A five-year study of mortality in a busy ski population. A 5-year study of a busy ski population in Utah revealed a total at-risk period of approximately 3.5 million skier-days. While the morbidity (fractures, strains, sprains, and occasionally more severe injuries) associated with skiing is well recognized and considered by most physicians concerned to be distributed somewhat unevenly within the various skills of skiing, the authors have identified an exceedingly low mortality among the same population. Six individuals died as a result of injuries directly attributable to skiing. Three of these were considered to be advanced skiers and three were of intermediate skill. In three instances the environment was considered to play a role in the accident. Two of these victims were skiing out of control, one as a result of ice-covered snow and one as a result of speed in combination with a small jump. The third victim was crushed in an avalanche. One accident was completely unexplained, the skier having skied without apparent attempt at checking or change of course into a nonrecreational area. The two remaining skiers of intermediate skill both suffered injuries incident to falling forward with considerable force onto a relatively flat, hard snow surface. Notwithstanding the intense and sometimes prolonged exertion at relatively high altitudes (9,400 to 11,000 ft or 2.9 to 3.3 km), only one skier with a previous history of atherosclerotic heart disease died while skiing. One additional middle-aged skier with similar history died at the conclusion of the day.(ABSTRACT TRUNCATED AT 250 WORDS)


Rehabilitation of delinquents: the tale of an experience. Nineteen mentally retarded men with a history of violent behavior were transferred to a civilian institution as a result of a court decision. The problems encountered in the day-to-day management of the unit specially created for their care as well as the behavior changes observed in the group are described and their implications discussed.


Toxic or tolerant: chloral and the drug dilemma. The role that a drug or combination of drugs plays in the causation of death cannot always be stated with certainty. Drugs associated with the development of tolerance create a particular problem, and there is need for additional data concerning tolerable concentrations achieved by drug abusers. The common drug chloral hydrate falls into this category, and a case of possible chloral hydrate intoxication has been presented.


The pathology of self-mutilation and destructive acts: a forensic study and review. Self-destructive behavior of man and its consequences may be presented in various forms, including self-mutilation, injury, and malingering, and with various manifestations, including the Munchausen syndrome, polysurgery, purposeful accidents, impotence, and frigidity. The general subject of focal suicide has been a relatively unknown and unrecognized entity for different reasons, including the fact that most physicians are trained to approach a case in a manner which treats the patient-physician relationship as one of honor and faith regarding the authenticity of the complaints of the patient. The maturity of years and experience may be required before the physician becomes aware of the motivation of patients' behavior. It is hoped that this article will provide new insight into areas which may be unfamiliar to the forensic practitioner and clinician but which might enable them to learn about the background of an unexpected death or the possibilities of motivation in civil suits alleging professional negligence or malpractice.


The use and abuse of the rape treatment center. The author acknowledges the fact that the new system of managing alleged rape victims via the RTC is superior to the former method. The RTC has performed very well, giving aid and succor to rape victims. However, it appears that the unit has attracted some individuals who are not completely truthful and have given fraudulent accounts to investigators. Methods have been suggested to screen out these persons.


Electron impact mass spectrometric detection of Freon in biological specimens. Freons from an aerosol spray can were detected in the blood, liver, brain, and lung of a 14-year-old girl who died after intentional inhalation. A headspace mass spectrometric analytical technique was employed to detect the fluorocarbons. The spectra from the specimens showed the presence of m/e peaks at 101, 103, and 105 from the ion (CFCL2)+ which arises from fragmentation of trichlorofluoromethane (Freon 11) and dichlorodifluoromethane (Freon 12), and peaks at 85 and 87 from the ion (CF2Cl)+ which arises from fragmentation of dichlorodifluoromethane (Freon 12). The technique presented here provides greater specificity than previously reported analytical procedures for the identification of these volatile toxic chemical compounds in biological specimens.


Simultaneous determination of cocaine and benzoyl ecgonine in urine by gas chromatography with on-column alkylation. A gas chromatographic procedure has been developed for the simultaneous determination of cocaine and benzoyl ecgonine in urine specimens. The two drugs are extracted by isopropanol/chloroform from urine samples saturated with a bisalt buffer. The organic extract is evaporated to dryness, and an aliquot of the residue is injected onto the gas chromatograph to determine the presence of cocaine and the location of any extraneous peaks. Benzoyl ecgonine is then analyzed as its particular alkyl ester subject to the least interference from extraneous peaks as observed in an initial underivatized injection. The reconstituted residue is co-injected with the appropriate dimethylformamide dialkyl acetal for on-column alkylation. The use of two columns or more than one benzoyl ecgonine alkyl ester gives positive identification, and the use of isopropyl benzoyl ecgonine as an internal standard allows accurate quantification.


The spatial distribution of zinc and cobalt in single human head hairs. The concentration patterns of indigenous zinc and of zinc and cobalt absorbed from radiotracer solutions have been measured via flameless AA and radioactivity assay, respectively, in individual human head hairs. Patterns for indigenous zinc were found to be relatively flat and featureless. Patterns for absorbed zinc (like those for indigenous and absorbed copper in the same subjects) showed increasing concentrations with increasing distance from the root, plus zones of locally increased concentrations at positions different from those for zones of increased copper concentrations. In bleached hair, indigenous zinc concentrations were decreased, and absorbed zinc and cobalt concentrations were increased compared to values in normal hair. The data for absorbed zinc and cobalt were interpreted in terms of a variable concentration of metal-binding sites in the hair structure, coupled with an increased porosity induced by hair bleaching. The flat patterns for the indigenous zinc content were interpreted as indicating the importance of dietary zinc and incorporation via the follicle, and the unimportance of external contamination as the source of this zinc. The forensic implications of the data have been discussed.


The absorption of arsenic into single human head hairs. Single head hairs from several subjects have been soaked in arsenic radiotracer solution and the arsenic absorbed on 2-mm hair segments has been determined by radioactivity assay. The absorption patterns were characterized for some subjects by regions of high uptake where (in other hairs from the same subject) regions of low uptake of copper and zinc were found, and vice versa. These data have been interpreted in terms of varying densities of binding sites in the hair structure, with specific chemical character. Arsenic absorption patterns for other subjects were highly structured, showing zones of very high and very low absorption. The dangers of interpreting similar patterns for the indigenous arsenic content of hair in terms of the dates on which elevated arsenic ingestion took place have been discussed.


Forensic aspects of trace element variation in the hair of isolated Amazonas Indian tribes. Thermal neutron activation analysis and instrumental gamma-ray spectrometry were used to analyze the elemental constituents in the head hair from sedentary Indian populations in the Venezuelan Amazonas region. Concentration values for 30 elements were determined quantitatively, and the presence of 7 others was detected qualitatively. The remoteness of the area and the primitive ecological conditions of the local population prevents the exposure of their biological systems to industrial and agricultural contamination, either external or metabolic. These conditions are reflected in a marked decrease of the concentration ranges of the trace elements, and a significant reduction or even the total absence of some components. The results demonstrate that closed groups of individuals exposed to similar dietary and environmental conditions exhibit closely similar trace element patterns in their hair and, consequently, in other biological tissue. This fact severely limits the use of trace element patterns in hair for forensic comparisons. The results also indicate that a large part of the constituents found in hair is probably deposited externally from ambient contamination and that any metabolic deposition occurs much more uniformly and probably in lower concentrations. Tables of analytical results in parts per million are presented, together with representative gamma-ray spectra of the hair. Comparison with earlier data in the literature is also shown.


Effect of hemoperfusion with coated and uncoated charcoal on human blood in vitro. During 4 hours, in-vitro hemoperfusion of human blood was performed in 4 series of experiments: control, cellulose coated charcoal, polyacrylohydrogel coated charcoal and uncoated charcoal. In the control series little change on corpuscular elements and electrolytes was observed. In all hemoperfusion series there was little change of RBC and uniformly a marked fall of the granulocyte count. Platelet- and lymphocyte counts were significantly less affected by cellulose coated charcoal than by the other preparations. Coated and uncoated charcoal absorbed avidly calcium and glucose from the blood. By contrast the potassium level decreased moderately with polyacrylohydrogel coated and uncoated charcoal, whereas the opposite was observed with cellulose coated charcoal.


Evaluation of the Gambro Lundia Major 1.36 m2 disposable parallel plate dialyzer. The Gambro Lundia Major 1.36 m2 dialyzer was assessed in vivo in ten hemodialysis patients. Urea and creatinine clearances (measured as whole blood values at 60 minutes with a blood flow rate of 200 ml/minute) were 166 +/- 8 m/minute (mean +/- standard error of the mean, n = 9) and 115 +/- 4 ml/minute (n = 11). The creatinine clearance is 15% lower than in vitro data. There was a marked decrease in urea and creatinine clearance with third use of the dialyzer. The ultrafiltration rate was 490 ml/hour/100 mmHg. The priming volume was 125 ml (at a transmembrane pressure of 100 mmHg) and residual blood volume in the dialyzer was 0.57 +/- 0.11 ml (n = 5). The handling, storage and ease of disposal of the dialyzer is better than previous models and its performance characteristics are clinically acceptable.


Treatment of dialysis elbow by simple aspiration. Olecranon bursitis with effusion in four maintenance hemodialysis patients was successfully treated with simple aspiration.


The treatment of severe drug intoxication with charcoal hemoperfusion in series with hemodialysis. Two patients were treated for serious phenobarbital intoxication with charcoal perfusion and hemodialysis in series. Both patients experienced decreases in coma, but both of them bled after treatment. Phenobarbital levels were decreased to 50% with treatments, and there was not any significant difference of the clearance for the two devices.


