Sex steroids as a cause of adenocarcinoma of the dorsal prostate in Nb rats, and their influence on the growth of transplants. The development of adenocarcinoma of the dorsal prostate of Nb rats following prolonged treatment with pellets of testosterone propionate alone or with esterone allowed the establishment of transplantable tumor models. Whereas most transplants were autonomous and not influenced by hormones, one estrogen dependent tumor was studied in detail. This tumor would only grow in estrogenised hosts, cells remaining dormant in normal animals. Removal of estrogen from animals with growing tumors led to tumor regression but with progression and eventual regrowth of tumors which were autonomous. Replacement with lower doses of estrogen reduced the extent of regression and prevented autonomous change. When a regressed estrogen dependent tumor was exposed to prolonged treatment with testosterone propionate pellets, the eventual regrowth was found to be androgen dependent and would not grow in estrogenised animals. Progression could apparently be directed by this procedure from estrogen to androgen dependency.


The limitations of model systems in prostatic cancer. The quest for an ideal model useful for designing treatment strategies as well as providing biological information is not a realistic goal. A multitude of models are required to answer a multiplicity of questions. However, given the currently available treatment modalities much can be accomplished directly in man without resorting to preclinical models.


HLA antigens in bronchogenic carcinoma.

HLA antigens in bronchogenic carcinoma. A decrease in the frequency of HLA-A2 was noticed in 37 bronchogenic carcinoma patients studied. HLA-B8 was found to be increased in the prolonged survivors of bronchogenic carcinoma.


Effect of lithium carbonate on the neutropenia caused by chemotherapy: a preliminary clinical trial. Lithium carbonate (Li2CO3) increases circulating polymorphonuclear leukocytes (PMN) and perhaps granulopoiesis in man. 25 patients with advanced malignancies ingested Li2CO3 during a cycle of intermittent combination chemotherapy. Weekly hemoglobin, platelet, total white blood cell (WBC) and lymphocyte counts in the evaluable patients were not significantly different from cycles before and after the Li2CO3 cycles. However, the mean absolute PMN nadir while on Li2CO3 was 26% and 40% higher than the control cycles before and after Li2CO3 respectively. When compared individually, the PMN nadirs were significantly higher during the cycle with Li2CO3, than before (p = .05) or after (p = .05). The clinical and biological significance of this observation is presently unclear.


Inhibition of experimental metastatic spread by nonspecific stimulants. It has been demonstrated by a syngeneic metastatic model of the XVII mouse that pretreatment of the animals with BCG and Freund's adjuvant brings about a significant inhibition of metastatic growth. This inhibition is further increased by combined pretreatment with nonspecific stimulants and additional specific immunisation of the animals against the given tumor.


Antineoplastic activity and pharmacokinetics of adriamycin and daunomycin in tumor bearing mice. In C57B1/6 mice bearing the intramuscular Lewis lung carcinoma, single intravenous doses of Adriamycin showed an higher antineoplastic effectiveness on the primary tumor and its lung metastasis than equal doses of its analog Daunomycin. The in vitro cell-binding of Daunomycin to these tumor cells was higher than that of Adriamycin, but no differences in cytotoxicity were found between the two agents. Pharmacokinetic studies revealed that Adriamycin (and/or its metabolites) accumulated in the neoplastic tissue more promptly, in significantly greater quantities and for longer periods than Daunomycin. The possible importance of these findings in explaining the greater therapeutic activity of Adriamycin in experimental animals is discussed.


Localisation of Hodgkin's disease and lymphomas by 67-gallium substraction scanning. 67Ga-subtraction scan was found to be useful and a promising new method for the pre-treatment evaluation of the patient with Hodgkin's disease or non-Hodgkin's lymphoma. The scan appeared to be most accurate in the neck, chest, and axillary regions. It appears to offer a means of increasing the accuracy of evaluating the abdomen, the para-aortic and pelvic regions. It may be a useful method for the follow-up to detect recurrences. It was an easily performed, safe, non-invasive test, well tolerated and accepted by patients.


Establishment and cytogenetic analysis of a cell line derived from a human epithelioma of the lung.. A continuously growing cell line, established from a bronchial carcinoma of sqamous cell type derived from a 56 year old white male, has been kept in culture since 1971. The line, named E14, is now in its 158th passage. Cytogenetic analysis demonstrates a slight gain of chromosome number up to the 100th passage, since when the stem-line has remained fairly stable at between 58 and 61 chromosomes. Banding analyses indicate that, whereas minor changes in the structural rearrangements of the karyotype are constantly occuring, the basic tumor genotype remains fairly stable.


Lewis lung tumor system as a model for studying the immune function in syngeneic in equillibrium allogeneic chimeras. Lewis lung tumor (LLT) passaged in F1 hybrids of the original C57B1/6 strain, where it arose spontaneously, is rejected by allogeneic SWA (Swiss albino) mice. However, aggregation chimeras derived from these SWA mice and the F1 hybrids of C57B1/6 developed an increased growth of primary tumor and reduced number of metastases when compared with the F1 hybrids. In the present study LLT passaged in C57B1/6 mice is not rejected by SWA mice. It is demonstrated that in aggregation chimeras now derived from two strains both taking the tumor, primary tumor growth was enhanced and the number of metastases reduced as in the former experiment. The tendency of reactions of lymphatic orgains in chimeras to tumor burden was comparable with the SWA and F1 hybrid (C57B1/6 multiplied by SWA and SWA multiplied by C57B1/6) recipients' response. Furthermore, chimeras had the highest spleen enlargement. Possible alternations in immune functions of chimeras due to their differing genotype combination are discussed in the LLT model.


Suppressed tumor growth and metastasis by vitamin A + BCG in Lewis lung tumor bearing mice. The anti-tumor effect of vitamin A and/or BCG was investigated in Lewis lung tumor system. Tumor growth and lung metastases were significantly suppressed, when tumor cells were mixed with BCG and inoculated subcutaneously into vitamin A-treated animals. Survival time was also prolonged by the same treatment. Vitamin A alone, without BCG, showed no effect on tumour growth, lung metastases or survival time.


Demonstration of tumor-associated antigens on tumor cell hybrids by means of the leucocyte-migration-inhibition-test. The lymphocytes of patients with inoperable bronchus carcinoma were investigated for their in vitro reactivity toward tumor-associated antigens. The leucocyte-migration-inhibition-test (LMIT) was applied using formalinised tumor cells and tumor cell hybrid cell lines. 34 patients with inoperable suqamous cell carcinoma of the lung and 21 healthy controls were tested for their leucocyte sensitisation to these cells. 55 percent of the patients with lung cancer showed a specific LMI toward the E-14 cell line, (an established cell line from a human squamous cell carcinoma of the lung), compared to only 9 percent of the controls. There was about the same percentage of specific reactions of the lymphocytes to three different hybrid cell lines which have only a few human chromosomes left over. There was no reactivity to the parental hamster fibroblasts. It is assumed that the hybrid cells carry the same tumor-associated antigens on their cell surfaces as the E-14 tumor cells.


Active specific and active non-specific immunotherapy in patients with malignant melanoma. Patients in clinical stage I-III of malignant melanoma were treated after resection of the tumor mass with membrane extracts of autologous tumor tissue and BCG or BCG alone. They were monitored immunologically by delayed cutaneous hypersensitivity reactions, i.e. skin tests with recall antigens, with autologous tumor membrane extracts and 2-4Dinitrochlorobenzene (DNCB). The lymphocyte reactivity was assessed in vitro with direct lymphocyte migration inhibition assay; purified tuberculin and autologous or allogeneic tumor extracts were used as antigens. In this study, which includes 50 patients up to now, it could be demonstrated that it is possible to increase tumor-specific and general immune reactivity by this form of treatment.


Stimulation of immune response in lung cancer patients by vitamin A therapy. Based on a clinical trial, in which patients with unresectable bronchogenic cancer were treated with a combination of vitamin A plus chemotherapy, or vitamin A plus radiotherapy, a study was initiated in which vitamin A alone was given for tumor treatment. 9 male patients with metastatic unresectable squamous cell carcinoma of the lung were treated with vitamin A palmitate or 13-cis vitamin A acid. Up to seven treatment courses were given during a period of 60 weeks. Through weekly evaluation of the patients' immune status, an immune potentiating effect of the vitamin A therapy could be demonstrated. An increase of lymphocyte blastogenesis response to PHA which is significant (p less than 0.001) compared with the pretreatment values, was found in all patients at the end of one vitamin A treatment course. Increased delayed cutaneous hypersensitivity reactions were observed also in all patients. The immune potentiating effects of vitamin A therapy, as well as the demonstrated direct effect on the tumor, introduces a wide range of combination therapies.


Fibrous dysplasia.

Fibrous dysplasia. An overview of the spectrum and natural history of fibrous dysplasia is an essential prerequisite of management. Current medical interest has focused upon the intriguing pathogenesis of the bone lesions, the endocrinopathies, the cutaneous pigmentation, and malignant transformation. The mundane aspects of diagnosis and the complications of a soft bone disorder reside with the clinical orthopedist. Diagnosis is straightforward with the aid of biopsy. Conservatism in the surgical treatment of monostotic lesions and experience in the care of fractures and deformity in polyostotic fibrous dysplasia constitute the lessons learned in a series of over 50 patients with fibrous dysplasia.


Pulmonary resection for sarcoma metastases. We use pulmonary resection in patients with metastatic disease confined to the lungs when the primary disease is controlled, when the tumor doubling time of metastases is longer than 40 days, and when there is no evidence of metastases to other viscera. A staged bilateral thoracotomy should be performed when necessary. The size of the lesions and the number of lesions are not contraindications for resection. Pneumonectomy has been performed with gratifying long term results. Treatment in patients who have rapidly progressive metastatic lesions (tumor doubling time less than 40 days) or who have other metastatic disease must be considered experimental. Chemotherapeutic regimens used as adjuncts to pulmonary resection may produce extreme toxicity in this group of patients. This form of therapy must be administered and followed by experienced personnel in a medical center with facilities for close supervision.


