A cross-national comparison of the institutionalized elderly in the cities of New York and London. Two random samples, each constituting 0.5% of the institutionalized elderly (over 65) in the cities of New York and London have been compared. This preliminary report of a collaborative study demonstrates the similarity of the 2 samples. Institutions in the 2 cities are shown to differ in size, type of ownership and the frequency that skilled nursing is provided. Some implications of these 2 findings are raised now, and will be discussed later when the full data for the study are presented.


An epidemiologic study of the human bite. The 892 human bites reported to the New York City Department of Health in 1977 were analyzed by time, place, and the victim's characteristics. The bites appeared to have a seasonality, increasing in March and exceeding the mean monthly average through August. The bite rate for the entire city, 10.7 per 100,000 population, was exceeded in 5 of the 10 Brooklyn health districts; one of these districts reported a rate of 60.9 human bites per 100,000 population. Most of the bites with identifiable locations occurred indoors (63.2 percent). In 72.8 percent of the bite episodes in which the activities surrounding them were known, these activities were aggressive in nature. Males exceeded females as bite victims in all age groups except those 10-20 and 55-60 years. Bites of the upper extremity accounted for 61.2 percent of the total bites. Left-sided bites exceeded right-sided, except for the hand. In frequency of reported occurrence, the human bite ranks third, after the dog bite and the cat bite. Human bites may be a useful indicator of antisocial behavior.


Where people die.

Where people die. Death certificates for 1977 filed with the New York State Department of Health were studied to determine where people died. Data were examined by the location and cause of death and by the age, sex, race, and marital status of the decedent. Comparisons were made with a similar study in which U.S. data were used for 1958 events. Approximately 60 percent of all the 1977 deaths in upstate New York occurred in hospitals; only 27 percent occurred outside an institution. The location of death varied by all the factors studied. Within all age categories, males had a higher percentage of hospital deaths. In those age categories in which nursing home deaths comprised a significant proportion of total deaths, females had a higher percentage of such deaths than males. Differences in the location of death according to its cause reflect the nature of the cause of death, for example, whether it was of sudden onset or the result of chronic disease. Most people do not consider in advance where they might die. The idea that age, sex, and marital status, as well as the more obvious cause, all play a part in the location may seem surprising. Yet all these factors were found to be associated withe location of deaths in upstate New York, and there is no reason to believe that this association does not hold true for the entire nation. More research, however, needs to be done based on more years and other geographic artal stutus may be instructive as to the present state of health resources.


A rubella vaccination program for women entering the U.S. Army. A voluntary rubella vaccination program for female basic trainees was initiated on April 21, 1975, at Fort Jackson, S.C. A total of 29,852 women were tested for rubella titers between April 21, 1975, and December 31, 1977, and 6,167 were found to be nonimmune. An average of 53 percent of the susceptible women were vaccinated. The best results were obtained from August 1 to December 31, 1977, when 67 percent of the susceptible women were vaccinated. During this period, blood specimens for rubella titer and for pregnancy testing were obtained simultaneously. This procedure reduced the number of referrals to the Obstetrics-Gynecology Clinic, as well as the amount of training time lost when pregnancy testing and rubella titer testing were done on separate days. Despite the vaccination program, however, rubella epidemics occurred among female trainees at Fort Jackson in 1975, 1976, and 1977. A significant number of women are still susceptible to rubella. To reduce morbidity and the risk of congenital rubella syndrome, rubella titer testing and immunization of susceptibles should be considered for women-especially where they can be screened, counseled, and vaccinated en masse.


[Angiography of the bronchial arteries in lung disease (author's transl)]. Anatomical basis and method of selective angiography of the bronchial arteries are described. Selective vascular angiograms of different lung diseases are different in appearance but are not always specific. Bronchial-arteriograms of the following diseases are demonstrated: tumors, inflammations, bronchiectasis, cystic lungs diseases and angiomatous changes of the vessel. Key features common to all investigated cases are: 1. Increased flow with dilatation of the afferent bronchial artery. 2. Bronchialangiography is more effective in defining the extensions of the hypervascularized lung diseases than other conventional diagnostic methods. 3. In all our cases we have observed arterial bronchopulmonary anastomoses which seem to be a significant cause for hemoptysis occurring during the course of the disease.


[Therapeutic angiography in hemoptysis (author's transl)]. Clinical results of therapeutic bronchial artery embolization in 100 patients are presented. The most frequent causes were chronic fibroproductive tuberculosis and bronchiectasis. 85 patients were cured, 10 patients showed recurrent bleeding and in 4 patients bleeding could not be stopped. Complete embolization of all supplying vessels is of great importance to achieve successful results. Caution has to be applied not to risk medullary complications.


[Roentgen signs of rare mediastinal masses (author's transl)]. Mediastinal masses are commonly classified into lesions of the anterior, middle, and posterior compartment as a first step in differential diagnosis. Teratoma,  neurogenic tumors, goiters, and thymoma with their characteristic localization constitute together already two thirds of all mediastinal neoplasms. However, the differential diagnosis of mediastinal masses should include also rare diseases: lymphangio-hemangioma, aneurysm of the pulmonal artery, intrathoracic meningocele, esophageal cyst, and pleurobronchial cyst are demonstrated. It is emphasized, that differential diagnosis has to consider history and physical data of the patient as well.


[Double contrast examination of the pericardial cavity in a case of exsudative pericarditis (author's transl)]. 1)Radiographic examinations of the pericardial cavity by double contrast technique yield good information about the pericardial layer itself, the pericardial cavity and its contents. -- 2) Pericardial puncture and fluid aspiration and subsequent creation of a pneumopericardium with installation of water soluble contrast material are important diagnostic tools and have an important therapeutic effect as well. -- 3) For an appropriate examination 300--400 ml gas (oxygen in inflammatory, room air in carcinomatous conditions) and 5--8 ml of 60% water soluble contrast material (0.1 ml per kg bodyweight) should be installed.


[Phenomenology and psychopathology of agitation states]. States of agitation are frequent psychiatric emergency cases, which stem from very different biological, psychic and social constellations. Very often it is a question of a slipping expression of strong affects like fear, anger, pain and of excessive, reactive performances like flight, defence etc., which are built on top of the affects. Inner restlessness, which rises from unrestrained and disfigured drives, and the accompanying autonomic reactions of the affects promote the beginning of these states of agitation; whereas sensible expectations and clearly aimed absorptions of the drive do reduce the disposition to becoming agitated.


[Diagnosis in a psychiatric case register]. This study examines the stability of psychiatric diagnosis over a five-year period and its agreement with the diagnosis of a case register. The stability of diagnosis over a period of time has two component parts: the course of the morbid process and the reliability of the diagnostic technique. We studied the importance of these components as far as the cause of disends in diagnostic changes, the discrepancy of instability in different diagnostic categories and factors which may possibly indicate instability of psychiatric diagnosis.


[Déjà vu: elaboration of a hypothetical model of explanation]. Although psychiatric literature abounds in allusions to the phenomenon of "déjà vu", few communications were devoted to an analysis of this interesting psychological state. After a short review of the "déjà vu" conditions, the author proposes a model consisting of two channels. Under normal conditions, the first deals with the reading of information already stored, and the second, the engrammic channel, will store future information. The "déjà vu" condition is produced when the reading channel and the engrammic channel meet in the same area. This mechanism can explain the various etiological possibilities of "déjà vu", ranging from more or less ordinary cases such as fatigue or anguish to the most important etiology which is a psychotic process.


Looking differences in relation to examiner's attitude in paranoid patients and normal controls. The differences in amount and pattern of looking during interviews of 20 male paranoid patients and 20 nomral controls are investigated in relation to a female examiner's change of attitude, as indicated by change in the tone of her voice, by means of a cross-over design. The results indicate that paranoids do not follow the "decreased looking" model suggested for schizophrenics in other studies. Patients show a significant order effect, a higher overall amount of looking and a quite opposite pattern of looking across interviews as compared to controls. It is suggested that patients may have difficulties in regulating their visual behaviour according to examiner's attitude, resulting to a "stereotyped" pattern of looking. These findings are discussed with particular reference to visual information processing.


Schistosome motility in saline media.

Schistosome motility in saline media. The authors observed the motility of 1067 worms used as a biological parameter indicating the vitality of the parasites, to define the survival time of S. mansoni males and females in 0,85% NaCl and PBS. Among the worms observed in 0,85% NaCl the mean time of survival in minutes was 204 for males and 240 for females and in PBS it was 267 min. for males and 344 min. for females. All the tested differences (media, sex; sex for saline group; sex for PBS group) were significant at a 0.0001 level.


[Bean and rice mixtures of high protein value (author's transl)]. The optimum content of different rice (Oryza sativa) and bean (Vigna unguiculata L.) combinations was studied in Albino rats. The mixture containing 3 g of rice proteins, corresponding to 41g of rice "in natura", and 7 g of bean protein, corresponding to 59 g of bean "in natura", presented the highest protein efficiency ratio and the feed efficiency ratio. Since the limiting amino acid of this mixture was methionine, new assays using varying levels of this amino acid as a supplement were carried out. The PER of normal rats as well as the "plateau" value of previously protein depleted rats were highest when 0.2% methionine was added to the mixture. The net protein utilization (NPU) confirmed these findings. The values attained after the addition of other amino acids were not higher than those attained by the mixture containing 7 g of bean protein and 3 g of rice protein supplemented with 0.2% methionine. The PER and the NPU values came close to those of milk.


Histochemical and electrophoretical studies in normal and infected Biomphalaria glabrata. II. Acid and alkaline phosphatase. Various organs of normal and infected Biomphalaria glabrata were analysed, electrophoretically and histochemically, with respect to the acid phosphatase and alkaline phosphatase activity. In general, digestive gland, ovotestis and stomach show an increase in acid phosphatase activity in infected snails, whereas kidney and albumen gland show less activity. Alkaline phosphatase does not show any significant different in activity between normal and infected snails. Electrophoretically digestive glands of snails, twenty days after infection, show an extra faint band, whereas seven days after infection, the snails do not show any such extra band. Histochemically also after twenty days, infected snails show more activity in the sporocyst region, but those infected for only seven days, do not show any increase in acid phosphatase activity.


