Warning signs in intracranial aneurysms. Warning signs preceding major hemorrhage were analyzed in 192 patients with intracranial aneurysms. One hundred and thirteen (59 percent) had warning signs. The average interval between the last warning signs and the major attacks was 16.9 ddays with anterior communicating and anterior cerebral aneurysms, 6 days with middle cerebral aneurysms, and 7.3  days with intradural internal carotid aneurysms. The incidence was much higher in aneurysms (69 percent) and with location of the aneurysms. Early recognition of warning signs may protect patients from the devasting effects of major hemmorhage.


Two unusual complications of ventriculo-peritoneal shunt in the same infant. A child with hydrocephalus had two rare complications of a ventriculo-peritoneal shunt: exposure of the abdominal catheter through the surgical incision and perforation of the intestine by a new Raimoundi catheter and its emergence from the anus. No infection occurred. The catheter was replaced with a new one on each occasion, without incident.


Conservative management of the recently ruptured aneurysm. Antifibrinolytic drugs and subtotal occulusion of carotid artery have been investigated in a series of 168 patients with recently ruptured intracranial aneursyms. It is concluded that epsilon-aminocaproic acid offers effective treatment, that aggressive hypotensive therapy is dangerous in the severely obtunded patient, and that epsilon-aminocaproic acid plus subtotal carotid occlusion (supplemented by a moderate hypotensive regime) offer the best treatment, in this experience, in the prevention of recurrent hemmorrhages.


Venous channels in the tentorium cerebelli: surgical significance. A practical surgical approach for exposure of the rostral part of the cerebellum is by way of an occipital craniectomy and incision through a leaf of the tentorium cerebelli. Venous channels of variable dimensions course in this intracranial dural process or partition. Neurosurgeons should be aware of their presence.


Intracerebral schwannoma.

Intracerebral schwannoma. A case is reported in which the authors describe a rare example of an intracerebral schwannoma in a 63-year-old woman having a clinical history suggesting the presence of the tumor for 40 years. Such an unusually prolonged course is ascribed to extensive regressive changes in the tumor. The occurrence of intracerebral schwannoma indicates the existence of schwann cells deep within the brain substance, although the precise source of these cells remains obscure.


Extraneural metastasis of pineal tumor.

Extraneural metastasis of pineal tumor. The case of an eight-year old male with a pineal tumor is reported, in which metastases occurred to extraneural organs. The pineal tumor consisted of portions of benign teratoma, malignant ependymoma and embryonal carcinoma. Only the embryonal carcinoma metastasized. The intracanial and spinal subarachnoid space alos was invaded by disseminated embryonal carcinoma. There have been seven other similar cases reported. All patients were males from five to 34 years of age.


A competitive protein binding radioassay for deoxycorticosterone in human plasma. A simple, sensitive and reliable competitive protein binding radioassay using dog transcortin has been developed for the measurement of 11-deoxycorticosterone (DOC) in human plasma. A 1% plasma solution from dexamethasone treated male dogs served as the source of the binding protein. Sephadex LH-20 column chromatography was used for the separation of the steroid prior to assay. The method is sensitive enough to detect 50 pg of DOC. The intra- and interassay co-efficients of variation were 11.5% and 11.3% respectively. Water blanks and plasma blanks from adrenalectomized rats and humans gave negligible readings for DOC. Support for the identity of the steroid being assayed as DOC was obtained by subjecting a plasma pool to multiple radioassays using 4 different binding proteins including 2 anti-DOC antibodies. The values obtained in all 4 systems were in good agreement confirming the fact that DOC was the steroid being measured. Morning plasma DOC levels measured in 29 healthy subjects averaged 8.0 plus or minus 1.2 (S.E.) ng% in 14 males, and 8.7 plus or minus 0.9 (S.E.) ng% in 15 females (p greater than 0.3).


In vivo androgen retention in mouse kidney. The in vivo retention of 3-H-testosterone, dihydrotestosterone (DHT), 3alpha-androstanediol (3alpha-DIOL), 3beta-DIOL, androstenedione, progesterone and cortisol by renal cytoplasm and nuclei of male and female mice was studied. Testosterone was the major androgen isolated from cytoplasm and nuclei following testosterone or androstenedione administration. By contrast, DHT was the major intracellular androgen after DHT, 3alpha- or 3beta-DIOL injection. The uptake of 3-H-testosterone or 3-H-DHT was abolished by excess unlabeled testosterone, DHT or cyproterone acetate. Androgen concentrations in kidney fractions from female mice were similar to those from males. There was no appreciable concentration of the isolated steroids following 3-H-progesterone administration. 3H-cortisol was concentrated in both cytoplasm and nuclei but was not displaced by non-radioactive androgens. These findings suggest that in contrast to prostate, mouse kidney can concentrate both testosterone and DHT. However, since testosterone is the major androgen in blood and since it is not metabolized in kidney, it is the major effector androgen in this organ. Androstenedione is active via conversion to testosterone while DIOLS are androgenic via metabolism to DHT.


The metabolism of synthetic estrogens in non-users and users of oral contraceptives. Using both pulse injections and constant infusions of 3-H-mestranol (3H-ME) (1) and 3-H-ethinyl estradiol (3H-EE) we have studied the metabolism of these compounds in non-users and users of oral contraceptives. Following pulse injection of 3-H-ME the disappearance of radioactivity could be described as a function which was the sum of two exponentials. Studied by both types of administration there was no difference in the metabolism of 3H-ME in the two groups; the overall mean plus or minus SE metabolic clearance rate (MCRM) was 690 plus or minus 45 1/day/m2, the mean ratio of the concentrations of radioactivity as EE following administration of ME (CRM-BB,E) was 0.23 plus or minus 0.02 and the mean (p)M,EBB (fraction of administered ME measured in blood as EE) was 0.19 (95% confidence limits equals 0.15 - 0.23). Following pulse injection of 3-H-EE the disappearance of radioactivity was best described as a function which is the sum of three exponentials. Results from both types of administration revealed no difference in the metabolism of 3H-EE between non-users. The overall mean plus or minus SE MCREE was 630 plus or minus 30 1/day/M2. The MCREE is significantly (0.02 greater than P greater than 0.01) less than the mean MCR for estradiol reported previously, in both non-users and users of oral contraceptives. The use of oral contraceptives containing estrogens and progestins does not appear to influence the metabolism of the estrogen used. Approximately 20% of mestranol is converted to and appears in the blood as ethinyl estradiol.


Comparison of dextran-coated charcoal and ammonium sulfate in the radioimmunoassay of estrogens. A comparison was made between the use of ammonium sulfate (AS) and Dextran coated charcoal (DCC) to separate free and antibody-bound estrogens in the RIA of estrone and estradiol in serum. Under the conditions tested, AS yielded values which were approximately twice those obtained using DCC. This difference was found for both estrogens, using male and female serum and regardless of whether the estrogens were separated from one another by means of the Girard reagent or TLC. There was no significant difference in the sensitivity, accuracy or usable range of the standard curve or in the water-blank for the two procedures.


Radioimmunoassay for fluoxymesterone (Halotestin). A specific, sensitive, precise and accurate radioimmunoassay has been developed for fluoxymesterone, 9alpha-fluoro-11beta,17beta-dihydroxy-17-methyl-4-androsten-3-one (Halotestin). The method is capable of detecting 25 picograms of drug in 0.1 ml of unextracted serum. The primary antibody was prepared against fluoxymesterone 3-(0-(carboxy-methoxime)) (CMO) bovine serum albumin. The specificity of the assay is greatly influenced by the hydroxyl group at position 11 and the methyl group at position 17. Physiological levels of endogenous steroids did not cross-react significantly with the primary antibody. Blood levels of fluoxymesterone were determined in both human subjects and male beagle dogs after oral administration of Halotestin.


In vitro metabolism of 3-H-androstenedione by the male rat pituitary, hypothalamus, and hippocampus. The in vitro metabolism of 2,2-3-H-androstenedione by the pituitary, hypothalamus, and hippocampus of intact and castrated adult male rats was studied. Conversion of androstenedione to radiochemically pure 5alpha-androstanedione, testosterone, 5alpha-dihydrotestosterone, androsterone, and traces of 3alpha, 5alpha-androstanediol was demonstrated in minced preparations of the three tissues in the absence of cofactors. 5alpha-androstanedione was the metabolite formed in the highest proportion. The pituitary showed the highest enzymatic conversions followed in decreasing order by the hippocampus and the hypothalamus. Castration performed three weeks prior to the experiments resulted in a significant decrease of pituitary 17beta-old-dehydrogenase activity with a concomitant increase of 5alpha-reductase. No significant changes were observed after castration in the hypothalamus and the hippocampus.


Characterization and physiological validation of a radioimmunoassay for plasma testosterone in the male rat. A radioimmunoassay (RIA) to measure testosterone concentration in the plasma of male rats was formalized, tested and physiologically validated. The procedure measured testosterone equally well, whether or not estimation of recovery and chromatographic purification preceded the RIA. The results were equivalent to those achieved by the method of competitive protein binding. No 17beta-hydroxy-5alpha-androstan-3-one was found in the plasma of male rats. Adrenalectomy did not significantly decrease plasma testosterone in either male or female rats. The simplified protocol met all requirements of precision, sensitivity, accuracy and specificity. A single investigator can analyze 1,000 plasma samples for testosterone in one week if necessary.


[Concept of metabolic deviations].

[Concept of metabolic deviations]. Disturbance of metabolism has to do always with systems. A change in one unit results in a flow of matter, energy or information to other units. The whole or almost the whole system participates at this chain reaction. Never a simple newtonian reaction can be encountered at this occasion, with its direct cause-effect connection. At least always the feed-back mechanism is triggered. Generally, however, multiple loops of the feed-back mechanism are activated. No strict determinism is present here. In the nature common laws for living and lifeless objects are valid. It does not matter that we cannot yet define the life in terms of classical physics. It will be necessary to construct on one side a new physical concept and on the other to introduce into our biological way of thinking also the quantum mechanics. Metabolism must be defined in terms of statistics and probability. The complex mutual interaction of individual functional levels makes it necessary to shift from the study of isolated events to the general theory of information, integration and control.


