Acute, eruptive Darier disease (keratosis follicularis). Because of the rarity of Darier's disease (keratosis follicularis) occurring as an acute, eruptive disease in a mature adult, a case with sudden onset in a 51-year-old white man is reported. Small, pale-gray, smooth papules on the sides of the arms spread to the sides of the chest, abdomen, and legs within a week. With a biopsy examination, histopathologic findings were acanthosis, hyperkeratosis, lacunae, acantholysis, corps ronds, and grains. Topical therapy with 0.05% fluocinonide (Lidex) cream has given marked improvement.


Erythema gyratum repens with metastatic adenocarcinoma. A patient with Erythema Gyratum Repens (EGR) had a marked increase of his eruption, with uncontrollable pruritus that was unresponsive to steriod therapy. This culminated in an exfoliative dermatitis. A metastatic, undifferentiated adenocarcinoma was removed following a right-sided craniotomy. The patient then had complete cessation of his pruritus, with moderate improvement of his eruption. All the reported cases of EGR were reviewed in terms of the source of the malignant disorder. The relationship between the time of onset of the EGR and the discovery of the malignant disorder, as well as the effect of treatment of the malignant condition on the course of the EGR, was studied. The data suggest a highly probable relationship between the two.


The skin in the Winchester syndrome.

The skin in the Winchester syndrome. The Winchester syndrome, a rare inherited disorder, is characterized by dwarfism, carpal-tarsal osteolysis, rheumatoid-like small joint destruction, corneal opacities, and thickening and hypertrichosis of the skin, unlike that seen in other genodermatoses. The early stages of cutaneous abnormalities are characterized by proliferation of fibroblasts deep in the dermis, while hypocellular homogenization of the collagen is evident later. Ultrastructural peculiarities of fibroblasts include dilated and vacuolated mitochondria, the presence of varying amounts of myofilaments in the cytoplasm, and a prominent fibrous nuclear lamina. Cells other than fibroblasts display no abnormalities. The basic defect in this disorder is unknown; however, it may be related to abnormal function of fibroblasts.


Proliferation pattern of hamster melanoma cells cultured in diffusion chambers in pre-immunized hosts. Fortner M Mel 1 melanoma cells from the Golden Hamster were capable of exponential proliferation during intraperitoneal diffusion chamber culture in xenogenic host animals (Balb/c mice, BD IX and Marshall rats). When the host animals had been preimmunized with these melanoma cells, rapid cell lysis was observed in the chambers within 4 hrs after implantation. The cell numbers were reduced to about 1 - 10% of the inoculum. At this level the cell numbers persisted for several days, as opposed to control cultures in untreated hosts, where the cells proliferated rapidly. After 6 - 10 days the cell numbers in chambers from immunized hosts slowly increased in spite of a high level of cytotoxicity in ther serum of the animals. The same pattern was seen after previous immunization with hamster lymphocytes, indicating that the antibodies were directed against a common antigen for melanoma cells and lymphocytes in hamsters. The diffusion chamber method appears to be a useful system for the study of a pure humoral immune reaction against tumour cells, and especially for investigation of the phenomenon that some tumour cells are able to escape a strong humoral cytotoxic effect from host animals.


On the structure of the normal nail. A scanning electron microscope study. A scanning electron microscopic (SEM) study of cut surfaces in normal human nails have confirmed the previous description of nail structure, i. e. the hard dorsal nail plate supported by the plastic intermediate nail plate.


Mast cells in the epidermis of piebaldism. The depigmented lesion in a case of piebaldism (partial albinism) was examined by electron microscopy. In the epidermis melanocytes were absent and the number of Langerhans cells was increased. In addition several mast cells were found in the epidermis.


Reliability of forecasts of annoyance reactions. A study of exposure to noise and air pollution. Studies of the effect of external environmental factors on the individual are often carried out in order to obtain a basis for forecasts. The aim of the case studies reported has been to check the reliability of predictions of annoyance from four different external sources of discomfort. The results confirm the assumption that forecasts based on empirical studies provide a reliable picture of what the occurrence and extent of the annoyance reactions will be.


Inhalation carcinogenicity of alpha halo ethers. I. The acute inhalation toxicity of chloromethyl methyl ether and bis(chloromethyl)ether. A range of acute studies were performed with chloromethyl methyl either (CMME) and bis(chloromethyl)ether (BCME), including 14-day LC50's following single seven-hour inhalation exposures. The LC50's for CMME were 55 ppm for rats and 65 ppm for hamsters. The LC50's for BCME were 7 ppm for both species. All animals showed characteristic changes of acute irritation of the respiratory tract manifested by congestion, edema, and hemorrhage. Severe shortening of life span was seen in 30-day exposures of rats to CMME and in all studies with BCME. Incidences of mucosal changes, including atypia, were generally increased in a dose-related manner in both species. The carcinogenicity of BCME in these range finding experiments was demonstrated by a skin cancer in a rat after three exposures and a nasal tumor in a hamster after one exposure to 1 ppm BCME.


Inhalation carcinogenicity of alpha halo ethers. II. Chronic inhalation studies with chloromethyl methyl ether. Rats and hamsters were exposed to 1 ppm of chloromethyl methyl ether six hours per day, five days per week, throughout their lifetime. Mortality and weight gain of the exposed animals paralleled that of the control animals. Malignant tumors of the respiratory tract were found in two rats. These were a squamous cell carcinoma of the lung with blood vessel invasion and an esthesloneuroepithelioma originating in the olfactory epithelium and invading the forebrain. One hamster was found to have an adenocarcinoma of the lung and another, a squamous papilloma of the trachea. A single exposed rat had a pituitary tumor of primitive cell type that may well have been coincidental.


Inhalation carcinogenicity of alpha halo ethers. III. Lifetime and limited period inhalation studies with bis(chloromethyl)ether at 0.1 ppm. Rats and hamsters were exposed to 0.1 ppm bis(chloromethyl)ether (BCME) six hours per day, five days per week throughout their lifetime. Additional groups of rats were given 10, 20, 40, 60, 80, and 100 exposures to 0.1 ppm BCME and then held until death. Forty cancers originating in the respiratory tract were found in the 200 rats involved in these studies. These included 14 cancers of the lung and 26 cancers of the nasal cavity. They occurred in dose-related fashion. A single undifferentiated carcinoma of the lung was seen in a hamster.


Serum thyroxine in the early diagnosis of carbon disulfide poisoning. Serum thyroxine and blood lipids were assayed in 45 subjects exposed to carbon disulfide (CS2). A highly significant statistical reduction of thyroxine in relation to the exposure time was found and the levels appeared lower in the subjects with retinal vessel alterations. A significant interrelation between cholesterol and serum thyroxine was also evidenced. Serum thyroxine assay is suggested as a reliable test in the early diagnosis of CS2 poisoning.


Lung function consequences of dust exposure in asbestos cement manufacturing plants. A comprehensive study of health effects associated with the mixed dust exposure in this industry has included the collection of clinical, radiographic, lung function, and dust exposure data on 859 workers in two plants. Evidence is presented supporting a dose-response relationship between indexes of dust exposure and lung function, similar to the previously reported relationship with extent of x-ray film changes using the ILO U/C classification. Lung volumes and maximum expiratory flow rates decrease in relation to increasing cumulative dust exposure while pulmonary diffusing capacity (DL) is not dust-dose related. Worders who had crocidolite exposure had smaller lung volumes, lower expiratory flow rates, and reduced DL when compared with those having only chrysotile exposure. When the study population is divided into exposure groups, data thus far analyzed suggest that the chest x-ray film will reveal small opacities as early as significant functional changes can be detected, but individuals may have functional reduction prior to the appearance of x-ray film changes.


Occupational exposure to organophosphate pesticides: a neurobehavioral study. Acute organophosphate intoxication in man is well known to result in substantial central nervous system dysfunction. To test the hypothesis that similar neurobehavioral abnormalities might be present in mild degree in workers chronically exposed to organophosphate pesticides, 23 such subjects were tested for abnormalities in memory, signal processing, vigilance, language, and proprioceptive feedback performance. The performance of the exposed workers was not deficient in any of the five measures assessed when compared with the performance of a control group matched for age and educational background. Plasma and red blood cell cholinesterase levels were found to be in the normal range in both exposed and control groups, although plasma levels of exposed subjects were depressed somewhat below control values. Relative resistance of higher nervous system functions to mild chronic organophosphate exposure is suggested by these results.


The health of retired fibrous glass workers. A total of 416 men, retiring during the period 1945 to 1972 from six plants engaged mainly in the manufacture of fibrous glass insulation, were studied to see how their mortality experience compared with that of white men in the entire United States living in comparable age and time intervals. The mean follow-up period from first exposure was about 30 years. Overall mortality was low and there was no evidence of an excess in respiratory cancer mortality. No mesotheliomas were noted. For 115 men retiring from the same six plants during the period 1945 to 1972 due to a disability the distribution of disabilities by cause was compared with an expected distribution based on the experience of the Social Security Administration. This comparison showed no evidence of any unusual health hazards among fibrous glass workers, except a possible excess in chronic bronchitis.


Photochemical air pollution: its effects on respiratory function of elementary school children. The effects of photochemical air pollution on respiratory function of Tokyo elementary school children were investigated. Nine types of environmental factors were continuously recorded. Seven categories of respiratory function tests were performed on 20 normal 11-year-old children once a week from June to December 1972, as a general rule. The correlation coefficients between respiratory function measurements and each of the environmental factors were calculated. The maximum expiratory flow rate (V max) showed high correlation with the largest number of environmental factors. Among environmental factors, temperature highly affected various respiratory function tests. The O3 was significantly associated with airway resistance (Raw) or specific airway conductance (Gaw/Vtg), NO or NO2 with V max, and temperature with Raw, Gaw/Vtg, and V max. Two subjects among all subjects were considered as the reactors to the environmental factors.