Reassessment of fistula puncture site blood loss. Fistula puncture site blood loss during and after hemodialysis was measured in 12 patients with end-stage renal disease. It was found to be 0.74 +/- 0.32 ml per dialysis and 115.4 +/- 49.9 ml per year in patients with Cimino A-V fistulas. Puncture site blood leak in patients with heterologous grafts was 1.77 +/- 0.36 ml per dialysis and 276.1 +/- 56.1 ml per year. The values obtained in this study are 5 to 10 folds less than those found in the original reports. Recent advances in dialytic technology are probably responsible for the observed improvement. The results also suggest that Cimino A-V fistulas are superior to the heterologous graft.


Use of microanalytic laboratory methods to reduce blood loss in dialysis patients. Annual blood losses from diagnostic tests were determined in 10 stable hemodialysis patients and were found to be 1130 +/- 420 ml per patient. The projected losses if microanalytic laboratory methods are utilized were 122 +/- 34 ml per year, representing a remarkable saving of blood (90 percent) in these anemic patients. We, therefore, recommend that microanalytic laboratory methods which have been reliably used in pediatric services for years be adopted by dialysis facilities.


The binding of theophylline to serum proteins of hemodialysis patients. The binding of theophylline to serum proteins was studied by 18 hour equilibrium dialysis at 37 degrees C in serum from 10 chronic dialysis patients and 6 healthy subjects. The healthy subjects had a mean (+/- S.D.) unbound fraction of 54 +/- 5% while the dialysis patients had 63 +/- 5% unbound (p less than 0.02). For dialysis patients to achieve the same theophylline concentration in plasma water that metabolically normal asthmatics achieve at the "therapeutic" serum theophylline levels of 10-20 micrograms/ml, their total serum theophylline levels should be 8.6-17.3 micrograms/ml.


Evaluation of new membranes for hemodialysis: preliminary studies with a polycarbonate membrane. A synthetic polycarbonate (PC) membrane supplied by C.R. Bard Inc. was assessed as to its clinical usefulness and suitability to regular use with artificial kidney. The permeability of the PC membrane to 11 solutes of increasing molecular volumes (Na+, Ca++, K+, Cl-, HPO4-, urea, creatinine, uric acid, glucose, BSP, cyanocobalamine) was measured in vitro by rotating dialysis cells, as compared to that of Cuprophan PT 150. The evaluation of the PC membrane in vivo was carried out during a regular hemodialytic treatment in 5 patients using a Kiil dialyzer. The dialysance of 6 solutes (HPO4-, urea, creatinine, uric acid, hypaque, cyanocobalamine) across the PC membrane was measured at 200 ml/min blood flow rate. Both in vitro and in vivo the PC membrane showed permeability and dialysance coefficients to small molecules approximately the same than standard PT 150; the ultrafiltration rate of the PC membrane was also superimposable to that of PT 150. On the contrary, larger molecules were removed much more efficiently by the polycarbonate membrane than by PT 150. These data suggest that the membrane evaluated in this study possesses some peculiar features which could possibly result in an improvement of the quality of regular hemodialysis.


The concept of "classical" psychoanalysis. In this essay, the term classical psychoanalysis is discussed historically and conceptually. What characterizes classical analysis and distinguishes it from current innovative trends in the practice of psychoanalysis is reviewed from a comparative standpoint. The impact of the widened scope of conditions the psychoanalyst currently includes in his therapeutic work is considered, with special attention to the distinction between psychoanalysis per se in the classical sense and psychoanalytic psychotherapy.


Working alliance, therapeutic alliance, and transference. Examination of the clinical evidence offered by proponents for the concepts of therapeutic and working alliance leads the author to conclude that neither concept is justifiable. Both refer to aspects of the transference that neither deserve a special name nor require special treatment. The related topic of frustration/gratification as necessarily inherent in the analytic situation is also considered.


The concept of therapeutic alliance: implications for the "widening scope". As a result of studies in ego and developmental psychology, psychoanalytically oriented psychotherapy, empathy, countertransference, and object relations, the sphere of interest in psychoanalysis has been extended beyond the patient's intrapsychic life to embrace all aspects of the therapeutic relationship. A significant contribution to this trend has been a study of the collaborative aspects of the analytic relationship as exemplified in the concepts of therapeutic alliance and working alliance. A historical survey of writings on this subject serves as a background for a critical examination of the theoretical and clinical implications of these concepts. These studies have provided a useful conceptual basis for the understanding of many "given" aspects of the analytic relationship, delineating those personality attributes which make collaboration in the analytic work possible. This in turn has been helpful in making appropriate applications of psychoanalytic principles in the therapy of a broader range of clinical conditions. It is suggested that, along with the gains achieved by making explicit the rational and irrational elements of the collaborative aspects of analysis, there is also the danger of a shift of focus away from the nuclear analytic concepts of unconscious intrapsychic conflict, free association, and interpretation of transference and resistance. This danger lies especially in the tendency to see the therapeutic alliance as an end in itself--to provide a new and corrective object relationship--rather than a means to the end of analyzing resistance and transference.


The genesis of interpretation.

The genesis of interpretation. Opinions regarding the significance of the analyst's response to his patient's productions differ. This response is only one of many steps by which the analyst understands his patient's productions. In this paper, I have suggested a rationale for the process of the origin of insight. There is a split in the analyst's functioning, corresponding to what takes place in the patient. Through a transitory identification with the patient--empathy--the process of intuition is facilitated. The analyst conceptualizes the clinical data outside of consciousness. The end product is the analyst's inner response, made conscious to him through introspection. The analyst's response is a form of inner communication. It has to be made consonant with the patient's material according to disciplined, cognitive criteria before being formulated into an interpretation.


Some implications of object relations theory for psychoanalytic technique. Whereas, traditionally, object relations theory--a refinement of structural theory that links structure more closely with genetic and dynamic aspects of mental functioning--has been applied mostly to the understanding and treatment of patients with severe regression in the transference, it also has application for technique in the standard psychoanalytic situation. This paper has focused on the object relations approach to the nature of conflicts to be interpreted in the transference; the varying relationships between transference, genetic history, and early development, revealed by an object relations focus; the technique used under conditions of regression in the communicative process in the transference; and the relation of empathy and regression in the transference. Two clinical cases are presented to illustrate the points made.


The technical significance and application of Mahler's separation-individuation theory. Greater knowledge and integration of developmental concepts and of the frame of reference of separation-individuation, add to the analyst's richer insights and to his more complete interpretations and reconstructions. Freud recognized the complexity of preoedipal development and the importance of the object and of object relations. Contemporary contributions have enabled us to proceed beyond the preoedipal conceptualizations of and since Freud, to better understand ego- and drive regression and evidence of fixations or ego distortions which may appear parallel to "normal neurotic" findings. I question whether we encounter different patients today and suggest that we understand our patients better, thus making our analytic assessments and practices so different from 50 years ago. Separation-individuation theory encompasses and organizes findings from many sources, research and clinical, and permits us to perceive and process material in a multifaceted way. It must affect the timing and content of interpretations and reconstruction, and has a profound influence upon the understanding of psychopathology as well as normal development.


The analysis of the transference.

The analysis of the transference. Let me summarize. I distinguish between two major different relationships between transference and resistance. One is resistance to awareness of the transference and the other is resistance to resolution of the transference. I argue that the bulk of the analytic work should take place in the transference in the here and now. I detailed Freud's view that the transference should be encouraged to expand within the analytic situation. I suggested that the main technique for doing so, in addition to the analytic setup itself, is the interpretation of resistance to the awareness of transference by searching for the allusions to the transference in the associations not manifestly about the transference; that in making such interpretations one is guided by the connection to the actual analytic situation which every transference includes; that the major work in resolving the transference takes place in the here and now, both by way of examining the relation between the transference and the actuality of the analytic situation from which it takes its point of departure and the new experience which the analysis of the transference inevitably includes; and that, while genetic transference interpretations play a role in resolving the transference, genetic material is likely to appear spontaneously and with relative ease after the resistances have been overcome in the transference in the here and now. Working through remains important, and it, too, takes place primarily in the transference in the here and now.


Truth from genetic illusion: the transference and the fate of the infantile neurosis. I have attempted to show that the relative decline of genetic interpretation and reconstruction in modern analysis is a result of historical and methodological problems built into an enduring and developmentally restricted model of the infantile neurosis which has descended more or less intact into our time, a model still parochialized to the phallic-oedipal period and its prototypic oedipal conflict. Mounting direct evidences from both longitudinal developmental studies and child analyses, as well as from the more indirect evidences inferred from the genetic reconstructions of adult analyses, all argue for a developmental reconsideration of infantile neurosis to include preoedipal determinants. I have also asked that we include a measure of postoedipal determinancy as well in any such reconsideration, insofar as latency is the developmental condition for the usual resolution of the infantile neurosis. It must be emphasized that to argue for preoedipal determinancy is to say that problems with early object relatedness and early narcissistic pathology deform the oedipal conflict and its phase-adequate resolution. It does not suggest that narcissistic conflict can replace an oedipal one as the organizing conflict of the infantile neurosis during the phallic-oedipal period. The continuing parochialization of the infantile neurosis to the phallic-oedipal period has been perpetuated in great part by a technical legacy which has tended to restrict reconstructions of the infantile neurosis to the more discursively recoverable libidinal events of that period, and to exclude its preoedipal and aggressive determinants which are more apt to be expressed through the nondiscursive modes of the transference through its acts and self states.


The role of insight in psychoanalysis.

The role of insight in psychoanalysis. I have described some of the vicissitudes of acquiring insight in both child and adult analysis, giving particular attention to the part played by the ego's synthetic, organizing, or integrating function.


Some additional remarks on problems of transference. I have dwelt on the nature of the analytic relationship with patients suffering from narcissistic character pathology. I prefer the term narcissistic tie to narcissistic transference. The narcissistic patient lacks the resources necessary to establish a working alliance, and the analyst's principal task is to bring the patient to the point where he is capable of a sense of reality, of tolerating frustration, of taming rage, and of true object relatedness. I have also pointed to the particular tasks these patients set for the analyst in terms of countertransference reactions.


