The extent, nature, and utility of evaluating consumer satisfaction in community mental health centers. Evaluating consumer perceptions is a recent development in community mental health. The authors surveyed the 504 federally funded community mental health centers to discover the extent to which they assessed consumer satisfaction, the methods used to collect data, and the utility of the results. Of the 366 centers that responded, 48% had gathered consumer feedback in the previous 18 months, and most others planned to initiate such evaluations within a year. Methods of conducting the studies were extremely diverse. Respondents felt the results were useful and shared them primarily with agency personnel, rather than with outside funders, fellow agencies, or clients. The authors conclude that community mental health centers are evaluating consumer satisfaction more frequently than in the recent past, but this movement has not yet developed clear, standardized methods. Until evaluators consolidate their efforts this evaluation strategy will continue to have limited utility.


Transportation, stress, and community psychology. Conditions of transportation were investigated as sources of psychological stress as they affect the physiology, task performance, and mood of commuters. Participants in the study were 100 employees of industrial firms. Traffic congestion was construed as a behavioral constraint in terms of the concept of impedance which is defined by the parameters of distance and time. It was expected that the effects of impedance would be mediated by personality factors, such as locus of control. Multivariate tests of the internal validity of the impedance factor were significant. However, significant main effects for impedance were obtained only for mood and residential adaptation. The predicted interactions of impedance with locus of control were obtained across task performance indices. In multiple regression analyses, the distance and speed of the commute to work were found to account for significant proportions of variation in blood pressure, while several indices of personal control had significant regression effects on the task measures. The implications of the results for research in community psychology are discussed.


Economic, life, and disorder changes: time-series analyses. Implicit in recent social science research and political discussions is a model linking the economy to mental disorder through the intervening constructs of life change and trauma. Using time-series analysis of a 16-month survey in Kansas City, Missouri (n = 1,140), economic and noneconomic life events and the Midtown scale were predicted using a variety of economic measures for the standard metropoliton statistical area. Both life event variables and the symptom measure were related positively to unemployment, and absolute economic change measures lagged 1 and 2 months. However, the life event variables were not strongly associated with the Midtown scale. Most striking of the subgroup findings was that, on the Midtown scale, the low-income group was more responsive than the middle-income group to economic fluctuations.


Socioeconomic differences in coping with childbearing. The socioeconomic status of 200 women, who were completing a childbearing year, was found to be significantly associated with their attitudes, affective arousal and coping strategies. Differences in attitude existed toward 11 of 18 aspects of childbearing, working-class women holding more positive attitudes with the exception of their negative attitudes concerning physical problems and labor. Affective arousal, as measured by the application of 12 content analysis scales to the women's recollections, was greatest among working-class women who experienced more mutation, guilt, and total anxiety. This was associated with their tendency to avoid confrontation and be fatalistic in dealing with problems. They were less likely to exhibit instrumental coping by attending prenatal classes, seeking information, or planning. Interactions of socioeconomic status, type of problem, and coping strategy chosen occurred, as did some variations in the reactions of middle- and upper middle-class women.


Personality and resistance to illness.

Personality and resistance to illness. Personality was found significantly to mitigate the illness-provoking effects of stressful life events. Two groups of executives had comparably high degrees of stress over a 3-year interval, as measured by the Holmes and Rahe Schedule of Recent Life Events. One group (n = 86) suffered high stress without falling ill, while the other (n = 75) reported becoming sick after their encounter with stressful life events. Illness was measured by the Wyler, Masuda, and Holmes Seriousness of Illness Survey. Discriminant function analysis supported the prediction that high stress/low illness executives show, by comparison with high stress/high illness executives, more control, commitment, and interest in change as a challenge.


Life stress and maladaptation of children. Social environmental variables differentiating maladapting children from matched controls in four inner-city elementary schools were investigated. Teacher selection was used to identify the maladapting children. Identified maladapting children were more likely to have been on welfare and to have experienced significantly more stressful life events during the previous year than the matched control children. The maladapting group was subdivided into welfare and non-welfare groups. Comparisons between groups on the life stress event measures indicated that the nonwelfare maladapting group experienced more life events than either the nonwelfare controls or the maladapting welfare children. The measures of life events correlated with parent ratings of behavior problems for the nonwelfare maladapting group but not for the welfare maladapting or the control groups.


Some effects of positive life events on community mental health. Measures of positive and negative events were derived from a life-event inventory to test the predictions of an equilibrium model and a positive mental health model of psychological well-being. These measures were related to indicators of individual and community well-being with data obtained through a household survey of 454 residents. Residents who reported more negative events also reported more psychological distress and less positive adjustment. Positive events were associated with reports of positive adjustment. An analysis of census tract scores on life events revealed that the relative absence of positive events in census tracts was associated with higher service utilization rates to the community mental health center serving those tracts. The number of negative events was unrelated to service rates for census tracts but was related to several demographic indicators of well-being.


Personal versus situational determination of anticipation and control of the occurrence of stressful life events. A wide variety of laboratory and clinical studies have indicated that stressful events are most harmful when they are perceived as uncontrollable. However, these studies diverge on the question of whether perceptions of control of stressful events are determined by environmental contingencies associated with the events or by a stable expectancy of the perceiver. In a community study 118 respondents were asked to report stressful life events experienced in the last year and were then asked to what extent they anticipated and controlled the occurrence of each event. Data were collected in two waves 1 year apart. Analysis of the reliability, within each wave, of perceptions of control does not indicate a strong personal expectancy effect. It does show some evidence of environmental determination of perceptions, but this result is not consistent on the two waves. These results are interpreted in relation to the issue of ways of reducing harmful effects of stressful life events.


Family with three apparently balanced t(3;15) (p27;q22) translocation carriers. Association with deficits in language acquisition and mental retardation: a possible example of position effect in man. A father, son, and daughter had a (3;15) (p27;q22) simple reciprocal translocation. No abnormality in the G-banding pattern was noted. The girl was most severely affected; she had an abnormal phenotype, noticeable delay in receptive and expressive language development, bilateral hearing impairment, and definite mental retardation. The boy had a moderate delay in receptive language skills, had moderate hearing impairment in one ear, and showed mild mental retardation. The father has low-set ears, some deficits in receptive language skills, is illiterate, and was found to be borderline mentally retarded. The mother and younger child do not have the translocation and are normal in terms of phenotype, intellect, and verbal skills. The accumulating evidence suggests that balanced translocations are associated with an increased frequency of intellectual deficit and congenital anomalies, and the cytogenetic mechanism may be that of position effect.


Partial trisomy of chromosome 3 (3q12 leads to qter) owing to 3q/18p translocation. A trisomy 3q syndrome. In four previously reported patients with partial 3q trisomy, only a small portion of 3q was trisomic (3q21 leads to qter or 3q25 leads to qter). Clinical features in these cases have included the following: low-set ears, mongoloid slant of eyes, hypertelorism, cleft palate, webbed neck, simian creases, short finger, clinodactyly, hypotonia, and low-set hairline. Cytogenetic studies of a premature, 1,680-g female infant with with these clinical features showed this extra material to be part of the long arm of chromosome 3 (3q12 leads qter), which resulted in partial trisomy for this segment, ie, 46,XX,-18, +t (3;18) (q12;p11). Although a larger portion of 3q was involved in this case, the clinical picture was similar to other cases of 3q duplication with or without 3p deletion.


Acute renal failure in Reye's syndrome.

Acute renal failure in Reye's syndrome. Three patients with initial clinical manifestations and biochemical findings suggestive of a diagnosis of Reye's syndrome had acute renal insufficiency develop and had evidence of consumptive coagulopathy, not generally considered features of the syndrome. As a group, they could not be distinguished, either on the basis of their clinical manifestations or liver pathologic findings, from the 17 patients with Reye's syndrome without renal failure seen in our institution during the same period of time. The use of osmotic diuretics in an effort to decrease cerebral edema may be life threatening in these patients with compromised renal function since hypervolemia, cardiac failure, and worsening of cerebral edema may occur.


Pancreatitis and Reye's syndrome.

Pancreatitis and Reye's syndrome. A review of 18 cases of Reye's syndrome autopsied at Indiana University Hospital since 1970 was done to document pancreatic lesions associated with the syndrome. A spectrum of inflammatory lesions was identified and grouped into four categories: group 1, no changes; group 2, minimal microscopic changes; group 3, moderate changes, ie, focal necrosis, exudates, or congestion; and group 4, severe acute pancreatitis. Patients in group 4 often had clinical or laboratory data suggesting the onset of pancreatitis after hospitalization. Acute pancreatitis is associated with Reye's syndrome, and patients should be monitored for its development. Hypotension, hypocalcemia, and glucose lability may herald the onset of acute pancreatitis in these patients.


Potential bacteremia in pediatric practice. The potential consequences of bacteremia are considerable in all infants but particularly in those from 3 to 24 months of age with temperatures of 38.3 degrees C or more. Physicians have been advised to scrutinize these patients carefully with a variety of diagnostic tests and to treat their conditions vigorously if bacteremia is seriously considered or proved. We undertook to determine how often primary care pediatric practitioners encounter such patients "at risk" for bacteremia. Among the practices of nine pediatricians in Monroe County, New York, involving 220 practice days throughout 1977 and 4,151 patient visits, we found 145 instances of potential bacteremia. Depending, then, on the season of the year, practitioners may face this diagnostic and management dilemma as often as once each day. Therefore, laboratory means for determining those infants at highest risk for bacteremia or for rapidly diagnosing bacteremia will need to be readily available to practitioners.


