Measurement of SoflensTM posterior curvature with Moiré fringes. The posterior surface curvature of eight Bausch and Lomb SoflensesTM was measured by using a Moiré interference fringe technique. This unique method was used to allow measurement of the curvature variation across the lens surface and to provide new information which may be helpful in understanding difficult fitting problems and improving fitting techniques. Central apical curvature agreed with values published by Bausch and Lomb within 6%. Low negative power lenses became steeper, whereas higher minus power lenses became flatter away from the apex toward the lens periphery. However, none of the lenses tested was a flat in the outer portion of the lens as predicted by hydrodynamic forced-vortex theory which should be applicable for spun-cast fluid lenses. There was also a significant change in curvature, first flattening, then steeping across the lens as it dried out during the course of the measurement.


Effect of tinted contact lenses on color vision. This study was designed to investigate the effects of various contact lens tints on color vision. Color vision performance of eight subjects was evaluated with the Farnsworth-Munsell 100 Hue Test while each subject wore each of 13 differently tinted contact lenses. No significant differences in color vision were found with the various lenses. However, performance on the test was affected by repetition. Regardless of the lens tints tested, color discrimination for the blue quadrant of the 100 Hue Test was the poorest. Further research is needed to determine the effect of tinted contact lenses on scotopic and mesopic vision.


High power lens with a measurement water cell. A simple water cell can be used to increase the range of an ordinary lensometer by about three times by using an application of Snell's law. This technique can be very useful in low vision applications where other methods of measuring high plus ophthalmic lenses are always cumbersome and time consuming and sometimes inaccurate or inconclusive.


Classification of practitioners by urban Chicano patients: an aspect of the sociology of lay knowledge. This study in the sociology of lay knowledge seeks to conceptualize the "everyday rules" by which a patient makes choices about which practitioner should be consulted for which episode. A lay person must often choose a practitioner from among competing coteries of specialists, without having recourse to their specialized knowledge in order to classify them. The patient must develop her own typology of specialists, utilizing her own criteria. The patient becomes aware of a number of aspects of an epsiode, each of which requires a response of some sort. In the course of her interaction with a practitioner, the patient discovers  that the practitioner is competent, in her perception to handle some aspects and inadequate to handle others, thereby presenting her with a particular constellation of competencies and inadequacies. When seeing different practitioners, the patient encounters vertical and horizontal conflict between the assessments offered her by each. She must decide which offers the competencies most needed and the inadequacies most tolerable. A practitioner's constellation may change over time or by episode. In order to secure the competencies she feels necessary, the patient may utilize a number of practitioners either sequentially or simultaneously, thereby functioning as an assembler of her own health care team.


Postnatal changes in corneal curvature.

Postnatal changes in corneal curvature. Corneal curvature was measured in 10 kittens from three litters and found to change significantly during postnatal development. From our data analysis, corneal curvature can be predicted from an animal's age and weight. To facilitate this prediciton for use in fitting contact lenses as occluders or diffusers in developmental studies, prediction equations are given as are expected weights of kittens as a function of age.


The state of accommodation during the measurement of axial chromatic aberration of the eye. The axial chromatic aberration of the eye was determined as in previous studies by finding the lens required to eliminate or minimize blur of the fixation target when it is illuminated by a series of monochromatic sources. Objective measurement of the refraction of the eyes during this procedure showed that accommodation remained constant throughout. Hence, the conclusion that the accommodative state does not in this case respond automatically to changes in the vergence of light falling in the retinal plane. It is suggested that some other stimulus, perhaps perceived distance, predominates. Further, the least amount of plus lens required to blur a near target was about the same for white and red but much less for blue. This substantiates an earlier finding that the eye accommodates for near only sufficiently to place the blue end of the chromatic interval on the retina.


Apical bearing and success with the Bausch and Lomb Soflens (polymacon) contact lens. Thirty-three patients (63 eyes) were fitted with Bausch and Lomb soflens (polymacon) contact lenses. The initial lenses were selected with the mean posterior apical radius 0.45 mm flatter than the flat keratometer reading of the cornea (S.D. = +/-0.31 MM). Forty-eight eyes (76%) were successfully fitted and 15 eyes (25%) were unsuccessfully fitted. Among the successfully fitted eyes, 31 were fitted with the initial lens, 12 required steeper lenses, and 5 required flatter lenses. The final successfully fitted lenses were on the average 0.40 mm flatter (S.D. = +/-0.32 mm) than the flat keratometer reading of the cornea. The unsuccessfully fitted lenses were not significantly different than the successfully fitted lenses, being 0.47 mm flatter (S.D. = +/-O.32 mm) than the flat keratometer reading of the cornea. Although the central lens-cornea relationship is helpful in fitting the Soflens, the number of successful results are increased significantly by changing to a lens with different parameters when lens performance and patient response are not optimal.


The effect of a nitrous oxid-oxygen mixture on the lateral heterophoria. The distance and near lateral heterophorias were investigated in 10 subjects to determine the effect of a nitrous oxide (N2O)-oxygen (O2) mixture. The heterophorias were measured by the Maddox method before and after a 3-minute induction period of nitrous oxide. It was found that the distance lateral heterophoria for all 10 subjects changed toward more esophoria, whereas the changes in the near lateral heterophoria were inconsistent in their direction.


Application of biofeedback and behavior modification techniques in visual training. A review of the biofeedback literature was made and proposals for use in optometry advanced. To this end electromyograph units can be connected to an apparatus which gives a reward when a patient performs proper eye movements. By this means, patients who undergo visual training become conscious of their eye movements. As a reinforcement, they are rewarded by music or the motion of toys when they give the right answer. Application of the system in cases of strabismus, limitation of gaze, convergence insufficiency or excess, ptosis, and other cases are discussed. Methodological and financial advantages of incorporation of biofeedback reinforcement into visual training are enumerated.


Construction of simple vectographic slides for Ver stimuli. A series of 35-mm vectographic checkerboard slides has been developed which, when projected through a rotating polaroid analyzer, generate an oscillating checkerboard for use as a stimulus in visual evoked response (VER) experiments. Sample VER data are presented from a 4-year-old and a 23-year-old subject, using a variety of check sizes and using a color-sound cartoon superimposed over the checkerboard to encourage attention. These slides provide a simple yet versatile means for producing VER data.


Laser meridional refractometry.

Laser meridional refractometry. Laser meridonal refractions were undertaken on 30 subjects. The results  were compared to classical subjective techniques utilizing both correlative statistics and clinical criteria. The laser meridional techniques were highly correlated with the subjective procedures and were accurate when judged by clinical criteria.


Paralysis of elevation of one eye a case report. A vertical diplopia in a 53-year-old woman was diagnosed as euthyroid Grave's disease, which was arrested by systemic chemotherapy. Subsequent corrective surgery was effective.


Contour interaction and temporal masking in strabismus and amblyopia. Visual acuity of amlyopic eyes, measured under binocular viewing conditions, was improved by reducing the contrast of targets presented to the normal eye. Improvement was also obtained by adjusting the temporal relationship between inputs to the normal and amblyopic eye. Optimal acuity was obtained by alternately presenting targets to the two eyes at rates centered about 2 and 7 Hz. These results are interpreted in terms of binocular contour interaction and metacontrast suppression. They suggest that a portion of the amblyope's acuity loss during binocular viewing conditions results from excessive masking by the dominant normal eye.


Reflections on retinoscopy.

Reflections on retinoscopy. It has often been stated that static retinoscopy findings are not affected by the examiner's refractive correction. To what extent this statement remains true is the subject of this statement remains true is the subject of this paper. The basic principle of retinoscopy is the Foucault test. In this test, a knife edge placed on the principal axis of an optical system (S) intercepts a bundle of rays coming out of (S). Depending on the position of the knife edge, various distributions of light and shadow can be observed on the anterior surface of (S). In retinoscopy it is either the entrance pupil of the examiner or the peephole of the instrument that plays the role of the knife edge. Therefore, any change in conditions that bring about a change in the "knife-edge-pupil" position will result in errors in static retinoscopy. Nevertheless, calculations show that these errors do not become significant under usual clinical conditions of static retinoscopy.


Role of gravity in prism ballasting.

Role of gravity in prism ballasting. One of the techniques commonly used in stabilizing the rotation of a contact lens is prism ballasting. The idea is to gain stabilization by the action of gravity pulling on the base of the prism. The determination of just how much prism is necessary in any particular case is usually made empirically, gradually increasing prism amount when more stability is required. This paper will present the results of a mathematical investigation which demonstrates that gravity forces alone do not play the major role in the stabilization of prism ballasted lenses. It is hoped that this preliminary analysis will stimulate further theoretical work of a similar nature, in the growing field of contact lenses.


A comparison of enzyme reagent strip tests for lacrimal glucose. Lacrimal glucose screening for diabetes mellitus is becoming increasingly popular in optometric practice. Several commercial glucose test kits are available and can be used for this purpose. This paper compares the cost, reaction range, and reaction time reported for six different types of reagent strip tests.


Effects of wearing the Bausch & Lomb SoflensTM while skydiving. The use of Soflenses as a method of ametropic correction and ocular protection while skydiving is explored. The use of the Soflens with and without the addition of protective goggles is compared. Vision is seen to be relatively stable and clear while jumping with the Soflens, yet stability and clarity improve significantly when protective goggles are worn over the Soflenses. Stability and clarity improve significantly when protective turbulence in the facial area increases due to more involved skydiving maneuvers. A definite short-term corneal epithelial disturbance is observed when lenses are blown off the eyes due to wind turbulence.


Analytical aids for determining induced vertical prism imbalances in anisometropia. Anisometropes may experience considerable discomfort as a consequence of the vertical prismatic imbalance induced in their correcting lenses. Many patients successfully adapt. Where difficulties continue to be experienced, the prescription must include some degree of compensation. When the patient's correction involves cylinder, determination of the induced imbalance frequently proves to be tedious. For the clinician who wishes to calculate the induced imbalance before determining the required compensation, three useful methods have been developed and are presented in this paper. After a brief discussion of the problem, the three analytical aids are detailed, with examples, followed by their derivation and analysis.