Carbon monoxide in the urban atmosphere: hazards to the pedestrian and the street-worker. The carbon monoxide (CO) concentrations encountered by pedestrians and workers in the streets of a large metropolis were monitored by a reliable and sensitive portable detector (the Ecolyzer). Up to 1,000 observations per day were collected for several months during the summer and fall of 1973. The CO levels ranged from 10 to 50 ppm (varying with wind speed and direction, atmospheric stability, traffic density, and the height of nearby buildings). Much higher average concentrations were found in such adverse sites as poorly ventilated underpasses and underground garages. Street closures for a pedestrian mall reduced levels on the mall to around the general urban background withoug large increases in readings on adjoining streets. Many street-workers have little medical supervision, and for this reason the urban eight-hour CO ceilings may be a more appropriate air quality target than the usual industrial figure of 50 ppm. However, even the latter is sometimes exceeded on busy city streets.


Heat wave mortality in New York City, 1949 to 1970. Epidemiological studies have been carried out to search for an influence of air conditioning on patterns of heat wave mortality in New York City. Two models were used to predict total daily summer mortality as a function of temperature; one of the models included heat acclimatization effects. Ratios of the models' predictions of heat wave mortality to actual mortality were calculated for heat waves occurring during 12 summers in the period 1949 to 1970. Trends in these ratios as a function of time were sought. The analysis suggests that the relative magnitudes of excess mortality during initial summer heat waves may have decreased over the 21-year period. No trend was observed for excess mortality during late summer heat waves.


Bacterial contamination of organic dusts: effects on pulmonary cell reactions. The influence of water extracts from different organic dusts on the number of free lung cells was studied in short-term exposure experiments. A large increase in the number of leukocytes was found 24 hours after exposure to extracts from cotton and hay. The number of macrophages was not affected. The increase was greater when the dusts were incubated at 37 C and 100% relative humidity prior to the preparation of the extract. This procedure caused an increase in the number of bacteria. When different bacterial species were studied endotoxin-producing strains were found to cause the largest effect.


Cadmium accumulation in rat liver.

Cadmium accumulation in rat liver. The biochemical accumulation and clinical pathological conditions induced by intraperitoneal administration of cadmium was studied in Sprague-Dawley rats. Injected doses of cadmium ranging from 0.5 to 3 mg/kg of body weight were administered. Distribution studies of Cd in the liver indicated the metal was bound to a soluble protein, and that the amount of metal present increases with increasing dosage. The pathological changes were found to correlate better with hepatic concentration of metal than with the injected dose.


Cadmium-binding in human liver and kidney. Autopsy specimens of liver and kidneys from 40 patients have been analyzed for cadmium and zinc. Sephadex chromatography was performed on soluble extracts from these tissues. In samples from 19 patients a cadmium-binding protein was found. The mean cadmium content of kidney in this group was higher than the corresponding value for all 40 patients. A molecular weight of 10 to 12,000 was estimated for the cadmium-binding protein by Sephadex chromatography. Isoelectric focusing resolved two peaks with pl 4.8 and pl 6.0, the OD254/OD280ratio for both peaks being about 5. These data indicate that humans without known occupational exposure to cadmium do have a cadmium-binding protein similar to metallothionein in their liver and kidney.


Mediastinoscopy. Its application in central versus peripheral thoracic lesions. In an attempt to ascertain the value of mediastinoscopy in peripheral lung lesions, records of 157 patients undergoing cervicomediastinal exploration (CME) at Wilford Hall USAF Medical Center were reviewed. Among patients with benign lesions, CME was positive in 90.6% of those who had central lesions and 58.3% of those with peripheral lesions. It was positive in all 7 patients who had peripheral lesions with associated mediastinal nodes on roentgenogram and negative in all 5 who had peripheral lesions without nodes. In the patients with malignant lesions, CME was positive in 72.9% of those who had central lesions and 58.1% of those with peripheral lesions. It was positive in 24 of 27 patients who had peripheral lesions with associated mediastinal nodes and negative in 15 of 16 patients with peripheral lesions without nodes. Although we recognize this to be a selected series, CME does appear to be valuable in patients with central lesions and peripheral lesions with mediastinal nodal involvement on roentgenogram. It does not appear to be as useful in those with peripheral lesions who do not have central nodal involvement.


Prognostic value of electroencephalography in cardiac surgery. One hundred seventeen patients undergoing cardiac operations over a two-year period were studied. Electroencephalograms were recorded preoperatively, in the recovery room (up to 12 hours following operation), 24 hours later, and further as required. Operative and anesthesia data were correlated with EEG findings. All patients had normal EEGs preoperatively. This unusual occurrence may largely reflect the absence of congenital heart disease and the small number of valvular lesions in our patients. Prognosis was not significantly influenced by age. Bypass time appeared directly related to outcome by group but not individually. Hypotension prior to pumping occurred most often and mean blood loss was greatest in the patients who had abnormal EEGs in the recovery room with progressively worsening patterns until death. In the recovery room many patients were awake, while others were either drowsy, lethargic, or asleep. Some were comatose. The level of consciousness was not as prognostic as was the EEG. The pattern of EEGs in the first few postoperative days is more important than any single record by itself. All those who showed progressive deterioration in the first two or three days died shortly thereafter.


The use of saline-washed frozen red cells for extracorporeal bypass. The use of saline-washed frozen red cells and homologous whole blood during cardiopulmonary bypass was compared in two groups of patients with similar medical disease, sex, age, pump time, types of operation, and surgical techniques. A technique for using saline-washed frozen red cells for cardiopulmonary bypass with no increase in hemolysis is described. Increased platelet counts were present at the end of bypass in the patients who were given frozen cells. The availability and the many advantages of frozen cells, such as improved oxygen transport and the absence of homologous blood reactions and viral infections, make them the preferred cellular blood component for use during open-heart operations.


Aneurysm and fistula of the sinus of Valsalva. Clinical considerations and surgical treatment in 45 patients. Aneurysms and fistulas of the sinus of Valsalva, although rare, present a challenging surgical problem. Forty-five patients with this lesion have undergone operative treatment during the last 17 years. The series includes 32 male and 13 female patients ranging in age from 2 to 68 years with a mean age of 35.3 years. Only 1 early death occurred in the series, a hospital mortality of 2.2%. Diagnosis of the aneurysm was made preoperatively in 30 patients and discovered at operation 15. The lesion involved the right coronary sinus in 28 patients, the noncoronary sinus in 19, and the left coronary sinus  in 5. The aneurysm had not ruptured in 22 patients and had formed a fistulous communication between the right coronary sinus and the right ventricle in 13. Acute rupture occurred in 10 patients (22.2%). Long-term follow-up data were obtained in 38 patients after 1 to 15 years. Late mortality is low. A nonruptured aneurysm of the sinus of Valsalva should be managed conservatively when it occurs as an isolated lesion. Our experience supports the concept that perforated aneurysms and fistulas of the sinus of Valsalva, even if asymptomatic, should be treated operatively.


Correction of absence of the aortopulmonary septum by creation of concentric great vessels. An 18-year-old patient is reported who had simultaneous occurrence of aortopulmonary septal absence, complete interruption of the aortic arch, and patent ductus arteriosus. This is the only known patient who has had total anatomical correction of this combination of defects. Correction was accomplished by staged procedures; the first stage consisted of obliteration of the patent ductus and establishment of aortic continuity; this was followed one year later by the second stage, which included a unique method for repair of absence of the aortopulmonary septum. The surgical desirability and embryological implications of criteria for differentiating truncus arteriosus from aortopulmonary septal defect are presented. Follow-up physiological evaluations and the patient's death from the effects of increasing pulmonary vascular disease (despite early symptomatic improvement) approximately two years after completion of the repair underscore the importance of early diagnosis and operative intervention.


Balloon catheter for endoscopic removal of foreign bodies. A method for endoscopic removal of foreign bodies in the bronchial tree and esophagus using a balloon catheter is described.


Pseudosarcoma of the esophagus.

Pseudosarcoma of the esophagus. Polypoid lesions of the esophagus occur infrequently and may be benign or malignant. One malignant polypoid tumor, pseudosarcoma, appears to be a distinct pathological entity; the polypoid portion is composed of sarcomatous spindle cells and the base of the polyp shows in situ or invasive squamous cell carcinoma. A patient with this lesion is described and the 16 previously reported patients are reviewed. The results indicate that local resection is inadequate; radical esophagectomy is required for cure.


Late embolization of prosthetic mitral valve occluder with survival following reoperation. Embolization of the occluder from a prosthetic mitral valve is an extremely rare event. Previous reports in the literature have described the uniformly fatal outcome of this complication. A case in which the occluder from a Wada-Cutter mitral prosthesis embolized five years following implantation is presented. The patient survived following emergency reoperation. Several unique features of escaped mitral poppet are discussed. Depending upon cardiac reserves, patients who have this complication may live long enough to allow emergency operative intervention and eventual recovery.


Esophageal injury.

Esophageal injury. This review considers all possible modes of esophageal injury, based on a schema originally published in 1954 and more recently modified in 1970. For each category of injury there are detailed discussions of diagnosis and treatment. The best available knowledge of present-day modalities has been based on a survey of the literature for the past decade. When diverse methods of treatment were encountered, we have made comments consistent with our personal experience, when appropriate. The medicolegal literature contains a number of references to esophaegeal injury. Certain excerpts dealing with several types of potential actions are extracted: (1) suits to recover damages for esophageal perforation in which negligent endoscopy was claimed; (2) suits following endoscopic accidents in which lack of informed consent was claimed; and (3) suits for professional liability based on misdiagnosis, delayed diagnosis, or wrong treatment of esophaegeal perforation.


Citrate lyase from Streptococcus diacetilactis. Association with its acetylating enzyme. Citrate lyase (EC 4.1.3.6) was purified 38-fold from cell-free extracts of Streptococcus diacetilactis. The enzyme was homogeneous in analytical ultracentrifugation and polyacrylamide gel electrophoresis. The final enzyme preparation contained acetate: HS-citrate lyase ligase--an acetylating enzyme which converts inactive HS-citrate lyase into enzymatically active acetyl-S-citrate lyase. This enzyme activity was purified 25-fold over the crude extract and seemed to be associated with citrate lyase. Partially purified citrate lyase from Leuconostoc citrovorum contained also its acetylating enzyme. Purified citrate lyases from Klebsiella aerogenes and Rhodopseudomonas gelatinosa were devoid of acetylating enzyme activity. The HS-form of citrate lyase from S. diacetilactis was completely acetylated and hence activated by incubation with ATP and acetate for 25 min at 25 degrees C. The enzyme did not acetylate the HS-lyases from R. gelatinosa and K. aerogenes. In contrast to the citrate lyases from R. gelatinosa and K. aerogenes the enzymes from S. diacetilactis and L. citrovorum showed only a very weak reaction inactivation. It is assumed that this is due to the association of the acetylating enzymes with these lyases.


