The use of prophylactic partial exchange tranfusion in pregnancies associated with sickle cell hemoglobinopathies. Sickle cell anemia is associated with an alarming attrition rate during pregnancy. The maternal morbidity rate, perinatal wastage rate, and the incidence of severe morbidity in both mother and child are elevated above acceptable limits. In most cases, these statistics have been compiled using conservative therapeutic modalities. In contrast, this report utilizes prophylactic partial exchange transfusion therapy in patients with severe sickle cell hemoglobinopathies. The protocol involves the introduction of 750-1000 cc of buffy coat, poor washed red cells exchanged with 1000-1500 cc whole blood during phlebotomy at 28 weeks' gestation and again prior to term. Thirty-six consecutive pregnant patients with sickle cell anemia have been managed in this fashion. The one maternal mortality occurred in a patient who did not complete the protocol. Major maternal morbidity and perinatal wastage rates were significantly decreased. Two cases of serum hepatitis occurred. It appears from these data that the use of prophylactic partial exchange transfusion in pregnant patients with severe sickle cell hemoglobinopathies can be of benefit. Further trials of this method seem justified by these results to assess completely the benefit-risk ratio of this procedure.


Vasopressin response and terbutaline inhibition of the uterus. A study of the effects of 8-lysine vasopressin (LVP) and its long-acting analogue N-a-triglycyl-8-lysine vasopressin (TGVP) on the myometrium and vasculature of the normal human nonpregnant uterus was undertaken. The results suggest that the vasopressins decrease local endometrial blood flow both directly by effects on the uterine vascular bed, and indirectly by increasing myometrial activity. The effects in vivo can be effectively counteracted by beta2 receptor stimulation.


Enterovaginal and enterocutaneous fistulae in women with gynecologic malignancies. From 1957 to 1975, 43 women with gynecologic malignancies had associated enterocutaneous or enterovaginal fistula. Thirty-four of these women underwent surgical correction of the fistula. The etiology, diagnostic evaluation, preoperative complications, and surgical correction of such fistulae are discussed. In addition, a staged planned management of these fistulae is outlined.


Vulvar histology after neutral red photoinactivation of herpes simplex virus. The use of photodynamic dye and light inactivation for the treatment of genital herpes simplex virus infections has been associated with the risk of potential oncogenesis. Sixteen patients treated with neutral red and fluorescent light for documented herpetic infections were studied at intervals ranging from 9 to 52 months following treatment. Four patients treated with other modalities were included in the study. Biopsies of the treated areas were obtained, and 3925 tissue sections were examined. Mild atypical epithelial changes were focally present in most specimens regardless of therapy. Histologically identifiable premalignant change could not be demonstrated.


Microinvasive carcinoma of the cervix.

Microinvasive carcinoma of the cervix. The clinical and pathologic features of 51 cases of microinvasive carcinoma of the cervix treated by radical hysterectomy and pelvic lymphadenectomy are presented. Microinvasion was defined as stromal penetration by carcinoma not exceeding a depth of 5 mm from the surface at the point of origin. Patients with confluent patterns and lymphatic invasion were not excluded. Lymphatic invasion was demonstrated in 24% of the patients, but none of the resected lymph nodes from the entire series contained metastatic tumor. Residual invasive disease was present in 9 of 47 patients who underwent conization including 1 in which the residual tumor invaded to 8 mm, although the depth of invasion in the cone biopsy was only 2.5 mm. Factors related to the presence of residual invasive disease included the pattern and extent of invasion and involvement of the cone margin. There were no surgery-related deaths or fistulae in this series; the actuarial survival rate at 5 years was 100%. Simple hysterectomy seems justified if the cone margin is free of tumor since none of these patients has residual disease. In contrast, radical hysterectomy may be indicated if the cone margins are involved in view of high frequency of residual tumor (39%) and the possibility of invasion in the cervix exceeding 5 mm.


Cell-mediated immunity and blocking factor in ovarian carcinoma. Lymphocyte-mediated cytotoxicity (cell-mediated immunity) to ovarian carcinoma cells and serum blocking factor were measured in 37 patients. Short-term cultures of tumor cells and a low ratio of effector to target cells were used throughout the study, minimizing nonspecific cytotoxicity. Sixteen patients were followed for long periods of time, and correlation with the course of the disease and with therapy could be obtained. Although the level of cell-mediated immunity did not always correspond to the clinical status of the patient, the presence of blocking factor was associated with clinical relapse in 14 of 16 patients. Chemotherapy with single alkylating agents or combinations of drugs caused no significant or permanent depression of cell-mediated immunity as measured in this way. In addition, blocking factor disappeared in 2 patients during remission. It appears that the chemotherapy for ovarian carcinoma may not be significantly immunosuppressive against established levels of cell-mediated immunity and may in certain instances have effects potentially beneficial to the host as evaluated by lymphocyte-mediated cytotoxicity and blocking factor studies.


Hormonal findings associated with aluteal cycles. Menstrual bleeding with no detectable luteal function was observed cyclicly in 3 infertile patients. Anovulation was suspected and documented by basal body temperature charts and repeated endometrial biopsies prior to expected menses. A sporadic anovulatory cycle in a normally ovulating volunteer was studied and the hormonal parameters included for comparison. To elucidate the significance and the possible cause of this defect, five aluteal cycles were evaluated with serum follicle stimulating hormone (FSH), luteinizing hormone (LH), total estrogen, progestin, and prolactin determinations. No similar patterns of FSH, LH, or estrogen values were observed. No abnormality of prolactin levels was noted. The lack of progestin rise and proliferative endometrial biopsies during the second half of these cycles were the only consistent findings. When clomiphene citrate therapy was instituted, a luteal phase was promptly established.


Corpus luteum function during pregnancies of previously infertile women. Seventy-nine previously infertile women were studied during the first 9 weeks of their pregnancies. Pregnancy had occurred either without any specific therapy or following treatment with clomiphene, prednisone, or human chorionic gonadotropin, singly or in various combinations. Serum levels of progesterone, 17 alpha-hydroxyprogesterone, and estradiol were measured at 2-week intervals. A profile of early pregnancy in terms of these hormones is presented and discussed with regard to its significance for corpus luteum function. Aspects of the hormonal profile predictive of the pregnancy outcome are noted. Ovarian over-stimulation was directly related to the dosage of clomiphene, and the increased levels of 17 alpha-hydroxyprogesterone thus produced persisted into the seventh week of pregnancy. This hormonal excess probably derives from multiple corpora lutea which may also account for the increased incidence of multiple pregnancy associated with clomiphene therapy.


Correlation between amniotic fluid optical density and L/S ratio. A test that circumvents the complex methodology needed for the determination of L/S ratios has been developed. It has been observed that the optical density, measured at 400 nm, of supernatants collected from fresh amniotic fluids centrifuged at 2000 g for 10 minutes correlates with L/S ratios.


Giant sertoli cell adenoma in testicular feminization syndrome. An extremely large Sertoli cell adenoma discovered incidentally in an elderly phenotypically femal patient with testicular feminization syndrome is reported. The patient is alive 3 years following removal of the tumor.


Laceration of umbilical cord vessels secondary to amniocentesis. Amniocentesis has been established as a valuable diagnostic tool in the management of high-risk pregnancies. Although infrequent, various fetal complications have been reported. A serious and potentially fatal complication is laceration of the umbilical cord vessels. Three cases are presented to illustrate this complication and a scheme is proposed for management when bloody fluid is obtained at the time of amniocentesis. If the bleeding is of fetal origin, and the fetus is at or near term, immediate delivery should be considered. Expectant management should be considered only in the premature fetus when continuous fetal heart rate monitoring is possible and no bradycardia is encountered. Induction and vaginal delivery should be attempted only in the absence of a bradycardia and if the patient is able to be continuously monitored. Postamniocentesis fetal bradycardia should prompt immediate delivery via cesarean section regardless of gestational age. Any newborn whose uterine existence has been complicated by a traumatic or bloody tap should have an immediate hematocrit determination at birth.


Electron microscopic observations on rat epidermis during experimental carcinogenesis. Early ultrastructural changes and their progressive evolution were studied in rat epidermis following topical application of carcinogen (3-methylcholanthrene) and were compared to ultrastructural features of fully developed tumors (sebaceous epithelioma and basal cell epithelioma) in animals of the same group. Similar cytologic alterations were found, such as a marked increase in free ribosomes and polysomes, extensive endoplasmic reticulum, considerable increase of mitochondria, and dilated intercellular spaces, occupied by cytoplasmic projections. Predominance of dark cells, considered by us to be only phenotypically different from normal (light) cells, was also observed. A two-stage or multiple-stage of neoplastic evolution was suggested.


Carcinogenicity of Benzo(a)pyrene and dusts in the hamster lung (instilled intratracheally with titanium oxide, aluminum oxide, carbon and ferric oxide). The possible carcinogenic or fibrogenic effects of intratracheal instillation of a polycyclic hydrocarbon, benzo(a) pyrene (B(a)P), alone or in combination with several dusts - titanium dioxide (TiO2), aluminum oxide (Al2O3), carbon (C), and ferric oxide (Fe3O3) - were investigated in hamsters. When administered alone, the dusts induced interstitial cell proliferation, bronchial epithelial alterations and a few granulomatous changes in the pulmonary system, but no tumors. B(a)P alone induced only two tracheal papillomas. However, combined treatment with B(a)P and the dusts caused a number of tumors, dependent upon the dust used. B(a)P plus TiO2 in a small particle size (below 0.5mu) induced papillomas, squamous cell carcinomas and a few adenomas and adenocarcinomas of the larynx, trachea and lungs. These were morpholoigcally similar to neoplasms found after B(a)P and Fe2O3 treatment. B(a)P, combined with C or Al2O3, induced mainly laryngeal and tracheal papillomas. B(a)P- and C-treated hamsters also showed a few lung adenocarcinomas.