Eosinophilic granuloma and its variations. The orthopedist is most likely to encounter solitary or multiple forms of eosinophilic granuloma of bone. Management includes curettage for diagnosis and treatment with insertion of autogenous bone. Radiation therapy and chemotherapy are reserved for patients with multiple lesions and for the less common forms of histiocytosis X, i.e., Hand-Schüller-Christian disease and Letterer-Siwe disease.


Angiography for mass lesions of bone, joint, and soft tissue. Information can be acquired from the angiogram that would aid the surgeon in his approach. Such problems as the site of biopsy, the size and extent of the growth, and variant anatomical situations can be known beforehand. The extent of major vessel involvement is also important. Knowledge that a tumor may be difficult to excise without compromising a vital neuromuscular structure is worthy of consideration. We have endeavored to summarize our experience as it relates to mass lesions of the musculoskeletal system. Certain signs -- arteriovenous shunting, hypervascularity -- appear to indicate that the mass is malignant, whereas five other features can be seen in any of the conditions reviewed. As with any invasive procedure, the risks must be weighed against the information gained. At the time of this writing we consider angiography to be a worthwhile procedure.


The position of nitrate respiration in evolution. Egami's hypothesis that oxygen respiration evolved from nitrate respiration, and this from nitrate fermentation, is not accepted. The reasons are: (1) Presumably there was no nitrate before O2 in the biosphere. (2) On mechanistic grounds, respiration (oxidative phosphorylation) is to be derived directly from photosynthesis (photosynthetic phosphorylation) rather than from any form of fermentation.


Phosphorus, a key to life on the primitive Earth. The phosphorus of the primitive Earth was present as phosphates. It is strongly probably that a portion of the phosphate was present as condensed phosphates. The primitive Earth was highly deficient in the total available phosphorus until a sufficient quantity of phosphorus weathered from the igneous rocks in which it was entrapped. Approximately three billion years were required for the seas to become saturated. Until this time passed the seas acted as a giant sink for phosphorus, diluting it to the extent that all forms of life were deprived of the vital nutrient. When the seas became saturated, the rate of turn over of the phosphorus increased rapidly. As the seas pulsated, they left the excess precipitate phosphorus as sedimentary rock in locally righ deposits on which life could thrive.


The length of the transition period from the reducing to the neutral biosphere. The development of the complicated mechanisms for N2 fixation, which in nature is an endergonic process and requires a great deal of ATP, must have taken a long time. During that time primeval NH3 must still, albeit to a decreasing extent, have been available as a source of nitrogen. This is true, whether N2 fixation originally arose in the primitive anaerobes, or, according to Postgate, in more advanced bacteria. As NH3 resists UV radiation only in the presence of excess H2 it follows that the disappearance of H2 and the transition from the reducing to the neutral biosphere also took a long time, probably of the order of 10(9) degrees yr. According to previous evidence, the transition from the neutral to the oxidizing biosphere likewise took long; this length enabled the organisms to adapt the N2 fixing machinery to aerobic conditions.


Somatomedin and growth hormone in psychosocial dwarfism. The diagnosis of psychosocial dwarfism (PSD) was made in a 7 year old boy upon admission to the hospital. In the period following admission, he grew at a slightly accelerated rate of 0.6 cm in 24 days (extrapolated growth rate--9.1 cm/yr); his caloric intake was 1663 calories/day (147 cal/kg/day), stimulable growth hormone was 5.9 ng/ml and somatomedin activity was in the hypopituitary range (0.24, 0.05 U/ml). In the following period of marked catch-up growth of 8.6 cm in 102 days (extrapolated growth rate 30.8 cm/yr), his caloric intake decreased significantly to 1514 cal/day (106 cal/kg/day, 0.005 less than p less than 0.01), stimulable growth hormone in this period was 13.6 ng/ml and somatomedin activity normalized (0.98 U/ml). While under continued observation, with separation from his favorite nurse, his growth velocity dropped significantly to the rate immediately following admission, but there was no change in his stimulable growth hormone or in somatomedin activity. With the return of his favorite nurse, he resumed his previous rapid catch-up growth with no change in caloric intake (p equals not significant), growth hormone level, or somatomedin activity. Upon transient return to his depriving home, his growth rate decreased to 1.4 cm in 70 days (extrapolated growth rate 7.2 cm/yr); growth hormone remained in the normal range. Somatomedin activity was in the low normal range (0.57 U/ml) and rose to high normal activity (1.31 U/ml) as rapid catch-up growth resumed after he had been readmitted. We conclude from these data that: 1. Serum somatomedin in longstanding untreated PSD may be in the hypopituitary range. 2. Markedly fluctuating growth rates during recovery in this patient with PSD were not due to changes in caloric nutrition, growth hormone release or somatomedin activity, but to an as yet unidentified factor affecting growth during emotional stress.


Hypergonadotrophic male pseudohermaphroditism due to complete 17-alpha-hyroxylase deficiency. This is a case report of a 43 years old phaenotypic female (karyotype 46 XY) with congenital adrenal hyperplasia and male pseudohermaphroditism presenting with severe hypertension and hypokalaemic alkalosis. Evaluation of the steroid biosynthesis of the adrenals as well as of the intraabdominal testes demonstrated a severe degree of 17-alpha-hydroxylase deficiency in this patient. This defect was associated by a complete lack of deoxycortisol and cortisol as well as of testicular testosterone synthesis, and by an overproduction of DOC and corticosterone. Sruvival of the patient in spite of severe cortisol deficiency was due to the glucocorticoid activity of corticosterone. This compound and DOC account also -- due to their mineralocorticoid properties -- for the hypertensive state of this male pseudohermaphrodite.


[Possibility of a TSH-Screening method for detection of hypothyroidism in the newborn (author's transl)]. In congenital hypothyroidism the TSH level reaches at age 5 days values about 100-times of the normal. Due to this fact, and having a good RIA-method for TSH in the own lab at hand, the possibility of TSH-determination in dried wholeblood on a filter-paper was examined. Control studies with normal blood-samples proved that the values of dried-blood samples had sufficient accuracy. On the 5th day of life the normal TSH-values were below 20 muU/ml while values above 100 muU/ml were suspicious for hypothyroidism. In 1200 newborns the TSH-screening was performed in combination with the routine Guthrie-test. Among them one child with a value above 100 muU/ml proved to have hypothyroidism. The results show that the determination of TSH in dried blood is possible, and that the method described is a useful tool for the early diagnosis of primary hypothyroidism.


[Plasma androgens and maturation of the hypothalamo-pituitary-gonadal axis in infants and children (author's transl)]. The plasma androgens testosterone (T) and delta(4)-androstenedione (delta(4)) were measured by RIA in 245 children under 1 year of age, in 70 children of prepubertal age, and in 250 adolescents during puberty. The values presented in the tables, and their changing relation to each other, suggest, that 1. at birth T and delta(4) are of fetal origin demonstrating the important endocrine function of the fetal testis; 2. after 6 months of age there is no significant endocrine activity of the gonads any more; 3. the prepubertal activation of the adrenal androgens production (adrenarche) is similar in the 2 sexes but their chronology is different for each androgen: an increase is observed after age 8 for delta(4), after age 10 for T. 4. in puberty the increase of T- and delta(4)-values differs markedly according to the two sexes. So, while the gradual prepubertal maturation of androgen steroid production, passing the stage of "adrenal puberty", could be demonstrated convincingly, the role of the different androgens in the maturation of the "gonadostat" (hypothalamopituitary complex) still remains a matter of hypothesis.


[Screening for hypothyroidism in the newborn with a total T 4-RIA method (author's transl)]. A screening method for detection of congenital hypothyroidism is presented in detail in cooperation with the "Austrian Program for Inborn Errors of Metabolism". Screening is performed by measuring the total T4-content of 1/8 inch filter paper dots filled with dried blood of newborns. The strategy for recall of newborns with borderline or pathological T4-values used, results in a definite diagnosis on day 55 of life. The advantages of additional TSH determination in the filter paper dots are discussed. So far (Sept. 1976) 8645 newborns have been investigated, covering the regions of Vienna and Carinthia (Austria). Preliminary studies reveal a slight dependency of the measured T4-values on the day of sampling. Two congenitally hypothyroid children have been diagnosed so far, corresponding fairly well with the reported frequency in the literature (1 : 6000).


[Transient hypoaldosteronism. A case report]. We observed a 2-week old boy who developed a typical salt-losing syndrome. Urinary 17-ketosteroid excretion of 2.4 mg per day lead us to the diagnosis of congenital adrenal hyperplasia and the usual treatment with hydrocortisone, DOCA and NcCl orally was started. The 6-months old child will tolerate a reduction and subsequent withdrawal of hydrocortisone. Mineralcorticoid and NaCl treatment, however, is to be continued. Further studies clearly showed that in the 8 and 9-month-old child cortisol production could very well be stimulated by synthetic ACTH, but the base line plasma aldosterone was exceedingly low and stimulation by ACTH and salt depletion was impossible. Instant cortisol as well as aldosterone stimulation occurs not until the child is 14 months old. There is valid evidence for a defect in aldosterone biosynthesis, which may be caused by 18-hydroxylation or 18-dehydrogenation deficiency.


[Plasma prolactin in different age groups (author's transl)]. After a detailed introduction to the problems of radioimmunological measurement of Prolactin and a review of the possible connections between PRL and urological and andrological diseases, respectively, the results of Prolactin measurements carried out with a Prolactin Radioimmunoassay Kit (Cea-Ire-Sorin) will be described. This Kit makes use of the "double antibody" method. In 99 healthy male subjects the plasma levels of Prolactin in 3 age groups were ascertained. These were as follows: Group I ages 10 to 20: 2.4+/-1.2 ng/ml; group II ages 20 to 40: 3.9+/-1.5 ng/ml; group III ages 50 to 80: 5.2+/-3.8 ng/ml. In the cases of 4 patients suffering from prostate cancer stage D, treated with hormones at various intervals and after orchiectomy the range of PRL levels was 13.1--18.7 ng/ml.


