IgA synthesis by peripheral blood mononuclear cells from normal and selectively IgA deficient subjects. IgA secretion and intracellular IgA synthesis by PWM-stimulated peripheral blood lymphocytes from normal and IgA deficient subjects were measured by radioimmunoassay. Cultured lymphocytes from eleven out of twelve IgA deficient subjects had impaired or undetectable IgA production. Measurement of intracellular IgA showed that the defect was more basic than simply defective secretion by IgA plasma cells. Co-culture of lymphocytes from IgA deficient and normal subjects revealed defects in both the B and T cell populations of IgA deficient subjects. In one subject the defect was in the T cells, in another the B cells, and in two others both T and B cells were defective.


Tissue C3b receptors.

Tissue C3b receptors. Using fluorescein-labelled S. typhi coated with C3b (FBC) the presence of a receptor for C3b in normal human glomeruli has been confirmed. A quantitative system, counting the number of FBC bound per unit area of glomerulus, has been developed. Experimental variables have been studied to determine optimal conditions for FBC binding. Glomerular FBC binding has been shown to be dependent on FBC concentration, temperature and time of tissue incubation. A standardized procedure has been adopted. Using this technique we have examined a number of target tissues, including synovium, skin, lung, choroid plexus and uveal tract, which are frequently affected in systemic immune complex diseases. No evidence of this receptor has been found in these tissues. These results suggest a mechanism different from the C3b receptor operating to localise immune complexes in these non-renal sites.


Non-specific leucocyte migration inhibition of gynaecological carcinoma patients. Leucocyte migration inhibition in the presence of tumour crude ovarian tissue antigen was demonstrated in 64.51% of ovarian cancer patients, in 58.18% of other gynaecological carcinoma patients and in 19.04% of healthy individuals. Patients with benign ovarian disease showed 12.5% leucocyte migration inhibition. No significant difference was seen between results obtained in the presence of ovarian carcinoma antigen and normal ovary antigen.


Blood lymphocyte subpopulations in breast cancer patients following post-operative adjuvant chemotherapy or radiotherapy. The peripheral lymphocyte population was examined in sixty-five randomized breast cancer patients before and after post-operative adjuvant cyclic chemotherapy or local radiation therapy. During 10 months of chemotherapy total lymphocyte and T cell counts were reduced to 70% and non-T cells to about 50% of pretreatment values. The population of T cells was unaltered whereas the proportion of non-T cells was significantly reduced at the end of the period. Immediately after radiotherapy total lymphocyte and T cell counts were reduced to 30%, and non-T cells to 15% of pretreatment values. During 10 months' observation total lymphocyte and T cell counts increased to 70%, and non-T cells to 50--60% of pretreatment values.


The effects of azathioprine and levamisole on lymphocyte stimulation. Azathioprine at 10 micrograms per ml caused approximately a 50% inhibition of phytohaemagglutinin (PHA), purified protein derivative (PPD) or Veillonella induced in vitro lymphocyte stimulation. This suppression was significantly reduced in lymphocyte cultures from patients undergoing an eight week course of levamisole therapy. Azathioprine-induced suppression was also reversed when culturing lymphocytes in the presence of levamisole. On the other hand, levamisole in vitro failed to reverse the azathioprine suppression of cord blood lymphocyte responses.


Systemic karyomegaly associated with chronic interstitial nephritis. A new disease entity? In 3 patients, two 26 and one 29 years of age, a nephropathy was accidentally discovered which progressed to end stage renal failure within 4 to 6 years. Renal biopsy revealed an unusually marked karyomegaly particularly of the tubular epithelium. These cytopathological changes were associated with chronic interstitial nephritis. Biopsies of other organs, i.e. liver, colon, bronchus and lungs indicated in 2 patients a systemic distribution of the karyomegaly, particularly in mesenchymal cells. Neither the chronic interstitial nephritis nor the karyomegaly could be ascribed to a recognized etiology. This suggests, therefore, that there is a relationship between these changes. The karyomegaly could be the result of the action of some antimitotic agent such as chemical toxins or virus infections.


Serum vitamin A levels and associated abnormalities in patients on regular dialysis treatment. Multivitamin preparations are commonly administered to regular dialysis treatment (RDT) patients. Serum Vitamin A was measured in 72 patients on RDT. Elevated serum Vitamin A levels (102.29 +/- 26.95 microgram/dl [3.57 +/- 0.94 mumoles/l]) were found in the dialysis population (normal 40.98 +/- 6.71 microgram/dl [1.43 +/- 0.23 mumoles/l]; P less than 0.0005). Serum Vitamin A levels increased with duration (months) of dialysis but not with frequency of dialysis (twice or thrice weekly). Patients taking a VitaminA-containing multivitamin preparation had higher serum Vitamin A levels than those on a non-Vitamin A supplemented diet. Bilaterally nephrectomized patients had the highest serum Vitamin A levels while patients with obstructive uropathy had the lowest levels. Serum Vitamin A levels did not correlate with symptoms of uremia. Positive correlations were found with serum levels of calcium, cholesterol and triglycerides. Patients receiving a Vitamin A supplement had higher serum cholesterol levels than non-supplemented patients. Vitamin A might be a factor in the high incidence of cardiovascular disease in RDT patients. We therefore advise discontinuing the long-term administration of Vitamin A-containing multivitamin supplements to patients on RDT.


Pre-vs. post-dilutional hemofiltration.

Pre-vs. post-dilutional hemofiltration. The advantages and disadvantages of pre- and postdilution in hemofiltration are discussed, and formulae are derived for sieving coefficient, fractional clearance, and hemofiltration clearance. On the basis of these formulae the two methods are compared, and it is concluded that the present state of membranes is such that the postdilution method is more convenient and cheaper.


Renal artery thrombosis occurring in an adult with the idiopathic nephrotic syndrome: results of local treatment with streptokinase. A 55 year old male with the idiopathic nephrotic syndrome (minimal glomerular lesions by light microscopy and negative immunofluorescent stainings) presented righ renal artery thrombosis as evidenced by clinical and arteriographic findings. Local Streptokinase infusion by means of a renal artery catheter resulted in revascularization of the arterial tree, although recovery of renal function was only partial.


Percutaneous femoral vein catheterization for hemodialysis: a single needle technique. A method of single needle dialysis using femoral vein cannulation particularly suited for treatment of acute renal failure is described.


Renal vein fibrin degradation products (FDP's) in glomerulonephritis. In order to determine the role of intrarenal vascular coagulation (IVC) in chronic glomerulonephritis, coagulant parameters in renal blood (RVB), urine FDP's and renal histology were examined in 70 patients with chronic glomerulonephritis (CGN). RVB was obtained by Seldinger's technique. A correlation was obtained between an increase of fibrinogen, FDP and soluble fibrin monomer complexes (SFMC) in RVB and the degree of intraglomerular fibrin deposition shown on immunofluorescence. An increase of FDP's, SFMC and a slight decrease of fibrinolytic activity in RVB were observed in patients with CGN with decreased renal function or with the nephrotic syndrome. Daily excretion of FDP in the urine and the extent of intraglomerular fibrin deposition were greater in nephrotics than in non-nephrotics. We conclude that measurement of coagulation parameters in RVB is a reliable and sensitive method of assessing IVC, and that IVC plays an important role in aggravation of chronic glomerulonephritis, particularly when the nephrotic syndrome is present.


Circulating immune complexes and phagocytic activity of polymorphonuclear cells in patients with glomerulopathies. Out of 92 renal patients with various types of glomerulonephritis diagnosed by renal biopsy 49 (52 per cent) proved to be immune complex positive by the platelet aggregation test. The highest frequency of circulating immune complexes was found in Henoch-Schoenlein (5 out of 5) and IgA (4 out of 5) nephropathies. The occurrence of circulating immune complexes correlated well with the clinical activity of the renal disease. The phagocytic activity of the polymorphonuclear cells was investigated in 46 patients and depressed activity was detected in all but one of the patients. There was no relationship between the titer of circulating immune complexes in serum and the extent of phagocytic activity.


Scintigraphic skeletal changes in non-dialyzed patients with advanced renal failure. Technetium-99m-polyphosphate (Tc-PP) bone scintigraphy was performed in 51 patients with advanced renal failure in order to evaluate the applicability of this method in detection of metabolic bone changes in these patients. The creatinine clearance varied from 2 to 40 ml/min and none of the patients had previously been on dialysis treatment. The scintigrams were graded according to the focal and the generalized abnormal uptake of the tracer in the skeleton. 34 patients showed generalized scintigraphic changes and among these the changes in 18 patients were classified as severe. An inverse correlation was found between the kidney function and the generalized scintigraphic classification. Focal bone changes were found in 11 patients. In order to evaluate the influence of the lack of kidney function on the scintigraphic results, 3 patients with acute oliguric renal failure were examined. All had normal scintigrams. It is concluded that Tc-PP bone scintigraphy is a sensitive method in revealing renal osteodystrophy in non-dialyzed patients with advanced renal failure in agreement with previous reports on patients on chronic hemodialysis and after kidney transplantation.


A fall of plasma osmolality created at dialyzer and its possible effect on circulating blood volume. A mathematical analysis of fluid exchange during hemodialysis therapy was performed in order to determine which factors affect the circulating blood volume, and hence the circulatory stability. It was found that both fluid removal and also the fall of plasma osmolality during the passage of blood through the dialyzer can affect the circulating blood colume profoundly. The later was found to accelerate the decrease of circulating blood volume by an indirect action on capillary refilling. Some treatment systems such as those involving recirculation or ultrafiltration were found to show a small fall in osmolality with a correspondingly small fall in blood pressure. This result seems to be compatible with clinical experiences reported earlier and may explain why some methods of treatment are accompanied by stable circulatory function in spite of rapid removal of large amounts of fluid.


