Uterus didelphys associated with unilateral imperforate vagina. Two cases of uterus didelphys associated with unilateral imperforate vagina are reported with a review of the literature. In all cases investigated, ipsilateral renal agenesis was found on the affected side. A summary of the embryologic development of the female reproductive tract is included, as well as a possible explanation for this rare anomaly. The authors describe their proposed method of management to achieve freedom from symptoms and maintenance of a relatively intact reproductive tract.


Pregnancy in hepatitis B antigen positive cirrhosis. Two pregnant women with chronic active viral hepatitis (HBs Ag+) and cirrhosis are described. In the first patient, maternal death occurred postpartum due to bleeding esophageal varices and liver and renal failure. Postmortem examination revealed advanced nodular cirrhosis and thrombosis of the splenic and portal veins. The infant was premature but did well and did not become infected despite the detection of HBsAg in the cord blood. Nine members of the patient's immediate family were tested; the blood of one sibling of the patient was found to be HBsAg+ and samples from 5 other members were found to be anti-HBs+. In the second patient, death due to liver failure occurred in the seventh month of pregnancy and postmortem examination revealed advanced nodular cirrhosis. Examination of multiple fluids from the mother and fetus were negative for HBsAg. In contrast to the apparent lack of effect of pregnancy on cirrhosis of the liver in general, the possibility of an adverse effect in this particular type(HBs Ag+) should be considered.


Burkitt's lymphoma involving the ovary and jaw. Unilateral jaw and ovarian Burkitt's lymphoma occuring in an adult American female is reported. The patient was treated with a combination of surgery, radiation, and chemotherapy. The diagnosis, treatment, prognosis, and relapse patterns are briefly reviewed as they relate to the specialty of gynecology.


Hypertrophy of the labia minora.

Hypertrophy of the labia minora. Gynecologic disorders during childhood and adolescence have received relatively little attention. Since earlier sexual activity among teenage girls is becoming more common, it is desirable that those interested in the diseases of women keep abreast of the current developments in adolescent gynecology. Two patients with congenital hypertrophy of the labia minora are presented and the treatment is discussed.


Long-term followup of 1121 cases of carcinoma in situ. A series of 1121 patients with carcinoma in situ have been followed for 5 to 25 years. Recurrences of in situ lesions and development of invasive cancer wwere found, often many years after treatment. Thereapeutic conization was performed in 795 patients, of which 19 (2.3%) had recurrent carcinoma in situ and 7 patients (0.9%) developed invasive cancer. The corresponding figures for 238 patients treated with hysterectomy were, respectively, 3 (1.2%) and 5 (2.1%). The invasive lesions appeared after treatment several years later than the in situ lesions. It is stressed that women having once had in situ carcinoma of the cervix will always be at some risk, and therefore should be carefully followed for a much longer time than the conventional 5 years. Of 42 cases of preinvasive carcinoma extending to the border of the surgical specimen in which conization was performed, 25 were not immediately treated but only observed. Four of these patients developed recurrence from 2 to 6 years after treatment, while 21 are well after a followup period of between 5 and 15 years.


Radical hysterectomy with or without preoperative radium for stage IB squamous cell carcinoma of the cervix. A retrospective study of 119 patients ranging from 30 to 69 years of age was undertaken to evaluate the effectiveness of preoperative radium treatment for patients with Stage IB (FIGO 1971) squamous cell carcinoma of the cervix undergoing radical hysterectomy. Results in 61 patients who had radical hysterectomy without preoperative radium treatment were compared to those in 58 patients who had received radium preoperatively. The patients receiving radium systems had an uncorrected 5-year survival rate of 89.7%, while the patients without preoperative radium treatment had a 75.1% 5-year rate of survival. This difference in survival rate was judged to be secondary to the greater incidence of lymphatic invasion and residual tumor in the surgical specimens of the patients who did not receive preoperative radium. The occurrence of significant gastrointestinal and urinary tract complications was identical in the 2 groups.


Quadrichemotherapy for advanced ovarian carcinoma. In an effort to improve the length and rate of objective responses in patients with advanced ovarian carcinoma, a combination of four drugs was administered. Vincristine (10 mug/kg intravenously weekly), actinomycin D (500 mug intravenously weekly), oral methotrexate (1.25 mg daily), and oral cyclophosphamide (50 mg daily) were given to 25 evaluable patients with FIGO Stage III and IV ovarian carcinoma. After 12 weeks the vincristine and methotrexate were discontinued; cyclophosphamide and methotrexate were continued until disease progression was evident. Objective responses occurred in 56% of the patients. Toxicity was minimal. Patients not previously treated with radiotherapy or chemotherapy had a higher complete response rate (30%) than patients previously treated (13.3%). Mean length of complete response was 10.6+ months. The 1-year survival rate of these patients was 69.5% and the 5-year rate 22.7%. While the results are encouraging, single agent chemotherapy with an alkylating agent produces similar responses.


Colpotomy drainage of pelvic abscess.

Colpotomy drainage of pelvic abscess. Sixty-five patients who had a pelvic abscess drained by colpotomy or rectal incision were studied. The minority of the patients (28) developed the abscess after a hospital-acquired infection (Group I) while the other 37 patients developed the abscess after a community-acquired infection (Group II). Except for those patients who developed an abscess after hysterectomy, about one-third of the patients in both groups required a subsequent major operative procedure because of residual infection or symptoms. Of the 40 patients in whom there was a possibility of conceiving following the drainage procedure, 4 (10%) conceived at a later date.


Ovarian response to exogenous gonadotropins in women with elevated serum prolactin. To determine if elevated serum prolactin hPRL inhibits ovarian steroidogenesis and contributes to the amenorrhea associated with galactorrhea syndromes, the following study was performed. Four women with amenorrhea, galactorrhea, and elevated serum hPRL levels were treated with menopausal gonadotropins (Pergonal) for the associated infertility. Urinary estrogen response was comparable to that in normal ovulatory women in each patient. Ovulation occurred in 3 of the 4 women with resultant conception and normal pregnancies. There was no evidence to support the contention that elevated hPRL interferes with ovarian function.


Consumptive coagulopathy in severe preeclampsia. Our experience with consumptive coagulopathy associated with preeclampsia at North Carolina Baptist Hospital is presented. All cases of recognized consumptive coagulopathy on the obstetric service from 1969 to 1975 are reviewed and the associated obstetric entities given. Two cases of consumptive coagulopathy complicating severe preeclampsia are presented. Consumptive coagulopathy occurred in 9.1% of eclamptic patients and in 2.6% of severe preeclamptic patients. No previous incidence figures were found in the literature.


Fc receptors on the human placenta.

Fc receptors on the human placenta. The Fc receptors on the human placenta have been evaluated using hemadsorption to cryostat sections of fresh forzen placenta. Indicator cells were sheep erythrocytes sensitized with various amounts of rabbit IgG antibodies. The receptor activity of the placenta varied with the degree of sensitization of EA but quantitatively was greater at all dilutions when compared to other normal tissues.


A technic for the detection of rupture of the membranes. A review and preliminary report. Correct diagnosis of rupture of the fetal membranes is sometimes difficult. A new technic is proposed to confirm the diagnosis of rupture of the membranes based on the introduction of sodium fluorescein into the amniotic cavity via transabdominal amniocentesis.


Intrauterine growth retarded infants. Correlation of gestational age with maternal factors, mode of delivery, and perinatal survival. Fifty-eight infants of 3332 deliveries (1.7%) were found to be growth retarded (IGR) at birth. For purposes of analysis, the infants were divided into 2 groups according to gestational age at delivery: Group I infants were delivered between 38 and 43 weeks' gestation, and Group II infants were delivered between 28 and 37 weeks'. The infants at greatest risk are those who manifest chronic intrauterine fetal distress associated with prematurity. Asphyxia was evident in 9 of 19 infants (47%) in Group II as compared to 9 of 36 infants (25%) in Group I. The premature IGR infants delivered by low forceps and cesarean section had higher 1- and 5-minute Apgar scores than those delivered spontaneously. There was a five-fold increase of intrauterine demise and a two-fold increase of neonatal deaths in Group II IGR infants as compared to the non-IGR premature infants. In the management of IGR, a combined obstetric-pediatric approach is important. A higher index of suspicion, appropriate evaluation, earlier diagnosis, and expedient delivery are essential if the prognosis for an IGR infant is to be improved.


Fetal heart rate patterns in patients with intrauterine growth retardation. Fetal heart rate recordings were examined in 953 patients with special reference to the different patterns occurring during labor. After delivery the infants were examined with special emphasis on evidence of growth retardation, defined as birthweight below the 10th percentile for the gestational age. Heart rate patterns of growth-retarded infants were compared with those of normal newborns. A statistically significant increase in early, late, and variable decelerations was noted in infants with growth retardation. The difference in loss of beat-to-beat variation was not statistically significant. Also, as might have been expected, low Apgar scores were found more frequently in the small-for-gestational-age infants.


Fetal and neonatal cardiopulmonary response to histamine. Effects of intravenous histamine and its H1 receptor blocker (Benadryl) were investigated in near-term fetal and in newborn lambs. Fetuses were studied before and after closure of the ductus arteriosus. Newborn lambs were chronically instrumented and the same animal was tested periodically from 3 to 70 days old. The results show that a) in the fetus whose pulmonary vascular resistance is already high, histamine produces a profound pulmonary vasodilation; b) in contrast, in the neonate with reduced pulmonary vascular resistance, histamine produces pulmonary vasoconstriction similar to that of the adult; c) both responses can be attenuated by Benadryl indicating that they are mediated by the same receptor; d) in the fetus, histamine produces marked constriction of the ductus arteriosus which could be partly attributed to the pulmonary vasocilatation; and e) when neonatal pulmonary vascular resistance was raised by hypoxia, histamine elicited a biphasic response, part of which was blocked by Benadryl. These findings are discussed in terms of their possible role in cardiovascular and pulmonary changes that occur after birth.


Adrenal cortical response to circumcision in the neonate. A study was designed to document the responsiveness of the hypothalamic-pituitary-adrenal axis to the stress of circumcision during the first 6 hours of life. There was a rise in both serum cortisol and cortisone levels in all infants studied. The rise in cortisol was greater than the rise in cortisone in all infants.


