Spermatogonial stem cells in the albino rat. The existence of two classes of spermatogonial stem cells in the rat testis, i.e., reserve type A0 spermatogonia and renewing, types A1-A4 spermatogonia, postulated by Clermont and Bustos-Obregon ('68), was reexamined in a quantitative analysis of type A spermatogonia in both whole mounts of tubules and in radioautographed sections of testes from animals killed at various times, up to 26 days, after one or multiple injections of 3-H-thymidine. The cell counts obtained from whole mounts of tubules revealed that the number of isolated type A0 cells per unit area of limiting membrane remained constant throughout the cycle of the seminiferous epithelium. Paired type A0 spermatogonia also remained unchanged in number per unit area of basement membrane from stage I to stage VIII of the cycle. The low mitotic index of type A0 spermatogonia (0.1%) indicated that these cells were not actively involved in the production of spermatogonia or spermatocytes during each cycle of the seminiferous epithelium and thus were considered as reserve stem cells. The type A1 spermatogonia, which are formed during stage I of the cycle, remained resting until stage IX, when they undertook a series of four successive divisions resulting in the production of new type A1 and Intermediate-type spermatogonia. An analysis of the labeling indices of type A spermatogonia obtained from cell counts in radioautographed testicular sections after a single or multiple 3-H-thymidine injections indicated that the percentages of labeled type A cells corresponded to the percentages of type A1-A4 at each stage, whereas the percentages of unlabeled type A cells corresponded to the percentages of type A0 spermatogonia obtained from counts of cells in whole mounts. This confirmed that type A0 cells were generally non-proliferative throughout the cycle of the seminiferous epithelium while the type A1-A4 spermatogonia underwent complete renewal during each cycle. The present results thus support the concept of the existence of two classes of spermatogonial stem cells in rats.


Ultrastructural studies of traumatic cataractogenesis: observations of a repair process in mouse lens. Lenses of CFI mice were studied with the transmission electron microscope at frequent intervals through 13 months following a transcorneal needle injury to the lens. While this kind of injury causes a high incidence of traumatic cataract in the human and frog, it elicits a repair process in the mouse lens whereby the damaged capsule, epithelium and lens fibers are rapidly renewed and permanent lens opacity seldom occurs. Ultrastructural changes in lens epithelial cells adjacent to the wound, which precede and accompany localized cellular proliferation and production of new capsule, involve a rapid increase or enlargement of organelles associated with protein synthesis and assembly. The capsule and epithelium are repaired within a couple of months. Cortical lens fibers in the wound area undergo conformational changes into smaller, ordered arrays of "membranous sacs". These are replaced within a week by normal appearing lens fibers. There is minimal degeneration or hyperplasia noted, and except for a few fibroblastic cells on the lens surface, little evidence remains of the injury by two months. Ultrastructural differences between mouse and human lens, such as presence or absence of dense bundles of microfilaments and desmosomes are considered in relation to lens shape and tension, and susceptibility to injury-induced cataract.


Direct quantitative estimation of Paneth and total cell populations in the jejunal glands of Lieberkühn. Direct morphometric estimation of the number of intestinal crypts per 10 mm length of jejunum, the total number of cells per crypt, and the number of Paneth cells per crypt was performed using Zenker-fixed, serially sectioned small intestines from adult BALB/c mice. The mean volume of a crypt cell was estimated to be in the order of 6.6 plus or minus 0.1 times 10-4 mm-3, while the total volume of all cells in a single crypt was 1.833 plus or minus 0.02 times 10-1 mm-3. The cell population per crypt was 278 plus or minus 7 cells, of which 44 plus or minus 10 were Paneth cells. It was estimated further that 265 plus or minus 30 crypts per 10 mm length of jejunum contained 7.4 plus or minus 0.1 times 10-4 cells, including 1.2 plus or minus 0.24 times 10-3 Paneth cells. The volume of all crypt and Paneth cells per 10 mm length of jejunum was in the order of 49 plus or minus 1.2 and 8 plus or minus 1.8 mm-3, respectively. The volume of the tunica muscularis and the surface area of the crypt's lumina were estimated to be 33.5 plus or minus 2.2 mm-3 and 118 plus or minus 19 mm-2, respectively.