[A new method for the determination of steroidal hormones in biological material (adrenal tissue) (author's transl)]. A rapid method is described for the determination of some steroidal hormones in adrenal tissue. The following steroids were measured: pregnenolone, progesterone, deoxycorticosterone, corticosterone, aldosterone, 17-alpha-OH-pregnenolone, deoxycortisol, cortisol, cortisone, 17-alpha-OH-progesterone, dehydroepiandrosterone, androstendione, and testosterone. After extraction of the steroids the purification steps were performed by thin layer chromatography. Gas chromatography was used for further separation and quantitative analysis of underivatized steroids. The GC-analysis of steroids without any derivatisation makes this procedure comparatively simple and exact. Recovery of the steroid content of the tissue ranged from 30% to 70%. This method described herewith has several advantages, and allows the analysis of two tissues at the same time for a large number of adrenal steroids within two weeks.


Biochemical determinants in Gender identity. The purpose of this communication is to report cognate studies which suggest that the nature of the peripheral metabolism of testosterone may impart gender direction to thought construction and motive. In patients with the complete testicular feminizing syndrome [4], the XO/XY syndrome [4], female trans-sexualism [4] and testicular agenesis [5] HCG-tests of 3 days duration were performed, and plasma and urinary testosterone, urinary excretion of 5 alpha-androstane, 3 alpha, 17 beta-diol (5 alpha-diol), 5 beta-androstane, 3 alpha, 17 beta-diol (5 beta-diol) and epiandrosterone before and after stimulation were measured. In addition steroid transformation was examined by incubation studies with human fetal brain tissue. The results of the latter method presented here are in agreement with published work. It seems clear therefore that the peripheral levels of androgens, oestrogens and their metabolites combine with cerebral steroid transformation, metabolism and possible also synthesis in order to establish gender identity. Exploration of the role of peripheral hormones as stimulators of both gender identity and gender function has dictated the need for a new approach to therapy for gender abnormalities in psyche and soma.


Distribution of taste thresholds for phenylthiocarbamide among different age groups in Turkey. The relation between age and taste threshold in populations living both in Istanbul and Resadiye, a town located in eastern part of Turkey, was investigated. In Turkey the nontaster/taster ratio has been found lower than in the other countries of Europe and Asia (3 ,4 ,8 ,9). With aging the taste sensitivity of tasters does diminish. However, the differences in  the taste threshold levels of nontasters, in different age groups, have been found as being statistically not significant.


Nematode larvae of medical  importance found in market fish in Iran. Two species of fish, tuna fish (Euthynnus spp.) from the Persian Gulf and pikeperch (Lucioperca lucioperca) from  the Caspian Sea were examined for nematode larvae. The larvae of Anisakis which is considered to be one of the zoonotic helminths, was found in 75 percent of the tuna fish and 20 percent of the pikeperch. The possible role of fish as a source of infection in man in Iran is discussed.


The german cockroach, Blatella germanica L, from the human ear. A case of invasion of the human ear by the German cockroach Blattella germanica (L) IN Mash'had, Khorassan, Iran is described. As far as the Author  is aware this is the first such case recorded and published from Iran.


Aortic intimal changes in aging swine.

Aortic intimal changes in aging swine. Aortic intimal lesions in aging swine contained smooth muscle, monocyte-like and unclassifiable cells. The most frequent cellular constituent was the smooth muscle cell that had slightly different features than those in the media. Monocyte-like and unclassified cells appeared largely in the innermost layer of the intima; both types of cells were ultrastructurally similar in appearance except the former had heterophagic vacuoles and overall resemblance to circulating monocytes in shape and size. These cells seemed to preexist in aortic lesions of untreated, aging swine. The intima-media strips of the grossly normal thoracic aortas in 3 1/2 year old swine showed significantly higher contents of cholesterol, triglycerides, phospholipids and total lipids than those of a 6 month old swine. Three to four month old cultured aortic cells accumulated extracellular components, such as fibriles, electron dense substances and cellular debris, which appeared similar to the extracellular matrix of aortic plaques in aged swine.


Lesions caused by copper depletion in the chicken. Light and electron microscopic study. Lesions of the aorta and other organs of copper depleted layers, roosters, day-old chicks and chick embryos were studied by light- and electron microscopy. Copper deficiency results in late and abnormal development of elastic fibres: inhibition of the formation of cross linkages causes a decline of elastin synthesis. The microfibrils constituting the blackbone of the elastic fibre form a honey-comb pattern. The small amount of amorphous elastin is digestible by elastase, the microfibrils are resistant to the action of the enzyme. The aortic elastic fibres are irregularly shaped, broken revealing a honey-comb like pattern. They maintain an increased affinity to PTA. Tears--dissecting aneurysms--arise in the media, vacuoles appear in the heart muscle, haemorrhages and inflammatory changes may arise in other organs.


[Relative C H D predictive value of serum cholesterol and triglycerides. New epidemiological data (author's transl)]. The epidemiological question whether triglycerides (TG) adds a significant information to cholesterol (CH) alone in predicting coronary heart disease is so far controversal. The problem is taken up from the results of the prospective study of the G.R.E.A.: 148 new coronary cases have been observed in a 7263 working male population followed during four years and aged 42-53 at entry. It is shown that risk increases continuously with TG and CH but the contribution of TG (or Log TG) is not per se significant.  From an alternative model founded upon the hypothesis of two subgroups (less than 220 mg p. 100, greater than or equal to 220 mg p. 100) in the TG distribution, a slight but significant risk supplement is shown to be associated with TG values more than 220 mg p. 100. This result may be interpreted by qualitative and/or quantitative differences in plasma lipoproteins according to the TG level, and may reconcile clinical and epidemiological data concerning "atherogenic" hyperlipidemias.


The significance of epithelial polyps of the large bowel. We have reviewed 801 epithelial polyps removed from large intestines of 611 patients. Among these, there were 250 pure adenomatous, 304 adenomatous polyps with villi, 123 villous, and 124 hyperplastic polyps. Of the lesions classified as purely adenomatous, there were no observed carcinomas or carcinomas in situ. It would appear that a villous component may be an important indicator of the chance of the lesions harboring a carcinoma in situ or an invasive carcinoma. On the basis of our review, it would seem that it would be reasonable for a pathologist to indicate the estimated precentage of villous component in epithelial polyps of the large intestine.


Propionyl-CoA carboxylase deficiency in a patient with biotin-responsive 3-methylcrotonylglycinuria. The abnormal metabolites 3-hydroxypropionic acid (1.6-4.0 mg/day) and methylcitric acid (3.7-5.8 mg/day) were identified and quantitated in the urine of a patient in whom biotin-responsive 3-methylcrotonylglycinuria and deficiency of 3-methylcrotonyl-CoA carboxylase had previously been documented. The level of excretion of these metabolites was in the lower range of those found in patients with propionic acidemia in whom there is a deficiency of propionyl-CoA carboxylase. The activity of this enzyme in fibroblasts derived from the patient and grown in media low in biotin was 4% of normal. This is the range of patients with propionyl-CoA carboxylase deficiency. Documented deficiency in this patient of two carboxylase, both of which contain biotin, suggests that the primary defect is in the metabolism of biotin.


Renal functions of low birth weight infants during the first two months of life. A postnatal contraction of extracellular fluid occurs in low birth weight infants. Patterns of postnatal renal maturation were assessed with the assumption that changes in body composition were mediated in part by the developing kidney. Twenty-two appropriate for gestational age, low birth weight infants (birth weight mean = 1380 g, gestational age mean 31 weeks) were studied between 12 hr and 61 days of age to evaluate simultaneously glomerular and tubular functional maturation. Since most low birth weight infants have respiratory morbidities (respiratory distress followed by chronic lung disease), the infants were grouped into: group I (13 infants), transient or absent respiratory morbidities; and group II (9 infants), persistent and severe respiratory morbidites. Sodium excretion decreased with postnatal age in both groups. Sodium intake did not vary with postnatal age. The percentage of fractional sodium excretion was inversely related to postnatal age. Creatinine clearance correlated directly with postnatal age in both groups. Increased sodium excretion and percentage of fractional sodium excretion in the first 10 days of life may reflect extracellular fluid solute losses through the kidney. The premature kidney matured in a balanced fashion and persistent respiratory morbidities did not alter this pattern.


Value of preoperative chest X-ray examinations in children. To assess the value of routine preoperative chest x-ray films in pediatric patients, a prospective study of 1,500 patients, ages newborn to 19 years, was undertaken. Of all the patients, 7.5% demonstrated at least one roentgenographic abnormality, with 4.7% of the patients demonstrating a totally unsuspected significant roentgenographic anomaly. In 3.8% of the patients, surgery was eihter postponed or cancelled or the anesthetic technique was altered as a result of the roentgenographic finding. It is believed that the routine preoperative chest film is justified if the film is evaluated before surgery and the results clinically followed up.


Electrocardiograph monitor artifacts in a neonatal intensive care unit. A wide variety of artifacts may be found when monitoring the ECG in a neonatal intensive care unit. Many of the artifacts resemble arrhythmias, and unless they are recognized as artifacts they may lead to serious errors of diagnosis and therapy. Many of the artifacts are caused by patient movement such as seizures, tremulousness, or hiccups. Others may be introduced by the monitor itself or be caused by electrical equipment in the vicinity. A group of ECG tracings is presented to illustrate the various artifacts encountered. Features that distinguish the artifacts from the arrhythmias they mimic are described, as are suggestions for elimination of the artifacts.


Diagnostic criteria for influenza B-associated Reye's syndrome: clinical vs. pathologic criteria. Between December 15, 1973, and Jun 30, 1974, a total of 379 cases of Reye's syndrome was reported to the Center for Disease Control. One hundred forty-seven (40%) were confirmed by either autopsy or biopsy, while 232 were diagnosed by clinical and laboratory parameters. Comparisons of the epidemiologic and demographic characteristics, the hospital course, the outcome, and the laboratory abnormalities of the clinically diagnosed and the pathologically confirmed cases revealed no significant differences. In the epidemiologic setting of influenza B outbreaks, children who have the acute onset of noninflammatory encephalopathy associated with elevated serum transaminase levels, hypoprothrombinemia, and elevated blood ammonia levels should be considered to have Reye's syndrome. Further evaluation of diagnostic criteria is needed, however, for sporadically occurring, nonepidemic cases of noninflammatory encephalopathy associated with hepatic dysfunction.


