Examination of the premature infant.

Examination of the premature infant. Ophthalmoscopic examination of the premature infant requires binocular indirect ophthalmoscopy, use of an eyelid speculum, and wide pupillary dilatation. Normal and pathologic features unique to the infant eye often are encountered. Familiarity with these features is essential for accurate diagnosis and prevention of unnecessary therapeutic intervention. Supplemental oxygen is the mainstay of supportive therapy for idiopathic respiratory distress syndrome, a common cause for morbidity in premature infants. Arterial oxygen monitoring is essential for survival and for prevention of retrolental fibroplasia, but precise arterial oxygen levels associated with development of retrolental fibroplasia have not been established.


Fluorescein angiography in retrolental fibroplasia: experience from 1969-1977. Acute proliferative retrolental fibroplasia (RLF) has been studied in premature infants employing a Zeiss fundus camera and fluorescein angiography. A total of 164 angiograms have been performed on 122 infants. At the present time, angiography is reserved for studying infants with peculiar or puzzling fundus pictures. A dose of 0.1-0.4 cc of 10% sodium fluoresceinate is employed, depending on the age and the weight of the baby. Fluorescein clearly outlines the major arteriovenous shunt in the retina, which is the hallmark of acute RLF. The shunt fills with fluorescein and leaks it profusely. On regression, a fine brush border of capillaries is seen in the region where the shunt previously had been located. Study of the population susceptible to RLF reveals it to be the smallest sickest babies in the premature nursery.


Netherton's disease: a case of congenital ichthyosiform non-bullous erythroderma (Brocq) with trichorrhexis invaginata. The authors report the case of a seven year old girl originally diagnosed as a case of congenital ichthyosiform non-bullous erythroderma (Brocq). Further specific examination of the hair led to a final rare dual diagnosis of congenital ichthyosiform non-bullous erythroderma and Netherton's disease.


A classification of retrolental fibroplasia to evaluate vitamin E therapy. A refined classification of the stages of the retinopathy of prematurity (RLF) based on the experience of over 7500 examinations during the past decade is presented. We have been using the basic elements of this classification since 1972 in order to evaluate the influence of vitamin E on retrolental fibroplasia (RLF). It is our impression that it provides a more accurate clinical method of following the course of the retinopathy and a tool for assessing the factors other than prematurity and hyperoxia that may play a subtle role in the development of RLF.


[One case of primitive lymphoblastic malignant lymphoma of the appendix vermiformis (author's transl)]. On the occasion of diagnosing one case of primitive malignant lymphoma of the appendix at the Institute of Surgical Semiology, University of Pavia, the authors discuss a number of aspects of the clinical picture, anatomopathology, and therapeutic approach to this rare malignancy.


[Primary lymphoid sarcomas of the stomach. Ten cases (author's transl)]. These sarcomas fall within a precise definition and must be differentiated from gastrointestinal involvement in a haematological disorder. For certain histological forms (nodular forms), the prognosis is less bad than that of carcinomas. Pre-operative diagnosis, often difficult, must be established by large biopsies. The best results are likely to result from a combination of surgery and radiotherapy or of surgery and chemotherapy.


The off--centered TORP.

The off--centered TORP. Refinement of the techniques of ossicular reconstruction has provided satisfactory hearing results for a majority of patients with chronic ear disease. As documented in 1976, 16% of patients, those requiring a columneller type of ossiculoplasty because of absence of the malleus, did not realize the same degree of hearing improvement as with other types of reconstruction. These procedures, short and long "L-shaped" assemblies, used for patients without a malleus, resulted in a mean 27 dB bone-air gap postoperatively. The conclusion reached after comparison with the results obtained with other types of reconstruction was "... the L-shaped conductive system is less efficient than normal by the amount observed (27 dB). If these results are to be improved, a change in the method of reconstruction resulting in a more normal system may be required." Following duplication of the aforecited report a change in the method of reconstruction used for patients with the malleus absent was instituted, but perversely creating a less normal conductive system. This paper will present the one year results of those patients in which a Plastipore prosthesis has been used as a replacement of the previously described method and will compare these results with those of the past technique.


Stapes surgery at the Otologic Medical Group. We reviewed the records of 498 primary stapedectomy cases in regard to duration of disease, age at surgery, oval window pathology, hearing results, dizziness, and tinnitus. Ninety percent of the cases in which a tissue graft had been used as an oval window covering obtained a postoperative hearing level within 10 dB of the preoperative bone conduction. Postoperative sensorineural hearing impairment occurred infrequently and was two to three times more common in cases in which Gelfoam had been used as an oval window covering as compared to tissue grafts. Postoperative dizziness of one degree or another persisted at four months in 2 percent of the cases and was a problem for the patient in two cases (0.4%). This dizziness was likewise more common in Gelfoam cases. We concluded that tissue grafts are a better covering for the oval window than Gelfoam both in regard to hearing improvement and lack of postoperative complications.


Effects of substituted 1,2,3-triazoles on adenosine deaminase, guanine deaminase and xanthine oxidase. The action of some known and new synthesized substituted 1,2,3-triazoles on adenosine deaminase, guanine deaminase and xanthine oxidase was studied. The effect of substituents in 1, 4 and 5 positions was studied and discussed. The presence of a carboxamido group in 4 position seems to be essential in the binding to adenosine deaminase.


Medical treatment of sexually transmitted diseases in developing countries. Part II: Other venereal diseases. Although gonorrhoea and syphilis are the better known of the sexually transmitted diseases, attention has been drawn to the other sexually transmitted diseases caused by bacteria, viruses, fungi and parasites. Although statistics are not available in most developing countries, herpes genitalis has been suggested as commoner than syphilis as a cause of genital ulceration while non-specific urethritis is commoner than gonorrhoea as a cause of urethritis. The incidence, clinical features and diagnostic procedures of syphilis, herpes genitalis, non-gonococcal urethritis, lymphogranuloma venereum and trichomoniasis have been briefly discussed. The management of these conditions in developing countries have been outlined.


The surgical management of the lid changes of Graves' disease. There are three areas of surgical intervention available to patients with the eye changes of Graves' disease-lids, extraocular muscles, and orbital decompression. The lid changes may be managed by lateral tarsorrhaphy, levator tenotomy, recession of the levator with or without graft, "tenotomy" of the retractors of the lower lid, or recession with graft. The success of these procedures is dependent on proper patient selection and surgical execution, and when these are achieved, definite benefits result.


Special types of muscle anomalies associated with Graves' disease. This paper discusses two cases of superior oblique paresis, two cases of cyclic hypertropias, and ten cases of large angle esotropia with high myopia. The association with Graves' disease, the treatment, and favorable prognosis in all cases is presented.


Management of eye movement restriction (particularly vertical) in dysthyroid myopathy. Sixteen cases of vertical rectus muscle myopathy in dysthyroid patients are described. In mild cases without diplopia prisms may be adequate treatment. When uncomfortable diplopia is present surgery is indicated when the muscle dysfunction has become stable. Even after surgery further contracture is often experienced, particularly after Ogura antral decompression. The amount of correction obtained by recession of a contracted muscle is greater than that following ordinary strabismus surgery so that usually only one muscle should be operated upon at a time. Care should be exercised in tenotomy of severely contracted muscles. The prognosis is excellent in dysthyroid myopathy if the patient permits the required number of surgical procedures which may be necessary.


Early chemical evolution of nucleic acids: a theoretical model. Recent experimental work suggests a possible cyclical pathway for early prebiotic oligonucleotide formation that involves (i) dry-state (nontemplate) synthesis of random copolymers with mixed 2',5' and 3',5' bonds, (ii) passage of these oligomers into solution at low temperatures, and (iii) a preferential hydrolysis of the 2',5' bond in any short helices that have formed. This early system could have selected for complementary sequences that were largely 3',5'-linked, but may not have selected efficiently for a single enantiomer of ribose.


Temperature and force-velocity relationship of human muscles. The force-velocity relationship of maximal contractions with the handgrip muscles is established in a group of subjects. The effect of different muscle temperatures is studied. The parameters vo (maximal velocity), Fo (maximal force), Pmax (maximal power), a/Fo and H (both parameters describing the shape of the curve), and Ft/Fo (the value of the force at which power is maximal) are established. It is shown that 1) in repeated measurements the coefficient of variation in general is less than 10% for all the parameters except a/Fo; 2) the parameter a/Fo should be discarded in comparative measurements since it is not linearly related to the course of the curve. A parameter called H should be used instead to describe the curvature; 3) an increase in muscle temperature is accompanied by an increase in magnitude of all parameters except Fo. The temperature effect expressed as Q10 in the range 22-38 degrees C is in the order of 1.2.


Effect of lung inflation and hypoxia on pulmonary arterial blood volume. Isolated cat lungs were perfused with constant blood flow. During control conditions (Pa02, 100 Torr), pulmonary artery pressure increased as the lungs were inflated. Hypoxia (Pa02, 22 Torr) increased arterial pressure. However, as the lungs were inflated arterial pressure fell. Thus, the magnitude of the hypoxic pressor response was reduced by inflation. During control conditions, arterial volume (ether bolus method) increased with increasing transpulmonary pressure. Hypoxia decreased arterial volume, and the increase in arterial volume with inflation was somewhat less than that during control conditions. When the influences of vascular and transpulmonary pressures were examined independently by changing one while holding the other constant, increasing transpulmonary pressure increased arterial volume beyond that which could be accounted for by changes in the differences between arterial and pleural pressure. However, this influence of transpulmonary pressure did not appear to be altered by hypoxia. Thus, while hypoxia decreased arterial volume at all levels of lung inflation, it had relatively little effect on the influence of interdependence between the pulmonary arterial bed and the surrounding lung tissue.