A histologic study of the placentas of patients with saline- and prostaglandin-induced abortion. A comparative histologic study of plancentas aborted after infusion of hypertonic saline or prostaglandin F2alpha into the amniotic cavity toinduce abortion is presented. Five placentas from spontaneous abortions served as controls. Saline abortion produced edema of the membranes; congested,dilated, thrombotic blood vessels; and subchorionic necrosis. Prostaglandin did not produce edema, but created marked vasospasm as evidenced by thickened vessels without subchorionic necrosis. The absence of serious sepsis and defibrination in prostaglandin-induced abortions is probably related to the absence of tissue necrosis.


Early pregnancy interruption by 15 (S) 15 methyl prostaglandin F2alpha methyl ester. Suppositories of 15-methyl PGF2alpha methyl ester in triglyceride were administered vaginally to 75 women in whom 31 to 49 days had elapsed since their last menstrual period. Three or four suppositories of 0.5, 1.0, or 1.5 mg were given at intervals of 3 hours. Pregnancy was later confirmed in 63 of the women. In the pregnant women vaginal bleeding usually started 3 to 6 hours after the initiation of therapy and continued for 10 to 14 days. Patients were followed for 2 to 4 weeks with serial measurement of serum progesterone and hCG. There were no failures in the trial, but in 2 cases the treatment resulted in incomplete abortion. In 2 other patients curettage was performed due to prolonged bleeding, but histologic examination revealed no remaining signs of pregnancy. Gastrointestinal side effects were well within acceptable limits, and no serious complications occurred. Clinical signs of pelvic inflammatory disease were not found. The vaginal use of 15-methyl PGF2alpha methyl ester seems promising as a reliable outpatient nonsurgical self-administered procedure for termination of early pregnancy.


Electronmicroscopic studies of leiomyomatosis peritonealis diseminata. Leiomyomatosis peritonealis disseminata (LPD) is a rare clinical entity which is currently the object of serious study. Electron microscopic studies to further elucidate the ultrastructural features of the pathology are discribed here.


Effect of ergonovine on prolactin secretion and milk let-down. The effect of ergonovine maleate on prolactin secretion and lactation was determined in 10 puerperal women. Serum prolactin concentration measured by radioimmunoassay resulted in 537.2 +/- 45.9 ng/ml (M +/- SE) before the oral administration of 0.6 mg ergonovine maleate, and 89.7 +/- 25.6 ng/ml after 7 days of therapy. The serum prolactin concentration seen in the control group of nonlactating women (562.0 +/- 36.1 and 218.0 +/- 27.3 ng/ml) was significantly greater than (P less than 0.01) that seen in the treated group. In 2 additional patients it was also demonstrated that the simultaneous administration of ergonovine by oral and intravenous routes potentiates the suppressive effect on prolactin secretion. Three of the 10 treated women showed progressive inhibition of lactation. This study shows that ergonovine maleate interferes with prolactin secretion, and may decrease milk production.


Dynamic pituitary testing in a female with Kallman's syndrome and associated cardiac anomaly. A patient with Kallman's syndrome and an anomalous right aortic arch is described. Dynamic pituitary testing was carried out revealing no significant response of prolactin to chlorpromazine stimulation or water loading suppression. A normal response of growth hormone to insulin induced hypoglycemia was observed. These data are interpreted as indicating a primary hypothalamic abnormality in Kallman's syndrome. In addition, this is the first report of the association of a cardiovascular abnormality with Kallman's syndrome.


A simplified method for measuring fetal hemoglobin. Despite confirmation of the placental location by ultrasound examination, bloody tap during diagnostic and therapeutic amniocentesis may occur. If the blood originates from the fetus, such unfavorable complications as fetomaternal transfusion or maternal sensitization may result. Thus, it is necessary to determine immediatley the origin of the blood by the presence of fetal hemoglobin (HbF) in the specimen. To meet an urgent demand for a simpler and faster method for measuring HbF within a few minutes at bedside without requiring complicated procedures or instrumentation, a method has been developed which uses the alkali denaturation technic.


Endogenous creatinine clearance during pregnancy. Part I. Methodologic considerations. The effect of noncreatinine chromogens on the endogenous creatinine clearance (ECC) during pregnancy was investigated. It was found that these chromogens measured as plasma "creatinine" cause a significant reduction in the ECC value. This fact should be considered when the ECC value is used to evaluate renal function during pregnancy.


The fine structure of merozoites of Babesia bovis in the gut epithelium of Boophilus microplus. Electron microscopic studies on merozoites of Babesia bovis in epithelial cells of the gut of Boophilus microplus revealed that the pellicle apparently consists of 3 membranes, and an osmiophilic layer intimately associated with microtubules. Micropores in the pellicle were often associated with micronemes. An unidentified tubular structure extended from the anterior polar ring to the nuclear region where it appeared to be associated with the nuclear envelope. A Golgi complex, typical protozoan mitochondria, food vacuoles and rhoptries could not be identified.


Volatile fatty acid metabolism in sheep. 1. Average daily volatile fatty acid production in the rumen of sheep fed lucerne hay. Changes in the total concentration of the volatile fatty acid (VFA) pool in the rumen were followed over a 24 hour period in 2 groups of sheep, 1 fed at 08h00 and the other twice daily at 08h00 and 20h00. Although similar maximum (143 and 147 meq/1) and average (100, 3 and 102, 1 meq/1) levels were found in the 12 and 24 h groups respectively, the twice daily feeding regimen resulted in a lower variation (S.D.=17, 0 meq/1 and 28, 9 meq/1 respectively). It was concluded from changes in the percentage molar composition of the VFA pool over the same period that the other of VFA absorption from the rumen was propionate greater than acetate greater than butyrate for both groups, but that the differences were less marked for the twice daily fed sheep. Long term infusions of 14C labelled acetic, propionic and butyric acids into the rumen of sheep fed a total of 1 600 g lucerne hay twice daily (08h00 and 20h00), gave an average net total VFA production rate of 4,52+/-1,01 moles/800 g/12 hours irrespective of the acid infused. The net individual turnover rates for acetic (2,81 moles/12 h), propionic acid (0,82 moles/12 h) and butyric acid (0,55 moles/12 h), derived by the subtraction of the inter-conversion factors from the gross production rates of the acids, and expressed as the percentage contribution of each acid to the total net VFA turnover (acetic=62%, propionic=18% and butyric=12%) closely resembled the percentage molar composition of the VFA pool in the rumen (acetic=60%, propionic=23% and butyric=12%). The total net VFA production was found to be directly proportional to the total VFA concentration in the rumen (correlation coefficient=0,83), and the relationships can be described by the equation y=0,034 x + 0,16 where y=VFA production in moles/12 hour and x=VFA concentration in meq/1. A specific VFA production rate of 0,85 moles per 100 g digestible organic matter was calculated from the average daily VFA production rate and the composition of the lucerne hay.


The effect of gamma radiation on the cysticerci of Taenia solium. Cysticerci of Taenia solium were exposed to gamma radiation in doses varying from 20-140 krad. Radiation had an adverse effect on the ability of the cysticerci to evaginate in vitro after a time lag of 9 days. This effect was most marked at doses of 100 krad and higher, thus no cysticerci exposed to 140, 120 and 100 krad evaginated after 12, 18 and 21 days, respectively. On Day +24, when 60% of the control cysticerci evaginated, 55%, 50%, 30% and 40% of the cysticerci exposed to 20, 40, 60, and 80 krad, respectively, evaginated in vitro. Cysticerci exposed to radiation doses of 20-120 krad are as infective to golden hamsters as are unirradiated cysticerci. Cestodes resulting from irradiated cysticerci, however, cannot maintain themselves indefinitely, and are excreted or digested at varying times from Day +12 onwards. Moreover, cestodes resulting from such irradiated cysticerci do not grow, but are resorbed, and finally consist of only a scolex. By Day +30 the mean length of the worms resulting from the unirradiated cysticerci is 173,8 mm, while those resulting from cysticerci exposed to 20 and 40 krad consist of scolices only and the hamsters fed material exposed to 60 krad were negative. It appears, therefore, that radiation inhibits the ability of the cells in the neck region to divide and thus form new proglottids. Carcasses infested with cysticercosis can possibly be rendered fit for human consumption by exposure to gamma radiation at doses between 20 and 60 krad.


Ticks from the African buffalo (Syncerus caffer) in Ngamiland, Botswana. In November 1972, 93 out of 100 African buffalo from 3 areas in Ngamiland, Botswana, were found to be infested with ticks. The tick species present and the percentage of buffalo infested by each were: Hyalomma truncatum (63%), H. rufipes (54%), Rhipicephalus evertsi evertsi (68%), R. tricuspis (11%), R. simus (4%) and Boophilus decoloratus (1%). The mean number of ticks per animal was 8,6 (standard deviation +/-4,1), representing a mean of 6,5+/-3,4 male and 2,1+/-1,9 female ticks. The incidence of infestation with H. truncatum and the number of ticks of this species on infested animals were lowest in areas where plentiful surface water was responsible for an increase in humidity.


[Study of the parasitofauna of salmon fry of the genus Oncorhynchus in the Sea of Okhotsk]. Parasite fauna of the genus Oncorhynchus in sea was studied and characteristics is given of its peculiarities in the following species of the young: O. kisutch, O. nerka, O. keta, O. gorbusha and O. tschawytscha. Parasite fauna of O. nerka young from the Kurilskoje Lake before the migration and 2--3 months after its stay in sea is analysed.


[Genetic and physiological compatibility of different forms of the stem eelworms. V. The crossing of the red clover race with other eelworms]. Reciprocal hybrids between the stem eelworm of the red clover and those of onion, straw berry, parsnip, parsley and narcissus were obtained. Observations were conducted on the state of hybrid and control populations within 10 generations. A partial genetic and physiologica incompatibility of crossed forms of stem eelworms which manifests itself to a different extent in various combinations of parental pairs, was revealed. The red clover eelworm is a biological race of the collective species Ditylenchus dipsaci, which is at a certain stage of intraspecific differentiation.