[Walker's 256 carcinosarcoma: metastatic dissemination in two cell lines (author's transl)]. Walker's 256 carcinosarcoma a transplantable tumor of the rate changes its behaviour as a consequence of various factors. In this paper we compare the evolution of 2 lines of the tumor: WM 16 (muscular) and Christ Hospital (ascitic) both inoculated intramuscularly. Animals receiving line WM 16 had a severe rapidly progressive evolution dying around day 14 after inoculation with diffuse metastases to lymph nodes (65% of animals), kidneys (53%), spleen (50%), lungs (46.5%), liver (45%), bone marrow (44.8%), in 56% of the animals there were circulating tumoral cells. Animals receiving Christ Hospital line survived up to 40 days, metastases were limited do lungs (48.7%) and lymph nodes (31.7%) and only in 2 of 45 animals circulating tumoral cells were observed.


Lack of evidence for hepatic control of renal sodium excretion in rats. Three experimental protocols were used: a) normal and partially hepatectomized rats were expanded with isotonic saline; b) normal rats were expanded with isotonic saline; b) normal rats were infused with hypertonic saline (5%), either by the femoral or portal vein and c) hypertonic saline was sequentially and alternatively infused into normal rats via portal and femoral veins. All the experiments were made under anesthesia. Inulin clearance and absolute and fractional urinary sodium and potassium excretion were measured. Multiple analysis of variance was made to compare normal and partially hepatectomized rats, as well as portal and femoral infusions made either in the same or in different animals. In none of these experiments it was possible to demonstrate an effect of the liver in enhancing the natriuresis induced by saline infusions.


Innervation of the articular disc of the temporomandibular joint in guinea-pig Cavia cobaya (Rodentia - Mammalia). The innervation of the articular disc of the temporomandibular joint of 6 adults guinea pigs was studied with the use of Nonidez technique. Only occasional nerve fibers next to blood vessels at the posterior inferior peripheral part of the articular disc were observed.


[Progressive antithrombin activity in blood of pregnant women and neonates in the first four days of life (author's transl)]. Progressive antighrombin activity was assayed in 45 term infants in the first four days of life, in 20 cord blood specimens and in the blood of 20 pregnant women (at term). In the term infants a positive correlation was shown between progressive antithrombin and postnatal age. No correlation could be demonstrated with sex, ethnic group or type of delivery. Maternal antithrombin activity was shown to be moderately decreased, maternal values being closely related to cord blood values.


[Effects of choledochal perfusion with biliary acid solutions on activity of the sphincter of Oddi (author's transl)]. The changes of sphincter of Oddi's resistance, induced by choledochal perfusion of conjugated (taurocolic) and non-conjugated (colic) biliary acid solutions, in anesthetized dogs, were studied. The perfusions were made at a constant flow and intracholedochal pressures were registered. The mean number of contractions per minute, the mean maximal pressures and the mean minimal pressures in each study periods were analysed. The choledochal perfusion with the biliary acids solutions induced a slight but significative increase in sphincteric resistance. After 15 minutes, the perfusion with colic acid solution induced maximal pressures significantly more elevated than the ones observed with taurocolic acid solution. The non-conjugated solution induced a pressure tracing significantly distinct from the tracing observed with the conjugated acid solution. No changes in resistance were observed with a 2% NaCl solution. This implies that the observed changes in resistance were not related to osmotic stimulation of the sphincter of Oddi.


Thermophilic Campylobacter-associated diarrhoea in Rio de Janeiro. Thermophilic Campylobacter is reported as the agent associated with chronic and acute diarrhoea in Rio de Janeiro. Nine strains were isolated from 186 children with gastroenteritis. To our knowledge this is the first report of human Campylobacteriosis in Latin-America.


The effects of hypophysectomy on the retinomotor responses of the killifish, Fundulus heteroclitus. This paper presents the results of an investigation concerned with the effects of long-term hypophysectomy on the retinomotor responses of the euryhaline killifish, Fundulus heteroclitus: 1. The eye of hypophysectomised Fundulus heteroclitus responds to light and dark in the same manner as that of intact controls: the retina is not in a state of permanent light-adaptation as claimed by Vilter (1942) for the hypophysectomised eel. 2. There is no evidence of a persistent circadian rhythm during continous darkness. 3. Unilateral illumination of the eye of intact fish results in dispersion of retinal pigment in both illuminated and unilluminated eyes, as in the goldfish (Ali, 1964), but no such contralateral response was evident after hypophysectomy. The cones are unresponsive.


Relationships between hormone-induced calcium release and 86rubidium uptake stimulation in starfish oocytes. 86Rubidium+ uptake, but not 86Rubidium efflux, is strongly stimulated after addition of the meiosis inducing hormone 1-methyladenine (1-MeAde) to prophase blocked oocytes of the starfish Marthasterias glacialis. This stimulation is a transient process which does not require the continuous presence of 1-MeAde and is elicited within 1 minute of contact. 1-MeAde and its biologically active structural analogs fully stimulate Rb+ uptake at concentrations which are about two orders of magnitude lower than those required to trigger meiosis reinitiation but which already release underthreshold levels of Ca2+ from the inner part of the plasma membrane. External Ca2+ concentrations effective in triggering meiosis reinitiation also stimulate Rb+ influx, while drugs like D600, theophyllin and caffein which suppress the hormone induced Ca2+ release, simultaneously preclude the stimulation of Rb+ uptake. Dithiothreitol (DTT) which mimicks 1-MeAde action in releasing Ca2+ and inducing meiosis acts both on the efflux and on active and passive Rb+ influxes. Ouabain, the classical inhibitor of the Na+, K+ pump does not preclude meiosis reinitiation under the influence of 1-MeAde, its agonists of mimetics. It suppresses the active component of Rb+ uptake both in control or stimulate oocytes. When applied only in preincubation before starting the hormone treatment, it cannot however inhibit the stimulation of Rb+ uptake, while basal pump inhibition is preserved. These results demonstrate that stimulation of the active Rb+ or K+ transport is not indispensable to meiosis reinitiation. They suggest moreover that the hormone induced Ca2+ release from the plasma membrane may be responsible for unmasking new ouabain sensitive transport sites.


Quality of light effects on immature stages and adults of Pieris rapae (L.) (Lepidoptera: Pieridae). Larvae of Pieris rapae (L.), the imported cabbage worm, were reared to the adult stage under controlled light conditions. Spectral quality affected their development. The effect of the long wave ultraviolet light was to significantly decrease developmental time. The light source used also appeared to exert an effect on pupal colouration.


Salinity adaptation in the snake eel Pisoodonophis boro (Ham-buch). The snake eel Pisoodonophis Boro (Family Ophichthidae) burrows, causing leaks in the bunds and damaging the salterns and paddy fields adjoining estuaries. The animal's capability to withstand brine in salterns and fresh water in paddy fields was determined from laboratory experiments. The eel tolerated salinities ranging from deionized water to 75%. Adaptation to fresh water as well as full strength seawater was completed within 24 h. The concentration of sodium and chloride in the blood varied by 10--20% on transfer from seawater to fresh water. P. boro can survive in paddy fields but not in salterns. However, their occurrence in both is described as a rare phenomenon and not obligatory.


[Elongated mitotic cells in the neuroepithelium of Xenopus laevis and Notophtalmus viridescens]. Most neuroepithelial cells in the embryos of Xenopus laevis and Notophtalmus viridescens become round upon entering into mitosis. However, many maintain their elongated form, or show long cytoplasmic processes, during mitosis. It therefore seems possible that, in these species, two groups of microtubules are present during mitosis: cytoplasmic microtubules and mitotic microtubules.


Urine production in the halothane anesthetized rabbit. Urine and blood parameters were studied in rabbits subjected to anesthesia and abdominal surgery. Conscious control animals both fasted and fed to which water was freely available were used for comparison. During anesthesia and operation one group of animals were given no intravenous fluid, other groups were infused with normal saline at a rate of 0.5 ml, 1 ml, or 2 ml per minute. The results demonstrated that an intravenous saline infusion of 0.5 ml per minute, maintains an essentially normal state of hydration and is beneficial to rabbits during anesthesia and surgery. However, with such an infusion, the rabbits do not produce urine under the experimental conditions. Higher rates of infusion are associated with a declining heart rate and blood pressure, abnormal urine, and metabolic acidosis. We conclude that the rabbit is an inappropraite species for renal studies involving anesthesia and surgery.


Visual pigment absorbance and scotopic spectral sensitivity in the goldfish, Carassius auratus. Factors relating to the comparison of the absorbance spectra of visual pigments to experimentally determined relative spectral sensitivities of the eye are discussed with specific reference to the goldfish. It is concluded that the experimentally determined scotopic sensitivity of the goldfish can be directly related to the absorbance of goldfish porphyropsin without the need to infer input from long wavelength-sensitive cones.


Preparation of human leukocytes for SEM observation: a modified technique. Variations in the mode of preparation, type of fixation and leukocyte collection can plan an important part in the determination of the surface structure of a given population, and can result in modifications of the microprojections, and their number, evident on the cell surface. We present preparatory modes that circumvent these difficulties, and the results obtained clearly show that the techniques are profitable, appear essential for the preservation of cell population and integrity, and allow accurate scanning electron microscopy observations without resort to time consuming procedures. Indeed, the entire process can be completed in one day.


[Cephalic gastroduodenopancreatectomy in cancer of the duodenobiliopancreatic crossover]. Over a period of 29 years (1949--1977) a total of 50 extended gastroduodenopancreatectomies have been performed in 309 patients with cancer of the subhepatic region. The indication for this type of surgery was determined by: 20 malignant lesions of the head of the pancreas, 14 cancers of the Vater ampula, 10 neoplasies of the juxta-vaterian duodenal portion, and 6 stenosing malignant tumors of the terminal choledocus. The major operation, of long duration, employed in radical oncologic treatment, entailed 13 postoperative deaths (26%) and resulted in an average survival of 2 years. Eight of the patients were alive after a follow-up of 5 years. The Child procedure was used 32 times, the remaining cases being operated according to a personal technique, in two variants. The results of paleative interventions are discussed in parallel. These consisted in simple bilio-digestive derivations. Based on the authors personal experience, and considering the data published in the specialized literature it may be postulated that oncologic surgery, such as that applied in extended gastroduodenopancreatectomy is fully justified when general and intra-operative conditions allow such interventions. The results depend, to a large extent, on the early diagnosis of these cancers.