Effects of serum and plasma from hemodialysis patients on the lymphoproliferative response. The effect of serum and plasma from hemodialysis patients on the immune response was investigated in vitro using phytohemagglutinin(PHA)-, concanavalin A(Con A)-, and staphage lysate(SPL)-induced and spontaneous blastogenesis of peripheral lymphocytes from a healthy person. An immunosuppressive substance(s) was found to exist in these samples and markedly increased in activity after hemodialysis. This substances(s) was heat-labile (56 degrees C, 30 min) and had a molecular weight of 50,000 daltons or more. It was not related to heparin. The appearance of this substance(s) was not influenced by the patients' sex or age or by the duration of hemodialysis.


Tc-99m-IDA hepatobiliary imaging: a fractured liver. The authors describe the scintigraphic appearance of a fractured liver using a Tc-99m-IDA derivative. Tc-99m-IDA imaging provides both functional and morphologic information which is necessary in evaluating biliary tract trauma.


Combined superior vena cava and pulmonary artery obstruction by an ascending aortic aneurysm. A case report is presented on the use of intravenous radioisotope angiocardiography in the diagnosis of an atherosclerotic aneurysm of the ascending aorta in a 44-year-old man who presented with mild superior vena cava obstruction. In addition to outlining the site and extent of the aneurysm, intravenous Tc-99m-albumin radioisotope angiocardiography and blood pool imaging permitted demonstration of the site of obstruction of the cava, indicated the presence of venous collateral channels bringing about delayed filling of the right heart, and also detected obstruction of the right pulmonary artery by the aneurysm. The procedure is simple, rapid, and entirely noninvasive and permits both anatomic and hemodynamic evaluation of the abnormality.


First-pass or single-pass radionuclide angiography evaluation of left ventricular ejection fraction using a microcomputer system. Left ventricular ejection fractions of 31 patients determined from first-pass or single-pass radionuclide angiography from the anterior position using a microcomputer system and floppy disc were compared to angiographic catheterization data obtained from the right anterior oblique position. This study demonstrated a good correlation with r = 0.91. To our knowledge, this is the first report of comparative first-pass left ventricular ejection fraction data and contrast angiography using a microcomputer system and a floppy disc.


Radioxenon ventilation studies with disposable apparatus: technique and application. Modification of commercially supplied disposable apparatus for radioxenon ventilation imaging solved several problems: occasional poor inhalation of the initial bolus of gas, awkward initiation of the wash-out phase, and building up of pressure against which the patient must exhale in the wash-out phase. Two cases illustrate results of ventilation and perfusion imaging in chronic obstructive pulmonary disease and pulmonary embolism. A third case illustrates results before and after bullectomy, including quantitative data analysis of the wash-out phase. Although long-range economy is possible with permanent equipment, the use of the modified disposable apparatus may be preferable in certain circumstances.


Dental lesions causing abnormalities on skeletal scintigraphy. The dental lesions of periodontitis, periodontal cysts, and tooth extraction were studied by Tc-99m phosphate scintigraphy of the jaws. Inflamed apical periodontal lesions caused a localized area of increased concentration of radiotracer regardless of the presence or absence of symptoms. Scintigrams may be positive up to eight months after dental extractions but tend to return to normal thereafter unless complications arise.


Radionuclide cerebral angiography in moyamoya disease. During the early arterial phase of a case of moyamoya disease, the radionuclide cerebral angiogram showed abnormal increased perfusion at the surface and the base of the head, but there was no recognizable activity in either middle cerebral artery. Contrast angiography demonstrated bilateral occlusion at the carotid siphon, characteristic net-like vascularities in the base of the brain, many anastomotic connections between the dural and cerebral branches, and collateral transdural circulation. The combination of radionuclide angiography, static brain imaging and CT scanning proved useful in investigating moyamoya disease.


Radionuclide scanning in patients with advanced malignant melanoma. The results of liver, bone, and brain scans in 84 patients with recurrent or metastatic malignant melanoma were reviewed. The liver scan was initially positive in 18% (14/78) and ultimately in 32% (25/78). Serum alkaline phosphatase and lactic dehydrogenase were elevated in 92%. These patients ultimately developed positive liver scans, while convincing hepatomegaly was noted in only 44%. Bone scans were eventually positive in 33% (16/49), all of whom had pain. Brain scans were positive in 15% (10/65), all of whom had CNS symptoms. In asymptomatic patients, bone and brain scans only rarely disclosed occult lesions.


Decreased lung perfusion due to broncholithiasis. Two patients each with symptoms of an endobronchial lesion showed decreased unilateral lung perfusion upon radionuclide imaging. Chest films were normal except for hilar lymph node calcifications. Bronchography and tomography revealed compression and obstruction of the bronchial tree by the calcified lymph nodes, accounting for the patients' symptoms. Incomplete bronchial obstruction or collateral air drift accounted for the normal appearance of the lungs on the PA chest films.


Radionuclide imaging of splenic laceration and trauma. Tc-99m colloids are the pharmaceuticals preferred in the radionuclide diagnosis of splenic rupture. Spleen scintigraphy is also the preferred diagnostic method. It is rapid, safe, and reliable and should be recommended in all clinical situation where diagnosis is in doubt. A most important point is its value in following the healing of a splenic rupture managed nonoperatively or by suturing or resection, treatment modalities which are increasingly used at the present time.


EEG data acquisition and preprocessing by microcomputer satellite system. Recent development in computer technology allows already medium scale EEG data processing to be performed within the clinical neurophysiology department, if a fast minicomputer with adequate mass storage and graphical output facilities is used. Data acquisition, however, should be delegated to a microcomputer which also should take over as much preprocessing as possible. A system is presented, where one or several microcomputer-based satellite units perform analog-digital conversion, Fourier transformation (FFT), calculation of power spectra and crossproducts, as well as event related averaging or other preprocessing procedures. The units are connected to a fast central minicomputer, where a supervisor program loads the microprocessors with their programs, supervises their activity, receives preprocessed data and activates appropriate postprocessing programs to produce the final results.


The rapid generation of strength-interval curves under computer control. A system was developed to allow for the rapid evaluation of myocardial excitability and conduction in canine preparations. The stimulus strength required to excite a propagated response, as a function of time since the last depolarization, can be summarized by a strength--interval curve. Our system generates strength-interval curves under computer control with high accuracy and efficiciency. The conduction time of each ventricular response is also determined. At a heart rate of 2.5 Hz, the average time for curve generation is 94 s, an efficiency which is 85% of the theoretical maximum. This system has been employed in over 120 dogs to generate strength--interval curves during rapidly changing periods of myocardial ischemia and during interventions with various drugs.


Mlab--a mathematical modeling tool.

Mlab--a mathematical modeling tool. An interactive interpreter called Mlab is described. One uses Mlab by typing commands. In this sense, Mlab is a programming language. It has various mathematical and graphical facilities which make it a useful tool for mathematical modeling. The curve fitting capabilities of Mlab are augmented with differential-equation-handling and matrix-manipulation capabilities which provide a powerful and civilized facility for curve fitting. Many people are engaged in this activity, and, in general, they use programs which are neither sufficiently general nor easy to use. (Some conventional programming is usually required, for example.) Mlab purports to be easier than alternate approaches. The nature of Mlab is discussed with accompanying examples. The main example is the use of curve fitting to determine molecular weight from ultracentrifuge data. This example was chosen because it exhibits a special feature of Mlab, namely the root operator, which appears in the definition of the model function.


Dihydroabietyl alcohol (Abitol): a sensitizer in mascara. A nickel-sensitized female patient developed a contact dermatitis reaction to her mascara that was maintained by her spectacle frames, which contained nickel. On patch testing, she reacted to dihydroabietyl alcohol (Abitol), which was present in her mascara, and to hypoallergenic adhesive tape containing methyl abietate. There was also cross-reactivity with colophony and abietic acid.


Cumulative effect of surfactants on cutaneous horny layers: adsorption onto human keratin layers in vivo. An attempt has been made to determine the adsorption ability of surfactants by the human horny layers in vivo. For this purpose, a technique utilizing an acidic dye such as indigo carmine was applicable and convenient. Our in vivo study estimating adsorbing residual amounts of surfactants has revealed that there is a positive correlation between adsorbing and roughening effects. It is suggested that the pathogenesis of hand roughness is primarily related to the cumulative injury of the stratum corenum by adsorbing residual surfactant molecules.


Human cutaneous vulvar reactivity to irritants. To better understand the cutaneous reactivity of vulvar skin, two chemical irritants were applied topically to 21 subjects. The forearm of each subject served as a comparative control. Test sites remained open and were read at 24 hours. A significantly increased response to the irritants was noted on the vulvar skin.


Age distribution of the incidence of contact sensitivity to standard allergens. The incidence of contact sensitivity to standard allergens present in the daily environment, such as chromium ion, cobalt, nickel and formaldehyde, is found to decrease in the fourth decade. It strongly suggests the presence of some immunoregulation in human beings, because sensitivity to these allergens should be equal in any decade.


Itching erythema among post office workers caused by a photocopying machine with wet toner. For two years the employees in a Danish post office complained of irritation of the eyes and the skin. The symptoms were of varying intensity and disappeared during absence from work. A photocopying machine using wet toner proved to be the cause of the symptoms. It has not been possible to ascribe the symptoms to specific chemicals.


Histological changes in rabbits after application of medicaments and cosmetic bases. A staged histological study of skin changes induced in rabbits by daily application of five bases used for topical medicaments and cosmetics, namely glycols, petrolatum, Modulan, Acetulan and Amerchol L 101, over periods of 100 days, is reported. Sections obtained every 10 days were examined for changes in the epithelium, in the character of the dermal infiltrate and in the superficial collagen fibers. Glycols showed no particular effects on the skin; petrolatum produced acanthosis and vacuolization in the epidermis, and mononuclear cell infiltration of the dermis but evident collagen changes. Lanolin derivatives produced acanthosis and vacuolization of the epidermis, with lymphomonouclear infiltration of the dermis and with dissociation of collagen; examination around the 30th day showed a tendency to basal layer disorganization by the infiltrate.


