Blurring and layer thickness in narrow beam rotation radiography. The definition of the blurring of narrow beam rotation radiography is revived. The relative value of the blurring is considered to be the most reliable measurement. Calculations of the layer thickness should be based on the definition of the relative blurring. Experimental tests were performed, which confirm the mathematically presented hypothesis and also confirm the validity of the mathematical model of narrow beam rotation radiography presented by WELANDER (1974).


Tooth pulp stimulation as an unconditioned stimulus in defensive instrumental conditioning. In an experiment performed on five cats, stable escape and avoidance reflexes in a bar-pressing situation were established using tooth pulp electric stimulation as the unconditioned stimulus. The influence of changes in parameters of the unconditioned stimulus (current intensity, single pulse and train durations, frequency of pulses and rate of train presentations) on unconditioned and instrumental responses was analysed in three additional subjects. Among other relationships the dependence of the threshold of bar press responses on the amount of charge in a single pulse was determined.


Cytoarchitecture and acetylcholinesterase activity of the amygdaloid nuclei in the dog. The cellular structure and distribution of histochemically demonstrated acetylcholinesterase (AChE) activity were studied in the amygdaloid body of 9 dogs. Cytoarchitectonic observations were made in series of paraffin and celloidin sections stained with cresyl violet. For the demonstration of the acetylcholinesterase activity, modifications of Koelle method were used. The general pattern of morphological structure of the dog's amygdaloid body is similar to that in other mammalian species. The corticomedial group of the nuclei was characterized generally by cytoarchitectonic uniformity of small, lightly stained cells and low intensity of the AChE reaction, except for the nucleus of the lateral olfactory tract and the lateral part of the central nucleus. The latter showed further differentiation in both cellular arrangement and distribution of AChE activity and may be divided into three subdivisions. The basolateral group of nuclei was characterized by higher differentiation of the cellular arrangement and distribution of the AChE activity. The highest enzyme activity was observed in the basal magnocellular nucleus. These findings support the homology of particular amygdaloid nuclei in various mammalian species.


Interaction of converging peripheral and cerebellar cortical inputs on interpositus neurons of the cat. Anesthetized and immobilized cats were used. The interval between the peripheral (conditioning) and the cortical (testing) stimulation equalled the latency of the response to effective peripheral input. Efferent nuclear neurons were identified by antidromic stimulations from contralateral brainstem nuclei. Various sequences of excitation and inhibition of different duration were induced by peripheral inputs. Initial excitation was observed in efferent neurons in cases of selective reactions to one of the peripheral stimulations. In some neurons both initial excitation and inhibition were observed. Besides selective reactions, in neurons with background activity a convergence of different peripheral inputs was seen. Responses to converging peripheral influences had usually a similar pattern of PSTH, with the shortest latent period to the dominant afferent input. Effects of cerebellar cortical stimulation were observed in nuclear neurons, both efferent and intranuclear. Effects of cortical stimulation were evoked from a limited area of the stimulated cortical surface; convergence and divergence of influences were observed. Peripheral and cortical stimulations induced various patterns of impulse activity of nuclear neurons. Interaction of converging peripheral and cortical inputs on a nuclear neuron was determined by the level of excitation or inhibition evoked by the peripheral stimulus and the phase of the cortical action (inhibition or "disinhibition"). Besides its participation in integrative processes at the nuclear level, the cerebellar cortex determines the duration and frequency of successive onsets of excitatory bursts at the "output" of the cerebellum, thus playing a decisive role in the coding of information to other structures of the brain.


Implications of the inhibition of animal tumors by dietary zinc deficiency. Because zinc is an essential nutrient for tissue growth, cellular division, protein synthesis, and DNA and RNA replication, it also ought to play a critical role in the growth of tumors. To test this thesis, a series of experiments were performed to test the effect of zinc deficiency on the lethality of a variety of solid and ascites tumors in mice and rats. Specifically, the following models were tested: Walker 256 carcinosarcomas, solid and ascites forms in rats; three mouse leukemias (L5178yf, L1210, and P388) in CDF, male mice; and Lewis lung carcinoma in C57BI/6 male mice. Rats receiving a zinc-deficient diet showed marked reduction of tumor growth, both of solid or ascites models, and this was accompanied by striking increase in survival. Survival of mice with transplanted leukemia was also significantly prolonged by zinc deficiency. In addition, growth of the Lewis lung carcinoma was inhibited, but the survival through increased, was probably limited by the adverse effects of zinc deficiency. The results suggest that tumor inhibition is a general effect of zinc deficiency, irrespective of cell type, cell growth rate, species, or site of growth. There are numerous potential applications of zinc metabolism to the diagnosis, therapy, and understanding of cancer.


Carcinogenicity of nickel subsulfide in Fischer rats and Syrian hamsters after administration by various routes. In an endeavor to expand the variety of experimental models for study of nickel carcinogenesis, nickel subsulfide (Ni3S2) was administered to rodents by five previously untested routes. In two groups of Syrian hamsters, Ni3S2 induced multiple sarcomas at the sites of single im injections (5 or 10 mg of Ni3S2). In contrast, Ni3S2 did not induce any malignant tumors of the cheek pouches, oral cavity or gastrointestinal tract, despite multiple local applications to the cheek pouches of several groups of hamsters in total dosages as large as 1.1 g of Ni3S2. In a group of Fischer rats, single intratesticular injections of Ni3S2 (10 mg) induced many testicular sarcomas. In contrast, no malignant tumors developed in two groups of rats that received single injections into the submaxillary gland (2.5 mg of Ni3S2) or into the liver (5 mg of Ni3S2 via the portal venous system).


Removal of plasma bilirubin by hemoperfusion in dogs. The removal of plasma bilirubin by hemoperfusion in dogs with hepatic insufficiency was investigated. The quantity of bilirubin adsorbed from the plasma and from tissue flux during hemoperfusion was measured. The relationships of the mass of removed bilirubin, its initial concentration in the blood and the time of perfusion showed a good correlation. These studies have shown that the anion-exchange resin MCTI-2A used for removal of plasma bilirubin did not alter the electrolyte composition, acid-base balance and the concentration of other measured metabolites.


Rapid development of micronodular cirrhosis following small bowel by-pass for obesity. A form of iatrogenic nutritional cirrhosis? Two cases of rapidly progressive fatal liver disease in females after by-pass surgery for obesity are reported. Histologically the livers are similar to the florid cirrhosis of the alcoholic described by Popper and Szanto. It is postulated that the nutritional disturbance, including protein deficiency, and large amounts of fatty acids delivered to the liver from the fat depots, results in fatty metamorphosis, the Mallory bodies and finally cirrhosis. Bacterial toxins from the excluded loop of intestine may contribute to this process.


Chronic calcific pancreatitis in association with celiac disease. Painless pancreatitis with extensive calcification and villous atrophy of the small intestine was observed in a nonalcoholic female patient. The etiology of villous atrophy could not be established. The pathophysiological significance of this association is discussed.


Fiberoptic endoscopy of the gastrointestinal tract in infants and children. I. Upper endoscopy in 53 children. Fiberoptic endoscopy of the upper gastrointestinal tract was performed on 53 patients without incident, ranging in age between two months and 18 years, of whom 35 were out patients at the time of examination. Of 27 patients with recurrent abdominal pain and normal upper gastrointestinal series, eight had abnormal findings at endoscopy: a duodenal ulcer in four, a gastric ulcer in two and duodenitis in two. Of 18 patients with hematemesis and/or melena, esophageal varices were demonstrated both by endoscopy and x-ray in two, gastric ulcer by endoscopy in three and x-ray in one, duodenal ulcer by endoscopy in three and by x-ray in two, esophagitis by endoscopy only in one patient, erosive gastritis by endoscopy in five and by x-ray in two and duodenitis by endoscopy in three and by x-ray in two. Of the remaining eight patients with abnormal x-rays findings and other symptomatology, endoscopy demonstrated foreign bodies in two (coins, esophagus and stomach), duodenitis in two, a gastric ulcer in one, a duodenal ulcer in one and normal examination in two. The data indicate that fiberoptic endoscopy significantly improves diagnostic accuracy in the evaluation of disorders of the upper gastrointestinal tract in children and is a safe and effective procedure in ambulatory pediatric patients.


Carcinoids of the stomach. Report of two cases. Endoscopic, histologic and clinical findings of two cases with disseminated carcinoids restricted to the stomach are described. Endoscopically different forms of polypoid lesions were observed: 1. polypoid type of Yamada III, usually seen in epithelial tumors; 2. small lesions elevated with bridging folds and 3. slightly elevated types with necrotic surface similar to an early stage of cancer. An exact diagnosis is possible  with sections obtained by polypectomy, button-hole-biopsy or by hot-biopsy. There are some problems in interpreting the histology, especially the differentiation from carcinomas. Carcinoids limited to the stomach do not produce typical clinical symptoms. 5-HIA and serotonin levels in the thrombocytes are in the normal range. Since surgical procedures depend upon the exact localization and the invasive or noninvasive morphological character, endoscopy with polypectomy is of great help in assessing the pathology as well as the necessity for surgery.


Herpes simplex ulcerative esophagitis in a healthy subject. A 20-year old white male developed a self-limited ulcerative esophagitis followed by a transient vesicular skin eruption due to infection by herpes simplex virus Type I (HSV-I). While herpetic esophagitis has been described previously, this case appears to be unique in that there was no concomitant serious delibitating illness or pharmacological immunosuppression. Herpes simplex Type I should be included in the differential diagnosis of unusual esophageal ulceration in otherwise healthy patients.


Chronic active hepatitis and membraneous glomerulonephritis. A 26-year old man with documented HBs antigenemia of five years' duration developed the nephrotic syndrome. Histologic patterns of chronic active hepatitis and membraneous glomerulonephritis were found. The glomeruli stained positively for Ig-G, complement and HBs Ag. The relationship of HBs Ag-positive chronic active hepatitis and membraneous glomerulonephritis is discussed.


