A simple fluorometric assay of protoporphyrin in erythrocytes (EPP) as a screening test for lead poisoning. A simple microfluorometric procedure for the measurement of protoporphyrin in erythrocytes (EPP) is described. The technique, which can be performed in less than 4 minutes with portable equipment, utilizes 40 mul of capillary blood and only one reagent (94 percent acidified ethanol) for the extraction. The results obtained by this micromethod are in close agreement with those of the ethyl acetate/hydrochloric acid double-extraction methods. The EPP concentration increases markedly when the blood lead level is increased, and the test can be used to screen children for lead poisoning. This new micromethod also gives reproducible results when dried blood spots on filter paper are used instead of liquid blood.


Validation of a stable emulsion for the assay of lipoprotein lipase activity. The preparation of a stable, stock, radioactive, trioleoyl glycerol emulsion in glycerol and its application to the assay of lipoprotein lipase are described. The data presented indicate that this stock emulsion combines the convenience and reproducibility of commercially available, nonradioactive emulsions with the sensitivity of sonicated, radioactive, aqueous emulsions. Furthermore, in practice, this glycerol-based emulsion appears to be specific for the protamine-sensitive extrahepatic lipase, having little or no reactivity toward the hepatic lipase measured in postheparin plasma.


Iodination by human polymorphonuclear leukocytes: a re-evaluation. The conversion of iodide to a trichloroacetic acid-precipitable form (iodination) by polymorphonuclear leukocytes (PMN's) has been re-evaluated as a measure of neutrophil function. Optimum conditions are described which result in an iodination value for normal cells during the phagocytosis of zymosan of 64.1 +/- 13.2 (S.D.) nmol. per 10(7) PMN's per hour. Iodination is inhibited by agents which decrease phagocytosis, inhibit myeloperoxidase-catalyzed reactions, or degrade H2O2 and is stimulated by superoxide dismutase, an enzyme which catalyzes the conversion of the superoxide anion to oxygen and H2O2. When patients' cells and normal serum are employed, the iodinating capacity of the patients' cells is evaluated. It is low in patients with myeloperoxidase deficiency and chronic granulomatous disease, and an intermediate value was observed in a carrier of chronic granulomatous disease. When normal cells and patients' serum are employed, the iodination reaction is an indirect measure of the opsonic activity of the patients' serum. The decreased opsonic activity for zymosan of human sera deficient in the fourth or third component of complement was demonstrated in this way. Thus measurement of iodination is a convenient and sensitive screening test for cellular or humoral abnormalities of the phagocytic process.


Detachment of the trachea following total laryngectomy. Two cases of tracheal detachment following laryngectomy are described and a suitable method of repair is suggested. The possible causes of detachment of the trachea following total laryngectomy may be summarized as follows: (a) Poor surgical technique when fashioning the tracheostome. (b) Poor quality of the tissues. (c) Poor general condition of the patient. (d) Excessive tension on the trachea. Reconstruction of the tracheostome requires:- (a) Elimination of infection by antibiotics and total debridement of non-viable tissue. (b) Absence of tension on the wound and the raising of adequate skin flaps. Should these conditions be met, the method of repair described above has been shown to be satisfactory.


Membranous tracheitis following endotracheal intubation. In this study, four patients with membranous tracheitis following endotracheal intubation are presented. Possible causes for the development of the condition were mostly related to subglottic epithelial trauma caused by the pressure of the cuff of the tube for a long time on the mucosa and the drying effect of atropine. The literature concerning the development of membranous tracheitis in previous studies is also presented.


Temporal bone findings in the late stage of secretory otitis media. The temporal bone findings in a patient with secretory otitis media are presented. One ear had been fitted with tympanostomy tubes for five and the other for three years. Before death the latter ear had been without a tube for two years. Histological study revealed secreting tympanic mucosa with a very high density of goblet cells both in the ear with a ventilating tube in position and in the ear with an intact tympanic membrane. The case represents a late stage of secretory otitis media. It seems that ventilating tubes cause the degeneration and disappearance of subepithelial glands but the effect on goblet cells is less pronounced.


Nasal aspects of cystic fibrosis in children. Despite the extraordinary prevalence of upper respiratory allergy and infection in children nasal polyposis is an extremely rare condition. Seven cases of cystic fibrosis are presented in order to demonstrate the nasal aspects of the disease. All but one had nasal polyposis. The literature has been reviewed with particular reference to clinical, radiological and histo-pathological features. Conservative treatment is stressed.


Craniometaphyseal dysplasia.

Craniometaphyseal dysplasia. A case report of craniometaphyseal dysplasia is presented with a classification of this disease, supported by a review of the literature. Certain unusual features are observed-mastoid surgery and later contralateral tempory facial paresis. The patient showed no further deterioration of symptoms when last reviewed.


Iatrogenic reflux oesophagitis.

Iatrogenic reflux oesophagitis. A report on two patients with severe reflux oesophagitis  caused by Emepronium Bromide ('CETIRPIN') prescribed for the treatment of urinary symptoms.


Midline cleft lip with associated abnormalities. A rare case of midline cleft lip with the following deformities is presented: (a) Partial midline cleft of the upper lip. (b) Cleft alveolus. (c) A fibro-cystic swelling arising from the left side of the nasal septum and columella. (d)  A frenulum and a cystic swelling attached to the frenulum and hanging into the mouth by a narrow pedicle.


Kinetic enzymatic method for automated determination of glucose in blood and serum. Studies are reported on the reaction kinetics of the glucose assay according to Trinder which involves the specific oxidation of glucose by glucose oxidase and the determination of the hydrogen peroxide released by means of phenol and 4-aminophenazone in the presence of peroxidase. The results have been used to develop a general kinetic fixed-time method for the analysis of glucose in whole blood and serum. The single reagent method has been adapted to the ENI GEMSAEC centrifugal analyzer and to the Abbott ABA-100 analyzer. The procedures exhibited excellent precision and the results correlated well with those obtained by the hexokinase method, Linearity was achieved from 3 to 64 mmol/1 glucose for the GEMSAEC method, and from 3 to 33 mmol/1 glucose for the ABA-100 method. Reagent or sample blank corrections were not necessary. There were no interferences from various drugs, hemoglobin, bilirubin, or lipemia.


[The influence of pentagastrin on the concentration of free amino acids in the gastric juice (author's transl)]. The content of the free amino acids in the gastric juice is different in the state of normo-, hypo-, hyper- and anacidity. Free amino acids can be determined by the amino autoanalyzer after deproteinisation and delipidation of the gastric juice. 45 min after pentagastrin stimulation the content of free amino acids is significantly reduced compared to the values before stimulation, except for patients with anacidity.


Injuries in amateur ice hockey: a two-year analysis. A compilation of injuires sustained in an amateur ice hockey program over a tw0-year period revealed that the majority of those injuires were facial lacerations. The number of injuries increased with the level of players' skill and with the intensity of the games. Youth players who were required to wear head and total face protection had fewer injuries than either the adult league or semi-professional players. Injuries were greatest to the semi-professional players who wore little or not head protection, and no facial protection. Physicians have a duty to urge all hockey players to wear adequate head and face protection to prevent such injuries. Equipment which is currently available is illustrated.


Myelopathy associated with cervical spondylosis: a frequently unrecognized disease. Cervical spondylosis or chronic diskogenic disease of the cervical spine is a relatively common cause of myelopathy, but it is often not recognized or is incorrectly diagnosed. The clinical presentation may mimic several types of neurological disease including multiple sclerosis and amyotrophic lateral sclerosis. Even more frequently, and especially early in the course of the disease, neurologic impairment is not recognized and the symptoms are thought to be due to osteoarthritis. Early recognition of this condition is important since adequate treatment can prevent slowly progressive neurologic impairment. Knowledge of the pathophysiology of myelopathy due to cervical spondylosis and adequate radiographic evaluation will often lead to treatment that can prevent progressive spinal cord damage. Cervical spondylosis with myelopathy is one of the most frequently unrecognized and misdiagnosed, yet treatable, conditions affecting the nervous system.


Ten years' experience in a British casualty department staffed by general practitioners. Ten years' documented experience in a British Casualty Department shows that the family physician has a potentially large role to play in the accident and emergency services of his community. It is clear that a well-trained family physician in a properly equipped hospital department can care for the great majority of his patients' injuries, minor surgical operations, and anesthetic needs. This is especially so where group practice and helpful specialist colleagues provide a supportive framework for problem sharing. A case is made for education of all family practice students and residents in this large and important area of medicine.


Orthopedic practice and training of family physicians: a survey of 302 North Carolina practitioners. A mailed survey questionnaire was distributed to the North Carolina Academy of Family Physicians to assess their orthopedic training and their opinions of the orthopedic training of resident physicians in family practice. Approximately 300 questionnaires were analyzed and the spectrum of orthopedic activities in office, hospital, and community were tabulated. There was no significant geographic variation in practice within the state for these variables, but there were statistis in their management and referral practice of several patient problems. Seventy percent of respondents thought that their training in orthopedics was appropriate to their present practice, but half felt that their training was inadequate. Most of the respondents (57 percent) had less than one month of postgraduate training in orthopedics. The majority (68 percent) recommended some postgraduate training in orthopedics, with about 50 percent recommending one to three months of postgraduate training. The mail survey questionnaire is proposed as a useful aid in curricular design in family practice.


Developing behavioral science for a family practice residency. The development of behavioral science in a family practice residency has first to be structured around a statement of purpose and adequate goals. These goals can only be implemented when the purely custodial function of the medical profession is rejected and the ethical responsiblity of the physician to society is allowed to direct the role innovations that must be incorporated. It is the person of the physician as a diagnostic and therapeutic tool that must be cultivated. The curriculum presented has included behavioral science conferences, a one-month behavioral science rotation, a two-month orientation program, behavioral science clinical attendings, and a personal counseling program for each resident throughout the three years of training. To be complete, such a program requires the further refinement of behavioral objectives that allow reliable evaluation and redefinition by residents and faculty.


On becoming a teacher of family medicine. The emergence of family practice education in the past decade has created an unprecedented demand for faculty. Since no reservoir of trained teachers existed, it has become necessary for practicing family physicians to enter the academic world and assume the role of teacher. This paper examines the internal processes by which this transformation occurs. It begins with the fantasies common to physicians who are considering the decision to teach;, and progresses through self-assessment of qualifications to a consideration of the content of family practice teaching. It concludes with guidelines for negotiation with an academic institution and the early stages of professionalization in the new role.