Sociological perspectives of the profession of optometry: a new look at trends since 1958. The paper identifies many features of optometry which have changed in the fifteen years since the last paper by Orzack and Uglum; other aspects have remained surprisingly unchanged. Some of these developments could have been predicted from the analysis of the original article in 1958. This paper will be useful in evaluation of the directions in which optometry seems headed and will stimulate some planning for the future. Some of the questions raised and areas discussed will provoke contention among the optometric community and among others, and this can serve as the impetus for some critical optometric-sponsored research.


Personality patterns of academy fellows and high-income optometrists. Practicing optometrists who have achieved Academy membership status, and, separately, optometrists who have attained unusually high incomes in practice were studied and compared with optometrists in general. Academy fellows differed from non-fellows in their greater initiative, self-confidence, independent spirit, and a pattern of interests like persons engaged in professional social service occupations. High-income optometrists were more like Academy fellows than were optometrists in general, but showed somewhat less of the leadership potential evidenced by Academy members. High-income optometrists showed more interest than other optometrists in business occupations. The findings show that personal qualities and interest patterns associated with being financially successful and with achieving Academy membership can be assessed in a meaningful and objective manner.


Pulmonary mineral dust. A study of ninety patients by electron microscopy, electron microanalysis, and electron microdiffraction. The results of a study of 90 patients are presented. Intrapulmonary mineral deposits were characterized by electron diffraction and electron probe microanalysis. Using this method, pneumoconioses may be distinguidhed from other pneumopathies. In cases of pneumoconiosis, there exists a specific relationship between the etiology of the dust exposure and the crystallographic characteristics of the intrapulmonary deposits. The nature of the deposits may be indicative of a specific type of pneumoconiosis. This method is particularly useful in differentiating between asbestos bodies and ferruginous bodies. The value of the method in general and its importance in the study of pneumoconiosis are discussed.


Parathyroid adenomas and glands in normocalcemic hyperparathyroidism. A light microscopic study. Surgical exploration of the parathyroid glands was carried out in 84 patients who had recurrent kidney stones and serum calcium levels in the upper quartile and most of whom had hypercalciuria. Parathyroid adenoma(s) were found in 19 cases, hyperplasia in 39 cases, and normal parathyroid glands in 26 cases. Postoperatively, a clinical follow-up was carried out for 2 to 5 years. No relapse has occurred in the cases with adenoma(s) but did occur in 24% of the group with hyperplasia and in 48% of the group with normal glands. The histopathologic findings are described here, while the clinical results are given in another paper. The adenomas do not differ histologically from those giving rise to hypercalcemic hyperparathyroidism. The hyperplasia was of the chief cell type and was slight in most cases. The "normal" glands did not differ from other normal glands from euparathyroid subjects. There was no significant difference in weight and histopathologic appearance between the hyperplastic glands of patients who relapsed and those who did not. Nor did the normal glands of "cured" patients differ from those of patients with relapse. However, in both these groups, some histologic features seem to indicate a favorable outcome; in the group with hyperplasia, there were higher glandular and parencymal cell weight as well as predominance of light chief cells and small fibrotic areas. In the normal group, higher number of argyrophil cells and small fibrotic areas also seem to implicate a better prognosis.


Cellular autophagocytosis induced by deprivation of serum and amino acids in HeLa cells. Morphologic alterations in HeLa cells deprived of serum and amino acids were studied by light and electron microscopy. After complete deprivation for 1, 3, or 6 hours, many cells contained autophagic vacuoles enclosing clearly recognizable cell organelles. The proportion of cells showing autophagy rose from 4 to 37% in the first 3 hours of deprivation. Acid phosphatase reaction product was localized within many of the autophagic vacuoles by a modified Gomori method. After 12 to 24 hours of deprivation, many membranous residual bodies were noted within the starved HeLa cells. These electron microscopic studies indicate that complete deprivation of serum and amino acids provides a useful model for the further study of cellular autophagocytosis.


Pancreatic neoplasms induced in Syrian golden hamsters. I. Scanning electron microscopic observations. Pancreases from Syrian golden hamsters treated with N-nitrosobis(2-hydroxy-proply)amine for 10 to 25 weeks were examined under scanning electron microscopy (SEM). Findings indicate that the neoplasms originated from the ductal epithelium and developed progressively. Adenomas were lined by epithelium of differing cells types, ranging from a flat singly ciliated form to cuboidal-columnar types, or to mixed cell populations. The epithelial lining of the ductal carcinomas exhibited tubular and papillary cystic spaces, and cell surfaces were similar to the cuboidal and columnar epithelium of adenomas and of ductal epithelial hyperplasia. However, microvilli were dense and of varied lengths. The SEM observations correlated with patterns seen in routine histologic preparations.


Effect of angiotensin-induced hypertension on rat coronary arteries and myocardium. Acute hypertension has been produced in rats by the intravenous infusion of angiotensin amide for 4 hours. Both control and hypertensive animals were injected intravenously prior to sacrifice with either horseradish peroxidase (HRP) or colloidal carbon. Epicardial arteries and blocks of ventricular myocardium containing intramyocardial arteries and arterioles have been processed for electron microscopy. HRP appears to penetrate the endoethelium of epicardial arteries from control animals within vesicles that bypass endothelial junctions and empty into interendoethelial clefts. Peroxidase does not traverse the endothelium of intramural arteries and arterioles of controls over the 10-minute period of observation. There is acceleration of lateral vesicular transport in the endothelium of epicardial arteries after angiotensin infusion and direct permeation of interendothelial clefts of intramural arterial vessels. Medial fragmentation and more extensive necrosis are observed in intramyocardial but not in epicardial arterial vessels. Foci of myocardial damage resembling irreversible ischemic or anoxic injury followed by reflow are described. It is suggested that the increased permeability of epicardial arteries may be due to elevated pressure, while the altered permeability and vascular lesions of intramural arteries and arterioles are more readily attributable to the vasoconstriction produced by angiotension. The vascular and myocardial lesions are also discussed in relation to the regional actions of angiotensin on the coronary circulation and known effects of this vasoactive peptide on myocardium.


Alterations of the thymus and other lymphoid tissue in young horses with combined immunodeficiency. Combined immunodeficiency (CID) is a significant disease in terms of prevalence in Arabian foals and is a useful animal for study of a similar condition in children. Thymuses from all CID foals examined were extremely hypoplastic. Light and electron microscopic examination of thymuses from CID foals, as well as a thymus from an aborted CID fetus, demonstrate that the basic thymic structure is intact, despite a number of dissimilar morphologic appearances. From these data, we inferred that the thymic hypoplasia was caused by a failure of committed lymphocytes from the bone marrow to populate the organ. The lack of uniform organized lymphocytes in the spleen and lymph nodes provides considerable support for the absence of lymphoid precursors or their inability to respond to differentiating influences.


Effects of repeated deprivation of drinking water on the structure of renal medulla of rats. Rats were exposed to repeated episodes of hydropenia for periods of 5 and 16 weeks, and structural alterations of renal medulla were investigated by light and electron microscopy. The hydropenia induced, within the inner medulla, focally severe structural changes in the tubular and endothelia and loss of interstitial cells. The findings present evidence that repeated episodes of hydropenia are capable of inducing cellular alterations of the renal medulla, particularly in the interstitial cells.


Analysis of five tests commonly used in determining the ability to control single motor units. A correlation regression analysis was used to analyze five individual test and two types of scores in terms of their predictive value in determining overall performance in single motor unit (SMU) control. Fine wire electrodes were inserted into the biceps brachii muscle of twenty-five women subjects. Each subject was tested for electrical silence, motor unit isolation, on-off control, frequency control and rhythm control. A detailed protocol and scoring criteria are described for each test. Ten predictors were analyzed--a time score and an error score for each of the five tests. A correlation regression analysis showed that the On-Off Control, the Rhythm Control and the Motor Unit Isolation tests have greater predictive value than the remaining tests. Furthermore, the error scores obtained from these tests are more reliable than the time scores in predicting overall performance in SMU control. The implications that the present findings may have on future studies are discussed.


Prenatal origin of brachymesophalangia-5. As shown in 91 embryos and fetuses in the 41-235 mm crownrump length, brachymesophalangia-5 may be identified in prenatal time. Although the ratios involving different combinations of length of mid-5 relative to other segments yield different frequencies of BMP-5, the short middle segment of the little finger is already associated with clinodactyly and developmental eccentricity as early as the ninth week of prenatal development.


Head posture and craniofacial morphology. The associations between craniofacial morphology and the posture of the head and the cervical column were examined in a sample of 120 Danish male students aged 22-30 years. Two head positions were recorded on lateral cephalometric radiographs, one determined by the subject's own feeling of a natural head balance (self balance position), and the other by the subject looking straight into a mirror (mirror position). Craniofacial morphology was described by 42 linear and angular variables, and postural relationships by 18 angular variables. A comprehensive set of correlations was found between craniofacial morphology and head posture. The correlations were similar for both head positions investigated. Of the postural variables, the position of the head in relation to the cervical column showed the largest set of correlations with craniofacial morphology. Extension of the head in relation to the cervical column was found in connection with large anterior and small posterior facial heights, small antero-posterior craniofacial dimensions, large inclination of the mandible to the anterior cranial base and to the nasal plane, facial retrognathism, a large cranial base angle, and a small nasopharyngeal space. The possible role of functional factors in mediating the relationship between morphology and posture was discussed.


A comparative study of tooth and dental arch dimensions in Jewish children of different ethnic descent. I. Kurds and Yemenites. Dental casts of 99 Kurdish and 98 Yemenite Jewish children evenly distributed between the sexes, aged 12 years, were measured for mesiodistal and buccolingual tooth dimensions, and arch depth and width. Dental dimensions showed significant differences between the two groups in certain permanent teeth in mesiodistal length, while in the buccolingual diameter the differences did not reach statistical significance. Dental arch form in Kurdish children was more rounded due to significantly bigger arch width, while arch depth was not significantly different from Yemenites. Intragroup sex differences were found in both groups with reference to arch dimensions, while in the dental parameters they were more strongly expressed in Kurdish children.