Heat production of fetal sheep brain in utero. Thermojunctions were implanted in the brains of 10 near term fetal sheep in utero under halothane anesthesia. Brief total occlusion of fetal brachiocephalic artery was followed immediately by an increase in brain temperature (mean +/- SE) of 0.130 +/- 0.014 degrees C-min-1. Occlusion of main pulmonary artery and ascending aorta, simultaneously, led to a brain temperature increase of 0.144 +/- 0.018 degrees C-min-1. Specific heat of three fetal brains was determined to be 0.898 +/- 0.014 cal-g-1. degrees C-1 or 3.76 +/- 0.059 J-g-1. Rate of fetal brain heat production, computed as the product of the higher rate of temperature change and brain specific heat, was 0.129 +/- 0.014 cal-g-1-min-1 or 9.00 +/- 0.98 mW-g-1.


An electromyographic index for localized muscle fatigue. A new method for objective quantification of localized muscle fatigue is described. The method is based on power spectrum analysis of myoelectric signals obtained from the fatigued muscle. It permits real-time investigations and yields statistically based criteria for the occurrence of fatigue. The findings are interpreted in terms of muscle action potential conduction velocity changes and rate of the fatigue development.


Correlation between ventilatory and cerebrovascular responses to inhalation of CO. To study the determinants of carbon monoxide (CO) induced hyperpnea simultaneous measurements were made of carboxyhemoglobin level in arterial blood (HbCO), ventilation (VE), cerebral blood flow (CBF), O2 delivery to the brain (CBF X O2 content of arterial blood), O2 consumption of the brain (CMRO2), and O2 tension in cerebral venous blood (PVO2) during inhalation of 1% CO in 40% O2 by six unanesthetized goats. HbCO increased to 65% in 10 min; VE remained constant until a HbCO level of approximately 50% was reached and then increased abruptly; CBF increased progressively; O2 delivery to the brain and CMRO2 decreased somewhat with CO inhalation; these decreases reached statistical significance at a HbCO level of 30-40% whereupon the rate of decline with respect to HbCO level increased substantially; and PVO2 decreased progressively from an average of from 31 to 14.6 Torr and averaged 19.2 Torr when hyperpnea was manifest. When considered in the light of previous studies which indicate that CO-induced hyperpnea is not caused by stimulation of the carotid bodies, these data suggest that this phenomenon is related to brain hypoxia. Calculations of brain tissue O2 tension with the Krogh equation support this contention.


Studies on nodulation of soyabean in Egypt. I. Selection of an efficient strain of Rhizobium japonicum. Both pot (sterilized sand cultures) and field experiments were run, using 23 different strains of Rhizobium japonicum and the commercial soyabean inoculum "Okadin". The failure of the control (non-inoculated plants) to form nodules may be due to the abscence of adequate densities of effective soyabean-rhizobia strains and their low persistence under Egyptian soil conditions. Therefore, inoculation with an efficient strain of R. japonicum seemed to be necessary. However, the strains used varied in their effectiveness, indicating that both the total number of nodules and total nitrogen content of the nodules should not be taken as an index.


The adjuvant effect of tuberculin in experimental sensitization to merthiolate. When guinea pigs were sensitized to tuberculin by exposure to complete Freund's adjuvant the size of the intradermal PPD test was positively correlated to the body weight of the animal. Old Tuberculin showed stimulating effect in a subsequent sensitization to merthiolate (thimerosal). The high frequency of delayed cutaneous allergy to merthiolate in Swedish population is probably explained by sensitization through intradermal testing with tuberculin containing merthiolate as a preservative.


Juvenile melanoma--a case report and histogenetic investigation. A case of juvenile melanoma which appeared to be completely intradermal was studied by optical and electron microscopy. The histological dopa reaction was negative and melanin granules could not be detected with Fontana-Masson stain, but detailed electron microscopic examination revealed melanosomes very similar to those found in intradermal nevus cells. The tumor was therefore thought to be composed exclusively of melanogenic nevus cells, and participation of schwannian nevoblasts could be excluded. This view would support the concept of the unitary origin of such nevus cells.


The influence of cyproteron-acetate orally on the hair root status in women with idiopathic hirsutism. The hair root status was used to evaluate the effect of cyproterone-acetate (CA), given orally, on hair cycle in a clinically homogeneous group of 11 women with idiopathic hirsutism. The therapy was continued for 12 menstrual cycles of treatment. The hair root status on the left upper leg and chin was determined before, directly after CA-treatment and 3 months later. The absolute number of anagan hair roots in both fields was decreased directly after therapy. Three months later this value on the upper leg increased again significantly while on the chin there was no significant increase in this period. The number of catagen/telogen hair roots showed no significant differences before, directly after CA-treatment and 3 months later. The number of regrowing hairs on the upper leg showed a significant increase of dysplastic-dystrophic hair roots.


[Inhibition of the cardiochronotropic component of baroreceptor reflexes following activation of somatic afferents]. Stimulation of cutaneous or muscle nerve as well as activation of ventral roots L6--S1 led to inhibition of vagal bradycardia evoked by noradrenaline, in unanesthetized decerebrated cats. Unnociceptive stimulation of m. gastrocnemius in unrestrained cats evoked contraction of the muscle and was followed by depression of the cardiac component of baroreceptive reflex. Propranolol had no effect on this response, while methylatropin abolished it completely.


Pulmonary calcifications in a child with renal failure. A chronically azotemic 2 6/12 boy developed diffuse, bilateral pulmonary calcification. The radiographic features and pathologic mechanism of such pulmonary calcification is discussed.


The clinical picture in occult hydrocephalus. From a study of 16 successfully shunted cases of symptomatic normal pressure hydrocephalus, the typical symptomatology has been characterized. It was found that gait disturbance preceded impaired mentation in 12 of the 16 cases, it began at the same time in three cases and in only one case did impairment of mentation precede it. Of 11 cases of shunt failure, dementia came first in nine and the disturbance of locomotion was relatively less severe or was absent. The various ways in which hydrocephalus may present have been outlined.


Timing of peripheral nerve repair: important local neuropathological factors. A review of the local neuropathological factors suggests that in lesions-in-continuity, the timing of surgical intervention should be predicated by the histological structure of that particular lesion-in-continuity. This cannot be derived by inspection or palpation of the lesion. The information must be gained from clinical and electrical studies. In the case of the divided nerve, the interrupted fascicles should be sutured as soon as the longitudinal extent of the injury can be accurately determined. The ultimate factor limiting the successful outcome of delayed peripheral nerve surgery is probably related to the state of the end organs and muscle fibers.


Metabolic factors in surgery of peripheral nerves. Respect for the metabolic changes within the neuron is critical in planning peripheral nerve surgery. Only by understanding the different metabolic responses of the nerve tissue and the supportive tissue can anastomosis be planned where the budding neuron stands its best chance of successfully regenerating across a repair site. Often, a short delay in nerve repair is indicated. With all factors ideal, good motor function can be counted on across one joint from the next group of muscles. Rarely is there good function across two joints. Protective sensory function can be achieved distally even under the most adverse metabolic conditions because of the independent metabolic state of these end organs.


Metastatic neoplasms to the brain.

Metastatic neoplasms to the brain. The incidence, pathogenesis, pathology, clinical presentation, diagnosis, and treatment of metastatic brain tumors are reviewed. The efficacy of the present diagnostic techniques is discussed. The results of brain scanning and/or computerized axial tomography should be confirmed with cerebral angiography to determine as accurately as possible the site and number of metastatic lesions. The treatment of choice at the present time for patients with brain metastases is surgical excision, if the lesion is solitary and is located in an accessible area in a patient who is in good condition. The bases for this choice include palliation of symptoms, prolongation of survival, and identification of a lesion--benign or non-metastatic--which may respond to a specific form of therapy.


Posterior decompression for myelopathy due to cervical spondylosis: laminectomy alone versus laminectomy with dentate ligament section. In summary we have reviewed some of the studies and theories regarding the role of the dentate ligaments in cervical spondylosis and myelopathy and the logic which has been proposed either for or against their transection in the surgical treatment of this disease. A review of our own series of patients shows no significant increased morbidity in patients undergoing decompressive laminectomy, dentate ligament section, and dural graft as compared to laminectomy alone for treatment of myelopathy due to cervical spondylosis. Of equal importance is the fact that we could demonstrate no superiority in terms of neurological benefit between these two types of operative therapy. However, intradural inspection carried out as a matter of routine did reveal unexpected midline disk protrusions in two cases, the removal of which allowed the patients to do better than might have been expected from laminectomy alone. These findings lead us to conclude that intradural exploration is always indicated if there exists any doubt as to the nature of the basic pathological process. Also there has been presented some experimental evidence to support division of the dentate ligaments if an unresectable anterior lying mass is found.


Anterior cervical discectomy with and without fusion. Operative treatment of the diseased cervical disc can be effectively and efficiently performed by the anterior approach with or without interbody fusion. Good results are not related to effecting a fusion or to any inherent advantages of either technique, but only to removal of the pathological anatomy. Whether or not an interbody fusion is performed is related to the extent of the bone removed, and probably most importantly, to the preference of each individual surgeon.


Pathophysiology of trigeminal neuralgia. Tic douloureux is a painful affliction of man without known similarities to diseases in infrahuman species or to other human afflictions. It seems to be associated with structural abnormalities encroaching upon the trigeminal nerve, gasserian ganglion, or root entry zone. The multiple unique features of tic douloureux can be explained by a theory which is based upon presynaptic inhibition and reflection sites due to focal changes in axon diameter or myelination. We believe that this theory satisfactorily explains the varied phenomena of tic douloureux and is compatible with the limited anatomical and physiological data relevant to tic douloureux. It makes use of known physiological and anatomical concepts. It is capable of verification or refutation by experimental means.


The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implication for surgical management. 1. In the first 6 months, at least 50% of the patients with untreated anterior and posterior communicating artery aneurysms will rebleed. 2. Thereafter, the rate of rebleeding is not less than 3%/year with two-thirds of these late hemorrhages resulting in a mortality. 3. Carotid ligation for posterior communicating aneurysms protects against a high rate of rebleeding for 6 months, but thereafter the rate is not different from the course of untreated aneurysms. 4. On the basis of these first three points and a review of the literature, a theory is proposed that incidental and symptomatic unruptured aneurysms, multiple unruptured aneurysms, and subarachnoid hemorrhage where no lesion is demonstrable, have a natural history similar to that of the untreated aneurysm that survives at 6 months. Namely, we would predict a yearly rebleed rate of not less than 3%/year.