Nickel sensitivity: relationship between history and patch test reaction. The prevalence of nickel sensitivity in 415 young adults was examined by patch testing with nickel sulphate 5% in pet. Before testing the persons filled in a questionnaire about personal or family history of atopy and skin reactions after metal contacts. Nickel sensitivity was found in 2.8% of males and 9.8% of females; 13 out of 28 persons with a history of metal contact dermatitis had negative patch test reactions to nickel; eight out of 23 persons with positive patch test reactions to nickel had never experienced skin reactions from metal contacts. These findings indicate that nickel sensitivity cannot be reliably predicted from pretest historical information.


Abortion counselling by nurse specialists. This paper describes additional training given to nurse specialists in family planning to cover abortion counselling. The primary counselling was carried out by general practitioners or family planning clinic doctors, following this the patient was referred to hospital for counselling by nurse specialists. Of the first 742 patients seen, 3.2% were not pregnant and a further 25 patients (3.4%) decided against termination, 21 after counselling, and 4 because of advanced gestation. The interval between nurse counselling and termination (TOP) was 3 to 9 days, and of 682 TOPs 566 (83%) were in the first trimester. The additional training for nurse specialists prevented the unnecessary wastage of resources as only 42 (5.1%) required a second visit to confirm blood test results, e.g. rubella titres, and only a further 44 (5.3%) required referral to medical social workers.


Serum prolactin concentrations related to copper or inert intrauterine devices (IUDs) in women. A report that serum prolactin concentrations were almost doubled by the use of copper IUDs led us to study the effect of both copper and inert IUDs. We studied 105 normal women in whom all other prolactinergic factors had been excluded; 25 of them were using copper IUDs, 25 were using inert IUDs and there were 55 controls. No differences were found in the mean prolactin levels between these groups (4.3, 4.5 and 4.3 microgram/l, respectively). We conclude that copper and inert IUDs do not affect prolactin secretion.


A comparative study of the effect of the Progestasert TM and Gravigard IUDs on dysmenorrhoea. Data obtained from questionnaires on the occurrence of dysmenorrhoea in women using IUDs inserted randomly (146 of them Progestasert and 149 Copper 7) are analyzed. In both groups a reduction in the intensity of menstrual cramps was observed over 12 months of use. Although these reductions are significant in each group, they are slightly higher in Progestasert users. However, on comparing the reduction tendencies of both groups, the difference between them is not significant. No significant differences become apparent either when comparing premenstrual and intermenstrual camps. The usefulness of simple questionnaires directed at detecting the nature of pain in currently used family planning forms for IUD users is discussed.


Intravaginal contraception with the synthetic progestin, R2010. Four women used polysiloxane vaginal rings of core design containing 50 mg of norgestrienone (17 alpha-ethynyl-17 beta-hydroxy-estra-4,9,11,trien-3-one). The treatment was given in three-week cycles, leaving one treatment-free week between the cycles. The patterns of bleeding were registered and plasma norgestrienone (R2010), estradiol, progesterone, and gonadotropins were determined. Altogether twelve cycles were studied. The patterns of bleeding were unsatisfactory; only one subject had regular bleedings, and two of these were preceded by a luteal phase. The mean plasma concentration of norgestrienone (R2010) produced by the rings was 0.9 ng/ml. Ovulation was observed in 25% of cycles studied. Some follicular activity was present in every subject as judged by estradiol peaks. Excluding LH peaks in subjects who ovulated, mild pituitary suppression was achieved by this treatment. The only side-effect complained of was acne in one subject. The ring was regarded as easy to use.


Plasma levels of 15 (S) 15-methyl-PGF 2 alpha-methyl ester following vaginal administration for induction of abortion in women. A single suppository containing 3.0 mg 15 (S)15-methyl-PGF2 alpha-methyl ester was administered vaginally in women to terminate mid-trimester pregnancy. Plasma levels of the drug (both methyl ester and free acid forms) were measured at different time intervals using deuterated carriers and gas chromatography-mass-spectrometry. 15(S)15-methyl PGF2 alpha (sum of methyl ester + free acid) was found to have a mean value of 1166 pg/ml plasma at 3 hrs after administration of the suppository. The mean levels were subsequently found to be maintained in the range of 1000 pg/ml. Preliminary studies showed that unlike the successfully aborted women, in those who did not abort within 30 hrs with this suppository, the plasma levels of the drug were not maintained for a sufficiently long time. The episodes of side effects, body surface area and the induction-abortion interval in relation to the plasma levels are discussed.


Locational profiles: incoming veterinary students and outgoing new veterinarians, 1971-78, New York State College of Veterinary Medicine, Cornell University. Relationships between the demographic areas of incoming veterinary students and first placement locations were examined during 1971-1978 for the New York State College of Veterinary Medicine at Cornell University. Seventy-four percent of the incoming students were New York residents whereas only 52 percent of the graduates selected New York sites for their first placement after graduation. Part of the net loss may be the result of temporary moves into the state to gain residence status, educational preparation and possibly some hope for improving admission eligibility. After completing their veterinary education, they are more likely to return to areas closely associated with family and childhood experiences for first placement choices or for advanced educational offerings. Three demographic classifications were used to identify patterns of movement into and out of the state (Urban, Suburban and Rural). No significant differences in area distribution patterns were observed between incoming and outgoing students/graduates. However, when the data were separated by sex, the outgoing distribution patterns were significantly different for female graduates (Urban and Rural areas preferred over Suburban). Sixty-five percent of the out-of-state placements were in New England and other Northeastern states, with Rural areas showing major strengths.


Evaluation of the anaplasmosis rapid card agglutination test for detecting experimentally infected elk. Anaplasmosis was experimentally transmitted from cattle to elk to cattle. Six non-splenectomized adult elk (Cervus canadensis canadensis) that were inoculated with freshly collected heparinized blood from cattle chronically infected with Anaplasma marginale became asymptomatic carriers. Although the exposed elk did not develop clinical or hematologic evidence of infection they become seropositive by the serum and plasma rapid card agglutination (RCA) tests. Blood from the experimentally infected elk produced disease in splenectomized bovine calves and the carrier state persisted for at least one year. Infection did not occur when two elk were inoculated with 0.5 ml of frozen blood from known bovine carriers. The blood had been frozen for four weeks in liquid nitrogen with six percent dimethyl-sulfoxide.


Trypanosoma theileri: a literature review and report of incidence in New York cattle. The incidence of infection in adult dairy cattle in New York State with Trypanosoma (Megatrypanum) theileri (Laveran 1902) was determined by culturing buffy coats of peripheral blood samples in tissue culture growth media. Three sample groups of cattle were studied and revealed an overall rate of trypanosome infection of 44.4% (67 of 151) as determined by a single culture. Fifty-seven cows, representing four herds from three different geographic locations in the Southern-tier region of the state, comprised the first group. The infection rates of these herds ranged from 56.5 to 100%. The second group consisted of 81 cows randomly selected from animals admitted to the Large Animal Clinic of the New York State College of Veterinary Medicine. Trypanosoma theileri was cultured from 25.9% (21 of 81) of these animals. Repeated blood cultures from a third group of thirteen yearling heifers during the spring and summer revealed an increase in the infection rate from 0% in May, to 66.7% (8 of 12) in September, with 76.9% (10 of 13) positive at least once during this period. These findings are compared with the reported incidence of bovine T. theileri infections in other areas of the United States and in other countries.


Aerosolized clenbuterol (NAB 365) and salbutamol in exercise-induced asthma. The effect of clenbuterol (NAB 365) in inhibiting exercise-induced asthma was compared with that of salbutamol in a single-blind, placebo-controlled, crossover study. Single doses of 20 microgram clenbuterol and 200 microgram salbutamol were given by inhalation 180 minutes before exercise to 9 patients. The exercise used was treadmill running. Clenbuterol offered complete protection to 7 patients, partial protection to 1 and no protection to 1 patient. Salbutamol offered complete protection to 5 patients, partial protection to 1 and no protection to 3 patients. One patient was not protected by any treatment. The protective effects of the two beta-adrenergic bronchodilator drugs were similar (p = 0.42 for FEV1 and p = 0.10 for FEF25-75%). Placebo failed to prevent exercised-induced asthma in any patient. No adverse reactions were manifested or reported by the patients.


Evaluation of tissue levels of cefamandole in severely ischaemic lower limbs using two regimens of dosage. Cefamandole levels were measured in peripheral blood, and in skeletal muscle and subcutaneous fat samples taken from 20 patients during amputation of the leg for severe ischemia. Tissue samples were taken from both proximal and distal levels in the amputated limb. Cefamandole was administered as either a 2 g intravenous bolus given with induction of anaesthesia, or a combination of 1 g intramuscularly with the premedication plus 1 g intravenously with anaesthetic induction. Levels of cefamandole in serum and proximal muscle and fat samples were well above the minimum inhibitory concentrations required for most Gram-positive and Gram-negative organisms. Cefamandole levels in more distal samples were somewhat lower but still achieved therapeutic levels in most cases. Higher tissue levels of cefamandole were achieved when 2 g were given intravenously as a bolus.


Plasma lipoprotein changes during oral contraception. Changes in plasma concentration of high-density lipoprotein (HDL) cholesterol concentration were measured in healthy young women who received 21-days' oral treatment with either norethisterone acetate (1, 2, or 5 mg daily) or ethinyloestradiol (20 or 50 microgram daily). Similar measurements were also made in groups of women receiving progestogens or oestrogens for gynaecological indications, and in women taking oral contraceptives. Oestrogens alone stimulate increases in HDL-cholesterol, while progestogens alone suppress the concentration. Combinations of oestrogens and progestogens have variable effects depending on the relative doses and chemical compositions of the two hormones. Because HDL-cholesterol concentration is thought to be negatively correlated to cardiovascular disease risks, products which induce a large decrease are to be avoided, though other risk factors must be taken into account in the selection of oral contraceptives.


