Determination of inorganic phosphorus using a centrifugal analyzer. A method involving the molybdenum blue reaction for measurement of serum phosphorus using a centrifugal analyzer is described. The need to measure a separate serum blank is eliminated by measuring the rate of color development compared to that of a known standard. The procedure which uses o-phenylenediamine as a reductant is precise and compares well with a continuous flow automated procedure.


Abortion deaths associated with the use of prostaglandin F2alpha. Six abortion-related deaths associated with the use of prostaglandin F2alpha were reported through the Center for Disease Control's surveillance of abortion deaths between 1972 and 1975. Prostaglandin may have had only indirect association with these deaths. The patients' ages ranged from 16 to 38 years, their length of gestation ranged from 15 to 24 menstrual weeks, four were white, and three were nulliparous. Four patients had pre-existing conditions that increased their risks and contributed to their death. The estimated death-to-case rate for prostaglandin F2alpha was 10.5 per 100,000 abortions. Although lower than the rate for intra-amniotic saline instillation, this death-to-case rate is only an approximation. The relative safety of intra-amniotic prostaglandin F2alpha as a second-trimester abortifacient, compared to saline, remains to be established.


Induction of midtrimester abortion with intra-amniotic urea and intravenous oxytocin. Midtrimester abortions were induced in 295 patients with a combination of intra-amniotic urea and intravenous oxytocin. The mean injection-abortion interval was 26.4 hours. Abortion occurred spontaneously within 50 hours of amnioinfusion in 257 patients. The macerating effect of the hypertonic urea on fetal tissues allowed easy termination of the remaining 38 pregnancies by suction curettage at 50 hours after injection. Decreased urinary output occurred during the oxytocin infusions, but water intoxication was prevented by close monitoring of urinary output and serum electrolytes, and by the use of a concentrated solution of oxytocin in normal saline, allowing the administration of small volumes.


The effect of smoking on serum human placental lactogen levels. Serial serum samples (162) were drawn weekly from normal pregnant women (53) during the last month of gestation and measurements were made of the human placental lactogen (HPL) content. The women were interviewed as to their smoking habits and divided into nonsmokers (32) and smokers of from one to two packages of cigarettes per day (21). The infant birth weight and placental weights were not significantly different. The HPL levels were elevated in the women who smoked and the differences were significant at the thirty-sixth and thirty-eighth weeks. The importance of this in interpreting HPL as a placental function test and in terms of the biology of placental function and the control of protein hormone synthesis is emphasized.


New lung functions and pregnancy.

New lung functions and pregnancy. Newer lung function tests (e.g., flow volume-loops and closing volume), as well as standard pulmonary function tests, were performed on 19 healthy individuals in the third trimester and after delivery. We found that the flow characteristics, manifested in the FVL, and the CV remained unaltered during pregnancy. In regard to the standard pulmonary function tests, we found no statistically significant change except for a decrease in the ERV and in the FRC during pregnancy.


Effect of contraceptive steroids on human lactation. Biochemical studies to detect changes occurring in the composition of mother's milk from the initiation of proper lactation to weaning were done in a group of 36 postpartum women, volunteers who were either using the conventional contraceptives or taking a low-dose combination pill, a low-dose progestational compound, or a 3 or 6 monthly injection as a mode of contraception. Apart from a significant increase in the protein content of milk and a slight increase in the quantity, the 3 monthly injection group behaved exactly like the control. On the other hand, the 6 monthly injection group showed a significant increase in quantity but with a significant decrease in protein, fats, and calcium. The low-dosage progestogens group showed a significant decrease in the quantity of fats and the calcium content of milk, but, surprisingly, the addition of 10 micrograms of estrogens to the low-dosage progestogen indicated a pattern almost similar to the control.


Antimicrobial effect of amniotic fluid against anaerobic bacteria. Amniotic fluid samples were obtained at term and tested for their antimicrobial effect on anaerobes, Peptostreptococcus (Ps.) anaerobius, Peptococcus (Pc.) prevotii, Bacteroides (B.) fragilis, and B. coagulans with facultative Escherichia (E.) coli serving as control. Amniotic fluid had only temporary bacteriostatic effect on Pc. prevotii and B. fragilis for 8 to 16 hours. This effect lasted for only 8 hours on Ps. anaerobius. On the contrary, the bacteriostatic effect of amniotic fluid was well sustained on E. coli and B. coagulans, lasting for the entire test periods of 20 and 32 hours, respectively. At the end of the time intervals mentioned, Ps. anaerobius, Pc. prevotii, and B. fragilis exhibited logarithmic growth, confirming the earlier reports that it is not nutritionally deficient. Amniotic fluid exhibited temporary bacteriostatic effect on Ps. anaerobius, P. prevotii, and B. fragilis, but this effect was well sustained against B. coagulans.


Prediction of intrauterine growth retardation by determination of total intrauterine volume. Total intrauterine volume (TIUV) measurements were performed with ultrasound on 100 normal patients at different times in gestation, and a nomogram was constructed. Ninety-six patients at risk for intrauterine growth retardation (IUGR) were then examined ultrasonically. Twenty-eight of the patients in this group delivered growth-retarded babies; in 21 of these cases the TIUV was in the abnormal zone (more than 1.5 S.D. below the mean for gestational age as determined by biparietal diameter). In the remaining seven growth-retarded cases, the TIUV was in the gray zone (between 1 and 1.5 S.D. below the mean). Although 15 normal cases were in the gray zone, there was none in the abnormal zone. There were no abnormal cases in the normal zone. An explanation for the overlap in the gray zone is offered. These results strongly suggest that TIUV is an accurate predictor of IUGR.


In vitro metabolism of prednisolone, dexamethasone, betamethasone, and cortisol by the human placenta. Many of the factors influencing the pharmacologic action of corticosteroids on the maternal-placental-fetal unit remains obscure. To clarify the effect of the placenta on corticoid transfer, tritiated steroids were incubated in saline for 2 hours with minces of midgestational or term placental tissue. The media were extracted and chromatographed on Sephadex-LH-20. Large peaks corresponding to the inactive 11-keto metabolites were observed for cortisol (67 per cent) and prednisolone (51 per cent) while conversion of dexamethasone (1.8 per cent) and betamethasone (7.1 per cent) was low or negligible.


Effects of dexamethasone on maternal and fetal hemodynamic states and fetal oxygenation. The effects of dexamethasone on maternal and fetal hemodynamic states and fetal oxygenation were determined in chronically instrumented unanesthetized pregnant ewes and fetal lambs. Intravenous injections of pharmacologic doses of dexamethasone to the mother failed to alter maternal blood pressure, heart rate, blood flow in the uterine artery supplying the pregnant horn, or uterine vascular resistance. Direct administration of dexamethasone to the fetus had no effect on fetal blood pressure, heart rate, acid-base state, or oxygenation. Furthermore, direct fetal administration of dexamethasone did not produce premature parturition.


Agonadism: case report and review.

Agonadism: case report and review. A 24-year-old phenotypic girl with primary amenorrhea was referred for further evaluation. The cervix and uterus were absent and no gonadal tissue was present by physical examination or at laparotomy. Her serum FSH was elevated and there was no increase in serum testosterone following HCG stimulation. The defect(s) in this case and similar patients with "agonadism" reported to date are compatible with various genetic hypotheses.


Papillary tumors of the peritoneum in women: mesothelioma or papillary carcinoma. It has been urged recently that the surface tumors of the ovary be classified as mesotheliomas because both of these neoplasms have a common ancestry. It was suggested also that the rare extragonadal peritoneal tumor of a microscopic morphology similar to that of the ovarian tumor be considered as a mesothelioma. In the present report, objections to this classification are offered. Fifteen cases of diffuse and/or localized peritoneal tumors interpreted as papillary carcinoma arising from extraovarian tissue of Müllerian potentiality are described, and distinctions from mesothelioma are pointed out. Reasons for opposing the grouping of ovarian carcinoma or extragonadal papillary carcinoma of the peritoneum with mesothelioma include the need for categorizing the latter separately in order to monitor its association with asbestos exposure and the possibility that biological differences between these tumors may lead to the development of different modes of therapy.


Hypertension and the obstetrician-gynecologist. Hypertension is a major risk factor for cardiovascular-related morbidity and death. Antihypertensive therapy markedly reduces the risk caused by elevated blood pressure. Earlier treatment of hypertensive patients should reduce deaths and morbidity even further. The obstetrician-gynecologist has the opportunity and responsibility to identify hypertensive patients early in the course of their disease. He must also confront the problem of elevated blood pressure associated with the use of oral contraceptives. In addition to its impact on the general population, chronic hypertension presents special problems during pregnancy. Pregnant women with elevated blood pressure have an increased fetal mortality rate and develop pre-eclampsia more frequently and earlier than nonhypertensive women. Antihypertensive treatment possibly increases fetal survival; when used appropriately, it definitely does not decrease fetal salvage. The appropriate use of antihypertensive therapy during pregnancy requires an understanding of the mechanism of action of these agents and recognition of side effects, especially those important during pregnancy.


Pelvic celiotomy in the obese patient.

Pelvic celiotomy in the obese patient. We have responded to the challenge of surgery in the overweight patient by promoting it to an area of special interest. These individuals should not be deprived of good medical care although their obesity makes the physician's task more arduous and increases the risk of a poor result. With the use of intensive preoperative preparation, including prophylactic antibiotics and heparinization, a modified operative technique, and an active recovery regimen, a more sanguine view toward the surgical care of obese women can be taken.


Hysteroscopy: a clinical experience with 320 patients. Hysteroscopy has added a new dimension to the management of patients with common clinical problems, increasing the accuracy of diagnosis and serving as an adjunct in treatment of intrauterine conditions. This report summarizes the hysteroscopic experience with 320 selected patients, 104 in the reproductive age group with abnormal uterine bleeding, 91 who underwent hysteroscopy for location and retrieval of intrauterine contraceptive devices, 36 with primary or secondary infertility, 36 with postmenopausal bleeding, and 15 with uterine leiomyomas. Paracervical block anesthesia was used successfully in 214 patients. General anesthesia was used in the remainder because of planned additional surgical intervention. Uterine distention was achieved with D5W in 270 patients, with dextran 32% in 30 patients, and with CO2 gas insufflation in 20 patients. In 71.6 per cent of the patients,visually recognizable or pathologically suspicious intrauterine abnormalities were found. This study further demonstrated the utility of hysteroscopy in diagnosis of endometrial polyps, uterine submucous leiomyomas, uterine malformations, and intrauterine adhesions. Hysteroscopy was also helpful in taking directed biopsies of selected areas of the endometrium in patients with adenomatous hyperplasia and early adenocarcinoma of the endometrium and helpful in removal of intrauterine foreign bodies and evaluation of the recently pregnant uterus when there was a question of persistent pregnancy. Hysteroscopy is a safe ambulatory procedure that is appealing to both patient and gynecologist in its economy and simplicity.


