillance have led to compromised function, resection, and/or destruction of the kidneys, ureters, or bladder. The series indicates those findings which are likely to result in urinary tract destruction and points out those clinical situations in which delays or conservative management must be undertaken only with pressing indications and then only with continued and careful surveillance.


Maternal deaths associated with postpartum vulvar edema. Reported are three maternal deaths in four patients who presented with a similar syndrome following a normal antepartum course and normal labor and delivery managed by regional or local anesthesia and midline or proctoepisiotomy. Beginning about the second postpartum day, the patients developed unilateral perineal edema and induration which progressed to generalized vulvar, vaginal, perineal, and gluteal edema and induration. These patients developed marked leukocytosis, fever, and ultimately vascular collapse; three of them died. The one patient who survived had a similar course except for vascular collapse. Unilateral vulvar induration and edema associated with fever and marked leukocytosis are ominous signs. Aggressive treatment should include the use of multiple antibiotic, crystaloid, colloid, and steroid drugs and appropriate monitoring. By this report we hope to bring attention to this rare but lethal syndrome.


A study of endocrine and metabolic variables in postmenopausal women with endometrial carcinoma. Although an underlying endocrine-metabolic disorder has been implicated as causally related to the development of endometrial carcinoma, data to support such an association are ambiguous and/or contradictory. In this prospective study of 16 consecutive nonobese postmenopausal women with endometrial carcinoma and 16 cancer-free postmenopausal women matched for age and weight, fasting values for growth hormone (GH), insulin, prolactin, follicle-stimulating hormone, luteinizing hormone, estrone (E1), and estradiol (E2) were measured on 3 consecutive days. Intravenous glucose tolerance, pituitary GH release in response to arginine infusion, hyperglycemia, and hypoglycemia, and insulin secretion in response to arginine infusion and to hyperglycemia were analyzed. Our data show that these endocrine-metabolic profiles were not significantly different between the cancer patients and control subjects, suggesting that the postmenopausal women with endometrial cancer who is not obese exhibits no accountable endocrine or metabolic disorders.


Delivery of the tiny newborn.

Delivery of the tiny newborn. Obstetric factors related to the survival of 100 newborn infants weighing between 800 and 1,350 grams were analyzed. Available data suggest that maternal intrapartum antibiotic and steroid administration and delivery by classical cesarean section are associated with increased newborn survival.


Squamous carcinoma of the vulva: results of treatment, 1938 to 1976. Clinical data on 264 patients with squamous cell carcinoma of the vulva seen between 1938 and 1976 are reported. Two hundred and four patients were "eligible" for 5 year assessment for a 55% survival rate. Patients treated with radical vulvectomy and bilateral lymphadenectomy had a corrected 5 year survival rate of 86% if the lymph nodes failed to show metastatic disease. Twenty-eight percent of the patients treated with lymphadenectomy had lymph node metastasis at the time of surgery. The presence of lymphatic metastasis appeared to be the most significant prognostic factor. The results obtained have led to a degree of individualization in current treatment policies, together with a re-evaluation of the possible role of radiotherapy.


The value of intravenous urography prior to abdominal hysterectomy for gynecologic disease. Negligence and failure to "test timely" are the two most common charges in obstetric and gynecologic malpractice suits. Both charges are often made in cases involving urinary tract injury during gynecologic surgery. These injuries occur most commonly during abdominal hysterectomy. This report is a 6 year study of 170 consecutive abdominal hysterectomies to ascertain the value of routine preoperative urography in preventing urinary tract injuries. As a control, 260 consecutive abdominal hysterectomies were performed without preoperative urography. There was one ureteral transection in the control group, but unrecognized urinary tract injuries did not occur in either the study or control group. The risks, costs, and benefits of urography are analyzed.


Office termination of pregnancy by "menstrual aspiration". A program of office menstrual aspiration was initiated in our institution in 1972. Since that time 1,443 patients have been admitted into the study. These patients were evaluated by age, marital status, gravidity, repeat pregnancy terminations, complications, and detailed tissue analysis as well as contraception utilized at the time of conception and following counseling after the procedure. A majority of these patients were less than 25 years old and single; 28% had had a previous termination and 51% a previous pregnancy. Pathologic evaluations revealed Arias-Stella reaction in 78%. When these data were compared to those of a similar group of women whose pregnancies were terminated in the hospital by suction curettage, it was found that the office procedure is comparatively safe and should therefore be the therapy of choice.


Pretreatment lymphangiography and operative evaluation in carcinoma of the cervix. Ninety-five patients with cervical carcinoma who were not candidates for definitive operation underwent initial lymphatic and 24-hour nodal phase lymphangiography and lymphadenectomy prior to radiation therapy. Operation by a transperitoneal or extraperitoneal approach consisted of bilateral pelvic and periaortic lymphadenectomy, exploratory laparotomy, and intraperitoneal biopsies as indicated by the findings. Radiation therapy was modified to include proved sites of metastases. Intestinal injuries followed transperitoneal operation and radiation therapy but were uncommon in patients in whom exploration was done by the extraperitoneal route. Eighteen patients (19%) had unsuspected metastases to common iliac or periaortic lymph nodes identified at operation. The characteristics of the primary tumor and the interpretation of the lymphangiogram provided an inaccurate basis on which to modify treatment. As further studies confirm the risk of disseminated disease in those patients with metastases to common iliac and the periaortic lymph nodes, future treatment plans might incorporate adjuvant chemotherapy or immunotherapy in addition to extended-field irradiation.


Evaluating student performance in an obstetrics and gynecology clerkship. The development of a comprehensive evaluation system for an obstetrics and gynecology clerkship at the Unviersity of Utah is described and the results of two years experience using it are presented. Seven different measurement procedures were developed and used with 111 junior medical students including pre- and post-tests, oral examination, clinical performance ratings by residents, and ratings by faculty on oral and written presentations and participation in tutorial sessions. Learning gains as measured by pre-post test scores were significant at the 0.001 level. Only six of 37 correlations among the evaluation measures were significantly related at the 0.01 level; furthermore, little relationship could be found between measures of student achievement in cognitive as compared to clinical skill areas. The need for multiple sources of information on student performance in clerkships is discussed.


A comparison of clindamycin-gentamicin and penicillin-gentamicin in the treatment of post-cesarean section endomyometritis. A random comparison of clindamycin-gentamicin (C-G) and penicillin-gentamicin was made in 200 women who developed endomyometritis following cesarean section. All pretreatment profiles indicated similar populations. The clinical response was more favorable in the women receiving clindamycin-gentamicin. The implications of these results upon clinical practice is discussed.


Effects of magnesium sulfate treatment on perinatal calcium metabolism. I. Maternal and fetal responses. Serial maternal and cord blood determinations of the ions and hormones involved in calcium homeostasis were made in pre-eclamptic women treated with intravenous magnesium sulfate. A 4 gm loading dose followed by 1 to 2 gm/hr caused maternal serum magnesium concentrations to rise 150%, to levels of 3.3 to 4.5 mEq/L, and ionized calcium levels to fall 16%, to 1.89 mEq/L. The hypocalcemia etly altering calcitonin. Changes in total calcium paralleled those of ionized calcium; phosphorus levels were not affected by magnesium infusion. At the time of delivery the offspring of these women were hypermagnesemic and relatively hypocalcemic, although less so than their mothers. Fetal ionized calcium levels, although lower with magnesium treatment than in control subjects, were within the lower limits of the normal range, which perhaps explains why the fetus did not respond with increased PTH or decreased calcitonin output. These results indicate that the principal maternal response to magnesium-induced hypocalcemia involves increased parathyroid hormone secretion which tends to preserve maternal calcium homeostasis, while the fetus is partially protected from hypermagnesemia and hypocalcemia by the placenta.


Human polymorphonuclear leukocyte phagocytosis in pregnancy. Development of inhibition during gestation and recovery in the postpartum period. The phagocytosis of S. aureus by normal human PMN leukocytes was inhibited by pregnancy serum. Control sera from normal adult nulliparous women, from men, and from cord blood all functioned normally in support of phagocytosis. However, particle ingestion was reduced significantly (p less than 0.001) when leukocytes were in 15% pregnancy serum obtained at term. To determine at what stage in pregnancy the inhibition of phagocytosis could first be detected, sera were obtained from multiple pregnant donors and pooled according to week of gestation. Significantly fewer bacteria were ingested in each of the serum pools obtained after week 16 of pregnancy and the inhibitory effect persisted through gestation. Following delivery, less inhibition was detected as early as 2 days post partum. Phagocytosis assays were performed in six matched maternal and cord serum pairs. Five of the six maternal sera showed inhibition of phagocytosis; one pregnancy and all cord sera functioned normally in support of bacterial ingestion by normal granulocytes. Since neutrophils are essential to the development of rheumatoid arthritis and certian other inflammatory disorders, the subsidence of these diseases during gestation and their exacerbation post partum could be related, at least in part, to the inhibitory effects of pregnancy serum on leukocyte functions.