[Therapeutic attitude in some clinical forms of hepatic trauma]. Six cases of hepatic trauma are presented, that have raised particular problems of therapeutical attitude. The severity of the complications is discussed in this type of trauma, especially aspects related to hemobilia and hepatic suppurations which are accompanied by toxico-septic syndromes. The authors stress the role of sutures of deep hepatic wounds in the development of suppurations, as well as the opportunity of early re-interventions in such cases. Also some particular, more rare, clinical forms are discussed, that made necessary a differentiated therapeutical attitude.


[Results of the Childs-Phillips operation (34 cases of repeated intestinal occlusion)]. The authors sustain the methods used in the Childs-Phillips operation that they have performed in 34 patients. Details are given in relation with the diagnosis and the auxilliary interventions that have been requested. The authors stress the exclusive use of No. 5 of nylon or thread. Postoperative death-rate (11,5%) was due only to coexisting affections, the necropsies revealing intact enteroplicatures. The postoperative abdominal discomfort was detected in 8 patients over a duration of 1--2 years after surgery. Repeated radiologic controls have been carried out that showed in 8 patients the disappearance of aspects typical for disturbances following enteroplicature. The radiologic investigations have been performed at variable intervals (between 3 months and 2 years after surgery).


[Ciguatera fish poisoning in New Caledonia. Clinical and epidemiological aspects (author's transl)]. The author studies the incidence of ciguatera fish poisoning on the public health in New Caledonia. He gives the results of a large scaled inquiry on the clinical and epidemiological aspects of the disease. The geographical distribution and the toxic species are discussed. It does appear that, though being not an acute medical problem, ciguatera is an important cause of morbidity in some tribus of the Pines and Loyalty Islands primarily, where the reef fish is the chief animal proteic resource.


[Gastric localization of Crohn's disease]. The authors present a case of Crohn disease with gastric location. The lesion was complicated by a blind fistula in the body of the pancreas. Surgery, which consisted in gastrectomy, solved the case for the time being, and the patient is followed up.


[Complications of surgery of cancer of the colon]. In the paper a systematic analysis is carried out of postoperative complications of colon surgery, 118 patients had complications, out of a total of 400 interventions on the colon. The complications are studied in relation with the time of their occurence and the localization of the neoplastic process, as well as from the point of view of the influence exerted by age and the "background" of the patients. A review is also made of the therapeutic attitudes required by the various complications, of the results obtained and finally a detailed analysis is presented of the causes that led to death of operated patients.


[A comparative study of two similar groups of 364 children treated for rheumatic fever according to identical protocols (1955--1961, 1965--1972) (author's transl)]. From 1955 through 1972, all children admitted to two after-care centers for rheumatic fever were examined by the same physicians with the same diagnostic criteria and treated according to the same rules. A comparaison between two groups of children who were examined ten years apart has confirmed the changes which took place in the course of rheumatic fever during this period. The incidence of recidives recorded at admission has dropped considerably. Multiple recidives, too, have grown rarer. The incidence of the forms with cardiopathy at admission has dropped. This is, for the most part, due to the reduction in the number of recidives. The severity of cardiopathies has abated, too, and this goes irrespective of the number of previous attacks. The results of treatment in children with cardiopathy are identical in both groups. Treatment methods have not changed from the beginning to the ending of the study; there is a good ground for thinking that the advances observed are due principally to the secondary prevention and related, therefore, to improvements in the health education level, which leads to a recidive prevention better done than in the past.


[An incidence study of digestive cancers in a well defined population. Results of two years registration in the departement of Côte d'Or (author's transl)]. A systematic registration of mortality and morbidity from digestive cancers was started in January 1976 in the French department of COTE-D'Or (population 455,727). In the course of two years 913 new cases of digestive cancers were recorded. Nearly half of these cancers were colorectal cancers. The survey gives informations on histology, stage of the disease and survival. The morbidity survey allows comparison with the incidence rate of digestive cancers in other countries.


[Incidence of cystic fibrosis in Brittany (author's transl)]. Incidence of cystic fibrosis has been estimated in three adjacent geographic areas of Brittany: North Finistere, South Finistere and Morbihan. This incidence is respectively 6.0 x 10(-4), 4.8 x 10(-4), 2.9 x 10(-4) in these three areas. A significant difference between North Finistere and Morbihan was found. Without proofs in favor of natural selection, genetic drift seems to be a possible explanation of this variation. Moreover, as in other studies, a genetic heterogeneity of the disease was not shown.


[Health indexes and "sanimetry": conceptual aspects of recent research on the measurement of a population's state of health (author's transl)]. The major health indexes based on the classical concepts of mortality and morbidity are reviewed while emphasizing their limitations: underestimation of health problems socio-economic impact, inadequacy for the evaluation of certain main objectives of health care delivery systems, purely negative measurement of health. This paper investigates the recent attempts to improve these aspects: extension of the concept of morbidity by the introduction of disability measurements and the development of a "positive health" concept. Finally, a discussion is presented of the major health indexes whose development is based on the use of these concepts and the main conceptual, methodological problems they give rise to.


Cigarette smoking and children's respiratory symptoms: validity of the questionnaire method. Children who report that they smoke cigarettes, also report increased respiratory symptoms. Could this be an artefact of the questionnaire method? Reports of children's respiratory symptoms obtained from children and from their parents were compared. There was a significant association between these reports, although the relationship was not close. The relationship between symptoms and cigarette smoking was consistent, whichever report was used. It is concluded that the questionnaire technique is valid, and that children who smoke cigarettes are more likely than non-smokers to have respiratory symptoms.


Triexponential disposition pharmacokinetics of gentamicin in rabbits. Using a sensitive high-pressure liquid chromatographic method for the determination of gentamicin, plasma-level profiles of gentamicin were found to fit to a triexponential equation in 3 out of 4 rabbits studied after bolus intravenous administration by the application of the Minimum Akaike's Information Criterion Estimation (MAICE) method. This is different from the monoexponential or biexponential decay of gentamicin often reported in humans. Volumes of distribution of central compartment and at the steady-state in rabbits were similar to those reported in humans. Extensive distribution and tissue binding of gentamicin in rabbits were indicated by their high Vdarea, about 3.9 l/kg. It is proposed that rabbits may serve as a useful model for studying the mechanism and prediction of renal toxicity of gentamicin in patients.


Pharmacokinetics of hydralazine, apparent hydralazine and hydralazine pyruvic acid hydrazone in humans. Hydralazine is an antihypertensive vasodilator agent. Lack of specific assay techniques for its measurement have delayed elucidation of its pharmacokinetic profile. This study compares the plasma profiles of hydralazine, measured both by a specific and by a previously published nonspecific assay and of a major plasma metabolite, hydralazine pyruvic acid hydrazone. After po and iv administration of hydralazine, peak hydralazine levels were lower (7-33%) and plasma half lives were shorter (15-31%) when measured by the specific technique. The mean plasma half life of the pyruvic acid hydrazone was 156 min and mean urinary clearance, 28 ml/min. The plasma profile of hydralazine and of the major metabolite, the pyruvic acid hydrazone, do not appear to correspond to the duration of antihypertensive effect of administered hydralazine.


Interaction of aminoglycosides and cephaloridine in the rabbit kidney. Toxic doses of aminoglycosides augment organic anion transport in the rat kidney. Studies in rabbits and guinea pigs have shown that the nephrotoxicity of cephalosporins is closely related to their active transport by the organic anion carrier in the proximal renal tubule. We have examined the effects of the aminoglycosides neomycin and gentamicin on cephaloridine transport and cytotoxicity in the rabbit kidney. There was no effect of these aminoglycosides on renal cortical cephaloridine uptake. In several regimens of combined administration, there was also no additive nephrotoxicity of the aminoglycosides and cephaloridine, even though some degree of tubular necrosis was seen in the single drug control groups in each protocol. These results are in agreement with those of studies in the rat and provide evidence that the cellular mechanisms of nephrotoxicity of the cephalosporins and aminoglycosides are not closely related.


Errors in interpretation of data from equilibrium dialysis protein binding experiments. In equilibrium dialysis protein binding experiments, the fraction of free or bound drug determined at equilibrium by dialysis of a patient plasma sample does not correspond to the drug concentration in the initial plasma sample, but to the drug concentration inside the plasma compartment of the dialysis apparatus at equilibrium. That fraction of free or bound drug corresponds to a lower total drug concentration than that in the initial plasma sample because of loss of drug due to passage of free drug into the buffer compartment in the equilibrium dialysis experiment. The magnitude of the difference between the initial drug concentration and the equilibrium drug concentration depends on the extent of drug binding and experimental conditions. If the initial total drug concentration in the plasma or serum sample as well as the fraction of drug bound at equilibrium as determined by radiotracer methods are known, then, using methods given in the text, the equilibrium drug concentration, the binding parameters corresponding to equilibrium conditions, and the free drug concentration in the initial plasma sample may be estimated.


Serum binding of aluminum.

Serum binding of aluminum. The binding of aluminum in the serum of a normal male volunteer was examined using gel filtration chromatography and flameless atomic absorption spectrometry. The elution profile obtained with Sephacryl S-200 gel separated the aluminum into four major peaks. These peaks appear to be associated with a high molecular weight protein(s), albumin, and possibly some low molecular weight protein(s) and/or some inorganic anions. The elution profile for a renal dialysis patient gave similar results.


Application of the charge-transfer constant for correlation of acetylcholinesterase affinity reciprocals vs. physico-chemical properties of aromatic inhibitors. Some properties of the charge-transfer constant (CT) have been described. The constant in association with the Hansch coefficient (pi, hydrophobic coefficient) for 32 aromatics was applied for the correlation with reciprocals of their acetylcholinesterase affinities (KD). The investigated aromatics constituted p- and m-substituted phenyl methylcarbamates, carbaryl (1-naphthyl methylcarbamate), p-substituted phenylmethyl methylcarbamates, and various aromatics without the carbamyl group, the dependencies found for the following relations: KD vs. (CT + sigma delta CT), where CT is the charge-transfer constant for a whole aromatic system and delta CT refers to effects of substitutents upon it; KD vs. sigma pi; KD vs. (CT + sigma delta CT) + sigma pi; and KD vs. [(CT + sigma delta CT), sigma pi] were characterized by the correlation coefficients 0.72, 0.82, 0.92, and 0.93 respectively.


