Aortic orgin of the left pulmonary artery. Variant of tetralogy of Fallot. A case of tetralogy of Fallot with aortic origin of the left pulmonary artery is presented. This rare malformation should be suspected in a child with stunted growth, cyanosis, a continuous murmur over the pulmonary area and a hypervascular left lung on chest roentgenogram. Final diagnosis depends upon cardiac catheterization and angiocardiography. During surgical correction of the tetralogy, the left pulmonary artery can be divided from the aorta and anastomosed to the main pulmonary artery.


Variability of hemodynamic responses to acute digitalization in chronic cardiac failure due to cardiomyopathy and coronary artery disease. Eight patients with chronic congestive heart failure (four with cardiomyopathy and four with ischemic heart disease) underwent hemodynamic studies during acute administration of digoxin, given intravenously in two 0-5 mg doses 2 hours apart. Observations were made before administration of digitalis (control period) and serially therafter for 4 hours after the first dose. Resting mean cardiac index and pulmonary arterial wedge pressure were as follows: 2.0 liters/min per m2 and 23 mm Hg (control period); 2.1 and 24 (at 1 hour); 2.0 and 23 (at 2 hours); 2.7 and 19 (at 3 hours); and 2.3 and 20 (at 4 hours). Exercise responses of mean cardiac index and pulmonary arterial wedge pressure in five patients were: 3.1 liters/min per m2 and 36 mm Hg (control period); 3.2 and 33 (at 1 hour); 3.2 and 28 (at 2 hours); 3.1 and 27 (at.3 hours); and 3.4 and 31 (at 4 hours). The pulmonary arterial wedge pressure remained elevated during exercise in all cases. Arrhythmias were seen in five patients after administration of 0.5 mg of digoxin. Hemodynamic improvement at 4 hours involving both reduced filling pressure and increased blood flow was observed in only two patients at rest and in one additional patient during exercise. Acute deterioration of cardiac function (elevated pulmonary arterial wedge pressure of decreased cardiac index) occurred 30 minutes after administration of digoxin in four patients, concomitantly with increased systemic resistance. In six patients, a peak hemodynamic effect appeared 1 to 1 1/2 hours after administration of digoxin, with partial or total loss of initial benefit by 2 and 4 hours. In previously performed studies observations have seldom exceeded 1 hour; the results of this 4 hour study suggest that, in patients with cardiomyopathy or coronary artery disease and chronic congestive heart failure, acute digitalization does not necessarily lead to consistent, marked or lasting hemodynamic improvement. Thus, current concepts of the use of digitalis is such patients may require revision.


Dose-response relation between therapeutic levels of serum digoxin and systolic time intervals. A dose-response relation between cardiac glycosides and systolic time intervals has previously been established in short-term studies in which the glycoside was administered intravenously in these studies there was uncertainty regarding the steady state kinetics, and maintenance of the early serum levels would have resulted in toxicity. Accordingly, we studied the effect on systolic time intervals of small increments of serum digoxin within the therapeutic range. Serum digoxin concentration and systolic time intervals were measured in 21 patients receiving 0.25 mg of the glycoside daily. The daily dose was increased to 0.5 mg and measurements were repeated 5 to 7 days later. Serum digoxin concentration with the smaller dose was 0.56 plus or minus (standard error) 0.06 ng/ml and increased to 1.18 plus or minus 0.11 ng/ml with the larger dose. Associated with the increased serum digoxin was a mean decrease in duration of total electromechanical events of 6.3 plus or minus 2.9 msec (P smaller than 0.025), which resulted from a mean shortening of left ventricular ejection time of 5.6 plus or minus 3.0 msec (P smaller than 0.05). The mean decrease in preejection phase of 1.1 plus or minus 2.1 msec was insignificant (P larger than 0.2). Repeated measurements in control patients showed no change in serum digoxin concentration or systolic time intervals. In nine patients the digoxin dose was randomly varied between 0 and 0.75 mg and measurements were made 4 to 5 days after drug administration at each dose level. The correlation coefficient between changes in serum digoxin and changes in left ventricular ejection time was minus 0.55 (P smaller than 0.01) the data indicated that increasing the maintenance dose of digoxin while keeping the serum level within therapeutic range will result in improved ventricular function as assessed by determination of systolic time intervals.


Echocardiographic studies of left ventricular wall motion and dimensions after valvular heart surgery. Echocardiograms obtained from 50 patients after valvular heart surgery (in 33 cases within 2 months of the procedure) were examined to study patterns of interventricular septal motion and left ventricular dimensional changes. Preoperative echograms were available in 28 cases. Before and after mitral commissurotomy septal motion and left ventricular diameters as well as the percent systolic shortening of the echocardiographic transverse axis were within normal limits. Before operation, aortic and mitral regurgitation were associated with increases in end-diastolic and end-systolic diameters, septal motion and percent systolic shortening of the left ventricular diameter. Septal dyssynergy, defined as paradoxical motion or marked hypokinesia, was seen within 2 months of operation in 91 percent of patients after aortic valve replacement and in 42 percent after mitral valve replacement. Of subjects studied more than 2 months postoperatively, none with mitral valve replacement and only 33 percent with aortic valve replacement manifested septal dyssynergy. After valve replacement for aortic or mitral regurgitation there were significant decreases in end-diastolic diameter, septal excursion and total and percent left ventricular systolic shortening. Two subjects not having valve replacement also demonstrated paradoxical septal motion postoperatively. The cause of septal dyssynergy after valvular surgery was not apparent although the use of cardiopulmonary bypass was an esential condition. We conclude that echocardiography can be utilized to follow up changes in left ventricular wall motion and dimensions after surgery for valvular heart disease, and that it may be of value in assessing the early and late postoperative results.


Hemodynamic consequences of total removal of the tricuspid valve without prosthetic replacement. Tricuspid valvulectomy without prosthetic replacement has been advocated as a life-saving measure in the treatment of Pseudomonas endocarditis of the tricuspid valve. This report describes the hemodynamic data obtained in 10 patients before and after removal of the tricuspid valve. Seven patients remained free of carciac decompensation, but right heart failure developed in three. Analysis of the preoperative data did not permit differentiation of these two groups of patients.


Altered refractory periods in patients with short P-R intervals and normal QRS complex. To evaluate the refractory periods of the atrioventricular (A-V) conducting system in patients with a short P-R interval and normal QRS complex, 57 patients with a P-R interval of 110 to 280 msec were studied with His bundle recording and premature atrial stimulation at similar cycle lengths of 660 to 720 msec. In 13 patients with a short P-R interval (120 msec or less) the mean value for the functional refractory period of the A-V node was 368 plus or minus 36 msec (standard deviation), which was significantly lower (P smaller than 0.01) than the mean value of 415 plus or minus 50 msec in 36 patients with a normal P-R interval (between 120 and 200 msec) and the mean value of 492 plus or minus 57 msec in 8 patients with an increased P-R interval (200 msec or greater). Patients with a short P-R interval had a mean value for the effective refractory period of the A-V conducting system of 247 plus or minus 26 msec, which was significantly lower (P smaller than 0.01) than the mean values of 297 plus or minus 51 msec in patients with a normal P-R interval and 369 plus or minus 87 msec in patients with an increased P-R interval. The results identify a characteristic conduction abnormality that is compatible with a partial A-V nodal bypass or dual A-V nodal conduction pathways. The relation between the duration of the P-R interval and the regractory period may aid understanding of the clinical significance of the scalar electrocardiogram.


Sinus nodal function in the intact dog heart evaluated by premature atrial stimulation and atrial pacing. Sinus nodal function was analyzed in 25 dogs by premature stimulation of the right atrium. The return (AT-AR) and post-return (AR-A) cycles were plotted as a function of the premature cycle, and four zones were identified. Zone I (compensatory zone) was observed during the last 4.8 percent (mean value) of the sinus cycle (A-A). Zone II was observed during 43.6 to 95.2 percent (mean value) of the sinus cycle. During the latter part of zone II, AT-AR was nearly constant and AR-A remained nearly equal to A-A during the last 29 percent (mean value) of the cycle. Earlier in zone II three distinct patterns of return cycle responses were observed whereas post-return cycles either remained nearly equal to A-A or showed progressive lengthening. Zone III (interpolation) was observed in 10 animals during 39.5 to 46.2 percent (mean value) of the sinus cycle. AR-A was nearly equal to A-A in zone III. Interpolation was incomplete late and complete early in the zone. Zone IV (echo zone) was seen in another 10 animals during 40.9 to 45.3 percent (mean value) of the sinus cycle and in this zone AR-A was greater than A-A. No significant difference in these zones was seen among the animals anesthetized with pentobarbital or alpha-chloralose, or given 6-OH-dopamine. The AR-A was important in the analysis of these zones and appears to be essential to the interpretation of data derived from premature atrial stimulation. Responses to premature atrial stimulation through a catheter electrode positioned against the sinus nodal region compared favorably with responses to direct epicardial stimulation. After periods of continuous right atrial pacing a vairety of patterns of sinus nodal depression were observed at different rates and durations of stimulation. The frequent occurrence of a short sinus escape cycle followed by the maximal pause observed during rapid pacing rates suggests sinus nodal entrance block. This may be an important factor to consider in determining an optimal pacing rate for assessing sinus nodal function.


Ischemic heart failure: sustained inotropic response to small doses of I-epinephrine without toxicity. As a prelude to a study of severe ischemic heart failure, the therapeutic response of the ischemic ventricle to epinephrine and acetylstrophanthidin in nontoxic doses was determined in 24 intact anesthetized dogs undergoing a first episode of acute regional ischemia. A thrombotic obstruction was produced in the left ventricular dysfunction. The elevation of end-diastolic pressure and reduced stroke volume in control dogs were not significantly altered by administration of strophanthidin. Epinephrine (0.05 mug/kg per min) elicited a significant reduction in end-diastolic pressure and increase in stroke volume. The latter was not attended by an increased incidence of ventricular fibrillation, whereas fibrillation occurred in half of the group given strophantihidin. Thus, the catecholamine was selected to study pump failure. Severe ischemic heart failure was assessed in two groups with scar from previous infarction for up to 4 hours. By 60 minutes of ischemia the increase in end-diastolic pressure and volume and decrease in stroke volume and ejection fraction were comparable in both groups. Thereafter, alternate animals received small doses of epinephrine (0.05 to 0.15 mug/kg per min) with graded increments at 60 minute intervals to counter tachyphylaxis and findings were compared with those in control dogs. Over the subsequent 3 hours, there was progressive deterioration of left anterior descending coronary artery, affecting ventricular function in the untreated group with an increase in end-diastolic pressure from 10 plus or minus 1 to 33 plus or minus 2.4 mm Hg. End-diastolic volume increased by 63 percent; stroke volume and ejection fraction decreased by 48 and 66 percent, respectively. The infusion of epinephrine was attended by a significantly lower end-diastolic pressure of 20 plus or minus 2.5 mm Hg, whereas end-diastolic volume, stroke volume and ejection fraction were restored to control levels after 4 hours of ischemia. Mortality in the untreated group was 62 percent by 4 hours; all seven animals in the treated group survived.