Methodoloigcal study on examiniation of primary tumors of the respiratory tract "in toto" and histologically. The results of histological evaluation of DENA-induced tracheobronchial tumors in the Syrian golden hamster are described and compared with those of an in toto method of visualization. In 55 animals, roughly twice as many tumors were detected in the lungs in the in toto preparation as those found by the histological technique [92:42]. The examiniation of the respiratory tract, as a whole, would consequently appear to afford an efficient and economical means of quantifying the effects of, for instance, chemotherapeutic agents in the growth of such tumors, which can subsequently be complemented, especially in the qualitative sense, by histological techniques.


Skeletal metastases in pancreatic carcinoma: study by isotopic bone scanning. A review of the literature of 2,155 reported patients with primary carcinoma of the pancreas, revealed 110 cases or 5% to have skeletal metastasis by radiographic or autopsy study. A study conducted over a 2 year period disclosed that 1 case of skeletal metastasis was detected by bone scanning in 16 patients with pancreatic carcinoma. This indicates a minimum skeletal metastasis rate of 6%. We feel these percentages are low and can be further defined by the more routine employment of the bone scan to evaluate patients with carcinoma of the pancreas. The true figure may be much higher, perhaps as high as 20%.


Chemical carcinogens in the human environment; problems and quantitative aspects. A short review on environmental carcinogenesis by chemicals is given. Problems related with the determination of carcinogenicity of chemicals are mentioned. Some critical factors in the monitoring of environmental carcinogens are discussed in relation to a quantification of human exposure to such compounds. An attempt at risk evaluation is made for polycyclic aromatic hydrocarbons, vinyl chloride, N-nitroso compounds and aflatoxins. It is concluded that there is a "threshold dose" for individual carcinogens that does not lead to tumor induction within the normal life span. The probability of multifactorial cause of human cancer by environmental carcinogens, however, does not allow the definition of "safe" levels of such compounds in view of syncarcinogenic and other enhancing and/or modifying effects.


Evaluation of environmental carcinogens for cancer in man. The problem of the presence of carcinogens in the environment has become of considerable concern to the public, as it has been to the biomedical community for some time. The burden of identifying carcinogenic agents and determining threshold levels, if they exist, falls upon the scientific community. Particular care must be exercised in the design, conduct and analysis of experiments directed toward the identification of carcinogens. The data generated from such tests provides the basis for regulatory decisions by governmental authorities. The advice provided by scientists must be based on sound data. There have been instances, however, and there will be others, in which biological variability and the limits of sensitivity of our tests will give equivocal results. It is the duty of scientists to bring such uncertainties to the attention of the public while working towards the development of more sensitive and precise techniques.


Mathematical aspects of dose-response studies in carcinogenesis--the concept of thresholds. Many of the previously proposed theories of carcinogenesis which relate the exposure level of a carcinogen to expected tumor response, are summarized and it is pointed out that these theories assume the existence of no threshold level. A modification of the one-hit carcinogenic model which would incorporate a threshold, is proposed along with a generalization to variable thresholds over the population at risk. The statistical problems of discriminating between threshold and non-threshold models from experimental bioassay data are discussed and an example is given.


Some examples of dose-response studies in chemical carcinogenesis. Three studies of DRUCKREY and his group, on diethylnitrosamine and 4-dimethylaminostilbene, are described. In a recent experiment, urethane was given chronically to rats and mice, at doses between 100 and 12,500 mug/kg/day. The results in rats were evaluated with the Mantel-Bryan procedure; risk estimates greatly differed, depending on the slope used for calculation.


Repair excision of alkylated bases from DNA in vivo. Recent experiments are reviewed which indicate that O6-alkylation of guanine in nuclear DNA constitutes a promutagenic lesion possibly implicated in malignant transformation by monofunctional alkylating carcinogens. The differential capacity of various organs to enzymically excise O6-alkylguanine from their DNA seems to correlate with the organ specificity of the carcinogenic effect.


Technique of combined lid and medial canthus reconstruction. Standard lid reconstruction techniques (sliding flaps or tarsoconjunctival grafts) may be combined with the Laissez-Faire treatment of large medial canthal defects. Using this methods, satisfactory results were achieved in three cases in which it was necessary to excise both a large portion of an eyelid and the adjacent medial canthus.


The management of early lacrimal tube complications. The introduction of a closed loop of suture material through the Jones lacrimal tube, the DCR opening, and the nose at the time of surgery, facilitates the management of early postoperative complications in conjunctivo-dacrocystorhinostomy.


Traumatic hyphema: treatment of secondary hemorrhage with cyclodiathermy. Four patients were treated with diathermy applications to the ciliary body for recurrent hemorrhage and elevated intraocular pressure following traumatic hyphema. In all cases, the hemorrhage and intraocular pressure were controlled without major complications. Indications for use of diathermy include a patient with recurrent secondary hemorrhage or a clotted hyphema, with elevated intraocular pressure or corneal blood-staining, in whom a site of bleeding can be identified during surgical intervention.


The prognosis of penetrating keratoplasty based upon corneal morphology. In this paper, the author has attempted to express the prognosis for successful penetrating keratoplasty based upon a morphological classification of corneal disease. Four groups have been designated with their basic prognosis ranging from excellent to poor. The importance of appraising the diseased cornea in the area of its optimal recipient zone has been stressed. Ancillary factors adversely affecting the estimated final prognosis of keratoplasty have been considered, with emphasis upon the importance of glaucoma, lid function, tear film, ocular inflammation and patient compliance. Not only is it important for the surgeon to appraise the chance of successful surgery, but it is essential for the patient to be informed in advance regarding the probability for successful surgery and the need to comply with sometimes demanding requirements of postoperative care.


Intraocular irritation evaluation of benzalkonium chloride in rabbits. The purpose of this study was to define the threshold for intraocular irritation of benzalkonium chloride, a preservative used in some formulations which enter the anterior segment of the eye during ocular surgery. Various concentrations of benzalkonium were injected into anterior chambers of albino rabbit eyes. Conjunctivitis, flare, iritis, and corneal changes occurred in a dose response pattern. The threshold of irritation was 0.03%, with highest nonirritating concentration being 0.01%. In other works in this laboratory, threshold of irritation for topical ocular benzalkonium was 0.05%, but the nature of ocular changes was less substantial than those observed intraocularly. Because the threshold for intraocular irritation is less than that topically, the nature of ocular changes was different for two routes, and there is a paucity of clinical data for intraocular benzalkonium chloride, a safety factor of 10 was utilized in setting the highest safe concentration of 0.001% for intraocular use. The preservative efficacy of 0.001% is questionable; therefore, we cannot endorse benzalkonium chloride as a preservative for formulations which will enter the anterior segment of the eye.


Phacoanaphylactic endophthalmitis: echographic diagnosis of phacoanaphylactic endophthalmitis. A sixty-year-old black diabetic female developed a severe postoperative endophthalmitis eight days after unplanned extracapsular cataract surgery. Gram stain of a diagnostic vitreous aspirate showed no organisms, and culture of the aspirate was negative for bacteria and fungi. A- and B-scan ultrasonography showed the presence of intra-vitreal lens fragments; the diagnosis of phacoanaphylactic endophthalmitis was made and intensive steroid therapy was instituted early in the course of the disease. Resorption of the lens fragments in association with gradual diminution of the inflammatory process was documented by serial echograms of the eye. The vitreous ultimately cleared and the patient regained useful vision. Ultrasonography is recommended as an essential part of the diagnostic evaluation of any patient with postoperative endophthalmitis especially with a history of extracapsular surgery.


Unusual presentation of phacoanaphylaxis following phacoemulsification. A case of phacoanaphylaxis following phacoemulsification is presented. The unusual features of the disease included the markedly delayed onset and the clinical appearance of the hypopyon. Emphasis is placed on the cytologic examination of anterior chamber aspirate in such cases.


Pitfalls in the determination of intraocular lens power without ultrasound. The rule is simple: An 18 diopter intraocular lens tends to restore the basic refraction. For each diopter of basic refraction to be corrected add or subtract 1.25 diopters. To determine the basic refraction a careful history and an examination of old glasses and past refraction records is necessary. When the basic refraction cannot be ascertained, capital errors may occur. Given the basic refraction, errors or several diopters are still apt to occur. Calculation of intraocular lens power based on K-readings and ultrasonic measurements is therefore always advisable and a must when there is doubt about the basic refraction.


Monocular aphakia and contralateral pseudophakia. The implanatation of an intraocular lens into the contralateral eye of non-implanted monocular aphakic patients is reviewed. The specific indications, contraindications, and advantages are discussed. The results of a series of 31 cases are presented and analyzed. The generally good results and specific advantages of this technique, when utilized under proper conditions, indicate that it merits inclusion in the ever expanding spectrum of options available to the modern cataract surgeon.


The efficacy of general anesthesia for cataract surgery. This is a report of 259 consecutive cataract extractions performed under general anesthesia over a two-year period. The age of the patients ranged from 6 to 93 with an average of 71. The purpose of this paper is to reiterate the safety of modern general anesthesia for cataract extraction in the elderly, and to demonstrate it can provide a very soft eye in a completely immobilized patient. It offers the most ideal conditions to the surgeon for lens extraction and careful wound closure without the necessity of retrobulbar block, digital massage or osmotic agents.


Combined cataract extraction and thermal sclerostomy versus combined cataract extraction and trabeculectomy. We performed either a combined cataract extraction and trabeculectomy or a combined cataract extraction and thermal sclerostomy on 43 eyes. All eyes had chronic open angle glaucoma or chronic angle closure glaucoma, or a combination of the two. In our cataract/trabeculectomy group, 74% had improvement in visual acuity, 91% had normalized intraocular pressure without anti-glaucoma medications, 31% had transient postoperative hyphemas. In our cataract/thermal sclerostomy group, 61% had improvement in visual acuity, 61% had normalization of intraocular pressures without antiglaucoma medications, 17% had transient postoperative hyphemas. We could not correlate any of the complications of surgery with poor intraocular pressure results in either groups. The mechanism for the higher success rate with a combined cataract extraction and trabeculectomy as compared with a combined cataract extraction and thermal sclerostomy was not obvious after analyzing these patients.


