Skin conductance responding/nonresponding and pupiliometrics in chronic schizophrenia. A confirmation of Gruzelier and Venables. In a number of reports, Gruzelier and Venables have demonstrated that about 50% of the schizophrenic population do not show the skin conductance orienting response (S.C.O.R.), while those that do respond, do not show normal habituation. Zahn (Orienting response in schizophrenics. J. Nerv. Ment. Dis., 162: 195-199, 1976) has questioned the bimodality of the S.C.O.R. in schizophrenia and suggests that responding/nonresponding could well be due to differential effects of phenothiazine medication. In two experiments (with equally medicated patients), in two different hospitals, the present report confirms the finding of a large proportion of nonresponding in schizophrenia but also suggests that both normal and nonhabituation are seen within schizophrenics and normals. Differential pupillary dilation and constriction parameters are seen in responders and nonresponders although both of these patient groups show tachycardia (the most usual effect of phenothiazines) in comparison to the normal group. The results do not fit easily into the differential effect of phenothiazines hypothesis proposed by Zahn.


Phenothiazine death: an unusual case report. This paper is a case report of sudden, unexpected autopsy-negative death in a hyperactive, hopspitalized patient being treated with a modified schedule of rapid tranquilization. The data of the study suggest that death was caused by phenothiazines and that phenothiazines can cause clinically significant depression of the medullary respiratory centers of the brain stem. Clinicians should monitor rate and quality of respirations as well as blood pressure closely when schedules of rapid tranquilization are implemented.


Changes in environmental life events and their relationship to psychiatric hospital admissions. This study was designed to determine if differences exist in the number of stressful life events experienced by individuals precipitating a first admission vs. readmission to an inpatient psychiatric facility based on diagnostic classification and sex. The subjects consisted of adult patients diagnosed as schizophrenic, depressive neurotic, or chemically addicted, who had not been hospitalized for psychiatric problems for at least 12 months prior to the current hospitalization. The Holmes and Rahe Social Readjustment Rating Scale was used to quantify the life stresses experienced. A 3 X 2 X 2 analysis of variance showed no significant differences between groups.


Patient variables supporting chronic illness. A scale for measuring attitudes toward respiratory illness and hospitalization. To enable the study of attitudes as one basis for the maintenance of chronic illness, a scale of patient attitudes toward chronic respiratory illness and hospitalization was developed. Key cluster analysis was performed on a large set of statements which had been rated by patients hospitalized for chronic asthma in a residential treatment setting. The analyses identified six attitudinal clusters: Optimism, Negative Staff Regard, Specific Internal Awareness, External Control, Psychological Stigma, and Authoritarian Attitudes toward Illness and Hospitalization. The clusters showed good internal consistency, reliability, and generality. The low to moderate inter-relationships among clusters suggest the existence of identifiable patterns of attitudes which may be related to differences in coping styles to chronic illness.


Distribution of dopamine in the rat cerebral cortex. The rat cerebral neocortex was sectioned by 3 transverse cuts and analyzed for dopamine and noradrenaline. Dopamine concentration decreased gradually from the rostral (97 +/- 4 ng/g) to the caudal (59 +/- 2 ng/g) end of the neocortex. Also, the noradrenaline concentration was highest in the rostral part (269 +/- 6 ng/g) and decreased gradually reaching a concentration of 238 +/- 3 ng/g in the caudal part. Since the quotient dopamine/noradrenaline showed similar changes in the neocortex parts investigated the data support the view that dopamine serves as a transmitter in cortical neurons apart from being a precursor for noradrenaline.


In vivo assessment of decarboxylase inhibition or potentiation: urinary dopamine and L-dopa output after L-dopa administration. In the L-Dopa treated rat, a decreased urinary output of free and conjugated dopamine and an increase in free and conjugated L-Dopa excretion after administration of decarboxylase-inhibiting drugs provide a good in vivo index of Dopa decarboxylase inhibition. With the exception of free dopamine output, which showed an equivocal change, these measurements appear to provide a good yardstick of decarboxylase status in man also. Using this approach, it was not possible to find any evidence of facilitation of decarboxylase action, in L-Dopa-treated parkinsonians given pyridoxine supplements, to account for the ability of this compound to neutralize the beneficial effect of L-Dopa.


Separation of pineal extracts by gelfiltration. V. Location by paper chromatography of a sheep pineal principle inhibiting hypophyseal gonadotropic activity. Previously we were able to isolate by simple and mild methods from an aqueous sheep pineal extract an inhibiting principle action on the anterior hypophysis of male rats in vitro. This substance could be located by paper electrophoresis. In the present paper we describe the further purification of this active principle by paper chromatography in two different solvents. In two regions possessing a special fluorescence an inhibiting factor of the gonadotropic activity of the anterior pituitary was found in vitro.


Study of deterioration in long-term treatment of parkinsonism with L-dopa plus decarboxylase inhibitor. 35 parkinsonian patients have been treated over 3 years with L-Dopa combined with benserazide. After an impressive improvement during the first months of treatment a slow but significant deterioration of the patient's condition was observed. At the end of the observation period however their condition was still significantly better than before starting the treatment. A reduced mean L-Dopa dosage was ruled out as the cause of this deterioration. Withdrawal of the L-Dopa therapy for a few days in 13 patients provided strong evidence that it is due to the progression of the disease and to a partial loss of L-Dopa efficacy.


Present morality in parkinson's disease: the ratio of observed to expected deaths with a method to calculate expected deaths. Excess mortality, i.e. more deaths than expected in a similar normal population, has been reduced in Parkinson's disease by levodopa. A California series and a large collaborative study throughout the United States show the ratio of observed to expected deaths to be normal. In contrast, a New York study was similar patients and a Montreal group of much more severely disabled patients showed greater mortality. The reasons for these differences are unclear, but some variations in results may be attributed to different methods of calculating expected deaths to derive the ratio of observed to expected deaths.


Influence of age and time interval between death and autopsy on dopamine and 3-methoxytyramine levels in human basal ganglia. The caudate nuclei and putamens of 30 human brains were analyzed for dopamine and its metabolite 3-methoxytyramine, most of which was presumably formed from dopamine postmortally. It was found that dopamine and the sum (dopamine + methoxytyramine) but not methoxytyramine declined with the time interval between death and autopsy as well as with age.


Time course of nigrostriatal degeneration in parkinson's disease. A detailed study of influential factors in human brain amine analysis. It could be shown that the post mortem analysis of biogenic amines, precursors and metabolites in the human brain are influenced by various parameters. 1. The patient's medical history; long term observations of the course of the disease; age; sex. 2. Terminal illness; duration of terminal illness. 3. Previous treatment with drugs; last drugs. 4. Time interval between last drug treatment and death; time of day and date of last drug consumption. 5. Rapidity of death; time of death; duration of coma. 6. Changes occurring in tissues before death; patients' constitution during terminal illness. 7. Changes in concentration of the biogenic amines, precursors, and metabolites depending on the patient's age. 8. Time between death and necropsy. 9 Dissection of specimen. 10. Period of storage; temperature of storage. 11. Chronbiological rhythm of substances. 12. Methods of assayL 13. Homogeneity of all mentioned parameters in the control group and patient's group. For the first time it could be demonstrated that the time course of nigrostriatal degeneration, independent of the age of the parkinsonian at the beginning of the illness, is linear for the last stage and the denervation progressively increases as the duration of illness progresses.


Synaptic development in the crayfish opener muscle. Nerve terminal regions in walking leg opener muscles of several crayfish of different ages (0 to 245 days after hatching) were examined by means of electron microscopy. This muscle is innervated by two axons (excitatory and inhibitory) and at maturity contains three classes of synapse: excitatory and inhibitory neuromuscular synapses, and inhibitory axo-axonal synapses. The muscle itself is initially a syncytium, which gradually becomes subdivided into distinct "muscle fibers" as the animal matures. Innervation was not found in the opener muscle just before or just after hatching, but was present in restricted locations on the inner side of the muscle within a few days of hatching. As the muscle enlarged and became subdivided, innervation appeared in various other locations. Synaptic contacts were located in young stages soon after hatching, and in later stages. Morphological differences characteristic of excitatory nerve terminals could be found even at the earliest stages of innervation. Both excitatory and inhibitory synapses, but particularly the former, showed evidence of progressive enlargement to a final size within the first two months, and no evidence for further enlargement of existing synapses thereafter. Synaptic maturation also involved the appearance of presynaptic "dense bodies" though to be regions at which transmitter substance is preferentially released. Nerve terminals at different levels of maturation were observed in opener muscles of young crayfish. Clear evidence for differential maturation of the three types of synapse present in this muscle was obtained. The inhibitory neuromuscular synapses attained their final average size and developed their dense bodies sooner than the excitatory neuromuscular synapses. The inhibitory axo-axonal synapses were the last to appear and to mature.


A regional study of developing rat brain: the accumulation and distribution of proteolipid proteins. The accumulation and distribution of proteolipid proteins in rat brain and selected brain regions (cerebellum, cerebral cortex, basal ganglia, and hippocampus) were studied during early postnatal development. In whole brain an eightfold increase of proteolipid was observed between ten and 33 days after birth. This was reflected in the separate regions examined where the proteolipid protein content increased six- to ten-fold during the same period. The basal ganglia and cerebral cortex contributed the greatest amount to the total proteolipid present. However, at 28-33 days the greatest concentration (mg/g tissue) was observed in the basal ganglia and hippocampus. When the proteolipid protein preparations were examined by sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis, distinctive, heterogeneous patterns for each brain region were obtained. Proteolipid from basal ganglia (the region richest in white matter) consisted primarily of two major protein bands with apparent molecular weights of approximately 21,500 and 26,000. Both of these bands dramatically increased in quantity during myelination, and the larger protein coelectrophoresed with isolated myelin proteolipid protein. Both bands were also found present in proteolipid preparations from the other brain regions but in varying amounts relative to the total. The data suggest that the increase in proteolipid observed during this developmental period was due in large measure to the accumulation of myelin-specific proteolipids, but also that a significant proportion of the increase was due to the accumulation of nonmyelin components.