Risk factors for myocardial infarction and death due to ischemic heart disease and other causes. As part of a study of the male population in an industrial city in Sweden, one third of all male inhabitants of Göteborg born in 1913 were invited to an examination in 1963. Of those invited, 855 (88 percent) accepted. This report examines the incidence of nonfatal myocardial infarction and death from ischemic heart disease and other causes in this group of men during the ensuing 10 years. There were 6l deaths; autopsy was performed in 56 cases. Nineteen men died of ischemic heart disease and 18 of cancer; 12 men died violently. Thirty-one men survived an acute myocardial infarction. Cigarette smoking and registration with the Temperance Board at the time of the initial examination were more common in men who later had a nonfatal myocardial infarction or died of ischemic heart disease or other causes than in surviving subjects and men who did not have an infarction. Dyspnea was more common in men who died of ischemic heart disease but was less common in those who died of other causes than in the remaining subjects. Values for systolic blood presure were higher and those for peak expiratory flow lower in men who died of ischemic heart disease. Serum cholesterol values were higher and those for serum triglycerides tended to be higher in men who died of ischemic heart disease than in other subjects. Heart size tended to be greater in those who had nonfatal or fatal ischemic heart disease. Obesity, the level of physical activity, fasting blood glucose levels, doffee consumption, hematocrit and erythrocyte sedimentation rate as determined at age 50 years had no predictive value for assissing the risk of nonfatal myocardial infarction, fatal ischemic heart disease or death from other causes before age 60. The results indicate that many so-called risk factors have a different relation to fatal than to nonfatal ischemic heart disease.


Influence of race, sex and weight on blood pressure behavior in young adults. This study is concerned with blood pressure behavior in young adults (aged 15 to 29 years) in the biracial community of Evans County, Ga., on two occasions 7 years apart. On the basis of casual blood pressure recordings the prevalence of systolic pressure equal to or greater than 140 mm Hg or diastolic pressure equal to or greater than 90 mm Hg, or both, showed race/sex differences as follows: white males 19.0 percent, white females 12.7 percent. black males 34.0 percent, black females 31.6 percent. Similar differences were noted in the incidence during the 7 year interval. The problem presented by the variability of the casual blood pressure recording is apparent in this interval study. Of particular interest is the association of weight with blood pressure in this youthful group, particularly among white males and females and black females, in relation to both initial and subsequent pressure levels. The data suggest that in this population under 30 years, weight is a risk factor for hypertension, and that maintenance of ideal weight, instituted in youth, may be a preventive measure.


The omnicardiogram: new approach to detection of heart disease in patients with a normal resting electrocardiogram. The omnicardiogram is a new technique in which various leads of the standard electrocardiogram are digitized and subjected to a nonlinear mathematical transformation so as to detect subtle degrees of abnormality not apparent in the original electrocardiogram. Its usefulness in the detection of heart disease was studied in 121 male patients with a normal resting 12 lead electrocardiogram who underwent selective coronary cineangiography for a chest pain syndrome. In normotensive patients with a normal resting electrocardiogram, an abnormal omnicardiogram was recorded in 81 percent of those with three vessel disease, 67 percent of those with two vessel disease and 41 percent of those with one vessel disease. Nineteen percent of patients with normal coronary arteries or nonobstructive coronary artery disease had false positive tracings. The omnicardiogram was abnormal in 81 percent of patients with hypertension whether or not cornary artery disease was present. A double Master exercise test was performed by 109 of the 121 patients. In normotensive patients results of the test were positive in 67 percent of those with three vessel disease, 31 percent of those with two vessel disease and 14 percent of those with one vessel disease. There was a 4 percent rate of false positive tracings. Thus in our study, the omnicardiogram appeared to be superior to the Master test and to provide a useful new approach to detection of coronary artery disease in male patients with a normal resting electrocardiogram.


Effect of transducer placement on echocardiographic measurement of left ventricular dimensions. An echocardiogram from the left ventricle may be used to estimate left ventricular volume and rate of circumferential fiber shortening, to measure posterior wall and interventricular septal thickness and to evaluate the normality of septal motion. Extended application of this technique in this laboratory has emphasized the need for a more standardized means of transducer location and direction. The effect of placing the ultrasonic transducer in several intercostal spaces along the left sternal border was tested in 14 patients. Variability in the left ventricular dimension and the difference in this dimension from end-diastole to end-systole were greater than for duplicate measurements from the same interspace. A system has been developed for more consistent placement of the transducer in each patient, using intracardiac landmarks and observation of transducer orientation to record specific cardiac structures.


Turnover of phospholipids in rat aortic smooth muscle cells in culture. Smooth muscle cells derived from rat aortic media were explanted and grown in culture for 14 to 60 days. During that time they formed a confluent multilayer and depostied extracellular material resembling newly formed elastin. The lipid composition of the cells in culture differed slightly from the parent cells in the intact aorta with respect to a higher phospholipid/DNA ratio and a higher lecithin content. The cholesterol content resembled that of parent cells. After incubation with labeled precursor the cultured cells show an active lipid synthesis; choline is incorporated mainly into lecithin, whereas glycerol and palmitate appear in phospholipids and to a lesser extent in neutral lipids. After a 2 hour pulse and up to 96 hour chase there is a linear fall in the specific acitivty of lecithin with a half-time of 28 to 30 hours. The rate of fall in specific activity of glycerol- or choline-labeled lecithin was found to be similar, indicating that choline does not turn over by an exchange reaction and is a suitable marker for studying phospholipid turnover in cultured cells. The results provide a basis for investigation of the effect of increasing cellular cholesterol content on phospholipid turnover.


Developmental morphology of the subarachnoid space and contiguous structures in the mouse. Development of pia-arachnoidal membranes in the mouse occurs in four stages: the first (prenatal days 10-13) follows closure of the neural tube and is a period of initial vascularization of the developing telencephalon; the second (prenatal days 14-16) is a period of delineation during which the limits of the subarachnoid space are defined; the third (prenatal day 17 to birth) is a period of ensheathment of pia-arachnoidal blood vessels; and the fourth (birth to postnatal day 21) includes addition of smooth muscle to larger vessels, the appearance of macrophages in the subarachnoid space, and a general increase in extracellular collagenous and elastic fibers. The mesenchyme over the telencephalic surface in the 10-day fetus has a typically large extracellular space. By the 13th fetal day cerebrospinal fluid begins to seep into and replace it. The mesenchymal extracellular compartment is reduced peripherally, resulting in a compacted pia-arachnoidal tissue which limits the peripheral extent of the subarachnoid space. By the 21st postnatal day a subarachnoid space typical of the adult animal has been established.


Permeability of ovarian follicles and capillaries in mice. The permeability of ovarian capillaries and follicles in prepubertal and sexually mature (proestrus and metestrus) randomly bred Swiss Albino female mice (SCH:ARS HA ICR strain) was studied by intravenous injection of either ferritin or horseradish peroxidase (HRP), followed by examination with light and electron microscopes. The study revealed that capillaries in the interstitial and perifollicular regions were provided with a continuous endothelium that had constant permeability characteristics irrespective of sexual maturity or phase of the estrous cycle. Horseradish peroxidase left the capillaries primarily through interendothelial cell junctions and was present in all follicles within 30 seconds after administration of the tracer. Ferritin, on the other hand, was absent from endothelial cell junctions, and left the capillaries, at a slower rate than HRP, via cytoplasmic vesicular transport. Both tracers were found in the granulosa cells but rarely in the oocytes. The tracers reached the oocyte through the intercellular spaces between granulosa cells. These findings demonstrate that the follicular apparatus of the mouse is permeable to ferritin and HRP, and that follicular regions such as the basal lamina of the follicle and the zona pellucida do not stop or retard the passage of either tracer.


Tubules and filaments in satellite cells and axons of sensory neurons. Satellite cells covering the axon hillock region and initial axon process of the neurons of rat and mouse trigeminal ganglia contained numerous parallel microtubules and microfilaments. These were oriented circumferentially to axonal neurofilaments and neurotubules. The latter were sometimes grouped in fascicles. The results suggest a specialized role for the supporting cell in this region and that fascicles of neurotubules are not related to action potential initiation.


Effect of gonadotropins on ovulation and ovarian histology in the immature Mongolian gerbil. The present study is an analysis of the effects of superovulatory doses of gonadotropins on the rate and time of ovulation and ovarian histology in immature gerbils. Groups were treated with various combinations of pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin (HCG). The maximum superovulatory response followed treatment with 10 IU PMSG and 20 IU HCG. High dosages of PMSG inhibited superovulation, as did some combinations involving the highest dose of HCG. Entrapment of ova within corpora lutes was common in groups receiving high doses of either gonadotropin. Luteal regression, appearing by day 3, occurred often in groups receiving high doses of HCG. A dose of 10 IU PMSG and 5 IU HCG resulted in both a near maximal superovulatory response and the least abnormal ovarian alteration.


Depressed cell-mediated immunity in megaloblastic anemia due to folic acid deficiency. Cell-mediated immunity has been studied in patients with 1) megaloblastic anemia of folic acid deficiency, 2)megaloblastic anemia of pregnancy, or 3) iron-deficiency anemia. Using dinitrochlorobenzene skin tests,  phytohemagglutinin-stimulated lymphocyte transformation, and rosette inhibition by antilymphocyte globulin, we have shown that cell-mediated immunity is depressed in megaloblastic anemia due to folate deficiency; this depression was reversed by folate treatment. Cell-mediated immunity was not impaired by iron-deficiency anemia. Suggested interactions between iron deficiency and folate metabolism were not clarified by these studies.