Influence of pentoxifylline on erythrocyte deformability in peripheral occlusive arterial disease. Impaired red cell deformability  has been found in patients suffering from chronic peripheral vascular disorders, the implication being that microcirculatory blood flow is hindered and tissue hypoxaemia is aggravated. Measurement of erythrocyte deformability by a standard filtration technique for whole blood was carried out in 40 young healthy persons, in 25 untreated patients with peripheral occlusive arterial disease and in 25 patients with matching vascular disease, before and after a 6-weeks' oral treatment with 400 mg pentoxifylline 4-times daily. The filtration rates were significantly lower in the patient groups compared to those of healthy volunteers. After the oral administration of pentoxifylline, a significant increase in filtration rates was observed pointing to an improvement in erythrocyte deformability. The findings suggest that by improving erythrocyte deformability pentoxifylline positively influences the microcirculatory blood fluidity, an important factor for efficient therapy in peripheral arterial occlusive disease.


Treatment of anxiety-related insomnia with chlormezanone. Twenty-nine patients seen in general practice suffering from sleep disturbance due to mild neurotic anxiety were treated with 400 mg chlormezanone per night for 2 weeks. Patients' and doctors' assessments of quality of sleep and Hamilton anxiety rating scores were carried out initially and after 1 and 2 weeks. Patients also completed a daily record card assessing their sleep. The results suggest that chlormezanone produced prompt improvement within 2 nights of the start of treatment, and by the end of the study period only 2 (7%) patients still reported their sleep as being poor compared with 80% initially, and 19 (66%) rated their sleep as good or excellent. There was a steady reduction in anxiety rating scores throughout treatment. Only 1 patient reported a transient mild side-effect.


A double-blind study of the peripheral vasoconstrictor effects of the beta-blocking drug penbutolol in patients with Raynaud's phenomenon. A double-blind, placebo-controlled study was carried out in 10 hypertensive patients who were subject to frequent attacks of Raynaud's phenomenon and suffered from cold hands, to assess the peripheral vasoconstrictor effects of penbutolol. After a wash-out period of 2 weeks on placebo, patients received two 14-day treatment periods, in random order, with either 20 mg penbutolol twice daily or placebo separated by a second 2-week single-blind wash-out period on placebo. The results of digital blood flow measurements showed that penbutolol did not produce any additional vasoconstrictor effect on digital circulation. The significance of these findings is discussed.


A study of the effect of sulphinpyrazone ('Anturan') on blood viscosity. A double-blind, placebo-controlled crossover study of the effect of sulphinpyrazone on blood viscosity and its determinants (haematocrit, plasma fibrinogen and plasma viscosity) was carried out in 7 healthy male volunteers. Apart from a transient rise in fibrinogen (p less than 0.05) after 3 days of sulphinpyrazone treatment, no significant change in viscosity factors was seen over a 14-day period.


Evaluation of a high nitrogen source amino acid solution ('Aminofusin' L Forte). A new high concentration nitrogen source solution ('Aminofusin' L Forte) was evaluated in 9 patients requiring complete parenteral nutrition regimens. Excellent clinical tolerance was observed and the solution proved capable of maintaining patients in nitrogen balance. Although the non-essential part of the amino acid profile is incomplete, no significant deviations from the normal range in plasma amino acid concentrations were noted. It is concluded that the solution is a useful addition to the range of amino acid preparations available for intravenous feeding.


Severe acidosis from acetazolamide in a diabetic patient. An insulin-dependent diabetic patient with nephropathy developed severe acidosis after treatment with acetazolamide for glaucoma. A renal tubular abnormality may have allowed the usually self-limiting acidosis of acetazolamide to progress. It is suggested that the plasma electrolytes of patients at risk should be monitored.


Use of keto acids in inborn errors of urea synthesis. Our experience with nitrogen-free analog therapy of these disorders indicates that these compounds are adequate nutritional supplements which are non-toxic and which promote mental and somatic growth. They prevent or reduce hyperammonemia for varying periods of time in three of these disorders, but as yet have not prevented hyperammonemic coma and death in infants with complete enzyme deficiencies. Further work wi-l be necessary to determine how impending hyperammonemic coma can be detected before it becomes irreversible, as asll as to improve the therapy of hyperammonemic coma when it develops.


Disorders of hemostasis in malignancy.

Disorders of hemostasis in malignancy. Disorders of hemostasis are frequent in malignant disease and their cause is often multifactorial and complex. Both primary (platelets and vessel walls) and secondary (coagulation factors) hemostasis are impaired, often concurrently. Therapy is most often directed toward the underlying disease; however, a knowledge of the complications and treatment of each malignancy will often prevent a number of the problems cited in this chapter. The hypercoagulable states are still poorly understood and need better definition, but their recognition, treatment and prevention may decrease morbidity significantly.


[Spermatogenesis in a pteridophyte. 1. First stages of the motile apparatus]. The first appearance of the motile apparatus can be seen just before the last spermatogenous division. It is a granular cluster of electron dense material which sends out arms which are transformed into spindle-microtubules. After division, the latter disappear, and procentrioles differentiate in a blepharoplast from the material of the 'organizing centre' from which are successively born two different systems of microtubules. In addition, the motile apparatus is initiated in the cytoplasm away from the nucleus. It is only later that the centrioles are intimately combined with the nucleus through the medium of the microtubule ribbon, thus marking a fist stage in the maturation of the spermatozoon.


Plastid ultrastructural features in the various tissues of sunflower leaves. In young sunflower leaves a cell differentiation gradient has been observed along the major leaf where the leaf basal cells are less differentiated than the apical ones. The tip-base gradient also affects plastid differentiation. Moreover, diverse differentiation speeds are observed among the plastids of the various leaf tissues. The first plastids to take on a well-differentiated appearance are those of the mesophyll. In both the epidermis and vein regions (i.e. in a monocellular sheath round the bundle) one can observe plastids with electron-dense intrathylakoid compartments and lightly stained membranes which, however, are numerous and well-arranged in the grana. The latter membranes have a definite appearance for some plastids. It is assumed that the cell's internal environment is able to control the rate of plastid differentiation.


Chromosomal polymorphism in three species of Indian snakes. Interesting results regarding the polymorphic state of one or more pairs of macro-chromosomes in three species of colubrid snakes viz., Ahaetulla nasutus, Chrysopelea ornate and Acrochordus granulatus were obtained. Morphological variations were statistically estimated and idiograms prepared. These observations, when compared with those of the normal karyotypes, confirmed that the centric shifts were real and in all probability due to pericentric inversions. Such observations yield significant information regarding the mode of speciation in this group of animals.


Human tonsil lymphocytes in the transfer of cell-mediated immunity. Peripheral blood lymphocytes have the ability to transfer cellular immunity. In this study, we investigated whether human tonsil lymphocytes could transfer cellular immunity. Human tonsil lymphocyte ultrafiltrates, after separation through gel filtration, showed five fractions in Sephadex-G-10, as well as four in Sephadex-G-25,4. The extracts and the fractions have characteristic biochemical as well as biological properties. The biological activity of ultrafiltrates from human tonsil lymphocytes was compared with the activity of ultrafiltrates prepared from human peripheral blood lymphocytes, for identification studies of a 'Transfer Factor' from human tonsils. Ultrafiltrates prepared from human peripheral blood lymphocytes (Ascher et al., 1976) and tested, showed similar biochemical and biological properties.


Endosymbiotic bacteria in Vaucheria (Xanthophyceae): association with cytoplasmic microtubules in Vaucheria sessilis. Ultrastructural investigation has shown the presence of rod-shaped endosymbiotic bacteria in the cytoplasm of three species of Vaucheria. Particular attention is directed to the relationship in V. sessilis where the symbiont moves along the vegetative filament on cytoplasmic microtubules of the host.


The ultrastructural localization of alkaline phosphatase activity in the tegument of the cysticercus of Hydatigera taeniaeformis. Alkaline phosphatase activity of the cysticercus of Hydatigera taeniaeformis was studied by means of electron microscopy. Beta-glycerophosphate was used as the substrate. The reaction product was localized within the microtriches of the distal cytoplasm, and in the cytoplasm and processes of perinuclear cells. Activity was also demonstrated within circular and longitudinal muscle bundles and in calcareous corpuscles.


An ultrastructural study of peritoneal mononuclear phagocytes from iota carrageenan injected mice. Mononuclear phagocytes harvested from peritoneal cavities of mice injected intraperitoneally 24 h previously with iota carrageenan were invariably vacuolated or lysed. The incidence of lysed cells was approximately 25%. Carrageenan could be identified as fibrillar material within phagolysosomes of varying size, and retention of the fibrillar structure of this material, even within lysed cells, suggests that iota carrageenan is relatively resistant to biochemical degradation and hence persists within the phagolysosomes. The limiting membranes of many of the larger vacuoles were frequently ruptured, probably indicating osmotic stress on these membranes as the phagolysosomes swell.


Chromosomal polymorphism in Cassida syrtica Boh. (Coleoptera: Chrysomelidae). Intraspecific polymorphism with regard to autosomes has been observed in Cassida syrtica, where an additional large autosome (marker chromosome) has been encountered in the diploid as well as the haploid set of chromosomes. The diploid number for the normal type is 18 (n = 8 + Xyp). Its polymorphic form reveals a diploid set of ninetten chromosomes with an exceptional karyotype (n = 8 + 1 Mt + Xyp).


The effect of ascorbic acid on RNA and protein synthesis on two cultured cell lines in vitro. Previous work in this laboratory has thrown some light on the possible mechanism involved in the anti-tumour activity of ascorbic acid (AA). In order to elucidate this mechanism further, the present studies, involving the effect of AA on protein and RNA synthesis, were carried out. The results obtained in this investigation may support the hypothesis previously put forward for the action of AA on cell proliferation.


Nucleolar organizing regions of normal Chinese hamster and CHW cell line chromosomes. The chromosome preparations from fibroblasts of normal male and female Chinese hamsters and the cell line CHW were stained with AgNO3. The silver stain was usually localized at the telomeres of autosomes. The marker chromosome M1 in the CHW cell line has Ag-NOR near the centre of the long arm, which indicates that either the long arms of two number 5 chromosomes fused at the telomeres or the intact telomeric region of one chromosome fused with one with a deleted telomere. The variation of Ag-NORs' number per cell and Ag-heteromorphism in chromosome number 4 were observed. The Ag-NORs of chromosome number 4 and 5 are in approximately the same position as the positive C-bands and these may play a role in the preservation of heterochromatin.