Why home visits? Analysis of 142 planned home visits. The functions of the traditional home visit in practice and teaching are controversial. A different kind of planned home visit was developed and implemented as part of orientation of first-year family practice residents. The objectives were to get acquainted and establish communications; to facilitate observational skills and awareness of the community; and to improve research parameters of the family record. This kind of home visit is feasible: all residents participated; 92.2 percent of families participated of whom 90.8 percent responded to a follow-up questionaire. Communication patterns between doctor and patient/family were analyzed for skills at listening and speaking clearly. Poor communication was infrequent, occuring in only 8 to 12 percent of the encounters. Ethnic differences between family and resident were important in such visits.


Analysis of the work of nurse-practitioners in family practice and its effect on the physicians' activities. A three-year study on the inclusion of nurse-practitioners (18 months basic training) in family medicine is presented. The nurses were entitled to screen patients and to treat minor ailments. Patient-nurse contact rates were 6.1, 7.1, and 4.2 per year in 1971, 1972, and 1973, respectively. The increased responsibility given the nurses resulted in a decrease in patient-physician contacts from 4.0 in 1970 to 2.0, 2.1, and 1.3 in 1971, 1972, and 1973, respectively. This permitted the physicians to spend more time with each patient, to look for disease in the community, to participate actively in the work of the department of medicine in the regional hospital, and to engage actively in research. As a result, numerous surveys have been performed and a great amount of important medical and epidemiological information has been accumulated. More than one third of all patients handled by nurses suffered from respiratory infections; these were followed by musculoskeletal disorders and skin infections. Diagnosis and treatment accounted for 50 to 53 percent of the nurses' activities. Consequently, the medical and social status of the nurses rose markedly and patients seems to rely increasingly on their judgment.


The consultation process and its effects on therapeutic outcome. There is little in the literature dealing with consultation from the point of view of patient care. Since one of the major elements in the definition of family practice deals with the synthesizing role and the responsiblity of the family physician to help guide patients through the complex health-care system, it is entirely appropriate to take a critical look at the consultation process. This will allow more appropriate teaching of the family practice resident, so that he may use consultation and referral in a more productive manner in the future. This paper defines and discusses six common problems in the consultation process. Classification of pitfalls in the consutative process can serve as a starting point from which a more critical and systematic study of the consultation can be made, to the end of making the consultant and the referring physician both more skilled and more comfortable with their coordinated tasks.


Lumbar puncture in infants and young children. Lumbar puncture is an important diagnostic procedure in infants and young children, particularly to rule out acute meningitis. Special problems are presented to the physician with respect to technique and interpretation in this age group. This paper discusses lumbar puncture in infants and young children with attention given to certain procedural details (including the use of the Butterfly Infusion Set) and to significant differences in interpretation of findings in the cerebrospinal fluid in the newborn.


Relation between nerve fiber number and pectoral fin regeneration in the teleost. The number of nerve fibers per unit of amputation surface area has been determined in four teleosts capable of regenerating their fins (Gobius paganellus, Gobius minutus, Ictalurus nebulosus and Fundulus heteroclitus) and in two-non-regenerating ones (Cottus bubalis and Blennius pholis). The number of nerve fibers is about 16 in the non-regenerating fin and varies between 25 and 35 in the regenrating ones. These data, correlated with previous ones obtained on tetrapods, affirm the principle that there is a phylogenetic decline in the quantitative innervation of the vertebrate appendage. Moreover, they show that in the fish a quantitative neuronal threshold must also be satisfied in order for fin regeneration to occur. The threshold, in terms of fiber number, is higher than in the urodele amphibian. However, the fibers appear to be of smaller caliber; and so, the total amount of neuroplasm at the amputation surface which is required for regeneration may be similar to that for the amphibian.


Biosynthesis of crustacean lipovitellin. III. The incorporation of labeled amino acids into the purified lipovitellin of the crab Pachygrapsus crassipes. Electrophoretically pure subunits were obtained from the lipovitellin (LV) of the intertidal crab, Pachygrapsus crassipes. The molecular weights of these subunits were determined. In addition, it was demonstrated that the ovaries of Pachygrapsus, incubated in vitro, incorporated 3H-leucine into the two principal subunits of lipovitellin. At the end of a 30 hour incubation the specific activity of each of the principal subunits was approximately 30,000 dpm/mg protein. It is concluded that the ovaries of Pachygrapsus crassipes are capable of synthesizing the proteinaceous yolk found in the mature egg.


Esterase isozyme patterns in developing embryos of Brachydanio rerio (zebra danio), Brachydanio abolineatus (pearl danio), and their hybrids. The ontogeny of esterase isozymes in Brachydanio rerio (zebra danio), Brachydanio albolineatus (pearl danio), and hybrids formed by their reciprocal crosses was investigated using polyacrylamide disc electrophoresis. Seven esterase isozymes were identified in each species from the unfertilized egg stage to nine days posthatch. Electrophoretic analysis of qualitative changes in enzyme pattern indicated that some esterases were present at all stages of development while other esterases abruptly appeared at a specific stage of morphological differentiation. The esterases of both species were classified on the basis differential substrate and inhibitor specificities. In developing hybrids formed by B. rerio eggs inseminated with B. albolineatus sperm, the maternal isozyme pattern persisted until Stage 17 (gastrulation). Embryonic extracts from Stage 17 onward showed a slow-moving, DFP-sensitive carboxylesterase of paternal origin. In developing hybrids formed by B. albolineatus eggs inseminated with B. rerio sperm, a paternal contribution to the esterase pattern was probably present by the end of gastrulation; esterase activity of distinctively paternal origin was present by Stage 22 (retinal pigmentation) The maternal contribution to the total esterase profile appeared to remain high through hatching. Additional evidence for gene activity at gastrulation was obtained in experiments utilizing actinomycin-D and cycloheximide. Results of exposing embryos of B. rerio to 15 mug/ml of actinomycin-D indicated that transcription of the template RNA coding for cholinesterase occurred during gastrulation or some 20-30 hours prior to the appearance of the isozyme at Stage 22. This template RNA was translated sometime during that 10-hour interval immediately preceding Stage 22.


Inhibition of hamster sperm acrosome reaction and fertilization by oligomycin, antimycin A, and rotenone. Effects of respiratory inhibitors (oligomycin, antimycin A and rotenone) on hamster sperm acrosome reaction and fertilization were studied. Hamster spermatozoa were incubated in a mixture of a modified Tyrode's solution and heat-treated human serum in the presence and absence of inhibitors. Oligomycin (2.4 x 10(-6) M), antimycin A (2.5 x 10(-6) M) and rotenone (2.5 x 10(-6) M) all reduced the incidence of the sperm acrosome reaction and fertilization without markedly affecting sperm motility. Antimycin A was the most effective in reducing the incidence of acrosome reaction. A reduction in the rate of fertilization was found in the presence of all of these respiratory inhibitors. The reduction in the incidence of acrosome reaction and fertilization by respiratory inhibitors implies an intimate relationship between high energy production (via respiration and oxidative phosphorylation) and capacitation and the acrosome reaction of spermatozoa. The necessity of oxidative metabolism for efficient capacitation and acrosome reaction of spermatozoa is suggested.


Changes in the cell coat at the onset of gastrulation in Xenopus laevis embryos. Four developmental stages of Xenopus laevis embryos were fixed in standard electron microscopic fixatives with 1% lanthanum nitrate added. This treatment reveals a lanthanum staining material (LSM) on the cell surface and in extracellular spaces. Morula and blastula stage cells have a small amount of LSM; in blastulae, 3 +/- 3 SD % of the cell surface is coated with LSM. In early gastrulae, 29 +/- 6 SD % of the cell periphery is covered with LSM. In late gastrulae, 82 +/- 13 SD % of the cell periphery is either coated with LSM or faces a space with LSM in it. There is also an appreciable accumulation of LSM within extracellular spaces during gastrulation.


Base composition of DNA from some reptiles. The DNA base composition was studied in 9 reptilian species (4 chelonians, 3 saurians, and 2 ophidians) by the thermal denaturation method. This preliminary investigation has brought to light differences in GC percentages and in the shape of melting curves between chelonian DNA and that from saurians and ophidians.


Involvement of a trypsin-like activity in sperm penetration of zona-free mouse ova. The presence of trypsin inhibitors during insemination reduced penetration of zona-intact and zona-free mouse ova by capacitated sperm. This inhibition was dependent upon both concentration of inhibitor and sperm. Preincubation of gametes in inhibitors did not markedly influence their subsequent fertility, nor did it alter sperm motility. Trypsin inhibitors may exert an effect on penetration by interfering with the induction of the sperm acrosome reaction or with the process of sperm-egg fusion.


The relationship between growth, developmental stage and postamputation age of the regeneration blasterma of the newt, Notophthalmus viridescens. The growth of the regeneration blastema of the newt forelimb has been quantitated and analyzed as a function of postamputation age, developmental stage, animal weight, animal length, and cross sectional diameter of the blastemal base in both the anteroposterior and dorsoventral dimensions. Correlation coefficients computed for these variables show that growth of the regenerate in both length and volume is more closely correlated with developmental stage than postamputation age. In addition, the results show a linear relation between the loge (regenerate length) and developmental stage, and between regenerate length and volume. Thus, length can be used to assess growth of the regenerate according to a developmental rather thana chronological time scale. There were no significant correlations between regenerate length or volume and animal length, animal weight or cross sectional dimensions of the blastemal base. These results show that one can use a randomly selected population of animals and study the growth of the regeneration blastema by relating to a developmental time scale through a logarithmic transformation of the linear growth data.


Acetylcholinesterase isozymes in developing mouse tissues. Several isozymes of acetylcholinesterase are separated by 10% acrylamide gel electrophoresis of mouse blood, brain, heart, muscle and tongue tissues. Two isozymes migrating near the origin are described which show changes in relative activity during development. The faster of the two bands is proportionately higher in concentration in embryonic tissues and is highly specific for the acetylthiocholine iodide substrate. This isozyme corresponds to the erythrocyte membrane AChE in electrophortic mobility and substrate specificity. The slower of the two bands is predominant in adult tissues and exhibits considerable cross reaction with the butyrylthiocholine iodide substrate. During embryonic and postnatal developmental stages there is a gradual shift from the faster migrating isozyme toward a predominance of the slower migrating isozyme.


