Plasma aldosterone concentrations during the neonatal period. The direct radioimmunoassay for plasma aldosterone (PA) set up in this laboratory has been reported elsewere. Subjects were 115 normal full term newborns and infants. During the first week of life, there was a wide dispersion in the PA levels (less than 1 - 445, n = 89), but on the whole these levels were high (greater than 6 ng/100 ml) and 35% were higher than those observed in children after stimulation (greater than 48 ng/100 ml). Furthermore, there was a negative correlation between PA values and the day of sampling (P less than 0.01). In older infants, PA values were lower and the ranges narrower. A highly significant negative correlation was found between Na:K ratios and PA levels. The mean geometrical value for PA levels was 53 ng/100 ml vs. 1.012 for Na:K mean ratio. When related to weight variations, PA values were randomly distributed. No correlation was found between PA and sodium intakes. The daily urinary excretion of tetrahydroaldosterone and 3-oxoconjugate of aldosterone were lower per se, but when related to surface area, were found to be roughly 3-fold those of control adult subjects. We conclude that in the newborn, both the production and excretion of aldosterone are different than values in the adult and that responses to the regulation factors mentioned above are decreased.


Ornithine decarboxylase and S-adenosyl methionine decarboxylase in skin fibroblasts of normal and cystic fibrosis patients. The key enzymes in the synthesis of the naturally occurring polyamines, ornithine decarboxylase (ODC) and S-adenosyl methionine (SAM) decarboxylase, were investigated during cell growth and aging in fibroblast cultures from normal patients and patients with cystic fibrosis. A linear correlation between increased S-adenosyl methionine activity and putrescine concentration was apparent in all cell lines. A putrescine concentration of 0.8 mM was optimal for enhancement of SAM decarboxylase activity. The passage number of the cell line correlated inversely with maximal putrescine-stimulated SAM decarboxylase activity, earlier passage numbers having the highest specific activity (Fig. 1). No significant differences in basal or putrescine-stimulated SAM decarboxylase activity were noted between normal fibroblast cultures and cells from patients with cystic fibrosis (Fig. 2). SAM decarboxylase activity increased as the cell lines approached confluence. Activity was lowest during exponential growth (Fig. 3). ODC activity was increased during early exponential growth and fell as cells reached confluence (Fig. 4). No differences in ODC activity and putrescine inhibition between the normal and cystic fibrosis cell cultures at equivalent points of exponential growth were noted.


Maturation of the rabbit alveolar macrophage during animal development. I. Perinatal influx into alveoli and ultrastructural differentiation. Rabbit alveolar macrophages (AM's) were collected by tracheobronchial lavege at sequential times during animal development. The total number of cells recovered by this technique was found to increase markedly shortly before birth (Fig. 4). This apparent influx of macrophages into the alveoli continued during the first postnatal week, and, at a reduced rate, throughout the first postnatal month of life (Fig. 3). Ultrastructurally, AM's of the prenatal period resembled their monocyte precursors, and contained modest numbers of lysosomes and mitochondria, scant lamellae of ribosome-studded endoplasmic reticulum (RER), and a small Golgi apparatus (Fig. 12). A considerable amount of phagocytosed material was observed in these AM's, and consisted largely of cellular debris and two forms of surfactant-related phospholipids, termed tubular and lamellar myelin (Figs. 12-15). The quantity of these ingested phospholipids increased dramatically shortly after birth, in correlation with the known release of similar material from type II pneumocytes at this time. (Figs. 16 and 19). During the first postnatal week AM's showed a considerable increase in number of mitochondria and in the development of the RER and Golgi apparatus (Fig. 22). Increased accumulations of lipid droplets were also noted during this period. Ingested material continued to consist largely of surfactant-related phospholipids, but was less abundant at this time. By 28 days after birth, AM's were nearly morphologically mature (Fig. 25). They showed large numbers of lysosomes and mitochondria, and well developed RER and Golgi apparatuses. Ingested phospholipid material was still visualized, and the incomplete degradation of this material appeared to give rise to the dense intraphagolysosomal whorls characteristic of the mature AM.


Dextromethorphan toxicity: reversal by naloxone. Naloxone has been shown to be effective in antagonizing the effects of a number of narcotic and related drugs. Its successful use in managing a patient with an overdose of dextromethorphan extends its application as a specific antidote.


Chromosomal abnormality in congenital rubella. An infant with congenital rubella was found to have two extra chromosome fragements in most cells examined. This is an unusual finding in congenital rubella and it is suggested that it may be related to the infection.


Centronuclear myopathy in the newborn period causing severe respiratory distress. Centronuclear myopathy can be classified into four clinical varieties based on age, severity at onset, and rapidity of progress. In the severe form with involvement of respiratory muscles at birth, the progress is rapid and fatal before 3 years of age. The case described in this report illustrates rapid progression of muscle paralysis and death in a neonate. However, in a majority of cases the disease is either moderately severe or mild with the affected individuals confined to wheel chair by adolescence or early adult life. Diagnosis of the disease is based on appropriate muscle histopathology and electron microscopic studies.


Prediction of morbidity in Hemophilus influenzae meningitis. A dramatic decrease in mortality from Hemophilus influenzae meningitis has occurred in recent years. Morbidity and long-term sequellae remain significant problems. A follow-up investigation of 73 cases of H. influenzae meningitis seen over a three-year period revealed: 2 deaths, 6 children with major sequellae (retardation, spastic quadriplegia, blindness, persistent seizure disorder), 10 with minor residua, and 55 with no detectable disability. Statistical analysis of clinical parameters demonstrated a significant risk of death or major morbidity in those patients who, at the time of admission, had seizures, coma, hypothermia, shock, age less than 12 months, hemoglobin less than 11 gm/100 ml, pretreatment symptoms for longer than three days, a spinal fluid white blood cell count less than 1,000/cu mm, or a spinal fluid glucose value less than 20 mg/100 ml. Using these parameters, those patients at highest risk of having lasting major morbidity with H. influenzae meningitis can be predicted, allowing more vigorous intensive care which may reduce the mortality and morbidity further.


Custom-made tracheostomy tube to relieve lower tracheal obstruction in infants and young children. Two case histories are presented in which special difficulties were encountered in the management of lower tracheal obstruction in children. These problems were successfully overcome by the use of a tracheostomy tube which was custom-made from a standard thin wall polyvinyl chloride endotracheal tube sufficiently long to relieve this obstruction.


Use of homologous platelet survival in differential diagnoses of chronic thrombocytopenia in childhood. Twenty-one children with chronic thrombocytopenia of obscure etiology, 19 of whom had normal numbers of bone marrow megakaryocytes, were evaluated in order to determine if factors extrinsic to the platelets themselves (presumably antibodies) caused the thrombocytopenia. The rapid destruction of platelets by such antibodies has been demonstrated to cause idiopathic thrombocytopenic purpura (ITP). History, physical examination, and routine laboratory studies were unable to provide an exact diagnosis in these patients. Measurement of platelet survival, using sodium chromate Cr 51 labeled homologous platelets obtained from unrelated donors, permitted a clear separation of these children into two groups. One group (11 patients) had a markedly shortened platelet life span, and was considered to have chronic ITP. The other group (10 patients) had a normal or only slightly reduced platelet life span. Thus, the destruction of platelets by extrinsic factors could be ruled out. Since the diagnosis of chronic ITP was excluded, splenectomy could be avoided in these patients since it is rarely useful in children with nonimmune forms of chronic thrombocytopenia. Homologous platelet survival measurement is a useful diagnostic tool in certain children with chronic thrombocytopenia.


Erythromelalgia.

Erythromelalgia. Erythromelalgia is an extraordinary disease which remains elusive in its pathophysiology and management. Victims suffer intense burning and redness of the hands and feet. In what appears to be the antithesis of Raynaud's disease, the pain is relieved by emersion in cold. A child with erythromelalgia is described whose symptoms began at age 3 years. Pharmacological management trials and thermography are incorporated in the report.


The determination of aspirin levels in the presence of hyperbilirubinemia. Many major medical centers are presently utilizing a shortened method (Keller) for determining serum aspirin levels which does not remove interfering compounds. This report documents that the presence of even 1 mg of bilirubin/dl of serum is sufficient to cause a falsely high aspirin level. It is suggested that any method for determining serum bilirubin which does not remove interfering substances constitutes a danger to many groups of patients and should be discontinued.


Value of esophageal manometric studies in the gastroesophageal reflux of infancy. Fifteen infants with symptoms of gastroesophageal reflux (GER) were evaluated with esophageal manometric studies. Six infants failed on a medical regimen of frequent thickened feedings and an upright position 24 hours per day for three weeks. These infants had Nissen fundoplications. Their mean lower esophageal sphincter (LES) pressure was 12.7 mm Hg. The nine infants who did well on the medical regimen had a mean LES pressure of 19.6 mm Hg. These means are significantly different (P less than .001). Esophageal manometric studies should be included in the evaluation of all infants with symptoms of chronic GER.


Evaluation of gastroesophageal reflux surgery in children. Fifty-five infants and children with complications of gastroesophageal reflux required operative management for control of symptoms. All patients, except those with severe esophageal stricture, received a six-week trial with 60-degree constant elevation before an operation was considered necessary. The operation was performed to control (1) persistent vomiting, (2) vomiting with growth retardation, (3) esophagitis, (4) esophagitis with stricture, and (5) recurrent aspiration pneumonia. Preoperative and postoperative evaluation involved both X-ray fluoroscopy and esophageal manometry with pH studies. A good surgical result was not dependent upon an increase in the lower esophageal pressure following operation. The Boerema anterior gastropexy is simple and effective for controlling gastroesophageal reflux for cases uncomplicated by esophagitis, stricture, or previous operation. Complex cases with inflammatory or operative changes in the lower esophagus are more effectively treated by Nissen fundoplication.


