Toxoplasma antibody prevalence in veterinary personnel and a selected population not exposed to cats. To further elucidate the epidemiologic factors involved in the transmission of Toxoplasma gondii from cats to humans, veterinarians, animal hospital workers and a selected population of non-contact subjects were questioned about rural or urban residency, pets owned, contact with cats and whether their cats used a litter box in the house. Sera samples were tested at 1:128 dilution for toxoplasma antibodies using indirect fluorescent and hemagglutination techniques. None of the 60 non-contact individuals were seropositive. Of 60 contact subjects, 18.3% were identified as carrying antibodies. Other factors were not significant. Because only one veterinarian was seropositive, we propose that exposure to cats per se does not supply sufficient evidence upon which to expect a risk of toxoplasmosis infection. Direct or indirect association, personal hygiene, duration of exposure and the infectivity of the cats should be considered.


Short pregnancy interval, low birthweight, and the sudden infant death syndrome. Pregnancy intervals were calculated for 54,369 later-born singletons delivered during 1969 in the State of North Carolina. Subsequent infant deaths among this cohort were categorized into probable sudden infant death syndrome (SIDSp), other postneonatal home deaths, all postneonatal hospital deaths, all neonatal deaths, and all deaths due to congenital malformations. Each death was matched with a control drawn from the population of infants surviving the first year of life. The matching variables were maternal age, race, mother's education and number of previous live births. All categories of death showed higher proportions of short intervals among cases than controls. Comparing the interval distributions by means of the X2 test for linearity produced significant results for only SIDSp and neonatal deaths. It was concluded, however, that short-pregnancy interval probably has a similar effect on the risk of death from all five cause of death groups. The introduction of birthweight as a fifth matching variable left no significant differences in the distributions of pregnancy intervals between cases and controls. This was interpreted as evidence that short pregnancy interval exerts its influence on risk of death in infancy through its effect on birthweight. The estimated reduction in prematurity and infant mortality that might result from the elimination of short pregnancy intervals was 5% and 6%, respectively.


Common-source epidemic of hepatitis due to glazed and iced pastries. Sixty-one clinical cases of hepatitis occurred in Ogemaw County, Michigan, in late April and May 1968. The clustering of cases in time and the high attack rate for persons 10-19 years of age suggested a common source of exposure. Investigation implicated a local bakery, where one of the employees directly involved in the baking had had an icteric illness one month before the outbreak. Comparison of exposure histories of patients versus healthy family members established pastries covered with glaze or icing as the vehicle of infection. The glaze and icing were applied to the pastries after all baking had been completed. During the epidemic, immune serum globulin was given on a community-wide basis. No secondary cases of hepatitis were identified.


Bubonic plague from exposure to a rabbit: a documented case, and a review of rabbit-associated plague cases in the United States. A 62-year-old woman developed bubonic plague with an epitrochlear bubo one to two days after skinning two cottontail rabbits. The implicated rabbits were later recovered from the patient's freezer, and Yersinia pestis was isolated from marrows of both rabbits. Although human plague cases in the United States have occasionally been traced to exposure to wild rabbits, this is the first documentation of plague infection in the actual rabbits to which the patient was exposed. All reported cases of rabbit-associated plague in the United States were then reviewed. Eight cases were characterized by direct exposure to rabbit tissues. Seven of the eight cases occurred in adult males who had hunted rabbits during winter months in plague-endemic areas. These patients had upper extremity buboes, and the case-fatality ration for the group was 50%. Three other cases in which rabbit exposure was indirect or its role less clear, were also analyzed.


Spontaneous hematologic remission in agnogenic myeloid metaplasia. A 60 year old man had well documented agnogenic myeloid metaplasia with pancytopenia. Frequent red cell transfusions were required for two and a half years. Androgen therapy was not beneficial and was discontinued 26 months before a spontaneous hematologic remission occurred. The remission was documented by bone marrow biopsy and reticuloendothelial scanning of the marrow. Hepatosplenomegaly, poikilocytosis and expansion of the marrow space have persisted despite hematologic remission.


Nonmalignant monoclonal immunoglobulinemia, pernicious anemia and gastric carcinoma. A model of immunologic dysfunction. Report of two cases and review of the literature. The association of an autoimmune disease with a monoclonal immunoglobulin is not exceptional and most probably results from a dysfunction of the immunologic apparatus. This study describes two patients with monoclonal immunoglobulin A (IgA) and M (IgM) gammopathy, respectively, in whom pernicious anemia and finally gastric carcinoma developed. One patient had autoantibodies to gastric parietal cell and to thyroid microsomal antigen which could not be identified with the M-component. This observation, together with the fact that pernicious anemia occurred in one case before and in the other case after the discovery of M-component, suggests that different clones of cells were responsible for both disorders. Sixteen cases in which the patients had the same association have been collected from the literature and the data are compared with ours.


Unilateral renal vein thrombosis and nephrotic syndrome. Report of a case with protein selectivity and antithrombin III clearance studies. A case of the nephrotic syndrome with unilateral renal vein thrombosis is reported. The patient, an 18 year old man, presented with a six month history of edema and the recent development of a left-sided varicocele. An enlarged left kidney and a thrombus in the left renal vein were demonstrated roentgenographically. A biopsy specimen of the right kidney was interpreted as membranous glomerulonephritis. Selective renal function studies showed nearly identical creatinine excretion, and similar total protein excretion and protein selectivity from each kidney. Thus, the thrombus in the left renal vein did not influence glomerular filtration rate or quantitative or qualitative protein excretion. A high urinary output and a decreased serum level of antithrombin III were measured. These findings suggest a mechanism to explain the increased thrombotic tendency seen in this and other patients with the nephrotic syndrome.


Malignant lymphoma with "myeloma kidney" acute renal failure. The first cases of malignant lymphoma with a "myeloma kidney" type of acute renal failure are presented. With appropriate therapy, both patients regained partial renal function; the first after three months of dialysis. It is suggested that the term paraproteinemic nephropathy is preferable to "myeloma kidney."


Thrombotic thrombocytopenic purpura in a previously splenectomized patient. Idiopathic thrombocytopenic purpura was diagnosed in a 26 year old man who had rectal bleeding and marked thrombocytopenia (10,000 platelets/mm3). Complete recovery followed treatment with steroids and splenectomy. There was no clinical, laboratory or histopathologic evidence of thrombotic thrombocytopenic purpura. Several months later typical thrombotic thrombocytopenic purpura developed; recovery followed treatment with steroids, aspirin and dipyridamole. The presence of Howell-Jolly bodies and a negative scan indicated that an accessory spleen was not present. Since thrombotic thrombocytopenic purpura developed in the absence of a spleen in this case, it may be that in some, if not all, instances of thrombotic thrombocytopenic purpura the spleen is not importantly related to the pathogenesis of thrombotic thrombocytopenic purpura; this is in contrast to the situation in idiopathic thrombocytopenic purpura. Benefits attributed to splenectomy in thrombotic thrombocytopenic purpura, therefore, may in fact be due to the platelet inhibitory properties of common anesthetic agents, or to some other factor in the surgical procedure rather than to removal of the spleen per se.


Pericardial fluid analysis in scleroderma (systemic sclerosis). A patient with scleroderma who presented with pericarditis and effusion is described. Aspirates from this pericardial effusion had the characteristics of an exudate with no evidence of autoantibodies, immune complexes or complement depletion. These findings suggest that the mechanisms operating in the production of pericardial effusion in scleroderma may be different from those found in rheumatoid arthritis and systemic lupus erythematosus.


Is there a discipline of community medicine? Community Medicine is a distinct and definable discipline. Through Community Medicine Departments of medical schools and hospitals, patient care, teaching and research programs are conducted in an integrated fashion, concerned with a broad definition of health which is beyond the range of other clinical departments. Because Community Medicine is a developing field, and Departments of Community Medicine are not rigidly tied to traditional approaches, there exist unusual opportunities for new design and fresh insight. Community Medicine is in the fore of Medicine's ability to evolve with the society around us. Community Medicine both identifies the need for change, and acts as an agent for the change. There are obstacles. The most difficult challenges we face are obtaining curriculum time for a new discipline which, to those caught in "the vice-like irrational grip of tradition" (18), may not appear worthy; and ridding ourselves of the sterotype that the hospital can be the single unified source of health care for all community people. These problems are being resolved, however, and the inherent value of community medicine as a new body of theory and practice becomes increasingly clear.


Methyldopa Hepatitis. A report of six cases and review of the literature. Six cases of methyldopa hepatitis, including two in which the patients died are reported; and 77 cases from the literature are reviewed. Patients in whom severe hepatotoxic reactions to methyldopa develop usually complain of prodromal symptoms typical of hepatitis, often with fever, one to four weeks after therapy is initiated. Jaundice, when it occurs, is usually manifest within three months. Asymptomatic, transient elevations of serum transaminase levels may occur in patients receiving methyldopa. However, since the clinical and histologic features of hepatic injury from methyldopa are indistinguishable from viral hepatitis, it is suggested that the incidence of this iatrogenic disease is higher than generally appreciated. Serum transaminase levels should be determined at the initiation of therapy with methyldopa and four weeks later. Moreover, any patient who has unexplained fever or the prodromal symptoms of hepatitis should undergo liver chemistry studies immediately.


Comparative effects of morphine, meperidine and pentazocine on cardiocirculatory dynamics in patients with acute myocardial infarction. The cardiocirculatory effects of the commonly used parenteral analgesics, morphine sulfate 15 mg, meperidine hydrochloride 100 mg and pentazocine 60 mg, each administered intravenously, were compared in 12 patients with acute myocardial infarction during cardiac catheterization and by echocardiogram. No untoward hemodynamic effects occurred following the administration of morphine or meperidine. In contrast, pentazocine produced significant (p less than 0.01 to less than 0.05) increases in systemic and pulmonary arterial pressures, left ventricular filling pressure, systemic vascular resistance, and systolic and diastolic dimensions; and decreases in left ventricular ejection fraction and mean velocity of circumferential fiber shortening. These deleterious actions of pentazocine appeared due to peripheral vasoconstriction and negative inotropic properties. Further, pentazocine-induced increases in left ventricular preload and afterload increased myocardial oxygen demands. Since this study demonstrates that pentazocine is hazardous in myocardial infarction, morphine and meperidine are the preferred analgesics in this condition.