A comparative study of the temporal bone in three populations of man. A comparative study was made to determine race and sex differences in the temporal bone, to investigate growth relationships, and to establish a basis for phylogenetic studies of the temporal bone and the temporal lobe of the brain. Data on Eskimo, Indian, and white crania were collected from radiographs and directly from the skulls. Of the 25 variables studied, only the minimum diameter of porus failed to demonstrate some difference among the races. Variation between sexes was found for all measurements except the cranial base angle (of deflection) and three angles related to the petrous pyramids. Correlation coefficients indicated that none of the angles are related in any consistent manner to the other variables studied. This is interpreted as further evidence of cranial base stability. The Indians have the lowest, longest squamae, differing most from the whites. The position of squama is more anterior in the Eskimos. Females of each race possess more anteriorly positioned squamae than males. When the squama is more anteriorly located, the porus is in a more posterior position within the squama itself. Strong race variation exists in the shape of porus. In order to establish a basis for phylogenetic studies of the temporal lobe of the brain better reference points for reflecting its size and shape must be found.


Hereditary and environmental determinants of growth in height in a longitudinal sample of children and youth of Guatemalan and European ancestry. The effects of hereditary and environmental factors upon the growth in stature of children living in Guatemala City has been studied. Heights at yearly examinations were fitted, by individual, to a double logistic curve in samples of Guatemalan and European children attending a private school in Guatemala City. These two samples differed genetically yet shared the same environment. Their growth was compared, by a multivariate analysis of the parameterized curves, to that of children from the Berkeley Growth Study, genetically similar to the European sample, yet living in different environments. The European children in Guatemala grew, before adolescence, more similar to Guatemalan and differed significantly from the Berkeley sample children. However, the amount of growth during the adolescent years experienced by the European children was similar to that of the Berkeley sample and differed from their Guatemalan counterparts.


The etiology and porotic hyperostosis among the prehistoric and historic Anasazi Indians of Southwestern United States. Porotic hyperostosis was studied in 539 crania from maize-growing prehistoric and historic groups who occupied two dissimilar ecological zones of the Plateau country of Arizona and New Mexico--canyon bottoms and sage plain. Defined as abnormal localized sieve-like structural changes involving the hematopoietic areas of the cranium, it was found in 185 (34.3%) of these skulls. More frequent in children than in adults, it shows significant frequency differences between both children and adults of the two ecological zones. The two ecological zones differ in the availability of iron in the diet; the canyon inhabitants depended heavily on maize (which interferes with iron absorption) while the sage plain people consumed more iron-rich animal products. We hypothesize that an increased dependence on maize produced more iron deficiency anemia and resulted in more porotic hyperostosis. Maize is known to have permitted a food surplus which in turn allowed for increased Southwestern population growth in marginal areas like the canyon bottoms. Heavy dependency on a single food type with consequent hematologic problems may have been an important reason for the subsequent abandonment of the Anasazi region.


The biomechanical analysis of bone strength: a method and its application to platycnemia. Traditional methods of bone analysis (both metric and topographic) are restricted to external characters. Special distribution of material is, however, equally critical to an understanding of a bone's function. Dynamic testing to determine whole bone strength can only be performed on fresh specimens. Methods for the calculation of both bending and torsional strength of other specimens (such as preserved or fossil bones) are developed in this paper. In order to illustrate the methods, the functional significance of tibial shaft cross sectional variation is investigated.


The association between Harris lines and enamel hypoplasia in prehistoric California Indians. Hypoplastic defects of tooth enamel and Harris lines in the long bones have been heralded as potentially useful indicators of health conditions in prehistoric populations. Both result from temporary cessation of growth processes due to similar types of disease, malnutrition, or other metabolic insult. An association test for the first six years of life was conducted on a large series of prehistoric California Indians, using femora and canines from young adults. No significant association was found. This is ascribable to differences in etiology and stability.


A factor analysis of body build in the rat. Following a survey of the problems associated with the comparative study of measures of physique in domesticated and laboratory animals, techniques were developed for the measurement of body build in the adult albino laboratory rat (Rattus norvegicus). They involved anesthetisation of the animals and the use of calipers and a simple apparatus devised for the purpose. The 17 measures taken on 100 rats, 50 of each sex, are detailed and the reasons for excluding other given. Intercorrelations of all the measures and their reliability co-efficients, which were judged satisfactory, are presented. The tables of intercorrelations, one for each sex, were factor analysed separately, and rotations to simple structure performed. Two factors were identified, one having factor saturations on measures of body length and the other similarily defining body width. This pattern was similar for the two sexes and a single index of body build was therefore proposed in which the length of the rear foot is divided by the width of the shoulder girdle and multiplied by 100 to avoid decimals. The use of the index in other investigations is mentioned.


Gallbladder pressure-volume response to gastrointestinal hormones. The pressure-volume (PV) response of the opossum gallbladder was studied under basal conditions and after the continuous intravenous infusion of gastrin I, secretin, and cholecystokinin (CCK). The hormone effects were examined individually and in combination. The unstimulated gallbladder was capable of accommodating increases in intraluminal volume with only slight changes in intraluminal pressure. Cholecystokinin significantly increased the pressure recorded from the gallbladder. The pressure generated depended on the concentration of CCK and the intraluminal volume. Gastrin I had no independent effect on the PV response of the gallbladder but reduced the stimulatory affect of CCK. Secretin, alone, decreased the PV response of the gallbladder. Secretin also antagonized the stimulatory response to CCK. These findings suggest that the regulation of gallbaldder motor function and pressure generation exclusive of neural input, may depend on the interaction of CCK with gastrin and secretin and the intraluminal volume of the organ at the time of stimulation.


Changes in intestinal vascular diameter during norepinephrine vasoconstrictor escape. The hypothesis that escape from norepinephrine-induced vasoconstriction in the intestine is due to relaxation of initially constricted vessels was tested in 18 anesthetized cats. Intestinal blood flow was measured by an electro magnetic probe on the superior mesenteric artery. Intestinal submucosal and muscle arterioles and small mesenteric arteries were studied by in vivo microscopy with an image-splitting technic. Continuous recordings of mesenteric flow and vessel diameter were made during the infusion into the superior mesenteric artery of norepinephrine (NE) at a rate of 1-2 mug/min for 3 min. Mesenteric flow decreased soon after the NE infusion began but then escaped. Microscopically, arterial constriction and escape were noted in submucosal, muscle, and mesenteric vessels with a time course similar to that for flow. Arteriovenous anastomoses were not seen. These findings support the hypothesis that escape from Ne-induced vasoconstriction is due to relaxation of initially constricted vessels.


Effects of limited food intake on the obese-hyperglycemic syndrome. In ob/ob mice a 12-wk period of food restriction led to a reduced rate of somatic growth and a decreased lean body mass, along with small but reliable reductions in systemic immunoreactive insulin levels and evidence of increased insulin sensitivity. However, no effects of limited access to food were noted on the basal hyperglycemia, the elevated percent carcass lipid, or on the significantly higher levels of serum corticoids that occur in obese animals. These data indicate that hyperphagia alone is not responsible for the maintenance of many of the commonly reported characteristics of the obese-hyperglycemic syndrome, but do not exclude the contribution of factors secondary to the quantity of ingested food. Additionally, the present data lend support to recent work suggesting that chronic hyperinsulinemia or an elevated set point of total carcass lipid may be instrumental in the development of this syndrome.


Temporal relationships of barosensory attenuation in conscious rabbits. Electrical stimulation of anterior or posterior hypothalamus with 10-s trains elicited heart rate and blood pressure decreases. Presentation of anterior hypothalamic stimulation coincident with or 5, 10, or 15 s prior to 5-s train stimulation of aortic nerve (AN) summated with depressor-decelerator responses to AN stimulation. The summating effect was more pronounced for heart rate than for blood pressure. Simultaneous onset of AN and posterior hypothalamic stimulation did not influence AN responses. In contrast, when AN stimulation was delayed until 5, 10, or 15 s after onset of posterior hypothalamic stimulation, small, moderate, and full attenuation of AN responses occurred, respectively. Since AN and posterior hypothalamic stimulation each led to depressor-decelerator responses, attenuation of AN responses cannot be attributed to simple summation of cardiovascular responses elicited by intracranial and aortic nerve stimulation.


Analysis of inhibitory effect of dopamine on carotid body chemoreceptors in cats. The inhibitory effect of dopamine on carotid body chemoreceptors was studied in anesthetized cats to determine whether it was dependent on changes in blood flow in the vicinity of the receptors. The blood supply to the carotid body was isolated, and flow was controlled with a perfusion pump. Single- or few-fiber recordings were made from the peripheral end of the cut carotid sinus nerve in seven cats. The rate of discharge of 68 chemoreceptor strands increased when flow through the carotid body was stopped. This response was reduced or abolished by dopamine in animals ventilated with either room air (15 strands) or a gas mixture of 95% O2 and 5% CO2 (53 strands). These results suggest that dopamine exerts its inhibitory effect primarily through a direct action on the chemoreceptors rather than by a vasomotor effect in the carotid body.


Secretion of new digestive enzyme by pancreas with minimal transit time. A small amount of labeled digestive enzyme is secreted within 5 min of adding radioactive leucine to whole rabbit pancreas in vitro. This rapid secretion of labeled protein suggests that some new protein is able to bypass intracellular storage pools and is secreted immediately. The amount of protein secreted this way varies inversely with overall protein secretion in the unstimulated state and is decreased as the result of cholinergic stimulation of protein secretion as well. Under the conditions studied, a mean of 2.5% of secreted protein is apparently not stored prior to secretion.