Charcterization and physiological function of a soluble L-amino acid oxidase in Corynebacterium. A general L-amino acid oxidase (L-amino acid: oxygen oxidoreductase (deaminating), EC(1.4.3.2) has been characterized in Corynebacterium. The enzyme is soluble (MW 130000-140000) and is active with most L-alpha-amino acids but not with aspartate, threonine, proline and glycine. It is subject to substrate inhibition. This amino acid oxidase is induced along with catalase by growth in the presence of amino acids as a nitrogen source and is repressed when ammonium ions are present in the medium. Its probable physiological function is to allow the utilization of amino acids as a nitrogen source.


The uptake of fructose by Pseudomonas putida. Fructose transport was not apparently affected in a number of Pseudomonas putida strains with deranged activity of a common glucose-gluconate uptake system, indicating the existence of an independent fructose uptake system. Fructose uptake by glucose-gluconate uptake mutants was induced by fructose and obeyed saturation kinetics (apparent Km equal 0.3 mM). The fructose uptake system serves to transport glucose in addition to fructose. The entry of fructose into P.putida cells appears to be mediated also by the glucose-gluconate uptake system, as shown by the ability to accumulate fructose of wild type cells grown on glucose, a substrate that induces the glucose-gluconate uptake system but not the fructose uptake system. In addition, fructose was found to be an inducer of the glucose-gluconate uptake system. The physiological significance of these observations is not clear because the fructose uptake system can provide the cell with a high enough internal concentration of fructose to support maximum growth rate on this hexose, as shown by following the growth course of a glucose-gluconate uptake mutants on fructose.


Sex specificity of hormone synthesis in Mucor mucedo. Sex specificity is observed in mating types of the fungus Oucor mucedo with respect to the production of 4-hydroxy methltrisporates (plus mating type) and trisporins (minus mating type), and in the conversion of these metabolites to trisporic acids by the mating partner. These compounds induce zygophores on the opposite mating type only.


Microbial assimilation of hydrocarbons. II. Intracytoplasmic membrane induction in Acinetobacter sp. 1. The induction of intracytoplasmic membranes was demonstrated to occur in Acinetobacter sp. when grown on hexadecane, heptadecane, and hexadec-1-ene. 2. Evidence for a physical relationship between the cytoplasmic hydrocarbon "pools" and the intracytoplasmic membranes is presented. 3. The specificity of cytoplasmic pooling of hydrocarbons and the induction of intracytoplasmic membranes was investigated in relationship to hydrocarbon oxidation. 4. These results suggests that both processes are required for the growth of Acinetobacter sp. on hydrocarbons.


"El duende" and other incubi. Suggestive interactions between culture, the devil, and the brain. The belief in persecution or possession by evil sprits is still popular in Latin American countries. Observations were made on 12 Columbian families who were haunted by 'el duende' (a special kind of imp, goblin, or poltergeist) and other spirits. Interviews elicited a detailed account of events, a demographic and socioeconomic description ofthe families, exploration of the psyhosocial antecedents, and a psychiatric evaluation of individual members of the group regared as key persons. Possible psychodynamic mechanisms are involved in the production of the phenomenon and factors in the successful 'therapeutic'interventions of spiritualist rather than psychiatric or religious healers. The interaction of culture , folk belief, and the brain impaired by lesion or faulty learning appears as the important accountable dimension.


Molybdenum and iron as functional consitituents of the enzymes of the nitrate-reducing system of Azotobacter chroococcum. The roles of molybdenum and iron in the enzymes of the assimilatory nitrate-reducing system from Azotobacter chroococcum have been investigated. 1. By adding 99 Mo-molybdate to a cell culture of A. chrocococcum with nitrate as the nitrogen source, it has been possible to incroporate the radioactive metal into a purified preparation of the enzyme nitrate reductase. 2. When 185 W-tungstate was supplied to a culture medium lacking added molybdate, a 185 W-labelled nitrate reductase preparation with negligible activity could be obtained. This in vivo incorporation of tungsten was competitively hindered by molybdenum. 3. The cellular level of nitrite reductase activity gradually increased in response to the addition of increasing amounts of iron to the culture medium. Under the same conditions, of the level of nitrate reductase activity was not affected.


Observations on a sidewalk ashram.

Observations on a sidewalk ashram. Meetings between an American guru and his followers were observed and 14 of the devotees were interviewed. Virtually all gave histories of chronic unhappiness and unsatisfactory parental relations. On involvement with the guru and a new 'family,' the experienced increased well-being and periods of bliss, and their acceptance of mystic Hindu beliefs was solidified. Factors relating to the devotees' psychological 'lift' are delineated, including ways that the bond to the leader possibly aided them in dealing with inner conflict. Earlier experiences with psychedelic drugs appeared to have influenced many of the subjects to Hinduism and the guru. It is postulated that a psychological characteristic of the devotees is a strong underlying wish for union with a powerful object,and that this bore on their susceptibility to the influence of certain regressive psychedelic experiences.


Sociopathy as a human process. A viewpoint. Case histories of narcotic addicts who also were imprisoned for felony were selected to illustrate some underlying dynamics of Cleckley's so-called psychopath and some principles useful in their management. Often in outpatient settings, such individuals seem to be without anxiety, unable to experience depression, and without motivation for recovery; but in inpatient settings, such deficits appear illusory. Once such chronically sociopathic individuals are prevented from 'running' their resemblance to individuals with severe but thoroughly 'human' and comprehensible personality disorders becomes evident. In treatment, external controls are important. It is vital both to appreciate the contagion of the psychopath's invisible anxiety and to provide such individuals with alternative defenses with which to mitagate their depression. Finally sociopaths must be realistically, but not puntively, confronted with consequences of their behavior.


Facilitation of somatosensory average-evoked potentials in hysterical anesthesia and pain. Psychophysiological inhibition theories of hysterical anesthesia were not supported in a study of habituation of scalp somatosensory average-evoked responses. Facilitation, rather than habituation, was found in responses contralaterial to the affected side with strong tactile stimuli in patients with hysterical heminesthesia or hemihypoesthesia, regional pain, and weakness. We suggest that the increase in response amplitude is related to the unusual congnitive set in these patients. Corticufugal influences on tactile sensory input might be mediated through increasing-excitation in a spinal-gating system.


Changes in attitude toward methadone.

Changes in attitude toward methadone. Staff and client attitudes toward heroin users and toward maintenance and abstient clients were assessed in 1970 and again in 1973. On each occasion there was striking agreement between the ratings made by staff and client groups. Abstinent clients were rated by all groups as significantly more effective and more responsible than either maintance clients or heroin users; maintenance clients were rated as more conservative, self-conscious, and self-effacing than were the other groups. While heroin users and abstinent clients were characterized similarly in the two rating periods, raters in the 1973 survey viewed methadone hydrochloride clients as more passive and less inclined to undertake adult responsibilities than was true of raters in the 1970 survey.


Controlling the abuse of illicit methadone in Washington, DC. Methadone hydrochloride has been found to be medically safe when administered in the setting of a well-organized heroin addition treatment program. The abuse of illicit methadone, outside the therapeutic setting, has aroused considerable controversy, particularly with regard to the public health hazards of primary methadone addiction, overdose, abuse, and childhood poisoning. We attempted to document the nature and extent of these negative aspects of the diversion of methadone into the illicit drug market, using data collected between 1969 and 1974 in the District of Columbia. The data illustrate the severe problems created by the widespread availability of illicit methadone, and document that, with the appropriate controls, the large-scale use of methadone in addiction treatment is feasible with minimum risk of methadone addiction and overdose in the community.


Drinking amid abundant illicit drugs. The Vietnam case. We studied drinking patterns and problems of 451 US Army enlisted men after their return from Vietnam. Before Vietnam, nearly half were regular drinkers and one quarter had drinking problems. Problem drinking declined in Vietnam as opiate use rose sharply; half had tried opiates and 20% were opiate dependent. After Vietnam, opiate use decreased (now less than 2% opiate dependent) and problem drinking again became ascendant. At time of interview, 17% had drunk in an alcoholic pattern at some period in their lives and another 41% had had problems from drinking. The younger men were more likely to have had problems. Alcholism predictors included:becoming intoxicated at an early age; dropping out of school; truancy and expulsion from school; and having a father with a history of alcoholism or arrests.


Physiological and psychological effects of methadone in man. Methadone hydrochloride-maintenance outpatients were compared to abstinent exaddicts on physiological and psychological measures, and to normal subjects on physiological measures. The battery of psychological tests measure cognitive abilities and mental state. Methadone depressed respiration rate below other groups; abstinent subjects had higher heart rates than methadone or control subjects. No other physiological differences appeared. Electroencephalographic spectral analysis disclosed that the location of the alpha peak was at the lowest frequency in the methadone group, next lowest being the abstinent group. Discriminant functions based on a weighted combination of variables (frequencies) successfully distinguished the EEGs of the three groups. Both discriminant analysis and multiple regression analysis indicated that EEG changes were dose-dependent. Methadone subjects performed significantly poorer on several tests of learning and immediate recall compared to absitinent subjects.


Personal violence in infantry combat.

Personal violence in infantry combat. Thirty-one soldiers who had killed while in combat and who had subsequent psychiatric examinations were asked about acts of 'personal violence' in Vietna m (acts against persons at close range judged to be unnecessary from a military point of view.) Fourteen reported engagement in personal violence, while nine others reported witnessing such behavior. In this group, all who reported participation in personal violence had volunteered to serve in Vietnam. Significantly more participants reported killing four or more persons in Vietnam than did nonparticipants, and the participants more frequently had a history of arrest prior to military service. As a group, participants could be distinguished from nonparticipants by the average number of positive items present in each of several groupings of precombat variables. Personal violence in combat results from an interaction of individual, group, and situational factors.


