Management of the patient with renovascular hypertension. Renal artery stenosis, either fibromuscular or atheromatous, is probably the most common cause of secondary hypertension in man. Both of these diseases are active, ongoing processes that may be ameliorated but not cured by medical or surgical treatment. The clinical history and examination of the patient with hypertension may help differentiate renovascular hypertension from essential hypertension. The presence of a systolic-diastolic or continuous bruit is often an indicator of severe renal artery stenosis. Systemic hypertension is the physiologic consequence of significant renal artery stenosis. Knowledge of the basic concepts of the renin-angiotensin-aldosterone system, as has evolved from experimental models of renovascular hypertension, forms the basis for understanding the process of evaluation and treatment of such patients. The treatment of choice for the patient with severe hypertension and a functionally significant renovascular lesion is surgical--both in terms of successful treatment of hypertension and improved long-term prognosis. Diligent periodic reevaluation of these patients as well as those with less severe hypertension who are receiving medical treatment enables the physician to select the proper management that offers optimal control of patient blood pressure and avoids target-organ damage to the kidneys, central nervous system, or cardiovascular system.


Survey of need for industrial hygienists. Grass roots surveys of the need for industrial hygienists, areas of specialization, and related subjects can fill a real void in currently available information. AIHA local sections and other professional groups may wish to conduct regional studies similar to the one described here. A pooling of results by reporting to their national organizations would be beneficial to all in the profession.


Experience with a high output sulfuric acid aerosol generator. Experience with a high output sulfuric acid aerosol generator suitable for large chamber exposure studies is described. Sulfuric acid aerosol is produced by combining sulfur trioxide (SO3)(g) vapor with water vapor in the exposure chamber air supply. The mass output of the generator is stable over long periods, and the mass median aerodynamic diameter of the aerosol produced is in the submicron size range (0.3-0.6 micrometer).


Respirator cartridge service lives for exposure to vinyl chloride. Respirator cartridge service lives (1 ppm breakthrough) were determined for low level (approximately 10 ppm) exposures to vinyl chloride using simple apparatus and an infrared spectrophotometer. Two classes of organic vapor cartridges were tested; six brands which received approval from MESA-NIOSH before July 15, 1975 ahd two brands which were not approved but were available through local safety supply outlets on that date. Cartidges were tested both as they came from the supplier and after being preconditioned for 6 hours. Effects of insult concentration, preconditioning, and absorbent weight were investigated. No cartridge service life exceeded 1 hour; many did not provide protection for even 30 minutes. As a result, the use of cartridge containing half mask respirators for vinyl chloride exposure should be questioned.


Comparison of recommended respirable mass dust sampling devices. The draft, "Revised Guide for Respirable Mass Sampling," prepared by the AIHA-ACGIH Aerosol Hazards Committee, recommends five respirable mass sampling devices that sample in accordance with the "Los Alamos" respirable dust criterion. The spectrum of recommended sampling rates for these devices ranges from 1.8 to 430. liters per minute. A study was conducted to determine if simultaneous measurements with these devices yielded comparable respirable mass concentrations. The penetration characteristics of the first stage separators were also evaluated and compared.


Odor detection and respirator cartridge replacement. If the odor threshold of a compound is greater than its TLV, overexposure of a respirator user is possible since breakthrough may not be detected. Odor threshold data are assembled for a number of different materials and compared to their TLV's. Use practices are recommended for chemical cartidge respirators for various grouping of compounds, based on their odor threshold to TLV ratio.


Collaborative testing of a gas chromatographic charcoal tube method for seven organic solvents. The National Institute for Occupational Safety and Health has undertaken a program to provide reliable sampling and analytical methods for a number of industrial hygiene uses. Recommendation of methods to the Department of Labor for compliance testing and inclusion of methods in critera for Recommended Standards for Occupational Exposures are two prime areas of utilization. This paper presents the results of our initial efforts in collaborative testing. The method is a charcal tube sampling procedure and a gas chromatographic analytical technique. Samples of seven single component solvents which included benzene, carbon tetrachloride, chloroform, dioxane, ethylene dichloride, trichloroethylene, and xylene along with two solvent mixtures which consisted of a benzene-xylene combination and an ethylene dichloride-trichloroethylene conbination were tested in two phases by 15 participating laboratories. The data analysis indicates the overalll error associated with the method and identifies sources of error within each segment of the method.


Trace metal contamination of evacuated blood collection tubes. A study was undertaken to investigate the magnitude of potential trace metal contamination contributed by various commercial evacuated blood tubes to blood samples under experimental conditions. None of the tubes tested contributed significant Cu contamination whereas the 1% nitric acid and human blood leaching data clearly indicate that Zn, Pb and Cd contamination of blood samples can be a significant problem with certain blood collection tubes under normal handling, shipping and storage conditions. The implications of these experimental findings are discussed. It is recommended that several of the evacuated blood tubes be leach tested prior to use with blood or plasma and the eluate analyzed for potential trace metal contamination problems.


Electrophysiologic effects of anterior septal arterial occlusion. The effect of reduction in anterior septal arterial flow on the conduction system was studied in seven anesthetized dogs. After 2 hours of occlusion P-Q, A-H, and H-V intervals as well as atrioventricular nodal effective and functional refractory periods were significantly prolonged, sinoatrial conduction time was prolonged and the heart rate was decreased. The duration of the His bundle electrogram was significantly prolonged and the configuration altered. However, QRS duration did not prolong significantly. Fifteen minutes after reperfusion, A-H interval, duration of the His bundle electrogram, effective refractory period and functional refractory period returned toward control values. However, the H-V and QRS intervals as well as sinoatrial conduction time were unchanged after reperfusion. Thus, reduction of anterior septal arterial flow influences not only the distal but also the proximal portion of the conduction system; the most vulnerable part is probably the His bundle. The distal portion of the conduction system is directly influenced by ischemia itself, whereas the proximal portion is influenced through other mechanisms induced by reduction of anterior septal arterial flow.


End-systolic pressure/volume ratio: a new index of ventricular contractility. A thesis recently developed from a series of experiments on the isolated canine left ventricle is described. It is claimed that the ventricular presure/volume ratio at end-systole is relatively insensitive to cardiac loading and varies greatly in response to changes in ventricular contractility. The clinical viability of this basic finding rests on the substitution of diameter for volume in this formulation. Diameter can be measured using a noninvasive ultrasonic technique in the clinic. Accordingly, end-systolic pressure/diameter ratio was studied in the isolated preparation and found to be similarly insensitive to loading conditions and sensitive to inotropic interventions. A further analysis of the pressure/diameter ratio in the ventricle of the conscious dog is in progress. In parallel with these studies, use of the pressure/diameter ratio to evaluate contractility in cardiac patients is being tested. The preliminary findings from conscious dogs and clinic patients are briefly discussed.


Echocardiographic assessment of the relation between left ventricular wall and cavity dimensions and peak systolic pressure in children with aortic stenosis. Echocardiographic measurements of the left ventricular end diastolic minor axis and posterior and septal wall thickness were obtained in 19 children with congenital aortic stenosis with left ventricular peak systolic pressures ranging from 110 to 225 mm Hg at cardiac catheterization. From these measurements were derived (1) the left ventricular peak circumferential wall stress, (2)the end-diastolic h/r ratio (that is, mean of septal and posterior wall thickness (h) to minor semiaxis (r) ratio), and (3) the LVM/LVV ratio (that is, left ventricular mass (LVM) to left ventricular end-diastolic volume (LVV) ratio). The peak stress was found to be within the normal range and independent of the left ventricular peak systolic pressure. The end-diastolic h/r and LVM/LVV ratios had highly significant linear relations to the left ventricular peak systolic pressure. It is concluded that these easily determined echocardiographic measurements provide a useful noninvasive means of assessing left ventricular peak systolic pressure in patients with aortic stenosis without myocardial decompensation.


Development of the pulmonary circulation in ventricular septal defect: a quantitative structural study. The application of quantitative morphometric techniques to evaluation of the lungs of nine children who died with a ventricular septal defect between the ages of 3 months and 4 years showed that the presence of pulmonary hypertension interferes with the growth and development of the pulmonary circulation. In all cases the preacinar arteries were of normal size and not dilated, and arterial size and number within the acinus were reduced and similar to those seen in the normal child at birth. Arterial and venous muscularity was increased as judged by an increase in wall thickness and by the presence of muscle in smaller and more peripheral arteries than is normal. Elevation of resistance was associated with failure of the intraacinar pulmonary circulation to develop normally rather than to obliterative pulmonary vascular disease. In view of the rapidity with which impairment of growth and elevation of resistance can develop, closure of a large defect is recommended before age 2 years.


Echocardiographic findings in severe paradoxical pulse due to pulmonary embolization. A 47 year old man with acute pulmonary embolism had severe pulsus paradoxicus in the absence of pericardial disease. Echocardiography demonstrated inspiratory failure of the aortic valve to open, a decreases in left ventricular cavity size and a decrease in mitral valve diastolic excursion.


Pacemaker-induced endocardial friction rub. Two patients had a typical sounding cardiac friction rub after placement of a temporary transvenous pacemaker. Absence of myocardial perforation was documented in one patient during thoracotomy for placement of an epicardial electrode and in the other with an electrogram recorded from the pacemaker as it was being withdrawn. The rubs disappeared during pacemaker removal. These cases are believed to represent endocardial friction rubs resulting from contact of the pacing wire with the endocardium.


Traumatic right coronary artery-right ventricular fistula with retained intramyocardial bullet. A case of traumatic right coronary artery-right ventricular fistula secondary to a gunshot wound is presented. In addition, the bullet was retained within the interventricular septum. The diagnostic approach, surgical findings and operative procedure of this and other reported cases are discussed. Several key points are emphasized. First, extended follow-up is necessary after trauma to the heart since fistulas may develop years after the initial injury. Second, surgery is generally indicated for fistulas although some data are presented suggesting that small to moderate fistulas may be treated medically. Third, if surgery is undertaken, very careful operative technique must be utilized to locate and close the fistula. Surgical treatment of choice may be coronary arterial ligation with a distal bypass graft if necessary. Postoperative evaluation is mandatory because fistulas may recur. Indications for removal of a foreign body within the myocardium are also discussed.