Recovery of anaerobic bacteria from pediatric patients. A one-year experience. During 1975, 115 speciments from the soft tissues, body fluids, and purulent sites in 105 pediatric ward and nursery patients were submitted to the clinical laboratory for anaerobic study, and 75% of the cultures were positive. In most instance specimens were collected in anaerobic transport tubes containing peptone yeast extract and glucose. In the laboratory, samples were processed by the anaerobic holding jar method. Nineteen different anaerobic organisms were isolated; the average number of species per specimen was 1.8 Bacteroides sp were the most common isolates (45 strains). Other isolates included 44 anaerobic cocci (15 of which were Peptostreptococcus sp), 22 Propionibacterium sp, ten Fusobacterium sp, nine Clostridium sp, eight Veillonella sp, six Bifidobacterium sp, and four Eubacterium sp. The main sources of anaerobic isolates included 52 gastric aspirates, 46 soft tissue sites, 14 blood specimens, 12 CSF samples, and 12 samples from the external ear canals. Forty-one (43%) of the 86 specimens that contained anaerobic bacteria also had aerobic organisms present.


Primary amebic meningoencephalitis.

Primary amebic meningoencephalitis. Primary amebic meningoencephalitis a rapidly fatal CNS infection caused by the free-living ameba Naegleria fowleri. The disease is acquired by swimming in fresh water and is being recognized with increasing frequency. Results of early diagnosis and treatment with amphotericin and other drugs suggest therapeutic optimism. Epidemiological surveys have shown the organism to be commonly present in fresh-water lakes in the warmer parts of the world. Prompt recognition and treatment is vital.


Echocardiographic findings in a fatal case of Kawasaki's disease. Kawasaki's disease or mucocutaneous lymph node syndrome is being diagnosed with increasing freqency in this country. Although death is a rare complication coronary arteritis with associated myocardial changes is common. Echocardiography is proposed as a non-invasive study that may aid in the early detection of cardiac involvement.


Neonatal scabies.

Neonatal scabies. Scabies contracted during the neonatal period demonstrates a distinct clinical pattern that differs greatly from manifestations seen in older individuals. Involvement of the face, neck, scalp, palms, and soles is a consistent finding, as is the tendency for these lesions to form pustules early in the course of the infestation. Poor feeding and failure to gain weight appropriately are also characteristic features. The skin lesions include erythematous papules, nodular crusts, and putules. The possibility of scabies should be entertained for any young infant who has these findings. Scrapings should be obtained from multiple sites to confirm the diagnosis. In the absence of positive findings for scrapings, examination of close contacts and a careful history should lead to the correct diagnosis.


Intrauterine diagnosis of renal anomalies by ultrasonography. The diagnosis of renal disease was made antenatally in three patients by ultrasonographic examination. In two cases a multicystic kidney was detected in utero and removed shortly after delivery. In another case, a hydronephrotic kidney was detected in utero; repair was then performed early, before symptoms developed in the infant. Antenatal diagnosis of renal disease by ultrasonography may help reduce morbidity and mortality in some cases.


Cardiovascular disease risk factor variables during the first year of life. Cardiovascular risk factor variables were measured in a cohort of 440 infants at birth 6 months, and 1 year of age. Blood pressures at 6 months of age were 93/47 mm Hg (systolic/diastolic pressure, fourth phase) and 97/51 mm Hg at 1 year of age. Serum total cholesterol, beta-lipoprotein, and alpha-lipoprotein levels rose dramatically from birth to 1 year of age. Serum triglycerides also showed an increase from birth to 6 months of age, but a decrease from 6 months to 1 years of age. At 6 months of age, the infants were consuming 949 kcal and at 1 year, 1,356 kcal. A statistically significant correlation between serum cholesterol level and protein, fat, cholesterol, and carbohydrate intake was noted at 1 year of age. These observations provide a background for tracing the evolution of risk factor variables as part of the early natural history of arteriosclerosis.


Controlling post-transfusion hepatitis: a proposal to publicize hepatitis rates of transfusion facilities. A federal requirement that donor blood be labelled as either "paid" or "volunteer" took effect on May 15, 1978. A major rationale for requiring such labelling is that physicians, now that they can distinguish between categories of blood, will fear liability for post-transfusion hepatitis resulting from the use of paid blood. Thus, supporters of the labelling requirement hope that it will deter the use of high-risk commercial blood. Some paid blood, however, is not commercial blood and in fact may be safer than volunteer blood. The labelling strategy for hepatitis control, therefore, has negative as well as positive attributes. This Article considers the efficacy of blood labelling as a hepatitis control measure and proposes an alternative strategy--the periodic publicizing of hepatitis rates of facilities that perform transfusions--that, if practiced responsibly, could significantly decrease hepatitis transmission rates.


Survey of outpatient pharmaceutical services in university hospitals. The results of a 1978 survey of outpatient pharmacies in university-affiliated hospitals are reported. A questionnaire with 55 items was sent to 75 university-affiliated hospitals with outpatient clinics. Sixty hospitals responded. Of the 47 usable responses, 44 were from hospitals with outpatient pharmacies. The outpatient pharmacies served a mean of 163 patients/day, dispensing a mean of 295 prescriptions/day. Prescriptions from outpatient clinics accounted for a mean of 57% of the outpatient pharmacies' prescriptions. Only four outpatient pharmacies provided 24-hour, seven-day/week services; the remainder provided a mean 11.1 hours of service per day on weekdays. The mean number of full-time equivalent pharmacists employed in the outpatient pharmacies (2.9) correlated positively with the number of prescriptions dispensed daily. The straight-fee pricing system was used by 62% of outpatient pharmacies but pricing systems varied with the type of product dispensed. Computer services were used in 28% of the outpatient pharmacies but were restricted mainly to accounting and inventory functions. Only 15% of the outpatient pharmacies maintained patient profiles for all patients served, and only 21% conducted special patient education programs in drug therapy.


Development of a multifunctional drug file for hospital pharmacy computer applications. The development of a multifunctional master drug file (MDF) which satisfies initial pharmacy data base requirements and has the capability to support increasingly sophisticated computer applications is described. The computerized purchasing, inventory, drug use review and formulary systems in a 1,100-bed teaching hospital were evaluated to determine which existing data fields should be included in the MDF, Functional requirements for the MDF and 27 data fields, each with its own particular specifications for programming, were identified. A method of data input was designed to create and maintain the file using keypunched Hollerith cards. Data input forms were designed to serve as coding documents for drug file data. Verification of all data in the file can be performed by running a program which lists the contents of each drug recorded. Based on 1975 salary rates, the total cost of the MDF development was $4,010; total time required was 640 hours. Approximately one hour per week is needed to keep the file contents up to date. File design specifications and contents are discussed, with special emphasis on the functional aspects of the MDF. The MDF successfully fulfilled the initaial pharmacy computer system requirements and has the potential to accommodate increasingly sophisticated applications.


Evaluation of albumin use by medical audit. The appropriateness of albumin prescribing and accuracy of records of albumin use were studied at a 476-bed hospital. Medical records of 15 adults who had undergone surgery within one week of albumin administration were compared with eight prescribing and charting criteria that were developed by pharmacists. Charts of patients who did not meet every criteria were reviewed by a committee to determine if exceptions to the criteria were justifiable. Albumin prescribing was empirical for approximately 60% of the patients. Albumin use as judged by laboratory values was inappropriate in three patients. Charting of the amount and rate of albumin administered was inaccurate, incomplete or difficult to interpret for eight (53%) of the patients. The dosage of albumin prescribed was inappropriate for two (13%) patients. Appropriate concomitant therapy (e.g., packed red blood cells) was not prescribed for two patients. For only three patients did the patient's charge correspond to the amount charted as being administered. On an annual basis, patient charges for albumin were projected to be $9,321 less than the hospital's cost for the product. The audit identified problems in albumin prescribing and charting that, when corrected, would result in cost savings and improved patient care.


Aminoglycoside use monitored by clinical pharmaceutical services. A pharmacy-infectious diseases program designed to promote the rational use of, and decrease the adverse reactions attributed to, amikacin and tobramycin is described. Requests for amikacin and tobramycin were screened initially by a pharmacist and later reviewed by an infectious disease physician. When the appropriateness of amikacin or tobramycin use was questionable, the drug was released pending review of the order by the chief of infectious diseases. Pharmacists, in consultation with the infectious diseases service, made recommendations for alternative antibiotic therapy or dosage regimens, provided drug education to prescribing physicians and nurses, and aided in monitoring efficacy and toxicity of therapy. During a two-year period, 12 patients received tobramycin and 42 patients received amikacin. The drugs were discontinued as recommended in the 12 patients for whom culture results were negative or indicated sensitivity to other antibiotics. Two initial requests for the drugs were denied. No incidents of renal impairment were definitely associated with tobramycin or amikacin use. During an 18-month portion of the study, the two drugs accounted for approximately 2% of the hospital's total aminoglycoside costs and 4% of the total number of aminoglycoside therapy courses. Monitoring of antibiotic use may promote safe, rational antibiotic use and potentially reduces hospital costs.


Reimbursable pharmacy teaching program for adrenalectomy patients. A three-step, pharmacist-taught education program for adrenalectomy patients is described. Twenty-three patients were trained during the two years of the project. Training included: (1) an explanation of the patient's disease state and need for supplementary medication; (2) an explanation of each medication taken; and (3) training on self-administration of an i.m. dose of dexamethasone. Blue Cross agreed to pay the hospital ø25 per patient trained. Thirteen patients were available for interviews designed to evaluate the program. All patients knew the signs and symptoms of adrenal crisis and had excellent recall of information about their medication. Eight patients had increased their oral steroid doses as instructed to avoid adrenal insufficiency during stress. Substantial cost savings resulted from the program. The costs saved by offering the program justified the cost of supplying the service.


Response rates to direct reprint requests. The response rates to mail reprint requests, time required to receive reprints and the cost of obtaining reprints were studied. Over 1,300 reprint requests representing articles published in 193 journals were sent to authors in 31 countries. A reprint was received for approximately 72% of the requests. Authors in the United States responded at a significantly higher rate (78.7%) than authors in foreign countries (64.5%) (p less than 0.001). About 75% of all reprints arrived within three months of their request. The mean number of days required to receive a reprint from an author in the United States was 55, while 99 days was the mean for authors outside the U.S. The estimated cost of obtaining reprints by mail was 22 cents per article received. The use of reprint request cards is a viable method of obtaining reprints within the limitations of an incomplete return rate and moderate delay in the arrival of the reprint.