Suicide attempts and recent life events. A controlled comparison. Life events experienced in the six months before a suicide attempt were compared with events for two matched control groups. Suicide attempters reported four times as many events as were reported by subjects from the general population and 11/2 times as many as were reported by depressed patients prior to depressive onset. A substantial peaking of events occurred in the month before the attempt. The excess over general population controls spanned most types of event. That over depressive onset was more selective, and it involved events with threatening implications, including undesirable events, those rated as stressful, and those outside the respondent's control. Unlike depression, suicide attempts were preceded equally by entrances and exits in the social field. Overall, the findings indicate a strong and immediate relationship between suicide attempts and life events.


Genetic determinant of lithium ion metabolism. II. An in vivo study of lithium ion distribution across erythrocyte membranes. A study was conducted to determine if membrane factors, known to influence the distribution of sodium ion (Na) and potassium ion (K), also influence lithium ion distribution. Two groups of sheep with genetically determined differences in their cation concentrations were administered lithium chloride for ten days. The low red blood cell (RBC) potassium ion sheep (LK) had a greater RBC lithium ion concentration than the high RBC potassium ion sheep (HK). In vitro incubation of erythrocytes with lithium chloride also produced substantially different RBC lithium ion: plasma lithium ion ratios similar to those seen in the vivo study. Distribution of lithium ion was generally similar to that of Na ion. It seems that lithium ion distribution may be controlled by the same genetic factors that regulate Na ion distribution.


Diagnostic criteria and five-year outcome in schizophrenia. A report from the International Pilot Study of schizophrenia. Systematic psychiatric assessment was undertaken on 131 patients (the American cohort of the International Pilot Study of Schizophrenia). Nine areas of outcome functioning were assessed five years later at follow-up evaluation on 63% of these patients. An analysis of 66 clinical and demographic variables established that the patients sucessfully followed-up were representatives of the entire cohort. Diagnostic data from initial evaluations and follow-up outcome assessment were used to examine the relationship between diagnostic criteria and outcome in schizophrenia. Applying the criteria for schizophrenic diagnosis defined by Langfeldt, by Schneider, and Carpenter et al failed to define a poor outcome group. No difference in outcome was found when traditional schizophrenic subtypes were contrasted. Overall outcome in 61 patients with conditions diagnosed as schizophrenic was heterogeneous. However, despite overlap, the mean outcome in the schizophrenic cohort was poorer than in the 19 nonschizophrenic patients.


The assessment of social adjustment. A review of techniques. Interest in the community adjustment of psychiatric patients has led to the development of rating techniques for its evaluation. Selection of an appropriate scale for the task should include a review of its item content, anchor points, coverage, method of obtaining information, informant, psychometric properties, precision, cost, scoring, and instructional material. While no scale is without limitations, this report describes 15 currently available scales that meet many of the important criteria for assessing social adjustment and are sufficiently developed to be useful in evaluative research. This review also contains a list of pertinent references to the scales and guide to the literature on behavioral rating scales.


Physostigmine. Its use in acute anticholinergic syndrome with antidepressant and antiparkinson drugs. We reviewed the use of physostigmine in the diagnosis and management of acute toxic psychosis due to drugs with anticholinergic properties. The syndrome of agitation and toxic confusional psychosis associated with peripheral signs of cholinergic blockade is produced by several plant toxins, antispasmodics, ophthalmic preparations, and certain proprietary sedatives, as well as antiparkinson medications, antidepressants, and some antipsychotic drugs. Physostigmine, uniquely among the available reversible anticholinesterase agents, can pass the blood-brain barrier to exert central as well as peripheral cholinomimetic actions to reverse this syndrome. Psychiatrists should make more use of this safe, specific, rapid, and effective treatment for anticholinergic drug toxicity, and should particularly be alert to reversible anticholinergic brain syndromes associated with antidepressants and antiparkinson medications, and even with antipsychotic medications.


Minimal brain dysfunction, stimulant drugs, and autonomic nervous system activity. Autonomic base levels and responsivity to stimuli were investigated in normal and minimally brain dysfunctioned (MBD) children. Continuous recordings of skin conductance, heart rate, skin temperature, and respiration rate were made during rest, at presentation of tones, and when performing a reaction time task. No significant differences in base levels were obtained between normal and MBD children when not taking drugs, but stimulant medication increased skin conductance and heart rate and decreased skin temperature and reaction time. The MBD children were less reactive, autonomically, to all types of stimuli. Stimulant drugs decreased electrodermal responsivity, which was predictable from concurrent changes in base line skin conductance and skintemperature. The MBD performance deficits are not related to lower autonomic responsivity or lower absolute base levels of arousal, but MBD children may perform better at relatively high autonomic base levels.


Sexual attitude reassessment workshops: effect on spinal cord injured adults, their partners and rehabilitation professionals. Five workshops, focused on the sexuality of adults with acquired spinal cord injuries, were offered for rehabilitation professionals and spinal cord injures adults between December 1971 and October 1972 by the University of Minnesota's Program in Human Sexuality and Department of Physical Medicine and Rehabilitation. The fifth workshop was jointly sponsored with the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and included an optional third day on sexual counseling. The objectives of the workshops were to assist the professional to be more helpful with others and the disabled to be more helpful to themselves. These objectives were accomplished by demythologizing sexual behavior, desensationalizing sexual stimuli and aiding the disabled person and professional to come to an understanding and acceptance of the sexuality of themselves as well as others. Preworkshop, immediately postworkshop and follow-up questionnaires evaluated the effects of the seminars upon all participants: disabled, able-bodied, professional and nonprofessional. Of the 76 who returned anonymous questionnaires mailed to the 95 spinal cord injured adults and their partners, 96.0 per cent reported that they were gland they attended, 82.8 per cent stated that they were personally benefited and 90.8 per cent reported that they would recommend the program to others like themselves. Of the 168 signed evaluations, 119 were returned by the professional group. Of 112 indicating that they or their institutions were currently involved in providing sexual counseling and education to the physically disabled, 97.3 per cent reported that the University of Minnesota workshop had given ideas, impetus or form to the current effort. Sexual attitudes and attitude changes in the AAPM&R-sponsered workshop were similar to those measured in participants in other workshops involving medical and seminary students and community members. Further workshops have been planned based upon these results.


Sexual functioning in women with spinal cord injury. The literature on women with spinal cord injury deals primarily with the factors of hormonal function, fertility and delivery.  Unfortunately, information is limited concerning issues which are relevant to the total sexual functioning of these women.  Little is known about potential hazards of contraceptives, the incidence of gynecological problems, the reactivity of vagina and external genitalia during sexual excitement, the nature of orgasmic experience, factors leading to orgasm and responsivity of nongenital erogenous zones.  Sociocultural restrictions on vomen's sexual responsivity and willingness to discuss such issues are considered along with areas for future research,  The authors emphasize the  need to consider the totality of sexual functioning in future research and the need for women professionals to join research teams on this topic.


Negative pressures during swing phase in below-knee prostheses with rubber sleeve suspension. Negative pressures in the small space between the distal stump and the below-knee prosthetic socket were measured during swing phase for a series of nine subjects.  A molded rubber sleeve connecting the prosthesis and the thigh was found to enhance this effect so that suction suspension occurred during the entire swing phase.  Deterioration of the suction occurred when the sleeve was intentionally pierced, and when other suspensions such as a suprapatellar cuff or thigh band were tested.  The findings indicate that the total-contact socket, gel liner and elastic sleeve combine to create suction in the below-knee socket which improves overall comfort and function for the patient in using the prosthesis.


Pneumatic orthosis PILOT STUDY;.

Pneumatic orthosis PILOT STUDY;. The pneumatic orthosis is potentially a substitute or replacement for conventional long-ler and under outer clothing.  Pneumatic tubes are incorporated into the orthosis and may be inflated at will by the patient.  In a preliminary test it was found to be lighter, more comfortable and cosmetically more acceptable than conventional braces.  This paper presents the results of the first pilot study of the orthosis in the United States, conducted by the New York Medical College--Bird S. Coler Hospital Department of Rehabilitation Medicine, using 11 patients with different levels of cord transection.  The orthosis was tested for its effect in the following areas: pulmonary function, blood chemistries to determine calcuyn function and phosphorus metabolic retention or loss; spasticity; urinary tract studies; skin; systemic blood pressure and pulse; physical comfort; and effect of temperature and humidity on patient.  Wearing time was increased daily until a patient tolerated a minimum of one hour of inflation and six to eight hours of deflation comfortably without negative results.  All the patients tested tolerated daily use of the pneumatic orthosis up to six to eight hours with no harmful effect on the skin.  It did not interfere with healing of existing decubiti.  Use of the pneumatic orthosis prevented postural hypotension in all tested cases, facilitated urinary outflow, increased vital capacity and reduced spasms related to postural changes.


Vocational potential assessment.

Vocational potential assessment. Determination of employment potential will become increasingly important in the foreseeable future, largely due to pending Federal legislation which relates to welfare reform.  The heretofore "permanently and totally disabled versus able-bodied" principle in welfare reforms is being abbandoned.  Pending legislative proposals dealing with welfare reform provide for considering physically impaired persons as partially disabled and partially employable simultaneously.  Thus, the need to systematically and effectively assess physically impaired citizens' capacities to participate in the job market will increase.  Unquestionably, rehabilitation medicine in general, and the emerging art and science of vocational evaluation in particular, will contribute much to supplying these services.  While it is widely acknowledged that the vocational potential of physically impaired persons should be evaluated in an organized manner, there are differences of opinion among professional evaluators as to which approach, or approaches, are the most meritorious;  The four principal approaches are: (1) mental testing, (2) work sampling, (3) situational analysis, and (4) job tryouts.  Each of these approaches is explained, contrasted, and evaluated in this paper.


Carcinoid tumor metastatic to neck.