The influence of a change in practice setting on pediatrician activity: a case study. A time-and-motion study was performed of a pediatrician's activities in his fee-for-service solo practice and again after he joined a prepaid group practice. A comparison was made between time spent with fee patients in solo practice and time spent with fee patients continuing to see him in group practice. Total time per patient visit was not changed significantly by the group setting. Activities within the visit were modified in the group setting. History-taking and physical examination were reduced; counseling and charting were increased. Time spent in well-child visits in the group setting was significantly longer with the increased time spent in counseling. For sick visits there was no change in total time per visit nor in activities within the visit.


Nonorganic failure to thrive: a long-term follow-up. Twenty-one children diagnosed as having nonorganic failure to thrive were reviewed at an average of 6 years 4 months after their initial presentation. Most of the children were found to be of normal height and weight but disorders in personality traits and educational attainments were common. One half of the children have abnormal personalities. Two thirds have a delayed reading age. Intelligence testing shows that one third have verbal scores significantly lower than their performance scores. Two children from the original series have died in suspicious circumstances. The families of these children have a high incidence of marital instability and economic difficulties. The traditional medical approach to nonorganic failure to thrive needs to be complemented by intensive social support for these families at the time of initial presentation in the hope that the long-term effects of this syndrome can be ameliorated.


Counseling parents of children with behavior problems: the use of extinction and time-out techniques. The pediatrician is the professonal most frequently sought out for advice concerning disciplinary problems with children in the home. Behavioral psychologists have advocated the use of contingent ignoring and time-out procedures to help reduce problem behaviors; however, practicing pediatricians have found that these two procedures are often not successful. In fact, sometimes the two procedures seem to exacerbate inappropriate behavior. This paper documents the difficulties found in using the ignoring and/or time-out procedures in the home setting. Ptential pitfalls in the use of ignoring, including not specifying the target behavior, not taking a baseline, inadvertently, intermittently reinforcing the inappropriate behavior, response bursts, spontaneous recovery, and not reinforcing an appropriate alternative behavior, are described. In addition, several pitfalls in the use of the time-out procedure, including selection of isolation area, inappropriate selection of time intervals, interference from others in the family, and escape attempts on the part of the child are discussed. For each potential problem a remedy is suggested.


Knowledge about and attitudes toward genetic screening among high-school students: the Tay-Sachs experience. High school students (ages 15 to 18 years; No. = 930) taking biology in their curriculum were surveyed (the first survey), in the classroom, for their knowledge and attitudes about Tay-Sachs disease and other "public" issues in genetics. High-school students now constitute 38.9% of those screened for the Tay-Sachs gene in the Montreal program and the participation rate is 75% among eligible Jewish students. Knowledge and attitudes about the screening experience were also surveyed (the second survey) in a sample (No. = 120) containing equal numbers of carriers and noncarriers matched for sex and age. The response rate was 75% in the second survey. The first survey revealed that the level of knowledge about Tay-Sachs disease is high among students, only 28% percent of whom were Jewish. Students have a very positive attitude toward genetic screening in general. These findings are associated with an effort to expand the human genetics content in the biology curriculum. The second survey revealed a favorable attitude toward the screening experience and the self-knowledge obtained among screened students. The screening clinic in the schools, and literature provided by the screening authority, was an effective source of knowledge about the significance of Tay-Sachs heterozygosity. Carriers experienced initial anxiety; later attitudes were similar in carrier and noncarriers. Self-image was unchanged in 90% and diminished in 10% of carriers and enhanced in 10% of noncarriers. Heterozygous students perceive information about their genetic status as useful to themselves and 95% want to know the gennotype of an intended spouse; 88.4% would marry a carrier and only 11.6% would "reconsider." These findings encourage us to emphasise high-school screening as the preferred program in our community and to offer it as an effective aid to the physician faced with increasing demands in medical genetics. It is also an effective model for teaching some genetics and human biology in the schools.


Ductus arteriosus dilatation by prostaglandin E1 in infants with pulmonary atresia. Infants with pulmonary atresia depend on patency of the ductus arteriosus for survival in the immediate postnatal period. Despite continuing hypoxemia after birth the ductus arteriosus usually constricts, thus reducing pulmonary blood flow. This often occurs while awaiting surgical palliation or correction, leading either to marked deterioration in the infant's condition, or death. In ten infants with pulmonary atresia, we infused prostaglandin E1 (PGE1) at a rate of 0.1 mug/kg/min in six and 0.05 mug/kg/min in four into the descending aorta at the orifice of the ductus arteriosus. The ductus arteriosus was effectively dilated; at the narrowest point the diameter, measured in eight infants, almost doubled. In all ten infants arterial blood PO2 increased, averaging 24.6 mm Hg before and 43.7 mm Hg after the infusion was started. Infusion of PGE1 directly into the aorta adjacent to the ductus arteriosus avoided the complications of pyrexia, muscular twitching, and excitability which may be related to the effects of prostaglandins on the central nervous system.


Neonatal circulatory changes: an echocardiographic study. Serial echocardiograms were performed in the first three days of life on 38 normal full-term infants. Right ventricular systolic time intervals were measured from the pulmonic valve echogram and left ventricular systolic time intervals were determined from the aortic valve echogram. The heart rate, left ventricular pre-ejection period (LPEP), left ventricular ejection time (LVET), and LPEP/LVET ratio showed insignificant variation with increasing postnatal age. The right ventricular pre-ejection period (RPEP) shortened, the right ventricular ejection time (RVET) lengthened, and the RPEP/RVET ratio decreased with increasing age. The findings suggested that alterations in the RPEP/RVET ratio reflected the decreasing pulmonary artery diastolic pressure and pulmonary vascular resistance of the early neonatal period and may be valuable in the noninvasive evaluation of the newborn's pulmonary vascular bed.


Neonatal thermography.

Neonatal thermography. Anterior and posterior view thermograms were recorded in 37 neonates. Studies were performed under a radiant heater servocontrolled to an abdominal skin temperature of 36.0 C. Heart, liver, and kidneys, being highly vascular structures, were detected as "warm" areas on the body surface. A longitudinal study of an infant with a patent ductus arteriosus and congestive heart failure deomnstrated a generally cooler chest following a decrease in pulmonary artery blood flow accomplished by ductal ligation. Another infant demonstrated a unilateral warm area posteriorly over the left flank. At autopsy the right kidney and its vasculature internal organs. Thermography may prove to be a simple noninvasive tool for routine screening in the neonate of highly vascular internal organs. Thermographic detection of renal malformation may offer considerable potential.


Morbidity of childhood near-drowning.

Morbidity of childhood near-drowning. An assessment of morbidity in near-drowning was made from a review of emergency room and hospital records of 72 patients, ages 9 months to 20 years, who suffered near-drowning during the period January 1972 through June 1974. Fifteen patients (21% evidenced severe anoxic encephalopathy; the remainder had no detectable neurologic deficits. Hypoxemia was demonstrated in 56 patients. Severe acidosis was not present unless respiratory failure occurred. Neither electrolytes, red blood cell hemolysis, nor cardiac arrhythmias presented a problem. Respiratory complications included pulmonary edema, aspiration pneumonia, atelectasis, shock lung, pneumothorax, and pneumomediastinum. All children requiring cardiopulmonary resuscitation in the emergency room suffered anoxic encephalopathy. The occurrence of seizures, fixed and dilated pupils, flaccid extremities, and lack of response to deep pain in the emergency room had almost universal correlation with resultant severe anoxic encephalopathy, as did a submersion period of six or more minutes. The morbidity of near-drowning is significant with regard to the number of children affected and the severity of the central nervous system insult received. The statement by the American Heart Association that resuscitative efforts in children should be continued for periods longer than ten minutes needs reevaluation, since neurologic recovery did not occur in any child requiring cardiopulmonary resuscitation (CPR) in the emergency room. More importantly, new methods of cerebral resuscitation need to be developed and established. In short, medical personnel need to think in terms of cardiopulmonary cerebral resuscitation (CPCR) rather than in terms of CPR.


Cyclic vomit in children: seen through the psychiatrist's eye. Sixteen patients have been seen since 1956 at the Children's Hospital of Pittsburgh with a disgnosis of cyclic vomiting. Five of these patients were reverred for psychiatric consultation or treatment. Four of the 16 had laparotomies and no specific pathological condition was found; seven of the patients did not have surgery or psychiatric intervention. Descriptive follow-up is given for all patients, as well as various methods of handling the problem. The psychological conflicts were found to be parental anxiety, a prolonged symbiotic relationship with the mother, and the failure of the child to separate and individuate.


The value of phenobarbital in the child who has had a single febrile seizure: a controlled prospective study. A group of 355 children who were seen after a first febrile convulsion at the Kaiser Foundation Foundation Hospitals in Southern California from 1970 to 1975 were randomly assigned to three treatment groups-daily phenobarbital, "intermittent" phenobarbital given at the onset of fever, and no phenobarbital. We found that 42% had a relative with a febrile seizure and 16% a relative with an afebrile convulsion. 13% had seizures which were either lateralized or longer than ten minutes. Parents were unaware of the fever prior to the seizure in about 30% of the cases. In 81% the preseizure duration of fever was less than 24 hours. The mean follow-up was 28 months, with a range of 6 to 70 months. There was no significant difference in the recurrence rate between children receiving "intermitent" as compared with no phenobarbital. The recurrence rate in children receiving daily phenobarbital was significantly decreased compared to either of the other two groups. Severe recurrent febrile seizures occurred in no children on daily phenobarbital and in 4.4% of the children receiving either intermittent or no phenobarbital. Parental resistance, compliance, and reversible hyperactivity were the main problems encountered with the continuous phenobarbital regimen.


Abnormal in vitro granulopoiesis in phenotypically normal parents of some children with congenital neutropenia. Bone marrow from hematologically normal parents of congenitally neutropenic children showed defective myeloid differentiation in vitro. In one family only the mother's marrow differentiated abnormally; in the second family both parents demonstrated abnormal myeloid differentiation. In vitro culture of bone marrow may be useful in establishing the mode of inheritance of some forms of familial neutropenia.