[Anemia in old people].

[Anemia in old people]. In older age the incidence of anemia is more frequent, in patients over 15 years of age anemia was found in 16%, whereas in patients over 60 years of age in 22.5%. The study was done on hospitalized patients. In younger age groups anemic women were more numerous, in older patients on the contrary the majority of anemic patients were men. In both age groups anemia is mostly of a lighter form, but in the older age group a serous form of anemia is more frequent. The development of anemia is due in the first place to economic and social conditions, insufficient health and social care of old persons. The leading cause of anemia is malnutrition of the old, often immobile or mentally altered individuals. To consider the anemia in the old age as physiologic is questionable, as 77.5% of hospital admitted old individuals have no anemia. Anemia is often an early sign of an organic or systemic disease, being in this way an indication to a thorough clinical examination. The treatment should consist in therapy of the underlying disease, in the correlation of nutrition, substitution of nutritional and hemopoëtic factors and in increased care of old individuals.


[Glycide metabolism disorder in renal failure, therapeutic sequelae]. The in vitro effects of increased concentration of urea, creatinine, phosphate, glucose and of decreased concentration of potassium and calcium on the inhibitory effects of IGU was studied. The following results were obtained: 1. Urea, creatinine and increased concentration of phosphate in the degrees significant clinically did not influence the effect of IGU. 2. Decreased concentration of potassium did not influence utilization of glucose, but abolished completely the inhibitory effect of IGU. 3. Increased concentration of glucose increased its utilization, but did not abolish the inhibitory effect of IGU. The therapeutic implications of these findings for glycid metabolism in renal insufficiency are analysed.


[Problems of myocardiopathies in the clinical and experimental cardiology]. The first part of the study deals with the early diagnosis of cardiomyopathies on the ground of physical examination of the patients and of his ECG and X-ray finding. It is stressed, that in the majority of cases already this set of examination can in the physicial of the first contact awake a suspicion of cardiomyopathy. Further precision of diagnosis demands examination in a cardiological center where the facilities for cardiac catheterization, angiography and coronarogrpahy are available. The second part of the study deals with the problem of mechanism of the early heart failure in caridomyopathies. Studying the structural, metabolic and functional changes of the heart muscle in the dietetic, catecholamine and alkoholic model of experimental cardiomyopathy, the authors came to the conclusion that the main factor in this pathological event is disturbance of the oxidative process and thus of the energy generation at the subcellular level in the heart muscle. This metabolic disturbance is progressively leading to morphological changes and to a weaking of the contractile power of the heart muscle.


[Did the introduction of rehabilitation improve the course and prognosis of myocardial infarct?]. Experience with early mobilization and rehabilitation of patients after myocardial infarction in a coronary care unit is presented. There was not visible unfavorable influence of the early rehabilitation in patients after overcoming the acute phase of myocardial infarction. Early rehabilitation had a positive influence on physical as well as on mental condition of patients and resulted in a shortened stay in hospital and duration of impaired working capacity.


[Effect of ethanol on blood serotonin level]. The level of blood serotonin was determined in 11 healthy young men after administration of 1.0 g ethanol per 1 kg of body weight and in healthy dogs after administration of 2.0 g of ethanol per 1 kg of body weight. In men there was no substantial change in the blood level of serotonin. After administration of 2.0 g of ethanol per 1 kg of body weight in dogs, the blood level of serotonin was not found changed in the 60th minute of the experiment. After 4 hours after administration of ethanol already a significant decrease of the serotonin level appeared. After 24 hours following administration of ethanol there was a slight increase of the serotonin level as compared with the initial level. Slight changes of the serotonin level observed in the 30th and 60th minute of the experiment cannot explain the negative inotropic effect of ethanol.


[Effect of ethanol and inderal on the heart cycle]. Ingested ethanol at a dose of 1.0 g per 1 kg of body weight in an experiment on healthy young men changes in the 30th minute the duration of individual phases of the heart cycle. By the effct of ethanol in the dose mentioned and by administration of 20 mg of Inderal, the negative inotropic effect in the 60th minute and by increased index of preejection period as well as by decreased volues of the index of tension of the left ventricular heart muscle. Left ventricular ejection period is only slightly shortened by the influence of both ingested substances. Ethanol as well as Inderal prolong the interval of isovolumic relaxation, but at the some time they increase the percentual relation of the left ventricular presystolic filling "a" wave to the ejection relaxation wave V-O. By the influence of both substances the systolic and diastolic pressure is decreased more than by the influence of ethanol only.


[Acute toxic liver lesion through industrial noxious substances and drugs in higher than therapeutic doses]. From the accessible material an attempt was made to estimate the frequency of acute toxic disturbances of liver and its relation to all intoxications together with special regard to the composition of noxious substances on the conditions of this country. From 3700 cases of all acute intoxications or serious attempts of intoxication 54 cases were discovered to have marked hepatic disturbance (about 1.5%). The noxious substance causing hepatic disturbance in the overwhelming majority of cases was tetrachlormethan (and chemically related substances) or new herbicide drugs of the dipyridine compounds. The last mentioned group is highly lethal and the more important as it is a relatively new substance to which health control and practice is less accustomed as to a potential hepatotoxic drug than to tetrachlormethan. It is pointed further to a less frequent potential intoxication by phenylbutazone and its derivatives especially in children and to the acute intoxication by INH when high single doses of this drug are used.


[Changes in the composition of liver tissue and blood in liver steatosis]. The results of clinical and biochemical evaluation of liver steatosis are presented. The advantage of the quantitative determination of lipids in the liver tissue is underlined. A direct correlation between accumulation of fat in the liver and that of lipid phosphorus in blood was found. The concept is put forward that in the group of patients studied the increased supply of lipids to the liver prevails in the mechanism of development of steatosis.


[Basis of statistical methodology in medicine. VII. Description of the statistical complex]. Description of statistical population is based on clear classification of the data obtained, construction of tables and graphs and calculation of suitable statistical parameters. The proceeding of calculation of the arithmetical means, distribution, standard deviation, and of coëfficient of variance is described.


Course of lymphocytic choriomeningitis virus infection in young and aged mice. The course and histological picture of intracerebral LCM virus infection was found to differ in mice with their thymus displaying an age-dependent involution and in young adult animals. Signs of lymphocytic choriomeningitis were absent in 75 per cent of the aged animals. The change of the characteristic clinical and histological picture referred to the decreased cellular immune response of aged animals, ascribed to the age-dependent involution of the thymus.


A new two-stage respirable dust sampler. The design and laboratory evaluation of a new two-stage aerosol sampler is described. The first stage of the sampler employs an integral flat plat impactor to remove particles  greater than 10 micrometers; particles that penetrate the impactor are collected on a 37 mm membrane filter with 5-micrometer pore size. The theoretical design parameters and experimental calibration data developed for the impactor sampling heads at flowrates of 2.0 and 3.0 liter per minute are presented, and their collection characteristics compared to those of present two-stage respirable dust samplers. The advantages and disadvantages of the two-stage impactor sampler are discussed.


Thermal oxidative decomposition studies of neoprene compositions. Four neoprene compositions--uncured gum, known cured rubber, cable insulation, and hose conduit, the latter two used in underground mining--were subjected to thermal oxidative degradation under static and dynamic environments, and the volatile products were quantitated on a milligrams-per-gram basis. In a quiescent system at 370 degrees C, no glow was observed, the extent of oxidation was low, up to 84% of the chlorine content was evolved as hydrogen chloride, and the sulfur present was released largely in the form of carbon disulfide. Under more drastic conditions (higher temperatures and flowing air), glow occurred in several instances resulting in an increased production oxidation products as represented by CO2, COS, SO2, HCOOH, and CH3COOH, among others. Thermogravimetric investigations of the neoprene compositions show the first weight loss to correlate closely with hydrogen chloride evolution; furthermore, the use of thermogravimetric curves as means of meterial differentiation appears to offer a definite promise.


Cobalt metal inhalation studies on miniature swine. Cobalt is considered to be the chief component in the tungsten carbide mixture responsible for hard-metal disease. An animal inhalation study was undertaken simulating conditions under which these workers in the tungsten carbide industry are exposed to cobalt. In this semichronic study, miniature swine were exposed to an inhalation of pure cobalt metal powder at concentrations of 0.1% mg/m3 (present TLV) and 1.0 m/m3. At peroidic intervals, the following studies were performed: pulmonary function tests, electrocardiograms, x-ray examinations, blood and urine tests, electron microscopy, and light microscopic pathology. Early detection of pulmonary disease is apparent from the pulmonary function tests showing a mark decrease in lung compliance, and from electron microscopy showing an increase in the amount of septal collagen. This study demonstrates that the present TLV of 0.1 mg/3 for cobalt seems to be too high, even at this relatively brief duration of exposure.


Measurement of the influence of a cement kiln stack on a surrounding residential community by injection of an identification particulate. An identification particulate, barium sulfate, was injected into the kiln stack of a large cement plant in order to determine the effect of the particulate effluent of this stack on the immediately surrounding residential community. Meteorological conditions at the time of the injection favored deposition of the stack plume fallout directly over the location of a 7.75-km2 area in which both dustfall and suspended particle samplers were located. Dustfall data are reported for a 24-hour period to permit collection of all possible BaSO4-relatable stack emission. Collected particulate was analyzed for calcium and barium by atomic absorption spectroscopy. Collected dustfall particulates showed no stack effluent effect; collected suspended particulates exhibited a content of stack-relatable material in the amount of 1% of the total observed weight.


A novel form of diffusion battery.

A novel form of diffusion battery. A novel form of diffusion battery uses a series of 635-mesh screens instead of the customary cluster of circular tubes or holes. Fifty-five screens are arranged in series so that the amount of aerosol penetrating through different numbers of screens can be measured with a condensation nuclei counter. This "filter stack" must be calibrated because theory is not available to calculate the performance of such screens with sufficient accuracy. For calibration a polydisperse aerosol such as ambient or silver aerosol is used to compare the performance of the screens with that of the cluster-tube and collimated-holes diffusion batteries, whose performance is known from theory. It was observed that a given number of screens is equivalent to a given number of batteries independent of the size or size distribution of the aerosol. This filter stack is very compact and light in weight (0.9 kg). It is particularly useful for measurements in the field.