Transposition of a plasmid deoxyribonucleic acid sequence that mediates ampicillin resistance: identity of laboratory-constructed plasmids and clinical isolates. The structural gene for ampicillin resistance resides upon a 3.2 X 10(6)-dalton sequence of deoxyribonucleic acid, TnA that can be transposed from replicon to replicon in laboratory experiments. TnA was transposed from a large conjugative plasmid to a small nonconjugative plasmid, RSF1010. Several RSF1010::TnA plasmids isolated in these laboratory experiments have been shown to be identical to plasmids found in clinical isolates. These data provide direct support to the theory that transposition of drug resistance genes play a key role in the evolution of R plasmids.


Proteus rettgeri infections: a review.

Proteus rettgeri infections: a review. Proteus rettgeri is an aerobic gram-negative bacillus that displays marked resistance against most of the antibiotics presently available. This organism causes infections usually confined to the urinary tract of certain types of compromised patients. Occasionally, it is recovered from soft tissue abscesses, and rarely from the blood and respiratory tract. Proteus rettgeri is notorious for causing nosocomial outbreaks of urinary tract infections in urological and physical medicine wards. Our experience with a patient who had bacteremia with a multi-drug resistant strain of Proteus rettgeri prompted a review of the literature concerning infections with this organism. The salient features of these reports are discussed and summarized. Data on the antibiotic sensitivity of 15 other strains of Proteus rettgeri are included.


An analysis of various teaching modes in dental health education. A study of varied dental health instructional modes was conducted with the five predominant modes: a parent-applied behavior modification program, student-centered instruction, health education teacher dominated instruction, dental hygienist dominated instruction, and a combination of the above termed the "kitchen sink" mode. There was found to be no statistically significant difference among the teaching modes, nor between the teaching modes and a control group. However, several trends were evident, of which the most promising was a possible carry-over effect of the parent-applied behavior modification mode. It was recommended this possible carry-over effect be studied further to be able to verify its existence and determine its means of operation.


The effects of selected field experiences upon the drinking behavior of university students. A study was conducted to determine the effects of selected field experiences upon the driking behavior of university students. Students in the experimental groups were required to participate in alcohol related field experiences, whereas students in the control group were not. An anonymous self-report inventory was used to assess driking behavior. The inventory was administered before and after the field experiences to determine impact. Significant differences occurred in the frequency of perceived intoxication when inventories of the experimental groups were compared with the control groups. No significant differences resulted in the number of alcoholic beverages consumed and the number of alcoholic beverages that would be consumed at a hypothetical party. Students in the experimental groups reported a lower utilization of automobiles during and after driking. The selected field experiences had a positive effect upon the alcohol education program. As result of this study certain implications related to field activities were identified that are conditional to the behavioral change process via instruction in alcohol education. The activities can be designed to provide first hand knowledge and direct interaction experiences with individuals who have experienced alcohol problems. The activities assisted the students in understanding the parameters related to alcohol problems including economic loss, family problems and other disruptive behaviors. The activities were viewed by the students as helpful in thie own clarification of values. For these reasons, the field activities were deemed to be an important aspect of the program that improved the responsible drinking behavior of the students.


Fosfomycin: Laboratory studies.

Fosfomycin: Laboratory studies. Fosfomycin, a nontoxic broad-spectrum antibiotic, different in structure from all previously described antibiotics, acts selectively by inhibiting cell wall formation. It was overlooked during many years of screening because of antagonism by culture medium ingredients and frequent occurrence of resistant mutants. It is effective in many because the neutralizing substances are not present and resistant mutants of most species are avirulent. Fosfomycin has favorable pharmacologic characteristics. It is not cross resistant, does not show antagonism, and has been used successfully in combinations. An insoluble calcium salt is used in oral formulation and a sodium salt for parenteral administration. Overall success rates of 86% were reported with 1,000 patients in Spain and 79% in Japan.


In vitro sensitivity of anaerobic bacteria to fosfomycin. The minimum inhibitory concentrations were determined in 98 strains of anaerobic bacteria that came from clinical samples against fosfomycin, penicillin, cephalothin, tetracycline, chloramphenicol, clindamycin and lincomycin. The results obtained indicate that fosfomycin is usually inactive against Bacteroides sp. and is active up to 32 mug/ml or less against 85% of Peptococcus and 95% of Peptostreptococcus, being consequently comparatively less active than the rest of the antibiotics that were tested against Bacteroides, sp., while against Peptococcus and Peptostreptococcus it is less active than penicillin, cephalothin, clindamycin and lincomycin, and somewhat more active than chloramphenicol and tetracycline.


[Statistical investigations of nosological parameters (sex distribution, diagnosis, age of onset) in 120 pairs of endogenous psychotic parent-child and sibling relationships (author's transl)]. 120 pairs of parent-child and sibling relationships with endogenous psychoses--registered through 60 schizophrenic and manic-depressive probands each--are statistically investigated with regard to the nosologically and biologically relevant parameters of sex distribution, diagnosis and age of onset.


[Family constellation in mental disorder. results and methods of statistical investigations of family size, birth order and sib position (author's transl)]. Possibilities, difficulties and results of statistic investigations on the relation between schizophrenia, depression, neurosis and alcoholism are reported: The schizophrenic patients showed an excess of single childs and children of large sibship. In depressive patients the eldest are overrepresented. In neurotics single and eldest children are more numerous than in the general population. In alcoholic males tha last born und specially the youngest children are overrepresented. But nearly al of the relations found here have been contested by some other authors. The results are different because of the different methods. The reasons are explained in the second part of this study. The methodical differences consist in variable diagnosis, inadmissible selection, investigation without direct interviews, different statistical methods, summation of heterogenous samples and nonrepresentative controls. Methodical consequences for further investigations are discussed.


[Analysis of chronic psychotic states in young drug-addicts (author's transl)]. 60 young drug-addicts with prolonged psychotic states have been examined. Taking account of the family situation and psychosocial development, of typical timing and drug-specific factors the psychopathologic picture is described as to its course and the multiple effects of drugs. An existing psychosis may be the motive for drug-taking in special ways. On the other hand there is with many patients a coincidence in time between drug-addiction and manifestation of the psychosis. Psychoses independent from drugs i.e. running their own specific course, are seen remarkably often. They cannot be distinguished phenomenologically from endogenous psychoses and end up quite often in a number of defects.


Thallium-201 myocardial imaging.

Thallium-201 myocardial imaging. Thallium-201 is a promising intravenous imaging agent for observing myocardial perfusion patterns. It appears to be the best of the currently available cation tracers for regional myocardial perfusion imaging, because it has overcome many of the disadvantages associated with other potassium analogues. Although its many possible uses will require further research and verification, 201Tl will play an increasing part in the assessment of patients with ischemic heart disease.


Clinical evaluation of a new ear oximeter. Ear oximetry offers a noninvasive method of determining and monitoring oxygen saturation in arterialized capillary blood. A new apparatus has recently been developed which provides improved accuracy as well as increased ease of use. We have found it to be at least as accurate as the American Optical oximeter which measures oxygen saturation directly from arterial blood. It has proved to be of value in clinical situations such as monitoring critically ill patients (particularly those being mechanically ventilated) and patients undergoing treadmill exercise or fiberoptic bronchoscopy and in the diagnosis of disorders characterized by periodic hypoxia.


Disposable defibrillator electrodes.

Disposable defibrillator electrodes. The transthoracic impedance to direct-current defibrillation discharge of the half-sinusoidal waveform was compared using recently marketed disposable defibrillator electrode pads (SAF-D-FIB and DEFIB-PADS) with electrode paste as the interfaces between the defibrillator paddle electrode and chest wall. Twenty-four mongrel dogs with an average weight of 17.3 kilograms were used. Half were shocked with the defibrillator meter setting at 100 watt-seconds (mean delivered energy, 59 watt-seconds) and half at 400 watt-seconds (mean delivered energy, 205 watt-seconds). Each animal received six shocks with both paste and one of the sets of disposable pads. The sequence of shocks was changed in alternate animals. At a meter setting of 100 watt-seconds, the mean impedance using SAF-D-FIB was 59 +/- 6 ohms compared to 46 +/- 6 ohms with paste (p less than 0.001), while that encountered with DEFIB-PADS was 57 +/- 5 ohms compared to 50 +/- 5 ohms with paste (p less than 0.01). At settings of 400 watt-seconds, the impedances encountered were also significantly higher with the disposable electrode (p less than 0.01). The output of many defibrillators in use today is inadequate for consistent defibrillation of adult patients weighing more than 50 to 80 kilograms. Since a minimal peak current per unit of body weight is required for ventricular defibrillation and since a higher transthoracic impedance results in a lower delivered peak current, one should use the paddle electrode-chest wall interface that results in the lowest impedance to defibrillator discharge. The impedance encountered with disposable electrodes is significantly higher than that encountered with electrode paste. Therefore, we do not recommend the use of these disposable electrodes for defibrillation or elective cardioversion.


The role of body image in patient compliance and education. This study investigated the relation between one aspect of body image (body cathexis) and the achievement of knowledge about life after a heart attack, as well as subsequent compliance with posthospitalization prescriptions. There was no significant correlation between body cathexis and achieved knowledge. The hypothesis which proposed that a relationship exists between body cathexis and compliance with posthospitalization prescriptions was statistically significant, body-cathexis effects are inferred to be present in compliance behaviors, and the hypothesis was supported. A statistically significant correlation was not found to exist between achieved knowledge and subsequent compliance behavior.