Recurring digital fibrous tumors of childhood: a review. Two new cases that conform to the clinical and histopathological features of recurring digital fibrous tumor of childhood, described by Reye in 1965, are reported. This tumor, which is considered a distinct entity among the juvenile fibromatoses, characteristically presents in infancy and early childhood, involves only the digits, recurs frequently following surgical excision without metastatic spread, and demonstrates the distinct histopathological finding of intracytoplasmic inclusion bodies within proliferated fibroblasts. This tumor is reviewed with reference to clinical features, histopathology, etiological considerations, and management.


Milk protein quantity and quality in low-birth-weight infants: II. Effects on selected aliphatic amino acids in plasma and urine. The optimal quantity and quality of protein for low-birth-weight infants is undefined. In this study, 106 well, appropriate-for-gestational-age, low-birth-weight infants weighing 2,100 gm or less were divided into three gestational age groups and assigned randomly within each age group to one of five feeding regimens: pooled human milk; formula 1 (protein content, 1.5 gm/100 ml- 60 parts bovine whey proteins to 40 parts bovine caseins); formula 2 (3.0 gm/100 ml, 60:40); formula 3 (1.5 gm/100 ml, 18:82); and formula 4 (3.0 gm/100 ml, 18:82). The concentrations of the free amino aicds in the plasma and urine of these infants were determined. The plasma concentrations of free amino acids were generally far greater in the infants fed the 3.0-gm/100 ml protein diets than they were in the infants fed pooled human milk. The plasma concentrations of free amino acids of the infants fed the 1.5-gm/100 ml protein diets were intermediate. In general, the concentrations of the free amino acids in the plasma of the infants fed the 3.0-gm/100 ml casein-predominant formula (F4) were furthest from those fed pooled human milk. Glutamate showed the highest plasma amino acid concentrations in infants fed the 3.0-gm/100 ml casein-predominant formula (F4) were furthest from those fed pooled human milk. Glutamate showed the highest plasma amino acid concentrations in infants fed both the high- and low-protein casein-predominant formulas. This was true despite the fact that the intake of glutamate on the high-protein, whey-predominant formula was twice that on the low-protein, casein-predominant formula. The differences between groups in the essential amino acids in plasma were generally greater than those of the nonessential amino acids. The concentrations of amino acids in the urine tended to parallel those of the plasma.


Dietary essential fatty acids in cystic fibrosis. Analyses of serum lipids of children with cystic fibrosis (CF) have indicated a deficiency in essential fatty acids (EFA). In view of a report that intravenous administration of soybean oil emulsions normalized sweat sodium values in CF children, we studied the effects of orally administered essential fatty acids (as corn oil) for one year. Some improvement was noted in all patients, but no one consistent factor predominated. However, arachidonic acid, which was found only in trace amounts or was absent in sera of all children with CF before the clinical trial, was increased significantly in the sera after the oral administration of EFA for one year. Other findings included a significant decrease in sweat sodium and T3 in most patients.


Therapy of familial hypercholesterolemia in childhood: diet and cholestyramine resin for 24 to 36 months. In 16 children heterozygous for familial hypercholesterolemia, two- to three-year therapy with diet and cholestyramine resin (16 gm/day) was assessed in terms of effectiveness, practicality, and safety. All 16 children had previously taken a low-cholesterol (less than 300 mg/day), polyunsaturate-rich (P/S ratio, 1.5:1) diet and choeltyramine resin (12 gm/day) for 12 months. In this study, the cholestyramine resin dose was increased to 16 gm/day, and follow-up was maintained through months 13 through 18, 19 through 24, 25 through 30, and 31 through 36. Eleven children had good drug adherence (four packs of cholestyramine per day) and five children had fair adherence (two to three packs per day). Plasma total cholesterol and low-density lipoprotein (LDL) cholesterol levels were not significantly lowered on the drug-plus-diet regimen as compared to diet alone in five children with fair drug adherence. For children with good drug adherence, mean plasma cholesterol level was lowered below levels achieved on diet alone by 13% (months 13 through 18), 12% (months 19 through 24), 12% (months 25 through 30), and 11% (months 31 through 36) (P less than .05). Reduction in plasma cholesterol level was no greater with 16 than with 12 gm of cholestyramine per day. There were no group changes in mean plasma triglyceride levels. Cholestyramine resin, when added to diet and maintained for two to three years effects a significant reduction in total and LDL cholesterol levels in about 60% of children heterozygous for familial hypercholesterolemia. Continued reinforcement of both diet and drug adherence is necessary in the face of gradual increments in plasma cholesterol level with time.


Triglyceride storage disease: a defect in activation of lipolysis in adipose tissue. A child, aged 6 years 3 months, with a triglyceride storage disorder in peripheral adipose tissue, microcephaly, and gross emaciation has been studied at autopsy. The mean triglyceride content of adipocytes in hand and foot was 0.17 +/- 0.02 mug/cell and 0.18 +/- 0.02 mug/cell. Adipocytes from abdominal tissue were small, irregular, and difficult to measure accurately, reflecting the degree of cachexia. Basal tissue contents of cyclic AMP and release of glycerol and fatty acid from peripheral tissue of the child were in the same range as adult tissues. None of these measurements, however, were increased by incubation with isoprenaline (10(-5 M), compared to a three- to seven-fold increment in adult subcutaneous tissues and to a four- to ten-fold increment of glycerol and cyclic AMP in peripheral adipose tissue of a control child aged 10 years. We postulate that the proband may have had a defect of adenyl cyclase or catecholamine receptor, which has a role in the abnormal storage of triglyceride in peripheral adipose tissue.


Relation between quantities of lead ingested and health effects of lead in humans. Major metabolic effects of lead are briefly reviewed and available data on quantitative relationships between lead ingestion and development of toxicity in adults and children are discussed. Levels of lead ingestion producing clinical toxicity in adults are compared with normal levels of exposure. For children, comparison of levels of lead ingestion and quantities of lead producing toxic effects is not currently possible, as information on levels of lead producing clinical toxicity appears to be highly variable on the basis of the small amount of data available. However, recommendations on tolerable levels of lead exposure for childrne are proposed, based on estimates of lead exposure for children having normal and elevated body burdens of lead.


Hexachlorophene storage in a burn patient associated with encephalopathy. Hexachlorophene (HCP), a chlorinated phenolic hydrocarbon with bacteriostatic properties against Staphylococcus, is used in a number of topical products. Absorption through normal and damaged human skin has been appreciated and neurologic changes have been described in experimental animals, but instances of human toxicity have been reported infrequently. A 10-year-old boy who sustained a 25% burn did well initially but died in the second week of convalescence with hyperthermia, lower-extremity weakness, and cerebral edema. His treatment had included frequent applications of HCP. Analysis of post-mortem tissue revealed the presence of toxic levels of HCP in the blood (2.2 mug/gm) and brain (2.2 mug/gm), with storage in skin (25 mug/gm), liver (4.4 mug/gm), and fat (6.0 mug/gm). This case suggests that topical applications of HCP in man may result in an extensive absorption with fat storage and may cause fatal encephalopathy.


Sex differences in perception of a provocation, a survey. A survey was conducted to examine what constitutes provocation for 70 women and 60 men respectively. Results indicated that women are most angered by condescending treatment regardless of the sex of the provoker, while men's hostile feelings are triggered by a man's physical or verbal aggression or a woman's condescending attitude.


Comparison of phonetic judgments and electropalatographic measurements of articulatory place of production. Judgments of articulatory place of production were obtained for a set of consonant-vowel nonsense syllables spoken with a known place of production by two normal speakers. Correspondence between judgments and actual place of production was poor.


Field dependence and facial recognition. 29 male and 28 female undergraduates were administered two measures of Witkin's field-dependence dimension--the Portable Rod-and-frame Test and the Group Embedded-figures Test--and a test of facial recognition. Field-independent males were significantly more accurate in the recognition of photographed human faces than field-dependent males. Field-independent females were also more accurate than field-dependent females, although the relation was nonsignificant. While it has often been claimed that field-dependent individuals remember faces better, the results of the present study, as well as others which have examined this relationship, support the opposite conclusion.


WAIS differences between murderers and attackers referred for evaluation. 12 first and second degree murderers were matched on sex and age with subjects who had perpetrated aggressive interpersonal attacks short of homicide. Both groups had been referred for psychological testing by courts and social agencies. A substantial and significant difference in IQ was found in favor of the attackers over the murderers. Results were interpreted as lending credence to the hypothesis that differences in IQ exist among important sub-populations of murderers.


Auditory frequency discrimination in patterned-sound-naive albino rats. To test the hypothesis that prior patterned or varied auditory experience was necessary for the development of discrimination of auditory frequency, Sprague-Dawley albino rats were deprived of patterned sound from birth by the technique of rearing them in white noise. The sound-deprived rats learned a frequency discrimination as easily as controls reared in varied sound conditions.


Graphological signs for extraversion.

Graphological signs for extraversion. Graphological signs of extraversion were rated from handwriting samples of undergraduates (ns = 35 males, 31 females; 23 males, 20 females) and correlated with extraversion scores from an objective psychological test. No evidence was found for the validity of the graphological signs.


Cardiovascular disease history and behavior patterns. Type A behavior has not been studied as a developmental behavior process in older persons. This study examined the relationship between ratings of overt behavior patterns and cardiovascular health history in 60 men and 58 women, 59 to 90 yr. of age.


Articulation improvement and oral tactile changes in children. To determine whether oral tactile changes accompany improvement in articulation, 16 children were administered two tests of oral tactile perception and two tests of articulation competency at three time periods: before, during, and at the end of speech therapy. A positive relationship between articulation proficiency and oral tactile perception was established. Both articulation tests reflected a progressive improvement for the group across the three testing periods. One of the tests of oral tactile perception reflected the same progressive trend and the second test, while not exhibiting the identical trend, did reflect a general improvement from the first to the third testing period. These findings indicate that oral tactile skills appear to be important factors in speech production and that such skills should be assessed in cases of functional articulation disorders,


Idiot savants: rate of incidence.