Laminaria use in midtrimester abortions induced by intra-amniotic prostaglandin F2alpha with urea and intravenous oxytocin. A laminaria tent was used as an adjunct during midtrimester abortion to attempt to shorten the injection-abortion interval without adversely affecting the frequency of infection, hemorrhage, failed abortion, or cervical laceration. Eighty patients, between 14 and 20 weeks' gestation and desiring pregnancy termination, were randomized into three groups. Abortion was initiated by an intra-amniotic infusion of 20 mg of prostaglandin F2alpha and 80 gm of hyperosmolar urea in Ringer's lactate (135 ml total volume), followed by oxytocin infused intravenously at 333 mU/min. Group I (N = 28) received no additional therapy; Group II (N = 23) had laminaria placed at the time of the abortifacient injection and removed 4 hours later; Group III (N = 29) had laminaria placed 4 hours prior to inejction and removed at the time of injection. The injection-abortion intervals in these three groups were 17.76, 20.80, and 12.96 hours, respectively. This study illustrates that a laminaria tent palced 4 hours prior to injection is significantly more effective than a laminaria tent placed at the time of injection, and produces a shorter mean injection-abortion interval than that in patients receiving no laminaria. Furthermore, laminaria augmentation results in no demonstrable increase in the frequency of serious complications.


13, 14-dihydro-15-keto-prostaglandin F2alpha concentrations in human plasma and amniotic fluid. An antiserum to 13,14-dihydro-15-keto-prostaglandin F2alpha (PGF2alphaM) was prepared and a radioimmunoassay evaluated in various reproductive states. PGF2alphaM plasma concentration was 63.6 +/- 10.3 pg/ml (mean +/- SEM) in cycling women. The concentration fluctuated throughout the menstrual cycle and pregnancy, but no discernible patterns were noted. PGF2alphaM concentrations were elevated at the time of urea + oxytocin induced abortion (238 +/- 54 pg/ml) and during late stages of normal labor (352 +/- 107 pg/ml) but were not elevated during labor prior to 7 cm dilatation. Following intra-amniotic instillation of 5 mg of PGF2alpha tromethamine into the amniotic sac, PGF2alphaM concentration increased in the amniotic fluid. In the plasma of these patients there was an eighteenfold rise in plasma PGF2alphaM concentration compared to a 3.5-fold rise in PGF2alpha at 1 hour, suggesting changes in PGF2alphaM may be more easily detected than the parent compound. While PGF2alphaM may be a useful index of PGF2alpha production, it appears that PGF2alphaM is of little value in predicting the occurrence of uterine contraction.


Effect of maternal glucose load on fetal activity. The effect of a MGL upon fetal activity has been studied in 39 normal and 54 high-risk pregnant patients between 30 and 42 weeks' gestation. The perinatal morbidity and mortality rates were significantly lower in the group showing an increase in fetal activity following a MGL. It is suggested that this may be useful for identifying the fetus at risk.


Relationship of fetal bradycardia to maternal administration of lidocaine in sheep. The casual relationship between the use of lidocaine and fetal bradycardia and the effect of the drug on maternal and fetal hemodynamics were studied on 13 chronically instrumented pregnant sheep. Lidocaine was infused intravenously to the mother for 60 minutes during arterial lidocaine concentrations were maintained at 2 to 5 microgram per milliliter in the mother and at less than 2 microgram per milliliter in the fetus. A decrease in uterine blood flow and an increase in uterine vascular resistance and uterine activity occurred immediately following the administration of lidocaine to the ewe. These changes were followed by a transient fetal bradycardia in 12 out of 17 experiments, accompanied by a decrease in fetal PaO2 values. These phenomena were seen in the absence of such predisposing conditions as maternal hypotension and fetal acidosis. It would appear that the mechanism responsible for a transient fetal bradycardia following regional obstetric anesthesia, particularly paracervical block anesthesia, in the initially nonasphyxiated fetus may in part be related to a brief decrease in perfusion of intervillous spaces. The bradycardia can occur at low lidocaine concentrations in both the maternal and fetal blood in a range similar to that observed in clinical practice.


Studies on the cytodynamics of human endometrial regeneration. III. In vitro short-term incubation historadioautography. The proliferation kinetics of endometrial regeneration were assessed by tracing nucleoprotein precursor, radiothymidine. Increased isotope uptake occurred by cycle day 3 and was confined to the gland cells of denuded stratum basale (basal layer) and persistent uterine lining, bordering peripheral areas of denudation. This increase resulted in the formation of flattened surface epithelial cells, which initially were devoid of significant deoxyribonucleic acid synthesis. Such alterations are consistent with changes in cells involved in ameboid migration. Maturation of migrating cells was accompanied by a significant rise in labeling indices and replication at cycle days 3 and 4. By cycle day 5, endometrial repair was complete. The findings indicate that, following physiologic loss of stratum functionale, endometrial healing involves both migration and replication of surface cells, which originate from the gland stumps of the residual basal layer and the persistent surface epithelium adjacent to the periphery of denuded endometrium.


A syndrome characterized by recurrent symptomatic functional ovarian cysts in young women. A syndrome characterized by the persistent recurrence of symptomatic functional ovarian cysts, elevated plasma estradiol levels, and infertility in four young patients is described. Two of the patients experienced recurring ovarian cysts following total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pathologic findings confirmed the presence of ovarian tissue in all cysts. Recurrent cysts formation is attributed to either an increased production of gonadotropins or a hypersensitive response to normal gonadotropins. The development of recurrent cysts following bilateral oophorectomy indicates that some ovarian or "ovarian-like" tissue is present within the pelvic cavity, anatomically unrelated to the normally positioned ovaries. This extraovarian tissue may become sensitive to circulating gonadotropin levels in the absence of normal ovarian tissue. The source of this extraovarian tissue is discussed from an embryologic standpoint.


Ovum transport in women treated with methyl ergonovine. The location of ova in the genital tract was studied between 24 and 120 hours after the luteinizing hormone (LH) surge in 32 women who had been treated with methyl ergonovine in doses known to stimulate tubal contractility. Thirteen eggs were found in the fallopian tubes, between 48 and 120 hours after th LH peak, and no eggs were recovered from the endoemtrial cavity. No significant difference in tubal ovum recovery or in tubal segmental distribution of ova was found in comparison with these parameters in an untreated control group. These results indicate that stimulation of tubal contractility with methyl ergonovine does not accelerate ovum transport through the fallopian tubes in the human.


Ultrasound in the diagnosis of congenital anomalies. With high-resolution ultrasound equipment, it is now possible to diagnose certain fetal anomalies in the third trimester and in some cases before the twentieth week of gestation. During a 27 month period 2,548 ultrasound scans were performed in high-risk patients. An anomaly was diagnosed in 10 of 122 second-trimester patients who were at risk for recurrent fetal defects. Fetal deformity was also found in 26 third-trimester patients. Of the 2.8% of patients found to have polyhydramnios 18% were associated with various types of anomaly. With ultrasound it was possible to examine internal fetal anatomy and to identify abnormalities of the fetal cranium, spine, chest, abdomen, and limbs. These anomalies are reviewed here in detail. Based on ultrasonically derived information, second-trimester patients can be offered information concerning the status of their fetuses at risk genetically and physicians can better manage third-trimester patients with diagnosed fetal deformities.


Deformation and creep in the human chorioamniotic sac. This paper presents a review of physical principles involved in deformation and creep in the human chorioamniotic membrane. These are definable rheological properties found in many materials. Experimental data are presented on 66 human fetal membranes. A difference in the stress tolerance between preterm and term membranes is demonstrated. A computer model has been devised which allows for the calculation of changes in thickness of the membrane at the point of fracture. This computer model allows for the study of the physical property of the tissue in ways which have not previously been suggested. The model suggests that the pathophysiology related to rupture of the membrane is based on changes in the thickness of this tissue occurring secondary to acute and chronic stress applications. The data derived in these experiments suggest a possible physical model for rupture of the membranes; they also introduce questions regarding the anatomic and biochemical makeup of the chorion and the amnion and the respective role that each plays in maintaining the integrity of the human chorioamniotic sac.