An ultrastructural study of normal human mammary epithelial cells in culture. The ultrastructure of normal human mammary cells cultured from post-weaning breast fluids is described. Cells from confluent monolayers in two week old cultures were studied. The epithelial nature of these cells was established by the demonstration of a well developed system of cell-to-cell interdigitation and numerous desmosomes. These cells also share with breast epithelial cells in vivo, polarity, with blunt short microvilli on the apical surface and an oriented arrangement of organelles in the basal and apical portions of the cells. The Golgi apparatus, which is the most highly developed organelle, is localized in the apical pole and contains substantial quantities of secretory material in the cisternae and vesicles. A variegated palisade of finely granular material mixed with tonofilaments is seen in the basal portion of the cells; many of these tonofilaments end in the terminal web of the desmosomes. The regular occurrence of these cells in breast fluids during the terminal phases of lactation suggests that their separation is a part of normal breast involution.


Anomalous patterns of mammalian oocyte maturation and fertilization. This report illustrates some of the errors that may occur during in vivo and in vitro maturation and fertilization of mammalian ova, considers the possible mechanisms accounting for their occurrence, and discusses their functional consequences. Included in the description are anomalies of oocyte and follicular development, i.e., multinucleated oocytes, polyovular follicles, and aberrations of zona pellucida formation. Also considered are deviations from the normal process of oocyte maturation such as chromosomal anomalies, development of abnormal nuclear structures (subnuclei), inhibition of polar body formation and abberations of polar body structure. Anomalies of the process of fertilization such as polyspermia, sperm penetration into polar bodies, and development of multinucleated blastomers in two-cell embryos are also described.


Ultrastructural immunocytochemical localization of neurophysin in freeze-substituted neurohypophysis. Using an immunohistochemical technique at the electron microscopic level, we have observed that within the axon terminals of the guinea pig neurohypophysis neurophysin is present in the large neurosecretory granules, as well as in the axoplasm. A description of a freeze-substitution technique for neural lobe is also present.


Urinary 4-pyridoxic acid, plasma pyridoxal phosphate, and erythrocyte aminotransferase levels in oral contraceptive users receiving controlled intakes of vitamin B6. Fifteen women who had used combination type oral contraceptives (estrogen plus progestogen) and 9 control women who had never used these agents were given a diet deficient in vitamin B6. After 1 month, this diet was supplemented daily with 0.8, 2.0 or 20.0 mg of pyridoxine hydrocholride for an additional month. At weekly intervals, measurements were made of urinary 4-pyridoxic acid, plasma pyridoxal phosphate, and erythocyte alanine and aspartate aminotransterases. No significan differences were observed between oral contraceptive users and controls in any of the above measured indices. The data suggest that if the use of oral contraceptives of the combined estrogen-progestogen type does alter the requirement for vitamin B6, the effect is a mild one and of doubtful clinical significance to the majority of women taking these steroid preparations. The amount of vitamin B6 (as pyridoxine) needed to maintain normal levels of the above indices of vitamin B6 nutrition in these subjects were between 0.8 and 2.0 mg/day.


Protein deficiency in primates. IV. Pregnant rhesus monkey. Young adult female rhesus monkeys, maintained in a seminatural environment, when pregnant 30 days were fed a balanced semisynthetic diet containing 15.3 percent casein (13.4 percent protein) or 0.5, or 0.25 that amount for the remainder of thir pregnancy. The diets, made isocaloric by the addition of carbohydrates to replace the missing casein, supplied 4, 2, or 1 g protein/kg per day if the animals ate 120 kcal/kg per day, an assumption that was reasonably accurate. We studied the responses of monkeys delivering normal young at term. All monkeys were clinically healthy during the experiment. All reduced their total plasma protein concentration, principally by decreasing their albumin concentration. Greatest loss occurred in the low-protein group. Albuminuria was a common finding in all groups. Food consumption though varying throughout pregnancy, remained fairly comparable from group to group. Weight gain of the highest protein group was greatest; that for the lowest protein group barely covered the weight of the products of conception. Blood pressure declined during pregnancy while blood glucose rose. There were no morphologic changes in hair bulbs and only suggestive changes in liver cells that pointed to increased vacuolation. Increased metabolic efficiency  during pregnancy enables the mother to safely pass through a long pregnancy during most of which she is fed a low-protein diet. Nonpregnant aminals suffer more under the same circumstances.