Slow sodium inactivation in nerve after exposure to sulhydryl blocking reagents. Exposure to N-ethylmaleimide (NEM), a reagent that binds covalently to protein sulfhydryl groups, results in a specific reduction in sodium conductance in crayfish axons. Resting potential, the delayed rise in potassium conductance, and the selectivity of the sodium channel are unaffected. Sodium currents are only slightly increased by hyperpolarizing prepulses of up to 50 ms duration, but can be restored to about 70% of their value before treatment if this duration is increased to 300-800 ms. The time to peak sodium current and the time constant of decay of sodium tail currents are unaffected by NEM, suggesting that the sodium activation system remains unaltered. Kinetic studies suggest that NEM reacts with a "slow" sodium inactivation system that is present in normal axons and that may be seen after depolarization produced by lowered the holding potential or increasing the external potassium concentration. NEM also perturbs the fast h inactivation system, and in a potential-dependent manner. At small depolarizations tauh is decreased, while at strong depolarizations it is increased over control values. Experiments with structural analogs of NEM suggest that sulfhydryl block is involved, but do not rule out an action similar to that of local anesthetics, p-Chloromercuriphenylsulfonic acid (PCMBS), another reagent with high specificity for SH groups, also blocks sodium currents, but restoration with prolonged hyperpolarizations is not possible.


Properties of visual cells in the lateral eye of Limulus in situ: intracellular recordings. Two types of potential fluctuations, large and small, recorded intracellularly from photoreceptors in the dark-adapted Limulus eye in situ underlie the dual properties of the impulse discharge of the optic nerve fibers. The small potential fluctuations (SPFs)--the well-known quantum bumps--were normally less than 20 mV in amplitude. The large potential fluctuations (LPFs) were up to 80 mV in amplitude. LPFs appear to be regenerative events triggered by SPFs that enable single photon absorptions in retinular cells to fire off nerve impulses in the eccentric cell. In the dark, SPFs and LPFs occur spontaneously. At low light intensities, LPFs are the major components of the receptor potential. At high intensities, LPFs are suppressed and SPFs become the major components. SPFs and LPFs together enable single photoreceptor cells to encode approximately a 9-log unit range of light intensity. Excising the eye from the animal or cutting off its blood supply generally abolishes LPFs and thereby reduces the range of light intensity coded in the optic nerve discharge.


Force velocity relations of single cardiac muscle cells: calcium dependency. Cellular cardiac preparations in which spontaneous activity was suppressed by EGTA buffering were isolated by microdissection. Uniform and reproducible contractions were induced by iontophoretically released calcium ions. No effects of a diffusional barrier to calcium ions between the micropipette and the contractile system were detected since the sensitivity of the mechanical performance for calcium was the same regardless of whether a constant amount of calcium ions was released from a single micropipette or from two micropipettes positioned at different sites along the longitudinal axis of the preparation. Force development, muscle length, and shortening velocity of eitherisometric or isotopic contractions were measured simultaneously. Initial length, and hence preload of the preparation were established by means of an electronic stop and any additional load was sensed as afterload. Mechanical performance was derived from force velocity relations and from the interrelationship between simultaneously measured force, length, and shortening velocity. From phase plane analysis of shortening velocity vs, instantaneous length during shortening and from load clamp experiments, the interrelationship between force, shortening, and velocity was shown to be independent of time during the major portion of shortening. Moreover, peak force, shortening, and velocity of shortening depended on the amount of calcium ions in the medium at low and high ionic strength.


The virus particle nucleic acids and proteins of four bunyaviruses. The structural polypeptides of five bunyaviruses, snowshoe hare, Lumbo and La Crosse viruses (members of the California encephalitis subgroup of bunyaviruses), Bunyamwera and Main Drain viruses (members of the Bunyamwera subgroup of bunyaviruses), have been compared by polyacrylamide-SDS gel electrophoresis. Each virus was found to possess three major structural polypeptides, two glycoproteins (G1 and G2), and one nucleocapsid protein (N). Although the sizes of the G1 polypeptides (mol. wt. approx. 115 X 10(3)) and G2 polypeptides (mol. wt. approx. 38 X 10(3)) of the five viruses were found to be essentially similar, the sizes of the N polypeptides of the various viruses differed (mol. wt. range 19 to 24 X 10(3)). The RNA genomes of four bunyaviruses (snowshoe hare, La Crosse, Bunyamwera and Main Drain) have also been compared. Each virus has three RNA species of mol. wt. approx. 3 X 10(6), 1-9 X 10(6) and 0-4 X 10(6). Minor size differences were observed for the smallest RNA species of the four viruses (mol. wt. range 0-34 to 0-50 X 10(6)). For snowshoe hare virus the RNA segments hav a 5' sequence of pppAp...which suggests that the RNA is linear and not circular.


Interaction of mouse peritoneal macrophages with different arboviruses in vitro. In vitro cultured mouse peritoneal macrophages are inefficient host cells for both alpha and flaviruses tested. Production of infectious virus ceased 6 to 24 h after infection, except for virulent and avirulent SF strains. This limited growth is unrelated to interferon production. No correlation was found between the LD50 of different virus strains for mice and the virus yields of in vitro infected macrophages therefrom. When macrophages from SF immunized mice were inoculated in vitro with SF or EEE, a cytopathic effect occurred, while the multiplication of SF, but not of EEE, was decreased. Virus multiplication in proteose peptone induced macrophages was enhanced for SF strains only. These results are discussed in relation to the virulence of several arboviruses for mice.


Isolation of Enterobacteriaceae bacteriophage particles catalysing cell wall lipopolysaccharide degradation. Using pairs of smooth and rough forms of Enterobacteriaceae, six smooth-specific bacteriophages were isolated from sewage and another was obtained from Dr Hedda Milch, Budapest. Upon incubation of the individual extracted (smooth) host cell wall lipopolysaccharides with the homologous purified viruses, liberation of reducing groups (i.e. of about di- to nonasaccharides) was observed in four cases, indicating the action of glycanases - but no liberation of acetic acid, indicating the absence of esterase activity. Under the electron microscope, all phages were seen to exhibit Bradley group B or C morphology and to carry tail spikes.


The effects of actinomycin D on RNA synthesis in measles virus-infected cells. The effect of actinomycin D on the production of genomic RNA, messenger RNA and protein in measles virus-infected cells were investigated. It was found that whereas high concentrations of the drug inhibited genome synthesis, the production of messenger RNA was unaffected and in some cases enhanced. These effects were shown, at least in part, to be due to a secondary effect of the drug which caused an inhibition of virus-specific protein synthesis.


Variables of color, duration, frequency, presentation order, and sex in the estimation of dot frequency. The estimation of number depends on the information as dot frequency, exposure conditions, order of presentation, and sensitivity of the observer to color. Ninety-six color-normal observers (age 17-27) equally divided by sex were assigned so that each one viewed 42 cards, each of which contained dots of one of three colors on one of two grounds at one of seven frequency levels. For any observer, cards were exposed for either .5 second or 1.0 second intervals and in either ascending or descending order. The ANOVA indicated a significant effect for the following variables: dot frequency, dot color, and exposure time. Estimates increased with dot number on the several displays. Yellow-red (YR) dots were slightly overestimated. Yellow-green (YG) and gray dots were not. The briefer exposure yielded an underestimation and the longer an overestimation. Interpolated intervals are given for correct estimates.


Effects of lithium carbonate on motor activity in mania and depression. A telemetered movement recording system and nursing ratings of behavior were utilized to assess spontaneous motor activity and symptom intensity of 15 patients with affective illness before and during lithium carbonate treatment. Prior to treatment, patients rated hyperactive-elated, angry, and agitated had more motor activity, and patients rated anergic and retarded had less motor activity. Lithium carbonate treatment was not associated with any uniform change in motor activity for all patients; however, patients with a decrease during treatment in thought disorder, motor agitation, and hyperactivity-elation had a decrease in motor activity, and patients who had a decrease in depressed mood, anergia, motor retardation, and social withdrawal had an increase in motor activity. The decrease in activity of manic patients, except for the 11 p.m. to 3 a.m. period of apparent sleep, appeared to occur fairly uniformly throughout the 24-hour period, but the increase in activity of the depressed patients occurred mostly during the daytime. The data indicate that lithium does not exert a strong and consistent direct effect on spontaneous motor movement, and that when changes in movement do occur, they relate to changes in clinical states.


Are there precursors to repression?

Are there precursors to repression? The author examines the possibility that repression has developed out of phylo- and ontogenetic precursors. The adaptive task of repression is to control instinctual behavior by screening out those stimuli (internal or external) which could trigger unacceptable behavior. Habituation, i.e., cessation of response to a repeated stimulis, is a mechanism for controlling behavior, with properties strikingly similar to repression. It operates by inhibiting sensory input, can discriminate and "recognize" the stimuli to be inhibited, and is impaired by brain damage, drugs (especially barbiturates), and perhaps also influenced by hypnosis. The author suggests that repression may be an evolutionary step from habituation, providing for inhibition of irrelevant as well as relevant but undesirable stimuli. In infants, habituation and withdrawal of attention from noxious stimuli operate through similar and perhaps identical mechanisms.