Granulomatous hepatitis in a healthy adult following BCG injection into a plantar wart. This is the first reported case of granulomatous hepatitis in a healthy adult following intralesional injection of BCG into a plantar wart. Previous reports of disseminated disease following intralesional injections have all been in patients with malignancies. The clinical course in this patient was characterized by fever, chills and drainage from the injection site. Diagnosis was made by demonstration of noncaseating granulomas on liver biopsy. No acid-fast organisms were identified by stain or culture. The patient responded to antituberculous therapy.


I131-rose bengal scanning in the detection of cholecystocolic fistula. New use of an established procedure. A case of cholecystocolic fistula diagnosed by I131-Rose bengal scanning and later confirmed at the time of laparotomy is reported. The fistula was not seen by conventional contrast radiographic studies. It is suggested that I131-Rose bengal studies be considered in the study of patients suspected of having cholecystenteric fistulas.


The radiology corner. Bouveret's syndrome. A case of gallstone obturation of the duodenal bulb is presented. The general topic of gallstone ileus is briefly discussed and a review of the reported cases of Bouveret's syndrome is presented. The radiographic criteria for diagnosis of these entities are emphasized.


Bad law, bad medicine.

Bad law, bad medicine. In this Comment, Dr. Altschule contends that in a variety of ways the American legal system currently is endangering the existence of positive physician-patient relationships, which are essential to the effective practice of medicine. First, he contends, physicians are exposed to an excessively high risk of liability for malpractice, and as a result must substitute the use of "defensive," often unnecessary laboratory tests for reliance on their own sound medical judgment. Second, the confidentiality of communications between physicians and patients is receiving inadequate legal protection; therefore, patients often are hesitant to reveal aspects of their medical history that may be critical to their case. Third, the federal government, by its medically inappropriate attempts to ban drugs that do not meet certain federal "safe and effective" standards, and to ban food additives that fail to pass certain federally controlled tests aimed at determining whether the additive causes cancer, is making it increasingly difficult for physicians to prescribe substances that may be of great value to their patients. The author warns that our society's failure to substantially alleviate such problems is likely to lead to an inferior brand of medical practice.


Medicolegal causation: a source of professional misunderstanding. The authors of this Comment--a lawyer and a physician--suggest that most physicians who are called upon to testify concerning medical issues in personal injury litigation do not understand that judges and attorneys view "causation" quite differently than do members of the medical community. For example, medical practitioners tend to be concerned with all possible causes of the patient's current medical condition, whereas legal practitioners in personal injury cases generally focus on a particular event as possibly precipitating, hastening, or aggravating a particular aspect of the patient's condition to the extent that the event in question is, in legal language, the "proximate cause" of an injurious result. The authors summarize and analyze the differences--and the occasional similarities--between the medical and the legal approaches to causation, in the hope that they will thereby (1) contribute to greater understanding by the two professions of each other's theory and practice, and (2) help the expert medical witness to be more comfortable and more effective in his courtroom role.


Genetically defective children: emerging legal considerations. Despite modern medical advances, births of genetically defective children still occur. The author outlines the problem of genetic disease, and describes the medical and legal advances that now make possible a reduction in its incidence. Then she cites--and briefly comments upon--some court cases brought by parents of genetically defective children against their physicians for allegedly failing to predict or to diagnose genetic defects in those children in time for the parents to exercise any procreative options such as sterilization, contraception, or abortion. In addition, the author speculates on various questions that may arise in future litigation in this area--among them, the question of whether or not courts someday will endow genetically defective children with a cause of action against their parents for bringing them into the world.


Nonsecretory multiple myeloma. Immunohistologic and ultrastructural observations on two patients. Two well documented examples of nonsecretory multiple myeloma were studied by electron microscopic and immunohistologic methods. In one case, repeat studies revealed no intracytoplasmic immunoglobulins, and the cells displayed a "plasmacytoid" appearance with poor development of rough endoplasmic reticulum and Golgi regions. In the other case, most cells contained intracytoplasmic immmunoglobulins of a monoclonal type and the ultrastructural appearance was that of cells actively engaged in protein synthesis. These findings and others in the literature suggest that myelomas without an M component can be separated into nonproducers and true nonsecretors of immunoglobulins. In one case, immunofluorescence of bone marrow smears with double labels demonstrated three different plasma cell populations: those producing either monoclonal immunoglobulins M (IgM) or A (IgA) and those synthesizing simultaneously IgM and IgM. Dual immunoglobulin production, although known to occur in myelomas with paraproteinemia, has not been previously documented in the nonsecretory variety.


Immunoblastic lymphadenopathy with pulmonary infiltrates, hypocomplementemia and vasculitis. A hyperimmune syndrome. A detailed description of the clinical and morphologic characteristics of four patients with immunoblastic lymphadenopathy, pulmonary infiltrates, hypocomplementemia and vasculitis is presented. Noteworthy in the patients described here is the clinical similarity to patients with collagen-vascular diseases and systemic drug reactions. The frequent occurrence of pulmonary symptoms, bilateral interstitial infiltrates and pleural effusions is emphasized. The morphology suggests stimulation of the immune system by antigenic agents, and the low complement levels and the presence of vasculitis suggest that circulating immune complexes may be present. Immunoblastic lymphadenopathy may represent a syndrome in which the adenopathy is but a nonspecific part of a systemic hyperimmune response to unknown antigens. The clinical course of the patients reviewed suggests that supportive treatment and corticosteroids constitute the safest therapeutic approach.


Intestinal absorptive and digestive function in pernicious anemia. We examined the digestive and absorptive function of the small intestinal mucosa in three patients with pernicious anemia to determine the functional correlates of the morphologic changes previously described. Digestive brush border enzymes (disaccharidases and leucyl-naphthylamidase) in jejunal biopsy specimens from the patients followed a normal distribution compared with those in the control group. With the exception of one patient with mild steatorrhea, the rest of the absorption test results were within the normal range. Jejunal perfusion studies, however, with glucose, sodium and water showed intestinal secretion of sodium and water, i.e., net movement of sodium and water from plasma to lumen, in the presence of normal glucose absorption. Follow-up studies in two patients after treatment with vitamin B12 did not reveal any significant improvement in the absorption rates from the pretreatment period. This abnormality of sodium and water transport in pernicious anemia represents another intestinal defect of a systemic disease which is not corrected by vitamin B12 replacement therapy.


Effect of carbon monoxide on exercise performance in chronic obstructive pulmonary disease. We evaluated the effect of breathing 100 ppm of carbon monoxide versus compressed, purified air for 1 hour on exercise performance in 10 patients with chronic obstructive pulmonary disease in a double-blind, randomized, crossover study. The mean arterial carboxyhemoglobin was 1.48 per cent in the carbon monoxide control period and increased from 1.43 to 4.08 per cent after breathing carbon monoxide (P less than 0.001). The mean arterial carboxyhemoglobin level was 1.52 percent in the air control period and decreased from 1.47 to 1.34 per cent after purified air (P less than 0.001). The mean exercise time until marked dyspnea decreased from 218.5 seconds in the carbon monoxide control period to 146.6 seconds after breathing carbon monoxide (P less than 0.001). The mean exercise time was 219.9 seconds in the air control period and 221.3 seconds after purified air (P not significant). Breathing 100 ppm of carbon monoxide for 1 hour caused a significant reduction in exercise performance in patients with chronic obstructive pulmonary disease.


Apomorphine-stimulated growth hormone release. Apomorphine, a dopaminergic receptor stimulant, was tested and compared in subemetic doses (0.76 mg subcutaneously) to levodopa (500 mg orally) as a stimulant of growth hormone release in 10 normal volunteer subjects (five male, five female). The administration of levodopa failed to cause a normal increment in serum growth hormone levels (greater than 5 ng/ml from base line) in four patients, produced a borderline normal response in two patients with a normal response in four patients. Apomorphine stimulation produced a borderline normal response in one patient and a normal response in the remaining nine patients. The peak response to apomorphine administration was 26.94 +/- 6.60 ng/ml and to levodopa 9.76 +/- 2.67 ng/ml (p less than 0.025). There was no statistical difference between men and women in whom apomorphine testing was utilized. Side effects (nausea, vomiting) were seen in three patients tested with levodopa and in four patients tested with apomorphine. Such symptoms began within 20 minutes of apomorphine administration, persisted from 30 to 40 minutes and disappeared abruptly. All patients treated with apomorphine noted transient drowsiness.


Diaphragm function and lung involvement in systemic lupus erythematosus. Lung involvement was assessed in 30 consecutive patients with systemic lupus erythematosus (SLE), not selected by respiratory symptoms. Pulmonary function tests revealed a higher rate of abnormality than either clinical history or radiography. The single breath carbon monoxide diffusing capacity was below 80 per cent of the predicted value in 24 patients (80 per cent), and a reduced total lung capacity was present in 13 (43 per cent). There was a weak correlation between the severity of the functional defect and disease activity, assessed antinuclear factor and DNA binding. No correlation was found with serum complement of Clq precipitation. Since pulmonary fibrosis in SLE is uncommon it cannot account for the high frequency of abnormal findings, and the pathogenesis of the functional changes is probably multifactorial. In seven of the patients with the smallest lung volumes, measurements of static pressure volume curves and of maximum respiratory pressures indicated extrapulmonary volume restriction. In five of these patients, diaphragm function was specifically assessed and found to be grossly abnormal in four. The inability of the diaphragm to generate normal pressure may be due to either severe weakness or immobility following extensive pleural adhesions. The well recognized syndrome of "shrinking lungs" and high "sluggish" diaphragms with clear lung fields on radiography is probably due to dysfunction of the diaphragm rather than to primary intrapulmonary pathology.