Protein metabolism during intensive physical training in the young adult. Two groups of men consumed two levels of protein (1.4 and 2.8 g/kg body weight) during a 40-day experimental period. Physical activity and the sweat rates were fairly high during the entire experimental phase. Urinary nitrogen excretions remained fairly constant for both groups during the training and heavy physical activity periods. Nitrogen balances were positive exclusive or inclusive of the daily sweat nitrogen losses showing nitrogen retention. The essentially unchanged blood hemoglobin and serum protein levels showed that the control group was receiving an adequate protein intake to maintain nitrogen equilibrium, under conditions of fairly heavy physical acitvity. Although others may have suggested some compensatory reductions in the urinary excretion of nitrogen under conditions of profuse sweating, our data have not supported these conclusions. It appears that sweat losses of nutrients become relevant in determining requirements and will increase in importance as sweat rates are increased. The data again demonstrate that the nutrient losses during profuse sweating consitute an error that could seriously invalidate the accuracy of metabolic balance studies. In this study, although the men did increase body protein stores and muscle mass with high-protein diets, the additional body protein did not enhance physiological work performance. It is suggested that in this sutdy 100 g of protein/day was adequate for men performing fairly heavy work.


Endogenous fatty acids in alimentary triglyceridemia in normolipemic young males. The contribution of endogenous triglyceride fatty acids (TGFA) in alimentary lipemia was studied in ten normolipemic males under 26 years. Serum, drawn before and during absorption of 50 ml of corn oil, was separated by ultracentrifugation into two fractions, one containing chylomicrons (Sf is less than 400), the second containing all other lipoproteins (Sf is less than 400). The percent of dietary triglyceride fatty acid in each fraction of the postprandial samples was calculated using triglyceride fatty acid percent composition patterns in the meal and each fraction of the fasting and postprandial samples. Corn oil was chosen for the meal because it differs considerably from fasting serum in percent of palmitic (16:0) and linoleic (18.2) acids. The endogenous triglyceride fatty acid in the chylomicron fraction remained constant during the absorption period, while the dietary triglyceride fatty acids reached a peak level of 63 percent of the total at 4 hours and decreased to 50 percent by 8 hours. In the nonchylomicron lipoprotein fraction, the dietary triglyceride fatty acids increased throughout the test period to 29 percent of total triglyceride fatty acids at 8 hours. At 2 hours endogenous triglyceride fatty acids showed a slight increase relative to the fasting level, then decreased continuously at a slow rate so that by 8 hours it was below the fasting level. These data suggest that during alimentary triglyceridemia, dietary triglyceride fatty acies incorporated into chylomicrons during absorption are rapidly released in the serum as free fatty acids and subsequently utilized in hepatic lipoprotein production and secretion. The data also indicate that circulating endogenous triglyceride fatty acids play a role in alimentary triglyceridemia by remaining essentially constant during early and peak periods and then decreaseing to aid in the subsequent recovery.


Functional capacity of the tryptophan-niacin pathway in the premenarchial phase and in the menopausal age. Studies on the interrelationship between female hormones associated with reproduction and the  vitamin B6-dependent enzymes along the kynurenin pathway of trytophan metabolism were carried out in girls with an age less, and more than 10 years (just before the onset of the first menstrual cycle), and in postmenapausal women with and without relative (excess) production of estradioll from the adrenal cortex. It is found that most of the determined metabolites are retained by the girls with age less than 10 years after tryptophan loading without and with vitamin B6 supplementation. Estradiol from either the ovaries (in girls just before menarch), or the adrenal cortex-in postmenopausal women with relative (excess) production of this hormone-interferes with the further degradation of 3-hydroxyanthranilic acid. However, this interference could be completely restored by vitamin B6 supplementation. The extra presence of a partial impairment in the kynureninase enzyme is also suggested in these postmenopausal women. In the latter case, this enzymatic activity could be partially resored by vitamin B6 supplementation. On the contrary, the enzymes: kynureninases and adrenocortical estradio. Pyridoxine supplementation partially corrected the inhibition especially that of 3-hydroxykynurenine transaminase enzyme.