Management of prolonged pregnancy: results of a prospective randomized trial. Prolonged pregnancy was rigorously defined in 180 gravid women without other complications. Patients were randomly assigned to be serially followed, either by amniocenteses or by oxytocin challenge tests (OCT's). Induction of labor, based upon only (1) a finding of meconium in the amniocentesis group or (2) a positive test in the OCT group, was nearly three times more frequent in the amniocentesis group. The incidence of meconium, which overall was 22% initially and 44% at delivery, as well as the frequencies of obstetric and perinatal complications, were similar in both management groups. Although meconium was significantly associated with abnormal labor progression, intrapartum fetal distress, and low 1 and 5 minute Apgar scores, induction of labor after discovery of meconium, when compared to nonintervention, did not improve perinatal outcome. It is concluded that a search for meconium is of little value in the management of prolonged pregnancy.


Female sex hormone receptors and their importance in clinical practice. We now know a great deal about the early steps in the induction of a steroid hormone response at the cellular level. This helps to explain some of the observed clinical responses and also the development of some congenital anomalies. The importance of progesterone as a balance to the proliferative effects of extrogen both in hormone replacement therapy and in the hormone-sensitive tumors is clear. It is hoped that further studies will guide us to ways in which we might enhance these benefits.


Cesarean hysterectomy: a twenty-five-year review. This article analyzes cesarean hysterectomies performed at Louisville General Hospital on clinic patients for the 25 year period 1953 through 1977. During this time there were 63,259 deliveries, of which 2417 were cesarean sections and 149 were cesarean hysterectomies. Twenty-six of the latter were classified as emergency operations done for urgent medical indications; in the remaining 123 patients the indications were elective to some degree. Operative and postoperative complications and morbidity are discussed, and changing trends regarding the place of cesarean hysterectomy in obstetrics over the years are evaluated.


A controlled trial of the differential effects of intrapartum fetal monitoring. A controlled prospective study of the differential effects of intrapartum fetal monitoring on mothers and infants has been conducted at Denver General Hospital, Denver, Colorado. A total of 690 high-risk obstetric patients in labor were randomly assigned to one of three monitoring groups--auscultation, electronic fetal monitoring alone, or electronic monitoring with the option to scalp sample. There were no differences in immediate infant outcomes in any measured category (Apgar scores, cord blood gases, neonatal death, neonatal morbidity, nursery course) among the three groups. There were no differences in rates of infant or maternal infections. The cesarean section rate was markedly increased in the electronically monitored groups, especially in the electronically monitored alone (18%) as compared with the auscultated (6%) (P less than 0.005). In this controlled trial electronic monitoring did not improve neonatal outcomes and the mothers were at increased risk of cesarean section.


Perinatal deaths in twin pregnancy. A five-year analysis of statewide statistics in Missouri. Analysis of computer-stored State of Missouri birth and death records over a 5 year period revealed 3,594 twin pregnancies (1.02% of all pregnancies), which accounted for 10.1% of the perinatal deaths. The mean birth weight according to weeks of gestation was computed for the pregnancies with no complications noted prior to labor and the perinatal mortality rate was determined. Complications of pregnancy were evaluated. Low birth weight appears to be the major factor in the elevated perinatal death rate in twin pregnancy, with a significant elevation of the perinatal death rate noted with labor prior to 36 weeks, any episode of hemorrhage, or premature rupture of membranes. A more liberal use of cesarean section currently shows no effect in altering the perinatal mortality rate. Programs are suggested to increase early detection and appropriate consultation and referral of multiple pregnancies in a statewide comprehensive effort to decrease the perinatal mortality rate in twin pregnancy.


Ultrasonic evaluation of the fetal heart. A report of experience and anatomic correlation. Identification of fetal intracardiac structures in utero is accomplished with B-scan, gray-scale ultrasonography. Sagittal and transverse ultrasonographs of the interventricular septum, aortic root, tricuspid, and mitral valves are presented. These structures are characterized with respect to their relations to each other, atrial and ventricular chambers, and acoustic appearances. Correlation of these cardiac structures is made with gross anatomic fetal specimens sectioned in longitudinal and transverse planes. Recognition of fetal intracardiac detail may be of aid in future noninvasive investigations of human fetal cardiovascular dynamics.


Ten-year review of hysterectomies: trends, indications, and risks. This report concerns the indications, morbidity, and death associated with 6,435 consecutive abdominal and vaginal hysterectomies at Hutzel Hospital during a 10 year period. There was an extraordinary number of high-risk patients included in this group. Morbidity and postoperative bleeding were more common following vaginal rather than abdominal hysterectomy. These complications were also more common when the operation was performed during the proliferative phase of the menstrual cycle. There were 17 deaths. Thromboembolic complications were the major cause of death. Selective use of prophylactic antibiotics and low-dose heparin and reduction in the number of blood transfusions by preoperative endocrine and hematinic therapy may reduce the postoperative morbidity and mortality rates. Probably few operations will ever contribute as much to improving the quality of life of women as do indicated hysterectomies. However, the added risk do not seem to justify utilizing this operation for the sole purpose of sterilization in preference to simpler and safer procedures.


Unsuspected subclinical pregnancies in patients with luteal phase defects. Patients with different types of luteal phase defects were studied with the use of the radioimmunoassay for the beta subunit of human chorionic gonadotropin (hCG) to determine if unsuspected subclinical pregnancies were more common in a particular type of defect. A type I luteal phase defect is always characterized by a chronologic lag in endometrial development when repeatedly studied with timed endometrial biopsies. A type II luteal phase defect is always characterized by an in phase endometrium when repeatedly studied by timed endometrial biopsies but always has less than a 14 day luteal span. All blood samples were drawn at least 7 days after ovulation/conception. In 22 cycles in which patients had a type I luteal phase defect, no subclinical pregnancies were detected. In 18 cycles in which a type II luteal phase defect was present, 12 instances of unsuspected subclinical pregnancy were detected and all ended in spontaneous abortion. This study shows that unsuspected subclinical pregnancies ending in abortion do occur and are quite commonly associated with the type II luteal phase defect.


Stage I squamous cell cancer of the vulva. A review of 106 patients with Stage I squamous cell cancer of the vulva treated at the Mayo Clinic from 1950 through 1975 is presented. Microinvasive lesions (5 mm penetration or less) were present in 96 patients (91%); invasive lesions (more than 5 mm penetration) were diagnosed in 10 (9%). Inguinal node involvement was present in nine patients (8.4%); one of these also had pelvic node involvement. Recurrence developed in 13 patients (12%). Four patients experienced inguinal node metastasis after initial surgical therapy. The incidence of positive nodes among patients with lesions invading the stroma for 3 mm or less was 3%. Thus, individualization for inguinal lymphadenectomy may be possible according to the age and condition of the patient when the depth of invasion is 3 mm or less.


The nonstress test for the antepartum assessment of fetal reserve. Seven hundred and twenty-two nonstress tests (NSTs) that were performed on a total of 471 patients were reviewed. The results of the study suggest that the NST is a simple, reliable test as a primary screening procedure in antepartum fetal heart rate (FHR) monitoring. The active and reactive tests were indeed reliable indicators of fetal well-being while the nonreactive test required an additional discriminatory evaluation. A tentative classification is suggested for those cases with FHR decelerations associated with fetal activity and uterine contractions.


A radioreceptor assay for human chorionic gonadotropin in normal and abnormal pregnancies: a clinical evaluation. The human chorionic gonadotropin-radioreceptor assay (hCG-RRA) offers a rapid and accurate method of diagnosing early and abnormal pregnancies. Such a method is described along with clinical correlations in 139 assays done on 122 patients with amenorrhea, normal pregnancies, infertility, trophoblastic disease, ectopic pregnancies, and missed or incomplete abortions. The accuracy of the test is correlated with weeks of amenorrhea, weeks after ovulation, and clinical diagnoses. The overall accuracy of the assay was 95%. Those performed more than 28 days after the last menstrual period had an accuracy of 96.4%. There were no errors in the diagnosis of eight ectopic pregnancies among 33 suspected cases. Three patients are described who had serial changes from negative to positive early in pregnancy, providing data on precise timing of a positive result. Cases of missed abortion sometimes demonstrate a positive hCG-RRA after documented fetal loss. Recommendations for the most appropriate use of the hCG-RRA are presented based on the clinical experience at one referral center during the period January, 1977, to June, 1978.


Social problems of women patients in a private obstetrics and gynecology clinic. Patients present or exhibit problems other than physical ones to their physicians and need access to some type of assistance for them. Over a 1 year period, women patients were referred to and seen by the medical social worker employed by a private obstetrics and gynecology clinic. Their social problems were studied by content analysis of patients' records, patients' social services cards, and monthly social services summaries. Results showed that 163 women exhibited 288 social problems consisting of three major types, financial, marital, and emotional. Various relationships were shown between the type of social problem and the primary reason the patient visited the clinic. It was also shown that if a patient has a financial problem, she is more likely to have a greater number of social problems than are other patients.