Colchicine, nocodazole and trifluralin: different effects of microtubule polymerization inhibitors on the uptake and migration of endosymbiotic algae in Hydra viridis. Hydra viridis (= Chlorohydra viridissima) the freshwater coelenterate, is symbiotic. Each individual animal harbours Chlorella sp. in its endodermal cells. The symbiosis may be disestablished, the partners grown independently, and then re-established experimentally. The most effective method to produce alga-free hydra was developed by Pardy (1976). In this study algae from homogenized H. viridis, English (= European) strain, were either used directly or first grown in pure culture and then injected to re-establish the symbiosis. The uptake of algae grown in culture was compared with that of algae released directly from fresh hydra. Fewer cultured algae were taken up. Four strains were tested: English, Carolina, Frome, and Jubilee. Each takes up a characteristic number of Chlorella when injected in excess. Colchicine, nocodazole and trifluralin, were tested for their effects on either uptake or migration. Colchicine had no effect. Nocodazole and trifluralin reduced both the number of algae taken up and the rate at which they were transported to the distal region of the hydra digestive cell. The effects of these drugs tended to be proportional to the concentration between 10(-8) and 10(-5) M.


Enuresis: the clinical application of an etiologically based classification system. Enuresis is a common problem of childhood, but both a theoretical understanding and an etiologically based clinical approach to the symptom are lacking. The present descriptive study was undertaken to delineate subgroups within large, heterogeneous populations of enuretic children between the ages of four and 14. A number of variables were assessed through a detailed parental history for 116 enuretic children. Several relevant and significant correlations were identified, but overall no clinically useful patterns involving sleep stages, psychopathology, environmental events, or medical or family history were discovered. The results of this study confirm recent work in the field of enuresis and emphasize the need for new research directions.


The emotional disturbance underlying alopecia areata, alopecia totalis and trichotillomania. A psychological study on fifteen children with diverse etiologies of hair loss, viz., alopecia areata, alopecia totalis and trichotillomania was conducted in order to assess the degree of underlying psychodynamics in children with hair loss. The results confirm the relationship of the underlying emotional disturbance to the hair loss. Further, it appears that the more severe the psychopathology of the individual, the greater is the hair loss and/or the clinical manifestation of trichotillomania.


Lauretta Bender on autism: a review.

Lauretta Bender on autism: a review. Lauretta Bender, internationally known as one of the pioneers in the field of child psychiatry, has written extensively on autism and other forms of childhood disturbance. This paper reviews and analyzes the development of her theories on autism, especially as it relates to childhood schizophrenia. Bender believes that the condition is one of the manifestations of schizophrenia occurring in earliest childhood. This review traces, through her writings and through personal contact, the development and elaboration of this view, and discusses influences on her work of Schilder, Gesell and others.


Mother-infant interaction as a function of maternal ratings of temperament. Mother-infant pairs (N = 38) were observed at home when infants were three months old; mothers also completed a questionnaire measure of infant temperament. Infants who were rated as irregular in biological functioning received somewhat less responsive mothering. A subgroup of infants rated as difficult, that is, extremely irregular, nonadaptable, and negative in mood, were then compared with matched controls; mothers interacted less and were less responsive to the social bids of infants they rated as difficult. This pattern of lowered maternal responsiveness was still in evidence at an eight-month follow-up observation, suggesting that negative perceptions of infant behavior can be persistent effects on the quality of caretaking.


Home visits in child psychiatry.

Home visits in child psychiatry. Written from the viewpoint of a Foreign Medical School Graduate, this paper describes the use of psychiatric home visits in the Philippine Islands and the United States including a general explanation of the prevailing attitudes. Two case histories are used to illustrate the value of home visits in child psychiatry. A single home visit may be more revealing as to the cause of the pathology than numerous clinic sessions. The paper concludes with a brief literature survey followed by a summary discussion which presents the author's observations of personal gains derived from home visits.


Speech skill levels and prevalence of maladaptive behaviors in autistic and mentally retarded children: a statistical study. Forty-seven autistic and 128 mentally retarded children, ages 6 to 14, from a special school were assessed in terms of nine maladaptive behaviors and speech skill levels. The results indicated that the group of the mentally retarded children with withdrawal had significantly lower speech skill levels than the group of those without withdrawal, and the group of the autistic children with self-injury had significantly lower speech skill levels than the group of those without self-injury.


[Endobrachyesophagus and adenocarcinoma of the esophagus]. The columnar epithelium lined esophagus is usually the result of a chronic reflux disease. In the literature one can find more and more references to a malignant transformation of this columnar epithelium. Our own observations of 14 patients with an adenocarcinoma in a columnar-lined esophagus support this suspicion. Because the adenocarcinoma of the esophagus has therapeutic consequences other than a squamous carcinoma of the esophagus, the surgery has to give attention to this malignant transformation of the columnar-lined esophagus.


[Esophageal myoplicature in the treatment of decompensated achalasia]. Heller's cardiomyotomy or one of the modifications are not sufficient in the third stage of achalasia. Additional surgery is required for reversion of the dilated and elongated esophagus. Two patients with third-grade achalasia were treated by cardiomyotomy in combined with esophagomyoplication and followed up for one year. The results were evaluated clinically, radiologically, manometrically, pH-metrically, and endoscopically. We concluded that esophagomyoplication satisfactorily completes cardiomyotomy in cases of third-grade achalasia.


[Tracheoesophageal fistula after blunt thoracic trauma: recognition and treatment]. Three cases of tracheoesophageal fistula as a result of nonpenetrating chest trauma were surgically repaired. Another 31 cases were found in the literature. 'Thrown against a steering wheel' was the cause of injury in the majority of patients. Though the fistula became characteristically symptomatic 3 to 7 days after the accident, the diagnosis was often delayed for several months. No patient recovered without operation. After demarcation of the area of contusion and necrosis, especially in the esophagus wall, surgical repair is the therapy of choice.


[Early diagnosis of ileus by the gastrointestinal passage of a resorbable contrast medium and of recurrent intestinal obstruction]. The differential diagnosis of paralytic ileus vs mechanical intestinal obstruction using Gastrografin is a useful method because a correct decision can be made for or against surgery in doubtful cases. Gastrografin is a valuable diagnostic aid in cases with pseudo-obstruction since recurrent obstruction often seems to be a pseudo-obstruction. We doubt if a recurrent obstruction should be treated by any method of intestinopexy.


[Treatment of late occlusions and stenoses after an aortofemoral bypass operation]. Thirty-three patients with one or several late occlusions in 43 limbs of aortofemoral dacron grafts underwent 56 reconstructions because of impending limb loss. Thrombectomy alone with patch closure was less successful. Excision of the femoral anastomosis, resection of the distal part of the occluded prosthetic limb and replacement by a new velours graft tube together with profundaplasty and further downstream reconstruction revealed the best results. The early reocclusion rate was 10%, the late reocclusion rate was 10%. There was no operative mortality and no amputation. Two late deaths occurred, in one case due to grade III infection with sepsis. Another late graft infection was successfully managed by an extraanatomic bypass and excision of the infected limb. The reasons for late occlusions of aortofemoral grafts were found to be incomplete reconstruction of the outflow tract, technical failure at the time of primary reconstruction and progressive atherosclerosis. Hypertonus was common in all cases with progression of the disease. Technical details of the operative management for late occlusion are presented.


[Retrocaval ureter: a rare differential diagnostic possibility in a suspicion of appendicitis]. The retrocaval ureter is a rare malformation and may simulate acute appendicitis. Diagnosis shoud be made by a lateral X-ray view of the inferior vena cava and the ureter simultaneously. Surgical treatment is mandatory in the case of flank pain and consists of nephrectomy or dismembered pyeloplasty in front of the vena cava inferior or finally, dismembered angioplasty of the vena cava inferior behind the ureter.


Obstruction of the respiratory pathways, its evaluation by methods of functional examination of the lungs and development in patients with cystic fibrosis. In 28 patients with cystic fibrosis aged 5--24 years the values of maximum expiratory flow rates (Vmax) at lower volume levels were assessed, as well as the "specific" conductance of the respiratory pathways (Gaw/TGV), the vital capacity (VC), total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC), RV/TLC and FRC/TLC ratios and the one-second forced expiration of the vital capacity (FEV1) to evaluate obstruction of the respiratory pathways. Most markedly and most frequently abnormal were the values of Vmax, RV and of the RV/TLC ratio. These findings revealed that in almost all patients with CF there was already during the initial examination an obstruction of the peripheral respiratory pathways and hyperinflation of the lungs. During repeated measurement of the above values of lung function in 15 patients with cystic fibrosis during a period of 1--5 years when the patients increased in height by 10 cm on average, the above values did not deteriorate on average. There was, however, an individual variability of the investigated values during this period. The comprehensive treatment provided in our country prevented in patients with CF a deterioration of obstruction of the respiratory pathways during the period of investigation.


Ekwall's method in social medicine.

Ekwall's method in social medicine. The application of Ekwall's method is of considerable importance not only in medicine but also in social sciences and in all sciences concerned with man where qualitative information is used. The authors developed their own variant of Ekwall's method and used it for the evaluation of results of a survey concerned with children at risk. After an explanation of the essence of the method and principles of its application, the authors explain the variant for possible use in social medicine. An important contribution of this procedure is above all the possibility to evaluate the individual comprehensively according to defined signs and to assess accurately the distribution and also the order of comprehensively evaluated individuals of the investigated group.