The curative and creative aspects of insight. Insight is a sine qua non of the psychoanalytic process and is a condition, catalyst, and consequence of the psychoanalytic process. Analytic insight is defined and differentiated from other types of self-knowledge and awareness and from pseudo insight; there are different levels and underlying processes in the development of insight. The importance of insight is delineated in theory and therapy, in analyst and patient, and in psychoanalysis and psychotherapy. Psychoanalysis aims to minimize noninsightful influences and to maximize insight leading to structural change. Psychoanalysis is not without a goal, but has the inexorable goal of expanded insight. Clinical limitations to gaining and retaining insight are recognized. Stress is placed on the acquisition and creation of insight and its relation to ego development, analytic progress, and adaptive mastery. Insight and creativity are complementary, and insight has creative and novel configurations. Although it is organized and consolidated in conscious verbalization, insight may proceed outside awareness. An unnoticed case of Freud's provides an example of creative insight. The achievement of insight effects and reflects structural change. Clinical psychoanalysis maximizes insight and minimizes other therapeutic influences.


Comments on the therapeutic action of psychoanalysis. Together with some of the problems inherent in psychoanalysis as a therapy, I have described what the various schools of psychoanalysis hold in common--the basic assumptions, if you will, underlying any properly conducted psychoanalysis.


Contemporary issues in the theory of therapy. I have drawn comparisons of psychoanalysis as a process and as a treatment between 1954 and 1979. I have selected for discussion controversies centering on the subjects of transference versus reconstruction, oedipal versus preoedipal, and the cognitive-affective duality. Also considered were the quantitative factors in the negative therapeutic reaction, the fate of signal anxiety, and the role of the patient in the process of cure.


The role of insight in child analysis: a developmental viewpoint. I have traced a developmental line for the capacity for insight. The conclusions reached are based on psychoanalytic material gathered from treatment cases at the Hampstead Clinic over the past 25 years. I have elaborated on the relevance these conclusions have to techniques employed in the analysis of children.


Peripheral nerve responses during ischemia in the evaluation of diabetic neuropathy. The stability of sensory conduction and evoked potentials during ischemia has been used in the evaluation of diabetic neuropathy and diabetic control (Hgb A1C). Six newly diagnosed juvenile diabetics were studied at diagnosis and 3 to 12 months later. In three patients in good control, ischemic "resistance" became normal. In three patients in poor control, resistance remained increased; two of these three experienced a 10%-20% slowing in conduction velocity. Similar relationships between control and ischemic resistance are found in long-term diabetics. These data suggest that abnormal ischemic resistance may herald the onset of an electrical and clinical neuropathic state.


Preservation of bulk and strength in muscles affected by neurogenic lesions. Mechanisms involved in maintaining bulk and strength in partially denervated muscles of patients with neurogenic lesions are discussed. Estimation of muscle fiber hypertrophy by electrophysiological examination is possible, but it depends on the construction of sampling electrodes with precise geometry. The arrangement of muscle fibers of motor units within the muscle is discussed by analogy with the four-color map problem. An experiment to measure the twitch tensions of individual motor units in man is devised; it requires the use of microprocessor control of the stimulus and recurrent measurements of the twitch forces.


Early electrophysiologic changes in conduction block. Fibrillation potentials and positive sharp waves were recorded in the paralyzed muscles of 31 patients with a conduction block of more than 14 days' duration. In 75% of the muscles, these effects were attributed to axonal damage in addition to the local demyelinating block, this conclusion being based on changes in the properties of the motor unit found electromyographically when recovery had taken place. In the remaining 25% of the muscles, the denervation-like activity was thought to be an effect of the local demyelinating block alone. The delay of the sensory action potential recorded above the presumed site of nerve compression most likely arises from a block of the largest myelinated nerve fibers. This assumption is based on the fact that the amplitudes of the fastest- and the slower-conducted components in the patients differed little from corresponding components in the normal nerve.


Impaired regulation of the firing pattern of single motor units. The firing pattern of single motor units from the anterior tibial muscle was studied during constant isometric contraction. Recordings were made with bipolar, fine-wire electrodes from 4 normal subjects and from 10 patients with spasticity. A microcomputer was used to classify the motor unit potentials automatically and to measure the interspike intervals. The patients had reduced firing frequencies and reduced variability between neighbor intervals. Seven patients with spasticity due to supraspinal lesions had positive correlation between neighbor intervals.


Myopathies with abnormal mitochondria: a clinicopathologic classification. Of 185 patients with myopathy, 22 showed abnormal muscle mitochondria. In 12 of the 22 patients, all of whom had ocular myopathy or the ophthalmoplegia-plus syndrome, muscle biopsies contained 5%-25% "ragged red" fibers. In 4 patients with a facioscapulohumeral distribution of weakness, ragged red fibers were less numerous (3%-8%). In both groups, routine histology showed almost normal muscle. The remaining 6 patients were clinically heterogeneous, all without ptosis or ophthalmoplegia. The biopsies of three of these patients showed severely affected muscle. It is possible that mitochondrial changes in these muscles were nonspecific. Electromyography indicated or suggested a myogenic lesion in 21 of the 22 patients; in 10, the serum creatine kinase was increased.


Pattern of electrical activity in normal and diseased muscle. Examination of the number of spikes (turns) per 5 sec and the mean amplitude of electrical activity, measured both at a force adjusted relative to maximum force (Po) and at a standard force, made it possible to distinguish between a decrease in force arising from loss or inactivity of motor units, and loss of muscle fibers or diminution in their cross-sectional area. The initial decrease in force of disused quadriceps muscle (following immobilization of the knee joint) resulted mainly from inactivity of motor units. In patients with motoneuron disease or a lesion of the brachial plexus, the number of turns at a force adjusted relative to Po was diminished because of increased potential duration and loss of motor units. Turns at a standard force of 2 kg were normal. In myopathy, the ratio of turns to amplitude was increased in two-thirds of the patients.


Early changes in chlorphentermine myopathy of rat studied by freeze fracturing. Chlorphentermine interferes with the metabolism of phospholipids. When administered to the rat in daily doses for 5 days, it causes necrosis of muscle fibers that are rich in mitochondria. Before the onset of necrosis, the following characteristics of freeze-fractured muscle preparations were observed: multilayered lipid globules and single-layered lipid membranes without membrane particles; different stages of exocytosis of lipid through the plasma membrane of the muscle fibers; and areas of plasma membrane that were devoid of particles of intramembranous proteins. These latter areas may arise secondary to exocytosis, to fusion of lipid vesicles with the plasma membrane, or to a direct action of chlorphentermine on the membrane. It is not known whether these areas give rise to membrane defects and fiber necrosis.


Clinical aspects of the visually evoked potential. The visually evoked potential (VEP) was studied in normal and abnormal human subjects, and in Rhesus monkeys. A relatively simple protocol for clinical VEP testing is described. The monkeys showed similar but smaller VEP responses compared to those obtained from human subjects. Central, but not paracentral or peripheral photocoagulation retinal lesions were associated with VEP abnormalities. The second, smaller wave of the response complex to 10 Hz flash stimuli corresponds to the primary evoked response, and is closely related to visual acuity. It was possible to recognize visually this VEP waveform and subjectively interpret the record correctly in 85% of eyes with regard to visual acuity. Therefore, the clinician can "read" the VEP record in response to non-patterned flash stimuli. This test was further validated in a series of patients with opacities of the ocular media. VEP promises to become a procedure of diagnostic and prognostic value in ophthalmology.


A new irrigating solution for intraocular surgery: TC Earle Solution. Electrolyte solutions--Plasma-lyte, TC Medium 199, TC Medium 199 plus additional bicarbonate, TC Earle Solution, and glutathione bicarbonate Ringer Solution--were evaluated for effectiveness in maintaining corneal thickness and endothelial viability. The TC Earle Solution was shown to be the most effective commercially available solution; little difference was demonstrated between TC Earle Solution and the experimental GBR Solution. Glucose and bicarbonate were found to be essential ingredients in the efficacy of the TC Earle Solution.


Acetylcholine receptor antibodies in the diagnosis of human and experimental myasthenia gravis. Aspects of acetylcholine receptor immunology and circulating receptor antibodies are reviewed with regard to both human and experimental myasthenia gravis. Receptor antibodies that have negligible cross-reactivity with skeletal muscle receptor can nonetheless cause destruction of the postsynaptic motor endplate area. Antibodies to mammalian skeletal muscle receptor can bind in-situ receptors. Transfer of myasthenic IgG increases neurophysiologic symptoms in rabbits showing slight signs of experimental myasthenia gravis, suggesting a block of in-situ receptors. Determination of receptor antibodies using RIA tests and partially purified human skeletal muscle receptor has been evaluated in the diagnosis of myasthenia gravis. Ninety percent of Swedish myasthenic patients in one study were found to have receptor antibodies. A rough correlation has been found between antibody titer and the severity of disease. Immunosuppressive treatment and thymectomy decrease the titer. In patients with thymoma, high antibody titers remain. When taken together, antibody-titer determination and electrophysiologic tests--particularly single-fiber electromyography--are very valuable diagnostic tools.


Intravitreous silicone balloon: an experimental study. A specially designed silicone balloon, expanded in vivo with normal saline, was tested for possible use as a retinal tamponade in desperate cases of rhegmatogenous retinal detachment. In six pigmented rabbits there were extensive postoperative complications, but in eight owl monkeys results were noticeably better. When the seam of the balloon was in contact with the retina there were adverse effects; seamless areas of the balloon did not appear to disturb the retina. Histopathologic studies indicated that excessive expansion of the balloon can cause significant damage, but that carefully controlled expansion can probably minimize complications. The presence of the balloon appears to alter electroretinographic response, but without necessarily causing histopathologic changes. Balloons of this type have been used in treatment of a small number of otherwise inoperable cases of retinal detachment with promising results.