Effects of barbital and disulfiram on the metabolism of intracerebroventricularly administered [14C]-5-hydroxytryptamine in rats. Effects of barbital and disulfiram on the metabolism of serotonin (5-HT) in vivo were studied. One hr after intracerebroventricular injection of [14C]-5-HT (3 nmoles, 0.5 muCi), the levels of the total and deaminated radioactive materials were increased in rats receiving either barbital or disulfiram, as compared to those of control rats. In addition, an additive effect was observed by a combined administration of these two drugs. The results in this paper strongly suggest that barbital and disulfiram inhibit the metabolism of 5-hydroxyindoleacetaldehyde (5-HIAAld), a first deaminated metabolite in 5-HT metabolism.


The effect of purothionin on bovine adrenal medullary cells. The effect of purothionin, a peptide isolated from wheat flour, on adrenal medullary cells was examined in perfused bovine adrenal glands. Addition of purothionin (4 microgram/ml) to the perfusion fluid caused the release of cytoplasmic glutamic oxaloacetic transaminase (c-GOT), DOPA decarboxylase (DDC) and magnesium ions, which are present in the cytoplasmic fraction of adrenal medulla, but not the release of dopamine-beta-hydroxylase (DBH) or mitochondrial glutamic oxaloacetic transaminase (m-GOT), which are located in the particulate fraction. These results suggest that purothionin makes small pores in the cytoplasmic membranes of bovine adrenal medullary cells, resulting in the leakage of the cytoplasmic proteins and ions from the cells.


Characterization of analgesic and activity effects of methotrimeprazine and morphine. The interactions of Methotrimeprazine (MTM) with the CNS opiate receptor, with naloxone, and with morphine were investigated. MTM (16--256 nM) did not compete with 3H-naloxone for specific binding sites in mouse brain homogenates. In vivo, MTM induced analgesia was not antagonized by naloxone. After 14 days administration of MTM partial tolerance developed to the activity effect but not the analgesic effect. After 14 days administration of morphine, tolerance developed to both the activity effect and the analgesic effect.


The roles of brain noradrenaline and dopamine in the anorectic activity of diethylpropion in rats: a comparison with d-amphetamine. The anorectic activity of diethylpropion and d-amphetamine was studied in rats subjected to various treatments known to affect brain monoamines. The effect of diethylpropion, like that of d-amphetamine, was completely prevented by a lesion of the ventral noradrenergic bundle, which selectively decreases brain noradrenaline, but was not significantly modified in desipramine pretreated rats by an intraventricular injection of 6-hydroxydopamine, a condition decreasing only dopamine. Pretreatment with penfluridol significantly reduced the effect of d-amphetamine but not that of diethylpropion. A non-significant reduction of drug effect was found with alpha-methyl-p-tyrosine. Lesion of the nucleus medianus raphe, which destroys central serotonin neurons, or treatment with methergoline, a central serotonin antagonist, caused no changes in the effects of both compounds. The findings show that integrity of central noradrenergic neurons is an important condition for diethylpropion and d-amphetamine to exert their anorectic effect. Dopamine does not seem to play any role in the effect of diethylpropion but might contribute to that of d-amphetamine. The data are against any involvement of brain serotonin in diethylpropion anorexia.


Influence of pyrazole, an inhibitor of alcohol dehydrogenase on the prenatal toxicity of ethanol in the rat. Pyrazole, a potent inhibitor of alcohol dehydrogenase, induced a high incidence of ocular and urinary bladder anomalies in the offspring of rats following treatment on gestational day 9. A single moderate dose of ethanol potentiated the teratogenic action of pyrazole, but alone did not affect embryonic development.


Acute toxicology of butyl nitrites and butyl alcohols. Commercially available isobutyl nitrite (iBN), n-butyl nitrite (nBN), sec-butyl nitrite (sBN) and tert-butyl nitrite (tBN) were found to be 63%, 79%, 44% and 96% pure, respectively, by GLC analysis. Pure samples of each compound were synthesized by the action of nitrous acid on each of the corresponding butyl alcohols; GLC analysis indicated greater than 99% purity for each nitrite. In determining LD50 values (mice, i.p.) for each compound, no deaths were observed after 30 min post-administration of sBN or tBN. Gross post-mortem examination suggests the delayed lethality may be due to liver damage. Administration of isobutyl, n-butyl, sec-butyl or tert-butyl alcohols to mice produced similar hepatotoxicity, suggesting that butyl alcohols may play a role in the hepatotoxicity observed after sBN or tBN administration.


Toxicological evaluation of new calcium antagonists: 2-substituted 3-dimethylamino-5,6-methylenedioxyindenes. The 2-n-propyl (pr) and 2-n-butyl (bu) methylenedioxyindenes (MDIs) developed in our laboratories are intracellular calcium antagonists with coronary dilating and antiarrhythmic actions. Acute toxicity studies resulted, in mice, in an iv LD50 of 40 and 32 mg/kg for pr-MDI and bu-MDI, respectively, and an ip LD50 of 185 mg/kg for both MDIs. In rats, the ip LD50 was 175 and 240 mg/kg for pr-MDI and bu-MDI, respectively. An iv dose of 16 mg/kg decreased motor activity and prolonged barbiturate sleeping time in mice, but did not affect conditioned avoidance behavior or motor coordination tests. In sub-acute toxicity studies, rats received daily for 4 weeks 26.25 or 52.5 mg/kg ip of either MDIs, while mice received 23.13 or 46.25 mg/kg ip of either MDIs. No alterations were observed in serum alkaline phosphatase, glutamic-pyruvic transaminase, glutamic-oxalacetic transaminase, creatine phosphokinase, bilirubin, chloride, cholesterol, uric acid, prothrombin time, and bromsulphalein retention. Blood glucose was slightly lowered. Serum calcium was slightly lowered in male mice. The higher dose of pr-MDI elevated serum lactate dehydrogenase in rats. Both MDIs elevated serum isocitric dehydrogenase in male rats. Light microscopic examination of brain, kidney, liver, spleen, intestine, stomach, and myocardium showed no anomalies resulting from the 4-week MDI treatment, and electron microscopic examination of hepatocytes revealed no deleterious effects of either MDIs.


Unusual response of anaesthetised pigs to asphyxia. The effects of vagosympathectomy, asphyxia, hypoxia and hypercapnia on the breathing of anaesthetised pigs are described. Vagosympathectomy caused changes in cardiovascular variables and in the pattern of breathing characteristic of the loss of stretch receptor activity. After vagosympathectomy the linear relationship between tI and tE was abolished. Hypoxia in intact animals produced changes in minute ventilation by peripheral chemoreceptor drive. When this drive was removed by vagosympathectomy the central depressing effects of hypoxia were revealed as a slowing of breathing and reduction in minute volume. The central depressing effect of hypoxia on respiration was very potent in the pig and very clearly seen in asphyxia. Vagosympathectomy caused a reduction in frequency of breathing and respiratory arrest occurred when a dead space of only moderate size was used. Breathing slowed from the moment of connection of the dead space to produce respiratory arrest within 2 min. The pig lung has been considered similar to the human lung on morphometric and physiological grounds but these results show that there are very important species differences in response to asphyxia.


Long-term vasoligation in the domestic fowl (Gallus domesticus). The effects of long-term (14 months) unilateral vasoligation on the tests and their excurrent ducts of the domestic fowl were studied histologically and ultrastructurally. Severe testicular degeneration and epididymal atrophy were observed in the ipsilateral organs while the contralateral control organs were normal. Massive macrophage activity was observed in the epididymal regions and to a lesser extent in some severely degenerated seminiferous tubules. Several granulomata occurred in the epididymal regions and the ducti deferentes, and most were resorbed or were undergoing resorption at the time of examination.


Immunological parameters in the intestinal lymph of pigs including changes during experimentally induced diarrhoea. Experiments were undertaken to provide basic immunological data on the intestinal lymph of young pigs. For this purpose indwelling cannulae were established in the main efferent intestinal lymphatic ducts of 12 animals and measurements were made of lymph flow rate, and concentrations of IgG, IgA and IgM. Measurements were also made of cell numbers, differential counts and immunoglobulin specificity of lymphoid cells in lymph. Similar measurements were also made on six pigs in which experimental diarrhoea was induced. The mean number of leucocytes in intestinal lymph was extremely low (0.66 X 10(5)/ml). However a high proportion of lymphocytes contained cytoplasmic IgA (19.65 per cent) and IgM (12.53 per cent), with few containing IgG (1.35 per cent). The concentrations of IgM and IgA in intestinal lymph were 0.51 mg/ml and 1.64 mg/ml respectively, values which suggest that the intestine is an important organ for synthesis of these two classes of immunoglobulin in young pigs. Following induction of diarrhoea and consequent dehydration of the intestine, the lymph: serum concentration ratios for immunoglobulins increased but subsequently declined when the water balance in the intestine returned to normal.


The pathophysiology of ovine fascioliasis: studies on the feed intake and digestibility, body weight and nitrogen balance of sheep given rations of hay or hay plus a pelleted supplement. The effect of Fasciola hepatica on feed intake and digestibility, body weight and nitrogen balance was measured during the course of experimental infections in sheep given a diet of hay or hay with 'concentrate'. A system of paired feeding was used to allow comparisons between infected and control animals. After the sixth week the appetites and body weights of all infected animals declined but both features were more prominent in the group given the diet of hay alone. By week 14 these animals became moribund and were necropsied whereas those given hay with concentrate which had the same fluke burdens, survived until week 20. At necropsy, the loss of weight in both groups was comparable but greater than in their pair-fed uninfected controls, suggesting that inappetence was not solely responsible. Measurements of feed digestibility revealed few differences between infected and control animals on either diet, but nitrogen retention was markedly lower in the infected animals after the eighth week, and sufficient to account for their inferior weight performance. Reduced nitrogen retention was primarily a reflection of a high urinary excretion in the infected animals, faecal excretion remaining unaltered despite the loss of substantial amounts of nitrogen into the gut as a result of the parasites' haematophagic activities.