A mutant of Paramecium with increased relative resting potassium permeability. Fast-2, a membrane mutant of Paramecium aurelia, is due to a single-gene mutation and has behavioral abnormalities. Intracellular recordings through changes of external solutions were made. The mutant membrane hyperpolarized when it encountered solutions with low K+ concentration. This hyperpolarization and other associated activities were best observed in Ca- or Na-solutions devoid of K+. Membrane potential was plotted against the concentration of K+ (0.5 to 16 mM) in solutions of fixed Na+ or Ca++ concentration. The slopes of the curves for the mutant membrane were steeper than those for the wild type at the lower concentrations of K+. Inclusion of 2 mM tetraethylammonium chloride (TEA-Cl) counteracted the mutational effects. Spontaneous action potentials in Ba-solution and the electrically evoked action potentials in various solutions are normal in this mutant. We conclude that the resting permeability to K+ relative to the permeabilities to Na+ and Ca++ has been increased by the mutation.


Discharge pattern of single motor units in the tonic vibration reflex of human triceps surae. Using a single fibre EMG electrode the firing pattern of 46 motor units in the triceps surae has been studied during vibration of the Achilles tendon at frequencies of 25--200 Hz. Potentials activated in the tonic vibration reflex (TVR) were phase-locked to the vibration cycle but tended to become somewhat less so with continued vibration. The firing pattern of voluntarily activated motor units became locked to the waveform by the application of the vibrator. The discharges of 21 motor units were studied during low threshold (sub-M wave) tetanic stimulation of the tibial nerve at 25--100 Hz. No evidence was found of synchronization of potentials activated in the resulting tonic contraction. During weak voluntary contractions, stimulation also failed to regularize voluntarily activated motor units. The findings can be reconciled by postulating that, in normal man, vibration activates monosynaptic and polysynaptic pathways, the latter circuit being adequate to generate reflex contraction, while the former merely affects the temporal patterning of the motor outflow.


Diagnostic yield of analysis of the pattern of electrical activity and of individual motor unit potentials in myopathy. The analysis of the pattern of electrical activity and of individual motor unit potentials in the same muscle both identified about 90% of 41 patients as having a myopathy. The pattern of electrical activity was analysed during a force which was a fixed fraction of maximum; individual motor unit potentials were analysed during weak effort. The two methods supplement each other as some of the patients were identified only by one or by the other of the two procedures. The parameter of the pattern of electrical activity which was most often abnormal was the ratio: numbers of turns to mean amplitude between turns.


Correlation between diffuse EEG abnormalities and cerebral atrophy in senile dementia. Thirty-five elderly patients were investigated because of clinical signs of dementia. The presence or diffuse cerebral atrophy, and its severity, were determined by the use of computed tomography (CT scan). All of the patients were also examined by electroencephalography (EEG), and the presence of diffuse abnormalities, especially diffuse slowing, was noted. Specifically, patients with normal or near-normal EEGs were compared with those with severe diffuse slowing. No correlation between the presence or severity of diffuse EEG abnormalities and the degree of cerebral atrophy as measured by CT scan was found. Though the EEG is clearly identifying physiological dysfunction of nerve cells in demented patients it does not appear to be reliable tool for the prediction of diffuse cerebral atrophy in this population.


Evidence for the presence of a vasoactive substance (possibly involved in the aetiology of cerebral arterial spasm) in cerebrospinal fluid from patients with subarachnoid haemorrhage. Cerebrospinal fluid from patients with subarachnoid haemorrhage and cerebral arterial spasm contracted the isolated basilar artery and potentiated contractions produced by 5-hydroxytryptamine, noradrenaline, and six prostaglandins. The unidentified substance in cerebrospinal fluid probably plays a role in the aetiology of cerebral arterial spasm.


Relationship between plasma and lymphocyte linoleate in multiple sclerosis. The linoleate level in total lipids was measured in lymphocytes from control subjects and patients with multiple sclerosis. A small but significant decrease was found in cases of multiple sclerosis. The percentage composition of lymphocyte fatty acids was determined in rats fed diets with various linoleate contents. There was a correlation between lymphocyte linoleate and plasma linoleate in both humans and rats.


Orbicularis oculi reflex in brain death. The early and late components of the orbicularis oculi reflex were absent bilaterally in three patients who fulfilled the clinical and electroencephalographic criteria of brain death. A response to peripheral facial nerve stimulation was obtained in all. These preliminary observations suggest that the study of the orbicularis oculi reflex is a simple, objective, bedside neurophysiological test of brain stem function, complementing the electroencephalogram in the diagnosis of brain death.


The Munich Coma Scle (MCS).

The Munich Coma Scle (MCS). The level of coma can be measured by the assessment of changes of behaviour after different intensities of stimulation. Two additive scales (Guttman scales) for susceptibility to stimulation and reactivity were developed, constituting the Munich Coma Scale (MCS). The findings of previous investigations were repeated in a new sample of 67 comatose patients. Implications of the additivity of reactivity are discussed and related to the concept of 'behavioural arousal' advanced in the recent literature.


Alexander's disease presenting as astrocytoma. A case of progressive fibrinoid degeneration of astrocytes is described. Symptoms began with convulsions at the age of 6 weeks and cerebral tumour was suspected because of enlargement of the head, increased intracranial tension, and marked proliferation of astrocytes in the brain biopsy which was interpreted as an astrocytoma. Fibres and granules staining deeply with PTAH are a constant feature of the few cases so far described. The aetiology is unknown but an inherited metabolic defect of astrocytes may be responsible.


The shoulder girdle disc.

The shoulder girdle disc. Weakness and wasting of shoulder girdle muscles occurred in 40 cases of cervical spondylosis at the level C 3/4 intervertebral space with spinal cord, and lower with nerve root compression. Often there was no sensory loss. Prompt recovery followed Cloward's operation in more than half the cases. The pathogenesis and the need for early diagnosis and radical treatment of the condition are considered.


Hypertrophy of the branchial muscles. A case with unusual features. A detailed morphological and histochemical description of pathological changes previously unreported in hypertrophy of the masseter muscle is presented. The patient differed from earlier cases in reacting adversely to anaesthetic agents.


Lateral canthal advancement of the supraorbital margin. A new corrective technique in the treatment of coronal synostosis. In coronal synostosis, in addition to fusion of the coronal suture, the frontosphenoidal and frontoethmoidal sutures are usually closed. A linear craniectomy along the coronal sutures does not affect the synostotic process at the base of the skull. The facility with which the supraorbital margin could be mobilized in Tessier's method of craniofacial repair suggested to us that we could easily modify our approach to coronal synostosis and advance the supraorbital margin, creating an artificial suture at the base of the skull and allowing for proper correction of this disorder. During the past 3 years, we have treated 15 patients with coronal synostosis by this technique, which we have termed lateral canthal advancement. The method of this form of surgical management and its results are discussed.


Physiopathogenesis of subdural hematomas. Part 1: Histological and biochemical comparisons of subcutaneous hematoma in rats with subdural hematoma in man. The dorsal subcutaneous injection in rats of 12 ml or more of autologous hemolyzed whole blood clotted in situ induced the formation of sterile, hemispheric lesions, 47% of which showed an initial decrease in volume followed by a progressive enlargement. The behavior, histology, and biochemical characteristics of the liquid contents of these lesions were found to be remarkably similar to those of subdural hematomas in man. To evaluate the role of the various blood components that may have influenced the formation and growth of these lesions, more than 150 clots composed of human platelet-free plasma, autologous hemolyzed blood, or autologous whole blood were implanted subcutaneously in rats by either surgical or injection techniques. The in vitro behavior of the different clots used was also assessed. This systematic approach led to the following conclusions: 1) the composition and volumes of the clots are critical variables; 2) plasma-fibrin provides the matrix shape of the lesions; 3) the breakdown products derived from erythrocytes, hemoglobin, leukocytes, and other solid blood elements induce neomembrane formation and contribute to the lesion's subsequent growth; and 4) inflammation mechanisms appear to be essential, while cerebrospinal fluid plays no discernable role in this process.


Physiopathogenesis of subdural hematomas. Part 2: Inhibition of growth of experimental hematomas with dexamethasone. A previously described experimental hematoma model, achieved by the subcutaneous injection of 12 ml of autologous hemolyzed blood clotted in situ, was made in 33 rats. Sventeen animals served as controls; the other 16 received daily intra-muscular injections of dexamethasone. After an initial decrease in size, 47% of the lesions in the control animals enlarged to a mean weight of 12.1 +/- 2.5 gm, while the lesions in the 16 steroid-treated rats weighted 3.2 +/- 0.70 gm (p less than 0.01). Histologically, lesions from the steroid group showed absence of neomembrane formation. These data offer further support to the theory that the neomembrane development and subsequent enlargement of subdural hematomas is due to inflammatory reactions of tissues in contact with large blood clots.


Electron microscopic study on the satellite cell in the muscle of Duchenne muscular dystrophy. The ultrastructure and the distribution frequency of the satellite cells of biopsied muscle fibers from 10 patients with Duchenne muscular dystrophy (PMD-D) and 10 patients free of neuromuscular diseases were studied. The increase in the number of satellite cells in muscles of patients with PMD-D over those in the normal control cases were noted. Markedly increased pinocytotic vesicles or the thin and thick filaments were found in these satellite cells. The possible role of satellite cells was discussed.


Clinical and pathological study of 24 cases of gliosarcoma. The authors review the clinical and pathological features of 24 patients with gliosarcoma. The study revealed the following findings. Gliosarcoma occurs more frequently than is indicated in the literature, and in our series was present in 8% of all cases of glioblastoma multiforme. The presenting features are not significantly different from those of glioblastoma multiforme. The lesion often presents itself at surgery as a firm, well circumscribed mass within the temporal lobe, and at surgery it is commonly mistaken for a meningioma. There is an increased likelihood of metastasis compared to that of glioblastoma. The prognosis is no worse than that of glioblastoma, in spite of the addition of sarcomatous elements.