Activation of protein mediators of inflammation and evidence for endotoxemia in Borrelia recurrentis infection. Fifteen patients with Borrelia recurrentis infection were studied to evaluate the role of certain plasma proteins and endotoxin in the pathophysiology of both the acute illness and the Jarisch-Herxheimer-like reaction. The causative spirochetes disappeared from the blood during the Jarisch-Herxheimer-like reaction, which occurred about 2 hours after antibiotic therapy. The mean titers of Hageman factor, plasma prekallikrein and serum hemolytic complement activity were decreased at the time of admission and 2 hours after treatment, and rose to normal values during convalescence. Serum properdin titers were decreased in 14 patients at the time of admission, in 12 patients 2 hours after treatment, and in none during convalescence. The frequency of elevated levels of fibrinogen-related antigens increased from three patients at the time of admission to 12 patients 2 hours after treatment. Results of plasma limulus tests for endotoxin-like material were positive in 11 patients at the time of admission and in 13 patients 2 hours after treatment. These findings demonstrated that Hageman factor, prekallikrein and proteins of the complement system are activated in B. recurrentis infection and that endotoxin may play a role in both the acute illness and in the development of the Jarisch-Herxheimer-like reaction after treatment.


Exacerbation of diabetic renal failure following intravenous pyelography. Twenty-two of 29 (76 per cent) diabetic patients with a creatinine level of more than 2 mg/100 ml had exacerbation of renal failure following intravenous pyelography. In nine patients this was irreversible. Particularly at risk seem to be patients with early onset diabetes (less than 40 years), and those patients with severe renal failure (creatine over 5 mg/100 ml). No less that 15 of 16 (93 per cent) such patients had problems after intravenous pyelography; of these, nine (56 per cent) had irreversible deterioration. This report, in context with the increasing number of case reports of similar findin.gs, indicates that intravenous pyelography is dangerous in patients with juvenile onset diabetes who have a creatinine level of more than 5 mg/100 ml.


Treatment of iron overload in adults with continuous parenteral desferrioxamine. Adult patients with transfusional hemosiderosis were given ascorbic acid and treated with the iron chelator, desferrioxamine B. The drug was administered by continuous subcutaneous or intravenous infusions using a light weight portable constant infusion device. On this regimen, four of the five patients studied were able to excrete significant amounts of iron (greater than 35 mg/da) when receiving a daily desferrioxamine dose of 1.5 to 2.2 g. Continuous subcutaneous infusion was well tolerated and about 80 per cent as effective as intravenous therapy in chelating iron. The number of prior transfusions, the hepatic iron content and the serum ferritin levels appear to be useful in predicting which patients will respond to iron chelation therapy, especially if there is little bone marrow erythropoietic activity. One patient with ineffective erythropoiesis did not have significantly increased hepatic iron stores but responded to the administration of desferrioxamine. Continuous subcutaneously administered desferrioxamine may prove to be adaptable for long-term outpatient therapy, allowing patients with ongoing transfusion requirements to go into negative iron balance. Long-term studies will be needed to demonstrate reversal of endocrine, hepatic and cardiac dysfunction secondary to iron deposition in these patients.


Generalized microsporum audoninii infection and depressed cellular immunity associated with a missing plasma factor required for lymphocyte blastogenesis. Described herein is a 15 year old girl with a generalized, possibly systemic Microsporum audouinni infectin associated with anergy and defective lymphocyte transformation as a consequence of a deficiency of an uncharacterized plasma factor. Intravenous administration of plasma, obtained from normal donors, has produced consistent although incomplete clinical improvement. Defective lymphocyte transformation to M. audiouinii antigen cultured in autologous plasma became normal after infusions of normal plasma were instituted. Systemic administrations of griseofulvin, clotrimazole and miconazole produced transient and incomplete clinical improvement. Clearing of the cutaneous infection and stabillization of the neurologic status was finally achieved with plasma infusions combined with parenterally administered amphotericin B.


The Humphrey Vision Analyzer tm: reliability and validity of refractive-error measures. Four subjective measures of the refractive error of 42 eyes (21 patients) were obtained by 2 examiners, one using a Humphrey Vision Analyzer TM and the other using a conventional refractor. Each examiner made 2 separate measures of each subject's refractive error, one without and one with an added cylindrical lens chosen at random from a predetermined set of powers and axes. The order of using the instruments and the added lenses was mixed. Measures of the refractive errors differed with the 2 instruments by approximately the same amount on average as did duplicate measures with either instrument. Refractive-error measures obtained with the 2 instruments are about as valid as they are repeatable.


Soft and hard contact lenses worn in combination. Each of 5 subjects with normal corneas was fitted with a Bausch & Lomb F3-series Soflens contact lens and with an experimental F3-series ultrathin Soflens. A best-fit PMMA lens was worn in combination with each of the soft lenses. In addition, a best-fit CAB lens and a tight PMMA lens were separately worn in combination with the ultrathin soft lens. Each of 3 subjects with keratoconus was fitted with an ultrathin soft lens combined with a PMMA lens. For the normal corneas, the combination that produced the least corneal edema after 5 hr was an ultrathin soft lens with either a PPM or CAB lens of best fit. Two of the 3 keratoconic subjects were able to wear their contact lens combination for the 5-hr test period; corneal swelling was 1.7% and 5.3% For all subjects, acuity with a combination co ntact lens system was better than with a soft or hard lens alone.


Oxygen-transmissibility considerations for a hard-soft contact-lens combination. A combination formed by covering a soft contact lens on the cornea with either an oxygen-permeable or an impermeable hard lens offers some advantages over a soft lens or a hard lens alone. Several procedures can be used to fit such combinations to the eye. The amount of oxygen that is delivered to the cornea will depend strongly on the fit on the soft lens to the cornea and the fit of the hard lens to the soft lens; the amount of oxygen delivered by 4 different combinations is described here. The results show that the proper choice of lenses and fit will permit an adequate supply of oxygen to reach the cornea in daily wear.


Brightness changes during book retinoscopy. Book retinoscopy involves the observation of fundus reflex changes that are said to be related to the reading levels or interpretive levels at which persons are functioning. Recent investigations have shown that increasing the cognitive demand on a person can result in accomodative changes in his eye that increase the luminance of the fundus reflex. Since the ability of observers to distinguish such changes is not known, this experiment was designed to determine the minimum detectable increase in luminance. The experiment involved a 2-alternative forced-choice procedure in which observers were required to indicate during which of 2 designated intervals the reflex from a schematic eye became brighter. The luminance of the reflex had to increase by at least 11% beforeit could be detected. A reduction in the lag of accommodation and dilation of the pupil probably account for the changes observed during book retinoscopy.


Dynamics of the human eyeblink.

Dynamics of the human eyeblink. High-speed photography of eyeblinks in 4 subjects provided displacement and velocity time functions. The results from dynamic measurements made with a mechanical transducer connected physically to the upper eyelid gave estimates of the passive spring constant (Kp = 1.5 gmf/mm) and the passive viscosity (Bp = 0.09 gmf - sec/mm) of the eyelid. Noting the similarity between the reciprocal-innervation mechanisms in the eyelid and the eye-movement systems, a mathematical eyelid model was derived based on the well-known eye-movement model and using similar ideal mechanical-element representations. The model-simulation time course shows the essential characteristics of an eyeblink and suggests that the force program consists of reciprocally acting pulse forces during the downblink, and pulse-step forces during the upblink. When 1 mm of lid displacement is equated with 5 deg of eyeball rotation and when the main sequences for lid movements and for time-optimal saccadic eye movements are compared, the eyeblinks are not found to be time optimal for their various amplitudes.


Perimetry: a need for standardization.

Perimetry: a need for standardization. Luminance measurements of targets and backgrounds revealed differences for various types of perimetric instruments. A lack of uniform testing conditions for instruments of the same design was also noted. Of the instruments measured, hemispheric-projection perimeters seemed to provide the most repeatable test conditions.


Patient responses to 13.6-mm diameter Bausch & Lomb thin Soflens contact lenses. Responses were obtained from 12 subjects (24 eyes) who wore 2 types of 13.6-mm diameter Bausch & Lomb Soflens contact lenses-thin F 3 lenses and conventional-thickness F3 lenses. These responses were also compared with those of patients who had worn thin F lenses that were 12.5 mm in diameter. Fewer patients experienced discomfort or corneal changes with the thin F3 lenses than with the conventional ones. Lens diameter was also an important factor in improving the patients' responses. Only 35% of a different sample of 23 patients who had been fitted with 12.5-mm diameter thin F lenses had been able to wear them successfully, compared with 75% of those wearing the 13.6-mm diameter thin F3  lenses, even though the mean corneal thickening caused by the smaller lenses did not differ significantly from that caused by the smaller lenses did not differ significantly from that caused by the thin F3 lenses. Thin hydrogel lenses with diameters larger than 13.6 mm thus might produce an even better overall patient response while still causing minimal corneal edema.


Evaluating and improving clinical instruction. An empirical method for developing a form to describe and evaluate clinical teaching is presented. The form consists of descriptive statements that characterize teachers nominated by students and faculty as the BEST teachers and that do not characterize those nominated as the WORST teachers. Each instructor receives a profile summarizing the students' ratings of him and compares his teaching effectiveness with that of his colleagues. It is emphasized that teaching evaluations do not in themselves improve teaching but that they can inspire improvement when they are used as a framework for introducing specific new teaching behaviors to instructors during consultations with an independent person such as a psychologist.


Review of diseases of the optic nerve, optic tract, and visual cortex: 1975-76. The ophthalmic literature dealing with diseases of the optic nerve, the optic tracts, and the visual cortex was reviewed for the period November 1975 through November 1976. Twenty-nine papers on topics of interest to optometrists were abstracted. The main areas of interest include: papilledema and optic atrophy (with ophthalmoscopic signs of both optic atrophy and papilledema); giant-cell arteritis; papillitis; interesting malformations of the face, palate, and orbital position that occur in conjunction with microphthalmus, situs inversus, and hypoplasia and aplasia of the optic nerve; the proposed association of myopia with unusual eyebrows; myelinated nerve fibers at the nerve head; pigment anomalies; the continuing discussion of nerve-head blood supply; an unexpected cause for nerve-head neovascularization; the importance of the swinging-flashlight test in the diagnosis of glaucoma; an unusual type of glaucomatous cupping; doubts about the peripapillary "halo" as a sign of glaucoma; new uses for old field tests; and new methods of ocular photography.