Effect of dietary lactose on the absorption of protein, fat and calcium in the postweaning rat. To assess the effect of dietary lactose on the intestinal absorption of protein, fat and calcium in lactose intolerance due to low levels of intestinal lactase, balance studies were carried out on postweaning rats (initial weight 164 g) for a period of 10 days. The experimental diets contained either 10% or 30% lactose, while in the control diets the lactose was replaced with equivalent amounts of sucrose. The excretions of fecal and urinary nitrogen, calcium and fat are expressed as precent of intake over the 10-day period. The fecal excretion of nitrogen and fat was significantly higher in the lactose groups (P less than 0.05). The fecal calcium excretion, however, was lower in the lactose groups, the difference being significantly only in the case of the 30% lactose diet (P less than 0.001). There was no difference in urinary nitrogen excretion between the lactose and sucrose groups, but urinary calcium excretion was significantly higher in the rats fed the 30% lactose diet (P less than 0.01). These findings suggest that dietary lactose may reduce the absorption of protein and fat, but not of calcium, in individuals with low levels of intestinal lactase activity.


Utilization of different quantities of fat at high altitude. Investigations on utilization of fats have been carried out at altitudes of 3,500, 3,800, and 4,700 m, respectively, on 27, 7, and 12 soldiers staying at these altitudes for over 4 months in tentage accommodation. At 3,500 m the fat utilization was 95.9, 96.2, and 96.6% on intakes of 128, 168, and 198 g fat/day. At 3,800 m on maximum fat intake of 364 g/day, the fecal fat content was 11.48 g and percentage digestibility 96.9. At 4,700 m the digestibility was 97.5% on a fat intake of 232 g/day. Urine examination did not reveal ketone bodies on any of these fat intakes. Neither was there any incidence of constipation nor diarrhea. While 364 g of fat/day could not be fully consumed, digestibilty was not affected up to an intake of 324 g/day though, at this intake there was feeling of thirst at night. Thus, digestibility and utilization of dietary fats up to 324 g at 3,800 m and 232 g at 4,700 m are not distrubed.


Increased rate of alcohol removal from blood with oral fructose and sucrose. The effect of oral glucose, fructose and sucrose on the disappearance rate for intravenously administered alcohol was studied in eight abstinent alcoholic subjects. The three sugars were ingested on separate days in random sequence. alcohol levels were determined at hourly intervals. During sugar ingestion, the mean rates of alcohol disappearance were: 19 plus or minus 1.4 mg/100 ml per hour (plus or minus SE), with glucose, 23.9 or minus 1.4 mg/100 ml per hour with sucrose, and 25.4 plus or minus 1.4 mg/100 ml per hour with fructose. Compared to glucose both fructose and sucrose increased the rate of alcohol from the blood. The blood levels of fructose were similar after the oral dose of 2 g/kg of fructose or 4 g/kg of sucrose.


Nutritional status and mortality: a prospective validation of the QUAC stick. In December 1970, 8,292 rural Bengali children the ages of 1 and 9 had their height and arm circumference measured. Eighteen months later the fate of 98.8% of these children was ascertained. Overall, 2.3% of the children had died. Those the 9th and between the 10th and 50th percentiles of arm circumference for height were at 3.4 1.5 times greater risk of dying, respectively, than those above the 5oth percentiles. A gradient was present at every age, although it was greatest for the bulnerable 1- to 4-year age group, for whom the relative risks were 4.5, 1.6, and 1.0, respectively. The discriminant efficiency of these categories was greatest immediately following measurement and decreased with time. During the first postmeasurement month the risk of dying the poorest nutritional category was 19.8 times that of the best, and for the first 3 months, 12.2 times. By the last 3 months of followup it was only twice that of the best. Females in all three categories fared slightly worse than males, being at 1.1 times the risk of dying. This same vulnerable group of 1. to 4-year olds could be identified without knowing their age. Limiting the analysis to children whose heights were between 65 and 89 cm resulted in relative risks, for the three categories, of 4.1, 1.6, and 1.0, respectively. These arm circumference to height categories and the QUAC stick survey technique for which they were devised appear to be valid tools for identifying nutritionally disadvantaged individuals and populations at high risk of death.


Nitrogen retention and plasma amino acids of men who consumed isonitrogenous diets containing egg albumen or mixtures of amino acids. Experimental diets that furnished approximately 6.0 g of nitrogen per day were consumed by young men. Nitrogen retention was not altered significantly when egg albumen was replaced by its constituent essential and nonessential amino acids or by the essential amino acids (including cystine, tyrosine and histidine) plus a source of nonspecific nitrogen. Concentrations of essential amino acids in fasting or postprandial plasma were not influenced significantly by source of amino acids or by replacement of nonessential amino acids by nonspecific nitrogen; but concentrations of certain nonessential amino acids were altered by treatment. Responses to an elemental diet or to a similar diet in which egg albumen replaced the amino acid mixture did not differ significantly.


Plasma amino acid pattern in pellagra.

Plasma amino acid pattern in pellagra. Plasma free amino acid levels were determined in subjects suffering from pellagra and compared with levels observed in normal subjects of both low and high socioeconomic groups. In pellagrins, a wide variation was seen in the plasma levels of tryptophan and these levels overlapped considerably with those in the low socioeconomic group controls. Administration of 5 g L-leucine daily for 5 days to normal subjects belonging to the low socioeconomic group did not affect the plasma tryptophan levels. These data suggest that the pellagragenic action of leucine is not mediated through changes in circulating levels of tryptophan. They also indicate that a low level of plasma tryptophan per se may not be a reliable biochemical indicator in the diagnosis of pellagra.


Effect of ethynodiol diacetate and mestranol on serum folic acid and vitamin B12 levels and on tryptophan metabolism in baboons. The effect of an oral contraceptive agent on serum folate and vitamin B12 levels and on some aspects of tryptophan metabolism in the baboon has been investigated. Folate levels were not affected by this treatment. Vitamin B12 levels were lowered during oral contraceptive treatment (P smaller than 0.1) and increased during a 30-day period of pyridoxine supplementation (P smaller than 0.01). Trends indicating deterioration of glucose tolerance and abnormal tryptophan metabolism were also observed. Definite conclusions concerning the effect of oral contraceptive agents on nutritive parameters could not be made. This is in keeping with the vast volume of literature published on the effects of oral contraceptive agents in humans and other species. It is concluded that perhaps, due to the biologically variable responses to oral contraceptive agents by individuals of any species, studies of serum levels of vitamins and other superficial biochemical parameters. Further, we conclude that the baboon could be a useful model for the study of endocrine influences on nutritive parameters, first because endocrine parameters resemble those of humans and second, because experimental protocols can be rigidly adhered to.


Dietary intakes and plasma concentrations of folate in healthy adolescents. Dietary intakes of folate and concentrations of plasma folate were obtained from healthy adolescents of families having low or high income. Results were tested statistically in relation to ages and to sex maturity ratings of the subjects. Maturity was a significant factor and age was not. Boys had higher dietary intakes of folate than girls, and family income was not significant. Low folate intakes are in general attributed to incomplete tables of folate content of foods and suggest a need for revision of existing standards. Plasma folate concentrations were higher in girls than in boys at all maturity ratings but both sexes showed decreasing concentrations as they became more mature. The paradox of increased dietary intake associated with decreased plasma folate concentration reflects increased need of folate for cellular manufacture associated with adolescent growth, particularly in boys. Plasma folate concentrations were subnormal in 9.4 percent of boys and 4.7 percent of girls from low-income families. Girls of higher income families had higher plasma folate due to their taking nonprescribed vitamin preparations containing folic acid. Family income did not affect dietary intakes but, either income or cultural pattern indirectly affected plasma folate concentrations. The study demonstrates the value of relating nutritional investigations to maturity ratings.


Effects of oral contraceptive steroids on vitamin and lipid levels in serum. The results of a comprehensive study to determine the effects of oral contraceptive agents on nutrient metabolism have been reported. The group of women using oral contraceptive agents was found to have significantly higher levels of hemoglobin, packed cell volume, serum vitamin A, total lipids, triglycerides, vitamin E, and alpha1-protein and significantly lower levels of serum and red cell folacin, vitamin B12 and albumin. The biological significance of many of these differences has not been elucidated satisfactorily.


Effect of oral contraceptive agents on nutrients: I. Minerals. The epidemiological aspects of oral contraceptive agents on nutrient metabolism were studied in a large population of women. Incidence of clinical abnormalities, related to malnutrition, were more frequently observed in the lower (B) as compared to the higher (A) socioeconomic groups. In the A groups some clinical signs were more common in the nonsupplemented groups of subjects. In general, the intake of oral contraceptive agent subjects for calories, protein, calcium, magnesium, iron, copper and zinc did not differ from the controls. The intake of the above nutrients in group A subjects were higher than those of group B except for calories. The subjects who took supplements had higher intakes of calcium, iron, magnesium and copper. No effect of oral contraceptive agents was seen on hemoglobin, hematocrit and erythrocyte count. Serum iron was increased due to "Norinyl." Total iron binding capacity was increased as a result of oral contraceptive agent administration. Total iron binding capacity values were higher in group B as compared to group A and in the nonsupplemented as compared to the supplemented groups. Plasma copper was increased and plasma zinc was decreased as a result of oral contraceptive agent administration. An increase in erythrocyte zinc was observed due to "Norinyl." No effect of oral contraceptive agents on plasma calcium, magnesium and erythrocyte magnesium was observed. Although no effect of oral contraceptive agents on plasma total protein was found, serum albumin was decreased.