An improved aerosol generator.

An improved aerosol generator. An aerosolizer has been developed which automatically compensates for changes in the concentration and volume of a solution during aerosolization by adjustment of the temperature and pressure of the atomizing air jet. It represents the redesign of a generator previously used for short-term inhalation exposures (one-half to a few hours) where variability in solution concentration was not of great concern and solutions could be replenished daily. The stability of the original generator was quite inadequate, and it was not satisfactory for production of aerosols of constant physical characteristics over longer or repetitive time periods or where a minimum of manipulation is required--viz., for radioactive and other highly noxious materials. The redesigned aerosolizer should be valuable for long-term or repetitive use, since it requires no cleaning, merely refilling, and can 0e made as small or as large as experimental needs require. It should be particularly useful where correlations between the amount of deposition and aerosol characteristics are being studied.


Determination of beryllium, cadmium, and tellurium in animal tissues using electronically excited oxygen and atomic absorption spectrophotometry. A method using electronically excited oxygen for destruction of organic matter and atomic absorption spectrophotometry for the determination of beryllium, cadmium and tellurium in animal tissues is presented. Samples are solubilized in dilute aqua regia after being subjected to an oxygen plasma, low-temperature (less than 190 degrees C) ashing system for 20 to 30 hours. Recovery data from spiked NBS freeze-dried bovine liver indicate a quantitative determination for the three elements. Limits of detection in micrograms of element per milliliter of solubilized sample solution are: beryllium, 0.05; cadmium 0.05; and tellurium, 0.50. Beryllium, cadmium, and tellurium assay data are reported for the fresh tissues of albino rats exposed to inorganic chemicals by oral or intraperitoneal routes. The tissues analyzed include: adrenal, brain, femur, heart, kidney, liver, lung, mesenteric lymph node, pancreas, prostate, seminal vesicle, spleen, testicle, and tracheal-bronchial lymph node.


Hearing sensitivity in rural Michigan.

Hearing sensitivity in rural Michigan. In a survey of the hearing sensitivity of a rural mid-Michigan population, 1,325 adults over 15 years of age received pure tone air conduction tests in a "mini" IAC room housed in a small trailer. In addition, a detailed questionnaire was administered to each person to obtain information about his exposure to noise vocationally and avocationally, family history of hearing loss, etc. Results indicated that, on the average, individuals displayed hearing losses considerably greater than was predicted on the basis of presbycusis alone. Also, people who had never had any industrial noise exposure had thresholds almost as poor as those who had worked in factories. These findings are discussed in view of the subject's exposure to various types of nonoccupational noise such as snowmobiles and motorcycles.


Study of some parameters affecting noise level in textile spinning and weaving mills. Noise was evaluated in six spinning and five weaving halls located in three textile mills in Egypt. Spindle speed (rpm) and loom speed (picks per minutes) were found to be important parameters affecting the noise level in these mills. Reduction of the number of spinning machines to five spindles per square meter of floor area will probably bring the noise level below the TLV. In the weaving departments, the decrease in the number of looms will not effectively reduce the noise level.


Effect of informational load on human performance in a combined manual and decision task. With the increased automation, the worker's role in the industry is changing. He is required to make use of his decision making as well as motor capabilities (Type II tasks). Production system designers and managers are required to predict and evaluate human performance. The techniques available are suitable for tasks involving manual motions. To obtain an insight of the human performance characteristics for Type II tasks, experimental investigations in which the informational load could be varied and the magnitude of manual motions could also be altered were undertaken. Five subjects were tested in a 3 x 2 completely randomized and full factorial experiment. The three levels of informational load were 1, 2 and 3 bits and two distances of manual motions were 7 inches and 14 inches. In addition to measuring performance times, heart rate and breathing rate of the subjects were also monitored. Performance time and heart rate difference were observed to increase as the informational load increased, while the distance was kept invariant. Breathing rate was not found to be a significant variable.


Needle aspiration biopsy. A safe diagnostic procedure for lesions of the pancreas. Thin-needle aspiration biopsy of the pancreas is a safe, accurate procedure that may be used for immediate diagnosis at the time of laparotomy. Twenty-eight aspiration biopsies of the pancreas were examined. Of the 18 cases of carcinoma, 16 were correctly diagnosed, one was considered atypical, and no abnormal cells were seen in one specimen. All ten of the cases diagnosed as benign are apparently free of pancreatic malignancy. The tumor cells are easily identifiable. No complication followed the procedure.


Leiomyosarcoma of the long saphenous vein. An unusual instance of primary leiomyosarcoma of the left long saphenous vein, possibly the tenth recorded case, is presented. Leiomyosarcoma of large veins appears to be a distinct entity, in contrast to the benign counterpart, leiomyoma. The origin of the tumor from the vessel wall, its intraluminal growth, and its ultrastructure are demonstrated. Incidence, sex and age distribution, fate and therapy of patients who have leiomyosarcomas of the large veins gleaned from reported cases in the literature are included.


The effects of age, sex, and smoking on erythrocytes and leukocytes. Coulter model S blood counts were related to the age, sex, and smoking habits of 1,000 clinic patients. It was found that (1) women have larger erythrocytes than men; (2) erythrocytes enlarge as people age; (3) smokers have larger erythroycytes than nonsmokers; (4) the mean leukocyte count is higher in smokers and increases in proportion to the intensity of smoking. The causes of these alterations are not known. The data indicate that the normal standards for blood cell counts should be adjusted for age, sex, and smoking habits.


Antithrombin and antithromboplastin activity accompanying IgG myeloma. Report of a case with a severe bleeding tendency. Four basic coagulation tests, the prothrombin time, thrombin time, partial thromboplastin time, and prothrombin consumption time, were used, with relatively simple modifications, to demonstrate the presence of two circulating anticoagulants in the blood of a patient with IgG myeloma and a severe bleeding tendency.


Platelet activity ratio. A new approach for quantitation of platelet factor 3. The ratio of kaolin recalcification time in platelet-poor plasma to kaolin recalcification time in platelet-rich plasma appears to provide a more accurate estimate of platelet factor 3 activity than measurement of kaolin recalcification time in platelet-rich plasma alone. This ratio is termed the "platelet activity ratio." Over a fairly wide range the platelet activity ratio appears to follow a linear log-log relationship to platelet count (platelet counts of 12,500 to 200,000). The use of diluted platelet substitute as artificial standard greatly simplifies preparation of (1) standard curves and (2) quality control plasmas. If platelet activity ratio is expressed as a percentage of normal platelet factor 3 activity, the normal range for "total" platelet factor 3 (PF3t) is 60 to 175% and normal range for "available" platelet factor 3 (PF3a) is 14 to 47%.


The CLUE test. A multiparameter coagulation and fibrinolysis screening test using the platelet aggregometer. Optical density measurements of plasma clot formation and lysis were recorded using a platelet aggregometer and strip chart recorder. It was discovered that, by adding standard solutions of ellagic acid-activated partial thromboplastin, urokinase, and CaCl2, and monitoring the reaction via the recorder, characteristic curves would be generated by normal human plasma. The curve segments were labeled Tc (clotting time), which correlated with the activated partial thromboplastin time, Fc (maximum optical density change), which paralleled fibrinogen concentration, and Tl (lysis time), which corresponded generally to plasminogen levels. Deviations from normal curve segments, observed in disseminated intravascular coagulation, hypo- and hyperfibrinogenemia, factor VIII deficiency, severe hepatocellular disease, juvenile rheumatoid arthritis, and neonates (normally low in plasminogen), indicated abnormalities which were substantiated by standard procedures. This new test, given the acronym "CLUE" for clotting and lysis, urokinase enzyme activated, appears to be sensitive, inexpensive and easily performed on a sample of 0.2 ml. of plasma in only 15 minutes.


Transient, spontaneous bruising with long bleeding time and normal platelet count. Spontaneous, widespread bruising in apparently healthy individuals relatively common among Thai children. It is a transient problem, unaccompanied by any common bleeding disorder of childhood. The physical defect is limited to the painless cutaneous lesions. Screening tests for hemostasis as well as tests of platelet function were measured in 24 of these patients. The significant abnormal findings were eosinophilia, prolonged bleeding time, positive tourniquet test and platelet dysfunction--i.e., defective ADP release and adhesivity to glass beads. So far, the condition appears to 0e a self-limited diathesis of unknown etiology.


Hemoglobin hope: beta136 (H13) Gly leads to Asp in Georgia. A fast-moving hemoglobin variant was detected in a screen for abnormal hemoglobins. Structural analysis shows that there is a substitution of glycine by aspartic acid at position in 136 in the beta chain.


Endometrial biopsy. Pathologic findings in 3,600 biopsies from selected patients. During a 14-year period (1959-1972), 3,600 endometrial suction biopsies were performed in the office for specific indications in selected patients. Three hundred seventy-seven biopsies (10.5%) revealed abnormal findings. Of these, 233 showed endometritis, 96 associated with necrotic decidual or placental tissue, or both; one with tuberculosis, and 136 with no specific causative agent. In 84 biopsies endometrial hyperplasia was present; 34 contained polyps from the cervix or endometrium. Eighteen malignancies were diagnosed, four of which originated in the cervix and the remainder in the endometrium. Used judiciously, the procedure is per,aps the most reliable means of evaluating the uterine cavity short of a formal dilatation and curettage..


The presence of Hb J alpha15 Gly leads to Asp in an Italian family in the United States. A fast-moving hemoglobin variant was detected by electrophoresis. Sequence analysis revealed a substitution of glycine by aspartic acid at position 15 in the alpha chain.


Adsorption chromatographic purification of isopropanol for triglyceride precision. A simple continuous flow adsorption chromatographic column is used to remove trace impurities in reagent grade isopropanol. The use of this purified reagent grade isopropanol as the extraction solvent for triglycerides results in improved precision in triglyceride assays.


Proficiency testing, trouble shooting and quality control for the RPR test. A Syphilis Serology Proficiency Testing Program revealed that 182 of the 272 (67 percent) participating laboratories failed to report acceptable results for a minimally reactive pair of serum samples. It was noted that serious technical errors involved the antigen, use of controls, procedures and in some cases, the lack of training. A program involving strict quality control measures is presented for  use in routine syphilis serologic procedures.