One-way maternal transport: an evolving concept. Inpatient services. Transporting the high-risk pregnant woman to a tertiary center prior to labor or delivery, in an attempt to offer more intensive care to the patient and her infant, has gained increasing support from medical communities over the past few years. Because of this concept, tertiary centers need to be actively involved in the organization of these transport systems and to be certain that all members of the perinatal team at the referring as well as the receiving center are kept informed of events. This paper describes how Vanderbilt University Hospital initiated an acitive one-way maternal transport system and how that system is maintained and reviews the first 176 patients treated under that system. Establishing direct lines of communication between the practicing physician and the tertiary center and emphasizing continuing education at all levels seem to be important aspects in the development and maintenance of such a referral system.


Induction of labor following intrauterine death with intra-amniotic hyperosmolar urea and prostaglandin F2alpha: evaluation of placental endocrine function and changes in coagulation parameters. A practicable and reliable method for inducing labor in patients whose pregnancies are complicated by intrauterine death of the fetus is described. The method involves the intra-amniotic instillation of 30 mg of prostaglandin F2alpha with 60 gm of urea. Twenty patients had pregnancies ranging between 22 and 41 weeks and the estimated duration of fetal death ranged between two and eight weeks. Delivery was achieved within 24 hours in all cases. Side effects and complications were minimal. Plasma human placental lactogen (hPL) and progesterone concentrations, as well as several blood coagulation parameters (i.e., plasma fibrinogen, blood platelet count, and serum fibrin degradation products (FDP) concentrations), were measured immediately prior to induction of labor. The latter (i.e., coagulation factors) were repeated at parturition. The presence of residual viable placenta prior to induction did not influence the induction-delivery interval. No statistically significant alterations in blood coagulation parameters that could be attributed to the specific method of induction employed were noted.


The effect of chlorotrianisene as postpartum lactation suppression on blood coagulation factors. Coagulation changes and increased risk of thromboembolic disease may occur in association with estrogen administration. The puerperium is also a high-risk period for thromboembolism, and estrogen administration at this time may increase this risk. Patients with congenital deficiency of antithrombin III have recurrent venous thromboembolic disease, suggesting that low levels of this factor may be associated with "hypercoagulability" states. We studied 50 postpartum patients who received chlorotrianisene (Tace) or placebo for lactation suppression in a prospective, double-blind, randomized fashion. Antithrombin III values were significantly lower on the third day post partum in the treated group compared to the placebo group (p less than 0.05). In addition, our clinical data from a total of 99 patients support the previous evidence that estrogens delay rather than prevent breast engorgement. Thus, with questionable benefit and a possible increased thromboembolic risk, it would appear prudent to discontinue the practice of estrogen administration for lactation suppression.


Acceleration of the fetal heart rate.

Acceleration of the fetal heart rate. Acceleration of the fetal heart rate during contractions was usually followed by deceleration, and evidence is presented to show that it results from increased sympathetic drive and may be associated with fetal tissue hypoxia. However, the presence of accelerations are not serious and merely warn the obstetrician of the possibility of the occurrence of subsequent decelerations. The mechanism thought most likely to produce accelerations is uterine compression of the umbilical vein during contractions.


Assessment of fetal lung maturity: a comparison of the lecithin/sphingomyelin ratio and the tests of optical density at 400 and 650 nm. Seventy-eight amniotic fluid samples were obtained by transabdominal amniocentesis and were analyzed for their L/S ratio and optical density at 400 and 650 nm. The L/S ratio was considered to be mature if the values were greater than 2.0. The optical density of the fluids decreased with prolonged refrigeration. With freshly centrifuged samples, the OD650 reading of greater than 0.15 gave the best correlation with the mature L/S ratio. There were 3.8% false positive results and 14.1% false negative results. The study confirms that the OD650 test on fresh amniotic fluid is a rapid and inexpensive way to determine fetal maturity. All samples with values of less than 0.15 must, however, also be tested for their L/S ratio since some of the infants with these values may also be mature.


Antepartum fetal testing. I. The oxytocin challenge test. Two hundred seventy-eight high-risk patients were managed by a comprehensive assessment of the anatomic, biochemical, and functional environment of the fetoplacental unit utilizing predetermined guidelines. Decisions to terminate pregnancy were reserved for patients who demonstrated a positive OCT. Perinatal outcome in patients with positive OCT's was significantly worse than in patients who did not have a positive OCT. Patients with suspicious OCT's frequently had positive OCT's and were more likely to bear growth-retarded infants, whereas negative OCT's in general were associated with a favorable outcome. Correlation of estriol excretion with the OCT and perinatal outcome was inconsistent. There were a total of four prenatal deaths, all of which were considered unpreventable.


Antepartum fetal testing. II. The acceleration/constant ratio: a nonstress test. For a period of one-half hour of undisturbed fetal monitoring, periodic changes of the FHR in response to spontaneous fetal movements (FM's) were recorded. FM's in patients who subsequently had positive OCT's were less likely to show accelerations (p = 0.001) and more likely to show variable decelerations (p = less than 0.001) and no change (p = less than 0.001) in the FHR when compared with patients who did not have a positive OCT. A ratio between the number of FM's associated with accelerations and the sum of FM's associated with no change and decelerations was defined as the acceleration/constant (A/C) ratio. The outcome in patients who exhibited reactive tests (i.e., A/C ratio greater than 1) was more favorable than the outcome in patients with nonreactive tests (i.e., A/C ratio less than or equal to 1). Patients with positive OCT's universally showed nonreactive tests, whereas patients with false positive OCT's were more likely to have reactive tests. Evidence is presented to suggest that the A/C ratio is more predictive of the intrauterine environment than the OCT.


Fetal breathing movements in uncomplicated pregnancies. I. Relationship to gestational age. Fetal breathing movements occur in uncomplicated gestations. The relationship of fetal breathing movements recorded in 30 min sessions to gestational age and blood glucose levels is described. A total of 142 recording sessions were obtained from 45 gravid women with uncomplicated pregnancies from 24 to 41 weeks' gestation. There was a significant increase in the proportion of time spent in fetal breathing as gestational age increased. Glucose levels in a normal range (70 to 120 mg/100 ml) at the time of the recording sessions showed no correlation with the proportion of fetal breathing time.


Prenatal diagnosis of Tay-Sachs disease: studies on the reliability of hexosaminidase levels in amniotic fluid. Measurement of hexosaminidase A activity in amniotic fluid was found to be a reliable diagnostic test in the prenatal diagnosis of Tay-Sachs disease. Including normal control specimens, analysis of 39 amniotic fluid samples have correctly predicted the condition of the fetus or, in pregnancies not yet come to term, have been in agreement with results from cultured cell extracts. In each case where both fluid and cultured cell extracts were analyzed, the results were in agreement. Analysis were performed by means of Cellogel, starch gel electrophoresis, polyacrylamide gel electrophoresis, or heat inactivation.


Correlation between retinal and pelvic vascular status: a determinant factor in patients undergoing pelvic irradiation for gynecologic malignancy. The degree of arteriolar sclerosis in pelvic vessels has previously been shown to be related to the incidence of radiation-related enteric and genitourinary injury. Retinal vessel changes were compared to pelvic vascular changes in 48 patients, half of whom were either diabetic or hypertensive. There was an absolute correlation between retinal vessel changes and bowel or cervicovaginal vessel changes in 74% of the cases, and only one patient had a marked (more than one grade) discrepancy between retinal and pelvic vascular status. The findings of this investigation suggest that funduscopic examination of the retina can provide useful information concerning the extent of vascular disease in structures normally present in the field of pelvic irradiation.


Uterine leiomyosarcoma.

Uterine leiomyosarcoma. A series of uterine leiomyosarcomas was reviewed in an attempt to assign prognostic significance to clinical and pathologic features. Extension of the sarcoma at the time of initial diagnosis was associated with a dismal outcome; no patient with disease beyond the confines of the uterus survived. Histologic grade was a useful prognostic feature, although low-grade sarcoma can be associated with metastases. Mitotic count was also useful in prognosis, although it did not correlate as well with clinical outcome as did histologic grade. There was no number of mitoses below which the diagnosis of leiomyosarcoma was excluded.


Further observations on the effect of topical progesterone on vulvar disease. Follow-up studies have confirmed the beneficial effect of topical progesterone in the treatment of vulvar dystrophy, whether of the atrophic, hypertrophic or mixed variety, in both postmenopausal and premenarchal women. If pruritus is a major symptom, topical corticosteroids should be alternated with the progesterone preparation in order to obtain maximum results. Topical progesterone was also found to be useful in the treatment of labial agglutination in children.