Effect of oral contraceptive agents on the metabolism of some trace minerals. Biochemical and metabolic alterations noted in women taking the oral contraceptive agents have included changes in blood levels of some trace minerals. Only a few of these, namely, iron, copper and zinc, have been studied. This paper intends to review the changes reported and outline the beginning of a series of studies to attempt to determine whether there is any metabolic significance to these alterations. The alterations reported in blood levels are generally believed to be related in large measure to alterations in levels of specific "transport" proteins induced primarily by estrogen. The significance of these changes is generally unknown, however, they involve slight elevations in serum iron and copper and possibly a reduction in serum zinc, although these are not as clear-cut as those of the other two trace minerals. In an attempt to determine whether any metabolic significance could be attributed to these changes, several studies have been instituted. The first, reported in this paper, consisted of a metabolic study on a group of seven women aged 18-32 who had been taking oral contraceptives for at least 3 years. The subjects were studied over four metabolic periods for a total length of 116 days. They were studied in a random fashion, generally 2 months on and 2 months off the pill, although this varied slightly. The subjects were fed a controlled formula diet throughout this study and vitamins and trace minerals, other than copper, iron and zinc, were given orally in capsules. A trace mineral solution was administered so that the total daily iron, copper and zinc could be fed in four equal feedings per day with the formula. Measurements consisted of studies of the blood levels of the trace minerals as well as their binding proteins, various indices of blood chemistry to assess health, hematological indices and total balance studies for each of the trace minerals and nitrogen. The balance studies included not only urine and fecal loss but also skin, menstrual and hair losers. Preliminary results are discussed as well as the formidable problems involved in trace mineral studies in humans. These problems are not only related to contamination but also are analytic in nature.


Relationship between levels of blood lipids, vitamins C, A, and E, serum copper compounds, and urinary excretions of tryptophan metabolites in women taking oral contraceptive therapy. To evaluate which women using oral contraceptive agents might be at risk, biochemical indices known to be affected by the estrogens and progestogens were studied in women who take oral contraceptive agents, in women who do not use oral contraceptive agents, in women in third trimester of pregnancy and 6 weeks after parturition, and in men with normal and high blood lipid levels. The most consistent changes due to oral contraceptive agents were in serum levels of copper, triglycerides, and vitamin A and in the urinary excretion of xanthurenic acid and niacin derivatives before and after a tryptophan load test. There was only a slight suggestion, with no statistical significance, that serum vitamin C levels decreased when the serum levels of ceruloplasmin were high. The highest blood pressures and serum triglycerides and vitamin A levels were obtained in those women who ingested the highest level of estrogens. Pregnant women had the lowest levels of serum vitamin A. The oral contraceptive agents users had the lowest average levels of carotenoids corresponding to the highest average levels of vitamin A in the serum. Thus, estrogens not only increase the rate of change of tryptophan to niacin but may also increase the rate of conversion of carotene to vitamin A. Relative reactivity to oral contraceptive agents and possible risk to a patient might be evaluated by a profile of blood pressure and serum triglycerides, copper, and vitamin A.


Telemetric ECG data (biorhythms) in operations with acupuncture analgesia in the People's Republic of China. During seven operations with acupuncture analgesia in the People's Republic of China, recordings were made with a self-developed device for telemetric transmittance of the ECG. Among others, the amplitude of the QRS complex as well as the period of time between two cardiac cycles were electronically measured and registered for evaluation. Through comparison of the values from China with our own material, the following statements can be made: (1) All patients were in conditions ranging from restlessness and slight excitation to weariness and drowsiness. A condition similar to narcosis must be excluded. (2) In a large number of cases a preoperatively performed strong psychological sedation through pharmacological agents can be excluded with certainty. (3) The massive reaction to events such as the cleansing of the operative field refutes-at least partly-our concept of "Asiatic indifference". (4) Acupuncture cannot depress reflexes. (5) Finally, the hypothesis that acupuncture has a stabilizing effect on the circulation is invalid.


Ryodoraku therapy for migraine headache. The authors discuss Ryodoraku electric acupuncture therapy in detail in Part I. The results of the treatment of migraine headache (20 cases) by Ryodoraku therapy were investigated in part II. In the present study 15 out of 20 patients achieved good to excellent responses to this type of therapy.


Acupuncture for chronic pain--a small pilot project. A prelminiary report is presented on the results of a small pilot project utilizing acupuncture in the management of chronic painful conditions. Problems associated with patient selection and evaluation are outlined along with a suggested future mechanism for triage and assessment. A description is given of the early clinical results of this pilot project.


Effects of procedural variations on the activity of aminoglycosides in vitro. Am J Clin Pathol 63:438-445, 1975. The effects of procedural variations on the activities of gentamicin, tobramycin, sisomicin, kanamycin, and amikacin in vitro were evaluated using 134 clinical isolates. In broth dilution studies, a change in assay medium from brain-heart infusion broth to Mueller-Hinton broth resulted in significant changes in minimal inhibitory concentrations in 36% (242 of 670) of assays. A change in the bacterial population size utilized in broth dilution studies resulted in significant changes in minimal inhibitory concentrations in 34% (155 of 456) of assays. These variations in activities appeared to depend more on the organism tested than on the particular aminoglycoside used; with strains of Staphylococcus aureus, Proteus, and Providenica being most affected. For all five aminoglycosides, minimal inhibitory concentrations determined by broth dilution, regardless of medium, showed poor correlation with zone sizes obtained by the Bauer-Kirby technic. These results suggest that unless some standard assay procedure for activity of aminoglycosides is adopted, meaningful comparison of results within and among laboratories will not be possible.


A case of hartmannellid amebic meningoencephalitis in Zambia. A case of amebic meningoencephalitis recognized in an adult Zambian is described. This is the first authenticated case from Africa. The morphologic features of the organism, its ability to form cysts in tissue, and the granulomatous tissue response denote that the ameba is an hartmannellid rather than a Naegleria. Free-living amebas of the family Hartmannellidae have not been incriminated before as a cause of primary amebic meningoencephalitis in man. To our knowledge this is the only case where such an ameba was responsible for fulminating meningoencephalitis. The presence of the amebas in a cellulocutaneous abdominal lesion suggests hematogenous dissemination.


Results of the 1972 CAP/NBS study of radionuclide measurements. In 1972 a pilot study was carried out to evaluate radioactivity assay procedures for in-vivo administration in nuclear medicine. The plan was to determine the accuracy with which a measured quantity of radioactivity can be administered to a patient. Delivered samples were returned to the National Bureau of Standards by 33 participants. The activity values of 47% of the participants were within plus or minus 10% and 81% were within plus or minus 20% of the activity value of the samples subsequently measured by the National Bureau of Standards. The analysis of the variability indicated that many of the difficulties encountered by the participants were due to two factors outside their control: differences in assay values of chromium-51 between radiopharmaceutical companies and poor calibration or instruction by the manufacturers of dose calibrators.


Spinal fluid cytology during chemotherapy of leukemia of the central nervous system in children. During a two-year period 170 children were treated for leukemia. Forty-seven per cent had clinical and cytologic evidence of central nervous system involvement. Of these, 38 patients had repeated cytologic examinations of the spinal fluid and were suitable for a study of changes that occurred during the course of their disease and treatment. A total of 112 cytologyc specimens from the 38 patients over a period of 8 to 60 months was reviewed. There was accurate correlation between cytologic evidence of leukemia in the spinal fluid, clinical signs and symptoms of central nervous system disease, and autopsy evidence of meningeal leukemia, though the number of cells present did not predict the severity of clinical disease or extent of meningeal infiltrate. Almost every patient with leukemic cells in the spinal fluid had a corresponding leukemia infiltrate in the bone marrow, but not in peripheral blood. The differential diagnosis of leukemia in spinal fluid cytology is discussed and the clinical response to intrathecal chemotherapy correlated with cytologic findings. Serial cytologic observations during treatment, and the phenomenon of autonomous CNS leukemia, are discussed in terms of cell cycle physiology and chemotherapy. The results stress the usefulness of spinal fluid cytology as a screening procedure in asymptomatic patients with leukemia and are of interest in regard to the pathophysiology of leukemia of the central nervous system.


Hemoglobin A2 level. A proposed test for confirming the diagnosis of iron deficiency. The absolute hemoglobin A2 concentration in mg. per 100 ml. of blood was calculated from the hemoglobin level in Gm. per 100 ml. and hemoglobin A2 percentage for 38 patients with documented iron deficiency, 37 patients with proven beta-thalassemia minor, 26 patients with simple chronic anemia and 40 normal control laboratory workers. The mean hemoglobin A2 concentration (mg. per 100 ml.) in the control group was 459 plus or minus 60 (2 S.D.) and that in the beta-thalassemia group, 766 plus or minus 99. However, in the iron deficiency group it was 229 plus or minus 58, while in the simple chronic anemia group it was 315 plus or minus 39. The mean corpuscular volume (M.C.V.) in cu. mu was 90 plus or minus 8 (2 S.D.) in the normal controls, 68 plus or minus 10 in beta-thalassemia, 69 plus or minus 9 in iron deficiency, and 90 plus or minus 15 in secondary anemia. It is proposed that the absolute hemoglobin A2 level in mg. per 100 ml. of blood taken in conjunction with the M.C.V. is of value in establishing the diagnosis of iron deficiency.


Platelet morphology after aspirin.

Platelet morphology after aspirin. Previous studies have revealed morphologic platelet abnormalities, particularly inclusions, in patients who have acute malarial infections. To determine the possible role of aspirin (ASA) in the etiology of these abnormalities, the thrombocytes of 14 normal men were examined before and after ingestion of 2 Gm. of ASA. A significant decrease in platelet size was noticed after ASA: however, no ultrastructural alteration of these circulating platelets was found, although functional impairment was manifested in vivo (bleeding time) and in vitro (aggregation). It is concluded that inclusions and other morphologic abnormalities in thrombocytes of malaria patients are not caused by aspirin ingestion.


Spontaneous platelet aggregation. Occurrence in an asymptomatic individual. Spontaneous platelet aggregation in an asymptomatic individual is described. The platelet-poor plasma of the subject greatly enhanced the response of normal platelet-rich plasma to adenosine diphosphate. The spontaneous platelet aggregation was easily inhibited by aspirin.