Concurrent and subsequent serum cholesterol of breast- and formula-fed infants. Animal studies have suggested that feeding a high-cholesterol diet early in life will reduce serum cholesterol of later life. We tested this hypothesis by comparing the serum cholesterol of breast-fed children and bottle-fed children. The former type of feeding has a cholesterol content 26-52 mg of cholesterol/8 ounces, and the latter type of feeding has 4 mg/2 ounces. Serum cholesterols were determined by the Wybenga technique. At the end of 4-6 months, both groups were switched from their original feeding to skim milk. The parents were counseled to avoid high-cholesterol content foods such as eggs and to limit the intake of the more moderate cholesterol dietary forms. Our objective was to achieve a cholesterol intake of 200 mg/day for both groups. The serum cholesterol was evaluated at the following ages: 2-4 months, 12 months, 18-24 months, and 15-19 years. The same child was not necessaryily followed longitudinally. Our results indicate that breast-fed children had significantly higher serum cholesterols than bottle-fed children at ages 2-4 months and 12 months. After 1 year, no significant difference in serum cholesterol was found when the two groups were compared. We concluded that no protection against high serum cholesterol in later life occurred as the result of initial feedings high in cholesterol.


Harmful effect of megadoses of vitamins: electroencephalogram abnormalities and seizures induced by intravenous folate in drug-treated epileptics. Folic acid was administered intravenously during constant EEG monitoring to eight epileptic subjects who had received diphenylhydantoin therapy for more than 1 year. Six of the subjects displayed low folate levels by Lactobacillus casei assay in plasma and/or whole blood. Six patients received 75 mg of folate intravenously over a 30-min period without clinical effect of EEG change. One patient exhibited an increase in spike discharges on the EEG in comparison to the baseline pattern, but no clinical change or seizure while receiveing 150 mg of folate in a 30-min period. One patient displayed a 2-sec burst of spike and slow wave activity on the EEG after receiveing 7.2 mg of folate in a 3-min period. A tonic-clonic seizure occured after the infusion of 14.4 mg of folate, and again after infusion of 19.2 mg of folate. There appear to be wide variation in the ability of drug-treated epileptic subjects to tolerate infusions of folic acid. These variations help explain conflicting reports in the literature concerning the effect of folic acid administration on seizure control. Megadoses of folic acid should be employed with great caution in all subjects, but particularly among epileptics. Information is lacking as to whether folate might induce seizures in certain ostensibly normal individuals. It is postulated that folic acid exerts a direct effect among sensitive subjects on existing pathways concerned with the metabolism of folate, histidine, or other important brain metabolites. The mechanism of the anticonvulsant action of diphenylhdantoin remains unknown, but there is considerable evidence to suggest that it interferes with the deamination of histidine.


Vitamin profile of 174 mothers and newborns at parturition. Thiamin, biotin, B12, folate, pantothenate, riboflavin, nicotinate, B6, vitamins A, E, C, and beta-cartene was estimated in the blood of 174 mothers and in the cord blood of their neonates at parturition. A vitamin profile of normal preganancy was established for mother and neonate. This was based on values obtained from 95 percent confidence limits in 74 mothers not taking oral vitamins and 133 mothers ingesting various vitamin supllements. Circulating vitamin levels in 38 neonates born to mothers with no laboratory evidence of hypovitaminemia was persented. The higher incidence of hypobitaminemia in gravidas not taking vitamins was folate, thiamin, vitamins A, C, B12, BL and nicotinate in descending order. Ingestion of vitamins supplements reduced the incidence of hypovitaminemia. A similar relationship held for neonates from these mothers. However, despite vitamin ingestion thiamin, folate, vitamins C, A, B6, B12 and nicotinate hypovitaminemia was evident. There was an approximate 1:2-5 ratio between mother and neonate blood vitamins; vitamins A, B6, E, and beta-carotene were exceptions. Vitamin B6 ran parallel, while vitamins A, B6, E, and beta-carotene ratios reversed in favor of the mother at an approximate ratio of 2:1, 4:1 and 7:1, respectively. It is concluded that vitamin profile for mother and neonate, taking into account values established from a lorge gravid population, should now permit an evaluation of the effects of hypoviteminemia on the outcome of pregnancy and infant health.