Pheochromocytoma of the urinary bladder: a broad clinical spectrum. A case of pheochromocytoma of the urinary bladder is reported, and 35 perviously reported cases are analyzed. This interesting entity can present with symptoms of catecholamine excess and severe hypertensive spells (often micturition-induced) or as asymptomatic hematuria without hypertension. The present case represents the severest end of the clinical spectrum, with advancing acute retinopathy and visual loss, very high blood pressure and greatly increased catecholamine excretion. Several special precautions were utilized during diagnostic studies and surgery. On the whole, prognosis is excellent in nonmalignant cases properly handled, and the location of the tumor provides opportunity for early case finding and complete cure.


Rupture of the papillary muscle of the tricuspid valve. A complication of cardiopulmonary resuscitation and a rare cause of tricuspid insufficiency. Rupture of a papillary muscle is a rare occurrence. Two patients are described in whom rupture of a papillary muscle of the tricuspid valve developed after external cardiac massage during cardiopulmonary resuscitation. One of these patients survived briefly with clinical evidence of triscupid regurgitation immediately after resuscitation. Although tricuspid valve papillary muscle rupture has been described as a complication of bacterial endocarditis, chest trauma and myocardial infarction, it is a generally unrecognized complication of external cardia massage. Findings in the two patients reported here suggest that patients with a dilated right ventricle may be more susceptible to this rare complication of cardiopulmonary resuscitation.


A study of light and scanning electron microscopy of the lining epithelium of the guinea pig bladder following artificial ulceration. Following artificial ulceration of the guinea pig bladder epithelium, study by light microscopy showed that mitotic activity occurs within 24 hours in the basal layer of the remaining epithelium; which leads to thickening, disorganization and cell shedding. At the ulcer margin, the epithelium forms a rolled edge, from the extremity of which a two-layered sheet of flat cells grows over the edematous ulcer bed, and the ulcer site is protected during dilation of the bladder by localized muscle spasm. Healing is effected within about one week, as the mitotic activity declines. Organization of the new epithelium commences at the periphery and the cells acquire glycogen and alkaline phosphatase. Study by SEM, which included normal bladders, confirmed that new epithelium spreads from a rolled epithelial edge, and also showed that cells undergoing rejection have globular profiles with surface microvilli. The immature epithelial cells are markedly distorted from mutual pressure during migration and their surfaces show only short microvilli. Ulcers heal after four to seven days, depending on size, and the new cells rapidly assume the pentagonal and hexagonal outlines and the reticular pattern of surface ridges, characteristic of mature surface cells. The ridges apparently develop by fusion of rows of microvilli. By the tenth day it is difficult to identify the original ulcer site.


A study by scanning electron microscopy of the bladder epithelium of the guinea pig. Under scanning electron microscopy (SEM) the surface cells of the guinea pig bladder have pentagonal or hexagonal outlines. Their borders are clearly defined since they are elevated. They possess a large reserve of surface membrane which is markedly folded and wrinkled when the bladder is empty. The folds disappear and the cells become flat during distension. The luminal surface is characterized by numerous reticular ridges which are a remarkably constant feature and persist even under acute artificial distension. A small proportion of the surface cells are small and have less than five sides. Since they show only sparse microvilli as a surface feature, they have a smooth appearance. These are believed to be young surface cells which have just emerged from the intermediate layer, and have not yet acquired the ridged pattern of mature cells.


Phagocytosis of spermatozoa in the terminal region and gland of the vas deferens of the rat. The existence of a discrete group of cells that are able to phagocytose spermatozoa is reported in the terminal vas deferens of the rat. In addition it is shown that phagocytosis of spermatozoa occurs in the gland of the vas deferens. The cytological mechanisms involved in the phagocytotic process are discussed, and the role that this activity may have on the removal of surplus spermatozoa is discussed.


Development of the metatarsophalangeal joint of the chick embryo: morphological, ultrastructural and histochemical studies. The histogenesis and mechanism of joint clefting of the developing chick embryo up to the fifteenth day of incubation have been studied morphologically, ultrastructurally, and by histochemical methods. Cell degeneration was consistently noted 24 hours after differentiation of the joint tissue, and it is postulated that this early cell necrosis might account for the loosening of the medial part of articular mesenchyme (interzone) leading to differentiation of a three-layered embryonic joint. At the time of joint clefting degenerative cells were also seen in the peripheral parts of the developing articular cavity. In some cases clefting was immediately preceded and/or accompanied by the appearance of elongated, basophilic and electron-opaque cells closely arranged along the zone of tissue cleavage. These cells were thought to be implicated in some way in the clefting process and later to constitute a surface cell layer of articular cartilage. In addition to these observations clear morphological and histoautoradiographic evidence was found for the presence of an organic component, presumably mucopolysaccharide, in the primitive synovial fluid. Fluid secretion might also account for tissue cleavage at the sites of its accumulation. The data reported here suggest that joint cavity formation results from a combination of both intrinsic, genetically expressed and extrinsic mechanical factors acting synchronously.


Sulfate-reducing anaerobic bacteria in human feces. Human feces contain: 1) Chemotrophic anaerobic bacteria (strains XII, 57, IV) identified with D. desulfuricans ssp. faecalis (nov. ssp.) at a level approaching 10 7/g. 2) Organotrophic anaerobic gram positive rods (strains 30, 35, and 43) at between 10(5) and 10 7/g. 3) Chemo-organotrophic anaerobic gram positive rods (strains 22, 27, 47, and 66) were present at 40 5/g. Strains of these two last groups have not been described in the literature and are not found in any accepted toxonomic scheme.


Specific adhesion of lactobacilli to keratinized epithelial cells of the rat stomach in vitro. Indigenous bacteria isolated from rats and chickens demonstrated host specificity in adhering to the keratinized epithelial cells of the rat stomach and the chicken crop epithelium. Of the indigenous bacteria isolated from the rat only lactobacilli and staphylococci attached to the keratinized cells of the rat stomach, suggesting that they are dominant bacteria of the microflora of the stomachs of rats. The effect of the addition of enzymes and other compounds on the adhesion of lactobacilli were investigated. Adhesion was inhibited by treating the lactobacilli with heat, detergents, or certain lipid solvents.


Fecal microbial flora in Seventh Day Adventist populations and control subjects. A comparison of 13 vegetarian Seventh Day Adventists with 14 nonvegetarian Adventists revealed relatively few statistically significant differences in fecal flora. A separate study involved a comparison of vegetarian Adventists (49 subjects), nonvegetarian Adventists (45), and non-Adventists on a conventional American diet (31) re: the incidence of the C. paraputrificum group in the fecal flora. The Adventist groups had significantly fewer C. septicum and C. tertium isolates than the non-Adventists. Reference to earlier diet studies done by our group revealed certain striking differences. Fusobacterium and C. perfringens counts were very low and lactobacillus counts very high in Adventists as compared with Japanese-Americans on either a Japanese or Western diet or Caucasian individuals on a conventional U.S. diet. Comparison of nonvegetarian Adventists with the other groups on a nonvegetarian Western diet also revealed several statistically significant differences. Finally, there were a number of significant differences in fecal flora when high risk groups (Japanese-Americans on Western diet and Caucasians on conventional U.S. diet) were compared with low risk groups (Japanese-Americans on a Japanese diet and Adventists).


Viral infections during pregnancy and in early life. There is evidence that fetal antigenic stimulation and intrauterine infection is much more frequent in developing rural populations than in industrialized societies. A similar contrast is observed for postnatal intestinal infection that is significantly greater in the less developed areas. The differences are explained by the divergence in environmental sanitation and personal hygiene. Intestinal infection is important in that diarrheal disease is one of the main factors leading to malnutrition. It is apparent that for developing nations to attain better nutrition, much of the present burden of intestinal infection needs to be controlled.


Rapid serum gentamicin assay by enzymatic adenylation. An improved, rapid and accurate enzymatic adenylation assay for gentamicin has been developed. It can be completed in one hour with an accuracy of +/- 2.7% (+/- 1 SD) for the range of gentamicin concentrations of 6-12 microgram/ml. Concentrated enzyme was used to prepare a complete adenylation mixture, which was stored frozen in aliquots suitable for daily assays. A special apparatus designed for efficient washing of phosphocellulose disks was used in the assay.


Spontaneous and stimulated nitroblue tetrazolium tests of leukocytes from patients with solid malignant tumors. Histochemical nitroblue tetrazolium (NBT) reduction tests, spontaneous and endotoxin-stimulated, were performed on samples of blood from 202 adult patients with solid neoplastic tumors and 37 healthy control subjects. The patients were classified according to activity of the disease, chemotherapy, and presence of bacterial infection. The NBT test did not prove helpful in detecting the latter condition in these patients. Low median spontaneous reduction values were recorded for patients with active malignancies, or receiving chemotherapy, compared with controls or cured patients without chemotherapy. Stimulated reduction values were significantly lower for all groups of patients than for controls, although for those apparently cured and untreated, stimulated reduction attained significantly higher values than for the other patients. A leukocyte dysfunction caused by both the underlying disease and its chemotherapy is assumed, and the usefulness of the endotoxin-stimulated NBT reduction test in detecting this dysfunction is stressed.


Effect of hyperchylomicronemia on the measurement of hemoglobin. The effects of plasma triglyceride levels on the measurement of hemoglobin and other erythrocyte indices have been studied in blood samples from ten healthy controls, 11 patients with type IV hyperlipoproteinemia, and five patients with hyperchylomicronemia (type I or V). Measurements were made using erythrocytes in their own plasmas and repeated after resuspension of the cells in physiologic saline solution. Hemoglobin, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were decreased by removal of plasma in erythrocytes from three patients with hyperchylomicronemia. It is concluded that the triglyceride contained in very-low-density lipoprotein does not affect hemoglobin measurement, while triglyceride contained in chylomicrons increased hemoglobin readings linearly.


Enzymatic activity patterns in probability population samples. Serum lactate dehydrogenase. Sex- and age-specific serum lactate dehydrogenase values provided by a natural population of 2,378 individuals selected by a multistage area cluster probability sampling scheme are given. The activity of this enzyme has definite sex and age associations over the age range studied (larger than or equal to 10 years). In both sexes, it is characterized by elevations in preadolescents, by a sharp decrease in adolescent groups, and by a gradual increase in adult and senescent groups, which, however, does not bring it back to earlier levels. Males have higher mean serum lactate dehydrogenase activities than females in most age groups until about 50 years of age. Unusually high activities have been found in this study, compared with those found in two other widely separated areas in North America using the same assay procedures.