Idiot savants: rate of incidence. Based on the replies to a survey of 300 public residential facilities for the mentally retarded, an incidence rate for idiot savants was established. This rate of .06% is based on the reporting of 54 idiot savants within a population of 90,000 residents. Several reasons for caution in the acceptance of this incidence rate are discussed.


Effect of demand characteristics on heart rate during a behavioral avoidance test. A 2 X 2 experimental design utilized two levels of verbally reported snake fearfulness (high-low) and two levels of experimental demand (high-low) with 16 college student subjects during a behavioral avoidance test. Subjects given high-demand instructions for heart-rate increase increased their heart rate more than subjects given low-demand instructions. Results were specific to heart rate, as demand produced no effects on approach behaviors or fear ratings. Heart rate during the behavioral avoidance test was shown to be as susceptible to experimental demand as other studies have shown approach behaviors to be influenced.


Effects of self-esteem and status on size of signature. 142 second year university students from both Memorial University of Newfoundland (n = 81) and Laurentian University (n = 61) wrote their own signatures as they imagined the following people would do: (a) faculty member (high status) with high self-esteem, (b) faculty member (high status) with low self-esteem, (c) student (low status) with high self-esteem, and (d) student (low status) with low self-esteem. The areas of the signatures were calculated in square centimeters, and there was a significant positive relationship between size of signature and the conditions of high and low self-esteem for both "faculty" and "student" role-playing conditions. There was however no significant relationship between size of signature and status. The results held for both groups of subjects.


Undergraduate self-perceptions of creativity and independence. 596 undergraduate students from 7 schools of a major university responded to a group of 20 questions relating to self-perceptions of creativity and independence employed in earlier studies of graduate faculty members and industrial inventors and producers. The hypothesis was that these students would tend to perceive of themselves in terms of popular expectations relating to the schools of their choice. The results indicated that students of architecture, engineering, liberal arts, and science tend to see themselves as significantly more independent, individualistic, and creative than students of business, education, and to some extent, agriculture.


Altering arousal in humans by varying ambient sensory conditions. Reaction times of 6 male and 6 female college students were used as a measure of arousal under different levels of ambient sensory stimulation. Subjects were tested under conditions of light-quiet, light-noise, dark-quiet and dark-noise with a non-signalled reaction-time task using a tactile stimulus. All sensory conditions were presented to each subject in a counterbalanced order and replicated in a second session 3 to 8 wk. later. Significant main effects were noise and replication. Improvement in performance across replication was related to the sex of the subject. White noise and level of illumination interacted to produce the typical U-shaped function. Results are discussed in terms of their relevance for research using behavioral and physiological measures of arousal.


The enigmatic eidetic image: a reply to Gray and Gummerman. Gray and Gummerman (1975) contended that eidetic imagery differs from visual-memory imagery only in quantitative aspects. There is evidence to controvert that argument and to support a theory of eidetic imagery as a qualitatively distinct phenomenon. It is proposed that eidetic imagery plays an essential role in early development and that superimposition methods are adequate for measurement of eidetic imagery in young children. It is further suggested that eidetic imagery is the precursor of iconic storage. The persistence of eidetic imagery in older children appears to be associated with some but not all forms of brain damage and may be overshadowed by more advanced memory imagery.


Simultaneous monotic masking as a function of linguistic violations. An investigation was conducted to determine whether grammatical, semantical, and phonological constraints affect aural masking. The rationale centered around the non-representative and non-optimal characteristics of white noise as a masker. Also, prior conclusions that content and linguistic rules do not influence masking warranted examination. Six lists, each of 25 simultaneously competing message of 36 college-age, normal hearing, native speakers of English. The 6 classes of competing messages were forward grammatical strings, forward semantically anomalous strings, forward ungrammatical strings, and the same 3 sets reproduced backwards. Articulation scores computed in percentages served as measures. Performances when the forward semantically anomalous strings and the forward ungrammatical strings functioned as maskers were depressed relative to the other conditions and not significantly different from each other.


Effect of stimulus context and repeated aversive visual stimulation on the cardiac correlate of attention. The experiment investigated cardiac deceleration responses to repeated presentations of an aversive visual stimulus (a slide of a mutilated homicide victim) as a function of interspersing presentations of different types of other provocative visual stimuli amidst the aversive stimulus. 30 male volunteers were divided into three groups of 10 subjects each. One group viewed the aversive stimulus randomly interspersed with presentations of female nudes (positive context); a second group viewed the aversive stimulus amidst presentations of slides of skin-disease patients (negative context); and the third group viewed the aversive slide surrounded by presentations of other male undergraduates (neutral context). After repeatedly viewing the single homocide-victim slide, subjects viewed five different homicide scenes without contextual slides. These identical procedures were repeated during a second experimental session. A significant context-by-sessions interaction (p less than .05) reflected a decrement in cardiac deceleration over sessions for the positive context and an increase in deceleration from the first to the second session for the negative context. The neutral context did not affect cardiac deceleration over sessions. The series of different homicide scenes elicited greater cardiac deceleration than repeated exposures to the same slide. These results were discussed in terms of the possible role of stimulus context in affecting attention and vigilant-avoidant coping orientations.


Alpha asymmetry over the right and left hemispheres of stutterers and control subjects preceding massed oral readings: a preliminary investigation. Interhemispheric alpha asymmetry of both stutterers and non-stutterers measured preceding each of five massed oral readings of the same material was investigated. Preliminary results indicated a reduction of alpha over the left hemisphere for non-stutterers, while a reduction for stutterers was found for the right hemisphere. Present results, together with other investigations using dichotic, tachistoscopic, and EEG procedures, suggest right hemispheric processing for the stuttering group as compared with left hemispheric processing for the non-stuttering group.


Psychomotor rehearsal: enhancement of rotary-pursuit tracking using a massed-training procedure. Two groups of male volunteers (n = 8/group) performed 14 10-min. sessions of either alternate 30-sec. rotary-pursuit tracking and rehearsal of tracking or rotary-pursuit tracking and object-slide naming (nonrehearsal). Ten-min. problem-solving tasks separated these sessions. Results showed that subjects in the rotary-pursuit/mental rehearsal group displayed significantly enhanced tracking performance relative to those in the rotary-pursuit/object slide group, i.e., mean time-on-target scores of 12.8 sec. and 8.9 sec. per trial, respectively.


Cardiac deceleration as an indicator of correct performance. A within-subjects experiment involving 10 subjects was performed to examine the relationship between the accuracy of judgment of position and cardiac deceleration. The results supported the hypothesis that accurate (correct) performance is accompanied by greater cardiac deceleration than inaccurate performance for those subjects (9 out of 10) who exhibited cardiac deceleration to stimulus onset. The data indicated, however, that the relationship varied with time. Part of this variability appears related to the initial exploratory behavior in which subjects engaged and later reported during the post-experiment interview.


Predictive head-movements during automobile mirror-sampling. Eye-head response patterns of 3 novice, 3 young experienced, and 3 mature drivers were recorded by television cameras as they sampled their vehicle's mirrors just prior to making freeway left-lane changes, right-lane changes, and entrance merges. Eye-head responses were called "classical" if the eyes moved before the head and "predictive" if the head moved before the eyes. Drivers made about twice as many predictive responses as classical ones. Data suggested that the rate of making predictive head-movements was 90 msec. and that of classical responses was 45 msec. Latency was not related to the amount of driving experience.


Electromyographic and girth considerations relative to strength training. 19 male and 23 female volunteers were tested for surface electromyograms. Girth and skinfold measures were taken at the same location, while cable tensiometer readings indicated quadriceps strength. After a 7-wk. strength improvement program, measures were repeated. Both men and women increased their quadriceps strength. The men's thigh girth significantly increased, whereas the women's did not. Both groups demonstrated significant electromyogram change for a 16-lb. load, whereas only the men showed significant change for a 26-lb. load.


A weight illusion produced by lifting movements. The perceived relative heaviness of objects was manipulated by instructing 13 subjects to lift them gently or vigorously, as was predicted by the motor theory of weight judgment and the known behavior of proprioceptors. The time-order error was shown to be significantly related to lifting movements.


Dose-related heart-rate, perceptual, and decisional changes in man following marihuana smoking. Information processing was tested in 12 male subjects after smoking marihuana containing 0, 10, or 20 mg. of delta-9-tetrahydrocannabinol (THC) in three consecutive experimental sessions according to a Latin square protocol. Successful dose control was indicated both by the dose-related linear increase observed in heart rate and by preliminary assays of THC metabolites excreted in the urine. During tachistoscopic presentation of varying numbers of circles, statistically significant decrements in information processing occurred as a function of THC dosage. However, adding irrelevant information (triangles) to the display of circles eliminated effects of marihuana on accuracy of counting. Complex reaction times for oddity discrimination increased significantly only after the high dose. Nonetheless, both the social and high doses inappropriately inhibited the general tendency to respond to changing stimuli during oddity discrimination. Marihuana had no effect on field-dependence as measured by the Rod-and-frame test.


Evaluation of guidelines for safe exposure to continuous noise of moderate and high intensity. In a 1974 report the Environmental Protection Agency made predictions, based upon extrapolations from the literature, as to what constitutes a 5 dB equal 90th percentile TTS2 curve, i.e., a "safe exposure" curve. However, because of a dearth of data for brief exposures to noise, they were uncertain as to the accuracy of some of their predictions. Therefore, in the present investigation, the TTS2 consequences of brief exposures to noise were systematically evaluated. Specifically, 40 subjects were tested at each of 10 appropriately spaced durations of exposure to noise. The 90th percentile TTS2 at 4000 Hz was determined for each duration of exposure and then a multiple regression equation was fitted to these values. From this equation, a 5 dB equal 90th percentile TTS2 curve was calculated, which represents our predictions as to the trade-offs between noise intensity and duration of exposure necessary to produce 90th percentile TTS2S of 5 dB. A comparison of our predictions to those of the EPA (in the area of uncertainty) suggests that the conservative EPA predictions may be too conservative while the EPA's modified and extended CHABA-criterion predictions (from Nat. Acad. Sci., Nat. Res. Council Committee on Hear., Bioacoustics, Biomechanics) may not be sufficiently conservative. Although our predictions reflect the trends which were actually observed in the present investigation, it would be unreasonable to assume that our predictions are more than "ball park" estimates of reality. They do suggest, though, that in reality a 5 dB equal 90th percentile TTS2 curve would probably be intermediate between the conservative EPA curve and EPA's modified and extended CHABA criterion curves.