Carcinoma of the small intestine associated with transmural ileitis (Crohn's disease). A case of adenocarcinoma of the small bowel arising in pre-existing transmural ileitis (Crohn's disease) is reported and 28 previously reported cases are reviewed. Carcinoma associated with transmural enteritis occurs more often in the distal ileum, in younger patients, and in more males than expected from published data on carcinoma not associated with transmural enteritis. If the patient has had exclusion procedures, the carcinoma has been found to arise in the excluded bowel segment.


Hemochromatosis. Pathophysiologic and genetic considerations. The clinical, genetic, and pathologic findings, and the pertinent case histories in two families with idiopathic hemochromatosis are presented. These studies support the view that idiopathic hemochromatosis is a disease inherited in at least two ways. In one of these families, inheritance appeared to occur in an autosomal recessive manner, whereas in the other, autosomal dominant expression seemed evident. Evidence that an inability of the reticuloendothelial cells to handle iron may play a major role in the pathogenesis of hemochromatosis is presented. The early age of onset and poorer prognosis associated with the recessive inheritance suggest that the defect in reticuloendothelial cell function present in such cases is different from or more severe than those associated with dominant inheritance.


Mast cells and myelofibrosis.

Mast cells and myelofibrosis. Autopsy of a patient with well-documented myelofibrosis revealed marked proliferation of mast cells associated with areas of bone-marrow and splenic fibrosis. The findings suggest that the local fibrosis represents the healed phase of an inflammatory reaction mediated by mast cells via the release of histamine into the tissue spaces. Tissue mastocytosis may be the pathogenetic mechanism in some cases of myelofibrosis.


A rapid, quantitative determination of clottable fibrinogen unaffected by heparin. A turbidimetric assay for clottable plasma fibrinogen which is not sensitive to heparin or Pyran inhibition is described. The basis of the assay is the substitution of Reptilase-R for the thrombin usually employed. The assay correlates very well with a thrombin turbidimetric method and also has other advantages, including better stability of the clotting enzyme and more rapid attainment of equilibrium.


Training and organization for pathology in Britain. The role of chemical pathologists. In Britain, the term "clinical pathology" indicates the discipline of pathology applied to patients, whereas "chemical pathology" refers to pathology in its chemical and biochemical aspects, both as a basic science and for patient care. The initial training of a chemical pathologist is usually in general pathology, in metabolic medicine, or in research. This training continues solely in chemical pathology, and the specialist qualification, namely Membership of the Royal College of Pathologists, is taken at about 32 years of age. Training is similar in the other disciplines of pathology, and a pathologist usually achieves a senior permanent appointment by the age of 34 years. By national policy, pathology laboratories, each with departments of chemical pathology, hematology, histopathology, and microbiology, are centered in about 250 District General Hospitals. The chemical pathology section ideally includes both a medical consultant and an equivalent non-medical scientist. These ideals are unlikely to be reached because of pathologists usually include laboratory supervision, clinical liaison, teaching, and research. Many chemical pathologists also have specific clinical consultant activities, such as overseeing a Metabolic Unit.


Improved culture method for the isolation of Histoplasma capsulatum and Blastomyces dermatitidis form contaminated specimens. Studies were performed to evaluate a method for selective isolation of Histoplasma capsulatum and Blastomyces dermatitidis from contaminated specimens. Ammonium hydroxide placed on an agar medium surface was found to inhibit the growth of many bacteria, yeasts, and saphrophytic fungi normally found in specimens such as animal tissues and sputum. In one study involving the culture of B. dermatitidis from canine tissues, 24% more isolations were obtained on a medium using NH4OH compared with a similar medium. Increases in the isolation of H. capusulatum from sputum specimens were also obtained, ranging from 20 to 32% compared with four other media without NH4OH.


Templates for inoculation and microscopic observation of micro cell cultures. Simple, inexpensive plastic templates have been devised to aid in proper identification of cell cultures in microtiter plates during inoculation and microscopic observation. These have resulted in greater accuracy in performing and reading tests and in a saving of the microbiologists' time.


Benign polyps with prostatic-type epithelium of the urethra. Benign polyps of the male urethra may be composed of prostatic-type epithelium and acini. Usually located in the prostatic portion of the urethra, they have been reported to be a major cause of hematuria in young men. Three new cases are described to foster an awareness of this distinctive clinicopathologic entity.


Crohn's disease of the vulva.