Atrial tachyarrhythmias in acute myocardial infarction. Causative factors, clinical consequences and treatment of atrial tachyarrhythmias were reviewed in 917 monitored patients with definite acute myocardial infarction. Significant atrial tachyarrhythmias were found in 104 (11 per cent) of them and included atrial fibrillation in 67, atrial flutter in 29 and paroxysmal atrial tachycardia in 33. These episodes were single in 79 patients and multiple in 25, and began within the first four days of acute myocardial infarction in 90 per cent of the patients. Fifty per cent of these atrial tachyarrhythmias were heralded by premature atrial contractions. The incidence of atrial tachyarrhythmia was not related to the location of the acute myocardial infarction or to the presence or degree of power failure; however, atrial tachyarrhythmias were significantly more frequent in patients with pericarditis. Atrial tachyarrhythmias were well tolerated in almost one fifth of the patients, caused marginal compromise in almost two thirds and led to severe clinical deterioration in one fifth. Paroxysmal atrial tachycardia rarely required specific treatment, atrial fibrillation was best managed with intravenous administration of digoxin except when associated with severe clinical compromise, and atrial flutter generally required cardioversion or rapid intravenous therapy and usually caused severe clinical deterioration. Over-all, atrial tachyarrhythmia was not associated with a significantly increased mortality, and in those who died, death was not related specifically to the atrial tachyarrhythmia but rather to the severity of the underlying acute myocardial infarction. However, persisting atrial tachyarrhythmias, particularly atrial flutter which tends to be refractory to both heart rate control and cardioversion, may contribute indirectly to morbidity and mortality.


Life-threatening arrhythmias in the mitral valve prolapse syndrome. This study describes seven patients with the mitral valve prolapse or click-murmur syndrome who have survived one or more episodes of life-threatening ventricular arrhythmias. These arrhythmias include cardiac arrest due to ventricular fibrillation, recurrent ventricular tachycardia causing syncope or sustained ventricular tachycardia requiring electroversion. These patients were seen over a two-year period in a single medical center. Five of the seven had repolarization abnormalities in the resting electrocardiogram. Premature ventricular contractions were present in the routine resting electrocardiograms of six of the seven patients and were frequent during treadmill testing and ambulatory electrocardiographic monitoring in all six tested. There were electrolyte abnormalities or changes in medications known to affect myocardial repolarization during the week before the episode in three of the four patients with cardiac arrest. The diagnosis of mitral valve prolapse click-murmur syndrome was made prior to the episode of life-threatening arrhythmia in only two of the seven patients. Varying forms of antiarrhythmic therapy were given to these patients during follow-up periods of five to 26 months. Although the incidence of fatal arrhythmias in the mitral prolapse syndrome is probably small, we suggest that such arrhythmias may not be extremely rare, particularly among those patients who have repolarization abnormalities in the resting electrocardiogram and frequent premature beats. Patients with unexplained ventricular arrhythmias should be screened for mitral valve prolapse.


Evaluation of left ventricular function in patients with sickle cell anemia. The echocardiographic measurements of cardiac chamber dimension, ejection phase indices of left ventricular function and the systolic time intervals of 23 adult patients with sickle cell anemia were compared to those of normal control subjects. Patients with sickle cell anemia had a significantly greater mean left ventricular systolic dimension index, left ventricular diastolic dimension index, left ventricular mass, stroke volume index, interventricular septal width, aortic root index and left atrial index. No significant differences were noted between the mean velocity of circumferential fiber shortening, ejection fraction or systolic time intervals. The anemic population was divided into two groups; one consisting of patients less than 30 years old and the other of patients over 30 years old. There was no significant differences between the ventricular dimensions, velocity of circumferential fiber shortening, ejection fraction and systolic time intervals of the two groups. These data indicate that the chronic volume overload of sickle cell anemia is well tolerated without development of left ventricular dysfunction.


Renal transport of urate during diuretic-induced hypouricemia. The effect of two weeks administration of a uricosuric diuretic (SKF-62698) on renal urate handling has been examined in 11 normal men. Plasma urate concentrations had declined by more than 60 per cent after two weeks. Urate excretion per unit of glomerular filtration rate and urate clearance (Curate) per unit of glomerular filtration rate were increased after the administration of SKF-62698. The importance of intact tubular secretion of urate in producing these changes was assessed by administering pyrazinamide, an agent that curtails urate secretion, to each participant. The decrements in urate excretion and clearance produced by pyrazinamide both increased significantly, whereas the residual urate excretion rates and clearances not suppressible by pyrazinamide were only minimally altered by SKF-62698 treatment. These results suggest that the excretion of secreted urate was enhanced by prolonged administration of SKF-62698, probably secondary to the inhibition of postsecretory urate reabsorption. In addition, because the nonsuppressible urate excretion did not decline despite a 63 per cent reduction in the plasma urate, it is likely that the reabsorption of filtered urate also was impaired by SKF-62698.


Mitral valve prolapse. Recent concepts and observations. The conditions associated with prolapse of the posterior leaflet of the mitral valve are multiple. The mechanisms of mitral valve prolapse as well as the pathogenesis of pain and ectopic impulse formation are reviewed. Propranolol appears to be the drug of choice for the symptomatic treatment of patients with this syndrome since it decreases myocardial oxygen demand and wall tension thus reducing or abolishing the discrepancy between myocardial oxygen demand and supply within the mitral apparatus. It has also been reported to modify the auscultatory findings associated with this condition. The frequency of this mitral valve abnormality in patients with obstructive coronary artery disease is reviewed. It appears that prolapse of the posterior leaflet scallops in patients with significant obstructive coronary artery disease represents an intermediate stage before mitral insufficiency occurs. This group of patients with papillary muscle dysfunction includes those with prolapsed leaflets without mitral insufficiency, those with systolic murmurs and compensated heart failure and others with progressive cardiac decompensation and severe mitral regurgitation.


Bartter's syndrome. Study of a 52 year old man with evidence for a defect in proximal tubular sodium reabsorption and comments on therapy. A patient with Bartter's syndrome in whom the disease was recognized at 52 years of age is described. Studies of his renal function suggest that the basic pathophysiologic defect was an abnormality in proximal tubular sodium reabsorption which led to extracellular fluid volume depletion and consequent stimulation of the renin-angiotensin-aldosterone axis. After comparing the physiologic studies in this patient with those in other reported cases, we postulate that Bartter's syndrome may represent the end result of different pathophysiologic processes which share in common juxtaglomerular hyperplasia, increased renin release and secondary hyperaldosteronism. Therapy with B-adrenergic blocking agents produced adverse effects, but the patient responded well to more conventional measures.


Hypercalcemia of acute renal failure. Clinical significance and pathogenesis. Hypocalcemia is a frequent accompaniment of acute renal failure, but paradoxically hypercalcemia also has been described in association with acute renal failure. In this paper we describe two patients who provide some insights into both the potential clinical importance and mechanism of the hypercalcemia associated with acute renal failure. The clinical significance is emphasized by the presence of diffuse metastatic calcification observed at postmortem examination in one patient. In both patients the increase in serum calcium concentration was not coincident with a decrease in serum phosphorus concentration; when measured in one patient, serum levels of parathyroid hormone were undetectable. These findings, along with the consistent association with rhabdomyolosis, support the proposal that the hypercalcemia of acute renal failure is caused by dissolution of dystrophic calcifications in traumatized muscle and may lead to severe metastatic calcifications.


Primary empty sella syndrome with visual field defects. A patient with an enlarged, asymmetric sella turcica and visual field defects suggestive of a pituitary or parasellar tumor underwent extensive roentgenographic and pituitary function studies. No abnormalities in pituitary luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, ACTH, prolactin or vasopressin secretion were detected. Growth hormone secretion was provoked by arginine infusion but not by hypoglycemia. Pneumoencephalography revealed air in the sella turcica, and no evidence of tumor. Thus, an enlarged sella turcica in a patient with visual field defects but normal pituitary function may suggest the presence of an "empty sella syndrome."


The syndrome of multiple endocrine gland insufficiency. Addison's disease, when caused by idiopathic atrophy of the adrenal cortex, is frequently associated with other endocrine abnormalities. Primary hypothyroidism and hypogonadism have been reported in association with adrenal insufficiency; understandably, such cases may lead to diagnostic confusion with respect to possible pituitary disease. This case study concerns a woman who exhibited, in sequence and over a period of 17 years, hypogonadism, hypoadrenalism, diabetes mellitus and, finally, hypothyroidism. Originally misdiagnosed as having Sheehan's syndrome, she eventually became hyperpigmented. The true nature of her illness was then revealed to be primary insufficiency of multiple endocrine glands, with the demonstration of elevated levels of several pituitary hormones. Because multiple endocrine insufficiencies may coexist or develop with time, we suggest that a patient with a single documented endocrine deficiency be investigated initially and serially for additional glandular deficiencies.


Ectopic hyperparathyroidism (pseudohyperparathyroidism) in esophageal malignancy. Report of a case and a review of the literature. Described here is a patient with esophageal carcinoma who had hypercalcemia, an elevated serum level of parathyroid hormone and normal parathyroid glands. A review of the literature reveals that a total of 25 other patients with ectopic hyperparathyroidism in esophageal malignancy have been described, four of whom had documented elevations of serum parathyroid hormone levels. Esophageal neoplasms should be added to the list of tumors associated with ectopic secretion of parathyroid hormone.


Primary hyperparathyroidism and breast cancer. Three cases demonstrating the coexistence of primary hyperparathyroidism and breast carcinoma with the disappearance of hypercalcemia following removal of parathyroid adenomas are presented. In these cases, the patients had the typical diagnostic findings of primary hyperparathyroidism. Reluctance to perform neck explorations in such patients does not appear warranted.


Fever with dissecting aneurysm of the aorta. Following acute aortic dissection, it two of the four cases we describe the patients experienced a prolonged febrile syndrome which spontaneously resolved five and 11 weeks later. Because of fever and a murmur of aortic regurgitation, the two other patients with aortic dissection were initially treated for acute bacterial endocarditis. These four cases serve to re-emphasize fever as an important clinical manifestation of dissecting aneurysm of the aorta.