Experimental autoimmune myasthenia gravis: a sequential and quantitative study of the neuromuscular junction ultrastructure and electrophysiologic correlations. Neuromuscular junction ultrastructure in rat forelimb digit extensor muscle was sequentially and quantitatively investigated in experimental autoimmune myasthenia gravis (EAMG). Experimental animals were immunized with highly purified eel electroplax acetylcholine receptor protein plus complete Freund's adjuvant and B pertussis vaccine; control animals received only adjuvant and vaccine. During the first 7 days (latent period) after immunization end-plate structure and neuromuscular transmission remained normal in the experimental group. Between day 7 and 11 (acute phase) mononuclear cells infiltrated those regions of muscle where the end-plates were located and there was intense degeneration of the postsynaptic regions with splitting away of abnormal junctional folds from the underlying muscle fibers. Macrophages entered the gaps thus formed and removed the degenerating folds by phagocytosis. The nerve terminals were displaced from their usual location but maintained their structural integrity. Neuromuscular transmission was blocked in many muscle fibers. Miniature end-plate potentias (MEPPs), detectable in only a few fibers, were of abnormally low amplitude. After day 11 (chronic phase) the nerve terminals returned to the highly simplified postsynaptic folds became reconstituted and again degenerated. Immature junctions with poorly differentiated postsynaptic regions and nerve sprouts near end-plates were also observed. In two animals relapsing during the chronic phase degeneration of the postsynaptic folds was more intense than in the other chronic-phase animals. The posysynaptic membrane length and length per unit area and the MEPP amplitudes were significantly decreased in all chronic phase animals and the decreases were greater in the relapsing than in the non-lapsing animals. Minor morphometric alterations were also observed in the nerve terminals. These might have been secondary to the postsynaptic changes. The postsynaptic region is the primary target of the autoimmune reaction in EAMG. The ultrastructural, morphometric and electrophysiological abnormalities of the end-plate in chronic EAMG resemble those which have been observed in human myasthenia gravis.


Ultrastructural evidence for CSF production by a choroid plexus papilloma. A choroid plexus papilloma (CPP) removed from a child with communicating hydrocephalus was studied with the electron microscope. In addition to the usual organelles, the neoplastic epithelial cells contained polypoid microvilli, cilia, coated pinocytotic vesicles, and apical tight junctions. The basal surfaces were consistently juxtaposed to large capillaries lined by fenestrated endothelium. The fine structural details of the tumor were essentially the same as those of normal CP and thus appeared ideally suited for an active secretory function. Two additional features in this tumor were tubular bodies in the endothelium and well developed pericytes. The present findings provide strong evidence for cerebrospinal fluid production by CPP, a phenomenon that has long been suggested by clinical observation.


Experience with Arnold-Chiari malformation, 1960 to 1970. A retrospective study of 60 adult patients with Arnold-Chiari malformation revealed that certain presenting clinical syndromes, although not pathognomonic, seemed to have definite prognostic significance. Surgical management by suboccipital decompression led to remarkable and enduring improvement in 65% of patients followed for as long as 14 years. In some patients, however, the initial postoperative benefit tended to fade into an insidious progression of neurological deficit. Despite operation, 18.6% of patients eventually experienced progressive neurological deterioration. Patients who presented with paroxysmal intracranial hypertension or cerebellar dysfunction had the best prognosis. Evidence of central cord involvement was the single most detrimental factor to neurological recovery.


Restricted fluid intake. Rational management of the neurosurgical patient. Water balance studies in postcraniotomy patients indicate that restriction of fluid intake to 1 liter daily maintains the patient in homeostatic balance. A larger fluid intake will expand the extracellular space and presumably unfavorably influence cerebral edema. Daily observation of serum sodium and osmolarity and blood urea nitrogen, and preserving their normalcy, is a rational way of regulating fluid intake of the brain-injured patient. Fluid restriction should be used with caution if hyperosmolar agents, diuretics, or dexamethasone are also administered.


Meningiomas causing spontaneous intracranial hematomas. Four cases of spontaneous intracranial hematomas caused by unsuspected meningiomas are reported. Nine previous cases were found in the literature and the entire series of 13 cases is reviewed. Because of their unusual clinical presentation, these cases were not diagnosed correctly prior to radiological studies. Hypertension, trauma, and blood dyscrasia played no significant pathogenetic role. The histological features of these hemorrhagic meningiomas are described, and the importance of adequate radiological investigations and early radical surgery is stressed.


Reopening some occluded carotid arteries. Report of four cases. Four cases are presented in which intermittent ischemic symptomatology was referable to a cerebral hemisphere. Arteriography in each case showed complete occlusion of the ipsilateral internal carotid artery in the neck with collateral filling of the ipsilateral intracranial carotid artery into the cavernous portion. Endarterectomy was performed successfully in each case from 1 to 5 weeks after the demonstrated complete occlusion. The collateral circulation to the intracranial portion of the internal carotid artery and the probable reasons for the technical success of these operations are discussed.


Treatment of hydrocephalus and bilateral subdural effusions in a patient with closed sutures. Case report. For management of bilateral subdural hematomas in a hydrocephalic child with fused sutures, a simple technique is described that involves minimal cranial procedures for modification of an already installed ventriculoperitoneal shunt system.


Persistent hypoglossal artery associated with aneurysms. Report of two cases. Two cases of persistent hypoglossal artery associated with aneurysm are presented. In one case the aneurysm arose from the anterior communicating artery and in the other from the persistent hypoglossal artery itself. Both aneurysms were treated successfully with direct surgery.


Value of routine cerebral radionuclide angiography in pediatric brain imaging. In addition to static brain images, cerebral radionuclide angiograms (CRAGs) were performed in 1,051 children to determine the value of routine radionuclide angiography. The CRAG resulted in a statistically significant increase in detection of abnormalities (p less than 0.01), as it provided the only evidence of confirmed abnormalities in 60 children (5.7%). The CRAG helped detect subdural fluid collections, cerebrovascular disease, and cerebral cysts, but it was of little value in detecting hydrocephalus. For maximum diagnostic yield, a CRAG should be performed with all pediatric brain-imaging studies.


Routine renal imaging after 99mTc-glucoheptonate brain scans. Immediately after brain scanning with 99mTc-glucoheptonate, the kidneys were imaged in 200 prospectively studied cases. Abnormalities were found in 22 cases (11%); they included renal metastases, renal cysts, and kidney displacement or obstruction by masses. In five instances, significant previously unknown abnormalities were found. The renal contours were usually better seen than on intravenous urograms or bone scans. Most kidney studies could be completed in less than 2 min, making renal imaging worthwhile as a low-cost high-yield routine addition to brain scanning.


Persistent dural cerebrospinal fluid leak shown by retrograde radionuclide myelography: case report. Following inadvertent spinal anesthesia for delivery, a patient developed incapacitating post-lumbar puncture headache that persisted for 9 weeks. Scintigrams of the lumbar region, obtained after injection of 99mTC-human serum albumin into the cisterna magna, showed the cerebrospinal fluid leak. Blood patch repair was carried out, with immediate relief of all symptoms. Because of subsequent atypical headaches, a second cisternogram was done by the same technique. This study confirmed that there was no further dural leak, and other evidence indicated that the recurrent headache was related to functional problems.


Tissue distribution of 203 Pb-acetate: comparison with 67 Ga-citrate as an abscess-localizing agent. Since 203Pb-acetate accumulates in necrotic tumor tissue, the possibility was raised that it might also accumulate in other necrotic tissue such as abscess. We first studied the tissue distribution and excretion of 203Pb-acetate in control rats at 4, 24, 48, 72, and 96 hr. An enterohepatic circulation for lead is suggested. We then compared the uptakes of 203Pb-acetate and 67Ga-citrate in experimental abscesses in rats. The mean gallium accumulation in the abscess was 10 times that of lead at 24 hr and 12 times that of lead at 72 hr. The abscess-to-tissue ratios were greater for gallium for every tissue examined, although the abscessed areas were clearly visualized by scanning at 24 and 72 hr with both agents. With the exception of blood, abscess-to-tissue ratios for 67Ga at 24 hr were higher than or equal to those at 72 hr. However, the 67Ga ratios for the inflamed tissue surrounding the abscess to muscle and blood were higher at 72 hr than at 24 hr, which suggests that inflammation without abscess might be better identified by gallium scanning at 72 hr.


Preparation of a chemically characterized 99mTc-penicillamine complex. In the reaction labeling penicillamine with 99mTc, serveral different chemical states of 99mTc were observed to occur with slight changes in the labeling conditions, such as the concentrations of penicillamine, 99mTcO4-, stannous chloride, and hydrogen ion. We have studied the effects of these conditions on the formation of the monomer complex that we call Complex I, in which 99mTc is coordinated with the penicillamine as 99mTcO+2. Our approach is based on the thesis that Complex I formation competes with 99mTcO+2 hydrolysis, which leads to other 99mTc complexes. On this basis, the specific labeling conditions for Complex I formation have been established. Highly reproducible in vivo behavior in mice and rats was obtained with this chemically controlled Complex I.


Technetium-99m-kethoxal-bis(thiosemicarbazone), an uncharged complex with a tetravalent 99mTc state, and its excretion into the bile. Technetium-99m-kethoxal-bis (thiosemicarbazone) complex (99mTc-KTS), a potentially useful radiopharmaceutical for cholescintigraphy, is prepared by the reaction of KTS with 99mTcO4- in the presence of stannous chloride. Under the described conditions, a complex extractable with organic solvent was detected. Thin-layer chromatography, electrophoresis, and spectrometric analysis indicate the formation of an uncharged 99mTc(IV) complex. Organ distribution and biliary excretion studies are described. The complex showed a marked highly reproducible accumulation in the gallbladder.


Gonadal radiation dose and its genetic significance in radioiodine therapy of hyperthyroidism. Published estimates of radiation dose to the gonads from 131I therapy of Graves' disease vary widely, largely because of differences in assumptions regarding the details of iodine kinetics. The calculations described in this paper show that hyperthyroid patients treated with 10 mCi of 131I will usually receive a total radiation dose to the ovaries or testes of less than 3 rad. Several common roentgenographic diagnostic procedures may involve a greater radiation dose and a greater genetic hazard than does the usual 131I treatment for hyperthyroidism. It is important to minimize total exposure to radiation, but it seems unreasonable to deny 131I treatment for hyperthyroidism to young men and nonpregnant young women on the grounds of genetic hazard alone.


Estimates of radiation dose to the embryo from nuclear medicine procedures. These phantom studies and computer calculations provide a direct means of estimating the radiation dose to the embryo resulting from the administration of a radiopharmaceutical to the mother during organogenesis. The specific absorbed fractions to the embryo from 19 source organs were computed for 12 monoenergetic photon energies. Tables of absorbed dose per unit cumulated activity, S, for the embryo as a target organ have been assembled for 99mTc, 111In, 113mIn, 123I, 131I, and 133Xe. In addition, the dose to the embryo was calculated for several of the radiopharmaceuticals for which the MIRD Committee has published dose estimate reports.