Urinary glucose and vitamin C.

Urinary glucose and vitamin C. The recent popularization of self-prescribed large doses of vitamin C has increased the possibility for erroneous conclusions to be drawn from standard clinical methods used in urinary glucose monitoring, due to interference with these methods by the greatly elevated excretion of vitamin C. The coupled-enzyme-chromogen strip tests showed erroneously negative glucose levels in urines of both a diabetic individual and a subject with a genetic low renal threshold for glucose when they were supplementing their normal diets with 1-2 g vitamin C per day. With this regimen, their urinary vitamin C levels reached 200 mg/dl (11.4 mmol/l). For normal urine with vitamin C added, false-positive tests for glucose were found using Benedict's reagent when vitamin C was present at 250 mg/dl (14.3 mmol/l) or higher concentrations. In diabetic individuals consuming large quantities of vitamin C, this interference with standard coupled-enzyme-chromogen strip tests or Benedict's test could present a significant problem in diagnosis and clinical management of the disease. A simple anion exchange method of treating the urine was used to correct the false results.


A device for efficient washing of paper disks for gentamicin or other assay procedures. A new device has been developed for efficient washing of phosphocellulose disks used in enzymatic assays of antibiotics. Its construction and operation are described. The device allows all disks to receive identical washing, including agitation, and the sequence of the disks is maintained. A comparison has been made of the results of adenylation assay of gentamicin using the new device and hand-washing of the paper disks.


Evolution of reactive lymphadenopathy into lymphoma over a nine-year period. A clinicopathologic study. Reported is a case of lymphoma which was preceded for nine years by an apparently reactive lymphadenopathy. Original slides of the multiple lymphoid tissue samples are reviewed, with emphasis on the gradually increasing numbers of mitoses, atypical histiocytes, and eosinophils, suggestive of malignant transformation. The scarcity of such cases in the literature prompts this report.


Unilateral tubo-ovarin actinomycosis in the presence of an intrauterine device. A case of unilateral tubo-ovarian abscess due to Actinomyces in the presence of an intrauterine device is presented. The gross and microscopic features are described. As the diagnosis of this potentially serious infection is usually made by the histologic demonstration of sparsely distributed sulfur granules, the pathologist should approach every case of IUD-associated pelvic inflammation with a high index of suspicion.


Heart block, sudden death, and atrioventricular node mesothelioma. We report a case of mesothelioma of the atrioventricular node with congenital complete heart block and sudden death in a 15-year-old girl. This benign tumor probably represents a hamartoma derived from mesothelium with a constant anatomic location and uniform association with heart block. The clinical course of such patients, however, has been variable. The tumor has been associated with sudden, unexpected death in infancy or adolescence, but has more often been discovered as an incidental finding at autopsy in a middle-aged or elderly patient.


Rocky mountain spotted fever in childhood. Experience with 138 cases of Rocky Mountain spotted fever indicates that the major clinical features of characteristic rash, fever, and tick bite, in combination with low serum sodium concentration and thrombocytopenia, are helpful in recognizing this serious and potentially lethal infectious disease.


Monocyte-macrophage function in the newborn. Analysis of 20 human cord blood samples for monocyte-macrophage function demonstrates a selective defect in monocyte cellular chemotaxis. Monocyte bacterial phagocytosis, phagocytosis of paraffin oil particles, and bacterial killing of staphylococcus 502A were normal when compared with 30 healthy young adult controls. Impaired response of neonatal monocytes to chemotactants is an additional host defense defect that may help explain the undue susceptibility of neonates to certain infectious agents.


Pseudotumor cerebri of childhood.

Pseudotumor cerebri of childhood. In a study of 38 children with pseudotumor cerebri, the evaluation of the response to treatment received special emphasis. Sixteen children underwent spontaneous remission following diagnosis, or improved following sequential lumbar punctures. Sixteen other children were treated with corticosteroids. Of this group, four children who failed to respond to repeated lumbar punctures prior to the initiation of corticosteroid therapy, had their subsequent course on varying doses of steroids charted clinically and by frequent measurement of the CSF pressure. An Inverse relationship of steroid dosage to CSF pressure was documented, as was the children's dependence on corticosteroid therapy for continued remission as the pseudotumor cerebri ran its course. In twelve other children, treatment with corticosteroids may have been effective. Two children had neurosurgical procedures. Permanent visual deficit did not occur in any child.


Somatomedin and growth hormone in the newborn. Somatomedin (SM) levels were measured by porcine cartilage bioassay, and growth hormone (GH) levels by radioimmunoassay in 52 full-term umbilical cord plasma samples and 28 maternal plasma samples. The SM levels in cord plasmas was 0.50 +/- 0.19 units/ml (mean +/- SD) compared to an adult standard plasma pool of 1.0 units/ml. The cord GH levels were 41.7 +/- 36 mmicrogram/ml. The low relative value of SM in the cord plasma is consistent with that found during early childhood, and may reflect a lower level of requirement. The high neonatal GH levels are hypothesized to be a compensatory increase to overcome factors suppressing SM production in fetal life.


The clinical value of pediatric herniography. We review the herniography experience at a community hospital. Twenty-nine patients, aged 4 weeks to 6 years, were examined. Herniography was most often helpful (25 of 29 patients) in determining the need for exploration of the clinically normal side in the patient with a unilateral hernia. By herniography, patients with a right inguinal hernia were found to have a left sac in 47% of cases; whereas with a clinical left inguinal hernia, the incidence of right sacs was 67%. Herniography was also useful (four of 29 patients) as a diagnostic aid in children with a history of hernia but inconclusive physical findings. In all patients explored, the roentgenographic findings were confirmed at surgery.


Systemic candidiasis in infants: a case presentation and literature review. A 4 1/2-month-old male infant with systemic candidiasis had anuria secondary to Candida albicans fungus balls impacted in the renal pelves. The patient was treated with temporary urinary diversion, amphotericin B, and flucytosine. Six weeks after therapy had been concluded, the patient had C albicans arthritis of the right hip and responded to a second course of amphotericin B and flucytosine therapy. This article discusses immunologic evaluation and presents a literature review.


Hypothyroidism due to ectopy in siblings. Two families each had two siblings with hypothyroidism due to ectopy and hypoplasia of the thyroid. A genetic factor controlling normal thyroid development and descent may be responsible, and the importance of plasma thyroid-stimulating hormone estimation in borderline hypothyroid cases is emphasized. We suggest screening of siblings of patients with ectopic thyroid for hypothyroidism.


Infantile psoriasis.

Infantile psoriasis. We report 14 infants younger than 2 years of age with psoriasis vulgaris in order to call attention to the existence of infantile psoriasis. Three of the patients were noted to have psoriasis in the neonatal period; the onset may have been prenatal in one. In 13 of the 14 patients the site of onset was determined by the isomorphic effect (Köbners phenomenon). Although nail pitting is usually said to be infrequent in childhood psoriasis, 11 (79%) of our patients had typical psoriatic nail changes. Psoriasis must be considered in the differential diagnosis of papulosquamous disorders in infants.


Feasibility of low-dose and intermittent chenodeoxycholic acid therapy of gallstones. Chenodeoxycholic acid, by reducing the concentration of biliary cholesterol relative to that of bile acid and phospholipid, dissolves cholesterol gallstones. This bile acid, however, has potential dose-related hepatotoxicity and causes dose-related diarrhea. Therefore, the feasibility of low-dose and intermittent therapy was assessed by studying the induction and persistence of chenodeoxycholic acid-induced biliary lipid changes. Biliary lipid composition with each of 3 doses of chenodeoxycholic acid was determined in bile samples obtained by cholecystokinin-stimulated duodenal drainage before, after one week and one month of treatment, and up to 9 weeks after discontinuation of treatment. The lowest dose that significantly reduced the relative concentration of biliary cholesterol was 250 mg/day. A significant reduction occurred one week after initiation of treatment and was maintained for 9 weeks following discontinuation of treatment. Thus, clinical trials on low-dose and intermittent chenodeoxycholic acid therapy for gallstone prophylaxis or dissolution are warranted.


Relative concentrations of individual nonsulfated bile acids in the serum and bile of patients with cirrhosis. The relative concentrations of individual nonsulfated bile acids were determined in samples of serum and bile obtained simultaneously from 16 patients with biopsy-proven alcoholic cirrhosis. A highly significant (P less than 0.001) correlation was found between the fasting relative concentrations of each of the three major bile acids (cholic, chenodeoxycholic, and deoxycholic) in serum and bile. This relationship persisted after manipulation of bile acid pools produced by feeding of individual bile acids. We conclude that the relative concentrations of individual nonsulfated bile acids in serum accurately reflect those in bile and that measurement of individual serum bile acids may be used for screening and serial determination purposes. In particular, low levels of biliary deoxycholate can be reliably predicted by serum measurements.


Human colonic myoelectric activity in response to prostigmin and the gastrointestinal hormones. Colonic myoelectric activity was determined using a mucosal clip electrode in normal human subjects, in the basal state and following the administration of prostigmin, pentagastrin, cholecystokinin, or secretin. Slow-wave activity was present 49 +/- 3.0% of the recording time and occurred at two frequencies, 6.5 +/- 0.1 cycles/min and 3.5 +/- 0.1 cycles/min, in the rectum. Spike potentials were infrequent in the basal state. Prostigmin, pentagastrin, or cholecystokinin did not affect the slow-wave activity or frequency, but these agents significantly increased the number of spike potentials (P less than 0.05). Secretin had no effect on myoelectric activity. The electrode system was tested in the cat and showed excellent correlation of the myoelectric activity between the mucosal clip electrode and a serosal electrode. These studies indicate: (1) a mucosal clip electrode provides an accurate method of recording colonic myoelectric activity when compared to a serosal electrode in the cat; (2) in man, slow-wave activity is present only intermittently and exists at two frequencies, approximately 6 cycles/min and 3 cycles/min; (3) gastrointestinal hormones and prostigmin increase spike potential discharge without altering slow-wave activity or frequency.