Influence of cold bath on maximum handgrip strength. 12 female college students participated in a repeated-measures experiment, receiving an experimental treatment and a control treatment. The former was a 30-min. cold bath to the forearm while the control was a simolar 30-min. period without the cold bath. Subjects' maximum handgrip strength was measured 11 times, immediately prior to treatment, immediately following treatment, and then every 20 min. for 3 hr. The subjects were tested at the same time of the day, on the same day of the week, for two consecutive weeks. Grip strength was significantly decreased immediately following the experimental treatment below pre-treatment measures and post-treatment measures for the control session. Grip strength during the experimental session significantly increased at 80 min. post-treatment when compared to the strength measures for the control at the same time interval or when compared to pre-treatment measures for either treatment. The strength measures for the two treatments remained significantly different over the rest of the testing occasions.


Capacity sharing and refractoriness in successive reactions. Subjects performed two rapidly successive tasks. They first pressed a key to stop a digital counter at one of three stopping times. The key-press was followed after a variable interval by the presentation of one of three lights, which required a choice response. 20 students and 20 flight cadets participated in the main experiment. Both responses showed impairment in the dual-task condition. The delay of the choice response was affected by the stopping time and by the interval between the key-press and the second stimulus. Complete refractoriness for a period of 200 msec. was observed only for the shortest stopping-time. In the other conditions, the delay of the second response decreased gradot support single-channel theory and are better explained by a capacity-sharing model on the assumption that preparation for a choice-response requires effort.


The old man as woman: detecting stereotypes of aged men with a femininity scale. Male and female college students (N = 244), divided into seven experimental groups, rated women in general and men age 65 significantly higher in femininity than men at four younger ages and men in general. Ratings were made on the Broverman, et al. (1970) masculine-feminine (MF) scale. It appears that both women in general and aged men are viewed through the same "femininity" stereotype, which is largely a perception of psychological timidity. Relatively high femininity ratings for men age 55 indicate that these characteristics are believed to increase in men as a function of the aging process. Results also suggest that the students' MF ratings of "men in general" are based primarily on their perceptions of young men.


Relation of the frame in a portable rod-and-frame apparatus to judgements of perceived verticality. To assess the effect of the frame on the mean error in the portable rod-and-frame 18 subjects were tested once with frame present and once without it. 11 frame-dependent subjects produced smaller mean error without the frame; 7 frame-independent subjects were not significantly affected by removal of the frame. Nyborg's statistical method of differentiating frame-dependent and frame-independent subjects appears validated.


Somesthetic hallucinations and motility in schizophrenia: neurophysiological views and information flow model. Clinical study of three schizophrenic men without known seizure disorders has heuristic implications, pointing to neurophysiological factors in their somesthetic hallucinations: (a) In two instances the body areas involved in such hallucinations (the abdominal cavity and the top of one foot) also happen to be represented side by side on the "map" of the receptive somesthetic areas at the postcentral gyrus. (b) In all three schizophrenic men the occurrence of their somesthetic hallucinations can be conceptualized along the lines of MacKay's (1970) information flow model for perception in general, with some specific modifications, which center around the key roles of sufficient change occurring in two specific aspects of this model. (c) Further conceptualization is suggested within Grey Walter's (1973) testable model of triple association among Conditional, Imperative and Operant Response--albeit mostly in reverse sequence with respect to somesthetic hallucinations under discussion. These schizophrenic men reveal in their past and present experiences a pattern in which the sequence of events is initiated through changes at the efferent side (restriction of voluntary motility), which trigger afferent experiences, albeit hallucinated ones. Practical implications center around the probably salutary role of voluntary motility performed purposefully and at the person's own pace.


A musical conservation problem.

A musical conservation problem. 7 piano pupils (8 to 16 yr.) judged which of two printed musical passages required more playing time. It was hypothesized that younger pupils would not conserve the indicated rhythm. Results support the hypothesis, showing that these children based their judgments on spatial/perceptual characteristics rather than on implied quantitative dimensions of the stimuli. Implications for developing non-traditional teaching methods are discussed.


Patterns of environmental adjustments underlying measured cognitive complexity and field independence in men and women. 73 male and 72 female college students completed several measures delineating aspects of the relationships they perceived between themselves and their social and physical environment, as well as cognitive complexity and field-independence measures. Correlational and cluster analysis showed complexity and field independence occurred within differing patterns of self-environment relations for men and women. Differing implications for the simultaneous development of verbal and non-verbal analytic cognitive styles in men and women were suggested by the findings. Results emphasized an ecological approach to cognitive styles as necessary for understanding the information processes underlying the styles themselves as well as their adjustive implications for men and women.


Neural interactions and subjective contours. Increment thresholds were measured on either side of the locus of subjective contours and inequivalent loci for control figures. The data indicate a small change in increment threshold value in the direction predicted by theories postulating neural interactive components in the formation of subjective contours.


Vision with isoluminant colour contrast: 1.A projection technique and observations. An optical technique is described for projecting two-colour pictures with controlled brightness contrast, which may be set to zero-at isoluminance. Colour registration is maintained without adjustment or special setting up. It is suggested that colour-and brightness-contour registration in the visual channel is a problem which may be solved neurally be master brightness signals locking slave colour signals. The projection apparatus allows the supposed master brightness signals to be removed-at isoluminance-when contour disturbances should occur. Observation of this kind are reported.


The role of vision in the perception of speech. The ability of hearing adolescents to use speech-read information in order to report lists of CVC words presented in white noise was investigated. The conditions of stimulus presentation included were auditory and visual information in synchrony, out of synchrony, auditory input alone, visual input alone, and a condition where the information presented in the auditory input conflicted with the visual input. The results indicated that the amount and type of type of information reported varied according to the condition of presentation, and that vision provided a complementary source of information for the perception of speech.


Component analysis of orientation illusions. Orientation illusions occur when the inducing figure is a line or grating (the tilt illusion) or a square outline frame (the rod-and-frame illusion). In the range of inducing figure tilts between vertical and horizontal, the tilt illusion describes one cycle of positive (direct) and negative (indirect) effects but the rod-and-frame illusion describes two such cycles. In two experiments, angular functions of illusions were measured with the six possible inducing figures which result when two of the four sides of a square inducing frame are deleted. As expected, the parallel-side frame amputations induced angular functions similar to the tilt illusion and these functions differed from those induced by the orthogonal-sided amputations. In agreement with previous findings on the nonadditivity of tilt illusions, the sum of angular functions induced by frame amputations, which together form a complete frame, were not always equivalent to the angular function induced by a complete frame, and there were asymmetries in the data fro which neither of two simple hypotheses could adequately account. The discussion focuses upon properties of inducing figures which psychophysical hypotheses might need to consider in order to account for the shapes of angular functions of orientation illusions and, in particular,a distinction is drawn between the global orientation of the inducing figure and the orientations of it (local) component features. It is suggested that it might be fruitful if the tilt illusion and the rod-and-frame illusion were conceived of as illusions resulting from inducing figures composed of all or part of n gratings of spatial frequency fn intersecting at angles of 180 degrees/n.


Pattern evoked average EEG potentials and dichoptic visual percepts. Monocular xenon flashes were used to evoke average EEG potentials while blank, dot or grid targets were shown simmultaneously in ten dichoptic stimulus conditions, either continuously illuminated (added to the flashes, or contraocularly), or presented only by the flashes. Mean evoked-EEG-potential waveforms over repeated conditions were computed from average evoked potentials (EPs) for each stimulus condition and each hemisphere. Correlation coefficients were computed between mena-EP waveforms of all stimulus condition for each subject. Mean correlation coefficients over subjects were treated in a cluster analysis to diagnose conditions associated with similar EP waveforms. Data from the two hemispheres yielded identical cluster results. Presence or absence of continuous target illumination for the flashed eye was the most powerful descriptor. Next important was continuously visible structure (regardless whether seen by the flashed or the nonflashed eye) in conditions with continuous illumination seen by the flashed eye, and flashed structure in conditions without continuous illumination for the flashed eye. It was concluded that a visual percept which enters the processor as non-EP-evoking information nevertheless is reflected by the EP waveform. However, the waveforms are different if the flashes carry the perceptual information exclusively. More powerful than visual structure is the mode of flash presentation (with or withoug continuous target illumination) for the EP waveform.


The spatial selectivity of early and late waves within the human visual evoked response. Two studies on the amplitude, latency, and waveform of human visual evoked responses to the onset of sine-wave grating patterns were made. Results indicated that the peak latencies of both early and late waves were a function of the spatial frequency of the stimulus. The amplitude of the early wave (N1-P1) was consistently greatest at low spatial frequenciies while the late wave (N2-P2) showed consistent attenuation at low spatial frequencies. In addition the location of the peak amplitude response of the late, but not the early, wave depended on the location (macular versus extramacular) and area(small versus large stimulus field) of retina stimulated. These findings are discussed in the light of evidence for separate transient and sustained systems within the human visual system.


Shape constancy: a systematic approach.