Carcinoid tumor metastatic to neck. A 50-year old woman was admitted with a mass in the anterior triangle of the neck. Because of interpretation of a needle biopsy specimen as undifferentiated adenocarcinoma, a radical excision of cervical lymph nodes was performed and the specimen showed metastatic adenocarcinoma suggestive of carcinoid tumor. Four months later the patient developed an abdominal mass that turned out to be large mesenteric lymph nodes involved in carcinoid tumor, the primary lesions being in the terminal ileum. Following resection of all visible tumor, the patient has remained symptomatically and chemically well for 15 months. No previous case of carcinoid tumor metastatic to the neck can be found.


Axillary-axillary bovine arteriovenous fistula for hemodialysis. A preliminary evaluation of bovine carotid artery heterografts as axillary-axillary arteriovenous fistulas suggests that this graft may be an easily constructed and easily utilized portal for hemodialysis cannulation. At present, this fistula should be reserved for use when all other commonly employed peripheral sites and methods of constructing arteriovenous fistulas have been exhausted.


Leiomyosarcoma of a vein: survival for six years. A 7-year old girl with leiomyosarcoma of the femoral vein is alive without evidence of recurrence six years after radical resection. This is, to our knowledge, the longest survival recorded of a patient with this condition.


Sclerosing cervicitis: homologue of sclerosing retroperitonitis and mediastinitis. The first known case of an invasive, sclerosing fibrosis of the deep soft tissue of the neck is presented. The morbidity, clinical course, and, most importantly, pathological identity with sclerosing retroperitonitis and sclerosing mediastinitis led us to consider this lesion as the cervical homologue of these lesions, ie, sclerosing cervicitis.


Primary internal fixation of femoral neck fractures. The principles in treatment of femoral neck fractures by primary internal fixation have been reviewed. In the rare, undisplaced stress or fatigue fracture, early internal fixation with threaded pins is recommended. Impacted fractures should be treated by primary internal fixation in patients who do not follow orders and patients whose general condition is poor and would require early weight bearing. Displaced fractures may be treated by primary internal fixation at any age and regardless of the patient's general condition. The following principles are emphasized: early operation, anatomical reduction and slight valgus in some cases, compression and impaction of fragments, and firm immobilization of fragments with a device that has a sliding mechanism and provides lateral cortical fixation.


Primary prosthetic replacement for femoral neck fractures. Treatment of displaced femoral neck fractures remains a problem. Routine prosthetic replacement is controversial. Review of 100 patients treated at the Campbell Clinic from 1957 to 1966 suggests that 60% long-term good results can be anticipated at a cost of 5% mortality and 25% morbidity. We believe prosthetic replacement probably should be restricted to (1) those patients admitted for treatment late or those in whom previous internal  fixation has failed, (2) elderly patients whose fracture cannot be reduced closed, and (3) patients with special circumstances such as pathologic fractures, seizure disorders, Parkinsonism, and so on.


Treatment for fixation complications: Femoral neck fractures. Of 102 hips with femoral neck fracture complications, 75 required major secondary procedures such as total hip replacement, femoral prosthesis, cup arthroplasty, tibial bone grafting, and head and neck resection. The method chosen depended on the specific problem: nonunion, aseptic necrosis, infection, degenerative arthritis, or a failed primary prosthesis. Other factors influencing treatment were the patient's chronological and physiological age, his general health, his life pattern, and the familiarity of the surgeon with the technique and the advantages and disadvantages of the various salvage procedures.


Intertrochanteric fractures. The role of complications of fixation. A review was made of 244 intertrochanteric fractures of the hip. The complications of fixation were examined; nail penetration, plate separation, or bending or breaking of the device. Factors associated with fewer such complications were (1) stable (noncomminuted) fractures, (2) nails that can accomodate to varus, (3) placement of the nail tip more than 10 mm from the subchondral cortex of the femoral head, (4) valgus reduction of the fracture, and (5) high osteoporosis grade (denoting less osteoporosis). Neither medial displacement osteotomy nor exact anatomic reduction of unstable fractures improved resuts. In most patients, complications of fixation did not adversely influence the clinical course measured in terms of altered walking capacity, need for secondary surgery, or residual hip pain.


Subtrochanteric fractures of the femur.

Subtrochanteric fractures of the femur. Subtrochanteric fractures of the femur comprise only 5% to 7% of hip fractures, but are important because of the difficulty in management. They combine the problem of instability to varus deformation common to comminuted intertrochanteric fractures and the problem of delayed union common to diaphysial fractures of the femur. While the benefits of open reduction and internal fixation in decreasing morbidity and mortality have been well established, formidable operative complications have occurred when this fracture is treated like an intertrochanteric fracture. Improved results have been obtained by utilizing a fixation device that can control the intertrochanteric instability and that has sufficient strength to withstand deforming forces that may be present for up to a year while the fracture is uniting. Bone grafting has been found very useful in shortening the overall period of healing.


Noninvasive study of extremity perfusion by potassium 43 scanning. In nine patients with lower extremity symptoms of arterial insufficiency, potassium chloride K 43 was injected intravenously during rest, reactive hyperemia, or exercise. Decreased radioactivity in muscle tissue was observed to correspond with symptoms, physical findings, Doppler ultrasound pressures, and angiographic findings in all six who had the procedure. Studies following surgical endarteractomies in two, a bypass procedure in one, and exploration without attempted reconstruction in one showed good correlation with postoperative symptoms, physical findings, and pressure measurements using Doppler ultrasound in three of four patients. The fourth patient showed no change on the postoperative study despite clinical imporvement. These findings suggest that intravenously administered radioactive potassium provides a noninvasive means for demonstrating the perfused muscle mass of the extremities with delieation of ischemic areas. The risk of arterial puncture is eliminated, and the ability to visualize perfusion patterns during exercise is unique to this method.


Axillary hidradenitis.

Axillary hidradenitis. The magnitude of the social, economic, and medical problems confronting patients with chronic suppurative axillary hidradenitis is not generally recognized. Nonoperative treatment is disappointing. Total excision of all apocrine-bearing axillary tissue with primary closure is the treatment of choice. Operative treatment can be safely accomplished even when draining sinuses are present. Twenty-six patients representing 47 operated axillae are presented.


Retrograde aortic perfusion by partial cardiopulmonary bypass: effect of mixing on measured arterial oxygen tension. Partial venoarterial bypass with return of oxygenated blood to the femoral artery can produce mixing in the aorta of the blood from the oxygenator and left ventricular sources at flow rates of less than 50% of the total body flow. This was observed in six anesthetized sheep with normal lungs maintained on controlled ventilation on partial cardiopulmonary (venoarterial) bypass. The evidence of mixing increases with the extracorporeal flow rate, reaching the aortic arch in a majority of cases at the higher rates. Management of bypass and the interpretation of its effects depend on definite knowledge of the presence or absence of mixing. Partial bypass will raise the arterial oxygen tension (Pao-2) of the blood continuing to flow through the lungs. This effect is independent of mixing (Pao-2) and may be related either to the addition of oxygen to the blood or to an enhanced pulmonary ventilation-perfusion relationship.


Operative choice and technique following pancreatic injury. During a five-year period, 50 patients were operated on for pancreatic injury. Forty had open trauma and ten closed. Half of each group were treated by drainage alone. Overall mortality was 14%, with all deaths following open injuries due to gunshots. Deaths were more frequent after drainage than after resection. Substantial complications occurred in 70%, with more frequent amd more serious morbidity in drained patients. Sump drainage was associated with less morbidity than Penrose drainage. Guidelines for management of pancreatic trauma are (1) resection of sinistral gland for perforating injuries of the body or tail; (2) drainage of perforations of the pancreatic head when the major duct is intact; (3) resection of duodenum and pancreatic head for devitalizing injury of both structures.


Type of compression for reducing venous stasis. A study of lower extremities during inactive recumbency. Determination of the optimal compression to reduce venous stasis was studied in terms of the amount of pressure and manner of application (graded or uniform pressure). Both lower extremities of seven inactive recumbent subjects were tested using transcutaneous Doppler ultrasonic measurement of femoral vein blood flow velocity. Optimal compression was defined as the externally applied pressure that produced the greatest increase in femoral vein flow velocity consistent with safety and the practicality of hospital use of elastic stockings. Optimal compression for elastic stockings to be used by hospitalized patients who spend substantial time in bed should be 18 to 8 mm Hg (ankle to midthigh). At this compression, average femoral vein blood flow velocity is increased to 138.4% of base line. Gradient compression at this level was found to produce a greater femoral vein flow velocity than the same amount of compression distributed uniformly over the lower extremity.


Venous atherosclerosis associated with arteriovenous fistulas for hemodialysis. In two patients, venous loops fashioned into arteriovenous anastomoses for long-term hemodialysis developed gross irregularity and narrowing of the lumen. Histological and ultrastructural examination of the affected vein in one patient revealed atherosclerosis similar to that that develops in the anastomosed veins of experimental arteriovenous fistulas in sheep. The second patient, with angiographically similar changes in the venous loop, developed on aneurysm followed by thrombotic occlusion of the arteriovenous fistula. The development of venous atherosclerosis in these patients was analogous to that in the experimental animal, and was attributed to local hemodynamic stresses in the vein associated with the shunt.


Routine intraoperative angiography. An essential adjunct in vascular surgery. Intraoperative angiography was performed during a variety of 155 arterial reconstructive procedures including bypass, endarterectomy, embolectomy, thrombectomy, primary reconstruction, and angioplasty. In 27 or 17% of these cases, defects were identified that could be corrected. These included technical errors at the suture line, accumulation of platelet thrombus and atherosclerotic debris, or unrecognized lesions in the runoff. The likelihood of identifying such lesions is greatest in patients undergoing bypass surgery, particularly when the distal anastomosis involves one of the leg arteries. Routine use of intraoperative angiography as an adjunct to vascular surgery is justified and will help to obviate many early graft failures.