A study of synthesis of DNA, RNA, protein, and oxygen uptake in segments of the rat pancreas. The determination of whether metabolic homogeneity exists in an organ is of importance to both the clinician and investigator. These studies examine synthesis of DNA, RNA, protein, and oxygen uptake in the three anatomical segments of the rat pancreas. There was rather close agreement among the three segments insofar as these metabolic measurements were concerned. We concluded that there is metabolic uniformity in the rat pancreas and that measurements obtained in one segment reflect activities in the other two segments.


A study of antibody production for the radioimmunoassay of gastrin. Gastrin conjugated to bovine serum albumin was administered to New Zealand white rabbits by repeated injections at a standard immunizing dose of 2 mg BSA-gastrin conjugate, as well as at 0.2 mg (10%) and 0.02 (1%) of BSA-gastrin conjugate. The immediate dose of immunogen (0.2 mg) was also given by multiple simultaneous intradermal injections, with one later booster immunization. Resultant antisera from footpad injected rabbits were found to be of comparable high affinity, which was uninfluenced by the size of the administered dose of antigen conjugate. Antibody binding sites concentrations in these antisera, however, were found to be proportional to immunizing dose. Antibodies to gastrin produced after intradermal injection, although of comparable serum antibody concentrations, were of significantly lower affinity than after footpad immunization. It is concluded that high affinity antisera suitable for use in radioimmunoassay of gastrin can be produced by footpad immunization utilizing a small fraction of the standard immunizing dose of gastrin-bovine serum albumin conjugate.


Effect of folate deficiency and ethanol ingestion on intestinal folate absorption. The effects of folate deficiency, generalized malnutrition, and alcohol ingestion on jejunal transport, mucosal uptake, and reduction of folic acid were evaluated in rats. As measured by an everted gut sac technique, a folate-deficient diet fed ad libitum did not alter transport or mucosal uptake of folate. Partial starvation, which was produced in rats pair-fed with animals ingesting ethanol, increased jejunal folate transport and mucosal uptake in animals ingesting either a folate-deficient or control diet. A 20% ethanol ingestion by rats consuming folate-deficient or control diets resulted in transport and mucosal uptake rates intermediate in value compared to those from ad libitum fed and pair-fed groups. No differences in reduction of folic acid were found. These results suggest that folate depletion and ethanol ingestion, alone or in combination, do not affect the ability of the rat jejunal to transport folate but that partial starvation results in an increase in folate transport activity.


Hyperoxaluria and intestinal disease. The role of steatorrhea and dietary calcium in regulating intestinal oxalate absorption. Hyperoxaluria was documented in patients with pancreatic insufficiency, adult celiac disease, regional enteritis after ileectomy and partial colectomy, and jejunoileal bypass. The degree of hyperoxaluria correlated directly with the severity of the steatorrhea and inversely with the dietary calcium content. High-calcium diets suppressed oxalate excretion to normal when fecal fat excretion was approximately 30 g/day or less. In patients with more severe steatorrhea, decreasing dietary fat and oxalate content further reduced urinary oxalate excretion. These data suggest that, while steatorrhea is the most important determinant for enhanced absorption of dietary oxalate, variations in dietary calcium content modulate the amount of oxalate absorbed.


Pseudotumor caused by gastric varices.

Pseudotumor caused by gastric varices. On upper-gastrointestinal examination a patient with cirrhosis of the liver was found to have prominent gastric varices presenting as a pseudotumor near the cardia. The diagnosis of varices was confirmed by gastroscopy and angiography. A correct diagnosis is necessary to avoid an ill-advised biopsy or unwarranted surgery.


Individual free fatty acids in patients with liver disease. The total free fatty acids, blood glucose, and individual free fatty acids were studied in 8 patients with viral hepatitis and 13 with cirrhosis. The results were compared with those obtained in 9 normal control subjects. Free fatty acids were significantly elevated in liver patients as compared with normal controls. A fall in free fatty acids following ingestion of amino acids and dextrose was noted in normal subjects as well as liver patients. Glucose tolerance test, when done on patients with liver disease, was abnormal in most cases. Highly significant differences were found in the composition of individual free fatty acids in liver patients as compared with normal subjects. Arachidonic and linoleic acids were decreased, while monounsaturated and saturated fatty acids were increased in patients with viral hepatitis and cirrhosis. No significant changes were noted in the percent composition of individual free fatty acids following ingestion of amino acids and dextrose.


Herpetic gastritis.

Herpetic gastritis. A case of herpes gastritis is presented. This complication is being described more frequently in the gastrointestinal tract and can be best diagnosed by endoscopic appearance and examination of brush specimens by cytology.


Fasting and postprandial serum bile acids as a screening test for hepatocellular disease. Postprandial serum bile acid estimation was recently proposed as the most sensitive test of liver function. In our study, the fasting and postpranidal serum bile acid measurements were performed on 19 normal subjects, 20 patients with cirrhosis, 10 with acute hepatitis, 4 with resolving viral hepatitis, and 6 with chronic active hepatitis. A gas-chromatographic method was used. One healthy subject had postprandial serum bile acid levels above the normal range, while 7 patients with liver disease had postprandial levels within normal limits. Of the latter group, 2 had chronic active hepatitis in remission and 3 had resolving viral hepatitis. Significant correlations were seen between serum bile acid levels and most of the conventional "liver function" tests. Our data indicate that the postprandial serum bile acid determination is better than any of the other conventional tests taken separately, but no better than their combined use. No significant modification of the cholic acid/chenodeoxycholic acid ratio was observed between the fasting and the postprandial determinations.


Gastric varices. Problem in diagnosis.

Gastric varices. Problem in diagnosis. Gastric varices may appear in association with esophageal varices secondary to portal-hypertension or as an independent manifestation of splenic vein obstruction. Since gastric varices often manifest as radiologic filling defects in the gastric fundus or cardia, differentiation from tumors and many other diseases becomes imperative. Unfortunately, routine diagnostic pprocedures may be of limited value. The difficulties in the diagnosis of gastric varices are illustrated with three specific cases. Correct diagnosis is best established with the aid of endoscopy and such special procedures as celiac angiography or splenoportography. With the help of three cases, the characteristics of gastric varices are reviewed and their evaluation and management are outlined.


Esophageal histology in gastroesophageal reflux. Morphometric findings in suction biopsies. Esophageal suction biopsies were taken in 24 subjects with proven gastroesophageal reflux, 12 subjects with suspected reflux, and 20 healthy controls. Sixty-two percent of the patients with proven reflux, 33% of the patients with suspected reflux, and 10% of the control subjects had neutrophilic and/or eosinophilic granulocytes in the lamina propria. Lymphocytes, plasma cell, and basophilic granulocytes were shown to be constituents of the normal esophageal mucosa. All epithelial dimensions showed marked individual variations in reflux patients and controls. The relative length of stromal papillae as expressed in percent of total epithelial thickness showed a linear correlation with relative basal cell thickness and an indirect linear correlation with epithelial thickness. Elongation of stromal papillae in proven reflux could only be demonstrated by arbitrary retrospective stratification of the data. Hyperplasia of the basal zone and thinning of the epithelium were not observed in the reflux patients. It is concluded that granulocytic infiltrates and not epithelial alterations are the most prominent histological finding in gastroesophageal reflux.


Adenomyoma of the stomach.

Adenomyoma of the stomach. Two cases of adenomyoma of the stomach and a review of previous reports in the literature are presented. Adenomyoma is a benign lesion of the pylorus of the stomach composed of smooth muscle, cysts, and glandular structures lined by all columnar epithelium, Brunner's glands, and sometimes pancreatic tissue. The histopathological and radiological characteristics of this lesion are discussed.


Gastrin content of columnar mucosal lining the lower (Barrett's) esophagus. Tissue gastrin was determined in 36 biopsies obtained from the esophagus and 35 biopsies from the stomach in 12 patients with Barrett's esophagus. Histology of the mucosa from the area adjacent to the biopsy sites was also examined. Esophageal biopsies were obtained from three different sites in each patient. The gastric biopsies were obtained from the antrum, fundus, and the area just distal to the lower border of the lower esophageal sphincter. The columnar mucosa lining the esophagus was of three distinct types, namely, fundic, transitional (cardiac), or specialized. None of these epithelia nor the squamous epithelium showed any detectable gastrin. In contrast, antral mucosa had very high gastrin content; smaller amounts of gastrin were detected in duodenal epithelium, whereas fundic mucosa sometimes contained small amounts of gastrin.


Severe chronic active liver disease. Prognostic significance of initial morphologic patterns. To determine the usefulness of recognizing the different morphologic patterns of chronic active liver disease (CALD), we compared clinical and biochemical features as well as responses to treatment in 32 patients with chronic active hepatitis (CAH); 36 with subacute hepatitis and bridging necrosis (SHB); 30 with subacute hepatitis and multilobular necrosis (SHMN); and 30 with cirrhosis and active hepatitis (Cirrh). The morphological lesions did not correlate with clinical or etiologic features. Patients with CAH had less severe biochemical abnormalities, entered remission more often, and failed to respond to treatment less frequently than those with SHMN or Cirrh. SHB and SHMN resembled each other in many regards and showed greater functional changes than CAH. Cirrhosis developed more often after SHMN than CAH and was associated with a poorer prognosis than CAH. Serial liver biopsies revealed all possible histologic transitions, with reduction of inflammation usually occurring in patients treated with steroids and extension of inflammation being more frequent in those not receiving these drugs. CAH, SHB, SHMN, and Cirrh, therefore, reflect the degree and extent of disease activity at any given time in CALD, rather than representing different conditions. Identification of the initial morphologic lesion is helpful because of differences in prognosis.


Significance of changes in blood pressure and pulse rate after percutaneous liver biopsy. Blood-pressure and pulse-rate changes were evaluated prospectively in 50 patients undergoing uncomplicated liver biopsies and retrospectively in 4 patients who, since 1973, had recognized postbiopsy hemorrhage requiring transfusion. In uncomplicated biopsies a wide range of variations in vital signs was encountered between "baseline" and "before" controls and between controls and postbiopsy measurements. To place the changes in perspective, percentile scales were developed for percent maximum deviation from control for systolic blood pressure, diastolic blood pressure, and pulse rate. Analysis of changes in patients with significant hemorrhage revealed; (1) marked changes in vital signs in the early (2-hr) postbiopsy period; (2) the association of early hypertensive changes with pain followed by later evidence of hemorrhage in two of the four patients; (3) the lesser helpfulness of pulse change (1 of 4 bleeders) as compared to blood pressure change (4 of 4 patients).