Pulmonary metastases of thyroid carcinoma. In a group of 840 patients with thyroid carcinoma the authors found pulmonary metastases in 123 patients, i. e. in 14.6%. In 78 pulmonary metastases were the only remote ones, in the remainder they were combined also with other remote metastates, almost always bone metastases. Cases of "pure" pulmonary metastases were found in the whole group without a proved relationship to age and histology, with a slight prdominance of men, while in patients with a combination of pulmonary and bone metastases follicular carcinoma predominates and it is found mainly in patients of more advanced age. The biological behaviour of these two groups differs completely, and this should be taken into account in the international TNM classification. When investigating the biological properties of thyroid carcinoma, we evaluated in detail in a recent publication (15) bone metastases. As all remote metastases of thyroid carcinoma are included according to the classification of WHO under the common sign M1 (9), we wanted to compare some factors in the incidence of pulmonary and bone metastases.


Measurement of tissue impedance in the prevention of carcinoma of the uterine cervix. The authors tested the possibilities of an apparatus for the assessment of tissue impedance -- DIACA LDN 200 -- in routine prevention of carcinoma of the uterine cervix. They found that by assessment of the impedance it is possible to differentiate normal squamous epithelium from calumnar epithelium and pathological epithelium. The latter two cannot be differentiated reliably by the apparatus. Therefore DIACA is not suited as a single method for the detection of precancerous conditions but in combination with colposcopy it may provide reliable services. In the discussion the authors reflect where to include most aptly the above method in the complex of prevention of carcinoma of the uterine cervix. Recently a new apparatus, DIACA LDN 200, was introduced on the market which can be used to measure tissue impedance. This apparatus proved useful in the detection of precancerous conditions and early carcinoma of the intestine (1, 2, 3). The basic idea links up with the work of Zwinger and Vrana (5, 6, 7) which some time ago aroused considerable attention but never was introduced in practice on a major scale. It is therefore of interest to test whether measurement of tissue impedance by means of this apparatus can be used in gynaecology and whether we may count on this method as a screening procedure in the prevention of carcinoma of the cervix.


Management of late complications of Teflon sling repair for rectal prolapse. Recurrent rectal prolapse or postoperative rectal stricture occurred in four of 88 patients (4.5 per cent) who underwent Teflon sling repair at the Lahey Clinic during the past 15 years. Management of these and six other similar patients referred for treatment suggests that young men appear to be at a higher risk for recurrence. Strictures may be more likely to develop in patients with a long history of prolapse or problems with constipation. Teflon sling repair followed by recurrent prolapse or stricture formation should probably be treated by low anterior resection.


Use of omental pedicle graft to protect low anterior colonic anastomosis. We feel that a pedicle graft of omentum makes an excellent protective wrapping about low anterior resections. We do not propose the technique to cover sloppily constructed anastomoses. Good nutrition, proper timing, adequate bowel preparation, and good surgical technique are the keys to successful low anterior resection, while omental pedicle grafting adds a further dimension in helping to assure a complication-free postoperative course.


Use of glucagon in conjunction with the end-to-end anastomosis (EEA) stapling device for low anterior anastomoses. We have found intravenous glucagon useful in overcoming the spasm of the rectal stump that one sometimes encounters while performing transanal end-to-end anastomosis using the EEA stapling device.


When should radiotherapy be given for rectal cancer? There are a number of reasons why radiotherapy is better given before rather than after radical surgery for rectal cancer. When this policy is adopted, however, two related problems arise. First, how are patients requiring radiotherapy to be selected? Second, how are irradiated patients to be compared with unirradiated patients stage by stage in clinical trails? It is suggested that the Dukes' staging system in inappropriate for both, and that a clinical staging system for rectal cancer is urgently required to solve both these problems. The way in which such a staging system might be developed is indicated. In the meantime trials of adjuvant radiotherapy for carcinoma of the rectum should be interpreted with caution for two reasons. First, a reduction in local recurrence may not necessarily be reflected in a reduction in death rates. Second, since the origin of local recurrence is obscure, the radiation dose to the regional lymph nodes should be recorded carefully.


Intestinal obstruction following operation for inflammatory disease of the bowel. Acute small-intestinal obstruction is not an uncommon complication following excisional operation for inflammatory disease of the bowel. In the Monash series the most common cause was adhesion formation. Stoma problems accounted for a small number. There was a special tendency for the complication to appear soon after the excisional surgery. A significant mortality rate accompanied obstructive complication and, over the long term, one in five patients needed further surgery for a recurrence.


Primary epithelial tumors of the appendix and a reappraisal of the appendiceal "mucocele". A 28-year review of the records at Hines V.A. Medical Center revealed 17 primary epithelial tumors of the appendix. Five of these tumors were benign and 12 malignant. It is suggested that the term mucocele be abandoned, because it represents the end result rather than a definite pathologic entity. The majority of benign tumors and carcinoid tumors of the appendix are discovered incidentally to other procedures. The majority of adenocarcinomas cause symptoms and signs of appendicitis. Simple appendectomy is sufficient treatment of all benign tumors of the appendix, and for all carcinoids that show no gross local metastases and are less than 2 cm in diameter. Simple appendectomy followed by right hemicolectomy or initial right hemicolectomy is the treatment of choice for all carcinoids of the appendix that show gross local metastases and are 2 cm or more in diameter and for all adenocarcinomas of the appendix, whether mucinous or colonic, in the absence of distant metastasis. A new classification for primary epithelial tumors of the appendix is suggested.


Colorectal carcinoma: a decade of experience at the Lahey Clinic. Carcinoma of the colon and rectum is the commonest visceral malignancy in this country today. Uncorrected five-year survival rates (1967-1971) for Dukes' A, B, and C lesions were 81 per cent, 62 per cent, and 33 per cent respectively, and are essentially the same as those observed in the previous five-year period (1962-1966). The actuarially corrected five-year survival rates for Dukes' A, B, and C lesions for the ten-year period (1962-1971) were 95 per cent, 90 per cent, and 55 per cent. Further improvement in these statistics depends on bringing the patient to operation with less advanced disease and possibly on supplementing resection with other modalities of therapy.


Outpatient anorectal surgery.

Outpatient anorectal surgery. Over a period of 16 months, three-fourths of the proctologic surgery performed by our clinic was done on an outpatient basis. By doing so, 1,200 patient visits and approximately 300 histories, physicals, and discharge summaries are eliminated, while obviously benefiting patients and reducing health care costs. Thus, we can conclude that hospitalization is not necessary for the majority of proctologic surgery patients.


The effect of Lord's procedure on anal pressure. In this study, the authors recorded pre- and postoperative anal resting pressures in 28 patients with hemorrhoidal disease and in 32 controls. No significant difference was found between these two groups preoperatively. In the patient population anal pressure was significantly lowered following Lord's anal dilation treatment. No such pressure reduction was recorded after a standard St. Mark's hemorrhoidectomy. Finally, the authors confirm that anal pressure measurements record only the tonus of the sphincter apparatus and are not influenced by the volume of the hemorrhoidal masses themselves.


Volvulus of the transverse colon: report of case and review of the literature. A case of transverse colon volvulus is reported, bringing the total number of collected cases in the English language medical literature to 45. Although this type of volvulus is rare, a definite pattern can be appreciated. Patients tend to be young, female, and give a history of chronic or recurrent difficulty in having bowel movements. A triad of underlying factors predisposes to the development of the volvulus: a distal impediment (either organic or functional) to the evacuation of the bowel, a redundant bowel and mesocolon and a fixed point around which the bowel can twist. The best treatment is resection with either anastomosis or exteriorization, depending on bowel viability.


Giant condyloma (Buschke--Loewenstein tumor) of the anorectum. A case of giant condyloma of Buschke and Loewenstein is presented. The clinical course and pathology of these tumors are reviewed. This case illustrates the delay in establishing the diagnosis in spite of numerous biopsies. It is emphasized that the only effective treatment is wide local excision.


Electrical ileal perforation: an unusual complication of colonoscopy. A case of electrical burn perforation of the ileum is described, occurring after colonoscopic snare polypectomy from the left colon. An adequate explanation of the cause of this complication has yet to be determined.


Survey of hemorrhoidectomy practices: open versus closed techniques. A questionnaire was sent to members of the American Society of Colon and Rectal Surgeons. Four hundred and forty-five (43.6%) were tabulated to establish criteria and results of surgical treatment of hemorrhoidal disease. The most frequent indication for surgery, was internal and external hemorrhoids with mucosal prolapse. Significant differences were found in time required for complete healing, frequency of wound dehiscence, frequency of postoperative stenosis, and frequency of postoperative infection. Results did not support opinions that the closed technique was associated with significantly less pain, fewer complications, shorter hospital stay or earlier resumption of work.


A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VIII. Levator hiatus and tunnel: anatomy and function. The anatomy of the levator hiatus and tunnel has been studied, aiming at the elucidation of their functional role in mechanisms of defecation, urination, and continence. The material comprised 25 cadavers studied by dissection and serial histologic sections. The levator hiatus occupies the anterior portion of the levator plate which consists of two "crura," that bound the hiatus, and two "lateral masses." Three crural patterns could be identified: classic, crural overlap and crural scissor. The levator tunnel is a muscular tube which surrounds the intrahiatal organs along their way down from the levator hiatius to the perineum. It is double sheathed, with an inner coat of the suspensory sling and an outer of the puborectalis. Both coats are of striped muscle bundles. The inner coat is a tunnel "dilator," whereas the outer is a tunnel "constrictor." The puborectalis not only acts as a "common tunnel" sphincter but provides an "individual" sphincter for each intrahiatal organ. A detailed study of the hiatal ligament which firmly binds the levator plate to the intrahiatal organs is presented. A "tunnel septum" could be identified to line the levator tunnel, and separate it from the intrahiatal organs. Its surgical significance as a landmark for mobilizing the intrahiatal organs from within the tunnel is stressed. The levator plate consists of two functionally separate zones: a lateral "visceral support" zone and medial "dilator" one. The double sphincteric control provided to each intrahiatal organ by the "individual" and "common" sphincters would suggest that unless both sphincters are destroyed, continence could be maintained by either. The role of the "levator complex" which comprises levator crura, tunnel and hiatal ligament in fixation of intrahiatal structures, as well as in mechanisms of defecation, urination, and continence, is discussed. The understanding of the anatomic details of the levator hiatus and tunnel could be of value in mobilizing the intrahiatal structures from within the levator tunnel with preservation of their voluntary sphincteric mechanism.