Utilization review of the late adolescent patient in a mental health center: steps toward the development of criteria for the adequacy of assessment and treatment. This study is concerned with an attempt to determine whether meaningful utilization review criteria could be productively generated by viewing a patient population from a developmental perspecitve. During a 2-year period, a multidisciplinary panel at Yale University sought to identify the sociodemographic, clinical, and administrative issues posed by late adolescents seeking treatment at the Connecticut Mental Health Center, New Haven. We sought to address the following questions: a) From what segment of the population were we drawing our adolescent patients? b) Who referred them for help? c) What kinds of problems led to referral? d) What were the diagnostic characteristics of the adolescent's evaluation? e) Under what conditions do adolescents terminate treatment? The charts of over 1222 adolescent patients were studied to help us answer these questions. Our investigation revealed that the adolescent patients seen at the Mental Health Center were sociodemographically and diagnostically heterogeneous. An increasingly large number of adolescents are referring themselves for evaluation and treatment, rather than being sent by schools, physicians, or social welfare agencies. The majority of patients seeking help come from blue collar or working class backgrounds mainly because of intrapsychic complaints of anxiety and depression. Upwardly mobile, they constitute a group who have completed their high school education, often live away from home, and are struggling with problems of defining an identity different from that of their family. Review of their charts indicated that significant sholastic, medical, and developmental information was frequently lacking or vaguely recorded. Our chart review also indicated that many clinicians did not ask their patients about symptoms relating to body functioning such as difficulties with sleeping, eating, or psychosomatic complaints. The study also discovered that it was difficult in the great majority of the charts reviewed to specify the adolescent's own perception of the difficulties which led them to seek help. Suggestions are then outlined for developing review criteria dealing with the emancipated adolescent, parental involvement in the treatment of the adolescent, treatment plans, and the termination of treatment. The comparative advantages of combining utilization review criteria from both a traditional "disease model" and a "developmental model" are discussed. The panel concluded that input from both perspectives is necessary in understanding the impact of a mental health delivery system upon adolescent patients, their family, and the community.


Psychological correlates of survival on renal dialysis. The Minnesota Multiphasic Personality Inventory was administered to 47 male patients on the Renal Dialysis Unit at the Seattle VA Hospital. The patients were divided into three survival groups for comparison. Group A died within 1 year of initiating dialysis. Group B had been alive on dialysis between 3 and 7 years, while group C had been alive between 7 and 10 years at the time of data analysis. Group A differed significantly from group B on the Hs, D, and Hy scales, and from group C on the F, Hs, D, and Pt scales. Interpretation of the mean MMPI profiles implies that persons in group A are characterized by feelings of helplessness, high levels of depression, anxiety, and preoccupation with somatic difficulties, whereas those in groups B and C tended to be dependent, have mild levels of depression, and have a sense of hopefulness about the future. The authors suggest that psychiatric intervention might increase the longevity of those patients judged to be moderately to severely depressed with somatic preoccupations.


Diagnosis and expectation for change: an inverse relationship? The purpose of this study was a test the  hypothesis that the use of psychiatric labels leads to reduced expectations for patient change and recovery. Thirty-nine staff members at a residential mental hospital were given a description of a patient and asked to indicate expected length of stay in the hospital, chance of readmission, chance of leading a normal life, and overall prognosis. A diagnosis of schizophrenia, paranoid type was included at the end of half of the descriptions and was omitted in the other half. It was found that staff working in the acute treatment areas were significantly negatively affected by the diagnosis when overall prognosis was considered. In addition, the findings of this study with respect to occupation, sex of patient, and treatment area suggested that such variables should not be overlooked when assessing staff attitudes or treatment orientation. Since an admitting diagnosis is required by most treatment facilities, the results highlighted the limitations of these preliminary labels and spoke to the necessity of individualized evaluations. Finally, further work was indicated on the development of scales which could measure expectations for change and the behavioral concomitants of such expectations.


A case of functional sleep seizures.

A case of functional sleep seizures. The author presents a case of functional seizures occurring only when the patient is asleep. Discussion of the case includes the limitations of the traditional psychoanalytic explanation of conversion reactions, and focuses on reassessing conversion phenomena in terms of their communicated messages.


Effect of calcium removal on monoamine-elicited depressions of cultured tuberal neurons. The role of extracellular calcium in monoamine responses of central neurons was ivestigated using explant cultures of tuberal hypothalamus. The spontaneous activity of neurons in cultures was recorded in balanced salt and calcium-deficient salt solutions. This increased firing rate was counteracted by the addition of magnesium. Addition of magnesium also regularized the pattern of firing. Iontophoretic application of putative monoamine neurotransmitters reversibly decreased the rate of firing in both normal and calcium-deficient salt solutions. These results suggests that monoamine inhibitions are not primarily mediated by transmembrane calcium fluxes.


Nonhomogeneous distribution of 5-hydroxyindoleacetic acid and homovanillic acid in the lumbar cerebrospinal fluid of man. The volume of the lumbar sac measured in 4 subjects was found to be 15.5 ml. Exactly 15 ml of lumbar cerebrospinal fluid (L-CSF) was permitted to flow freely out during a lumbar puncture in 20 neurological patients and small samples of the L-CSF were collected in the beginning (sample 1), at the middle (sample 2), and at the end (sample 3) of this procedure either for 5-HIAA or HVA measurement. The concentrations of 5-HIAA and HVA increased in an exponential manner from sample 1 to sample 3. These results indicate that CSF in the lumbar sac is not a homogeneous fluid as is generally believed and that certain rules have to be followed in the sampling of the L-CSF to obtain reproducible biochemical data.


Liposome toxicity in the mouse central nervous system. This study has shown that while some liposomes are highly toxic to the central nervous system, others, of different composition, are tolerated well in the dosage used (0.02-0.05 ml = 4-12 mg of lipid/inoculum). Those composed of lecithin-cholesterol-dicetyl phosphate or lecithin-cholesterol-stearylamine produced generalised epileptic seizures and some deaths due to respiratory failure immediately after injection,and a subsequent widespread tissue necrosis. However liposomes composed of lecithin-cholesterol-phosphatidic acid, or dipalmitoyl lecithin only, produced minimal morphological changes and by the sixth day post-injection the pathology was limited to the mechanical trauma caused by the injection. It is concluded that liposomes of appropriate composition may be sufficiently benign to use as carriers of therapeutic agents into the CNS.


The ocular microtremor record as a potential procedure for establishing brain death. The normal ocular microtremor possesses certain characteristics. Abnormal records are found in unconscious patients. Six patients with clinical manifestations of brain death showed complete absence of ocular microtremor when it was recorded shortly before death. A seventh patient who had taken an overdose of barbiturates had a virtually flat record which gradually improved as her coma lightened. The ocular microtremor record is proposed as a potential monitor of brain stem viability or death.


Biochemical and ultrastructural aspects of the inhibited phagocytosis by neutrophil granulocytes in acute brain-damaged patients. In a study of 60 head-injured patients inhibition of phagocytosis by neutrophil granulocytes was observed over a period of up to 5 weeks. This inhibition of phagocytosis could be correlated with the severity of head injury as well as with the state of unconsciousness at the time of the investigation. No correlation was found between neutrophil granulocyte counts and the inhibition of phagocytosis. A good correlation could be demonstrated between the level of lumbar CSF 5-HIAA and the inhibition of phagocytosis. After in vitro incubation with albumin the cells showed a recovery of phagocytosis. Electron micrographs of the cells showed ultrastructural appearances suggesting a changed permeability of the plasma membrane and, in addition, alterations in the cytoplasmic region beneath the plasma membrane. It is suggested that head injury may influence the pituitary-adrenal system and the autonomic nervous system, giving changes of neutrophil function and of neurotransmitter metabolism; these changes may represent an adaptation mechanism.


Cyclizine-induced chorea. Observations on the influence of cyclizine on dopamine-related movement disorders. Cyclizine was observed to induce generalized chorea in a patient with mild lingual-facial-buccal dyskinesias. The mechanism for this action was shown to be cyclizine's central anticholinergic activity. This was consistent with previous findings that acetycholine antagonists can lower the threshold for appearance of abnormal choreatic movements related to dopaminergic mechanisms by alteration of the dopamine/acetylcholine balance in the corpus striatum. Furthermore, our study was supportive of the hypothesis that spontaneous lingual-facial-buccal dyskinesias in the elderly may be the mildest manifestations of senile chorea.


Dystrophia myotonica. A model of combined neural and myopathic muscle atrophy. Reports on clinical, electrophysiological and histological studies in dystrophia myotonica have shown that the peripheral nerves are usually not intact. In a few patients the neuropathy exceeds the myopathy. On the basis of these findings some authors believe that muscle changes in dystrophia myotonica are entirely due to the nerve lesions. However, despite the commonly found evidence of neuropathy, electromyographic and muscle biopsy findings are reported usually as "myopathic". Furthermore, clinical and laboratory findings indicate that the degree of muscle atrophy and peripheral nerve changes are unrelated. This report attempts to explain the discrepancies by suggesting that the "myopathic" and "neuropathic" changes in the muscle fibres in dystrophia myotonica are independent processes.


Neurological manifestations of gnathostomiasis. Neurological features of 24 patients with nervous system gnathostomiasis were reviewed. The commonest presenting features were radiculomyelitis or radiculomyelitis terminating with encephalitis, and subarachnoid haemorrhage. A primary encephalitic form was noted in 2 patients. The salient feature of the disease was a sudden onset of extremely severe radicular pain and/or headache followed by paralysis of the extremities and/or the cranial nerves. Migration signs were also the hallmark of nervous system gnathostomiasis. No single area of the nervous system was inaccessible to the highly invasive gnathostome lava. Multiplicity and/or rapid progress of lesions beyond the degree of cerebral oedema could only be explained by further migration of the parasite. Death occurred in 6 patients from direct extensive involvement of vital centres in the brain stem or from complications such as pneumonia or septicaemia. Multiple cranial nerve palsies were usually bad prognostic signs.


Influence of exogenous triiodothyronine on axonal regeneration and wound healing in the brain of the rat. Rats with parasagittal incised wounds of the telencephalon were treated for 1,7, 21 or 56 days with triiodothyronine (T3), 0.5 mug/100 g body weight, injected once daily. Controls were injected with the aqueous solution in which the T3 was dissolved. The brains were examined histologically and quantitative assessments were made of the regeneration of axons into and across the lesions and of the healing of the wounds. T3, when administered over an 8 week period, stimulated axonal regeneration in the dorsal cortex and corpus callosum and promoted healing of the wound in the corpus callosum. The results of this investigation suggest that the use of T3 in the clinical treatment of injury to the central nervous system may be of less value than the work of earlier authors had indicated.


Meningeal carcinomatosis: development of an experimental model. An experimental model of meningeal carcinomatosis has been produced by intracisternal inoculation of Walker 256 carcinoma cell suspension into Wistar rats. The tumor grows rapidly and is fatal in about 15 days if 10(6) cells are injected. The histopathological pattern observed is similar to that seen in diffuse leptomeningeal involvement of systemic cancer in human beings. The model will be useful for investigating the pathophysiology of the neurological disability produced by meningeal carcinomatosis and the efficacy of chemotherapeutic agents.