Menopause and myocardial infarction.

Menopause and myocardial infarction. Age and circumstances of menopause (natural or artificial) are detailed in 104 cases of recent myocardial infarction (MI). The results of this study with statistical analysis show no correlation between the age at menopause and the age at onset of MI; so for this study, an early menopause, cannot be considered, whatever circumstances, as a risk factor for coronary heart disease.


Increased reporting of menstrual symptoms among women who used induced abortion. A mail survey was conducted among 3,222 Japanese women 20 to 44 years of age to determine and compare the characteristics of menstruation among women with and without a history of induced abortion. Women with prior abortion consistently reported an excess of symptoms in all age groups. While it is not yet known whether induced abortion results in a physiologic change in the uterus, it is suggested that a psychic component may be present by which women with prior abortion perceive their menses differently than nonabortion respondents.


A prospective study of angiotensin II pressor responsiveness in pregnancies complicated by chronic essential hypertension. The present study was designed to (1) outline, in a prospective manner, vascular responsiveness to angiotensin II (A-II) in gravidas with essential hypertension and (2) ascertain if increased sensitivity to infused A-II could be detected before worsening of hypertension developed in those women who were destined to develop superimposed pregnancy-induced hypertension (PIH). Sixty-three women with chronic essential hypertension were studied sequentially throughout pregnancy and two groups of patients were defined on the basis of clinical outcome and serial measurements of vascular reactivity to exogeneously administered A-II. The first group consisted of 29 gravidas with chronic hypertension alone and the second group was composed of 34 patients with chronic hypertension who were destined to develop superimposed PIH. Vascular resistance to infused A-II (more than 7 ng. per kilograms per minute required to increase diastolic blood pressure 20 mm. Hg) was observed from weeks 21 to 27 of gestation in both groups of patients. In the gravidas with essential hypertension alone, resistance to A-II persisted throughout the remainder of pregnancy. However, in those women destined to develop PIH, an increased sensitivity to A-II developed after week 27 of gestation and the differences in mean values between the two groups of patients became highly significant after week 30 of gestation (P less than 0.025). although individual determinations obtained in both groups of patients between weeks 28 and 32 of preganncy suggested that pressor responsiveness to A-II might be used as a screening technique to identify those women destined to develop PIH, additional studies conducted between weeks 28 and 32 of gestation will be required before the efficacy of such a screening technique is clearly established.


The effect of normal labor on the renin-angiotensin system in mother and fetus. Plasma renin activity (PRA) and angiotensin I concentration (AI) in mother, umbilical vessels, and amniotic fluid were measured during 11 elective cesarean sections and after 12 normal labors. During cesarean section, PRA and AI were significantly lower in umbilical vessels than in mother or in amniotic fluid. This finding reflects the steady state in the late pregnancy. PRA and AI were significantly higher in the umbilical vessels after normal labor in comparison to the levels of cesarean section. In the mother there was no difference in PRA after normal labor and during cesarean section, but AI was significantly higher after normal labor. After normal labor no difference of PRA between mother, umbilical vessels, and amniotic fluid was found. The rise of fetal PRA and AI as a reaction to uterine contractions may be of great importance in ensuring the fetoplacental circulation during the labor.


A capillary tube pregnancy test.

A capillary tube pregnancy test. The experience with a new, simple, and sensitive capillary tube pregnancy test requiring no refrigeration is described. The results of this test and other tests are compared against histologic results. The 1/2 unit capillary test, defined as having a sensitivity of 0.5 I.U. of HCG per milliliter, had a higher percentage of agreement with histopathologic results (99.65 per cent) than all other tests studied. The false-positive rate was 0.07 per cent and the false-negative rate was 0.28 per cent. In this series of 1,486 tests, 21 cases of pregnancy, identified by a 1/2 unit test, were missed by one or two unit tests. The earliest detection of pregnancy by the 1/2 unit capillary test confirmed by histology was 3 weeks from the last menstrual period (four cases).


Acute fatty metamorphosis of the liver: a report of two patients who survived. Two patients with acute fatty metamorphosis of the liver of pregnancy who survived are presented. Clinical and pathologic features, possible etiologic factors, and principles of treatment are discussed. Both patients subsequently were allowed to become pregnant again, both had uncomplicated second pregnancies without evidence of liver disease, and both delivered healthy babies.


The incidence of intrapartum fetal distress with advancing gestational age. A total of 679 fetal monitoring records were carefully reviewed in order to determine the incidence of occurrence of late and variable deceleration patterns with respect to advancing gestational age. No statistically significant increase in occurrence of these patterns could be detected in gestations that progressed beyond 42 weeks. The previously held concept that routine prophylactic intervention in gestations of 42 weeks or more must be challenged.


Outcome at ages 1, 3, and 5 years of children born to diabetic women. A prospective study of infants born to women with diabetes mellitus is reported. The children were examined at birth and followed at 1, 3, and 5 years of age. Medical and psychological information was obtained through follow-up examinations. Intrauterine growth was atypical and there was an increase in neonatal problems and congenital malformations. There was an increased incidence of intellectual delay at 3 and 5 years of age. The presence of acetone in the urine during pregnancy had a significant, adverse effect on intellectual status of the offspring at 5 years of age. Birth weight was negatively related to intellectual status at both 3 and 5 years of age.


True knot of the umbilical cord.

True knot of the umbilical cord. Fifty umbilical cords were prepared and examined and their venous perfusion pressures measured with and without a true knot in the cord. Contrary to information in the literature, a loose umbilical cord knot did not affect the venous perfusion pressure. With a tightened knot, the smaller the umbilical cord diameter, the greater was the pressure required to perfuse past the knot. The umbilical vessels, protected by the myxomatous structure of the Wharton's jelly, were rarely completely occluded. These findings correlate clinically with the relatively high incidence yet low fetal mortality rate actually due to a true knot in the umbilical cord.


Survival in the fetal rabbit exposed to intermittent hypoxia. To investigate the time course and mechanisms of fetal O2 deprivation, we exposed 93 near-term, pregnant rabbits and their fetuses in utero to intermittent hypoxia. We administered a gas mixture containing 3, 4, 5 or 6 per cent O2 in N2 to a rabbit for 0.5, 1, 2, or 3 minutes, alternately with a recovery period of air breathing of 0.5, 1, 2, or 3 minutes. A given cyclical pattern was continued for 2 hours and fetal survival recorded 1 hour thereafter. Fetal survival decreased significantly at lower O2 levels, longer durations of exposure, and shorter durations of recovery intervals between exposures. Chances for survival were significantly greater among fetuses located at either end of the uterine horn.


Solitary oculomotor nerve palsy in childhood. In most cases of isolated oculomotor nerve palsy in 30 patients under age 20 years the palsy was congenital, and aberrant regeneration was present. The most common causes of acquired oculomotor nerve palsy were blunt trauma and infectious processes, both local and systemic. Neoplasms, aneurysms, and ophthalmoplegic migraine caused the other cases. The causes of isolated oculomotor nerve palsy in childhood differ from those in adults both in nature and in frequency of occurrence.


Abnormal saccades in paralytic strabismus. Saccadic eye movements were measured in ten patients with unilateral limitation of function of an extraocular muscle. With the paretic eye fixating, there were a series of saccades when refixating in the direction opposite to the paralysis. Between each saccade, the eye drifted back toward the starting position; the drift rate decreased as the eye moved into the field of action of the strong agonist muscle. In one patient, the normal (covered) eye was immobilized during attempted refixations. In this case, the abnormal pattern of saccades made by the paretic eye persisted. Thus, the central nervous system uses innervation or efference to calculate the position of the eye in the orbit for saccadic eye movements.


Permanent wear of soft contact lenses in aphakic eyes. In a five-year study, permanent wear of soft contact lenses was achieved by selecting patients and lenses properly, and offered a viable and probably safer alternative to intraocular lenses. Twenty-five of these 49 patients wore their initial lens or a similar lens continuously for over three years. A visual acuity of 6/12 (20/40) or better was obtained in 45 (91.8%) patients. Four (8%) had ocular problems not related to contact lenses that precluded the same improvement in central vision. The most common complications were reversible epithelial edema, superficial vascularization, and conjunctivitis. There was a strong correlation between edema and superficial vascularization in eyes fitted with lenses having a poorly made inside bevel. Calcium deposits were the most frequently found spot on permanent-wear soft contact lenses (nine eyes, 18%).


Deep corneal vascularization caused by aphakic soft contact lens wear. A 61-year-old man developed deep corneal vascularization, decreased visual acuity, and associated corneal opacity at the level of Descemet's membrane after prolonged wear of an aphakic soft contact lens. The vascularization markedly diminished and the vision improved after cessation of soft lens use; however, the associated opacity remains.


Modified cryoprobe for retinal detachment surgery and cyclocryotherapy. A cryoprobe with a large elliptical freezing surface, used in retinal surgery and cyclocryotherapy, reduced the number of applications and the treatment time.


Familial polyposis and angioid streaks in the ocular fundus. A 48-year-old white man had angioid streaks associated with familial polyposis. Although the streaks were seen only in the right eye when examined by ophthalmoscopy, a tiny angioid streak was also discovered in the apparently uninvolved left eye during fluorescein angiography.


Automatic timer for cryotherapy.

Automatic timer for cryotherapy. An automatic timer, built into an electric cryounit, was useful when repeated applications were necessary during cryotherapy.


Microsurgical anterior chamber utility forceps. Anterior chamber utility forceps were designed primarily to remove capsular fragments and aid in performing iridectomies through small incisions in extracapsular cataract extractions.