Muramidase (lysozyme) in Crohn's disease and in ulcerative colitis. Estimation of lysozyme (LZM) activity in the serum was suggested as a valuable test to distinguish between Crohn's disease and ulcerative colitis. Subsequently several reports either supported or denied the original observation. Selection of patients and methodological differences were suggested as an explanation for the controversy. We estimated serum LZM in a large group of patients using the lysoplate method and human LZM as a standard. The conditions of the assay were strictly standardized. In 90 patients with Crohn's disease the LZM level was 8.3 +/- 2.1 (SD) microgram/ml, in 57 patients with ulcerative colitis was 7.4 +/- 2.0 (SD) microgram/ml, and in 40 healthy individuals it was 7.0 +/- 1.2 (SD) microgram/ml. Although the difference between the mean LZM levels in Crohn's disease and in ulcerative colitis was statistically significant, there was a definite overlapping of values between these two diseases. No significant correlation of LZM level to the duration or extent of the disease, activity, or treatment was found in Crohn's disease. In ulcerative colitis the LZM level was often a little higher in severe disease, especially when the whole colon was involved.


Spectrum of methyldopa liver injury.

Spectrum of methyldopa liver injury. The administration of alpha methyldopa resulted in serious liver injury to seven patients, requiring hospitalization. All patients presented with symptoms indistinguishable from viral hepatitis. Histological changes ranged from those compatible with acute hepatitis to chronic active hepatitis and subacute hepatic necrosis. One patient with subacute hepatic necrosis rapidly progressed to hepatic failure and died; autopsy revealed postnecrotic cirrhosis. Inadvertent rechallenge after recovery resulted in dramatic recurrence of symptoms in one patient, confirming the fact that a hypersensitivity phenomenon is involved. A high state of awareness among physicians of this unpredictable toxic effect of the drug may reduce its unrecognized perpetuation.


Hepatic amebiasis, analysis of 56 cases. I. Clinical findings. The clinical findings in 56 patients with hepatic amebiasis are reviewed. This illness was most frequent in male black patients, 20-39 years old. The clinical picture is dominated by upper right quadrant abdominal pain, general malaise, pain on percussion of the right hypochondrium and tender hepatomegaly. Jaundice is not rare and appears to have no prognostic significance. The importance of early diagnosis is emphasized.


Serum gastrin in patients with various types of chronic gastritis. Fasting serum gastrin was determined in 35 Chinese patients with various types of chronic gastritis and in 23 Chinese control subjects. The mean (+/- S.D.) fasting serum gastrin levels for 13 patients with chronic atrophic gastritis, 16 patients with chronic gastritis and six patients with acute-on-chronic gastritis were 32.1 (+/- 38.9) pg./ml., 36.1 (+/- 23.2) pg./ml. and 33.7 (+/- 19.4) pg./ml., respectively. The mean (+/- S.D.) fasting serum gastrin levels for the whole gastritis group (35 patients) and the control group were 34.2 (+/- 28.8) pg./ml. and 24.6 (+/- 13.7) pg./ml., respectively. Statistical analysis showed that the mean basal serum gastrin levels of the three gastritis groups did not differ significantly from control subjects and with each other.


Splenic erosion and hemorrhage secondary to pancreatic pseudocyst. A review of the literature and additional case report. A case of splenic invasion and rupture by a pancreatic pseudocyst is presented and previously documented cases are reviewed. The serious consequences of this complication are stressed. In the present case, splenic rupture occurred during clinical and radiological resolution of the pseudocyst.


Uncommon presentation of pancreatic pseudocyst. Five cases of pancreatic pseudocyst are presented with unusual manifestations. Clinical features of each entity are discussed to enable one to diagnose the rare manifestations and complications of pancreatic pseudocyst. Reasonable understanding of such cases enables accurate diagnostic work-up for confirmation and early surgical intervention.


Surgical management of toxic megacolon.

Surgical management of toxic megacolon. Toxic megacolon developed in ten of 220 patients (4.5%) admitted for chronic ulcerative colitis over the past 11 years. Nine of these patients came under the care of the Surgical Department. Only three of these 10 patients had previously been treated with steroids. Steroid therapy reversed the acute process in three patients (33%). All three patients later came to surgery. Toxic megacolon developed during the first episode of ulcerative colitis in seven of ten patients (70%). Three of the seven (43%) had perforated their colons prior to operation. Two patients died after a subtotal colectomy and one without operation. A delayed diagnosis was associated with sepsis in five patients (50%) and with all three deaths. Seven patients survived proctocolectomy. Prolonged medical management without dramatic response appeared to correlate with a high postoperative morbidity. This study supports the concept of aggressive diagnosis and early surgical intervention for toxic megacolon.


Biliary ascariasis presenting in the United States. Infestation of the bile ducts by the adult Ascaris lumbricoides roundworm is a common condition in many parts of the world. The most frequent clinical presentation is as upper abdominal colicky pain with a normal or only slightly raised serum bilirubin. In most cases these worms can be visualized by intravenous cholangiography because of the absence of obstructive jaundice and can therefore be specifically treated by nonsurgical methods. The radiographic appearance is diagnostic. This is the first report of such a case presenting in North America or the United Kingdom, where the importance of biliary ascariasis in endemic areas is not fully appreciated.


Pyoderma gangrenosum complicating Crohn's disease. Of the many acknowledged systemic complications of inflammatory bowel disease, arthritis, iritis and erythema nodosum are observed most commonly and considered parts of the natural history. Pyoderma gangrenosum is a more ominous, less common but similarly associated complication that classically occurs in the course of ulcerative colitis. Its rarity in Crohn's disease stimulated the following report.


Pneumatosis and cystoides intestinalis. Report of a case with colonoscopic findings of inflammatory bowel disease. A patient with pneumatosis cystoides intestinalis noted on barium enema performed for evaluation of rectal bleeding was found on fiberoptic colonoscopy to have evidence of inflammatory bowel disease, consistent with granulomatous colitis, the sigmoid colon element of which responded to topical steroid therapy as documented by repeat colonoscopy three months later.


Race, education and prevalence of hypertension. Data from the Hypertension Detection and Follow-up Program (HDFP), in 14 U.S. communities, were used to examine the relationship of education to the well-documented racial differences in prevalence of hypertension. Standardized blood pressure (BP) measurements, a medical history, and socioeconomic information were obtained on 158,906 adults. Hypertensive individuals were defined as 1) those with a diastolic BP greater than or equal to 95 mm Hg and 2) those with a diastolic BP less than 95 mm Hg who reported they were currently taking antihypertensive medication. Overall, 18.0% of whites and 37.4% of blacks were defined as hypertensive at the first screening. Education was found to be inversely associated with hypertension for each race and sex group. This inverse association remained when age was taken into account, was more striking in the younger age groups and in blacks, but was diminished in the highest weight classes. Educational differences, however, do not fully account for the observed black-white differences in hypertension prevalence. Even at the higher education levels, the adjusted prevalence of hypertension remained nearly twice as high in blacks as in whites.


Changing patterns in the incidence of Rocky Mountain Spotted Fever on Long Island (1971-1976). Clinical data from 124 Rocky Mountain Spotted Fever (RMSF) cases submitted by Long Island physicians and hospitals were compiled for the six-year period 1971-1976. This information was subsequently compared to two parameters: first, the geographic distribution of human cases and rickettsia-infected Dermacentor variabilis (Say), and, secondly, the human population dynamics in Long Island towns since 1950. Despite an overall decline in the rate of suburbanization and population growth, cases of RMSF have increased significantly not only in eastern towns where RMSF has been endemic, but also in well-established western towns where recent population increases have been negligible. Phenomena associated with suburbanization, primarily the association of domestic and sylvan animals and their exposure to infected vector populations, may be instrumental in explaining the increased transmission of RMSF.


Bacterial meningitis in southwestern Alaska. Between July 1, 1971, and June 30, 1974, thirty-nine cases of bacterial meningitis were diagnosed at the Alaska Native Health Service Hospital at Bethel, Alaska. Thirty-two (82%) occurred in infants less than one year of age. Haemophilus influenzae (H. influenzae) was the predominant causative agent, and was isolated from 23 (72%) of the 32 patients under one year of age. The annual incidence of H. influenzae meningitis in the Bethel area was 63/100,000, and the annual incidence of H. influenzae meningitis in children less than five years of age was 474/100,000 cases.


The age distribution of human cancer for carcinogenic exposures of varying intensity. The time and age dependence of cancer incidence rates resulting from various type of carcinogenic exposure are calculated and compared with observed cancer incidence rates. Implications for the detection of increased cancer incidence are discussed. The calculations assume that exposure affects one of several changes necessary for malignant cell transformation.


Effect of inline filtration of intravenous infusions on the incidence of thrombophlebitis. The effect of inline filtration on the incidence of infusion phlebitis was examined in a community hospital. Two general surgical units, comparable in their patient populations, were studied during a one-month period. On one unit, an extension set with a 45 micrometer filter was attached to every i.v. catheter; no inline filtration was instituted on the second unit. The use or nonuse of a filter was not blinded. The filter was replaced every 24 hours or sooner if blockage occurred. A total of 49 patients (107 i.v.s) were studied in the group with filters and 40 patients (84 i.v.s) without filters. Phlebitis was graded on a scale of 0 to 4. The proportion of patients with phlebitis in the filter group was 86%; in the no-filter group, 75%. In the filter group, 67% of the catheterizations ended in phlebitis; in the no-filter group, 63%. Upon first catheterization, phlebitis developed in 63% of the filter group and 58% of the no-filter group. None of these differences was significant (p = 0.05). There was also no significant difference between the two groups in the severity of phlebitis and the incidence of phlebitis following the administration of irritating solutions containing cephalothin sodium or potassium chloride. Based on this study, the value of inline filtration in routine clinical conditions appears to be questionable.