An unusual malformation of the forebrain and concomitant destructive encephalopathy with calcifications. A 9-year old boy with profound mental retardation and severe neurologic deficit presented an unusual malformation of the forebrain distinguished by the following features: 1) microtelencephalon, alobulation, afissuration, and abnormal convolutional pattern; 2) persistence of hippocampal formation at its embryonic site in the dorsomedial wall of the telencephalon; 3) hypoplasia and abnormal configuration of ventricles; 4) agenesis of cerebral commissures; and 5) abnormal location and orientation of gray structures. Important concomitant findings characterized by severe destructive lesions, massive calcification, granular ependymitis, and low grade inflammation were suggestive of late sequelae of an infectious process, possibly congenital. Transplacental transmission of an unidentified pathogen with teratogenic properties was hypothesized as the probable cause. The teratogenic insult started in an early embryonic period and affected primarily the development of the neopallium in the telencephalic wall. The arrested development of the neopallium disrupted the chain of interdependent developmental events; consequently characteristic morphological modifications normally induced by the continuous growth and differentiation of the neopallium failed to occur or took an abnormal course. The name architelencephalon (Greek: arche, beginning; telencephalon, cerebral hemispheres) proposed for this particular malformation of the forebrain indicates its resemblance both to the human brain at early stages of development and also to mammalian brains on a lower level of phylogeny. Associated anomalies included an unilateral microphthalmia with cataract, severe stenosis of the aqueduct of Sylvius and macrocephaly. The microphthalmia was either a developmental anomaly or was infectious in origin. The stenosis of the aqueduct was attributed to granular ependymitis. Tearing of the thin dorsal diencephalic plate and arachnoid membrane and escape of the cerebrospinal fluid into the subdural space probably accounted for the macrocephaly.


Electron microscopic-cytochemical and biochemical studies of acetylcholinesterase activity in denervated muscle of rabbits. Acetylcholinesterase (AChE) activity has been studied in normal, control and denervated muscle of rabbits by electron microscopic-cytochemistry and radiometric assay. A small amount of butyrylcholinesterase (BuChE) activity is also found in biochemical assay of unfixed muscle, but it is not demonstrable cytochemically in fixed specimens by the method used in this study. Both a soluble and particulate AChE activity are present in all specimens examined. The particulate activity is probably due to enzyme localized in the sarcotubular system and at the motor end-plate. Soluble AChE activity may represent those sites exhibiting random cytochemical end product, such as some areas of normal and denervated muscle and muscle nuclei, Schwann cells, and AChE-containing mononuclear cells in the connective tissue. There is a greater proportion of particulate than soluble AChE activity in normal and control muscle, a finding which is compatible with the well localized cytochemical sites. Four to six weeks post-denervation, there is a marked increase in extrajunctional AChE activity to peak values 15 to 30 fold above control values. The increase is accompanied by a reversal in the proportion of particulate to soluble enzyme, so that there is almost twice as much soluble as particulate AChE. There are also numerous "spots" of random cytochemical end product throughout extrajunctional muscle. The increase in levels of AChE activity, the change to predominantly soluble form, and the large numbers of new cytochemically active sites indicate that synthesis of new enzyme has taken place. Changes in AChE activity in denervated rabbit have been compared to those occurring in dystrophic mouse muscle. It has been suggested that there might be a relationship between the formation of new extrajunctional sarcoplasmic sites of AChE activity and the spread of alpha-bungarotoxin binding sites and chemosensitivity in developing and denervated muscle.


Temporary regional cerebral ischemia in the cat. A model of hemorrhagic and subcortical infarction. A comparison was made on some of the effects that temporary and permanent occlusion of the middle cerebral artery may have on the circulation to the ipsilateral hemisphere in the cat. Reperfusibility of the corresponding capillary bed was unimpaired for the initial six hours after occluding the vessel, as demonstrated by in vivo intravenous injection of carbon black. Short-term occlusion of the middle cerebral artery, followed by re-opening of the vessel, resulted in either (a) no demonstrable parenchymal lesions (i.e., areas of softening), (b) smaller lesions, or (c) infarctions that were either hemorrhagic or confined to the subcortical white matter of the ipsilateral hemisphere.


Gap junctions between the supporting cells in some acoustico-vestibular receptors. Extensive gap junctions are found between the supporting cells in acoustico-vestibular receptors (saccular macula of the goldfish; ampullar crista, utricular macula and organ of Corti of the guinea pig). The fine structural details of these gap junctions were examined using lanthanum hydroxide staining and freeze-fracture replicas, as well as conventional thin sections. It was found in the lanthanum treated saccular macula of the goldfish that the gap junction globules consist of five or six subunits surrounding a central 2 nm hole. Similar subunits of the gap junction globule are also found in freeze-fracture replicas of the saccular macula of the goldfish and the ampullar crista of the guinea pig. Possible functions of the extensive gap junctions between supporting cells of these receptors are discussed.


Axonal degeneration in demyelinating disorders. Changes in the L7 and S1 segments of the spinal cord and the corresponding dorsal root ganglia (DRG), spinal roots and sciatic nerves of guinea pigs immunized with whole rabbit sciatic nerve in complete Freund's adjuvant have been studied and compared with the changes found in guinea pigs immunized with purified P.N.S. myelin. In both groups of animals, pathological changes were found in the posterior roots, DRG and root entry zones. In the posterior roots, axonal degeneration and segmental demyelination evolved in parallel, affected different populations of myelinated axons and showed no indication of interdependence. The aetiology of axonal degeneration in this and other demyelinating disorders is discussed. It is concluded that axons can be damaged by being in the vicinity of areas where cell-mediated immune reactions are taking place, i.e. as a consequence of the so-called 'bystander' effect.


Synaptic and non-synaptic acetylcholinesterase activity in the electroplaque of Mormyrid fishes. Electron microscopical study of AChE localization in the Mormyrid electric organ shows intense enzymatic activity in the synaptic region of the pedicle and a clearly recognizable enzymatic activity on the non-synaptic surface of the pedicle and on the anterior non-innervated face of the electroplaque.


The distribution of peroxidases in the sciatic nerves of normal and hexachlorophene intoxicated developing rats. Horseradish peroxidase (mol. wt. 40 000) or microperoxidase (mol. wt. 1900) were injected over the sciatic nerve of normal or hexachlorophene (HCP) intoxicated developing rats (3,7,14 and 21 days). Light and electron microscopic studies of nerves after histochemical staining for peroxidase revealed: a) the perineurial barrier to the two peroxidases was established in 21 day normal and HCP intoxicated rats; b) in animals 3-14 days, the perineurial barrier to both peroxidases was not formed and peroxidase staining was observed in the periaxonal space and in the space between paranodal loops of myelin; c) intramyelinic vacuoles, induced by HCP in animals 7-14 days did not show peroxidase staining. HCP-induced intramyelinic vacuolation is due to the separation of the myelin lamellae at the intraperiod line; although these vacuoles are potential extensions of the extracellular space, they are not stained with the extracellular markers horseradish or microperoxidase.


Neuromelanin and RNA in cells of substantia nigra. We have found that with accumulation of neuromelanin granules within cell bodies of neurones of the human substantia nigra there is a reduction in cytoplasmic RNA and a decrease in nucleolar volume. These observations imply a gradual decrease in the functional capacity of the cell such that eventually, the cell is unable to produce sufficient protein to maintain its metabolic economy with atrophy and death ensuing. This reduction in protein synthesis may result from the mechanical displacement and disruption of the endoplasmic reticulum by the accumulated pigment granules.


Growth in culture of the peripheral axons of the spiral neurons in response to displacement of the receptors. Observations were made on the growth of the peripheral axons of the spiral neurons in injured explants of the cochlea of the mouse. Opening of the cochlear duct during explantation usually results in a displacement of the hair cells into the outgrowth zone if the basilar membrane of the excised organ of Corti faces the substrate. Spiral neurons respond with vigorous growth to the stress created by the displacement of their receptors. Two different growth reactions occur in succession: 1) growth by elongation of the synaptically engaged fibre 2) free growth. The response of the neuron to an incipient displacement of the hair cells is an elongation of the fibre while its contacts with the receptors are, at least partly, preserved. Most or all fibres that are connected with the displaced cells elongate. The growth is well organized, limited to the region of the displaced hair cells, and restricted in length by the position of the receptors. It is inferred that tension on the synaptically engaged fibre may be a stimulus for its growth and that the growth ceases when the tension is relieved. Continuous stress eventually leads to a rupture of the fibre. The break usually occurs near or at the terminals, leaving the terminals attached to the hair cells. The proximal end of the fibre--now free--starts to grow. The growth is independent of the receptors, unrestricted in length, uncontrolled in amount, and continues for at least three weeks after explantation. The path of the fibre is tortuous, and collaterals are often emitted. Free growth proceeds at a markedly faster rate than growth by elongation. Maintenance of the synapse and growth of the fibre seem to be mutually dependent events. A peripheral axon of the spiral neuron can sustain in culture a normal innervation pattern, without any obvious signs of abnormal growth, if its connections with the hair cells are undisturbed; it elongates in an organized manner, if these connections come under stress; it responds with an uninhibited growth if the connections are broken.


Subacute necrotizing encephalomyelopathy in a neonatal infant. This infant, born after a normal pregnancy by cesarean section, appeared entirely normal for the first 44 hours of life, at which time she was found to have become completely apneic, suddenly and without known cause. The infant was resuscitated, placed in a respirator, treated energetically but with limited response, and expired 15 days later. At autopsy, bilaterally symmetric lesions were found in the walls of the third ventricle, the periaqueductal gray matter and the floor of the fourth ventricle, characterized by marked destruction of most neural elements, but with a selective preservation of neurons and their processes. The process is interpreted as that of subacute necrotizing encephalomyelopathy. Many of the preserved neurons had reacted by a multiplication of nuclei, as many as 11 being present in a single cell. Binucleated macrophages were also present; There were hypoxic changes as well, with a loss of neurons in the hippocampal gyrus, and with basophilic PAS positive granules in the cytoplasm of many neurons, some containing iron. If resuscitation had failed this would have been considered a "crib death". The possibility exists that some other cases of crib death may be of this nature.