Wound healing in the early chick embryo studied by scanning electron microscopy. A simple incision was made in the early chich embryo (stages 3-5) are pellucida endoderm and its subsequent healing studied by scanning electron microscopy (SEM). Initially the wounded edges of the endoderm layer curl towards the ectoderm creating a gaping slit. The endoderm cells adjacent to the slit from large mounds probably in response to a loss of substrate and the trauma of the incision. Healing begins as the endoderm cells direct processes across the underlying cell layers and the two cut edges move towards one another. Many intervening mesoderm cells have cup-shaped processes. As the two endoderm edges meet in the corners of the wound, the wound outline changes to an oval shape. After 2 hours the wound outline is changed to a slit with the cut edges contracting in one or two areas. The cup-shaped mesoderm processes remain in the slit until the wound is healed primarily by endoderm cell movement.


Ultastructural analysis on acetylcholinesterase localization in the cerebellar cortex of teleosts. The histochemical localization of acetylcholinesterase (AChE) was studied by electron microscopy in the cerebellar cortex of the goldfish and the catfish. The patterns of enzyme distribution show noticeable differences in the two teleost species at the level of the corresponding cerebellar structures. Among the most distinctive features is the prevailing intracellular localization of enzyme activity in the goldfish and the prevailing extracellular localization in the catfish in the molecular layer and, to a lesser extent, the granular layer. Only quantitative differences in the ability to synthesize AChE can be recorded among the different cerebellar neurons in the two species, since all these neurons exhibit different amounts of enzyme activity linked to their cytoplasmic structures. Comparing the results obtained with those of previous histochemical, experimental and developmental researches, the hypothesis seems well founded that the embryonic pool of cerebellar neurons is made up of AChE-synthesizing nruroblasts which, during development, loss or maintain to a different the mechanisms for AChE synthesis. In addition the light and electron microscope histochemistry reveals at different levels of resolution that the final pattern of AChE distribution in the cerebellar cortex is the sum of different degress of AChE synthesis by cerebellar neurons and different degrees of enzyme release in extracellular spaces.


Ultrastructural pattern of acetylcholinesterase distribution in the cerebellar cortex of the quail. The ultrastructural localization of acetylcholinesterase (AChE) was studied in the cerebellar cortex of the quail by means of histochemical method. The greater amount of AChE was detected at leve of the molecular layer in the intracellular spaces between parallel fibers and between parallel fibers and dendritic terminals. Many neurons showed intracellular localization of enzyme activity: the AChE positive neurons were all Golgi cells, most stellate the basket cells and different aliquots of Purkinje and granule cells. The enzymatic activity was usually localized in the cisternae of endoplasmic reticulum, in the nuclear envelope (but this last localization was not present in Purkinje cells- and sometimes in the Golgi apparatus; reaction granules were usually scarce in the different dendritic branches ramifying in the molecular layer. On the basis of the ultrastructural pattern of AChE distribution, some considerations are developed on the methodological aspects concerning the reliability of histochemical methods, the differences recorded at light and electron microscope level, the problems related to extracellular localization of enzyme, the difficulty of establishing a precise correlation between AChE localization in a cerebellar neuron and its possible cholinergic and/or cholinoceptive nature.


Relationships between shape and size of the osteoblasts and the accretion rate of trabecular bone surfaces. The structure of the osteoblastic layer on trabecular bone surfaces showing different accretion rates was examined. Volume and secretory surface of the cells and thickness of the underlying osteoid border were measured within serial sections. Shape, size and arrangement of osteoblasts varied greatly on the different trabeculae examined, but were relatively homogeneous over each surface. A correlation was found between the volume-secretory surface ration (i.e. the relative amount of protoplasmatic volume involved in osteoid production) and the thickness of the underlying osteoid seam measured separately for each osteoblast.


The cerebellar projection from the raphe nuclei in the cat as studied with the method of retrograde transport of horseradish peroxidase. Following injections of horseradish peroxidase (HRP) in the cerebellar cortex and nuclei of the cat, the distribution of labeled cells in the raphe nuclei was mapped. The findings confirm those made previously in studies of retrograde cell degeneration following cerebellar ablations (Brodal et al., 1960a), and in addition reveal new details in the projection of the raphe nuclei onto the cerebellar cortex and nuclei. All the raphe nuclei except nucleus linearis intermedius and nucleus linearis rostralis project onto the cerebellar cortex. The nuclei raphe obscurus and pontis contribute the greatest number of afferents to the cerebellum. With the exception of lobule VI which probably is the recipient of a weak projection, all parts of the cerebellar cortex receive afferents from the raphe nuclei. The heaviest projection is to the vermis of lobules VIIA and X, and to crus II. The afferents to the cerebellar nuclei are few in number (Tables 2-6). The observations indicate that each raphe neuron probably projects to more than one terminal site in the cerebellum. The findings are discussed with reference to other efferent and afferent studies of the raphe nuclei. All these studies indicate that the raphe nuclei have widespread efferent and afferent connections, making them capable to participate in a variety of regulatory functions.


An electron microscope study of the differentiating capillaries of the mouse neurohypophysis. The developing capillaries of the mouse neurohypophysis were studied in the electron microscope to elucidate the fine structural differentiation of the vascular component of the neuro-hemal contact zones in the external median eminence and the neural lobe. In the embryo the growth  of the superficial net of the primary plexus of the hypophysial portal system is largely manifested by the presence of proliferation areas located within the capillary plexus covering the surface of the median eminence. Presumptive shallow capillary loops diverge from these ares in the first postnatal week. Differentiation of the capillary wall follows the pattern outlined for continuous capillaries. A few fenestrae appear in the endothelium of immature, superficial vessels at the 17th gestational day, increase in frequency during the following embryonic days, and occur regularly in the postnatal animal. In the neural lobe the internal capillaries proliferative by vascular sprouts emanating from the vessels on the surface of the gland. At the end of embryonic time an extensive net has developed, composed of capillaries with immature characteristics. Proliferation is largely finished by the end of the third postnatal week, when mature capillaries dominate the picture. Formation of attenuated, porous areas is a postnatal process, apart from single fenestrae appearing in the walls of a few immature capillaries in late fetal life. The structural possibilities for an onset of neurohypophysial function in the mouse is discussed.


Genetic markers in Herdwick sheep: no correlation with succeptibility or resistance to experimental scrapie. Genetic markers were studied in Herdwick sheep, bred at Compton, with special reference to genetically selected lines which differ in susceptibility or resistance to experimentally produced scrapie. There were no correlations between susceptibility to the disease and albumin, pre-albumin, esterase and haemoglobin phenotypes, and between reduced glutathione levels and alpha-mannosidase isoenzymes, the latter possibly representing a previously undescribed genetic marker in sheep.


Characterization of tumour virus proteins. II. Expression of the protein P30 in transformed productive and non-productive Ki/NRK cells. The structural protein of murine tumour virus P30 has been measured by radioimmunoassay. The titer of each serum was determined by using as antigen the purified Rauscher viral protein labeled with 125iodine. Standard competition curve was constructed in order to determine the equivalent of protein to inhibit the precipitation reaction under limited antibody concentration. Competition by purifed Kirsten virus suspension, normal rat kidney cells, transformed-productive and transformed non-productive cells were measured in homologous and heterologous system. Type, group and interspecies determinants were characterized using the proper antigen-antibody system. Once the proteins have interspecie determinants, it is possible that we might be able to use some mammalian virus protein as tool to determine the presence of viral protein in human processes.


Cryotherapy of trichiasis with use of the retinal cryoprobe. A new method for the treatment of trichiasis is presented. A retinal cryoprobe is used in a freeze-thaw-freeze (double freeze) of the lid. The method is highly successful with no major complications occurring thus far when used on nonpalsied lids.


Overactive inferior oblique muscle.

Overactive inferior oblique muscle. The most common type of overactive inferior oblique muscle is secondary to a delay in the development of superior oblique muscle function. Operative intervention is not indicated because as a child matures the overactivity of the inferior oblique muscle will gradually disappear. In those cases where surgery is performed, the desired effect of elimination of excess elevation is achieved indirectly. The theory that the inferior oblique muscle is not primarily an elevator is supported by this explanation involving an indirect surgical effect. An explanation of a common postoperative finding after unilateral recession of an inferior oblique muscle is presented.


Alport's syndrome: case report and review of ocular manifestations. A 66-year-old man with the classic signs of Alport's syndrome--progressive hemorrhagic nephropathy and sensorineural deafness--plus bilateral anterior lenticonus, anterior and posterior subcapsular cataracts, and scattered lens opacities is presented. Bilateral anterior leniconus is rarely seen in patients without the syndrome. The syndrome is usually fatal in males by the second or third decade of life. This patient is of interest because of his advanced age. We believe this patient is the oldest living man with the classical lesions known as Alport's syndrome.


Light-deprivation and light-adaptation: a preliminary study. Preliminary data are presented on the effect of light-deprivation on the b-wave evoked in an eye exposed to and during recovery from a 500 msec duration conditioning pulse. The data indicate that the greatest differences between the amplitude of the b-wave evoked in the normal and light-deprived eyes are found for the dark-adapted retina. If the normal and light-deprived eyes are exposed to a conditioning pulse, the differences in b-wave amplitude between them are reduced. There is an increase in the difference between the b-waves evoked in the normal and light-deprived eyes as a function of time after the offset of a conditioning pulse. Latency of the b-wave evoked in the light-deprived eyes is not longer than b-wave latency in the normal eyes.