[Effect of larval feeding and imaginal supplementary nutrition on the degree of autogeny and fertility of Culex pipiens molestus mosquitoes at different periods of the year]. Studies of ovogenesis of C. p. molestus at different food regimes (water, sugar, blood) have shown that in winter the imaginal feeding with carbohydrates nearly twice increases the degree of autogenity and fecundity of these mosquitoes. In warm seasons the carbohydratous feeding does not affect the autogenity but increases the fecundity of females and maturation of their ovaries. Poor larval feeding decreases only slightly the autogenity and sharply decreases the fecundity of females. Blood feeding favours the maturation of ovaries in most members of C. p. molestus and the growth of their fecundity.


[Some aspects of nitrogen metabolism in the liver tissue of chicks infected once and 3 times with a large dose of Eimeria tenella oocysts]. Studies of the contents of total, albuminous and residual nitrogen in the liver tissue of chickens at a single and 3-fold infection with 100 000 oocysts of E. tenella were undertaken. It was established that a single infection of 20-, 40- and 60-day old chickens is accompanied by a decrease in the contents of total and albuminous and an increase in the residual nitrogen. Their level is restored as a rule by the 20-th day after infection. In 40-day old chickens by the 20-th day after the 2-nd and 3-d infections, in contrast to non-immunized chickens the level of total and albuminous nitrogen increases. Residual nitrogen concentration remains in the standard ranges.


Evaluation of the child with repeated infections. The workup of a patient with suspected immune deficiency can be initiated by the primary-care physician utilizing readily available diagnostic tests (Table 1). Carefully obtained history and physical examination are crucial and will identify the patient at risk. In almost all cases, simple procedures performed by the physician in his office with routine laboratory assistance will enable him to establish a provisional diagnosis. Referral may then be made to a specialized center for more elaborate diagnostic procedures, confirmation of diagnosis, and definitive therapy.


[Method for an absolute count of the number of parasitic protozoa in fish]. A new technique is given of the absolute calculation of parasitic Protozoa in fishes. The mucus from the body and gills of fishes was mixed with such volume of water (V) that the drop of mixture (v) was clearly seen under themicroscope. The calculation of Protozoa was done in a sample from three drops of mixture covered with three slides (S). From 50 to 100 viewing fields were seen the them and an average number of Protozoa in one field was calculated. The total number of Protozoa in one fish (N) was equal to an average number of parasites in a viewing field (n) multiplied by the total number of viewing fields (m) which could be obtained at the examination of the whole mixture. The latter was calculated conventionally (see articles).


[Life cycle of the trematode, Crowcrocaecum skrjabini (Iwanitzky, 1928) (Allocreadiata, Opecoelidae)]. Crowcrocaecum skrjabini has an intermediate and additional hosts. The mollusk Lithoglyphus naticoides serves as an intermediate host; the invasion extensity is 43.88% in summer and 28.57% -- in autumn and winter. In the experiment Gammarus (Rivulogammarus) balcanicus has turned to be an additional host and Carassius auratus givelia -- a definitive hot. The descriptions are given of cercaria (which belongs to a cotylocercal type), metacercaria and marita, reared in the experiment.


Experience with a direct reading dedicated fluorometer for determination of erythrocyte protoporphyrin. Data are presented for erythrocyte protoporphyrin (EP) concentrations determined by the direct reading tecnhique of Lamola et al. (1) Mean concentration of EP in children whose blood lead concentration was less than 30 mug/dl was 34.7 mug/dl whole blood +/- 13.4 (SD). Mean EP concentration in children with blood lead concentrations of 40-59 mug/dl was 80.0 mug/dl. It was 158 mug/dl. It was 158 mug/dl for children with blood lead concentrations greater than 59 mug/dl. All children in this last group had concordant values for Pb and EP on the first or second test.


[Larval migration of the Oedemagena tarandi botfly in an artificial infestation of deer]. After penetrating the skin the first instar larvae spread diffusively and rather evenly in the subcutaneous and intermuscular conncective tissue over the whole body of a deer and do not migrate upwards. The number of larvae in the intermuscular tissue decreases with age and increases in subcutaneous cellulose. During migration their growth varies much that can be partially explained by the heterogeneity of the tissus they advance ahead. On the places of larval localisation a granulomatose inflammation appears with a prevalence of lymphoid cells in the infiltrate and location haemorrhages into surrounding tissues.


Acceleration of fetal lung maturation by aminophyllin in pregnant rabbits. To test the hypothesis that fetal lung maturation can be accelerated by one of the xanthine derivatives, aminophyllin was given to 40 pregnant rabbits beginning on the 20th gestational day for a period of 7-10 days. The fetuses were delivered by cesarean section and fetal lung maturity was assessed by determining the biochemical, functional, and ultrastructural characteristics of aminophyllin-treated vs. control animals. The phospholipid content of the lung tissue homogenate from the aminophyllin-treated group was significantly higher than in the control subjects (saline injected) at 28 days of gestation (421 +/- 9 vs. 368 +/- 12 mug/mg wet wt, mean +/- SEM) and at 29 days of gestation (531 +/- 10 vs. 475 +/- 20). The alveolar wash phospholipid content of the aminophyllin-treated group was higher at 30 days (167 +/- 9 mug/mg dry wt, mean +/- SEM vs. 117 +/- 17). The lung compliance derived from pressure volume curves was also significantly higher in the aminophyllin-treated group when compared with controls at 27 days of gestation (0.023 +/- 0.0005 ml/cm H2O, mean +/- SEM vs 0.010 +/- 0.0002) and at 28 days of gestation (0.048 +/- 0.0003 vs 0.035 +/- 0.0006). There was no significant difference in the number of lamellar bodies in the type II cells between the aminophyllin-treated and the control groups. The data show that aminophyllin has accelerating effects on fetal lung maturation in rabbits when the drug is given to pregnant rabbits during the last 7-10 days of gestation.


[Fate of the promastigotes of Leishmania tropica major and L. gymnodactyli in the body of Phlebotomus papatasi under conditions of a mixed infection]. Experimental infection of males and females of Phlebotomus papatasi Sc. with Leishmania tropica major from man and L. gimnodactyli from Agama sanguinolenta was carried out in order to obtain mixed infection. Sand flies from the laboratory culture were successively infected with promastigotes of each species of Leishmania by means of compulsory dose feeding according to Alekseev's method. For identification of Leishmania cultures isolated from experimentally infected sand flies Alder's serological test modified by Safjanova was used. The mixed infection was obtained both in males and females of sand flies. The success of modelling of mixed infection depends on the succession of the administration of studied strains of Leishmania. It depends as well on the interval between infected feedings. The dependence of the experimental results on the number of promastigotes administered into the intestine of sand flies was not recorded.


Effect of postweanling pyridoxine deficiency on growth and concentration of the coenzyme pyridoxal-5'-phosphate in heart, kidneys, lungs, and adrenals in rats. Dietary pyridoxine deficiency induced in postweanling rats to led to severe growth retardation and growth failure, with a sharp increase in the mortality rate after about 8 weeks on the diet. The absolute weights of heart, lungs, kidneys, and adrenals were all lower in the deficient animals than those of the controls. However, when the weights were expressed in terms of percentage of body weight, a 2-fold increase was observed indicative of marked hypertrophy. The depletion of the coenzyme pyridoxal-5'-phosphate from these tissues was extensive (heart 48%, lungs 85%, and kidneys and adrenals 88%.) The extent of loss of the coenzyme from the tissues suggests possible functional changes.


Histidine decarboxylase activity in fetal intrauterine growth-retarded rats. Fetal intrauterine growth retardation was induced in nine rats at 17 days' gestation by ligating the blood supply to one of the uterine horn. The 27 festuses from the uterine vessel ligated side were the intrauterine growth retarded fetuses (IUGR) and the 37 fetuses from the nonligated side were controls. The mean weight of the IUGR fetuses was 3.4 +/- 0.3 g which was significantly smaller (P less than 0.005) than the mean weight of the control fetuses, 4.0 +/- 0.3 g. Whole body histidine decarboxylase (HDC) activity was assayed by a radioisotope method. The HDC activity per g tissue was not correlated to body weight in the control fetuses. This is in contrast to the IUGR festuses in which the HDC per g tissue was significantly and inversely related to body weight (r - 0.48, P less than 0.001).


The pancreas in cystic fibrosis: chemical composition and comparative morphology. Sections of pancreas from 16 individuals who died with cystic fibrosis (CF) were classified by morphometric criteria into four categories in increasing order of pancreatic involvement. The concentration of acini, islets, main ducts, lobular ducts, connective tissue, and fat was compared with control levels. The results show that in the least involved pancreases, from neonates who died under 5 months of age, acini were reduced to 33% of control levels and the following were increased: islets, to 410%, lobular ducts, to 250%; and main ducts, to 1700% of controls. With increasing severity of the pancreatic disease the acini were further reduced to 5% and lobular ducts to 37% of control levels, respectively. Main ducts increased by 19-fold, and fatty infiltration accounted for more than 25% of the fresh weight of the pancreas in 9 of the 16 specimens. Comparative biochemical studies of 35 fibrocystic pancreases were quantitatively related to the severity of the pancreatic involvement as follows. Water and volatile matter, normally accounting for 80 +/-% of the weight of the fresh pancreas, was reduced to less than 30% in the most affected organs. The concentration of zinc diminished from near normal mean levels of 193 mugZn/g dry pancreas to 10% of this amount in the severely involved pancreas. Elevated concentrations of calcium, amounting to over 10 times control level, were found in obstructed ductal structures. Calcium was depleted from pancreatic sections adjacent to the obstructions. The following biochemical indicators were significantly different in their mean levels in the 35 fibrocystic pancreases when compared with the 17 controls: (P less than or equal to 0.001) fat, water, zinc, calcium, copper, magnesium, potassium, and sodium (P less than or equal to 0.01).