Comparison of three different models of the copper T intrauterine contraceptive device. A random sequential comparative study of three models of the Copper T intrauterine contraceptive device (IUD) was undertaken in 1,792 women. For 7 months, the TCu 300 and TCu 220C were randomly inserted, and then the TCu 380A and 220C were randomly inserted for the next 12 months. The log-risk method of life-table analysis of event rates was performed at the end of each of the first 3 years of use of each device. The TCu 380A had the lowest pregnancy rate during each year of use, although the difference was not significant. At the end of each of the first 2 years, the TCu 300 was removed significantly less than the TCu 220C and TCu 380A for bleeding and pain. At the end of three years, the rates of removal for bleeding and pain for the TCu 380A and TCu 300 were similar and lower than that for the TCu 220C, but the overall difference was not significant. There were no differences among the devices for any other relevant use-related reasons. The TCu 380A was removed for other medical reasons significantly more frequently than the other devices at the end of 2 and 3 years. Adjusting for parity did not alter the results. The findings of this study suggest that the copper sleeves along the horizontal arms together with copper wire on the vertical arm in the TCu 380A model provide greater protection against intrauterine pregnancy, whereas the copper sleeves along the vertical arm as in the TCu 220C caused increased removals for bleeding and pain. The TCu 380A should be studied in a larger number of patients for a longer period of time to determine its clinical effectiveness. It may become the IUD of choice for all women irrespective of parity.


Naproxen sodium in uterine pain following intrauterine contraceptive device insertion. In a double-blind parallel trial, repeated doses of naproxen sodium (550 mg initially, followed by 275 mg every 6 hours as needed) and placebo were administered to a group of intrauterine contraceptive device (IUD) users in whom dysmenorrhea and premenstrual uterine pain developed or increased following the insertion of the IUD. Seventeen subjects were treated with naproxen sodium and 16 received placebo. The study covered three episodes of uterine pain and/or cramping. Efficacy of pain relief was judged by: (1) the overall relief which the patients experienced during the treatment and (2) the changes in the pain intensity (measured on a 6 point scale). By both these criteria, naproxen sodium was statistically significantly superior to placebo (p = 0.02); consequently, naproxen sodium appears to offer a new treatment modality for pain associated with IUD usage.


Vasoactive intestinal polypeptide in tissues of the human female reproductive tract. Vasoactive intestinal peptide (VIP) is a known potent hypotensive and vasodilatory agent. Studies were performed to determine the possible role of VIP in the human menstrual cycle in 44 patients in the reproductive age group, some of whom were using oral contraceptives, three pregnant patients, and four postmenopausal patients. No significant relationship between VIP and menstrual cycle phase was found.


Survival rates after enucleation of eyes with malignant melanoma. We investigated the rates of mortality for several types of malignant melanomas for evidence that surgery accelerates metastasis. Additionally, we reanalyzed uveal melanoma survival rates from the Armed Forces Institute of Pathology. Our computations showed higher death rates in years two to five after diagnosis than in years one or six to ten. The same pattern of a peak mortality in the early years after diagnosis and lower rates six to ten years thereafter was seen in all tumor types studied. Our analysis of survival rates produced no evidence to alter the existing pattern of treatment for malignant melanoma of the uvea.


Recurrent orbital and metastatic melanoma in a patient undergoing previous glaucoma surgery. A 61-year-old woman had unilateral acute angle-closure glaucoma and subsequently underwent a Scheie filtering operation. After a two-week interval, a large choroidal and ciliary body melanoma in the glaucomatous eye was found. No evidence of metastatic disease was found and the eye was enucleated. Histopathologic sections did not show extrascleral extension. Two and one-half years later the patient developed local orbital recurrence of the melanoma and fatal metastatic disease. We hypothesized a possible causal relationship between the filtering surgery and the local and systemic recurrence of the tumor.


Comparison of radioactive phosphorus (32P) uptake test in comparable sized choroidal melanomas and hemangiomas. We compared 19 choroidal hemangiomas and 21 choroidal melanomas of comparable size as to the percent of radioactive phosphorus 32P uptake. The results were significantly lower in choroidal hemangiomas than in comparable sized melanomas.


The ultrasonographic and radiologic features of a histologically proven case of alveolar soft-part sarcoma of the orbit. An 18-year-old woman had a rapidly progressive proptosis, vascular congestion, and orbital pain. Ultrasonographic and radiologic tests supported the diagnosis of a solid vascularized mass that proved histologically to be an alveolar soft-part sarcoma of the orbit. Uncertainty as to the histogenesis of alveolar soft-part sarcoma still exists, but prognosis for patient survival is poor.


Treatment of symptomatic retinal breaks. Forty-three patients with symptomatic retinal breaks were treated with photocoagulation and a comparable group of 43 patients were treated with cryopexy. All patients had either a vitreous hemorrhage, or photopsia and floaters. Most of the breaks were of the horseshoe type. Of the patient eyes, 14% (six patients) in both groups developed new retinal tears without detachment during the long term postoperative observation. The new breaks were treated with the method used for the original breaks, and no scleral surgery was necessary. The incidence of retinal detachment was 7% in patients treated with photocoagulation and 11.6% in patients with cryocoagulation, but two cases that developed retinal detachment arising from new tears years after the initial procedure were included.


The autosomal dominant syndrome of progressive optic atrophy and congenital deafness. Four members of a family had the heriditary syndrome of dominantly inherited progressive optic atrophy and congenital sensorineural deafness. Hearing evaluations revealed that two members had a potentially treatable form of deafness.


Frozen section control in the surgery of basal cell carcinoma of the eyelid. Two groups of patients, 37 with primary basal cell carcinoma of the eyelid and 16 with basal cell carcinoma of the eyelid previously treated by other physicians were reviewed. All of the tumors were excised with at least 3 to 4 mm of normal-appearing tissue at each margin of resection. All of the excised specimens were submitted for frozen section studies of the margins. A total of 20 (54.04%) of the previously untreated tumors and eight of the previously treated tumors had at least one margin involved with tumor cells. Repeated excisions under frozen section control were done until all of the margins were free of tumor cells. To date, none of the patients treated in this manner had a recurrence of the tumor.


Inverted follicular keratosis.

Inverted follicular keratosis. We reviewed 17 cases of inverted follicular keratosis. The median age of the patients at the time of surgery was 69 years. Follow-up in 14 cases showed no recurrences of inverted follicular keratosis, which is a benign skin lesion, often mistaken clinically and pathologically for a malignancy. Inverted follicular keratosis is characterized histologically by the presence of squamous eddies, acantholysis, acanthosis, and hyperkeratosis.


Contraindication to the use of ocular phenylephrine in idiopathic orthostatic hypotension. We studied the effect of topical ocular application of 2.5% phenylephrine ophthalmic solution in patients with idiopathic orthostatic hypotension and in normal subjects. The normal subjects had no pressor effect to the drug. However, the patients with idiopathic orthostatic hypotension, had a marked pressor response. The maximal pressor response in the four patients averaged 44/27 mm Hg. The usual 10% phenylephrine used in practice could have delivered a fourfold greater amount of drug, and presumably would have led to dangerously high blood pressure responses.


Acute myocardial infarction after fluorescein angiography. A 68-year-old man with a history of previous myocardial infarction and peripheral vascular disease had an acute myocardial infarction 30 minutes after the injection of intravenous fluorescein for fundus angiography. The situational stress or phenylephrine dilating drops could have contributed to the complication.


Vitreoretinal dissection instruments.

Vitreoretinal dissection instruments. We developed and evaluated clinically a series of three vitreoretinal dissection instruments with a constant-diameter shaft and various tip designs including a 90-degree hooked tip, a 130-degree hooked tip, and a blunt-tip right-angle spatula. The instruments, manufactured from a titanium alloy, are lightweight and glare resistant. We have used these instruments interchangeably with other vitreous surgery instruments introduced through a 20-gauge sclerotomy. They facilitate delicate manipulations associated with separation of epiretinal membranes from the inner retinal surface.


Peroxisomes of rat peritoneal macrophages during phagocytosis. The peroxisomes of resident macrophages in the rat peritoneal cavity were examined during the phagocytosis of latex microbeads, employing the akaline diaminobenzidine (DAB) technique. Peroxisomes generally were located in close proximity to phagosomes and were often observed in a process of apparent fusion with phagosomes. Cytochemical evidence was also obtained for discharge of catalase from peroxisomes to phagosomes. The profiles indicating fusion were observed after 10 minutes of incubation with microbeads. The number of peroxisomes was increased in macrophage profiles examined 30 minutes after exposure to microbeads. Acid phosphatase was localized in small vesicles that were distinct from peroxisomes, and peroxidase was not demonstrable in peroxisomes. A method for ultrastructural localization of periodate reactive complex carbohydrate demonstrated glycoproteins in numerous small vesicles or granules, some of which possibly represented peroxisomers. The possible function of peroxisomes during phagocytosis in rat peritoneal macrophages is considered.