Synaptic frequency alteration on rat ventral horn neurons in the first segment proximal to spinal cord hemisection: an ultrastructural statistical study of regenerative capacity. To study the regenerative capacity of the spinal cord in adult rat, presynaptic boutons were classified as S (spherical vesicles), F (flattened vesicles) and C complexes, and analysed statistically on alpha-motoneuron somata and lamina VII interneurons on the operated side in the first segment rostral to a spinal cord hemisection. Following chloral hydrate anesthesia left spinal cord hemisections were made on twenty adult rats (225 gms) at vertebral level T-2. Animals were prepared for electron microscopy at 7, 14, 30, 45, 60 and 90 DPO and compared with normals. All counts were made on coded material and subjected to statistical analysis. The normal frequency of presynaptic bouton types on alpha-motoneuron somata at 30 DPO. At 45 DPO, massive degeneration with concomitant synaptic remodeling resulted in a return to near normal frequencies of S and F presynaptic boutons. At 60 and 90 DPO a gain in S presynaptic boutons and a concomitant loss in F presynaptic boutons resulted in frequencies different from normal and decreased absolute numbers of presynaptic boutons. The interneuron somata also exhibited alterations over the postoperative period. There was a reversal of frequency of presynaptic boutons at 45 DPO. However unlike on alpha-motoneuron somata the frequency of S and F presynaptic boutons returned to normal at 60 and 90 DPO. The alpha-motoneuron somata appeared to be cyclically and nonselectively reinnervated by ventral horn interneurons over 90 DPO.


An unusual intracerebral connective tissue mass. A sharply circumscribed, vascular, connective tissue mass which replaced the cortex of several adjoining cerebral gyri is described. The histology of the lesion differs from that of previously reported central nervous system maldevelopments and neoplasms. However, there are a number of similarities to the pathology found in late phases of syphilitic "colloid" or "hyaline" degeneration of the brain.


Regional cerebral blood flow alterations remote from the site of intracranial tumors. Regional cerebral blood flow (rCBF) was investigated in 12 patients with brain tumors, using a 254-channel dynamic gamma camera. In nine of the 12 cases, hyperemic regions with loss of autoregulation were seen in sites remote from the tumor (the area around the tumor was in most cases also hyperemic). These remote rCBF abnormalities were found in the lower posterior part of the hemisphere in six cases, and in the frontal region in three. The location of the remote rCBF abnormality seemed to depend on the site of the tumor: cases with frontal and posterior fossa mass lesions had hyperemia in the lower part of the temporooccipital regions, cases with centroparietal mass lesions had hyperemia mostly in the frontal region. This may mean that the remote rCBF abnormality is due to local tissue compression against unyielding anatomical structures, namely, the tentorium and the falx. It is suggested that these abnormalities may constitute evidence of an early stage of a dangerous clinical condition: a state of preherniation.


Cerebral edema, mass effects, and regional blood volume in man. The authors conducted quantitative analysis of computerized tomography (CT) scans to measure tumor size, cerebral edema, and regional blood volume in man. Mass lesions without edema caused a local reduction in blood volume. Cerebral edema also reduced blood volume in proportion to its severity. Consideration of the electrolyte changes and water shifts in white-matter edema suggested that the decrease in absorption coefficient seen in CT scans was due to the increase in water content. Thus, in cerebral edema separation of blood vessels as well as increased interstitial pressure decrease blood volume, and the regional differences in turn reflect pressure gradients within the brain.


Ruptured intracranial aneurysms. Case morbidity and mortality. The authors review 100 consecutive cases of ruptured intracranial aneurysms to assess the overall morbidity and mortality. Patients were placed on a regimen of bed rest, sedation, control of blood pressure, anticonvulsants, and antifibrinolytic therapy. Surgery was performed on 86 patients with hypotensive anesthesia and microsurgical techniques. The incidence of early rebleeding while on epsilon aminocaproic acid and control of blood pressure was 11.8%. The overall surgical mortality was 8.1%, and the surgical mortality of patients in Grades 1, 2, and 3 was 6.3%. Of the 100 patients, 60 were able to return to their prior activities, and 25 had moderate neurological deficits that required limitation of their activities. The total case mortality was 15%. The evidence presented indicates that the regimen of active medical treatment before microsurgical intervention has improved the overall case morbidity and mortality, as well as the chance for long-term survival.


Cerebrovascular sensitivity to vasoconstricting agents induced by subarachnoid hemorrhage and vasospasm in dogs. In anesthetized dogs, subarachnoid hemorrhage (SAH) was induced by the mechanical rupture of the unilateral intracranial internal carotid artery. Vasospasm was angiographically determined 24 hours and 7 days after SAH. Contractile responses to serotonin, norepinephrine, histamine, and K+ were compared in control and bleeding sides of the middle cerebral arteries removed from dogs with SAH, and from sham-operated dogs. Under sham operation and 2 hours after SAH, responses in the arteries of both sides did not appreciably differ but response was significantly less in arteries from the bleeding side as compared with the control side 24 hours and 7 days after hemorrhage. However, median effective concentrations of serotonin, histamine, and K+ were approximately the same in arteries from both sides. Vasospasm and decreased sensitivity to the vasoactive agents of middle cerebral arteries were reversed 42 days after SAH. It is thus quite likely that initiation and maintenance of post-hemorrhage vasospasm is not associated with an increase in the sensitivity of cerebral arteries to vasconstricting endogenous substances, rather the state of decreased sensitivity of cerebral arteries in contact with SAH may be instrumental in relieving prolonged vasospasm.


Wave-form characteristics and spatial distribution of evoked spinal electrogram in man. The evoked spinal electrogram (SEG) in man was recorded from the epidural space, applying the technique of continuous epidural block, and compared with cord dorsum potential (CDP) in wakeful rabbits. Wave-form characteristics of the evoked SEG'S activated by the segmental nerves were almost the same in both cervical and lumbar regions. Somatosensory evoked response from the scalp was clearly demonstrated by stimulation of both the tibial nerve and fifth toe skin, whereas the evoked SEG was produced only by stimulation of the former. This finding might indicate that large nerve fibers are more responsible for producing the evoked SEG. Central latencies to the peaks of the second components of the P2 wave were 29 to 33 and 42 to 48 msec, in cervical and lumbar enlargements, respectively. This probably indicates the presence of a long feedback loop producing the second components. The amplitude of the N1 wave showed a steeper decline along the spinal cord than that of the P2 deflection, indicating between origins of these two components. Polarity of both the N1 and P2 waves became reversed when the recording electrode was situated in the anterior epidural space. The wave-form characteristics of the evoked SEG in man were very similar to those of the CDP in wakeful rabbits.


Ethanol potentiation of central nervous system trauma. Two models have been used to study the effects of ethanol on injuries of the central nervous system. The spinal cords of cats were injured by delivering a 200 gm-cm impact to the exposed dura mater. A second group of animals received a similar injury to the exposed dura mater overlying the cerebral hemispheres. The animals were divided into two groups, those that received an infusion of ethanol before injury, and control animals that received no ethanol. The parameters of injury used in this model produced small and insignificant lesions in those animals that received no ethanol; however, when the animals were pretreated with ethanol, a considerable increase in the extent of the injury was noted. These include alterations in membranes-bound enzymes and clotting mechanisms, and alteration of cell membranes through abnormal free radical reactions.


Norepinephrine levels in experimental spinal cord trauma. Part 1: Biochemical study of hemorrhagic necrosis. Levels of norepinephrine (NE) in the spinal cord tissue of nontraumatized cats are highest in the cervical and lumbar enlargements. A rather uniform but slightly increasing concentration gradient from cephalad to caudad is observed in the thoracic segments. A 500 gm-cm trauma at the T-5 or C-7 spinal cord segment did not demonstrate any significant increase in NE levels measured sequentially over a 4-hour period after trauma. Dopamine levels could not be detected in the nontraumatized or traumatized cat spinal cords. Four traumatized cats treated with alpha methyl tyrosine, a tyrosine hydroxylase inhibitor, and followed clinically for 5 months showed no improvement in neurological function when compared to untreated traumatized cats. This study does not support the norepinephrine hypothesis of experimental spinal cord trauma.


Norepinephrine levels in experimental spinal cord trauma. Part 2: Histopathological study of hemorrhagic necrosis. Alpha methyl tyrosine (AMT) or reserpine administered intravenously 24 hours before sacrificed in the nontraumatized cat resulted in significant reduction in tissue levels of norepinephrine (NE) tested at the T-5 spinal cord level. Phenoxybenzamine given 2 hours before sacrifice did not alter NE levels at T-5. Histological sections of spinal cord examined 1 hour after a 500-gm-cm trauma at the T-5 level in cats, pretreated 24 hours before trauma by a single dose of AMT or reserpine demonstrated no reduction of gray or white matter hemorrhages when compared tocontrols. In cats pretreated with phenoxybenzamine 2 hours before trauma there was a marked reduction of hemorrhages at 1 hour posttrauma when compared to controls. The animals treated with phenoxybenzamine had a 32% reduction of systemic blood pressure before trauma, demonstrated no pressor response to spinal cord trauma, and were severely hypotensive posttrauma. It is concluded that posttraumatic blood pressure has greater etiological significance in the pathogenesis of experimental spinal cord hemorrhages than tissue levels of NE.


Use of crocetin in experimental spinal cord injury. Mongrel dogs with experimental spinal cord injury were treated with the carotenoid compound crocetin. It has been shown that crocetin increases the diffusion speed of oxygen through plasma, and should provide a net increase in oxygen at the level of the capillary endothelial cell. The treated animals showed a significant improvement in recovery rates as compared to controls.


Neurophysiological and neurochemical alterations during electrical stimulation of human caudate nucleus. Lumbar cerebrospinal fluid (CSF) norepinephrine (NE) concentrations were preoperatively determined in five patients using a radioenzymatic assay technique. Stereotaxic thalamotomy was performed using depth coagulating electrodes with stimulating points at 5.0-mm intervals along the shaft. No significant alterations in prestimulation  lumbar CSF NE levels were noted 12 days after electrode installation. Stimulating points within the caudate nucleus were anatomically localized using ventricular landmarks and stimulation-induced neurophysiological responses were recorded. Twelve hours after intermittent electrical stimulation of the caudate nucleus, lumbar CSF NE concentrations were significantly decreased. Our data suggest the presence of noradrenergic pathways in man that are inhibited by caudate nucleus stimulation.