Primary care by a pharmacist in an outpatient clinic. Primary care by a pharmacist in an outpatient clinic of the Indian Health Service is described. Primary care responsibilities of the pharmacist included the diagnosis and treatment of certain acute illnesses and the management of selected chronic disease patients. Protocols were written by the pharmacist and physician to cover 31 acute illnesses and seven chronic conditions. The pharmacist was also trained to perform many routine laboratory tests. Further, the pharmacist provided patient consultation as to the use, storage, benefits and expected side effects of prescribed medications. Pharmacy visits accounted for nearly one-third of the clinic visits in 1975. Diagnosis and treatment of 10 common acute illnesses made up more than 40% of the pharmacy visits; another 40% of these visits were for pharmacist monitoring of chronic conditions.


Effect of inline filtration on the potency of drugs administered intravenously. The binding of cephalothin sodium, phenobarbital sodium, dexamethasone sodium phosphate, isoproterenol hydrochloride, digoxin, dactinomycin and phenytoin sodium to three intravenous inline filters--a 5-micrometer stainless steel depth filter, a 0.2-micrometer cellulose ester membrane and a 0.2-micrometer polycarbonate membrane--was studied. The experiments were conducted simulating inline i.v. filtration of these drugs in three i.v. solutions--lactated Ringer's, 5% dextrose and normal saline. Cephalothin was assayed colorimetrically, phenobarbital and phenytoin spectrophotometrically, and the other drugs by radiotracer technique. Binding of the drugs to the filter was found to be insignificant from a therapeutic standpoint, except for dactinomycin which bound to the 0.2-uicrometer filters. The binding of dactinomycin was approximately 13% of the amount administered through cellulose ester and polycarbonate membranes, respectively. The binding occurred during the initial period of filtration of the drug solution. It was concluded that inline filtration of drugs administered in relatively high does should not present any problem concerning the reduction of the therapeutic potency because of filtration.


Palatability comparison of oral potassium chloride solutions. The palatability of various commercially available potassium chloride preparations was studies. Twenty potassium chloride samples were tested by 152 people from February 1975 to April 1975. Nine samples were placed into a "most preferred" group and divided into 36 possible pairs, each to be tested four times. Twenty-four volunteers tested six pairs of samples and chose the preferred sample in each pair. The three samples, which finished with the highest scores (K-Lyte/Cl Packets, Kato Powder Packets and Kaochlor 10%), although not significantly different from the rest of the subgroup of nine, were all highly flavored and among the most expensive. It is suggested that when selecting a potassium chloride preparation, cost, convenience, palatability, and most importantly, long-term compliance with the prescribed regimen, must be considered.


Pharmaceutical services in nongovernmental hospitals on the West Coast. A survey of nongovernment, nonprofit and for-profit hospitals in Washington, Oregon and California was conducted to determine the incidence of selected hospital pharmacy services (1) directly related to drug distribution and (2) not directly related to drug distribution. Questionnaires were mailed to all qualifying hospitals in the three states; the return rate was 75.4%. Unit dose drug distribution was used in combination with other delivery systems by 58.3% of the respondents; 26.5% used unit dose exclusively. Over half of the respondents provided i.v. admixture programs, outpatient and inpatient discharge prescriptions, and inpatient medication profiles. Additionally, 77.9% provided pharmacy consultation to physicians. Nonprofit hospitals had significantly higher pharmacy staffing levels (both pharmacists and supportive personnel) than for-profit hospitals in the categories, "open seven days per week," "open nine to 16 hours per day," "open 17 to 24 hours per day, "101 to 200 beds" and "201 or more beds." Hospitals that provided the following services had significantly higher pharmacy staffing levels than those that did not provide the serices: unit dose drug distribution, i.v. admixture services, inpatient discharge prescriptions, inpatient medication profiles, drug therapy monitoring, and cardiopulmonary resuscitation team participation (difference of supportive staff only).


Carbenicillin-gentamicin interaction in acute renal failure. A case is reported in which carbenicillin inactivation of gentamicin resulted in subtherapeutic serum gentamicin levels in a 77-year-old man with acute renal failure. The drugs were administered separately to prevent in vitro inactivation. Carbenicillin inactivation of gentamicin resulted in subtherapeutic serum gentamicin levels (less than 2 microgram/ml) even with unusually large doses of gentamicin (1.8 mg/kg/day). The large dose of carbenicillin (15 g/day) resulted in serum carbenicillin levels more than 500 microgram/ml and an increased rate of gentamicin inactivation. After carbenicillin was discontinued, therapeutic serum gentamicin levels were achieved and maintained with doses of 0.9 - 1.8 mg/kg/day. It is suggested that if the combination of carbenicillin and gentamicin is used in patients with severe renal failure, the dose of carbenicillin should be reduced to prevent rapid inactivation of gentamicin. Further, to assure therapeutic gentamicin levels, serum levels of both drugs should be monitored frequently.


Lithium carbonate treatment in the syndrome of inappropriate secretion of antidiuretic hormone. A case of a 76-year-old man with the syndrome of inappropriate secretion of antidiuretic hormone (ADH) is discussed. The patient was initially treated with fluid restriction followed by the administration of hypertonic saline. After failure to achieve rapid correction of the condition and continued lethargy and muscle weakness in the patient, a trial with lithium carbonate 300 mg three times daily via nasogastric tube was initiated. This resulted in a prompt reversal of the hyperosmolar state and improvement in electrolyte balance. However, despite the apparent success in treating his inappropriate ADH, the patient expired as a result of a massive cerebral vascular accident. The potential benefit of using lithium in the treatment of the syndrome of inappropriate secretion of ADH, and possible mechanisms of action, are reviewed.


A modified Malloy-Evelyn procedure for total bilirubin in microsamples. A one-step modification of the Malloy-Evelyn procedure for total serum bilirubin assay is described. Color development occurs in five minutes. This modification, which is suitable for automation and ultramicrodetermination, is compared to the Malloy-Evelyn and Jendrassik-Grof methods with special reference to pediatric samples.


Comparison of six procedures for the simultaneous determination of antiepileptic drugs. A comparison of six gas-chromatographic procedures for the simultaneous analysis of antiepileptic drugs was made. Methylation with 0.2M trimethylanilinium hydroxide was superior to other derivatizing procedures evaluated. The methylated derivatives of phenobarbital, carba-mazepine, primidone, and diphenyl-hydantoin were separated on the chromatogram, and the peaks were sharp and symmetrical. The four drugs gave linear curves to twice their toxic levels.


Laboratory problems in digoxin radioimmunoassay. This review discusses the various technical problems likely to be encountered in digoxin assay using 125I methods. Many of these difficulties are not limited to digoxin, but are potential dangers when measuring a wide variety of substances by radio-ligand techniques. Emphasis is placed on ways to avoid or solve these problems. Beside error induced through technical aspects, which include radio-ligand reagents, dispensing equipment, and well counters, other potential sources of interference which are considered are the effects of medications, serum proteins, and previously administered radioactivity.


Fve years later: a longitudinal study of medical technology graduates. A survey of graduates from two different curricula in medical technology, five to eight years following graduation, indicates that both curricula prepared individuals for professional practice and growth.


A rapid mini-thin-layer chromatographic procedure for the detection of barbiturates and common sedatives at overdose levels. A simple, rapid thin-layer chromatographic method is presented for the detection of barbiturates in blood, serum, or urine in overdose situations. Extraction with ether is followed by evaporation and reconstitution with methanol. Part of the extract is spotted on a 2.5 multiplied by 7.5 cm thin-layer chromatographic plate which is then developed in a mixed solvent system. After drying, the plate is sprayed with n, 2, 6-trichloro-p-benzoquinone imine and heated. The presence of a barbiturate is indicated by a blue spot. Chromatography in another solvent system assists in the identification of the particular barbiturate ingested.


An effective method for teaching clinical coagulation. A careful and thorough evaluation of the coagulation mechanism is critical for the diagnosis and management of some patients. A course designed to effectively teach coagulation principles and techniques to medical technology students prior to their clinical laboratory rotation is discussed.


Knife sharpening revolutionized.

Knife sharpening revolutionized. A new application has been found for an adhesive-backed, nylon polishing cloth previously used chiefly in the metallurgic field. When adhered to the glass plate of an automatic microtome knife sharpener, the cloth provides a superior sharpening surface and eliminates the need for resurfacing the plate. We have found this new technique simple, inexpensive, and timesaving.


Prostaglandins and abortion. I. intramuscular administration of 15-methyl prostaglandin F2alpha for induction of abortion in weeks 10 to 20 of pregnancy. World Health Organization Task Force on the Use of Prostaglandins for the Regulation of Fertility. A multicenter, multinational study of intramuscular 15-methyl prostaglandin F2alpha in 515 patients is described. Abortion of the fetus occurred in 79.3 per cent (408 patients) after 24 hours and 84.9 per cent (437 patients) after 30 hours. The abortion was complete in 35 per cent. The incidence of vomiting and diarrhea was high, 2.9 and 2.8 episodes per patient, respectively. Three patients had cervical laceration (0.6 per cent). There were no other serious side effects. It is concluded that this method has limited value as a primary method for induction of abortion but may be of value to finalize the abortion process when another method has failed.


Prostaglandins and abortion. II. Single extra-amniotic administration of 0.92 mg. of 15-methyl prostaglandin F2alpha in Hyskon for termination of pregnancies in weeks 10 to 20 of gestation: an international multicenter study. World Health Organization Task Force on the Use of Prostaglandins for the Regulation of Fertility. In a multicenter comparative trial, 15-methyl prostaglandin F2alpha(PGF2alpha), 0.92 mg., was administered by extra-amniotic injection to 660 patients. Abortion of the fetus occurred within 24 hours in 479 patients (72.6 per cent) and within 36 hours in 530 patient (80.3 per cent). Abortion was complete in 31 per cent of the cases. The commonest side effects were vomiting and diarrhea, but these symptoms were not severe, the mean frequencies being 0.9 episodes of vomiting per patient and 0.7 episodes of diarrhea per patient. It is concluded that this method is safe and effective for the induction of abortion.