Contamination from 131I, 103Ru, and 239Np in the eluate of 99Mo-99mTc generators loaded with (n, gamma)-produced 99Mo. Iodine-131, ruthenium-103, and neptunium-239 are present as contaminants in the eluate of 99Mo-99mTc generators loaded with 99Mo prepared by thermal-neutron irradiation of enriched 98Mo. The elution pattern of each of these contaminants is determined, together with the amounts found in the eluate of all generators tested over a 7-month period.


Digital low-pass filtering.

Digital low-pass filtering. Random noise beyond the maximum signal frequency of the imaging system can be removed by low-pass filtering without compromising signal transmission.


Iodine-125-digoxin radioimmunoassay: comparison of commercial kits. Iodine-125-digoxin radioimmunoassay kits available from Abbott Diagnostics (AD), Dade Division (D), Schwarz/Mann (SM), and Clinical Assays (CA) were evaluated with respect to assay quality. The kit accuracies did not differ significantly at 2.0 ng/ml and the interassay coefficients of variation ranged from 9% (AD) to 21.4% (CA) The accuracy for all kits above 4 ng/ml is questionable, and since serum-dilution values correlated well with undiluted serum values, the dilution method of dose quantitation is preferable for levels above 4 ng/ml. Although all the kits were adequate, for evaluating digoxin at the 2ng/ml level, the Abott kit seems to be of slightly better quality.


Dietary influence on bile acid conjugation in the cat. Cats fed a semipurified diet containing casein as the source of protein develop taurine deficiency. In order to establish whether this had an adverse effect on bile, kittens and adult cats were fed the casein diet or that diet with a supplement of taurine, cystine, or methionine, and gall bladder bile was characterized for its taurine-glycine conjugation and the cholesterol: phospholipid: bile acid ratio. The data indicate that cats conjugate their bile acids almost exclusively with taurine, and though plasma and retinal pools of taurine are largely depleted by feeding the casein diet, the conjugation of bile acids is only moderately affected. A major conversion to glycine conjugation did not occur, but free cholic acid did increase with decreased taurine conjugation. Dietary supplements of methionine or cystine, precursors of taurine, failed to satisfy the taurine requirement for bile acids in kittens whereas methionine appeared to satisfy this requirement in adult cats. The cholesterol: phospholipid: bile acid profile was not appreciably altered by these dietary circumstances. It would appear that kittens may require dietary taurine and that taurine pools in cats may be biologically independent of one another.


Decreased plasma insulin but normal glucagon in rats fed low protein diets. Plasma glucagon and insulin were determined in rats fed three diets, one control and two low protein (LP 1 & LP 2). In LP 1, the protein omitted was replaced by carbohydrate while in LP 2, fat and alpha-cellulose replaced the omitted protein. Among rats fed LP diets ad libitum, food consumption decreased and body weight loss occurred. In order to separate the effects of reduced food intake and weight loss from the effects of LP diet alone, paired feeding and paired weight experiments were conducted. In another experiment, ingestion of a LP diet for 8 to 10 days was followed by refeeding the control diet for 5 days. The results demonstrate that plasma insulin was reduced in LP rats compared to the full-fed controls and pair-fed controls, the lowest levels being observed in rats fed LP 2 diet. Furthermore, the paired feeding experiment revealed that the diminished food consumption plays no significant role in lowering plasma insulin in LP rats. The refeeding experiment showed that the decline in plasma insulin in LP rats is a transient phenomenon and the plasma insulin promptly reverts to normal upon resumption of feeding the control diet. Plasma glucagon was unaltered throughout these dietary manipulations.


Teratogenic effects of magnesium deficiency in rats. The effect of severe magnesium deficiency on plasma magnesium levels in pregnant and nonpregnant rats and on reproduction was investigated. Magnesium deficiency produced a rapid fall in plasma magnesium concentration, in both pregnant and nonpregnant rats. At term, all implantation sites of pregnant rats fed a diet severely deficient in magnesium showed total fetal resorption. When pregnant females were fed the magnesium deficient diet only between days 6 and 14 of gestation, there was a high incidence of resorptions and gross malformations were seen in full term fetuses. The results demonstrate the rapidity of the effects of severe magnesium deficiency in pregnant rats and indicate the importance of the element for embryonic development.


Magnesium, calcium and zinc levels of maternal and fetal tissues in magnesium deficient rats. The interaction of magnesium with two other mineral elements, calcium and zinc, was studied in maternal tissues and fetuses of pregnant rats fed a magnesium deficient diet throughout gestation. Reduction in maternal femur magnesium and a trend for increased kidney calcium reflected the dietary magnesium deficiency. In fetuses, however, total magnesium content was reduced and , in addition, fetal zinc content was also lower than normal in the group most severly deficient in magnesium. The possible interpretation of this magnesium-zinc interaction is discussed.


Enhancement of Ca++ uptake by lactose in the rat small intestine. In previous experiments, lactose was shown to increase the absorption of Ca++ by the small intestine of the rat and other mammals. To further investigate the mechanism of the lactose effect, Ca++ uptake was studied in everted gut sac preparations. Gut sacs from the rat ileum were preincubated with or without lactose for 45 minutes, and then the tissue uptake of 45Ca over the first 3 minutes was measured in the presence or absence of lactose. The presence of 160 mM lactose increased the initial rate of Ca++ uptake in the first minute by 64% compared to the NaCl control. The lactose effect was dependent on the presence of lactose in the preincubation medium only and not on the presence of lactose during the measurement of Ca++ uptake. Lactose increased Ca++ absorption when the Ca++ concentrations ranged from 0.1 to 10 mM. However, the magnitude of the enhancement was dependent on the lactose concentration and was reduced below 160 mM lactose. When Ca++ and lactose uptake during a 45 minute period was measured in parallel experiments, no evidence for the co-transport of lactose and Ca++ into the tissue was found. These and other data indicated that lactose is not interacting directly with Ca++ in solution but is interacting with the absorptive cells of the intestine to increase their permeability to Ca++.


Fractors affecting the rate of gluconeogenesis from L-cysteine in the perfused rat liver. It has been shown that the net rate of gluconeogenesis from cysteine was only 10% the rate observed from pyruvate. This suggested that the rate limiting step in gluconeogenesis from cysteine was between cysteine and pyruvate. Evidence is presented showing that the cysteine-sulfinate pathway does not play a regulating role in the conversion of cysteine to glucose. Thus, liver cysteine desulfhydrase (CDS) activity and hydrogen sulfide production were evaluated for their potential effects. Liver CDS activity was increased by a 3 day starvation, by feeding a 90% casein diet or a 4% cysteine + 86% casein diet. In all cases the activity of the enzyme was in excess of that required to account for the rate of conversion of cysteine to glucose observed, thus the potential activity of this enzyme was not a rate limiting factor. The possible effect of H2S, an end product of the CDS reaction, on gluconeogenesis from cysteine was evaluated. The addition of NaHS abolished the glucogenic response observed from cysteine, but had very little effect on glucoeogenesis from lactate, suggesting that accumulated H2S may inhibit CDS, marking CDS rate limiting in the conversion of cysteine to pyruvate.


Comparison of the binding of various bile acids and bile salts in vitro by several types of fiber. The binding in vitro of the sodium salts of cholic acid, chenodeoxycholic acid, deoxycholic acid, taurocholic acid, taurochenodeoxycholic acid, taurodeoxycholic acid, glycocholic acid, glycochenodeoxycholic acid, and glycodeoxycholic acid by alfalfa, bran, cellulose, lignin, and cholestyramine was measured. Cholestyramine bound an average of 81.3% of all the bile acids and salts tested whereas cellulose bound only negligible amounts (1.4%). Of the other substances tested, lignin bound 29.2%, alfalfa, 15.9% and bran, 9.0%. No distinct pattern of binding was discerned. It is therefore apparent that the validity of statements concerning the effect of fiber on bile salf metabolism rests upon the specificity of the composition of the fiber involved and the bile acids or salts tested.


Changes in patterns of feeding activity, parotid secretory enzymes and plasma corticosterone in developing rats. The diet and feeding patterns of developing rats were determined from feed bin weight losses and analysis of stomach contents (details in a previous report). Parotid gland development in the same rats was assessed from the specific activities of the secretory enzymes alpha-amylase, RNase and DNase, with particular attention to the occurrence of circadian variations. The results indicate that during the first week post partum, rats suckle much more by day than by night but have no circadian cycles in their parotid glands. Between 10 and 20 days, there were no consistent cycles either in feeding activity or in parotid enzymes. The progressive change from milk to stock diet between 14 and 30 days appears to promote the maturation of the parotid gland. The halfway point in the dietary change at 21 days coincides with the onset of inversely related circadian cycles in feeding and the parotid enzymes. Premature weaning at 21 days accentuates both cycles and accelerates parotid maturation. The findings indicate that the physical consistency of the diet has an imporant regulatory role in the developmental patterns of feeding activity and parotid glands of rats, but they also hint that other dietary qualities may be involved. Chronologic fluctuations in plasma corticosterone suggest an intricate relationship among this hormone, feeding behavior, and parotid glands in developing rats.