Evaluation of hepatitis B antigen testing in federally licensed blood banks in the United States. Between August 1972 and January 1974, the Burear of Biologics distributed four panels of 20 coded serum samples to all federally licensed blood banks for hepatitis B antigen testing. Initially, all but six blood banks reported results by counterelectrophoresis (CEP) only, but by January 1974, 152 of 247 banks reported results by radioimmunoassay (RIA). On the four panels distributed, correct results were reported for 63 to 83% of all potentially detectable samples by CEP and for 98 to 100% of all samples potentially detectable by RIA. Perfect scores were obtained by only 5 to 25% of blood banks using CEP but by 77 to 100% using RIA. Nonreproducible results on duplicate reactive samples, included to evaluate internal consistency, ranged from 0.5 to 25% by CEP and from zero to 5% by RIA. These results demonstrate greater reliability in addition to greater sensitivity of "third generation" RIA testing in comparison with "second generation" CEP testing.


Optic nerve hypoplasia with hypopituitarism. Septo-optic dysplasia with hypopituitarism. Four children had optic nerve hypoplasia with hypopituitarism, and their clinical picture varied with age. The newborn had apnea, hypotonia, seizures, hyopglycemia, and prolong jaundice. The young infant had defective vision, behavioral delay, hypotonia, and seizures. Except for a mildly receding lower jaw and a high-arched palate, the appearance of the patients was not unusual. The fasting blood glucose level was mildly depressed. In two cases the liver was palpable and results of liver function tests were abnormal. The older child, who was blind and mentally retarded, had growth failure. The extent of the pituitary hormone deficiencies was variable, including diabetes insipidus. The septum pellucidum was not invariably absent. Clinical and pathological findings indicate that the brain lesion might be more diffuse than hitherto recognized. Early recognition of this syndrome and timely intervention might diminish serious sequels.


Bacterial endocarditis in children under 2 years of age. The risk of bacterial endocarditis in infants with bacterial sepsis was assessed by review of clinical and autopsy records (1930 to 1972). There were 12 cases of bacterial endocarditis among 847 patients (1.4%) dying with bacterial sepis; a single survivor was noted during the entire period. Of the 12 autopsy patients, six had underlying congenital heart disease (CHD). Among 61 patients with bacterial sepsis associated with CHD, six acquired bacterial endocarditis (10%), whereas in 786 infants with sepsis but without underlying heart disease, only six developed bacterial endocarditis (0.8%) (P less than .01). There is a high mortality in infants with bacterial endocarditis, and an increased risk of it in infants with sepsis and CHD.


The school health team and school health physician: new role and operation. A new concept of school health redefines the school physician's role as dealing primarily with behavior and learning disorders in children. It is an on-site operation, using a multidisciplinary team of professionals. We outlined internal team operations, as well as modes of remediation. Many types of behavior and learning problems were seen by our school health team during the first year of operation. It is important to recognize the multiplicity of diagnoses on individual elementary school children, as well as the differentiation of early organics from late functional primary causes. We need to reassess the delivery of school health care. The expansion of school health to include the multidisciplinary team approach to behavior and learning problem is a primary priority. We suggest using outside medical agencies for periodic physical illness.


Absence of intravascular coagulation in the hemolytic-uremic syndrome. Four patients had clinical manifestations of the hemolytic-uremic syndrome. No evidence of active intravascular coagulation was found during the acute phase of the illness, using a sensitive assay to measure soluble circulating fibrin in the plasma of these patients, three of whom developed the clinical syndrome while hospitalized for gastro-enteritis. These findings, coupled with the findings of others, suggest that either the episode of intravascular coagulation precedes the development of the clinical manifestations, or that platelet thrombosis is occurring in the absence of activation of plasma clotting factors. In any case, heparin anticoagulant therapy does not seem indicated.


Recurrent hyperosmolar nonketotic episodes in a young diabetic. A 15-month-old girl was successfully treated for substantial hyperosmolarity in the absence of ketosis at the onset of permanent insulin-requiring diabetes mellitus. Hypotonic solutions containing small amounts of glucose and subcutaneous administration of low doses of insulin were empolyed. Potassium was added to the hydrating solutions during the second hour of treatment. In the next three months, two recurrences of this syndrome were verified and successfully treated in a similar manner.


An endoscopic method for recording DC potentials in the upper gastrointestinal tract. An endoscopic sensing electrode for measuiring mucosal potential differences along the duodenum, stomach and esophagus is described. Potential profiles were plotted for 31 humans. The profiles of 11 patients with documented carcinoma differed in shape from the profiles of 20 reference subjects with no such documentiation. The profiles of all the reference subjects demonstrated a distinct concave shape with a single pronounced dip. On the other hand, carcinoma profiles did not manifest such a dip but were flattened out and/or manifested an undulatory trend.


Dispersion analysis of prognostic and relapsing factors of duodenal ulcer by use of electron computer. Among 192 cases of duodenal ulcers and ulcer scars, which were endoscopically observed in the last three years, complete healing was observed in 109 cases. Study of the data in these cases by computer indicates that the healing tendency of duodenal ulcer is poorer with advancing age. It is less in a linear ulcer than in a round or irregularly shaped one and worse in an ulcer without marginal swelling than in one with it. Shape, number, distribution of lesions and degree of radiological deformity of duodenal cap are of no use in prognosis. Ulcer scars with redness or converged folds, however, are apt to relapse.


Atropine and exocrine pancreatic secretion in alcohol-fed dogs. In dogs provided with chroinic pancreatic and gastric fistulas (Thomas canula), one of them vagotomized and alcohol-fed for 17 months with 50% (v/v) intragastric ethanol (0.2gm./kg.), an atropine perfusion (1.0 mg./hr.) superimposed on a continuous i.v. injection of secretion (GIH, 1.0 CU./kg./hr.) and CCK (GIH, Crick, Harper 3.0 U./kg./hr) prevents the excitatory effects on pancreatic secretion of an acute i.v. ethanol infusion (1.3 gm./kg.). In alcohol-fed dogs, the i.v. ehtanol-induced excitatory effect on 'pancreon' is exerted through a cholinergic mechanism, elicited at the hypothalamic bulbar centers and/or the intrapancreatic ganglia.


Tuberculous enteritis. Review of a protean disease. Prior to the advent of antituberculosis drugs, at least 70% of patients with far advanced pulmonary tuberculosis had tuberculous enteritis. Despite the effectiveness of drug therapy, overt cases of tuberculous enteritis occur in the United States and particularly among immigrants from endemic areas. Clinicians often forget to consider this entity. The patient may have no or minimal abdominal complaints. Vague abdominal distress, anorexia and weight loss can be overlooked because of the extensive pulmonary exudative or cavitary disease. Even after an enteric lesion is identified, often it is mistaken for other entities, particularly neoplasm or Crohn's disease. Obviously, the diagnosis is difficult but certain radiological criteria can be indicative of the disease. This report demonstrates the protean manifestations of this entity, the complications which occur despite drug therapy and the need for continued awareness of its existence.


Ileocecal tuberculosis.

Ileocecal tuberculosis. Three cases of ileocecal tuberculosis are presented with a review of pathogenesis, diagnosis and therapy. Emphasis is placed upon preoperative suspicion and the indications for resectional surgery in combination with antituberculous drugs in the management of the patients.


Malignant tumors associated with granulomatous enterocolitis. Three cases of malignant tumor associated with Crohn's disease of the large intestine are reported.  The reasons for a low incidence of carcinoma associated with Crohn's disease have been postulated.


Silent acute pancreatitis with encephalomalacia mimicking hepatic coma. A very rare case of acute pancreatitis with concurrent encephalomalacia and ascites mimicking hepatic coma is described. The possibliity that the pancreatitis was caused by the administration of chlorothiazide in a diabetic patient is suggested as possible etiology. It is emphasized that when a cirrhotic patient develops coma, the possibility of painless,silent pancreatitis with encephalomalacia as well as hepatic coma should be considered in the differential diagnosis.


The radiology corner. Anorectal melanoma. A case of malignant anorectal melanoma is presented together with a short review of the literature. The lesion arises from the melanocytes normally present within the squamous epithelium of the anal canal. It presents as a small polypoid tumor and spreads rapidly into rectum, perirectal tissues, pelvic and inguinal nodes. It should be considered in the differential diagnosis of sessile lesions located or involving the anal canal.


The radiologic diagnosis of spontaneous mesenteric venous thrombosis. Spontaneous mesenteric venous thrombosis is a distinct clinicopathologic entity that typically presents as abdominal pain of obscure origin.  Pathologically, thrombosis of multiple small tributaries of the superior mesenteric vein causes segmental congestion, edema, hemorrhage and ultimately mucosal necrosis.  Characteristic radiologic changes were found in  10 of 12 cases.


The double-contrast upper gastrointestinal examination in the Japanese style. An experience with over 2,000 Japanese-style double-contrast upper gastrointestinal examinations is presented.  Results indicate that, in combination with the conventional single-contrast films, the double-contrast examination of the stomach greatly increased the yield and accuracy of the radiographic procedure.  The double-contrast study appears to have particular applicability in detecting lesions which do not greatly elevate or depress the surface of the stomach, such as early carcinomas, shallow ulcers, ulcer scars, small polyps and other similar mucosal abnormalities.


Electromyography of the sphincter of Oddi.  Technic and experimental results in the rabbit: Effect of certain drugs. Electromyographic activity of the sphincter of Oddi was recorded by means of bipolar suction electrodes applied to the rabbit, in which the sphincter of Oddi is easily identifiable and independent of the duodenal musculature.  Seventy animals were investigated (20 in vitro and 50 in vivo).  The bile duct was catheterized so that the pressure could be recorded.  The sphincteric traces show basal activity consisting of bursts of 1-8 spike potentials which recur every 3-5 seconds on average and are accompanied by a transient rise in biliary pressure.  The patterns are different from those recorded for the duodenum, the activity of which does not affect biliary pressure.  On the basis of these findings, it can be asserted that the sphincter of Oddi plays a part in biliary flow apart from any duodenal muscular action.  This method has made it possible to study the behavior of the sphincter of Oddi under the influence of certain physical agents or drugs.  Within certain limits, the frequency and amplitude of the spike potentials increase with temperature and the rise in biliary perfusion pressure.  Acetylcholine, prostigmin and morphine hydrochloride increase the frequency and amplitude of the spike potentials and shorten the resting intervals.  Inhaled amyl nitrite and intravenous hexamethonium reduce electrical activity.  The depressant effect of atropine is much less marked in the rabbit.  Intravenous administration of alcohol results in a substantial increase in the electrical activity of the sphincter and in biliary pressure.  This effect is reduced by vagotomy and suppressed by hexamethonium.