Lateral knee compartment osseous pseudoligamentous instability. Five occurrences of intra-articular lateral knee compartment osseous pseudoligamentous instability associated with three cases of fractures of the posterior lateral femoral condyle are reported. The instability being located within the knee joint region was termed false in that it was due to fracture instability rather than the usual ligamentous, or true, instability. The main clinical diagnostic guide to this type of instability was a positive manual straight-knee adduction snap-click test that consisted of an initial snap followed in sequence by a click on release of adduction. The positive adduction snap-click test is an adjunct to the roentgenographic recognition of lateral knee compartment osseous pseudoligamentous instability.


Canine kidney preservation for 24 to 72 hours. Use of intracellular-like perfusate. For universal application and usefulness, methods of renal preservation need simplification. Recent studies using initial brief perfusion with, and storage in, an intracellular, hyperosmolar type of perfusate have suggested the feasibility of this simple method. In the present study, 49 nephrectomized dogs received 16, 19 and 14 renal autografts preserved for 24, 48, and 72 hours, respectively, by this simple method. Long-term survivors in the three groups were seven of 16, ten of 19, and seven of 14, with return to normal or near-normal function. This method of preservation offers promise for wide clinical application in the near future.


Renal trauma. Treatment by angiographic injection of autologous clot. The safety of treatment of renal hemorrhage from trauma with angiographic injection of autologous clot was investigated in rats by demonstrating the effect of various sizes of clot emboli on renal survivial. A large amount of clot injected into the entire distal part of the renal arterial tree (equivalent to 20 cu cm in the human) was required to produce a 15% infarction. This large safety range is possibly due to the endogenous fibrinolytic capability of normal vascular endothelium.


Myocardial perfusion and metabolism at normothermic and hypothermic levels. Changes in intramyocardial carbon dioxide tension (Pco2) and arterial oxygen tension (Po2) were recorded in dogs with a mass spectrometer after temporary occlusion of the aorta and the proximal part of the anterior descending coronary artery at normothermic and hypothermic levels. Patterns of hypoxic and hypercapnic changes and their recovery were favorably modified with moderate hypothermia. Deep levels of hypothermia seemed to enhance this protective effect and progressively slow the myocardial metabolism. Occlusion of the proximal part of the anterior descending coronary artery for 30 minutes had a regional effect similar to the general myocardial changes recorded after aortic clamping, while the posterior myocardial probe showed stable control values. These data support previous studies showing that moderate hypothermia halves the oxygen consumption and doubles the "safe" period of anoxic arrest.


Malignant lymphoma of the jejunum in a patient with Wiskott-Aldrich syndrome. Surgical treatment. An 8-year-old boy with Wiskott-Aldrich syndrome underwent laparotomy and resection of a stage 1E malignant lymphoma of the jejunum. Although preoperative platelet counts were less than 10,000/cu mm, intraoperative bleeding was minimal, and postoperative bleeding from the wound was easily controlled with platelet infusions and local application of epinephrine. Six weeks later, he underwent reoperation for small intestinal obstruction and no residual tumor could be identified. The patient died 4 1/2 months following the initial surgery from an intracerebral hemorrhage. Postmortem examiniation did not reveal residual lymphoma.


Competency test after fundoplication for treatment of reflux esophagitis. A simple competency test has been devised that will establish the adequacy of a Nissen fundoplication at the operating table. Saline, 250 ml, is instilled into the stomach through a nasogastric tube and then the nasogastric tube is withdrawn to above the level of plication. The pylorus is occluded and the stomach compressed. If the cardia is competent, no saline can be aspirated from the esophagus. Ten patients studied immediately after the opening of the abdomen showed regurgitation by this test, whereas no regurgitation could be produced in 30 patients studied immediately after completion of the fundoplication.


End-to-side splenorenal shunt for treatment of portal hypertension. Twenty-eight patients with portal hypertension were treated with splenectomy and end-to-side splenorenal shunt. Nineteen had cirrhosis and nine had portal vein thrombosis. Among the patients with cirrhosis, there was one hospital death due to recurrent bleeding in a patient in whom shunt could not be constructed and only splenectomy was done. During the follow-up period, one patient developed encephalopathy and later died of liver failure. There were three additional deaths, one due to an unrelated causes and two due to liver failure. All the remaining patients are well and none has had recurrent bleeding. All the patients with portal vein thrombosis survived the operation and are well. None has had recurrent bleeding. Encouraged by these results, we continue to use end-to-side splenorenal shunt in all patients except small children.


Perfusion of ischemic ulcers of the extremity: a prognostic indicator of healing. Forty patients with an ischemic ulcer of the lower extremity had peripheral vascular perfusion studies, performed with intra-arterial injections of aggregated technetium Tc 99m serum albumin microspheres (15mu to 30mu in diameter), in an attempt to develop an objective prognostic criterion for healing. The association between ulcer healing and the presence or absence of diabetes mellitus, palpable peripheral pulses, and patent trifurcation vessels on the arteriogram was reviewed and no association was noted. When, however, there was a relative hyperemia of the ulcer bed in comparison to the adjacent tissue of at least 3.5:1, as determined by counting the amount of radioactivity per unit area, 86% of patients went on to heal their ulcers. In those without this degree of hyperemia, only 11% were healed with conservative nonsurgical management. The results have shown that relative hyperemia of the ulcer bed is a clinically useful prognostic indicator in the patient with ischemic ulcer disease.


Hypophysectomy in metastatic breast cancer. Experience with 50 women undergoing extracranial transethmoidal-sphenoidal hypophysectomy for metastatic breast carcinoma with 12-month follow-up showed an objective remission of metastases after hypophysectomy in 58% of patients. The highest incidence of remission following the operation occurred in those women with only osseous metastases (83%) or with previous remission to both therapeutic oophorectomy and androgen administration (86%). No patient with primary central nervous system metastases, only one of ten with hepatic metastases, and none who had failed to respond to both oophorectomy and exogenous androgen administration experienced remission after hypophysectomy. The operative approach to the pituitary was via a periorbital incision, the posterior ethmoid cells, and the sphenoid sinus. Cerebrospinal fluid rhinorrhea occurred in three early patients, and has been successfully avoided in later ones by a fascia lata graft. Diabetes insipidus, seen in 13 patients, and extraocular palsies, seen in two, were transient.


Compensatory hypertrophy of the ileum after gastroduodenojejunal exclusion. One theory of compensatory hypertrophy of the gut suggests that ileal growth after jejunectomy results from exposure of the ileum to villus-enlarging factors emanating from the papilla of Vater. This hypothesis was tested by examination of the ileum after bypass of pancreatobiliary secretions to the colon. Hypertrophy of the ileum occurred after esophagoileostomy and gastroduodenojejunal exclusion, suggesting that adaptive growth of the gut depends on additional factors. There is evidence to support several theories of compensatory hypertrophy. A hypothesis seeking to reconcile the conflicting notions of intraluminal and hormonal stimuli is suggested.


Hamartomatous polyp of the esophagus.

Hamartomatous polyp of the esophagus. Hamartomatous polyp of the cervical esophagus in a 60-year-old man was treated by local resection, and the patient did well. The histopathologic findings showed a predominance of cartilaginous tissue, but the specimen also contained glandular structures and adipose tissue. The diagnosis was choristoma or hamartoma. Review of the literature shows this to be the third case reported.


Control of arteriovenous fistula of splenic vessels by Fogarty catheter. A large arteriovenous fistula of the splenic vessels was identified by angiography. A splenic-artery-to-splenic-vein fistula developed shortly after a staging procedure for Hodgkin disease. A second surgical procedure failed to adequately control the arteriovenous communication. Intra-arterial obliteration of the fistula was accomplished by use of a Fogarty catheter.


Liver failure after jejunoileal shunt.

Liver failure after jejunoileal shunt. Reports of fatty infiltration of the liver following jejunoileal shunt for obesity and hyperlipemia are frequent. Cases of overt liver failure, in contrast, are rare and poorly documented following the various types of small bowel bypass. Fifteen months after jejunoileal bypass, a 41-year-old nonalcoholic woman whose preshunt liver function was chemically normal was found to have morbidly abnormal liver chemistry values. A biopsy examination demonstrated severe fatty metamorphosis bordering on frank cirrhosis. Reversal of her shunt led to return of her liver chemistry values to normal and reversal of the morphologic changes noted at biopsy examination. Close follow-up of patients subjected to small bowel bypass for obesity or hyperlipemia is mandatory. If liver function abnormalities persist for more than six months, strong consideration should be given to reversal of the shunt.


Detection and localization of intra-abdominal abscesses by diagnostic ultrasound. In four patients, intra-abdominal abscesses were identified by ultrasonic technique: a right lower quadrant abscess in Crohn disease, a pyogenic liver abscess, a pelvic abscess following rejection and removal of a transplanted kidney, and a perinephric abscess. In all four the establishment by ultrasound that the mass was filled with fluid was critical in guiding drainage. Diagnostic ultrasound is a safe and effective means for the detection, localization, and characterization of retroperitoneal, intraperitoneal, or intraparenchymal inflammatory masses.


Weaning from mechanical breathing with intermittent mandatory ventilation. Intermittent mandatory ventilation allows a gradual transition from mechanical ventilation to spontaneous breathing. This is accomplished by providing a continuous source of fresh gas from which the patient can breathe as ventilator rates are decreased from 1 to 2 per minute. Monitoring of arterial blood gas tension values documents the safety of further withdrawal of ventilatory support. Many patients are more easily and safely weaned by this method than by conventional techniques.


Increased platelet aggregability in young patients with stroke. Diagnosis and therapy. Four patients ages 20 to 38 years had repeated cerebrovascular occlusions. Three of the four patients had vascular headaches (classical migraine in two) for some years before their first occlusive event occurred. When first seen at the time of their major cerebrovascular occlusion, all had evidence of plasma hyper-coagulability, and two of the women were receiving birth control pills. Many months later, while off the "pill" and on warfarin sodium (Coumadin) therapy, two women and one man continued to have new cerebrovascular symptoms. For the first time, their platelet aggregability was tested to several biological substances known to come in contact with platelets in vivo. At this time, all four patients were found to have platelet hyperaggregability. The three symptomatic patients also had a shortened platelet survival time. Long-term management of these patients with chronic platelet aggregability and chronic plasma hyper-coagulability is described.