Prognostic factors in acquired aplastic anemia. A study of 352 cases. The prognostic factors of short- and long-term survival have been studied in 352 patients with aplastic anemia of all grades of severity. This group was homogeneous with regard to the clinical and laboratory survey, and the treatment used [high-dose androgen therapy]. The "hierarchy" of the individual prognostic parameters has been established: current severe infection, granulocyte count, percentage of the nonmyeloid cells on the bone marrow slides, platelet count, reticulocyte count, 59Fe utilization, and stromal disorganization on the bone marrow biopsy specimen. As these parameters are interrelated, a multiparametric analysis enables us to define groups of patients with different short-term evolution and to derive a prognostic index from these data. The use of such an index, however, allows a correct prediction in only 73 per cent of the cases, better in the milder than in the more severe cases. It is possible that the short-term evolutive tendency (improvement or worsening during the first six weeks of therapy) may contribute supplementary information useful for prognosis and the choice of treatment. After the first three months critical period, the mortality rate no longer depends on the initial severity of the disease but exclusively on the clinical and hematologic improvement. Thus, comparing the hematologic data obtained initially and after three months of androgen therapy allows us to correctly predict the long-term evolution.


Tuberculosis in patients undergoing maintenance hemodialysis. Tuberculosis was diagnosed in eight patients undergoing maintenance hemodialysis and occurred with an incidence 10 times that of the general population. Dialysis-associated tuberculosis is characterized by intermittent fever, anorexia, weight loss and hepatomegaly. Ascites was present in 50 per cent of the patients. A recently converted positive tuberculin skin test was observed in five of eight patients. Tuberculosis was extrapulmonary in seven of eight cases and consequently the diagnosis was frequently delayed. Over-all mortality was 37.5 per cent and correlated with the duration of symptoms prior to initiation of therapy. A trial of antituberculous therapy is warranted in patients undergoing dialysis in whom fever of unknown origin, anorexia, weight loss and/or hepatomegaly develop particularly in areas endemic for tuberculosis.


A randomized study of carbenicillin plus cefamandole or tobramycin in the treatment of febrile episodes in cancer patients. Patients were randomly assigned to receive carbenicillin plus tobramycin by continuous infusion (C+T), carbenicillin plus cefamandole by continuous infusion (C+CC) or carbenicillin plus cefamandole by intermittent infusion (C+IC) during 490 febrile episodes. Carbenicillin was administered over 2 hours every 4 hours. The per cent of cures achieved during the 235 documented infections was 65 per cent for C+CC, 57 per cent for C+IC and 54 per cent for C+T. Among those infections caused by single gram-negative bacilli, C+CC produced a higher cure rate than C+IC or C+T(74 per cent versus 59 per cent versus 50 per cent). C+CC was significantly more effective than C+IC among patients with persistent severe neutropenia of less than 100 neutrophils/mm3 (65 per cent versus 21 per cent, p = 0.03). If the infecting organism was sensitive to both antibiotics, the cure rate which occurred during 12 per cent to 13 per cent of the febrile episodes, regardless of antibiotic regimen. However, it occurred significantly more often during documented infections than during fevers of unknown etiology (20 per cent versus 6 per cent, p less than 0.001). C+CC appears to be the most effective of the three regimens for the treatment of infections in patients with persistent severe neutropenia.


Trephine biopsy of the bone marrow in disseminated histoplasmosis. Twenty-two patients had bone marrow aspirates for culture and marrow trephine biopsies for histologic examination during the evaluation of an illness eventually proved to be disseminated histoplasmosis. These procedures provided evidence of involvement of the bone marrow with Histoplasma capsulatum in 19 cases. Fungi were demonstrated in trephine biopsy sections in 15 of the patients, permitting a rapid specific diagnosis. Three patterns of bone marrow morphology were observed; each reflected a variation of macrophage proliferation. In two of the patterns, diffuse macrophage proliferation and loose aggregates of macrophages, typical 2 to 4 microns intracellular hisoplasma organisms were numerous and obvious in hematoxylin and eosin-stained sections, were infrequent and were often relatively large (6 to 12 microns). There were four patients from whom H. capsulatum was cultured when organisms could not be demonstrated in either hematoxylin and eosin- or silver-stained sections. The patients with diffuse proliferation of macrophages in the marrow comprised a distinct clinical group associated with immunosuppression, a fulminant course and a fatal outcome despite therapy. Patients in the other two morphologic groups responded well to therapy even though the immune responses on many were also suppressed. Bone marrow examination is an excellent diagnostic procedure in disseminated histoplasmosis. Trephine biopsies permit a rapid diagnosis in most cases and may be of prognostic significance.


Demonstration of antigenemia in patients with invasive aspergillosis by solid phase (protein A-rich Staphylococcus aureus) radioimmunoassay. A solid phase radioimmunoassay (RIA) was used to detect Aspergillus antigenemia in three patients, two with autopsy proved disseminated aspergillosis and one with a suspected infection. These RIA studies suggest that screening for antigenemia may be a specific and sensitive diagnostic test for disseminated aspergillosis.


Acute and chronic pulmonary function changes in allergic bronchopulmonary aspergillosis. Pulmonary functions of patients with allergic bronchopulmonary aspergillosis were studied during an acute episode (n = 6); during a mean follow-up period of 44 months (range four months--14.8 years) (n = 16); and for any correlation between duration of ABPA and asthma with the total lung capacity (helium dilution), 1 second forced expiratory volume (FEV1), vital capacity, 1 second forced expiratory volume-forced vital capacity ratio (FEV1:FVC per cent) and diffusing capacity of carbon monoxide (DL:CO) (single breath) for the entire group (n = 22). All patients were treated with corticosteroids (intermittent or continuous) and bronchodilators. For the 16 patients, slopes using linear regression analysis were determined from the function as per cent predicted versus time in months from diagnosis and then analyzed for significance. Significant functional loss was shown in three of 16 patients for FEV1, two of 16 patients for vital capacity, one of 16 patients for FEV1:FVC per cent, none of 10 patients for DL:CO and one of 10 patients for total lung cital capacity, FEV1:FVC per cent and the duration of asthma or allergic bronchopulmonary aspergillosis was found by multiple regression analysis correcting for age and smoking (mean 4.24 years; range 0.3 to 14.8 years). Roentgenographic criteria and blood eosinophilia were used to define a "flare" of allergic bronchopulmonary aspergillosis. The six patients during a flare showed a significant reduction in total lung capacity (P less than 0.001), vital capacity (P less than 0.05), FEV1 (P less than 0.01) and DL:CO (P less than 0.001) which uniformly returned to baseline values during steroid therapy. The FEV1:FVC per cent remained unaltered. These findings, contrary to suggestions in the literature, indicate that in the majority of our patients there was no significant progressive functional deterioration after diagnosis. However, during acute episodes of allergic bronchopulmonary aspergillosis, transient reduction of volumes and DL:CO were uniformly present.


Deficiency of the fifth component of complement in human subjects. Clinical, genetic and immunologic studies in a large kindred. The discovery of a large kindred with a heritable deficiency of the fifth component of complement (C5) has permitted the accumulation of new clinical, genetic and immunologic data concerning the role of C5 in human subjects. The proband, who has had nine episodes of disseminated gonococcal infection, has a hemolytic C5 level of approximately 0.5 per cent of normal. No C5 protein was detectable, but low levels of functional C5 activity could be found using a sensitive bactericidal assay. The proband's twin as well as another sister also had extremely low levels of hemolytic C5(approximately 0.5 per cent normal), but both these subjects have been healthy. Hemolytic complement and bacteriolytic activity could be restored by the addition of purified C5. No chemotactic activity for polymorphonuclear leukocytes could be generated in the C5-deficient serums upon activation of either the classic or alternative pathways, again demonstrating the importance of C5 in human subjects for the production of chemotactic factors. The chemotactic responsiveness of the patients' polymorphonuclear leukocytes and monocytes to preformed chemotactic factors was not depressed. Twenty-two of 32 other family members from three generations had depressed whole hemolytic complement levels. In 19 of 30 family members, levels of hemolytic C5 ranged from 13 to 64 per cent of normal. No linkage for C5 deficiency and the A or B loci of the major histocompatibility complex could be found. These data suggest an autosomal codominant mode of inheritance of C5 deficiency. Deficiency of C5 is compatible with good health, but it can be associated with repeated disseminated gonococcal infection.


Necrotizing colitis in patients with cancer. Necrotizing lesions of the colon occur in patients with malignancy. We identified 26 patients with cancer (23 with acute leukemia and three with solid tumors) who died from necrotizing colitis. Autopsies revealed three pathologic categories: pseudomembranous colitis in 69 per cent, agranulocytic colitis in 19 per cent and ischemic colitis in 12 per cent. Most died from sepsis. A comparison of characteristics was made with a control population matched for diagnosis, age, cause of death and duration of neoplasia. Nearly all patients in both groups had fever and were granulocytopenic secondary to chemotherapy. Most received antineoplastic and antimicrobial regimens during the month prior to their terminal illness. Abdominal pain and distention, stomatitis and necrotizing pharyngitis were frequently associated with colitis. Hyperbilirubinemia was a frequent late complication in those with colitis and the control group. Single and multiorganism septicemia were found more frequently in patients with colitis. As antemortem diagnosis was unusual, aggressive attempts at diagnosis are necessary to assess the true incidence of this disorder and the best therapy.


Reye's syndrome in the adult patients.

Reye's syndrome in the adult patients. Reye's syndrome has been thought to represent a childhood illness. Our thesis is that it is a postviral systemic disease which may affect adults as well. A 51 year old woman is presented whose case meets all of the major criteria for Reye's syndrome. The diagnostic criteria for Reye's syndrome are summarized, and two other reported cases of Reye's syndrome in adults are reviewed. The diagnosis of Reye's syndrome in adults requires familiarity with the diagnostic criteria and a "high index of suspicion."