Concentrations of free amino acids in maternal and fetal plasma from conscious catheterised ewes during the last five weeks of pregnancy. Concentrations of amino acids, urea, glucose, fructose and corticosteroids were measured in maternal and fetal plasma from nine Scottish Blackface ewes during the last 35 days of pregnancy. During this period maternal plasma levels of most amino acids did not change significantly. In fetal plasma the concentrations of most amino acids decreased or remained relatively constant until about 20 days before birth (day -20) and then increased as term approached. Glucose levels in plasma from both sources did not change, but urea concentrations rose to maximum values about day -20. Except for valine and isoleucine, the concentrations of amino acids in fetal plasma varied independently of levels in maternal plasma up to day -20, but thereafter 10 amino acids, including seven essential amino acids, showed a significant positive correlation with maternal values. Possible causes of the observed variations in fetal plasma composition are discussed.


Haptoglobin in the serum of thoroughbreds in training. A method is described for the measurement of haptoglobin in equine serum using the peroxidase activity of the haemoglobin-haptoglobin complex. The problems of interference with Fe2+ and Fe3+ ions are described. Normal values for haptoglobin in 629 blood samples from thoroughbreds in training are presented showing a log normal distribution with a 5 per cent to 95 per cent range of 0.42 to 1.7 g/litre. There was no consistent alteration in haptoglobin concentration throughout the season in spite of a change in red cell size and total bilirubin concentration. It is concluded that the measurement of haptoglobin is useful in the detection of frank haemolytic states but is insufficiently sensitive to detect mild red cell destruction. The test, after further investigation, might be used as an adjunct to the current batch of blood tests employed to assess liver function.


Pasture infectivity with trichostrongylid larvae in the northern Guinea Savanna of Nigeria. For the study of pasture infectivity in the northern Guinea Savanna of Nigeria, variable numbers of helminth-free tracer lambs grazing an unimproved pasture were slaughtered monthly throughout a period of 12 months. The numbers of worms recovered showed that large numbers of infective trichostrongyle larvae were ingested with the pasture from June till October. Infectivity started to decline from November until the end of January after which the pasture became completely free of parasitic nematode larvae and remained so until the end of May.


Antimicrobial susceptibility patterns of the A and T types of Pasteurella haemolytica. Minimal concentrations of penicillin, ampicillin, cephalothin, chloramphenicol, tetracycline, erythromycin, nitrofurantoin, kanamycin and gentamicin inhibitory to Pasteurella haemolytica biotypes A and T were determined. They were found to be significantly higher for T than for A type strains in the case of all the antimicrobial drugs tested except the two aminoglycosides kanamycin and gentamicin, for which no differences were observed. In the case of penicillin the differences were so marked that they may be useful as a basis for biotyping P haemolytica isolates. The emergence of antibiotic-resistant strains observed in recent years, however, may limit such application.


Bracken carcinogenicity.

Bracken carcinogenicity. The study of bracken carcinogenicity affords an interesting example of the close alliance, with mutual benefit, between the work of veterinarians in the field and experimental research. On the one hand was the condition found in many parts of the world of bovine enzootic haematuria with uncertain aetiology and, on the other, the investigations conducted on the acute radiomimetic cattle bracken poisoning under laboratory conditions. The two have led to the recognition of the long term cancer dangers of bracken consumption and the vulnerability of a wide variety of species of animals. In these the types of tumour vary to include many organs other than the bladder, such as the gastrointestinal tract and blood forming tissues. Work on the search for the chemical compounds involved is described, together with the possible hazards, both mutagenic and carcinogenic, on an environmental basis.


Immunoglobulin containing cells in the bronchopulmonary system of non-pneumonic and pneumonic calves. In an examination of the immunoglobulin containing cells in the respiratory mucosa of three-month-old non-pneumonic calves, IgA was found to be the predominant plasma cell type. In calves with cuffing pneumonia there was a marked increase in the plasma cell population in the bronchial wall and IgG1 cells became the major cell type. Similarly in calves with an exudative type of pneumonia IgG1 plasma cells were the significant cell type in the respiratory mucosa but the total number of plasma cells was similar to that found in the non-pneumonic animals. The immunohistochemical results suggest that IgA and, to a lesser extent, IgM are both transported across the mucous membrane via bronchial epithelial secretory cells and submucosal glands.


Staphylococcus hyicus in cattle.

Staphylococcus hyicus in cattle. Staphylococcus hyicus (subsp hyicus) was found to be a frequently occurring inhabitant of the skin of cattle. Significant numbers of this bacterium were found to be present in mange lesions of cattle between one and three years old. Experimental inoculations revealed that S hyicus had a pathogenic effect on the superficially scarified skin of young cattle.


Chronic infection with Trichostrongylus vitrinus in sheep. Pathological changes in the small intestine. Eight four-month-old sheep were infected daily for 90 days with 2500 Trichostrongylus vitrinus larvae. Infections were patent by week 3; mean faecal egg counts reached a peak of 645 epg at week 5, then subsequently declined. Mean worm burden at slaughter was 6100 (range 60--25,080). Two sheep had visible lesions in the small intestine at slaughter. In both sheep, numerous shallow red depressed areas extended for 5 to 7 metres distal to the pylorus while, in one, more extensive irregular depressed areas occupied the first 1.5 metres. Microtopographical examination and scanning electron microscopy showed that these affected areas were devoid of villi and contained numerous worms embedded in the mucosa. Histological examination revealed many similarities with the lesions caused by T colubriformis. Subtotal villous atrophy and crypt elongation were present in the intestines from five of the remaining six sheep, and in these the mucosa contained numerous mononuclear cells and intraepithelial globule leucocytes.


Chronic infection with Trichostrongylus vitrinus in sheep. Some effects on food utilisation, skeletal growth and certain serum constituents. The effect on food utilisation and skeletal growth of daily infection for 90 days with 2500 Trichostrongylus vitrinus larvae was investigated. Controls were killed initially or fed ad libitum. Food intake, digestibility of dry matter and nitrogen and content of body fat, protein, water and minerals were determined, and selected bones examined chemically and histologically. Serum constituents were determined weekly. Digestibility of food dry matter and nitrogen were reduced during weeks 3 and 5 after initial infection but subsequently recovered. Deposition of fat, protein, calcium and phosphorus in the body was reduced by 36, 58, 67 and 78 per cent respectively. Gross efficiency of utilisation of metabolisable energy was reduced by 36 per cent. Bone changes were associated with a reduction in osteoblastic activity. Hypoalbuminaemia, hyperglobulinaemia and hypophosphataemia were present in infected sheep. There were no significant changes in serum calcium or urea concentrations. It is concluded that the effects of continuous intakes of T vitrinus and T colubriformis larvae on host metabolism are essentially the same.


Polioencephalomalacia (cerebrocortical necrosis) induced by experimental thiamine deficiency in lambs. Lesions of polioencephalomalacia (PEM, cerebrocortical necrosis) have been demonstrated in pre-ruminant lambs fed on synthetic, thiamine-free milk. Thiamine deficiency in these lambs was confirmed by transketolase assay.


The effect of parturition on the blood picture of sheep. Parturition in sheep was associated with significant increases in the packed cell volume, haemoglobin concentration and red cell counts. Subsequently these values gradually declined, attaining prepartum levels by the seventh day post partum. Blood leucocyte counts were also elevated at parturition and this was associated with marked neutrophilia, lymphocytopenia and mild eosinopenia. These changes were gradually reversed thereafter, with normal values being attained by the fourteenth day post partum.


A simple technique to establish a self-retaining rumen catheter suitable for long-term infusions. A simple and rapid technique is described for the establishment of a self-retaining permanent catheter in the rumen of sheep. The equipment required is minimal, the procedure takes less than five minutes and causes little disturbance to the animal. The technique has been used successfully on 39 sheep.


The effect of oxfendazole on Echinococcus granulosus and Taenia hydatigena infections in dogs. Trials with oxfendazole carried out on 120 dogs infected with either Echinococcus granulosus or Taenia hydatigena indicated that a single treatment significantly reduced the proportion of dogs infected with tapeworms. Diarrhoea occurred occasionally when the dose rate exceeded 20 mg/kg.


The effect of Taenia hydatigena infection on existing and concurrent infections of Fasciola hepatica in sheep. Sheep given a primary infection of Fasciola hepatica were challenged 18 weeks later with Taenia hydatigena or F hepatica, or both parasites together, or were not challenged. At the same time, control sheep were infected with T hydatigena and/or F hepatica separately or concurrently. All sheep were killed seven weeks after challenge and the number of cysts and flukes counted. Challenge infection with T hydatigena did not affect the numbers of flukes recovered from either primary or challenge F hepatica infections. On the other hand, the numbers of cysticerci were reduced in sheep previously infected with F hepatica but not in those given T hydatigena and F hepatica concurrently.


The side of action of bronchodilating drugs (beta 2-stimulators) on antigen-induced bronchoconstriction. The prophylactic effect of a sympathicomimetic drug (Fenoterol) was tested separately for the upper and the lower respiratory tract on 14 boxer dogs exposed to antigen challenge. In the lower airways, a restricted short-lasting diminution of bronchoconstriction was observed when both antigen and Fenoterol were administered to these airways. Administration of Fenoterol to the upper respiratory tract showed a long-lasting strong local effect in prevention of antigen-induced bronchoconstriction. There is a strong long-lasting effect of sympathicomimetic bronchodilators on the sensoric part of the reflex way into the airways. There is, with similar dosages, a weak short-lasting direct effect of these drugs on bronchial muscles.


Relationships of carbon dioxide retention to ventilatory impairment and hypoxemia in chronic obstructive lung disease. In a group of 80 male patients (average age 52.5 years) with severe obstructive ventilatory impairment (FEV1.0 less than 40% of predicted) due to chronic bronchitis and/or emphysema, the blood carbon dioxide tension measured at rest, in a stable clinical status, was confronted to the spirometric variables and the oxygen tension. PaCO2 (range 31--60 mm Hg) was loosely related to the VC (r = -0.28) and the FEV (r = -0.30, both p less than 0.05) and strongly related to the PaO2 (r = 0.60; p less than 0.001). When patients were classified as bronchitic or emphysematous according to clinical, roentgenologic and biological criteria, the correlations above were found to be higher for bronchitics. In patients with chronic bronchitis with severe obstruction a very good estimation of PaCO2 is possible from PaO2: PaCO2 = 75.8-0.44 PaO2 (SEE 0.4 MM Hg).