Gastrointestinal control of sodium excretion in sodium-depleted conscious rabbits. Recent studies of sodium-depleted rabbits have shown that oral sodium loading is followed by greater natriuresis than intravenous sodium loading. The present study was undertaken to determine if this is dependent on differences in aldosterone excretion. Rabbits in balance on a low-sodium diet were given bolus doses of sodium either orally or intravenously. Those receiving oral sodium responded with a greater natriuresis than those receiving it intravenously. No differences in aldosterone excretion were demonstrated after oral or intravenous sodium repletion. Rabbits given large doses of exogenous aldosterone continued to excrete more sodium after oral than after intravenous repletion. This study demonstrates that in rabbits the gastrointestinal tract functions to regulate renal sodium excretion and that the mechanism is independent of aldosterone.


PAH transport and fluid absorption by isolated perfused frog proximal renal tubules. Para-aminohippurate (PAH) transport and fluid absorption were studied in isolated perfused frog (Rana catesbeiana) proximal renal tubules. With 2 X 10(-5) M PAH in the bath, tubule fluid-to-bath (TF/B) concentration ratios averaged 3.0 and net secretion averaged 746 X 10(-15) mol min(-1) mm(-1) in the proximal tubule. Net PAH secretion did not vary with perfusion rate. During PAH secretion, cell water PAH concentration exceeded that in the tubular fluid or bath, suggesting active transport into cells and subsequent diffusion into lumen. In accordance with this concept, luminal membrane permeability (3.8 X 10(-5) cm s(-1) calculated from perfusion studies was about 6 times greater than peritubular membrane permeability (0.66 X 10(-5) cm s(-1)) determined from studies of PAH efflux from tubules with oil-filled lumens. Net transepithelial PAH transport saturated at bath concentration of about 6 X 10(-5) M. Addition of 20 mM urea to PAH bath concentration of 2 X 10(-5) M reduced net PAH secretion by 32%. Fluid absorption in proximal tubules averaged 0.34 nl min(-1) mm(-1). Ouabain (10(-4), 10(-5), or 10(-6) M) added to bath blocked fluid absorption. Fluid absorption was partially restored following removal of ouabain.


Inhibition of NaCl absorption from perfused rat ileum by furosemide. The effect of furosemide on intestinal absorption of water and electrolytes was studied using segments of rat ileum perfused in vivo. Furosemide (1 mM) in the perfusion fluid reduced absorption of Na, Cl, and water by 50% from a balanced electrolyte solution without changing the transepithelial potential difference (PD). This effect was also observed in the absence of luminal glucose and was largely reversible. Substitution of all Na in perfusion fluid with choline produced secretion of Na and water and abolished Cl absorption; substitution of all Cl with SO4 reduced Na absorption to 20% of control values. Under both these conditions, furosemide had only trivial effects on electrolyte absorption and exerted no effect on PD. Measurements of unidirectional fluxes of Na and Cl showed that furosemide decreased net flux by reducing lumen-to-blood flux of these ions rather than increasing blood-to lumen flux. These results resemble those obtained in this tissue following exposure to acetazolamide, and suggest that furosemide inhibits a coupled, neutral process of NaCl transport from lumen to blood. Although this effect could be a result of carbonic anhydrase inhibition it more likely occurs from a separate action of furosemide on ileal transport.


Adenosine and active hyperemia in dog skeletal muscle. Adenosine as a possible mediator of active hyperemia in skeletal muscle was studied in hindlimbs of dogs. Sciatic nerve stimulation decreased vascular resistance to 55 +/- 5% (mean +/- SE) of the control value in hindlimbs perfused at a constant flow rate (61 +/- 6 ml/min). Venous plasma K+ concentrations were elevated after 2 min (from 4.0 +/- 0.2 to 4.8 +/- 0.2 meq/liter; P is less than 0.005) and 20 min (4.7 +/- 0.2 meq/liter; P is less than 0.001) of contraction, but the arteriovenous difference in plasma osmolality was changed only after 2 min of contraction (from -3.0 +/- 0.6 to -7.2 +/- 0.8 mosmol/kg H2O; P is less than 0.001). The muscle adenosine contents were not significantly elevated after 5 min of contraction, but were increased after 10 min (from 1.97 +/- 0.33 to 8.35 +/- 0.97 nmol/g; P is less than 0.05) and 25 min (from 1.64 +/- 0.22 to 7.57 +/- 2.20 nmol/g; P is less than 0.05) of contraction. Thirty minutes after contraction had ceased, the adenosine contents were significantly below control values (from 2.22 +/- 0.59 to 1.51 +/- 0.40 nmol/g; P is less than 0.005). Venous plasma adenosine concentrations did not increase during muscle contraction. No relationship was found between the increase in the plasma inorganic phosphate level and the activity of the muscles. These data indicate that the adenosine content of skeletal muscle is increased by contraction, and support the concept that adenosine may be a mediator of sustained active hyperemia.


Insulin and jejunal electrical activity in dogs and sheep. The effect of insulin on jejunal myoelectric activity was studied in conscious dogs and sheep by injection of insulin and stimulation of insulin release. In dogs, the migrating myoelectric complex (MMC), characteristic of fasting, was replaced by a continuous pattern of activity after feeding, injection of insulin, or infusion of D-glucose, L-leucine, or L-arginine. The response to feeding was reduced in alloxan-diabetic dogs and completely abolished following additional vagotomy when only exogenous insulin induced the "fed" pattern. Vagotomy alone had only minor effects on the response to feeding. Sheep exhibit a continuous sequence of MMC, regardless of feeding, but infusion of insulin or volatile fatty acids produced activity similar to that seen after feeding in dogs. In alloxan-diabetic sheep the recurrence and intensity of the MMC were decreased, and the effect of volatile fatty acids was eliminated. Insulin injection restored the pattern to normal. Thus, insulin levels are of importance in the control of the jejunal motor profile and may mediate the postprandial disappearance of MMC in dogs.


Uptake of and response to norepinephrine by certain tissues of hypertensive rats. A decrease in the capacity of the sympathetic nervous system of hypertensive rats to take up norepinephrine (NE) has been previously described. In the present study, rats were made hypertensive by one of the following technics: "adrenal regeneration," figure-of-eight knot around one kidney, ingestion of a 10% NaCl solution. After 2 mo, the adrenal regeneration rats were hypertensive, and there was a significant decrease in the capacity of their hearts to take up NE as well as a significant increase in the inotropic response to the amine. Similar results were obtained with hearts and aortic strips of renal hypertensive rats, as well as of rats made hypertensive by drinking a 10% NaCl solution. In renal hypertensive rats, there was no appreciable difference in the time of appearance of hypertension, the decrease in NE uptake by the heart or aorta, or the increase of the inotropic response. Previous work showing a decrease of NE uptake in rats made hypertensive by administration of deoxycorticosterone has been confirmed utilizing three other models of the disease.


Mechanism of decrease in plasma renin activity during volume expansion. The importance of filtered load of sodium and extracellular volume expansion (ECVE( per se on plasma renin activity (PRA) was studied in two groups of hydropenic dogs. Group I protocol consisted of bilateral ureteral obstruction (UO) followed by isotonic ECVE and finally UO release. During UO, PRA rose significantly above control (15.4 leads to 41.7 ng/ml per h). Superimposition of ECVE did not significantly alter PRA, but UO release returned PRA toward control (24.8 ng/ml per h). Fractional sodium excretion (FE(Na)) after UO release was higher than control (0.6 leads to 12.6%). In group II, ECVE preceded UO and caused a fall in PRA below control (16.8 leads to 4.8 ng/ml per h). FE(Na) was significantly increased over control (0.3 leads to 14.7%). Superimposition of UO reversed the fall in PRA to a value not significantly different from control. On release of UO PRA fell, but not significantly, whereas FE(Na) fell to 12.6%, a value not different from that during ECVE alone. The results indicate that filtration is required for ECVE to elicit a fall in PRA, under the present experimental condition.


Effect of epinephrine on vascular space of gills and head of rainbow trout. The filling of the gills and head vascular space of a teleost fish was measured in vitro by perfusing an isolated head of a trout with a Ringer solution containing 131I-labeled human serum albumin. The presence of epinephrine in the Ringer solution significantly increased afferent (ventral aortic) flow rate and efferent (dorsal aorta) flow rate, whereas branchial venous system circulation was reduced. When perfused with an epinephrine-free Ringer, the branchial vascular space appears 5-6 times greater than the head vascular space (per 100 g of tissue). Epinephrine, 10(-5) M, in the Ringer solution significantly decreased the branchial vascular space without modifying that of the head. The increase in perfusion rate and decrease in branchial vascular space due to the epinephrine can only be interpreted by taking into account a branchial nonlamellar compartment of a considerable volume.


Forelimb blood flow distribution during hypothalamic dilator response. An attempt is made to determine whether hypothalamically induced forelimb vascular dilation in the dog affects primarily exchange beds or shunt circuits. Slug injections of [131I] albumin and 86RbCl were used to measure the active vascular volume of the forelimbs and permeability surface area product (PS), respectively. Changes in total vascular volume (TVV), filtration, and capillary filtration coefficient (CFD) were measured by plethysmography. During stimulation, forelimb blood flow increased 25% and TVV increased an average 1.5 ml. There was no plethysmographic evidence of outward capillary filtration. Active vascular volume decreased 11%. PS decreased 11%, and CFC decreased 20%. These results point to a redistribution of blood flow from exchange circuits to faster flow channels. During constant-inflow perfusion, there was evidence from CFC and PS measurements that the capillary surface area was increased while active vascular volume decreased. The results observed with hypothalamic stimulation are different from those obtained with pharmacologic dilators and denervation. It is suggested that the former method has a more selective effect in lowering resistance in the faster shuntlike vessels.


Histidine decarboxylase activity in trauma-resistant rats. Studies have been carried out to determine the possible role of nascent histamine in the development of traumatic shock. This was done by examining histidine decarboxylase (HD) activity of the lung, spleen, and plasma following exposure to trauma in normal and trauma-resistant rats. In normal rats, there was a significant increase in lung HD activity at 15 min and 4 h; and in the spleen the HD activity increased significantly at 4 h. In trauma-resistant rats exposed to trauma, there were no changes in enzyme activity in the lung and less pronounced changes in the spleen. The plasma HD activity remained stable in normal and resistant rats following episodes of trauma. Changes in total erythrocyte hemoglobin were observed in both normal and trauma-adapted rats following exposure to this stress, increasing significantly in normal rats, but decreasing in trauma-resistant rats. Blood volume decreased significantly at 4 h after trauma in normal animals; whereas only a slight decrease was noted in resistant animals. The data support the concept that newly formed histamine contributes to the pathogenesis of shock. It is also proposed that the increased resistance, characteristic of trauma-adapted rats, could be partly due to an inhibition of enzyme activation following trauma.