Stereologic analysis of dystrophic chicken muscle. Stereologic methods have been used to estimate the volume and surface densities of sarcoplasmic reticulum (SR) and T tubules of normal and dystrophic chicken pectoralis muscle fibers. The surface and volume densities of the T system in dystrophic muscle fibers showed large increases compared with normal muscle fibers; the surface and volume densities of the SR showed large decreases. In addition, the SR and T system in dystrophic fibers undergo changes in shape. The tubules of the free SR become much narrower; the T system becomes dilated and vesiculated. Dystrophic fibers, on the average, are much larger than normal but maintain the same sarcolemmal surface/fiber volume ratio as normal fibers. Alterations in the surface and volume densities of the dystrophic sarcotubular system may account for some of the altered contractile properties of these muscles.


Adrenal cortex in retired breeder Mongolian gerbils (Meriones unguiculatus) and golden hamsters (Mesocricetus auratus). Alterations occur predominantly in cells of the zona reticularis in retired breeder Mongllian gerbils and golden hamsters. In gerbils, the size and number of lipid droplets increased and numerous large lipid-lysosomal complexes were observed in zona reticularis parenchymal cells or in macrophages, which were more numerous than in younger animals. Abundant lipofuchsin pigment was observed in zona reticularis parenchymal cells, and mitochondria contained electron-opaque inclusions. In the hamster, lipid droplets were present in inner zona reticularis cells and there was an increased amount of pigment within macrophages. Some of the alterations in gerbils and hamsters may at least in part reflect a stimulation of zona reticularis cells in retired breeders, attributable to increased prolactin secretion.


Morphologic alterations in canine marrow of long-term survivors after 1200 R whole-body x-irradiation and autologous blood leukocyte engraftment. The marrow matrix of total-body x-irradiated dogs (1200 R midline dose) was able to support effective hemopoiesis for several hundred days if the animals were transfused with their own mononuclear leukocytes collected from the blood prior to irradiation and preserved at ultralow temperatures. However, a lesion developed in the marrow, consisting of a fibrosis originating in conjunction with or from the endosteum. The fibrotic tissue substantially reduced the available marrow space in dogs with advanced lesions. The number of autologous, cryopreserved mononuclear leukocytes transfused ranged from 0.32 X 10(9) to 1.63 X 10(9)/kg body weight. The observation period extended to a maximum of 898 days after irradiation.


Morphology and pathogenesis of adrenal cysts. Adrenal cysts represent a rare condition (approximately 250 cases have been reported). We report two additional cases: the first involved a huge lesion removed surgically and thoroughly studied preoperatively; the second was an incidental autopsy finding. Detailed ultrastructural studies have been made of both cases. We think that the basic cell of origin of the cyst is an endothelial cell lining lymphatic channels. We speculate that the pseudocysts, which have been described as having a fibrous lining, probably were at one time also lymphendothelial but, perhaps due to trauma or repeated bleeding, the major portion of the endothelial lining became replaced by collagen. The primary and secondary cystic malignancies and cases of cysts due to parasites should be classified separately from the adrenal cysts of lymphendothelial origin which probably represent a benign tumor-like overgrowth.


Neutrophil aggregation and degranulation. Effect of arachidonic acid. In response to aggregating and degranulating stimuli, platelets metabolize endogenous arachidonic acid to bioactive derivatives. These derivatives can stimulate platelets to degranulate and aggregate and, therefore, may be mediators of the platelet response. Because exogenous arachidonic acid also stimulates platelets to degranulate, aggregate, and form these mediators, we examined the effect of adding arachidonic acid to purified human neutrophil suspensions. Micromolar concentrations of arachidonic acid stimulated neutrophils to aggregate but not to degranulate. Cytochalasin B, a potentiator of neutrophil responses to chemotactic factors, also potentiated the arachidonic-acid-induced aggregation response; 5,8,11,14-eicosatetraynoic acid, an inhibitor of arachidonic acid metabolism, blocked this response. Aggregation of neutrophils, was not stimulated by several fatty acids with structural similarity to arachidonic acid. These results suggest that metabolic derivatives of arachidonic acid may be active in stimulating certain neutrophil responses. The role of these derivatives in mediating neutrophil responses to various stimuli needs to be examined.


Ultrastructural studies of the gray platelet syndrome. The gray platelet syndrome (GPS) is a rare inherited disorder in which peripheral blood platelets are relatively large, vacuolated, and almost devoid of cytoplasmic granulation. In the present study we have evaluated the ultrastructure and cytochemistry of platelets from 2 patients with the GPS to determine precisely which organelles are missing from their cells. The findings indicate that gray platelets contain normal numbers of mitochondria, dense bodies, peroxisomes, and lysosomes but specifically lack alpha-granules. Preliminary studies of megakaryocytes from 1 of the 2 patients suggest that the defect in granule formation may lie at the level of the Golgi zone.


Atrioventricular canal malformation interpreted as secondary to reduced compression upon the developing heart. This study was undertaken to evaluate the nature and pathogenesis of malformations of the atrioventricular canal in relation to normal cardiogenesis. Serial histologic sections of normal human embryos and fetuses were made, from which three-dimensional images were reconstructed to show the relationship between the developing heart and its surrounding structures, and the course of development of the atrial septum and atrioventricular valves. Based on these reconstructions and on examination of the hearts of 59 patients with atrioventricular canal malformations, it is suggested that the spectrum of atrioventricular malformations may arise as a result of reduced compression of the developing atria by surrounding structures during embryonic Stages 13 through 18. Comparison of hearts with atrioventricular canal defects with normal embryos indicated that the malformations may be classified as primitive canals, complete canals, or partial canals, corresponding to failure of completion of normal development in Stages 14 through 18. In primitive canal the atrial septum was absent or had only a portion of septum primum. In complete canal both atrial septums were present, but the atrioventricular valve material was not subdivided and the four chambers were in communication. In partial canal, the atrioventricular valve was divided, but atrial and ventricular septal defects and valve clefts were present in varying degrees of severity. It is proposed that the spectrum of cardiac abnormalities which constitutes atrioventricular canal malformations may be understood as arising from varying degrees of lack of normal compression of the developing heart by surrounding structures. (Am J Pathol 95.579-598, 1979)


A morphometric study of arterial intimal thickening in kidneys of dialyzed patients. Arterial intimal thickening is common in the end-stage kidneys of patients maintained on hemodialysis. We measured the intimal thickening in patients dialyzed for varying periods and in patients with the malignant phase of essential hypertension and with scleroderma-associated renal failure. The ratio of intimal area to medical area in intrarenal arteries was used as a measure of intimal thickening. In the dialysis groups, intimal thickening was relatively constant in arteries of all sizes and correlated with duration of dialysis, particularly in larger arteries. In the malignant hypertension and scleroderma groups, the intimal thickening was greatest in arteries less than 200 mu in diameter and least in those over 500 mu in diameter. There was much less intimal thickening in arteries of all sizes in kidneys of patients with end-stage polycystic disease than in other end-stage kidneys from patients with a similar diastolic blood pressure and similar duration of dialysis. We believe that the intimal thickening in dialyzed patients is probably a disuse type of change and may be related to reduction in the area of the renal microvascular bed.


Ultrastructural pathology of ozone-induced experimental parathyroiditis. IV. Biphasic activity in the chief cells of regenerating parathyroid glands. Sequential development of electron miscrosopic changes in the rabbit parathyroid gland was monitered during induction of parathyroiditis by 48 hours of ozone 0.75 ppm dosage regimen. By 4 to 7 days, electron microscopy revealed prominence of polyribosomes, rough endoplasmic reticulum, Golgi complex, secretory granules, microtubules, and frequent infoldings of the plasma membrane. Presumable this was the stage of parathyroid hormone synthesis. Between 14 to 18 days, ultrastructural observations showed dilatation of rough endoplasmic reticulum with continuity with annulate lamellae, disaggregation of polyribosome attached to the rough endoplasmic reticulum, and accumulation of numerous solitary free ribosomes in the cytoplasm. The dilated portion of endoplasmic reticulum contained medium electron-dense granular material, which also appeared between the intercellular spaces. The medium electron-dense material assumed to condensed appearance of basal lamina bordering the intercellular matrix. On the basis of the present observation it was concluded that the second set of ultrastructural changes signify the stage of basal lamina reconstruction. The significance of these changes as reparative responses to the inflammatory stimuli was discussed.