Oxitropium bromide, a new anticholinergic drug, in a dose-response and placebo comparison in obstructive airway diseases. 12 patients with obstructive airway diseases took part in a double-blind study in which 0.02 and 0.2 mg of Ba 253 as metered aerosols were compared with a placebo. Both doses of Ba 253 elicited a significant fall of mean total airway resistance compared to the placebo, and this fall was still discernible even 8 h after inhalation. Under the higher dose, the maximum response was significantly greater and it occurred about 2 h after inhalation; the response was still significantly more pronounced 8 h after inhalation. There was no objective evidence of local or systemic side effects attributable to a vagus-blocking effect. In the light of published reports and our own experience, when Ba 253 is inhaled in the stated doses it appears to be equivalent to ipratropium bromide as regards potency, duration of action, tolerance and therapeutic safety margin.


Functional evaluation of a physical rehabilitation program including breathing exercises and bicycle training in chronic obstructive lung disease. 20 patients suffering from chronic obstructive lung disease (COLD) were submitted to a 6-month rehabilitation program including breathing exercises only (A) or coupled with bicycle training (B). Functional results obtained at rest were the following: for A: nonsignificant changes in FRC, RV, FEV1, Raw, Pa O2, pH, Pp, VO2 max SL but significant changes (p less than 0.05)for TLC (+ 214 cm3), VC (+ 171 cm3), DL CO (+ 1.79 ml), Pa CO2 (-2.9 mm Hg). For B: similar changes as for A with additional significant changes in PaO2 (+ 7.4 mm Hg) VO2 max SL (+ 250 ml) and Pp (-4 mm Hg). These results, although minimal, are attributed to improved respiratory muscle strength and improved alveolar ventilation. Exercise training adds an increased ability to sustain higher loads.


Relationship of static respiratory muscle pressure and maximum voluntary ventilation in normal subjects. 40 normal subjects performed spirometry, maximum voluntary ventilation (MVV), and tests of static inspiratory (Pi max) and expiratory (Pe max) respiratory muscle pressure. Forced expiratory volumes in 0.5 (FEV0.5), in 0.75 (FEV0.75), and 1 sec (FEV1) correlated significantly with MVV (r = 0.805, 0.804, 0.779, respectively). When Pi max was considered as a second independent variable, the probability of predicting MVV from timed forced expiratory volumes was enhanced (r = 0.914, 0.900 and 0.872 for FEV0.5, FEV0.75, and FEV1, respectively). Statistical analysis indicated that multiple regression with Pi max was superior to regression with timed forced expiratory volume alone in the prediction of MVV. For any given FEV1, however, Pi max was widely dispersed (range: -60 to -200 cm H2O). MVV values, expressed as percentage difference between largest and smallest value, varied less than did Pi max. Pe max, vital capacity, height and age did not enhance the ability of timed forced expiratory volumes to predict MVV. These data indicate that while respiratory muscle strength is important for sustaining maximal ventilation, the MVV is not a sensitive indicator of respiratory muscle strength.


Lung function in children with recurrent bronchitis. Lung function was studied in 29 children suffering from recurrent bronchitis (average number of bronchitis attacks per year: 4.2 +/- 0.5). Most of them (73%) were 1--7 years old. The date of exploration in relation to the last acute bronchitis was on average 6 weeks. Lung mechanics, residual functional capacity, blood gases and regional lung function were measured. Most of the children were suffering from some kind of functional disorder; alteration of lung mechanics -- increase of lung resistance (22/29) decrease of dynamic compliance (15/23); increase of functional residual capacity (6/10), non specific bronchial hypersensitivity (12/17); regional ventilatory and perfusion malfunction. These functional disorders could be the first evidence of the bronchial lesions which cause chronic obstructive bronchitis in adults.


Airway response in asthmatic children during and after exercise. This study investigated the effect of moderate treadmill exercise on the airways of normal and asthmatic children using an effort-independent method (total respiratory resistance) as well as conventional pulmonary functions. Changes in total respiratory resistance (Rrs) were measured during and after exercise using a forced oscillation technique. Conventional spirometric (PEFR, FEV1 and MMEF) and body plethysmographic measurements (Raw, Vtg) were also determined before and after exercise. A rapid, signigicant decrease in Rrs, suggesting bronchodilation during exercise, was observed in both groups tested, but this decrease was greater in normal children than in asthmatic patients. The bronchodilation persisted throughout the exercise period in both the asthmatic and the normal children. Increasing the length of the exercise from 10 to 20 min did not alter the degree or the duration of exercise-induced bronchodilation. In both normal children and patients with bronchial asthma, during moderate treadmill exercice, a significant, persistent bronchodilation can be detected. At the end of exercise, bronchoconstriction developed in asthmatic patients, while the values in normal subjects returned to their preexercise levels.


[Occupational asthma and dermatitis after exposure to dusts of persulfate salts in two industrial workers (author's transl)]. Two workers developed dermatitis, rhinitis, bronchitis, and asthma after occupational exposure to dusts of persulfate salts. The causative role of the persulfate salts could be confirmed by case history, skin tests, occupational exposure tests and by removal of the 2 workers from their jobs. Patch tests produced late cutaneous reactions. Occupational exposure at the working place for 8 h resulted in each case in a pathological increase of airway resistance. Withdrawal from occupational exposure to persulfate salts resulted in recovery within a few days. Our results suggest that chemically irritative or toxic effects of persulfate salts play the predominant role in the pathogenesis of the reported cases.


Löffler's syndrome secondary to 'NTZ' nose drops: a self-limited illness. A case of Löffler's syndrome is presented. Emphasis is placed on the association of an 'over the counter' medication with Löffler's syndrome.


Morphology and therapeutic chances of interstitial lung disease. 101 cases of idiopathic interstitial lung disease diagnosed by lung biopsy, were reviewed according to clinical and X-ray appearance and especially to their response to steroid therapy. Four morphological inflammatory reactions are distinguished: (1) alveolitis; (2) onion-like mesenchymal proliferation; (3) sarcoid-like lesions, and (4) lymphofollicular reactions. Especially type 1 and/or type 2 show immediate response to steroid therapy. Only a few cases showed spontaneous improvement. Once a fibrosis exists, a 'restitutio ad integrum' cannot be expected any where. From this group of idiopathic interstitial lung diseases the conclusion seems to be justified that also other types of interstitial lung reactions should be treated with steroids to avoid it turning into lung fibrosis.


Pulmonary alveolar proteinosis associated with fanconi's anemia. A 16-year old patient with Fanconi's anemia developed pre-leukemia and pulmonary infiltration which was found upon autopsy to be pulmonary alveolar proteinosis. The question whether the pulmonary alveolar proteinosis was due to the marked leukopenia and an eventual defective phagocytic ability of the leukocytes is raised.


Adenocarcinoma of the lung secreting alkaline phosphatase. A 42-year old male was found to have adenocarcinoma of the lung and very high serum alkaline phosphatase levels. The clinical course and autopsy excluded the possibility that the enzyme elevation was due to liver or bone metastases, which is the most common cause for such a phenomenon. It was proven that the tumor secreted the alkaline phosphatase, and that the latter could serve as a marker of its recidivation. Although the phenomenon of tumors secreting alkaline phosphatase is not new, including some types of lung carcinomas (such as squamous cell and epidermoid), it is, to the best of our knowledge, the first time adenocarcinoma of the lung was found to secrete the enzyme.


Water-vapor conductance of testudinian and crocodilian eggs (class reptilia). Flexible-shelled eggs of snapping turtles (Chelydra serpentina) have conductances to water vapor that are 55 times higher than predicted for avian eggs of similar size, whereas rigid-shelled eggs of softshell turtles (Trionyx spiniferus) and American alligators (Alligator mississippiensis) have conductances that are only five times higher than expected for comparable eggs of birds. The differences between empirical and predicted values result from the much higher effective pore areas in reptilian eggshells than in those of birds. The relatively high porosities of these reptilian eggs presumably facilitate the transport of oxygen and carbon dioxide eggshells in later stages of incubation when air trapped inside nest chambers may become hypoxic and hypercapnic, yet seem not to lead to excessive transpiration of water vapor owing to the high humidities in nests where incubation occurs.


Lung compliance and cholesterol during stellate ganglion stimulation. The relationships between lung compliance, surface tension, and cholesterol during stimulation of the sympathetic nervous system were studied in 28 cats. Cats were anesthetized with ketamine hydrocholoride, injected with one of five sympathetic blocking agents or inhibitors and injected with isoprotenol. The left stellate ganglion was then stimulated electrically for 5 min. We found that stimulation decreased lung compliance and increased the surface tension and the cholesterol concentration in the lung wash fluid. Alpha blockers (phentolamine and phenoxybenzamine) and catecholamine inhibitors (reserpine and guanethidine) prevented these changes, but the beta blocker practolol did not. In additional experiments airway resistance, functional residual capacity and lung weights did not change during stellate stimulation. The results from the present study suggest that stellate ganglion stimulation resulted in decreased lung compliance with an increased surface tension and cholesterol in lung wash fluid.


Measurement of the distensibility of the parabronchi in duck lungs. Air flow resistance in the parabronchial lung of the duck was measured at various pressure differences between the lung and the body surface (Prs) using a body plethysmograph. One lung of the anesthetized animal was ventilated at a steady flow rate, from trachea, through the parabronchial lung, and out via a cannula in the caudal thoracic air sac (Tr leads to CS flow), or vice versa (CS leads to Tr flow), all flow being directed over the parabronchi (Pb) by blocking the main bronchus between the medioventral (MV) and mediodorsal secondary bronchi (MD). Pressure differences were measured between MV and MD (Ptot), and between the clavicular air sac and MD giving the pressure drop along the parabronchial tubes (PPb). The pressure drop along MV, PVb, was derived as Ptot-PPb. Air flow resistances, Rtot, RPb, RVb, were calculated from the ratio of the corresponding pressure difference to the flow rate. Results show: (1) All resistances decreased with increasing distending pressure (Prs) from -20 to +20 cm H2O this change being most pronounced around Prs = 0; (2) The flow resistance of these structures depended on the flow direction, being smaller with Tr leads to CS flow during distension than in the opposite direction; (3) Arterial blood gases did not significantly change with varying distending pressure, suggesting unimpaired gas exchange even when the lung is significantly compressed. The results indicate that the parabronchi and the secondary bronchi of the duck lung have a finite compliance but that changes in intrapulmonary pressure, compression of the lung, do not result in significant collapse of the air capillaries with ensuing impairment of gas exchange.