Ocular involvement in Yersinia enterocolitica infection presenting as Parinaud's oculoglandular syndrome. Ocular involvement in Yersinia enterocolitica infection presenting as a Parinaud's oculoglandular syndrome occurred in a 77-year-old woman with diabetes. Yersinia enterocolitica was recovered from cultures of the conjunctiva, cornea, fistula tract, and blood. The patient responded to parenteral and topical administration of gentamicin and a corneal transplant. While hospitalized, she developed peritonsillar inflammation and enlarged, tender lymph nodes in the preauricular, submaxillary, and submandibular areas. The combination of the unilateral granulomatous conjunctivitis and enlarged regional lymph nodes was consistent with the diagnosis of Parinaud's oculoglandular syndrome. Yersinia enterocolitica may be another cause of Parinaud's oculoglandular syndrome.


Macular colobomas in Leber's congenital amaurosis. Two siblings with Leber's congenital amaurosis had the unusual association of bilateral macular colobomas. In addition to the colobomas, the patients also had deafmutism, severe myopia, large corneas, and an unusual discrete area of peripapillary tapetoretinal sheen. Electrodiagnostic evaluation of patients with congenitally poor visual ascuity and a central retinal defect differentiated a localized loss of funciton from a degeneration involving the entire retina.


Leber's congenital amaurosis.

Leber's congenital amaurosis. An early stage of Leber's congenital amaurosis, characterized by white spots or lines in the fundus, occurred in two children. Light microscopic examination of eyes obtained from one child, a 16-month-old Japanese girl, revealed subretinal deposits corresponding to the white spots and lines in the fundus deposits. Light and electron microscopic examination of the eye showed distinctive changes in the outer retinal layers and choroid, while the inner retinal layers were nearly normal. Characteristic early lesions of congenital amaurosis appeared to be produced by deposits consisting of loose outer segments and apical processes of the pigmental epithelial cell and macrophages. Undifferentiation in the nuclei of the photoreceptor cell, the inner segment, the pigment epithelial cell, and the choriocapillaris were likely characteristics of the early changes of congenital amaurosis.


Anophthalmos in an infant with multiple congenital anomalies. A full-term, 2,828-g male infant who lived five weeks had histologically proven, bilateral, congenital anophthalmos. The infant had multiple congenital anomalies including esophageal atresia, choanal stenosis, tetralogy of Fallot, persistent left superior vena cava, arhinencephaly, retardation of myelination in the brain, cerebellar sclerosis, and dysplasias, as well as other developmental anomalies of the central nervous system. There was no family history of anophthalmos, and, in view of the arhinencephaly, we diagnosed sporadic secondary anophthalmos.


Large orbital conjunctival cyst after enucleation. A 33-year-old man, 28 years after enucleation for a perforating injury, had a four-year history of slowly progressive proptosis of his prosthesis. Examination revealed a spherical mass filling the space normally occupied by the globe. A cyst lined by conjunctival epithelium was encountered on surgical exploration.


Refractive errors associated with hemangiomas of the eyelids and orbit in infancy. Asymmetrical refractive errors, both astigmatic and myopic, were associated with infantile hemangiomas of the eyelids and orbit in 46% of 37 patients who had large lesions and upper eyelid involvement predisposing to the ammetropia. The axis of the astigmatic error related to the location of the eyelid hemangioma and correlated closely with keratometric measurements of corneal astigmatism. The refractive errors tended to be stable despite eventual resolution of the hemangiomas. Efforts to combat strabismic and refractive amblyopia were rewarding in many patients. A history of complete eyelid occlusion during part of the first year of life was associated with dense amblyopia and eccentric fixation in some patients, but in other patients this history was compatible with the eventual development of useful vision. Absence of an asymmetrical refractive error in patients with eyelid and orbital hemangiomas rendered the prognosis for vision good in involved eyes.


Axial length changes after retinal detachment surgery. A-scan echography was an accurate method for detecting changes in the depth of the anterior chamber, lens thickness, and length of the vitreous cavity after retinal detachment surgery in 30 eyes. Approximately 60% of the eyes had significant alterations in axial lengths exceeding+/-0.36 mm in aphakic eyes and +/-0.54 mm in phakic eyes. However, the operation of scleral bucklingg with large segments of hard silicone rubber implants or explants supported by an encircling band failed to result in a significant predictable shift of axial change in phakic or aphakic eyes. A-scan echography showed significant shallowing of the anterior chamber, and scleral buckling significantly increases lens thickness for at least six weeks. This induced a minor myopic refractive change that may explain some of the difference in postoperative refracitons between phakic and aphakic eyes.


Glaucoma occurring after closed vitrectomy. Six of 20 eyes developed postoperative glaucoma within two to ten days after closed vitrectomy for vitreous hemorrhage. Intraocular pressure was greater than 40mm Hg in all six eyes, and three developed pressure greater than 60 mm Hg. Intraocular pressure in four eyes was controlled with medical antiglaucoma therapy and two eyes required anterior chamber irrigation. Six months postoperatively three of the eyes had normal pressures, one was hypotonous, and two developed increased intraocular pressure secondary to angle neovascularization. Three of the 14 eyes that did not develop glaucoma developed a cellular accumulation in the anterior chamber. The glaucoma was caused mainly by obstruction of the trabecular meshwork by degenerated red blood cells known as ghost cells. The cells may be identified by phase-contrast examination of anterior chamber aspirates. Glaucoma can be prevented through irrigation of the vitreous cavity at the time of vitrectomy ensuring that no cells and debris are left behind to migrate into the anterior chamber and obstruct the trabecular meshwork. This type of glaucoma is caused mainly by ghost cells, whereas hemolytic glaucoma is caused mainly by macrophages and red blood cell debris.


An ultrastructural study of the retina in the Jansky-Bielschowsky type of neuronal ceroid-lipofuscinosis. A 7 1/2-year-old boy died of the Jansky-Bielschowsky type of neuronal ceroidlipofuscinosis. Although an electroretinogram showed reduced activity, pigmentary retinal atrophy was not demonstrable by ophthalmoscopy two years before death. At autopsy, the retina had severe loss of photoreceptor cells, pigment displacement, gliosis, and uniformly structured lipopigment bodies with an internal structure of curvilinear profiles in ganglionic and Müller cells, in pigment epithelia, in the remaining photoreceptors, and in the elements of the inner nuclear layer. These findings conformed to those in the juvenile type of neuronal ceroid-lipofuscinosis, differing only as to the severity.


Metal isotopes used as radioactive indicators of ocular melanoma. We studied radioactive metal compounds to determine their localization in malignant Greene melanoma in the eye of the Syrian golden hamsters. Scintigraphy of an ocular melanoma was achieved with several radioactive metals: radioactive indium(111In)-bleomycin, radioactive gallium (67Ga)-citrate, and radioactive lead (203Pb)-tris. The 111In-bleomycin had the highest tumor uptake (5.45% dose/g), but not the highest tumor-to-background ratios. The 67Ga-citrate had a maximum tumor uptake of 4.87% dose/g at 48 hours. The 111In-chloride had a melanoma uptake of 2.26% dose/g, while with 203Pbtris the uptake was 1.61% dose/g. These uptake ratios compare favorably with that of radioactive phosphorus (32P)-2.21% dose/g. Noninvasive localization of malignant melanoma in the eye was accomplished with metal isotopes. Detailed analysis of in vitro uptake date by tumor and background tissues revealed the optimum time for scanning and precluded unnecessary trials.


Spontaneous separation of preretinal macular fibrosis. A dart entered the eye of a 6-year-old boy causing a retinal hole located inferotemporal to the macula. The retinal hole was treated with an argon laser, and two months after the injury, tissue organization in the vitreous track created by the dart caused a limited retinal separation and stress lines. A preretinal fibrosis developed above and temporal to the macula, and visual acuity decreased to 6/60 (20/200). Four months after the injury, the preretinal membrane spontaneously separated from the macula to an extramacular nidus, and visual acuity subsequently improved to 6/9 (20/30).


The diagnosis of uveal malignant melanomas in eyes with opaque media. Of 358 eyes enucleated between 1962 and 1975, and found to contain posterior uveal melanomas, 31 had opaque media (8.6%). Eighteen of these patients with opaque media were seen between 1962 and 1971, before the use of combined ultrasonography and the radioactive phosphorus uptake (32P) test. Melanoma was unsuspected at enucleation in one third of these patients and there was often a long delay in diagnosis. Of the 13 patients seen between 1971 and 1975, after the initiation of combined ultrasonography and 32P) test, there was no delay in diagnosis becuase a melanoma pattern was recognized immediately with ultrasonography and confirmed with a positive 32P test. During the latter part of this study, 19 patients with opaque media had a "melanoma pattern" with ultrasonography. The 32P test was positive in 12 cases and a melanoma was confirmed histologically in every instance. The 32P test was negative in seven cases and all were documented on follow-up to have benign lesions, such as subretinal hemorrhages.


Measuring empathy in occupational therapy students. Empathy is one interpersonal skill dimension that contributes to the occupational therapy process. This paper explores the concept of empathy and briefly recapitulates some of the assessment devices used in an attempt to measure the skill. It further describes an investigation involving 23 occupational therapy students in a basic master's program. The students were administered the Hogan Empathy Scale, and scores were correlated with peer and faculty empathy ratings. The results revealed a significant correlation between measured empathy and perceived ability to empathize. Possibilities are discussed for using the Hogan Empathy Scale in occupational therapy education.


Correlation between kinesthetic discrimination & manual dexterity. Sixteen early-blinded adults and 16 normally sighted adults performed tests of manual dexterity and kinesthetic discrimination to determine whether or not a significant positive correlation exists between the two skills for each group. Manual dexterity was measured by the Minnesota Rate of Manipulation Test, Displacing and Turning tests. Kinesthetic discrimination was measured by the Kinesthesiometer Test and Kinesthesia Test of the Southern California Sensory Integration Tests. The Spearman Rank Order Correlation formula yielded a significant positive correlation (p less than .05) between manual dexterity and kinesthetic discrimination for the blind and sighted groups.


The initial interview & interaction analysis. Twelve occupational therapists with 1 to 18 years of clinical experience made audiotapes of their initial interviews with patients. Flanders' system of interaction analysis was used to analyze the tapes in order to described the patterns of interaction that occurred. The results indicated that the therapists' interactions were more concerned with the mechanics of gathering data than with developing interpersonal communication.