Supraventricular tachycardia that mimics ventricular tachycardia. A short PR interval, a delta wave, and attacks of paroxysmal tachycardia are the principal features of the WPW syndrome. A grossly irregular rhythm with bizzare QRS complexes at rates exceeding 180 per minute is one of the paroxysmal tachycardias characteristic of the WPW syndrome. This arrhythmia deserves special attention, because it is often misinterpretated as ventricular tachycardia. The interpretation is atrial fibrillation with varying degrees of ventricular fusion and phasic ventricular aberration. Prompt electrical cardioversion is indicated because, at times, ventricular fibrillation may result. Quinidine sulfate used prophylactically because of its negative dromotropic effect on the accessory pathway promotes A-V transmission via the A-V node.


Resistance of Staphylococcus aureus to semisynthetic penicillins and cephalothin. Six strains of Staphylococcus aureus resistant to semisynthetic penicillins were recovered from clinical sources during a two-month period. Resistance was detected by standard disk sensitivity tests at 37 C. Two resistant strains were responsible for infections (one of which was fatal), and five strains were susceptible only to phage type 92. All of the strains produced penicillinase, which did not destroy oxacillin, and each was resistant to oxacillin at low inocula. Relative resistance to cephalosporin was demonstrable by the tube dilution assay but not by standard disk tests. The strains susceptible to phage type 92 were susceptible to vancomycin and to the synergistic action of oxacillin or cephalothin plus gentamicin.


Clinical application of sodium nitroprusside. The potent vasodilator sodium nitroprusside has been used to treat hypertensive emergencies and to improve the hemodynamics of chronic heart failure and acute myocardial infarction. As the use of this seemingly beneficial agent appears to be increasing, personnel caring for patients should be familiar with nitroprusside in order to use it properly and safely. We have reviewed the pharmacology, mode of mixing and administering, monitoring requirements, and indications of nitroprusside so it may be used with maximal benefit and minimal risk.


The desirability of involving adolescents in sex education planning. In summary, several points which indicate the desirability of involving adolescents in sex education planning need to be reiterated. First, without adolescent representation, adults tend to lack an awareness of teenagers' needs for sex information services. The negative consequences of not serving these needs are well-documented. A second important consideration is that without adolescent input there is less chance the sex education programs will be tailored to fit the target population. The data from the Detroit program are useful for making people aware of teenagers' needs for sex education. These data can form a basis for beginning program planning, but they should be strengthened with input from the specific target population the program is intended to serve. And third, getting adolescent health consumers involved in program planning and operation by giving them meaningful responsibility is important to their growth and development. It is hoped increased representation of teenagers in the planning process will improve the quality of sex education programs available to them to the point where the current situation will be reversed so that the majority of sexually active teenagers will not have engaged in intercourse without using contraception because of inaccurate knowledge or difficulty in obtaining birth control. Adolescents must be regarded as people with important things to say and must be included in sex information programs not just as passive receivers, but as active partners in policy formulation and operation.


Distractions at nurses' stations during intershift report. Observations of distractions during intershift report at nurses' stations on ten medical-surgical units in an acute-care general hospital are summarized. Almost five times more auditory and visual distractions occurred at nurses' stations at which report took place at an open charting desk than at nurses' stations with a separate reporting area.


A study of illness referral in a Spanish-speaking community. In an anthropologic study of illness referral among Latin-American immigrants three phases were ascertained: First, there was extended use of self-treatment. Second, referrals were made to the social network, particularly to people from the same country of origin. Finally, referrals to the professional network were made to professionals with the same cultural heritage. Latin-American immigrant families living in a cooperative were studied over a 14-month period, utilizing the method of participant observation, a family health calendar, and interviews. This report focuses on the results of the family health calendar. Most illnesses reported by families did not go beyond self-treatment. Cultural influences including language, social network, priorities of daily living were related to the alternatives selected by families when illness incidents occurred.


The student's perception of his creativity. When 590 students at the New York State University of Plattsburgh--both nursing and nonnursing students--were questioned regarding their perceptions of their creativity, nursing students perceived themselves as significantly (p less than .05) less creative.


Death experience and death anxiety among nurses and nursing students. Educational programs designed to deal with death anxiety among nursing students are based to some extent on an untested assumption: that experience with death and dying is inversely related to death anxiety. In a study of death experience and death anxiety among 76 nurses and nursing students, the assumption was only partially supported. Additional findings suggested areas for needed future research.


Effects of bradykinin mediated by autonomic efferent nerves. Intra-arterial injections of bradykinin cause increases in blood pressure and increased impulse rates in single sympathetic efferent fibres. The peptide also causes one or more large bladder contractions, which are associated with increased impulse rates in pelvic nerve efferent fibres whose spontaneous discharges are temporally associated with increases in intravesical pressure. These induced increases in pelvic nerve discharge and intravesical pressure could be abolished or greatly reduced by interference with conduction in pathways which mediate reflex bladder contractions. It is concluded that bradykinin has little direct action on the bladder, and that the large contractions which result from its administration are mediated by the central nervous system.


The effects of bradykinin on afferent units in intra-abdominal sympathetic nerve trunks. The effects of intra-arterial injections of bradykinin on afferent discharges in the splanchnic and hypogastric nerves have been studied. All units which were excited by the peptide were mechanosensitive. Following i.a. bradykinin, the slowly adapting mechanoreceptors associated with the bladder showed increased discharge rates which appear to be related to changes in intravesical pressure. When the effects of bradykinin on the bladder were blocked by cord cooling, the afferents were not excited. It is concluded that bradykinin causes discharges in the slowly adapting mechanoreceptors around the bladder because it causes bladder contractions, and not because of any chemosensitivity of the nerve ending.


On the existence of parasympathetic motor nerves to the submaxillary gland of the dog. Duct pressure and salivary flow were recorded in submaxillary glands of anaesthetized dogs, to study whether parasympathetic stimulation caused effects referable to activity in myoepithelial cells. At fairly low frequency of stimulation, e.g. 3 Hz, the pressure curve had two distinct components, with initial steep and a secondary gradual rise. It resembled that obtained on sympathetic stimulation, where the first phase is ascribed to myoepithelial contraction, the second phase to secretion. When parasympathetic stimulation ceased, there was first a steep fall, then a more gradual decline of the pressure. The steep fall was of the same magnitude as the steep rise; both increased with the frequency of stimulation. The size of the initial fall was fairly independent of the pressure level from which it started. Such a steep fall did not occur subsequent to parasympathetic stimulation if the myoepithelial cells were already in a state of strong contraction caused by sympathetic impulses or bradykinin. The phase of steep fall was inferred to be due mainly to relaxation of contracted myoepithelial cells, the following decline to back-flow of fluid into the gland. The salivary flow rate was highest at the beginning of a period of parasympathetic stimulation, particularly if the duct system was well filled and the saliva thin. It was concluded that myoepithelial contraction had initially expelled saliva. A brief period of parasympathetic stimulation while a slow basal secretion at constant rate was going on was found to accelerate this flow, and afterwards there was a transient deceleration of the flow. Acceleration was attributed partly to myoepithelial contraction, mainly to superimposed secretion; retardation to myoepithelial relaxation. The effect appeared independently of the way in which the basal flow was evoked, and the retardation resembled that seen after sympathetic stimulation or bradykinin.


Electrical activity in sympathetic fibres to hind limb muscles of the cat produced by hypothalamic stimulation. Electrical stimulation of the "Defence Area" of the hypothalamus in anaesthetized cats was accomplished by stereotaxic placement of bipolar stainless steel electrodes; the spinal cord was sectioned at L4. The muscle blood flow in one hind limb was recorded with an electromagnetic flowmeter. Increases of between 100% and 300% were observed during hypothalamic stimulation. Electroneurographic recordings from small nerve filaments supplying tibialis anterior muscle revealed two populations of neurones whose activity was abolished by lumbar sympathectomy. It appears that the increased blood flow in skeletal muscle during stimulation of the hypothalamic "Defence Area" is brought about by a simultaneous inhibition of vasoconstrictor activity and increase in cholinergic vasodilator discharge.


Variations in the distribution of calcium, magnesium and inorganic phosphorus within chronically catheterized sheep conceptuses during the last eight weeks of pregnancy. The concentrations of calcium, magnesium and inorganic phosphorus were higher in foetal arterial plasma than in maternal jugular plasma in sheep examined between 90 and 145 days of gestation. During the same period the calcium and magnesium concentrations of foetal urine were usually less than amniotic fluid values which in turn were less than maternal plasma concentrations. In allantoic fluid, calcium concentrations were usually less and magnesium concentrations greater than maternal and foetal plasma values. A 2-5 fold increase in the calcium concentrations of allantoic fluid after superfical uterine surgery and in amniotic fluid from a group of foetuses that were exposed during operation, were considered to be artefacts of technique. Inorganic phosphorus concentrations in foetal urine, amniotic fluid and allantoic fluid were variable.


Depot iron in the rat liver after hypertransfusion with rat erythrocytes. In the rat liver the deposition of iron was measured after hypertransfusion with rat erythrocytes. The liver iron fractions were studied during four weeks after the hypertransfusions. In the first week the haemosiderin iron fraction increased together with the ferritin iron fraction. Most iron was deposited as ferritin iron. In the last week of the experiments, while the ferritin iron fraction still increased, the haemosiderin iron fraction decreased. At the same time plasma iron was utilized when erythropoiesis, which had been suppressed by the hypertransfusion, recommenced. It is suggest that, under these experimental conditions, liver haemosiderin iron is used in haemoglobin synthesis.


The effects of vasopressin on renal sodium excretion in pigs given intravascular hypertonic salt loads. Young pigs of about 25-30 kg liveweight were given intravenous infusions of a hypertonic sodium chloride solution (4-6 mol.1(-1)) at rates varying from 2-6 mmol.min-1. Such infusions resulted in a marked increase in the urine flow and in urinary sodium excretion, the size of these increases being proportional to infusion rate. Circulating vasopressin levels were also markedly increased, the size of these increases being the same as those seen in other pigs given exogenous vasopressin in amounts which were shown to increase urinary sodium excretion. This suggests that vasopressin was probably contributing to the increase in renal sodium excretion seen in those pigs given the intravenous salt loads.