Surgical treatment of complete rectal prolapse. The Ripstein procedure was used to effect a cure of rectal procidentia in 30 patients. There was no operative mortality, and morbidity was confined to problems related to two patients with intestinal obstruction, one with fecal impaction, and one with wound infection. We believe the operation to be the treatment of choice in patients to control the anatomic and clinical abnormalities related to rectal procidentia. Associated colonic abnormalities, such as an extremely redundant sigmoid or associated diverticulitis, may dictate the choice of a different procedure that does not require introduction of a foreign material.


Resected pulmonary metastases from colorectal cancer. A review of 35 patients who, over an 18-year preiod, underwent excision of pulmonary metastases from colorectal cancer, is presented. The cumulative five-year survival rate was 22 per cent, and this was significantly increased where the primary colonic cancer was Dukes' A or B. No difference in survival was found regarding the disease-free interval and the number of metastatic lesions. The follow-up of patients with colorectal cancer should always include yearly chest x-rays; and when metastases developed in the lungs alone, surgery for their removal is recommended.


Cloacogenic carcinoma of the anorectum in homosexual men: an observation of four cases. Cloacogenic carcinoma of the anorectum is an uncommon neoplasm which arises from the transitional zone (cloacogenic) epithelium. The transitional zone epithelium is derived from the embryonic cloacogenic membrane as is the epithelium of the vagina and uterine cervix in the female. Four cases of cloacogenic carcinoma in male homosexuals who have engaged in longstanding receptive and anal intercourse have been observed. This observation, along with the realization that the anorectal transitional zone shares a common embryologic origin with the uterine cervix, a site of cancer long known to be associated with factors related to sexual intercourse, leads to the serious question of the etiologic potential of receptive anal intercourse in the development of cloacogenic carcinoma.


Gallbladder contraction as a test for vagal innervation. A subthreshold dose of carbachol was used to test gallbladder reaction in a series of patients before operation, after truncal vagotomy with antrectomy (TA) and after parietal cell vagotomy (PCV) because of duodenal ulcer. A small but statistically significant size reduction was seen before operation, a much higher reduction after TA and after PCV, that after TA being significantly higher than after PCV. It must be assumed that after PCV a number of gallbladders is in a state of denervation.


A prospective survey of 474 patients with anorectal abscess. A prospective survey of patients with anorectal abscesses treated at Cook County Hospital over a 35-month period produced data on 474 patients. The peak incidence was in the third decade of life. Males were affected 1.76 times more frequently than females. Perianal abscess was the most common anatomic type (42 per cent), with ischiorectal abscess (20 per cent) being second. The supralevator space was involved in 7 per cent of the abscesses. Primary fistulotomy was performed when an anal fistula could be demonstrated (34 per cent). Our standardized method of treatment, utilizing radial incisions for drainage, produced satisfactory results with a complication rate of 3 per cent, an in-hospital reoperation rate of 0.6 per cent, and an average hospital stay of 5.7 days.


Giant condyloma acuminatum (Buschke-Loewenstein tumor) of the anus: case report and review of the literature. The fifth patient with anorectal giant condyloma of Buschke and Loewenstein is reported. Review of the world literature is presented with a summary of previous case reports. The malignant behavior of giant condyloma is emphasized. Successful local extirpation without abdominoperineal resection can be peformed when indicated.


Potential pitfalls in computer tomography. Some pseudotumours and pitfalls in computer tomography of the abdomen and the head are demonstrated. In abdominal CT the patient preparation is discussed.


Perineal endometrioma in episiotomy incisions: clinical features and management. Four patients, 23--34 years old, who developed endometriomas at the site of an episiotomy 19 months to 11-years postpartum are reported. Pain, Swelling and pruritus varying in intensity with the menstrual cycle were present in all. Complete excision is curative. Symptoms of incompletely excised endometriomas may be controlled by local hormonal injections or systemic hormonal manipulation. The anatomy of the endometrium and its physiologic behavior are reviewed. A concept of WHY endometriomas develop is presented which is compatible with the theories of HOW they occur.


Risk evaluation of diagnostic x-ray examinations of the chest. Mortality risk factors for individual organs for radiation-induced fatal malignancies were derived from epidemiological studies. A method to express the mortality risk due to diagnostic X-ray examinations of the chest in a single parameter, the somatically effective dose, is demonstrated. An estimate of the collective effective dose and the number of fatal malignancies as well as a calculation of the monies which could be justifiably spent in reducing the collective effective dose and hence the number of fatal malignancies by a shift from photofluorography to "full size" radiography will be given.


Spontaneous rupture of the distal colon with evisceration of small intestine through the anus: report of two cases and review of the literature. Two cases of evisceration of the small intestine through a spontaneous perforation of the distal large bowel are presented, and the literature is reviewed. The condition is associated with a sudden increase in intra-abdominal pressure and a past history of rectal prolapse. The etiology and management of this problem are discussed.


Inflammatory fibroid polyp of sigmoid colon. A case of inflammatory fibroid polyp of the sigmoid colon is presented. This is the eight case of this type of polyp in the colon and, to the best of our knowledge, the first one involving the sigmoid and producing intussusception. Symptomatology of the inflamed fibroid polyp in this part of the gut closely simulates gastrointestinal malignancy. The treatment is surgical excision of the polyp, or colonoscopic resection when it is possible. Intraoperative colonoscopy helps the surgeon to localize the lesion and to role out the existence of other lesions.


Central neurons are depressed by iontophoretic and micropressure application of ethanol and tetrahydropapaveroline. In an attempt to circumvent the complexities of systemically administered ethanol and tetrahydroisoquinolines (TIQs), iontophoresis and micropressure application were used to test these agents in single rat neurons. Alcohol applied by either method depressed cerebellar Purkinje cells in a concentration-dependent, non-specific, local anesthetic-like manner. Tests of tetrahydropapaveroline.HCl (THP) on neurons from three brain areas also showed depression of spontaneous discharge, although, in contrast to ethanol, little or no local anesthetic-like action was observed, and at equivalent ejection currents or pressures, the THP depressions appeared to be more pronounced. The underlying mechanisms for these responses are unknown.


Regional differences in high-affinity choline uptake in brain after acute and chronic treatment with ethanol. A single  dose of ethanol has been shown to affect both striatal and hippocampal high-affinity choline uptake. This effect is probably mediated through effects of ethanol on acetylcholine release. Choline uptake has also been shown to be altered in ethanol-dependent animals, and these effects may be coupled to alterations in dopamine neurons which are produced by chronic ethanol feeding and withdrawal.


Peptide--neurotransmitter interactions influencing ethanol tolerance. Chronic exposure of mice to ethanol leads to the development of functional tolerance to the hypothermic and sedative effects of this drug. Treatment of the animals with the mammalian antidiuretic hormone, arginine vasopressin, results in a prolonged duration of such tolerance, in comparison to animals exposed to ethanol but not to the hormone. Another neurohypophyseal hormone, oxytocin, at an equimolar dose, is ineffective in maintaining tolerance. The centrally mediated  effects of arginine vasopressin on memory processes may be related to the hormone-induced prolongation of ethanol tolerance.


Behavioral and biochemical effects of intracerebrally injected alkaloids. Tetrahydroisoquinolines and beta-carbolines, substances which may form in the brain following the ingestion of alcohol, could be responsible for some of the behavioral effects of alcohol. When certain of these alkaloids are infused into the brain of the rat they induce an enhanced consumption of alcohol in a free-choice situation, both during infusion and for months after the cessation of infusion. In investigating the possible mechanism behind this permanent change in preference for alcohol, it does not appear that the post-synaptic side of the catecholamine neurons is involved. Likely candidates for future investigation include the pre-synaptic side of the catecholamine neurons and the serotonergic and opiate systems.


A method of developmental assessment at four years and some associated findings. A method of assessing the developmental status of 4-year-old children, which can be included in a comprehensive medical examination, is described. It was designed for research purposes, so that a global score, and separate scores for each sector of development, are obtained. Girls, children in the upper social classes, and those who attended nursery school had higher scores, in general, at this age. The importance of assessing and investigating the factors associated with lack of cooperation is stressed.


Father-infant interaction at the first contact after delivery. The behavior exhibited by human fathers at their first contact with the young was studied on 15 fathers of full-term infants delivered by cesarean section. The naked infant was presented to the father approximately 15 min after delivery, and photographs were taken every second during the first 7 min of contact. An orderly progression of behavior was observed: the father began touching the extremities, and then proceeded to touch the infant with his fingers and fingertips, then to use his palms and finally the dorsal side of his fingers. An increase in eye-to-eye contact over time was observed. It was concluded that the father displayed a very similar behavior, in his first contact with the young, as has been described previously for the mother.


Effect on lung growth of cervical cord section in the rabbit fetus. Experiments were performed to clarify the mechanism by which cervical cord transection retards lung growth in the fetal rabbit. In 10 sets of fetuses operated on at 24 1/2 days gestation and studied 3--4 days later, cord section at C1--C3 (high section) caused a significantly greater reduction in lung weight and lung DNA than cord section at C5--C8 (low section) as compared with control littermates. Comparison with the lungs of additional control fetuses removed at the time of operation showed that high section had reduced lung growth by 70% and low section had reduced growth by 40% relative to sham-operated controls. The hypoplastic lungs of the high-section group had poorly expanded, thick-walled terminal sacs, while those of the low section group more nearly resembled the controls. Fetal weights and weights of liver, kidneys, thymus and diaphragm did not differ significantly between the groups, but the hearts of the low-section group were unduly large. In a separate 6 sets of fetuses tracheal ligation at the time of high-cord section was found to result in large fluid-filled lungs with a normal DNA content. The results indicate that preservation of an upper motor neurone supply to the phrenic nucleus is of critical importance for fetal lung growth, and confirm the growth-promoting effects of liquid distension of the fetal lungs. We conclude that normal fetal lung growth depends on development and maintenance of a sophisticated form of function involving integration of respiratory movements and lung lipid secretion. This functional control of fetal lung growth has important implications for perinatal medicine.