Prostaglandins and abortion. III. Comparison of single intra-amniotic injections of 15-methyl prostaglandin F2alpha and prostaglandin F2alpha for termination of second-trimester pregnancy: an international multicenter study. World Health Organization Tast Force on the Use of Prostaglandins forthe Regulation of Fertility. A multicenter, multinational study involving 1,521 patients has compared prostaglandin F2alpha (PGF2alpha) (40 or 50 mg.) and 15-methyl PGF2alpha (2.5 mg.) given intra-amniotically for induction of second-trimester abortion. The highest success rates for PGF2alpha at 24 and 48 hours were 67.8 and 86.6 per cent, respectively. The percentages for 15-methyl PGF2alpha for the equivalent times were 74.1 and 95.6 per cent, respectively. There were 75 cases classified as failures in 602 patients treated with PGF2alpha and only 34 cases were classified as failures among 919 patients treated with 15-methyl PGF2alpha. A further 35 patients required additional treatment to complete the abortion. The over-all incidence of diarrhea and vomiting was low, less than 3.4 episodes per patient. There were 20 cases of cervical laceration (2.9 per cent); only one extended into the lower segment of the uterus. It is concluded that intra-amniotic administration of either 50 mg. of PGF2alpha or 2.5 mg. 15-methyl PGF2alpha provides an effective and safe method for termination of second-trimester pregnancies.


Balanced reciprocal X-4 translocation in a female patient with early secondary amenorrhea. Balanced translocations involving an X chromosome and an autosome have been infrequently reported. A patient with a balanced X-autosome translocation 46,X,rcp(X;4)(q26;q21) who exhibited early secondary amenorrhea and gonadal dysgenesis is described. In an effort to explain the varied phenotypic expressions encountered in female cases of balanced X-autosome translocations, evidence will be provided to suggest an extension of the minimal limits of the "critical region" in the long arm of the X chromosome from A-B, as described by Sarto and associates, to new minimal limits C-D.


Absence of circulating chorionic gonadotropin in wearers of intrauterine contraceptive devices. Daily measurements of human chorionic gonadotropin (HCG) beta subunit, luteinizing hormone (LH), and progesterone were carried out in 24 subjects wearing intrauterine contraceptive devices. Detectable HCG was not found in any subject, but in four subjects delayed LH pulses resulted in apparent low levels of HCG because of cross-reactivity in the HCG beta subunit radioimmunoassay.


Effects of antenatal exposure to anorectic drugs. In a large prospective, observational study of pregnancy and child development, the anorectic drugs (amphetamines and phenmetrazine) prescribed to gravid women during different stages of pregnancy were evaluated for their teratogenicity. The severe congenital anomaly rate (SCA) per 100 live-born children at age five years did not differ from the SCA rate of the group of children whose mothers did not use these drugs. There was, however, an excess of oral clefts in the offspring of mothers who had amphetamines prescribed in the first 56 days from the last menstrual period. A rought test of efficacy of anorectic drugs by comparing mean weight gains in four-week periods before and after the prescription showed only short-term and limited reduction of weight gain.


Nephrotic proteinuria with pre-eclampsia. During a retrospective study of 100 patients who underwent renal biopsy because of pregnancy complicated by hypertension, we found 19 patients whom proteinuria exceeded 5.0 Gm. per 24 hours and an additional eight patients in whom excretion ranged between 3.5 and 5 Gm. per day. Of these 27 patients, 23 had the kidney lesion of pre-eclampsia, and three of them had superimposed hypertensive changes in the vasculature. The remaining four had other renal diseases. We located and re-examined 10 of the 23 pre-eclamptic women, 12 to 104 (mean, 36) months after delivery. Serum creatinine levels were normal in all but one, who was discovered to have polycystic kidney disease. During the same time period, we located the records of six women who had heavy proteinuria during gestation but were normotensive. Thus, at our institution, pre-eclampsia is the most common cause of the nephrotic syndrome in pregnancy. The frequency of nephrotic proteinuria in pre-eclampsia appears higher than previously suspected, but, despite this fact, recovery was complete in most instances.


Further investigation on the predictive value of human placental lactogen in high-risk pregnancies. Blood samples were taken from 254 women with pregnancies with various complications and 119 completely normal pregnant women for measurement of serum human placental lactogen (hPL) during the third trimester. The value of this test in the management of these pregnancies was retrospectively evaluated through details of outcome. Serum hPL and urinary estriol were compared as tools for assessment of fetal condition. Serum hPL was found to be very efficient in the prenatal diagnosis of intrauterine growth retardation associated with maternal hypertension. Low hPL levels were recorded in all severely hypertensive patients who were delivered of small-for-dates infants (a 100 per cent prediction rate), while 30 per cent of these patients had normal estriol values. Prediction rate of postmature infants by serum hPL level was 70 per cent as compared to 50 per cent by urinary estriol level. The diagnostic significance of low hPL levels is emphasized, with stress upon its value in early detection of unfavorable intrauterine environment. The importance of preterm deliveries in pregnancies involving intrauterine growth retardation and low hPL levels is discussed and demonstration cases are presented.


Oxytocinase and human placental lactogen for the prediction of intrauterine growth retardation. Oxytocinase and human placental lactogen (hPL) were measured in 705 serial maternal plasma samples collected from 74 patients whose pregnancies were complicated by hypertension. The trend and absolute levels of each substance were evaluated in a search for reliable antepartum indicators of intrauterine growth retardation (IUGR). There were 21 patients who were delivered of growth-retarded infants and the oxytocinase values were abnormal in 16 cases (75 per cent), while hPL levels were abnormal in 15 cases (71 per cent). There were 24 patients with subnormal placental weights. Abnormal oxytocinase values were observed in 17 (71 per cent) and abnormal hPL in 19 cases (79  per cent). The remaining 37 patients had "normal" fetal and placental weights. Abnormal oxytocinase values were observed in 15 patients (41 per cent) and abnormal hPL in 19 (52 per cent). In this group of pregnant mothers thought to be at risk for IUGR due to pregnancy hypertension, either test alone predicted subnormal neonatal or placental weight in about three fourths of cases. However, in the mothers with hypertension, who had no evidence of IUGR, false abnormal values of oxytocinase and hPL were found in nearly half the patients. No advantage was gained in the predictive accuracy when both tests were used.


Endothelial proliferation in inflammation. I. Autoradiographic studies following thermal injury to the skin of normal rats. Endothelial prolifertion was studied in sites of acute inflammation induced by necrotizing (60 C for 20 seconds) or mild (54 C for 20 seconds) thermal injury to the skin of rsts. DNA synthesis in endothelial cells was assayed 6 hours to 10 days following injury by quantitation of the (3)H-thymidine labeling indices on 2-mu Epon section autoradiographs. In lesions induced at 60 C for 20 seconds, increase in DNA synthesis in small vessels around the necrotic tissue began at 1 day and became significant at 2 and 3 days (10 to 12% for endothelial cells, 9% for perivascular cells). This increased endothelial replication resulted in the formation of new blood vessels by 5 to 7 days. Endothelial labeling diminished progressively after 3 days, as the epidermis regenerated. Foci completely covered by new epidermis consistently showed lower labeling indices than those which were not reepithelialized. Mild thermal injury (54 C for 20 seconds) also resulted in significant increases in endothelial labeling (6%), but the labeling was present mainly in superficial vessels and was not followed by neovascularization. The findings with mild injury are consistent with data that vascular leakage from superficial vessels is due to direct, albeit delayed, endothelial damage. Electron microscopic studies confirmed labeling in endothelial cells and indicated that ultrastructural alterations that were previously ascribed to activation, recovery, or regenerative transformation of endothelium represent, in the main, endothelial proliferation.


Endothelial cell morphology in areas of in vivo Evans blue uptake in the aorta of young pigs. II. Ultrastructure of the intima in areas of differing permeability to proteins. The fine structure of the intima of the pig aortic arch is described for areas of spontaneously differing in vivo endothelial permeability, as demarcated by uptake of the protein-binding azo dye Evans blue. Areas of enhanced permeability (blue areas) consistently show a variety of features not observed in areas devoid of dye accumulation (white areas). The subendothelial space of blue areas is markedly thickened and edematous, containing collagen, elastic tissue elements, and undifferentiated cells dispersed in an amorphous floccular matrix of low electron density. Endothelial cells in blue areas are generally cuboidal, with relatively short, frequently vacuolated junctions. In contrast, endothelial cells from white areas are flat and elongate, with long intercellular junctions exhibiting many interdigitations. Cytoplasmic differences include a well-developed rough endoplasmic reticulum and more frequent lysosomal bodies in blue areas and a prominent Golgi apparatus in the endothelium of white areas. Additionally, endothelial cell injury or death with and without denudation occurs with a significantly greater frequency in blue relative to white areas. An endothelial glycocalyx is some threefold thicker over the surface of white relative to blue areas. It is concluded that neither endothelial structure nor function are homogeneous within the aortic arch of the young pig and that areas of spontaneously differing permeability to proteins are associated with a spectrum of alterations in endothelial and intimal morphology.


The pathogenesis of bladder cancer.

The pathogenesis of bladder cancer. Carcinoma of the urinary bladder appears to arise, in at least some cases, from carcinoma in situ developing in a field of atypical epithelial proliferation. There is both a spatial and temporal relationship between invasive and in situ bladder cancer, although the exact relationship between the noninvasive flat and papillary types of tumors is not known. Prenoeplastic bladder lesions are defined as irreversible, although not necessarily progressive, and an experimental animal model of the disease has been developed. The appearance of pleomorphic microvilli on the luminal surface of epithelial cells of the urinary bladders of Fischer rats is correlated with the irreversibility of hyperplastic epithelial lesions induced by feeding N-[4-(5-nitro-2-furyl)-2-thiazolyl] formamide (FANFT) to the test animals. This alteration can be visualized by scanning electron microscopy of cytologic and histologic preparations.


On the causes of melanomas.

On the causes of melanomas. A large number of factors have been identified which seem to predispose an individual to develop melanoma. Black-skinned individuals rarely have malanomas, but this variety of tumors is common in red-haired or blond subjects. The incidence of melanoma is particularly high if such fair-skinned subjects are exposed for long perods of time to intense sunlight. Nevi, congenital or acquired, can degenerate into melanomas. In some families, many of the family members develop multiple nevi that are unusually large and red in color. All of these appear to degenerate into melanomas with time. Nature has provided other examples of genetic factors which induce melanomas, i.e., the melanomas which form in the platyfish and Sinclair miniature swine.