Wide-angle cutter vitrophage.

Wide-angle cutter vitrophage. A wide-angle cutter vitrophage facilitates removal of semi-solid or thick retropupillary membranes. The cutting orifice permits engagement of inflexible material which is then cut and removed via the instrument. The wide-angle cutter has successfully removed thick secondary membranes and expedites pars plana removal of cataracts with 2+ nuclear sclerosis.


The use of solid soft silicone rubber exoplants in retinal detachment surgery. A method of retinal detachment surgery utilizing soft solid silicone rubber exoplants is described along with its use in typical cases. Solid silicone rubber, long used as a scleral implant, is a well-tolerated exoplant scleral buckling material which has been found to provide excellent long-term results. The surgical procedure described is relatively short in duration and has a minimum of operative and postoperative complications.


Fundus changes in primary hyperlipaemia. The retinal vascular change described for two relatively young men and initially diagnosed as arteritis retinalis but subsequently regarded as an analogue of retinal lipaemia stresses the importance of biochemical exploration for a possible disturbance in the fat metabolism in unclear cases of retinal vasculopathy. If a disturbance in the fat metabolism is found, rational therapy will lead to disappearance of the vascular mural changes.


Detrimental results with the common inflared shoe: clinical questioning of a historic alignment concept. The detrimental results of shoe use manifested both in the foot and in footwear were studied and found to support earlier views that inflared alignment is a significant factor in foot damage. Mechanical implications of alignment also confirmed our impression that the inflared alignment is a deleterious influence. Absence of conclusive physiologic evidence justifying inflaring and the death of end results from use of standard straight last footwear for comparative evaluation suggest that further inquiry regarding this feature is warranted, with view to its elimination.


The effectiveness of shoe modifications for intoeing. Shoe wedges have no immediate clinically significant effect on the angle of gait in children. The circular Torqheel was found to be more effetive, but still corrected only a quarter of the apparent rotatory deformity during gait.


Metatarsus varus corrected by open wedge osteotomy of the first cuneiform bone. The persistence of metatarsus adductus varus has been a problem in management. We have treated a series of selected patients with this problem and believe that our results have been better than with the procedure we have used in the past. Fowler has described a procedure which seems ideal for the patients in our series. Through personal communication the procedure and its application were discussed and the series was started eight years ago. Our series is small because our patients are responding to other forms of treatment at an earlier age. The few that do not respond are now considered for the operation described. The procedure is relatively simple to perform. Full correction should be obtained at the time of surgery. Casting is utilized to hold the correction and immobilize the extremity for healing. Our unsatisfactory results occurred because of errors in technique or poor selection of patients. We believe that this procedure should be considered in the older patient with metatarsus varus.


The Stone operation: a clinical review of seven years' experience. A series of 46 patients who underwent 78 first metatarso-phalangeal operations is reported. The procedure for the Stone operation is detailed. The Stone operation is a satisfactory procedure in the surgical treatment of hallux valgus and hallux rigidus.


Bunionette correction by metatarsal osteotomy: preliminary report. A preliminary report is presented of 17 patients who underwent 27 fifth metatarsal osteotomies. Oblique osteotomy without internal fixation was used. Union of the osteotomy without external immobilization occurred in 16 of the patients. Correction was effected in a case of delayed union in one foot because it was symptomatic. Improvement and normal function were the result in 26 of the 27 osteotomies. Delayed union did not seem to mean failure of relief. No painful scars occurred.


Nonexcision triple arthrodesis of the foot. Nonexcision triple arthrodesis is proposed as a simple operation to relieve pain and stabilize the hindfoot. It was successful in seven of nine patients as a salvage procedure. Its further use is recommended.


Early posterior ankle release in the treatment of congenital clubfoot. Eighty-one patients (116 clubfeet) underwent posterior ankle release before the age of two years, following unsatisfactory responses to serial corrective casts applied according to the technique of Kite. Seventy-three per cent of these feet showed no or only mild talar flattening at an average follow-up of 7.5 years. Four years, following posterior ankle release there was a none-mild talar flattening rate of 69 per cent in this group compared to a 40 per cent none-mild rate in ankle release reduces the incidence of recurrent equinus deformity and the necessity for subsequent surgery in comparison to the results obtained with serial plaster casts or with tendo Achillis lengthening alone. Recent trends in clubfoot management have favored increasingly early operative intervention. Denham stated that "In the infant hard tissues (bone and cartilage) should be regarded as soft, and the soft tissues (tendon and ligament) as hard." Our operative experience with posterior ankle release supports this philosophy and indicates that early aggressive surgical management is the treatment of choice for the resistant clubfoot.


Tibiotalar torsion: bioengineering paradigm. 1. Medial tibiotalar torsion is the most common disorder peculiar to mankind. 2. The pathogonomic findings are (a) an axial medially rotated and adducted distal third of the shaft of the tibia, (b) the plafond of the tibia with its mortise containing the "track-bound" talus, which is deflected strongly toward the tibial side, (c) an exaggerated midtarsal equinus, (d) ostensible restriction of dorsiflexion of the hindfoot against the tibia, (e) mild separation of the distal tibiofibular articulation, and (f) forward displacement of the gravitational axis to the naviculocunei-form joint. 3. Faulty leg crossing in utero resulting in an abnormal pelvofemoral-tibial design is discussed and its important consequences in the vulnerable 40 per cent of the population are emphasized. 4. The kinesiomechanics of the leg, ankle and foot is reviewed. 5. The radiographic parameters of medial tibiotalar torsion are presented, as well as the multiple facets of the clinical examination. 6. Methods of treatment depending on age and severity of the disorder are recommended. Surgery, detortional casts, and corrective footwear are discussed. Shoes presently available are inadequate for tibiotalar torsion and therefore engineering principles must be applied in the design and construction of all footwear, including sneakers and sportswear. This can be done only if the pathological biomechanics of this group of disorders is recognized. Biplane proximal tibial osteotomy is recommended in refractory cases, especially when tibiotalar torsion is demonstrated. 7. After 30 years of experience, the author finds that results with these patients have been uniformly good to excellent, depending on age and mode of treatment. 8. In medial tibiotalar torsion, the consequent adaptive changes are readily observed, but rarely are they recognized as the inevitable sequelae of medial tibiotalar torsion. 9. Adaptive compensating disorders are identified and their mechanism described. 10. The management of torsional and static disorders and adaptations of the leg, foot, and knee should not continue on an empirical basis. Recognition of recently presented parameters of the lower limbs in the vulnerable "40 percenters" permits the use of sound engineering principles in both conservative and operative correction of these disorders.


Medial subtalar stabilization with posterior medial release in the treatment of varus feet: a preliminary report. The problem of the varus hindfoot in children ages six to 10 has been discussed. A preliminary follow-up is presented on six patients treated by extensive medial release, multiple tendon lengthenings, and subtalar intra-articular arthrodesis. Two of our patients revealed incomplete correction of the deformity because of technical errors in the medial release. However, there have been no failures of fusion and no progression of the deformity to date. This is a preliminary report and further follow-up is indicated. It should be noted that we have now extended our series to 40 patients.


Hemophilic arthropathy of the foot and ankle. The major deformities in hemophilic arthropathy of the foot and ankle fall into the three groups of equinus, varus, and cavus. These pathologic positions develop through a repetitive pattern of intra-articular and intramuscular bleeding within the area of the distal calf, foot, and ankle. Appropriate infusion therapy with factor VIII concentrate and factor IX concentrate plus splinting, bracing, and logical rehabilitative maneuvers can delay or prevent the advent of permanent deformity. The actual articular damage seems to be directly related to the release of digestive enzymes from leukocytes, synovial cells, and other blood products. These pathologic mechanisms appear to be similar to those recently described in explaining joint destruction in rheumatoid and degenerative arthritis. The indication for certain reconstructive orthopedic procedures in these situations are given and case examples provided. Total joint replacement in the area of the foot and ankle in hemophilia has been considered for certain patients by the authors but not attempted as yet.


Human milk lipases and their possible role in fat digestion. Human milk contains two lipases. One is a lipoprotein lipase with properties similar to the lipoprotein lipases that participate in the metabolism of blood plasma lipoproteins in several tissues. This enzyme is present in high activity in the lactating mammary gland where it facilitates the uptake of triglyceride fatty acids from the blood lipoproteins for production of milk lipids in the gland. The high activity of this enzyme in milk probably represent leakage of enzyme from the gland. This lipase is not stable at pH below 5 or in intestinal contents and it is unlikely that it participates in intestinal fat digestion. Its activity varies widely between individual milk samples, and there is a high correlation between its activity and the development of hydrolytic rancidity in the milk on storage. The other lipase is present in the milk in an inactive form which is activated by bile salts. This lipase is present in milk from primates but not in milk from lower animals. Human milk contains enough of this lipase to hydrolyze the milk lipids almost completely in less than half an hour at the pH and the bile acid and salt concentrations found in the small intestine of the human infant. It is probable that it increases the efficiency of milk fat absorption. The enzyme has a rather wide substrate specificity and may also act on other lipid substrates than triglycerides. In contrast to pancreatic lipase it hydrolyses all three ester bonds in a triglyceride. This may affect the physical chemistry of the lipids in the intestinal contents as well as their absorption and further metabolism in the musoca.


[Diagnosis and treatment of renal traumas in childhood (author's transl)]. The diagnosis of a kidney trauma is discussed and the great importance of angiography besides i. v. urography and retrograde pyelogram is pointed out. In surgical treatment exact urinary diversion and wound drainage are most important points to avoid later complications.