Crohn's disease of the vulva. Three patients with Crohn's disease primarily involving the large intestine had unusual abscesses of the vulvar area. At biopsy, the abscesses had classic features of the primary disease and were clearly separated from the intestinal tract. There was no fistula in the anal canal, and the perineum between the vulvar abscess and the anus was normal. One of the patients also had an early lesion of Crohn's disease in the sigmoid. The lesion appeared as a small erythematous spot without ulceration. Biopsy revealed a typical granuloma under an intact mucosa. It is concluded that Crohn's disease is not confined to the gastrointestinal tract, and that early lesions of the disease within the gastrointestinal tract are submucosal rather than mucosal.


"Mesothelioma of the atrioventricular node" with long-standing complete heart block. Report of a case. A case of mesothelioma of the atrioventricular node is presented. The patient had complete heart block for many years before death. The origin of the tissue in this apparently congenital tumor is discussed with reference to the literature.


Benign osteoblastoma of the ethmoid bone. Report of a case. The second reported case of benign osteoblastoma of the ethmoid bone, in a 13-year-old boy, is described, with emphasis on clinical, radiographic and pathologic features. The characteristics of benign osteoblastoma are briefly elucidated.


Laboratory diagnosis of autoinfection in strongyloidiasis. Among 10,072 examinations of concentrated stools, Strongyloides stercoralis rhabditiform larvae were found in 93, and filariform larvae in four. In two of the four cases harboring filariform larvae, subsequent stools revealed only rhabditiform larvae, but filariform larvae continued to be found in the stools and sputum of the other two cases. It was concluded that only two of the cases were true autoinfections, and the other two apparent cases resulted from prolonged storage of unrefrigerated stools in the hospital ward. The importance of distinguishing true autoinfections from a free-living Strongyloides life cycle in stools is stressed.


Improved micromethod for plasma fibrinogen unaffected by heparin therapy. An improved micromethod for plasma fibrinogen, based on the Ellis-Stransky thrombin-clot density procedure, is presented. Modifications includes: (1) addition of Polybrene eliminates heparin interference; (2) measurement of absorbance at 340 nm provides improved sensitivity at low fibrinogen levels as well as with small volumes of plasma (40 mul.); (3) higher concentration of thrombin reduces the incubation time. Plasma fibrinogen by the proposed method compares well with a reference procedure based on total clottable protein (coefficient of correlation 0.99).


Interpretive reporting of laboratory data. The Schilling test. Using a programmable calculator able to control an output printing device, the Laboratory can issue a comprehensive Schilling test report describing the test, calculating the resulting excretion, interpreting its significance, and cautioning against possible inaccuracies.


Significance of non-steady-state serum digoxin concentrations. In order better to define the optimal time for sample collection, the authors examined the serial concentrations of digoxin in serum and urine of six hospitalized patients during the first 8 hours after administration of their maintenance doses of digoxin. Expressed as % of baseline value, mean serum digoxin concentrations 1/2, 1, 1 1/2, 2,4, 6, and 8 hours after administration of the drug were 167, 185, 228, 256, 175, 145, and 134%, respectively. Steady-state serum concentrations were not established until 6-8 hours after administration of the drug, and high serum values during the first 6 hours did not correlate with clinical and/or electrocardiographic evidence of digoxin toxicity. It is concluded that when serum digoxin levels are utilized as an index of digitalization or toxicity in patients on maintenance therapy, the blood samples should be drawn just prior to the daily dose and no sooner than 6 hours after administration of the drug.


Chronic pancreatitis in African diabetics. Steatorrhea due to chronic pancreatitis was found in 23 percent of a consecutive series of 107 new african diabetics; 3 had pancreatic calcification. Of 16, 14 had definitely abnormal exocirne secretion function testing using secreation pancreozymin stimultion. Themorphology and function of the small intestine were normal by local standards. When compared with diabetics without steatorrhea they weighed less, their fasting blood sugars were lower, and their insulin requirements were greater. High alcoholic intake might be significant cause, but the incidence was similar in the diabetics without steatorrhea. No evidence of childhood or adult malnutrition was established. The etiology of this high incidence of chronic pancreatitis among african diabetics remains unexplained.


The stagnant loop syndrome in childhood: review and report of four patients. Four children presenting with a range of signs and symptoms were found to have chronic intestinal obstruction. Presentations included massive upper-gastronintestinal bleeding, chronic weight loss simulating neoplasm, andprofound megaloblastic anemia. The pathophysiology involved and a brief review of stagnant loop syndrome in childhood are discussed.