Rotation of spin-cast hydrogel lenses.

Rotation of spin-cast hydrogel lenses. This study was designed to determine if spin-cast hydrogel contact lenses rotate on the eye, and if so, to investigate the parameters which influence rotation. If these lenses do rotate, correction of residual astigmatism may be difficult, if not impossible. We monitored the lens rotation associated with 12 specially marked B and L Soflens TM contact lenses on six corneas after insertion and 30 minutes later by use of high speed motion pictures. To analyze lens rotation, the film was projected with a stop action projector and the amount of rotation measured with a protractor. Thirty-one percent of the 144 observations made showed some lens rotation, the majority of which was encyclorotation. Most of the lenses showed little or no change in rotation between the two time periods. Corneal curvature was the only lens or eye parameter associated with rotation. Why lenses were more likely to rotate on steeper corneas is not fully understood. Our findings indicate that Softlenses TM may rotate, but there is no definite way of determining in advance if a given lens will rotate on a given eye. This emphasizes the need for individualized lens fitting and proper patient monitoring.


The depth-of-focus of the human eye for Snellen letters. Snellen acuity is determined as a function of refractive error for two subjects under cyploplegia, using randomised test charts, constant test chart luminance and a series of artificial pupils. These results allow determination of the depth-of-focus of the eye for Snellen targets, and it is shown that both optical and retinal factors influence the depth-of-focus achieved. Depth-of-focus is found to increase with decreasing pupil diameter and visual acuity. The clinical significance of these results, particularly with respect to the precision with which refractive error may be determined, is discussed.


Diabetes screening with corneal aesthesiometer. Recent clinical evidence that diminished corneal sensitivity occurs far more frequently (p less than 0.003) ) among diabetics than nondiabetics, supports the addition of aesthesiometry to the routine optometric screening battery for patients at risk of diabetes. This evidence is reviewed and quantitative estimates are presented to illustrate the clinical efficacy of this screening test.


The non-contact ("air puff") tonometer: variability and corneal staining. We investigated the possibility of significant corneal trauma (as revealed by slit lamp observation of the fluorescein instilled eye), and massage effects following determination of intraocular pressure with the A. O. Non-Contact tonometer (NCT). Fifteen different, normal human eyes were each applanated 150 successive times with the NCT; leading to the conclusion that only minor, superficial corneal epithelial defects sometimes resulted and that, in line with other studies, the initially higher readings (about 1 mm), obtained with the NCT, were most likely due to patient apprehension, while the subsequently lower readings represented patient acceptance of the process and were not a result of true aqueous massage. As in an earlier study, we found the instrument's variability to be about plus and minus 1 or plus and minus 2 mm and probably due to the subject's own cardiac cycle.


Ocular dominance and amblyopia.

Ocular dominance and amblyopia. Ocular dominance, as measured in sighting tests, involves a temporary suppression of the input from the non-dominant eye in order to avoid diplopia. Amblyopia ex anopsia may be viewed as a long term suppression of the input from one eye for the same reason. In the absence of anisometropia, paralysis of extra ocular muscles, or other factors which would tend to determine which eye would manifest suppression, the non-dominant sighting eye should be more likely to develop amblyopia given the presence of strabismus. A sample of 258 amblyopes supports this prediction based on the population norms for sighting dominance.


Visual performance through a sample windshield segment of the B-1 aircraft. The stereopsis performance of 16 subjects was measured on an automated Howard-Dolman apparatus and compared with their performance through a sample segment of a proposed B-1 aircraft windshield. Recognition visual acuity was determined for 15 subjects using a low-contrast Landolt C target viewed with and without the segment. When the task was performed through the windshield segment, a statistically significant loss in stereopsis resulted, but no significant loss in visual acuity.


"Forced elimination" of anomalous retinal correspondence in constant exotropia--a case report. "Forced elimination" of anomalous correspondence in a patient with constant exotropia is discussed. Therapy was similar to classic visual therapy for esotropia: presenting targets at the angle of strabismus (Angle H) using a troposcope. Home therapy methods using anaglyphic techniques and after-images are described.


Evaluation of the status of binocularity in the non-strabismic and strabismic with regular and prolonged testing. The need for "in-depth" study of the status of binocularity in true space of both the non-strabismic and strabismic before orthoptics is discussed. Vectogram tests to ascertain the status of binocularity of the non-strabismic and the strabismic are explained. With the strabismic, the Single Oblique Mirror Stereoscope is used and the tests with it are enumerated. Significant enhancement of diagnosis of the status of binocularity in the non-strabismic is obtained by testing over a prolonged period of time, instead of relying only upon tests based upon instantaneous response. Prolonged testing techniques utilizing Vectograms in which the patient used alternating saccadic, jump, oculo-rotary fusional movements from the straight ahead position into the lower reading field are used.


Life strengths and life stresses: explorations in the measurement of the mental health of the Black aged. This paper describes an attempt to understand the self-concept, social characteristics, personal strengths, and frailties of a group of older black men and women, in order to tailor mental health and social work services to their needs. Difficulties inherent in obtaining such information were minimized by a methodology that integrated the research and service aspects of the project. Results of the pilot study, and service implications, are discussed.


Evaluation of a large-scale brief therapy program for children. A brief therapy program for children and adolescents is described, and a multimeasure evaluation of treatment is presented for all cases seen during the first four years. On the basis of previous intake-diagnostic procedures, readmission rates, therapist ratings, problem checklists, and follow-up questionnaires, brief therapy is seen as a highly efficient and effective treatment approach.


The ego and the integration of violence in homicidal youth. Youths committing homicides or other acts of violence appear to be increasing in number at an alarming rate, causing mounting concern to society and pressure upon those charged with their rehabilitation. Nine such youths were studied to define similar parameters in each around which a viable theory of causality could be delineated, and an approach to treatment designed.


Do doctors know what children know?

Do doctors know what children know? Adults often assume that if they explain something to a child calmly and rationally, the child will understand. Informed by piaget's theory about cognitive development, children of preschool and elementary age were asked to use two common pediatric tools, and to explain how they functioned. Predicted differences were found.


Intervention with families of gender-disturbed boys. A treatment program for gender-problem boys and their families is described. In addition to being highly effeminate in their interests, the boys were also markedly deficient in social skills, especially with peers. Intervention procedures were based largely on behavior modification principles, and were eventually applied in group settings for both the boys and their parents.


Symptom development in Vietnam era veterans. Recent studies and clinical reports concerning Vietnam returnees have led to contradictory conclusions as to maladjustment. A questionnaire and symptom checklist was obtain-d from 207 veterans. Significant differences in the mean number of symptoms (e.g., recurrent nightmares, fears, etc.) were found between the combat and non-combat groups.


The solo woman in a professional peer group. The role of the lone woman was studied in six small groups--three T-groups and three work-groups--each containing one woman. All the women became deviants, isolates, or low status regular members of their groups. Reasons for this finding are discussed, and strategies are suggested whereby a woman may avoid depression if she finds herself in a similar setting.


Mother-child interaction: a comparison of hyperactive, learning disabled, and normal boys. Groups of thirteen hyperactive, learning disabled, and normal boys were observed interacting with their mothers in a structured problem-solving situation. Mothers of hyperactive boys showed a higher level of involement in task solution, and reported more behavior problems, than did mothers in comparison groups. Likewise, hyperactive boys interacted more than learning disabled or control boys.


Relationship of certain childhood 'traits' to adult psychiatric disorders. An investigation of 174 adult psychiatric outpatients reporting on nine different difficulties they may have experienced as children suggests certain  links between childhood difficulties and lifelong personality traits, as well as adult psychiatric symptomatology. Findings suggest that the childhood traits related to schizophrenia might be manifestations of minimal organic brain dysfunctioning.


A comparison of voluntary and involuntary patients in a state hospital. A study of 78 involuntary and 47 voluntary patients three months after admission to a state hospital revealed significant differences in presenting symptoms and in the rate of elopement from the hospital. The data support maintaining procedures for involuntary hospitalization, but also suggest the need for alternatives in view of the high elopement rate.


Do mental patients want legal counsel? A survey. Fifty patients on the admission ward of a state hospital were asked questions about whether they felt a need for legal aid. Nearly all responded in a meaningful manner, and half indicated a need for legal aid. Most likely to express a need for counsel were older patients, those involuntarily confined, those who had been previously hospitalized, and those classified as paranoid schizophrenic.


Supervision and the emerging professional. A model for the training of supervisors of new professionals is presented. Highlighted are concepts, principles, and methods of supervision, with emphasis on such issues as entry, race, class, sex, and upward mobility of the emerging professional in the established mental health system.


Mental changes associated with hyperparathyroidism. To document the point that the hyperparathyroidism should be considered a possible cause of unexplained neurological and psychiatric symptoms, the authors present five case reports of confirmed primary hyperparathyroidism in which the patients initially appeared with problems that seemed mainly psychiatric. The presenting symptoms in these cases consisted of varying degrees of depression, catatonia, confusion, disorientation, fatigue, and lethargy; there was no associated bone or renal pathology in four of the cases. The authors include a review of the pertinent literature and a discussion of the effect of calcium and magnesium bivalent ions on the central nervous system associated with hyperparathyroidism. They conclude that more investigation of the role of magnesium in this disease seems warranted.


The effect of living alone on bereavement symptoms. The author reports on a study of widows and widowers who were followed for one year after the deaths of their spouses. The study shows that bereavement itself rather than the effects of living alone influences the occurrence of depressive symptoms in widows and widowers at one month. The data gathered also support the idea that younger people who have lost a spouse tend to show more physical depressive symptoms and to require hospitalization more often than either matched married controls or older widows and widowers at one year.


The validity and significance of the clinical diagnosis of hysteria (Briquet's syndrome). The author states that a valid diagnostic classification based on the medical model is a sine qua non for progress in psychiatric research and treatment and that such classification requires follow-up and family studies. To illustrate this point he reports on studies showing that hysteria, or Briquet's syndrome, is a valid clinical entity that follows a predictable course and clusters in certain families. He also reports that an association between hysteria and sociopathy has been demonstrated, suggesting that the two conditions may arise from sililar etiologic and pathogenetic factors.