The blanket principle: a technical note. Low-frequency attenuation of motor unit potentials may reveal abnormal complexity and instability of the motor unit. An ordinary concentric needle electrode is used, so the method bridges the gap between single-fiber and conventional electromyography.


Chalazion management by tarsus trephination. The use of a small trephine for chalazion surgery or tarsal biopsy is described. Over 1,000 cases have been treated in this manner with minimal recurrences and complications.


The regional curare test and electrophysiologic diagnosis of myasthenia gravis: further studies. Five hundred consecutive patients were evaluated for myasthenia gravis with repetitive stimulation of the median and ulnar nerves. Axillary nerve stimulation and repeated stimulation of wrist nerves following regional curare administration to the hand were performed when necessary. Abnormal responses were seen in 95% of 297 patients with generalized disease and in 35% of 54 patients with ocular disease, all of whom were clinically responsive to anticholinesterases. Identical responses were also seen in 32% of 124 patients with possible generalized disease, all of whom lacked clinical responsiveness to anticholinesterases. Abnormalities occurred following regional curare administration in 29% of 224 patients with normal responses during repetitive stimulation alone. This program for evaluating patients with suspected myasthenia gravis continues to be successful, safe, and practical.


Classification and management of patients with narrow or closed angles. Developments in the technique of gonioscopy and increased understanding of the mechanism of angle closure has made possible a more precise definition of "narrow-angle" and "closed-angle" glaucoma. It is, however, still not possible to predict with certainty which narrow angles will close spontaneously and which will not. A new classification of these conditions is suggested: Asymptomatic narrow angle; asymptomatic primary closed angle; symptomatic primary closed angle; fellow eye of symptomatic closed angle; narrow angle associated with chronic open-angle glaucoma; closed angle in previous chronic open-angle glaucoma; secondary angle closures. Recognition of these different types permits individualized and in most cases highly effective therapy.


Iridectomy technique in trabeculectomy.

Iridectomy technique in trabeculectomy. Peripheral iridectomy in trabeculectomy surgery should be larger than the scleral opening to prevent adherence of iris to the edges of the scleral opening. A method for the fashioning of such an iridectomy is described.


Levator aponeurosis tuck: a treatment for ptosis. Seven patients with acquired ptosis were treated with a tuck in the aponeurosis of the levator palpebrae superioris muscle. Although the etiology for the ptosis was not always clear, associated conditions included progressive external ophthalmoplegia, prior ocular irradiation, prior ocular surgery and enucleation. One patient with progressive external ophthalmoplegia had good functional results. All of the other patients had good cosmetic, as well as good functional results. Since local infiltrative anesthesia was used, patients were able to cooperate during surgery by elevating and lowering their eyelids. The amount of tuck necessary to sufficiently elevate the eyelid could therefore be determined at surgery. The amount of lid elevation attained at surgery closely resembled the final postoperative result.


Osteomas of the orbit.

Osteomas of the orbit. Clinical and histologic features of osteomas are reviewed. Techniques are described for the evaluation of osteomas, including the use of coronal and axial plane computed tomography. A series of 14 patients evaluated at the Massachusetts Eye and Ear Infirmary over a five-year period is presented. Two of these patients are discussed in detail. Two surgical approaches to osteomas of the frontal sinuses are described. A brow incision is recommended for tumors primarily within the orbit. A coronal incision and osteoplastic operation is recommended for tumors primarily within the sinuses. In one patient, unusually rapid tumor growth is documented by x-rays taken over a three-year period.


Treatment of frontal sinus mucoceles with the osteoplastic flap technique. The osteoplastic flap technique for treating frontal sinus mucoceles is described. This procedure has the advantages of: being a direct approach, which allows exposure of the entire sinus, provides complete obliteration of the sinus to prevent recurrence of the sinus disease, and prevents blind curettage of any exposed dura mater; leaving no facial deformity after the operation; being a relatively atraumatic procedure with low morbidity and minimum postoperative care; and allowing simultaneous surgery on both frontal sinuses when indicated.


Prospective views in the treatment of eyelid and adnexal malignancies. Some aspects of the surgical, radiotherapeutic, chemotherapeutic, cryosurgical, and immunological aspects of eyelid and adnexal malignancy have been discussed. Possibilities for future developments have been mentioned and even rationalized. Oncology is a constantly changing field. It is important for the oculoplastic surgeon to keep abreast of the changes. It is also important for him to be innovative and progressive in the area of possible improvements. It is not for those of us in the rank and file of ophthalmology to try all possibilities, but at least we should be aware of the new techniques and should support their trial.


Acquired ptosis secondary to conjunctival cysts. Two cases of unilateral ptosis caused by conjunctival cysts are presented. Their treatment and a brief discussion of the etiology of conjunctival cysts is presented.


Silicone in ophthalmic plastic and reconstructive surgery: a review and laboratory trial. Silicone is a material with wide application as an exogenous implant in ophthalmic surgery. Animal trials have indicated that extreme care must be taken in the use of this material in the presence of a viable eye. Acute corneal injury was seen in 10 of 14 rabbit eyes tested with a topical application of RTV silicone in the conjunctival cul-de-sac. Two of the 10 eyes demonstrated delayed healing of the corneal injury. Pretreatment with a viscous ocular lubricant, limited corneal contact time of the hardened forms, thorough and frequent corneal evaluation and prompt appropriate treatment of abnormalities are recommended for the successful use of silicone as an orbital molding material in the presence of the viable globe. For use as an orbital expander or as a stent after soft tissue socket reconstruction, despite its relative softness compared to acrylic orbital conformer, similar precautions must be observed to prevent mechanical corneal injuries.


Choroidal nevus with subretinal pigment epithelial neovascular membrane and a positive P-32 test. A 62-year-old white female was found to have a small, flat pigmented choroidal tumor. After fluorescein angiography and a positive P-32 test, the eye was enucleated for presumed malignant melanoma. Histologically, the tumor proved to be a choroidal nevus with a break in Bruch's membrane and a subretinal-pigment-epithelial neovascular membrane.


Hydraulic dissection of the nasal muco-periosteum in dacryocystorhinostomy. A method for the protection of the nasal muco-periosteum in DCR is presented. In five of the twenty-seven cases, minor perforations of the nasal mucosa caused no interference in cutting of the nasal flaps. In one case, due to an anomalous ethmoid cell, this method was of no advantage.


Differential effects of person in the dog and in the human. People have marked effects on dog's heart rate, with great individual variations for different persons. Apparently people to which the dog is attached have the greatest effect upon heart rate. Replications of the animal experiments using the psychotherapist and two other people revealed no effects upon the heart rate of a schizophrenic human. In the human the effects of people are probably best demonstrated in connection with verbal communication.


The hippocampus and stress induced 17-OHCS elevations. The physiologic contribution of the limbic brain to emotionally induced stress is still poorly understood. The present study is designed to more specifically evaluate the role of the hippocampus in stress induced plasma 17-OHCS elevations. The conditional reflex to a sequential presentation of tone and shock was used as the stress agent in adult mongrel dogs. Plasma 17-OHCS levels were determined by the Porter-Silber method. Control and stress levels of 17-OHCS were determined before and after unilateral (left) hippocampectomy, and subsequent contralateral (right) hippocampectomy. A unilateral posterior hippocampal lesion partially attenuated (20%) the normal 17-OHCS stress response. In contrast to unilateral lesions, equivalent bilateral posterior hippocampal lesions abolished the normal 17-OHCS stress response. These observations support the thesis that the elevated 17-OHCS levels in response to the conditioning paradigm is dependent on the hippocampus. Furthermore, it is dependent upon the continuity of the hippocampal circuit and not upon the volumetric steroid binding capacity of the hippocampus. These studies also suggest that a unilaterally functioning hippocampus may be adequate to meet the physiologic needs of stress, as reflected by the 17-OHCS response.


The influence of experimental neurosis on the conditional reflexes and the content of blood catecholamines and acetylcholine in dogs. Using experimental neurosis as a model, we investigated the mode of adaptive behavior, conditional reflexes and the blood level of neuromediators in four dogs placed in certain versus uncertain conditions in a Pavlovian laboratory. The research consisted of a two year training program with predictable (ordered partial reinforcement) followed by unpredictable (probabilistic reinforcement) situations. As a result, there was a decline in the acetylcholine as compared to a rise of catecholamine levels of the peripheral blood of some of these dogs. There were varied autonomic responses indicating a possible individual response specificity. In one dog, there was a disappearance of motor defense reflexes. The results support the hypothesis that probabilistic reinforcement following ordered partial reinforcement contributed to the dogs' neurotic disintegration, i.e., uncertainty is a cause of neurotic development.


The conquest of "schizophrenia:" Sisyphus revisited. Despite the fact that the diagnosis of schizophrenia, or dementia praecox, has been in use for over 80 years, there remains a great lack of clarity about the nature of this "disease." An impressive array of clinical and experimental data has been accumulated which pertains to the characteristics of "schizophrenics" but there are virtually no data which are schizophrenia specific. Quite to the contrary, the emerging picture is one of a complex and interacting field of several continuous dimensions or factors. Three underlying factors are suggested in an ad hoc fashion; the internal environment, the physical environment, and the human environment. It is suggested that these basic dimensions and their interactions over time should be the object of further investigation and definition, hopefully developing more adequate and productive description of clinical syndromes, rather than continuing the preoccupation with "schizophrenia" as a diagnostic label.