Studies on the distribution of cholinesterases: activity in the human and dog heart. The distribution and postnatal variation of cholinesterase (ChE) activity were studied in 25 human and 25 dog hearts. The observed distribution pattern is remarkably constant, In dog hearts, the pattern is as follows: sinus node (SN) greater than left atrium (LA) greater than right atrium (RA) greater than right ventricle (RV) congruent to left ventricle (LV). The average acetylcholinesterase (AcChE) activities as expressed in international units per g wet tissue are: 1.66 (SN), 1.14 (LA), 0.70 (RA), 0.22 (RV), and 0.21 (LV). In human hearts, the AcChE distribution follows the pattern of RA greater than LA greater than RV congruent to LV with corresponding average activities of 1.70, 1.38, 0.51, and 0.44 IU. The postnatal variation of ChE activity is most pronounced in the RS of the heart in both species. The average AcChE activity in the RA of the newborn puppies is 0.51 IU as compared with 2.27 IU in newborn infants. In the adult heart, however, the average atrial AcChE activity is nearly identical (1.02 IU) in both species. An additional difference is the large (34-64%) contribution of butyrylcholinesterase (BuChE) to the total activity in dog hearts whereas the contribution of BuChE is small (7-15%) in human hearts.


Inulin clearance in the newborn infant: relationship to gestational and postnatal age. Thirty-eight healthy newborn infants with gestational ages ranging from 25 to 42 weeks were studied at 2 days to 9 weeks postnatal age to evaluate the rate of glomerular maturation after birth. Glomerular function was assessed by a constant infusion method for inulin clearance (Cin). Cin was nearly identical when measured by the traditional clearance method and by the constant infusion technique. The Cin of 22 infants 2-3 days old ranged from 0.6 to 17.9 ml/min and was directly related to gestational age (r = 0.81, P less than 0.001). For 26 infants studied at 1-9 weeks of age, Cin was directly proportional to conceptual (gestational and postnatal) age (r = 0.89, P less than 0.001), and approximated that of infants of similar gestational age studied at 2-3 days of age.


Chest pain in children: a prospective study. In a prospective study of children with the primary complaint of chest pain, 43 patients were identified. This gave an occurrence (per patient visits) of 0.288%. The average age was 12.9 years for boys and 11.80 years for girls. Diagnostic categories identified were idiopathic chest pain (45%), costochondritis (22.5%), chest pain secondary to bronchitis (12.5%), miscellaneous (10%), chest pain secondary to muscle strain (5%), and chest pain secondary to trauma (5%). These six categories are discussed in terms of age, sex, resolution of symptoms, duration of the complaint, return for follow-up examination, quality of pain, psychiatric profile, and results of laboratories studies. It is concluded that chest pain in children is not as ominous a symptom as it is in adults, and that it infrequently signals underlying cardiac disease or other serious disease that is not apparent from a thorough history and physical examination.


Remaining sequelae with modern perinatal care. The incidence of major sequelae-cerebral palsy (CP), psychomotor retardation (PMR), sensorineural hearing defect, and acquired hydrocephalus--has been studied retrospectively in a nonselected population of 6,5000 3-year-old children born in 1969 and 1970 at one Swedish hospital and treated uniformly according to the principles of modern perinatology. The total incidence of these four types of handicaps was 3.5 per 1,000 when children with congenital malformation syndromes, chromosomal aberrations, verified congenital viral infections, or toxoplasmosis were excluded. The incidence of CP was 1.2 per 1,000. Extreme immaturity, traumatic delivery, postnatal asphyxia, and hyperbilirubinemia were found to be relatively small factors as causes of sequelae in this population. Babies showing various degrees of intrauterine malnutrition were found to be the major remaining group at risk for PMR and/or CP, two thirds of children with these handicaps being recruited from the 16% of newborns with birthweights more than 1 SD below normal in relation to gestational age. The most important further gains can probably be made by earlier intrauterine diagnosis of these cases, induced termination of pregnancy in selected cases, and further studies on the perinatal treatment and adaptation of these infants.


Intellectual deficits after transient tyrosinemia in the term neonate. In order to determine if prolonged, significant transient neonatal tyrosinemia (TNT) is injurious to the developing central nervous system, 15 term infants who had suffered from this disorder for a mean duration of 50 days underwent comprehensive psychometric evaluations at a mean (+/- 1 SD) age of 56.5 +/- 7.8 months. Their mean maximum detected tyrosine level had been 25.8 mg/dl (range, 13.6 to 42.0) and their defect was considered secondary to a combination of a high protein formula intake and a lack of supplemental vitamin C. Compared to a control group, significantly lower mean scores were obtained by the TNT group on the McCarthy Scale of Children's Abilities (77.1 vs. 92, P = .008) and the Illinois Test of Psycholinguistic Ability (92.3 vs. 109.9, P = .002). Performance scores varied inversely with the duration of TNT. Although these children are not classifiable as "mentally retarded," TNT may cause specific learning disabilities. There is, therefore, a need to determine the frequency of TNT in infants fed evaporated milk and other high-protein milk formulas and to develop ways to prevent its occurrence.


Transcutaneous PO2 monitoring in routine management of infants and children with cardiorespiratory problems. Results are reported concerning the clinical application of the transcutaneous PO2 method (tc PO2 method) according to Huch et al. for monitoring arterial PO2. Thirty long-term continuous tc PO2 recordings were made in 22 ventilated children and infants with cardiorespiratory problems in four different pediatric intensive care units (Zürich, Göttingen, Kassel, and Mainz). These recordings were compared with 132 arterial PO2 determinations made during the same period of time. There was a linear relationship and a close correspondence between arterial PO2 and tc PO2 (r = .94). The continuous recordings have shown that the variability of PO2 is much greater than assumed so far by single blood gas analysis. This fact restricts greatly the value of single samples. Continuous tc PO2 monitoring has proved to be a great help in optimal respirator setting.


Needle biopsy of the synovium of children. While the diagnosis of juvenile rheumatoid arthritis is based on clinical criteria and does not require confirmation by synovial biopsy, biopsy is occasionally desired to exclude other diagnoses. Needle synovial biopsy of the knee may be performed on young children as an office procedure and generally provides adequate tissue for examination. In the author's clinic this procedure has replaced open biopsy of the knee of children.


Hyperinsulinism in infancy: diagnosis by demonstration of abnormal response to fasting hypoglycemia. The metabolic adaptation to fasting in infants with hyperinsulinism was examined to see whether a characteristic abnormality could be found that would aid in the diagnosis of this disorder. Seven infants under 1 year of age with hyperinsulinism were studied; 7 control infants of similar age and 12 children with ketotic hypoglycemia served as contrast groups. At the time of hypoglycemia, four of the seven infants with hyperinsulinism did not have elevated levels of insulin. However, levels of beta-hydroxybutyrate were significantly lower in the infants with hyperinsulinism than in the control and ketotic hypoglycemic groups. Levels of free fatty acids were also lower in the infants with hyperinsulinism. Expected levels and normal limits for beta-hydroxybutyrate, insulin, and free fatty acids when plasma glucose is below 40 mg/100 ml were estimated by combining the control and ketotic hypoglycemic groups. Using these values as standards, the diagnosis of hyperinsulinism can be made by evaluation of the response to fasting hypoglycemia. The application of this approach is illustrated by three case examples.


Propranolol and exercise as a screening test for growth hormone deficiency. There is a need for a safe, inexpensive, and reliable screening test for growth hormone (GH) reserve. Exercise has been utilized for this purpose but false-negative responses (inadequate GH release in non-GH-deficient patients) has limited the effectiveness of this stimulus as a screening test. Beta-adrenergic blockade (propranolol) was used to enhance the effect of exercise on GH release. Thirty-two non-GH-deficient children and five GH-deficient children were evaluated. All of the non-GH-deficient children responded to propranolol and exercise with serum GH levels exceeding 7 ng/ml. The peak serum GH levels in the five GH-deficient patients did not exceed 4 ng/ml. Propranolol and exercise appears to be an effective screening test for GH function.


The coexistence of cystic fibrosis and celiac disease. Two patients with cystic fibrosis (CF) who subsequently developed celiac disease (CD) are described. Since organ culture of intestinal mucosa has been used to establish an in vitro model for the study of CD, we utilized this opportunity to determine whether duodenal mucosa obtained from each of these two patients and their immediate families differed in its organ culture behavior from mucosa obtained from patients with CD alone. Additionally, as specific HL-A types are associated with CD, we used HL-A typing to determine whether the two patients with CF-CD differed genetically from patients with CD alone. One of our patients was HL-A8, the most common type associated with CD; the other was HL-A12, as are many of the non-HL-A8 celiac patients. The response in organ culture of the mucosa of these two patients was the same as the response in organ culture of the mucosa from patients with CD alone. These and other data suggest that CD occurring in patients with CF is no different than CD occurring alone.


The Denver prescreening developmental questionnaire (PDQ). To facilitate periodic developmental screening of all children, a Prescreening Developmental Questionnaire (PDQ) was created to identify those children who require a more thorough screening with the Denver developmental Screening Test (DDST). Children positive on the DDST screen are then referred for a diagnostic assessment. To devise the PDQ, 97 of 105 standard DDST items were formulated into questions. Ten age-appropriate questions were answered by 1,155 parents with subsequent evaluation of their children with the DDST. Agreement between parental responses for individual items and the score for their children's corresponding DDST item varied from 68% to 100% (mean, 93.3%). When the PDQ was positive, 31.2% of the children were referred for a DDST screen. These referrals included 86.7% of abnormal and 53.8% of questionable DDSTs among the 1,155 children screened. The predictive value of a referral was 23.3%. The predictive value of a referral did not differ significantly whether the PDQ was answered by a parent or by day care center staff personnel. A subsequent field trial of 1,027 PDQs in private physicians' offices and public health clinics yielded a similar predictive value (24.7%) for a referral. The parents liked the PDQ which took them only about five minutes to answer and the physicians liked the PDQ since it decreased by almost 69% the number of DDSTs they felt obliged to administer.


Management criteria, documentation, and peer review of initial urinary tract infection. During part of a national study to formulate criteria for chart audit of quality assurance of child health care, criteria were developed for diagnosis and management of urinary tract infections. These criteria were validated by pediatricians and family physicians in academic medicine and in practice. They were judged relevant to the medical care process and patient outcome by both. The selected criteria were also recommended by the majority of two large physician groups for use in peer review. An important aspect of the study assessed the frequency of performing and recording indicated procedures or tests. In the first three phases of the study these criteria were said to be performed and recorded by a large majority of physicians. However, in the fourth (community) phase, when charts of 166 primary care physicians were actually audited, documentation was so poor that peer review by chart audit would be impractical at present. Assuming proper documentation of the medical care process, similar criteria could be used for chart audit, clinical research, and educational purposes. Since the diagnostic and management process of initial urinary tract infection is established, development of structured health care forms and education in proper record-keeping are two important challenges for those interested in the evaluation of ambulatory care.