[Infectious skin disease in the newborn (author's transl)]. The most important infectious skin diseases of the newbornperiod are discussed in a short survey. Those skin alterations which can already be observed immediately after birth are especially emphasized. The search for skin infections has to be a routine measure in the care of the newborn, because even the smallest pyoderms can lead to septic complications, and non-infected newborn must be protected through the quarantining and treatment of those newborns with the infection. Frequent occurrence of pyoderms should be taken as a reason for examining the hygienic measures in the delivery room, nursery and maternity ward.


[Hemangioma simplex of the larynx in an infant (author's transl)]. Symptoms of inspiratory stridor, dyspnoa and cyanosis appeared in a four month old boy. After the direct laryngoscopy and biopsy a hemangioma simples of the larynx was diagnosed. The tumor itself was successfully treated by cryosurgery. The advantages of this therapy were pointed out and the cryosurgery can be recommended in cases of larynxangioma.


Drug screening in cell culture for the detection of anticoccidial activity. Methods for screening compounds against Eimeria tenella in cell culture and in the chicken are described. An analysis for incidence of anticoccidial activity and host cell toxicity has been made of 11550 compounds screened in vitro, and some correlation of activity in vitro and in vivo has been attempted. The results show that screening compounds in tissue (cell) culture is not a satisfactory or reliable alternative to screening in chickens, although in vitro studies undoubtedly have a part to play in the evaluation of an active drug.


Molluscs interfering with the capacity of Fasciola hepatica miracidia to infect Lymnaea truncatula. Fasciola hepatica miracidia labelled with radioselenium were used to study aspects of their host-finding capacity by determining radioactivity subsequently taken up by exposed 'target' snails (Lymnaea truncatula). Possible interfering effects exercised by a number of non-host snails and bivalves were examined in linear test channels. The infection rate (radioactivity) among 'target' snails was markedly lowered when non-host Lymnaea species (L. pereger, L. palustris, L. stagnalis) were interposed as 'decoys'. The prosobranch Bithynia tentaculata and the bivalve Sphaerium corneum exhibited a slight decoy effect whereas pulmonate species like Anisus vortex, Gyraulus albus, Planorbis planorbis, Physa fontinalis did not interfere with miracidial host-finding. Other experiments showed that miracidia are more strongly attracted towards L. truncatula than L. pereger. Miracidia are not able to penetrate intact egg clusters of L. truncatula.


Schistosoma mansoni: the occurrence of microvilli on the surface of the tegument during transformation from cercaria to schistosomulum. Microvilli are developed on the surface of Schistosoma mansoni schistosomula during penetration of the host skin; they form rapidly but are lost approximately 90 min after penetration. Identical microvilli are also formed on schistosomula which have penetrated a mouse skin preparation in vitro, and on schistosomula prepared by mechanical separation of the tail from the body of the cercaria. The microvilli, which are limited by the trilaminate tegumental membrane of the cercaria, eventually degenerate and are cast off from the surface of the tegument. There is little change in the surface area of the schistosomulum at this time, and the formation and loss of microvilli coincides with the replacement of the cercarial tegumental membrane by the new heptalaminate membrane. It is suggested that during the cercaria/schistosomulum transformation, some intramembraneous components of the original cercarial membran e may migrate into the new heptalaminate membrane and thus be retained, while other peripheral components such as the glycocalyx are almost certainly lost.


Seasonal abundance of Proteocephalus ambloplitis (Cestoidea: Proteocephalidea) from largemouth bass living in a heated reservoir. Proteocephalus ambloplitis was recovered from largemouth bass inhabiting different thermal regimes, ranging from normal to greater than 10 degrees C above normal, on the Energy Research and Development Administration's (ERDA) Savannah River Plant near Aiken, South Carolina. Possible alterations in the mechanisms initiating plerocercoid migration as proposed by Fischer & Freeman (1969) were noted. According to these authors, a rise in temperature from 4 to 7 degrees C and above stimulated migration of parenteric plerocercoids into the gut. The lowest water temperature recorded for the reservoir for the entire sampling period was 8.0 degrees C. Theoretically, this should have terminated the life-cycle of this tapeworm since migration temperature was never attained. At Savannah River, the appearance of adult tapeworms coincided with a decrease in water temperature, while the appearance of adult tapeworms in Canada was correlated with an increase in water temperature. It is postulated that the decline in water temperature in southern latitudes and the increase in water temperature in northern latitudes initiates the same response, that is, migration of plerocercoids from parenteric to enteric sites where maturation to the adult form ensues.


Response of Haemonchus contortus cayugensis to a change in the ratio of smooth to linguiform. The equilibrium of vulvar phenotypes in Haemonchus contortus cayugensis was changed by infecting lambs with either a selected strain of smooth or of linguiform worms. Subsequently the lambs grazed the same pasture and observations were made on changes in worm populations in the lambs, and on pasture it appeared that the seasonal change in the relative frequencies of A and B linguiform worms was related to density-dependent factors in the host. In the spring, when lambs first become infected, the worm population is small and the majority of linguiform worms are A-type. As the season progresses the density of the parasite population increases. Once the population becomes crowded selection begins to favour the B-type females. The effects of crowding on linguiform A females can be seen as a positive correlation between the percentage of linguiform A and their weight. Population density also affected the survival of A-type worms since there was a negative correlation of percentage A-type on total worm numbers. There was a similar negative correlation between percentage A-type on total worm numbers. There was a similar negative correlation between percentage A-type and total worm numbers in both the continuously infected and tracer lambs. Population density did not affect the proportion of smooth worms. However, smooth worms increased in the tracers from approximately 10% at the beginning of the experiment to 55% at its conclusion 18 weeks later. The latter percentage is almost within range of the local subspecies, which has 60% or more smooth worms. It appears therefore that the proportion of smooth to linguiform worms is a stable equilibrium maintained by natural selection.


Cell and organ culture techniques applied to the study of carcinoma of colon and rectum. The value of a number of in vitro systems which have been used in the investigation of carcinomas of colon and rectum is considered. Tissue culture cell ines which have been established from human and mouse rectal and colon tumours are described. Both mouse and human cells retain ultrastructural features of the tumours of origin; acinus formations, junctional complexes, microvilli with surface glycoprotein strands. Normal colo-rectal epithelium has not been established in cell culture but organ cultures of mouse colon, which retain normal ultrastructural features can be maintained for at least 28 days. The possible origin of non-epithelial cells which appear in cultures from normal colon is discussed. The areas in which the various in vitro systems may be of used are reviewed.


Metaplastic conversion of the differentiation pattern in oral epithelia affected by leukoplakia simplex. A stereologic study. The present study applied methods of stereologic cytology to clinically specified lesions of leukoplakia simplex which originated from the oral mucous membrane at the cheek and the floor of the mouth. The data provided the following evidence: (1) The structure of and the differentiation gradients for various cytoplasmic constituents in leukoplakia simplex epithelium were identical at both sites. (2) The differentiation pattern of leukoplakic epithelia was adversely different from that of the respective normal epithelium. (3) This alteration which resulted in a striking resemblance between the leukoplakic epithelia and those of normal skin or hard palatum conceivably can be regarded as a squamous metaplasia characterized by the conversion of one differentiation pattern into another. (4) This shift in the differentiation pattern hardly could have been disclosed by means other than stereologic morphometry.


The internal surface area of the lung in emphysema. Quantitative histological studies on the lung are time consuming and for the pathologist may not reveal much additional imformation in relation to the time spent. Sixty-eight cases of emphysema were studied. The percentages of the lung tissue destroyed by alveolar, bronchiolar and bullous emphysema were determined by macroscopic point counting. The internal surface area (I.S.A.) and internal surface area at a standard lung volume of 3,000 ml(I.S.A.3,000) were determined by the mean linear intercept (M.L.I.) method. There was a significant correlation between both the M.L.I. and I.S.A.3,000 and the percentage of lung tissue destroyed. The M.L.I. was the most accurate guide to the presence of emphysema. The I.S.A. was the least reliable indication of emphysema. Cases of alveolar duct emphysema were both over and underdiagnosed on macroscopic point counting. It is therefore suggested that in cases with alveolar duct emphysema, apparently normal lungs or where full pulmonary function tests are available, quantitative histological studies should be carried out. In other cases it is possible to derive the I.S.A. and I.S.A.3,000 from the percentage of emphysema as determined macroscopically, without recourse to histological methods.


Gastroesophageal reflux in children: clinical manifestations, diagnosis, pathophysiology, and therapy. Gastroesophageal reflux in infants and children is a challenging diagnostic problem. A careful history and physical examination are of foremost importance. In infants, the esophageal manometry study and the Tuttle test are helpful in confirming gastroesophageal reflux. In older children, these two studies as well as the Bernstein test should be done to document reflux. The presence of esophagitis or esophageal strictures is best determined by esophagoscopy with concomitant grasp or suction biopsies. A medical regimen should be tried for three to six weeks in all children except those with esophageal strictures or severe malnutrition. Medical failures should be treated surgically with Nissen fundoplications, performed by a competent pediatric surgeon. The prognosis for children undergoing surgical correction is excellent.