Linking research to practice: suggestions for reading a research article. Although researchers and editorial review boards are obligated to communicate research information in readable fashion, journal readers also must assume responsibility for interpreting and evaluating research articles. The general format for reporting research results is described. In addition, seven major questions to be asked by cirtical readers are presented. These questions are designed to help readers identify the purpose of a study; assess its importance; evaluate the research design, sampling and data collecting procedures; interpret the results of data analyses; and form implications for practice.


Motor-driven treadmill for studying locomotion in cats. Increasing experimental concern with locomotion and its neural control prompted the construction of a motor-driven treadmill for cats. The apparatus was designed for kinematic analysis of gait from 16 mm movie film, but it  will also permit a variety of other records to be taken. A box, or base, houses two large drums and the belt drive. Space is provided on top of the base for a closed locomotion compartment that is transparent on the filming side. There is also sufficient space on top of the base for support apparatus, operator controls, and animal exits. Cats may be trained to work for food reward alone, as delivered from the front by the operator. Alternatively, they can be trained to stay near the front of the treadmill belt in order to avoid an aversive jet of air or electric shock, either of which can be delivered at the rear of the test chamber. The operator can maintain forward belt velocity at fixed levels between 0.5 and 6 m/sec, or he can vary velocity continuously. Displays of a tachometer and a special timing device are large enough to be clearly visible on the film. These various features in combination provide a controlled and varsatile stepping environment, in which the cat can move without physical restraints.


101 cases of spinal cord injury. 15-year follow-up study in a large city hospital. A study was undertaken of the long-term course of traumatic paraplegia and quadriplegia, secondary to spinal cord injuries, in 101 patients admitted to the Philadelphia General Hospital during the past 15 years. These patients belong to a special socio-economic group: poor, with a low level of education and mostly unemployed. We were interested in finding out how the socio-economic status, age at onset, sex, race, and other factors, would influence the prognosis, longevity, outcome of rehabilitation, and period of hospitalization. This study was carried out by clinical examination and by interviewing those patients still in the hospital or the nursing home attached to it, and by reviewing their medical records. The results of the study were compared with other studies in the literature of other groups of similar patients. One striking difference was the predominance of gunshot wounds as a cause in our series. The longevity was comparable, but the outcome of the rehabilitation was not encouraging, with most of the patients becoming hospital-dependent. The authors conclude that this is a very serious social as well as medical problem, and that considerations for its prevention are as important as its management.


Additional features of Ainu dentition. V. Peopling of the pacific. Crown morphology of 85 plaster dental casts from skeletal and living Ainus of less than 1/8 non-Ainu admixture is described and compared for microevolutionary and origins considerations. There is no significant sex dimorphism and few inter-sample differences through time. Inter-observer differences occur where observation standards are poorly established. Ainu teeth exhibit a simplified pattern and have trait frequencies more like those of Polynesians and Micronesians than like Chinese, Japanese or Europeans. There is no dental evidence in support of a Caucasoid origin or close relationship. Similarities outnumber differences between Ainu teeth and those of Micronesians and Polynesians suggestive of a past biological relationship.


Developmental changes of the cranial bone thickness in the human fetal period. The description of the developmental changes of cranial bone thickness in the fetal period is the primary aim of this paper. The materials utilized in this study consisted of the two series. One is those of dry bones of 62 Japanese fetuses ranging from the fifth month to term and the other is those of 56 Japanese fetuses ranging from the fourth month to term. The first series is mainly used for the tests of bilateral difference in the thickness of cranial bones. No statistical significance could be found. Allometry technique was then applied for the analysis in the growth of the thickness of cranial bones and an extremely positive alometric coefficient was obtained. This required us to study another material, i.e., the second series. The materials of the second series were first measured for crown-rump length, head length, head breadth and head circumference. The heads were then carefully dissected and the left side of individual bones of the cranium were removed to take further measurements for the arc length. The thicknesses at the ossification centers and midpoints were successively measured by a micrometer readable to 0.01 mm. The results of the second series were investigated from the viewpoint of absolute and relative growth. By allometric analysis, vertical and transverse arc lengths were found to be isometric with two exceptions, while every measurement of thickness shows an extremely positive allometry. This coincides with the results of the first series.


The effect of artificial cranial deformation on the incidence of Wormian bones in the lambdoidal suture. One hundred and twenty adult and 80 human fetal skulls were examined to find the relationship (if any) between the presence of wormian bones in the lambdoidal suture and artificial deformation of the skull. Wormian bones occur in deformed and undeformed skulls with no significant differences. Wormian bones detected in fetal skulls preclude cultural deformation as an important factor in the formation of these bones. It is hypothesized that a genetic predisposition (genes allowing formation of secondary ossification centers) is present and that wormian bones are under direct genetic control regardless of the presence or absence of detectable cultural deformation.


The use of penrose's C2H for an intra- and inter-population analysis of quantitative dermatoglyphic traits. Results of a part of multidisciplinary studies in six villages on the island of Hvar (Yugoslavia) are presented. Six quantitative properties of dermatoglyphics were analysed (TRC, PII, a-b, b-c and c-d ridge counts, and atd angle). "Biological distances" among the surveyed couples from all six villages were analysed using Penrose's C2H, and its components: C2Q and (v-1/v)C2Z with regard to sex and possibility of determining the direction of endogamy or exogamy. Significant correlation between "geographical distances" and (v-1/v)C2Z is obtained for males, indicating that the social organisation in the examined rural population, from the point of view of demography, has some influence on the distribution of the dermatoglyphical characters.


On techniques for stabilising and photographing skulls. The design and use of a small light portable craniostat is described. Made of clear polystyrene, with adjustable pegs of the same material, the device is small, light, unbreakable and easily portable. It facilitates rapid and stable positioning of skulls in any position for study of photography.


Sex and race differences in finger ridge-count correlations. Correlations between ridge-counts on the ten fingers were compared by race and sex in 11 samples representing Negroes and Caucasians: five from subsaharan Africa, one American Black, three European, one American White and one from India. The samples of European ancestry showed no consistent sex difference in mean correlation, although female American Whites significantly exceeded males. In three of the six Negro samples and in the Parsis of India males showed significantly higher average correlations than females. The pattern of sex and race differences suggests that the sex chromosomes, particularly the Y chromosome, play a role in dermal ridge development.


The Chipaya of Bolivia: Dermatoglyphics and ethnic relationships. Dermatoglyphic data on 15 traits (digital arches, digital radial loops, digital ulnar loops, digital whorls, I loops, Ir loops, H loops, H loops, III loops, IV loops, mainline C absence, total ridge count, a-b ridge count, atd angle, and mainline index) are presented for 141 Chipaya Indians of Bolivia. Ethnic relationships of these Indians to nine South American Indian tribes (Alacaluf, Atacameño, Aymara, Cashinahua, Chácobo, Chama, Chané, Quechua, and Sirionó) are explored by means of a genetic distance analysis using 21 alleles. Genetic distances are complemented with linguistic and geographic distances between the Chipaya and the other tribes. Genetic distances were found not to be significantly correlated with linguistic and geographic distances. Combining the information available, it is concluded that the Chipaya are most likely ethnically related to the Arawak speakers of the tropical forest.


A collation of marker gene and dermatoglyphic diversity at various levels of population differentiation. The use of dermatoglyphic traits to describe interpopulational diversity among human populations at various levels of differentiation is compared with similar analysis of gene frequency data by means of nonparametric methods employing distance matrices and dendrograms, and by a partition of total variability into its between and within population components. Congruence of dermatoglyphics and gene markers appears to vary with level of population differentiation -- the association remains insignificant until racial level of differentiation is considered. Different pitfalls of the data used are mentioned. The interpretation of these findings is discussed by comparison with other non-human studies.


Tooth, chin, bone and body size correlations. Correlations of size of teeth, chin, bone and body were investigated in 118 males and 102 females of the Burlington Growth Centre. In the males, the mesiodistal widths of the mandibular lateral incisors and canines were independently related to the thickness of the cortex of the second metacarpal and to body weight. Bone cortex thickness was significantly related to metacarpal width in males and to body weight in females. Chin depth of the males was significantly related to bone width and to body height, negatively related to tooth width when bone width or body weight was held constant in partial correlations. Bone width and length were significantly related to body height in both sexes.


Differentiation between endogenous pyrogen and leukocytic endogenous mediator. The crude material released from glycogen-stimulated rabbit peritoneal polymorphonuclear leukocytes when administered to experimental animals elicits a number of metabolic and physiologic alterations characteristic of those observed in the host inflammatory response. Classically, the mediator of febrile response observed in rabbits and other species has been termed endogenous pyrogen (EP), whereas leukocytic endogenous mediator (LEM) has been used as a general term to denote the substance(s) mediating multiple inflammatory responses observed in rats. The latter substance, however, has not been previously demonstrated to differ from EP. This report presents evidence indicating that EP and LEM are different molecular species. Evidence supporting the differentiation between these entities includes: physical separation of EP from one or more mediators that induce metabolic alterations attributed to LEM; production  of LEM activities by stimulated polymorphonuclear leukocytes in the absence of detectable pyrogenic activity; and differences in the release of EP and LEM from stimulated rabbit granulocytes in the presence of potassium ion.


Separation of active and passive components of short-range stiffness of muscle. The short-range stiffness of smoothly but submaximally contracting isometric soleus muscles of anesthetised cats was measured by applying small fast stretches. The ratio of isometric tension to stiffness was plotted against tension over a wide range of muscle lengths and stimulus rates. The results fitted a straight line well, as predicted from crossbridge theory, showing the stiffness to be a function of tension only, independent of the combination of length and stimulus rate used to generate the tension. The major deviation from this line was attributed to incomplete fusion at low frequencies of stimulation. Values believed to be tendon compliance and crossbridge tension per unit of stiffness were found from the graph, and the tendon compliance correlated with the maximum muscle tension. Shortening the tendon by attaching nearer to the muscle changed the results in a manner consistent with the theory, provided that appropriate precautions were taken against slippage.


Sodium in smooth muscle relaxation.