Felty's syndrome. Effect of lithium on granulopoiesis. The effect of lithium carbonate upon granulopoiesis was studied in eight patients with Felty's syndrome. Absolute granulocyte counts increased in all patients receiving 900 mg lithium carbonate daily for six weeks. Increased urinary and serum granulocyte colony-stimulating activity was observed in all patients during lithium therapy. A casual relationship between increases in colony-stimulating activity and increased granulocytes is postulated.


The gamut of paracoccidioidomycosis.

The gamut of paracoccidioidomycosis. Paracoccidioidomycosis is a systemic mycosis of importance in Latin America. Because of its polymorphic manifestations, it is not always suspected and patients are sometimes misdiagnosed. Case histories of patients with paracoccidioidomycosis are presented in order to illustrate its various manifestations, with emphasis on the primary pulmonary localization.


Low dose radioiodide thyroid ablation in postsurgical patients with thyroid cancer. Sixty-four patients with well-differentiated carcinoma of the thyroid were treated with initial high (80 to 100 mCi) or low (less than 30 mCi) doses of I131 after bilateral subtotal thyroidectomy. A total of 36 patients in the various histologic categories were initially treated with the low dose of I131 (group 1), and a total of 28 patients were treated with the higher dose (group 2). Disease-free criteria were no visible tissue in the neck or body, a protein-bound radioactive iodine (PBI131) of less than 0.005 per cent per liter at seven days and/or whole body retention of less than 3 per cent at seven days. Of the patients receiving less than 30 mCi (group 1), 56 per cent with papillary carcinoma, 67 per cent with follicular carcinoma and 56 per cent with mixed carcinoma of the thyroid were rendered disease-free after this initial dose. Of the patients receiving the higher dose of I131 (group 2), 67 per cent with papillary carcinoma, 50 per cent with follicular carcinoma and 67 per cent with mixed carcinoma of the thyroid were rendered disease-free after this initial dose. Disease-free mean follow-up time was 5.17 years (group 1) and 5.82 years (group 2). There was no statistical difference in these mean follow-up times, nor was there a statistical difference in the net (total minus initial) dose of I131 needed to render the patient disease-free. These data demonstrate that low dose I131 therapy is as effective as the larger more routine doses of I131 given in this disease.


Body composition and skeletal metabolism following pituitary irradiation in acromegaly. The change in body composition in acromegaly that resulted from pituitary irradiation was examined using the technic of total body neutron activation analysis. Before treatment, increased ratios of total body P:Ca, P:K and Na:K were noted. After pituitary irradiation, the total body levels of P, Na and K were reduced in a proportion that indicated restoration of body composition towards normal. Skeletal mass (total body calcium) decreased into the range observed in osteoporosis in several patients. Trabecular bone mass, as reflected by the Singh Index, was consistently reduced, and two patients had vertebral compression fractures. Local bone mass as determined by photon absorptiometry was reduced when the values were normalized for age, sex and body size. It is postulated that in untreated acromegaly there is differential bone remodelling with an increase in cortical bone accompanied by a reduced trabecular bone mass. When reduction of hGH levels is accomplished with treatment, cortical apposition may decrease. Since the increased cortical bone mass probably aids in preventing vertebral compression fractures, the treated acromegalic patient may incur an increased risk of fractures. This risk may be increased further by the hypogonadism which may arise secondary to pituitary irradiation or surgery. It would be prudent to ensure that the hypogonadal acromegalic patient receives an adequate calcium intake and sex hormone replacement therapy.


The investigation and treatment of renal bone disease. Neutron activation analysis of a hand has been used to monitor changes in skeletal calcium content of patients undergoing maintenance hemodialysis. Assessed by this technic supplementary magnesium therapy was of value of reducing the progressive losses of skeletal calcium in a proportion of the patients receiving maintenance hemodialysis. Oral calcium supplements produced a decrease in the skeletal calcium losses of all the patients studied. 1-alpha-hydroxycholecalciferol, a potent vitamin D analogue, caused a significant increase in the calcium content of bone in three patients receiving maintenance hemodialysis; it may prove to be a safe and effective form of therapy for azotemic osteodystrophy.


Effects of an inhaled bronchodilator on gas distribution and over-all ventilatory efficiency in patients with chronic obstructive pulmonary disease. The effects of an inhaled bronchodilator on the distribution of inspired gas and over-all efficiency of ventilation were studied by the nitrogen washout technic in 16 patients with chronic obstructive pulmonary disease; three normal subjects and two patients with asymptomatic asthma (and normal spirometric values) were also studied. In normal and asthmatic subjects and in patients with chronic obstructive pulmonary disease and mild to moderate functional impairment, the nitrogen clearance did not vary significantly or showed changes suggesting less uniform gas distribution and reduced ventilatory efficiency. In most patients with advanced chronic obstructive pulmonary disease, the bronchodilator caused changes suggesting more uniform distribution of inspired gas and increased efficiency of ventilation. Multiple regression analysis showed that the behavior of the nitrogen clearance after treatment was also related to the response of the anatomic dead space. The effects of the bronchodilator varied with time. The results are consistent with the assumption that the changes in nitrogen clearance after bronchodilator therapy reflect the concourse of multiple factors, which may be expected to have favorable or unfavorable effects on the distribution of inspired gas and the efficiency of ventilation.


A computerized data management system for the clinical laboratory. This report describes the computerized clinical laboratory data management system developed at the University of Alabama Hospitals Clinical Laboratory. The system uses the computer's data management capabilities to assist the laboratory in handling patient and laboratory data associated with the total processing of laboratory requisitions from their receipt to the production of a patient's cumulative test results. It supports all sections of the laboratory including the blood bank. It primary objectives are to reduce the clereical workload, reduce errors, decrease turn-around-time, and produce a patient's cumulative summary test results.


Clinical toxicity of reserpine in hospitalized patients: a report from the Boston Collaborative Drug Surveillance Program. Adverse reactions to reserpine were studied in 231 hospitalized medical patients who received the drug. Reserpine was administered specifically for hypertension in 91.3 percent of patients; 35.5 per cent of patients received the drug by intramuscular (IM) injection. The IM route of administration was associated with higher mean daily doses (1.28 +/- 0.14 mg/day) than was oral administration (0.37 +/- 0.02 mg/day). Adverse reactions to reserpine were reported in 26 patients (11.3 per cent), but only three of these reactions were considered life-threatening and no deaths were attributed to the drug. Central nervous system (CNS) disturbances, reported in 12 patients, were the most common unwanted effects. Gastrointestinal disturbances were reported in six patients, and hypotension in six. Toxicity occurred more frequently in those who received IM, and therefore high-dose, reserpine. Adverse reactions also were more common in patients who had not received rauwolfia derivatives prior to admission; however, this group of patients also received IM reserpine more frequently. Finally, reserpine toxicity, in particular central nervous system (CNS) disturbances, was reported more frequently in patients also receiving barbiturates, suggesting additive CNS effects.


The effects of excision of left ventricular scars on the electrocardiogram. The effects of resection of post-ischemic ventricular scars on the electrocardiogram have been studied in 29 patients. No change occurred in atrial rhythm, P wave morphology, and A-V conduction. Fascicular blocks developed postoperatively in five patients. These were attributed to surgical trauma. Changes in mean frontal plane QRS axis were noted in 25 of 29 patients. There was no correlation between postoperative shifts in QRS axis and preoperative QRS axis, calculated scar size, or ventricular end-diastolic volume. No significant postoperative change was observed in Q waves or S-T segment deviation. It is concluded that electrocardiographic changes following scar resection occur randomly in a minority of patients. The presence of several unquantified factors makes it difficult to evaluate the post-resection electrocardiogram.


Assessment of intrauterine growth retardation by diagnostic ultrasound. In the first 1,000 cases referred to the Department of Diagnostic Ultrasound for Obstetrics and Gynaecology, 200 patients with singleton pregnancies were examined by this modality for possible intrauterine growth retardation (IUGR). Inclusion in this study was based on one or more of the following criteria: past history of IUGR, present clinical impression of IUGR, present high risk of developing IUGR, and unsuspected IUGR evidenced by diagnostic ultrasound. In 34 per cent of cases, serial examinations indicated that the date of confinement had to be recalculated. Ultrasound was in agreement with delivery results in 82 per cent of cases. Sixteen per cent of cases in this study resulted in growth-retarded infants. Ultrasound correctly diagnosed 70 per cent of these.


Acute renal failure: a study of the course and prognosis of 104 patients and of the role of furosemide. The course and outcome of 104 patients with acute renal failure were studied. Nephrotoxic drugs emerged as the second commonest cause of this disease. Overall mortality was 57 per cent; surgery, age, and sex had no significant effect on it. The mortality in the group caused by nephrotoxic drugs (36 per cent) was significantly lower than that in the groups caused by hypovolemic shock (64 per cent), cardiogenic shock (77 per cent) or arrhythmia (80 per cent). Oliguria was not observed in 25 per cent of patients; in this group mortality was lower (38 per cent) than in the oliguric group (62 per cent). The development of congestive heart failure and ascites adversely affected the outcome. Furosemide administration resulted in a sustained diuresis in 22 per cent, and transient diuresis in 14 per cent of patients. Except for a significant reduction in the need for dialysis, furosemide had no other salutary effect.


The value of prophylactic antibiotics after vaginal hysterectomy. Prophylactic antibiotics were given postoperatively to a consecutive series of 74 patients who underwent vaginal hysterectomy. Antibiotics were administered in the immediate postoperative period. There was a highly significant decrease in febrile morbidity in the treated group compared to 190 control subjects having similar surgery but treated with antibiotics only on the appearance of fever and/or other signs of infection. There was a failure to relate the increased febrile morbidity in the control group to patient's age, menopausal state, type of catheterization, or to the type of operative procedure. The increased morbidity in the control group related only to the failure to use prophylactic antibiotics. The antibiotic-treated portion (58 per cent) of the control group had a longer period of hospitalization.