Interaction between dopamine and phospholipids. Studies of the substantia nigra in Parkinson disease patients. Interaction between dopamine and phospholipids was studied in the substantia nigra of ten patients with Parkinson disease and nine control subjects. There were no differences in the total content of phospholipids. However, in parkinsonian patients without previous levodopa treatment, the amount of sphingomyelin was increased and the amount of phosphatidylethanolamine and phosphatidylcholine decreased. Levodopa treatment corrected these values to the level of controls, whereas the amount of phosphatidylserine was decreased. It is concluded that changes in phospholipids are reflections of the deficiency of dopamine and loss of dopaminergic neurons in the substantia nigra of patients with Parkinson disease.


Schwann cell internuclear distances in developing rat unmyelinated nerve fibers. The interrelation of Schwann cells in developing rat cervical sympathetic trunk was studied by measuring distances between consecutive Schwann cell nuclei in teased unmyelinated nerve fiber bundles (Remak fibers). From 300 to 400 inter-nuclear Schwann cell distances (INDs) were measured at ten days and 2, 4, 5, 6, 8, 12, and 16 weeks after birth. Median INDs increased from 54mum at ten days to reach adult values (90mum to 100mum) at 16 weeks of age. Mean axonal diameters measured in the contralateral cervical sympathetic trunk increased from 0.57mum to 0.69mum during the same period. Developmental changes in median INDs of Schwann cells correlated significantly with age but did not parallel increases in axonal diameter.


Herpes simplex encephalitis. Prognosis and long-term follow-up. Electroencephalograms (73) of 11 patients with confirmed herpes simplex encephalitis were recorded. Based on serial recordings it was seen that the repetitive complexes could be recorded at any time of the illness; they were associated with a fatal outcome. The repetitive complexes were absent in all patients who survived. Long-term follow-up of the surviving patients shows spike discharges, which were transitory and not associated with clinical signs in three of them, with a return to normal rhythmic activity. It is proposed that the EEG may be used as a prognostic sign in herpes simplex encephalitis.


Transient ischemic attacks due to atherosclerosis. A prospective study of 160 patients. Patients with transient ischemic attacks (TIAs) due to atherosclerosis were studied by aortocranial arteriography. Onset of TIAs was before age 55 in 24% and between 55 and 64 in 47%. Men exceeded women by two to one. Of 160 patients, 77 were treated medically and 82 surgically. Five died in the immediate postoperative period. In the survivors, mortality has been the same in the medically and surgically managed groups. For patients with multiple lesions, surgical reconstruction of the carotid arteries was associated with very high surgical risk. In the medically treated group, anticoagulant therapy reduced the frequency of TIAs, but did not appear to protect patients from stroke. Mortality was 23% at four years, 57% of deaths being attributable to myocardial infarction and 38% to stroke.


Levodopa-induced postural hypotension. Treatment with fludrocortisone. Six parkinsonian patients with symptomatic postural hypotension secondary to levodopa therapy were treated with 0.05 to 0.2 mg of fludrocortisone acetate daily for six to ten months. Severe orthostatic light-headedness and frequent syncope had previously been alleviated only be reducing the dosage of levodopa to levels producing less than optimal antiparkinsonian benefits. In all six patients, symptoms were alleviated satisfactorily, and supine and upright blood pressures returned to normal levels during treatment with fludrocortisone acetate. There were no adverse reactions. Fludrocortisone acetate is an effective and safe drug for the treatment of severe and otherwise intractable postural hypotension secondary to therapy with levodopa.


The long-term effects of callosal sectioning. Report of a second case. Testing a patient 32 years after callosal sectioning revealed defects in transfer of learning and crossed (mixed modality) matching. This points out that defects may persist long after such surgery and that early reports of negative results of callosal section in patients were probably not correct.


Reflex epilepsy evoked by decision making. A patient had seizures while playing chess or cards or when filling out complex forms, doing complex mathematical problems, and during certain parts of the neuropsychological testing. Seizures were myoclonic and accompanied and electroencephalographic dysrhythmia of the atypical spike and wave type. Evoked seizures were not related to visual, tactile, or auditory stimuli or clues. In chess, seizures occurred when he was on the defense and threatened. Simple decision making or physiologic stress did not evoke seizures nor did nonsequential decision making under verbal pressure. Evoking factors were complex decision making in a sequential fashion and with an element of stress or concern regarding the outcome of the decision making. Stimulus was usually nonverbal. Three major factors--decision complexity, sequential factor, and related stress or concern--may have some reciprocal relationships.


Sleep attacks--apparent relationship to atlantoaxial dislocation. Sleep attacks, while being characteristic of narcolepsy, have been reported in several metabolic and central nervous system disorders--most of which are refractory to treatment. We have recently treated a 47-year-old man with disabling sleep attacks who was found to have atlantoaxial dislocation. Despite narrowing of the sagittal cervical canal diameter to 12 mm (behind the dens), symptoms of spinal cord compression were mild and intermittent, while signs were absent. Posterior fusion of the C-1 and C-2 vertebrae resulted in relief of symptoms. We suggest that this sleep disorder was a function of impaired efferent control of respiration.


Cardiac monitoring and demand pacemaker in Guillain-Barré syndrome. Life-threatening alterations of respiratory and cardiovascular functions may complicate the course of severe Guillain-Barre syndrome. Cardiac arrest, fore-warned by episodes of bradycardia or other arrhythmia, may occur despite adequately assisted respirations. A patient with Guillain-Barre syndrome required tracheostomy and ventilatory assistance. Continuous cardiac monitoring revealed that tracheal aspiration provoked an idioventricular rhythm of 40 beats per minute, which reverted to sinus rhythm after the procedure. To prevent cardiac arrest during the transition from idioventricular to sinus rhythm, a demand pacemaker was inserted into the right ventricle. Set to activate if the rate fell below 65 beats per minute, the pacemaker functioned both during and between tracheal aspiration procedures. Cardiac monitoring in severe cases of Guillain-Barre syndrome may detect potentially lethal arrhythmias that may then be avoided by a demand pacemaker.


Acute and chronic hyperosmolality. Effects on cerebral amino acids and energy metabolism. Acute and chronic elevations in osmolality were induced in rats and mice. After 48 and 96 hours of hyperosmolality, rat brain glutamine concentration increased to between 210% of control. This increase may account for 20% of the previously postulated idiogenic osmols that enable the brain to resist volume changes. Cerebral metabolic rates were reduced in the brains of mice made acutely and chronically hyperosmotic in spite of normal levels of adenosine triphosphate and phosphocreatine.


Invasive squamous cell carcinoma of the conjunctiva. In cases of invasive conjunctival squamous cell carcinoma, three cases of deep corneal invasion and two cases of intraocular extension were found. Four cases showed orbital invasion, and one patient died of generalized metastases 18 months after diagnosis. The relatively low-grade nature of these lesions and their potential for local treatment is noted, but it is emphasized that careful clinical examination and close cooperation with the pathologist to ensure adequate evaluation of excised tissue are essential.


Corneal contact times of ophthalmic vehicles. Evaluation by microscintigraphy. Lacrimal microscintigraphy, in conjunction with a recently developed computer system, was used to evaluate the corneal contact time of three ophthalmic vehicles in 18 humans. The percentage of a radioactively labeled vehicle remaining over the cornea after 90 seconds was 2.9% plus and minus 2.2% for saline, 4.3% plus and minus 2.4% for polyvinyl alcohol, and 8.8% plus and minus 4.1% for hydroxypropyl methylcellulose.


Infrared angiography of the cat fundus oculi. Infrared absorption angiograms of the cat fundus were obtained by regional arterial injection of indocyanine green. There was better resolution of the retinal circulation than that obtained by intravenous injection, but in the choroid only choriocapillaris filling was seen.


Polymer adsorption at the ocular surface. A new method for measuring ocular adsorption of polymers in solution and their resistance to removal by rinsing has been developed. The adsorptive properties of artificial tear solutions and mucin have been determined. Several solutions display properties similar to mucin and two seem to resist removal by rinsing.


Septo-optic dysplasia associated with see-saw nystagmus. Septo-optic dysplasia is a syndrome of midline abnormalities of the central nervous system resulting in absence of the septum pellucidum and dysplasia of the optic chiasm or optic nerves. The characteristic fundus findings of small, dysplastic discs and defects in the nerve fiber layer enable the clinician to predict this syndrome prior to contrast studies. An unsual form of nystagmus, see-saw nystagmus, was associated with septo-optic dysplasia in this case report.


In vivo photomicrography of the corneal endothelium. A technique and apparatus for observing and photographing the corneal endothelium in vivo at a magnification of approximately times 200 is described. The method is suitable for animal experimentation and for diagnostic observation and clinical research in humans.


Marfan-like syndrome with lens involvement. Hyaloideoretinal degeneration with anterior chamber angle, facial, dental, and skeletal anomalies. An autosomal dominant syndrome with Marfan-like features was found in a black pedigree. Eye findings included cataract, lens colobomas, dislocated lenses, myopia, hyaloideoretinal degeneration, and abnormalities of the anterior chamber angles. Facial and dental anomalies included slightly underdeveloped bridge of the nose, protruding maxilla, and dental malocclusions. Selected members of this pedigree showed dolichestenomelia or arachnodactyly or both. Good visual prognosis resulted after (1) cataract or dislocated lens surgery and (2) prophylactic therapy of retinal holes and degeneration.


Metaplastic cartilage in nondysplastic kidneys. Four hundred ninety-seven patients representing the 525 total or polar nephrectomies performed at the Children's Memorial Hospital from 1938 to 1973 (excluding 1947), were reviewed retrospectively to determine the incidence and characteristics of renal dysplasia. The 46 specimens with this histologic diagnosis all exhibited typical primitive ducts with 13 being also associated with cartilage formation. In five patients, kidney showed focal chondrous metaplasis of the interstitium in association with chronic inflammation but without primitive ducts. The findings strongly suggest that the renal interstitium occasionally may react to injury by chondrous metaplasia and that, in the absence of primitive, ducts, cartilage in the kidney is not pathognomonic of renal dysplasia.