Pentobarbital-induced apneusis in intact, vagotomized, and pneumotaxic-lesioned cats. While recording several respiratory parameters, sodium pentobarbital (PB) was infused into the inferior vena cava of spontaneously breathing, PB anesthetized cats. Three cat groups were investigated: intact control (group A); vagotomized (group B); pneumotaxic center-lesioned (group C). With a few exceptions, all cats developed PB-induced inspiratory apneusis. Groups B and C exhibited 10-sec inspiratory hold pattern at significantly lower PB levels than group A cats. All groups developed apnea at different PB levels. Ventilation was consistently depressed, predominantly by breathing frequently attenuation. Tidal volume remained comparable to control, but decreased in vagotomized cats at high PB levels. These results are interpreted to signify that (1) inspiratory inhibitory inputs are more susceptible to depression by PB than inspiratory drive mechanisms; (2) the breathing pattern of apneusis results when summed inspiratory inhibition is reduced below a critical minimum level; (3) vagal and pneumotaxic center inhibitions on inspiration are equally weighted at apneusis, but not at apnea. These results are further discussed in terms of the inspiratory off-switch model. A possible model of Biot respiration is also introduced.


Reflex stimulation of aortic chemoreceptors and the role of vascular receptors. Impulses were recorded in single afferent fibres of aortic chemoreceptors of cats anaesthetized with chloralose. As expected raising the blood pressure (BP) passively by occluding the abdominal aorta, consistently reduced or abolished the activity of the chemoreceptors. This reduction persisted for as long as the BP remained high. Stimulating the sensory receptors of the small intestines increased the activity of 10 aortic chemoreceptors. The increased activity persisted after bilateral adrenalectomy but it was abolished by blocking the nerves of the mesentery with xylocaine. The increased activity was noteworthy because it occurred in spite of the rise in blood pressure (that always occurred when the intestines were squeezed) which by itself would tend to reduce the activity of the chemoreceptors. It was concluded that stimulating the intestinal receptors produces a reflex increase in the activity of aortic chemoreceptors by causing a reduction of glomeral blood flow through impulses in the sympathetic fibres.


Ventilatory response to inspired CO2 in the sea turtle: effects of body size and temperature. The ventilatory response of green turtles (Chelonia mydas) to inspired CO2 was tested. Both immature (0.9--1.35 kg) and adult (59--130 kg) animals responded with increased ventilation (VE) that was primarily (immature) or exclusively (adult) due to increased respiratory frequency. The VE of the immature turtles while breathing air increased with temperatures between 15 and 35 degrees C with a Q10 of 1.95, but the peak VE of these turtles while breathing 4.5% CO2 in air was not significantly different at 15, 25 or 35 degrees C. VE increased irregularly with time throughout an hour of CO2 breathing in both groups, although several of the adult animals exhibited a first-breath response to CO2 and all animals increased VE within 5 min after the onset of CO2 breathing. The VE of an immature turtle at 35 degrees C increased with graded increases in CO2 up to 6%, but at 15 and 25 degrees C VE increased only up to 4.5% and decreased with 6% CO2. The results are discussed in terms of possible receptor mechanisms involved.


Cardiorespiratory responses to sudden release of circulatory occlusion during exercise. Cardiovascular and respiratory parameters were measured during and after release of pressure in thigh cuffs which occluded circulation to the legs of four human subjects exercising on a bicycle ergometer. The subjects exercised at 200 kg/min while thigh cuffs were inflated for 4 min and then released. Responses from 6 to 8 identical experiments were ensemble averaged so the precise timing of delays could be obtained. Five to ten seconds following cuff release, end-tidal CO2 increased, marking arrival of the trapped blood at the lungs. Ten to eighteen seconds after this increase in end-tidal CO2, ventilation, respiratory rate and tidal volume increased. This delay in ventilation must have resulted in an increase in arterial PCO2 and suggests that arterial chemoreceptors mediated the responses, and that no venous chemoreceptors or CO2-flux or disequilibrium receptors in the lung need be postulated.


Aerobic and anaerobic contributions to sustained activity in Xenopus laevis. In conditions of declining water PO2, Xenopus obtains the majority of resting oxygen needs from lung breathing at 15 degrees and 25 degrees C. The critical oxygen tension was 120 +/- 9 mm Hg at 15 degrees C, and 90 +/- 10 mm Hg at 25 degrees C. During 30 min stimulation of activity to complete exhaustion at 15 degrees C, frogs exhibited an aerobic capacity of 1.7 microliter O2.g-1.h-1 and accumulated 2.22 mg lactate . g-1. Following activity these animals exhibited an oxygen debt of 49.2 microliter O2.g-1. At 25 degrees C, Xenopus had an aerobic capacity of 16.1 microliter O2.g-1 and accumulated 1.94 mg lactate . g-1. Following activity, 25 degrees C frogs exhibited an oxygen debt of 261.9 microliter O2.g-1. Thus at 15 degrees C, Xenopus acquires 85% of the ATP used during a bout of sustained exhaustive activity from anaerobic sources, and 98% at 25 degrees C. Recovery from exhaustive activity was complete after 5 h at 25 degrees C and 9 h at 15 degrees C. Comparison of these data with those of other amphibians stimulated to sustained activity suggests that aquatic amphibians can tolerate a larger lactate load than can terrestrial forms.


Elbow joint forces in patients with rheumatoid arthritis. Whilst developing an elbow endoprosthesis, the joint forces were estimated for patients with rheumatoid arthritis. Elbow flexion strength of rheumatoid patients was found to be 45% of normal. Muscle strengths and limb geometry data were found by a dissection technique, which allowed joint forces to be calculated during flexion, extension and abduction efforts. Forces up to 2.4 kN were predicted to act on the distal humerus, with similar forces acting in both radius and ulna. The skeletal structure is well adapted to carry the predicted forces, and onlay-type prostheses are recommended for elbow replacement.


The use of scintigraphy in the diagnosis and management of traumatic foot lesions in ballet dancers. In this paper we report the use of the technetium-99m diphosphonate bone scan in the diagnosis and management of traumatic bone lesions in the ballet dancer's foot. Nine illustrative case histories are given. We conclude that this is a useful technique particularly in the recognition of stress lesions not identified by conventional radiography.


Multiple epiphyseal dysplasia: a family study. Three generations of a single family exhibited evidence of multiple epiphyseal dysplasia. The distribution of involvement was entirely consistent with an autosomal dominant mode of inheritance. The family was characterized by premature osteoarthrosis of the hips developing in adolescence or early adulthood. In most patients there were no obvious signs of an underlying anomaly and the diagnosis was not recognized for a long time. Eventual diagnosis of the disorder allowed easy genetic counselling.


[Technical factors, quality control, relevance of doctor's statements (author's transl)]. The correct description and classification of an x-ray film finding can be of vital importance to the patient. We must, therefore, always remain conscious of our responsibility. This responsibility can be discharged only via maximum quality and precision of performance.


[Quality criteria - urography (author's transl)]. The technique of urography is discussed on the basis of the pharmacokinetics of contrast media with easy renal passage. The quality characteristics of a technically good urogram are defined. The factors influencing the quality of this method of examination are discussed.


[Quality criteria in Mammography (author's transl)]. Definite quality criteria must be observed to achieve optimum diagnostic success in mammography. These criteria refer to the apparatus, film, development of film, method and interpretation of findings. Cooperation with a mamma centre is discussed in case extended diagnosis of breast findings is required, or in case it becomes necessary to mark any non-palpable changes.


[67Ga scintigraphy as an aid in the differentiation of fibrosis and granulomatosis in pulmonary sarcoidosis (author's transl)]. Gallium scintigraphy enables the following statements: 1. It is possible to establish the existence of an active granulomatosis both in the acute and in the chronic stage I, as well as the granulomatous pulmonary infiltration of stage II. 2. A therapy-induced or spontaneous regression of granulomatosis is associated with a reduced and later on absent deposition of 67Ga. 3. Signs of fibrosis visible on x-ray film do not exclude the continued presence of granulomatous pulmonary infiltrations. Such a granulomatosis can progress and thus produce further fibrosing and hence functional disorders up to the development of pulmonary heart disease (cor pulmonale.) It follows from this that in such cases corticoid treatment must be continued or resumed. 4. Reduced or no longer apparent storage of 67Ga under therapy does not represent a safeguard against relapse. X-ray controls chould be performed after discontinuation of corticoid therapy in order to discover, if any, discrete signs of recurring granulomatosis. In such cases, gallium scintigraphy can clearly show the revival of granulomatosis. 5. In our opinion, gallium scintigraphy is mandatory in all pulmonary affections.


[Radioisotopic methods of diagnosis in pulmonary embolism (author's transl)]. Pulmonary profusion scintigraphy is a simple, noninvasive and low-cost method for identifying acute pulmonary embolism. Although the method is highly sensitive, it is relatively non-specific, so that final assessment must include history, clinical findings and plain roentgenography of the thorax. Pulmonary scintigraphy is indicated whenever acute pulmonary embolism is suspected, on account of the therapeutic consequences resulting therefrom, in all cases where clinical findings and basic diagnosis cannot definitely establish the disease. It must not, however, be considered as an alternative to angiography of the pulmonary artery; as a matter of fact, it should be employed early and frequently in view of the high percentage of undiagnosed embolism of the lungs during the patients' lifetime.


[Sonographic structural analysis of circumscribed organ processes--possibilities and limitations (author's transl)]. For the clinical examination three sonographic patterns - cystic, solid and mixed - are defined. Using 8 characteristics cases the difficulties of structure analysis are discussed and the problems involved in recognizing the mixed pattern are explained.