Shock and noncardiogenic pulmonary edema following meglumine diatrizoate for intravenous pyelography. In a 25 year old man shock and pulmonary edema developed following the intravenous administration of meglumine diatrizoate for an intravenous pyelogram. A pulmonary-capillary wedge pressure of 3 torr and a high protein content in the pulmonary edema effluent confirmed the diagnosis of noncardiogenic pulmonary edema. We suggest that the basis of the increased capillary permeability in this patient may be related to an immunologic reaction to intravenous pyelogram dye.


Clinical isolation and characterization of aminoglycoside-resistant small colony variants of Enterobacter aerogenes. Small colony variants of Enterobacter aerogenes, as well as the parental large colony type, grew in blood drawn for cultures on three separate days from a patient who had received suboptimal gentamicin therapy. Minimum inhibitory concentrations of four aminoglycoside antibiotics were eight to more than 16 times higher for small colony variants than for the normal large colony type. Small colony variants had defective catalase activity, which may have interfered with oxidative metabolism and aminoglycoside uptake. Small colony variants reverted readily to the parental type in vitro in the absence of aminoglycosides. Clinically isolated small colony variants appeared similar to those selected in the presence of gentamicin in vitro, with respect to colony morphology, aminoglycoside resistance and catalase deficiency. The isolation of small colony variants during gentamicin therapy in vivo suggests that such variants may be a cause of treatment failure in patients receiving aminoglycosides.


Clostridial sepsis following hepatic arterial infusion chemotherapy. Three patients with clostridial sepsis during or following hepatic arterial infusions for the regional chemotherapy of hepatic metastatic tumors are described. In all patients abdominal roentgenograms revealed lucencies in the right upper quadrant consistent with gas-containing hepatic abscesses at the time of clinically apparent sepsis and positive blood cultures. The occurrence of three such cases in one year and the low incidence of clostridial infections in non-catheterized oncology patients at our institution suggest that clostridial infection is a previously unrecognized complication of hepatic arterial infusion chemotherapy. The possible sources of the infecting organisms and pathogenesis of this infection are discussed.


Toxoplasmosis presenting as brain abscesses. Diagnosis by computerized tomography and cytology of aspirated purulent material. A patient with brain abscesses caused by Toxoplasma gondii is described. Presence of brain abscesses was confirmed by computerized tomography, and T. gondii was identified as the etiologic agent in cytologic preparations of aspirated purulent material from one of the abscesses.


Model course for retraining inactive medical technologists. In the belief that there is an ongoing need for the retraining of inactive medical technologists, the University of Wisconsin-Madison initiated such a program in 1978. A model course in routine chemistry and instrumentation was developed, presented, and evaluated. This model is described in detail. Results indicate that most inactive medical technologists can regain competence. The program and individual courses are designed so they can be easily replicated or adapted for use by others interested in retraining inactive medical tehcnologists.


Genetics of hyperuricemia in families with gout. Complex segregation analysis supports the polygenic hypothesis of Hauge and Harvald and Neel et al, according to which hyperuricemia ascertained through gout is rarely due to a major gene, evidence for which is not significant in two studies that were considered to favor a major locus.


Cytogenetic findings in Roberts-SC phocomelia syndrome(s). Roberts syndrome and SC phocomelia syndrome are an autosomal recessive condition of prenatal and postnatal growth retardation, symmetrical limb reduction, and craniofacial abnormalities. A distinction has been made between the two syndromes on the basis of relative severity of these manifestations. Where chromosome studies have been carried out, most have been reported as normal. However, there have been two reports of consistent centromere abnormalities; one in a patient with SC phocomelia (pseudothalidomide syndrome), the other in a patient with Roberts syndrome. Four patients with similar phenotypic manifestations have recently been shown in our laboratory to have the same centromere puffing and splitting. These four patients had other clinical manifestations in common, including bilateral corneal opacities, microcephaly, absence of radii, limited extension at knees and elbows, apparent enlargement of the phallus, and survival beyond the neonatal period.


Multiple congenital anomalies/mental retardation (MCA/MR) syndrome due to partial 1q duplication and possible 18p deletion: a study of four individuals in two families. We have evaluated four individuals from two unrelated families with a similar multiple congenital anomalies/mental retardation (MCA/MR) syndrome due to partial duplication of chromosome 1q and possible deletion 18p. In both families the mothers and several relatives were carriers of the balanced translocation rcp t(1;18) (q42;p11). The features which the four have in common are relative macrocephaly, prominent forehead, micrognathia, and highly arched palate; three of the four individuals have short stature, scoliosis, kyphosis, hirsutism, camptodactyly, sacral dimple, repaired inguinal hernias, and eye abnormalities. Reproductive histories of five balanced translocation carriers in these families indicate that they have a high risk of spontaneous abortions and infants with multiple malformations.


Genetic and environmental determinants of periodontal disease. Reanalysis of data on periodontal disease in 241 families [Chung et al, 1977b], based on an extended and more satisfactory path model [Rao et al, 1979], failed to detect significant heritability, and concluded in favor of cultural inheritance only, without maternal effects or intergenerational differences. The most parsimonious hypothesis yields a relative variance component of 0.338 +/- 0.024 due to indexed environment for both children and adults, the remainder (1.0--0.338 = 0.662) being due to residual nongenetic factors.


Triplication of chromosome arm 20p due to inherited translocation and secondary nondisjunction. A patient with triplication of all of chromosome arm 20p is presented to illustrate the relatively modest degree of developmental delay that can result from autosomal triplication and the role of nondisjunction as a mechanism for deriving a partial triplication status.


Distal 2q duplication: report of two familial cases and an attempt to define a syndrome. Two cases of partial trisomy 2q are described, both resulting from a balanced translocation in one of the parents. In one case the chromosomes 2 and 11 were involved [paternal karyotype: 46,XY,t(2;11)(q33;q23)]; in the second case, chromosomes 2 and 8 [paternal karyotype: 46,XY, t(2;8(q32;p23)]. When the two patients were compared to the few cases reported in the literature, it was concluded that the associated clinical syndrome is characterized by severe psychomotor retardation and relatively mild abnormalities involving skull and facies.


Genetic counseling--the postcounseling period: I. Parents' perceptions of uncertainty. To investigate how parents who have had genetic counseling perceive the problems created by being at risk, transcripts of open-ended, semistructured follow-up interviews with 53 counselees were analyzed qualitatively. Rate information, though recalled accurately by parents considering further childbearing, was discounted as impersonal, and subjects overwhelmingly perceived the chance of recurrence in binary form -- it either will or will not happen. By processing rates this way, they simplified probabilistic information and shifted their focus to the implications of being at risk and the potential impact of that which might or might not occur. The many uncertainties they faced, the "consequences" of being at risk that parents felt had to be resolved during the decision-making process, fell into 3 major categories: uncertainty that arose because of the ambiguous impact and meaning of having an affected child; uncertainty about how to make a choice and how others would view it, the burden of decision-making; and uncertainty about their ability to fulfill their roles as parents. These issues were perceived as part of the problem to be resolved and were consolidated into "scenarios" in which the parents "tried out the worst." This analysis of counselees' perceptions of the problems created by being at genetic risk suggests that parents may process the disparate facts of their situation in common ways that emphasize their uncertainty, and it indicates that how parents perceive factual information may be more important in orienting their deliberations than what these facts (diagnosis, prognosis, risks) actually are.


Genetic counseling -- the postcounseling period: II. Making reproductive choices. Qualitative analysis of transcripts of follow-up interviews with 53 parents who had had genetic counseling was undertaken to characterize the process by which childbearing decisions were made and to determine how counselees resolved the problems created by being at risk. Although specific issues to be resolved varied with a parent's perception of his or her situation, all those who considered having subsequent children attempted to limit the uncertainties they faced and to neutralize those consequences perceived as most problematic. To do so, counselees uniformly inferred from factual information and experiences available to them how they could manage the possible consequences of taking a chance. Factors influencing a parent's ability to make a clear decision included the presence of a previous normal child, the diffusion of decision-making responsibility to others, and recognition that one had already managed the worst. When these "facts" could not be processed to provide a sense of coping, parents either decided against reproduction and took appropriate action or made a "non-decision" about reproduction by choosing to leave conception to chance. These various tactics allowed parents to create a "least-lose" option in terms of their child-bearing choices. This analysis of how parents make reproductive decisions, along with previous findings, suggests that being at risk both creates common problems and elicits common responses from counselees. Moreover, it highlights the importance of recognizing parents' perceptions of their situation to understand how their deliberations are structured and how factual information influences their ultimate choices.


Autosomal dominant atresia of the auditory canal and conductive deafness. We report autosomal dominant atresia and/or stenosis of the external auditory canal with or without conductive deafness. In the family described here the anomaly had occurred in 12 individuals in five generations. Penetrance was very high, expressivity quite variable. The clinical, audiometric, radiographic, and operative findings in three patients (grandfather, father, and son) are presented. This condition has been reported only once previously.


Stage of palate closure as one indication of "liability" to cleft palate. A new inbred mouse strain, SW/Fr, developed from a random-bred SW stock has a 6% incidence of spontaneous cleft palate without cleft lip. SW/Fr mice close their palates comparatively late in development. After cortisone treatment, the mean of the distribution (mean time to reach palate stage 5) is shifted towards later gestational ages. There is no change in the variance of the distribution. These data lend further support to the hypothesis that cleft palate in mice may fit a model where a continuous distribution is separated into discontinuous parts by a developmental threshold, and that time of palate closure is an important component of liability to cleft palate.


Evaluations of mentally retarded persons: "sympathy" or patronization? Subjects evaluated a hypothetical target person after reading a transcript of a bogus interview. The person was either labeled as retarded or was not labeled, and she was presented in a favorable or an unfavorable light. Subjects tended to evaluate the labeled (retarded) person more favorable than they did the nonretarded person on the adjective and social-distance questions, but only in the unfavorable condition. On a series of attribution questions, subjects assigned more responsibility for the retarded person's outcome to situational factors, regardless of how well she was doing. Consistent with this finding, subjects also reported less expectation of future success from the retarded person on various kinds of behavior. This evaluation pattern, of reduced blame after failure and less credit after success, was termed a patronization effect, and the implications of this kind of attitude were discussed.