Heavy metal-induced alterations in ion transport by turtle urinary bladder. Previous studies of heavy metal salt-induced acute renal failure demonstrated abnormalities of fluid and solute transport by nephron segments and alterations in glomerular filtration rate and renal hemodynamics. To determine the direct effects of uranyl nitrate (UN) or HgCl2 on ion transport, their effects were studied on the isolated urinary bladder of the turtle. Unidirectional 24Na+ and 36Cl- fluxes were measured across short-circuited bladders. The addition of 0.1 mM UN to the mucosal solution resulted in a 69.9 +/- 4% (SEM) decrease in short-circuit current (SCC) without change in transepithelial resistance. Net Na+ flux (7.95 +/- 0.81 mueq/h per 8 cm2) decreased by the same magnitude as the SCC, primarily due to a 5.75 +/- 0.76 mueq/h per 8 cm2 decrease in the mucosal- (M) to-serosal (S) Na+ flux. Net Cl- flux decreased also primarily due to a decrease in M-to-S Cl- flux. Addition of 0.4 mM UN to S did not measurably affect the SCC or ion fluxes. The addition of 10 muM HgCl2 in another group of bladders reduced SCC and M-to-S Na+ flux by 81 +/- 7% without change in Cl- fluxes or resistance. The removal of either UN or HgCl2 from M by washing did not reverse the decreased SCC, but after washing addition of either dithiothreitol, 2 mM, or amphotericin B, 20 mug/ml, to M completely reversed the effects of UN or HgCl2 on SCC. These studies suggest that heavy metal salts inhibit Na+ transport by the turtle bladder without altering passive ion fluxes.


Vitamin D metabolism: physiological regulation in egg-laying Japanese quail. Homogenates of kidney removed from reproductivity active female Japanese quail were incubated with tritiated 25-hydroxyvitamin D3, and the metabolites were extracted and identified by chromatographic methods. Kidneys removed from birds with and without an egg in the oviduct revealed that ovulation results in enhanced production of 1, 25-dihydroxyvitamin D3, the active hormonal form of vitamin D3. Further examination of this phenomenon in relation to the ovulatory cycle revealed that 1, 25-dihydroxy-vitamin D3 production is enhanced throughout the 24 h following ovulation. Particularly important is the finding that its synthesis is already enhanced during the first 6 h after ovulation, at a time before any calcification of the egg shell begins. If, following oviposition, no ovulation occurs, 1, 25-dihydroxy-vitamin D3 production decreases rapidly and significantly within the first 6 h following oviposition. This study has revealed for the first time a physiological state, namely the reproductive period in the female bird, in which endogenous control over 1, 25-dihydroxyvitamin D3 production is exhibited without any previous manipulation, dietary or otherwise, of the animals.


Similarities in coronary flow between external counterpulsation and intra-aortic balloon pumping. The ability of external counterpulsation (Cardiassist) and intra-aortic balloon pumping (AVCO) to influence collateral coronary blood flow in ischemic myocardium was measured in anesthetized dogs. Cardiac output and heart rate (atrial pacing) were held constant on right-heart bypass. Both external counterpulsation and balloon pumping augmented peak diastolic pressure (30 mmHg and 38 mmHg, respectively), while mean aortic pressure, peak left-ventricular pressure, left-ventricular end-diastolic pressure, maximum left-ventricular dp/dt, hematocrit, and osmolality remained unchanged. Regional coronary blood flow was measured using 9-mum radioactive microspheres. External counterpulsation and balloon pumping begun immediately following ligation of the left-anterior descending coronary artery significantly increased collateral coronary blood flow 29 +/- 7.5% (SE, P is less than .01) and 20 +/- 8% (P is less than .05), respectively, to ischemic myocardium. This redistribution of collateral coronary blood flow produced by both methods of counterpulsation was primarily to the subepicardial region of the ischemic myocardium. The mechanism responsible for the measured increases in collateral coronary blood flow appears most likely to be an increased pressure gradient produced by diastolic augmentation.


Insulin kinetics after portal and peripheral injection of [125I] insulin. I. Data analysis and modeling. The kinetics of insulin are commonly investigated by intravenous administration of labeled hormone, whereas native insulin is removed by the liver to some extent before mixing in the systemic circulation. A mathematical model has been developed which makes it possible to interpret the experimental data obtained by peripheral plasma sampling after portal and peripheral injection of the tracer. Equations are given that allow for the computation of metabolic clearance rate, initial distribution volume, production rate, and body mass of insulin. It is demonstrated that hepatic extraction can be calculated from the difference between the clearance rate values obtained after portal and peripheral injection of the tracer; an estimate of total hepatic catabolism is also derived. The assumptions and limitations underlying this mathematical analysis are discussed.


Insulin kinetics after portal and peripheral injection of [125I] insulin: II. Experiments in the intact dog. Insulin metabolism in man is usually investigated by peripheral injection of the hormone, whereas native insulin undergoes hepatic extraction prior to mixing in the general circulation. To quantify this difference, in 10 dogs [125I] insulin was injected into a peripheral vein, and the initial distribution volume (IDV), the metabolic clearance rate (MCR), and the mean transit time (t) were computed from the plasma disappearance curve of the immunoprecipitable activity. The splenic vein was then cannulated under pentobarbital anesthesia, and the parameters were again computed from the peripheral activity after portal introduction of the tracer. The MCR after portal injection [15.1 +/- (SE) 1.1 ml/min per kg] was greater (P is less than 0.001) than the MCR after peripheral administration (13.4 +/- 0.9 ml/min per kg). Also, IDV was larger (P is less than 0.01) after portal injection (167 +/- 12 vs. 138 +/- 10 ml/kg). Mean transit times did not change significantly. Insulin secretion rate (0.29 +/-0.04 mU/min per kg) and body insulin mass (7.03 +/- 1.5 mU/kg) were also measured. An estimate of hepatic extraction was obtained from the difference between the clearance rate values calculated following portal and peripheral injection. Under our experimental conditions, hepatic retention of insulin was found to be 19.6% (range 9.6-36.2%). The method is recommended for investigations in man.


Fluorometric studies of recovery metabolism of rat fast- and slow-twitch muscles. Recovery metabolism of fast-twitch extensor digitorum longus (EDL) and slow-twitch soleus (SOL) muscles of the rat has been investigated using fluorometric monitoring of reduction of nicotinamide adenine dinucleotide (NAD). In both EDL and SOL, groups of twitch contractions produced a decrease in fluorescence (oxidation of NADH) which returned to the resting base line after contraction ceased. These responses proceeded more quickly in EDL than SOL and were abolished by anoxia. A 1-s tetanus of SOL produced an initial reduction which could be abolished with iodoacetate followed by a prolonged oxidation which could be blocked by anoxia. The fluorescence of EDL was decreased immediately following a 1-s tetanus but then rapidly increased well beyond the resting level of reduction and persisted throughout the recovery period. This reduction was largely depressed by iodoacetate. The results indicate marked differences in the recovery metabolism of these muscles, consistent with predominantly mitochondrial oxidative activity in the slow-twitch muscles and predominantly glycolytic activity in the fast-twitch muscles.


Lung lymph and free interstitial fluid protein composition in sheep with edema. In 10 anesthetized sheep with mild or moderate pulmonary edema we determined whether the protein composition of lung lymph is representative of free interstitial fluid. We measured protein concentration and albumin fraction in 1-mul samples of plasma, lung lymph, and free interstitial fluid. We also measured lung lymph flow. In five sheep with edema caused by increased pulmonary microvascular pressure, the average (+/- 1 SE) plasma protein concentration was 6.0 +/- 0.4 g/100 ml, lung lymph 3.4 +/- 0.2, and interstitial fluid 3.1 +/- 0.3. Lymph flow increased from an average base-line value of 9.4 ml/h to 43.4 ml/h during edema. Average albumin fractions in lymph and interstitial fluid were 0.56 +/- 0.02 and 0.50 +/- 0.01, respectively, compared with 0.44 +/- 0.01 for plasma. In five sheep with increased-permeability edema, average plasma protein concentration was 5.7 +/- 0.3 g/100 ml, lung lymph 4.1 +/- 0.4, and interstitial fluid 4.6 +/- 0.4. Base-line lymph flow was 11.0 ml/h and increased to 27.8 ml/h during edema. Average albumin fractions in lymph and interstitial fluid were 0.53 +/- 0.01 and 0.50 +/- 0.02, respectively, compared with 0.43 +/- 0.01 for plasma. We conclude in both high-pressure and altered-permeability edema, the protein composition of lung lymph collected from the major lung efferent lymphatic is representative of the free interstitial edema fluid.


Effect of substance P on proximal tubular reabsorption in the rat. Micropuncture and clearance techniques were used simultaneously to determine the effect of substance P on proximal tubular and overall renal function in anesthetized rats. This polypeptide, infused in saline at 50 pg/min into the abdominal aorta above the renal arteries, produced increases in urine flow, 2.7-3.7 mul/min.g kidney wt (P is less than 0.005); urinary sodium concentration, 32-61 meq/liter (P is less than 0.01); and sodium excretion, 89-223 neq/min (P is less than 0.005). Tubular fluid to plasma inulin concentration ratio measured in the last accessible proximal convolution fell from 2.21 to 1.80 (P is less than 0.001), and thus fractional reabsorption was reduced from 54 to 44% (P is less than 0.001). Absolute reabsorption by the proximal convoluted tubule was also reduced 15.5-12.5 nl/min (P is less than 0.025). In a control series of animals, saline alone infused at the same rate did not produce any statistically significant changes in the measured parameters over the same time period. The intrerenal mechanism responsible for the reduction in proximal reabsorption appears to be a tubular one since no consistent or significant changes were observed in kidney or single nephron glomerular filtration rate, renal plasma flow, or intrarenal hydrostatic pressures. No evidence was found to indicate redistribution of filtration rate, or plasma flow, or a reduction in filtration fraction.