[Angiographic diagnosis of haemoptysis with particular reference to angiomas of the bronchial arteries (author's transl)]. It is hardly ever assumed that pulmonary bleeding can be due to the presence of angioma racemosum arteriovenosum. This is not only because it is relatively rare, but also because it cannot be visualised in conventional x-ray films of the lung. It is also not accessible to more detailed and invasive lung diagnosis. Definite confirmation is only possible via selective bronchial arteriography, which is too rarely applied during diagnostic differentiation. The authors observed angioma racemosum arteriovenosum in seven out of 47 patients in whom angiography had been performed after single or repeated haemoptysis; in six of these patients, the angioma was removed by surgery. Bronchial arteriography not only enables visualisation of the characteristic vascular patterns, but also to differentiate this disease against other pulmonary disorders which may also be responsible for the occurrence of haemoptysis. Furthermore, the angiogram enables exact determination of the extension and localisation of the angioma, this being an important prerequisite of successful thoracosurgery.


[The role of angiography in the diagnosis of chronic compression damage of the plexus brachialis (author's transl)]. The article reports on two cases of chronic compression of the plexus brachialis in the presence of osseous and vascular anomalies. The importance of selective angiography of the truncus brachiocephalicus or the a. subclavia for diagnosis and for selecting the most suitable therapeutic procedure, is emphasised.


[Alleviation of pain via lidocain in peripheral arteriography. Further experiences (author's transl)]. On comparing an ionic contrast medium with a contrast medium containing one or two mg Lidocain/ml contrast medium, the one with the higher Lidocain addition was found to be most effective in respect of pain alleviation. The feeling of flush could not be favourably influenced. The use of a higher dose of Lidocain in the contrast medium may involve more pronounced circulatory reactions, such as drop in blood pressure and enhanced pulse rate. Besides, the rate of side effects compared with the use of the pure contrast medium and contrast medium with one mg Lidocain/ml CM will be increased. For this reason, it is not recommended to add more than 1 mg/ml Lidocain to the contrast medium. In most cases, repeat examinations can be effected without any risk with 1 mg Lidocain/ml contrast medium. No absolute contraindications were found in the application to outpatients and risk patients. Relative contraindication exists in patients with bradycardia and bradyarrhythmia. Following preliminary injection of a vasodilatory substance, the Lidocain/contrast medium mixture is well suited for arteriography in the arm.


[Phlebography (author's transl)].

[Phlebography (author's transl)]. The article discusses the limitations of conclusive information supplied by different phlebographic methods. Particular attention is drawn to the insufficient staining properties, partly of the deep veins of the lower leg, the vena femoralis profunda and gastrocnemius veins. When assessing the course of acute phlebothromboses, conclusive information on the extent of thrombus formation is limited in complete obstruction of deep veins as well as in the reformation of thrombi in vessels which have already undergone post-thrombotic changes. Observation of the valvular function can supply essential information on the extent of fibrinolytic effects. Besides the conventional phlebographic techniques, the article also explains methods for the visualisation of rare angiomatoses with osseous involvement, using transosseous pelvic phlebography.


Acoustically evoked potential: dependence upon age. The slow components of the potentials evoked acoustically by pure tones (1 kHz, 0 to 90 dB HL) were compared between two groups of subjects. All subjects of one group were 22 years old; the members of the other group had an average age of 63 years. The P2-latencies of the older subjects were significantly shorter for 60, 75 and 90 dB HL than those of the younger group. This finding was interpreted as a sign of a decreased efferent inhibition of several nuclei of the auditory pathway in the older subjects. No significant difference between the two groups could be found for the amplitudes (N1/P2), the exponent of the intensity function, or the latencies of P1 and N1.


Critical bandwidth in patients with acoustic neuroma. Eleven patients with verified acoustic neuroma had critical band estimation performed by the method of loudness summation using noise bands centered around 1 kHz. The normal loudness difference between broad band noise and narrow band noise was reduced at all levels except the highest. Judged as single individuals, 9 of the 11 patients had a normal critical band. The pooled data indicated a normal critical band, both in patients with hearing loss less than 50 dB HL and in patients with hearing loss greater than or equal to 50 dB HL. The results are similar to those obtained in patients with Ménière's disease (Bonding, 1978c) and thus CB-measurements cannot be utilized for differentiating between cochlear and retrocochlear lesions. However, at the highest test levels applied the loudness difference between broad band noise and narrow band noise appeared to have some correlation to the presence or absence of recruitment.


Human auditory on- and off-potentials of the brainstem. Brainstem auditory evoked potentials (BAEP) elicited by bursts of white noise and 2 kHz sine waves were investigated in 3 subjects with normal hearing. The effects of Gaussian-shaped envelopes of varying half-width on the BAEP for stimulus on- and offset are demonstrated. The concept of "virtual trigger time, amplitude or energy" of the acoustic stimulus is proposed for an understanding of the effects of different envelope characteristics on the BAEP. Apart from potentials due to stimulus onset, we also found consistent potential changes after signal switch-off both for bursts of white noise and sinewaves. In the case of white noise these potentials appear to be related to a synchronized decrease in the firing rate of the cochlea and the auditory nerve. In the case of tone-bursts the potentials appear to be related to transient spectral components which elicit a new On-potential during acoustic stimulus offset.


The effects of age upon the visual perception of speech. A sample of 110 middle-aged and geriatric subjects (40 to 87 years) with normal hearing and vision was drawn from the general population in order to compare visual performance for consonant-vowel (CV) syllables and sentences. Results of this investigation revealed that, above 70, age was a factor affecting visual perception of syllables. Individuals above age 70 received the poorest speechreading scores and were inconsistent in viseme categorization. Results of a comparison of speechreading scores for sentences and syllables revealed a greater number of differences among sentences. Only individuals between 40 and 60 years of age received statistically similar mean scores when presented with common sentences. Finally, using a linear regression model, it was found that sentence speechreading performance could be accurately predicted from the CV syllable score within a range of accuracy of +/- 9.7%.


Aging and the use of hearing aids.

Aging and the use of hearing aids. Elderly subjects with both peripheral and central auditory deficits perform less well with amplification than elderly subjects with peripheral deficits only. This decrease in aided performance remains after control for degree of sensitivity loss, absolute speech understanding score, and chronological age. Furthermore, females show greater central deficits and, consequently poorer aided performance, than males. We discuss the implications of these findings for the auditory rehabilitation of the elderly.


Critical bandwidth in presbycusis.

Critical bandwidth in presbycusis. Twenty patients with presbycusis and a rather flat audiometric pattern had critical band estimation performed by the method of loudness summation, using noise bands centred around 1 kHz. The pooled data indicated a normal critical band both in patients with a hearing loss less than 50 dB HL and in patients with a hearing loss greater than or equal to 50 dB HL. The normal loudness difference between broad band and narrow band noise was reduced at all levels except the highest, giving rise to very flat CB functions. This reduction was more pronounced at the highest test levels in recruiting ears than in non-recruiting ears. A theory is suggested for parts of the anatomical and physiological correlate of the empirical phenomenon, the critical band.


Frequency composition of brain-stem auditory evoked potentials. It has been demonstrated by digital filtration and power spectra analysis that main energies of different components of human brain-stem auditory evoked potentials are concentrated in the following frequency bands: 400--1 000 Hz for waves I and II, 100--900 Hz for wave III, and 100--500 Hz for waves IV--VI. The data obtained are compared with those published in Scand Audiol by Terkildsen et al. (1975) and Elberling (1976).


Counselling and its effect on hearing aid use. The objective of this study was to determine if subjects who received pre- and post-issue counselling made better use of their National Health Service body-worn hearing aids than those who received no counselling. Assessment was by both subjective and objective methods, the latter employing a small use-time measuring device concealed within the aid. The findings suggested that subjects issued with hearing aids in the conventional NHS manner used their hearing aids even less than indicated by previous studies and achieved a low competence in handling. Significantly better use was made of their aids by subjects given a moderate amount of counselling. These patients were also considerably more adept in handling their aids and achieved a greater reduction in social hearing handicap than the non-counselled patients.


An evaluation of the English language version of the social hearing handicap index. It is widely acknowledged that standard clinical measures of hearing assessment can provide no more than a relative measure of social efficiency. A Danish language scale for self-assessment of hearing handicap has been reported both in terms of initial assessment, and of assessing response to rehabilitatory intervention. The English language version of this scale was included in a study on hearing handicap in a sample of adult native English speakers. The results essentially supported the claims of the authors but some reservations are noted.


The correlation between negative middle ear pressure and the corresponding conductive hearing loss in children. A 12-month study of 352 unselected 7-year-old children. An epidemiological study of negative middle ear pressure in children made it possible to test its relationship to conductive hearing loss. About 350 children were subjected to a screening procedure recording audiogram and middle ear pressure five times during a 12-month period. Those children who failed to perceive just one tone or who had a middle ear pressure equal to or worse than -150 mmH2O in one or both ears were referred to the Hearing Clinic for conventional audiometry and middle ear pressure measurement each month. By computing the weighted average of the regressions for each child, a straight linear relationship was found between negative pressure and conductive hearing loss. In addition, a frequency dependence was found, the hearing loss being maximal at about 500 Hz. In general, the study shows that tympanometry is of limited value in predicting hearing loss in a child. The threshold for pathology of about -150 mmH2O, being a predisposing factor in secretory otitis media, corresponds to the upper confidence limit of the normal range of hearing loss found in this series. There is no distinct value of negative pressure that clearly distinguishes between normal and pathological condition, but it is concluded that a middle ear pressure worse than -150 mmH2O should be considered a probable hearing handicap.


Programmable hearing aid with multichannel compression. A portable programmable hearing aid with multichannel compression was constructed with three channels with two independently variable crossover frequencies. The compression knee-point and attenuation in each channel and the two crossover frequencies can be programmed from a separate programming unit. Speech discrimination for seven subjects with sensorineural hearing loss was evaluated, comparing each subject individually in three different cases--equalization, multichannel compression and the subject's own conventional hearing aid. Each subject wore each aid for about a week in his/her own environment and was then tested. The following speech discrimination tests were used: monosyllabic phonetically balanced words with and without background noise, nonsense syllables in quiet, and a constant test in quiet and in noise. The study showed that some patients with sensorineural hearing loss accompanied by recruitment can double their speech discrimination by using a hearing aid with multichannel compression.