The repeatability of the measurement of aerobic power in man and factors affecting it. The repeatability of measuring man's aerobic power was tested with regard to the influences from the following; 1. The immediate repeatability of the test. 2. The time sequences in which the progressive load increments are applied. 3. The subject's personal activities in the eighteen hours prior to the test. 4. The temperature of the laboratory during the test. 5. The time of day at which the test is carried out. 6. The day of the week on which the test is carried out. 7. The nervous state of the subject during the test produced by drugs affecting the autonomic nervous system. It was considered that aerobic power can be consistently measured in man as a standard control measurement if the following criteria are taken into account. The subject should be tested: 1. during the first few hours of his working day, 2. in an ambient temperature of not more than 4 degrees C above that of his normal working environment, 3. when he has been normally active during the previous 24 h, 4. when he is systematically free from drugs, particularly those affecting the nervous system, 5. when free from a previous severe stress, 6. at least 1 h after a cigarette or contact with a smoke aerosol.


Susceptibility of three groups of Staphylococcus aureus to newer antimicrobial agents. Because of the need for non-beta-lactam antimicrobics with antistaphylococcal activity, 14 antimicrobics (3 penicillinase-resistant penicillins, 7 aminocyclitols [5 new], 2 macrolides [1 new], clindamycin, and a new polysaccharide, everninomicin) were tested in vitro for activity against 22 penicillin-susceptible, 51 penicillin-resistant, and 47 methicillin-resistant strains of Staphylococcus aureus. Gentamicin, tobramycin, sisomicin, and verdamicin inhibited almost all strains at concentrations less than 1 mug/ml. The methicillin-resistant strains were as susceptible as other strains to the aminocyclitols and everninomicin. In contrast, many of the methicillin-resistant strains were also resistant to erythromycin, rosamicin, and clindamycin at attainable serum concentrations. The use of the bacterial synthetic amino acid medium, in comparison with Mueller-Hinton broth, resulted in an increase in the observed resistance of methicillin-resistant strains to the penicillinase-resistant semisynthetic penicillins.


[The comparison of human reflex and instinct behaviour (author's transl)]. On the basis of characteristics of the exteroceptive reflexes and of the instincts it was shown that instinct behaviour developed from reflex characteristics (local characteristic of the stimuli, pos. and neg. taxis, habituation, conditioning). Most similarities are found between reflex and avoidance instinct behaviour (instincts for excretion, thermoregulation, body care, pain avoidance and safety). Except the safety instinct, all others react on stimuli, characterised by the localisation of the receptors. In the safety instinct the structure of the stimulus becomes important, together with the growing importance of the third dimension. This instinct shows also for the first time a variability of the threshold with spontaneous remaining low for some time after stimulation of the system. Inverse the gain instincts (nutrition, sex and social instinct). Here the threshold falls spontaneously, when stimuli are lacking and raises, when stimuli are found. The spontaneous motor expression of the lowering of the threshold is the appetite behaviour. It means seeking stimuli, which will be gained by elements of the initial and terminal success behaviour. The successfull nutritional and sexual behaviour is stopped by success inhibition, whereas the social instinct remains in the terminal success behaviour with group dynamic hierarchy, with imitating and helping behaviour. Overchanging of the gain instincts provokes avoidance behaviour with constant threshold. The neural systems of most reflexes lie distributed in the spinal cord and brainstem, the ones of the instincts in the limbic part of the brain, the nutrition and sex instinct with a hypothalamic pacemaker. Simultaneous activation of two or many instinct motivation systems result, not comparable with the direct reflex interaction, in interactions on the level of the global interaction, in interactions on the level of the global integration (summation, mixture, synthesis, rest, oscillation, intention) which projects the activity patterns via the motor cortex to the peripheral neurons. There it is completed by the reflexes. The hormonal and vegetative projection instead go directly to the end organs. The motivation is responsible for the subjective experience, the dominating integration with its motor projection for the instinct behaviour.


[The problem of juvenile alcoholism. An analysis of the literature (author's transl)]. In contrast to drug addiction juvenile alcoholism now also common in West Germany, has hardly been investigated. This is meant to be an analysis of the literature, based mainly paper on German and American writings which the author tries to link to his own experience. The older papers from around the turn of the century are particularly evaluated. Essentially the following may be said: Transition between the use, misuse and dependence on alcohol is fluid, particularly in juvenile alcoholism. In our type of Society drinking in adolescence is part of an anticipatory socialization process and so a normal transitional phenomenon. More attention has lately been paid to influences arising in the primary group (family and peers). Girls tent to accept the traditions of the family more readily and follow in alcohol consumption more their mothers than their fathers. The epidemiologic papers published in German on drug addiction of juveniles can hardly be compared with each other, even if they take account of alcohol consumption. Individual control investigations on comparable populations during the last few years show an increase of excessive alcohol intake particularly among the young. In West Germany there are no reliable statistics on alcoholism in adults, even less in juveniles. The methodic difficulties in assessing prevalence of juvenile alcoholism are specific, but they mirror the general difficulties of definition in research into alcoholism. Clinical experience suggests that alcoholism runs a different course in juveniles--and in women--from that seen in adult men. Literature on juvenile alcoholism is sparse compared with that on drug addiction. The question of a correlation between primary alcoholism and drug-addiction - the role of alcohol as initiator to drugs - cannot be defined in general, only in individual terms. In drug addicts alcohol had and has the function of an addition to/or replecement for drugs. The alcohol problem started under the cover of drug addiction but without the preceding wave of drugs it would not have reached the present level...


[Neuromyotonia syndrome (author's transl)]. In addition to the 19 cases of neuromytonia syndrome previously published, one further observation by the author is presented. The symptoms for neuromyotonia are an involuntary tensing of the musculature with impairment of movement, fasciculation and myokymia as well as specific electromyographic criteria. These symptoms are causes by a functional disturbance in the peripheral nervous system. They can be considerably improved by administering phenytoin and carbamazepine.


Transposition of a beta-lactamase locus from RP1 into Pseudomonas putida degradative plasmids. The beta-lactamase gene from the RP1 plasmid transposes into at least two Pseudomonas putida degradative plasmids. Donor strains that carry RP1 (bla+ tet+ aphA+) and a degradative plasmid yield transconjugants that have only the bla+ marker of RP1. This occurs in up to 80% of all bla+ transconjugants. Segregation of the bla+ marker requires the presence of a degradative plasmid in the donor and is only observed in transconjugants that have received degradative markers. The bla+ tet aphA transconjugants show 100% linkage of bla+ to degradative markers in conjugation,transduction, and transformation crosses. A transduction cross of an (RP1), (SAL) donor shows that 8% of all SAL plasmids also carry the transposed bla+ marker. Tn401 is the name we assign to the bla+ transposon from RP1 observed in Pseudomonas. Its identity with the RP1 bla+ transposon observed in Escherichia coli is not known. In four cases, Tn401 has inserted into the camphor genes of the CAM-OCT plasmid.


Synergism with aminoglycosides of penicillin, ampicillin and vancomycin against non-enterococcal group-D streptococci and viridans streptococci. The antibiotic susceptibility of 10 strains of non-enterococcal group-D streptococci was compared with that of 20 strains of viridans streptococci. The minimal inhibitory concentrations of penicillin, ampicillin, oxacillin, nafcillin, cephalothin, vancomycin, erythromycin and clindamycin for the two groups of streptococci were very similar in range and median values. Both groups of streptococci were resistant to the aminoglycosides. The effect of the combination of penicillin, ampicillin or vancomycin with streptomycin, kanamycin, gentamicin or tobramycin on the in-vitro killing of the two groups of streptococci was compared. For all the antibiotic combinations tested, synergism was demonstrated against all strains of non-enterococcal group-D streptococci after one or more of the time-intervals 6, 24 and 48 h. Some or all of the antibiotic combinations were synergistic against all strains of viridans streptococci after one or more of the same time-intervals. The other aminoglycosides (kanamycin, gentamicin and tobramycin) offered no advantage over streptomycin in synergism with penicillin, ampicillin or vancomycin against nonenterococcal group-D streptococci or viridans streptococci. These results suggest that non-enterococcal group-D streptococcal endocarditis may be treated by the same regimen as endocarditis caused by the viridans streptococci.


Blood transfusion in children with cancer. Blood component therapy in children with cancer continues as a major factor in all treatment programs. Current research in this area promises significant advances in the near future. Better methods of procurement, Storage, matching of donors and recipients, and investigations of granulocyte transfusions will all contribute to better supportive care and treatment of complications in cancer patients.


Childhood cancer: etiologic clues from epidemiology. Epidemiologic reseach has revealed a wide spectrum of etiologic information concerning childhood cancer. Often, important clues have come from observations made by alert practitioners. The school health professional can help further progress in cancer research by observing peculiarities of environmental exposures as well as the family's medical history when cancer affects a child. Any unusual findings should be referred to an appropriate research center for evaluation.


For a healthy tomorrow.

For a healthy tomorrow. When health education becomes mired in the past, our cause is lost. Education must be dynamic to respond to constantly changing needs. All changes in our approach to educating young people about cancer have been carefully planned. Changes in the American Caner Society's program have enabled us to reach more young people than ever before, and these young people are more involved in learning about cancer and meople, they have a fear-free attitude about the disease that we are encouraging them to maintain throughout their lives. The more young people know about cancer and their own role in preventing or treating the disease, the less chance there is that cancer will pose a serious threat to their health as adults.


Differential utility of predictors in graduate nursing education. The problem of predicting success in graduate education in nursing was addressed through a five-year study of students enrolled in four majors at the University of Iowa. Data from a sample of 198 graduates of the majors-medical-surgical nursing, nursing of children, psychiatric nursing, and nursing service administration-were analyzed to determine the efficiency of the traditional predictors, undergraduate grade point average (GPA) and Graduate Record Examination scores-verbal and quantitative-in predicting success in graduate education as measured by the masters GPA. Findings included support for the use of these predictor variables in the selection of graduate students in nursing and evidence that interprogram differences existed, indicating a need for different selection practices for the different majors.