A multidisciplinary approach to the treatment of child abuse. A multidisciplinary team of professionals and paraprofessionals provides an innovative therapeutic approach for the treatment of child abuse and neglect among a deprived and disadvantaged population of abusing mothers. The therapeutic approach stresses residential care for mother and child, behavior modification through corrective child care experiences, personality modifications through individual and group therapy, and environmental and social changes through staff assistance and education.


Educational intervention for preschool children in a pediatric clinic. A parent education program aimed at promoting cognitive development in 2- and 3-year-olds was instituted in both a pediatric clinic of a general hospital and a child health station in the community. Parent participants were asked to work at home daily with their children using age-graded play materials supplied by the program. They were tutored individually, in the clinic playroom, by bilingual playroom assistants using role-playing techniques. One hundred fifty children completed the program out of a total of 468. Subjects were tested before and after training on the Cattell: Stanford-Binet and showed a positive gain in performance. Parents reported that their program experiences made them aware of their ability to teach their children. This was reflected in their changing view of the children's activities which were previously seen as aimless and "bad" and were now viewed as constructive and amenable to modification by the parents.


The use of paraprofessionals to teach interviewing skills. Two nonphysician mothers were each trained to give a consistent and authentic history of a child's common medical problem. At the beginning of a Pediatric Clerkship, one half the students were randomly assigned to interview one of the trained mothers. The interviews were videotaped and then replayed in an evaluative feedback session with each student. At the end of the clerkship these students were rated significantly higher on the process of interviewing than those students who did not have the initial evaluative feedback session.


American Academy of Pediatrics. Committee on Nutrition: special diets for infants with inborn errors of amino acid metabolism. A sufficient variety of semisynthetic dietary products is now available to permit control of amino acid imbalance in several inborn errors of metabolism. However, they must be used carefully, and their effects monitored closely. Continuing development of products for this type of special diet--to provide a wider variety--is necessary. Regionalization of treatment programs for patients with inborn errors of metabolism is recommended. Metabolic centers which are accumulating experience and have good laboratory support may be the most efficient way of providing adequate treatment for patients with inborn errors of metabolism.


Congenital posterolateral defect in the right side of the diaphragm. The infant born with a posterolateral defect in the right side of the diaphragm may appear normal at birth. His abdominal viscera may be normally located; the right side of the diaphragm may seem to be intact. Later, part of the liver may herniate. As it does, it displaces the lower part of the right lung, and hepatic flexure follows into a high posterior position in the right upper quadrant of the abdomen. Rarely, obstruction of portal and hepatic venous flow at the hernial ring may cause liquid to accumulate in the right side of the chest. At any time the liver may resume its interrupted passage. Increase in herniation will quickly make the patient sicker.


Nationwide residues of organochlorines in starlings, 1974. Organochlorine residues in starlings (Sturnus vulgaris) from 126 collection sites were monitored during the fall of 1974. DDE, DDT, polychlorinated biphenyls (PCB's), and benzene hexachloride were present in all samples. Dieldrin, heptachlor expoxide, hexachlorobenzene, and oxychlordane were present in approximately 97% of the samples. DDE, dieldrin, and PCB residues in starlings were significantly lower than they had been in 1972.


Pesticide residues in total diet samples, Spain--1971-72. Average pesticide residue levels were determined for the 17 main food groups in the average Spanish diet. Using these levels and the estimated average intake of these foods, authors computed an individual's average daily consumption of pesticides from each of these food groups and her/his total diet. Foods were acquired over a 1-year period from the market of Valencia, a city that gets supplies from an agricultural area where pesticide consumption is appreciably higher than that of the rest of the country. Thus average residue levels found must be higher than the national average. Except for fruits and vegetables, the different items composing each food group were sampled in proportion to the amount consumed in the average Spanish diet. Foods forming each group were homogenized into composite samples. All foods were analyzed raw. The most frequently detected pesticides were DDT and BHC. Malathion was detected at levels less than 0.10 ppm in some samples of vegetable oils, pears, and apples. DDT and BHC levels varied from undetectable to amounts less than 1.0 ppm. Highest levels were found in lard. An individual's average daily intake of pesticides was calculated to be 78 mug DDT, a sum which includes residues of o,p'-DDT, p,p'-DDT, and p,p'-DDE, and 13.8 mug gamma-BHC. These levels are much lower than the maximum acceptable daily limits established by the United Nations Food Agricultural Organization and World Health Organization.


Residues of DDT and DDE in livers of waterfowl, northeastern Louisiana--1970-71. A study was conducted to determine the levels of DDT and DDE in the livers of 10 species of waterfowl collected in Louisiana from 1970 to 1971. Livers of 48 of 50 specimens contained detectable levels of DDT and/or DDE. DDT residues ranged from 0.01 to 10.90 ppm; DDE levels ranged from 0.02 to 38.69 ppm.


Organochlorine pesticides in the Hawaii Kai Marina, 1970-74. Sediments, water, and oysters from the receiving waters of the Hahaione Valley, a suburban development in south-easter Oahu, Hawaii, were analyzed for organochlorine pesticidal compounds. The insecticides dieldrin, alpha- and gamma- chlordane, and p,p'-DDT were found in the study site environment. Levels were in the low parts per billion range for oysters and sediments and in the low parts per trillion range for water. During the past several years dieldrin residues in the marina study site have increased, even though the only activity known to influence pesticide levels in the valley is the chronic treatment for subterranean and dry wood termites. If present trends continue, dieldrin may pose a threat to biota of the aquatic environment. Findings have shown that residue levels of dieldrin and p,p'-DDT in the sediments are within the LD50 (median lethal dose) range for estuarine fish and thus may have a deleterious effect on bottom-feeding organisms. According to present standards of the Food and Agriculture Organization/World Health Organization, pesticide residue levels within the study site do not appear to constitute a health hazard to humans.


Mercury in eggs of aquatic birds, Lake St. Clair--1973. Eggs from four species of aquatic birds inhabiting waterways of the Lake St. Clair region were collected in 1973 and analyzed for mercury. Species analyzed were mallard ducks (Anas platyrhynchos), common terns (Sterna hirundo), black-crowned night herons (Nycticorax nycticorax), and great egrets (Casmerodius albus). Mallard eggs contained relatively low residue levels, less than 0.05-0.26 ppm, and common tern eggs contained the highest residues, ranging up to 1.31 ppm. Mercury levels in the eggs were appreciably lower than those in the same species in 1970. The declines are attributed to the 1970 restrictions placed on industrial discharges of mercury into the St. Clair and Detroit Rivers.


A sterilizing tail stump sperm defect in a Holstein-Friesian bull. A case of sterility in an 18-month-old bull of the Holstein-Friesian breed was investigated. A semen sample sent to the laboratory showed a very low sperm concentration and abnormal sperm morphology. On the preliminary examination, the major sperm defect (60-70%) seemed to be tailless heads. When higher manification was used it was found that most of the defective heads had a short tail rudiment, a tail stump 2-3 mu long. Loose sperm tails were seldom seen in the smears. The defect has been described previously from Canada where it has occurred in different breeds, including Holstein-Friesians. The dam of the Danish bull in question was inseminated with imported American semen, and the sire is one of the most demanded Holstein-Friesian bulls at present. The possible heredity of the defect is discussed.


Aetiology and Pathogenesis of abomasal displacement in dairy cattle. A clinical chemical survey is given of the complex of factors which are involved during development of clinically manifest hypotony or atony of the abomasum prior to abomasal displacemnts. The importance of a change in the acid-base balance of the animals is especially stressed as a predisposing factor. The further pathogenesis of abomasal displacement is supposed to follow different ways, according to the feeding and to prevailing periods of indigestion.


Congenital osteogenesis imperfecta in Charollais cattle. An outbreak of an apparently new hereditary bone disease--congenital osteogenesis imperfecta--in six newborn half-sib Charollais calves is described. In many respects the clinical, pathological, radiological and genetical findings resemble the congenital osteogenesis imperfecta seen in man and sheep.


[The influence of Ascaris suum infection upon growth rates in pigs (author's tranls)]. The influence of experimental Ascaris suum infection upon growth rates in pigs has been studied in two experiments with disease-free pigs. In pigs where a patent Ascaris infection was established growth rates were decreased by appr. 20% compared with parasite-free controls. The experiments have revealed that the negative influence of Ascaris suum upon growth is caused both by the larvae during migration through the lungs and by the presence of adult worms in the intestine.


[Angioimmunoblastic adenopathies].

[Angioimmunoblastic adenopathies]. Angio-lymphoblastic lymphadenopathies are a newly described haematological entity, though not rare, characterised by a histological triad (vascular neogenesis, highly polymorphic or predominantly immunoblastic cellular proliferation and the presence of acidophilic protein deposits), a clinical syndrome consisting essentially of voluminous disseminated lymphadenopathy and hepatosplenomegaly and abnormal laboratory findings dominated by a polyclonal dysproteinaemia. This disorder, the first four French cases of which are described here, does not appear to be malignant in its early stages and is sensitive to corticosteroid therapy at that time. Secondary sarcomatous transformation is  possible.


[Angioimmunoblastic lymphadenopathies with autoimmune anemia and polyclonal hyperimmunoglobulinemia]. The study concerned 13 cases of angio-immunoblastic lymphadenopathy. This systemic lymphoid disorder has been identified only recently and is surely more common than has been thought. It is characterised by specific changes in the lymph nodes, which are infiltrated by plasmocytic and immunoblastic cells, associated with a marked degree of vascular neogenesis. This anatomical involvement is accompanied by numerous immunological manifestations, the most important of which are a positive Coombs test and a polyclonal hyperimmunoglobulinaemia. Despite the severe course of the disorder, its benign or malignant nature is uncertain and the therapeutic approach remains a subject of discussion.