Restitution of blood volume after hemorrhage: role of the adrenal cortex. Splenectomized and adrenalectomized-splenectomized dogs, anesthetized with pentobarbital, were bled so that the role of cortisol in restitution of blood volume could be examined. Intact dogs and adrenalectomized dogs infused with cortisol at a high rate (17 mug/min) showed restoration of blood volume and plasma protein at 24 h, preceded by an early increase in plasma osmolality. Adrenalectomized dogs infused with cortisol at basal rates (2 mug/min) showed no increase in plasma osmolality and no restoration of blood volume or plasma protein at 24 h unless extracellular fluid volume was expanded by exogenous fluid. It is concluded that hemorrhage leads to an increase in extracellular osmolality mediated in part by increased cortisol concentrations. As a consequence, there is a shift of intracellular fluid to the interstitium. The resulting increase in interstitial pressure accelerates lymphatic movement of interstitial protein to the vascular system. This results in a reequilibration of extracellular fluid toward the plasma, thus completing the restitution of blood volume. The osmotically active agents mobilized by cortisol do not appear to be glucose, sodium, or potassium.


Permeability of dog lung endothelium to sodium, diols, amides, and water. Bolus injection of T-1824-albumin, test indicator, and tritiated water into a jugular vein of the anesthetized dog and sequential sampling of blood from a carotid artery yielded multiple-indicator outflow patterns for the lung. Permeability-surface products of the test indicator for the lung endothelial barrier were obtained by comparison of test indicator with T-1824-albumin on the upslope of the test-indicator curve and correction for backdiffusion. The derived endothelial permeability coefficients, based on surface area/wet lung weight-500 cm2/g (mean +/- 2 SE, 10(-5) cm s(-1)), were: sodium ion, 2.9 +/- 0.8; ethylene glycol, 7.3 +/- 1.5; 1, 3-propranediol, 7.9 +/- 3.2; 1, 2-propanediol, 10 +/- 4; 1, 4-butanediol, 14 +/- 8; 1, 5-pentanediol, 21 +/- 6; 1, 6-hexanediol, 41 +/- 11; formamide, 16 +/- 9; acetamide, 13 +/- 4; propionamide, 31 +/- 12; butyramide, 42 +/- 24; valeramide, 79 +/- 12; tritiated water, 150 +/- 50. The backdiffusion correction varies from 8% for sodium to 75% for valeramide. A parallel-pathway model of blood-tissue passive exchange of small nonelectrolyte solutes is compatible with these results, with a lipid pathway through endothelial cells and an aqueous pathway possibly through interendothelial clefts.


Baroreceptor effects on renal and adrenal nerve activity. Spontaneous efferent discharges were recorded from nerve filaments dissected from adrenal and renal nerve bundles in the rabbit. Raising of the systemic blood pressure or stimulation of the depressor nerve caused a decrease in discharge rate in these nerve filaments. Portal vein occlusion or elevation of mesenteric venous pressure caused a depression of activity in these nerves. It is suggested that adrenal and renal sympathetic nerve cells receive inputs from baroreceptors in the systemic arterial system and from mechanoreceptors in the portal and mesenteric veins that cause reflex inhibition of activity in these nerve cells.


Endogenous prostaglandins and mechanical tension in canine trachealis muscle. Prostaglandin E (PGS) is synthesized and released in isolated canine trachealis muscle (CTM), and the PGE threshold concentration for an effect on isometric tension is very low, indicating this prostaglandin is a most likely candidate for an endogenous prostaglandin that modulates or regulates tension. Prostaglandin F (PGF) is also released, but the threshold concentration for a mechanical effect is probably too high for endogenous PGF to have a direct effect on tension in this muscle. Indomethacin and aspirin, at concentrations commonly used to inhibit prostaglandin synthetase, had effects on tension, membrane potential, and membrane resistance, but these effects were not appropriate if their only action was to inhibit PGE or PGF concentration in CTM. Release of PGE from CTM was increased fourfold by treatment with carbachol, but even under this condition, where presumably cell [PGE] was increased, electrophysiological studies failed to give convincing evidence that the actions of indomethacin on mechanical tension were related to inhibition of PGE or PGF synthesis.


Reduced high-energy phosphate levels in rat hearts. II. Effects of sodium cyanate. The effects of increased blood-oxygen affinity, due to carbamylation of hemoglobin in vivo, on aerobic metabolism in the heart were studied in rats. Adult male rats were injected intraperitoneally 3 times weekly for 10 wk with sodium cyanate (60 mg/kg). Significant derangement of blood-oxygen interaction was observed. Oxygen-dissociation curves were left shifted by 13 mmHg (35.1-21.8), and the overall deoxygenation rate (k) was reduced 41% (6.142-3.624; s(-1)); P is less than 0.001 for each parameter. Heart ATP and PCr levels were reduced (ATP: 19.4-16.7; PCr: 15.0-11.0, mum/g dry wt; P is less than 0.001 for each). In addition, glycogen levels fell (161.4-112.9, mum C6/g dry wt; P is less than 0.001). Myocardial lactate levels increased 54% (2.6-4.0, mum/g dry wt; P is less than 0.01) in the cyanate-treated group. These findings strongly suggest a hypoxia-induced activation of glycolysis as a consequence of altered oxidative metabolism in rats treated with sodium cyanate.


Recovery heat production of mammalian fast- and slow-twitch muscles. Relationships between initial heat and recovery heat in fast-twitch extensor digitorum longus (EDL) and slow-twitch soleus (SOL) muscles of the rat have been investigated by estimating the ratio of total heat (initial + recovery) to estimated initial heat. Results obtained from SOL agreed well with earlier data from amphibian skeletal muscle and indicated that in tetanic contractions of SOL the ratio,total heat/initial heat, was slightly greater than 2. Experiments on EDL revealed complexities not previously reported for amphibian muscle. Anaerobic total heat production by EDL was as much as 75% of aerobic heat production. When the initial heat was estimated under anaerobic conditions and with iodacetate present, the apparent ratio of total heat/initial heat in tetanic contractions of EDL approached a value of 2. The results are discussed in relation to the enzymatic characteristics of these muscles, and it is suggested that the recovery heat of SOL arises mainly from mitochondrial oxidative metabolism while that of EDL arises, to a large extent, from glycolytic activity.


The psychiatrist and the pain clinic.

The psychiatrist and the pain clinic. The author discusses the difficulties inherent in the role of the psychiatrist in a pain clinic as well as some of the recurring problems that he has seen in this setting. He states that the psychiatrist brings to the understanding of pain a multidimensional approach, which is hard for nonpsychiatrist clinicians to accept, and valuable psychophysical methods for evaluating and quantifying pain. He discusses aspects of the interplay between intrapsychic and interpersonal factors in the pain experience, particularly the relationship between pain and guilt, and illustrates these aspects with case reports.


Current issues in national insurance for mental health services. The current economic crisis has again placed in jeopardy the inclusion of mental health benefits under national health insurance. The author notes that progress has been made in establishing effective peer review systems and in demonstrating that costs of mental health services are reasonable. Yet the lack of agreement on diagnosis and appropriate treatment, the inadequacy of utilization, cost, and treatment outcome data, and the absence of professional self-regulation remain causes for concern in the effort toward eventual comprehensive coverage for mental disorders.


Agitated psychotic depression associated with severe hypomanic episodes: a rare syndrome. The authors present detailed clinical and follow-up data on 12 patients with agitated psychotic depressions who developed serious hypomanic or manic episodes. In six patients, each type of affective episode seemed to merge into the others, while in the other patients there was always a clear temporal distinction between each type of episode. The authors suggest that the older ages of their patients may have contributed to the syndrome. They also offer several possible theoretical explanations: the patients 1) had mixed affective states and were trapped in the "switch" state from depression to mania, 2) inherited both unipolar and bipolar diseases, 3) represent a subgroup of bipolar patients, and 4) were schizoaffective.


Immunoglobulin levels in psychiatric patients. In a study of 19 schizophrenic patients, 7 nonschizophrenic patients, and 31 controls, the authors found significantly higher mean serum levels of 1) immunoglobulin A in schizophrenic women then in control women and in schizophrenic blacks than in either schizophrenic whites or black controls. 2) immunoglobulin D in schizophrenic blacks than in schizophrenic whites, 3) immunoglobulin M in controls than in nonschizophrenic patients, and 4) immunoglobulin G (IgG) in schizophrenics whose urine was positive for phenothiazines than in schizophrenics whose urine was negative for phenothiazines. High serum levels of IgG were associated with no or mild hallucinations and low levels with moderate or severe hallucinations. Black female patients had significantly more severe hallucinaions than white female patients. The authors discuss the possible implications of these findings.


Personality disorder and parietal lobe dysfunction. An inability to relate transitionally is a major feature of personality disorder. The developmental independence of transitional relatedness from verbal-symbolic growth, its orienting function, and the nature of its visual and tactile components support the conclusion that it is a function of the nondominant parietal lobe. Therefore it can be hypothesized that dysfunction of this area is the cerebral analogue of personality disorder. The fact that unawareness of illness ("anosognosia") in conjunction with grossly intact intellectual function is common to both personality disorder and minor parietal lobe dysfunction further supports this hypothesis.


Psychiatric effects of prolonged Asian captivity: a two-year follow-up. The authors have been following a group of 6 prisoners of war and their families since the men were returned from North Viet Nam. They found that most of the men experiences cognitive, social, work, emotional, and family difficulties during the first two years after their return. However, most of these problems were resolved after two years, and there was no evidence of the concentration camp syndrome, homicidal or suicidal behavior, violent physical aggression, impotence, fugue states, psychosomatic disorders, or major psychiatric illnesses in any of the men. On the basis of their findings, the authors make recommendations for future reentry programs.