Sodium in smooth muscle relaxation. The contraction of guinea-pig taenia coli due to high K+ could not be reversed by washing when Na+ was absent from the medium. Reintroduction of Na+ (7 mM or more) caused relaxation. Similar results were obtained with rat uterus. The effect of sodium replacement was not due to change in ionic strength because equal or higher osmoles of choline, Ca++, K+, Mn++, or Mg++ had little or no effect. Persistence of contraction in the Na+-free medium was not due to a "catch state" of the contractile apparatus. Impairment of Ca+ removal from the cytoplasm rather than persistent increase in Ca+ influx seemed to sustain the mechanical response. This was because D600 (a calcium influx blocker) failed to completely relax K+-induced contraction in the absence of Na+ and also because the ability of EGTA to produce relaxation was reduced in the absence of Na+. Measurement of tissue calcium content using the lanthanum method revealed coincident decrease in tissue calcium and tension to control level during Na+-mediated relaxation. The results suggest a role for transmembrane Na+-Ca++ exchange in causing the Na+-mediated relaxation of taenia undergoing Na+-free contracture.


Effect of inhibitors on transepithelial efflux of Na and nonelectrolytes in frog skin. The transepithelial efflux of Na and several nonelectrolytes (mannitol, sucrose, and polyethylene glycol 900) were measured in the isolated frog skin under short-circuited conditions in chambers that had been specially designed to avoid edge damage. Ouabain (10(-3) and 10(-4) M) caused a dramatic increase in the efflux of Na, whereas the efflux of nonelectrolytes showed only a slight alteration. The efflux of Na increased after the application of dinitrophenol (10(-4) M), whereas the efflux of nonelectrolytes remained constant. Amiloride (10(-3) M) caused large variations in the efflux of Na, whereas the efflux of nonelectrolytes remained unchanged. The results provide evidence that these inhibitors do not alter the permeability of the paracellular pathway and that the total transepithelial efflux of Na or at least a very large portion of it, and possibly also the transepithelial efflux of Cl, proceeds via a transcellular pathway and not a paracellular pathway as has been widely accepted. The data further suggest that the Na proceeding via this pathway interacts directly or indirectly with the active transport step.


Interactions of intestinal lymph flow and secretion. The relationship between lymph flow and intestinal secretion was studied in an isolated, vascularly perfused cat ileal preparation in which secretion was caused by three different means: 1) plasma dilution from a constant infusion of Tyrode solution (2.5 ml/min per kg), 2) elevation of intestinal venous pressure to 30 mmHg, and 3) exposure to cholera toxin. In the plasma-dilution group, lymph flow attained a peak value of 38 times control at 60-90 min following the onset of the infusion, after which time lymph flow progressively decreased. Concomitant to the rapid decrease in lymph flow was a rapid increase in intestinal secretion (filtration secretion). A similar pattern, i.e., a rapid increase in lymph flow followed by a progressive decrease in lymph flow and concomitant increase in filtration secretion, was observed in the venous hypertension group; however, peak lymph flow (20 X control) was observed within 10 min of the pertubation. No correlation between the onset of intestinal secretion and a decline in lymph flow was observed in the cholera toxin group.


Effect of dopamine on esophageal motor function. Intravenous administration of dopamine produced a dose-dependent decrease in lower esophageal sphincter pressure and a dose dependent increase in contractile activity of the body of the esophagus. The threshold dose of dopamine was 0.25 mug/kg, and the effect reached a plateau at about 6 mug/kg. A dose of 6 mug/kg of dopamine produced 83%+/-3 (SE) reduction in the lower esophageal sphincter pressure and 12+/-1 (SE) contractions in the body of the esophagus within 5 min of the bolus injection. Atropine, phentolamine, propranolol, and bilateral cervical vagotomy did not modify the effect of dopamine. Both haloperidol and bulbocapnine potently antagonized the effect of dopamine. The amplitude of esophageal contraction in the lower esophagus in response to pharyngeal stimulation and esiogageal distention was significantly increased after administration of haloperidol. It is concluded that intravenous administration of dopamine has potent effects on the motor function of the lower esophageal sphincter and the body of the esophagus. The effect of dopamine is not mediated via the vagal centers in the brain or cholinergic muscarinic and adrenergic receptors. The response of the smooth muscle segment of opossum esophagus to intravenous dopamine is mediated via specific dopamine receptors. The inhibitory dopamine receptors may play a physiological role in controlling the amplitude of esophageal contractions.


Patterns of plasma free fatty acid concentrations in fasted, resting dogs. Free fatty acid (FFA) concentrations were determined in arterial plasma samples obtained during short or prolonged fasts from resting, conscious adult male mongrel dogs. Arterial blood was continuously collected during experiments ranging from 2.25 to 15 h, from dogs fasted 1 or 5 days. Each continuous collection stream was divided at 45 equal intervals into separate sequential samples. In 18 experiments, no consistent pattern was found in plasma FFA concentrations: the concentrations were never constant, and fluctuations were only rarely periodic. Large, spontaneous, seemingly random level changes with amplitudes of 200-600 mueq/liter were observed in 14 experiments, that took from 1 to 8 h to complete. There was no apparent relation between these fluctuations and time of day or rectal temperature, and glucose concentrations remained unchanged during the FFA fluctuations. The inconstancy of plasma FFA levels and the irregularity of their fluctuations suggests that FFA production rates may be unregulated or only loosely regulated within a wide regulation band during the first few days of starvation. No current model of FFA metabolism preducts the observed patterns of FFA levels.


Effect of histamine on canine gastric mucosal adenylate cyclase. The effects of histamine, Nalpha-dimethylhistamine, 4,5-methylhistamine, Ntau-methylhistamine, pentagastrin, carbachol, and NaF on the adenylate cyclase activity from canine gastric mucosa were investigated in cell-free preparations. In gastric fundic mucosa, histamine (10(-4) M), Nalpha-dimethylhistamine (10(-4) M), 4,5-methylhistamine (10(-4 M), and NaF (10)-2) M) significantly (P less than 0.001) increased adenylate cyclase activity (means+/-SE) by 44.7+/-6.6, 49.4+/-6.7, 34.0+/-6.4, and 572.0+/-100%, respectively, above basal activity. The effect of histamine and Na-dimethyl histamine was dose-dependent. In contrast, other tested agents failed to stimulate the formation of cyclic AMP in gastric fundic mucosa. Metiamide (10(-4) M) blocked the stimulation of fundic mucosa adenylate cyclase by histamine and Nalpha-dimethylhistamine, without significantly altering basal and NaF-induced adenylate cyclase activity. Histamine, however, did not stimulate the adenylate cyclase activity from the gastric antral mucosa. The findings support the proposal that the canine gastric acid response to histamine may be mediated by cyclic AMP formed in response to stimulation of histamine H2-receptors.


Effect of cholecystokinin on myoelectric activity of small bowel of the dog. The effect of cholecystokinin on the myoelectric activity of the small intestine was determined in conscious dogs. Six animals were implanted with electrodes along the small intestine, and a cannula was placed in the stomach. A second cannula was inserted into the duodenum in three animals, and a pancreatic fistula was prepared in three animals. Recordings were made in the fasted state, during the intravenous infusion of either saline or cholecystokinin-octapeptide (CCK-OP), during the intraduodenal infusion of either saline or L-tryptophan, and during the fed state. CCK-OP disrupted the fasted pattern of myoelectric activity, caused a dose-dependent increase in spike potentials, and caused a dose-dependent increases in pancreatic protein secretion. Stimulation of myoelectric activity occurred at doses that produced submaximal protein secretion; however, the stimulation was not identical to that seen with feeding. Intraduodenal infusion of L-tryptophan increased pancreatic protein secretion, interrupted the fasted pattern of motility, and induced a pattern similar to that seen with feeding. We conclude that CCK alters small intestinal motility and may play a role in the changes in small-bowel motility caused by the ingestion of food.


Electrical potential profile in rabbit ileum: role of rheogenic Na transport. The electrical potential profile of rabbit ileum was investigated in vitro with the microelectrode technique. The transmural electrical potential difference (PD), designated psims, was immediately reduced by 60% upon cooling the tissue from 37 to 7 degrees C; the PD across the mucosal membrane (transmucosal PD, psimc) was simultaneously reduced by 37%. These electrical changes could not be attributed to alternations in either transmembrane ion concentration gradients or total tissue conductance. The psimc and psims may have substantial values even after the concentration gradients of Na and K across the cell membane are eliminated, provided that active transport mechanisms are still operative. Conversely, in the presence of approximately normal transmembrane ion concentration gradients, but when active transport mechanisms have been inhibited. psimc is reduced by 45% and psims is zero. These observations are consistent with a model of electrolyte transport in which psims and the normal transmembrane cation concentration gradients are established by rheogenic active transport of Na out of the cell. The psimc is generated both by rheogenic active Na transport and by cation concentration gradients which exist across the cell membrane. The Koefoed-Johnsen and Ussing model (Acta Physiol. Scand., 1958, vol. 42, p. 298) of electrolyte transport by epithelial cells does not adequately describe the electrical properties of ileum.


Partition of capillary blood flow in rumen, reticulum, and omasum of sheep. Using radioactive microspheres, mucosal and muscular capillary blood flow have been measured in the rumen, reticulum, and omasum of conscious sheep. Total forestomach capillary blood flow (7.7 ml min(-1) kg body wt(-1)) was about 7% of cardiac output; 95% of the flow was in the mucosa and only 5% in muscle layers. Blood flow in the rumen was 6 times higher than in the reticulum and 4.4 times higher than in the omasum. Mucosal capillary flow per unit area of mucosal epithelium in the omassum (disregarding the increment in area due to papillae) was only one-third of that in the ventral rumen (long papillae); flow in the dorsal rumen (short papillae) was about half the flow in the ventral rumen. Mucosal flow seems to provide a convenient, indirect estimate of the increase in mucosal surface due to papillae and, thereby, of the functional forestomach surface area. Heat stimuli resulted in decreased capillary blood flow--primarily in mucosa during exposure to a warm environment and, also, in muscle during hypothalamic or spinal cord heating.


Influence of hepatic taurine concentration on bile acid conjugation with taurine. In vitro, addition of taurine to liver homogenates increases the proportion of cholic acid conjugated with taurine. In the present study, the relation between hepatic taurine concentration and the proportion of infused sodium cholate conjugated with taurine was studied in the whole organ. The isolated perfused liver was studied to eliminate possible transfer of taurine to or from the large extrahepatic poosl present in vivo. During cholate infusion, the proportion of taurocholate excreted in bile decreased, and the proportion of glycocholate increased in a complementary fashion. Infusion of taurine with cholate prevented these changes. Hepatic taurine concentration, calculated from measured hepatic taurine concentrations before and at the end of cholate infusion, fell. Fall in proportion of total bile acid excreted as taurocholate was most rapid at low hepatic taurine concentrations between about 1.4 and 0.65 mumol/g liver. Hepatic taurine concentrations is a major determinant of the proportion of bile acid conjugated with taurine.