Hospital-associated bacterial meningitis. Eighteen of 349 cases (5.2 per cent) of bacterial meningitis seen between 1949 and 1973 were hospital-associated (developed after admission to the hospital). The patients were adults, usually males, and developed symptoms and signs of meningitis from 2 to 23 days (mean, 10.1 days) after hospital admission. The diagnosis of bacterial meningitis was made from less than 1 day to 15 days (mean, 4.8 days) after the onset of symptoms. Fourteen of the 18 patients had received antibiotics during the week prior to developing meningitis. Nine (50 per cent) had a chronic, noninfection, underlying illness. Diagnostic or surgical procedures involving the neuraxis or adjacent structures preceded the development of meningitis in 10 of the 18 patients (56 per cent). Only 6 of the 18 patients survived their infection. Prompt recognition, diagnosis, and therapy of hospital-associated meningitis in high-risk patients may reduce the significant mortality.


Baseline fetal heart rate characteristics as an indicator of fetal status during the antepartum period. A retrospective study was designed to determine whether the baseline fetal heart rate (FHR), recorded before oxytocin infusion, would have any correlation with the outcome of the oxytocin challenge test (OCT).


Maternal, fetal, and intra-amniotic hormonal and biologic changes resulting from a single dose of hydrocortisone injected in the intra-amniotic compartment. A single intra-amniotic injection of 500 mg. of hydrocortisone sodium succinate was done 48 hours before elective cesarean section in nine patients in week 39 of gestation. Following that single injection, estriol values fell in all three compartments. Cortisol was rapidly increased in the maternal compartment but returned to normal levels at the time of cesarean section in maternal and umbilical vein cord plasma while remaining elevated in the amniotic compartment. Progesterone was increased in the fetal and amniotic compartments but remained essentially unchanged in the maternal compartment. The foam test was constantly improved in the direction of an intermediary or positive test and the quantitative lecithin-sphingomyelin values were increased by almost twofold. In our series, none of our babies developed a respiratory distress syndrome nor had any difficulty with the first breath or the Apgar score. We did not deliver any low-birth-weight infants and the creatinine values were even improved by our injection.


How prevalence of hypertension varies as diagnostic criteria change. In a effort to determine what impact diagnostic criteria might have in defining the magnitude of the "hypertensive" population, various definitions of high blood pressure were applied to the same population. At the initial encounter, 23.3 per cent of the subjects had blood pressures greater than or equal to 160/95 mm Hg, but less than half of these sustained that level on two subsequent occasions over the next three weeks. When an initial diastolic blood pressure of greater than or equal to 105 mm Hg was used to define hypertension, prevalence fell by more than two thirds (23.3 to 7.2 per cent). These results clearly demonstrate that even a very simple modification of diagnostic criteria can markedly alter the prevalence of "hypertension."


Uterine blood flow, oxygen consumption, and maternal plasma estradiol and progestins following fetal death. Fetuses of 42 near-term sheep were killed while they were in utero. Uterine blood flow, oxygen consumption, A-V O2, and maternal arterial plasma concentrations of estradiol and progestins were observed for the next 4 hours. There was an immediate (88 per cent) fall in oxygen consumption; blood flow decreased by 50 per cent within 30 minutes. Hormone concentrations changed, but only after 2 hours. Circulatory changes appeared to be related to local changes within the uterus, particularly to decomposition of the chorioallantoic membrane. This relationship was best seen in the experiments in which one of a set of twins was killed. The experiments are in accord with the theory that the rate of uterine blood is not directly related to acute changes in respiratory gases nor to plasma concentrations of certain hormones.


Hyperuricemia in pre-eclampsia. A reappraisal. Seventeen pre-eclamptic (PE), 22 hypertensive (H), and 13 normal pregnant women (C), all in the third trimester, were studied to examine the relationship of blood lactate (L) to the hyperuricemia characteristic of PE. The parameters measured were: serum and urinary uric acid, and creatinine, and lactate (L), and pyruvate (P) in the blood. Uric acid clearance (Cur), and creatinine clearance (Ccr), and fractional uric acid clearance (Fract. Cur) as well as L/P ratios were calculated. Some of the patients, from the three groups, were infused with approximately equal to 100 mEq. of sodium lactate during the course of 50 minutes. "Preinfusion," "midinfusion," and "postinfusion," determinations were compared, as well as the per cent change in the different parameters as the result of the infusion and after its discontinuation. The results showed that serum urine acid is elevated, and Cur is impaired in PE; however, L was lower in PE than in control subjects. There was no correlation between L or L/P and Cur. Lactate infusion caused comparable impairment of Cur in all groups. There was no significant difference in the response of the parameters studied, to the infusion, between the different groups. Our data cast serious doubts on the postulated role of blood lactate in the etiology of hyperuricemia in PE. Contracted plasma volume and/or local release of angiotensin II in the kidney of pre-eclamptic patients probably play a more important role.


Induction of labor with intravenous prostaglandin. The present study utilizing an open label design evaluates the efficacy of prostaglandin F2alpha in the induction of labor in normal and complicated primigravid and multigravid pregnancies and in particular in patients with an unripe cervix. The results reveal that labor was successfully induced in 33 of 38 (86.8 per cent) normal patients in the 0 to 5 Bishop group and in 17 of 18 (94.4 per cent) in the 6 to 13 Bishop group. In the complicated pregnancies (abnormal group) 26 to 28 (84 per cent) in the 0 to 5 Bishop group and 13 of 13 (100 per cent) in the 6 to 13 Bishop group were successfully induced. There were two cesarean sections for obstetric indications. Hypertonus occurred only four times and responded to dose reduction. The most common problem--nausea and vomiting (29 per cent)--was easily controlled. Prostaglandin when judiciously used appears to be a safe drug for the induction of labor at term in normal as well as complicated pregnancies and in patients with low inducibility scores.


Red cell hypoplasia and monoclonal gammopathy in a patient with lymphoproliferative disorder. A 69-year-old male was observed to have red cell hypoplasia. Two years later monoclonal gammopathy IgG-I, K, Gma+ and InV (1-) was documented in this patient. Persistent lymphocytosis, abnormal response to phytohemagglutinin, and at autopsy multiple lymphoid nodules occurring in the bone marrow, suggestive of lymphoproliferative disorder, were observed. A review of the literature indicates that this clinical presentation is rare. The possibility that red cell aplasia may be associated with lymphoproliferative disorder in some instances must be considered inasmuch as this may have an important bearing in the management of such patients.


The mechanical properties of prematurely and non--prematurely ruptured membranes. Methods and preliminary results. The mechanical properties of the chorioamniotic membranes have been studied by several investigators over the past 100 years. No relationship between membrane strength, as measured by rupture tension, and premature or non-premature rupture of the membranes has been demonstrable. In the present study, several measures of the mechanical properties of the chorioamniotic membranes were examined. These included thickness, rupture tension, work to rupture, strain to rupture, and moduli of elasticity (Young). Prematurely and non-prematurely ruptured membranes differed with respect to thickness near the rupture site and Young's modulus near the placenta. Differences between the groups for the other parameters were not significant. This study suggests that there may be inherent differences between membranes which rupture prematurely and those which do not.


Automatic balance for fetal weight studies. An automatic balance was constructed of aluminum sheet, miniature ball bearings, and a strain gauge. The balance was capable of measuring 1 to 4 kg. with an accuracy of +/- 0.5 Gm. and a 95 per cent response time of less than 0.3 seconds. Fetuses of term ewes were exteriorized and weighed continuously for up to 3 hours. Rapid depletion of the ewe's blood volume led to a 10 to 24 per cent increase in estimated fetal blood volume. Fetal weight loss occurred regularly during reversible occlusion of the umbilical veins.


Post--paracervical block bradycardia: its prediction and preventability. The fetal heart rate recordings of 100 parturients given PCB with less than 200 mg. of lidocaine were reviewed. No PCB bradycardia occurred if there were no pre-PCB FHR decelerations (92 per cent accuracy). In an effort to prevent post-PCB bradycardia, atropine was given in the maternal paracervical area and also intravenously. The most effective dose was 1.0 mg. intravenously, but the prophylactic efficiency of atropine was uncertain in preventing the post-PCB bradycardia.


The use of pr-reduced media and a portable jar for the collection of anaerobic organisms for clinical sites of infection. A system for the isolation of anaerobic organisms from clinical specimens was evaluated at the LAC-USC Medical Center. Clinicians were provided with a Gas Pak with a broth tube and two prereduced blood plates for direct inoculation of specimens. In the first 50 patients evaluated, 74 separate anaerobic isolates were recovered in 36 patients, 72 per cent of the total. Bacteroides fragilis was the most common organism recovered. The impact of this  system upon clinical management is discussed.


The influence of copper on the in vitro motility of the human Fallopian tube. Experiments were designed to examine whether one contraceptive action of the copper intrauterine contraceptive devices (Cu-IUD's) could be associated with an influence on the smooth muscle activity of the Fallopian tube. Sections of the isthmic portion of human oviducts were removed during operation. Preparations from the circular muscle layer were mounted for isometric recording of contractile activity. Subsequently, spontaneous rhythmic contractions appeared within one to five minutes after the preparation procedure was completed. Transmural nerve stimulation or addition of norepinephrine or prostaglandin F2alpha to the Tris buffer medium caused an increase in tone and frequency. Addition of CuCl2 caused a concentration-dependent increase in frequency and a concomitant decrease in amplitude. High concentrations of CuCl2 produced a marked initial increase in frequency, but the rhythmic activity was soon abolished. Metallic copper in the incubation medium caused the same qualitative effects on the smooth muscle preparation as CuCl2. Influences of copper on contractions of rat portal vein preparations were studied in the same way, and similar effects were found. The copper concentration of the secretion in the Fallopian tube was measured by atomic absorption in seven patients wearing CU-IUD's until operation. The levels found were of the same order of magnitude as the concentration of free copper ions which in vitro caused effects on the smooth muscle. It is concluded that copper can affect smooth muscle activity. An influence of copper on the motility of the human oviduct has to be considered as a possible factor contributing to the contraceptive action of the Cu-IUD.