Brief versus standard hospitalization: the families. A total of 175 newly admitted inpatients who lived with families were randomly assigned to three treatment groups: standard inpatient care (discharge at the therapist's discretion), brief hospitalization (one week or less) with transitional day care available, and brief hospitalization without day care. Outpatient aftercare was offered to all patients. There was no major differential family burden as a function of length of hospitalization. Generally, brief hospitalization had several positive effects on family functioning, primarily earlier resumtption of occupational roles and less financial burden, with few significant deleterious effects.


Prognostic correlates of psychotherapy in psychiatric outpatients. The authors examined the follow-up data for 113 psychiatric outpatients who had been treated for up to a year in an outpatient community mental health center. Correlations between therapist and patient ratings of improvement were generally low, and anlayses were done separately for therapist and patient ratings. The strongest confirmed hypothesis was the relationship between therapist and patient ratings of improvement and therapist and patient evaluations of each other as likable, physically attractive, and either a good patient for treatment or a competent therapist. The authors discuss the advantages and disadvantages of multivariate statistics for the analysis of psychotherapy data.


The murdered child and his killers.

The murdered child and his killers. The authors studied 112 cases of child homicide in New York City in 1968-1969 to identify contributing social and psychiatric factors and to determine the fate of the surviving siblings and the degree of involvement of the city's social agencies with the families. There was a pattern of long-term familial child maltreatment extending to the siblings and continuing after the murders. The victims were usually illegitimate preschoolers; the assailants, usually the mothers or their paramours, had backgrounds of assaultiveness and social deviance and killed in impulsive rage. Reports of sexual abuse of victims or of suicide or psychosis among assailants were rare. The authors present case illustrations and offer guidelines for improved prevention by psychiatrists and social workers.


l-Alpha-acetylmethadol (LAAM): prognostic considerations. The authors studied the responses of 28 adult male volunteers who were openly changed from methadone to l-alpha-acetylmethadol (LAAM) maintenance. They found that patients who had been receiving middle-range doses (50-70 mg) of methadone required a significantly lower mean increase in LAAM than patients who had been receiving either high or low methadone doses and that the patients who accepted LAAM differed significantly from those who did not in MMPI 2-point-code ratings and mean social adjustment scale scores. These findings may provide prognostic indicators for response to LAAM, a possible alternative to methadone.


A favorable response to lithium carbonate in a "schizo-affective" father and son. It has recently been suggested that patients with mania are often misdiagnosed as having schizophrenia. The authors report a favorable clinical response to lithium carbonate in a father and son with an apparent schizo-affective syndromes may respond favorably to lithium but caution that a favorable response in such cases does not absolutely confirm a diagnosis of mania.


Marital therapy when one spouse has a primary affective disorder. The authors explain why marital disharmony when one spouse has a primary affective disorder is difficult to treat but suggest that such couples can be treated successfully if the therapist is flexible and sets realistic goals. Because of the variability of the disease and the many unsubstantiated etiologies associated with it, the authors recommend a modified general system theory approach to treatment that includes a combination of psychotherapy and somatotherapy.


Psychiatrist-wife-mother: some aspects of role integration. Throughout her professional life the woman who chooses to combine the roles of psychiatrist, wife, and mother may find them not only compatible but complementary. If she can adopt a philosophy of life that permits her to function in these roles, and if those around her support her activities, she can perform with relative ease and proficiency. Her lifestyle must of necessity differ from that of her male colleagues, but differing lifestyles among members of a profession vitalize the field. A broad perspective is desirable, especially in a profession that deals with the emotional and mental lives of people. Married women and mothers afford such a broadened perspective to the field of psychiatry.


Some problems in learning to do "good psychotherapy". In a discussion of some problems that psychiatric residents encounter in learning to do good psychotherapy, the author compares learning techniques of medicine and those of psychiatry. He concludes that one of the most difficult experiences for the psychiatric resident is learning tolerance for ambiguity and uncertainty.


Physicians' erotic and nonerotic physical involvement with patients. The author surveyed 164 female physicians to determine their attitudes and practices regarding erotic and nonerotic physican contact with patients. Compared with a previous study of male physicians (1), more female physicians believe in and engage in nonerotic touching, but fewer believe in and engage in erotic touching. None of the female physicians reported sexual intercourse with patients as compared with 11% of the male physicians in the previous study.


The frequency of suicide attempts: a retrospective approach applied to college students. Suicide attempt rates are usually reported as an annual statistic. However, annual rates may underestimate the cumulative prevalence of attempters since they ignore people whose attempts occurred in years other than the one examined. The authors studied the prevalence of suicide attempters over several years through data gathered from retrospective reports of college students. They found that 15% of the total sample studied (N=293) reported having attempted suicide at one time. This unexpectedly high rate suggests that suicidal behavior is a serious problem among college students and underlines the need for further retrospective studies of the prevalence of suicide attempters.


Psychiatric test assessment of patients with psychomotor epilepsy. The authors evaluated the psychiatric status of 31 patients who had temporal lobectomies and 6 patients who received implantation of depth electrodes for relief of epileptic seizures. Results showed a general postoperative improvement in overall psychopathology (measured by the Brief Psychiatric Rating Scale) and in depression in particular; however, depression tended to recur with the passage of time after lobectomy.


Training community-based paraprofessionals as behavior therapists with families of alcohol-abusing adolescents. To combat the increase in chronic alcohol use among adolescents in a large metropolitan area, community-based paraprofessionals were trained in behavior therapy and treated these adolescents and their families in the home. Preliminary evaluation of the program revealed encouraging results. This training supplied structure for the paraprofessionals' interventions with families and provided them with skills they are continuing to use in their community work.


Penfluridol in the treatment of newly admitted schizophrenic patients in a brief therapy unit. The authors compared penfluridol, a long-acting neuroleptic that can be administered orally once a week, with chlorpromazine in the treatment of 33 newly admitted schizophrenic patients in a brief therapy unit. Patients receiving either drug improved enough to be discharged in 3 weeks. Penfluridol-treated patients experienced less drowsiness than those treated with chlorpromazine, but the severity of extrapyramidal symptoms appeared to be greater with penfluridol.


A possible subgroup of the schizophrenic syndrome and implications for treatment. Supported by extensive clinical data of three generations, the hypothesis is advanced that Minimal Brain Dysfunction is the major etiologic and pathogenic factor for one subgroup of adult schizophrenics. Genetic factors apparently play the main but not exclusive role. Pathogenic as well as diagnostic, therapeutic, prognostic, and preventive aspects are discussed.


Psychodynamic and psychosocial problems in our future society: Anticipated causes and suggestions for prophylactic techniques. Social and technologic changes are occurring at an ever-increasing rate. Psychodynamic and psychosocial problems that are likely to occur in our future society are considered in relation to certain determinant forces. The paper also considers the concept of psychosocial prophylaxis and discuss its format and applications.


The medical model and psychiatric training. The educational, sociologic and economic justifications for a recent decision to require an internship type of postgraduate experience in psychiatric training are discussed. There are many practical disadvantages to adding this requirement. Depending on the type of internship developed, such experiences may also impair rather than facilitate the trainee's progress as a clinician.


Amplification of the erotic enema deviance. Use of enemas for sexual stimulation has been observed and named klismaphilia. Some klismaphiliacs indulge their taste for enemas in other wise normal sexual settings. Others combine it with fetishes, excretory and otherwise or with masturbation. Still others practice klismaphilia in homosexual or sadomasochistic settings or in group sex.


Sobriety: problems, challenges, and solutions. Problems experienced by women whose alcoholic husbands have recently become sober are pervasive and varied. During the years of active alcoholism, a pattern develops of allowing other family members' needs to take priority. Group therapy, emphasizing congruent communication and expression of feelings, is one means of assisting members in this phase of adjustment.


Marital therapy of couples in which the husband is a physician. This paper is concerned with the therapeutic problems posed by the troubled "medical" marriage. Based on the authors' clinical experiences, certain common characteristics of these marriages are identified. Obstacles to early referral such as self-diagnosis and self-treatment are discussed, two illustrative case vignettes are presented, and therapeutic recommendations are outlined.


Modes of experience and psychiatric education. This paper describes two modes that an effective psychiatrist uses in understanding his patients. One mode is termed the rational-active, and the other sensuous-receptive. These modes present special problems in psychiatric education. The best teaching occurs when the superviser works in both modes and consistently and sensitively communicates these modes of experience to a resident.


Jung's and Freud's contributions to dream interpretation: a comparison. Carl G. Jung considers dreams as (a) aids to restoring and maintaining mental health, (b) as scientific insights into psychic casuality, (c) as symbolic representations of one's actual subjective state and (d) as expressions of "telepathic visions". In this paper Jung's considerations are contrasted to Freud's.


Survey of psychiatric treatment effectiveness in a medical student clinic. Eighty patients, from four university-based psychiatric outpatient departments, were seen for four to six weeks by medical students. Eighty-two percent of the patients reported "some" to "marked" improvement. The four groups were studied to determine significant variables. A mutually positive attitude between patient and therapist appeared to be the only significant factor.


Case reports the treatment of a child foot fetishist. The history of a childhood foot fetishist is discussed from a developmental, psychodynamic, and therapeutic point of view. Therapy revealed that the symptom, while initially created in response to parental pathology, later led to specific defense mechanisms which were utilized to avoid developmental tasks, resolve ambivalence, and maintain body integrity.


The eclectic and multiple therapy of a shoe fetishist. This case history presents not only the therapists' point of view but also the client's. Four critical periods during therapy with a shoe fetishist were described by the two therapists and the client. The results of this procedure suggest that it is a facilitating method of gaining insight into the therapeutic process.