Interoceptive conditioning through repeated suppression of morphine-abstinence. I. Basis for conditioning: once-daily vs. continuous intravenous morphine infusion. Experimental evaluation of Wikler's interoceptive conditioning hypothesis of relapse to opioid use in ex-addicts requires a preliminary study of the degree of physical dependence produced by two methods of drug administration. Wistar rats were made physically dependent on morphine by single daily intravenous injections or by a continuous i.v. infusion. Rats received the same total daily dose regardless of administration schedule. The initial daily morphine dose was 20 mg/kg, and was increased every fourth day by 20 mg/kg, until a dose of 200 mg/kg per day was reached. The rats were maintained at the highest dose level for 18 days, at which time morphine was discontinued. Body weight and water intake were the primary variables measured during addiction, maintenance, and abstinence phases of the study. Equivalent and parallel changes in mean weight and water intake in injection and infusion rats indicate equivalent degrees of physical dependence were developed. This finding allows separation of the contribution of conditioning factors and of protracted abstinence in facilitating opioid self-administration in formerly-dependent organisms.


Cognitive factors affecting sequential dependencies in differential eyelid conditioning. Sequential dependencies were examined as a function of learning, masking, and subject factors in a two-stage differential eyelid conditioning experiment. In Stage 1, all subjects were differentially conditioned to two Vanderplas and Garvin (1959) forms. In Stage 2, the conditional stimuli (CSs) were one of eight words, four reinforced (CS+) and four unreinforced (CS-), with taxonomic category (animals vs. musical instruments) as the discriminandum, and different subjects were given semantic, physical, or no additional CS processing tasks. The results showed sizeable and highly significant sequential dependencies in the form of greater conditional response probabilities when CS+ as opposed to CS- trials were recently experienced. These effects decreased over trials, were greater in the groups given additional processing loads, and were in some cases greater in C-form responders than in V-form responders and greater in subjects who were unable to verbalize the differential contingencies. It was concluded that the magnitude of sequential dependencies was inversely related to the subject's awareness of the differential contingencies and/or ability to use the contingency information to respond appropriately to the CS cues.


The effect of amygdalectomy on orienting and classical conditioning in monkeys. The basic findings of these two studies are as follows: a failure of orientating and conditioning of viscero-autonomic responses, but essentially normal orienting and conditioning of a temporal muscle response in amygdalectomized animals. Small procedural differences exist between the two studies,and a possible order effect exists as a result of the use of the same subjects consecutively. However, we fell that the difference between the responses of the viscero-autonomic system and the skeletal system would still be found were all of the measures gathered simultaneously in an optimal conditioning situation. The definitive study--simultaneous viscero-autonomic and skeletal (behavioral) recording--remains to be done. Trial-by-trial analysis of the correlations or lack of correlations between these responses in such a study should be highly informative. These two studies offer substantial information relevant to the original questions. When behavior is modified by simple repetition of experience the effect of amygdalectomy is restricted to the viscero-autonomic components of orienting and classical conditioning, not to the entire spectrum of responses. The issue raised, therefore, is the significance of the viscero-autonomic components of orienting and classical conditioning. The suggestion has been proposed (Pribram, 1969) that these components serve as mechanisms of internal rehearsal necessary to the registration (as novel or familiar) of the orienting and conditioning experience. This proposal requires further testing.


Crowding and mental health.

Crowding and mental health. An epidemiologic investigation of the mental needs and services of 1645 respondents, aged 17 to 92 years and living in a representative southeastern county in Florida, revealed that 7.8% of the sample lived in crowded conditions. The crowded respondents scored significantly higher than did the uncrowded on both a depression scale and on the Health Opinion Survey. Associations between crowding and high scores on both scales were strongest among: respondents in the childrearing and middle years of life, blacks at all income levels, whites in the intermediate annual family income range of $6000 to $9999, and especially, females rather than males. Consistently, the crowded black population, and particularly, crowded white women, had much higher scores than did the uncrowded women. A multiple regression analysis showed that three variables--being a female, having a lower income, and crowding--accounted for 16.5% of the variance. The discussion emphasizes that the relationship between crowding and higher scores on indices of emotional distress is quite complicated. In crowded situations, depression may be a costly, semi-adaptive reaction to excessive interpersonal stimulation. Women living in crowded situations appear to be at high risk for depressive illness; their plight brings to mind the classic animal experiments which showed that the maternal behavior of females deteriorated in crowded situations.


Sex differences in the relationship of recall to subvocal speech in preschool children. Previous research findings indicating that preschool-age boys use verbal means to encode pictorial material whereas preschool-age girls do not were further investigated. Detailed examinations were made of the polygraph tracings and serial position curves of recall of younger (mean age = 50 months) and older (mean age = 66 months) boys and girls. The older boys were different than the other sex by age groups in that their recall and subvocal speech scores were significantly correlated; they engaged in greater amounts of raw EMG activity on both high-labial and low-labial trials; and they recalled only a small per cent of the names of pictures they did not subvocalize. Analysis of the serial position curves of recall revealed a greater recency effect for older boys and a greater primary effect for older girls. These data strongly support the notion that girls as young as 5 and 6 years of age are using other than verbal means to encode information, whereas boys similar in age are highly reliant upon verbal encoding methods.


Autonomic concomitants of discriminative avoidance and punishment training in the monkey. Two Cebus albifrons monkeys were trained to press a back-lighted panel to postpone a brief electric shock to the tail using a Sidman avoidance schedule (SS = 40 sec, RS = 40 sec). After 25 training sessions, a discriminative schedule was introduced, with the Sidman avoidance continuing in the presence of one discriminative stimulus and punishment introduced in the presence of the other. The discriminative stimuli were colors on the panel. Discriminative training also involved 25 sessions, each with a random sequence of 6 avoidance and 6 punishment segments, with 30 sec intervals between the segments. Plantar skin conductance and heart rate were recorded along with the panel-pressing behavior. The two monkeys adjusted to the discriminative schedule quite differently from one another. One animal responded at a high level and avoided very well (during avoidance) but was punished frequently (during punishment). The other animal responded less frequently and received many shocks during avoidance but almost none during punishment. The animal that showed less ability to inhibit responding (and received about four times as many shocks overall) appeared to have discriminated better temporally in spacing its responses during avoidance training. The monkey whose panel-pressing behavior resulted in more shocks also tended to show a higher tonic level of autonomic arousal. However, within-animal differences in shock frequency (between avoidance and punishment) were not similarly related to autonomic arousal. The animal that received fewer shocks overall (but more during avoidance) showed greater arousal during punishment. The animal that received more shocks overall (but fewer during avoidance) showed no arousal differences between avoidance and punishment.


Electrical measurement of internal information processing during silent reading and listening. When one listens, one "say what one hears." In reading, one "says what one sees," following which, one "hears what one says." The processes of intermodal transfer and of phonetic coding to achieve lexical-semantic processing are hypothesized. The technologic consequence is that covert oral behavior (subvocalization) during silent reading is beneficial to children and should not be tampered with by the teacher.


Effect of restraint on gastric acid secretion in cats. Experiments were carried out on cats fitted with a gastric fistula. In one group of 6 cats basal gastric secretion, and in another group of 7 cats pentagastrin induced gastric secretion was collected two or three times a week during a 2 hr session. The sessions were conducted either in a "harness" situation where the cat's movements were restricted, or in a "cage" situation where the cat was unrestricted and could move freely. It was found that in four of 6 cats in the basal secretion group and in five of 7 cats in the pentagastrin induced secretion group, gastric acid output was significantly higher in sessions in harness than in sessions in cage. These differences in acid output were due to acidity rather than volume of secretion. It was hypothesized that restriction of the animal's movements in the harness could evoke a "reflex of freedom" which, however, could not be accomplished because of the confinement. This could evoke a neural conflict eventually leading to functional disturbances in the autonomic system. This, in turn, resulted in changes in gastric acid secretion.


Summation of excitatory and inhibitory control produced by traditional tone-shock contingencies and autocontingencies. Previous research has demonstrated that rats can be unsignaled shock to predict subsequent periods free from shock. This shock-no shock stimulus arrangement, termed an autocontingency, has appeared less likely to exert behavioral control when a traditional tone-shock contingency was simultaneously available. The present research examined the generality of CS-US contingency dominance in a conditioned suppression paradigm by using a summation test in which "probe" stimuli derived from tone-shock contingencies were superimposed upon responding maintained by an autocontingency. In experiment 1, an inhibitory CS accelerated responding only when responding was normally suppressed by the autocontingency. In experiment 2, an excitatory CS failed to yield conditioned suppression during an inhibitory (accelerative) period produced by the autocontingency. Unlike our previous findings (e.g., Davis, Memmott & Hurwitz, 1975), these results do not support a general notion of tone-shock contingency dominance over autocontingencies. Behavioral control by autocontingencies appears robust and "holds its own" in summation with both excitatory and inhibitory CSs derived from traditional contingencies.


Evaluation of bowel preparation methods for gallium scanning. Gallium-67, when injected into the body, is an important diagnostic aid for a variety of diseases. Because it is excreted by the liver into the bowel where accumulation of it can interfere with interpretation of abdominal and pelvic areas, adequate bowel cleansing is necessary. A study comparing three methods of bowel preparation showed the Evac-Q-Kit method to be the most satisfactory and cost effective.


Producing your own black and white 35 mm slides. Here is a simple, efficient and economical method of producing 35mm black and white slides in less than one hour in the standard radiology department darkroom equipped with a film subtraction device.


Analysis of a manual calculation technique for isocentric dose determination. A method is presented for manual calculation of the dose to points off the central ray for isocentric radiation therapy. A simplified technique for manual calculation is derived from a more general formula used in the computer dosimetry program developed by Sloan-Kettering Memorial Hospital in New York. The manual method assumes certain variables in the general case to be constant. The technique is evaluated by comparing its results to those of the computer program in three hypothetical examples.


Method for control of patient flow.

Method for control of patient flow. This article describes a method of patient flow control currently being used in the radiology department of Grant Hospital of Chicago. The control board specifically designed for this department's needs enables personnel to follow visually a patient's progress through the department in logical sequence. Its effectiveness enhances the quality of patient care.