Effect of clomiphene citrate upon amount and duration of human menopausal gonadotropin therapy. Human menopausal gonadotropin (HMG) was given to 10 patients who failed to ovulate after treatment with clomiphene citrate. Prior to one or more treatment courses, 200 mg. of clomiphene were administered daily for 5 days; at least one other treatment course was not preceded by clomiphene. Before therapy, progesterone in oil was administered and serum FSH, LH, and estrogen were measured. Those patients who had normal serum FSH levels and had withdrawal bleeding following progesterone had a reduction in amount and duration of HMG requirements for those patients with low serum FSH who did not withdraw. Thus, sequential clomiphene-HMG therapy is of benefit only for those women with normal serum FSH levels and is the treatment of choice.


Glucagon secretion in late pregnancy and the puerperium. Fasting plasma glucagon levels in late pregnancy were not significantly changed from those of nonpregnant matched control subjects, but at 6 to 8 weeks post partum a significant decrease in fasting glucagon levels was observed. Acute elevation of plasma glucose levels (via 25 Gm. intravenous glucose loading) induced a suppression of glucagon levels. This glucose-mediated glucagon suppression appeared to be less during late pregnancy which is probably related to the smaller increments of plasma glucose following intravenous loading in late pregnancy as compared to postpartum values.


Patterns of management with breech presentation. A review of 12 years' experience with term breech delivery at Overlake Memorial Hospital, Bellevue, Washington, was undertaken to ascertain patterns of care as practiced in a suburban community hospital setting. A total of 402 term breech deliveries were managed by 34 family practitioners and 21 obstetricians. X-ray pelvimetry was found to correlate with clinical pelvimetry in two thirds of the cases when used. There were 314 patients delivered vaginally and 88 by cesarean section (an over-all cesarean section rate of 21.9%). There was a striking increase to 43.9% during the last 2 years of the review. This review indicates increasing utilization of consultation with breech presentation, an increasing percentage managed by obstetricians, increasing use of x-ray pelvimetry, decreasing frequency of prolonged labor, a sharp increase in use of cesarean section, and a decline in perinatal morbidity.


The impact of mean arterial pressure in the middle trimester upon the outcome of pregnancy. Data on the outcome of pregnancy are based upon a prospective study of 14,833 single births to women whose blood pressures during the fifth and sixth months of gestation were recorded. With each 5 mm, Hg rise in the mean arterial pressure (MAP) there is a progressive increase in the perinatal mortality rate. At each MAP level, the stillbirth rates and neonatal mortality rates are higher in blacks than in whites. When middle-trimester MAP is 90 mm. Hg or more, there is a significant increase in (1) the stillbirth rate, (2) the frequency of proteinuria, hypertension, and diagnosed pre-eclampsia in the third trimester, and (3) the frequency of intrauterine fetal growth retardation. We believe that all of these events are due to an impaired uteroplacental circulation, with which elevated blood pressures are associated. Women who have an average MAP of 90 or more during the fifth and sixth months should be considered in a high-risk category.


Ectopic pregnancy associated with the intrauterine device: a study of seventy cases. Seventy cases of ectopic pregnancy associated with an IUD comprised 10% of all ectopics in a 9 year period. This increased to 15% in the last 19 months as more IUD's were in use. In two thirds of the ectopics the IUD had been in situ more than 1 year. Unusual bleeding and cramping attributed to the IUD obscured the diagnosis and resulted in removal or replacement of the IUD in over one half the cases 1 to 8 weeks before surgery. The episodic nature of the abdominal hemorrhage in two thirds of all ectopics resulted in surgery on day 44 average gestational age. The IUD is probably not causal in ectopic pregnancy but does not protect the predisposed patient from ectopic pregnancy which should be suspected in any patient with an IUD who has irregular bleeding and abdominal pain.


Pituitary tumors in patients with secondary amenorrhea. This study was undertaken to determine the prevalence of radiologically detectable pituitary tumors among patients seen initially in a gynecology clinic for a complaint of secondary amenorrhea. In a group of 144 women with secondary amenorrhea of more than 6 months' duration, 13 had radiologic abnormalities of the sella turcica detectable with standard skull films without tomography. These gynecologic patients composed more than half of the women in the reproductive age group who were diagnosed at this medical center as having a pituitary tumor. Only one patient with oligomenorrhea or secondary amenorrhea of less than 2 years' duration had a detectable tumor. Thus, for patients with short-term amenorrhea, the risk of having a pituitary tumor is small, especially in the absence of galactorrhea, headache, or changes in vision. However, 12 of 71 patients with amenorrhea longer than 2 years (17%) had detectable tumors and the risk appears to increase progressively with time. Assay of adrenal and thyroid hormones did not discriminate between patients with and without pituitary tumors. Early detection of these tumors is aided by serial sella x-rays, tomograms, prolactin assays, and newer pituitary function tests. Patients presenting with postpill amenorrhea and postpartum amenorrhea illustrate the hazard of interpreting a temporal relationship as a causal one.


Prolapse of the vaginal vault. Improved techniques for management of the abdominal approach or vaginal approach. A brief discussion of the history of techniques for the surgical management of prolapse of the vaginal vault is presented. The author's method for the abdominal procedure, sacral colpopexy, is presented together with a summary of twelve patients in whom it was used. The author's modification of the technique of the vaginal operation, "the anterior approach," is presented because it appears to make resection of the enterocele sac and identification of uterosacral ligaments easier and their utilization more effective.


Benign cervical and vaginal changes associated with exposure to stilbestrol in utero. Examinations of 320 young women allegedly exposed to stilbestrol in utero have revealed at least 12 unique and benign variations from normal anatomy, five in the cervix and seven in the vagina. Over two thirds of the patients revealed one or more of these variations. Some have been previously reported, others have not. None changed significantly or deleteriously during observation. All are described and a representative drawing of each is included. A classificational nomenclature is offered. It is felt that familiarity with these changes will allow presumptive identification by simple pelvic examination of at least two thirds of females exposed to stilbestrol in utero.


Stage I carcinoma of the uterine cervix in patients under 40 years of age. A retrospective analysis was made 94 patients, 39 years of age or younger, who were treated for Stage I carcinoma of the uterine cervix from 1942 through 1972 at the Los Angeles Tumor Institute and the Southern California Cancer Center. Comparisons were made between the frequency of Stage I and other stages of carcinoma of the uterine cervix, as well as the frequency of Stage I carcinoma in young and older individuals. Survival rates for the younger group were compared to those for the same stage of disease for all ages of patients. There is discussion of the treatment modalities used in light of recommendations for future plans of therapy for these young patients. Tumor recurrences are discussed, with special reference to 43 patients who survived over 10 years. Eight of these patients were found to show new or recurrent tumors after this period of time. The importance of careful, long-term follow-up and early secondary treatment for recurrent lesions is emphasized, since subsequent radical surgery may salvage a number of these individuals.


Changing trends in cesarean section.

Changing trends in cesarean section. There have been considerable changes in obstetric practice in the past 5 years, with corresponding changes in the application of ceasarean section to obstetric complications. In this paper, 4,003 cesarean sections done in a public hospital during four time periods dating back to 1948 are compared, and the changing applications of section are discussed. Breech presentation, fetal distress, and dystocia have contributed substantially to the increasing use of abdominal delivery.


Histopathologic evaluation of uteri curetted by flexible suction cannula. A prospective study was undertaken to evaluate the use of the flexible plastic cannula for obtaining endometrial specimens for diagnostic purposes. Suction curettage was performed immediately prehysterectomy, the specimens evaluated, and then compared to similar specimens obtained by a metal curette. Another group of patients had suction curettage performed as an office procedure 24 to 72 hours before hysterectomy. The results of our study confirm the adequacy of this method for obtaining endometrial samples.


Primary carcinoma of the Fallopian tube. A series of 26 unreported cases of primary carcinoma of the Fallopian tube is presented. These cases were collected from seven hospitals in Portland, Oregon, for a period of 10 years, i.e., from 1963 to 1974. No statistical data can be made except to state that seven patients of the 26 are known to be alive and well. Of these seven living patients, two have been followed for over 5 years and five have been followed for over 2 years. All are free of disease at the present time. Three other patients lived over 5 years but finally died of their disease. All of these patients were in the Stage I category except two who were in the Stage II category. This suggests that any breakthrough of the serosa of the Fallopian tube is an ominous sign with poor prognosis. The need for earlier diagnosis and supplementary therapy for Stage II of this disease is discussed.


Intra-amniotic administration of 15(S)-15-methyl-prostaglandin F2alpha for the induction of midtrimester abortion. To determine the practicability of administering 15(S)-15-methyl-prostaglandin F2alpha-tromethamine (15(S)-15-Me-PGF2alpha) intra-amniotically for the induction of midtrimester abortion, initially 2.5 mg. of 15(S)-15-Me-PGF2alpha was administered to 20 physically healthy gravid women, and was repeated after 24 hours in those patients who had not aborted. Within 24 hours, 65% aborted, and within 36 hours, 95% aborted. Although 67% experienced emesis, no serious complications occurred. This abortion rate is similar to that obtained with the recommended dose schedule of the dosage of prostaglandin F2alpha approved by the Food and Drug Administration and those reported with intra-amniotic administration of either hypertonic saline or urea when augmented with high, continuous, intravenous infusions of oxytocin. While the study intra-amniotic dose schedule appeared to be practicable, large, comparative studies will be necessary to determine the most satisfactory dose schedule and whether this method is more acceptable than other available methods.


Satisfaction with medical care during pregnancy and delivery. Societal attitudes toward the medical profession are apparently undergoing a change from awe and total respect to a more critical assessing of accountability and credibility. Based on mass media reports and the increasing number of malpractice suits, it would appear that a rational, unbiased review of medical doctors, hospital personnel, and care received is in order. This review should be concerned with technical aspects of medicine as determined by highly competent professionals and the consumer's view of the medical care he receives. The latter review should logically be taken directly to the consumers of medical care to determine their satisfaction with the care they received. Because of the varied areas of specialty within the medical profession, there are different types of relationships between doctors and their patients. The obstetrician, for instance, is usually associated with pregnancy as a joyful event, in contrast to a surgeon whose diagnosis may seldom be accompanied by joy. Satisfaction with medical care could thus be expected to vary according to the area of specialty and may be related to factors over which doctors have no control, factors which initially bring the patient to the doctor for care. The degree of anxiety related to the patient's condition could also be expected to contribute to the degree of satisfaction expressed by the patient.