Limiting intrusion-social control of outsiders in a healing community: an illustration of qualitative comparative analysis. The analytic shceme of "limiting intrusion" was generated in this study, using research strategies that involved direct contact with subjects under natural living conditions. Data were collected in an experimental treatment community for diagnosed schizophrenics, where conventional psychiatric control structures are muted and denied. Approximately 200 hours of field observation, in-depth interviews with staff members, and documents related to the setting formed the data base. Qualitative comparative analysis is presented in detail to emphasize its relevance to theory building in nursing science.


Stressful life events and coping methods in mental-illness and -wellness behaviors. A descriptive comparative study examined not only the relationship between stressful life events and mental-illness and -wellness behaviors but also the coping methods used by individuals exhibiting each behavior. Data collection included the use of the Holmes and Rahe Social Readjustment Rating Scale and an 18-item coping scale administered to experimental and control samples. The experimental group consisted of 30 psychiatric inpatients in three general hospitals who were oriented in three spheres. Control group subjects had no history of psychiatric illness, were currently not receiving medical treatment, and were adequately functioning in socially accepted roles. They were randomly selected to match the patient on the basis of age, sex, and county of residence. The experimental group reported that significantly more stressful life events had occurred in the last six months and significantly more short-term than long-term coping methods had been used when compared with the control group. Sex and age differences were noted. A significant association was found between high stress scores and short-term coping methods for subjects in both groups. The concept of change as it relates to stress and its effect on health is an important consideration for health care professionals whose goals are health maintenance and illness prevention.


Psychologic impact on nursing students of participation in abortion. Dreams were used to ascertain the psychologic impact on nursing students of articipation in abortion and of other educational experiences. Stressfulness of the experiences was measured by number of dreams, recurrence of dreams, and content analysis of the dreams during four data-gathering periods. During stressful periods, dreams tended to be more negative. The abortion experience was found to be more stressful than other experiences encountered during the data-gathering periods.


Teaching strategies: a microteaching project for nurses in Virginia. A microteaching project, designed to increase the teaching effectiveness of nurses in Virginia, is described. The vehicle for the project is Teaching Strategies, a graduate credit course offered at the University of Virginia School of Nursing and in other state locations through the university's regional centers. The course uses microteaching techniques and videotape recordings of student teaching performances. The teaching behavior of 57 students who attended the course was rated using the project's rating scales. All students showed significant positive increases in teaching behavior on pre-, mid-, and postcourse measures in lecture discussion and group discussion teaching modes. Additional measures of students' teaching indicate retention of the learned behaviors six months after course completion.


Women's health beliefs about breast cancer and breast self-examination. To investigate the nature of women's health beliefs about breast cancer and breast self-examination (BSE) and the extent of BSE practice, a questionnaire was administered to 122 women. Ninety-seven percent (118) scored high in perceived benefits of BSE in reducing the threat of breast cancer and 87 percnet (106) scored high in perceived susceptibility to breast cancer. Forty percent (48) practiced BSE monthly, but over 20 percent of the sample had high beliefs and were nonpracticers. Thus, it cannot be concluded that beliefs cause behavior. Other factors such as embarrassment or religious upbringing influence health beliefs and practices, it was found. A majority of women who did practice BSE, furthermore, were unsure of their ability to detect abnormalities. A separate group of 20 women with a history of breast lumps or cancer surgery had higher susceptibility beliefs, a higher rate of practice, no embarrassment in examining themselves, and more confidence in ability to detect abnormalities than the remainder of the sample.


Relationship among prospective parents' locus of control, social desirability, and choice of psychoprophylaxis. This study sought to determine if there is a relationship among locus of control, social desirability, and choice of psychoprophylaxis (PPM). It was hypothesized that internal locus of control and low social desirability would correlate significantly with the choice of PPM by husbands and wives; that externally controlled wives who participated in PPM would have more internally controlled husbands than externally controlled wives who participated in PPM would have more internally controlled husbands than externally controlled wives who did not participate; and that locus of control and social desirability, when taken together, would be better predictors of choice of PPM than either taken separately. Ninety-eight middle-class nulliparous couples, participant and non-participant, were studied in the seventh or eighth month of the wife's pregnancy. Rotter's I-E Scale and the Marlowe-Crowne Social Desirability Scale were used to measure locus of control and social desirability. Study findings did not support the hypotheses.


One integrated curriculum: an empirical evaluation. In recognition of accountability to both the community and the student consumer for the process and the product of their educational program, faculty and students of Harris College of Nursing, Texas Christian University, Fort Worth, undertook a three-year study of entering and graduating students. Students exposed to a new integrated curriculum, it was found, tended to possess a higher degree of leadership and empathic ability without sacrifice of knowledge but less critical thinking ability than students graduating from the older "block" curriculum. It is suggested that this might have resulted from too much consistency of approach in the integrated program. Intellective characteristics (IQ, scholastic aptitude test scores, critical thinking ability) plus leadership potential and empathic skill were significant in discriminating between successful and nonsuccessful students.


Effect of neuroleptics and other drugs on monoamine uptake by membranes of adrenal chromaffin granules. 1 The effects have been investigated of various reserpine-like, neuroleptic, antidepressant and other compounds on the adenosine-5'-triphosphate (ATP)-dependent uptake of noradrenaline (NA) (reserpine-sensitive) and tryptamine (reserpine-resistant) by membranes of isolated chromaffin granules of bovine adrenal medulla. 2 Reserpine and Ro 4-1284 (2-hydroxy-2-ethyl-3-isobutyl-9,10-dimethoxy-hexahydro-11bH-benzo(a)quinolizine) as well as neuroleptics (e.g. chlorpromazine and haloperidol) inhibited the NA uptake, but the reserpine-like drugs were more potent. In contrast, Ro 4-1284 showed a considerably weaker effect thatn the neuroleptics in interfering with tryptamine uptake. Chlorpromazine had about the same potency in inhibiting NA and tryptamine uptake, whereas the action of haloperidol was more pronounced on the uptake of NA than of tryptamine. 3 The relative potencies of neuroleptic drugs in inhibiting NA uptake by granule membranes in vitro corresponded only partly to their relative potencies in enhancing dopamine turnover in vivo. 4 The inhibition of NA uptake by chloropromazine and Ro 4-1284 appeared to be of the noncompetitive type. 5 Chlorpromazine did not influence the decrease in ATP induced by granule membranes in the incubation medium. 6 Other basic, but not acidic compounds also inhibited NA uptake by granule membranes; their potency was of the order of that of chlorpromazine (antidepressants) or weaker (e.g. benzodiazepines). 7 In conclusion, the mechanism of action of neuroleptics probably differs from that of reserpine-like drugs in the inhibition of monoamine uptake by membranes of catecholamine storage organelles. While interference with the granular storage of dopamine at the granule membrane level may contribute to the in vivo action of neuroleptics (e.g. in enhancing dopamine turnover), additional effects of these drugs must be involved in vivo, e.g. blockade of pre- and postsynaptic dopamine receptors.


The use of pacemaking for the treatment of acute arrhythmias. 2. Temporary cardiac pacing is an effective means of therapy for many arrhythmias and is potentially useful in treating all rhythm disorders except fibrillation. Although the right ventricular pacing is the easiest and most reliable, atrial pacing is in some instances more effective and safer; Atrial pacing is underused and should be considered even for ventricular arrhythmias. There are three methods for pacing: interruption, overdrive suppression, and rapid atrial stimulation. Each has a different physiologic mechanism, and the method must be matched to the arrhythmia under treatment. Pacing is best suited to the acute recurrent arrhythmia which can be suppressed or prevented by short-term pacing.


Disturbances of rhythm in chronic lung disease. Patients with chronic obstructive lung disease have a high incidence and wide variety of cardiac arrhythmias. These arrhythmias are often clinically significant and may be life threatening. Although they occur particularly in the context of acute respiratory failure, arrhythmias are not infrequent in clinically stable patients. The relatively high incidence of sudden arrhythmias seen in acute respiratory failure are associated with a very poor prognosis, in particular, ventricular premature beats and multifocal atrial tachycardia. Long-term electrocardiographic monitoring is valuable in increasing the detection of these arrhythmias and in assessing their clinical significance and response to therapy. The mechanisms producing these arrhythmias are poorly understood and probably multiple. However, disturbances of blood gases, blood pH, and electrolytes or the presence of cor pulmonale or associated coronary artery disease is probably important. The therapy of these arrhythmias must include efforts to improve the patient's ventilatory status as well as careful use of standard antiarrhythmic drugs. Further investigation is needed to define the mechanisms, determine the prognosis, and improve the therapy of the arrhythmias found in chronic obstructive lung disease.


Respiratory failure after injury: a review and a plea for accuracy. The more recent developments regarding respiratory failure due to injury are briefly discussed. The manner of presentation of this condition and its pathophysiology are outlined and classified, emphasizing some factors which are common, regardless of cause, and others which are peculiar to certain etiologic factors. The management principles are outlined. A plea is made for standardization and discipline in nomenclature in order to avoid confusion in the minds of writers and readers of this subject and, more importantly, in the management of patients suffering from this condition.


Living with a permanent cardiac pacemaker. Responses of 30 cardiac pacemaker recipients showed that 90 per cent were aware of warning signs and symptoms prior to pacemaker implantation, but only 37 per cent sought medical attention when the initial warning signs were evident. The group which sought care experienced more symptoms per patient than the other groups which did not seek early treatment. The most commonly occurring symptoms experienced by the patients prior to pacemaker insertion were blackouts and slow regarding pacemaker implantation were made by the physician alone. Patients took inventory after implantation, and 60 per cent reported that they were fortunate to have received a pacemaker. During the inventory and long-term recovery stages, patients who thought they had experienced few life-style changes after receiving a cardiac pacemaker reported positive feelings about living with a cardiac pacemaker. Many of the patients' problems in adjusting to a permanently implanted cardiac pacemaker and participating in its maintenance were related to a lack of accurate information about what to expect or how to assure normal functioning of the pacemaker.