The effect of systemic hypotension during cardiopulmonary bypass on intraocular pressure and visual function in humans. The effect of controlled systemic hypotension on intraocular pressure (IOP) and visual function was measured in a group of 12 patients undergoing extracorporeal perfusion during cardiovascular surgery. When venous pressure was controlled, intraocular pressure was noted to fall following a fall in the systemic blood pressure. There was a return of IOP toward normal levels with recovery of the systemic blood pressure. Systemic hypotension of 25 to 100 mm Hg for up to 201 minutes in the presence of hemodilution and hypothermia was not associated with any functional or morphologic change in ocular function.


Nasolacrimal duct reconstruction with the nasolacrimal duct prosthesis: an alternative to standard dacryocystorhinostomy. For many years the standard surgical treatment for chronic dacryocystitis has been the edge-to-edge anastomosis of the lacrimal sac mucosa to nasal mucosa over the margins of a hole made through the lacrimal bone. Failures of this standard procedure have been attributed to many factors and complications frequently require reoperation. The procedure described in this paper was developed as a means of overcoming some of these difficulties. It provides a normal, gravity draining, nasolacrimal duct system without pooling and not requiring destruction of the lacrimal bone or alteration of normal anatomy. It consists of the implantation of a permanent indwelling nasolacrimal duct prosthesis (available from Concept, Inc., Clearwater, FL) from the base of the sac through the interosseous canal into the vault of the inferior nasal meatus. Because it does not involve bypassing the normal lacrimal drainage system, the technique is more simple and less traumatic. This method of reconstruction of the nasolacrimal duct has converted a major hour and a half procedure into a 15 minute operation. Because normal anatomic relationships are retained, the nasolacrimal duct prostheis gives reasonable assurance of permanent drainage and is recommended as a primary procedure of choice.


[Initial results of a simple immunological study of E.N.T. carcinomas (author's transl)]. 45 patients suffering from carcinomas of the upper airway and digestive tract were studied from an immunological standpoint, by estimation of serum immunoglobulins and by a series of skin tests. This latter technique gave the most interesting results. It showed that immunodepression is statistically more frequent in extensive forms and that the prognosis in immunodepressed patients is much more severe than in those who have retained normal immune reactions.


[The embryology of cysts and fistulae of the neck (author's transl)]. The term "branchial" should not lead to errors of interpretation and of classification. The essential points of normal embryology and comparative anatomy are reviewed: the special nature of the first entobranchial or spiracular pouch, the important role played in correlation by the second pouch, the general course of the two parts, external and internal, of the branchial apparatus and, finally, with regard to the latter, the problems posed by the development of lymphoid tissue in this region. The thyroglossal duct, although distinct from the branchial apparatus, remains in close relationship with it, in particular in the region of the hyoid where median cysts do not have an exclusively, thyroid origin. Amongst the lateral fistulae and cysts, the different types of which are described in relation to the tissue of their origin, the distinction must be drawn between two main types: those derived from the second pair of branchial pouches and those derived from the third entobranchial pouch only. It should be possible to recognise them on the basis of the characteristics described before operation, the latter being different in the two cases.


[Fluctuating deafness (author's transl)]. The problem of fluctuating deafness merits a separate place in otological pathology. On the basis of 52 cases of recurrent fluctuations in hearing in patients observed over a sufficiently long period, the authors provide evidence to the effect that, in addition to pressure disturbances accepted up to now, other mechanisms may be responsible. An aetiological study emphasises the role of local factors, but examination for general causes is also necessary. Clinical study of fluctuating deafness also reveals interesting data which, taken in combination with pathogenic hypotheses, are of therapeutic significance.


[Electrogustometric threshold in diabete and chronic ethylism. Survey on 230 patients (author's transl)]. This study completes a previous one in which the authors tested the electrogustometric threshold in 300 normal subjects used as controls. The collected datas has been computerized on a programable calculator according to a lognormal model. Comparison between the electrogustometric threshold in diabetic patients, ethylic ones and controls demonstrate that they are statistically different. More than a half of the diabetics and ethylics have abnormaly high electrogustometric thresholds. The responses have been studied as a function of the evolution of the disease, of the clinical form and of gravity. Diabete and chronic ethylism do not disturb the gustatic function at the same speed and with the same intensity: one year evolution is at least necessary for diabetics, and ten years for ethylics in order to detect abnormal electrogustometric thresholds. But if the action of ethylic intoxication is slower, it determines the most important gustometric deteriorations.


[Intra-thyroid metastasis of a colonic carcinoma (author's transl)]. The authors report the case of a 58-year-old woman suffering from an intra-thyroid metastasis of a carcinoma of the colon for which she had undergone surgery two and a half years previously. This adenocarcinoma was, furthermore, clinically and radiologically "cured". The metastasis was accompanied by a cervical swelling and paralysis of the left recurrent laryngeal nerve, the reason for the consultation. Subsequent examinations revealed multiple lung metastases. Despite combined treatment with radiotherapy and chemotherapy, there was later development of further multiple metastases, in particular cerebral. The authors review the literature concerning this type of tumour. Particular emphasis is placed upon tumours with a high malignant potential, such as the naevo-carcinoma, together with tumours of neighbouring structures, in particular the upper airway and digestive tract, all of which may spread to the thyroid. There have nevertheless been other cases of thyroid metastasis of a carcinoma of the colon. One of the very first was that of Rankin and Fortune, published in 1936.


[The problem of malignant branchioma. A description of three cases of degeneration or epitheliomatous metastasis within amygdaloid cervical cysts (author's transl)]. The authors describe three cases of malignant degeneration observed within amygdaloid cysts in two male and one female patient aged sixty. In one of the cases in which the cyst had been present for more than two years, there was apparently some primary degeneration, the theory favoured was that of Veau's malignant branchioma; two other cases showed metastasis of a homolateral tonsillar epithelioma within an hitherto sub-clinical amygdaloid cyst.


[Surgically implanted electronic apparatus for the rehabilitation of total deafness and deaf-mutism]. An electronic device for multichannel cochlear implant is now available in case of total deafness and deaf-muteness. Any surgical technic of electrodes implantation may use this prosthesis. It consists in two parts, an outside package and an implanted receptor. The external device cut the sound in eight channels, whose frequencies correspond to those of the telephon bands. These eight sinusoidal waves are changed in pulses whose frequency and duration depend on the intensity of the initial signal. All these informations are multiplexed and injected in a high frequency wave to an antenna. Electromagnetic induction supplies through the skin the implanted receptor with power and informations. This receptor is preoperatively connected to the electrodes. With this device and with phoniatric training some speech recognition, and in case of deaf-mute patients voice improvement, may be obtained in some months.


[Research concerning the spontaneous course of 135 cases of Menière's disease. Critical study of operative indications (author's transl)]. 135 cases of Ménière's disease were observed for five and a half years. Out of 1120 Ent patients, one suffered from Ménière's disease. Out of 1 000 audiogram, 8 involved cases of Ménière's disease. Of 9 cases of non-traumatic vertigo where a vetsibular origin was suspected, I was Ménière's disease. The morbidity was 75 per million. Hearing was stable in 62% of cases, worsened in 15%, improved in 15% whilst in 8% there was total deafness before the onset of vertigo. Vertigo disappeared in 94% of cases. Bilateral Ménière's disease is associated with a particularly unfavourable course with regard to general condition, since the disease would appear to be the consequence of a more deep-seated organic disorder. These figures are exactly the same as those found after vestibular neurectomy. In 98% of cases surgery is useless and hence dangerous.


[Vascular problems involving the inner ear (author's transl)]. In this work we deal with so called "sudden deafness" of unknown etiology. By careful study of previous work done by different authors the disease seems to be due to vascular disorders. On this basis we tried a polyvalent therapeutic scheme for the treatment of "sudden deafness" the results of which are given in this paper. Emphasis is given to the fact that the earlier the commencement of treatment the better the result.


A comparison of the difficulty, reliability and validity of complex multiple choice, multiple response and multiple true-false items. Complex multiple choice (CMC) items, a type of multiple choice item used extensively in the health sciences, were compared with multiple response (MR) and multiple true-false (MTF) items. The results indicated MTF to be easier, more reliable and more valid than CMC items; therefore, test-makers such as the National Board of Medical Examiners who use CMC items are urged to explore alternatives item formats.


An investigation of three types of multiple choice questions. The present paper reports of the results of a preliminary evaluation of the A, and K, and E type multiple choice question.


The effect of open vs closed-book testing conditions upon performance on a multiple-choice examination in pediatrics. This study compared the performance of medical students and practicing pediatricians taking a graduate-level examination in pediatrics under open-book vs closed-book conditions. Students performed significantly better under open-book conditions, but there was no significant difference for the practitioner group.


Toward a comprehensive methodology for resident evaluation. The development of a useful system of medical resident evaluation over a two year period demonstrated that traditional measures used successfully in undergraduate medical education were less appropriate and acceptable than more complex measures designed to assess actual clinical performance. The greater cost, time involvement and personnel required by the more complex measures were shown to be partially offset by the greater utility and acceptability of the evaluative data provides. The feasibility of using skilled, non-medically trained personnel to minimize faculty-physician time was demonstrated.


A study of the applicability of a truly objective measurement model in medical education. The main purpose of this study is to examine a new measurement model, to explore the range of situations to which it can be applied, and to establish its value in the improvement of the decision-making process in medical education. The objective of this set of investigations is thus to help fill the gap between theory and practice, particularly in the light of a strong movement toward criterion-referenced testing.


Assessment of cognitive and interpersonal skills in clinical problem-solving--a comparison between certification examination and formative evaluation. The study describes an analysis of the relationship between formative evaluation of performance in the residency program in Family Medicine and performance in the oral components of the Certification Examination. Implications for the process of certification of clinical competence are discussed.


Validation of a cardiology subspecialty examination by faculty ratings of competencies: a multivariate approach. This study investigated the relationships between assessments of competence as supplied by clinical faculty and examination performance on the 1975 Cardiovascular Disease subspecialty examination. Canonical correlation analysis showed the existence of two factors, which accounted for 36% of the variance in common.