Effects in the rat of environmental temperature, diet dilution and treadmill running on voluntary food intake, body composition and endocrine organ mass: a multiple regression analysis. The effects upon weight gain, food intake, carcass composition, and weight of pituitary, adrenals, and testes of male rats subjected to three environmental temperatures (T; 16.0 degrees, 23.5 degrees, and 31.0 degrees), five diet dilution rates (D; 0%, 12.5% 25.0%, 37.5%, and 50.0%), and five daily treadmill running periods (E; 10 minutes, 40 minutes, 70 minutes, 100 minutes, and 130 minutes) were studied by multiple regression techniques. Equations describing regression surfaces could contain significant linear and/or quadratic coefficients of the independent variables (T, D, and E) and their first order interactions. Body weight attained was reduced by increased D and T. Total food intake increased linearly with increases in D, but this increase was smaller for the rats in the higher environmental temperature since there was a significant DT interaction. Total food intake was decreased by increases in T. The intake of food minus diluent was maintained until D attained a value of 37.5%; beyond this point the rats at all three temperatures failed to maintain digestible energy intake. The data strongly suggested that the energy intake was not limited by the gastrointestinal tract capacity. E did not significantly affect food intake. Significant regression coefficients were found for the dependent variables of body dry matter, nitrogen, ash, ether extract, and energy and of the weight of depot fat pads, adrenals, and testes, as follows: (1) For D, there was no linear coefficient for body nitrogen. All remaining linear coefficients were negative except for body ash. The only quadratic coefficients (both positive) were for adrenal and testes weights (2) For E, all linear coeffcients were negative except those for body nitrogen, body ash, and adrenal weight. There were not quadratic coefficients for body nitrogen, body ash, adrenal weight, and testes weight. The remaining quadratic coefficients were all positive; (3) For T, there was no quadratic coefficient for body energy. The remaining linear coefficients were positive except those for fat deposit size, body ether extract, and adrenal weight. The remaining quadratic coefficients were negative except those for fat deposit size, body ether extract, and adrenal weight; (4) For the DE interaction, no coefficients were significant; (5) For the DT interaction, there were no significant coefficients for body nitrogen, fat depot size, or adrenal weight. The remaining coefficients were positive except for body ash; (6) For the ET interaction, the only significant coefficients were negative ones for body ether extract and body energy and a positive one for testes weight.


Controlling factors in the development of ceruloplasmin in pigs during the neonatal growth period. The sequence of ceruloplasmin development and limiting factors controlling this process in neonatal piglets was studied in a randomized block design. Guided by the change in serum ceruloplasmin levels, the liver copper concentrations of piglets fed copper-deficient and copper-supplemented diets were compared in three different periods. The plasma of piglets was devoid of both apo- and holo-ceruloplasmin at birth. The system responsible for the synthesis of apoceruloplasmin developed shortly after birth as indicated by a steady increase in serum ceruloplasmin activity during the first week without being affected by the diet. Copper apparently was not the limiting factor at this stage since very high concentrations of copper were found in the livers of newborn piglets. However, the liver copper was depleted quickly within 1 to 2 weeks and became the limiting factor if the diet was deficient in copper. The livers of these piglets were fractionated by differential centrifugation to compare the liver copper distribution in the two dietary groups with and without copper supplementation. The treatments did not affect the copper distribution on a percentage of total liver copper basis. However, fractionation study revealed that, unlike adult pig livers, about 70% to 80% of copper was present in the heavier particle fractions of piglet livers.


Adipose tissue cell size and lipolysis in the rat: response to exercise intensity and food restriction. This experiment was designed to determine if the adaptive increase in adipose tissue epinephrine-stimulated lipolysis (ESL) observed in exercise trained rats is related to decreased adipocyte size or a direct response to exercise. Two levels of treadmill exercise and three levels of food restriction were imposed on male rats over a 12 week experimental period to create a distribution of adipose tissue cell sizes. Epinephrine-stimulated lipolysis was subsequently measured in the isolated adipocytes from rats trained at two different exercise levels and in untrained rats fed either ad libitum or 16%, 27%, or 35% dietary restriction. Energy restriction was effective in reducing body weight and to some extent epididymal fat pad weight; however, adipocyte size and number were not significantly affected. Exercise in both groups of trained rats was effective in reducing adipocyte size; however, cell size did not differ between training groups. The group receiving the greatest amount of daily exercise had significantly greater ESL indicating that the adaptive increase in lipolytic potential seen in adipose tissue of exercise trained rats is a true metabolic adaptation not secondary to reduced cell size.


Amino acid requirements of the growing mouse. Using diets based on rat amino acid requirements, containing 2.0% nitrogen and 4.1 digestible kcal/g, the dietary levels of ten essential amino acids required for normal post-weaning growth of Swiss X Carworth Farms No. 1 crossbred mice were estimated. The response criteria used were growth rate, dry matter intake, energy and protein contents of body weight gain, protein efficiency ratio and apparent biological value. Maximum responses were obtained when the dietary dry matter contained less than or equal 0.3% arginine, 0.2% histidine, 0.4% isoleucine, 0.7% leucine, less than or equal 0.4% lysine, 0.5% methionine, less than or equal 0.4% phenylalanine, 0.4% threonine, less than or equal 0.1% tryptophan and 0.5% valine.


Optimum dietary protein to energy ratio for channel catfish fingerlings, Ictalurus punctatus. Twenty-one semipurified diets were formulated to determine the optimum protein:energy ratio (P/E) for channel catfish fingerlings. Seven crude protein levels and three energy levels at each protein level were utilized. The protein, lipid, and digestible carbohydrate sources were hexane-extracted whole egg powder, salmon-corn oil mixture, and white dextrin, respectively. After an initial 2 week conditioning period, the experimental diets were fed in triplicate to groups of 30 +/- 3 channel catfish fingerlings weighing 205 +/- 10 g and kept in 110 liter flow-through aquaria at 26.7 +/- 1.1 degrees. The diets were fed at a rate equalling 3% of the total wet body weight/day divided into three equal feedings and adjusted weekly for 9 weeks. An approximate fivefold increase in body weight was observed. These data indicate that the concept of P/E ratios must be restricted to diets containing adequate levels of protein and total energy. Based on average daily gain, diets containing energy levels between 275 and 341 kcal/100 g had an optimum P/E ratio of approximately 88 (24-36% crude protein). Diets containing 24% crude protein and 275 kcal/100 g diet appeared to be utilized more efficiently in terms of percent protein deposited than diets containing higher crude protein levels.


Convulsive seizure induced by intracerebral injection of semicarbazide (an anti-vitamin B6) in the mouse. The direct injection of semicarbazide (SC), an antivitamin B6 (anti-B6), into the lateral ventricle of the mouse brain induced convulsion and tremors at a smaller dose after a shorter latent period than that in systemic administration. The symptoms were prevented by pyridoxine, aminooxyacetic acid or acetone, while they enhanced by pyridoxal, pyridoxal phosphate, or some other anti-B6. In mice fed a vitamin B6 (B6)-deficient diet, convulsion and tremors occurred at smaller doses of SC than those in mice given control food, and were counteracted by pyridoxine. On the other hand, mice into which SC had been injected in the neighboring site of the lambda first showed running fits, which was followed by convulsion and tremors.


Cardiac action of thiamine derivatives in guinea pig atria. Pharmacological studies were performed on allithiamine (TAD), thiamine propyl disulfide (TPD), and thiamine tetrahydrofurfuryl disulfide (TTFD) to investigate positive inotropic and negative chronotropic effects seen when they are applied to spontaneous beats in isolated guinea pig atria at concentrations higher than 10-5 g/ml. 1. The effects of thiamine 8-(methyl-6-acetyldihydrothioacetate) disulfide (TATD) and thiamine hydroxyethyl disulfide (TOED) at 5 x 10-4 were slight, and those of dibenzoyl thiamine (DBT) and thiamine were limited at any concentration. 2. Dimethyl propyl disulfide (DMPD) which has anti-thiamine activity, showed these effects at concentrations higher than 10-5. 3. The negative chronotropic effect of TAD, TPD, and TTFD was not influenced by the prior application of atropine, and the positive inotropic effect was not influenced by propranolol. 4. The effects of TTFD on the electrically driven left atrial muscle were remarkable when the muscle was driven at low frequency, while they were less remarkable at high frequency. 5. The decrease in tension of the electrically driven left atria induced by mersalyl at 5 x 10-4 g/ml was recovered by the subsequent addition of TTFD or TPD at 5 x 10-4 as well as dimercaprol at 5 x 10-5. From the results, it was assumed that (a) the effects of TAD, TPD and TTFD might relate to their common chemical structure of the disulfide, especially to the alkyldisulfide chain, (b) the effects are irrevelant to their common activity as an vitamin B1 and to either cholinergic or adrenergic effect, and (c) a mutual dependence is seen between the positive inotropic effect and the negative chronotropic effect.


Effects of low temperature and electrical (square wave) stimulation on spontaneous contractions in isolated guinea pig atria and influence of thiamine tetrahydrofurfuryl disulfide (TTFD) on these effects. The spontaneous contractions of isolated guinea pig atria were arrested by a temperature change in the medium for 30 to 20 degrees C within 20 min. 2. When thiamine tetrahydrofurfuryl sulfide (TTFD) at concentration of 10-5 g/ml was added in the medium, the arrest was not seen for more than 30 min. 3. Arrhythmic contractions induced by the electrical square wave stimulation of threshold intensity were prevented by TTFD at 10-4 g/ml which was added to the medium. 4. These effects of TTFD at respective concentrations were seen even 30 min after the drug was removed from the medium, when the atria had been pre-incubated with the drug for one hour before the removal. 5. From these results, it was assumed that TTFD might show these effects against the extrinsic physical invasions through the stabilization of the tissue membrane.


Relationship between serum vitamin E levels and serum cholesterol in normal adults in rural regions of Yamagata Prefecture, Japan. Serum vitamin E and cholesterol levels were determined for the residents in rural regions of Yamagata Prefecture, Japan. The average serum vitamin E were 0.99 +/- 0.25 mg/100ml in 166 men, and 1.06 +/- 0.26 mg/100ml in 178 women. Only 0.6% of the subjects were below 0.5 mg/100 ml. There was a significant difference between the serum vitamin E levels of men and women. However there were no statistically significant differences among serum vitamin E of various age groups. The best correlation for serum vitamin E was found with serum cholesterol.


Effect of vitamin B6 deficiency on collagen metabolism in rats. The effects of VB6 deficiency on collagen metabolism were studied using young and adult rats. It was observed in VB6 deficient rats, that both the amount of urinary hydroxyproline and salt soluble fraction of skin collagen decreased. Furthermore, decrease of the alpha-component and increase of the beta-component were also found in the soluble collagen. However, the activity of plasma amine oxidase was lower and the aldehyde content in the acid soluble collagen were also lower than the control group. These changes were revealed more clearly in young growing rats than in adult rats. Based on these results, it may be that VB6 participates in the allysine (alpha-amino-adipic-delta-semialdehyde) formation which is considered as the first step of collagen maturation and also in the synthesis of protocollagen peptide chains.