Shape constancy: a systematic approach. This work contains the analysis of one experiment and its results. It was carried out to demonstrate that: (i) Shape is a shape-constancy 'factor'. In other words, there must be a 'shape-constancy scale' where the various shpaes can be arranged; (ii) when the shape factor is isolated, the shape constancy of a visual pattern is directly proportional to the strength of the 'linear-perspective cue' and inversely proportional to its degree of 'simplicity'. A pattern such as the cross (which has many linear components and a high degree of complexity) should therefore exhibit a maximum of constancy. The results of the experiment have confirmed the above hypothesis except for an unexpected low degree of constancy of the cross. Another experiment is being performed to explain this last result.


Radiation nephritis.

Radiation nephritis. There is considerable similarity in the morphologic expression of radiation nephritis in man and in the rat. In both species the cellular structures as well as intercellular substances are affected. The most sensitive elements are the tubular epithelium, glomerular endothelium, the glomerular mesangium, and subendothelial and endomysial basement membranes in the arterial walls. The characteristic separation of cells from basement membranes in the glomeruli and tubules is probably due to the damage of both the cells and the membranes. Subsequent degeneration of muscle cells in the arterial media and deposition of fibrin lead to fibrinoid necrosis and thrombosis. Within the range of 1500 to 10,000 rads the nature of radiation changes remains the same irrespective of dose. Higher doses merely accelerate and aggravate the lesions and increase the frequency of severe arterial damage.


[Assessment of the caliber of the uterine isthmus at the beginning of pregnancy. Its value in the indication for cervical cerclage. 134 cases]. In capable hands, measurement of the uterine isthmus in early pregnancy is without danger. Apparent incompetence of the isthmus as determined by examination other than during pregnancy or a previous cervical cerclage do not necessarily represent a formal indication for a cerclage in a subsequent pregnancy. Calibration of the isthmus during pregnancy was carried out in 129 patients who were "candidates" for a cerclage. It was possible to avoid the procedure in 80 of them, i.e. 62% of cases. Furthermore no risk to the pregnancy was involved. Since beginning this study, the number of cervical cerclages in our department has decreased and we have observed a parallel decrease in premature deliveries, since with the elimination of problems related to the isthmus we have directed our efforts towards other causes of premature labour. Thus we have been led to include calibration of the isthmus in routine examinations in pregnancies occurring on the one hand in women with previous infertility as well as in those in which pregnancy follows a period of involuntary sterility. Calibration reveals early incompetence of the isthmus, making cerclage possible at the appropriate time.


[Rupture of the free wall of the left ventricle during myocardial infarct. Contribution of echocardiography to its diagnosis. Surgical cure]. Parietal rupture of heart is one of the most dramatic complications in the acute stage of myocardial infarction. Generally it is fatal within few seconds or minutes. The authors report a case of rupture of the left ventricle into the free pericardial cavity, occurred at the 13th hour of an anterior infarction and surgically repaired with favourable result. On this occasion they emphasize the contribution of echocardiography to the diagnosis of cardiac rupture and the exceptional complexion of this case, which, to their best knowledge, is the third to have survived left ventricular rupture associated with ischemic heart disease, more than two months.


[Diagnostic value of anti-mitochondria antibodies]. The histological lesions found in patients with hepatic disease and positive anti-mitochondrial antibodies (AMA) by immunofluorescence were compared with those in 10 subjects of the same age and sex with negative AMA. The majority of the patients with positive AMA were suffering from primary biliary cirrhosis, the diagnosis being based upon the histological appearance (Stage 1 of Scheuer's classification: 40%) or the presence of clinical signs of cholestasis with a compatible histological appearance (40%). None of the remaining patients (20%) with positive AMA nor the 10 individuals with negative AMA showed histological signs suggestive of primary biliary cirrhosis. The absence of certain clinico-biological factors, with the exception of Stage 1 histology, gives a high degree of value to a high level of AMA in the diagnostic of PBC.


Evidence for en bloc incorporation of exogenous oligonucleotides into HeLa cell RNA. 3H uridine and 3H guanosine labeled oligonucleotides were separately produced by degradation of high molecular weight RNA by endogenous intracellular ribonucleases of HeLa cells. After incubation of this low molecular weight RNA with HeLa cells under conditions limiting labeled mononucleotide incorporation, significant label was found in high molecular weight 18s RNA, but not in 28s RNA. The label in the 18s RNA was alkali labile and remained with the 18s RNA peak under denaturation conditions. Actinomycin in the incubation mixture prevented the appearance of label in the 18s RNA. These results raise the possibility that exogenous oligonucleotide segments can be incorporated en bloc into RNA.


High resolution thermal denaturation of mammalian DNAs. High resolution melting profiles of different mammalian DNAs are presented. Melting curves of various mammalian DNAs were compared with respect to the degree of asymmetry, first moment, transition breath and Tmi of individual subtransitions. Quantitative comparison of the shape of all melting curves was made. Correlation between phylogenetical relations among mammals and shape of the melting profiles of their DNAs was demonstrated. The difference between multi-component heterogeneity of mammalian DNAs found by optical melting analysis and sedimentation in CsCl-netropsin density gradient is also discussed.


Single strand breakage and repair in eukaryotic DNA as assayed by S1 nuclease. A sensitive new approach for measuring the repair of single strand breaks in DNA induced by low doses of gamma irradiation was tested in cultured fibroblasts from Chinese hamster lung, human afflicted with ataxia telangiectasia or Fanconi's anemia and in normal cells of early and late passages. The assay is based on the increasing rate of strand separation of DNA duplexes in alkali for molecules with increasing numbers of single strand scissions. DNA strand separation is shown to follow the relation, in F = -(1/Mn - const) - tbeta where F is the proportion of double-stranded DNA, detected as S1 nuclease resistant, after alkaline denaturation time, t. Mn is the number-average molecular weight of DNA between single strand breaks. beta less than 1 is an empirically determined constant. The results suggest an increase in the number-average molecular weight between breaks, Mn, with increasing times for repair. The final level attained corresponds to the Mn of control DNA in unirradiated cells. As few as one break introduced into 109 daltons of single-stranded control cell DNA can be detected. The kinetics, requirements and sensitivities of this assay are described.


Light-induced free radical alkylation of polynucleotides and their enzymatic digestion. Ultraviolet light-induced free radical alkylation with 2-propanol or D-ribose, initiated with di-tert-butyl peroxide, of poly (G), poly (U20G), and poly(A) led to the substitution of the appropriate group for the H-8 atom of the purines and addition across the 5,6-double bond of the pyrimidines. The alkylated polynucleotides were subjected to nucleolytic digestion with several nucleases. T1-RNase digestion of poly(G) irradiated with 2-propanol gave a mixture of the modified and non-modified mononucleotides. Similarly, pancreatic RNase digestion of the irradiated poly(U20G) resulted in a mixture of the appropriate mononucleotides. A T2-RNase treatment of poly(A) irradiated with 2-propanol gave the modified Ado-21:3'-P, while T2-RNase digestion of poly(A) irradiated with D-ribose led to the cyclic modified mononucleotides, in addition to the modified mononucleotides.


Stimulation of RNA polymerase I and II activities by 17 beta -estradiol receptor on chick liver chromatin. The endogenous transcriptional capacity (RNA polymerase I and II activity) of liver chromatin from chicks treated with 17 beta-estradiol for 24 h (E 24) was double that of the controls. E 24 chromatin contained estradiol receptor activity while control chromatin did not. Its presence suggested an implication in the enhanced activities of RNA polymerases of E 24 chromatin. When semi-purified estradiol receptor was added to control chromatin, the endogenous transcriptional capacity of this chromatin was greatly increased. Studies with alpha-amanitin showed that both RNA polymerase I and II were stimulated by the estradiol receptor. This stimulation was observed as long as homology of the system was maintained. Solubilized homologous RNA polymerases were stimulated much less by the hormone complex in the presence of heterologous DNA than with homologous chromatin. Prokaryotic RNA polymerase could not be stimulated by chick liver estradiol receptor in the presence of heterologous DNA.


Terminal deoxynucleotidyl transferase is present in athymic nude mice. Terminal deoxynucleotidyl transferase activity is normal in the bone marrow of congenitally athymic nude mice, regardless of whether transferase activity is calculated on the basis of cell number, DNA content, or activity per femur. This suggests that terminal transferase containing cells of marrow do not originate in thymus.


Direct evidence that ribosome bound RNA-dependent RNA polymerase does not play a role in globin messenger RNA replication. The radioactively labelled product of RNA-dependent RNA polymerase+ from ribosomes of immature chicken erythrocytes was tested for the presence of newly replicated globin mRNA using unlabelled globin complementary DNA. No radioactively labelled globin mRNA sequences were found in the product, providing direct confirmation that this RNA-dependent RNA polymerase is not involved in globin mRNA amplification.


Physical properties of nucleoprotein cores from adenovirus type 5. Analytical ultracentrifugation, thermal denaturation, and electron microscopy have been used to study nucleoprotein core particles, obtained from disrupted type 5 adenovirus and partially purified on glycerol density gradients. Electron microscopy at low salt concentrations has shown that the cores are homogeneous particles with characteristic structures, which vary with conditions of observation from a fairly loose network of fibers to a highly condensed, compact particle. Sedimentation measurements in the analytical ultracentrifuge, both by boundary and by band techniques, show that the cores are relatively homogeneous in solution and have sedimentation coefficients near 185 S at low salt concentrations, about 243 S in 1 or 2 M NaCl, and 376 S in 1 mM MgCl2. Correlation of sedimentation data with electron microscopic observations suggests that the 185 S particle has a loose, fibrous structure, while the faster species are more highly condensed particles. The melting temperature of the cores in 5 mM Tris/HCl is 79 degrees C, which is 10 degrees C higher than the Tm for purified, viral DNA. This indicates that the protein enhances the stability of DNA in the nucleoprotein complex.


Coronary risk factors and anginal pain patterns. Major risk factors for coronary heart disease include hypertension, high serum cholesterol and triglyceride levels, and cigarette smoking. Minor risk factors include glucose intolerance, electrocardiographic changes, and personality type. Often the initial manifestation is angina pectoris. To prevent coronary heart disease, physicians need to know the answers to the following questions: (1) In which person will coronary heart disease develop, and when? (2) What is the cause? (3) What major and minor causative factors can be modified? (4) How can these modifications be achieved in a free-living, working, well population? (5) What is the earliest manifestation of coronary atherosclerosis? (6) What special diagnostic procedures are useful in coronary heart disease? These subjects are examined briefly.