Immobilization device for use on patients undergoing radiation therapy of the head or neck. A unit for head and neck immobilization during radiation therapy is described. The treatment machine's laser lights and a cardboard template insure the accurate reproduction of the position of the patient's head and neck. The immobilizing unit quickly and easily locks to maintain the patient's position.


Total myelography in the evaluation of lumbar discs. With the presentation of three cases of thoracic neoplasms simulating nerve root lesions. It has been our practice to perform total myelography in all cases of lumbar disc disease including the various syndromes of spinal stenosis, because experience has indicated that myelographic abnormalities in the cervical and thoracic areas could have clinical importance despite the presence of gross changes in the lumbar region. Failure to establish a definite diagnosis by restricted lumbar myelography makes it mandatory to evaluate all levels of the spinal axis. Recently, 3 patients with thoracic spinal cord tumors presented with primary signs and symptoms of lumbar spine disorders. Evidence of spinal cord disease was minimal and could be readily overlooked. Total myelography disclosed varying degrees of lumbar spinal pathology, but also showed evidence of lesions in the thoracic region. One proved to be an intramedullary astrocytoma of the spinal cord, and two were schwannomas. The symptoms of low-back pain and lumbar radiculopathy improved after excision of the schwannomas and following x-ray therapy and chemotherapy in the patient with the intramedullary neoplasm.


Patient selection for lumbar discectomy. An objective approach. A reproducible method is presented for selecting patients with low-back pain and sciatica for lumbar discectomy based on specific objective criteria in four categories: neurologic signs, sciatic tension signs, personality factors (MMPI scores), and lumbar myelography. Operative findings for 50 consecutive cases selected using this method revealed complete nucleus pulposus herniation in 43 cases. This contrasts with complete herniation in only 5 of 26 patients undergoing lumbar discectomy before the method was employed. This objective preoperative evaluation method reduced negative disc explorations and improved early surgical results. We recommend its use for patients being considered for elective lumbar discectomy.


The Pennsylvania Plan. An algorithm for the management of lumbar degenerative disc disease. An algorithm for the sequential management of the patient with low-back pain has been formulated from evaluation of treatment outcomes. Patients presenting with back pain complaints and cauda equina syndrome are evaluated with immediate myelography. Without this complication, back pain patients are treated with 6 weeks of conservative therapy. Those who fail to respond are evaluated with progressively more complex techniques. When sciatica predominates, treatment may ultimately include laminectomy. When back pain predominates, medical and psychosocial appraisal are recommended. Some with normal medical and psychosocial evaluations may become candidates for spine fusion. The remaining are treated according to the findings of such appraisals. Rigorous screening is mandatory prior to any surgery.


Variations in the amount and distribution of cortical bone across the partes interarticulares of L5. A predisposing factor in spondylolysis? The possible role of the physical and mechanical properties of the neural arch as contributing factors in the etiology of spondylolysis was tested by comparing two groups of vertebral specimens obtained at necropsy. Group I specimens had been subjected to repetitive cyclic force which they withstood without fracturing. Group II specimens were randomly selected. The cross-sectional distribution of cortical and cancellous bone in the partes interarticulares were measured, and the two groups compared. The previously stressed group was found to have a greater percentage of cortical bone than the random group. The data are interpreted to suggest that thin partes interarticulares may predispose to spondylolysis through the mechanism of fatigue failure.


Lumbar spinal stenosis. A cause of continued pain and disability in patients after total hip arthroplasty. Eight patients, all with continued posterior hip pain following total hip arthroplasty, were seen during a 15-month period. In each patient, that pain and other disabling symptoms were traced to a degenerated, stenotic lumbar spine. The relationship of lumbar stenosis to degenerative hip disease is presented. Myelography was used to diagnose the stenosis in all patients, and findings were confirmed at laminectomy. Wide decompressive laminectomy and partial facetectomy was followed by complete relief of pain and other disabling symptoms in the 6 patients who were able to undergo it.


Myelographic defect on the side opposite the leg pain. A case report with an explanation of mechanism of action. An explanation for leg pain on the opposite side of the myelographic defect in one case is reported. Disc herniation was located superior to the exit of the root and thus displaced the dura and compressed the root on the opposite side against the pedicle producing contralateral leg pain.


Pedicle fat grafts for the prevention of scar formation after laminectomy. An experimental study in dogs. The formation of scar tissue always follows lumbar disc surgery and usually causes no difficulty. Reoperation may be necessary because of disc reherniation or because of the scar tissue itself. Reoperation is tedious and dangerous because of the presence of scar formation. Beginning in February 1975, the authors performed laminotomies in 107 dogs in an attempt to study the possibility of prevention of scar tissue formation about the dural sac and nerve roots. Gelfoam and Gelfilm were found to increase scar formation. Micropore tape and plastics such as polyethylene, mylar, and woven and smooth silastic were tried without complete success. Free fat grafts gave better protection than other substances, but it was found that pedicle grafts of fat gave more complete prevention of scar. The living pedicle fat grafts also prevented the usual closure of the laminotomy. The technique of pedicle fat grafts has also been used with success in 36 human patients to date.


The effect of fructose infusions in the course of labor upon parturient and fetus. Fructose infusions were administered to parturients with healthy term fetuses at a speed of 1 g/min for 106 on the average. The results confirm that fructose has the expected properties. The blood glucose and FFA levels show that a substantial part of the infused fructose is indeed stored and that only a small portion is used to cover immediate energy needs. This positive result is predominant by a considerable degree of acidosis arising in the parturient in spite of the fact that fructose was infused at a slower rate than in the majority of papers published so far. Since the fructose infusions were intended for premature fetuses, which already have an increased tendency toward acidosis, the results confirm the unsuitability of such a treatment.


Iron metabolism and placental transfer of iron in the term rhesus monkey (Macaca mulatta): a compartmental analysis. The kinetics of iron and the transplacental iron transport in the near-term rhesus monkey were investigated by means of injection of 59Fe(III) bound to rhesus monkey transferrin into the maternal or into the fetal circulation. The experimentally obtained 59Fe(III) bound to rhesus monkey transferrin into the maternal or into the fetal circulation. The experimentally obtained 59Fe dissappearance and appearance curves were analyzed. The analyses were based on a 5-compartmental system. Alternative models were considered but found to be inadequate. Very high maternal as well as fetal iron turnover were calculated. The daily reflux of iron in the mother and in the fetus amounted to 75% of the amount of iron cleared from the plasma compartment daily. The calculated iron transport from mother to fetus was about 1.0 mumol/day/100 g fetus. The reverse transplacental iron transport was negligible. A small placental iron pool of exchangeable iron had to be assumed. There were no clear difference in the distribution of 59Fe over the fetal organs when the tracer dose was injected into the maternal or into the fetal circulation. Only one of the experiments showed a preferential labeling of the fetal liver when the label was given to the mother, a preference which would be expected on the basis of the hypothesis of Fletcher and Suter (1969).


Fetal death: coagulation defects and management. Report of 20 cases with study of the half-life of [125I]fibrinogen. This report concerns 20 patients with intrauterine fetal death. Blood samples for coagulation studies were obtained before, during and after delivery. No clinical defibrination or bleeding was noted. Coagulation defects were observed as follows: 2 biological defibrinations: The first case was a pregnancy of 32 wk with retention for more than 12 wk; hypofibrinogenemia was noted in all 6 samples, between 180 and 280 mg/100 ml. The second was a pregnancy of 32 wk with retention for more than 8 wk; fibrinogenemia was between 170 mg/100 ml and 140 mg/100 ml. 2 intravascular coagulations with normal fibrinogenemia, increase of fibrin degradation products and positive ethanol tests. 3 cases with slight coagulation defects that were difficult to explain. The coagulation defects appeared to be transient, and sometimes resolved themselves spontaneously. Induction of labour was made in 19 cases; quinine sulfate, used in 17 cases, was remarkably successful (1 intolerance, 1 failure). Study of the half-life of [125I]fibrinogen was made in 18 of the 20 cases. On average, it was reduced by half in comparison with the half-life of healthy men. The decrease was noted even in cases of fetal deaths without the coagulation defects detected by classical tests. The half-life of [125I]fibrinogen in 6 pregnant women before therapeutic abortion was also studied. The decrease of half-life was noted. Changes of metabolism of fibrinogen during pregnancy are discussed.


Elective induction of labor conducted under lumbar epidural block. I. Labor induction by amniotomy and intravenous oxytocin. Epidural analgesia (bupivacaine) was administered during labor after amniotomy, in some cases supplemented by intravenous oxytocin. A higher incidence of transient uterine hypertonus was seen after blocking. Fetal heart rate changes mainly took the form of bradycardia (in association with uterine hypertonus). At birth, the maternal biochemical condition was characterized by a lower degree of metabolic acidosis, compared to normal unanesthetized controls. The fetuses displayed a slight degree of hypoxia and hypercapnia. The mechanisms underlying these modifications are discussed. Epidural blockade in combination with elective induction of labor, whether or not supplemented by intravenous oxytocin, may carry a risk. Its magnitude is considered acceptable for both mother and fetus provided they are constantly under close surveillance, limited amounts of bupivacaine are administered and the second stage of labor is kept short. However, some warnings against epidural analgesia apply to patients with placental insufficiency and very active labor.


Discriminant analysis, exemplified with quantitative features of endometrium. In this paper we illustrate the potential usefulness of discriminant analysis as a means of separating groups of patients and aiding in differential diagnosis of an individual patient. Some of the most important problems are discussed. The analysis is performed with various microscopical endometrial features of endometrial biopsies from 4 groups of 7 patients in different hormonal conditions. There is some evidence that a combination of stereological features gives a better separation of the groups than the usual histological examinations.