Reye's syndrome: clinical progression and evaluation of therapy. The hospital course and therapy of 369 patients with Reye's syndrome were evaluated. Eighty-three percent of patients had deepening coma during hospitalization. Stage of coma on admission, evidence of increased intracranial pressure, and blood ammonia levels greater than 300 microgram/100 ml were all significantly associated with increasing mortality. Among survivors of Reye's syndrome, 30% of those who developed either decerebrate posturing or seizures during hospitalization had serious neurologic sequelae upon discharge. When analyzed by (1) stage of coma during admission (2) progression of coma during hospitalization, (3) degree of blood ammonia level elevation, and (4) presence of increased intracranial pressuring, no significant differences were noted between patients receiving intensive supportive care and those receiving exchange transfusions and/or peritoneal dialysis.


The fontogram: a noninvasive intracranial pressure monitor. The applanation transducer was used to measure intracranial pressure (ICP) through the intact fontanel. The method is painless, rapid, and accurate. The pressures recorded with this fontogram were correlated with direct measurements of ICP. The correlation coefficient of the 21 paired determinations was .98--a very good correlation. Fontanel pressure was determined in 35 normal newborn infants. The mean pressure was 7.37 mm Hg with an SD of +/- 1.45 (range, 3.5 to 9.5 mm Hg). Three clinical cases are presented to illustrate the usefulness of this apparatus in the detection of increased ICP and in monitoring the effectiveness of treatment.


Fisher's syndrome in children.

Fisher's syndrome in children. Fisher's syndrome is characterized by ophthalmoplegia, ataxia, and areflexia. The clinical course is usually benign with complete recovery. We report a case that developed following a bee sting and review the literature of Fisher's syndrome in children. Its history, pathogenesis, and relationship to Guillain-Barré syndrome are also discussed.


Eye fixation and attention as modifiers of perceived distance. An error in the perceived distance of a physically stationary object results in an apparent horizontal motion of the object if the head is moved horizontally. Procedures have been developed to use this apparent motion to measure the apparent distance of the object. Research also has indicated that the apparent distance of an object will tend to be displaced toward the distance at which the eyes are fixated. In the present study head-motion procedures were used to measure the effect of eye fixation and attention upon the apparent distance of a point of light in two experiments. Substantial errors in perceived distance occurred in the predicted direction as a function of fixation distance. Attending to an object at a distance other than the distance of the fixated point of light had a much less effect upon the apparent distance of the point. It is concluded that the apparent conomitant motion which occurs in a variety of situations as a function of the distance of fixation indicates that substantial errors in perceived distance are common in most environments.


Effect of the Harvard Step Test on visual acuity. A replication with 5 females in a laboratory setting of findings by Kashuk that physical activity improves visual acuity used the Harvard Step Test for the exercise load and grating acuity (resolution acuity) to determine possible changes. The results support Kashuk's work.


Creative activity and sex-role identity in elementary school children. The relationship of creative activity to sex-role identity was examined in boys (N = 80) and girls (N = 56), aged nine to twelve, of above average intelligence. Endorsement of personal characteristics that cut across sex stereotypes was associated with participation in a wide variety of creative activities. When analyzed by specific activity, the relationship with sex-role followed a consistent pattern for boys and girls combined: male activities such as sports with scores on the masculine scale, female activity such as dance or art with scores on the feminine scale, and sexually indeterminate activities such as drama or social leadership with scores on both scales.


Taste preferences in the cotton rat (Sigmodon hispidus). This study focused on taste preferences in hispid cotton rats (Sigmodon hispidus) as measured by 2-bottle, 48-hr. drinking tests. In a series of continuous tests, fluid intakes were recorded for 5 sugar solutions (fructose, glucose, sucrose, maltose and lactose), 3 salt solutions (KCl, MgSO4 and NaCl), and 2 acid solutions. In as attempt to supplement incomplete and divergent comparative data on rodent's taste preferences, this study investigated sugar and salt preferences at five concentrations (.005, .05, .10, .50, and 1.0 M) and acid preferences at six concentrations (4.0, 2.3, 2.0, 1.8, 1.6, and 1.5 pH). Significant differences in concentration in intake of all salts, acids, and sugars were noted. Significant sex differences were observed for intakes of sucrose and NaCl at several concentrations. All sugars were preferred maximally at .10 M. The salts NaCl and KCl were preferred maximally at .005 M and MgSO4 was preferred maximally at .05 M. The role of the sugars used in the experiment was discussed in terms of incentive values and possible reinforcers for later experiments.


Descent behavior of rats and chicks in a cliff and non-cliff situation. A visual cliff was constructed so that patterns could appear below the centerboard as "shallow" and "deep" or vertical to the centerboard as "near" and "far". Preference for the shallow side was significant only for chicks. Preference for the vertical pattern was significant for both chicks and rats. These findings indicate that both rats and chicks will descend to the nearer of two patterns in a non-cliff situation.


Communicability and complexity as predictors of creativity: validity of the Barron-Welsh Art Scale. The construct validity of the Barron-Welsh Art Scale as a measure of creativity was questioned. It was hypothesized that figure preferences of creative subjects are more strongly determined by stimulus communicability than stimulus complexity. In a first study a significant negative relationship between operational measures of communicability and complexity of Barron-Welsh drawing was found. A second study of 24 undergraduate subjects showed communicability to be significantly related to peer ratings of creativity whereas complexity was not. A third study of 60 high school subjects showed that a derived score, reflecting the relative preference for drawings of low communicability and low complexity over those of high communicability and high complexity, was significantly related to staff's ratings of creativity. These results were in direct opposition to an interpretation involving complexity in previous research on the Barron-Welsh Art Scale. An alternative interpretation was discussed.


Comparison of self-report and performance measures of attention. The attentional scales of the Test of Attentional and Interpersonal Style were correlated with performance measures of attention, the Digit Span and Block Design subtests of the WAIS. Of the 24 correlations computed only one was statistically significant. The need for the construct validity of these scales to be established against some behavioral measure of attentional focus was emphasized.


Daydreaming styles and nocturnal dreaming: further observations. This investigation examines the relationship between patterns of daydream activity and nocturnal dreams. When persons of differing but relatively pure daydream styles are compared as to nocturnal dream characteristics, the stylistic consistencies observed in waking fantasy appear also in dream productions, particularly affective polarity and bizarreness. Dreams and daydream appear to be highly interrelated aspects of the fantasy process, sharing important affective and structural components.


Similarities and differences in encoding processes in chronic schizophrenics and normals. The encoding of visual stimuli was compared for 9 female chronic nonparanoid schizophrenics and 9 normals using the Sternberg paradigm. This paradigm allows an examination of several hypothetical stages in information processing using a reaction time measurement. Degradation level (degraded vs nondegraded), type faces of letter stimuli (varied versus constant type face), and order of degradation levels (mixed or constant level across a block of trials) were manipulated in order to examine differences in encoding process between the two groups. Results suggest two subprocesses in encoding, only one of which is defient in schizophrenics. Additional processing of encoded information at a memory stage may be comparable in normal schiziphrenics. Chronic schizophrenics are also more easily disrupted by the context of varying stimulus conditions such as mixing degradation levels and type faces. This finding suggests schizophrenic perseveration in encoding processes.


Within-modal and cross-modal reliabilities of two laterality tests among left handers. 20 left handers were administered four repeat testing of a dichotic listening task and a verbal visual half-field task. Scores on the dichotic task were reliable between Days 1 and 4 while visual half-field performance did not stabilize until two testing sessions. Left handers showed a clear right channel, superiority of the right visual half field for the verbal material. No significant cross-model reliabilities were observed. It was also found that, in comparison to right handers, left handers show more variability in channel/visual half field than right handers on the same procedures.


Effects of retention interval on pupillary responses during a simple discrimination. Responses from 6 subjects show that pupillary changes observed during short-term information processing with retention intervals of 0, 5, and 10 sec. delay occur during recognition memory for tones as well as recall of 7-digit numbers.


Some aspects of the psychological representation of speech sounds. If one listens to a meaningless syllable that is repeated over and over, he will hear it undergo a variety of changes that can be described systematically in terms of reorganization of the phones constituting the syllable and changes in a restricted set of phonetic distinctive features. When the repeated syllable is followed by a different syllable but in the same voice, the new (test) syllable will be misperceived in a manner related to the perceptual misrepresentation of the repeated syllable. In the present experiment subjects (N = 24) listened to 72 different experimental sequences of repeated syllables in a male voice followed by test syllables in a female voice. Identification of penultimate and test syllables was independent and in no instance were the phone constituting the syllables reorganized. These results are interpreted as evidence against both auditory and phonetic feature detector theories of speech perception.


A validity study of the Neural Efficiency Analyzer in relation to selected measures of intelligence. This study attempted to determine the validity of the Ertl Neural Efficiency Analyzer as a measure of intellectual ability by using NEA-Alpha and Neural Efficiency scores to predict collage grade point average (GPA) both alone and in combination with paper-and-pencil measures of intelligence for 22 male and 64 female college students. Results indicate that NEA-Alpha scores can predict GPA with moderate sucess and also that NEA-Alpha scores account for variability in grade point average not associated with paper-and-pencil tests.


Auditory discrimination as a predictor of reading for bilingual Mexican-American migrant children. The performance of 61 bilingual Mexican-American migrant children, ages 8 to 14 yr., was compared for Spanish and English formats of the Wepman Auditory Discrimination Test. The two formats correlated significantly with each other and both were predictive of reading recognition as measured by the Peabody Individual Achievement Test. The data suggest that auditory discrimination as measured by the popular Wepman test may not be a pure perceptual skill but may be language bound. Consequently auditory discrimination as a pure perceptual skill may not be accurately assessed in bilingual or monolingual Spanish-speaking children if the Wepman test is used in its published format. A Spanish-based alternative is suggested for assessing auditory discrimination for uses other than reading prediction.