Review of current concepts in aspiration pneumonia. Aspiration pneumonia is a form of ARDS resulting from an acid injury of the lung and is primarily a problem of arterial hypoxemia requiring adequate oxygen therapy. All other modes of therapy have not been shown to alter survival in man. In the otherwise healthy individual, immediate and long-term prognoses are excellent. However, in debilitated patients with significant underlying disease processes, rates of both immediate and delayed death are high. The late deaths reflect the significance of secondary infection due primarily to anaerobic organisms.


The hyperacute phase of true posterior infarction. The hyperacute phase of true posterior myocardial infarction is described in detail. This electrocardiographic manifestation, hitherto unnamed as such, presents with slope-depression of the S-T segments with relatively wide and deep T-waves in the right precordial Leads V1 to V4. The condition then progresses to the well-recognized fully evoked phase of acute true posterior wall myocardial infarction.


Atrioventricular block: incidence in acute myocardial infarction and determinants of its "degrees". There are several reasons why an atrial impulse may not reach the ventricles; only one of them is A-V block. Widespread failure to appreciate this simple truth is mainly responsible for the persisting confusion in the diagnosis and treatment of heart block. We have defined and illustrated the various "degrees" of A-V block; applied our definitions in analyzing the examples of block encountered among 300 consecutive incidents of acute myocardial infarction; listed, discussed, and illustrated the several factors that determine conduction ratios and, therefore, the "degree" of block; and used references and illustrations from widely accepted authorities to substantiate our claim that diagnostic and, therefore, therapeutic chaos reigns.


Supraventricular tachycardia that mimics ventricular tachycardia. Part II. Concealed WPW is a newly described clinical entity. The existence of this syndrome can be ascertained only through specific electrophysiologic intracardiac studies. From the clinical standpoint, the existence of an accessory unidirectional A-V pathway anatomically located in the general area of the Kent bundle should be suspected in those patients with chronic BBB who have recurrent paroxysmal atrial tachycardias initiated by sinus arrhythmias or premature atrial beats. It should be noted that functional BBB can occur following a premature atrial beat. This will also set the stage for the initiation of a reciprocating tachycardia in concealed WPW. Pharmacological therapy aimed at preventing the recurrent tachycardias is disappointing. Pacemaker implantation appears to be successful by rendering one of the bundle branches refractory through concealed conduction. With chronic block of the remaining bundle branch, the natural pathway of A-V conduction is totally blocked at a critical time during the tachycardias, thus eliminating the reciprocating tachycardia.


Atherosclerosis: a major cause of peripheral vascular disease. Atherosclerosis is one of the most common causes of peripheral vascular disease. Complications result from arteries compromised because of focal accumulations of lipids and other materials within and between cells in the vessel walls. Factors including hyperlipidemia, hypertension, diabetes mellitus, obesity, physical inactivity, smoking, social stress, and genetic background have been implicated as promoting a higher risk of atherosclerosis and its consequences.


The physical assessment of the patient with arterial disease. Utilizing techniques of inspection, palpation, and auscultation the complete arterial system of a patient should be examined when arterial insufficiency is suspected. Examination of pulses of the upper part of the body is important not only in localizing disease but also in indicating diffuse disease. Although described separatley in this article, the examination of the arterial system can be integrated in a complete physical examination when the examiner is assessing the extremities, the abdomen, and the cardiovascular system.


Reconstructive arterial surgery for ischemic lower extremities. Patients with ischemic lower extremities who are to indergo arterial reconstruction must be carefully selected. A careful history and physical examination will disclose the point of obstruction and the degree of ischemia. Arteriography is essential for the determination of runoff adequancy below the point of obstruction and for selection of the best site for distal anastomosis. Various potential routes for bypass graft have been discussed and some of the factors that determine the procedure ultimately chosen have been presented. Types of graft materials currently enjoying popularity have been listed and the general techniques of operation have been outlined.


The nurse's role in nutritional management of radiotherapy patients. The education of the cancer patient is a nursing responsibility. The authors feel strongly that individualization in diet therapy is most important. The guidelines, therefore, stress assessments, development of individualized diets, education, and periodic reassessment. The educational content includes information regarding the side effects, with known preventive and therapeutic measures. Measures that are acceptable, practical, and effective for one individual may to another individual be ineffective, impractical, or unacceptable. Since this is true, multiple alternatives have been given for each problem.


Giving health care to minority patients. Health care is usually thought of as a basic right of each individual. This so-called basic right is denied to many mainly because of their economic situation and the color of their skin. There is a need for more blacks, Indians, Mexican-Americans, Puerto Ricans, and Asians in the health care field. The numbers are low and the training process slow. Time is needed to prepare ethnic people of color. Since most of the deliveries of health care are white, these white workers must become sensitive to the traditions, values and attitudes of the ethnic groups of color. Schools of nursing are beginning to include cultural differences in nursing curriculums, but the majority of the nurses who practice are not aware of and are not sensitive to the needs of nonwhite patients. Nursing must help solve problems of the ethnic groups of color. Nurses must become personally involved in the injustices of health care. As Marie Branch states, there must be "personal reeducation." When this occurs, health care to the minority client will improve.


[Intraamniotic application of lecithin in pregnant rabbits (author's transl)]. In order to find possibilities to influence therapeutically the respiratory distress syndrom at the premature infant animal experiences were carried out with 14C-lecithine. High pregnant rabbits got 14C-lecithine by intraamnial application. Investigation of the distribution of lecithine in the amniotic fluid and in the fetal organism showed an accumulation of lecithine metabolits in lung and lever tissue.


Inactivation of penicillin by purulent exudates. Four of 22 specimens of human pus inactivated up to 90% of added penicillin within one hour in vitro. Ampicillin and cephaloridine were also inactivated, but streptomycin and fusidic acid were not. The effect was not related to the protein content of the pus, nor to its pH value. Microbes that may produce beta-lactamase in small quantities were isolated from three of the four specimens, but the enzyme was not detected in the pus by physical methods nor by microbiological inhibition assay. The inactivating effect was shown to be a property of the solid portion of the pus, and was absent from the filtrate. We suggest that the effect may be an intrinsic property of the host, which should be investigated further as it has important implications for clinical practice.


Extracellular protein A from a methicillin-resistant strain of Staphylococcus aureus. Protein A has been isolated from a methicillin-resistant strain of Staphylococcus aureus, A676, which produces only extracellular protein A. The material is homogeneous after a one-step separation and has a molecular weight of 41000. Its physicochemical and immunochemical properties have been studied.


[Neurologic and psychiatric syndromes of rare para-rheumatic diseases (author's transl)]. In Wegener's granulomatosis peripheral nerves are more often involved than central nervous structures; functional psychoses are secondary e.g. to renal complications. Neurologic-psychiatric symptoms are varied and result from local spread from the upper respiratory tract with separate granulomata and vasculitis. Striped muscle is involved in about 10% of cases. Specific vegetative disturbances of function do not appear to occur. This is also true for Granuloma gangrenescens. Its multicentric inflammatory, ulcerating and necrotic foci involve midline structures and often start at the anterior neuroporus. Becet's disease, however, shows clear characteristic localisation, symmetry of various dermatologic phenomena in the extremities and the almost obligatory involvement of mouth, stomach and the genitals and their surroundings. This one may assume to be due to a mesencephalic parasympathicotonic reaction as the basis for the occurrence of perioral and acro-syndroms after Fischer-Brügge and Sunder-plassmann. Some similarity with the localization of other collagenous diseases is evident. The anterior basal ganglia represent a favored focus where e.g. initial, imcomplete and readily recurrent processes, possibly of an exsudative nature, may start off neurovascular changes of limited areas without necessarily producing clinically detectable signs of the usual neurologic-psychiatric type. In Behcet's disease, rather as in scleroderma, the nervous system appears to be decisively involved. About one third of the cases show changes in the nervous system ("Neuro-Behcet" in the usual sense) with little peripheral signs and rare myositis. But Behcet's disease may also-like erythematodes or progressive sclerodermia-simulate a disseminated encephalomyelitis. The pathogenetic factors of Reiter's syndrome appear to be closely related. The relatively constant main symptoms are also localized and permit the conclusion that they depend on vasomotorically linked innervation of the first bulbar segment. The preference for distal localization of bilateral skin involvement hints - as in Behcet's disease at hypothalamic distribution; main localization in midface and the oral mucosa, in eyes and the ends of the midline and, often, also involvement of certain midline and, often, also involvement of certain favored joints permit the assumption of mutural relations between the cranial and sacral fields of incidence of the trophotrop-endophylactic system which is linked via the parasympathic with periphery. According to present knowledge the bundles of Schütz and, further, Krüke may be the pathways. Where pelvic processes predominate viscero-cutaneous or cuto-visceral reflexes may - as in dermatomyositis - be involved. E.g visceroreflectory changes explain coincidences of signs in similar or adjacent segments of the urogenital system, the rectum and certain joints. Psychose on a physical basis are rare. As in other collagen diseases the spinal cord is rarely involved, but "multiple sclerosis" may be simulated...