Gastrointestinal leiomyomas.

Gastrointestinal leiomyomas. An exogastric asymptomatic leiomyoma and a ileal leiomyoma presenting as an intussusception are reported on account of rarity.  The diagnostic problem involved are discussed with a short review of the literature.


Constipation of prolonged duration.

Constipation of prolonged duration. A case is reported of a 19-year old man who went periods of four and a half and four months without a bowel movement and who experienced no distress throughout these periods except for late appearing abdominal cramps.


The Radiology Corner.  Gastrointestinal histoplasmosis, roentgenographic, clinical and pathological correlation. Five cases with gastrointestinal histoplasmosis are presented.  Gastrointestinal involvement is moderately frequent during the hematogenous dissemination of histoplasmosis.  Depending on the underlying pathological changes, six roentgenographic patterns can be identified: 1. malabsorptive; 2. ulcerative; 3. polypoid; 4. granulomatous; 5. tumefactive and 6. compressive.  Perforation, hemorrhage, obstruction and erroneous diagnosis for ulcerative colitis, Crohn's disease or carcinoma are the major complications.  Histoplasmosis should be included in the differential diagnosis of diseases presenting with a malabsorption pattern, gastrointestinal polyposis, ulcerative and granulomatous gastrointestinal diseases and carcinoma, particularly if pulmonary lesions co-exist.


Epidemic Venezuelan equine encephalitis in North America in 1971: vertebrate field studies. Epidemic Venezuelan equine encephalitis in North America in 1971: vertebrate field studies. Am J Epidemiol 101:36-50, 1975.-In June 1971, epidemic Venezuelan equine encephalitis (VEE) invaded the lower Rio Grande Valley in south Texas. The Boca Chica area of Cameron County was selected as a study site to investigate vertebrate involvement in the natural cycle of epidemic VEE on the basis of considerable evidence of VEE virus activity there in equines, humans, and mosquito vectors. Only one VEE virus isolation was made from 4739 wild and domestic non-equine vertebrates, although numerous equine and human VEE virus isolations were made in concurrent studies. Serologic studies indicated that VEE virus activity was far greater in large domestic animals than in wild birds, wild mammals, or reptiles. Apparently epidemic VEE virus failed to establish itself in a wild vertebrate cycle in south Texas, since VEE antibody was found only in rabbits in 1972. Eventual cessation of VEE transmission in south Texas has been attributed 1) to the elimination of equines as a source of VEE virus by death, naturally acquired antibodies, or vaccination, 2) to quarantines, 3) to mosquito control, and 4) to the failure of epidemic VEE virus to become established in the wild vertebrate population. Equines emerge as the most important vertebrate host in the amplification and spread of virus during an epidemic of VEE.


Epidemiology of hepatitis B in hospital personnel. To identify occupational categories and work areas of possible risk for acquisition of nosocomial hepatitis B by hospital personnel, serologic sampling for hepatitis B surface antigen (HBSAg) and antibody (anti-HBS) by radioimmunoassay was carried out in 513 employees of a large metropolitan hospital serving predominantly indigent patients. HBSAg was detected in 0.7%, HBSAg and anti-HBS in 0.4%, and anti-HBS in 13.3% of the study population. No significant difference in seropositivity was noted between sexes. Furthermore, neither exposure to patients with hapatitis nor previous blood transfusion correlated with serologic evidence of hepatitis B infection. However, frequency and intensity of exposure to blood products was associated with serologic evidence of infection: 18.9% of those with frequent blood contact were positive for HBSAg or anti-HBS, compared with 11.4% of those without blood product exposure (p less than .05). Direct patient contact, apart from blood exposure, did not appear operative as a major factor in hepatitis B transmission in this population. Accordingly, occupational categories and work areas with highest risk for acquisition of nosocomial hepatitis B were those with greatest blood exposure.


Interviewer effect on responses to a questionnaire relating to mood. A community mental health assessment questionnaire relating largely to depressed mood was administered during 1972 to 1,212 respondents in Washington County, MD, by six interviewers. Analysis of 15 psycho-social tests showed that responses obtained by one interviewer differed significantly from responses obtained the other five. Suggestions for minimizing interviewer effects include 1) selection of interviewers with similar characteristics and backgrounds; 2) adequate training and periodic field assessment of interviewer performance; 3) simplification of questions and reduction in the number of possible responses per question; and 4) allocation of various types of subjects to interviewers as uniformly as possible.


Congenital adrenal hyperplasia caused by 11 beta-hydroxylase deficiency with onset of symptoms after one spontaneous pregnancy. A case of adrenogenital syndrome due to 11beta-hydroxylase deficiency is described in a mother, 25 years of age, who had experienced a successful pregnancy 5 years previously. At that time no abnormality had been suspected and pregnancy was achieved without therapy. Subsequently the patient was examined because of secondary sterility. The menstrual cycles were anovulatory. Only slight virilization was observed and blood pressure was normal. Diagnosis was based on the observation of highly increased urinary excretion of 17-ketosteroids and 17-ketogenic steroids, with especially high excretion of tetrahydro-11-deoxycortisol. Following suppression with dexamethasone and adequate maintenance treatment, the patient conceived and had an uneventful pregnancy. This is apparently the first report of pregnancy in adrenogenital syndrome due to 11beta-hydroxylase deficiency.


Latent period, time to reach maximum effect, and disappearance of uterine contractility induced by desamino-oxytocin. The effect of buccal desamino-oxytocin (CAO) upon uterine contractility was studied in pregnant women at term by recording the amniotic pressure. The DAO increased uterine activity and the intensity and frequency of the contractions; basal pressure did not vary. The time required to reach the maximum effect ranged between 57 and 106 minutes, whereas the time elapsed between the administration of the first tablet and the beginning of the increase of uterine activity ranged between 13 and 96 minutes. An inverse linear correlation between the percentage increase of uterine activity and the spontaneous uterine activity was observed. Ninety minutes after the suppression of DAO uterine activity remained above basal levels; uterine activity after DAO was found to be in direct linear correlation with stabilized utertine activity during DAO.


A conceptual model for regionalization and consolidation of obstetric-gynecologic services. The regionalization and consolidation of obstetric-gynecologic services, especially maternity services, is a significant current trend in our specialty. The concepts of consolidation and regional organization are interdependent and interrelated, and the movement has received impetus from economic considerations as well as the needs for organizational efficiency. Regionalization and consolidation of services are also consistent with the stated goals of The American College of Obstetricans and Gynecologists which call for the assurance that adequate obstetric-gynecologic care is available to all women, through (1) solutions to the problems of maldistribution of personnel and facilities, and (2) reductions in health-care costs by the more efficient utilization of personnel and facilities. Activities in this field have been enhanced by the interests of such health-related entities as the National Foundation-March of Dimes and the Robert Wood Johnson Foundation in these studies. It is mandatory that progress in this activity be dictated by practical as well as theoretical considerations. A conceptual model for the organization of these developments will be presented with considerations of patient care and services, medical education (both continuing and residency), and research (including basic and clinical) as they apply to the model.


Blood flow to the human uterus during maternal metabolic acidosis. Uterine blood flow and metabolism were estimated at cesarean section under general anesthesia in pregnant women at term with the use of the Fick principle with nitrous oxide as the test material. Observations were made without superimposed maternal metabolic acidosis and during the infusion of ammonium chloride. Increasing maternal metabolic acidosis was accompanied by a decreasing rate of blood flow in the uterine circulation. There were no statistically significant differences in the metabolic rate of the uterus and its contents during maternal metabolic acidosis induced by the infusion of ammonium chloride.


Is the obstetrician-gynecologist a specialist or primary physician to women? In an attempt to answer the question, "Is the practicing obstetrician-gynecologist a specialist or a primary physician to women?" 1,008 patients of 51 Michigan obstetrician-gynecologists were asked a series of questions concerning their health care. Forty-four per cent have no primary-care physician and 86 per cent see only their obstetrician-gynecologists for regular periodic examinations. Forty-one per cent reported that their obstetrician-gynecologists either had treated them for nongynecologic conditions or had decided that no treatment was necessary. The training and practice of obstetrician-gynecologists must be altered in view of the role they are assuming--that of primary physician to women.


The effects of danazol on gonadotropins and steroid blood levels in normal and anovulatory women. The effect of Danazol, a new gonadotropin inhibitor, was examined in four categories of patients. (1) Ten normal women medicated orally with Danazol, 800 mg. daily for 91 days, showed no depression of serum LH, estrone, estradiol, or progesterone below control, second-day levels. The serum FSH was slightly depressed; (2) Two anovulatory patients having elevated serum LH values were treated with Danazol, 400 to 800 mg. daily, for 1 to 3 days at midcycle. One patient repeatedly showed a temperature rise and LH flood within 24 hours of initial medication. Both had menstrual periods 7 to 9 days later. (3) Two normal midcycle ovulators were treated with 400 and 800 mg; of Danazol, respectively, for 1 day in the midfollicular phase and one apparently ovulated promptly prematurely. (4) Two patients having severe hot flushes following surgical menopause were treated with Danazol, 800 mg; daily, without reducing FSH or LH but with disappearance of hot flushes.


Continuing education of obstetricians and gynecologists in fertility management. One of the current fundamental problems in medicine is the massive quantity of new information that continues to develop and the requirement for the application of these data to good patient care. New techniques of merit need to be placed rapidly in the patient-care arena and the time lag between the steps from laboratory to clinic minimized. One approach to the achievement of the goal in fertility management is described in the following report; namely, a summary of the results of an education program in fertility management established in November, 1972, for the continued education of obstetricians and gynecologists from "developing countries". This report reviews the experience and data derived from the first 95 physicians completing a course in population dynamics. An estimate of the factual knowledge that these individual physicians possessed at the beginning of the course is compared with an estimate of the knowledge acquired within the 4 week training program. In a similar manner, an important part of this survey was a study of the attitudes of the clinical fellows in the areas of sex education, contraception, sterilization, and abortion. The results of this study suggest that newly developed techniques in clinical medicine may be taught to a specific and highly motivated group in an effective and efficient manner. The initial interest and response of physicians for admission to this program have demonstrated the need for the development of more similar educational programs.