Short form of the Speech Sounds Perception Test. Although numerous studies have investigated the diagnostic effectiveness of the Speech Sounds Perception Tests, few have investigated the qualities of the test make it effective. Different writers have suggested that it may be effective because of interference from earlier syllables and items, an inability to understand speech, fatigue or an inability to match letters and sounds. If the effectiveness is due to fatigue or interference, the lengh of the test (60 items) would contribute to its accuracy. Otherwise, a short form of the test could be as effective. Data from 37 brain-damaged and 21 normal individuals indicated that a 30-item version of the test was slightly more accurate diagnostically than the 60-item form. This suggests that a short form of the test could be used without sacrificing diagnostic accuracy, enabling the clinician to save time in assessing neuropsychological patients.


Critical evaluation of the Obscure Figures Test as an instrument for measuring "cognitive innovation". The Obscure Figure Test has been conceptualized by Acker and McReynolds (1965) as a measure of Cognitive Innovation. As a general concept Cognitive Innovation refers to an integration of different kinds of behavioral systems, e.g., creativity and exploratory behavior. Considering recent research about the relationship between curiosity and creativity as well as basic assumptions underlying this test, it is hypothesized that this is an instrument for measuring creativity rather than curiosity. 41 boys and 41 girls ranging from 7 to 10 yr. of age were given a battery of tests of curiosity and creativity. There were significant correlations between Obscure Figures Test and creativity measures. No such relationships were found between obscure figures and curiosity measures. A factor analysis yielded two factors which could be interpreted as "visual exploration" and "creativity", the obscure figures being a marker variable on the latter factor. Results are discussed in terms of the theoretical assumptions underlying the concepts of curiosity, creativity, and Cognitive Innovation. Further implications with respect to the requirements for an operationalization of Cognitive Innovations are mentioned.


Temporal patterns of alcohol use by alcoholics. Examination of data gathered from 21 hospitalized alcoholics regarding rank order to time intervals for use (most common to least common) of alcohol showed a significant correspondence to the temporal pattern for drug use in young polydrug users (rho = .943). The most common time for use was 6 PM to 10 PM.


Visual following in newborns: role of figure-ground contrast and configurational detail. Visual pursuit was used in studying the ability of newborn infants to discriminate levels of contrast. Ratings of the degree of eye and head following were made as subjects pursued facial targets which varied in terms of the degree fo figure-gound contrast and te degree of contrast internal to the figure as defined by the presence of contrast such that the strongest pursuit occurred to stimuli which had clearly discriminable facial detailing in addition to strong figure-ground contrast. These results suggest that the newborn is sensitive not only to large border areas of high contrasting illumination but to finer configurational details of stimuli as well.


Components underlying the relation between field dependence and extraversion. Components of Eysenck's Extraversion scale were examined to account for previous findings indicating that field independence, as measured by individual and group forms of the embedded-figures test, is associated with Introversion. In two of the three samples of female unversity students, field independence, as measured by the Group Embedded Figures Test, was associated with low impulsivity and slow decision time, as measured by items on Eysenck's Extraversion scale.


Picture mediation in abstract-concrete paired associates. The present study investigated the hypothesis that pictures of abstract-concrete paired associates would serve to make the abstract stimulus member more concrete thereby enhancing the learning process. 60 subjects were equally divided into 6 groups, varying conditions of concreteness and abstractness of the stimulus items and pictures or no picture. The results supported the basic proposition that the picture mediation presented during the learning-testing condition facilitated the learning of the abstract paired associates.


Concept and verbal ability as related to the cerebral hemispheres. A new theory of human brain function is outlined in terms of the cooperative interaction of the cerebral hemispheres. The well-established verbal, symbolic functions of the left hemisphere and the wholistic, spatial functions of the right hemisphere are seen as separate and independent manifestations of the normally integrated verbal-analytic (or "error detector") and conceptual (or "goal state") functions of the left and right, respectively. The relationship between the hemispheres is described in terms of the "goal-directed" system of cybernetics and then compared with related ideas previously presented by Dimond, Penfield, and Piaget.


Scores on Adjective Check List, Eysenck Personality Inventory, and Depression Adjective Chck List for a male prison pupulation. Normative data are presented for a male prison population on the Adjective Check List (Gough & Heilbrun, 1965), Form A of the Eysenck Personality Inventory (Eysenck & Eysenck, 1975) and Form C of Depression Adjective Check List (Lubin, 1967). The intercorrelations among the instruments also are presented. In the sample were 60 recently admitted male inmates of a maximum security correctional institution randomly drawn from a large sample of 205 consecutive admissions. Subjects described themselves as markedly depressed, high on neuroticism, low in personal adjustment, low in self-confidence, and low in self-control.


Short-latency acceleration of human heart rate as a function of stimulus intensity. The study examined the effectiveness of three intensities of white noise in evoking short-latency acceleration of human heart rate. 3 groups of 10 female subjects were presented with 1-sec. bursts of white noise with virtually instantaneous rise times at intensities of 100 db (re 20 mu N/m2), 90 db, or 80 db SPL as measured at the headset. 5 bursts were presented at intervals of 45 sec. while the EKG was recorded. An increase in heart rate during poststimulus beats 3 and 4 compared with the mean rate of the three beats prestimulus was reliably evoked on the first two trials in the 100-db and 90-db groups but not in the 80-db group. Apart from a recovery of acceleration on Trial 5 for the 100-db group, the 100-db and 90-db groups did not differ in amplitude or rate of habituation of the response. Poststimulus heart-rate level was not significantly related to prestimulus level as expected in terms of the law of initial values. The results were interpreted as consistent with F.K. Graham's interpretation of short-latency cardiac acceleration as a component of startle.


Time estimation: effects of attentional focus and a comparison of interval conditions. Time estimation was studied as a function of the subject's attention to the stimulus interval and the stimulus condition of the standard interval. 111 subjects from lower level psychology classes were randomly assigned to a interval condition. Time estimation of a standard interval was significantly lower when sujects attended to the stimulus material than when attending to the interval of passing time. A significant difference was not obtained among the three intervals.


Recognition decrement for modes of letter forms. 40 undergraduates were presented with simple letters made up of patterned line modes. Other subjects were shown the same modes but in the form of parallel unconnected lines. On subsequent recognition tests recognition was superior for the lines presented in the unconnected condition. This was true despite various types of recognition tests designed to control for possible bias in favor of the unconnected condition. These improved procedures support the suggestion that the articulated form itself becomes an added factor in the memory span that hinders retention of its component elements.


Abnormality of catecholamines balance relating to social deviance. Approximately a quarter of maximum security hospital patients convicted of highly deviant crimes exhibited low 'anxiety-type' psychophysiological responsivity to stressors together with an abnormal catecholamine balance during stressor anticipation which resulted in noradrenalin to adrenalin ratios in excess of 5.5, an abnormally high value not exceeded by any control subjects and a result which is significant (p less than 0.005).


Hypoxemia and auditory reaction time in congenital heart disease. The purpose of this study was to determine if previously documented perfomances deficits of patients with cyanotic congenital heart disease are peculiar to centrallly mediated visual tasks or are also manifested on tests of other centrally mediated sensory functions such as hearing. A simple auditory reaction time test was, therefore, performed on 239 patients with congenital heart disease, 43 of whom were cyanotic. Results indicated that (a) there is no significant relationship between level of arterial oxygen saturation and auditory RT. (b) Auditory RT for the group as a whole declines until the mid-teens and then rises, a pattern at variance with that of normal subjects. (c) The audiroty RT of females was significantly higher, i.e., slower, than that of males.


Acquisition of two gaze-contingent aftereffects. Previous studies have shown that subjects could acquire a prismatic aftereffect contingent on the direction of gaze. Other studies have shown that subjects could acquire two simultaneous aftereffects with multiple cues. In the present study 12 subjects practiced alternately under two opposite 20-diopter lateral displacements and displayed two gaze-contingent aftereffects.


Comparison of Wechsler Adult Intelligence Scale indices of cerebral disfunction. This study assessed and compared the diagnostic accuracies of eight cerebral dysfunction indices based upon the Wechsler Adult Intelligence Scale (WAIS). Patients with extreme values of the Halstead Impairment Index were used to compose Impaired and Not Impaired groups. The Impaired group did significantly worse than the Not Impaired group on all 11 WAIS subtests, and there was little overlap between the groups in Full Scale IQ. The WAIS cerebral dysfunction indices ignore such differences in over-all level of performance and instead use the eight indices predicted impairement status at levels which exceed chance, but the total correct classification rates were quite modest. Statistical correction for group age differences reduced classification rates even more. Deviation score analyses were employed to assess relative strengths and deficits on the WAIS subtests, controlled for over-all level of performance. Compared to the Not-impaired group, Impaired subjects did relatively poorly on Block Design and Object Assemby, and relatively well on Information, Comprehension, Vocabular, and Picture Completion. Significant education effects and education by impairment status interactions also occurred for several subtests. It was concluded that the WAIS indices have limited value in screening for cerebral dysfunction, and reasons for this were discussed.


Developmental study of similarity judgments involving dimensions. In order to examine the nature of dimensional processing in children, kindergarten and third grade children were asked to make similarity judgments for unidimensional sets of stimuli differing in color (hue), size, and shape, respectively. Age differences were generally confined to the color set. The judgments of the older children in their age group than were the younger children's. The frequency of good-fitting scaling solutions was also higher for the older children. The processing of color in a relational manner thus seems to develop more slowly than relational processing of size or shape. Results from any task which depends on or is facilitated by relational processing could be altered by the dimensions used. The methods developed in the paper also provide an alternate method of studying seriation .


Combined effects of tobacco and caffeine on the components of choice reaction-time heart rate, and hand steadiness. Eight male smokers were tested under 6 conditions comprising the combinations of 200 mg. caffeine or no caffeine, with no cigarette, one 0.3-mg. nicotine cigarette or one 1.3-mg. nicotine cigarette, for decision time and motor time scores on a choice reaction-time task. Heart rate was monitored from a pretest period throughout the session, and hand steadiness measured on repeated occasions. Decision-time scores were significantly decreased by both caffeine and nicotine, but no interaction was found. The high-nicotine cigarette had the greatest effect. Motor time scores were improved by caffeine only. Both caffeine alone and nicotine alone accelerated the heart rate but in combination appeared to have antagonistic effects. Hand steadiness was significantly impaired by both drugs but with no interaction.