Circulating maternal serum progesterone in high-risk pregnancies. Serum progesterone was measured by competitive protein-binding assay in 331 cases of normal pregnancy ranging from 6 to 42 weeks. Serial estimations of serum progesterone were performed in nine cases of severe hypertensive disorder of pregnancy, eight cases of twin pregnancy, three cases of twin pregnancy complicated by severe hypertensive disorder of pregnancy, three cases of triplet pregnancy, three cases of previous bad obstetric history, one case of anencephaly, and seven cases of intrauterine fetal death. Serum progesterone remained within normal range in severe hypertensive disorder of pregnancy and the levels were indistinguishable in cases of fetal growth retardation from those without growth retardation. In twin and triplet pregnancies, serum progesterone was within normal range or elevated and was usually higher than normal in twin pregnancies after weeks 33 to 34. Serum progesterone levels were normal in anencephalic pregnancy and in most cases of intrauterine fetal death. The findings are discussed with reference to placental hormonal activity. It is concluded that serum progesterone is a poor index of placental function.


The effect of epidural anesthesia on uterine activity and blood pressure. Because of the unresolved controversy regarding the effect of epidural anesthesia upon uterine contractility, it was decided to study its effect on a small number of patients. Intrauterine and intra-arterial continuous pressure, continuous fetal heart rate, and maternal heart rate recordings were obtained from at least 20 minutes before administration of the epidural anesthic until complete dilatation in these patients. Nineteen patients were in spontaneous labor, and 18 had labor stimulated with oxytocin. Plain lidocaine, 1 or 1.5%, was used in 12 patients (30 observations), and lidocaine with epinephrine, 1:200,000 was used in 26 patients (51 observations). Uterine contractions were calculated in Montevideo units for 60 minutes following the epidural anesthetic. The changes, if any, were compared in both groups. There was a significant decrease in uterine activity when epinephrine was added to the anesthetic solution, mainly a lessening of intensity. There were comparable decreases in systolic/diastolic blood pressure in both groups and compensatory tachycardia. In one case, severe hypertension was observed following administration of lidocaine epinephrine. It was concluded that the addition of epinephrine to the anesthetic solution predictably produces diminution of uterine activity, and it does not give "cardiovascular support" to the laboring patient.


Demonstration of gonadotropin during the second half of the cycle in women using intrauterine contraception. A highly sensitive pregnancy test based upon partial purification of urinary gonadotropins by Sephadex gel filtration and concentration of the gonadotropin-containing fraction by lyophilization has been developed. Values over 100 I.U. per liter after Day 22 are considered to indicate conception. They are verified by radioimmunoassay (RIA) of the beta-subunit of human chorionic gonadotropin (HCG) in plasma. Urine samples from users of intrauterine contraception were examined at random. Among samples collected after Day 21, 14 contained more than 100 I.U. per liter. In three of these cases, RIA of the beta-subunit HCG in plasma was employed and verified the results. The results support the hypothesis that intrauterine contraception interferes with implantation and establishment of pregnancy but not with fertilization and blastocyst formation.


Traumatic rupture of healed cataract wounds. Three patients suffered blunt trauma that caused rupture of the site of cataract incision three to 12 years after surgery. Epithelial cells were noted in the old cataract would of a 79-year-old white man. The second patient, a 25-year-old black women, had bilateral ocular toxoplasmosis and loss of vitreous humor at the time of lens extraction. The third patient, a 63-year-old white woman, had open-angle glaucoma treated previously with filtering procedures and cyclocryotherapy. The ultimate outcome was poor in each case.


Retinal detachment in a battered infant. A 12-week-old battered infant boy had bilateral retinal detachments. The retina in the left eye was considered inoperable, but retinal detachment surgery was performed in the right eye. This retina was reattached and limited vision was restored. The history, the location of the retinal pathology, and the absence of a lens coloboma helped differentiate this result of physical abuse from a congenital retinal detachment.


Severe perforating injuries treated with pars plana vitrectomy. Forty-one patients underwent vitrectomy through the pars plana for sequelae of severe penetrating injuries. Almost all were inoperable by conventional techniques. After a minimum follow-up time of six months, 13 eyes (32%) had visual improvement and six (15%) were technical successes. The main cause for failure was intravitreal proliferation of fibrous tissue.


Vitrectomy in the treatment of ocular perforating injuries. Using pars plana (closed) vitrectomy with related procedures we achieved improved vision in certain catagories of perforating ocular injuries. These procedures were particularly useful in removing retained nonmagnetic foreign bodies and correcting retinal detachments associated with traction bands and opaque vitreous. Limited success was obtained with longstanding injuries, double perforations from shotgun injuries, and large corneoscleral lacerations. Early vitreous surgery produced the best results.


Ocular manifestations of acute pandysautonomia. A 33-year-old white man developed premature presbyopia and anisocoria as initial manifestations of acute pandysautonomia. Nine months later signs and symptoms of generalized, severe autonomic dysfunction developed, and six years later only paralysis of pupillary reactions, presbyopia, and orthostatic hypotension were unresolved. Pharmacologic testing of the pupils demonstrated no mydriasis to cocaine 4% or hydroxyamphetamine 1% and hypersensitivity to epinephrine 0.1%, methacholine 2.5%, and pilocarpine 0.0625%, suggesting the presence of sympathetic and parasympathetic, postganglionic blockage of autonomic innervation of the iris.


Central areolar pigment epithelial dystrophy. We examined nine members of a family with a unique hereditary macular dystrophy by using stereoscopic color photography, fluorescein angiography, electroretinography, electro-oculography, dark adaptation, H-R-R color plates, and the Farnsworth-Munsell 100-hue test. The disorder was transmitted as an autosomal-dominant trait with increased penetrance and variable expression. Four of the family members, representing three successive generations, exhibited defects in macular pigmentation ranging from a 1-disk diameter excavation to a more subtle central loss of macular pigment. Only one eye with macular hemorrhage had decreased visual acuity; visual acuity in this eye was 20/25 when the hemorrhage resolved. All other retinal function studies were normal. The unusual nonprogressive areolar depigmentation of the central macula together with normal retinal functions made it impossible to classify this disorder, and indicated a new and unreported dominant macular dystrophy, central areolar pigment epithelial dystrophy.


Extraocular muscle lacerations.

Extraocular muscle lacerations. Five cases of laceration of an extraocular muscle without involvement of the globe or significant involvement of the  adnexa occurred after injury with a pencil, mower blade, screen door, and building nail, and at surgery when the surgeon operated on the wrong muscle. The inferior rectus muscle was involved in three cases, the lateral rectus muscle in one, and the medial rectus muscle in one, Traumatic muscle laceration involves the inferior or medial rectus muscles more often than the other muscles. This may occur for two reasons: these muscles are closer to the corneoscleral limbus, and they are more visible during the protective blink with associated upward and usually outward movement of the globe (Bell's phenomenon). When the lacerated muscle could be found, it was repaired either by reinsertion to the sclera or reunion of the severed muscle segments. When the muscle could not be found, a muscle transfer procedure was carried out. Patients with fusion before injury regained fusion in part of the visual field after muscle repair.


Low-tension glaucoma.

Low-tension glaucoma. A retrospective study of 45 patients with low-tension glaucoma revealed the mean age at diagnosis to be 66 years. Seventeen patients had follow-up visual field examinations, the average follow-up period being 6.4 years. There was no significant difference in prognosis of the ocular course between patients with Po/C equal to or greater than 100 and those with Po/C less than 100. The presence of splinter hemorrhages at the optic disk (10% of affected eyes) or of systemic arterial hypertension (diastolic blood pressure greater than 100 mm Hg) was associated with progression of visual field defects. Patients with sudden visual loss or associated hemodynamic events (33% of the total patients) had a more favorable prognosis regarding stability (lack of progression) of visual field defects than those without such an event. Extension of visual field defects across the macula was a common finding (25% of affected eyes). No firm evidence was obtained to indicate that treatment of the low-tension glaucoma improved the prognosis of the ocular course.


Alterations of Descemet's membrane in interstitial keratitis. Twenty corneas from patients with interstitial keratitis were examined by light microscopy and one of these by electron microscopy. Seventy percent of patients had either a positive serologic test for syphilis or a history of treatment for syphilis. Focal or diffuse multilaminar thickening of Descemet's membrane with secondary linear guttata was present in 88% of cases. Confluent linear cornea guttata formed retrocorneal hyaline ridges that clinically showed a central gray core surrounded by a translucent sheath. Microscopically, these ridges consisted of concentric laminations of newly formed Descemet's membrane. Some ridges hung into the anterior chamber as a bow-like strand or a spiderweb network. A possible pathogenetic sequence may include (1) inflammatory insult to a relatively young endothelium; (2) alteration of endothelial function to fibroblast-like activity; (3) the production of abnormal basement membrane and other collagenous material and formation of a new multilaminar Descemet's membrane; and (4) separation of some ridges from the multilaminar Descemet's membrane to hang into the anterior chamber as strands and networks.


Juvenile glaucoma associated with goniodysgenesis. Clinicopathologic studies, including electron microscopy, of trabeculectomy and peripheral iridectomy specimens from three patients with "juvenile" glaucoma revealed varying forms of maldevlopment of the chamber angle in all cases. A 20-year-old white woman (Case 1) had associated iridogoniodysgenesis with a pseudopolycoria-like iris pattern. In a 39-year-old white woman (Case 2), goniodysgenesis was associated with degenerated cell remnants in the angle "cleavage" area. A 15-year-old mentally retarded white boy (Case 3) displayed features of juvenile pigmentary glaucoma with associated goniodysgenesis and megalocornea.