Angiogenesis of cervical neoplasia.

Angiogenesis of cervical neoplasia. Recent studies concerning the role of an angiogenic factor in cancer have produced a renewed interest in vascular studies of the cervix. Colposcopic and histochemical vascular studies demonstrate changes in the vascular pattern of cervical neoplasia which progress from early dysplasia to carcinoma in situ. There is a restructuring of the terminal vascular network of the pre-existing columnar epithelium in noninvasive cervical neoplasia which is caused by compression of the capillaries by the epithelial proliferation. In contrast, neovascularization is observed in those cases of carcinoma in situ which will progress to invasive cancer. The position is taken that this process of neovascularization, which is recognized by the development of horizontal vessels, may be the direct effect of an angiogenic factor. Evidence is also presented that the initial vascular changes may precede the histopathologic criteria of cervical neoplasia.


The surgical management of invasive cancer of the cervix in pregnancy. During a 13 year period ending in July, 1974, 42 obstetric patients with a diagnosis of invasive carcinoma of the cervix were seen. Nine patients were treated with primary radiation therapy; 33 patients were treated with primary surgery. Total hysterectomy with partial vaginectomy was performed in seven patients with Stage I-A, and extensive abdominal hysterectomy with bilateral pelvic lymphadenectomy was performed in 26 patients (14 with Stage I-A, nine with Stage I-B, and three with Stage II-A). Thirty-eight patients are alive and well from three months to 13 years following treatment. Extensive abdominal hysterectomy and pelvic lymphadenectomy can be done in selected obstetric patients with invasive carcinoma of the cervix with an acceptable morbidity and cure rate. Normal ovaries left in place will continue to function normally. Seven patients with a conization diagnosis of Stage I-A had a planned delay in definitive treatment until delivery at term.


Synthesis and use of affinity-labeling steroids for interceptive purposes. Synthesis of 17 beta-bromoacetoxy-19-nortestosterone was carried out by reaction of 19-nortestosterone with bromoacetic acid in the presence of dicyclohexycarbodiimide. The steroid was capable of alkylating cysteine, methionine, and histidine under physiologic conditions, indicating its potential as an affinity-labeling steroid. 17beta-Bromoacetoxy-19-nortestosterone interrupted postimplantation pregnancy in the rat when administered into the lumen of the uterus at low doses or subcutaneously at higher doses. Exogenous gonadotropins or steroids in dosages sufficient to maintain pregnancy do not prevent the interceptive action of this steroid. Animals whose first pregnancies were interrupted by this steroid had a subsequent normal pregnancy. The mode of action may be via covalent bonding to the progesterone receptor resulting in exclusion of endogenous progesterone.


Use of serum lutenizing hormone in the clinical management of short-term amenorrhea. Serum luteinizing hormone (LH) values determined by radioimmunoassay can be of aid in evaluating patients with short-term amenorrhea. These values have proved useful in ruling out pregnancy in cases of hypothalamic amenorrhea and amenorrhea occuring during treatment with contraceptive pills and also in diagnosing early pregnancy after clomiphene therapy.


The Pap smear: take two.

The Pap smear: take two. The results of two "pancervical" Pap smears taken sequentially at the same sitting were evaluated on 2,823 patients in a Family Planning Program as part of a national sample to evaluate abnormal cervical cytology and method of contraception. It was found that obtaining two smears increased the detection of abnormal cytology in these patients by 86 per cent. Every group participating in this national study found a large increase in sensitivity, though not to the degree noted in our population. The importance of this result for case-finding and subsequent rescreening procedures is evident, and emphasizes that the single "pancervical" Pap smear is an insensitive procedure for detecting abnormal cervical cytology.


A functional analysis of the myogenic control systems of the human Fallopian tube. Electrical and mechanical activity of segments of isolated human Fallopian tubes was recorded with the use of extracellular pore electrodes and a transducer recording tension in the longitudinal axis. Electrical activity was regularly recorded in ampullar segments of tubes from premenopausal women and consisted usually of one spike apparently preceded by prepotentials associated with each contraction. These spikes were propagated at 2 to 9 mm. per second in either direction with equal velocity. The direction or velocity of propagation was not influenced by the hormonal status of the woman from whom the tube was derived. It was concluded that the myogenic system of the human Fallopian tube was organized on a symmetrical principle, any directionality being imposed by hormonal, neuronal, or other modulating systems in vivo. Stretch was able to enhance the excitability of this system.


A computerized aid to Ball pelvimetry.

A computerized aid to Ball pelvimetry. A computer program is presented that will generate a table of capacities and volumes for use with the Ball technique for cephalopelvimetry. The technique of Ball pelvimetry is reviewed and directions for use are described. This table may be produced on any medium or large-scale digital computer equipped with a FORTRAN compiler and a standard page printer. Its use eliminates many errors inherent in previous methods of volume computation. Physician acceptance has been excellent.


The safety of lincomycin in pregnancy.

The safety of lincomycin in pregnancy. The progeny of mothers treated with lincomycin during the first, second, or third trimester of their pregnancy were extensively evaluated at various periods extending to 7 years after birth. As compared to a control group (mothers not receiving lincomycin), the study group did not show any more developmental anomalies of the teeth, specific physical defects, general developmental anomalties, or late developing abnormalities in speech, emotional and mental make-up, or ability to adjust to schooling, than would occur in the normal population. The relationship to clindamycin, a closely related derivative, and to antibiotic therapy during pregnancy is discussed.


Pyridoxal phosphate and hypertensive disorders of pregnancy. Pyridoxal phosphate (vitamin B6) concentrations in peripheral and cord blood obtained at the time of delivery were measured in 30 women. The average plasma concentration in nine women with normal pregnancy was 4.3 ng. per milliliter; in 10 women with pre-eclampsia, 3.3 ng. per milliliter; and in nonpregnant women, 17 ng. per milliliter. The average cord blood plasma concentration of normal infants was 28.4 ng. per milliliter, whereas that of infants of pre-eclamptic mothers was 12.2 ng. per milliliter. This twofold difference in the cord plasma concentrations was statistically significant (p smaller than 0.001). Pyridoxal phosphate concentrations in the infants' cord plasma were increased in all pregnancies studied by administration of pyridoxine either orally or intravenously. These findings together with other data, demonstrating (1) that B6 deficiency during pregnancy may lead to abnormal neurologic development in experimental animals and (2) that brain development in infants of toxemic mothers may be retarded, suggest that dietary supplementation with vitamin B6 should be instituted in women at high risk for development of toxemia of pregnancy.


Effect of regional analgesia on maternal oxygen consumption during the first stage of labor. Oxygen consumption, tidal volume, and minute volume decreased in 20 patients during the first stage of labor after either epidural or paracervical block. The elimination of pain with optimum regional analgesia is associated with a decrease in tidal and minute volumes, apprehension, and consequently a decreased oxygen consumption. These factors may contribute to a decrease in maternal lactic acidosis during labor.


Ultrasonography: its usefulness and reliability in early pregnancy. A review of 210 cases. A total of 210 women who had ultrasonic examination done during early pregnancy, and whose final pregnancy outcome was known, were reviewed to assess the usefulness and reliability of the procedure. Ultrasonography was found to be diagnostic in 96.2 per cent of these cases, with the primary indication for its use being "assessment of pregnancy wellbeing." Multiple gestations, hydatidiform moles, and pelvic tumors associated with pregnancy were readily diagnosed and assessed in their early stages and the gestational age was correctly determined when dates were uncertain.


Rubella vaccination: fertility control in a large-scale vaccination program for postpubertal women. Despite nationwide immunization programs, rubella infections during pregnancy continue. To solve this serious health problem direct immunization of women of reproductive age may be required. On a clinic basis, using nonphysician personnel, we vaccinated 404 susceptible women, ages 18 to 33; half were sexually active. Since pregnancy is proscribed for 2 to 3 months following rubella vaccination, a full range of family-planning services and a variety of contraceptive methods were used to ensure sustained fertility control. Sixteen vaccinees presented with possible conceptions in a 3 month follow-up. Of these, only five required treatment: two received diethylstilbestrol, two had menstrual inductions, and one an abortion. Administration of vaccine during a menstrual period was effective in preventing inadvertent vaccination of pregnant women. It was concluded that contraceptive counseling with adequate pregnancy termination backup makes it feasible to give rubella vaccine to highly motivated women.


Failure of insulin hypoglycemia to produce rise in serum prolactin. Serum prolactin and growth hormone responses to insulin-induced hypoglycemia were measured in 5 normal individuals. While growth hormone rose appropriately in all subjects studied, serum prolactin levels did not significantly change despite the production of symptomatic hypoglycemia during testing. Prolactin response to insulin hypoglycemia is not a useful diagnostic test for prolactin secretion and cannot be used as such for assessment of pituitary reserve.


Serum prolactin patterns in early human gestation. The relation between levels of human prolactin (HPRL), other protein hromones, and estradiol in serum immediately prior to and for the first weeks after conception was determined. HPRL was measured by radioimmunoassay in serum samples obtained daily from these women during the menstrual cycle in which conception took place and for several weeks therafter. It was found that the concentration of HPRL initally increased above nonpregnant levels 32 to 36 days after the luteinizing hormone (LH) peak. The patterns of estradiol and HPRL were similar in early gestation, while there was no similarity between the patterns of HPRL and human placental lactogen. These results are in aggreement with other studies showing that high levels of estrogen influence HPRL secretion in the human subject.


Tubal electrocoagulation under hysteroscopic control (three hundred and fifty cases). Three hundred and fifty patients of the Family Planning Service of the Hospital De Gineco Obstetricia of the Medical Center at the Mexican Social Security Institute were treated by tubal electrocoagulation under hysteroscopic control. Our results in these patients are presented, with a follow-up period of between nine and 30 months after electrocoagulation.


Pressure gradient changes on the trabecular meshwork of monkeys. The cellular lining of the inner wall of Schlemm's canal was anatomically different at different pressure levels. When the anterior chamber pressure rose above that of the canal, there was a marked increase in the number and size of the vacuoles present. At the same time the canal became smaller. When Schlemm's canal pressure exceeded that of the anterior chamber, the vacuoles decreased in size and number, and the canal enlarged. These findings were independent of postmortem artifacts.