Tubal pregnancy in a 'low-risk' population: occasional association with follicular salpingitis. Long-standing tubal inflammatory lesions occurred in 35 (14%) of 250 tubal pregnancy patients, aged from 14 to 45 yrs, encountered from 1948 to 1969 in an eastern Canadian population where clinically manifest pelvic inflammation is not prevalent and 1/180 is the approximate ratio of ectopic pregnancy to live births. Present in 24 of these 35 patients was follicular salpingitis. For most of the eccyeses, functional derangements appear likely to have been responsible more often than structural alterations of the oviducts; but possible roles for 'physiological salpingitis' in leading to tubal pregnancy may be worthy of investigation.


Effects of glucocorticoids during pregnancy on the outcome of the children directly after birth and in the long run. We studied 17 mothers and the outcome of their 34 pregnancies. The purpose of this retrospective study was to determine possible adverse effects on growth of prolonged use of glucocorticoids, which have been recommended for short-term use in the prevention of respiratory distress syndrome (Liggins). There was no effect on duration of pregnancy; no congenital abnormalities were seen in this small group of children when corticoids were used during the whole pregnancy. There was a slight decrease in birth weight and placenta weight and, when known, also in length in almost every case. However, after long-term follow-up all of these children except 1 showed a catch-up growth and were slightly above normal. Their neurological and mental development was also normal except in 1 child who was born severely asphyxiated. We conclude from these results that there appears to be no adverse effect on later growth in the use of glucocorticoids during pregnancy. Therefore, it is unlikely that the short-term use of glucocorticoids as recommended by Liggins would have any influence on later growth.


Three case reports of fetal growth retardation in the second trimester. Antenatal and postnatal growth and development were assessed in a prospective study involving 100 children. 3 cases of second trimester growth retardation exhibiting varying degrees of catch-up growth are described.


Marriage and childbearing in relation to cervical cancer. In order to assess any correlation between cervical cancer and age at marriage and childbearing, matched control groups were formed. From the comparison it appears that cervical cancer patients are more likely to be married and to have married at an earlier age than control women. In the same age groups at marriage there was no difference in the number of children between the cervical cancer patients and the control women. It appeared that cervical cancer patients had their first child earlier than control women. There were more illegitimate children in the cervical cancer groups than in the control groups, but after the wedding date there were no differences between the cervical cancer groups and the control groups in the time between the wedding date and the date of birth of the first child. The data show that after pregnancy or childbirth, in particular at an early age, there is a greater risk of getting a cervical cancer. By contrast, nulliparous married women seem to have a low risk of cervical cancer.


The pathogenesis of amniotic fluid embolism with particular reference to transabdominal amniocentesis. A fatal case of amniotic fluid embolism is presented. Several amniocenteses had been performed during the pregnancy. A review is presented of definite and probable examples of amniotic fluid embolism following amniocentesis.


Cribriform polypoid adenomatous (atypical) hyperplasia of the endocervical glands of the uterus under hormonal contraception. The occurrence of cribriform adenomatous hyperplasia of the endocervical glands of the uterus was examined in 92 women, in whom punch biopsies of the ecto-endocervical line were taken during the second half of their cycle. Of these, 79 women had taken combined estrogen-progestogen preparations, 9 women had taken progestogens alone, while 14 patients formed a control group. There was a significant difference only between the control group without hormones and the groups treated with hormones. The groups of patients under the various regimens of hormonal treatment displayed a varying percentage of cribriform adenomatous hyperplasia. There was a clear tendency for such lesions to be observed more frequently under the combined type of contraception than under the sequential type. These differences were not, however, significant. A correlation with specific exogenous groups of steroids could not be established.


Acute fatty liver of pregnancy with survival of mother and child: a case report. A case of acute fatty liver of pregnancy (obstetric acute yellow atrophy or acute fatty metamorphosis of the liver) is reported in which cesarean section was made and both mother and child survived. The authors suggest that the prognosis was improved by rapid termination of pregnancy. The course of the disease, differential diagnosis, treatment and prognosis are discussed.


Orciprenaline and fetal lung maturation in rabbits. The palmitic and stearic acids and the palmitic/stearic ratio in fetal rabbit lungs were studied after orciprenaline administration to the mother from the 26th to the 31st day of gestation. The results were significantly higher in the treated groups than in the control group for the palmitic acid and palmitic/stearic ratio.


Recurrence of gestational diabetes.

Recurrence of gestational diabetes. The recurrence rate of gestational diabetes in 58 patients who had had the foregoing pregnancy complicated by diabetes was estimated to be 30% if our former criteria for abnormal glucose tolerance were strictly applied and 25% if our new, more stringent criteria were used. The recurrence rate is not influenced by prophylactic administration of pyridoxine. The perinatal morbidity complicating the 'second' pregnancy of former gestational diabetics was not increased in those patients who were not treated again, as compared with those who were. Recurrent gestational diabetes is associated with a degree of overdiagnosis in an attempt to detect all gestational diabetics. It is suggested that recurrent gestational diabetes occurs mainly in prediabetic patients.


Closure of the human umbilical artery: a physiological demonstration of Burton's theory. 30 umbilical cords of normal full-term infants were examined immediately after birth for closure of the arteries. Multiple constrictions were observed in the arteries at birth, which increased in number and degree with time. Between the constrictions there were segments of dilatations with trapped blood. Cutting through the constrictions in the cords clamped later than 1 min after birth did not result in leakage of blood from the adjoining dilated segments which contained trapped uncoagulated blood indicating complete closure. This behavior of the vessels is a physiologic example of critical closure of small arteries according to Burton's theory.


The fetal autonomic nervous system, the fetal heart rate and the beat-to-beat irregularity. In the exteriorized fetal lamb an experimental study on the influence of the fetal autonomic nervous system upon the heart rate pattern is described by means of blockage of the cholinergic, alpha-adrenergic and beta-adrenergic system. The alpha-adrenergic system proved to have no effect upon heart rate. The beta-adrenergic system had a positive chronotropic effect and the parasympathetic system had a negative chronotropic effect. Beat-to-beat irregularity was independent of a functional alpha-adrenergic system, but at a high basic heart rate disappeared completely after cholinergic blockage and at a low rate after beta-adrenergic blockage. It is concluded that most probably the beat-to-beat irregularity is the result of the competition of the enhancing influence of the beta-adrenergic system and the inhibiting influence of the cholinergic system on fetal heart rate.


The effect of various drugs on maternal serum cystine aminopeptidase. Serial estimations (87) of serum cystine aminopeptidase (CAP) in pregnant women (18) using diphenyl hydantoin, phenobarbital or diazepam revealed that the enzyme levels were below the average for normals in 89% of patients. The initially low CAP levels in women on diazepam were improved within 24 h after betamethasone administration. Subsequent studies in vitro confirmed that diphenyl hydantoin, phenobarbital, diazepam and acetyl salicylate markedly inhibited CAP levels in sera of women (72) with clinically uncomplicated pregnancy. No inhibition of CAP by any of the drugs tested was observed in sera from nonpregnant women (8). However, nonpregnant women receiving medroxyprogesterone acetate injections showed CAP inhibition by various drugs, suggesting some changes in the enzyme moiety under the influence of the hormone.


Placental transfer of thiamphenicol in term pregnancy. The placental transfer of thiamphenicol was studied in 21 subjects at term after an intravenous bolus injection of 1000 mg of the drug. Detectable antibiotic levels were present in umbilical blood and amniotic fluid within 15 min of maternal administration. With the dosage applied, minimum concentrations required for the inhibition of many Gram-positive and Gram-negative organisms causing intrauterine infections were attained in maternal plasma, cord plasma and amniotic fluid. The value of thiamphenicol for the treatment of intrauterine infections is discussed.


Quantitative nuclear image analysis: differentiation between normal, hyperplastic, and malignant appearing uterine glands in a paraffin section. II. Computer assisted recognition by discriminant analysis. Quantitative image analysis was applied to data from microscope photometry of nuclei in a paraffin section. The data were essentially the same as described in a previous publication (Baak and Diegenbach, 1977). The results from measurements on the nuclei of morphologically normal, atypical hyperplastic and carcinomatous uterine glands were used in discriminant analysis. With this method it is possible to discriminate between the three groups of nuclei. Depending on the (sub)set of the variables used, 60-70% of all nuclei are correctly classified in one of the three groups. Discrimination of one of the groups against the other two results in up to 81% correct classifications. Therefore, discriminant analysis offers a possibility of assisting diagnosis in an objective way.


Quantitative morphology of the placenta. II. The growth of the placenta and the problem of postmaturity. The morphological changes in the placenta concomitant with the transition from maturity to postmaturity were investigated by stereology under early clamping of the umbilical cord. 37 placentas from nonpathological pregnancies delivered after a period of 224-303 days of amenorrhea were examined. It appeared that after 267-288 days of amenorrhea, 8 out of 9 placental components showed no further growth and even showed regression. Only the volume of the trophoblast continued to grow in postmaturity. It is suggested that during postmaturity the villous capacity to produce steroids is continuing at a normal rate (as judged by the increase of the volume of the trophoblast), whereas the capability to transfer is deteriorating (as testified by the decreasing surface of the trophoblast).


Clinical evaluation of econazole nitrate in 1% vaginal cream for treatment of vaginal candidosis. 30 patients with mycologically confirmed vaginal candidosis on culture were treated with econazole vaginal cream (Gyno-Pevaryl) applied intravaginally once a day for 2 wk. 8 days after the end of treatment, mycological and clinical cures were demonstrated in 26 patients. Symptoms generally subsided rapidly, and the drug was well tolerated. This study confirms the efficacy of econazole in the treatment of vaginal candidosis.


A case of listeriosis in pregnancy with fetal survival. Listeriosis during pregnancy is generally considered to result in an intrauterine infection which affects the fetus before birth or in the perinatal period. A case of listeriosis in a 38-yr-old diabetic woman with an influenza-like disease in her 32nd wk of pregnancy is presented. Two successive blood cultures were positive for Listeria monocytogenes type 4b and her serum showed a rising titer for agglutinins to this organism. After antibiotic treatment of the patient she gave birth to a healthy child.