Deliberate presleep control of dream content: an experimental study. 29 subjects attempted, over a period of 10 nights, to influence their dream using techniques described in Garfield's book, Creative Dreaming (1974). A target suggestion was selected from a list of six suggestions compiled by, or for, each subject. Subjects kept daily records during the experiment both of their efforts at dream influence and of the dreams they recalled. Four judges attempted to identify from the dream material the target suggestion on each subject's suggestion list. The results indicated that the judges were unable to do so at better than chance levels. Thus analysis indicated no reliable evidence that conscious presleep suggestions become incorporated into dream content.


Trade-off between remembering words and their source of location. On each of 32 trials subjects heard 32 words, 16 presented to each ear in randomly aternating manner. The subjects were requested to remember the location of the source of the words and to recall the words themselves.  Memory for location was assessed by a recognition probe. A probe presented on each trial had to be judged as new or old and, if it was called old, it had to be identified as left or right. Then free recall followed. The subjects were able to identify the location of the probe at a better than chance level. However, further analysis gave evidence of such memory only on trials with relatively low recall. These results replicate findings by Geiselman and Belleza (1976) that retaining the location of verbal materials occurs at the expense of remembering the materials.


A technique for evaluating the stability of figures in a figure-ground pattern. A technique is described which uses a reversible word-figure for studying effects of experimental variables on the stability of figures. In a reversible word-figure black on white inter-letter spaces represent "nonsense" forms which are usually perceived first. In this study the latency of reversal to the white on black word-configuration is taken as an index of the stability of the perceptual construction involving the black nonsense forms. The results show that pre-exposure of the nonsense forms increases their stability. Either labelling the forms or attempting to memorize them increases stability somewhat more than merely rating them for "aesthetic appeal."


Concrete and verbal reinforcement in creative thinking of disadvantaged cildren. The effects of verbal and concrete reinforcement on creative thinking were investigated in disadvantaged Israeli seventh-graders (N = 90) in a baseline-treatment design. When compared to a no-incentive condition, both concrete (giving a piece of candy for each response) and verbal reinforcement (giving verbal praise to each response) raised the level of ideational fluency on the abbreviated Wallach and Kogan creativity battery by 114% and 61%, respectively. The high correlations between baseline and incentive creativity scores were interpreted as supporting either cognition or motivation but not exclusively the former as the source of individual differences in creative thinking among these disadvantaged children.


Studies on visual perception of locomotion. The problem about visual discrimination between seeing objects in motion and perception of motion of the perceiver (locomotion) was taken up. A flow of vertical motion was presented to limited areas of the far periphery (45 degrees-90 degrees) of the retina simultaneously with optical information about a stationary room over the rest of the retina. The result was that most subjects perceived themselves as sitting in an elevator continuously moving upward or downward. Thus, peripheral motion stimulation over a few percent of the retinal area determines locomotion perception in apparent competition with information about a static state over the rest of the retina. The same type of stimulus presented to the central part of the retina always brought about perception of object motion and a static perceiver. Effects of size and localization of the area stimulated with the motion flow was studied. Theoretical consequences and problems for further experimental analyses are discussed.


Abstraction of information from a complex display. Two experiments concerned with simultaneously abstracting information about different dimensions from the same display were carried out. In experiment 1 the subject was briefly shown a complex display containing coloured forms with three values of each dimension. Instead of identifying the individual items in the display (such as red triangle, blue square, etc), the subject was to abstract and report in any order the different dimensional values (e.g. red and blue for colour, and triangle and square for form). The results showed that the accuracy of performance was independent of the way in which two dimensions were combined, whether they were orthogonal, partially correlated, or completely correlated. The results showed that colour and form were processed independently and that the perception of one was not facilitated or interfered with by the presence of the other in the same display. In experiment 2 various numbers of values from each dimension were combined orthogonally within each display. The subject's task was the same as in the previous experiment except that the order of report of the two dimensions was specified for each subject. Suppose the dimension reported first is X, and that reported second is Y. The results showed that the number of X values not only detrimentally affected the accuracy of reporting the X values, it also reduced the accuracy of reporting Y owing to memory impairment. The number of Y values, on the other hand, affected only the report of Y values. The results were discussed in terms of a parallel-processing system which proposes no capacity limitation.


What is the child's own view in a spatial task?: a spatial by temporal interaction affecting errors in perceptual reports. Children are sometimes called 'egocentric' on the basis of their performance on Piagetian spatial-inference tasks. They often inappropriately substitute their own perceptual report for another observer's. Little is known about what responses are activated in giving perceptual reports. An experiment is presented which tightly controls spatial and temporal stimulus ordering. One condition elicted reports of that aspect of the display which children could not see instead of what they could see. Explanations are considered on the basis of relational coding and temporal responsiveness.


Feature analysers, optical illusions, and figural aftereffects. Simple displacement models cannot explain some aspects of optical illusions and figural aftereffects. The orientation-detector interaction model proposed by Blakemore and others is more suitable to explain many aspects of the Zöllner illusion, positive and negative illusions, the effect of gap between the inducing and test lines, and the anisotropy of illusions. If we hypothesize size detectors whose tuning width and distribution steps are proportional to logarithmic size, interactions between them explain well the fact that the Delboeuf illusion and figural aftereffects of circles are determined by the size of the inducing to test circle, not by the absolute distance between the contours of these circles.


Distortions and disappearances of geometrical patterns. Prolonged observation of a stationary grating has a number of perceptual consequences. Initially the lines appear well-resolved and straight. The lines then take on a wavy and oscillating appearance, which is followed by scintillation of the pattern. The scintillations are often accompanied by cloudy disappearances of the grating. A streaming or scintillating aftereffect is visible subsequently, upon viewing a homogeneous surface. The literature concerning these effects is reviewed and several experiments are reported which examined the apparent waviness and scintillating disappearances. The basis for the apparent waviness remains unresolved. It is suggested that the scintillations are produced by small involuntary eye movements over the contours and that the associated disappearances might be due to binocular rivalry.


Effects of gap size between shaft and fins and of angle of fins on the Müller--Lyer illusion. Assimilation theory was employed to generate quantitative predictions relating the ingoing Müller--Lyer illusion to both angle of fin and gap between shaft and fin. Gap sizes were varied from zero to 18 mm in steps of 2 mm, and angles of fins were varied from 30 degrees to 180 degrees in steps of 30 degrees. Five subjects adjusted the length of a comparison line to match the apparent length of the shaft at each combination of gap size and angle of fin. It was predicted that the gap necessary for a reversed illusion to occur, and the gap at which the maximal reversed effect occurred, would be inversely related to angle of fins. Empirical functions verified the predictions.


Orientation masking and the tilt illusion with subjective contours. Exposure to one edge renders another edge less visible as a function of relative orientation. Experiment 1 showed that orientation-selective masking occurs between phenomenal edges located at sites where the visual display is homogeneous (subjective contours) as well as between edges defined in terms of luminance discontinuity (real edges). In addition, real contours can be masked by subjective contours, and vice-versa. In experiment 2 it was found that the tilt illusion (apparent expansion of the angle formed by intersecting lines) can be induced with subjective as well as with real contours. These results suggest that it is inappropriate to attribute the perception of real and subjective contours to fundamentally different processes.


Effect of distance information and range on two indices of visually perceived distance. Subjects made verbal reports of the perceived distance of near visual targets and indicated their distances by pointing at them with an unseen hand. The targets were presented under three stimulus conditions: monocular, binocular, and multicue. Two ranges of target distance were studied in separate experiments: 11-39 cm and 21-33 cm. When reciprocals of both response distance and target distance were plotted, all functions were approximately linear. The verbal and manual responses (distance indices) differed greatly, but were found to be related by a constant transform. The range of target distances had no effect on either index. The standard deviation of the manual response was about half that of the verbal response. Stimulus condition had a large effect, with the multicue condition producing the greatest change in indicated distance. and the monocular condition the least. The results are discussed with reference to the definition of perceived distance, and hypothesis concerning the integration of distance information.


Spatial effects in speech perception in the absence of spatial competition. Two synthetic speech syllables, differing in pitch, were presented over one loudspeaker situated at one of the following azimuths: 0 degrees (in from of the subject); 45 degrees, 90 degrees, and 135 degrees to the left or to the right; and 180 degrees. The subject's task was to report the high-pitch syllable. The pattern of performance can be described in terms of two component effects: a decreasing anterior-posterior gradient, and right-side advantage. Competition between messages from one direction only appears to be as effective in determining auditory spatial effects as competition between spatially distinct sources.


The microstructure of dual task interaction. 3. Incompatibility and attention switching. This report is the third in a series of reports concerned with close analysis of a dual task situation in which a five-choice serial task is combined with an auditory--verbal response task. A situation is described in which 'incompatibility' is incorporated into the five-choice task in order to increase the information processing load and thus explore the effect on the mechanism believed to control the microstructure of the time-sharing process. Results supported the notion that subjects were continuing to operate a sequential processing strategy in combining the two tasks. The structure of the interval generated by the occurrence of the auditory--verbal task was different in comparison with the compatible five-choice condition reported earlier, suggesting that the introduction of incompatibility causes a change in the characteristics of the time-sharing process. The structure of the interval remained organised and consistent, suggesting that the mechanism which controlled the time-sharing process was not disrupted by increased main task load and therefore was likely to involve a process which did not compete for attention space with task variables. Results also revealed an effect of the digit task response on the following two serial responses. It was suggested that these were probably best described as two independent effects: one arising from the sequential processing strategy adopted, and the other arising perhaps as a function of perception of overall task difficulty.


A simple on-line device for scanning photographs. A cheap scanner, based on an x-y plotter, is described which has a resolution of 128 elements x 128 elements minimum. Digitisings obtained suggest that, at most, 20 grey levels can be resolved.


[The renin-angiotensin-aldosterone system in hypertensive subjects. I-Analytical study of 124 patients (author's transl)]. An analytical study of the renin-angiotensin-aldosterone system was made in 124 individuals with essential hypertension, aged from 25 to 55 years. The results obtained, with rigorous control to posture and sodium balance, indicate the existence of a number of subgroups of hypertensive subjects related to their renin activity and plasma aldosterone in the upright position. This classification thus makes possible comparison with patients suffering from secondary hypertension.