An autoradiographic study of cellular proliferation in remyelination of the central nervous system. The proliferation and origin remyelinating oligodendrocytes was studied by light and electron miscrosopic autoradiography in the superior cerebellar peduncles of mice demyelinated by Cuprizone. In the early phases of demyelination, the cells undergoing mitotic activity were macrophages and astrocytes. In the later phases of demyelination, immature proliferating oligodendrocytes appeared; these differentiated into mature (dark) oligodendrocytes which were responsible for the remyelination of axons seen when animals were again placed on normal diets. The pattern of differentiation recapitulated that seen in developing oligodendrocytes in normal animals. Dark oligodendrocytes did not show mitotic activity. There was no mitotic activity in the subependymal cells around the fourth ventricle adjacent to the superior cerebellar peduncles. This study demonstrates the regenerative capacity of oligodendrocytes and their ability to carry out remeylination in the central nervous system.


Quantitative evaluation of the development of the exocrine pancreas in cystic fibrosis and control infants. The development of the exocrine pancreas has been determined quantitatively in 31 infants with cystic fibrosis (CF) both  with and without meconium ileus and in 29 control infants. In the normal pancreas, the ratio of acinar to connective tissue volume is 0.5 at 32 weeks postconceptional age (PCA) and increases linearly to 2.0 at 52 weeks PGA. In cystic fibrosis infants, with or without meconium ileus, the ration is 0.5 at 35 weeks PCA  anddecreases linearly to 0.3 at 52 weeks PCA. The volume of acinar and duct lumens is greater in CF than control infants but is independent of age or acinar volume. The development of the exocrine pancreas in infants with CF with and without meconium ileus diverges from the normal pattern: There is consistent lack of exocrine tissue before or a full-term birth, which persists throghout the age range of this study. CF infants above 42 weeks PCA can be discriminated from controls on the basis of the quantitative assessment of acinar volume.


Canine granulocytopathy syndrome: an inherited disorder of leukocyte function. A disease closely resembling the human neutrophil dysfunction syndromes has been identified in a colony of dogs. The syndrome, referred to as the canine granulocytopathy syndrome, is characterized by recurrent-life-threatening bacterial infections and a greatly shortened life span. The disease is genetically determined, being transmitted as an autosomal recessive trait. The increased susceptibity to pyogenic infections and shortened life span is related to an impairment of leukocyte function at the cellular level. Preparation of neutrophils from affected animals exhibit impaired in vitro killing of Esherichia coli. The defect in bactericidal activity is associated with reduced glucose oxidation by the hexose monophosphate shunt and an increase capacity to reduce nitroblue tetrazolium dye. The data obtained thus far indicate the canine granulocytopathy syndrome will be of considerable value as a model for study of granulocytypathy sydromes in man.


Pathology of the stone heart syndrome. Massive myocardial contraction band necrosis and widely patent coronary arteries. Among 201 patients dying at some time after cardiac surgery employing cardiopulmonary bypass and studied at autopsy following postmortem coronary arteriography and fixation of the heart in a distended state there were 4 (2%) with the stone heart syndrome. All 4 fo these patients had undergone aortic valve surgery for aortic stenosis employing hypothermic anoxic arrest. At the conclusion of an uncomplicated operation the heart was firm, contracted, prone to fibrillate, and could not sustain the circulation. Pathological study showed widely patent coronary arteries and severe contraction band necrosis of the inner portions of both ventricular walls. The observations here, as in previous studies, suggest that contraction band necrosis may be elicited by a brisk reflow phase following a potentiating phase of anoxic arrest of the myocardium. The stone heart syndrome appears to be simply the manifestations produced by massive contraction band necrosis in a severely hypertrophied heart.


The effect of methylmercury on isolated cardiac tissues. The effect of methylmercury hydroxide (MMH) on the frequency of spontaneously beating atrial-SA node and on the isometric tension of electrically stimulated left atrial (1 Hz) preparation isolated from rats were investigated. The tissues were also fixed for ultrastructural study at the end of the experiments. We found that MMH, at low doses (0.5 and 2ppm), increased the frequency of contractions and the isometric tension of isolated atria and decreased the isometric tension of isolated papillar muscles, and at higher doses (greater than 2ppm), decreased all the above parameter. Morphologically, there were dilation and swelling of mitochondrial and sarcoplasmic reticulum. Occasionally, deposits of amorphous material in the mitochondria and myofibrillary degeneration of myocardial fibers were noted. It is concluded the MMH has direct effect on intracellular organelles (mitochondria, sarcoplasmic reticulum, and myofibril) of myocardial tissue and induces functional changes of atria and papillary muscles


Comparison of heavy particle with X-irradiation on the hamster lung. Important new modalities for cancer therapy are being developed, and one of the most promising is heavy charged particle irradiation. We are currently assessing the effects of 375-MeV/nucleon neon irradiation in the plateau region of ionization compared to 230KVp X-rays on the whole thorax of hamsters. Single dose levels for neon irradiation ranged from 150-1000 rad. Dose levels for X-irradiation ranged from 225-1500 rad. The animals were followed for 1 year after irradiation, and the most useful results emerged, using morphometric methods. One year after irradiation, pulmonary parenchyma and nonparenchyma appear morphometrically unchanged. However, the volume density of pulmonary septums, septal cells, all tissue, connective tissue, and alveolar Type II cells was increased while the volume densities of alveoli, empty alveolar space, and capillary lumens were diminished. Most of these changes were dose dependent not clearly demonstrable until a year after irradiation. The relative biologic effect of neon compared to X-irradiation using this techniques is 1.6-1.8.


Dietary induced atherogenesis in swine. Morphology of the intima in prelesion stages. Hypercholesterolemia was induced in pigs by feeding a chow diet supplemented with 1.5% cholesterol and 19.5% lard for periods up to 12 weeks. The aortic intima from areas of spontaneously differing permeability to proteins, as demarcated by their uptake of Evans blue dye, was examined using light microscopy and both scanning and transmission electron microscopy to describe the earliest detectable changes in intimal morphology induced by the diet. After 2, 4, and 6 weeks of feeding, cholesterol/lardfed pigs demonstrated monocyte adherence to the endothelium in areas of enhanced permeability (blue areas) in 86% of samples examined, as compared to 52% in areas of lesser permeability (white areas) and 17% in control animals. Similarly, the number of monocytes in the intima was higher in blue areas than in adjacent white areas or blue areas from control animals. After 12 weeks of feeding, all blue areas showed intimal monocytes, with fewer seen in white areas. Aortic endothelial cells in hypercholesterolemic pigs were normal in ultrastructural appearance, except they contained more lysosomes and cytoplasmic filaments than those from control animals. No lesions were observed at 2, 4, and 6 weeks, although plasma cholesterol levels were substantially elevated (200-400 mg/dl) at these times. A marked hyper-beta-lipoproteinemia was evident from 4 weeks onward, but no elevation of serum triglycerides was evident at any stage. Plasma phospholipid concentrations increased but not in direct proportion to cholesterol levels. At 12 weeks, foam cell lesions were observed in areas of enhanced permeability but not in adjacent areas of normal permeability. Lesion foam cells appeared to be derived from the monocytes which adhered to and penetrated the endothelium at earlier stages, since no intimal involvement, or lipid engorgement, by medial smooth muscle cells was observed.


Neural factors versus hypertrophy in the time course of muscle strength gain. The time course of strength gain with respect to the contributions of neural factors and hypertrophy was studied in seven young males and eight females during the course of an 8 week regimen of isotonic strength training. The results indicated that neural factors accounted for the larger proportion of the initial strength increment and thereafter both neural factors and hypertrophy took part in the further increase in strength, with hypertrophy becoming the dominant factor after the first 3 to 5 weeks. Our data regarding the untrained contralateral arm flexors provide further support for the concept of cross education. It was suggested that the nature of this cross education effect may entirely rest on the neural factors presumably acting at various levels of the nervous system which could result in increasing the maximal level of muscle activation.


Palmar conduction time of median and ulnar nerves of normal subjects and patients with carpal tunnel syndrome. The wrist-palm conduction time for the median and ulnar nerves was determined using antidromic technique in thirty normal subjects. For the median nerve, the conduction time was 1.6 msec. to initial deflection from baseline and 1.7 msec. to peak of the initial negative deflection for the mean plus 2 SD. The median wrist-palm conduction time was then compared to the difference between the median and ulnar wrist-digit conduction times (mean plus 2 SD of 0.5 msec. measured either to initial deflection or peak negative deflection) in order to determine which technique aids more in the electrodiagnosis of patients with a presumptive clinical diagnosis of carpal tunnel syndrome but which normal distal sensory latencies. It was found in ten patients that the results of these two electrodiagnostic methods paralleled each other, and neither appeared more sensitive than the other in establishing the diagnosis.