The rate of cerebral utilization of glucose, ketone bodies, and oxygen: a comparative in vivo study of infant and adult rats. Cerebral blood flow (CBF) was measured by means of Celabeled microspheres in infant (20-day-old) and adult (3-month-old) rats, anesthetised with Na-5-ethyl-5-(1-methylpropyl)2-thiobarbituric acid. Cerebral arteriovenous differences of acetoacetate, D-beta-hydroxybutyrate, glucose, lactate, and oxygen and brain DNA content were determined in other groups of similarly treated infant and adult animals fed or starved for 48 or 72 hr. The mean CBF values of 0.48+/-0.04 and 0.62+/-0.07 ml/(g X min), +/- SEM, in infant and adult animals, respectively, were not significantly different. CBF was unaffected by starvation. At any given arterial concentration the cerebral arteriovenous difference of acetoacetate was significantly higher in infant than adult rats. The same was true for D-beta-hydroxybutyrate at arterial concentrations above 1 mmol/liter. There was an approximately linear relationship between arterial concentration of acetoacetate and its cerebral arteriovenous difference in both infant and adult rats. A similar relationship was found for D-beta-hydroxybutyrate only in infant animals. In the fed state, the cerebral uptake of glucose and ketone bodies (micromoles per (mg DNA X min)) was not different in infant and adult rats. During starvation, cerebral uptake of ketone bodies expressed as micromoles per (mg DNA X min) was higher in infant than adult rats, indicating a higher rate of utilization of ketone bodies per cell in these animals. For glucose, no such difference was found in either fed or starved groups (Table 3). The average percentage of the total cerebral uptake of substrates (micromoles per min) accounted for by ketone bodies increased in both infant and adult rats during starvation. This percentage value was clearly higher in infant than adult rats during starvation. After 72 hr of starvation the values were 38.8% and 15.2% in infant and adult rats, respectively (Fig. 3). Calculated cerebral metabolic rate for oxygen (CMRO2), assuming complete oxidation of glucose and ketone bodies and expressed as micromoles per (mg DNA X min), was similar in fed and starved rats of both age groups (Table 3), indicating that ketone bodies serve as an alternative substrate for glucose during starvation. Calculated CMRO2 for glucose plus ketone bodies was similar to the measured CMRO2 in adult rats both in the fed and the starved groups. For infant rats, calculated CMRO2 for glucose plus ketone bodies was higher than measured CMRO2, indicating that in this age group a portion of substrate was used for synthesis or storage rather than for complete oxidation.


Ornithine transcarbamylase deficiency: enzyme studies on a further case and a method of diagnosis using plasma enzyme ratios. The activities of the urea cycle enzymes in the liver of a female patient with hyperammonemia were determined (Table 1). Ornithine transcarbamylase (OTC, EC. 2.1.3.3) was reduced to 5-10% of normal and the residual enzyme showed an apparent Kmorn of 0.69 (normal 0.37 +/- 0.10) mmol liter. The pH dependence was normal. The patient's mother also showed hyperammonemia but was not clinically affected. Consideration of the genetics of the disease suggested that many female patients should have a mixture of normal and mutant enzymes. Electrophoresis of the patient's liver extract showed an additional band of OTC activity probably due to this mutant enzyme. The ratio of plasma glutamate-pyruvate transaminase to OTC was abnormal in four clinically affected patients with OTC deficiency (Fig. 4B) but not in two of their mothers without clinical signs.


Growth retardation and zinc nutrition.

Growth retardation and zinc nutrition. Based on a previous report of a zinc deficiency syndrome in children characterized by low hair zinc, anorexia, poor growth, and hypogeusia, 12 children attending  a pediatric endocrinology clinic for growth retardation and judged as having short stature as a variant of normal (SVN) were evaluated as to their zinc nutriture to learn whether zinc deficiency was a contributory factor. None was found to have the above syndrome, although one child did have a hair zinc concentration below 70 mug/g. The mean hair zinc of the SVN subjects was lower than the hair zinc of 40 apparently normal adolescents, 131+/-37 mug/g vs. 168+/-44 mug/g (P less than 0.02), but there was no difference found in plasma levels of zinc or in taste acuity. In contrast, five patients with total growth arrest secondary to juvenile Crohn's disease (CD) were found to have multiple findings consistent with zinc deficiency including low plasma zinc, low hair zinc, or hypogeusia.


Growth and nutrition of uremic piglets.

Growth and nutrition of uremic piglets. Piglets aged 6 days were rendered uremic by subtotal nephrectomy and their growth and dietary intakes studied over the next 21 days. Eleven control piglets fed a voluntary intake of a sow's milk substitute (group A), 11 nephrectomized piglets fed a voluntary intake of the same feed (group B), 6 nephrectomized piglets tube fed the same milk (group C), and 11 nephrectomized piglets fed a voluntary intake of a low protein, isocaloric food (group D) were studied. After nephrectomy the piglets had an initial rapid rise in blood urea concentration which had fallen by day 7 and then leveled out around 13 mmol/liter in group B and 8 mmol/liter in group D. After operation control piglets (group A) ate more from day 4 and were larger from day 7 than the nephrectomized piglets (group B). Those piglets tube fed (group C) were of a similar size to the controls but all died between day 7 and day 11 with associated high blood urea concentrations. Piglets fed the low protein, isocaloric feed (group D) were smaller than both the controls and group B. They also ate less food than the controls and those nephrectomized piglets in group B which were on a voluntary intake of the normal feed.


Effect of undernutrition and amino acid deficiency on the timing of puberty in rats. Sexual maturation was examined in underfed or amino acid-deficient rats. We have demonstrated a highly significant negative linear relationship (r = -0.80, P less than 0.001) between the age at puberty and the growth rate in rats under conditions of food restriction. The weight at puberty in animals growing at different rates because of undernutrition was not constant but behaved as a quadratic function of growth rate, as predicted from the assumption that growth rate was an independent variable. Growth rate is therefore more important than arrival at a particular fixed weight in determining the timing of puberty. Feeding of low valine diets resulted in delayed sexual maturation. Both the weight at vaginal opening (182 +/- 5.9 g) and the weight at first estrus (187 +/- 6.1 g) were significantly greater in the valine-deficient group when compared with growth-matched control (139 +/- 10.7 g and 161 +/- 9.3 g, respectively, P less than 0.05). The valine-deficient group also had significantly later vaginal opening (98.8+/- 4.7 days) than growth-matched controls (76.6 +/- 6.6 days, P less than 0.02). Valine deficiency seemed to have a specific effect on the hypothalamic-pituitary-gonadal axis since puberty in valine-deficient animals was delayed more than could be accounted for by impairment of growth.


An evaluation of the safety of a low-saturated-fat, low-cholesterol diet beginning in infancy. This study was designed to detect developmental, body chemistry, or somatic differences that might be present in children who had been on a low-saturated-fat, low-cholesterol (LSFLC) diet since birth. Comparison to a matched control group at age 3 years failed to demonstrate significant differences in percentile height, percentile weight, head circumference, age, skinfold thickness, total serum protein, hemoglobin, number of failures on a Denver Developmental Screening test, or number of sick visits. Experimental children did have significantly lower serum cholesterol than a large group of children of similar age. It is concluded that at age 3 years, no significant adverse findings were present in the group who had been nourished on a LSFLC diet since birth as compared to a control group.


Relationship of passive cigarette-smoking to sudden infant death syndrome. The smoking habits of 56 families who lost babies to the sudden infant death syndrome (SIDS) were compared to those of 86 control families. A higher proportion of SIDS mothers smoked both during pregnancy (61% vs. 42%) and after their babies were born (59% vs. 37%). SIDS mother also smoked a significantly greater number of cigarettes than controls. Exposure to cigarette smoke ("passive smoking") appears to enhance the risk of SIDS for reasons not known.


Respiratory distress syndrome of the newborn and complications of pregnancy. A group of 412 infants with birthweights between 501 and 2,500 gm and gestational ages of 36 weeks or less were studied for the influence of both prolonged ruputre of amniotic membranes and maternal hypertension on the incidence of idiopathic respiratory distress syndrome (IRDS). The occurrence of these complications was associated with a significant decrease in the incidence of IRDS only in infants with birthweights between 1,501 and 2,500 gm (37.4% in the no complications group versus 12.8% in the complications group; P less than .01) or gestational ages of 33 to 36 weeks (35.2% in the no complications group versus 13.1% in the complications group; P less than .01). In infants with birthweights of 1,500 gm or less or gestational ages of 32 weeks or less, the specific antecedent complications of pregnancy did not alter the incidence of IRDS. Rupture of the membranes for more than 72 hours had no greater effect on the incidence of IRDS than those lasting 24 to 72 hours.


Differential effects of maternal heroin and methadone use on birthweight. An analysis of birthweights of 337 neonates in relation to history of maternal narcotic usage was undertaken. Mean birthweight of infants born to mothers abusing heroin during the pregnancy was 2,490 gm, an effect primarily of intrauterine growth retardation. Low mean birthweight (2,615 gm) was also seen in infants born to mothers who had abused heroin only prior to this pregnancy, and mothers who had used both heroin and methadone during the pregnancy (2,535 gm). Infants born to mothers on methadone maintenance during the pregnancy had significantly higher mean birthweights (2.961 gm), but lower than the control group (3,176 gm). A highly significant relationship was observed between maternal methadone dosage in the first trimester and birthweight, i.e., the higher the dosage, the larger the infant. Heroin causes fetal growth retardation, an effect which may persist beyond the period of addiction. Methadone may promote fetal growth in a dose-related fashion after maternal use of heroin.


Municipal child health services: a ten-year reorganization. There has been increasing interest within the medical community in developing primary care programs in teaching hospitals that meet the medical needs of a community. The Cambridge Hospital system provides a working model for such a mutually beneficial interaction. Based on principles of administrative centralization and utilization of the pediatric nurse practitioner, the neighborhood health centers operate as part of a cost-effective series of concentric circles. Administrative centralization within the Department of Pediatrics at the Cambridge Hospital has permitted the elimination of duplicate medical services and the development of a responsive community health service. The pediatric nurse practitioner under close senior staff supervision, serves as the primary caretaker in the neighborhood centers. In addition to her role as the provider of a protocol-determined, age-related series of physical psychometric, and laboratory examinations the pediatric nurse practitioner also cares for minor injuries and illnesses of childhood. Any child deviating from a clearly established range of norms for any physical, developmental, or laboratory parameter is immediately referred to the senior staff pediatrician for further evaluation. Finally, any patient requiring subspecialized inpatient care is referred to the Massachusetts General Hospital. The senior pediatric staff of the Cambridge Hospital serves the function of coordinating and supporting the rapid interlevel communication which must occur between community service, primary hospital, and a tertiary care facility. This neighborhood health care system is, we feel, a medically sound, educationally exciting, and fiscally responsible solution to a problem facing many urban areas and their academic medical institutions.