The treatment of adopted versus neglected delinquent children in the court: a problem of reciprocal attachment? The authors investigated the discrepant treatment by a juvenile court of adopted versus neglected delinquents. Adopted delinquents received harsher dispositions in spite of the fact that neglected delinquents often faced more serious charges. The two groups are compared in terms of family structure and the criminal and psychiartic histories of their parents; none of these seems to account for the adoptees' harsher treatment. The authors hypothesize that an interplay of late adoption intrinsic vulnerabilities in the children, and weakness of parental bonds accounts for the differential outcomes.


Prevention in mental health: a controlled study. The authors conducted a controlled study in which families who had experienced the sudden death of a family member were given crisis intervention services and compared at follow-up with two untreated control groups. Results did not support the hypothesis that such services decrease the risk of psychiatric illness, disturbed family functioning, or increased social cost to the families. The authors suggest that environmental and social systems factors and individual variables are powerful predictors of outcome in bereavement.


Suicide in the psychiatric hospital.

Suicide in the psychiatric hospital. The authors note that although the psychiatric hospitals is often used as a means of preventing the suicide of disturbed patients, some hospitalized patients succeed in committing suicide; such as an event is distressing for hospital staffs as well as for patients and families. However, the authors believe that the occasional occurrence of in-hospital suicide is inevitable. They present data on the frequency and characteristics of suicides among hospitalized psychiatric patients in Los Angeles County during the period from 1967 to 1972.?23AUTHOR


The addict, abstinence, and the family.

The addict, abstinence, and the family. The drug addict generally has an extremely difficult time terminating drug use and remaining abstinent. A partial explanation can be found in an investigation of the relative meaning of the drug for the addict within his social context rather than viewing the drug simply as a pharmacological agent. The idea that addiction is a social phenomenon within the addicts family suggests a relationship between the functioning of the families of addicts and their inability to tolerate abstinence. Because the abuse of heroin or barbiturates by one family member can result in "rewards" for all family members, the family, in behaving as if the addict cannot control his drug use, functions in such a way as to reinforce the addiction.


A teaching drill in child psychiatry.

A teaching drill in child psychiatry. The authors report on a teaching drill for psychiatric trainees that tests their ability to communicate child psychiatry concepts to a nonpsychiatric physician and to parents of a disturbed child as well as their abilities in the role of a supervisor and a "visiting professor." It was found that the drill was a learning experience for the trainees that focused attention on their problems in integrating their psychiatric skills and identity with their identification with the medical model.


Sexual dysfunction in college men and women. The author presents data and illustrative excerpts from 1,000 letters relating to health and personal concerns that were sent to his column in a college newspaper. There were 532 letters expressing sexual concerns, 65 percent of which raised questions about anatomy and physiology. A comparison of the distribution of problems of sexual dysfunction in this study with that of an earlier study involving older patients showed very different distributions. The author points out the need for sex counseling and education for young people who are sexually active and discusses the unique problems involved in treating this population.


Short-term treatment of Sexual problems: interim report. Of 52 couples requesting treatment for sexual disorders, 16 were treated in accordance with the protocol of Masters and Johnson except that most were seen once a week for 10 or more weeks rather than daily for a briefer period. The treatment results were less successful than those obtained by Masters and Johnson. The authors believe that the successes of this approach nonetheless suggest a need to reevaluate the degree to which sexual problems may be conditioned responses. They also stress the need for specifying the degree of improvement among nonfailures for purposes of comparison and follow-up.


Difficulties in brief conjoint treatment of sexual dysfunction. The authors offered conjoint treatment of sexual dysfunction to an unselected population in a military hospital for one year. Of the 10 couples who requested treatment, 7 were treated by techniques outlined by Masters and Johnson. The couples who completed the treatment exercises improved, and neurotic interactions, presumably resulting from the symptoms, often disappeared. The couples who avoided the exercises had interactional patterns dominated by projection and blame, sadomasochism, and depressive features; typically their marital difficulties were aggravated by the treatment.


Psychopharmacologic management of patients: a method for recording treatment decisions. The authors describe a drug treatment form they designed, the KDS-8, that is suitable for use in all types of treatment settings. An important feature is a checklist of treatable target symptoms, with categories of improvement, no change, or worsening. Changes in drug regimen and the clinician's reasons for them are noted. Among the advantages the authors cite are easy retrievability of drug treatment data and the forms suitability for use in audit procedures and research.


Brain hypoxia, minimal brain dysfunction, and schizophrenia. The author hypothesizes that individuals who suffer brain hypoxia prenatally, perinatally, or immediately postnatally constitute a population at risk for minimal brain dysfunction and for schizophrenia in adulthood. This hypothesis has implications for early intervention with children who have MBD and their families and for multidisciplinary management of these cases throughout childhood.


Civil liberties versus involuntary hospitalization. The authors examine the issue of involuntary hospitalization for mental illness with particular reference to legal rights and civil liberties. Follow-up data of patients treated on a closed ward, as well as other available evidence, indicate that society is not ready for the abolition of involuntary hospitalization. The authors believe that the most fundamental right of the patient is that of adequate treatment, and therefore this should take precedence over an absolute right to liberty.


The educational process as a treatment modality in a drug rehabilitation program. The authors describe an eductional program that is an integral part of a residential drug rehabilitation program. They believe that effective treatment of drug addiction must provide individuals with the opportunity to acquire skills that will make it easier for them to compete in the job market when they leave the program. They discuss how the educational process serves as a treatment modality that supplements and complements the other aspects of the therapeutic community.


Translating despair.

Translating despair. The author reviews two cases of suicide by Spanish-speaking patients who were evaluated and treated by English-speaking psychiatrists using a translator. He suggests that the patient's emotional suffering may be selectively underestimated when the clinician works by means of translation. The diagnosis may emphasize psychotic features of the illness and minimize the affective component; consequently the risk of suicide may be underestimated.


Deep vascular schizogony in Plasmodium fragile: organ distribution and ultrastructure of erythrocytes adherent to vascular endothelium. Erythrocytes infected with Plasmodium fragile, like those infected with P. falciparum and P. coatneyi, adhere to vessels in heart, adipose tissue and, to a lesser ex00 nm knob protrusions on the plasma membrane of infected erythrocytes. The close apposition between knobs and endothelium (1 nm or less) excludes macromolecules such as fibrinogen or antibodies as the adhesive force. The components on the membrane responsible for adhesion at the knobs remain unknown.


Vibrio parahaemolyticus gastroenteritis during, the El Tor cholera epidemic in Togo (West Africa). In the course of the El Tor cholera epidemic in Togo (West Africa), Vibrio parahaemolyticus was identified as the causative agent of a cholera-like gastroenteritis. From September 1971 to March 1973 81 cases were confirmed bacteriologically. Seventy patients developed cholera-like symptoms and at first were wrongly diagnosed as cholera cases; 6 other patients were simultaneoulsy infected with El Tor vibrios and V. parachaemolyticus. There was a markedly higher incidence in males than in females. Only sporadic cases occurred, and outbreaks and secondary cases have not been observed. It is suggested that V. parahaemolyticus might be an important agent of acute gastroenteritis on the coast of West Africa.


Lobomycosis as a disease of the Atlantic bottle-nosed dolphin (Tursiops truncatus Montagu, 1821). Skin lesions on an Atlantic bottlenosed dolphin, captured off the coast of Florida, were investigated and found to be histologically and microbiologically indistinguishable from those caused in humans by Loboa loboi. All attempts to isolate the etiologic agent or to transmit the infection to mice and monkeys ended in failure. Sight records of other suspected dolphin cases of lobomycosis in Florida waters are described along with citations of two previously confirmed and published dolphin infections.


The relative resistance of dengue-immune monkeys to yellow fever virus. Dengue-immune rhesus monkeys were challenged with a South American and two African strains of yellow fever virus. Levels of viremia were reduced as compared with control nonimmunized monkeys. The results support the hypothesis that immunity to dengue in a human population acts as a barrier to establishment of yellow fever in that population.


Ecology of California encephalitis viruses on the Del Mar Va Peninsula. II. Demonstration of transovarial transmission. The high rate of Keystone virus recovery from Aedes atlanticus collected in 1971 and 1972 suggested that these mosquitoes might be emerging infected. To demonstrate the suspected transovarial transmission of this virus, developmental stages of A. atlanticus were collected from the field. Larvae were identified and pooled for virus isolation in suckling mice. Pupae were allowed to emerge in the laboratory, then were segregated by sex and pooled for virus isolation. Keystone virus was recovered from larvae, reared males and reared females, demonstrating transovarial transmission of the Keystone strain of California encephalitis by A. atlanticus.


Genetics of pigmentation in Biomphalaria straminea. A monogenetic factor determining basic pigmentation in Biomphalaria straminea follows simple. Mendelian inheritance and has at least three alleles, as in B. glabrata. Wild type pigmentation with black body, mantle collar and eyes is dominant; albino with no black pigment is recessive; and "blackeye" pigmentation, deficient in black pigment in body and mantle collar, is recessive to wild type but dominant over albino.


Human urinary gnathostomiasis: a case report from Thailand. Acase of urinary gnathostomiasis in a 32-year-old Thai woman, caused by an adult male Gnathostoma spinigerum, is described. The patient who had suffered from intermittent, subcutaneous gnathostomialis for about 10 years, developed pneumonia of the right lower lung followed by swelling on the right hypochondrium, and paresis of both legs accompanied by perianal numbness and retention of urine, and it seems reasonable to assume that the parasite migrated to the lung, hypochondrium, and the cauda equina, respectively. She later passed the worm, which we beleive problably came from the bladder. To the best of our knowledge, no case of human urinary gnathostomiasis has previously been reported in the English literature.