Abnormalities in taste preference in hypothyroid rats. Rats made hypothyroid by administration of radioactive iodine and age-matched controls were individually caged and offered a choice between either water or varying concentraions of sweet (sucrose), bitter (quinine sulfate), salty (NaCl) or sour HCl solutions to drink ad libitum for 48 h periods. Comparative measurements were made of the volume of test solution consumed to that of total volume consumed and were expressed as taste preferences. Throughout a wide range of concentrations, taste preferences for sucrose were significantly lower (P less than 0.001) and those for quinine sulfate and NaCl significantly higher (P less than 0.001) in hypothyroid animals than in controls. Taste preferences for HCl were generally similar in both groups. Daily intraperitoneal injections of thyroxine, 10 mug/100 g body wt. to hypothyroid rats for 18-24 days eliminated completely the difference between hypothyroid and control rats in taste preference for quinine sulfate. These studies show that significant and reversible changes in taste preferences occur in rats rendered hypothyroid with radioactive iodine.


Effect of serotonin treatment on intestinal transport in the rabbit. The hormone serotonin (5-hydroxytryptamine) has been implicated as the cause of the diarrhea seen in many patients with the carcinoid syndrome. To determine whether serotonin is an intestinal secretagogue, the effect of serotonin on intestinal water and electrolyte transport was evaluated in the rabbit. Two weeks of daily subcutaneous injection of serotonin suspended in oil resulted in a blood serotonin level elevated to twice that of controls. Intestinal transport was studied in vivo by a perfusion technique. Serotonin treatment resulted in ileal secretion and decreased mid-jejunal absorption of water and electrolytes but did not effect water absorption in the proximal jejunum or colon. Intestinal absorption of D-glucose and the amino acid L-tryptophan and glucose-dependent water and electrolyte absorption were normal in serotonin-treated animals. Serotonin-induced ileal secretion was reversed by methysergide, a peripheral antagonist of serotonin action. No alterations in intestinal histology or permeability occurred in serotonin-treated animals. Serotonin-induced intestinal secretion was not associated with alterations in the activities of intestinal mucosal adenylate cyclase, cyclic nucleotide phosphodiesterase, or Na-K-ATPase.


Effect of acute unilateral renal denervation on tubular sodium reabsorption in the dog. The effects of acute denervation of the kidney on renal tubular sodium and water excretion were studied in anesthetized, hypophysectomized, and cortisone-treated mongrel dogs during stable water diuresis produced by the infusion of 2.5% dextrose. In all experiments, denervation natriuresis, and diuresis were observed without significant change in glomerular filtration rate (GRF) and renal plasma flow (RPF). Fractional sodium delivery to the distal nephron (CNa + CH2O/100 ml GFR) and fractional free water clearance (CH23/100 ml GFR) was significantly greater in the denervated kidney compared with the innervated kidney (9.6+/-1.2 vs. 6.7+/-0.9% and 8.8+/-1.2 vs. 6.5+/-0.8%, respectively). Distal tubular sodium reabsorption (CH2O/(CNa + CH2O)) was not significantly different. We conclude that renal denervation primarily affects the proximal tubule as manifested by a decrease in the reabsorption of sodium and water. A small effect of denervation on the distal nephron is not completely ruled out.


Urinary acidification: CO2 transport by the rabbit proximal straight tubule. Proximal straight tubules from rabbit kidneys were perfused in vitro in order to study transport of bicarbonate. Total CO2 content was measured in perfused and collected tubule fluid, using microcalorimetry. When the initial perfusate and bath contained 25 mM bicarbonate, the concentration of total CO2 decreased in the collected tubule fluid, indicating net reabsorption of bicarbonate. When the initial perfusate contained no bicarbonate and the bath contained 25 mM bicarbonate, total CO2 appeared in the collected tubule fluid. The rate at which total CO2 appeared in the tubule fluid was rapid, indicating a high permeability. Proximal straight tubules from superficial and juxtamedullary nephrons were compared and found to differ in permeability to CO2 and in transport rate. This functional heterogeneity may affect urinary acidification when there is redistribution of renal blood flow.


Acute unilateral renal denervation in rats with extracellular volume expansion. Sodium reabsorption along the nephron was studied before and after acute unilateral denervation of the left kidney in anesthetized rats with extracellular volume expansion. Studies were also performed before and after sham denervation. Denervation increased urine volume (V) from the left kidney from 35.2 to 59.2 mul min-1 (P less than 0.001) and urinary sodium excretion (UNaV) from 6.9 to 11.8 mueq min-1 (P less than 0.001). The control right kidney showed a simultaneous 45% decrease in V and UNaV. Inulin clearance (GFR) and renal plasma flow (RPF) remained unchanged after denervation in both kidneys. Left kidney late proximal (F/P)m decreased from 1.50 to 1.24 (P less than 0.01); single-nephron GFR (SNGFR) remained unchanged. (F/P)m ratios were also decreased in early distal (3.87-2.65, P less than 0.005) and late distal (5.48-3.83, P less than 0.02) convolutions. Fractional and absolute Na reabsorption in the distal convolution did not decrease. GFR, RPF, V, UNa, late proximal (F/P)m, and SNGFR were unchanged in sham-denervated rats. The increases in V and UNa V produced by acute renal denervation in the volume-expanded anesthetized animal are thus caused by further depression of proximal tubular salt and water reabsorption.


Role of calcium in bone maturation arrest after thyroparathyroidectomy in the rat. Thyroparathyroidectomy in the rat results in decreased plasma calcium and magnesium and increased phosphorus. The associated bone changes are decreased calcium, hydroxyproline, carbonate, and wholebone density. Bone magnesium, sodium, mineral density, and percent crystallinity are increased. The delayed matrix formation and mineralization previously identified by histologic techniques are herein characterized by direct measurement as arrest of the normal increase of hydroxyproline/matrix and percent mineral. The bone mineral present is of high density and x-ray-diffraction crystallinity, suggesting a decrease in the mineralization front high in the amorphous phase and/or small nondiffracting crystalloids. The chemical studies reveal that in the absence of available Ca, Mg and Na are substituted, and CO3 is decreased. The restoration of these plasma and bone abnormalities to normal by a diet high in CaCO3 adds further emphasis to the essential role of Ca in bone cell function.


Effect of hypotonic medium on K and Na content of proximal renal tubules. The intracellular content of K and Na was measured in isolated nonperfused proximal straight renal tubules (PST) in order to determine the mode of cell volume regulation in hypotonic bathing media. Immersion in hypotonic medium caused PST to lose K and Na (with anions) in a magnitude sufficient to account for the regulation of cell volume. Hypothermia (10 degrees C) blocked cell volume regulation in hypotonic medium by promoting net accumulation of Na, although K loss was equivalent to that observed at 37 degrees C. Ouabain (10(-5) M) caused rapid loss of cell K and gain of Na in an isotonic bath, but the glycoside did not inhibit the subsequent adjustment of cell volume in hypotonic medium. In hypotonic medium ouabain-treated tubules lost Na, but not K, to account for hypotonic volume adjustment of PST in ouabain. We conclude that proximal straight tubules extrude electrolytes (K, Na, and anions) in the adjustment of cell volume in hypotonic media; in normal tubules K and Na are lost whereas Na moves primarily in ouabain-treated tubules. The adjustment of size through the extrusion of intracellular solutes in dilutional states appears to be a general property of mammalian cells.


Permeability of the rabbit colon in vitro. The rabbit colon, in vitro as everted-sac or diaphragm preparations, exhibits a transmural PD, as high as 70 mV, a short-circuit current (SCC) of 100 to 150 muA cm-3 and a resistance of 300-500 omega-cm2. It maintains these functions for at least 3 h. The SCC can be abolished by amiloride or increased by amphotericin B. Na, Cl, and K flux measurements showed a net influx (mucosa to serosa) of Na and a net efflux of K. The SCC can be accounted for by the movements of these ions. The SCC in the presence of amphotericin B was nearly equivalent to the net Na flux. Amiloride abolished the net Na transfer but did not ht (Ktrnas X 10(7)) for water was 5,000 cm s-1 while that for urea was 26 cm s-1. The rabbit provides a viable pn and the present observations appear to be consistent with its physiological role.


Dynamics of glomerular ultrafiltration. IX. Effects of plasma protein concentration. Experiments were carried out on 42 Munich-Wistar rats with surface glomeruli accessible to micropuncture to investigate the effects of reduction in systemic plasma protein concentration. CA, and thus afferent oncotic pressure, IIA, on the determinants of glomerular ultrafiltration. In animals in which CA was reduced by a variety of maneuvers, observed values for single-nephron GFR were lower than values predicted by the Starling relation, when the latter were calculated assuming that the observed increase in the net driving pressure for ultrafiltration (due to the reduction in IIA) was the only factor perturbed. In all experimental conditions where CA was reduced, rats were invariably observed to be at filtration pressure disequilibrium, permitting calculation of unique values of the ultrafiltration coefficient, Kt. In all low-CA groups, mean values of Kf were uniformly lower than values obtainedin normoproteinemic control animals. The failure of SNGFR to rise to predicted values when CA is reduced is therefore due to the concomitant reduction in Kf. No morphological basis for this reduction in Kf was discerned.


A single-injection method for measuring glomerular filtration rate. A method for estimating glomerular filtration rate (GFR) has been developed that is based on an analysis of the total area under  the plasma radioactivity-time curve after a single intravenous injection of [125I]iothalamate. Glomerular filtration rates obtained by this method (method A) and those obtained with two widely used single-injection techniques, the slope-intercept method (method B), and the two-compartment method (method C), were compared with GFRs obtained by standard inulin clearance techniques in 14 dogs. Method B consistently over. estimated inulin clearances more than 30%. Method C also overestimated inulin clearance considerably in dogs with an increased extracellular fluid volume, but was fairly reliable in normal dogs. Glomerular filtration rates obtained by the new method (method A) were in excellent agreement with inulin clearances in all dogs, regardless of the state of body hydration. The mean inulin clearance for all 14 experiments was 72.7+/-6.0 SE ml/min, while GFRs obtained by method A averaged 75.1+/-6.0 ml/min. The data from this study suggest that method A is a reliable means for estimating GFR that is especially useful in chronic experiments.