Use of an oral exam in an internal medicine clerkship. Scores from an oral exam used to evaluate student performance at the end of an Internal Medicine clerkship are analyzed to assess inter-examiner consistency. Design aspects of the oral exam procedure are discussed.


Consistency in ratings of clinical performance of the same students throughout medical school and internship. Ratings of student clinical performance were analyzed to determine consistency of supervisor and coordinator judgements of the same students as they progressed through medical school and on into the internship. The results suggested that students were consistently and progressively rated higher.


The evaluation of teaching effectiveness: the myths about student ratings. This study presented to a conceptual framework for gathering and using student ratings to evaluate teaching effectiveness. Within the framework student evaluations of all courses of a second year pathophysiology curriculum were analyzed. Data analyses indicated student evaluations of courses and teaching activities were not related to the grades students received, nor did they varyin relation to the time they were obtained.


Clinical teacher effectiveness in medicine. Characteristics of best and worst clinical teachers in medicine were described by a random sample of faculty, residents and third- and fourth-year medical students at the University of Washington. The responses were factor analyzed and examined to determine whether the ratings were influenced by professional role (faculty, resident, student), faculty department (surgical, medical, basic science) and teaching method (formal in-patient, formal ambulatory, formal didactic, and informal teaching.)


The diffusion of self-instructional units among medical school faculty members. This paper examines traits of individual faculty members which may be associated with instructional "innovativeness." A model of instructional innovation is tested by examining patterns of adoption of self-instructional units at sixteen medical schools.


Factors affecting time allocations of teaching physicians. Regression analysis was used to determine the relative influence of amounts of compensation from patient care and research, as well as teaching hospital characteristics, specialty, and compensation arrangements (strict full time versus geographic full time), on teaching physicians' time allocation between patient care and teaching/research activities. The results show that the amounts of compensation and the compensation arrangements have some effects, but physician specialty, hospital size and ownership, and whether the hospital's patients are private or non-private are more important determinants of their time allocations.


Academic and personal characteristics as predictors of clinical success in medical school. Interviewer ratings of personal characteristics such as maturity correlated with clinical success, and were more important in determining clinical success than were conventional cognitive variables of grade point average or MCAT scores for five classes of University of Missouri-Columbia medical students.


The measurement of affective sensitivity: the development of an instrument. The Affective Sensitivity Scale, Form D is a media-based, multiple-choice test of one facet of human empathy. It is machine scorable, has norms based on over three thousand people and is likely to be useful in research on medical education.


Learning style and instructional preformances of family physicians. The learning styles and instructional preferences of two groups of family physicians were compared. One group of physicians attended a refresher course sponsored by a medical school; the other group did not attend the course.


A theoretical and practical approach to evaluating clinical skills. Using two taxonomies as a conceptual framework, a methodology for evaluating students clinical skills in vitro was developed. The simulation methodology offers the advantage of standardized assessment of a variety of discrete clinical tasks.


Recruitment strategies in the health professions. This paper first explores some of the strategies suggested in the literature for increasing black representation in the medical profession. Second, the study investigates methods schools of nursing have used to recruit and retain black student nurses, and evaluates how successful these methods have been.


Medical specialty choice: replications and extensions. A large longitudinal data base is used to provide information about 1) stability of specific specialty choice, 2) stability between specialty choice groupings, and 3) distributions and patterns of specialty choice.


Factors influencing internship/residency and practice locations: implications for public policy. This study analyzed the location attachment characteristics of graduates of the University of Wisconsin-Madison Medical School to test three hypotheses describing the relationship of these characteristics to the graduates' choice of internship and practice location. Data analyses revealed no significant relationships between graduates' place of birth and academic performance and their decisions to intern and/or practice in Wisconsin.


Styles of practice of female physicians. This study reports findings on a study of styles of practice of female physicians from the revised program in medical education at Case Western Reserve. It contrasts some of the results with practice sytles of male physicians from the same period.


Problem solvers or medical dictionaries: what are we teaching for? This paper describes an analysis of videotaped segments of a medical school clerkship. The purpose was to quantify variables critical to clinical teaching such as the ratio of instructor to student talk and the nature of their verbal interactions.


A comparison of primary care educational experiences in two urban pediatric settings. The purpose of this study was to initiate the evaluation of the ambulatory care training programs of the Johns Hopkins Medical Institutions and affiliated programs as resources for primary care education, and to provide input into the development of a primary care educational curriculum. It was determined that these settings fell short of fulfilling an a priori set of educational objectives designed to emphasize primary as opposed to secondary care. Foresight must be exercised in the selection of sites and the design of the clinical practice of an acceptable training program in primary care is desired.


An internal review of a residency training program. Six residency units at the University of Minnesota Affiliated Hospitals Residency Training Program in Family Practice and Community Health participated in an internal evaluation which resulted in changes both in the program and in the program's standards. The evaluation model used, a modified Provus approach, is suggested for other programs along with a discussion of the difficulties and positive affects found in the Minnesota study.


Student/patient contact--do the patients mind? This paper reports the results of a survey of patients in both a community clinic and a large HMO hospital to assess: 1) Attitudes toward the presence of students during patient care, and 2) The effects of student training on patient attitudes and satisfaction. It was found that the overwhelming majority of patients in both settings reported high satisfaction and favorable attitudes, and that previous student contact was associated with more favorable attitudes toward the presence of medical students.


Experiment in an early admissions program at the University of Utah College of Medicine. Thirty-one selected high school graduates were accepted into the College of Medicine prior to any college course work. The program was established to provide greater educational opportunity to the gifted student.


Do admission decisions predict performance during medical school? A comparison of one medical school's rejected and accepted applicants who attended other schools. The relation of one school's admission decisions to performance in medical school was examined by comparing accepted applicants who chose to attend other institutions with rejected applicants who went to those same institutions. When differences among schools were controlled, no effect of admission decisions was observed.


The choice of rural practice: a longitudinal view. The geographic maldistribution of physicians in the United States is an issue which more and more medical schools are being forced to address, however changing admissions policies to give preference to rural-oriented students may do little to alleviate the problem. This study analyzes the effectiveness of such a policy and concludes that training at a tertiary medical facility fosters an urbanizing, specializing influence which intervenes in the relationship between hometown background and choice of rural practice location.


A statistical procedure for predicting medical school graduates' specialty choices. A statistical procedure was devised for selecting, from a group of contenders, a relatively small set of variables which most efficiently predict medical specialty choice. While it is possible to predict medical specialty choice with fair accuracy using subsets of variables, predictions are not conclusive enough to be useful in actual decision-making concerning individuals.


A monitor for the medical curriculum.

A monitor for the medical curriculum. A set of standardized questionnaires that provides a monitor for the operation of the medical curriculum has been developed at Michigan State University's College of Human Medicine.


Predictors of impact of a minority program upon a medical school. The race of the respondents, and the racial orientation of the white respondents, were found to be predictors of how the individuals perceived the impact of the minority program at the University of Michigan Medical School.


The development and use of a comprehensive test for evaluating decentralized medical education--the WAMI experience. The development of a comprehensive examination at the end of the first year of medical school is discussed. The implications of the results for the evaluation of the WAMI Program in decentralized medical education are presented.


Interpersonal problem solving: a theoretical perspective and methodology for the evaluation of residency education and its' relationship to health care processes and outcomes. The study conceptualizes and implements an interaction model of interpersonal problem solving in the clinical milieu. This method of representing the interpersonal problem solving process and its relation to patient adherence is shown as an important tool for the evaluation of residency programs.


Reliability and validity of simulated problems as measures of change in problem-solving skills. Two contruct validity studies and two reliability studies for Diagnostic Management Problems are reported. Construct validity was confirmed, internal consistency was partially demonstrated, and two test packages were found to differ substantially on all five subscores.


Death education in selected medical schools as related to physicians' attitudes and reactions toward dying patients. These data obtained from 1093 recent graduates of five selected medical schools suggest that the physician who chose to take a medical school course on relating to dying patients tends to actually relate better to the dying patient than does the physician who did not take such a course.


Measuring the outcome of clinical problem-solving. The authors describe a new technique for measuring the outcomes of a clinical encounter using objective criteria derived from the performance of a criterion group.


Clinical problem solving: the relationship of cognitive abilities to PMP performance. The relationship between patterns of individual differences on PMP performance and selected Gulford's Structure of Intellect test of cognitive abilities is shown. The groups were interpretable using the Guilford tests and confirm the use of the individual differences model.


Teaching the psychiatric aspects of medicine: report of a successful pilot experience. Teaching the Psychiatric Aspects of Medicine during a required medicine clerkship was evaluated by before and after cognitive tests and attitudinal measurements. The students who took this course demonstrated a marked improvement in mastering didactic material and their attitudes toward the teaching of psychosocial concepts changed appreciably in a favorable direction.


Evaluation of the community phase of a regionalized medical education program. Evaluation of the community phase of a regionalized medical education in the states of Washington, Alsska, Montana and Idaho (WAMI) is producing data to suggest that peripheralization of medical education, including remote site clinical training, offers a viable alternative to traditional methods.


Senior medical students as patient-preceptors to introduce basic history and physical examination skills to second year medical students. Senior medical students are used as the patient and the preceptor to introduce the fundamentals of history taking and physical examination to sophomore medical students and this technique compared to the established method for teaching basic skills at the University of Iowa. Senior medical students were equally as effective as staff (residents, fellows, and faculty) in teaching the techniques of history and physical examination and statistically better than staff in providing the sophomore with a) suggestions as to how to improve their technique, and b) how their approach might affect the patient's attitude and behavior.


The nurse practitioner as a teacher of physical examination skills. The service role of Nurse Practitioners has been widely recognized. (1) However, their potential as clinical instructors of physical examination skills has not been previously documented. This communication details a new first-year medical school course in physical examination in which Nurse Practitioners are key members of the instructional team.