A limitation on the law of effect.

A limitation on the law of effect. Nineteen mildly or moderately retarded subjects were presented 32 oddity-training trials per day for 10 days with all new etimuli presented on each trial. Six subjects learned oddity, approaching an asymptote of 100 percent correct. Six others showed a strong preference (78 percent) for the odd stimulus but failed to improve. Seven remained in the performance range of 50 to 60 percent without improving. On eight trials per day, the two specific cues of an oddity display, chosen randomly, were presented alone as probes for specific-cue learning. Probe trials were above chance for all subjects. These results show that attention to the relevant dimension, demonstrated by oddity preference, plus adequate reinforcing conditions, indicated by specific-cue learning, did not ensure oddity learning. We concluded that subjects do not necessarily learn about the cues that control behavior. The operation of differential forgetting and/or rehearsal of relative vs. specific vs. specific cues was proposed as a likely explanation.


Assessing community attitudes toward mentally retarded persons. Although many researchers have found evidence of discrimination toward retarded individuals in employment, education, and housing, attitude-survey researchers generally report acceptance of retarded people in the community (Gallup, 1976; Gottwald, 1967). To examine this discrepancy, we compared responses on a survey concerning retarded people of a "threat" group, who lived near a house for sale that was described as "having the necessary characteristics" for a potential group home, and a "nonthreat" control group. Analysis between and across groups yielded differences that have implications for public education efforts and the validity of the survey method for research on mental retardation.


Attitudes of parents of mentally retarded children toward normalization activities. Parents of mentally retarded children were surveyed via a 5-point Likert scale to determine their attitudes toward normalization in general and in relation to their child. Results indicated significant differences in response, with the more positive attitudes being those associated with a general (the mentally retarded population) rather than specific (my child) referent. Within the general-referent group, parents of TMR children displayed the most positive attitudes. Age, sex, and level of retardation had no effect on child-specific responses.


Effects of social-skills training in a community-based program. The effects of social-skills training upon the behavior of 8 previously institutionalized mentally retarded adults, residing in community group homes were evaluated. In comparison to a control group, the subjects who received training showed substantial changes in the desirable direction for each behavior. Generalization to unfamiliar situations was also noted. The problems in placing retarded clients in the community without social-skills training and the potential disadvantages of inadequate training were discussed.


Levels of political knowledge of mildly mentally retarded adults. The levels of political knowledge of institutionalized and noninstitutionalized retarded adults were compared with fifth- and eight-grade children and nonretarded CA-matched low SES adults. On all four knowledge indices, the retarded adults' performance closely resembled that of nonretarded fifth-grade children. The retarded subjects performed better on indices that dealt with particular leaders and state and local government information than on the more complex regime and national government indices. Results indicated that in both retarded group subjects had acquired minimal political knowledge, even though none had been exposed to any voter education.


Mentally retarded offenders: prevalence and characteristics. The range of prevalences rates for retarded offenders reported in the literature varies from 2.6 to 39.6 percent. This wide variability appears to be due to the use of different population bases and to the way intelligence is measured. When these issues were explored empirically, prevalence rates for retarded offenders in two northeastern states were found to be only slightly higher than the prevalence rate of mental retardation in the general population. A second issue in the literature is identification of the predictors of offenders' offense severity, sentence length, and past recidivism. Results of this study showed that social and legal variable are better predictors than is intelligence, although no predictors were particularly strong.


Language comprehension processes of mentally retarded children. The strategies for sentence comprehension employed by a group of 18 severely retarded children were compared with those of a group of nonretarded children matched on MA. Using toys, the children acted out a series of simple active- and passive-voice sentences describing events that were either probable, improbable, or neutral with respect to semantic expectations. The retarded children tended to rely more on semantic expectations than did the nonretarded children. Retarded children whose MAs were less than 3 years did not take word order into account, but those of higher MA did use a word-order strategy. They assumed that the first noun in the sentence corresponded to the actor in the external situation.


Vigilance of performance of mildly mentally retarded children. The contribution of developmental factors to the vigilance performance of mildly mentally retarded children was investigated by comparing their vigilance performance with that of nonretarded children of the same CA and with younger nonretarded children of about the same MA. The retarded children showed an earlier and faster decline in vigilance performance than did the CA control group. This result was similar to that of Semmel (1965), but contrasted with that of Kirby, Nettlebeck, and Bullock (1978), who found no such difference in vigilance performance when comparing mildly mentally retarded and nonretarded adults. The MA control group performed in a similar way to the retarded children, suggesting that the more rapid decline in vigilance performance was largely a developmental phenomenon.


Discrimination, translation, or response organization: a clarification of factors underlying slower responding among mentally retarded persons. Apparently contradictory findings regarding the locus of information-processing differences between retarded and nonretarded persons were discussed. We suggested that these apparent contradictions may be due to differences in the relative involvement of central processes associated with perception, stimulus--response translation, and response programming in the experimental tasks that have been used in this type of research.


Spoken words and manual signs as encoding categories in short-term memory for mentally retarded children. The release from proactive inhibition paradigm was used to test differential encoding of manual signs and spoken words by six severely retarded children. Scores for shift conditions were significantly different from scores for nonshift conditions on the last trial, indicating that manual signs were encoded differently from spoken words for short-term memory storage. Implications of separate encoding categories for the investigation of language processes were discussed.


The dimension of adaptive behavior in mental retardation research: an analysis of recent practices. The dimension of adaptive behavior has been accepted by many professionals as an important component of identification in mental retardation since the definitions of Heber (1961) and Grossman (1973). In order to investigate the impact of this more comprehensive concept of mental retardation on research practices, we analyzed the use of adaptive behavior in the selection and description of subjects. This investigation was based in research articles published in the Americal Journal of Mental Deficiency from 1974 through 1978. In a significant percentage of the articles reviewed, the researchers had not attended to adaptive behavior and used only measures of intellectual functioning for descriptive purposes. These results were discussed in light of the validity of research on mental retardation. Recommendations were included for future research practices.


Staff members' attitudes toward the sexual behavior of mentally retarded residents. Seventy-five staff members from four private residential facilities for mentally retarded adults were surveyed to elicit their attitudes toward the sexual behavior and sexual knowledge of residents in their care. Facility policies and programs applicable to residents' sexuality were also the subject of inquiry. Comparable attitudinal surveys and studies dealing with the sexuality of mentally retarded persons were reviewed in the context of the present findings.


Elevations in skin temperature of the finger as an objective index of postmenopausal hot flashes: standardization of the technique. The present study was designed to validate and standardize a technique of continuous recording of skin temperature of the finger as an objective index of hot flashes. Significant skin temperature rises (greater than 1 degree C) were recorded in close temporal relationship to 69% of subjective hot flashes experienced by seven postmenopausal women. The temperature elevations occurred at an interval of 54 +/- 10 minutes (mean +/- standard error) and lasted an average of 31 minutes. The mean increase was 2.7 degrees +/- 0.2 degrees C. The extent of the temperature elevations found in the postmenopausal subjects was significantly greater than in premenopausal control subjects (P less than 0.05) and was reduced by estrogen treatment (P less than 0.02). This study substantiates that the recording of skin temperature changes of the finger provides an objective index of hot flashes. This should assist in the investigation of the underlying disturbance and provide more accurate evaluation of modes of therapy.


Sonar cephalometry in twins: a table of biparietal diameters for normal twin fetuses and a comparison with singletons. In 123 normal twin pregnancies, 589 biparietal diameter (BPD) measurements were obtained between 16 and 40 weeks' gestation and mean values for each week were computed. A table of BPDs for normal twin pregnancies based on these data is proposed. Mean twin BPDs were consistently smaller than those of singletons, the difference averaging 3.5 mm between 16 and 40 weeks' gestation. The development of a twin BPD table now permits a more accurate assessment of twin gestational age and fetal growth.


Disappearance of human chorionic gonadotropin and resumption of ovulation following abortion. The disappearance of human chorionic gonadotropin (hCG) and resumption of pituitary ovarian function was investigated in 13 patients following first- and second-trimester abortions. First-trimester abortion patients (with suction curettage) had a mean time of 37.5 +/- 6.4 days for the clearance of hCG to a level of 2 mlU/ml. Second trimester abortions (with prostaglandin) had a mean time of 27.4 +/- 4.8 days. Patients undergoing second-trimester hysterectomy had a mean disappearance time of 39.7 +/- 5.3 days and only 12 days if the hysterectomy was initiated with ligation of the uterine and ovarian vessels. No significant difference in clearance time was found when it was compared on the basis of the baseline hCG levels. Based on a concomitant luteinizing hormone (LH) and follicle-stimulating hormone (FSH) peak, nine of 12 patients resumed normal pituitary function. These LH and FSH peaks were seen even though the serum hCG levels were as high as 35 mlU/ml. Based on serum progesterone levels of greater than 3 ng/ml, all these nine patients ovulated as early as 21 days after abortion. In view of these results, the clearance of hCG after pregnancy termination depends mainly upon the type of procedure used. Moreover, in view of the early time of ovulatory recovery, contraception should be instituted within the first 2 weeks following pregnancy termination.


The effects of hydrocortisone on the development of the amine systems in the fetal brain. Human and animal studies suggest impaired central nervous system (CNS) development due to corticoid use in the perinatal period. In this study, hydrocortisone was given to pregnant rats and the development of the fetal dopamine (DA) and norepinephrine (NE) systems in the CNS was investigated. In the fetal rat brain DA and NE systems develop between days 12 and 17 of gestation. Hydrocortisone (HC), 57 mg/kg/day, or saline (SAL) was given intraperitoneally at day 12 or 15 of gestation. The offspring were studied at days 20 to 21 of gestation and days 12 to 13 in the neonatal period. Brain amine systems were visualized using a modified cryostat glyoxylic acid histofluorescence method, and DA and NE levels were determined in whole brains by means of a radioenzymatic assay. The visualized amine systems were evaluated semiquantitatively for distribution and fluorescence intensity without previous knowledge of the administered drug. The amine systems of the HC and SAL groups showed an equal maturation. In both groups cell bodies were demonstrable in areas A1 to A13 and axon terminals in all examined final regions. The distribution and the fluorescence intensity did not show consistent differences for the HC and SAL brains. The concentrations of DA and NE were similar in the offspring of the SAL- and HC-treated animals. The results indicate that HC given during pregnancy does not influence the proliferation of amine cell bodies or the arrival of axon terminals in the regions where the synapses form.