[Management following mammography revealing grouped microcalcifications without palpable tumor]. On the basis of a series of 60 cases, the authors report their experience of excision of grouped microcalcifications detected at mammography in the absence of any clinical sign. The breast zone in which the microcalcifications were located by the radiologist was removed surgically. Per-operatoire X-ray of the excised specimens using a mammography apparatus confirmed that the microcalcifications had been totally removed. In addition it was useful to locate aceuretaly the calcifications in view of a careful histological examination of the area. The technique led to the discovery of 27 carcinomas at a sub-clinical stage. A classification of the various types of microcalcification was established in relation to histology. It will be of assistance in suspecting malignancy on the basis of mammography findings in the majority of cases. Excision can then be reserved for cases of presumed malignancy or where a doubt exists. By detecting breast carcinomas at a sub-clinical stage, the method makes possible early and minimally mutilating treatment with the best chances of cure.


The 3'-terminal sequence of mitochondrial 13S ribosomal RNA. We have examined the 3'-terminal sequence of the "small" structural ribosomal RNA ("13S") of hamster cell mitochondria, using a procedure involving [3H]isoniazide labeling of samples subjected to sequential periodate oxidation and beta-elimination. The terminus was found to be PyUAUUAOH, which is similar, but not identical, to the corresponding terminus of eukaryotic cytoplasmic 18S rRNA.


A combined use of triphenyl phosphite and 2,2'-dipyridyl diselenide as a coupling reagent in oligonucleotide synthesis. Oligonucleotides and nucleoside phosphoramidates can be synthesized in high yields by a combined use of triphenyl phosphite and 2,2'-dipyridyl diselenide as a coupling reagent.


Histone dimers: a fundamental unit in histone assembly. Histone interactions which occur, at moderate ionic strengths, when several types of purified, renatured histones are mixed at equimolar ratios have been studied. The four histones H2A,H2B,H3 and H4 complex and form dimers. Histone H1 does not interact with the other four histone types and does not form dimers. Mixing of single histone species with preformed histone pairs as well as mixing of two different types of histone pairs, leads to exchange of histones among the pairs and formation of dimers. No trimers are formed. The dimers are in equilibrium with high-molecular weight histone structures. The results indicate that histone dimers may serve as a stable intermediate in histone assembly. Because each histone type (except H1) can interact with itself as well as with each of the other three histone types we suggest that each histone type should be considered as an interchangeable subunit of a multichain protein in which the dimer species is the most stable structure.


Stacking self-association of pyrimidine nucleosides and of cytosines: effects of methylation and thiolation. Stacking self-association equilibria in aqueous solutions of m3uridine, m34,2',3',5'uridine, 2'-deoxyuridine, m13,4,4cytosine, m14,4,4,5cytosine, s2cytidine and s4thymidine were studied at various temperatures by vapour-pressure osmometry. Equilibrium constants Kst's were computed on the assumption of the isodesmic model of self-association. Enthalpies of association were also obtained from the temperature dependence of Kst according to the van't Hoff equation. Analysis of the equilibrium and thermodynamic parameters demonstrated involvement of hydrophobic interactions in the stabilization of complexes of tetramethyluridine. Dipole-induced dipole interactions seem to predominate in the formation of s2C, s4T and of both dimethylaminocytosine complexes.


Electrostatic potential modulations on polynucleotides as a function of ionic content: potentiometric determinations. pK values of ionisation of cytidine residues, in poly C and poly I. poly C, have been determined by potentiometric titration as a function of either ionic strength (Na+) or Mg2+ concentration. The results are interpreted as a consequence of the existence of a local pH, prevailing in the vicinity of the polynucleotides, smaller than that of the bulk solution. This local pH is dependent upon the electrostatic potential psi due to the negatively charged phosphate groups of the polynucleotide. Moreover psi can be modulated through variation of either ionic strength or Mg2+ concentration. At a given pH Mg2+ addition leads to the release of protons which, in the case of complex systems of limited stability, might be detected by the use of the pH-stat method. Possible functional implications for genetic translation systems are examined.


Acetylation and cleavage of purine nucleosides. Synthesis of 6-azauridine, 5-fluorouridine, and 5-methyluridine. Inosine (I) when acetylated with acetic anhydride in the presence of acetyl chloride in acetic acid solution (the so called "acid acetylation"), affords an acetylated nucleoside III (75%) along with cleavage products of the nucleoside (hypoxanthine, 19%). The reaction of I with acetyl chloride (7 days) results in the formation of hypoxanthine (95%) and triacetylribofuranosyl chloride (IV) isolated in the form of tetraacetylribofuranose (47%). The acetylated purine nucleoside affords a similar result by reaction with acetyl chloride or acetyl bromide. 2'-Deoxyuridine gives a diacetyl derivative (80%) by reaction with acetyl bromide. On treatment with acetyl bromide, the nucleoside bond of purine nucleosides is quantitatively cleavaged (4 h, 20 degrees C) with the formation of tri-O-acetyl-D-ribofuranosyl bromide (X). The halogenose X affords pure beta-anomers, namely, 1,2,3,5-tetra-O-acetyl-beta-D-ribofuranose (75%), the triacetyl derivatives of 5-methyluridine (XVIIa; 75%, referred to guanosine), 6-azauridine (XVIII; 71%), and 5-fluorouridine (XIXa; 75%).


Investigation of the mechanism of the synthesis of oligonucleotides. IX. 31P NMR spectra of the active dinucleotide derivatives and their analogs. The interaction of 3'-O-acetyldithymidilate (pdTpdT(Ac)), thymidine-3',5'-diphosphate (pdTp) and thymidine-3'-phenyl-phosphate-5'-phosphate (pdTpPh) with 2,4,6-triisopropylbenzene sulphonyl chloride (TPS) and N,N'-dicyclohexylcarbodiimide (DCC) in pyridine and dimethylformamide (DMF) was studied by pulsed NMR spectroscopy on phosphorus nuclei. Thymidine cyclic 3',5'-pyrophosphate and dimeric pyrophosphate derivatives were shown to be the main products of the reaction of pdTp with TPS and DCC. The former shows spin AB-system with the unusually large spin-spin coupling constant about 28Hz upfield to the signals of the dimeric pyrophosphates in NMR spectrum. Analogous spin AB-systems with large spin-spin coupling constants (up to 32 Hz) were observed in the spectra of the reaction mixtures of pdTpdT(Ac) with TPS or DCC and of pdTpPh with TPS. These spin AB-systems were ascribed to 3',5'-cyclic pyrophosphate derivatives of pdTpdT(Ac) and pdTpPh.


Elimination of double strand nuclease activity from S1 nuclease prepared from crude alpha amylase. Single strand-specific s1 nuclease prepared as previously described from crude alpha amylase by DEAE-cellulose chromatography also contains nuclease which degrades double strand nucleic acid. The double strand activity can be removed by repeating the DEAE-cellulose chromatography procedure at least two additional times. S1 nuclease prepared by this procedure does not degrade double strand sheared DNA as measured by Sephadex chromatography. Under the same conditions single strand DNA is completely degraded. Thus, S1 nuclease prepared by this procedure is suitable for use in removing single strand regions in DNA/DNA duplexes and DNA/RNA hybrids.


Abdominal tuberculosis in Britain.

Abdominal tuberculosis in Britain. A series of fifteen patients with abdominal tuberculosis, managed personally by two clinicians over a five-year period, is presented. These fall into three broad groups: tuberculous peritonitis, gastrointestinal tuberculosis and tuberculous hepatitis. In more than half of the patients the chest radiographs were normal and three patients had negative tuberculin reactions. In emphasizing the fact that abdominal tuberculosis is not longer a rarity in Britain, attention is drawn to the many different ways in which the disease may present. One patient in the series, who presented as a possible case of cholera, had duodeno-colic fistula (only the third proven case in the literature) and two other patients presented with jaundice due to hepatic tuberculosis, again a rare form of abdominal tuberculosis.


Color-matching technique to train children in the correct use of stairs. Color cues were used to train four severely retarded children and two learning disabled children to move in a left foot-right foot alteration pattern when using stairs. The occurrence of left-right alterations and marking time behavior was recorded throughout baseline and training conditions. The color-cue procedure effectively produced a consistent pattern of alteration of four of the children and eliminated marking time in three of the children. Physical prompts were used to train alteration in two children for whom color-cue training was not sufficient. At the termination of training, observations of the children's performances in new settings and to new adults were conducted. Results indicated that the children continued to alternate correctly. In addition, follow-up investigations conducted between two weeks to 16 months after training indicated that the children were maintaining the stair alteration pattern. Future research should determine whether a visual-cue procedure could be used in training other forms of locomotion or motor behavior.


Standardization of the physical therapy record. The question of where to begin the assessment of quality care in physical therapy is examined. A standardized format to enhance patient-care record is presented, and the reasons for a systematized approach to recording patient care are explained.


Overview of cancer pathology.

Overview of cancer pathology. A brief review of cancer pathology is presented for physical therapists interested in cancer treatment programs. The relationship of cancer pathology to diagnosis and treatment is illustrated. Cancer biology definitions, cancer classification, grading and staging, and the multidisciplinary approach to treatment are discussed.


Dance in physical rehabilitation.

Dance in physical rehabilitation. Dance shows promise as an efficient, effective, and exhilarating physical therapy modality, with inherent sources of motivation for long-term neurological and orthopedic patients in a hospital or community setting. Four years' experience in adapting dance to the purpose of therapy in a group setting is described. The dance program developed combines the theories and techniques of physical therapy with the expressive, creative, and intellectual challenge of dance using music and other artistic motivating stimuli. Several dimensions of the modality are discussed and positive results are noted, through concrete illustrations.


Total joint replacement in extremities with below-knee amputations. Patients with knee and hip joint diseases or fractures in a limb with a distal portion amputated were successfully treated with total joint arthroplasties. Two patients with below-knee amputations recieved total joint replacements. One underwent a total hip arthroplasty and the other had a total knee arthryplasty on the side of the amputation. Physical therapy was modified minimally for the two patients in comparison to other patients with total joint replacements. Prosthetic changes were required in both cases. With new prostheses, both patients were able to return to work.


Orthotic collar in the treatment of intertriginous impetigo. This article illustrates a manner in which physical therapy can provide adjunctive treatment management of an infant with intertriginous impetigo. This treatment program was an interdisciplinary approach to a difficult clinical problem. The medical staff concluded that implementation of the cervical orthosis expedited the patient's recovery and reduced the potential complications of the disease process.