Carotid-cavernous sinus fistula caused by rupture of a primitive trigeminal artery aneurysm. Case report. A case is reported in which an aneurysm arising at the junction of the right internal carotid artery and a persistent primitive trigeminal artery ruptured to form a carotid-cavernous fistula. The internal carotid artery was ligated without any signs of brain-stem ischemia due to inverted blood flow through the primitive trigeminal artery.


Traumatic false aneurysm of the superior cerebellar artery simulating posterior fossa tumor. An example of traumatic false aneurysm of the right superior cerebellar artery is described. The chronicity of the clinical picture and a positive brain scan strongly suggested a posterior fossa neoplasm; however, the angiographic findings permitted a specific diagnosis to be made.


Malignant hyperthermia.

Malignant hyperthermia. The authors report the case of an infant with noncommunicating hydrocephalus, Arnold-Chiari malformation, and a lumbar myelomeningocele, in whom malignant hyperthermia occurred. The genetics and presumed etiology of this unusual problem are reviewed. The management is directed toward establishing effective cooling measures, reversing tissue hypoxia, and correcting respiratory and metabolic acidosis.


Pantopaque pulmonary embolism during myelography. A case of Pantopaque pulmonary embolism during myelography is presented. All reported cases of venous intravasation of Pantopaque have been associated with traumatic lumbar tap, and a mechanism whereby a bloody lumbar tap causes venous intravasation and hence Pantopaque pulmonary embolism during myelography is postulated.


Xenon-127, a comparison with xenon-133 for ventilation studies. In 133Xe ventilation studies the 81-keV gamma photon emitted is a major disadvantage for imaging. Using a lung model with the same attenuation coefficient as inflated lung, we compared 133Xe with 127Xe to determine the smallest "lesion" that could be imaged at different places within the lung. With the "lung lesion" directly against the collimator, the lesion had to be 10 ml in volume in order to be seen with 127Xe, but with 133Xe "lesion" had to be 30 ml. Xenon-127 gave better resolution, no matter where the lesion was placed within the lung. Xenon-127 was not better than 133Xe in resolving a lead bar phantom. When 133Xe was used with 99mTc in a model of pulmonary embolism, a "ventilation defect" was apparent even though the distribution of xenon was even throughout the model. This artifact was not seen when the 127Xe model was imaged.


Determination of extraction fraction by a double-tracer method. A relatively simple dual-tracer method for measuring renal extraction fraction was compared with the direct method. In the dual-tracer method an extracted and nonextracted tracer are mixed together and administered into the arterial circuit and samples of venous blood are obtained. The ratio of recovered to injected tracer then determines the extraction fraction. In the direct method tracer is administered directly into the renal artery and the total venous effluent is collected. Extraction fraction is then calculated as arteriovenous difference divided by the quantity injected. In our experiments the extraction for 201Tl and 203Hg-chlormerodrin were determined. The extraction fraction for 201Tl averaged 81 +/- 5% by the direct method and 81 +/- 6% by the dual-tracer technique (r = 0.94). The extraction fraction for 203Hg-chlormerodrin was found to change as a function of the renal blood flow. At normal flow the extraction fraction averaged 48% by the direct method and 45% by the dual-tracer technique. At reduced flow, in contrast, it averaged 78% by the direct method and 71% by the dual-tracer technique.


Gallium-67 scanning in the evaluation of therapy of malignant tumors of the head and neck. Gallium-67 scintigraphy was performed on 25 patients with a variety of malignant tumors of the head and neck in order to evaluate the susceptibility of the tumors to irradiation and chemotherapy before treatment and to monitor the effectiveness of therapy. If certain limitations are borne in mind, gallium scanning may prove a valuable tool in planning and evaluating therapy of malignant tumors.


Imaging experimental pulmonary ischemic lesions after inhalation of a diffusible radioaerosol: concise communication. Regional lung ischemia was imaged with a rapidly diffusible radioaerosol of pertechnetate. The method is compared with similar techniques using 11C and 15O. The principles involved include (A) the rapid alveolar-capillary diffusion of inhaled radioactive gases (11CO, C15O, and C15O2) and the radioaerosol of 99mTcO4-; (B) the patency of the airways to the ischemic regions; and, most importantly; (C) the much slower tracer removal from lung tissue with a stagnant circulation as opposed to the surrounding normal lung. The 11CO and C15O label the hemoglobin in red blood cells, and the C15O2 labels water in the circulation and in the stagnant ischemic region. The TcO4- probably labels the albumin of the plasma in the embolized regions and in the circulating blood. Experiments involving pulmonary embolism in dogs, proved by pre- and post-mortem angiography and gross post-mortem examination, show that positive ischemic lesions (hot spots) are observed, after TcO4- aerosol and C15O2 gas inhalation, in the embolized region on the same day. Clinical trials with aerosol-inhalation method in suspected pulmonary embolism and now under way.


Suitability of radiopharmaceuticals for determining right-to-left shunting: concise communication. Right-to-left shunting in noncyanotic patients was quantitated following the injection of either 99mTc-microspheres, 99mTc-macroaggregated albumin, or 113mIn-Fe(OH)3 particles. Shunting was determined by wholebody scanning followed by estimation of the nuclide fraction located in the systemic circulation. Both 99mTc-labeled radiopharmaceuticals yielded results consistent with normal pulmonary shunting in a noncyanotic patient, whereas 113mIn-Fe(OH)3 was less satisfactory. If the onset of scanning was delayed, however, the calculated shunt can be falsely elevated as the pulmonary particles fragment and pass onward or as the label is released. Consequently, proper choice of radiopharmaceutical and prompt scanning are crucial for accurate quantitation of right-to-left shunting.


Effect of particle number on lung perfusion images: concise communication. Twelve normal mongrel dogs were injected with decreasing numbers of 99mTc-labeled macroaggreagated albumin particles (99mTc-MAA),  and lung images were recorded using both parallel-hole and pinhole collimators. The quality of normal lung images was found to decrease with decreasing numbers of injected radiolabeled particles (from 10,000 to 250 particles per injection). The quality was unaffected by adding carrier MAA. The minimum number of particles compatible with a good-quality image of the normal human lung is approximately 60 radiolabeled particles per gram of lung.


Hepatic adenomas and focal nodular hyperplasia of the liver in young women on oral contraceptives: case reports. Two cases of hepatic adenoma and one of focal nodular hyperplasia presumably associated with the use of oral contraceptives, are reported. Special reference is made to their clinical presentation, which may be totally asymptomatic. Liver-function tests are of little diagnostic value, but valuable information may be obtained from both liver scanning and hepatic angiography. Histologic differences and clinical similarities between hepatic adenoma and focal nodular hyperplasia of the liver are discussed.


Congenital abscence of the left pericardium detected by imaging of the lung: case report. A patients with congenital absence of the left pericardium had an unusual scintillation camera image of the lung showing perfused lung between the heart and diaphragm and a priminence in the area of the pulmonary artery. This finding was not duplicated in 500 other gamma images of the lung and is probably characteristic of congenital absence of the left pericardium.


Intestinal perfusion studies using 133Xe during correction of mesenteric vascular insufficiency: case report. Radioxenon clearance studies of bowel perfusion were obtained during laparotomy in a patient with mesenteric vascular insufficiency. These studies were obtained both before and immediately after bypass of the occluded superior mesenteric artery. Although clearance rates improved after the bypass surgery, normal rates were not achieved.


High ectopic kidney presenting as an abnormal liver-lung scan: case report. An unusual cause for a positive liver-lung scan is presented. A cold area between the base of the right lung and the liver in a 78-year-old woman was reported as being due to a subphrenic abscess. This defect was subsequently found to be a right subphrenic kidney.


In vitro stability and in vivo clearance of fibrinogen or serum albumin labeled with 77Br, 131I, or 125I by direct or indirect synthetic methods. Conventional protein iodination involves the addition of an oxidizing agent to the protein solution. Through the use of the acylating agent N-succinimidyl-3(4-hydroxyphenyl)propionate, labeling can be accomplished without subjecting the protein to oxidizing conditions. Fibrinogen and serum albumin labeled with 131I and 77Br by this technique were compared with each other and with 125I-protein prepared by direct iodination using the ICI, chloramine-T, and lactoperoxidase methods. Iodinated proteins have two drawbacks: the high radiation dose accompanying 125I and 131I, and the ease of hydrolysis of the weak carbon-iodine bond. These drawbacks can be overcome by using 56-hr 77Br.


Organ distribution of canine leukocytes labeled with 99mTc-sulfur colloid. Previous reports have shown that scintigraphic localization of acute inflammation can be achieved using autologous leukocytes labeled in vitro with 99mTc-sulfur colloid (TcSC). The technique is limited, however, by a marked accumulation of radioactivity in the lungs and liver of normal animals. A modified procedure was developed using preparations of TcSC of small particle size to label blood leukocytes in vitro. Markedly decreased levels of lung and liver radioactivity and elevated levels of blood radioactivity were found after intravenous infusion of autologous canine leukocytes labeled by this method. These leukocytes could be used to image areas of acute inflammation resulting from induction of septic or sterile venous thrombi.


Simultaneous measurement of triiodothyronine and thyroxine in unextracted serum samples using a double-tracer radioimmunoassay method. A method is described for the simultaneous measurement of triiodothyronine (T3) and thyroxine T4) in 0.04 ml of unextracted serum. Antibodies were prepared by immunization of rabbits with T3 and T4 conjugated with human serum albumin. Bound and free labeled hormones were separated by the double-antibody technique, and 8-anilino-1-naphthalene sulfonic acid was used to inhibit binding of the two hormones to thyroxine-binding globulin. The validity of the assay using 125I-T3 and 131I-T4 is shown by the excellent recovery of T3 and T4 added to serum and by the finding that curves obtained by assaying various dilutions of a hyperthyroid serum run parallel to the standard curves. In all clinical serum T3 and T4 values obtained using the double-tracer radioimmunoassay method were in excellent agreement with those obtained by single-tracer RIA techniques. The combined T3-T4 method appears to be accurate, sensitive, and specific, thus making the assay highly desirable as a technical time-saver.