Premature ventricular systole detection by applanation tonometry. We first identified (and probably stimulated) premature ventricular systoles in six patients while performing Goldmann applanation tonometry. One patient developed atrial fibrillation and one patient had a follow-up electrocardiogram showing increasing numbers of these extra systoles without any other abnormalities. Just as in tonography, these were detected during applanation tonometry as rapid decreases in intraocular pressures followed by a gradual return to prior levels. The decrease in measured intraocular pressure was occasionally 8 mm Hg but usually was between 2 and 5 mm Hg. These systoles probably occurred during the first part of applanation tonometry and during the first few office visits.


Treatment of rhegmatogenous retinal detachment secondary to proliferative diabetic retinopathy. Fifty eyes with rhegmatogenous retinal detachment associated with proliferative diabetic retinopathy were treated surgically. Follow-up examination was from six months to 14 years with an average of 33 months. Successful reattachment of the retina was achieved in 74% of the cases, and visual acuity was preserved or improved in 60%.


The association of femal hormones with blindness from diabetic retinopathy. The rates of blindness from diabetic retinopathy with or without other causes for persons in the Model Reporting Area (14 states) were determined in five-year intervals by sex. Diabetic males younger than 45 years of age had a higher rate of diabetic blindness than females under 45 years of age. However, for ages 45 and older, the risks of blindness among diabetics were approximately equal for men and women. These data were consistent with the hypothesis that the presence of female hormones improves the prognosis in diabetic retinopathy.


Electron microscopy study of cryogenic chorioretinal adhesions. By electron microscopy, the cryogenic chorioretinal adhesions in eight-day-old lesions from human eyes lacked anatomic adhesion between retina and choroid. In eight-month-old lesions, the neurosensory retina adhered to the retinal pigemtn epithelial layer by both desmosomal attachments and villous interdigitation.


Sickle cell trait and transient monocular blindness. Five episodes of transient monocular blindness during a six-month period occurred in a 42-year-old black man who had sickle cell trait. Other than the hemoglobin abnormality no cause for the transient monocular blindness was determined.


Gastrointestinal sarcoidosis diagnosed by conjunctival biopsy. Ophthalmologic examination of a 31-year-old black man presenting with an intractable gastric ulcer revealed small conjunctival nodules in the lower cul-desac that were sarcoid granulomas by microscopy. Previous endoscopic examination had revealed polyps in the gastric antrum, and a biopsy and microscopic examination had revealed granulomatous lesions, but a definite diagnosis could not be made until the ophthalmoscopic examination.


Serum lysozyme in sarcoid uveitis.

Serum lysozyme in sarcoid uveitis. In a study of 100 patients, the mean serum lysozyme value for patients with sarcoidosis and active uveitis was elevated, while the mean value for patients with inactive sarcoidosis and inactive uveitis was within the normal range. The mean value for patients with a clinical picture of sarcoid uveitis, but without an established diagnosis of sarcoidosis, was high. In patients with ophthalmologic findings compatible with sarcoidosis, but without radiologic, immunologic, or other clinical evidence of the disease, an elevated serum lysozyme level may be indicative of sytemic disease.


Biological equivalence of ophthalmic prednisolone acetate suspensions. We compared both concentrations (0.125 and 1.0%) of two widely used commmerical brands of prednisolone acetate suspensions. We investigated the concentration that each product attained in the cornea and aqueous humor, and each product's anti-inflammatory effectiveness in the cornea. There was no statistically significant difference in the corticosteroid levels measured in cornea or aqueous humor after administration of the two suspensions. Similarly, there was no significant difference in the ability of the two commercial preparations to suppress corneal inflammation.


Cloxacillin penetration.

Cloxacillin penetration. We investigated the intraocular penetration of cloxacillin in 14 patients undergoing surgery for senile cataract after intramuscular and subconjunctival injections of the drug. No antibiotic level was detected in the aqueous humor when cloxacillin was administered intramuscularly in a dose that ranged between 1 and 4 g. With subconjunctival injection, therapeutically effective cloxacillin activity was detected in the aqueous humor only after a dose of 250 mg.


Cryosurgery for treatment of trichiasis. We cryosurgically destroyed eyelashes in rabbits and applied the technique to treat 23 selected patients with trichiasis. Liquid nitrogen was sprayed on the eyelid margin by using a double, rapid-freeze, slow-thaw cycle monitored by a subcutaneous thermocouple to -30 degrees C. It was an improvement on electrolysis and a simple alternative to surgery.


Malignant inverted papilloma characterized by proptosis. An inverted papilloma, presumably originating in the ethmoid sinus, was characterized by proptosis in a 67-year-old man. Clinically and radiologically it simulated a primary orbital tumor. Squamous carcinoma appeared in this lesion; irradiation and exenteration, 3 1/2 years after onset of symptoms, failed to prevent fatal intracranial extension.


HL-A 27 antigen associated with uveitis and ankylosing spondylitis in a family. Uveitis and ankylosing spondylitis coexisted in a family. Tissue typing of the family revealed the HL-A 27 antigen in five members: two had uveitis; two had ankylosing spondylitis; and one was asymptomatic. These diseases did not coexist in any one member of the family.


Presumed ocular histoplasmosis.

Presumed ocular histoplasmosis. A 21-year-old woman with the presumed ocular histoplasmosis syndrome developed a subretinal neovascular membrane at a site previously demonstrated to be free of atrophic scarring on fluorescein angiography.


The tilted disk syndrome.

The tilted disk syndrome. We noted occasional diagnostic confusion with papilledema and chiasmal compression when its true congential nature was not recognized in 12 patients with a benign ocular syndrome. Retinoscopy, fluorescein angiography, ocular ultrasonography, and histopathology suggested that associated visual field defects were related to a localized staphylomatous ectasia of the posterior globe.


Glaucomatous cupping of the optic disk by ultrasonography. B-scan ultrasonography was used to evaluate advance glaucomatous cupping of the optic disk (0.7 cup/disk ratio or greater) in one normal subject and six patients with glaucoma. The normal eye emitted a continuous echo from the posterior pole, which conformed to its mild degree of concavity. The glaucomatous eyes emitted echos from the posterior pole, demonstrating the more extreme concavity of the optic cup. Ultrasonographic evaluation of an acrylic plate containing holes of known diameter demonstrated the limits of resolution and artifacts that resulted from this examination.


Congenital anomalies of the optic disk.

Congenital anomalies of the optic disk. Six patients had congenital anomalies of the optic disk: epipapillary fibrous tissue, peripapillary pigmentary disturbance, and anomalies in the size of the optic disk and in the retinal vessels. Congenital anomalies of the optic disk form a spectrum in which many of the ophthalmoscopic features are shared and in which visual function varies.


Cataract extraction and the corneal endothelium. We examined and photographed the central corneal endothelium of 16 patients with the clinical specular microscope before and at intervals after cataract extraction. No detectable loss of the endothelial cells occurred in 75% of the patients, including 12 routine intracapsular cryoextractions and four phacoemulsifications of soft cataracts in young adults. Only one of the four cases of significant endothelial cell loss occurred in a normal cornea without demonstrable operative or postoperative complications. Two of the four corneas that lost central endothelial cells at cataract extraction continued to lose more cells during the ensuing weeks. A significant increase in central endothelial cell density was demonstrated in one patient. The four corneas with endothelial cell loss also had a significantly higher mean increase in corneal thickness postoperatively, although this was transient. All 16 corneas remained clear during the period of observation (maximum, 14 weeks), and long-term studies are needed to measure the chronic effects of the endothelial damage.


Corneal endothelial damage associated with phacoemulsification. Twenty-one cats underwent standard Kelman phacoemulsification procedures in their right eyes. The left eyes of the same amimals underwent a planned extracapsular cataract extraction or irrigation and aspiration for 15 minutes using the Kelman phacoemulsification unit. The corneal endothelium was evaluated at various times postoperatively using a stain for endothelial cell viability and scanning electron microscopy. The results suggested that the irrigation procedure alone is deleterious to the cat endothelium as is the rubbing of nuclear material against the endothelial cells. These two procedures caused additonal damage when combined in a routine phacoemulsification procedure.


A metabolic and electron microscopic study of human organ-cultured cornea. We examined the glucose metabolism and ultrastructure of human corneas stored for 11 to 37 days in organ culture using a modified Eagle's minimum essential medium. Changing the media twice weekly provided a stable pH of 7.22 to 7.28 but the glucose concentration of the media decreased from 110 mg/100 ml to 30 mg/100 ml, and lactate concentration increased from 7 mg/100 ml to 84 mg/100 ml before media replacement. The initial rate of glucose uptake and lactate release averaged 149 mug/hr and 95 mug/hr, respectively, and the rates decreased approximately 50% by day 12. The glucose uptake rate stabilized between 40 and 60% of the original rate to day 37, but the lactate release rate decreased again at day 25 from 64 to 25%. The lactate/glucose ratio averaged 65 to 82% during the first 25 days of organ culture and 33 to 53% from days 28 to 37. Electron microscopy revealed that the endothelium formed a complete monolayer of normal appearing cells covering Descemet's membrane. Intracytoplasmic deposition of glycogen granules was present in endothelial, stromal, and epithelial cells.


Congenital epithelialization of the posterior cornea. A 6-month-old infant boy who had a unilateral congenital corneal opacification with adhesions of abnormal iris to the posterior cornea underwent corneal transplantation. Pathologic examination of the excised cornea showed a central defect in Bowman's layer, an absent Descemet's membrane, and multilayered squamous epithelium replaced the endothelial layer. Electron microscopy confirmed that these cells had epithelial characteristics with numerous desmosomes, microvilli, and abundant cytoplasmic tonofibrils. While the pathogenesis remains obscure, a metaplastic process early in gestation probably resulted in the presence of epithelial cells in the endothelial layer.


Increased intraocular pressure induced by repository corticosteroids. Twelve patients (14 eyes) had intraocular pressure elevations induced by repository coritcosteroids. The duration and severity of the resulting pressure elevations were directly related to the decreasing solubility of the agent employed. Ten patitens had received intensive topical corticosteroids before injection, resulting in no intraocular pressure elevations during that period. Two patients who developed marked intraocular pressure elevations after repository corticosteroid injection did not manifest a positive response on subsequent topical corticosteroid testing.