[Abnormalities of calcium metabolism in hyperthyroidism (author's transl)]. With the aim of clarifying the effects of an excess of thyroid hormones on calcium and phosphate metabolism, a study was made of blood and urine calcium and phosphate levels and urinary hydroxyproline excretion in 35 hyperthyroid patients and 20 obese individuals receiving 150 microgram/day of l-tri-iodo-thyronine for a period of 8 days. There was a high degree of correlation (p less than 0.01) between values of hydroxyproline excretion and those of blood thyroid hormones in the hyperthyroid patients. There was no significant difference between the values of the parameters studied before and after the administration of l-tri-iodo-thyronine. A trial involving the simultaneous administration of thyrocalcitonin produced no significant result.


[Hemodynamic assessement of the subendocardial perfusion (author's transl)]. Due to its purely diastolic perfusion pattern, the subendocardium is particularly sensitive to ischemia. The subendocardial perfusion can be hemodynamically assessed by the subendocardial viability ratio (EVR), ratio of the diastolic pressure-time index to the systolic pressure-time index. EVR may be either calculated in the catheterization laboratory or contimously monitorized in intensive care unit. Contimous EVR monitoring may prove useful in some critical hemodynamic states (cardiogenic shock, cardiac surgery) to asess the effects on subendocardial perfusion of the various proposed therapeutics either pharmacological (catecholamines, vasodilatators) or mechanical (intra-aortic baloon conterpulsation).


[Transhepatic intubation with double "O" tubes (author's transl)]. In biliary stenosis involving disappearance of hepatic duct, or in re-stricture of hepaticojejunostomy, there is no other solution than to reconstruction the anastomosis, stenting with transhepatic transanastomotic tubes. Until recently, we had been successfully using double transhepatic "U" tubes tied together under hepatic bifurcation. Now, however, we have adopted a variation of our technique consisting in not trying the seton tubes together and having them come out through different orifices of the jejunum. The right tube comes out of the jejunum through the middle of jejunum Roux in "Y" loop. The left tube comes out through the stump of the Roux in "Y" loop. In this manner, the tubes pull the hepaticojejunostomy transversally between them, thus preventing restricture.


[Left coronary disease in postero inferior myocardial infarction (author's transl)]. Postero-inferior-myocardial-infarction (MI) results usually from the occlusion of the right coronary artery. Recent pathological and angiographic studies have pointed out that in such cases occlusion of the right coronary artery was often (30 to 80 per cent of cases) associated with a severe (greater than or equal to 70 %) stenosis of the left anterior descending coronary artery. Thus, serious left coronary artery disease is frequent and unrecognized in patients with chronic even uncomplicated MI. Exercise test does not allow to recognize accurately this high risk group of patients which should be identified by coronary arteriography.


[Non-invasive exploration of valvular heart disease using Pulsed Doppler Flowmetry with echography (author's transl)]. A new method for diagnosing and assessing valvular heart disease is proposed, based on the analysis of transvalvular, pulmonary artery and aortic flow velocity curves recorded transcutaneously using Pulsed Doppler-echography. The normal tracings are presented and anomalies of the curves disclosed in 97 patients are analysed. It is concluded that this new, simple, non-invasive and repetable method is useful for diagnosing and assessing valvular heart disease, within limitations which are discussed.


[The determination of amanitines in the serum of patients poisoned by amanita phalloides (author's transl)]. The serum of patients suffering from Amanita phalloides poisoning was analysed in order to determine whether amanitines, which are the principal toxins of this fungus, were still present in the blood at the time of hospitalisation. In addition, the authors measured the concentrations of amanitines in the blood of dogs at different intervals after the ingestion of a fatal dose of Amanita phalloides. Amanitines were detected in the serum of 9 patients out of 16. This discovery, together with the finding that, in the dog, very low concentrations of amanitines in the blood are associated with fatal cellular lesions, suggests the need for very prompt action in order to eliminate these toxins from the blood as soon as the diagnosis of poisoning is suspected.


[Hepatic overload of gangliosides after perhexiline maleate. Morphological and biochemical course (author's transl)]. A 72 years old man treated with perhexiline maleate (400 mg during 15 months) complained of skin rash, sensitive neuropathy, liver damage and mild renal insufficiency. Clinical status improved when the treatment was stopped, but liver size and renal status remained inchanged. Liver biopsy were performed at 0,6 and 15 months after the end of treatment. Inflammation and hepatocyte necrosis, seen on the first specimen, disappeared latter. Steatosis and voluminous, swollen, foamy liver seen were present in the three biopsies. Sclerosis had increased in the last one in spite of treatment arrest. Histochemical study exhibited liver storage of triglycerides, fatty acids, phospholipids, and gangliosides. Cytoplasmic glycogen was increased and some nuclei were glycogenated. Enzymatic pattern suggests a minor form of type I glycogen storage or increased neoglycogenesis. Perhexiline relation to this complex liver storage is discussed.


[Modification during treatment of the rate of acetylation of isoniazide clinically or biologically detectable hepatic damage (author's transl)]. The rate of acetylation of isoniazid is usually constant in a given subject. The authors report here a case where despite an adjusted initial dose there was a decrease in the rate of acetylation during treatment with INH-rifampicin and ethambutol, without hepatic involvement but accompanied by retrobulbar optic neuritis. The role of ethambutol and/or an overdose of isoniazid are discussed. The technique for its estimation is also described.


The association: scleroderma-silicosis or Erasmus' syndrome (author's transl). Classically more common in women, scleroderma nevertheless affects with predilection men exposed to the inhalation of silica particles. The association scleroderma-silicosis is essentially a statistical finding. It has no particular clinical, radiological nor histological distinguishing characteristics, other than the syndromic juxtaposition of the stigmata of each of the two disorders. This serious pathological combination is not due merely to chance. It is the result of depressed cellular immunity, related to the cytotoxicity of silica and responsible for auto-immune reactions and the formation of circulating immune-complexes. In the presence of an underlying predisposition, the polyvisceral diffusion of inhaled toxic mineral particles could also facilitate the sclerodermic process by stimulating fibroblastic proliferation.


[Pseudolupus induced by a vasculotropic drug (author's transl)]. The authors report eight cases of women suffering from pseudolupus erythematosus, with positive antimitochondrial antibodies. In six in the past history, a vasculotropic drug, Venocuran or Venopyridum, had been taken. All the patients had had episodes of fever, a pericarditis and/or myocarditis. A pleural effusion was present in six and pulmonary infiltrates in four. The course of the disease was for a limited period (1 to 3 months) in four cases and was chronic in the other four. One patient developed severe mitral incompetence and a cardiomyopathy.


[Interest of sequential "in vitro" cultures of granulomonocytic stem cells (CFUc) in the management of chemotherapy in a case of multiple myeloma (author's transl)]. Sequential measures of granulomonocytic stem cell (CFUc) pool were undertaken during chemotherapy in a case of multiple myeloma. Whereas the number of blood granulocytes remained unchanged, the total number of CFUc was markedly decreased. Therefore the CFUc marrow pool can be considered as one of the data in the management of chemotherapy. In multiple myeloma, the tumour mass can be evaluated by the secretion of monoclonal lg. It appears possible to adapt the schedule of chemotherapy considering both its effect against the tumoral cells and its toxicity on bone marrow stem cells.


[Demonstration of the hepatic veins by echotomography (author's transl)]. Provided that a rigourous protocol is adopted, exploration of the hepatic veins by echotomography (grey scale) is practically always possible. It should be integrated into every echotomographic study of the liver (parenchyma, biliary tract, portal system and inferior vena cava). The findings cover a narrow range: hepatic veins free, compressed or not visible. This method is harmless, rapid, reproducible and inexpensive.


[Intrathyroidal parathyroidal adenoma associated to a cold thyroidal nodule (author's transl)]. Parathyroid adenomas may have ectopic localizations, for example, intrathyroidal, which diagnosis is difficult. The present report illustrates this fact. A patient, 45 years old, euthyroidal, with a cold thyroidal nodule, underwent  a right thyroidal lobectomy. Immediately after the operation, a tetany crisis occured with a Chovstek's sign and a 65 mg/l blood calcium level. The possibility of an accidental parathyroidectomy was evoked, and a second histological exam of the tumor showed the presence of a trabecular parathyroidal adenoma in the back of a vesicular thyroidal adenoma. The presence of this parathyroidal adenoma should have been suspected because of the occurence of nephretics colics in the antecedents, but there was a high blood uric acid level and the diagnosis of uric concretion was retained; no dosage of blood calcium level has been done.


Genes and geography.

Genes and geography. The author discusses a number of genetically determined diseases, such as hemoglobinopathies, acute intermittent porphyria, familial Mediterranean fever and so-called acquired hypogammaglobulinemia from the geographical point of view. Possible factors explaining localized increases in incidence are discussed. The importance of isolates for the development of such foci is stressed.


Geographical distribution of HBs Ag in Africa. The incidence of HBs Ag carrier is high in Africa. The HBs Ag subtypes vary in 5 mean areas of the Africa continent. The subtype ayw4(a3) is the most characteristic African subtype, being found with a striking frequency in West Africa (88.8%). In North Africa ayw2(a21) is predominant as in other mediterranean countries. In Saharan area mixed types of HBs Ag are found, intermediary between North and West Africa. In Central Africa y is predominantly associated with w2(a21) or with w4(a3). In east and South Africa ad is largely predominant and the most widespread subtype is adw2(a21). No adr, nor adw4 were found in Africa.


[Lymphography in chronic lymphocytic leukemia (author's transl)]. Sixty-seven lymphangiograms were performed in 58 patients with chronic lymphocytic leukemia. These patients were classified according to a new anatomico-clinical staging system which has previously been shown to bear prognostic significance. The lymphangiograms were divided into four groups on the basis of lymph node size and each group was further divided into subgroups (12). Each subgroup corresponded to a different roentgenographic picture. A good correlation was observed between lymphangiographic and anatomico-clinical staging: lymphangiogram groups 3 and 4, anatomico-clinical stage III and IV (p less than 0.001). The absence of normal lymph nodes in all patients, the diversity of lymphangiographic appearance from one patient to another and even the diversity from one region to another in the same patient should be stressed.