Effects of riboflavin deficiency on the lipids of rat liver. Newly weaned male rats were maintained on a riboflavin-free diet for 5 weeks, and a study was made on the effect of the deficiency upon liver lipids. The content of glyceride in the livers varied among the deficient rats. High contents of glyceride were demonstrated in one-third of the deficient rats, whereas the similar level as that of control was shown in the remaining deficient rats. Contents of phospholipids and relative amounts of individual phospholipids were not altered significantly by the deficiency. Riboflavin deficiency exerted effects on fatty acid components of liver lipids. The composition of fatty acids of triglycerides varied in the deficient rats depending on the content of glycerides. However trends of increase in linoleic acid and decrease in palmitic acid towards fatty liver were observed in the deficiency in comparison with the control. On the other hand, the changes in phospholipid fatty acids were similar in all deficient rats, and the increase in linoleic acid and the decrease in arachidonic acid were brought about by the deficiency compared with controls, respectively. In liver homogenates, the incorporation of 14C-palmitate into triglycerides was higher in the deficient rats irrespective of the presence or absence of fluorde but incorporation into phospholipids was slightly lower in the deficient rats than in control animals.


Intestinal absorption of beta-alanine, anserine and carnosine in rats. Absorption beta-alanine, anserine or carnosine from rat intestine was studied in vivo by a force feeding method and in vitro using an everted sac method. Possibility of anserine and carnosine hydrolysis prior to intestinal absorption was also investigated using a glycylleucine dipeptidase-containing fraction prepared from rat intestine. The following results were obtained. 1) Anserine and carnosine were absorbed as they were from rat small intestine. 2) Both anserine and carnosine were partially hydrolyzed in vitro by the glycylleucine dipeptidase-containing fraction. Carnosine was hydrolyzed faster than anserine. The above rather conflicting results suggest that physiological amounts of anserine and carnosine might be absorbed from rat small intestine in dipeptide forms.


Alanine metabolism in pyridoxine-depleted rat liver. Alanine metabolism in normal and pyridoxine-deficient rats was studied in vivo and in vitro. Incorporation of 14C-alanine into various liver components was determined and no difference was shown between normal and deficient animals in the incorporation into liver homogenates, lipid, protein and plasma glucose. Using the liver slice syste, gluconeogenic activity from alanine or pyruvate was 40% lower in deficient rats compared with the activity of normal rats. However, inhibition was completely removed by the addition of 2-oxoglutarate to alanine. Penicillamine did not affect glucose formation alanine in the liver slice.


Effects of carnitine administration, fasting, and exercise on urinary carnitine excretion in man. 1. In this study, the carnitine level in 24-hr urine has been determined in males, (a) before and after a single dose of 500 mg (as carnitine) of DL-carnitine chloride, (b) during fasting, and (c) before and after a severe running program (3 x 2,000 m/8-8.5 min). 2. After the administration of DL-carnitine chloride, the urinary carnitine excretion was increased by only approximately 10% of the dose, suggesting a large body pool size of carnitine. 3. Urinary carnitine excretion was significantly increased during five-day fasting; a maximum level of 2.17 +/- 0.24 (mean and SD) mmoles/day was 4.6 times higher than the usual level of 0.47 +/- 0.10 mmoles/day (p less than 0.001). Respiratory quotients (RQ) decreased significantly (p less than 0.01) from the control value of 0.81 +/- 0.03 to the value of 0.75 +/- .02 after five-day fasting and was significantly correlated with urinary carnitine levels (r = 0.62, p less than 0.05). 4. The urinary excretion of carnitine increased slightly with heavy running exercise. 5. The results are discussed in relation to the physiologic regulation of the rate of carnitine synthesis.


Ultracytochemical studies on the effects of thiamine and thiamine tetrahydrofurfuryl disulfide on acetylcholinesterase activity in guinea pig atria. As a result of histological and ultracytochemical investigations concerning the influence of thiamine and its disulfide derivative, thiamine tetrahydrofurfuryl disulfide (TTFD), on acetylcholinesterase (AChE) in extirpated guinea pig atria, it was found that there was a clear increase in the AChE activity by 10(-4) M TTFD, a weak increase with 10(-5) M and an extremely weak increase, about the same as that in only the nutrient (Locke's solution), with 5 x 10(-4) M. However, with 10(-4) M of thiamine there was a tendency for the activity to be the same degree as with Lock's solution alone or be even inhibited at times.


In vivo incorporation of glucose carbon into brain and liver proteins in biotin-deficient rats. The in vivo utilization of D[U-14C]glucose with particular reference to its incorporation into brain and liver proteins was studied in biotin-deficient rats. The data show a significant reduction in the incorporation of glucose carbon into brain and liver proteins. A disturbance in the intermediary metabolism of glucose to be one of the factors responsible for the decreased incorporation of the label into proteins in biotin deficiency.


Legal aspects of medical confidentiality in the occupational setting. The law of confidentiality of medical information in the occupational setting is undeveloped and subject to change. Nevertheless, when a physician-patient relationship is established, all of the traditional trappings, including the duty to maintain confidences, go along with it. In other settings, such as preemployment physicals, examinees implicitly consent for their "fitness' for the job to be disclosed, but do not assume that specific findings will be disclosed without their informed and written consent. To promote physician automony and worker confidence in the occupational physician, an explicit policy of confidentiality should be developed and agreed to by both management and workers. This policy should spell out the conditions under which specific information will be made available to the employer and should guarantee the confidentiality of all other medical information. Workers should also be given routine access to their medical files, and offered the chance to refute and have amended information in them that they can demonstrate is inaccurate. In short, workers in the occupational setting should, in general, be treated like private patients. Such a policy will satisfy both the law and the ethical standards of physicians, and will promote worker trust in the occupational physician.


Long-term mortality study of steelworkers. This study examines the cause-specific mortality of men employed as masons in the steel industry. Their mortality experience is compared with the mortality predicted by the age--and race--specific death rates for a control group consisting of those steelworkers whose first job in 1953 was not in the mason department. The relative risks of dying from selected causes were highly dependent on race. The most important observations are: (1) The nonwhites have an overall excess risk when compared to the nonmason group. This excess is not confined to any particular category and appears to be due to the cumulative effect of an excess in many different categories. (2) The white masons have an excess risk for nonmalignant respiratory disease. Furthermore, this risk increases with length of exposure. (3) The whites have an excess risk for respiratory cancer when compared to the nonmason group. This excess is not present in the later years of the follow-up period. (4) The interpretation of the findings for cardiovascular disease remain unclear. Results for cerebral vascular disease and hypertensive disease in nonwhites are suggestive, but need further investigation before any strong statements can be made.


Variations of pulmonary function amongst workers in cotton mills. Lung function studies and clinical examinations of 493 workers in eight cotton mills in New South Wales revealed 12 workers with byssinosis. The reasons for the low incidence of byssinosis in view of relatively high cotton dust in air concentrations are discussed briefly.


Experimental allergic sialoadenitis. VIII. Acute parotitis following intraductal instillation of antiserum to salivary antigens in the rat. Antiserum to ammonium sulphate-soluble proteins of rat saliva was raised in rabbits. The introduction of this antiserum, via the excretory duct, into the parotid gland of rats induced severe acute sialoadentis. It is suggested that the inflammatory response developed as a result of formation of immune complexes, composed of acinar epithelial antigens and the antibodies introduced from without.


The ultrastructure of benign pigmented naevi and melanocarcinomas in man. Nine benign pigmented naevi and 16 melanocarcinomas (malignant melanomas) were studied by light and transmission electron microscopy and the fine structure of benign and malignant melanocytes is described. It was found that malignant melanocytes generally exhibit a range of abnormalities of structure of nuclei and cytoplasmic organelles which distinguish them clearly from their benign counterparts. Of the abnormalities, those affecting the specific organelle of the melanocyte, the melanosome, were the most constantly present. No firm evidence was found for the existence of two types of melanosome or two types of melanocarcinoma. Although electron microscopy is capable of showing in great detail within individual melanocytes many changes which are clearly associated with malignancy, the technique does not appear to offer significant advantages over light microscopy in determining the diagnosis and prognosis in this group of conditions.


Atrophy and apoptosis in the cyclical human endometrium. Electron microscopy of human cyclical endometrium indicates that there is considerable loss of gland epithelial cells with formation of apoptotic bodies in the late secretory, premenstrual and menstrual phases, but also to a lesser extent in the proliferative phase. Apoptotic bodies containing nuclear fragments may be recognised on light microscopy as basophilic or Feulgen positive granules. These granules accumulate in greatest numbers towards the end of the cycle and may be used as an additional aid in dating curettings.


The state of knee meniscal fibrocartilage in Liverpool necropsies. The state of the fibrocartilaginous menisci of the adult knee joint has been studied at necropsies in the city of Liverpool on a random series of 94 white Europeans (55 men, 39 women) aged 21 to 94 yr. The left lateral meniscus was selected for particular attention; in 20 of the subjects the left medial meniscus was also examined. The gross and histological appearance of the superior and inferior surfaces of the lateral meniscus and of its free inner edge is described and illustrated at various ages. The findings from necropsy specimens indicate that the fibrocartilage of the adult meniscus is susceptible to a focal process of matrix fraying and splitting which has several features similar to those seen in fibrillation of hyaline articular cartilage. Certain differences in detail between meniscal and hyaline cartilage in the pattern of cell changes at sites of overt splitting are, however, apparent. The implications of the findings are discussed in terms of an hypothesis that cartilage fibrillation represents a disruption of the collagen framework, and that "wear", of the matrix due to mechanical factors plays a major part in its development.


Some effects of phenacetin on the rat.

Some effects of phenacetin on the rat. Rats aged from 2 to 4 mth were given phenacetin 100 mg/kg/day and 1-14 g/kg/day, orally, for up to 26 1/2 wk and 3 wk, respectively. Signs of premature ageing such as senile plagues, neurofibrillary tangles and lipofucsin pigment were not demonstrated in the brains of these animals.


Systemic lupus erythematosus in childhood correlations between changes in disease activity and serum complement levels. Serial complement component (C3 and C4) determinations were performed in 26 children with systemic lupus erythematosus. Twenty-one children with SLE had 52 episodes of C3 depression (mean duration 25 weeks); only 11 of these children had active nephritis when serum concentrations of complement were depressed. Fourteen children had active rash associated with low C3; in seven of these children rash was the only clinical evidence of disease activity. Ten children had active CNS disease; in seven children the CNS involvement correlated with low C3. In general, variations in serum concentrations of C4 did not reflect changes in SLE activity which were not reflected by changes in serum concentrations of C3. Serum C4 occasionally remained depressed longer than C3, perhaps reflecting continuing subclinical disease activity. Increased C3 occurred in 18 of 26 children as doses of corticosteroid were increased, in six of 14 when cyclophosphamide was added, and in two children when hydroxychloroquine was added. Our findings suggest that a wide variety of manifestations of childhood SLE may produce hypocomplementemia. In addition to renal disease, variations in serum concentrations of C3 and C4 can reflect, or occasionally predict, changes in rash and CNS disease.