The underdevelopment of health of working America: causes, consequences and possible solutions. This article presents the health conditions of working America, and provides an analysis of the causes of that situation. It is postulated that the main health problems in the U.S. are due not to prevalent life styles-as the behavioralists indicate-but to the dramatic maldistribution of economic and political power in our society, with the absence of control by the majority of the U.S. population-the working and lower-middle classes-over the work process with which they are involved, the economic wealth that they produce, and the political institutions that they pay for. The production of goods and wealth as well as the political institutions of the United States are dominated and controlled by a minority of our population-the corporate and upper-middle classes. Empirical information is presented to support this postulate. In light of this explanation, it is asserted that a major public health task is to deliberately and actively contribute to the political mobilization of forces aimed at bringing about profound changes in the pattern of control of our working insitutions and of the distribution of wealth and political power, changes which seek to shift that control from the few to the many.


Occupational lead poisoning, animal deaths, and environmental contamination at a scrap smelter. Occupational lead poisoning and environmental contamination were evaluated at a lead scrap smelter. Thirty of 37 employees (81 per cent) has blood lead levels of greater than or equal to 80 mug/100 ml, indicating unacceptable absorption, and 35 had free erythrocyte protoporphyrin (FEP) levels greater than 60mug/100ml rbc, indicating toxicity of lead on heme metabolism in red blood cells; eight current and previous employees had been hospitalized with lead colic, and another with encephalopathy. Levels of lead in surface soil (1,800 ppm) and vegetation (20,000 ppm) at the smelter were high and decreased with distance. Animals on nearby pasture had died, and lead levels in the blood, milk, and hair of large and small animals were elevated. Adults living within 100 meters of the smelter had higher blood and hair lead levels than controls, who lived at greater distances, but there was no evidence in them of lead toxicity.


Categories of attempted suicide: a longitudinal study. A series of 151 index suicide attempts was categorized on the basis of situation and motivation: (a) 56 per cent occurred in a state of heightened emotionality due to a relatively limited stress;(b) 9 per cent were characterized by a life crisis which seriously challenged the patient' emotional homeostasis; and (c) 35 per cent attempted suicide in relation to the symptomatology of a pre-existing serious psychiatric disorder. At the time of first contact, usually in the general hospital emergency room, 69 per cent were sent home, the remainder being admitted for medical care (18 per cent) or transferred to a psychiatric hospital (13 per cent). In follow-up ambulatory care, successful referral correlated with the intensity of staff efforts during the early post-attempt contacts. The findings suggest that a brief hospitalization, perhaps two to three days, might be regularly utilized as a bridgehead for further ambulatory care, particularly for stress category patients with a high appointment failure rate. In a two-year follow-up, 16 of the 151 index cases re-attempted and two committed suicide. At the time of the index attempt, 24 (16 per cent) were in ongoing treatment. Among these 24 patients were many substance abusers and prior attempters as well as the two committed suicides of the follow-up period. Ongoing treatment should be weighed as a high risk factor suggesting particular caution in arranging the disposition for such patients.


The eradication of a large scabies outbreak using community-wide health education. The successful experience in eradicating a large outbreak of scabies in an underdeveloped Arabic village community in Western Galilee of about 3,000 people is reviewed. In this village the number of cases of scabies increased over a five-year period to a maximum of 22 per cent of the entire village population, representing 66 per cent of all the families. A seven-person health team with a strong background in health education was entrusted with the task of eradicating scabies in the community. A plan, conceived and carried out by the team, consisted of four phases: data gathering, information giving, treatment, and evaluation and summary. The goal of eradicating scabies in this community was achieved. The strategy of the campaign emphasized the following points: the entire community was the target group and was involved maximally throughout the campaign; the professional responsibility was concentrated in the hands of the team.


Mortality and morbidity associated with legal abortions in Hungary, 1960-1973. In Hungary, with 10 million inhabitants, the number of induced abortions in the 1960's first approached and then reached 200,000 cases annually. These data mean that the number of induced abortions has increased substantially compared with earlier decades. A qualitative change has also occurred, from criminal abortions to, in most cases, legally induced abortions performed in hospitals. On the basis of 32 deaths directly resulting from legal induced abortion in the first trimester during 1960-1972, maternal mortality is about 1.5 per 100,000 abortions in Hungary, the lowest rat observed until the present anywhere in the world. According to a special survey conducted in Budapest in 1966, the overall morbidity rate was 41.6 per 1,000 abortions of which 0.9 was due to perforations, 22.7 to post-abortal hemorrhages, and 18.0 to inflammatory complications, i.e., early post-abortal complications had to be reckoned with in every 25th case. Data in the present study suggest a correlation between induced abortions and the incidence of placenta previa, premature separation of the placenta, and premature births.


Drinking water for the future.

Drinking water for the future. The Safe Drinking Water Act of 1974 represents an important step in improving the quality of public water supply in the United States. However, it fails to address two important problems: (1) The 1970 Public Health Service Community Water Supply Survey revealed that small public water supply systems often deliver poor quality water. The Act does not assure that these supplies will now receive appropriate attention; furthermore, the Act does not address the needs of the 50 million people not now served by public water systems; (2) About one-third of our population draws its drinking waters from polluted sources. The decisions to use these low cost sources were made generations ago when consumers could be protected from water-borne infectious disease. A new problem has now arisen--the presence of numerous synthetic organic chemicals of uncertain health consequence, not removed by conventional water treatment. The Act does not address this problem. Regionalization and the integration of water resource and water pollution control authorities are proposed as a reasonable solution to these problems. The development of dual water supply systems in order to conserve scarce pure water sources for human consumption appears to be a feasible way to avoid using polluted waters for drinking. The development of dual supplies would be enhanced by regionalization and integration of water authorities.


Drug prescribing in hospitals: an international comparison. This paper presents a comparison of prescribing habits for patients hospitalized in medical wards of university hospitals in America and Scotland. American patients received almost twice as many drugs both during and prior to hospitalization than did comparable Scots. The differences between the countries were consistent for symptomatic and for more specific therapies. As compared to Scotland, drug therapy in America costs patients more in terms of financial outlay and adverse drug effects. The data do not permit evaluation of the relative benefits to the patients of the different quantities or types of drug used for similar circumstances in these countries.


Professional drivers: protection needed for a high-risk occupation. "On the job" motor vehicle deaths number more than 4,000 annually in the U.S. and comprise nearly one-third of all work-related deaths. Yet the Department of Labor has set no standards relating to on-the-road safety of the millions of workers whose jobs entail large amounts of driving, and Department of Transportation standards affecting occupational safety cover only drivers in interstate commerce. Drivers of some commercial vehicles, such as heavy trucks, are at special risk of injury because trucks have usually been exempted for many years from federal motor vehicle safety standards--such as standards for brakes and seatbelts--designed to prevent crashes or protect occupants in crashes. Observations based on a series of 150 fatal crashes involving tractor trailers illustrate the need for better protection of this large population of high-risk workers. Clarification of responsibility within the various federal agencies and application of available knowledge and technology are essential.


The psychiatric patient at work.

The psychiatric patient at work. Psychiatric consultations and job performance of 135 IBM employees were studied. Psychiatric referrals were made by management and the company medical department or were self-referred. The consulting psychiatrist conducted interviews, met with management, personnel representatives and other physicians to coordinate treatment with job requirements. Every effort was made to retain employees and improve performance. After a two-three year follow-up period, 82 employees (61.7 per cent) were with the company; ten were rated outstanding, 38 exceeded job requirements, 25 were meeting job requirements, and four were not. Performance data for five employees were not available. Forty-nine of 83 employees (59.0 per cent) rated unsatisfactory in job performance at the initial referral were performing satisfactorily at follow-up. The results support an optimistic attitude toward the working patient with psychiatric disease and highlight the value of a full-time medical department with consultation facilities leading to secondary and tertiary prevention.


Ambulatory care for chronic conditions in an inner-city elderly population. Factors affecting the extent to which individuals aged 65 and over living in inner-city households received health care for three chronic conditions (high blood pressure, heart trouble, arthritis) are examined. These factors are age, sex, living arrangements, and the presence of more than one chronic condition. Indicators of receiving care are having seen a health care provider within the previous six months and being on medication for the condition. A more detailed scrutiny of care received for high blood pressure is undertaken as well. This analysis is part of a larger study investigating health care of groups within East Baltimore who utilize different systems of care, focusing on a hospital outpatient department and a new HMO. Data were obtained from 1455 household interviews among three sample populations: enrolees in an HMO, public housing project residents, and the general community. The findings indicate that high proportions of the elderly who report having these conditions also report receiving care for them. For people with high blood pressure, the majority are receiving care and being given self-care instructions, and high proportions report compliance with instructions.


Hepatitis B antigen and antibody in the U.S. Army: prevalence in health care personnel. The prevalence of Hepatitis B surface antigen (HB(S)Ag) and antibody (anti-HB(S)) seropositivity and the association of seropositivity with demographic, personal health, and professional experiences were studied in a cohort of Army Medical Department officer personnel. Serologic evidence of Hepatitis B infection was found in 5.0 per cent of personnel and was associated with age, sex, place of birth, history of hepatitis, history of blood transfusion, and previous overseas assignments. Seropositivity rates were higher for patient care oriented officer personnel, especially for those in surgical specialties, and rose with increasing professional experience. These data present a composite of risk factors operative in the acquisition of Hepatitis B seropositivity and identify a cohort for prospective study.


Irritating effects on man of air pollution due to cigarette smoke. Sixty subjects were exposed to cigaretts smoke produced by a smoking machine in a climatic chamber. The irritating effects were recorded by questionnaire and related to concentrations of CO, formaldehyde, and acroleine. The eyes are most sensitive to these irritants, followed by the nose. Annoyance about air quality, and the desire to open the window or to leave the room proved to be other useful measures of sensitivity. With smoke produced by 10 cigarettes/30 m3 acroleine reaches 0.1 ppm, the threshold limit value for industries; simultaneously, CO and formaldehyde exceed the clean air standards for outdoor air. At this exposure level. 9 per cent of the subjects show a strong or very strong eye irritation, while 78 per cent "wish to leave the room." The most important of the measured irritants seems to be acroleine.


Noise and hospital stay.

Noise and hospital stay. Length of hospital stay for simple cataract surgery was compared retrospectively for a period of construction noise and for two similar periods without construction noise. Hospital stay was significantly longer during the period of construction.