Bilateral recurrent acute retinal pigment epitheliitis. Acute retinal pigment epitheliitis appears to be a specific discrete process of unknown etiology. It is generally unilateral but can be recurrent and can affect both eyes. Eyes in which the disease has run its course exhibit little or no unusual ophthalmoscopic or visual function abnormalities. The actue  phase  of the disease is localized to the macular area. The lesions are localized in the retinal pigment epithelium as shown by slit-lamp and contact-lens examination, the small lesions more or less surrounding the fovea. They vary from tiny grayish to black spots, which may become surrounded by a lighter halo. Fluroescein angiography is normal in acute phases but the halo-like areas may represent "window defects" with hyperfluorescence in later stages.


Retinal pigment epithelium in incontinentia pigmenti. An 18-month-old white girl with incontinentia pigmenti presented clinically with leukokoria of the right eye. B-scan ultrasound demonstrated a retrolental mass consistent with a detached retina. Histologic examination of the skin revealed changes compatible with the intermediate verrucous phase of the disease. Microscopic examination  of the right eye showed retinal detachment and nodular proliferation of the retinal pigment epithelium. The nodules contained macrophages laden with melanin and lipofuscin. An unusually large amount of lipofuscin was present for a child of this age. The basic pigmentary abnormality may affect the retinal pigment epithelium, resulting in changes in the overlying neurosensory retina that may lead to the retinal dysplasia or retinal detachemnt often associated with this condition.


Optic nerve glioma in an 18-month-old child. An optic nerve glioma in an 18-month-old child was examined by both light and electron microscopy. The tumor revealed the characteristic features of uniform benign and fibrillary astrocytoma. Rosenthal fibers and calcium depostis were found within numerous intracellular glial processes. The above features indicated a slow-growing tumor of long duration, confirming the generally supported assumption of the congenital nature of optic nerve glioma. One unsuspected feature was the presence of fenestrated blood vessels.


The survival and growth of microorganisms in mascara during use. Over 150 mascaras representing eight popular brands were examined for their susceptibility to microbial contamination during their use by study group members. Additional mascaras from patients with symptoms and clinical findings of long-term blepharitis also were investigated. Early in the study, two brands without preservatives supported reproducing populations of microorganisms, including potential eye pathogens. These products, as currently manufactured, were recalcitrant to microbial attack. Microbes associated with the facial skin and fingers of the study group users were typically isolated from mascaras after use. Initial microorganisms isolated from mascaras were usually transients. Establishment of reproducing populations within the cosmetics appeared related to the number of uses, personal habits of the user, and the formulation of the product. Four patients with staphylococcal blepharitis and cosmetics heavily laden with Staphylococcus epidermidis showed marked clinical improvement when they stopped using the contaminated cosmetics. The application of used eye area makeup prior to and following ocular surgery should be avoided.


Corneal alkali burns arising from accidental instillation of a hair straightener. A patient sustained mild bilateral alkali burns of the cornea following ocular exposure to a commercial hair straightening preparation. This compound and three other products all had an alkaline pH which was not reduced to neutrality by the neutralizer provided. Corneal alkali burns similar to those seen in our patient were produced in experimental animals after brief exposure. Histologic changes were primarily limited to the cornea. The warning against ocular exposure printed on the containers or package insert is not sufficiently emphatic to protect the consumer.


Ocular findings in patients with arteriovenous malformations of the head and neck. The hospital charts of 71 patients with congenital arteriovenous malformation of the head or neck, excluding carotid-cavernous sinus fistulas, yiedled 25 patients, referred to the ophthalmology service for examination. Of these, 22 patients had ocular findings; additionally, 12 patients with visual complaints or ocular findings were not referred for ocular examination. Forty-seven percent of all patients had ocular signs and symptoms including subjective visual complaints, visual field loss, ophthalmic artery pressure changes, nystagmus and motility findings, orbital and ocular vascular abnormalities, and fundus changes including optic atrophy, hypoxic retinopathy, and papilledema. Every patient with known or suspected arteriovenous malformation of the head or neck should have a thorough ocular examination. The findings can generally be correlated with the anatomic location and size of the lesion.


Nonfluorescent malignant melanoma of the choroid diagnosed with the radioactive phosphorus uptake test. A 57-year-old white woman presented with a small malignant melanoma of the choroid in the macular area of the right eye. The lesion failed to produce a visual field defect or to show fluorescence with angiography, but the radioactive phosphorus uptake(P) test was positive. Histologically, the retinal pigment epithelium was intact over the tumor and the sensory retina was normal. This unusual finding was the most likely explanation for the normal visual field. The intact retinal pigment epithelium over this nonfluroescent melanoma suggests that the destruction of the retinal pigment epithelium occurring with most choroidal melanomas may partially explain why these tumors usually demonstrate fluorescence. This case emphasizes the great accuracy of the P test for diagnosing small malignant tumors of the choroid, even before other popular diagnostic modalities indicate the malignancy of the lesion.


Effect of immunization with attenuated Mycobacterium bovis on experimental toxoplasmic retinochoroiditis. Administration of attenuated Mycobacterium bovis (Bacillus Calmette-Guérin or BCG) provides nonspecific resistance to a variety of microbial infections and tumors. This is associated with a state of augmented immunologic responsiveness. Mustering defenses against intracellular parasites, such as Toxoplasma gondii, presents a special problem that can be met only by measures that alter the intracellular environment. Our study was designed to evaluate the effect of prior immunization of rabbits with BCG on experimental toxoplasmic retinochoroiditis. One group of rabbits was immunized by the intravenous administration of BCG, another group by the retrobulbar injection of BCG, and a third group, unvaccinated, served as a control. Intravenous immunization provided significant protection against Toxoplasma organisms injected into the suprachoroidal space. In the immunized rabbits, the onset of Toxoplasma retinochoroiditis was delayed and the severity of the disease reduced. Although Toxoplasma was isolated from the chorioretinal tissues of both BCG-immunized and control rabbits, Toxoplasma antibody was not (with one exception) detected in the sera of BCG-immunized rabbits. While vaccination by the retrobulbar route produced little or no effect, intravenous administration of BCG provided nonspecific resistance to Toxoplasma retinochoroiditis in rabbits.


Subretinal cysticercosis.

Subretinal cysticercosis. Subretinal cysticercosis was discovered in two South African Bantu-speaking blacks. A 50-year-old man had a live, mobile, subretinal cyst, 0.3 mm in diameter, at the macular of his only eye, causing retinal edema and superficial and deep hemorrhage. A 25-year-old woman had a 6-mm wide, live, mobile cyst at the posterior pole of her right eye, surrounded by retinal edema, hemorrhage, and vasculitis involving the disk. This cyst was removed intact, after division of the lateral rectus muscle and maximum rotation of the eye. Massive vitreous hemorrhage occurred despite diathermy application, and vision was lost. Localization and incision of the sclera were difficult; in retrospect, a lateral orbitotomy would have been advisable. Histology of the cyst showed typical features of the larva of Taenia solium-a single scolex with suckers and hooks-gland-shaped folds in the neck and membrane of the cyst wall.


A disposable vitreous cutter-aspirator with electronic vacuum control. A sophisticated instrument system for performing vitreous surgery includes a disposable surgical tool, with all connecting tubing incorporated in a sterile template that is easy to assemble prior to surgery. The instrument console and foot switches provide all necessary surgical options, with a maximum degree of safety, for precise vitreous suction and infusion control with the disposable vitreophage or other available vitreous cutters.


A coaxial electrode for intraocular diathermy. A bipolar electrode was used in intraocular coagulation of vessels. This device was a useful adjunct for the coagulation of vessels in diabetic eyes undergoing vitrectomy. No surgical complications due to the diathermy occurred in the first six patients on whom the device was used.


An accountability model for occupational therapy. Clark recently challenged OTRs to investigate accountability theory. It is a topic which deserves attention. This paper describes briefly the nature of accountability theory and suggests how theory can be applied to occupational therapy practice. An accountability model based upon an education model is presented for occupational therapists who wish to design their own accountability plans. Examples are included to show how the model can be translated into operational terms.


A pilot community program: training adult retardates for private enterprise. This paper describes a community-based program for placing low-level retardates with no prior work experience or job training into work positions in private business and industry compatible with their needs and abilities. This paper also reports on the various problems and solutions encountered in the attempt to match the needs of employers, who experience rapid turnover and motivation problems of employees in routine work tasks, with the needs of low-level, nonworking, adult retardates who show potential for these types of jobs.


Computers and occupational therapy.

Computers and occupational therapy. The benefits and applications of computer science for occupational therapy are explored and a basic, functional description of the computer and computer programming is presented. Potential problems and advantages of computer utilization are compared and examples of existing computer systems in health fields are cited. Methods for successfully introducing computers are discussed.


Model occupational therapy practice act. The Model Occupational Therapy Practice Act has been assembled by the Government Affairs Department, American Occupational Therapy Association, for use as a guide by affilitate organizations concerned with developing legislation to regulate the practice of occupational therapy. The Model Act must be reviewed and carefully adapted to comply with state legislative requirements and practices. It must also be adapted to reflect the structure of state government of the particular state, and its particular administrative arrangements. The Model Ace leaves blanks,--, or indicates alternatives in brackets-[ ] in instances where further detail needs to be considered or where adaptations are especially necessary.


Metabolic bone disease in chronic renal failure. I. Dialyzed uremics. Garner and ball's point counting technic was used to compare metabolic bone disease in dialyzed and nondialyzed uremic patients. Histologic measurements of bone from dialyzed and nondialyzed uremic patients dying between 1966 and 1971 showed that dialyzed patients have quantitatively more severe bone resorption, distortion of trabecular architecture and mineralization defects. Mineralization defects become more severe as the duration of dialysis increases but are not related to serum calcium and phosphorus levels. Bone volume in both groups is normal or increased and in dialysis patients increases in proportion to the elevation of serum phosphorus. Mean serum phosphorus and calcium levels, bone volume, and volume: surface ratios all decreased in dialysis patients between 1966 and 1971, while bone resorption and mineralization defects did not change. These results suggest that lowering of serum phosphorus without increasing serum calcium may aggrevate the uremic bone disease by reducing bone volume without improvement of mineralization and resorption defects.