Newer insights into the pathogenesis of liver cancer. A new hypothesis leading to a new model of liver carcinogenesis is described; it is based on the acquisition by carcinogen-altered hepatocytes during initiation of a new functional handle--resistance to the cytotoxicity of a carcinogen--and on the ability of such cells to proliferate in an environment that prevents proliferation of normal hepatocytes. The creation of such a differential environment now enables a quantitative analysis for initiation, the beginning synchronization of the putative premalignant hepatocytes for about 15 cell cycles, the study of the pattern of growth of such resistant cells to form nodules that have some resemblance to the organizational pattern of fetal liver, the analysis of the appearance of distinctive positive and negative markers for these cells, and the further investigation of the development of liver cancer from such cells. The remarkable similarity in overall pattern betweeen the development of cancer in the skin and in the liver with chemicals and the possible role of both somatic mutation and neodifferentiation in carcinogenesis are briefly discussed.


Parental treatment, children's temperament, and the risk of childhood behavioral problems: 1. Relationships between parental characteristics and changes in children's temperament over time. Preschool children's temperament scores, correlated with eight parental domains, revealed that parental intolerance, inconsistency, and conflict were associated with negative temperament changes; strictness and maternal concern/protectiveness with both positive and negative changes, depending on age and sex. Implications with respect to the etiology of children's behavioral problems are explored.


Teenage status of hyperactive and nonhyperactive learning disabled boys. Three groups of learning disabled boys--hyperactives, normoactives, and hypoactives--were studied in grade school, reevaluated at fourteen. At follow-up, all three groups remained at disadvantage to controls on academic and cognitive measures and on complex reaction time. Half the hyperactives had experienced major conflicts with authority, and over a third of hypoactives exhibited psychologically disturbing behaviors. Mental health of normoactives appeared comparable to controls.


Anorexia nervosa in children: a follow-up study. Thirty children seen between 1954 and 1970 with the diagnosis of anorexia nervosa were contacted between five and twenty years after initial treatment. Patients outcomes in terms of education, weight in adulthood, medical problems, marriage, psychiatric treatment, and recurrence of anorexia were surveyed. Results corroborate those of earlier studies suggesting that adjustment in adulthood is related to personality type.


A case for permanent foster placement of dependent, neglected, and abused children. The number of children entering foster care continues to rise. Despite efforts to rehabilitate families and to place children for adoption, for many children foster care tends to be interminable. Return to the home is often impeded by a paucity of parental resources; adoption is often blocked by the courts' reluctance to terminate parental rights. Permanent foster placement is suggested as an alternative arrangement for better meeting the needs of some of these children.


An introduction to biofeedback.

An introduction to biofeedback. The status and potential of biofeedback are examined, and its drawbacks and limitations are discussed. This paper defines biofeedback, describes how it works, analyzes in detail a prototypical application, and considers the relationship of biofeedback to other therapeutic modalities.


Sex differences in the expression of adoption ideas: observations of adoptees from birth through latency. Longitudinal observations of 21 children, 19 of whom are adopted, reveal two consistent patterns---girls manifest greater interest and conflict in relation to adoption than do boys, and interest and conflict are greatest for both sexes during latency. Implications of the findings for the counseling of adoptees and of other children are discussed, and directions for further research suggested.


Reentry: living with childhood cancer.

Reentry: living with childhood cancer. The reentry process for the pediatric cancer patient involves returning to family, friends, and community while still undergoing rigorous medical treatment. This paper discusses the role of the mental health professional in helping child, parents, and siblings manage outpatient care, emphasizing resumption of normal activities and productive patterns of coping.


Crisis intervention in professional practice: implications for clinical training. Crisis intervention as a therapeutic model has had multiple roots, and is presently defined in a sound body of principles that provides an effective framework for professional practice. However, there are several areas of ambiguity that have prevented effective use of this model by clinicians, and have hindered its inclusion in professional training programs. Strategies toward the development of an effective training model for crisis therapists are suggested.


The effects of a school program on teenage mothers and their children. The need for educational opportunity and health care provision for the increasing number of teenage mothers is discussed. An educationally-based program for inner-city school-age mothers is described, and an evaluation of its effectiveness reported. Mothers in the program completed significantly more education than did control mothers, and their children showed superior social development compared to the children of control mothers.


Adolescent day treatment: a community alternative to institutionalization of the emotionally disturbed adolescent. This paper describes the need, the formation, and the structure of a partial day treatment program for severely disturbed adolescents, which uses local resources to maintain clients in the community. Components of the program, including family therapy in the home, are outlined and case illustrations are offered. Applications to other community settings are discussed.


Group and the Hispanic prenatal patient. A small group approach was implemented to meet the educational and emotional needs of a Hispanic prenatal hospital population, which staff characterized as hysterical and hard to manage during labor and delivery. Group sessions revealed that this behavior was due largely to lack of preparation and emotional support. Staff-patient communication improved, enhancing the quality of the medical care provided.


At the threshold of the Golden Gate: special problems of a neglected minority. The residents of San Francisco's Chinatown demonstrate the consequences of a substantial number of economic and social ills reflecting the history of the Chinese-Americans and the orientation of American society towards them. Changes in the immigration laws have presented particularly stressful circumstances for the traditional Chinese-American family. The relationship of such social stresses to the incidence and form of psychopathology--including an unusually high incidence of suicide--is noted.


Metal-film thermopiles for use with rabbit right ventricular papillary muscles. A method of fabricating Hill-Downing type, planar thermopiles by vacuum-deposition techniques is described in detail. The present model was designed for initial heat measurements on rabbit papillary muscles as small as 1 mg blotted wt, but it is also suitable for small bundles of frog muscle fibers (30-75). The thermopile has 20 or 14 junctions, an active length of 5 or 3.5 mm, and an actual thickness of 20 micrometer. It has an effective heat capacity of about 0.3 mcal/degrees C, a heat loss coefficient of about 0.3 mcal/degrees C - s, a temperature sensitivity of 1.4 mV/degrees C (20 junctions), and an electrical resistance of 180-200 omega. Infrared-emitting diodes are used to heat the thermopile and muscle artificially for thermal time constant and conduction-delay measurements. Performance of the thermopiles is demonstrated with initial heat records from rabbit right ventricular papillary muscles and a bundle of frog semitendinosus muscle fibers. Results of preliminary experiments concerning latency for heat generation, initial rate of heat generation, and activation heat in both types of muscles are presented.


Ascorbic acid flux across mucosal border of guinea pig and human ileum. The unidirectional influx of L-[14C]ascorbic acid (vitamin C) across the mucosal border of guinea pig and human ileum was determined. Influx follows saturation kinetics, indicating that a carrier mechanism is operative. The maximal influx in guinea pig ileum bathed in Ringer is 140 nmol/cm2-h and the ascorbic acid concentration greater than 6 mM , or when the tissue is bathed in Na-free media, influx is approximately linearly related to the ascorbic acid concentration, and absorption by simple diffusion may predominate. With mucosal ascorbic acid concentration of 0.28 mM, influx is reduced by at least 70% when Na-free media is used; however, influx is not dependent on the intracellular Na concentration. The brush border mechanism appears to be stereospecific and not closely coupled to cellular metabolism. A model of transport is favored that features a carrier-mediated transport mechanism for simultaneous entry of ascorbic acid and Na across the brush border. This model is similar in nature to, but functionally distinct from, the sodium-gradient mechanism postulated to effect sugar and amino acid transport in mammalian ileal mucosa.


Hypothalamic influence on insulin and glucagon release in the rat. Blood glucose, plasma insulin, and glucagon levels were measured in undisturbed and free-moving rats. The insulin and glucagon levels rise in the 1st min after the beginning of food ingestion, whereas the glucose level begins to increase only in the 3rd min if carbohydrate-rich food is eaten. This early rise in insulin and glucagon level is also observed under conditions in which carbohydrate-free food is eaten. A similar release of insulin and glucagon can be obtained by injection of 0.1 microgram of norepinephrine into the ventromedial hypothalamus, but the same injection made into the lateral hypothalamus causes release of insulin only, whereas injections in other hypothalamic areas are nearly without effect. Similar injections of isoproterenol did not cause changes in insulin, glucagon, and glucose levels. It is suggested that the early insulin and glucagon responses are of reflex origin and that the ventromedial and lateral hypothalamic areas are relay stations in the reflex pathways. The lack of effect of atropine to block the insulin and glucagon responses to noradrenergic stimulation of the ventromedial hypothalamus indicates that the efferent pathway is not cholinergic.


Static and dynamic characteristics of fluid-filled esophageal manometry systems. Esophageal manometric systems with water-filled catheters have been characterized by the use of model experiments. The examined parameters have been: catheter dimension, catheter compliance, catheter resistance, pump type, pump compliance, and perfusion flow. Accurate static pressure measurements have been obtained for perfused systems independently of the investigated parameters. The dynamic characteristics vary with catheter diameter and perfusion flow. For catheters with low diameter, a narrow bandwidth is obtained for the investigated perfusion flows. The results have been expressed in terms of an electric model of the measurement system. Perfusion pumps with low compliance are recommended to improve the dynamic properties of the measurement system.


Enhanced riboflavin incorporation into flavins in newborn riboflavin-deficient rats. The incorporation of a subcutaneous injection of [14C]riboflavin (2.5 muCi/100 g body wt) into flavin mononucleotide (FMN), flavin adenine dinucleotide (FAD), and flavins bound covalently to proteins was determined at 1, 6, and 18 h in liver, cerebrum, and cerebellum from progeny of normal and maternally riboflavin-deficient Holtzman rats. Radioactivity remaining as riboflavin was also determined under these circumstances. Experiments were initiated within 24 h of birth. In both groups of newborn rats, the incorporation of radioactive riboflavin into covalently bound flavins in liver and brain proceeded more slowly than into the other flavin fractions. In addition, radioactivity incorporated into covalently bound flavins comprised a relatively smaller proportion of the total amount incorporated in brain than in liver. In progeny of riboflavin-deficient dams, an increased rate of incorporation of riboflavin into all three flavin derivatives, particularly FAD, was observed in liver and brain, compared to results in normal progeny. These data provide evidence that maternal riboflavin deficiency enhances the incorporation of riboflavin into tissue flavins in liver, cerebrum, and cerebellum from newborn rats.