Nephritis in systemic lupus erythematosus in children. Twenty-five patients, aged six to 18 years, with lupus nephritis, followed for two to 103 months (median 22 months), have been classified according to renal histology into groups with diffuse proliferative glomerulonephritis (18), focal proliferative nephritis (2), and membranous nephropathy (5). Correlations have been made among specific histologic groups, clinical findings, renal function studies, urinary findings, and response to therapy. In sequential renal biopsies, lesions progressed in most patients with diffuse proliferative and membranous changes; however, chronic renal failure occurred in only one patient and the five-year survival rate (60.9%) is better than previously reported in pediatric patients.


Distal renal tubular acidosis in children with chronic hydronephrosis. The difference between the PCO2 of alkalinized urine and the PCO2 of blood has been proposed as an indirect means of assessing distal nephron H+ secretion. Following oral bicarbonate loading and alkalinization of the urine to pH greater than or equal to 7.2, eight of nine children with chronic hydronephrosis and four children with idiopathic distal RTA had low (U-B)PCO2 values when compared with seven normal subjects. This findings leads us to conclude that chronic hydronephrosis may cause a form of distal RTA which persists many years after surgical diversion procedures have been carried out.


Severe combined immunodeficiency with leukopenia (reticular dysgenesis) in siblings: immunologic and histopathologic findings. The hematologic and histologic features of two, nontwin, male siblings with severe combined immunodeficiency and variable granulocytopenia are compared to the four previously reported cases of reticular dysgenesis. These sibs died at 50 and 3 days of age, respectively, with Pseudomonas sepsis and congenital cytomegalovirus infection, respectively. A maternal uncle has selective IgA deficiency. Cord blood from the second sib contained a normal percentage of E-rosetting lymphocytes; however, these lymphocytes failed to respond to mitogenic stimulation in vitro. Erythrocyte and lymphocyte levels of adenosine deaminase were elevated in the father and the second sib. Serum immunoglobulin concentrations were low in both siblings.


Neutrophil oxidative metabolism in sickle cell disease. Bacterial infections are the most frequent cause of death and an important factor of morbidity in sickle cell disease. A defect in oxidative metabolism of neutrophils from these patients has been reported as a possible cause for these infections. Since normal neutrophil functions are essential in the defense against bacteria, it seemed important to reassess the capacity of neutrophils from patients with sickle cell disease to undergo the metabolic events associated with phagocytic bactericidal activity. Accordingly, neutrophils from patients and controls were compared for their ability to reduce nitroblue tetrazolium dye, to activate the hexose monophosphate shunt, and to generate superoxide anion, hydrogen peroxide, and chemiluminescence. Patients' cells performed normally in each of these assays and, in addition, killed Staphylococcus aureus as well as did cells from controls. Thus, an abnormality of neutrophil oxidative metabolism cannot explain the propensity to bacterial infections in sickle cell disease.


Course of cystic fibrosis in 95 patients. The course of 95 patients with cystic fibrosis is presented. Survivors have a mean follow-up period of over 14 years (minimum: 13 years). Of 45 patients diagnosed prior to extensive irreversible pulmonary involvement, only one has died and none is disabled. In contrast, of the other 50 patients diagnosed after substantial irreversible pulmonary disease was present, 26 have died. Mortality and morbidity has been greater in females. Possible factors contributing to the improving prognosis include early diagnosis, aggressive management with comprehensive care, easy access to specialized care, and improved antimicrobial therapy.


Course of cystic fibrosis in black patients. Seventeen black patients showed typical sweat gland, gastrointestinal, and pulmonary manifestations of cystic fibrosis. There was an unusually high incidence of meconium ileus equivalent (35%). Three infant siblings of patients in this study had died of cystic fibrosis prior to referral of a family member to this center. One patient died at age four years after emotional problems interfered with the treatment program; status asthmaticus played a major role in his terminal respiratory failure. The remainder of the patients have had substantially less morbidity from pulmonary disease than a comparable, much larger group of white patients. Only one patient, age 28, who is married and employed full-time has severe pulmonary involvement as assessed by pulmonary function studies and chest roentgenogram. The 16 surviving patients have a mean age of 13 1/2 years after a mean follow-up period of 10 years. If black patients with cystic fibrosis survive infancy, they then, as a group, may have a relatively good prognosis.


Mucosal recovery in treated childhood celiac disease (gluten-sensitive enteropathy). Follow-up studies on 36 children, in whom celiac disease (gluten-sensitive enteropathy) was established by gluten challenge, were carried out after management on gluten-free diets for a mean of six years. Evaluations included measurement of height and weight, which for the group approximated normal distributions, and histologic examination of the duodenal or jejunal mucosa. Mucosal morphology was  regarded as normal in 16, and there were minimal changes in 20. Epithelial cell height was within the  normal range in all the children. Interepithelial lymphocytes were within normal range in the majority and lymphoid cells in the lamina propria were not different from those in control subjects. Mucosal lactase was significantly lower in patients than in control subjects in the duodenum and the jejunum, whereas sucrase and alkaline phosphatase values were significantly lower in the jejunum but not in the duodenum. Low content of mucosal lactase and increased numbers of interepithelial lymphocytes may be sensitive indicators of persisting ingestion of gluten in mucosa that is otherwise normal or approximately so in appearance.


Complex alpha-thalassemia-like syndrome: a cause of neonatal normoblastemia. A previously unrecognized hypochromic anemia associated  with marked normoblastemia during the newborn period is reported. One male and two female siblings and a first cousin had a hypochromic anemia and marked normoblastemia (300 to 900 normoblast index per 100 white blood cells) at birth. Globin chain synthesis studies on peripheral blood of the proband at birth indicated the presence of alpha-thalassemia trait with possible reduced gamma chain synthesis. Studies of globin chain synthesis on the father, two older affected siblings of the proband, and the proband at 1.5 years of age revealed alpha-thalassemia trait. The data suggest this complex alpha-thalassemia-like condition as a new syndrome associated with marked neonatal normoblastemia.


Neonatal pneumatosis coli: a mild form of neonatal necrotizing enterocolitis. A distinctive form of necrotizing enterocolitis was observed in seven newborn  infants in a 4 1/2-year period. Characteristically these patients had gross blood in the stools, but other local and systemic signs were mild or absent. Radiography mainly revealed submucosal intramural intestinal gas which was limited to the colon (pneumatosis coli). There was no evidence of small bowel involvement as judged by the absence of small intestinal pneumatosis or distension. This form of colonic disease should be recognized as a benign variety of neonatal necrotizing enterocolitis that carries a favorable prognosis and responds to medical management without sequelae.


Necrotizing enterocolitis in term infants. Despite the fact that necrotizing enterocolitis is considered a disease of premature infants, 20% of all affected infants at Babies Hospital over the past 20 years were products of term gestations. Two distinct subgroups of such infants were noted (1) five infants with congenital heart disease and/or congestive heart failure (e.g.hypoplastic left heart syndrome), all but one of whom developed the disease in the first week of life; (2) eight infants who developed the disease at a much later age after a protracted period of diarrhea. This histopathologic features of the disease in term infants are the same as those in premature infants. Further, the pathogenesis of the disease in term infants does not appear to differ basically from that in premature infants. These facts, lead away from the concept of NEC as a disease of simple etiology.


The effect of paraben preservatives on albumin binding of bilirubin. The interaction of methylparaben and propylparaben with bilirubin-albumin complexes was studied using difference spectra, Sephadex gel filtration, red blood cell uptake of bilirubin, and the peroxidase assay. Methylparaben was found to be a weak competitor with bilirubin for binding to primary albumin-binding sites but a strong binding competitor (similar to sulfisoxazole) at secondary sites. The displacing effects of methylparaben and sulfisoxazole were additive. Propylparaben bound to albumin but did not displace bilirubin. Drugs and injectable saline and water preparations which contain methylparaben should be avoided in jaundiced newborn infants when the high-affinity albumin-binding sites approach saturation.


Growth, behavioral, and psychologic measurements of adopted children: the influences of genetic and socioeconomic factors in a prospective study. Perinatal, growth, social, and psychologic data, collected through seven years of age on 144 adopted children and on 288 matched controls as part of a prospective study of 3,120 children, were subjected to statistical analysis. Only single births and healthy children were included. The adopted subjects were  divided into two groups: 94 children who were adopted by nonrelatives (77 prior to one year of age and 17 after one year of age); and 50 children who remained with their biologic mothers and were subsequently adopted by stepfathers. Children who were adopted prior to one year of age had significantly higher IQs at four years of age then did their controls; at seven years of age, however, their IQs were similar even though the adopted children were raised in a higher socioeconomic environment. The adopted children had better academic achievement and were taller at four and seven years of age than were the controls. The performance of the children adopted after one year of age, even though they were raised in a higher socioeconomic environment, were, were like those of their controls at both four and seven years  of age. The performance of the children who remained with their biologic mothers was similar to that of their controls. Maternal intelligence generally did not correlate well with adopted children's intelligence; however, a specific significant positive correlation could be shown between maternal intelligence and the intelligence of children who remained with their biologic mothers.


Thyroid function in neonatal hypothyroidism. Various aspects of the thyroid function have been measured in 28 cases of neonatal hypothyroidism detected by means of the Quebec Screening Program for Metabolic Diseases. In all instances the T4 value in the blood of filter paper spot was below 2 SD of the mean of the day, averaging 0.39 +/- 0.04 ng/40 mul (mean +/- SEM) of eluted blood. The T4 value of a second similar sample averaged 0.22 +/- 0.04 ng/mul of eluted blood; this value was significantly lower than the first one. The serum T4 concentration was decreased in all the infants, whereas three of them had a normal serum TSH concentration. At least three groups of patients could be identified: (1) patients with primary thyroid failure, (2) those with secondary or tertiary hypothyrodism, and (3) those with abnormal synthesis of thyroid hormone.