The effectiveness of pediatric nurse associates as teachers of medical students in ambulatory setting. Pediatric Nurse Associates (PNA) can be effective teachers of medical students. This was measured by a greater gain in score on a post-test over a pre-test for those students with PNA interaction as compared to those who had no PNA contact.


A modified, personalized system of education for junior internal medicine clerkship at a multi-campused school. A personalized system of education is outlined for the junior clerkship in internal medicine at a multi-campus institution. Data are included of student response to the program in general and upon specifics, short-term retention of the cognitive knowledge, and National Board scores. Contrasts are drawn between this program and the former program of instruction.


Perceived ability versus actual ability: a problem for continuing medical education. Physicians attempting to rationally select appropriate Continuing Medical Education programs or conferences to attend are faced with an unending barrage of brochures, letters and other advertisements regarding available CME experiences. If they make their choice on the basis of felt needs rather than convenience, then the accuracy of this perception is of considerable importance.


Development of a medical record audit for continuing medical education. A self-instructional audit package for the identification and management of hypertensive patients was developed. The materials were field tested in the clinics of seven institutions to assess their clarity and collect data to illustrate the usefulness of an audit as an educational tool.


Assessing student response to participation in a simulated malpractice trial in a program of law in medicine. Results of evaluations for 49 students were examined to determine the effect of a simulated trial on both attitudinal change and cognitive growth in medical students. Plans for further data collection and analysis are discussed.


Changes in physician referral patterns as a result of continuing education. The evaluation of physician behavior as an outcome of continuing education has been an ellusive quantity of measure. This paper demonstrates one measure that can be used to evaluate the effect of continuing education in terms of physician behavior.


The effects of a geographic continuing education program on physician referral behavior: an unobtrusive study. This study reports on an unobtrusive study of changes in physician referral behavior after a need-oriented continuing medical education program.


Composition of blood plasma (calcium, phosphorus, magnesium, proteins) during the neonatal period in the calf. Influence of the state of health. The changes in plasma concentrations of calcium, phosphorus, magnesium and several protein fractions, were studied from birth to the age of twenty days in 68 calves. 32 animals remained healthy while 36 animals suffered from diarrhea but survived. The day of birth the two groups differed biochemically. During the whole period studied, calcemia, phosphatemia and albuminemia of diarrheic calves were systematically lower than those of animals showing no pathologic symptoms. In addition, after intake of colostrum, the increase in total proteins and globulins was much smaller in sick calves than in those which remained healthy. The possible causes of these anomalies and their roles in the appearance of pathology are discussed.


[Allergic diagnosis of abortive chlamydial infection in the goat (author's transl)]. A delayed hypersensitivity test was used for chlamydiosis diagnosis in four goat flocks. The skin-test was performed in the neck by inoculating 100 microgram of purified Chlamydia from yolk sac or McCoy cells. The reactions were read 72 h after inoculation. The two antigens gave the same results. The number of doubtful reactions observed was significantly smaller in hypersensitivity than in the complement fixation test.


[Hog cholera virus: influence of colostral passive antibody on immune response of pig following vaccination with the rabbit adapted Chinese strain (author's transl)]. Using the rabbit adapted chinese strain of Hog cholera, active immunization of piglets having passive colostral antibodies was studied. 65 piglets born from 11 sows were used. Concerning sows, vaccination was performed 5-6 months and 1 month before service (3 sows), 30 days (2 sows) and 60 days (3 sows) after service. Divided in 5 lots, piglets were vaccinated at 4 different periods after birth (15, 30, 60 and 90 days). Hog cholera immunity was determined for each animal by means of kinetic of serum neutralizing antibodies and resistance to virulent challenge performed 5 months after birth. High levels of neutralizing antibodies were observed in serum of each vaccinated sow at the time of farrowing. In piglets having ingested low quantities of colostrum, vaccination induces a good antigenic stimulation characterized by a normal humoral immune response and challenge resistance. But in piglets having ingested a normal quantities of colostrum, colostral passive antibodies have a partial or complete suppressive effect on primary immune response which is characterized by a delay in serum antibodies formation and by a low level at the time of challenge. According the conditions of sows vaccination, differences were observed in the properties of colostral passive antibodies (intensity of suppressive effect on active immune response, in vitro "avidity" for Hog cholera virus, mean value of half-life) present in piglets serum. On practical aspect, vaccination with the chinese strain becomes fully effective in piglets having passive immunity when they are 30-60 days old.


Variations in the digestibility of trace elements (Cu, Zn and Mn) during the first cycle of cocksfoot growth. The variations of trace element availability was examined with 6 adult male sheep (Texel) maintained in metabolic crates. They received cocksfoot cut each morning during the first vegetation cycle and offered ad libitum (10 % refused food), for 6 day periods. It appears from the resulting data that: -- The stage of cocksfoot development has a strong influence upon the digestibility and the retention of copper, zinc and manganese. --There is an almost perfect parallelism between the variations of manganese digestibility and retention and those of cocksfoot manganese content. -- For copper, the beginning of the first vegetation cycle (young grass highly digestible) is as poorly digestible as the flowering (strawy hay of poor quality). This last result would indicate that the low copper digestibility generally observed with young grass depends on specific factors related to the characteristics of forage at the early vegetation stage. Zinc behaves similarly.


[Biometry, hematology, plasma biochemistry and plasma and tissues enzymology of the red partridge (Alectoris rufa) (author's transl]. The following parameters have been estimated in 15 red partridges (young adults of both sexes): 1. Biometry: relative weight of 10 organs (liver, kidneys, heart, brain, spleen, lungs, small gut, coecum, stomach, gizzard). 2. Hematology (mean +/- S.D.): Erythrocytes, 3.4 X 10(6) +/- 0.3 X 10(6) cells/mm3; packed cell volume 0.46 +/- 0.17; haemoglobin 103 +/- 27 g/l; mean red blood cell volume, 135.6 +/- 10.4 micrometer3; haemoglobin per red blood cell, 32.2 +/- 5,2 pg; haemoglobin concentration in red blood cells, 24.0 +/- 2.9 %; leukocytes, 36.9 X 10(3) +/- 7.8 X 10(3) cells/mm3; heterophilic, 32.3 +/- 8.3 %; basophilic, 5.3 +/- 1.5 %; eosinophilic, 1.4 +/- 1.5 %; lymphocytes, 56.1 +/- 7.3 %; monocytes, 4.6 +/- 1.4 %. 3. Blood biochemistry: Na +, 155 +/- 6 mEq/l; K +, 6.5 +/- 1.2 MEq/l; Cl--, 107 +/- 4 mEq/l; Pi, 53.3 +/- 14.4 mg/l; urea, 0.19 +/- 0.05 g/l; uric acid, 33.2 +/- mg/l; creatinin, 14.7 +/- 0.9 mg/l; glucose, 2.77 +/- 0.35 g/l; cholesterol, 1.38 +/- 0.36 g/l; total proteins, 44.1 +/- 5.9 g/l; albumin, 50.0 +/- 8.7 %; alpha globulins, 3.9 +/- 1.5 %; beta globulins, 7.5 +/- 2.2 %; gamma1 globulins, 31.5 +/- 5.6 %; gamma2 globulins 8.0 +/- 3.5 %. 4. Serum enzymology: Alkaline phosphatase, 8177 +/- 5078 u/l; SGOT, 356 +/- 138 u/l; SGTP 28.3 +/- 12.5 m/l; LDH, 955 +/- 570 m/l; GLD 12.6 +/- 12.4 u/l; CPD, 136 +/- 77 u/l; choline esterase, 2181 +/- 506 u/l. 5. Tissue enzymology: the 7 preceding enzymes have been estimated in 10 tissues listed in 1.


Changes in pepsinogen, proteins and lipids in the serum during experimental haemoncosis in sheep. To determine the relationship between the course of infection by parasites of the genus Haemoncus and variations in the level of serum pepsinogen, an experiment was done with three groups of five lambs. The first was a non-infested control group. The lambs of the second group were given one dose of 10,000 H. contortus infective larvae. The animals of the third group were given one dose of 50,000 larvae. Fluctuations of the level of serum pepsinogen were determined throughout the experimental period (88 days). Observations also included variations of protein and lipid levels. Our experimental results showed that the development of H. contortus larvae, even when in small numbers, can cause lesions comparable to ostertagiosis in abomasum and produce the same rise in the level of serum pepsinogen. This increase in serum pepsinogen appeared to be related to the amount of larvae which were given. The high level of serum pepsinogen persisted over a long period. Variations of the serum, total protein and albumin levels were the same as described by other authors. There was no decrease in serum lipids.


Mechanisms of propulsion in the small intestine. In sheep like in rats 2 hr after feeding and in fasting dogs, the rate of passage of digesta along the small intestine is related to the migration of the myo-electric complexes (MMCs). The modifications of this basic common pattern and that of its two consecutive irregular and regular phases were related to changes in the flow of digesta in both the proximal and distal parts of the small intestine. A high flow rate in the jejunum is associated to an increase in duration of the phases of ISA and by supernumerary MMCs at this level. Normally at the ileal level, the flow of digesta was lower than in upper parts with an increase in retention time associated both with a slow migration of the complexes and the disappearance of about one third of them after traversing 60% of the length of the small bowel. These experiments suggest that the origin, propagation and frequency of the basic MMC pattern as well as the ratio of ISA to quiescence are operative factors involved in small intestine propulsive activity. The continuous spiking activity seen immediately after feeding in rats and dogs and the autonomous pattern of activity of the ileum during prolonged fasting in sheep represent extreme changes of the basic MMC pattern.


Application of various chemotherapeutic agents in experimental bovine anaplasmosis. A trial was conducted with several chemotherapeutic agents against clinical and carrier cases of experimental bovine anaplasmosis. Dithiosemicarbazone (in combination with oxytetracycline). Chloramphenicol and Rolitetracycline proved to be very efficacious in bringing about the clinical recovery and the elimination of the carrier status. Treatment with Imidocarb caused a clinical recovery but could not completely eliminate the organisms.