Estrogen and prothrombin synthesis: effect of estrogen on absorption of vitamin K1. Intact male and female albino rats fed a vitamin K-deficient diet develop a plasma prothrombin-proconvertin deficiency. Male rats respond with a precipitous drop to approximately 20-30% of normal plasma levels within 2-5 days, whereas female rats respond at a slower rate. Ethynylestradiol, 5-10 mug/day, or castration, reduces the progressive decline of plasma prothrombin-proconvertin seen in nonsupplemented intact male rats. The response of castrate females differs little from the response of intact females. Ethynylestradiol, 5-10 mug/day, affects both castrate males and females similarly, limiting the prothrombin-proconvertin decrease to about 13% below control value after 14 days. Intestinal absorption of vitamin K1 measured in the thoracic duct lymph of pentobarbital-anesthetized castrate male and female rats was shown to increase significantly after estrogen treatment. Estrogen-treated castrate male and female rats absorbed 25.8 mug and 11.8 mug vitamin K1, respectively. Nontreated control castrate male and female rats absorbed 0.0 mug and 1.2 mug, respectively, during a 240-min collection period. Use of radioactive vitamin K1 in similar experiments confirmed these results. Estrogen-treated castrate males absorbed vitamin K1 at the rate of 30-40 mug/g lymph whereas nontreated control males absorbed only about 6 mug/g lymph.


Adrenergic receptors regulating patterns of blood flow through the gills of trout. A technique of perfusing the isolated head of trout with a constant-fluid flow was used to study adrenergic factors controlling the vasomotricity of the gill. The use of adrenergic blockers (phentolamine 10(-4) M and propranolol 10(-4) M) enabled the vascular effect of epinephrine to be split into two components: an alpha-vasoconstrictor effect superimposed upon the dominant beta-vasodilator effect. Effect alpha appears more rapidly than effect beta and causes an initial vasoconstriction. Under constant-flow perfusion the effect of epinephrine on the efferent arterial and venous flows is a diminution of the venous flow and an increase of the arterial. This is the result of closure of the anastomoses between the efferent artery and the central compartment of the filament. It was shown that only alpha-vasoconstrictor adrenoreceptors occur in this region.


Electrophysiological and anatomical observations on the heart of the African lungfish. Electrophysiological and histological observations were made on the heart of the African lungfish. Impulse origin and propagation were studied using simultaneously recorded epicardial and pericardial electrograms. The primary pacemaker site in the lungfish was found to be at the sinus venosus at its junction with the left cardinal vein. Under a variety of circumstances, pacemaker function shifted to other sites. In response to stress, probably under vagal influence, the regular and rapid sinus venosus rate was generally superseded by an irregular and slower atrial pacemaker. Heart rate and sinoatrial and atrioventricular conduction times varied with changes in temperature [Q10=3.77, 2.55, and 5.46, respectively]. Although alterations in impulse formation and conduction did occur, the site of impulse formation and the patterns of conduction between heart chambers were usually fixed, implying the existence of an organized conduction system. Nonetheless, extensive histological study failed to disclose either organized nodal structures or specialized conduction pathways.


Effects of intravenous anesthetic agents on left ventricular function in dogs. The cardiovascular effects of ketamine hydrochloride and thiopental sodium were studied in 11 dogs. During anesthesia, mean heart rate rose to 185 beats/min with ketamine and 147 beats/min with thiopental. Cardiac output was increased with ketamine but unchanged by thiopental. The maximum first derivative of the left ventricular pressure (dP/dt max) fell by 14% with thiopental but did not change significantly with ketamine. Propranolol resulted in attenuation of the tachycardia and a fall of 10% in dP/dt max with ketamine but had little effect on the response to thiopental. Phentolamine had no consistent effects on either drug. With pentolinium both drugs decreased dP/dt max. Intracoronary injection of ketamine decreased dP/dt max. Adrenalectomy had little effect on the responses to either anesthetic. The results lead to the conclusion that both ketamine and thiopental have myocardial depressant effects, but, whereas thiopental does not alter sympathetic tone, the depressive effects of ketamine are obscured by stimulation of cardiac sympathetic nerves.


Effects of atrial pacing on regional myocardial gas tensions with critical coronary stenosis. Changes in myocardial carbon dioxide (PmCO2) and oxygen tension (PmO2) measured by mass spectrometry have been shown to reflect quantitatively progressive degrees of regional myocardial ischemia associated with stepwise reduction in coronary blood flow. The present study utilized mass spectrometry to assess the severity of regional myocardial ischemia developing during atrial pacing in the presence of a flow-limiting proximal critical coronary artend subendocardial layers was measured by the radioactive microsphere technique. Application of a "critical stenosis" resulted in a 6-mmHg decrease in PmO2 and a 17-mmHg increase in PmCO2 in the region of the myocardium supplied by the stenosed vessel. The addition of atrial pacing resulted in a 3-mmHg further decrease in Pmo2 and a 40-mmHg further increase in PmCO2. In the region of myocardium supplied by the critically stenosed vessel MBF increased in the subepicardial layer, but decreased or remained unchanged in the subendocardial layer. The failure of myocardial blood flow to increase in deeper myocardial layers in response to the increased myocardial oxygen demand of atrial pacing would provide a mechanism for the development of subendocardial ischemia in the presence of a critical coronary stenosis.


Measurement of intrarenal anatomic distribution of krypton-85 in endotoxic shock in dogs. Renal blood flow distribution was measured in control dogs and dogs in endotoxic shock by utilizing a modification of 85Kr washout. Kidneys, injected with 85Kr via a renal arterial cannula, were removed at several specific intervals after injection, rapidly frozen, and sectioned transversely so that pieces of tissue could be isolated and counted for radioactivity. Control outer cortical blood flow was 462 ml/min per 100 g tissue wt, but 122 ml/min per 100 g during shock. Control inner cortical outer medullary flow was 396 ml/min per 100 g, but 166 ml/min per 100 g in shock. Control flow in the inner stripe of the outer zone of the medulla was 130 ml/min per 100 g and 134 ml/min per 100 g in shock. In shock the initial volume of radioactivity distributed to outer cortex was smaller, to inner cortex the same, and to inner stripe outer zone of the medulla larger than in controls. This study delineates renal washout of 85Kr from specific areas of the kidney and indicates the alterations in extent and magnitude of this washout in endotoxic shock.


Blood reservoir function of dog spleen, liver, and intestine. The reflex decrease in blood volume of the spleen, the liver, and the intestine of vagotomized dogs was measured by plethysmographic techniques during bilateral carotid occlusion and moderate and severe hemorrhage. The volume of blood mobilized from each organ during carotid occlusion and moderate hemorrhage was from 6 to 30% of their respective blood volumes and from 55 to 81% during severe hemorrhage. In each experimental situation the spleen exhibited the greatest ability to release blood and the intestine, the least. During moderate hemorrhage (9 ml/kg) the spleen yielded a volume equal to 35% of the blood lost, the liver 14% and the intestine 7%. Comparable figures for severe hemorrhage were 26, 13, and 5%, respectively. This order of ranking the component regions of the splanchnic circulation with regard to function as a blood reservoir may be specific for the dog.


Potassium exchange and mechanical performance in anoxic mammalian myocardium. Mechanical performance and 42K exchange were studied during anoxia in isoalted, arterially perfused, interventricular rabbit septa at 42 beats/min and 28 degree C. The septa were perfused at 1.8 ml/min per g with a modified Tyrode solution having dextrose as the metabolic substrate. Developed tension declined to 16% of preanoxic control values during 60 min of anoxia, and returned to 65% of control during a 60-70 min recovery. Anoxia induced net potassium losses of 31+/-2, 53+/-2, and 90+/-14 mmol K+/kg dry tissue (means+/-SE) during 20, 40, and 60 min of anoxic stresses, determined by tissue probe analysis after asymptotic labeling. Potassium losses attributed to increased efflux of the ion from the cells during 20, 40, and 60 min of anoxia were determined from effluent analyses to be 32+/-4, 60+/-6, and 98+/-11 mmol K+/kg dry wt. Potassium loss began within seconds of the onset of anoxia and reoxygenation immedaitely reversed the potassium loss. These data indicate that 1) function of the membrane Na-K pump is maintained through 60 min of anoxia with the entire net potassium loss attributable to increased efflux from the cells, 2) anoxia decreases the rate of exchange of potassium after recovery, and 3) the cell membrane appears to be the rate-limiting site of potassium efflux during anoxia.


Construction of hydraulic cuff occluders for blood vessels. This report describes the construction technique for a simple and inexpensive cuff occluder for various size blood vessels. The occluder is made from polyvinyl chloride tubing and consist of two main parts, the balloon and catheter section, and the reinforcing back section. The occluders have functioned reliably in chronic dog preparations for up to 3 mo.


Thermoregulatory responses to altering hypothalamic temperature in the harbor seal. The rostral brainstem of the harbor seal Phoca vitulina was cooled and heated 33-41 degrees C while oxygen consumption and rectal, hypothalamic, flipper and dorsal skin temperatures were measured. These experiments were made on restrained seals at ambient temperatures -15 to 30 degrees C. Cooling the preoptic and hypothalamic (POH) tissue increased oxygen consumption in a way that could be approximated by a linear regression line with slope and threshold temperature at which the metabolic rate was minimal. The slope of the regression line was a function of ambient temperature and rectal temperature. At each ambient temperature, the slope was significantly higher for lower rectal temperature. At all rectal temperatures, the slope was significantly higher for lower ambient temperature. The threshold hypothalamic temperatures did not very consistently or significantly with either rectal temperature or ambient temperature. These results on the harbor seal are explicable by suggesting that the thermal-sensitive and reference neurons in the POH which regulate body temperature are inhibited equally by extrahypothalamic cold transducing neural elements.


On measurement of brain elastic response in vivo. The elastic response behavior of brain tissue in vivo has been shown to be sensitive to the physiological environment of the brain and thus represents a useful parameter for identifying effects of controlled changes on the system. Here we describe a method for measuring brain elastic response using an epidural pressure-depth transducer and a minimum number of insertions. The method also serves to identify the nonlinear response of brain tissue.