Impending myocardial infarction: medical management. It is our practice to suggest coronary arteriography for patients with impending myocardial infarction who respond poorly to medical managemnt. Aortocoronary saphenous vein bypass surgery is advised for patients with unstable angina and left main coronary disease. Surgery is not advised for patients with minimal irregularities of the coronary arteries (less than 50% obstruction). Rarely is surgery advised for patients with the syndrome of impending myocardial infarction in whom only the right coronary artery or the left circumflex artery is obstructed. Bypass surgery should be seriously considered for patients with unstable angina and hemodynamically significant disease involving the proximal left anterior descending coronary artery (proximal to the first septal perforating branch). On the basis of symptomatic improvement alone, surgically treated patients with the syndrome of impending myocardial infarction seem to fare better than do those treated medically.


Surgican considerations in management of angina pectoris. In deciding on the best form of treatment for patients with angina pectoris, a substantial number of important factors must be carefully and individually considered. These include symptomatic status, extent and location of occlusive coronary artery disease, left ventricular functional status, and risk factors. Relief of angina pectoris with revascularization surgery can be expected in 80% to 90% of patients, with an operative mortality well below 5% when preoperative left ventricular function is normal or only moderately depressed.


Managing hypertension: the postgraduate medicine lecture. Managing hypertension effectively requires careful evaluation of the patient, in particular for the presence of target-organ damage and of other risk factors for atherosclerosis. Dietary management has proved to be unsatisfactory in most hypertensive patients, as patients resist dietary restrictions or any other changes in life-style. Drug treatment has been shown to significantly reduce morbidity and mortality in patients with diastolic blood pressures above 104 mm Hg. Evidence suggests that drug treatment is also effective in those with diastolic pressures between 90 and 104 mm Hg. Selection of drugs is still an empirical decision--treatment with an oral diuretic usually is effective for mild hypertension (diastolic pressures 90 to 115 mm Hg). A sympathetic depressant, often propranolol, may be added to the regimen next, and if this is ineffective, a vasodilator (usually hydralazine) is included. Common side effects of antihypertensive drugs are seldom serious but can be annoying. Patients should be forewarned about them, and about the effects of untreated hypertension in an effort to improve compliance.


Basic concepts in Hodgkin disease.

Basic concepts in Hodgkin disease. The following is an example of a typical case of Hodgkin's disease, which illustrates the use of clinical and pathologic staging procedures. A 40-year-old man had fever and swelling of the left side of the neck for two weeks. Physical examination showed enlargement of the left supraclavicular and left axillary lymph nodes but no hepatosplenomegaly. Biopsy of the affected lymph nodes showed Hodgkin's disease, mixed cellularity type. A chest roentgenogram, lymphangiogram. 67Ga scan, and results of bone marrow biopsy of the right iliac crest were normal. The clinical stage was classified as IIB2. (Subscript 2 indicates the number of regions of lymph node involvement. The patient subsequently underwent laparotomy. The spleen weighed 150 gm and contained microfoci of Hodgkin disease. Biopsy of an upper para-aortic lymph node at the L-1 showed involvement by Hodgkin disease, but specimens from either lobe of the liver, lower para-aortic and iliac lymph nodes, and left iliac crest did not. The pathologic stage was therefore classified as IIIN+H-S+M- Polychemotherapy was prescribed.


Basic concepts in non-hodgkin lymphoma.

Basic concepts in non-hodgkin lymphoma. Non-Hodgkin lymphoma is a heterogenous group of lymphoreticular malignancies that can be classified into six major cell types. In comparison with Hodgkin disease, non-Hodgkin lymphoma is more common and tends to occur in older persons. The investigative procedures for clinical and pathologic staging are similar to those used in Hodgkin disease, except that staging laparotomy is performed less frequently. Results of biopsy reflect a high incidence of bone marrow, liver, and splenic hilar and mesenteric lymph node involvement in Non-Hodgkin lymphoma than in Hodgkin disease.


Eye disorders. Treatment of baggy eyelids. Blepharochalasis is a redundancy of the eyelid skin. It may be associated with herniation of orbital fat, and the eyelids may have a baggy appearance. They may become heavy and reduce the visual field. Blepharoplasty, in which the excess skin and fat are removed, can not only improve appearance but can also improve ocular function. The most common serious complication of surgery is overcorrection of the lower eyelids. Skin grafting may be required to repair the resulting ectropion. Since visual compromise is a rare but possible complication, complete preoperative ophthalmologic evaluation is advisable.


Traumatic injuries: office treatment of strain. Strain, defined as trauma to a musculotendinous unit, is characterized by pain, muscle spasm, swelling, and loss of range of motion. Conservative treatment consists of rest and elevation of the affected muscle, application of ice and compression, active and passive stretching, and resisted motion exercises. If rupture of muscle and fascia is extensive, surgery may be required. Chronic strain may result from repeated injuries. It is usually treated with rest and administration of an anti-inflammatory agent, such as oxyphenbutazone or a corticosteroid preparation. In the event that this regimen does not provide relief from pain and disability, surgery may be necessary.


Easy bruising in children.

Easy bruising in children. It is necessary to determine whether easy bruising in children is caused by a hemorrhagic disorder. A careful history for the patient and family should be obtained and a physical examination should be done. Any positive indications of hemorrhagic diathesis call for basic coagulation screening tests.


The neurologic workup by the primary care physician. The family physician can and should manage many neurologic problems. A satisfactory neurologic examination also requires a thorough general assessment of the patient's health. The history usually points up the likely diagnosis, while the examination pin-points the lesion. The workup should include routine studies and, when indicated, more specialized diagnostic procedures.


Correlation between antiinflammatory and antiproteolytic properties of substituted benzylidenes. Twelve substituted benzylidenes were evaluated for antiinflammatory activity against carrageenin-induced edema in rats. The protection afforded by these compounds at a dose of 100 mg/kg, i.p., ranged from 30 to 60%. Sodium salicylate (100 mg/kg, i.p.), used as a reference drug, exhibited a 30% antiinflammatory activity under similar experimental conditions. The in vitro effects of substituted benzylidenes were also investigated on the activity of trypsin during hydrolysis of bovine serum albumin, serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, and endogenous lipid peroxide formation by liver homogenates. These results have provided some correlation between antiinflammatory and antiproteolytic properties of substituted benzylidenes.


Comparison of the antidiuretic effects of single intravenous and intranasal doses of DDAVP in diabetes insipidus. In 13 patients with hypothalamic diabetes insipidus after daily single intravenous (0.04-24 mug) and single intranasal (5-320 mug) doses of 1-deamino-8-D-arginine vasopressin (DDAVP) the relationships between the log doses and antidiuretic responses (log osmolalities of 24-hour urine samples) were compared. On the basis of such comparisons the ratio of nasal per venous daily single dose requirement was determined and found to be 26:1. Similarly, the relative potency of venous DDAVP was investigated in two subgroups of patients classified according to their response to peroral drugs. Seven times more DDAVP was required for patients treated previously with high doses of peroral antidiuretics. It was concluded that in groups of patients with divergent peroral dose requirements different DDAVP single-dose treatment schedules should be planned.


Effect of atropine on bile flow and biliary excretion of 3H-ouabain in the isolated perfused rat liver. Effects of choleresis produced by atropine (4-10(-4)M) on the biliary elimination of 3H-ouabain and on the biliary clearance rate of 14C-erythritol were studied in the isolated perfused rat liver. The increased bile flow produced by atropine was associated with decreased level of 3H-ouabain in the bile. The cumulative biliary elimination of ouabain was not affected. Atropine choleresis caused an increase in the erythritol clearance rate and a reduction in the bile to plasma ratios of erythritol as compared to the controls. The results suggest that the choleresis induced by atropine is not entirely of canalicular origin but possibly reabsorption mechanisms in the bile ducts or ductules are also involved.


Effect of secretin on myoelectrical and mechanical activity of the isolated canine stomach perfused ex vivo. Totally isolated whole canine stomachs, perfused ex vivo with homologous blood, were used for recording of myoelectrical and mechanical activity prior to and following the injection of secretin. Secretin was given as flash injections (0.5 - 32 U) or constant infusions (60 U/h). Background stimulation of stomachs was obtained by intragastric instillation of fluid, by the infusion of pentagastrin or bethanechol chloride, and by electrical stimulation of the Latarjet branch of the vagus nerve. Hormones were injected into the gastric arterial circulation. Secretin had no effect on the frequency of electrical control activity. Secretin inhibited electrical response activity when injected against the background of electrical vagus stimulation. Secretin also inhibited or decreased mechanical activity of the gastric antrum, recorded at the site of the antral strain gauge.


Enhancement of the biological activity of adenosine analogs by the adenosine deaminase inhibitor 2'-deoxycoformycin. The potent adenosine deaminase inhibitor 2'-deoxycoformycin ((R)-3-(2-deoxy-beta-D-erythropentofuranosyl)-3,6,7,8-tetrahydroimidazo[4,5-d][1,3]diazepin-8-ol) inhibits the enzymic inactivation and potentiates the cytotoxic activity of a variety of adenosine analogs in the P388 murine leukemia cell culture system. The activity of all seven adenosine analogs examined was enhanced by 2'-deoxycoformycin with the exception of tubercidin (7-deaza-adenosine) which is not a substrate for the deaminase. In vivo, 2'-deoxy-coformycin potentiated the antineoplastic activity of 9-beta-D-xylofuranosyladenine in mice with P388 murine leukemia.