Fetal blood sampling by fetoscopy in pregnant ewes. Successful fetal blood sampling by fetoscopy is reported in 4 out of 6 pregnant ewes. No deleterious effect of the procedure on the course of pregnancy and fetal outcome could be demonstrated. There were two main problems: floating membranes and mobile fetal cotyledon vessels. Although the first problem could in part be overcome by infusion of saline, fetal blood sampling in the pregnant ewe is a rather difficult and time-consuming procedure.


Quantitative nuclear image analysis: differentiation between normal, hyperplastic, and malignant appearing uterine glands in a paraffin section. III. The use of texture features for differentiation. Markov chain statistic based texture features were used to discriminate nuclei from three regions in a paraffin section of human endometrium. The data of the digitized nuclei from which the texture features were calculated were the same as described previously (Baak and Diegenbach, 1977; Diegenbach and Baak, 1977). Several texture features proved to give a good separation between two of the three groups of nuclei. Combining two or more features can make a separation of all three groups possible. Most of the features are correlated, indicating that fewer than the 20 features used are needed for discrimination. The results are much better than with the features described in the previous articles.


Benign enlargement of the labia minora: report of two cases. 2 cases of bilateral hypertrophy of the labia minora are recorded. The patients presented with vulvar discomfort and redundant labia and reduction vulvoplasty was carried out. The resected specimens showed marked hyperplasia of the non-hair-bearing sebaceous glands, acanthosis, keratosis, and hyperpigmentation of the epithelium and a variable degree of neoangiogenesis and fibrosis in the upper dermis. No cause was established clinically or pathologically. The etiology and pathogenesis of this condition are briefly discussed.


Quantitative morphology of the placenta. III. The growth of the placenta and its relationship to birth weight. The relationship of placental components to birth weight was investigated by stereology. 37 placentas from nonpathological pregnancies delivered after a period of 224-303 days of amenorrhea were examined. The umbilical cord was clamped immediately after birth. The ratios of the volume, the surface, the length of the villous vessels and the surface of the villi with birth weight showed a decrease after 277 days of amenorrhea. In contrast to this decrease, the ratio of the volume of the trophoblast with birth weight seems to increase. No difference could be found for the ratios of the placental volume (placental index), the volume of the villous tissue, the volume of the intervillous space and the volume of the nonfunctional tissue with birth weight. These ratios reveal a quantitative morphological base for the clinical experience that postmature fetuses are at a higher risk through deterioration of the placenta.


Intrauterine detection of fetal phonocardiosignals. In this paper the application of an open-tip phonocatheter for the detection of fetal phonocardiosignals during parturition is described. The phonocatheter is easily inserted with a conventional polythene guide via the cervical route. The fetal heart sounds are detected by the sound pick-up element located in the catheter tip. Intrauterine pressure is measured simultaneously with the help of a Statham uterine pressure transducer externally connected via the lumen to the open tip of the phonocatheter. Since fetal heart sounds can also be detected before rupture of the membranes, it is possible to measure intrauterine pressure and fetal heart activity simultaneously using only one catheter and without being limited to a particular stage in parturition.


Symptomatic plexiform tumor of the myometrium: report of a case. The largest benign plexiform tumor of the myometrium on record is presented. The lesion, measuring 7.2 cm in diameter, was clinically palpable and symptomatic. The presence of scattered microfoci of typical smooth muscle differentiation within the tumor supports its smooth muscle origin.


Bilateral renal agenesis (Potter's syndrome) in two consecutive infants. Bilateral renal agenesis is a relatively rare congenital anomaly; its frequency is 1 : 3000-4000 deliveries, with a remarkable predominance of male infants. This anomaly is most often found in combination with characteristic facial features ('Potter's face') and pulmonary hypoplasia, the combination being known as Potter's syndrome. In the course of pregnancy an increasing oligohydramnios becomes manifest; during labor, virtual absence of amniotic fluid is found in most cases. This oligohydramnios should alert the obstetrician to suspect Potter's syndrome; serial ultrasonography may confirm the diagnosis. Most affected children are born alive but die within a few hours due to respiratory difficulties caused by the pulmonary hypoplasia. Despite the remarkable facial characteristics of these infants, it was only in a small minority that the diagnosis was considered before autopsy. This stresses the need for a full post-mortem examination in all cases of perinatal death. The etiology is still uncertain, though multifactorial inheritance is the most likely. As a consequence, the recurrence risk is not negligible; the small number of 'familial occurrence' observations, however, does not allow estimation of a risk figure. Genetic counseling is indicated in any family giving birth to a child with bilateral renal agenesis. A family is described in which two consecutive male infants with bilateral renal agenesis were born alive and survived 19 and 38 h.


Simultaneous measurements of intrauterine pressure, including the head-to-cervix pressure, by an open-end catheter and a strain gauge. An open-end catheter and a small strain gauge were tied and introduced into the uterine fundus during the labor of 8 parturients. As the tied probes were progressively withdrawn, the pressures given by each were simultaneously recorded. Normally the measurements are identical, but when the free ends of the probes are located between the head and the cervix, striking differences appear, the strain gauge giving much higher figures. Conversely, two intrauterine open-end catheters give the same results even if one is located in the fundus and the other is between the head and the cervix. It is suggested that the strain gauge measures a pressure which is not reliable enough because the area of application of the stress cannot be known accurately.


Low thymic weight in small-for-dates babies. The thymic weights of 20 growth-retarded babies dying at or about birth were found to be less than normal for their birth weights. It is suggested that small-for-dates babies that survive may be immunodeficient as are children who suffer from extrauterine malnutrition.


Quantitative nuclear image analysis: differentiation between normal, hyperplastic, and malignant appearing uterine glands in a paraffin section. IV. The use of Markov chain texture features in discriminant analysis. Discriminant analysis was applied to Markov chain texture features and elementary features calculated from data from microscope photometry of nuclei in a paraffin section. The results from measurements on the nuclei of morphologically normal, atypical hyperplastic and carcinomatous uterine glands were used in discriminant analysis. With this technique it is possible to classify up to 88.1% of the nuclei correctly in one of the three groups of uterine glands. The discriminating power of several smaller subsets indicated that with more than 28 features there is hardly any increase in discriminating power. Discriminant analysis with a selection from elementary and Markov chain features provides objective criteria of assistance in histopathological diagnosis.


Ovarian vascular accidents: a complication of anticoagulant therapy. Ovarian vascular accidents are usually more severe when the patient is being kept on anticoagulant therapy following cardiac surgery or for other reasons. 4 cases of massive hemoperitoneum are reported. Rupture of the corpus luteum and corpus luteum cyst and an ovarian ectopic pregnancy were responsible for massive hemoperitoneum. All 4 patients survived and recovered.


High molecular fibrin derivatives in pre-eclamptic and eclamptic patients. Soluble fibrin monomer complexes were assayed by agarose gel filtration and by ultracentrifugation. Increased values of SFMC were found in the normal third-trimester pregnancies. They were considerably higher in plasma of patients with pre-eclampsia. Concentrations were higher using ultracentrifugation as compared to gel chromatography. Using ultracentrifugation 4 components were identified, indicating that SFMC in this disease are not a homogeneous group.


Gynecological tuberculosis in the west of Scotland. Between 1st January 1950 and 15th June 1978, 638 women with proved tuberculosis of the genital tract were investigated. 7 different drug programmes were used to treat 581 patients. Apart from the most recent regimens employing ethambutol and rifampicin, the best results were obtained with a combination of streptomycin, PAS and isoniazid for 18 mth or 2 yr. Today the treatment of choice is a combination of rifampicin, ethambutol and isoniazid for 1 yr. Surgery should be employed where drug treatment has failed. It is essential that women with tuberculosis of the pelvic organs should be followed up indefinitely after drug treatment.


Subcutaneous mastectomy as ultimate treatment of galactorrhea. Galactorrhea, caused by hyperprolactinemia can successfully be treated by bromocriptine. Continuous long-term use of this drug is not always desirable or possible because of side-effects. In cases of hyperprolactinemia with severe galactorrhea, where surgical or radiological therapy is not possible and long-term treatment with bromocriptine is not acceptable, subcutaneous mastectomy might be considered as an ultimate solution.


Cytogenetic investigation in 413 couples with spontaneous abortions. 413 couples with one or more spontaneous miscarriages were karyotyped. Observed chromosomal rearrangements were classified as major rearrangements, i.e. Robertsonian and reciprocal translocations, pericentric and paracentric inversions, supernumerary small metacentrics, and minor rearrangements, i.e. pericentric inversions of chromosome 9, and constitutional fragility of particular chromosome sites. 2.30% of the individuals were carriers of a major rearrangement, which represents a ten-fold increase when compared to the general population. The contribution of each type of rearrangement is unequal, the most important being pericentric inversions (36 times more frequent than in the general population). Contrary to data from the literature, the probability of finding a rearrangement does not seem to increase with the number of miscarriages.


Maternal and fetal plasma zinc in pre-eclampsia. Zinc is important for fetal growth and is involved in several important enzyme systems. Maternal and umbilical plasma zinc concentrations were determined in 52 parturient women with mild and severe pre-eclampsia, and were compared with those obtained from 20 women in labor whose pregnancies had progressed normally. A decrease in maternal as well as umbilical plasma zinc concentrations was observed in pre-eclamptic women, and this decrease was statistically significant in severe pre-eclampsia. The causes of these changes in plasma zinc concentrations in pre-eclampsia were discussed, and the possible adverse effects of zinc deficiency on the mother and fetus were mentioned. Low plasma zinc concentrations in pre-eclampsia may be a sign of zinc deficiency, implying possible risks to the mother and her fetus. It is recommended that maintenance of adequate dietary zinc nutrition during pregnancy, and particularly in pre-eclampsia, is important.