Prolactin production by human endometrium during the normal menstrual cycle. Prolactin (PRL) synthesis by human decidua from term pregnancies has been reported. The present study examined the tissue content and in vitro production of prolactin by "decidualized" and "nondecidualized" endometrium unassociated with pregnancy. Tissue obtained throughout the menstrual cycle was dated histologically. When proliferative endometrium (N = 16) or secretory endometrium prior to day 22 (N = 6) was examined, no PRL was detected in the tissue or medium after a 24-hour incubation at 37 degrees C in Gey's buffer. Total PRL in tissue and medium measured by radioimmunoassay increased significantly from 1.2 +/- 0.3 ng/100 mg of tissue at cycle days 22 to 24 (N = 4) to 5.3 +/- 2.4 ng/100 mg of tissue at cycle days 25 to 26 (N = 7). The addition of 100 micrograms/ml of cycloheximide to the medium prevented the net increase in PRL content during incubation. It is concluded that PRL is synthesized by endometrium during the normal menstrual cycle and that the appearance and degree of synthesis and decidualization of the stroma correspond.


Effect of long-term bromocriptine infusion on plasma prolactin and ovine chorionic somatomammotropin in the pregnant ewe and fetal sheep. It has been shown in previous studies that the continuous infusion of bromocriptine (CB 154) into either the sheep fetus or pregnant ewe was followed by pronounced ultrastructural changes in the binucleate (BN) cells of the ovine chorionic epithelium, which are a likely source of ovine chorionic somatomammotropin (oCS). We have examined ovine fetal and maternal plasma prolactin (PRL) and oCS concentrations following intravascular CB 154 infusion separately into either the fetus (0.03 mg/hour) or ewe (0.2 mg/hour). The CB 154 infusions significantly depressed fetal and maternal plasma radioimmunoassayable PRL concentrations within 24 hours of the commencement of infusion. Maternal plasma radioimmunoassayable oCS concentration was significantly depressed during infusion of CB 154 to the ewe, but the infusion of CB 154 to the fetus did not lower fetal plasma radioimmunoassayable oCS concentration or affect the duration of gestation.


Hormone production during pregnancy in the primigravid patient. I. Plasma levels of progesterone and 5-alpha-pregnane-3,20-dione throughout pregnancy of normal women and women who developed pregnancy-induced hypertension. The plasma concentrations of progesterone and 5-alpha-pregnane-3,20-dione (5-alpha-dihydroprogesterone) were measured from as early as 12 weeks through 41 weeks of gestation in primigravid women. Two groups of primigravid women were assessed, those with uncomplicated pregnancies and those who developed pregnancy-induced hypertension. Plasma levels of progesterone and 5-alpha-dihydroprogesterone rose progressively throughout gestation in both groups of women. The ratio of the level of progesterone to that of 5-alpha-dihydroprogesterone in individual plasma samples of women with uncomplicated pregnancies was 7.0 from 12 to 15 weeks' gestation while at 35 to 41 weeks' gestation the ratio had declined to 4.6. Similar results were obtained in plasma samples of women who ultimately developed pregnancy-induced hypertension. Since no differences in plasma levels of progesterone or 5-alpha-dihydroprogesterone were detected between primigravid women with uncomplicated pregnancies and those who developed pregnancy-induced hypertension, we conclude that neither progesterone nor 5-alpha-dihydroprogesterone concentrations in plasma are of value in identifying women at risk of developing pregnancy-induced hypertension.


Glycosylated hemoglobins and diabetes mellitus in pregnancy. The glycosylated hemoglobins (HA1) were measured in the blood of normal nonpregnant (n = 50) and pregnant (n = 29) volunteers and pregnant diabetic patients (n = 21). HA1 in normal pregnancy (6.7% +/- 1.03%) did not differ significantly from values in nonpregnancy (7.5% +/- 0.73%) and did not vary with the stage of gestation. HA1 was increased in diabetic pregnancy (8.4+ +/- 2.15%) and was positively correlated with serial fasting blood sugar (FBS) mean values in samples drawn up to 16 weeks (r = 0.57) prior to the measurement of HA1, although the highest correlation (r = 0.73, p less than 0.001) was with FBS levels over the prior 8 weeks. A large standard error of the estimate (26.9 mg/100 ml) showed HA1 to be insensitive as an indicator of prior FBS. There was a large overlap of HA1 from known diabetic patients with the normal range for pregnancy. There was no correlation of third-trimester HA1 and newborn birth weight. It was concluded that (1) normal pregnancy does not alter HA1; (2) HA1 is proportional to prior mean FBS; (3) marked elevations of HA1 (greater than 10%) reliably predict poor diabetic control, but HA1 is not useful for fine control of FBS; (4) HA1 is not useful as a screen for diabetes mellitus; (5) HA1 is not predictive of newborn birth weight.


Circadian rhythms in maternal plasma cortisol, estrone, estradiol, and estriol at 34 to 35 weeks' gestation. In order to examine the relationship between circadian rhythms in different steroids, cortisol (F), estrone E1), estradiol (E2), and estriol (E3) were measured by radioimmunoassay in maternal venous plasma taken at 30 to 60-minute intervals over 24 hours from 11 healthy women at 34 to 35 weeks' gestation. Maternal F was maximal at 0730 hours and fell significantly to its lowest concentration at 0230 hours. Maretnal E3 was lowest between 1000 and 1130 hours and rose significantly to maximal values between 2230 and 0030 hours. Maternal E1 was maximal between 1000 and 1130 hours and showed a significant decrease to reach its lowest concentration at 0430 to 0630 hours. No significant circadian change was measured in uncorrected concentrations of E2. We conclude that there is an inverse relationship between maternal F and E3, which would be consistent with a maternal effect on fetal adrenal function, and the existence of circadian rhythms in F, E1, E2, and E3 must be taken into account in clinical investigations of these hormones during pregnancy.


Amniotic fluid phosphatidylglycerol and real-time ultrasonic cephalometry. The fetal biparietal diameter (BPD) was measured at the time of real-time ultrasound-directed amniocentesis in 159 cases and a phospholipid profile was obtained from the amniotic fluid. BPD measurements of 9.0, 8.7, and 9.2 cm were then compared with a lecithin/sphingomyelin (L/S) ratio greater than or equal to 2.0 for the ability to predict the presence of phosphatidylglycerol (PG) in the profile. The data from the diabetic and nondiabetic patients were analyzed separately. The results demonstrated that in the presence of a L/S ratio greater than or equal to 2.0 the BPD does not aid in the identification of amniotic fluid samples which contain PG in either the diabetic or nondiabetic groups. The data also confirmed previous findings that the BPD is not a reliable predictor of the L/S ratio. It is concluded that for the detection of PG in amniotic fluid, the use of real-time ultrasonic cephalometry cannot substitute for the performance of the phospholipid profile.


Metabolism of progesterone by placentas from several mammalian species in vitro. 20-alpha-Hydroxysteroid oxidoreductase (20-alpha-HSDH) activity and 20-alpha-dihydroprogesterone concentration (20-alpha-DHP) reach peak values in the human placenta after vaginal delivery. To determine if these findings are unique to the human, we measured 20-alpha-HSDH activity as well as endogenous progesterone (P) and 20-alpha-DHP concentration in the soluble supernatant fraction of placental tissues obtained from rodents (rat, rabbit, guinea pig), ungulates (horse, zebra, giraffe, cow), and primates (squirrel monkey, orangutan, man). P concentration was very low in rodents (mean 0.60 ng/mg protein), increased slightly in ungulates (mean 2.89 ng/mg protein), and reached a maximum value in the human (34.43 ng/mg protein). 20-alpha-DHP concentration had a strong positive correlation (r = 0.93) with P tissue content; it was low in rodents (mean 0.21 ng/mg protein), increased slightly in ungulates (mean 0.79 ng/mg protein), and reached a maximum value in the human (39.53 ng/mg protein). 20-alpha-HSDH activity, however, had a poor correlation with 20-alpha-DHP tissue concentrations: Its lowest value was in the guinea pig (9.34 pmole/mg protein/hour) and the highest was in the horse (3.19 nmole/mg protein/hour). These results indicate that a high level of activity of the P to 20-alpha-DHP pathway with significant tissue accumulation of 20-alpha-DHP is unique to the human placenta and reinforce the possibility of its causing in situ P withdrawal as a part of the overall mechanism of human parturition.


The role of anaerobic bacteria in postpartum endomyometritis. To evaluate the role of anaerobic bacteria in postpartum endomyometritis, intravenous metronidazole was used as the sole initial therapy in 25 women with clinical signs of infection. This agent has not been shown to have activity against aerobic pathogens in soft tissue pelvic infections. A clinical cure was obtained in 21 of 25 (84%) with oral metronidazole utilized after the patient had been afebrile for at least 24 hours. The mean fever index of the 21 successfully treated women was 35.9 degree hours with a SD of +/-30 hours. The four patients with treatment failure required alternate antibiotics and the mean fever index of these patients was 138.0 degree hours. Transcervical endometrial cultures were obtained prior to therapy in 24 women. Anaerobes were recovered in every instance with a total of 67 isolates, a mean of 2.8 per patient. The most common isolates were peptococcus and Bacteroides species. A culdocentesis was performed concurrently in 23 women. Anaerobes were recovered in 20 (87%) with a total of 55 isolates. The most frequent isolates were peptococcus and Bacteroides fragilis. In 23 women in whom paired transcervical endometrial and cul-de-sac cultures were obtained, at least one common organism was isolated in 18 (78%). Both the successful clinical response to metronidazole and the paired culture results suggest that anaerobic organisms have an important role in endomyometritis following vaginal delivery.