In vivo labeling of red blood cells with 99mTc: a new approach to blood pool visualization. A simple and rapid procedure for in vivo labeling of red blood cells (RBC) is presented. The labeling is done with two consecutive intravenous injections, first of "cold" stannous pyrophosphate (Sn-PYP) and then of 99mTc-pertechnetate. Experimentally, a lag time of 30 min between the two injections was found to result in a mean RBC labeling of greater than 95% during the first hour after pertechnetate injection. A total of 75 patients have been explored by scintillation camera imaging of brain, heart, great vessels, aortic bifurcation, testicles, and lower extremities using the technique outlined. High-quality images were obtained.


Review of four new indices of susceptibility to noise-induced hearing loss. The potential use of four new measures of susceptibility to acoustic trauma has been discussed. Each has the advantage, unlike TTS methodology, of not requiring a prior exposure stimulus. The use of an exposure sound has proven to be the major drawback to verification of Temkin's original hypothesis. A disadvantage inherent to the speech discrimination procedures involves the use of difficult-to-standardize speech materials and techniques. Consequently, one of the first three techniques, aural overload, threshold of octave masking, and brief-tone audiometry, is more desirable with aural overload having the most data to substantiate its use as a predictor of vulnerability to ear damage from acoustic overstimulation. None of these tests, on the other hand, has been correlated to permanent threshold shift (PTS). This necessitates the use of experimental animals or the long-term monitoring of the hearing sensitivity of industrial workers. Such data should prove invaluable in the search for an effective predictor of eventual noise-induced hearing loss.


A study of occupational stressor and the incidence of disease/risk. We have presented data correlating workers perception of their roles in an organization with the incidence of disease and/or risk of disease. The results indicate there is a significantly higher incidence of disease when particular stressors are operating. It is also evident that disease/risk occurs more frequently when workers are either under-stimulated or over-stimulated as hypothesized by Selye.


Physiological responses of fire fighting recruits to high intensity training. Data were obtained for 20 fire department recruits before and after a ten-week training program. Training consisted of interval running and circuit weight training. At the conclusion of the training program several parameters were examined. Total work capacity assessed on a bicycle ergometer significantly increased (27.3%) with a concomittent increase in maximum oxygen uptake (33.2%). Physical performance tests given showed marked increases in 12 foot rope climb, 600 yard run, push-ups, sit-ups and leg-lifts. Physical strength also showed significant increases for the bench press (18.5%), military press (19.4%) pulldown (11.7%) biceps curl (16.2%) and leg press (18.7%). Training of this nature also brought about significant changes in body composition of the recruits. The subscapula and abdomen skinfold sites showed significant decreases of -9.6% and -11.9% respectfully. Body segment circumferences showed significant changes for shoulder, thigh, flexed biceps and abdomen. The skinfold and circumference measures reflected changes in lean body weight (2.6%), absolute body fat (-13.4%), and relative body fat (-13.7%). It has been shown that interval training and circuit weight training significantly increase the physical performance capacities of the recruits. It has been suggested, due to the tremendous cost to the county and city agencies as well as to the aspiring recruit, that a preliminary physical training program be implemented to reduce the drop-out rate of recruits during the tower training drills.


Color vision in the peripheral retina. I. Spectral sensitivity. Spectral sensitivity was measured by heterochromatic flicker photometry both in the fovea and at 45 degrees in the periphery, using a 1200 troland standard. At each location, sensitivity functions were obtained using both large and small targets. While the foveal functions were normal, the peripheral ones showed a large enhancement in sensitivity to short wavelengths relative to long wavelengths. Similar results in the past had been criticized on the ground that they might have been due to differential chromatic adaptation of cone mechanisms. In this study such an interpretation was ruled out by additional control experiments including varying luminance and wavelength of the standard light. The possibility of a rod contribution to the peripheral functions could not be eliminated although several different techniques, including the Stiles-Crawford effect, were used to try to isolate cone mechanisms.


Color vision in the peripheral retina. II. Hue and saturation. Hue and saturation of spectral lights were measured (direct scaling) in the fovea and at 45 degrees in the periphery; all lights were of equal photopic retinal illuminance (1200 trolands). At each retinal location both large and small targets were used. As shown by previous studies, small peripheral targets appear desaturated and of uncertain hue, except long wavelengths which appear red. However, if target size is increased, saturation increases and a full range of hues is seen; the hue functions for large peripheral targets are comparable to foveal ones for very small targets. From a modified form of color matching, it was concluded that the color deficiency in the periphery is more tritanlike than deutanlike; this is strengthened by the observation, that, for small peripheral targets, hues are generally apportioned between two hue categories and the change from one to the other is at about 580 nm.


Spatial frequency and light-spread descriptions of visual acuity and hyperacuity. Resolution (visual acuity) and differential spatial localization (hyperacuity) targets were selected to allow rigorous psychophysical measurements as well as ready expression of both their spatial frequency spectrum and their retinal image light distribution. Thresholds were about 1 arc min for acuity and 4-6 arc sec for hyperacuity. As is consistent with the reciprocal relationship between the space and spatial frequency domains, the small locally restricted spatial differences between just distinguishable patterns are represented in the frequency domain by equally small differences, which are distributed over the entire spatial frequency spectrum. While they occur in many test situations, phase variations of spatial frequency components are not necessary for achieving optimum acuity and hyperacuity.


Instrumentation for the Farnsworth-Munsell 100-hue test. Standard Farnsworth-Munsell (F-M) disks and caps are numerically encoded in a two-digit, base-five, system using resistors and zener diodes connected to miniature jack plugs. When the subject orders the disks in the usual way, he connects the plugs to sockets that are in turn connected to an electronic processor. The various error scores are computed, and the error-versus-position graph plotted by a pen recorder, in a total time of between 0.5 and 2.5 min.


Milk protein quantity and quality in low-birth-weight infants. III. Effects on sulfur amino acids in plasma and urine. Well, appropriate-for-gestational age, low-birth-weight infants weighing 2,100 gm or less were divided into three gestational age groups and assigned randomly within each age group to one of five feeding regimens: pooled human milk; formula 1 (F1) = 1.5gm/dl protein, 60 parts bovine whey proteins: 40 parts bovine caseins; F2 = 3.0 gm/dl, 60:40; F3 = 1.5 gm/dl, 18:82; F4=3.0 gm/dl, 18:82. Plasma and urine concentrations of methionine and of cystathionine were higher in the infants fed F1 to F4 than in the infants fed BM. The plasma cystine concentrations of infants fed F2 (which had a cystine content at least twice that of any of the other formulas) were significantly higher than those of infants fed BM. Plasma taurine concentrations of infants fed F1 or F4, which were virtually devoid of taurine, decreased steadily during the course of study becoming lower than those of infants fed BM. Urine taurine concentrations of infants fed F1, F3, or F4 (but not F2 which had more taurine than F1, F3, or F4) were lower than those of infants fed BM. These results provide further evidence for the limited capacity of the preterm human infant to convert methionine to cystine, owing to delayed maturation of cytathionase, and suggest a limited capacity to convert cystine to taurine. The latter suggestion is consistent with low human hepatic cysteinesulfinic acid decarboxylase activity 0.26 (fetal) and 0.32 (adult) nmoles/mg protein/hour vs 468 in rat liver.


Milk protein quantity and quality in low-birth-weight infants. IV. Effects on tyrosine and phenylalanine in plasma and urine. Well, appropriate-for-gestational age, low-birth-weight infants were divided into three gestational age groups and assigned randomly within each age group to one of five feeding regimens: pooled human milk (BM); formula 1 (F1) = 1.5 gm/dl protein, 60 parts bovine whey proteins: 40 parts bovine caseins; F2 = 3.0 gm/dl, 60:40; F3 = 1.5 gm/dl, 18:82; F4 = 3.0 gm/dl, 18:82. Plasma and urine concentrations of tyrosine and phenylalanine were far higher in the infants fed F1 to F4, especially F2 and F4, than in the infants fed BM. These findings offer further evidence for the limited capacity of the low-birth-weight infant to catabolize tyrosine. Infants fed F3 had significantly higher plasma tyrosine concentrations than infants fed F1, and those fed F4 had higher concentrations than those fed F2. Thus, increased plasma tyrosine concentrations in low-birth-weight infants are related directly both to the quantity and to the quality of the protein in their diets.


Viral hepatitis type B during pregnancy, the neonatal period, and infancy. Eighteen women who developed type B hepatitis late in pregnancy or early in the postpartum period (Groups I and II), 12 women who were chronically infected with the hepatitis B virus (Groups III and IV), and 32 of their offspring were tested for hepatits B surface antigen, antibody to the hepatitis B  surface antigen, antibody to the hepatitis B core antigen, and the recently discovered hepatitis B-associated e antigen and its antibody. Twelve of 18 infants born to Group I and Group II mothers and 5 of 14 infants born to Group III and Group IV mothers became chronically infected with HBV: the outcome did not appear to be influenced by maternal anti-HBc titers, by HBsAg subtype, by the presence or absence of HBsAg in the cord sera, or by the infants' birth weights or gestational ages. The presence of maternal e Ag, however, did correlate with the development of chronic HBV infections in the infants studied. The e Ag appeared in five infants born of e Ag-negative mothers but did not appear to be associated with the morbid prognosis which generally accompanies its presence in adult HBsAg carriers. Data also suggest that maternal anti-e may favor HBsAg clearance and recovery in neonatally acquired HBV infections.


Serum somatomedin-C in hypopituitarism and in other disorders of growth. Serum levels of somatomedin-C have been measured by a competitive membrane binding assay in normal individuals, in hypopituitary dwarfs, and in children with growth retardation from causes other than growth hormone deficiency. The mean level in untreated hypopituitary children is about 40% of that of age-matched normal children. Treatment of hypopituitary dwarfs with human growth hormone results in prompt increases in the serum concentration of somatomedin-C. Normalization of somatomedin is associated with the return of pituitary function in hospitalized psychosocial dwarfs. Supporting the possibility that somatomedin-C plays a pivotal role in skeletal growth is the finding that serum levels in hypopituitary children correlate with growth rate both on and off growth hormone therapy. In our hands, this assay has proved to be an efficient, reliable method for the diagnosis of growth hormone deficiency.