Onchocerciasis in Guatemala. I. Epidermiological studies of microfilaruria. Microfilariae of Onchocerca volvulus were detected in the urine of 65 residents of three coffee plantations near Yepocapa, Guatemala. In this area the prevalence of microfilaruria is estimated to be between 17% and 30% of the population 10 years of age and older. Almost all of the people examined had clinical manifestations of onchocerciasis and 80% of them had microfilariae in skin snips. The frequency of microfilaruria is associated with the number of microfilariae in the skin. Within each age group those who had lived longer on the coffee plantations were more likely to have microfilariae in a skin snip and more likely to have microfilariae in their urine. The presence of subcutaneous nodules or history of prior nodulectomy did not reduce the incidence of microfilaruria nor did the presence of subcutaneous nodules increase the incidence of microfilariae in the urine.


Onchocerciasis in Guatemala. III. Daytime periodicity of microfilariae in skin. Periodicity of microfilariae of Onchocerca volvulus in the skin was not believed to exist until investigators in Africa recently demonstrated diurnal periodicity. Interestingly, this maximal density of microfilariae in the skin has been shown to coincide with the peak biting time of the Simulium vector. The current study was performed as part of other studies in Guatemala. Maximal density of microfilariae in the skin was at 1000 hours or shortly therafter. This peak is earlier than reported in Africa. The most active feeding period of Simulium ochraceum, believed to be the principal vector in Guatemala, had been previously shown to be from 0800 to 1000 hours. The current report lends support to other findings indicating that Onchocerca volvulus microlilariae have a diurnal periodicity. In addition, the occurrence of peak vector biting time at the same time as maximal numbers of microfilariae in the skin strengthens a hypothesis that these synchronous cycles have a biological significance.


Onchocerciasis: prevalence of microfilaruria and other manifestations in village of Cameroon. Onchoecercal microfilaruia was studied in the course  of an epidemiologic investigation of diseases, infections, and general health conditions in a rural village on the Adamaoua Plateau in northern Cameroon. Microfilariae of Onchocerca volvulus were observed in nearly one half of the skin snips taken from the village residents. The prevalence of onchocerciasis as diagnosed from skin snips increased with age, and was greater for males than females. The number of microfilariae per skin snip also increased wth age. The presence of subcutaneous nodules, inguinal lymphadenopathy, microfilariae in the urine, ocular lesions and prolonged itching all were related to both age and the presence of microfilariae in skin biopsy specimen, as well as to intensity of infection. Microfilaruria was not restricted to individuals with severe onchocerciasis.


Effect of diethylcarbamazine on third stage Brugia malayi larvae in cats. Forty-one experimental and 37 control cats were each infected with 50 Brugia malayi larvae in such a way that a preponderance of the larvae remained localized in the popliteal lymph node or in the lymphatics of the leg draining into that node. During the 1st week after infection cats were treated with varying doses of diethylcarbamazine citrate (DEC). Two weeks after infection, necropsy for worm recovery was performed on treated and control cats. No living larva was recovered from 21 of 22 cats treated with a total of 10 mg DEC/kg body weight or greater. A single living larva was recovered in only 2 of 5 cats treated at 5 mg/kg. At 2 mg/kg, 8 of 10 cats had substantially fewer larvae than their controls; the remaining 2 were negative. In 4 cats treated with a total of 1 mg/kg, there was no reduction of larvae. All 37 untreated controls harbored living larvae, with a mean of 56% of the inoculum being recovered.


Immune response of guinea pigs to Schistosoma mansoni. I. In vitro effects of antibody and neutrophils, eosinophils and macrophages on schistosomula. Schistosomula of Schistosoma mansoni were rapidly killed in vitro by IgG2 antibodies from serum of schistosome-infected guinea pigs and heat-labile factors present in normal serum. Addition of polymorphonuclear neutrophilic leukocytes greatly increased the rate and degree of killing. Eosinophils and macrophages did not increase the level of killing, though they did react with schistosomula already damaged or killed by antiserum. Neutrophils and eosinophils reacted with schistosomula only in the presence of specific antibody, while macrophages nonspecifically attacked dead schistosomula. Serum antibody levels reached a plateau at approximately 6 weeks after a single infection. Attempts to precoat schistosomula with antibody prior to exposure to complement were largely unsuccessful.


Hypersensitivity to parasite proteolytic enzyme in schistosomiasis. A proteolytic enzyme which hydrolyses hemoglobin was obtained from the supernatant fraction of homogenized Schistosoma mansoni. This enzyme elicited histaminic skin reactions in various animals, including man, which were infected with S. mansoni. It failed to induce reactions in monkeys harboring S. haematobium, S. japonicum, or S. intercalatum. In a preliminary field trial in the Caribbean, the skin test proved to be somewhat less sensitive than the customarily used extract of adult worms in Coca's solution. However, the enzyme appeared to induce fewer false positive reactions and delayed responses than did the Coca's extract. A new diagnostic test for schistosomiasis probably could be developed by using specific parasite enzymes against which the host has become sensitized in the course of infection.


Halothane inhibition of rna and protein synthesis of PHA-treated human lymphocytes. Cultured human lymphocytes treated with phytohemagglutinin (PAH) ahd higher rates of RNA and protein synthesis, as judged by incorporation of the labelled precursors -3H-URIDINE AND -14C-leucine, than did control cultures without PHA. These cultures were prepared from cells of the same donor, as were a third set of cultures which were equilibrated with 2 per cent halothane. The increased rates of RNA and protein synthesis six and 16 hours after PHA ADDITION WERE INHIBITED BY THE HALOTHANE, MODESTLY AT SIX HOURS AND STRIKINGLY AT 16 HOURS. These experiments provide further evidence that halothane prevents recruitment of resting cells into the active cycle of cell division.


Effects of halothane on automaticity and contractile force of isolated blood-perfused canine ventricular tissue. The effects of halothane on canine ventricular automaticity and contractility were studied in intact and isolated heart preparations in which the right anterior papillary muscle and sinoatrial node of a recipient dog were separately perfused with arterial blood from a donor animal. One percent halothane inhaled by the donor dog decreased blood pressure and heart rate in the donor animal and sensitized the ventricle of the donor dog to the arrythmic effects of norepinephrine. One per cent halothane inhaled by donor dogs also produced negative inotropic and chronotropic responses in the isolated, perfused sinoatrial and ventricular oprparations, but had no effect on positive chronotropic or inotropic responses to norepinephrine or perivascular nerve stimulation. Norepinephrine administered to donor dogs produced no arrhythmia in either spontaneously beating or electrically paced recipient hearts even though producing ventricular fibrillation in the donor. The results suggest that re-entry mechanisms play an important role in halothane-catecholamine-induced arrhythmias.


Methoxyflurane anesthesia in pediatric patients: evaluation of anesthetic metabolism and renal function. Serum ionic fluoride concentrations during and following low-dose (6.0 mg/100 ml, 3 hours) methoxyflurane anesthesia and elective operation were measured in 13 pediatric patients (mean age 10.2 years; mean weight 34.5 kg). Peak measured serum ionic fluoride concentration was 21.6 plus or minus 3.3 mumol/1 24 hours after anesthesia. In a previously reported study of adult patients (47.5 years; 71.9 kg), the peak measured serum ionic fluoride concentration was 43.9 plus or minus 5.7 mumol/1 24 hours after low-does (6.8 mg/100 ml,3 hours) methoxyflurane anesthesia. Possible explanations for lower serum ionic fluoride concentrations in pediatric patients comared with adults include 1) slower metabolism of nethoxyflurand; 2) increased renal clearance of ionic fluoride from the blood; 3) greater sorage of ionic fluride in bone; 4) more rapid methoxyflurane elimiantion in the postoperative period. Serum uric acid increased (4.4 to 6.4 mg/100 ml, not significant) 24 hours after anesthesia and operation, while blood urea nitrogen and serum creatinine and osmolality were unchanged postoperatively.


Effects of morphine-nitrous oxide anesthesia on cerebral autoregulation. The effects of morphine-nitrous oxide anesthesia on cerebral autoregulation were studied in healthy male volunteers. Anesthesia was morphine, 2 mg/kg, and 70 per cent nitrous oxide in oxygen. Ventilation was controlled and carbon dioxide added to keep Paco-2 constant at 40 torr. Cerebral blood flow was measured first at the subject's normal mean arterial blood pressure, than at 60 torr and at 120 torr in a randomly assigned balanced order. Last, in five subjects cerebral blood flow was measured again at normal mean pressure. Blood pressure alteration was accomplished using phenylephrine or trimethaphan. Cerebral blood flow was 38.9 plus or minus 6.4 (SEM) ml/100 g/min at normal mean pressure, 49.5 plus or minus 10.7 ml/100 g/min at 60 torr. These values are not different a P IS LESS THAN 0.05. The data were analyzed for the possible effect of time on cerebral blood flow, and no change could be domonstrated. It is concluded that with Paco-2 constant at 40 torr morphine-nitrous oxide anesthesia does not significantly affect cerebral autoregulation in normal man.


Individual organ contributions to the decrease in whole-body Vo2 with isoflurane. The present study was designed to determine whether there were differebnces between the effects of isoflurane and halothane on canine whole-body Vo2 and myocardial, splanchnic, renal, and skelatal muscle Vo2's were determined at isoflurane concentrations equivilent to those used in a previous study with holothane.  With increases in isoflurane, whole-body Vo2 decreased progressively. As with halothane, the major comdial Vo2 that was related to a reduction in cardiac output and arterial blood pressure; contributions from other organs were minor. No significant difference between the effects of isoflurane and halothane on whole-body or individual organ Vo2's was found. These finding support the view that anesthetic agents are no general metabolic depressants and that observed changed in whole-body Vo2 reflect the su-mated changes in individual argan Vo2's occasioned by an anesthetic-induced change in organ function and metabolic requirements.


Effects of succinylcholine and d-tubocurarine on epinephrine-induced arrhythmias during halothane anesthesia in dogs. The effects of subparalytic doses of succinylcholine and d-tubocurarine on epinephrine-induced cardiac arrhythmias during halothane anesthesia were evaluated in dogs. Succinylcholine markedly increased (P is less than .05) the arrhythmogenicity of epinephrine and d-tubocurarine slightly decreased (P is less than .05) its arrhythmic effect. Prior administration of atropine resulted in a partial, but significant, reversal of this action of succinylcholine.