Familial aggregation of blood pressures of newborn infants and their mother. The blood pressures and pulse rates of 257 normal full-term infants and their mothers were measured two to four days after birth. Birthweight was correlated with systolic (P=.038), but not with diastolic blood pressure. Infants who were asleep had significantly lower systolic and diastolic blood pressure than infants who were awake (P less than .001). Sex, body length, and feedings did not appear to influence infant's blood pressure nor did the anesthesia given to the mothers. Maternal diastolic pressure correlated with infant's diastolic pressure (regression coefficient, .128) (P less than .01), whereas for systolic pressure the regression coefficient between maternal and infant pressure was .085 (P=NS). The aggregation between the diastolic blood pressures of infants and mothers was not influenced by birthweight, age of the mother, or medication administered to the mother. The pulse rates of black infants were significantly higher than those of white infants (P less than .002). There was no correlation between the pulse rates and blood pressures in infants.


Serum enzyme abnormalities in juvenile rheumatoid arthritis. Elevated serum transaminases, particularly SGOT, as a result of acetylsalicylic acid (ASA) therapy have been reported in patients with juvenile rheumatoid arthritis (JRA). In order to evaluate the possibilities that these elevated transaminases may result from JRA itself or from concomitant muscle injury, we correlated liver function tests and a specific test for muscle damage, creatine phosphokinase (CPK), with ASA therapy in 37 patients. These JRA patients were evaluated serially; 20 took ASA continuously, 6 took it intermittently, and 11 were on no therapy. Thirty-five healthy children were also studied to establish normal control values for the serum enzyme tests. Mean SGOT and SGPT in the 11 untreated subjects were significantly (P less than.001) higher than normal controls while CPK and alkaline phosphatase (AP) were not elevated. Mean SGOT and SGPT were also significantly (P less than .001) elevated in 20 children receiving ASA continuously; CPK was normal and AP less (P less than .05) than normal. CPK was elevated in 13 patients. Elevation of enzymes was sporadic and there was no correlation with serum salicylate, sex, age, disease duration, type, or activity. We conclude that mild abnormalities of SGOT and SGPT in JRA patients are common, but that they occur sporadically and elevated values appear to be unrelated to ASA therapy.


A useful radiologic sign for the diagnosis of Turner's syndrome. A new X-ray sign of gonadal dysgenesis is described. In this series nine out of ten patients with Turner's syndrome have a coarse, reticular pattern of the carpal bones. A comparison with other previously described roentgenographic characteristics on hand and wrist films of these children leads to the conclusion that the new sign is more reliable and specific.


Developmental changes in the infants attention to pattern detail. To assess developmental changes in the importance of stimulus intensity and pattern detail for infants' visual attention, infants of 10, 17, and 25 wk. of age were shown pairs of stimuli equated for stimulus intensity but different in pattern detail (angles or straight lines). The youngest infants gave equivalent amounts of attention to the stimuli of each pair while the two older groups showed a significant preference for the angular stimuli. The results are interpreted as showing the increased attention to elements with development, and a possible explanation of the preference for the angle stimuli is discussed.


Feelings of inexperienced therapists in psychotherapy: a factor analytic study. The Therapy Session Report, a parallel-structured response questionnaire, was utilized to study the feelings of inexperienced therapists. 57 college student applicants at a university counseling center reported on their perceptions of their therapists' feelings immediately following an intake interview. The 19 therapists, clinical psychology graduate students in training, also reported what they felt during the intake session. Factor analysis of patients, perceptions of their therapists' feeling resulted in four factors, the first two accounting for 85% of the common variance. Factor analysis of therapists, perceptions of their own feelings resulted in nine factors. Results suggest that, while patients view their therapists in generally negative positive terms, inexperienced therapists experience considerable affective discomfort during their intake sessions.


Relation between optically induced and tracking-limb-movement curvature in a visual capture phenomenon. Two experiments were conducted to help determine the nature of visual capture in the perception of curvature. If an individual finger-tracks a straight edge while viewing limb movements through a curve-inducing lens, the edge is reported to feel curved even though the finger is moving in a straight path. It has recently been demonstrated, however, that the finger actually tracks the straight edge through a curved path with the same orientation as the induced visual curve. In order to specify more completely the degree of relation between the visual and tracking (motor) curves the first experiment determined the fate of tracking limb-movement curvature when the eyes were closed. The second experiment determined whether curvature of tracking limb movement decreased as the magnitude of the visual curve was decreased. Results from both experiments supported the contention that curved tracking limb movement may mediate the visual and felt curves. The nature of the mechanism underlying felt curvature in visual capture was discussed.


Selective hyperthermia and reaction time. Two reaction time studies are reported in which subjects responded under conditions of selective hyperthermia. Wearing a helmet prototype, the cortical surface of the subject was thermally stressed to a level 1.11 degrees C over baseline as measured by a thermocouple placed against the tympanic membrane. In a simple choice RT task, both reaction time and response variability were decreased compared to performance in either a control or placebo condition. Latency in Neisser's visual scanning task was also shortened under conditions of this thermal stress localized in the cortical region. In both cases, there was no observed decrement in accuracy or level of performance. Enhanced human performance resulting from the maintenance of cortical temperature above the normal diurnal range is implied.


Institutional males' perception of three counseling techniques. The use of advice-giving, Adlerian interpretation, and analytically derived interpretation with regard to whether feelings of approach, attack, or withdrawal were elicited was investigated by having subjects view a videotape of eight-role-played counseling segments. The videotape presented problem-statements by a role-playing adolescent followed by a role-playing counselor who made three separate responses to the statements. Subjects were 20 internally and 20 externally controlled incarcerated youth who indicated how each counselor's response made them feel (approach, attack, or withdrawal). Both internally and externally controlled subjects tended to respond to Adlerian interpretation and analytically derived interpretation with attack - and withdrawal - feelings and to advice-giving with approach-feelings in this quasi-counseling situation.


Usefulness of the group-comparison method to demonstrate sex differences in spatial orientation and spatial visualization in older men and women. This paper reports an analysis of sex differences in cognitive test scores covering the dimensions of spatial orientation and spatial visualization in groups of 6 older men and 6 women matched for speed of performance on a maze test and level of performance on a spatial relations task. Older men were more proficient solving spatial problems using the body as a referent, whereas there was no significant difference between the sexes in imagining spatial displacement. Matched comparisons appear a useful adjunct to population research to understand the type(s) of cognitive processes where differential performance by the sexes is observed.


Assessment of visual field impairment by objective technique. An objective psychophysical technique for investigating visual fields by averaged scalp potentials evoked by pattern gratings of alternating contrast and by sinusoidally modulated flicerking light is applied to a child with a right homonomous hemianopsia. This technique illustrates a value, in obtaining clinical data on visual fields in situations were subjective perimetry is difficult to administer or where conservating diagnostic methods do not yield evidence of pathology.


Field dependence among male and female alcoholics: II. Norms for the rod-and-frame test. 402 males and 160 females hospitalized for treatment of alcoholism were tested in a standardized manner on the Rod-and-frame test as a means of supplementing an earlier report of normative data on perceptual style among male alcoholics. When their performance was contrasted with that of normal and psychiatric samples, alcoholics were clearly the most field dependent of all groups studied. Statistically significant sex differences justify the need for separate norms for males and females.


On the validity of hypotheses derived from the Rorschach: 1. The relationship between color and affect. Interpretation of response to color on the Rorschach rests on Rorschach's assertion that color has affective connotations. His assumption was based on the connection of color and affect in culture and as regards the differential response to color by patients he tested. This review focused on research which could lend support to Rorschach's empirically derived notion. Ignoring clinical studies of psychiatric patients (in the absence of any theory of affects unique to specific psychiatric groups), this review focuses primarily on psychological tests of the hypothesis. Affect does seem to be associated with colors but not so specifically as to be useful in interpreting the meaning of the response by any one person. Moreover, affect was seen to affect the many dimensions of the Rorschach stimuli. Interpretation of the response to color must take into account the unsystematic way in which factors influence response to color on the Rorschach, e.g. saturation, context, area covered, etc, vary from card to card. These factors alone influence the response to color and make it impossible to draw conclusions using the plates as constructed. The interpretation of affect from response to color on the Rorschach was seriously questioned.


Visual orientational anisotropy and stimulus surround effects in discrimination of spatial numerosity. Visual spatial numerosity perception was investigated as a function of spatial orientation and surround conditions. 3 to 13 dots arranged linearly in horizontal, vertical, or oblique orientations were presented for 200 msec. in either a square or circular stimulus field. For patterns with small numbers of dots (3 to 7), surround and orientation conditions did not substantially alter perceived number except vertical arrangements were judged as having reliably more dots than identical horizontal arrangements. For large dot-number patterns (8 to 13), surround significantly altered perceived number and left oblique linear arrangements were judged to have reliably more dots than equivalent arrangements in all other orientations.


Prolonged practice of a simple motor task by preferred and nonpreffered hands. After prolonged practice (1300 10 sec. trials) the tapping speed of the nonpreferred hand reached that of the preferred hand on a simple finger-tapping task. Analysis of the intertrap intervals showed the variability of the duration of intertrap intervals was smaller for the preferred than for the nonpreferred hand, the difference was not affected by the prolonged practice for N = 1.