Successful replantation of an avulsed scalp by microvascular anastomoses. A totally avulsed scalp was replanted by microvascular anastomoses. This was feasible because suitable vessels were available in the superficial temporal region, and because the detached scalp was otherwise largely undamaged.


Closed compression technique for rupturing a contracted capsule around a breast implant. When a breast becomes hard after an augmentation mammaplasty, the fibrous capsule around the implant can be ruptured, in most cases, by closed compression of the breast-resulting in immediate softness of the breast. As yet the duration of this improvement is unknown, but follow-up examinations to date indicate that it is persisting in about 3 or 4 patients so treated.


Pitfalls of comparative photography in plastic and reconstructive surgery. Some of the pitfalls of comparative scientific photography are reviewed. Methods of avoiding these pitfalls and for maintaining consistency are suggested.


Airway hazards associated with pharyngeal flaps in patients who have the Pierre Robin syndrome. We describe 3 patients with the Pierre Robin Syndrome who developed severe problems of airway obstruction after having the cleft palate closed and a pharyngeal flap done simultaneously. We now believe that, even at a later age, pharyngeal flaps should be done in these patients only after a most careful assessment of the airway competence.


Blindness without direct injury to the globe: a complication of facial fractures. Two cases of bilateral told blindness, resulting from fractures of the middle third of the face without direct trauma to the globe, are reported. The mechanism of such blindness is discussed, and the literature on it is reviewed.


The third crus of the anthelix and another minor anomaly of the external ear. One minor anomaly of the external ear is a "third crus", which is an addition to the normal upper and lower crura at the anterior end of the anthelix. Another minor deformity is an extension of the crus of the helix, wherein it runs as a crest across the concha. An operation to correct the latter deformity is described.


The cause and prevention of electrical burns of the mouth in children. A protective cuff. An epidemiological review of electrical burns of the mouth in children pinpoints the cause to the female end of extension cords. The use of a protective cuff, designed to prevent these disfiguring injuries, is suggested.


The failure to survive of autogenous free grafts of whole gracilis muscles in dogs. An experimental study was undertaken to define the limits in size (if any) of successful free autogenous grafts of skeletal muscle. In 8 dogs, 16 gracilis muscle grafts were transplanted to the contralateral hind limb. The left hind limb served as a control for the right side, which contained paralyzed muscle. Macroscopic, microscopic, and EMG analyses demonstrated a complete failure of the free muscle grafts to take and survive. We have shown that one can exceed the limitations to the size of a successful muscle graft. Perhaps future investigators will define exactly what the maximum viable size is.


Bilateral accidental rupture of the fibrous capsules surrounding mammary prosthesis. Case report. A complication of augmentation mammaplasty is presented. Bilateral traumatic rupture of the surrounding fibrous capsule occurred without disruption of the prosthetic envelope. Questions are also raised about the effects of pregnancy on the maturing fibrous capsule.


Teratomatous choristoma and its associated syndromes. Case report. The literature on oral teratomata is reviewed, and a theory for the embryological basis for these malformations is presented. We present an unusual case of Class III (Schwalbe) teratoma, in association with a complete cleft of the hard palate. Corrective surgery was required in the neonatal period.


[Significant differentiation of the social psychiatry movement in capitalistic society. 1]. Rapid differentiations of the sociopsychiatric movement in the capitalist countries in general and in the Federal Republic of Germany in particular are closely related to different political concepts in reforming psychiatric care. One important group of psychiatrists consider the improvement in psychiatric care a major step in the direction of improving the social conditions of a capitalist system, striving to get the government's organizing help. Another group is formed by those experts who consider the abolition of repressive forms of therapy and, hence, the termination of the practice of regarding psychic disorders as medically relevant events to be prerequisite to radically improving the situation of mental patients. Essentially speculaiive interpretation results in an ideology of enlightenment that is without real consequences from a public helath and medical care point of view.


[Treatment of myasthenia gravis].

[Treatment of myasthenia gravis]. The authors discuss various therapeutical possibilities for myasthenia, such as drug therapy, immuno-suppression, radiological, and operative treatment. The indicatons of the different therapeutical methods are dealth with. Thymectomy was performed in 92 of our patients. Due to complex therapy the fate of patients with myasthenia is to be regarded as much more favourable than in the past.


[Ophthalmological characteristics of early cerebral atherosclerosis]. The results are discussed of a complex neuro-ophthalmological investigation of 439 patients with initial cerebral atherosclerosis. Their neurological characterization and the results of elecrcto-physiological, biochemical, and psychological examination methods are indicated. The opthalmologist had performed the opthalmoscopic examination, biomicroscopy of the vessels of conjunctiva and episclera the opthalmocalibrometry and angiophotometry as well as opthalmodynamometry. The most frequent opthalmological symptoms of initial cerebral atherosclerosis are pointed out. The methods are compared for their diagnostic value.


[Usefulness for differential diagnosis of the distribution of extrapyramidal symptoms resulting from neuroleptic therapy in psychiatric practice]. During the neuroleptic treatment of 100 schizophrenic and cyclophrenic patients, respectively, the developing extrapyramidal symptoms were found to reveal a peculiar single-sided overweight: in the case of schizophrenics on the right, whereas in maniacdepression cases on the left side. This lateral difference was maintained even at temporary different syndromatics in the course of the disease. All these raise the idea of applying the so-called Haloperidol test when differential diagnostically difficult cases, decided upon rather only on the basis of the longitudinal section are encountered. The single-sided overweight of the extrapyramidal symptoms developed have clearly indicated both initially and subsequently the diagnosis confirmed later on.


[Significance and advantages of Orap in the ambulatory care of schizophrenic psychoses]. The authors report clinical experience from therapy with Orap-Janssen and Orap-Richter from 1968 to 1974. Excellent tolerance makes Orap particularly suitable for long-term maintenance therapy in schizophrenic psychoses. The evaluation is based on observations in 91 patients.


[Clinical experiences with the new antidepressive agent ICI 58,834]. In an open study 17 patients with depressive disorders, 5 patients with unipolar affec. Only 9 patients completed the trial. The frequency of side-effects, especially nausea and vomiting was high, which will probably limit the clinical use of the drug. Of the sion NUD, were treated with a new potential antidepressant, ICI 58.834 (Vivalan). tive psychosis, 9 patients with reactio-neurotico-depressiva and 3 patients with deprespatients who completed the trial 1 was recovered and 4 were improved. Thus the antidepressive effect is dubious and must be tested in controlled studies.


[Significant differentiation of the social-psychiatric movement in capitalistic society. II. Activist impatience - psychiatric reform as revolution]. The relations between intentions in health politics and theoretical concepts within the debate on reformation of psychiatry, which have been dealt with in part I, are continued. Two further trends are considered; the attempts linked with the social ideas of left radicals to promote the socialist revolution with a reformation of psychiatry are regarded as peculiar transient signs, without profound theoretical effects. The ideas of those psychiatrists are particularly important for future development, who plead for socially just psychiatric care understanding the latter as an aim of the struggle within the frame-work of anti-imperialist-democratic policy. In general, it is true that trends with pronounced antimedical tendency in the social psychiatric movement are of little use in the practical transformation of the psychiatric care.


[Problems of occupational therapy and vocational rehabilitation in psychiatry]. The authors discuss the rehabilitative measures of occupational therapy, slight work and protected work with reference to their practical performance and optimum application. Critical remarks on the partly ineffective practical application of rehabilitative measures are followed by hints on laws, which show their objectives and possibilities.


[Determination of distal latency of the motor nerves of the hand]. The authors show the methodological problems connected with the determination of distal latency and the possibility of misinterpretation. They recommend the use of concentric needle electrodes together with surface electrodes for the determination of the distal latency of the hand nerves and also to always register both nerves.


[Effect of intravenous diazepam (Faustan) on EEG focal disturbances]. The influence of intravenous administration of diazepam (Faustan) on focal e.e.g. changes was checked in 34 patients. Bioelectric functional disturbances may remain unchanged, may be provoked or abolished; apparently etiological aspects are not decisive. According to the authors' results, the value of this provocation method for the differentiation of space-occupying intracranial processes and cerebrovascular disturbances should be regarded with caution.


[Methods of research on group therapy].

[Methods of research on group therapy]. In the field of what is known as group talk therapy it is rather difficult, but absolutely necessary to do more than merely discuss various concepts and make occasional observations. The possible methods described include the "pre" and "post" systems of principles, practices, and procedures; the reference group method; the method of investigating process variables; and the analog experimental method. Examples are given for each of the above methods. It is evident from a number of theoretical designs that major achievements will finally come from a suitable combination of different methods of research.


[Psychophysiological studies in the framework of objective diagnosis of neuroses with factor and discrimination analyses]. This paper describes a complex method of collecting objective data to be used in the diagnosis of neuroses on the basis of clinical, experimental psychological, and objective psychophysiological parameters. The data collected was processsed using the methods of factor and discriminatory analysis. The results obtained clearly show that this approach to additional objective diagnosis may be successfully used in spite of some procedural difficulties.


[Hysteria, hypnosis and psychopathology. Unknowns and perspectives]. The author, drawing on his wide experience, discusses a number of theoretical questions associated with the subject of practical work. He presents several concepts in connection with the description of a particular case and also discusses various historically important points of view made known through publication in the literature.


[Interdisciplinary relationships of physiotherapy to psychology, psychotherapy, and psychiatry]. The relationship of physiotherapy to psychology, psychotherapy, and psychiatry is critically examined from the point of view of physiotherapy. The relations existing between these disciplines cannot, at present, be considered satisfactory from an overall therapy point of view. The paper also discusses tendencies toward interdisciplinary collaboration.


[Theroretical and methodological aspects of music therapy in children with special reference to international developmental tendencies]. Two melodiotherapeutical principles, namely, the isoprinciple and the intermediary principle (Benenzon), are described in the light of results of recent investigations into the communicative function of music (Reinecke). The paper also discusses the difference between methods of musicotherapy used in the treatment of mental disorders in children and adults. Finally, international trends are analyzed and conclusions drawn in respect of the development of a standard methodology of melodiotherapy.


[Day-night therapy- a necessary step towards better care for mental patients]. The authors, after giving an outline of the history of what is known as day-clinics, comment on the importance of such institutions as a link between psychiatric inpatient and outpatient treatment. The results obtained in the treatment in day-clinics of 120 mental patients are compared with those obtained for 120 inpatients. Also discussed are a number of conclusions drawn from results to date. The authors finally consider the future development of this particular field of therapy.