Evaluation of a bovine viral diarrhea vaccine produced in a porcine kidney cell line. An attenuated bovine viral diarrhea (BVD) live-virus vaccine, produced in a continuous porcine cell line, evoked an immune response which produced a protective level of serum antibodies in vaccinated cattle. Post-vaccinal reactions to the vaccinal virus were not observed in cattle vaccinated at 5 feedlots or in cattle vaccinated in experimental tests. The vaccinal virus did not produce demonstrable viremia or detectable excretion of virus from the respiratory or digestive tracts. Leukopenia or abnormality in differential leukocyte values did not occur as with virulent BVD viral infection. Transmission of vaccinal virus from vaccinated cattle to susceptible controls did not occur under conditions in which vaccinated and nonvaccinated cattle were in constant contact for 28 days.


Effects of fasting on hepatic function in ponies. Hepatic function was measured, using sulfobromophthalein sodium (BSP) in fed and fasted ponies. In the 1st experiment, single injections of BSP were administered, and the rate of removal of BSP from plasma was determined. Fasting decreased the rate of BSP removal from plasma, as indicated by increased half-time (t 1/2). In the 2nd experiment, BSP was infused for 5 hours, and its clearance from plasma was determined. Fasting decreased BSP clearance. In the 3rd experiment, BSP was infused consecutively at 2 dose rates, and maximal excretion and hepatic storage were determined. Although fasting did not affect maximal excretion, it decreased hepatic storage. Thus, results in the 3 experiments indicated a decreased hepatic clearance of BSP during fasting.


Ventilatory alterations in normal horses in response to changes in inspired oxygen and carbon dioxide. The influence of various concentrations of CO2 and O2 in the inspired gases on minute volume (V), tidal volume (VT), and respiratory rate (breaths per min; BPM) was examined in nonanesthetized, nonsedated normal horses. The VT and BPM increased linearly in response to increases in inspired CO2 concentration and curvilinearly in response to decreases in inspired Os concentration. The V increased curvilinearly in response to both increases in inspired CO2 concentration and decreases in inspired O2 concentration.


Morphologic alterations associated with decreased cerebrospinal fluid pressure in chronic bovine hypervitaminosis A. Arachnoid granulations and villi, choroid plexuses, and ependymal epithelium from 18 male Holstein-Friesian calves fed 108 (control), 8,800 (midly toxic), or 17,600 (severely toxic) mug of vitamin A/kg of live weight per day for 12 weeks were examined by light and electron microscopy for structural changes which could be used to explain the decreased cerebrospinal fluid (CSF) pressure seen in chronic hypervitaminotic A animals. In the toxic calf group, granulations were reduced to approximately two-thirds the size of those in the control calves, with the fibrous cap particularly being thinner and smaller. Second, height of epithelial cells of the lateral and 3rd ventricular choroid plexuses decreased significantly and that of the 4th ventricular choroid plexus, only slightly, as vitamin A intake increased. Structural differences of ependymal cells were not apparent between control and hypervitaminotic A calves. It is hypothesized that the thinner and less extensive fibrous cap of the arachnoid granulations in the toxic calves may result in increased permeability to CSF outflow.


Epithelial cell migration in the small intestine of sheep and calves. Replacement of villous epithelium in the small intestine of sheep and calves was studied by tritiated thymidine (3-H-TdR) autoradiography. Sheep were less than 1 day old, 3 weeks old, 3 months old, or more than 1 year old, and calves were less than 1 day old or 3 months old. In both species, there was marked variation in the location of labeled epithelial cells on villi among individuals from the same age group studied at the same time after administration of a single intravenous dose of 3-H-TdR. Labeled epithelial cells were confined to the proximal half of the villi at 48 hours after thymidine exposure in the animals, except some 3-month-old individuals from both species. Labeled epithelial cells had reached or were near the tips of the villi in these individuals at 48 hours. In both species, villi were longer and crypts were shorter in the newborn animals than in the older animals. The data were interpreted to indicate that replacement times were well in excess of 48 hours in neonates from both species and decreased somewhat with age.


Ammonium nitrogen in fetuses of urea-treated sheep. Eight pregnant Southdown ewes were treated (by drench) with 12.5 ml of 3.3 M urea solution per kilogram of body weight, and ammonium nitrogen concentrations of blood and tissues of these ewes and their fetuses were measured and compared with those of control ewes (given water by drench) and their fetuses. Blood ammonium nitrogen (BAN) and tissue ammonium nitrogen (TAN) concentrations for liver, kidney, spleen, and muscle of ewes and fetuses were determined by an ion-exchange procedure. Samples of blood were collected before treatment, at 30, 90 and 150 minutes after treatment, and at death of the dam. The principal ewes had increasing BAN concentrations with time after drench, and their fetuses had significantly greater (P less than 0.01) BAN concentrations than fetuses from control ewes. All fetuses were alive after death of the dams and had lower TAN values than their dams. The differences in ammonia concentrations between ewes and fetuses were larger in the principal group than in the control group. Except for ewe muscle and fetal liver, all tissues of principals had significantly greater (P less than 0.01) TAN concentrations than those of controls. Muscle of principal ewes and hepatic tissues of their fetuses had greater (P less than 0.05) TAN concentrations than those of control ewes and their fetuses.


Serum proteins of the Beagle dog: a two-dimensional electrophoretic study. Beagle serum proteins were separated by 2-dimensional electrophoresis and identified by histochemical and autoradiographic techniques. Haptoglobin, hemoglobin, ceruloplasmin, transferrin, and lipoprotein and glycoprotein fractions were identified. Use of a continuous gradient polyacrylamide gel revealed serum protein fractions not previously described.


Circulatory effects of halothane and halothane-nitrous oxide anesthesia in the dog: spontaneous ventilation. The cardiovascular effects of equipotent (minimum alveolar concentration; MAC) doses of halothane versus halothane plus 25% N2O (H25N2O) in spontaneously breathing dogs do not differe except that nitrous oxide increased mean arterial pressure (AP) and decreased arterial oxygen partial pressure (PAO2). When 75% nitrous oxide was added to halothane anesthesia, AP, mean pulmonary artery pressure (PAP), heart rate (HR), cardiac output (CO), stroke volume (SV), total peripheral resistance (TPR), and left ventricular work (LVW) increased and PAO2 and hemoglobin saturation decreased. Arterial oxygen tensions below 80 torr were common at moderate and deep anesthetic levels of halothane plus 75% N2O (H75N2O). The specific contribution of N2O, hypoxemia, hypercapnia, or temporal recovery (or a combination of these) in producing cardiovascular stimulation were not determined.


Treatment of ethylene glycol toxicosis in cats. Ethylene glycol (EG) was orally administered to 27 cats at dose levels of 4, 6, or 8 ml/kg of body weight. Treatment was initiated 4 or 8 hours later and consisted of giving (intraperitoneal injection, IP) 5 ml of 20% ethanol in isotonic saline solution and 6 ml of 5% sodium bicarbonate in isotonic saline solution per kilogram of body weight. Treatment was repeated every 6 or 8 hours for approximately 56 hours after initial treatment was given. The 6 control cats (i.e., untreated) and all cats treated 8 hours after EG was given in doses of 6 ml/kg (4 cats) or 8 ml/kg (4 cats) died. Only 1 of 4 cats (25%) recovered in the group given EG at the dose level of 4 ml/kg of body weight and initial treatment started 8 hours later. Two of 3 cats (67%) recovered in each of the groups given EG at the dose levels of 4 ml/kg and 6 ml/kg and initially treated 4 hours after dosing, but only 1 of 3 cats (33%) recovered in the group given 8 ml of eg/kg and first treated 4 hours later. Limitations of successful treatment are high doses of EG and delays in initiating the treatment.


Effect of age on epithelial cell migration in small intestine of chickens. Villous length, crypt depth, epithelial cell migration rate, and replacement time were studied by autoradiography of histologic sections of small intestine from normal chickens exposed to tritiated thymidine (3-H-TdR). The results indicated that villi and crypts elongate, and epithelial cell migration accelerates between 1 day and 6 months of age. Epithelial replacement time seemed to increase with age of the chickens. Replacement was nearly complete in the 1-day-old group of chickens 5 days after thymidine exposure. In contrast, at this same time, replacement was only approximately 75 and 50% complete in the 3-week-old and 6-month-old groups of chickens, respectively.


A field trial, using killed-Mycoplasma gallisepticum vaccine to protect against chicken respiratory mycoplasmosis. In a field trial with chickens, the efficacy of killed Mycoplasma gallisepticum vaccine against respiratory mycoplasmosis was determined. Broiler chickens were vaccinated by aerosol administration at 3, 14, and 25 days of age, and observations were made of survival rate, body weight gain ratio, macroscopic lesion grade of airsacculitis, isolation of organisms, serologic test results, histopathologic changes, and clinical signs. Inhalation of the vaccinal aerosol did not influence livability and body weight gain ratios. In the control group, M gallisepticum, M synoviae, or both, wereisolated in 6 of 10 chickens at age 84 days and in 1 of 10 chickens at age 134 days. In all of the vaccinated groups (10 broilers each), however, results of bacteriologic cultural examination during the observation period were negative. The killed M gallisepticum vaccine also suppressed increase of antibody titers in the tube agglutination and the hemagglutination-inhibition tests at different intervals. Both the histopathologic changes and the clinical signs appeared minimal in the vaccinated group.


Bovine spastic paralysis: cerebrospinal fluid concentrations of homovanillic acid and 5-hydroxyindoleacetic acid in normal and spastic calves. Homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) concentrations were determined in the cerebrospinal fluid (CSF) of 28 normal calves and 29 spastic calves. Concentrations of HVA were significantly (P less than 0.01) lower in spastic calves, whereas differences in 5-HIAA concentrations were not found between normal and spastic calves. These findings indicate that a lower dopaminergic metabolism takes place in the central nervous system (CNS) of spastic calves.


Anomalous pulmonary venous return in a Great Dane. A five-month-old male Great Dane dog was clinically diagnosed as having a complex cardiac anomaly, including anomalous drainage of pulmonary veins. Thoracic radiographs were indicative of this condition, but cineangiocardiography was required for confirmation. At necropsy, examination of the heart revealed that all pulmonary veins entered the right atrium rather than the left atrium as in a normal animal. In addition, a large ostium secundum-type interatrial septal defect and stenosis of the pulmonic valve were demonstrated.