Subjective feelings and vascular responses in reaction to reduced control over aversiveness. Subjects were exposed to an aversive, modified Sidman avoidance procedure. One group had relative control over the aversiveness in that they could exercise an option for unlimited rest periods, and they could avoid electric shock by an appropriately fast-response rate on a monitoring task. The second group was yoked to subjects in Group I both with respect to rests and shocks, thereby producing decreased capability of behavioral control. The effects of this manipulation were evaluated by three types of dependent measures: vascular arousal (systolic and diastolic blood pressure), verbal reports of subjective feelings, and performance on a subsequent problem-solving task. The findings suggested motivational deficits along with reduced vascular arousal among the yoked subjects, a pattern of results which may clarify some of the alternative hypotheses pertinent to "learned helplessness".


Handedness in relation to measures of motor and tactile-perceptual functions in normal children. 10 boys and 10 girls were tested at each of six age levels (6, 7, 8, 12, 13, and 14 yr). All of the children were right-handed, and at each age level the groups did not differ in age, WISC Full Scale IQ, or educational attainment. The groups were compared on motor tasks (strength and speed) and tactile-perceptual tasks (finger localization and symbol recognition). The performances of the right and left hands were compared. The results indicated clear right-hand motor superiority, but no "sidedness" effect for the tactile-perceptual measures. The implication of these results for brain-behaviour relationships was discussed.


Experimental control of rhythm in stereotyped body rocking. A technique is described which enabled external control of the rhythm of stereotyped body rocking in a profoundly retarded, non-verbal subject. This technique consists of training the individual to synchronize the rhythm of his body rocking with an externally driven pacemaker light. Evidence is presented for experimental control of rhythm in a profoundly retarded, institutionalized child with a chronic history of body rocking.


Effect of degree of separation of visual-auditory stimulus and eye position upon spatial interaction of vision and audition. Subjects were exposed to a visual and to an auditory stimulus that differed spatially in laterality of origin. The subjects were observed for visual biasing of auditory localization (the momentary influence of a light on the spatially perceived location of a simultaneously presented sound) and for auditory aftereffect (a change in perceived location of a sound that persists over time and is measured after termination of the visual stimulus). A significant effect of visual stimulation on auditory localization was found only with the measure of bias. Bias was tested as a function of degree of visual-auditory separation (10/20/30 degrees), eye position (straight-ahead/visual stimulus fixation), and position of visual stimulus relative to auditory stimulus (left/right). Only eye position proved statistically significant; straight-ahead eye position induced more bias than did fixation of the visual stimulus.


Clothing as a nonverbal communicator or sexual attitudes and behavior. To test the hypotheses that people believe that certain kinds and styles of clothing are indicative of liberal sexual attitudes and behavior and these beliefs are correct, questionnaires were filled out by 259 subjects. These questionnaires asked each subject for the frequencies with which he wore various items and styles of clothing, his attitude toward premarital sexual relations, the number of persons with whom he had had sexual relations, the frequencies with which he believed sexually liberal men and women wore various items and styles of clothing, and the frequencies with which he felt sexually conservative men and women wore various items and styles of clothing. Correlations showed that, although subjects believed that a large number of items and styles of clothing are indicative of liberal sexual attitudes and behavior, only a few items and styles actually were associated with liberal sexual attitudes and reported behavior.


Distribution of movement time in a target-aiming task. Various characteristics of the distribution of movement time were analyzed for a task involving serial and rotary arm movements aimed at a target. For experimental data generated from five Ss, (a) the distribution tended to be unimodal and more peaked than a normal distribution, (b) the skewness of the distribution was predominantly positive and (c) the standard deviation, in addition to the mean, of movement time was significantly affected by the complexity of the task as measured by Fitts' index of difficulty, while the skewness and the kurtosis were not. For the average results for the Ss, a first-order linear model with the standard deviation of movement time as the dependent variable and Fitts' index as the independent one explained 67% of the variation in standard deviation as compared to 98% of the variation in mean movement time accounted for by the Fitts' index.


Anxiety, task-experience, and vocal-style of judges as determinants of performer confidence. To examine the effect of umpiring vocal-manner on a performance-measure of confidence, 30 baseball players viewed a series of videotaped pitching-catching-umpiring sequences and rated confidence in their ability to hit each pitch. Matched sequences were presented under each of two controlled conditions: for Conventional, the umpire called "strikes" emphatically and "balls" in an indifferent manner; for Modified, this vocal-manner was reversed. A single Conventional (or, Modified) sequence embedded within a series of contrasting sequences and a "bad" pitch (clearly out of the strike-zone) were included as tests of the effectiveness of the experimental manipulation. Results indicated: (1) Modified umpiring enhanced confidence; (2) this effect was most prominent among highly experienced players; (3) low-anxiety players showed higher confidence under both conditions; (4) Modified sequences embedded within a Conventional background elicited significantly greater confidence than in the background sequences.


Attitude and personality differences in physically active and inactive university teachers. This study assessed peronality factors and attitudes toward physical activity in a sample of university teachers. One group (N = 20) of subjects regularly participated in various forms of physical activity; the second (N = 20) showed no such interest. The psychological measures used were the Cattell 16 PF Form A and the Kenyon questionnaire on attitudes toward physical activity. Attitudes about physical activity rather than personality traits were shown to be important within the subpopulation studied.


Object, intensity and subject variables in visual evoked response. 10 subjects were studied to determine AEP effects of square, circle, and blank stimuli with variable stimulus intensity. For the group as a whole, object and intensity effects were significant on a number of amplitude and latency measures, but the object effect appears largely to reflect the presence or absence of a figure, rather than its nature. Increased intensity differentially affected latency, shortening the first negative deflection while lengthening the second positive. Amplitude is generally increased with higher intensity. Analysis of within-subjects effects showed considerable variability as to which parameters were significantly related to the independent variables in individual subjects. A repeated-measures, within-subjects research strategy is seen as appropriate on the basis of these data.


Influence of recall on reliability of perception of the autokinetic illusion. An autokinetic test was given to 76 females subjects who were then randomly assigned to 1 of 4 groups of 19 subjects each. Two groups were retested after 1 and 6 wk., respectively. The other two groups were asked to recall their initial experience after 1 and 6 wk., respectively. Intertrial correlations of the measures were generally higher for the recall conditions than for the retest conditions. The results were discussed in terms of the potential influence that recall may have on the test-retest reliability of autokinesis.


Empathy in learning disabled children.

Empathy in learning disabled children. 25 7- to 12-yr.-old boys with visual perceptual problems and learning disabilities were compared on the Borke Scales for Empathy with a greater matched control group. The learning disabled group had significantly greater difficulty recognizing and labeling emotions.


Sex cues in estimating and performing a simple motor task. The present study examined direct behavioral effects of sex cues in a modified level of aspiration experiment for 60 male and 60 female undergraduates. Each S was provided a constant referent score (25), identified as the average score, average score for men, or average score for women. E's sex was controlled and its effects examined. Male Ss estimated and performed significantly higher than female Ss. All Ss provided the average score for the men estimated and performed lower than Ss provided the average score for women. Effect of E's sex was nonsignificant. Results were discussed in terms of behavioral effects of sex-role stereotypes and the implications of such effects for future research.


Heterosexual social competence, anxiety, avoidance and self-judged physical attractiveness. The relationship between self-judged physical attractiveness and opposite-sex behavior was examined as part of a large survey on the interaction patterns of 963 college students. The findings suggest that a self-rated negative physical image is related to significantly high levels of heterosexual difficulties.


Information processing vs visual attention during incidental learning. The relationship between attention and incidental learning during discrimination training was studied in 30 children, aged 10 to 11. A polymetric eye-movement recorder measured direct visual attention. Consistent with previous findings, recall of incidental stimuli was greatest during the initial and terminal stages of intentional learning. Contrary to previous explanations, however, visual attention to incidental stimuli was not related to training. While individual differences in attention to incidental stimuli were predictive of recall, attention to incidental stimuli was not related to level of training. Results suggested that changes in higher order information processing rather than direct visual attention were responsible for the curvilinear learning of incidental stimuli during intentional training.


Effects of prolonged practice on duration of spiral aftereffect: an ideographic study. The effects of prolonged practice on the duration of the spiral aftereffect were investigated; 3,000 trials over 30 days with 5 levels of ambient illumination were randomly presented to a single subject. Scores gradually decreased until a plateau was reached during the last 13 days. A large decrement during the last 5 days was attributed to a decision process component. An early difference in performance at different illumination levels was largely eliminated by the last 5 days.


WISC characteristics of reading disabled children identified by three objective methods. The WISC and Spache Reading Diagnostic Scales were administered to 119 third-grade children. Groups of reading disabled children were selected by three objective methods (Below Grade Level, Bond and Tinker, and the Erickson Z-score Discrepancy). The Below Grade Level and Bond and Tinker methods tended to identify the same children whose IQs and reading achievement scores were below average. The Z-score method identified children with IQs at or above the group average. Comparison of the poor readers with control groups matched for IQ and sex gave only minimal evidence for WISC subtest patterns as characteristic of poor readers.


Reaction time as a function of peripheral retinal locus around fovea: effect of stimulus size. Using targets of four sizes between 18' and 116' at a fixed luminance of 5.8 cd/m2, human visual reaction times (RT) were measured on a circle at 30 degrees eccentric to the fovea. A foveal and 12 peripheral retinal loci were explored, covering the range between 0 degrees and 330 degrees in steps of 30 degrees units on a circle about the fovea. RT decreased significantly by the stimulation to the quadrant retinal loci between nasal and superior side. RT decreased as a function of increasing target size and the amount of decrement was relatively larger in the periphery than in the fovea.


Note on auditory perception of physiognomic properties in short melodic structures. The present study shows that short melodies composed to conform with the Gestalt features of line-schematizations which had been drawn to be expressive of certain emotions and concepts were, in turn, judged by both 28 blind boys and girls and 87 college students sighted subjects, according to prediction. The results are interpreted as supporting the underlying hypothesis that physiognomic properties are "similar" across modalities.


Subjective definitions of tension.