Free amino acid, protein, and fat contents of breast milk from Guatemalan mothers consuming a corn-based diet. Diet compositions and breast milk levels of free amino acids, protein, and lipid were compared in lactating American and Guatemalan women. The protein in the American diet derived principally from animal sources, whereas that in the Guatemalan diet was based most exclusively on cereal grains and legumes. Corn, in the form of cornmeal, was the predominant food. Because of these dietary differences, the Guatemalan women consumed significantly smaller amounts of protein than the American women. The concentrations of most of the free amino acids in aliquots of breast milk from the Guatemalan women were lower than those in samples from the American women. In particular, tryptophan and lysine levels were 23% and 29%, respectively, of the levels in the American breast milk samples. The Guatemalan samples contained less protein, and, when values from Guatemalan women who had nursed only for 6 mth or less were considered, the fat content was also less than in the American samples. The lipid content of the milk, however, did not differ between the two groups when the length of the lactation period was not controlled. The substantial cultural differences between the two groups in the frequency and duration of nursing probably prevented the identification of a clear dietary influence on milk lipid content. The correlations found between diet composition and either the amount of protein or the levels of free amino acids in breast milk suggest that, if a mother's diet is deficient in high-quality protein, the deficiency may be reflected in the composition of her milk, perhaps to the detriment of the nursing infant.


Seasonality of birth in sporadic cretinism. The seasonal distribution of birth dates of 31 patients with sporadic cretinism due to thyroid dysgenesis was analyzed in Osaka area for 14 years. The incidence was statistically high in the summer months. A hypothesis that some environmental factors such as viral infection may cause the disease is proposed.


Rapid whole blood lactate measurement in the fetus and mother during labour. Using a new rapid method, fetal and maternal whole blood lactate was measured before the onset of labour at elective Caesarean section in 8 patients, during labour in 34 normal patients, and in a further 28 patients whose babies showed varying degrees of clinical depression and/or acid base abnormality at birth. The mean (+/- SEM) umbilical venous and arterial and maternal venous lactate values in the 8 cases delivered by elective Caesarean section were 1.20 (+/- 0.16), 1.46 (+/- 0.22) and 1.14 (+/- 0.46) mmol/l, respectively. For the normal group the mean fetal lactates (+/- SEM) in the latent and active phases of labour, and in the umbilical vein and artery, were 1.91 (+/- 0.25), 2.42 (+/- 0.46), 2.71 (+/- 0.19) and 3.09 (+/- 0.20) mmol/l, respectively. The mean maternal venous lactate (+/- SEM) in the latent and active phases of labour and at delivery were 1.07 (+/- 0.09), 1.45 (+/- 0.12) and 2.69 (+/- 0.24) mmol/l. the rise in fetal lactate throughout labour was due in part to the rise in maternal lactate. Increasing neonatal depression was associated with increasing fetal lacticacidaemia. This associationachieved statistical significance at delivery.


The duration of maternal cigarette smoking, fetal and placental disorders. Data from a large prospective study of pregnancy were used to determine whether the number of years a mother had smoked cigarettes influenced the development of common fetal and placental disorders. Three disorders increased in frequency when mothers had smoked for more than 6 yr: placenta previa +143%, abruptio placentae +72% and large placental infarcts +37% (all P less than 0.05). Mothers' current smoking habits had a smaller influence on the frequency of these disorders, and the effects of smoking were largely independent of maternal pregnancy weight gain. The placentas of smokers had microscopic evidences of underperfusion from the uterus. The placental abnormalities were influenced by both the number of years mothers had smoked and by their current smoking habits.


Comparison of T4, T3, rT3 and TSH concentrations in cord blood and serum of infants up to 3 months of age. T4, T3, TSH and rT3 concentrations were measured by radioimmunoassay in cord and postnatal (8--94 days of age) serum samples from randomly selected normal newborn infants (Group I). T4 and TSH levels also were determined in cord and postnatal sera from an additional group of apparently healthy infants 8--260 days of age, whose cord serum T4 levels were in the upper or lower 10% of the normal range of values (Group II). Postnatal T4, T3 and TSH concentrations were stable over this age range; there were no significant differences between male and female infant samples. However, there was a significant decrease in serum rT3 concentrations from 8 to 50 days of age. For the Group I infants, there were significant positive correlations between cord serum T4 and postnatal serum T4 levels, cord serum TSH and postnatal serum TSH levels, and cord serum rT3 and postnatal serum rT3 concentrations. For Group II infants, a significant positive correlation was found for cord T4--postnatal T4 serum concentrations.


A study of infant growth in relation to the type of feeding. A total of 133 breast fed newborn babies, and 106 bottle fed babies, were selected and studied prospectively. Details taken of feeding practices have shown that by 5--7 wk of age bottle feeds had been introduced in about 50% of breast fed babies. Entirely breast fed babies received their first solid food later than breast-and-bottle fed or entirely bottle fed babies when such babies were in social class I, II or III, but in social class IV and V entirely breast fed babies were weaned at a similar age to those in the other two groups of babies. In the first 5--7 wk of life there was a significant negative correlation between the increase in skinfold thickness and the skinfold thickness at birth. The study has also shown that the present practice of feeding babies modified milks retards weight gain and the increase in subcutaneous fat in male babies.


Patterns of retarded fetal growth.

Patterns of retarded fetal growth. The measurement of weight, length and head circumference at birth was used to document the size and shape of infants born at term in a population where mothers are relatively short and underweight. Different patterns of intrauterine growth are proposed to explain the variation in the infant's appearance at birth. Most of the small-for-gestational-age infants were proportionately stunted. This pattern of fetal growth is probably characteristic of infants born to undernourished mothers in economically developing communities, and reflects prolonged intrauterine growth retardation.


Changes in body proportions over the first year of life: comparisons between 'light-for-dates' and 'appropriate-for-dates' term infants. The ponderal index (PI) has been used to compare changes in body proportions over the first year of life in light-for-dates (LFD) and appropriate-for-dates (AFD) term infants. At birth the mean PI of the LFD infants was significantly lower than that of the AFD infants, but at 1 year there was no significant difference between the two groups. These findings indicate that LFD infants increase their weight relatively more than their length over the first year of postnatal life, to become similarly proportioned to AFD infants.


Experimental intrauterine growth retardation in the rat. Evaluation of the Wigglesworth model. The validity of the Wigglesworth experimental model to produce newborn rats that are small for gestational age by ligation of one of both uterine vessels was confirmed. Newborn rats from the opposite horns are used as controls in the classical model. It is concluded from this study that newborns from sham-operated dams are more satisfactory controls for newborn rats that are small for gestational age from ligated horns.


[Reflections on primary care: a proposal for a conceptual framework]. The article begins with a general analysis of the salient health problems of most Latin American countries. It correlates the situation with changes that have come about in the various socioeconomic structures and take an historical approach to the different ways in which the health/disease phenomenon has been viewed, ways which are regarded as determined by the kind of care provided during particular eras. The author emphasizes the need to study the various theoretical framework of health and disease in order to be able to discern from the overall picture just where medicine is headed today and how medicine and nursing are practiced. She reflects on some factors that have limited the implementation of several of the more desirable aspects of health services delivery such as teamwork, reallocation of functions, and institutional regionalization. Lastly, she proposes a conceptual framework for primary care as a strategy for addressing the problems outlined.


[Nursing in the National Health Plan of Honduras]. After summarizing the health situation in Honduras and describing the National Health Plan launched in 1973, the authors explain the changes that have come about in nursing, the difficulties that had to be surmounted to reach a new professional position, and the administrative decisions that had to be taken to devise a health policy. An account is given of the changes made in the training of nursing staff and in the functions that staff must perform in the planning, implementation, and evaluation of the coverage extensive program. The article high-lights the role of the Nursing Division in the Ministry of Public Health and Social Welfare and the levels of coordination established with the other technical divisions and institutions responsible for the health personnel training. In closing, the article points out that the nursing sector represents the keystone of the model for the delivery of services to attain the goal of health for all by the year 2000.


[Educational technology in nursing: the conceptual framework and the experience of the Latin American centers]. In the first part of the article the assertion is made that educational corpus of technology should not be regarded as something apart, but as a corpus of teaching methods, techniques and resources rationally organized to solve problems of material and conceptual situations and processes. Several educational technologies are explained on the basis of their underlying theoretical frameworks, and grass-root educational technology is advocated because, while it does not emphasize efficiency, it is capable of inducing innovations that are effective in that they actually accomplish changes. The second part reviews the results of the Latin American Program for Educational Technology in Nursing, which PAHO conducts through a network of centers in the nursing schools of several countries. The purpose of the Program is to disseminate modern educational technology and to endeavor to harmonize nurse training with demands and trends in the delivery of health services.


[An experimental educational model, a complementary Program for Licensure in regional nursing]. A brief review is given of the Supplementary Licentiate Program in Nursing at a Distance offered by the Nursing Departament of the Valle University, Cali, Colombia. The purpose of the Program is to allow general nurses to pursue studies without leaving their place of work, using an experimental education model; if the results are good, it will be extended to other levels of nursing training. The methodology describes the administrative process resultant from the already completed planning stage, and the gains made to date.


[The future of nursing in Latin America]. The authors take up the subject with a retrospective review of the concepts of economic and social development, the health policy that has emerged in the last 25 years, and the salient characteristics of health practice and the training of nursing personnel. They interpret development in the health field and various approaches to the extension of the health services coverage that have been taken in the countries of Latin America through implementation of the strategies of primary care and community participation. Finally, they present several considerations on the future of nursing, with emphasis on a comprehensive view of the profession as an occupation and a social practice, after which they formulate a series of propositions that can serve as a basis for training of the nursing personnel that will be needed to serve society adequately.