Chronic subcutaneous implantation of a blood vessel catheter injection cap. A technique was devised for chronic subcutaneous implantation of a blood vessel catheter-injection cap. The device consisted of a disposable injection cap and blunt needle, which had been coated with silicone medical adhesive, and a silicone rubber catheter, which was attached to the blunt needle. The catheter was surgically placed in a blood vessel, and the injection cap was left in the subcutaneous pocket. For usage, such as blood sample collection for measurement of pressure, a hypodermic needle with a 3-way stopcock attached was pushed through the skin and into the injection cap. After the procedure was completed, the catheter was flushed with diluted heparin solution, and the hypodermic needle was pulled out. This has been used in dogs and sheep for as long as 8 weeks.


Absence of bacteremia after fiberoptic bronchoscopy. Fiberoptic bronchoscopy was performed in 43 consecutive afebrile patients with lung cancer. Blood cultures were drawn before the procedure, immediately afterward, and 30 min later. Although bacteria were isolated from all bronchoscopic washings and the majority of translaryngeal aspirates cultured, all blood cultures were bacteriologically sterile. No fever or evidence of infection developed in any patient within 24 hours after the procedure.


The preformed stomas connecting the pleural cavity and the lymphatics in the parietal pleura. Lympatics in the parietal pleura and diaphragm of rabbits and mice formed lacunas, terminal dilatations of lymphatic channels, with cribriform laminas bordering the pleural space at one end and one-way valves on the other end. The laminas consisted of a coarse mesh of connective tissue fibers covered by mesothelial cells at one side and endothelial cells at the other. At the fenestrated portions of the meshwork the basal surfaces of the 2 lining cells were closely apposed and some preformed stomas were found bridging the pleural and lymphatic spaces. No such structures were found in the visceral pleura, but similar cribriform laminas were also present in human parietal pleura at autopsy. Intrapleurally injected carbon particles reached the lacunas faster than similarly injected chicken red blood cells in living rabbits. Carbon particles appeared to pass through the closely apposed lining cells as well as the stomas but not into the intact interstitial structures. These structural and functional findings supported the observation that large particles and cells in the pleural cavity are removed only through the lymphatics and only at specific sites in the parietal pleura.


Relationship of air trapping to increased lung recoil pressure induced by chest cage restriction. Chest cage restriction was produced in 13 normal male subjects. We could not detect trapped air during restriction by comparing lung volumes determined by nitrogen washout with those determined by plethysmography. However, 3 subjects did have definite evidence of trapping because they released small amounts of air (mean, 61 ml) when the restriction was removed. Two subjects had suggestive evidence of trapping. Yet there was no correlation between trapping and the degree of increase in static lung recoil associated with restriction. Seven subjects had chest restriction produced while they were breathing air and again while they were breathing 100 per cent oxygen, in an attempt to reveal the presence of airway closure. In only one subject was oxygen breathing clearly associated with a greater then expected increase in lung recoil after restriction; suggestive changes were seen in 2 other subjects. However, there was no definite correlation between unusual increases in lung recoil induced by restriction while breathing oxygen and the presence of air trapping. We conclude that trapping, hence airway closure, is not required for the increase in static lung recoil that occurs with chest cage restriction.


The bronchiolar epithelium in cigarette smokers. Observations with the scanning electron microscope. Observations with the scanning electron microscope were made on the bronchiolar epithelium of 25 lungs removed at surgery. In all but 3 cases, the lungs were removed for a malignant tumor. Abundant ciliated cells were present in all lung specimens. In lungs obtained from nonsmokers, numerous Clara cells were present in the small bronchioles, whereas goblet cells were seen, and in most cases, the Clara cells were infrequent or absent. The evidence for the secretory nature of the Clara cells is discussed as is the possible effect on lung function of alteration in the type of secretory cell in the bronchioles.


Effect of light on tuberculin purified protein derivative solutions. The effect of light on the biologic potency of tuberculin purified protein derivative solutions at the concentrations commonly used in tuberculin skin testing programs in human and veterinary medicin was studied. Guinea pigs sensitized with bacille Calmette-Guerin were used to evaluate the potency of these solutions after exposure to light. The biologic potencies of solutions dispensed in colorless glass vials and exposed to daylight, fluorescent light, and ultraviolet light (366 nm) decreased significantly when compared to those of control solutions kept in the dark; solutions exposed to light assumed a deep brown color, whereas control solutions remained unaltered. The percentage loss of biologic potency decreased, whereas the absolute loss of potency, i.e., the loss expressed in tuberculin units, increased with tuberculin purified protein derivative concentration. In addition, after exposure to ultravoilet and, to a lesser degree, fluorescent light, the rubber stoppers of the colorless glass vials became sticky and adhered tightly to the glass. By contrast, the biologic potency of identical solutions dispensed in amber glass vials did not decrease significantly during 1 year of exposure to fluorescent or ultraviolet light. The solutions remained unaltered, and the rubber stoppers from all of the amber vials, whether exposed or not exposed to light, were not adversely affected. It is recommended that for storage of tuberculin the use of colorless glass or other containers that transmit ultraviolet light be discontinued.


The early detection of airway obstruction. To assess the sensitivity of tests for early, small airway obstruction, we selected 52 cigarette smokers with a ratio of 1-sec forced expiratory volume to forced vital capacity greater than 70 per cent from a smoking cessation clinic. From these subjects, 29 of the 46 tested demonstrated frequency dependence of dynamic compliance, a finding arbitrarily defined as indicative of small airway obstruction in this group. Dynamic compliance was correlated with the British Medical Research Council questionnaire, routine pulmonary function tests, closing volume as a per cent of vital capacity, maximal expiratory flow-volume curves, and flow dependence of distribution of inhaled boluses of xenon-133 (finite difference Xe). Symptoms of respiratory disease, and abnormal flow-volume curves, specific conductances, and ratios of residual volume to total lung capacity were also present in some subjects, but they correlated very poorly with frequency dependence of dynamic compliance. On the other hand, finite difference Xe was abnormal in 85 per cent of cases with frequency dependence of compliance and closing volume was abnormal in 70 per cent. In 8 of 12 subjects restudied 2 months after they stopped smoking, dynamic compliance was less frequency dependent than before smoking cessation. Similar improvements were noted in finite difference Xe, but closing volume was unchanged. Although closing volume and dynamic compliance tended to be abnormal in the same subject, concordance was not excellent, and the effects of smoking cessation suggested that the 2 tests had different determinants.


Clinical relevance of the flow rate response to low density gas breathing in asthmatics. The maximal expiratory flow rate response to low density gas breathing was examined at the mid-vital capacity point in 31 asthmatic patients. Clinical features and long-term follow-up date were documented to assess the clinical relevance of the various responses. Many of the patients with chronic asthma had not responded adequately to outpatient therapy, and they had been admitted to hospital for evaluation and management. With increased steroid doses and intensive bronchodilator therapy, all showed considerable improvement and were studied when this improvement occurred. The remainder of the patients were studied after recovery from acute asthmatic attacks or during maintenance management as outpatients. All patients with a forced expiratory volume in 1 second is greater than 75 per cent of the predicted value and mid-expiratory flow rate is greated than 50 per cent of the predicted value at the time of study showed a good response to helium. Those patients with more severe obstruction could be divided into 2 groups, responders and nonresponders. A qualitatively similar response to normal subjects (density-dependent flow rates) was a feature of those patients who in general showed further improvement in ventilatory function on follow-up. A qualitatively similar response to that seen in patients with chronic irreversible obstruction (density-independent flow rates) was a feature of those patients who in general showed no further improvement in ventilatory function on long-term follow-up. There were, however, exceptions to both groups. We conclude that in asthmatics with more than mild air flow obstruction, the assessment of helium response can be of value in identifying those patients who have, in addition to asthma, chronic irreversible obstruction due to concommitant chronic bronchitis and/or emphysema. Clinical assessment and measurement of single-breath diffusion of carbon monoxide provide additional support for the latter diagnoses and separate the few exceptions from the bulk of the nonresponders. Responders and nonresponders can be fairly reliably identified from the simply recorded exhaled flow volume curve, thus obviating the need for a volume displacement plethysmograph.


Variability of closing volume measurements in normal man. Single breath oxygen measurements of closing volumes were performed in triplicate in 15 healthy nonsmoking young adults 3 times per day for 5 consecutive days. The purpose of the investigation was to determine the degree of variability in this test of lung function and, if possible, to specify its cause. The results demonstrated that sizable differences in the absolute volume for closing volume and for closing volume as a percentage of vital capacity can be present from trial to trial in any given person even though the technical aspects of the procedure are seemingly highly standardized. The reasons for this were found to be a combination of (1) the inherent variation in the expired volume that marked the onset of airway closure, (2) reader difficulties in detecting the onset of phase IV, and (3) variations in the expired vital capacity due to incomplete filling and/or emptying of the subject's lungs. The differences were not due to daily or diurnal rhythms or to a training effect.


The N2 closing volume test in population studies: sources of variation and reproducibility. Sources of variation in the nitrogen closing volume test and derived measurements were examined in the results of 13 subjects, each of whom performed 3 sequential trials on 2 occasions 30 to 60 minutes apart, on 2 separate days 1 week apart (156 trials in all). Results were examined to evaluate the relative sensitivity of the various measurements for differences between sujbects and, by implication, their potential value in population studies. Using the ratio of signal (between-subject variance) to noise (within-subject variance) as the criterion, the sensitivities of the ratio of closing volume to vital capacity (CV/VC,%) and the ratio of closing capacity to total lung capacity (CC/TLC,%) were comparable; contrary to expectation, sensitivity decreased rather than increased with side-by-side compared to independent tracing analysis. Comparison of various test schedules showed the greatest sensitivity when the mean of 3 measurements was used, with a single measurement of CV/VC,% being only one-third as sensitive, and a single measurement of CC/TLC,% being one-half as sensitive as the mean. In addition, the validity of the measurements of total lung capacity from nitrogen dilution in a single oxygen breath was confirmed by the demonstration of good agreement with helium dilution values.