Radiation effects on pig skin. Exposure to different densities of ionization. The effects on pig skin from radiations producing different densities of ionization have been determined. For the qualities of radiation employed, erythema was produced at a dose range from 1,240 to 3,440 rads and ulceration at 1,250 to 5,000 rads. In no instance did a radiation-induced neoplasm develop. In determining dose response, two of the most important physical parameters, associated with time of appearance and extent of lesions, were found to be the size of the area irradiated and the density of ionization of the radiations used. These data, on normal tissue tolerance, should be a value in future programs initiated in experimental radiation therapy of both animal and human neoplasia utilizing protons, alpha particles, and carbon ions.


The liver in GM1 gangliosidosis types 1 and 2. A light and electron microscopical study. The livers from two cases of GM1 gangliosidosis types 1 and 2 were examined by histochemistry, light and electron microscopy. Type 1 GM1 gangliosidosis is characterized by large amounts of a water soluble substance in the hepatocytes, presumed to be keratan sulfate-like mucopolysaccharide, with similar material and probably a ganglioside in the Kupffer cells. In type 2 GM1 gangliosidosis, there is minimal storage of water soluble material and abundant presumed ganglioside in the Kupffer cells. The histochemical and ultrastructural features support the chemical findings and indicate a quantitative and morphologic difference in storage between the two types. These morphologic differences may provide an additional diagnostic parameter in the delineation of the two clinical variants.


Distribution of coronary arterial flow in acute myocardial ischemia. Thioflavin S (TS), a fluorescent dye, was used to visualize the distribution of coronary flow within the area of ischemia produced by circumflex artery occlusions. In the ischemic region, TS failed to penetrate the subendocardium and was seen in the subepicardium. Even though collateral flow was noted in the subepicardium, studies with methylene blue showed that it was inadequate to prevent the development of ischemia. The proportion of the posterior papillary muscle and subjacent myocardium showing TS nonfluorescence was similar after 15 and 60 minutes of ischemia and correlated with maximum lead II ST segment elevation and the percent of grossly injured myocardium found at 60 minutes postocclusion. The results suggest that flow to ischemic myocardium is reduced to the greatest extent in the subendocardium, ie, the site where irreversible injury first appears.


Fatal infectious mononucleosis. Association with liver necrosis and herpes-like virus particles. A 20-year-old woman died of infectious mononucleosis associated with extensive hepatic necrosis with herpes-type inclusions within nuclei of remaining liver cells. Electron microscopical examination of these liver cells showed intranuclear and occasional intracytoplasmic herpes-like virus. This case supports the concept that a herpes-like virus, or a structurally closely related agent, is the etiological agent of infectious mononucleosis.


Comparative toxicity of cadmium-metallothionein and cadmium chloride on mouse kidney. Cadmium-induced metallothionein may have a paradoxical role in the pathogenesis of cadmium toxicity. Mice are protected from cadmium-induced testicular necrosis by metallothionein, but in this experiment it was shown that cadmium-metallothionein complex injected into mice results in higher cadmium levels in renal cortex and more severe renal tubular cell injury than a comparable dose of cadmium chloride administered by the same route. Also, an injection of 1.1 mg/kg of body weight or more of cadmium bound to metallothionein was fatal to male CGA mice within seven days whereas five times this dose of cadmium administered as cadmium chloride was needed to produce a similar effect. A reason for the difference in renal effects of these two forms of cadmium has not been determined but may be related to differences in absorption or transport by renal tubular lining cells.


Malacoplakia in childhood. Case report with ultrastructural observations and review of the literature. Malacoplakia involving the adrenal gland and colon was found in a 6-week-old infant. To our knowledge, this is the first reported instance of adrenal involvement and it occurred in the youngest patient described to have malacoplakia. The adrenal gland was the site of a previous hemorrhage. Ultrastructurally, the cytoplasm of the malacoplakia cells contained numerous granular inclusions within which were tetrad-shaped particles resembling ferritin. A thorough search failed to show the presence of any bacteria. Several recent papers have suggested that malacoplakia represents a morphologic manifestation of altered host macrophage response and that Gram-negative enteric bacilli are the usual specific etiologic agents. The pathologic findings in the present case raise the possibility that the lesion in this instance represents an altered macrophage response to extravasated erythrocytes alone or to erythrocytes and bacteria.


Oncocytoma (mitochondrioma) of the parotid gland. An electron microscopical study. Electron microscopical study of an oncocytoma of the parotid gland disclosed the presence of two cell types, typical oncocytes and condensed oncocytes. The typical oncocyte contains abundant mitochondria that were tightly packed almost completely filling the entire cytoplasm. Only small areas were left for the remaining cytoplasmic organelles. The nuclei in these typical onocytes appeared oval or spheroid. Condensed oncocytes were scattered singly or in nests in tumorous tissue. These cells were also replete with mitochondria, but differed, however, in that many mitochondria showed evidence of degeneration and fusion. Nuclei of these cells were irregular, dense, and contained inclusions and glycogen granules. The relationship of nuclear envelopes to mitochondria and other cellular components has been described previously, but to our knowledge, this represents an original finding in the case of an oncocytoma.


Lymphoid "hypophysitis" with end organ insufficiency. A clinically hypothyroid patient had bi-lateral adrenal cortical atrophy and an extraordinary lesion of the pituitary gland. The parenchyma of the adenohypophysis was extensively replaced by a predominantly lymphocytic infiltrate with formation of nodules, many of which had pale germinal centers. There were areas of hyalinization with interstitial fibrosis and mildcapsular thickening. A similar lesion of the adenohypophysis has been reported previously, but without the evidence of adenohypophyseal insufficiency present in this case. It is speculated that this lesion may be related to cell-mediated autoimmunity and other organ-specific autoimmune disorders.


Effect of a general aviation trainer on the stress of flight training. Sixteen students were given flight training according to a highly standardized and rigidly controlled 35-h syllabus. Eight of the group (TG) recieved 10 h of their training in a Link GAT-1 ground trainer and 25 h in a Cherokee 140B. the other eight (AG) recieved all of their training in the airplane. The resting heart rate (HR) of group TG was significantly lower when the ground trainer was to be used than was the resting HR of group AG on equivalent lessons. The difference disappeared when group TG was to fly the airpland. In flight, group AG'S HR was significantly higher than group TG's in the ground trainer. Again the difference disappeared when group TG flew the airpland. Physcial work, as indicated by O2 consumption, was greater in the airplane than in the ground trainer. Urine chemistry indicated only a few and inconsistent points of significant differece between the groups. However, pre- and post-flight differences showed highly significant differences for both TG and AG. Objective flight tests administered four times during the syllabus indicated insignigicant differences between TG and AG, likewise, a check pilot who did not know to which group a student belonged could not differentiate between groups TG and AG. It was concluded that 10 h training in the GAT-1 did not compromise the flying skill as judged by the check pilot.


Effect of potassium depletion in normal males: an Apollo 15 simulation. In the course of Apollo 15, physiologic abnormalities, manifested by ectopic activity on the ECG and unusual alterations in excerise tolerance, occurred in the crew of the Lunar Excursion Module. These were associated with decreases in total body potassium, measured by 42K, of 10% and 15%. The possibility of inadequate potassium (K plus) intake existed. A simulation study was performed prior to Apollo 16, corresponding in duration to Apollo 15. Subjects endured the same sleep aberrations and caloric expenditure as the Apollo 15 astronauts. Subjects consumed a diet containing only 15 mEq/d of K plus during the entire 12 d of absolute bedrest. ECG was continuously monitored, body fluid compartments and total body K plus were measured at intervals by radionuclide methods, electrolyte balance was determined daily, and excercise and orthostatic tolerances were determined prior to and after bedrest. In spite of decreases in total body K plus measured by 42K of 14.5% and 10.5%, and by potassium balances of 3.3% and 6.5%, respectively, neither of the two subjects developed symptomatic hypokalemia. Minor ECG abnormalities were noted in one subject. Orthostatic and exercise tolerance showed only those changes expected as a result of bedrest. Muscle strength was unaffected. Study implications and reasons for discrepancies between K plus loss measured by balance techniques and 42K are reviewed.


Organ fluid changes and electrolyte excretion of rats exposed to high altitude. Electrolyte balances, serum electrolyte concentrations, and fluid changes in the liver, spleen, kidney, heart, and brain of albino rats were studied at Denver (1620 m) and Pike's Peak (4300m), in Colorado. Control animals were subjected to pair feeding and equal transportation stress. Animals were sacrificed after 2, 4, 6, 8, 10, and 12 h, and 1, 2, 3, 6, 9, and 12 d of exposure. There was no significant growth depression after the first 24 h at altitude. The water content of all tissues were increased during the first day of exposure. Liver showed an increased percent dry weight following 1 d, possibly due to an increase in fat content. Serum Na plus concentrations were significantly increased throughout the 12 d of exposure while K plus was decreased. Hematocrit and hemoglobin values were immediately increased at altitude with the RBC count being significantly higher by Day 9. Altitude rats retained more Na plus, K plus, Ca plus plus, and Mg plus plus than controls, with K plus and Ca plus plus showing the highest retention. The data indicated a shift of fluids from the extra- to the intracellular compartment, especially during the first 12 h of exposure.


Ultrastructural alterations observed in mouse lung after prolonged He/O2 exposure. Three generations of mice were exposed to an atmosphere of 80% helium and 20% oxygen. The parent generation, born and raised in air until the experiment began, was sacrificed in two groups--one after 160 d and the other after 350 d of exposure. The F1 generation, conceived in air, born and raised in an He/O2 environment, was sacrificed after 160 d. The F2 generation, conceived, born, and raised in the He/O2 atmosphere, was sacrificed also in two groups--one after 85 d and the other after 280 d. Lung tissue from these animals was prepared by conventional methods for ultrastructural study. The most obvious alteration observed was the extensive blebbing, possibly indicative of cellular edema, seen in both the capillary endothlium and the alveolar epithelium. In addition, a highly convoluted basement membrane was observed in many areas. There was debris in some of the alveoli and an increase in platelets in the capillaries.