Effect of electromyographic feedback and static stretching on artificially induced muscle soreness. Thirty-six male subjects aged 18 to 26 years were assigned at random to one of three treatment groups: biofeedback, static stretch, and control. Muscle soreness was produced in all subjects by an 80% maximal eccentric contraction of the biceps brachii. The subjects in the biofeedback group applied auditory electromyographic (EMG) feedback at 6, 25, 30, 49, and 54 hours after the exercise, and the stretch group applied static stretch to the exercised arm at the same time periods. Observations of EMG activity and perceived pain level were made immediately before and after exercise, and at 24, 48, and 72 hours following exercise. When compared with a control group, both auditory biofeedback and static stretching significantly reduced EMG muscle activity but had no significant effect on perceived pain. The EMG activity and perceived pain of the subjects in each treatment group significantly differed across observations.


Statistical methods for analyzing data on daily activity cycles of primates. Many field studies on primates have recently been carried out in which quantitative data have been collected using instantaneous scan sampling techniques. However, data collected in this manner are difficult to analyze statistically because of the problem of independence of samples, and a number of investigators have analyzed such data incorrectly. In this paper, we evaluate such analyses and suggest alternative techniques that may be more appropriate. Examples are drawn from data on daily activity cycles of Lemur catta and Lemur fulvus.


Relation to body fat to age in the Czech population. Density and percentage of fat in the body were investigated in 403 females and 356 males of Czech population using hydrostatic weighing. The group was divided into four age subgroups ranging from 17 through 22, 23 through 29, 30 through 39 and 40 through 49 years. Fat values were found to increase with age, growing in females and males between the ages of 17 to 49 years from 27.1 to 35.4 and from 16.3 to 26%, respectively. In both sexes, the highest difference in the percentage of fat was observed between the second and third decennium. Body weight was also seen to increase with age up to 40 years of age. On the other hand, from 40 through 49 years a decrease in weight was seen both in male and female means, with the body heights also less in older subjects. The values observed, particularly in females, exceed those reported as a rule in other populations. This is accounted for by nutritional factors such as the amount of calories and composition of food and possibly also by the effect of the genetically given somatotype.


The human mandible: lever, link, or both? Hylander ('78) recently published important new data on bite force in humans, and showed that the human mandible cannot function purely as a link during incisal biting. He concluded instead that the mandible acts as a lever. Reexamination of Hylander's data suggests that the mandible cannot function purely as a lever either, and in fact it probably functions simultaneously as both lever and link during incisal biting.


Skeletal changes produced by aortic aneurysms. The three major types of aortic aneurysms--arteriosclerotic, syphilitic, and dissecting are disussed in relation to the skeletal changes they produce. The favored location, age, and sex predilection are described for each type. Four documented cases from the Hamann-Todd osteological collection are presented with a description of the associated skeletal changes. All four cases appear to be the result of syphilitic infection. These documented cases provide forensic and physical anthropologists with a means of diagnosing aortic aneurysms in modern, historic, and prehistoric human skeletal remains.


Relationship of lower limb height to sitting height in black populations of Africa and the United States. This article examines a recently reported generalization. Materials from more than a score of invetigations are drawn upon. These materials show there is not a substantial research base for the claim that interbreeding in the United States between black people of African ancestry and white people of European ancestry has resulted in increased lower limb height relative to sitting height.


A correlation of tooth wear and age among modern Igloolik eskimos. The level of molar wear can be estimated reliably by measuring the cusp height. A correlation between age and the level of molar wear, expressed by a normalizing index (TWI) of cusp height, was found to exist in a sample of modern Igloolik Northwest Territories Eskimos. Not only was it possible to derive linear regression models to test the degree of correlation in the sample of 46 female and 39 male maxillary casts of Igloolik Eskimos, but the models were capable of accurately predicting the age of natives of the neighboring Hall Beach community. Sexual dimorphism in molar wear, perhaps attributable to differential bruxism, was demonstrated for the Igloolik sample. Based on the combined estimate of slopes for each maxillary molar pair for females and males, it was discovered that the male maxillary molars are worn approximately 30% more rapidly than female maxillary molars.


Time, age, and the life cycle.

Time, age, and the life cycle. Psychologists are increasingly interested in the life cycle as the unit for study and in such questions as whether adult development, like child development, is to be perceived as a succession of stages. A stage theory of adult life seems oversimplified for several reasons. First, the timing of life events is becoming less regular, age is losing its customary social meanings, and the trends are toward the fluid life cycle and an age-irrelevant society. Second, the psychological themes and preoccupations reported by young, middle-aged, and older persons are recurrent ones that appear and reappear in new forms and do not follow in a single fixed order. Third, intrapsychic changes occur slowly with age and not in stepwise fashion. These factors may have implications for the psychiatrist who, in helping the patient make a meaningful life story from a life history, deals always with issues of time, timing, and aging.


Pseudodementia.

Pseudodementia. Pseudodementia is the syndrome in which dementia is mimicked or caricatured by functional psychiatric disorders. The author describes 10 patients with pseudodementia and compares its clinical features with those of true dementia. The syndrome occurred in patients with various psychiatric diagnoses, but a striking feature in most patients was marked dependency. The recognition of this clinical syndrome should obviate the need for many neurological diagnostic studies and lead to earlier and more effective psychiatric treatment.


"Folk" explanations of mental illness in rural laos. To obtain "folk" explanations of specific cases of mental illness the authors interviewed 35 baa(insane) Laotian individuals and their relatives and neighbors. They obtained 54 explanations; 15 focused on supernatural causes, 15 on physical causes, 14 on social problems, and 10 on psychological states. Although 31 theories (57%) focused on etiologic factors familiar to clinical psychiatrists, many self-evident factors (such as familial prevalence) were not mentioned. Except for 3 cases, responsibility for the illness was attributed to factors outside the subject's control. This view of mental illness absolves the baa person from blame and ensures support from the social group.


The crisis group--an outcome study.

The crisis group--an outcome study. The authors describe the day-to-day functioning and outcome of an 8-session, active, crisis-oriented outpatient psychotherapy group. Symptoms of anxiety and depression improved significantly in participants of the crisis group; these changes were even more positive at 1-year follow-up. The authors speculate that the success of the crisis group can be attributed to the felicitous characteristics of the patients and to the group structure and function, which provided an excellent vehicle for crisis intervention management.


Familial (genetic) subtypes of pure depressive disease. The author reviewed data from five studies and found that depressed patients with a history of depression in a parent or child have more sibships containing depression than depressed patients without this family history. Thus, there is a clustering of depressions in certain families. Sporadic pure depressive disease (PDD), where no depressive illness exists in a first-degree family member of a depressed proband, is associated with a later age of onset than familial PDD, where depressive illness does exist in a first-degree relationship. The possibility exists that familial PDD and sporadic PDD are autonomous illnesses. The presence of a family history of depression may be predictive to some extent of a good response to adequate tricyclic medication or ECT.


Effect of chlorpromazine on human growth hormone. The authors studied basal HGH levels and HGH response to insulin-induced hypoglycemia in 12 schizophrenic patients who had been treated with 200--450 mg/day of chlorpromazine for 6 months  to 4 years compared with 12 schizophrenic patients who had received no drugs and 15 normal control subjects. They found no significant differences among the three groups in basal HGH levels or in maximum response HGH levels. No significant correlation was found between duration or dose of chlorpromazine therapy and HGH secretion. Longitudinal study in 5 previously untreated schizophrenic patients during 13 weeks of chlorpromazine administration showed a nonsignificant reduction in HGH response. Thus, the authors' findings fail to demonstrate any significant effect of chlorpromazine on growth hormone secretion in man.


A systematic investigation of tardive dyskinesia in inpatients. Although many scales to measure tardive dyskinesia have been developed, none has been widely accepted. The authors used the Abnormal Involuntary Movement Scale (AIMS) to evaluate a group of 293 inpatients who had been given a primary or secondary diagnosis of schizophrenia. They found a tardive dyskinesia prevalence of 30% using a criterion rating of 3 (moderate symptoms) or more on the AIMS. The prevalence figure declined as the criterion became more severe. They also found that women had a much higher prevalence of the disorder only when more severe symptoms were used as the criterion. They conclude that the AIMS is a reliable instrument for assessing tardive dyskinesia.


The development of an internship program in psychiatric nursing. As medicine and nursing have become increasingly specialized, the need for additional training for the graduate nurse has become more evident. One way in which nursing educators have dealth with this problem is through the establishment of general nursing internship programs. The authors review some of the historical background for the development of these programs and describe the establishment of an 8-week specialized nursing internship program in psychiatric nursing. They conclude with a brief evaluation of the program.