[Prognosis of hematopoietic dysplasia (author's transl)]. 90 patients with hemopoietic dysplasia (preleukemia) have been studied with iron kinetics for the mechanism of the anaemia, 23 patients had a bone marrow autoradiography and 18 a bone marrow culture in semi-solid medium. The death was caused in half the cases by acute myeloblastic leukaemia transformation (LAM) and in half the cases by complications of pancytopenia (infection, haemorrhage) or hemochromatosis. Three data give prognostic factors at short or long term: the bone marrow hypoplasia, no patient with major bone marrow hypoplasia (ratio of 59Fe fixation in liver and sacrum of more than 2) lived more than 2 years after the examination. The low labeling index of myeloblasts and promyelocytes, the mean LI is 0.20 patients having lived less than one year after the study and 0.35 for those who lived more than two years. The bone marrow culture of the macroclusters type, no patient whose bone marrow grew with macroclusters and no colonies survived more than 8 months after the study. These three data seem to be essential in the regular survey of the patients with hemopoïetic dysplasia.


[Chemotherapy-radiotherapy association in the treatment of localized forms of Hodgkin's disease. Prognosis of polychemotherapy after three trials of M.O.P.P]. 63 patients with Hodgkin disease of limited extent (I, II, III) are treated with two protocols: extended field irradiation versus chemotherapy (M.O.P.P.) + extended field irradiation. Three points are suggested by analysis of the results: 1) Advantage from the combination of chemotherapy-radiotherapy. 2) Resistance to chemotherapy frequent innodular sclerosis. 3) In patients treated with chemotherapy the reaction has a prognostic value: failure of treatment being seen only in patients who did not obtain a complete remission.


[Laparotomy in the therapy of Hodgkin's disease]. We have performed laparotomy and splenectomy for seventy patients with Hodgkin's disease. Among 43 stages I or II before exploration, primary laparotomy revealed ignored abdominal localizations in 16 cases (37,2%). Involvement of the spleen occurred in 13 of these 16 patients, lonely (5 cases), associated with positive nodes (4 cases) or associated with positive nodes and liver involvement (4 cases). Among 4 stages III before exploration, no regression was found. Among 9 patients with presumed stages I or II above the diaphragm and previously treated by radiotherapy, delayed laparotomy revealed abdominal relapse in 6 cases. At last, among 14 patients with obvious stages II or IV and previously treated by combination chemotherapy, laparotomy, caused by persistent evolutive signs, showed residual localizations under the diaphragm in 8 cases. According to these results, we preconise immediate laparotomy in almost all presumed stages I or II above the diaphragm. About third of these subjects have their staging advanced to stage III or IV and, according to us must be treated by combination chemotherapy while the remaining cases justify of radiotherapy. In obvious stages III and IV delayed laparotomy may be useful in some circumstances, after chemotherapy.


[Indication for splenectomy and exploration of the abdomen in Hodgkin's disease (author's transl)]. Splenectomies were performed on 142 patients (86 men and 56 women). The majority of them (117) were stages III or IV. The purpose of the laparotomy was therapeutic and not exploratory. Surgery was indicated, either due to evolution of the disease suggesting splenic involvement or to symptoms of hypersplenism. Splenic involvement was confirmed in 71% and hepatic involvement in 40%. Despite the risk of mortality during the first month after surgery, proportional to the extent of the disease, the overall results are encouraging provided that surgical intervention is followed by aggressive polychemotherapy. Serious infections were observed, however, in 9 patients; they did not occur for several months or even several years after splenectomy.


Prosthetic valve endocarditis: reviewing the problem. Bacterial endocarditis is a serious complication of valve replacement, with an overall mortality of 59%. Fever, although a constant feature of the condition, is a nonspecific finding; other manifestations may or may not be present and the diagnosis may be overlooked. Any patient with a prosthetic heart valve and bacteremia should be considered to have endocarditis and should be treated accordingly.


Common surgical problems of the head and neck. In most cases of epistaxis, bleeding can be controlled with anterior nasal packing or a Foley balloon catheter. If this fails, posterior packing and otolaryngologic consultation are indicated. In initial assessment of injuries of the head and neck, a classification that is useful divides the region into the following anatomic systems: integumentary, respiratory, vascular, neurologic, musculoskeletal, and digestive. The possible effects of injury on each of these must be considered. The early detection of asymptomatic cancers of the head and neck by primary care physicians depends in large part on a routine of systematic examination and a knowledge of the clinicopathologic course of the disease. A seemingly harmless lump in the neck may well be a cervical node metastasis from an occult primary tumor.


Special aspects of primary care.

Special aspects of primary care. Common dislocations that can usually be managed in the office include anterior dislocations of the shoulder, posterior dislocations of the elbow and joints of the fingers and toes, and lateral dislocations of the patella. A systematic approach based on an understanding of the mechanism of injury, roentgenographic documentation of the extent of injury, reduction, immobilization, and rehabilitation is recommended.


Tetanus in a 67-year-old man.

Tetanus in a 67-year-old man. A fatal case of generalized tetanus in a 67-year-old man is presented. The incubation period following finger damage was short, and the diagnosis was confirmed by the isolation of Clostridium tetani. Subsequently, a partial surgical amputation of the infected finger during the clinically active stage of the disease did not remove all the infecting organisms. Although convincing evidence of any previous active immunization was lacking, no form of tetanus antitoxin was given at the time of injury. This case illustrates the potential dangers of unfamiliarity with tetanus owing to its low incidence in developed countries.


Intravascular coagulation. 1. Differential diagnosis and conditioning mechanisms. Intravascular coagulation is an acquired thrombohemorrhagic disorder that occurs as a secondary phenomenon in various medical conditions, usually in patients who are seriously ill. It may occur as an acute fulminant disorder with massive bleeding or thrombosis but more commonly is subacute or chronic. Bleeding may be a prominent feature, or hemostatic abnormalities may be demonstrable only by testing.


Intravascular coagulation. 2. Underlying conditions and therapy. Therapy for intravascular coagulation is directed primarily against the underlying disorder. If the latter is not readily correctable or if the patient is bleeding actively, anticoagulation with intermittent administration of heparin by the intravenous route is indicated. If thrombocytopenia is present, heparinization must be accompanied by platelet transfusion. The efficacy of therapy is judged by the cessation of bleeding or thrombosis, improvement of organic dysfunction, and correction of the levels of the coagulation factors, particularly factor V and fibrinogen.


Longitudinal bone growth of the human femur. A study is presented of the histological structure and growth rate of the growth plate at the distal end of the femur in normal children. From a comparison of quantitative histological information from post-mortem specimens with measurements on serial radiographs it is estimated that the distal growth plate contributes about 66% of the total longitudinal growth of the bone. The marked differences between rodent and man indicate that caution is required in extrapolating data from these animals to man.


Dermatoglyphs in skeletal dysplasias.

Dermatoglyphs in skeletal dysplasias. Finger and palm print patterns (dermatoglyphs) are formed in very early pregnancy, at about the same time the limbs are developing, and their formation probably depends upon the surface contours of the palms and soles during morphogenesis. Dermatoglyphs are useful in skeletal dysplasias for the detection and study of syndactyly and symphalangism, for dating the onset and the dysplasias, for demonstrating and dating asymmetry, and sometimes for providing specific diagnostic features.


Osteoporosis in childhood.

Osteoporosis in childhood. Osteoporosis is defined as 'too little normal bone', the disorder being rarer in children than adults. The varied forms in childhood can be classified as those secondary to some other disease and primary forms of the disorder which include the genetically determined osteogenesis imperfecta types and idiopathic forms of osteoporosis. A plea is made for greater clinical application in attempting to discriminate differing forms of these primary disorders. Osteogenesis imperfecta it is argued is a heterogeneous condition with the evidence favouring both dominantly and recessively transmitted forms in different kindreds. Another possible osteogenesis imperfecta variant is characterized by dwarfing, scoliosis and peculiar cystic lesions of the proximal humeri. Idiopathic juvenile osteoporosis is a term reserved for the acute osteoporosis beginning in the immediate prepubertal years and may differ in its cause from idiopathic osteoporosis beginning rather earlier in childhood. It is emphasized that immobilization osteoporosis is of very great importance and may become superimposed upon other osseous dysplasias. A complete understanding of these conditions will be helped by elucidation of the basic underlying defects in collagen and other constituents of bone matrix.


Bone dysplasias and mental functioning.

Bone dysplasias and mental functioning. Fourteen patients suffering from various degrees of bone dysplasia and mental handicap with superimposed neuroses or psychotic episodes are reported. Known biochemical and chromosomal causes are noted. Mental states associated with syndromes and mental malfunctioning or impairment because of skeletal defects or other factors are briefly discussed. High IgE was noted in the three cases of bone dysplasias suffering from chromosomal anomalies. Importance of early diagnosis, treatment and genetic counselling in bone dysplasias to prevent mental disorder is emphasized.


Perthes' disease and multiple epiphyseal dysplasia. Five atypical cases were observed amongst ninety children with Perthes' disease, ten of whom had bilateral hip joint involvement. All five were boys, four being under 4 years of age. Four had bilateral hip joint disease, four presented with hip pain, three showing some degree of retardation of bone growth. In one case the hip disorder was familial, and in four there were bony abnormalities elsewhere. Despite the absence of the classic signs of multiple epiphyseal dysplasia, a mild form of this condition is a possible alternative diagnosis for these children. Racial and familial differences are known in the prevalence of Perthes' disease which itself may represent a dysplasia. The pathogenesis of Perthes' disease is still uncertain, although some abnormality of the blood supply to the proximal femoral epiphysis is postulated. That such a vascular defect may be engrafted on to multiple epiphyseal dysplasia is possible, with subsequent joint degeneration which may come to resemble Perthes' disease either clinically or radiologically. A plea is made for the closer study of young children presenting with what may seem to be atypical Perthes' disease.