TSH measurements from blood spots on filter paper: a confirmatory screening test for neonatal hypothyroidism. A sensitive radioimmunoassay for the measurement of TSH in the eluate of blood spotted on filter paper has been developed. The method is consistently sensitive to 0.1 to 0.25 muU of TSH and enables the detection of values equivalent to 6 to 15 muU/ml of serum. The measurement of TSH in the filter paper spot in all infants with low filter paper spot T4 has permitted rapid confirmation of 10 cases of neonatal hypothyroidism. However, cases of hypothalamic hypothyroidism with low or normal filter paper spot TSH concentrations would have been missed using only this method. Since these patients represent approximately 10% of our neonatal hypothyroid population, we do not recommend this method as a primary screening procedure, but rather as a confirmatory test which will accelerate the diagnosis and therefore the onset of therapy.


Delayed onset of hypopituitarism: sequelae of therapeutic irradiation of central nervous system, eye, and middle ear tumors. Four children with short stature who received irradiation to the head in conventional doses had clinical and laboratory evidence of hypothalamic-pituitary hormone deficiencies several years later. Growth hormone was deficient in all. One patient also had evidence of TSH, ACTH, and gonadotropin deficiency. Basal prolactin levels and prolactin response to synthetic TRF were normal in all patients tested. Treatment with human growth hormone significantly increased growth rate. We suggest that children should have the hypothalamic-pituitary area shielded from irradiation. Periodic measurements of hypothalamic-pituitary function should be performed in children who have had irradiation to the head, in order to detect and treat hormonal deficiencies before growth and development are seriously compromised.


Juvenile diabetes mellitus, optic atrophy, sensory nerve deafness, and diabetes insipidus--a syndrome. Four patients with diabetes mellitus, optic atrophy, and high-frequency neurosensory hearing loss, two of whom also had diabetes insipidus, are described. The frequency of this syndrome among patients with juvenile diabetes appears to be between 1/148 and 1/175. Because of the progressive nature of the disabilities and the autosomal recessive mode of inheritance, careful monitoring of all juvenile diabetic patients for other signs of the syndrome is warranted.


Developmental change in red blood cell volume: implication in screening infants and children for iron deficiency and thalassemia trait. The mean corpuscular volumen when determined by electronic counter is an accurate tool for identification of children with microcytosis due to either iron deficiency or thalassemia trait. The purpose of this report is to describe the normal developmental changes in MCV that occur in children afler 6 months of age. In 211 healthy infants and children screened to exclude those with borderline or overt iron deficiency, thalassemia trait, or hemoglobinopathy, we found that the lower limit of normal for MCV is 70 ft between 10 and 17 months of age and that there is a gradual increase of MCV with age; the lower limit is 74 between 1 1/2 and 4 years and 76 between 4 and 7 years. All of these values are well below the minimum adult level of 80 fl.


Percutaneous cardiac catheterization and atrial balloon septostomy in pediatrics. Between November, 1971, and July, 1975, 688 patients ranging in age from six hours to 21 years have undergone percutaneous transfemoral venous and/or arterial catheterization at the University of Oregon Health Sciences Center. This represents 93% of all venous catheterizations of the right side of the heart and 97% of all arterial catheterizations of the left side of the heart in the pediatric age range. One hundred and ninety-five patients (29% of the group) weighed 5 kg or less and 133 (20% of the group) were neonates. There were virtually no complications following the venous studies. The complication rate following percutaneous arterial studies is lower than is the reported experience with cut-down arteriotomies. Long-term survival following percutaneous atrial balloon septostomy in D-transposition of the great arteries was comparable to that following cut-down balloon septostomy. The ease of accomplishment, significantly lower complication rate, and successful accomplishment of atrial balloon septostomy prompt us to advocate that the percutaneous technique of cardiac catheterization be extended to include the neonate and young infant who weighsless than 5 kg.


Tracheal aspirate lecithin/sphingomyelin ratios as predictors of recovery from respiratory distress syndrome. In thirty infants with severe respiratory distress syndrome who required endotracheal intubation, serial tracheal aspirate lecithin/sphingomyelin ratios were determined. There was 19 survivors and 11 nonsurvivors. The L/S ratios were plotted as a function of postnatal age; the ratios of the survivors demonstrated a significant increase between 24 and 96 hours. Nonsurvivors did not show this change. There was a significant difference on Days 3, 4, and 5 between survivors and nonsurvivors in the percentage of L/S ratios greater than 2.5. Daily mean L/S ratios correctly identified the outcome of 23 of 24 infants alive on Days 4 and/or 5 and were a more accurate prediction of survival than a single L/S ratio. The changes in the L/S ratios of the tracheal aspirates were not related to gestational age.


Disturbances of the transitional circulation: spectrum of pulmonary hypertension and myocardial dysfunction. Thirteen neonates presented with central cyanosis due to right-to-left shunting across the foramen ovale or the ductus arteriosus or both. In three infants shunting occurred secondary to pulmonary vascular obstruction, presumably related to pulmonary vasospasm (persistence of the fetal or transitional circulation). In ten neonates right-to-left shunting was associated with heart failure; seven of these neonates had systemic hypotension.


Socioeconomic factors in relation to fetal growth in white infants. Over 1,200 white mothers who were delivered consecutively at this medical center were classified in four different socioeconomic classes according to family affluence and occupations of the heat of the household. The frequency of low-birth-weight infants was highest in the lowest socioeconomic class. The high incidence of LBW infants in the lowest socioeconiomic group was not affected by any significant increase in number of mothers with medical problems or medical complications of pregnancy; it was dependent on the large number of mothers who were involved in four specific practices, largely of their own choosing, including low-weight gains, cigarette smoking, use of certain drugs during pregnancy, and refraining from all prenatal care. Mothers in the four socioeconomic classes who were not involved with these four specific practices (smoking, etc.) and whose pregnancies were free of medical problems and complications had uniformly low incidences of LBW infants and the mean birth weights of their infants were uniformly high and not significantly different. Unfavorable outcome of pregnancy with respect to fetal growth in this study appeared to depend less directly on socioeconomic circumstances than on the four specific maternal practices listed above.


The effects of four commonly used drugs on platelet function. A number of commonly used drugs have been reportd to inter


The effect of maternally administered drugs on bilirubin concentrations in the newborn infant. The effects of drugs administered to pregnant women on bilirubin concentrations in 1,107 consecutively born infants are presented. Administration of narcotic agents, barbiturates, aspirin, chloral hydrate, reserpine, and phenytoin sodium all resulted in lowering of infant serum bilirubin concentrations. Diazepam and, to a lesser extent, oxytocin caused an elevation of infant serum bilirubin concentrations. Although many drugs were shown to alter serum bilirubin levels significantly, the clinical importance of such alterations was not dramatic except possibly in special circumstances. The phenothiazine derivatives, general or local anesthesia, sulfadimidine, ampicillin, and penicillin had no such effect on the newborn infant when given to the mother before delivery.


Risks to the offspring of women treated with hydantoin anticonvulsants, with emphasis on the fetal hydantoin syndrome. The fetal hydantoin syndrome is a variable pattern of altered growth and performance which includes unusual facies, distal phalangeal hyoplasia, and other defects occurring in some infants exposed in utero to hydantoins. A prospective study of 35 infants exposed prenatally to this class of anticonvulsants showed that 11% had sufficient features to be classified as having the fetal hydantoin syndrome. An additional 31% displayed some features compatible with the prenatal effects of hydantoins. A case-control study of 104 infants whose mothers received hydantoins during pregnancy supports these conclusions. Reduction of intellectual ability in infants with the fetal hydantoin syndrome is the area of greatest concern. Women being treated with hydantoin anticonvulsants should be told of the nature and magnitude of risks to the developing fetus before considering a pregnancy.


Intellectual and social development following prolonged isolation. A patient with severe combined immunodeficiency required protective isolation for the first year of life. He was discharged after an effective treatment program was developed and has remained well. Developmental testing at 14 and 16 months revealed near age level social and intellectual functioning. Optimal nursing care, frequent and prolonged maternal contact, and the patient's adaptive capacities permitted rapid adjustment to normal life following prolonged isolation.


Differentiation of Herpetomonas megaseliae: effects of hydroxyurea on morphology and growth. Herpetomonas megaseliae grown in the presence of hydroxyurea showed a decline in population during the first 24 hr, eventually increasing slightly over the 7-day incubation. Throughtout the 7-day incubation period the population of the treated organisms never equaled that of the control organisms. The percentage of promastigotes, as opposed to para-and opisthomastigotes, in the treated cultures did not differ from that in the control cultures through the first 3 days in incubation. Thereafter, the percentage of promastigotes in the treated cultures dropped significantly below that of the controls. At the light microscope level, the treated organisms showed an increase in size with associated striations at the anterior end. A multiflagellate (nondividing) condition was also observed in the hydroxyurea-treated organisms. TEM and SEM studies showed pellicular convolutions, which were interpreted as the striations observed under the light microscope. The differnces in population number, kinetoplast number and position and pellicular morphology between control and experimental cultures suggests that enhanced differentiation and abortive cytokinesis are the net effects of hydroxyurea on Herpetomonas megaseliae.


Plasmodium (Giovannolaia) pedioecetii from gallinaceous birds of Colorado. Forty-nine Colorado birds of 6 galliform species were positive for Plasmodium (Giovannolaia) pedioecetii which we feel to be the same parasite described by Wetmore (1939) from a shaptailed grouse from North Dakota. Except for its presence in Darwin's tinamou (Nothura darwinii) from Colorado, it has been reported only from gallinaceous birds. Most stages were predominantly subpolar to polar. There were a daily 8 am to noon peak of merozoite production, but no synchronicity. Merozoite number ranged from 8 to 22, with a mean of 10.9. Gametocytes were long and slender, some curving around one end of the host nucleus.


Parabothriocephalus sagitticeps (Sleggs 1927) comb. n. (Cestoda: Parabothriocephalidae) from Sebastes paucispinis of southern and central California. Parabothriocephalus sagitticeps (Sleggs 1927) from Sebastes paucispinis is redescribed and given a generic reassignment. The new combination is based on the dorsal, submarginal genital attrium and tests arrangement. The tapeworm prevalence was 84% of 354 rockfish in the coastal waters of Southern and Central California.