Elevated lactic acid dehydrogenase in aqueous humor in an eye without retinoblastoma. A 14-month-old boy had a microphthalmic left eye. An anterior chamber paracentesis was performed six days after examination under anesthesia. Lactic acid dehydrogenase (LDH) level in the aqueous humor was 1,158 mu and was 202 mu in the serum. The aqueous humor/serum LDH ratio was 5.73. This eye was eventually enucleated and found to have retinal dysplasia and diffuse hemorrhagic necrosis. There was no eividence of retinoblastoma. The elevated LDH level in aqueous humor was probably secondary to the ocular tissue necrosis and hemorrhage. This false-positive result emphasizes the limitation of using the aqueous humor/serum LDH ratio to distinguish eyes with retinoblastoma from those without retinoblastoma.


Methodology for teaching theory in occupational therapy basic professional education. This article proposes a methodology for teaching theoretical concepts to undergraduate occupational therapy students. The methodology is based upon a learning theory and three conceptual models of psychosocial dysfunction. It is suggested that such a method will help students to understand theoretical principles and to develop the ability to apply these principles to treatment. This method has been used successfully by the authors in classroom instruction.


The occupational career...

The occupational career... The health care system is responding to the demands for comprehensive services and is extending its services beyond the elimination of pathology to that of providing assistance with problems of daily role adjustment. Occupational therapists are beginning to base their practice on a role theory model, which permits consideration of both pathology and role adjustment. The acquisition of roles throughout an individual's life progresses from infancy through old age and forms a career of roles. Occupational therapists are developing evaluations of role performance to identify strengths and weaknesses of daily role adjustment. By complementing the existing body of occupational therapy expertise with assessments of occupational career, occupational therapists can easily respond to the increasing health care demands.


Validity of certification measures for occupational therapists. Major factors that can affect the results of validation studies are identified and include reliability, homogeneity of sample, and criterion contamination. An overview and a description of content, predictive, concurrent, and construct validities are presented as well as a review of the recent studies of the validity of the Field Work Performance Report and the Certification Examination for Occupational Therapists. Adequate evidence of content and concurrent validity has been established for the Field Work Performance Report, although evidence for long-range predictive validity is lacking. Content validity alone has been established for the Certification Examination for Occupational Therapists. The evidence indicates that the instruments should not be abandoned, that they are better than no measures at all. The directions research might take in the future are given and the implications of continued use of the instruments are evaluated.


Occulsion amblyopia.

Occulsion amblyopia. There have been a number of reports on the effects of early occlusion on the visual system of cats, monkeys, and humans. In the present paper, a patient with amblyopia resulting from prolonged early occlusion in the treatment of strabismus is described, and implications for management of early strabismus are discussed.


Rotation of lathe-cut hydrogel lenses on the eye. The rotation lathe-cut HydroCurveTM gel contact lens was measured on six eyes to evaluate the parameters that influence lens rotation and to determine if this lens could be used to correct astigmatism. Of the 72 observations made, 73.6% showed some lens rotation, and 33.4% of the sample rotated more than 5 degrees per 10 blinks. Of the observations in which rotation was noted, 88.7% were encyclorotation. These results are similar to those found for spin-cast hydrogel lenses. None of the lens parameters evaluated seemed to be related to lens rotation, whereas the eye parameters studied were. Lenses were more likely to rotate on eyes with smaller corneal diameters, smaller palpebral apertures, and corneal curvatures steeper than 4 3.00 DK (X2, N =72, p less than 0.05). Our findings indicate that some method of lens stabilization will be needed before lathe-cut hydrogel lenses can be used to effectively correct astigmatism.


A matrix formalism for decentration problems. A matrix approach to decentration problems is presented which reduces the common decentration problems of ophthalmic optics to simple matrix multiplications. The formalism also leads to an alternative derivation of Thomson's formulas for obliquely crossed spherocylindrical lenses.


Measurement of intraocular pressure over a gel lens. Tonometric measurements of albino rabbits were determined with and without the use of a gel lens while the intraocular pressure (IOP) was manometrically controlled. The IOP was evaluated over a 50-mm Hg range of pressures. A high degree of correlation between measurements made with and without a gel lens was found. The results suggest that the technique may have clinical applications on patients for whom a corneal anesthesia is contraindicated or on whom repeated tonometry or tonography might cause corneal trauma.


A vision profile of American Indian children. In an unselected study, Modified Clinical Technique screening plus keratometry was done on 398 American Indian grade school children. The results are compared to screening results for Caucasin grade school children.


Attempt to induce cataracts in rabbits by cutaneous application of acetone. Acetone is used as a solvent for chemicals in skin sensitization studies. Its low cost, high solvent powers, and comparative lack of toxicity make it one of the most widely used industrial solvents. Absorption of acetone through the skin is not considered hazardous; however, in an earlier study we found that acetone caused cataracts in a large group of guinea pigs when small multiple doses were administered either topically or intracutaneously on the backs of these animals. No cataracts were found when two rabbits were tested. The purpose of the present study is to repeat the earlier study using more rabbits. Here, none of the 10 experimental rabbits or the 10 control rabbits developed any lens abnormalities. Those drugs and toxic substances that have produced cataracts in rabbits are described.


Diseases of the optic nerve, tracts, and visual cortex: an annual review of the ophthalmic literature. The ophthalmic literature dealing with diseases of the optic nerve, tracts, and visual cortex was reviewed for the period September 1973 to November 1974. Eighteen papers dealing with topics of interest to optometrists have been abstracted. Principal subjects include: relation of central serous retinopathy to pregnancy, a stimulating discussion of the role of elastic tissue degeneration in formation of angioid streaks, methods of assessing internal carotid artery disease, ophthalmoscopy versus tangent screen evaluation, stereoacuity as a useful tool in detecting monocular problems, advances in head X-ray, and, lastly, developments in objective assessment of the nerve head and central retinal artery.


The lacrimal drainage system: pressure changes in the canaliculus. In order for tears to be removed from the eye, pressure gradients must be created in the ducts which lead to the nose. Blinking is only one of a number of mechanisms potentially capable of doing this. Pressure in the lacrimal canaliculus was recorded during voluntary blinks, tight squeezing of the lids, eye movements, and pressure changes in the nose. The results show that all of these produce pressure changes in the canaliculus.


The "Pooh Corner" vision study.

The "Pooh Corner" vision study. Two groups of children were screened by selected optometrical tests. Infants between the ages of 3 and 24 months and kindergarten children aged from 2 to 5 years were tested. The results indicated that meaningful data can be obtained from both groups and that the tests revealed visuosensory and visuomotor defects, correction of which at an early stage is not only desirable but, in most cases, essential.


Blurred imagery and the cylinder sine-squared law. The sine-squared law is shown to describe changes in spherical power which either minimize the blur or maximize the visibility of gratings oriented at various angles to the principal meridians of an astigmatic eye. These results help justify the use of the sine-squared law in applications such as meridional refraction. This derivation and its interpretation is quite different from the usual approach which emphasizes the meridional changes in curvature of a toric surface.


A home pleoptic method.

A home pleoptic method. A method of initiating an after-image in an amblyopic eye with eccentric fixation by using Haidinger's brush for fixation control is described. This technique makes home pleoptics possible.


Correcting high anisometropia: two case reports. In the cases reported, the anisometropia had not been corrected previously. Despite the common belief that such a correction would induce intolerable symptoms in adults, both patients successfully adapted to the full correction within a few days, showing marked improvement in binocular vision skills.


Improving student understanding and management of patients through role-playing and video taping. A teaching program that uses video tape and simulated patients assists the student in developing skills necessary for good professional relationships with patients and augments the student's ability in patient inverviewing and effective interview behavior. Role-playing by selected drama students and community theatre actors involves common problems encountered in the optometrist's office and management of problem patients (angry, aggressive, shy, withdrawn, talkative, flirt, hypocondriac, etc.).


A lubrication theory model of tear exchange under a soft contact lens. Tear exchange due to squeezing of a soft contact lens onto the cornea by the lid is calculated from lubrication theory. The theory predicts that for a normal blink and the usual tear film thickness (8 to 10 microns) there will be 10 to 20% tear exchange at each blink.


Oxygen tension under a soft or hard, gas-permeable contact lens in the presence of tear pumping. The oxygen tension under hard or soft, oxygen-permeable contact lenses is calculated. The calculation recognizes delivery of oxygen to the tear fluid under the contact lens by diffusion through the lens material and by entrance of fresh, air-saturated tears at each blink. The results show that oxygen diffusion through the lens material is much more effective than tear pumping in maintaining a useful oxygen tension under the lens.


Vision analysis and refractive status of youths in a juvenile detention home population. Clinical optometric findings of 633 juvenile dentention youths were statistically evaluated and compared to data from the general population. The youths had a higher referral rate of refractive errors, organic problems, and muscle in balances than the general population. Female youths exhibited a higher incidence and greater severity of myopia than males at all ages. Referral rate for astigmatism among the youths was higher than the general population although the dioptric power was in agreement with previous studies.


The refractive status of Zuni Indian children. American Indians show a high incidence of various ocular abnormalities. In the present study, refractive error and corneal curvature were measured in 420 Zuni school children. The mean spherical refractive error varied from +0.87 D in the lower grades to -0.62 D in the upper grades. The mean corneal astigmatism was 2.21 D was varied as function of grade. corneal and refractive astigmatism were highly correlated.


Aberrations of spherocylindrical spectacle lenses. A procedure has been developed for tracing a bundle of rays through and ophthalmic lens and a schematic eye with its primary line of sight pointed through various parts of the lens. A bundle of eight rays can provide data for assessing the quality of the image formed by such a system. To test the procedure and to generate data which can help in selecting a method for evaluating image quality, we selected a single lens as an example. The lens selected has a spherical back surface (-5.00 diopters) and a toric front surface (+15.00 diopters in the vertical and /10.00 diopters in the horizontal). It has a center thickness of 5 mm and glass of index 1.523. Spot diagrams were generated with the eye pointed in various directions through the ophthalmic lens. The data generated showed that peripheral bundles which fall between the principal meridians emerge as astigmatic bundles. This leads to the proposal that blur circle theory can be used for evaluating the quality of the optical image and that it suffices in the case of a spherocylindrical ophthalmic lens to base the tolerances for refractive power on measurements made in the principal meridians.