[Structural and functional conception of in-patient and ambulatory psychiatric care in Leipzig]. The present paper reports a model designed to optimize treatment of mental disorders. This model has as its basic principle the division into sections of the region to be cared for in addition to the restructuring of existing mental hospitals. The advantages of this model of sectionalisation are discussed in detail.


Children's understanding of their emotionally disturbed peers. I. The concept of emotional disturbance. Study of the interpersonal relations of emotionally disturbed children has focused largely on relationships within the family. Theories of childhood psychopathology focus almost exclusively on the parent-child triad as the etiological core of childhood emotional disturbance (Frank, 1965). Far less attention has been paid to the role of extra-familial attitudes and relationships in childhood psychopathology. In a general way, the increasing importance of the peer group during childhood has been recognized, but researchers have hardly begun to consider whether and how the manifold aspects of relationships between the emotionally disturbed and their normal peers might bear on the course of the disturbance or its refractoriness to treatment (e.g., Solomon and Wahler, 1973). Nor have they considered peer group influences on the development of the emotionally disturbed child's perception of the world and his place within it. Despite increasing recognition of the early importance of peer relations, virtually no systematic information exists on the ways in which normal children view their emotionally disturbed peers. Our purpose in this paper is to report the first of several analyses of data from an initial investigation of children's understanding of their emotionally disturbed peers. Specifically, we wish to examine whether there is evidence that normal children do, in fact, perceive as emotionally disturbed the symptomatic and distressing behavior of peers that mental health professionals would recognize as indicative of psychopathology. Further, we wish to study these issues with respect to grade and sex differences.


Comparison of rehospitalized and nonrehospitalized psychiatric patients on community adjustment: self-assessment guide. The measurement of community adjustment has become an essential component of community mental health program evaluation. The primary objective of community-oriented hospital psychiatric services is to return the patient to the community as quickly as possible, and to enable the patient to maintain himself in the community in a normal manner (Joint Commission on Mental Illness and Health, 1961). Attempts to evaluate hospital mental health programs have necessarily looked at measures of recidivism such as return rate and length of community tenure (Anthony et al., 1972; Rosenblatt and Mayer, 1974). For more immediate measures and qualitative assessment of community tenure, however, evaluators have relied on questionnaires that purport to measure community adaptation and social adjustment. A major reason for the use of community adjustment measures for evaluation in community-oriented hospital programs is the relative lack of predictive ability of any measures of patient adjustment while the patient is still in hospital (Ellsworth et al., 1968; Williams and Walker, 1961). It appears that all measures of success while the patient is still hospitalized, even goal-attainment measures, have little relationship to posthospital adjustment or recidivism (Willer and Miller, 1975). The present study examines the relationship of community adjustment to rehospitalization through comparison of rehospitalized and nonrehospitalized patients on a community adjustment scale.


Prison homosexuality and its effect on post-prison sexual behavior. Although there has grown up to a considerable literature on sex experiences in prison, little has been written on the post-prison behavioral patterns of those who, voluntarily or involuntarily, become initiated into homosexuality while incarcerated. In the light of the considerable number of prisoners and ex-prisoners in the original Kinsey sample, it is possible that the Institute for Sex Research might have in its files material that would shed light on this problem. To date, nothing has been forthcoming. In one of the few references to the subject, Kirkham (1972, p. 42) suggests that sexual experiences in prison may have permanent effects on the lives of some of the participants: "Can such men return to conventional heterosexual lives after release, or has the experience of being forced into acts of passive homosexuality been so traumatic as to preclude the resumption of sexual relations with members of the opposite sex?" In a search for an answer to his question, the present paper studies ex-prisoners whose initiation into homosexuality occurred during prison.


The secret.

The secret. The revelation of secrets lies at the core of much psychotherapeutic method and was the seed from which early psychoanalytic theory grew. The notion of "the secret" can therefore be regarded as critical to an understanding of the psychotherapeutic process. This paper puts forward a view which contrasts, in important aspects, with traditional concepts and which emphasizes the positive or creative value of certain hidden ideas and the importance of the social arena on which they are displayed.


Jóge Kankei: a key concept for an understanding of Japanese-American achievement. Jóge Kankei, or an emphasis on superior-inferior relationships, refers to the pervasive concern with ranking in Japanese society. This concept is associated with achievement motivation in that it is related to socialization practices that create in the individual a heightened sensitivity to the opinions of significant others. In this paper, the pervasive concern with ranking and the sensitivity to the opinions of others is first used as a conceptual tool to explain the alleged paradoxical behavior of the Japanese at various times in their history, and is then used as the basis of a study aimed at understanding the rapid acculturation of the Japanese Americans. The study is based upon interviews with 234 Issei (first generation, born in Japan), 241 Nisei (second generation, born of Issei parents), and 372 Sansei (third generation, born of Nisei parents). Additionally, these three groups were administered several tests and questionnaires designed to measure acculturation and the retention of Japanese values.


Dream patterns in Anglo and Chicano young adults. This study is the conclusion of an exploratory cross-cultural investigation of dream content and organization. Following our report in "Ego Modalities in the Manifest Dreams of Male and Female Chicanos," (Brenneis and Roll, 1975), this paper examines differences in the organization and content of dreams: (1) between Anglo men and women; (2) between Anglo and Chicano men and Anglo and Chicano women; and (3) between Anglos and Chicanos.


Presidential assassination: an American problem. Assassinations of Heads of State of foreign countries have usually been carried out by organized political groups seeking to overthrow the government or change its policies. In the United States, on the other hand, Presidential assassinations and threats and gestures of assassination have been the work of mentally disturbed individuals. The only exception is the attack on Blair House in 1950, by Puerto Rican nationalists attempting to assassinate President Harry S. Truman. The nationalists claimed that the United States was illegally occupying their country and that the purpose of the act was to call the world's attention to the cause of Puerto Rican independence.


Survival and development of maternally deprived rats: role of body temperature. Rat pups, 10-12 days old, survived maternal deprivation if kept warm at 35 degrees, but died within 6 days if allowed to become hypothermic at a room temperature of 23 degrees. Normal body temperatures facilitated feeding, but even without food, warm pups survived starvation longer than cool ones. Increased survival could not be attributed to decreased oxygen consumption, and warm pups lost more body water and solids than cool pups. Striking differences in development that may have affected survival were observed over 72 hr of separation without food. Cool pups showed a virtual arrest of the growth of the tail, fur, tibia, and femur, and failed to increase brain weight, protein, DNA, RNA, and catecholamine contents. Warm pups showed developmental growth more comparable to that of normally mothered pups and significantly exceeded controls in the rate of accumulation of brain norepinephrine and dopamine.


Plasma testosterone levels in the rapist. Plasma testosterone level was measured in 52 rapists and 12 child molesters who had completed the Buss-Durkee Hostility Inventory, the Megargee Overcontrolled Hostility Scale, and the Michigan Alcoholism Screening Test. The rapists were classified according to the degree of violence during the commission of the rape. The ranges and means of the plasma testosterone level for the rapist and child molester controls were within normal limits. The group of rapists who were judged to be most violent had a significantly higher mean plasma testosterone level than normals, child molesters, and other rapists in this study. Mean Buss-Durkee hostility rating scores for rapists were significantly higher than the mean for normals, but there was no correlation between individual hostility scores and plasma testosterone levels. There was no correlation between age, race, or length of incarceration and plasma testosterone level.


Psychological responses to the use of the fetal monitor during labor. Fetal monitoring, a major advance in obstetrical care, transforms the labor room into an intensive care setting. The psychological effects of this new technology were investigated by means of structured interviews with 25 postpartum women. The multiplicity of psychological responses obtained are described. The relationship of demographic, obstetrical, and psychosocial variables to women's overall positive or negative reaction to the monitor was investigated. Personality characteristics and life experiences with pregnancy and childbirth were factors that shaped the manner in which the monitor was experienced. The effect of fetal monitoring on maternal anxiety is discussed. The impact of mechanization on the total experience of childbirth is noted.


Effect of operant conditioning of heart rate on plasma renin activity. Cardioacceleration produced by operant conditioning was associated with elevation of plasma renin activity. This study suggests that emotional stimuli, which produce cardioacceleration, may also cause increased renin secretion, thus providing a mechanism by which factors operating through the mind and sodium intake could summate in the production of hypertension.


Ventilatory response to carbon dioxide inhalation in depression. The ventilatory response to carbon dioxide (CO2 response) was determined in 18 patients admitted to an inpatient service with endogenous depressive illness. Admission mean CO2 response value for the group was below the mean value for a control group. At the time of hospital discharge marked clinical improvement had occurred in depressive symptomatology; mean CO2 response had increased slightly and was no longer significantly below the control value. CO2 response deserves further investigation as a possible physiologic characteristic of certain depressed patients.


Paracetamol overdose in man: relationship between pattern of urinary metabolites and severity of liver damage. The urinary excretion of paracetamol and its conjugates was studied, using a two dimensional thin layer chromatography system, in three volunteers after therapeutic (6-5-26-6 mmoles) doses of the drug, and in 30 patients admitted early after overdoses taken in suicidal attempts. In both volunteers and patients 85-100 per cent of the drug was excreted into the urine--almost entirely as conjugates--in the first 24 hours, which was before biochemical signs of liver damage had appeared. Higher quantities of paracetamol conjugates were recovered from patients who developed moderate of severe liver damage than those less severely affected, although correlations in individuals between quantity excreted and clinical outcome was poor. The pattern of individual paracetamol conjugates changed markedly the higher the ingested dose of the drug. Thus, the excretion of paracetamol sulphate reached a plateau as the administered dose was increased from 20-26-5 mmoles in the volunteers, whilst in patients who developed liver damage after overdose there was also a plateau in the excretion of the glucuronide conjugate. In the latter group, there was a greatly increased production of the cysteine and mercapturic acid conjugates of the drug. These are formed via a highly chemically reactive metabolite of the drug, which binds to glutathione, and if hepatic stores of the latter become depleted, binding will occur instead to hepatocyte macromolecules with ensuing liver damage.