The role of the thoracic compression reflex in the Heimlich Maneuver. Using the dog as an experimental model, the relationship of the Thoracic Compression Reflex (TCR) to the Heimlich Maneuver (HM) was examined. TCR was equally effective as lateral chest compression in relieving artificially induced choke. Destruction of the TCR by vagotomy rendered relief of choke by HM ineffectual in 5 of 8 dogs. It was concluded TCR may be a factor in HM, but that mechanical compression of the lungs is also involved.


[Treatment of mastitis in dry cows: treatment of all cows vs treatment of infected cows only (author's transl)]. Within a herd, three groups have been randomly constituted. -- No dry cow therapy. -- Total Treatment group: all cows were submitted to dry cow therapy, in their four quarters. -- Limited Treatment group: cows were submitted to dry cow therapy in their four quarters, only if at least one quarter had given a CMT larger than or equal to +++, in the month before drying-off. --The cows were treated either with cloxacillin or with penicillin-streptomycin in 3% monostearate. The number of cows and quarters examinated and treated are given in table 1; the results of treatments are indicated in table 2. No significant differences can be found between Total and Limited Treatment groups; a slight improvement was observed when compared to CONTROL GROUP. Cloxacillin and penicillin-steptomycin gave similar results. The pathogenic and practical signification of these results is discussed.


Level of linoleic acid in pericardial lipids of Charollais cows with and without ovarian cysts. The content of linoleic acid, a precursor of prostaglandins, in pericardial lipid store is higher in cows with normal ovaries than in cows with cystic ovaries.


Diagnosis of classical galactosaemia.

Diagnosis of classical galactosaemia. We report a child with classical galactosaemia whose diagnosis was missed until 12 weeks of age. The limitations of urine screening tests are discussed and the wider use of a qualitative enzyme assay for screening is recommended. Reference ranges for a quantitative enzyme assay using 14galacoste-1-phosphate as substrate are presented.


Pressure and volume changes during the first breath of human neonates. The pressure and volume changes associated with the first breath were measured in 17 healthy term babies, using oesophageal balloons and a reverse plethysmograph. 5 babies expanded their lungs with less than --20 cmH2O (--2 kPa). The characteristic opening pressure pattern previously described was seen in only one baby, whose initial volume change was an expiratory one. It is concluded that opening pressures greater than 10 cmH2O (0.96 kPa) are rarely seen in term healthy infants.


Hyperlipidaemia in children on regular haemodialysis. Fasting plasma concentrations of triglycerides (TG), cholesterol, immunoreactive insulin (IRI), and blood glucose were raised in 16 children with chronic renal failure on regular haemodialysis compared with 18 healthy children. In the patients plasma IRI correlated positively with plasma TG, while blood glucose did not correlate with IRI or lipid concentrations. Dietary intake, expressed as percentage of recommended intake for height-age, did not correlate with plasma lipids, but there was a positive correlation between plasma TG and the proportion of calories derived from carbohydrate. The children were not malnourished as evidenced by normal plasma albumin and transferrin concentrations. The mechanism of the hyperlipidaemia is unclear but it may be related to the glucose intolerance with hyperinsulinaemia which is found in uraemia. In view of the risk of premature atherosclerosis, plasma lipid concentrations should be monitored in children with chronic renal failure and attempts made to ameliorate hyperlipidaemia with appropriate dietary manipulations.


Mannosidosis. Clinical and biochemical study. The clinical, radiological, and biochemical features of 2 male children with mannosidosis are described. Superficially they appeared to suffer from Hurler's syndrome, but the facies, eye signs, radiological and cytological features were atypical. Excess urinary oligosaccharides were found by thin-layer chromatography. The diagnosis was confirmed by determining the acidic alpha-mannosidase activity of leucocytes and cultured skin fibroblasts. Prenatal diagnosis is possible from cultured amniotic cells.


Increased protoporphyrin in erythrocytes in a child with acute intermittent porphyria. A child is described with acute intermittent porphyria but having an erythropoietic component, with disordered metabolism of porphyrins in bone marrow.


Organ mercury levels in infants with omphaloceles treated with organic mercurial antiseptic. Samples of fresh and fixed tissues from infants with exomphalos treated by thiomersal application were analysed for mercury content. The results showed that thiomersal can induce blood and organ levels of organic mercury which are well in excess of the minimum toxic level in adults and fetuses. The analysis of fresh and fixed tissues must be carefully controlled against normal tissues in order to interpret mercury levels accurately.


Influence of the central nervous system on fetal lung development. Experimental study. Upper cervical cord injury was produced in fetal rabbits at 22-26 days' gestation. In 11 setuses with severe cord injury delivered at 28-29 days' gestation there was a median reduction in lung weight (expressed as a proportion of body weight) of 43% and a median reduction in estimated total lung DNA of 16% in comparison with paired operated littermates with intact cords. The hypoplastic lungs showed collapse on histology; if cord damage had been inflicted before 24 days' gestation there was retarded maturation. We conclude that the central nervous system plays a vital role in fetal lung growth and maturation, probably by maintenance of fetal respiratory movements.


Congenital renal abnormalities in the Laurence-Moon-Biedl syndrome. Two children with Laurence-Moon-Biedl syndrome had radiographic evidence of cysts in the renal medulla, and one had impaired renal function and infection. The frequency of cystic disease in this syndrome implies that intravenous urography should be carried out on all patients with this syndrome. Children with renal abnormalities should be followed to avoid further damage from urinary infection, or from dehydration in those with a concentrating defect. Regular renal function tests should be carried out on other children. and full investigation should follow if abnormalities are found in order that the natural history of the often fatal renal lesion can be clarified.


Acute pancreatitis as a complication of anaphylactoid (Henoch-Schönlein) purpura. A case of acute pancreatitis complicating anaphylactoid purpura (Henoch-Schönlein syndrome) is reported. In cases of this syndrome with abdominal pain, serum amylase levels should be estimated.


13q- syndrome. Family study.

13q- syndrome. Family study. A patient is described who had a deletion involving the long arm of chromosome number 13. The mother and 4 of 7 living sibs showed a balanced translocation from the long arm of a number 13 chromosome to the long arm of a number 3 chromosome. We stress the importance of investigating the families of children with chromosomal defects.


Failure to thrive at the breast: an old problem revisited. Four apparently normal breast-fed infants failed to thrive when fed on demand. They all shared a tendency to accept long intervals between feeds from birth. Infant welfare clinics should be alerted to this problem. If infants who attend these clinics are accurately weighed and their progress carefully recorded on weight charts this insidiously developing complaint could be detected earlier and with appropriate advice, a potentially serious condition averted.


Retention of urine in the neonate possibly due to anticonvulsant drugs. Three cases of neonatal acute retention were associated with convulsions and heavy sedation. Inhibition of micturition may be due to diazepam-induced depression of the nervous system, in association with other anticonvulsants drugs.


Neurological complications of beta-thalassaemia major. Neurological complications in beta-thalassaemia major are uncommon, with cerebral ischaemic episodes related to severe anaemia or convulsions as the most usual manifestations. Two such cases of children of 6 and 8 years are reported. Cerebral venous infarction is advanced as the probable cause of the symptoms. Caution should be exercised in giving rapid, large blood transfusions to thalassaemic patients adapted to long-standing severe anaemia.


[Cor triatriatum in infants. Four cases with two surgical successes]. Four cases of cor triatriatum are reported in 6 weeks to 23 months old infants. Two were associated with partial anomalous pulmonary venous connection and one with a mild aortic stenosis. Two were successfully operated on and are now normal children: one of these underwent surgery at 3 months with an hemodynamic control one year later. The two others died: the youngest because of an inadequate overloading transfusion, the other soon after pulmonary angiography. Problems in diagnosis and treatment of this rare but very tractable condition are discussed.


[Monosomy 4 p-- (Wolf-Hirschorn's syndrome)]. The phenotype of the 4 p-- syndrome may be clinically distinguished from the one of the 5 p-- syndrome by the presence of fusion abnormalities of the median line. In the case reported, these abnormalities concerned a cleft palate, an iris coloboma and a fistula of the sacrum, in addition to an important hypotrophy and a severe mental retardation associated with epilepsy.


[Carpenter's syndrome].

[Carpenter's syndrome]. A newborn boy presented with an acrocephaly characterized by a coronal craniosynostoses, open sagittal sutures and abnormally high and straight forehead. He was the only child of young, unrelated, healthy parents; there was no familial history of dysmorphy. Facial asymmetry was important and associated with posterior cleft palate, syndactylia of the tips and polydactylia of feet, due to a splitting of the first metatarsus. The child also had a congenital heart disease, like in half of the 15 published cases. In older children, mental retardation is usually observed, often associated with obesity and hypogonadism. Polydactylia permitted to exclude Apert's acrocephalosyndactylia in which there is a normal number of finger arms and which seems to be a dominant mutation, while the transmission of Carpenter's syndrome appears autosomal recessive, thus requiring restrictive genetic counselling.


[Precocious puberty associated with Silver's syndrome]. Precocious puberty has been reported as an important feature of the Silver-Russell syndrome. The present case refers to a boy entered puberty at the chronological age of 11 years and the bone age of 6 years 6/12. Criteria for precocious puberty in this syndrome are discussed by comparison with previously published cases, and it is concluded that abnormalities in clinical pubertal development are quite unusual in this syndrome.


[Tuberculous mediastinal adenopathy in a child]. One case of mediastinal tuberculous lymph node with fistulae into the esophagus is reported in a 9 years old girl. The first symptom was the appearance of epigastric abdominal pain, with secondary dysphagia. The diagnosis was confirmed by histology after thoracotomy and surgical excision. Esophageal tuberculosis is rare and seems to be secondary to contamination from mediastinal lymph nodes. Treatment is always medical and often requires surgery.