[Acute hemisyndrome in childhood (author's transl)]. Neurologic hemisyndromes in childhood may be due to congenital or acquired changes in cerebral vessels. Among the congenital vascular malformations, which very rarely become manifest already in children, the  arteriovenous angiomata and saccular aneurysms are relatively the most common (in childhood about 4-8% manifest, 1-2% of all diseases). Venous angiomata, micro-angiomata and congenital dissecting aneurysms are very rare. But acquired thrombotic blocks of cerebral arteries are of greater importance as causes of acute neurologic hemisyndromes in childhood. Most often they have an inflammatory or traumatic cause, often the cause is unknown. Rare diseases only very recently described as arterial blocks of cerebral vessels are fibromuscular dysplasia and Moya-Moya-disease, the etiology of which is not yet fully understood. The prognosis of these diseases is generally unfavorable, but the focal signs in migraine as visual, sensory, aphasic and motoric defector irritative signs are as a rule reversible. In order to establish, where possible, the cause of acute neurologic hemisyndromes in childhood, early angiography may-classic migraine accompagnee types excepted-help. But also modern biochemical, immunologic, virologic, serologic, bacteriologic, clotting analytic and, possibly, histologic and histochemical techniques should be employed with particular attention to fat metabolism and to auto-immune disease.


[Disturbances of the human instinct behaviour in hypothalamic lesions (author's transl)]. Since the findings of W.R. Hess, who systematically stimulated the hypothalamus of the cat, motivational systems for instinct behaviour have been postulated in the hypothalamus and the surrounding limbic brain. It has been asked, if hypothalamic lesions in man would cause alterations in instinct behaviour, which could be attributed to the instinct motivational systems. Therefore 19 patients with hypothalamic lesions have been examined in respect of their instinct behaviour. They showed no qualitative alteration in their instinct behaviour, but quantitative diminution and rarefication of their gain instincts (nutritional, sexual and social instinct). Mainly reduced was the sex instinct together with hormonal deficiency. Inversely the safety instinct (the only avoidance instinct with variable threshold) was more often activated. The other avoidance instincts (for excretion, thermo-regulation, bodycare and painavoidance) remained intact. It is concluded that the pacemaker for the threshold of the gain instincts and of the safety instinct is disturbed and not the motivation system in its qualitative functioning. As this pacemaker is so characteristically different in each instinct, the theory of different specific motivational systems is more probable than the theory of one unspecific system with different functions.


[Catamneses of YY carriers in prison].

[Catamneses of YY carriers in prison]. Among the 700 inmates of a big Austrian prison 5 cases of XYY caryotype were detected by means of the Quinacrinfluorescence method and subsequent lymphocyte culture. Keeping in mind that, if at all, only a small amount of criminal behavior may be explained by chromosomal factors three hypotheses about possible links between the XYY abnormality and criminal behavior are discussed in this paper. 1. the connection is a spurious one, as both criminal behavior and the XYY caryotype are more frequent in a working class population without being necessarily linked causally. 2. criminal behavior may be a consequence of the bodily abnormalities connected with the XYY abnormality. 3. the XYY type may contribute to criminal behaviour by acting upon neuro-endocrinological structures.


[Unexplained tetraspasticity in adults (author's transl)]. 1. Between 1965 and 1974 146 patients with unexplained tetraspasticity were admitted and examined. In 123 cases extended neuroradiologic examination with myelography of the cervical spinal canal was carried out. A space occupying lesion was found in 59 cases: narrow spinal canal, protruding discs. In 64 cases no pathologic processes were seen radiologically. Comparison of both groups: no differences in clinical signs, history or findings. 2. Tetraspasticity alone was the leading sign in 30 cases. The legs were always more severely involved than the upper limbs. In 70% spasticity was more severe on the right. Further clinical analysis depends on additional signs, particularly paresthesiae, pain, disturbed joint-sense. Among the patients with protruding discs heart-and circulatory insufficiency is a little more common, but in the group without protrusion exogenous/endogenous metabolic conditions(intoxication, malabsorption) and neoplasms. -Protein content of CSF is raised equally in both groups, particularly albumin. This is probably due to reduced circulation of CSF. In 6 patients an internal hydrocephalus was found. 3. No single active causative factor could be found nor any familial relationship. In spite of increasingly extended diagnostic techniques no underlying condition could be discovered. Tetraspastic is a "polygenetic" reaction of the central nervous system without a final common path. The cases show that mechanical factors (cervical myelopathy) predispose locally to non-mechanical injuries.


[Development of the third ventricle width from premature birth to old age (author's transl)]. One-dimensional echoencephalographic investigations were made of the 3rd ventricle with the Siemens-Krautkrämer Unit USM 1 in 1841 subjects. 200 premature infants with a birth weight of up to 2500 premature infants with a birth weight of up to 2500 g were examined within 48 hours of birth. It was statistically proved, that with increasing weight, advancing gestational age and growth of the head-circumference, the width of the third ventricle diminishes. The material of 1641 children and adults shows the following results: The first phase up to 21/2 years is characterised by a rapid increase in size. The second phase covers the age group up to about the 16th to 20th year and ist characterised by a kind of plateau without significant change in the width of the 3rd ventricle. In the third phase concerning ages from 16 to 20 up to 57 to 58 years, a slow increase to higher values can be observed. The fourth phase, from the 57/58th to 78/79th years, shows a distinctly higher increase than the third phase. Results obtained beyond the 78/79th year were not uniform but rather heterogenous and unpredictable, questioning the concept of a further "physiological" development of the 3rd ventricle. A linear relationship between age and the 3rd ventricle can be demonstrated up to about the end of the 8th decade. Normal values for the 3rd ventricle should not be given in future, without indicating the age.


[Involvement of the nervous system in trichinosis (author's transl)]. Since the introduction of the obligatory inspection of meat, trichinosis has become a very rare disease in Germany. Nevertheless, the possible occurrence of sporadical epidemies and isolated cases of trichinosis has to be kept in mind. During the last 30 years about 1300 cases of human trichinosis have been reported in Germany. The involvement of the central nervous system ranges from 6-24%; the symptoms may be caused by meningeal inflammation or/and a focal or generalized encephalitis. Myelitis is a very rare finding, some patients develop signs of peripheral neuropathy. During the acute stage pareses may be caused as well by myositis as by peripheral neuropathy. Various serological tests allow to confirm the diagnosis of trichinosis, but muscle biopsy is still the most informative piece of evidence leading to the diagnosis of trichinosis. Tiabendazole (trade name in Germany: Minzolum) is at present the drug of choice in the treatment of trichinosis; in addition good results have been found by corticosteroid therapy. Although most cases have a good prognosis, chronic sequelae may occur (for instance "rheumatic" pains in the muscles, loss of reflexes, convulsions and psychiatric distrubances).


[In vitro activity of mezlocillin, azlocillin and carbenicillin against bacteroidaceae with particular reference to bacteroides fragilis (author's transl)]. The in vitro susceptibility of approximately 90 Bacteroidaceae strains to the the new broad-spectrum penicillins mezlocillin and azlocillin was determined by tube dilution tests and compared to susceptibility to carbenicillin. Bacteroides fragilis and Bacteroides thetaiotaomicron predominated among the strains tested. These strains are particularly important as pathogens and are known to produce beta-lactamase. At concentrations of 16 microng/ml or less, mezlocilin inhibited 81% of the Bacteroides cultures, and at 32 microng/ml 96% of the cultures. The amount of Bacteroides strains inhibited by 16 and 32 microng/ml of azlocillin was 67% and 93% respectively. Similar results were obtained with carbenicillin, concentrations of 32, 64 and 256 microng/ml inhibiting 55%, 87% and 94% of the strains respectively. Mezlocillin and azlocillin did not appear to be any more effective than carbenicillin against Sphaerophorus strains. Statistical analysis of the relationship between minimal inhibiting concentration and inhibition zone diameter showed that the susceptibility of Bacteroidaceae to mezlocillin, azlocillin and carbenicillin cannot be determined with sufficient accuracy by a standardized agar diffusion test.


Possible physiological significance of the initial step in the catabolism of noradrenaline in the central nervous system of the rat. The hypothalamus, the cerebral cortex and the cerebellar cortex of the rat were labelled in vitro with 3H-noradrenaline (3H-NA) and the metabolism of the tritiated transmitter was studied during spontaneous outflow and under conditions of release elicited by exposure to 20 mM K+. In the three areas of the central nervous system of the rat 3H-NA accounted for approximately 40% of the total radioactivity in spontaneous outflow while the 3H-O-methylated deaminated fraction (3H-OMDA) and 3H-3,4-dihydroxyphenylglycol (3H-DOPEG) were the main metabolites. Exposure to the reserpine-like agent, Ro 4-1284 induced a selective increase in the spontaneous outflow of 3H-DOPEG, while the contribution of the 3H-OMDA metabolites to the release induced by Ro 4-1284 was very small. During 3H-transmitter release elicited by exposure to 20 mM K+, approximately 80% of the radioactivity was collected as unmetabolized 3H-NA, while 3H-DOPEG was the main metabolite formed under these experimental conditions. Exposure to cocaine prevented 3H-DOPEG formation from 3H-NA released by K+, indicating that 3H-DOPEG was formed after neuronal reuptake of the transmitter released by K+. After in vitro labelling with 3H-NA, the unmetabolized transmitter represented approximately 70% of the total radioactivity retained in the tissue. However, when 3H-NA was administered in vivo, by intraventricular injection, only 30% of the total radioactivity retained by the tissue was accounted for by 3H-NA, and 60% of the radioactivity corresponded to the 3H-OMDA fraction, most of which was retained as 3H-MOPEG sulfate. When the rats were pretreated with pyrogallol, free 3H-DOPEG accounted for nearly 50% of the radioactivity retained in the three areas of the central nervous system after in vivo labelling with 3H-NA. When monoamine oxidase was inhibited by pargyline and 3H-NA was administered by intraventricular injection, 3H-NMN accounted for approximately 50% of the total radioactivity retained in the three areas of the central nervous system of the rat. The results obtained are compatible with the view that formation of the deamined glycol is the first step in the metabolism of 3H-NA in the rat central nervous system. In addition, it is concluded that the determination of the levels of some NA metabolites retained in the central nervous system does not necessarily represent an accurate reflection of the degree of central noradrenergic activity or of selective metabolic pathways. Consequently, in studies on the metabolism of NA it is important to take into account not only the transmitter and its metabolites in the tissue but also in the outflow from the structures studied either under in vivo or in vitro conditions.