Exercise, dietary obesity, and growth in the rat. Four regimens: high-fat diet, exercised (I); chow, exercised (II); high-fat sedentary (III); and chow, sedentary (IV) were initiated in 35-day-old male rats. Growth was exponential in I and II and exponential progressing to rectilinear in III and IV. The exponential model predicted the decreasing rank order in asymptotic weight to be: III, IV, I, II. Body composition data (9 components) showed rank order in masses of fat and the fat-free body mass compartment (FFBM) to be the same as for asymptotic live weight. The rectilinear growth mode probably reflected fat accretion. High-fat diet increased and treadmill exercise decreased FFBM, the latter being reversible. These effects depended on regimen initiations by the 5-7th wk of age. During growth, masses of H2O, muscle, and skin increased as functions of body size; bone as a function of age; and heart, liver, gut, testevity, and diet. Growth in body size was expressed more precisely with FFBM, instead of live weight, as the index of size.


CNS, CSF, and extradural fluid uptake of various hydrophilic materials in the dogfish. The distribution of 10 radioactively labeled materials from blood to CSF, extradural fluid (EDF), telencephalon (cerebrum), medulla, and spinal cord was studied in the dogfish shark. Plasma volumes, blood flows, and blood-to-tissue or fluid-transfer half-times (t1/2) were calculated from these distribution data. Blood-EDF exchange occurred at slow but similar rates for all tracers. Urea uptake by the CSF was very rapid compared to that of the other compounds and may be facilitated by a special mechanism. The tissue plasma spaces of all three CNS regions were small (1.1-1.5%). The calculated rates of tissue blood flow (in ml/g-min) were 0.11 for telencephalon and medulla and 0.055 for spinal cord. Choroid plexus blood flow was estimated to be 2.3 ml/g-min, a surprisingly high rate. Transport between blood and tissue was most rapid for water ethylene glycol and slowest for inulin. The tissue t1/2's of urea indicated that a significant portion of this compound's net uptake by periventricaul brain tissue occurred via the CSF.


Glucose turnover in kelp bass (Paralabrax sp.): in vivo studies with [6-3H,6-14C]glucose. [6-3H,6-14C]glucose was injected via an indwelling arterial cannula in free-swimming, fed, and fasted kelp bass to determine hepatic glucose production, peripheral glucose uptake, minimal glucose mass, mean transit time, and the percent of carbon recycling under the two different nutritional states. Mean plasma glucose levels remained unchanged in fed and fasted fish (48+/-8 vs. 43+/-8 mg/100 ml). During steady-state conditions, glucose replacement rates of fed and fasted fish determined with [6-3H]glucose are similar (0.035+/-0.006 vs. 0.025+/-0.003 mg/min per 100 g) and do not differ from rates determined with [6-14C]glucose (0.035+/-0.005 vs. 0.026+/-0.002). The minimal glucose masses and the mean transit tim-s determined with both isotopes are also similar suggesting that plasma glucose levels and glucose turnover are maintained in fish fasted up to 40 days with no apparent increase in carbon recycling. Nonsteady-state isotope experiments suggest that these fish can alter rates of hepatic glucose production and peripheral uptake in response to hyper- and hypoglycemia.


Psychiatric peer review: the Washington, D.C., experience, 1972-1975. The authors describe the method by which claims review for psychiatric practice is carried out by an APA district branch peer review committee in the Washington, D.C., metropolitan area and analyze the claims reviews handled by the committee from 1972 through 1975. On the basis of their findings they conclude that peer review of psychiatric treatment can be carried out in a medical framework, that it can have some effect in diminishing costs incurred by improper utilization or by abuses, and that it can improve the quality of psychiatric practice.


The relationship of psychiatry to primary care. Although it is not officially considered a primary care specialty, psychiatry is intimately related to training and practice in fields that are so designated. The primary care physician must have expertise in interviewing, counseling, psychophysiological disease, dependence syndromes, etc.--all areas in which psychiatry has a body of knowledge and intervention techniques. It is recommended that all primary care training programs develop behavioral objectives in the areas of mental illness and psychosocial aspects of disease; active liaison and consultation with departments of psychiatry should be an integral part of these programs. The author presents suggestions for possible program design and notes that the relationship between psychiatry and primary care specialties is a continuing challenge to the field.


Patients' attitudes toward behavior therapy and psychotherapy. A questionnaire survey of 50 patients treated by behavior therapy or short-term, analytically oriented psychotherapy revealed that both groups, as well as those patients who improved the most, placed a high value on insight, the patient-therapist relationship, catharsis, and trust. The findings suggest that behavior therapy patients tend to place more emphasis than do their therapists on factors that have traditionally been thought important in analytic psychotherapy.


gamma-Aminobutyric acid (Gaba) and the dopamine hypothesis of schizophrenia. gamma-Aminobutyric acid (Gaba) has been shown to influence dopamine activity in the brain. The author suggests that Gaba could be involved in the hypothesized dopamine hyperactivity in schizophrenia. He discusses pharmacological interventions that may raise Gaba-mediated function in the brain and states that further development of Gaba analogues seems clearly indicated. It is conceivable, he concludes, that these compounds could enhance the antipsychotic activity of dopamine receptor blockers, which could lead to the use of lower doses and therefore fewer extrapyramidal side effects.


Thiazide-lithium synergy in refractory mood swings. The unfortunate experience with lithium chloride as a salt substitute in the 1940s still directs the clinical usuage of lithium carbonate to a certain extent. We are still warned that lithium salts should never be used in low-sodium situations (e.g., with thiazide diuretics or salt-restricted diets); however, it has recently been shown that thiazide diuretics may be safely used in the treatment of lithium-induced nephrogenic diabetes insipidus (NDI). The authors recapitulate the dangers inherent in the use of this drug combination and present detailed clinical-pharmacologic data on 13 patients which suggest that thiazides are useful in the treatment of lithium-induced NDI and may actually synergize with lithium to produce improved mood control in some lithium-refractory manic-depressive patients.


Children's rights on entering therapeutic institutions. The authors delineate aspects of adolescent psychological development that should be considered in decisions regarding psychiatric residential treatment, reviewing the issue of consent to treatment in the context of developmental psychology. They state that rather than jettisoning the whole system of placing treatable disturbed young people in residential facilities without their explicit consent, the court should take as its proper role to ensure that adolescents placed in residential psychiatric facilities receive adequate treatment.


The treatment of drug abuse: evolution of a perspective. Current approaches to the treatment of drug addiction are based on an earlier approach derived from a traditional psychoanalytic framework. The author describes how this framework has been modified by three broad areas of understanding, i.e., issues related to addicts, to the methods of psychoanalysis, and to the earlier incomplete understanding about drugs. The comprehensive, multimodality treatment approach used today draws on psychoanalysis's contribution of a rational framework for the understanding of personal behavior in all forms of treatment and the need for a relationship as the core of all treatment, regardless of the modality.


Current social stressors and symptoms of depression. The author explores the relationship of current social stressors (cirumstances of daily social roles that are generally considered problematic or undesirable) to depressive symptoms. Subjects were 2,299 adults aged 18-65 in the Chicago area. Over a fourth of the variance in depressive symptoms is accounted for by five social stressors. Depression is most closely related to the social stressors of marriage and parenting, and symptoms increase proportionately to the total number of stress areas. These data suggest that a focus on intervention and prevention in areas of family and marital life is desirable.


Depression in veterans two years after Viet Nam. The authors evaluated the incidence of depression in a sample of 202 Viet Nam veterans an average of 28 months after their return from Viet Nam. Approximately one-third of the sample fell within the clinically depressed range of the Beck Depression Inventory. Comparison of the depressed and nondepressed groups indicated that the former had higher frequencies of drug abuse (particularly while in Viet Nam), more marital difficulties, a higher unemployment rate, and more current legal problems. This high incidence of depression, coupled with the finding that few of these men were being treated for the illness, indicates the need for an outreach approach to this population.


Impact of dramatized television entertainment on adult males. The authors studied the effects of a week's viewing of five types of television programs, including those with predominantly helpful or hurtful content, on the aggressive mood and hurtful behavior of adult men. They found, within the population studied, a significant decrease in aggressive mood and lower levels of hurtful behavior in viewers of helpful programs as compared with a control group, as well as some evidence that emotional arousal in response to helpful programs is negatively correlated with aggressive mood.


Suicide by vehicular crash.

Suicide by vehicular crash. The authors evaluated data on 182 fatally injured and 96 nonfatally injured drivers involved in vehicular crashes over a 6-year period. Only 1.7% of the total fatal crashes were considered to have been suicides, and 1% of the nonfatal crashes were deemed suicide attempts. Neither group of drivers had unusually high incidences of previous suicidal ideation or behavior, but both groups tended to be socially deviant, with above average levels of psychopathology and social aggressiveness. Crash victims in both groups also had poor driving records and high rates of alcohol abuse, findings that have important implications for accident prevention.


Childless by choice: a clinical study.

Childless by choice: a clinical study. The authors report on a longitudinal study that involved the interviewing and testing of 33 young women volunteers who chose either contraception (N=18) or tubal ligation (N=15) to achieve infertility. They found that for these women the choice to be childless was multidetermined, persistent over time, and ego-syntonic. Comparison with other samples of women indicate that this is a distinct and nontraditional population.


Peer review and professional ethics.

Peer review and professional ethics. The author points out that the medical profession, fiscal intermediaries, and government agencies have not fully informed the public of the nature and extent of peer review. He provides guidelines for physicians and committees of peers participating in peer review and suggests that review of professional ethics be incorporated into the review of the quality, cost, quantity, and availability of medical services.


In vivo inhibition of platelet MAO activity by tricyclic antidepressants. Platelet MAO activity decreased by 40% (p less than .001) in a group of 11 male patients with primary depression after 3 weeks of treatment with either amitriptyline or imipramine. This finding, together with data from previous in vitro studies demonstrating tricyclic-induced inhibition of mitochondrial MAO, suggests that inhibition of MAO plays a role in the clinical action of tricyclic antidepressant drugs.


Parkinson's disease, depression, and ECT: a review and case study. The author reviews the association between Parkinson's disease and depression and presents evidence to support the hypothesis that depression may be not only reactive but biochemically related to the disease. A psychotically depressed patient with parkinsonism responded positively to ECT as shown by improvement on a depression rating scale, two extrapyramidal rating scales, and handwriting samples. The beneficial effect on parkinsonian signs occurred before the improvement in depression, which suggests that ECT has a specific antiparkinsonian effect. Possible explanations for this observation based on biochemical theories of depression are discussed.