Evidence for separable binocular processes differentially affected by artificially induced anisometropia. Two measurable effects are produced by viewing a large disk rotating about the line of sight: a perceived displacement of the apparent horizon (tilt) and cyclotorsion of the eye (torsion). Previous results in our laboratory (see Refs.) using dichoptic presentation techniques show that both effects demonstrate binocular enhancement in normal subjects. Further, stereoblind subjects maintain enhancement for the oculomotor effect, torsion, but not for the perceptual effect, tilt. In this study we have found that this stereoblind pattern of results can be produced optically in normals by introducing a three diopter myopia in one eye. This renders the subject stereoblind and causes suppression of the artificially myopic eye. In this condition torsion still shows enhancement; tilt does not. This procedure may be useful in isolating causes of stereoblindness and in locating different sites of binocular interaction.


Objective assessment of accommodation orthoptics. I. Dynamic insufficiency. Three young adult females with symptoms related to focusing difficulties at near were treated by standard orthoptic procedures, including jump focus, plus-and-minus lens flippers, and pencil pushups. Home training was done 20 minutes each day for 4 1/2--7 weeks. Objective measures of dynamic accommodation were made each week in our Neuro-optometry Clinic. Initially, these objective measures showed prolongations of time constants and latencies of accommodation. During treatment, the patients showed significant reductions in time constants and latencies that correlated well with elimination of subjective symptoms. Also, in all three patients, flipper rates increased and symptoms were either markedly diminished or no longer present at termination of therapy. These results clearly demonstrate that orthoptic treatment in our three adult patients resulted in objective improvement of accommodation function.


Speckle motion in laser refraction. II. Experimental. The validity of expressions for the position of the plane of stationarity, apparent speed of speckle movement, and estimated observer ametropia is examined for laser refraction, using a cylindrical drum. The agreement between theory and experiment is satisfactory. It appears unlikely, however, that methods of subjective refraction depending on estimation of speckle velocity can match the accuracy and precision of those based on rendering the plane of stationarity conjugate with the observer's retina. Even with experienced observers, refractive values based on estimates of speckle speed showed the unsatisfactorily large standard deviation of approximately 0.5 D.S.


A recent explanation of Haidinger's brushes and their clinical use. The entopic phenomenon called "Haidinger's brushes" (HB) is used both as a diagnostic testing procedure and as a feedback mechanism in visual training. A recent explanation of HB incorporating corneal birefringence is presented. This new theory also explains a clinical phenomenon found by this author. By using a "heat-treated" glass prism, a HB pattern can be enhanced, stopped, or reversed along a continuum of rotation. Clinical application of this phenomenon in testing macular integrity as well as in visual training is discussed.


A statistical analysis of the Biological Theory of spherical error of refraction. It is widely believed that Adolph Steiger proved in Die Entstehung der sphärischen Refraktionen des menschlichen Auges (The Origin of Spherical Refractions of the Human Eye) that the Biological Theory of spherical error of refraction statistically explains the entire distribution of such errors, hence excluding other theories such as the Use-Abuse Theory. Although Steiger's Biological Theory is a statistical argument, he never put it into formal notation. This paper puts a modernized version of the Biological Theory into formal statistical notation. It shows that the Biological Theory explains the dispersion of distributions of spherical error of refraction but not the location of their means. The Use-Abuse Theory is an explanation of mean spherical error in populations. Since a complete theory of spherical errors of refraction needs to explain both the mean and the dispersion of their distribution, the two theories are potentially complementary. No empirical evidence, however, is presented here for either theory.


The effect of pupil size on visual acuity in uncorrected and corrected myopia. The effect of pupil size on the relation between Snellen visual acuity and corrected and uncorrected myopia was examined for 22 young subjects with degrees of myopia ranging from 0.75 D to 7.5 D. Effective pupil size was varied by inducing mydriasis and then placing artificial pupils of between 1.0 and 8.0 mm diameter before the eye. Both a constant chart luminance of 120 cd/m2 and a constant retinal illuminance of 2150 trolands were used. There was little difference in results for the two lighting conditions. For the corrected myopes considered as a group, maximum visual acuity occurred for 2--3 mm diameter pupils, but larger pupils reduced acuity only marginally. For the uncorrected myopes, variation in pupil size produced a large variation in visual acuity, and for refractive errors greater than about 1.5 D, the optimum pupil diameter was less than 1 mm. For uncorrected myopes of 3.0 D or less, visual acuity was nearly as good with a 1-mm pupil as for corrected myopes. The presented data are a useful guide to the clinician.


The definition of thickness for a lens.

The definition of thickness for a lens. The thickness of a lens depends upon the direction of the measuring vector. The thickness as commonly used from the sagittal height formula does not give the path length for movement of gas, water, and heat through a lens. Furthermore, the amount of gas, water, or heat moving through a lens depends upon an areal average thickness, not central thickness. A formula is derived for an approximate areal averaged sagittal height thickness. This average thickness has the advantage of being easily calculated from a sagittal height table. The equation for the areal average thickness along a radius of curvature is also derived. Sample calculations are made to show how this average thickness is a function of lens dimension. It is recommended that an areal average thickness be used when oxygen transmissibility of a lens is calculated from oxygen permeability of the lens material.


Lung injury induced by leukocytic proteases. Human polymorphonuclear neutrophilic leukocytes (PMNs) contain large amounts of neutral proteases that can degrade elastin, collagen, proteoglycan, and basement membrane. The instillation of one of the purified enzymes (elastase) into dog lungs in vivo causes degradation of elastic fibers and other alveolar septal components and results in anatomic changes similar to those of human pulmonary emphysema. Cigarette smoking is a major risk factor associated with pulmonary emphysema in man. One mechanism for this association may be interference with the regulation of PMN elastase activity by alveolar antiproteases. This possibility is supported by the observation that the oxidizing activity of tobacco smoke inactivates alpha 1-proteinase inhibitor in vitro. Macrophages also secrete an elastolytic protease, albeit at low levels. The short-term exposure of cultured mouse macrophages to cigarette smoke augments the rate of elastase secretion by these cells. Mouse macrophage elastase is not inhibited by alpha 1-proteinase inhibitor or alpha 2-macroglobulin. This unusual property of macrophage elastase may facilitate its attack upon elastin over prolonged intervals despite very low levels of macrophage elastase production. A unified hypothesis of lung injury in pulmonary emphysema is presented, involving both PMN and macrophage elastases and the actions of cigarette smoke. (Am J Pathol 97:111--136, 1979).


Prostaglandin biosynthesis in pulmonary macrophages. Cultured rabbit alveolar macrophages, prelabeled with 14C-arachidonic acid (AA), released into the medium a trace amount of labeled prostaglandins (PG) as well as their precursor, AA. Phagocytosis of zymosan, heat-killed Staphylococcus, or bacille Calmette-Guérin (BCG) increased the AA and PG release to 2--2.5 times control values. The released PGs consisted of PGE2, D2, F2 alpha, and 6-keto F1 alpha. Phagocytosis of latex particles had no effect on PG release. Indomethacin inhibited release of PGs but did not affect AA release at low doses. Analysis of the cellular lipids showed that zymosan decreased the radioactive label in phosphatidylcholine (PC), but not in other phospholipids or neutral lipids, suggesting that PC is the main source of AA for PG synthesis in pulmonary macrophages. Cytochalasin B (CB) at phagocytosis-inhibiting doses or below, markedly increased PG synthesis by zymosan-treated macrophages. These data suggest that PG release is not dependent on engulfment of the particles. Phagocytosis of zymosan (but not latex) also resulted in the release of two lysosomal enzymes, acid phosphatase and beta-glucuronidase, which appeared temporally associated with the release of PGs (but not to phagocytosis). Furthermore, CB augmented the zymosan-stimulated release of these enzymes at the same doses stimulating PG synthesis. However, indomethacin, at a dose completely inhibiting PG synthesis, failed to block lysosomal enzyme release. Thus, the coincidental release of PGs and lysosomal enzymes is not the result of a regulatory role of PGs in the release of lysosomal enzymes, but probably is the result of a common pathway of stimulation. (Am J Pathol 97:137--148, 1979).


Inflammatory and immune processes in the human lung in health and disease: evaluation by bronchoalveolar lavage. Bronchoalveolar lavage is an invaluable means of accurately evaluating the inflammatory and immune processes of the human lung. Although lavage recovers only those cells and proteins present on the epithelial surface of the lower respiratory tract, comparison with open lung biopsies shows that these constituents are representative of the inflammatory and immune systems of the alveolar structures. With the use of these techniques, sufficient materials are obtained from normal individuals to allow characterization of not only the types of cells and proteins present but their functions as well. Such observations have been useful in defining the inflammatory and immune capabilities of the normal lung and provide a basis for the study of lung disease. Lavage methods have been used to characterize inflammatory and immune processes of the lower respiratory tract in destructive, infectious, neoplastic, and interstitial disorders. From the data already acquired, it is apparent that bronchoalveolar lavage will yield major insights into the pathogenesis, staging, and therapy decisions involved in these disorders. (Am J Pathol 97:149--206, 1979).


The potassium permanganate method. A reliable method for differentiating amyloid AA from other forms of amyloid in routine laboratory practice. Alterations in affinity of amyloid for Congo red after incubation of tissue sections with potassium permanganate, as described by Wright el al, were studied. The affinity of amyloid for Congo red after incubation with potassium permanganate did not change in patients with myeloma-associated amyloidosis, familial amyloidotic polyneuropathy, medullary carcinoma of the thyroid, pancreatic island amyloid, and cerebral amyloidosis. Affinity for Congo red was lost after incubation with potassium permanganate in tissue sections from patients with secondary amyloidosis and amyloidosis complicating familial Mediterranean fever (consisting of amyloid AA). Patients with primary amyloidosis could be divided into two groups, one with potassium-permanganate--sensitive and one with potassium-permanganate--resistant amyloid deposits. These two groups correlated with the clinical classification in typical organ distribution (presenting with nephropathy) and atypical organ distribution (presenting with cardiomyopathy, nephropathy, and glossopathy) and the expected presence of amyloid AA or amyloid AL. Potassium permanganate sensitivity seems to be restricted to amyloid AA. The potassium permanganate method can be important in dividing the major forms of generalized amyloidosis in AA amyloid and non-AA amyloid. This can be used for differentiating early stages of the disease and cases otherwise difficult to classify. It is important to define patient groups properly, especially in evaluating the effect of therapeutic measures. (Am J Pathol 97:43--58, 1979).