IAEA-WHO cobalt-60 teletherapy dosimetry service using mailed LiF dosemeters. A survey of results obtaining during 1970-75. The IAEA-WHO postal dose comparison service for cobalt-60 teletherapy dosimetry is an ongoing programme aimed at improving dosimetric accuracy in IAEA-WHO Member States. LiF dosemeters were irradiated under specified conditions in a water phantom at the participating radiotherapy centres and returned to the IAEA's Dosimetry Labotatory for evaluation. The participants filled in a data sheet giving numerical values of physical factors (such as per cent depth dose, tissue-air ratio, etc.) that they employed. Nearly 65% of the comparisons showed deviations within +/- 5%, a figure which is believed to represent the overall uncertainty of the method itself. Almost 10% of the measurements deviated more than +/- 15%. It appears that participants applying 'in phantom' output measurements have better control over the dose they administer. Many of the errors observed are due to the use of faulty values for the various physical factors employed, and to the fact that often a check of the output just before the irradiation of the LiF dosemeters was not carried out.


The re-estimation of absorbed doses of less than 1 rad measured with lithium fluoride thermoluminescent dosemeters. The technique of ultraviolet light bleaching for the re-estimation of the absorbed dose of radiation received by lithium fluoride thermoluminescence dosemeters has been extended to the extruded ribbon and PTFE disc form of dosemeter. The threshold of detection for the re-estimation of absorbed dose was found to be 1-1 rad for the PTFE disc dosemeters and 2-8 rad for the extruded ribbon dosemeters. A further study of this technique has revealed that by raising the temperature of the dosemeter during bleaching the threshold for re-estimated absorbed doses may be substantially reduced. The optimum temperature was found to be 80 degrees C and the practical threshold for the re-estimation of absorbed dose using a PTFE disc dosemeter was determined as 750 mrad.


The problem of radiation dosage in the measurement of skin blood flow by xenon-133. The skin dose arising from the use of xenon-133 in the measurement of skin blood flow has been calculated for several situations. The results indicate the importance of prior assessment of radiation dose in any technique involving the use of radionuclides. Cases where particular care must be taken have been indicated and practical methods of reducing the dose are suggested.


Leakage testing of medical radium sources. The results of leakage tests on approximately 2000 clinical radium sources in current use in several hospitals are presented. The tests were carried out using a liquid scintillation immersion method. Less than 1% of the sources leaked radon gas (222Rn) to an extent greater than 1 nCi/24 h. The consequences of a small leakage of radon from a source while implanted in tissue are considered and compared with the hazards and problems created when sources leak during storage. A leakage rate of 1 nCi/24 h is suggested as an appropriate limit beyond which sources should be removed from use.


Measurement of lead content of children's teeth in situ by x-ray fluorescence. The central nervous system of young children is particularly sensitive to neurological damage due to excessive lead exposure. The lead stored in a tooth is permanent and related to the quantity of ingested lead. The lead is assayed by measuring the characterisitc radiation from lead in a tooth in situ irradiated with gamma rays from a cobalt-57 source. The sensitivity of the method is adequate to measure lead levels commonly associated with environmental background. The X-ray exposure to the tooth necessary for this determination is approximately one tenth of that required for a routine dental examination.


A new formulation of total unsharpness in radiography. A new formulation of total unsharpness in radiography based on line spread and edge spread function analysis is established and investigated. The unsharpness contributions due to (1) screen conversion, (2) object motion and (3) geometric effects are incorporated into a general integral formulation. Comparisons with experiments are undertaken and the ambiguity, as well as limitation, of a widely used empirical unsharpness formula is clarified.


Cervical traction. A comparison of sitting and supine positions. Eight students were studied todetermine the position which provided the greatest amount of posterior intervertebral separation during a cervical traction treatment. A standard angle of 45 degrees with traction apparatus set at zero, 14 Kg (30 pounds), and 18 Kg (40 pounds) were used in both sitting and supine positions. Measurements of posterior intervertebral separation taken from lateral roentgenograms of the C4-C7 vertebrae revealed greater separation in the supine positions. The results suggested that the supine position was more beneficial in treatment of the cervical spine with traction. The investigators concluded that the increased separation in the supine position was related to the patient's increased comfort and relaxation.


A problem-solving curriculum design in physical therapy. A systematic process used in planning a basic professional physical therapy curriculum design focused on problem solving is delineated and illustrated in this article. Disadvantages and advantages of the present subject-centered curriculum design are enumerated, as well as results of independent evaluations of the proposed alternative curriculum design. A method for validation of a curriculum design without implementation is discussed. The article is presented to stimulate thought and discussion by physical therapy educators about the processes used to plan curricula and about the content of an alternative curriculum design in physical therapy.


Comparison of oxygen uptake and heart rate during exercises on land and in water. Oxygen comsumption and heart rate response during identical calisthenic-type exercises performed on land and in the water were compared in eight subjects. Both the heart rate and the oxygen uptake were greater during exercises in water. Although gravity is the primary resistance to movement on land, viscosity friction and turbulence are dominant resistive factors in the water. The results of this study indicate that the latter two factors provide a greater load during exercise than the resistance of gravity in land exercises. At a moderate rhythm of leg exercises, oxygen consumption increased about ten times over resting values in the water for men subjects and about seven times for women. Arm exercise performed in the water require less energy than leg exercises in water, but arm exercises require significantly more oxygen when performed in water than the same exercises performed on land.


Psychotherapy and physical therapy common grounds. Psychotherapy and physical therapy involve charged emotional relationships with many common features. Understanding of these common elements can help physical therapists to work with their patients, to utilize the healing aspects of the relationship, and to reduce the tensions within the relationships that can interfere with job satisfaction. The importance of separation and its management are emphasized.


Preventing the high-riding nipple after McKissock breast reductions. We reviewed 50 patients who had reduction mamaplasties done by us using the McKissock vertical pedicle technique. The results were satisfactory, except for the high-riding nipple which developed. We describe a minor modification which seems to prevent this complication.


Axillary hyperhidrosis.

Axillary hyperhidrosis. The literature of axillary hyperhidrosis is reviewed. For treatment, we present a technique of radical glandular clearance, converting the flaps to attached "skin grafts". The extent of the area may be varied, according to the degree of excessive sweating.


Changed appearance of mammograms following breast reduction. Preoperative and postoperative mammograms were done on 50 patients who underwent a reduction mammaplasty. There were interesting and significant changes in the postoperative mammograms in all these cases.


Making uniform photographic records in plastic surgery. The photographic unit described requires a modest investment in equipment and space, and the photographs can be taken by an office aide after suitable instruction. It provides a means for obtaining clear, comparable photographs--without disrupting office routine. The key to success is consistency in camera settings, lighting, alignment, and positioning. Figures 8 and 9 show representative examples of long-term records.


Excisional wound biomechanics, skin tension lines, and elastic contraction. Confusion surrounding the concept of Langer's lines can be reduced by careful distinction among the operational definitions of the phenomenon, the empirical descriptions, and the theoretical explanations. An experimental analysis of the mechanical parameters of excisional wounds in pigskin shows that the marginal retraction, the elastic modulus at the wound midline, and the closing tension are higher for wounds oriented at right angles to tension lines--but the elastic modulus of the terminal segment of the force displacement curve is independent of orientation. The regional distribution of these values shows two patterns. The modulus parameters and the closing tension share a common distribution related to the steepness of regional force-displacement curves, while retraction has a qualitatively different distribution. On the basis of similarities in the behavior of retracting wound margins and in the distortion of punch holes which define tension lines, we hypothesize that the same mechanism may be responsible in both cases.


The pathology of congenital localized gigantism. Two cases of congenital localized gigantism are described. They illustrate a form of segmental limb disproportion, characterized pathologically by an excessive linear growth of the skeletal structures and by soft tissue lipomatosis. The gigantism was confined to bones of the right great toe and adjacent metatarsus in one case; it affected the long bones of a lower extremity in the second case. Case 2, followed for over 7 years, developed a fibrovascular hamartomatous neoplasm of rapid growth and some cytological atypia in infancy--but this was well controlled by conservative surgery. This type of gigantism of the limb appears to be compatible with a normal life expectancy, and it is conceptually useful to distinguish it from hemihypertrophy. The number of cases reported is insufficient to support a significant association of gigantism with malignant tumors or with other life-jeopardizing anomalies.


A second case of relief of blindness following blepharoplasty. Case report. A second case of blindness following blepharoplasty is reported. The symptoms became relieved and the vision became restored after prompt decompression of the orbit by opening the wound and evacuating clots. The importance of vigilant nursing care and observation after these operations is emphasized.


Calcification of implant capsules following augmentation mammaplasty. Case report. Bilateral calcifications in breast implant capsules were found 10 years postoperatively. Although the patient had a history of cholelithiasis, she was otherwise healthy. We believe this is the first such report in the literature.


A method of repair for unilateral macroglossia. Case report. A method is described for the operative correction of unilateral macroglossia. The method permits the tongue to be reconstructed so that it assumes a relatively normal size and shape. The scar is led out to the lateral border of the tongue so that the reconstructed tip retains sensation.


On being told of adoption.

On being told of adoption. Clinical data from the analyses of three adoptees document the deleterious effect of telling children under three years of age about their adoptive status. The knowledge, as well as the experiences, of being an adoptee imposes the need for defensive reactions which affect developmental process, cognitive function, object relationships, and fantasy life.


An unconscious irony in Plato's Republic. This study of some psychological themes in a classical philosophical work, Plato's Republic, is an exercise in applied psychoanalysis that attempts to formulate an integrated psychoanalytic and philosophical understanding of certain ideas to be found in that work. It contains an interpretative study of a legend introduced by Plato at a crucial point in the development of the philosophical argument of the Republic. It is hypothesized that his use of this legend can be traced to an unconscious conflict in Plato, which when identified and interpreted can broaden our understanding and appreciation of the humanity of this work.


Analysis of a congenitally blind musician. During the last two decades the unique developmental difficulties of blind children have been the source of important psychoanalytic investigations and have enriched our clinical and theoretical understanding of the ego in both sighted and blind children. In this paper I describe insight gained from the analysis of a congenitally blind musician.