Subjective definitions of tension. To examine the type of proprioceptive information which subjects include in the definition of tension, 52 subjects were asked to indicate the location of where they felt tension while engaging in a simple motor task. Responses indicated that tendon stretch, muscle tension, and other cues are utilized in the subject's definition of tension.


Practice effects for auditory localization: a test of a differentiation theory of perceptual learning and development. Practice and transfer of practice in an auditory localization task were observed for three different information conditions (normal, transformed and reduced) to examine four aspects of Gibson's (1969) differentiation theory of perceptual learning and development. Support was found for the propositions that: (i) dimensions of difference, rather than prototypes, are learned; (ii) specificity is a more appropriate response measure than number of correct responses; (iii) perceptual learning will occur regardless of whether feedback is given or not; (iv) transfer of practice will be greater if dimensions of difference (as opposed to prototypes) are learned. It was also found that feedback during practice did not affect transfer. In an apparent contradiction though, specificity increased in the absence of dimension of difference. This increase was interpreted as being associated with the detection of non-task-related information and was seen as lending support to Gibson's hypothesis that, perceptual learning is motivated by intrinsic cognitive drive and is terminated by a reduction in subjective uncertainty.


Personality dysfunction and lateralized deficits in cerebral functions as measured by the MMPI and Reitan-Halstead Battery. Previous research using the MMPI has failed to show personality differences between right and left hemispheric brain-damaged patients. The purposes of the present study were, first to determine whether lateralized deficits in cortical functioning as measured by neuropsychological testing are systematically associated with neurotic-psychotic distinctions on the MMPI. Secondly, we wished to determine the strength of predictive association in the relationship between lateralized functional deficits and personality organization. A localization key (Russell, et al., 1972) was applied to the "Reitan-Battery" test results for 94 patients who were referred for neuropsychological testing. Based on this approach, 15 pairs of patients were selected who were "left" or "right" hemispheric dysfunctional in terms of test performance. Pairs were  matched for age and "average impairment rating" (Russell, et al., 1972). Their MMPIs were also designated "neurotic" or "psychotic" using the Goldberg Psychotic Index (Goldberg, 1972). The results suggest that patients with deficits in left hemisphere functions tend to score in the psychotic range and patients with deficits in right hemispheric functions tend to score in the neurotic range of the MMPI Goldberg Index. In this set of data there was a 38% reduction in error of predicting neurotic-psychotic category but knowing whether the patient was left or right hemispheric dysfunctional in terms of neuropsychological tests.


Effect of item arrangement on perceived numerosity: randomness vs regularity. Subjects were shown pairs of dot patterns, a regular one and a randomly arranged set, and were asked to say which appeared more numerous. In three experiments using 53 college students regular patterns appeared significantly more numerous than random arrays, with an average illusion of 5.5%. The results were discussed in relation to the breakdown of conservation of number.


Instructional control of sleep reduction. Nightly sleep of 8 college students was gradually reduced from baseline levels by instructions implemented in a multiple baseline, changing criterion design. The reduction phases were 5%, 15%, and 30% decreases. Performance, academic, and sleepiness measures were collected. Consistent reductions occurred for all subjects from mean daily sleep times of 7.71 to 6.20 hr. per night, a 20% decrease. No negative side-effects were observed and subjects reported they enjoyed the additional free time afforded by reducing their sleep.


Three studies of personality: undergraduate students in physical education. In Study I, 85 male undergraduate physical education majors were compared to the norms on the 1962 16 PF test; Ss were higher in ego strength, dominant, enthusiastic, practical, naive, self-assured, and group-dependent. In Study II, 50 similar Ss took the 1967 test and were lower in intelligence, higher in superego strength, and were more practical and controlled. In Study III, 39 similar female Ss took the 1967 test and were lower in intelligence, reserved, practical, and conservative. Centiles calculated from the raw scores showed the groups deviated from the normative groups by 15 points or more on some of these traits. Findings generally agree with previous work using the same instrument and disagree with common conclusions regarding fitness for teaching by other investigators using different instruments.


The perception of familiar stimuli.

The perception of familiar stimuli. A model is described for the processing of word-like (regular) and non-word-like (irregular) letter strings in a situation where either type of string may occur. It is proposed that each type of string is processed by specialised routines which are deployed contingently on an initial decision about the regularity of an item. Three experiments involving word/nonword and same/different responses investigate how the processing of a string is affected by the brief exposure of a prior string. It is shown that processing is interfered with less when both strings are of the same degree of regularity than when they are not. The model is revised and extended in the light of the results obtained as well as some theoretical considerations.


The contribution of relational factors to line-length matches. Both Kunnapas and Rock and Ebenholtz investigated the effects of surrounding-frame size upon line-length judgments. Whereas Kunnapas obtained errors of the order of 10-15%, typical of those which occur in other geometrical illusion figures, Rock and Ebenholtz reported errors closer to 100%. Rock and Ebenholtz claimed that perceived size is largely relationally determined and that this fact was obscured in Kubnapas experiment by allowing observers to compare the test lines directly with each other and within a common framework provided by the wall of the room. On the contrary, the experiments reported here suggested that errors in the Rock and Ebenholtz study may have been inflated by their use of nondirective instructions and by the confounded effects of other variables. When the Rock and Ebenholtz experiments were repeated with adequat controls over these variables, the effect of surrounding frames on line-length matches were of the order of 15-19%, similar to those of Kunnapas but much smaller than those reported by Rock and Ebenholtz. The complexity of the stimuli in the Rock and Ebenholtz type of experiment is such, however, that the effects of a number of variables and possible cue conflicts remain to be investigated.


Away from a unisex psychology: individual differences in visual sensory and perceptual processes. Four tests of visual perception were given to twenty-five men and twenty-five women. These were a test of acuity, threshold for four field positions, visual persistence, and a measure of comfortable brightness. Subjects also completed five personality questionnaires. In most measures, differences were found to be related to sex rather than to personality factors. In fact, the analyses performed suggest that persenality tests do not measure equivalent processes in men and women. Correlational anaylsis showed all visual functions to be independent of one another with the exception of photopic acuity and scotopic threshold, which were highly correlated. Two new findings on the visual system emerged which have not been reported elsewhere: (i) Four distinct dark adaptation curves were produced, and have been labeled as exponential, flat-exponential, linear, and plateau. All subjects fell into one of these categories and showed a consistent trend to exhibit these curves for all field positions. (ii) Highly significant differences were found in sensitivity for the four visual fields, the upper field was superior, followed by the right, then left, with the lower visual field considerably poorer.


Sex differences in visual persistence: experiments on the Ganzfeld and afterimages. Sex differences were investigated in two experiments on visual persistence: the Ganzfeld and the afterimage. Males were found to hold visual sensation longer than females, particularly in the Ganzfeld where there was little overlap of scores. Variability of experience in the Ganzfeld was also greater for males and they commonly reported 'blank-out' effects while females did not. There was further evidence from both experiments that females are more responsive to the long-wave region of the frequency spectrum.


Striate cortex potentials related to eye movements in the light and in darkness in the waking human. Potentials in relation to eye movements were studied by means of direct recording of the striate cortex in a waking man. In a lighted environment, the usual evoked potential--lambda response--was obtained and was clearly visible after each eye movement. In complete darkness no individual potential was observable by means of visual analysis after each eye movement, but a slow potential of low amplitude could be obtained by superimposition and averaging of the cortical striate activity time-locked to the start of a series of eye movements. This eye-movement potential showed a longer latency and a lower amplitude than the lambda response. These data are discussed in reference to those obtained in the cat and the monkey; the significance of this eye-movement potential in darkness as a 'corollary discharge' is considered.


The aftereffect of tracking eye movements. When observers tracked moving stripes across a background either of stationary stripes, or of stripes moving in the opposite direction, they saw a clear motion aftereffect when the stripes stopped moving. The direction of this aftereffect was opposite to that of the previously tracked stripes, and was thus the same as the direction of the retinal movement of the non-tracked stripes. This aftereffect of tracking was shown not to depend upon slippage of the tracked contours on the retina during tracking, or upon the saccadic phase of optokinetic nystagmus. The effect showed storage over a period of time with the eyes shut. It appears that the effect is due to induced movement, and arises originally from stimulation of the retina by background contours in the tracking phase. This was shown by confining the view of the moving target to one eye, while permitting both eyes to be exposed to background stimulation during tracking. After such stimulation the magnitude of the aftereffect was equal in the two eyes.


The perpendicular error and the vertical effect in children's drawing. It has been known for some time that children have particular difficulty drawing lines that are not perpendicular. But this difficulty has not been studied systematically. By systematically varying, in three experiments, the baseline, the response, and the kind of figures to be copied, we showed that the tendency to draw angles as more perpendicular than they actually are is a general one which occurs as much with abstract as with meaningful material and with radically different responses. We also discovered an unexpected effect, the vertical effect, which takes the form of the error occurring much less when a vertical baseline is involved than with other baselines.


The magic number 4 +/- 0: a new look at visual numerosity judgements. Visual numerosity judgements were made for tachistoscopically presented linear arrays of dots or lines. The interelement interval (which could be specified in spatial frequency terms) was constant for a given array but varied across conditions. A clear limit in the accuracy of numerosity judgements was found to be set at 4 for regularly spaced elements with spatial frequencies below approximately 10 cycles/deg (element and interelement interval of 0-05 deg). This limit in terms of accuracy is accompanied by a fast and almost constant response time for arrays of 4 or less, compared to response times for arrays of more than 4 elements. The limit in accuracy falls to 2 elements rather than 4 for spacing narrower than 0-05 deg alghough with such spacing the elements are still easily resolved. The limit of 4 is found if the stimulus is a bright afterimage, lasting for approximately 60 s. This result suggests that the limit is independent of the time allowed for a single fixation and is a perceptual limit rather than a limit in some memory buffer. 'Numerosity' units are propsoed to account for the results.