The behavioral and neuropathologic sequelae of intoxication by trimethyltin compounds in the rat. Trimethyltin, when given by gavage to rats, has an LD50 of 12.6 mg/kg. Signs of poisoning include tremors, hyperexcitability, aggressive behavior, weight loss, and convulsions. After single (10 mg/kg) or repeated weekly doses (a maximum of four) of 4 mg/kg, rats, up to a survival time of 70 days, were perfusion-fixed for light microscopy. Trimethyltin was assayed in brain and blood in rats after similar treatments. Trimethyltin is cumulative and persistent and binds with high affinity to hemoglobin. Trimethyltin, unlike triethyltin, does not produce white matter edema in rats but does cause bilateral and symmetrical neuronal alterations involving the hippocampus (largely sparing the Sommer sector), pyriform cortex, amygdaloid nucleus, and neocortex. The earliest alteration was loss or dispersal of Nissl substance, then clumping of nuclear chromatin, followed by shrinkage and fragmentation of the nucleus within shrunken eosinophilic cytoplasm. These changes were associated with approximately 1.4 microgram trimethyltin/g wet weight in brain tissue 1 day after the second dose of 4 mg/kg or 2 days after a single dose of 10 mg/kg. Signs of poisoning gradually disappeared, and 4 rats surviving 70 days appeared normal, although their brains had severe damage with cell loss in the hippocampi and each pyriform cortex. Treatment of rats with trimethyltin, therefore, provides a chronic preparation with consistent lesions in the hippocampus of use in other behavioral and neuroanatomic studies. (Am J Pathol 97:59--82, 1979).


Complement fragments, alveolar macrophages, and alveolitis. Mechanisms of neutrophil infiltration into the rabbit alveolus have been investigated. Complement activation in the circulation induced pulmonary vascular margination but not a significant level of alveolar infiltration. Instillation of C5 fragments into the airways, however, attracted neutrophils into the alveolar airspaces. The anaphylatoxin-inactive fragment of C5, C5a des Arg, was found to be much more active in this regard than C5a. Furthermore, these fragments were shown to induce the production of a neutrophil-directed chemoctactic factor from pulmonary macrophages, raising the question of whether the C5a des Arg was acting directly to attract neutrophils or indirectly via the macrophage. To substantiate a possible role for C5 and C5 fragments in alveolitis, active C5 was demonstrated in lavage fluids, and macrophage-derived C5 cleaving enzymes have been described. Finally, a route of neutrophil infiltration via migration through the alveolar capillary wall into the interstitium is proposed, and subsequent penetration of the alveolar epithelium out into the airspace. (Am J Pathol 97:93--110, 1979).


Telephone therapy: a review and case report. The impact of the telephone upon the practice of medicine and psychiatry is reviewed. As an exclusively auditory medium, the telephone conveys meaningful vocal information while screening out visual and other stimuli. It is suggested that some highly anxious and unstable individuals, who find psychotherapy too threatening, may benefit from telephone contact with a therapist. An illustrative case of telephone therapy is presented.


Crisis in psychotherapy: principles of emergency consultation and intervention. A surprisingly large number of visits to a crisis intervention service are made by patients engaged in ongoing psychotherapy elsewhere. Data are presented from patients and their therapists that support the concept of a psychotherapy crisis as a major precipient of such visits. A typology for the therapy crisis is elaborated, and guidelines for the crisis worker's assessment and intervention are suggested.


Crisis intervention: a functional model for hospitalized cancer patients. A model for psychosocial rehabilitation of hospitalized oncology patients, found to be effective in use with gynecologic cancer patients, is described. It is suggested that the contribution of mental health professionals to the health delivery system of an oncology ward is essential to the maintenance of comprehensive care.


Psychiatric sequelae of surviving childhood cancer. Increasing survival rates for children with cancer raise questions about the long-term psychosocial impact of the disease and its treatment. Psychiatric evaluations of 114 survivors of childhood malignancies suggest a high rate of adjustment problems, with 59% indicating at least mild psychiatric symptomology. Interviews with former patients highlight the importance of adaptive denial in the face of the uncertainty connected with cancer survival.


The effects of congenital heart disease on cognitive development, illness causality concepts, and vulnerability. This study suggests that childhood cardiac illness has a depressive impact on the attainment of conservation tasks, but does not affect illness causality conceptualization. The group of twelve ill children studied appeared to feel somewhat more vulnerable to illness in general, especially when projecting to adult health status, than did a matched group of healthy children.


The aftermath of rape: recent empirical findings. In a longitudinal study of the effects of rape on a woman's subsequent psychological functioning, objective measures of mood state and psychological distress were obtained at four intervals from 46 recent rape victims and 35 nonvictims. Initial response to rape was characterized by intense generalized distress. Three months and six months later, this distress had diminished, leaving a residual of fear and anxiety problems that were clearly rape-related. Implications for treatment are discussed.


An exploratory approach to self-blame and self-derogation by rape victims. Quantitative and interview data on rape victims' self-evaluation and attributions of personal responsibility were studied to explore the relevance of theories of "defensive attribution" and maintenance of belief in a "just world." Clinical implications of the findings for adjustment of victims, counseling, victim compensation, and the legal system are discussed.


Incest: theoretical and clinical views.

Incest: theoretical and clinical views. This paper reviews the various theoretical approaches to incest and considers their relationship to the clinical literature. The dearth of treatment reports on incest is noted, and directions are suggested for research that will enhance our understanding of the phenomenon and guide practitioners in the appropriate therapeutic intervention with participants.


What's wrong with sex between adults and children? Ethics and the problem of sexual abuse. The belief that sex with adults causes harm to children is often offered as the most compelling argument against such relationships, and is the basis for much current concern about sexual abuse. This paper argues for the importance of a stronger ethical position, less dependent on an empirical presumption that is not firmly established. It is suggested that basing the prohibition of adult-child sex on the premise that children are incapable of full and informed consent will provide a more solid and consistent approach to the problem.


Hysterical seizures: a sequel to incest. Six cases are described in which hysterical seizures developed after incest and disappeared after psychotherapeutic exploration of the incestuous experience. Patients were adolescents referred for seizures, suicide attempts, sexual problems, and running away. It is suggested that Navajo and Galenic folk beliefs connecting epilepsy with incest may derive from observations of this symptom pattern in incest victims.


Free fatty acid oxidation in bovine muscle in vivo: effects of cold exposure and feeding. A mixture of (1-14C)-labeled free fatty acids (FFA), complexed in bovine plasma, was infused into the abdominal aorta of conscious young steers exposed to thermoneutral or moderately cold conditions for several hours and fed 6 or 22 h before the experiment. The uptake, release, and oxidation of FFA in one hindlimb was calculated from simultaneous measurements of leg blood flow and arteriovenous difference in the specific activities of plasma 14C-FFA and blood 14CO2. Despite an invariable net release of FFA from the resting leg, uptake of 14C-FFA was considerable; of this only 14 and 3% was immediately converted to 14CO2 in fasted and fed steers, respectively. During cold exposure, increases in whole-body oxygen consumption (VO2), arterial concentration and turnover rate of plasma FFA, and a decrease in respiratory quotient were accompanied by much greater increases in VO2, uptake, and oxidation of FFA by the shivering leg. Even so, most FFA taken up were apparently not immediately oxidized to CO2, and possible alternatives for FFA metabolism in shivering muscle are discussed.


Effect of fasting on insulin removal by liver of perfused liver-pancreas. Using in situ perfused rat liver-pancreas preparations, the hepatic clearance of biphasically released endogenous insulin was studied using livers of fed and fasted rats. Hepatic insulin extraction was determined by subtracting the mean endogenous insulin output found in the posthepatic vena cava effluent of liver pancreas preparations from the amount of insulin found in the prehepatic portal effluent of perfused pancreas preparations. All pancreas perfusions and liver-pancreas perfusions were subjected to the same plasma glucose stimulus (250 mg/dl) for 40 min. In the fed state, no significant hepatic extraction of insulin occurred. The biphasic pattern of insulin appearance in the posthepatic vena cava effluent, which ranged from less than 1 to 21 ng/ml, was unaffected by passage through the liver. In contrast, when rats were fasted for 24 h, approximately 50% of the insulin released into the portal vein was removed by their livers during one transhepatic passage. After a 48-h fast, insulin extraction capacity decreased relative to the capacity observed for livers of 24-h fasted rats.


Differential effects of epinephrine on glucose production and disposal in man. Normal subjects were infused 1) with epinephrine (50 ng/(kg.min)) for 180 min followed by epinephrine plus glucagon (3 ng/(kg.min)) for 60 min after which the epinephrine infusion rate was increased (125 ng/(kg.min)) or 2) with epinephrine plus somatostatin (500 microgram/h) for 180 min. Epinephrine increased glucose production and plasma glucagon transiently but caused persistent suppression of glucose clearance and sustained hyperglycemia (despite increased plasma insulin and gluconeogenic substrates); glucose production increased again on addition of glucagon and on increasing the epinephrine infusion rate. During epinephrine plus somatostatin, glucose production still increased transiently, but further suppression of glucose clearance caused more marked hyperglycemia. In conclusion, 1) in man hyperepinephrinemia within the physiological range caused sustained suppression of glucose clearance but only a transient increase in glucose production; 2) this transient hepatic response a) was not due to glycogen or substrate depletion, b) occurred without changes in plasma glucagon or insulin, c) was specific for epinephrine but permitted subsequent responses to changes in plasma epinephrine; 3) epinephrine can serve as a physiological regulator of glucose homeostasis in man both by increasing glucose production and by decreasing glucose clearance.