Unusual involvement of the rectum by carcinoma of the prostate. The authors present three cases in which carcinoma of the prostate simulates a primary carcinoma of the rectum. Direct invasion by prostatic carcinoma should be included in the differential diagnosis of mass lesions of the rectum in males.


Normal antipyrine metabolism in patients with cholesterol cholelithiasis. Evidence that the disease is not due to generalized hepatic microsomal dysfunction. Plasma antipyrine half-lives and metabolic clearances were measured after a single oral dose of antipyrine in 10 control subjects, 12 patients with gallstones, and 9 patients having undergone cholecystectomy for cholesterol cholelithiasis, to determine whether impairment of hepatic antipyrine metabolism occurs in patients with cholesterol cholelithiasis. The plasma antipyrine half-life and metabolic clearances in the control subjects were 11.7 plus or minus 1.3 hours and 42.5 plus or minus 3.3 ml/min, respectively; in patients with gallstones, 12.3 plus or minus 1.3 hours and 36.0 plus or minus 3.2 ml/min, respectively; and in patients having undergone cholecystectomy, 13.2 plus or minus 1.8 hours and 33.8 plus or minus 4.2 ml/min, respectively. Values for antipyrine half-life and metabolic clearance were not statistically different in these three groups. This study suggests the presence of normal hepatic antipyrine metablosim in patients with  cholesterolcholelithiasis.


The uses and limitations of radioisotopes in the investigation of gastrointestinal diseases. Advances in the physical and biological sciences have in recent years led to a rapidly increasing use of radioactive agents in clinical medicine. The distinctive properties of these agents have made them invaluable for a large variety of unique in vivo and in vitro diagnostic tests. In order to help the clinician employ such tests productively and realistically, we have attempted to review the present status of radiosotopes with regard to gastrointestinal diseases. Emphasis has been placed not only on their value but also on their limitations; the degree of safety for in vivo application has also been briefly considered.


The current mortality rates of radiologists and other physician specialists: deaths from all causes and from cancer. The cohort mortality experience of radiologists and other specialists over a 50-year period was examined on the assumption that these groups would differ relative to a presumed decrease in radiation exposure. Radiologists had an excess in all-cause mortality rates compared to the other specialists for all cohorts who entered the Radiological Society of North America before 1940; the excess remained even when the cancer deaths were removed from the rates. These data are consistent with the concept of accelerated aging due to radiation. The cancer mortality rates for radiologists were higher than those of other specialists for an additional decade through 1949. The 1950-1959 cohort had not aged sufficiently to demonstrate the expected peak cancer mortality in the 60-64 year age group. Several hypotheses are presented to suggest reasons for differences in the trends of age-specific cancer mortality by cohorts of entry.


The current mortality rates of radiologists and other physician specialists: specific causes of death. The cohort mortality experience of radiologists over a 50-year period has been compared to that of other specialists with low levels of radiation exposure. The 1920-1929 cohort of radiologists who joined the Radiological Society of North America had the highest mortality for several chronic diseases. After this early period, radiologists ranked highest only for cancer mortality. The excess risk of leukemia which was observed in the 1920-1929 and 1930-1939 cohorts has subsequently decreased. During the same period, lymphoma mortality, especially multiple myeloma, has been increasing with a significant excess of deaths appearing in radiologists who entered the specialty society between 1930-1939 and 1940-1949. A posible relationship between this finding and immunologic changes induced by radiation has been proposed.


Gestational exposure to rubella vaccinees: a population surveillance study. Over a two-year period an attempt was made to identify instances of transmission of rubella vaccine virus from rubella vaccinees to pregnant women in Nashville-Davidson County, Tennessee. Approximately 24,000 children were immunized in a mass campaign at the outset of the study. Several prospective surveillance methods of 11,635 women and their new babies were employed. Attempts were made to recover rubella virus from throat swabs of 10,951 newborns. No rubella vaccine virus was recovered. Wild rubella virus was isolated from a single infant with the congenital rubella syndrome whose mother had natural rubella during the first month of pregnancy. Rubella virus was not isolated from the products of 240 abortions. There were no seroconversions among 3990 women who had paired sera available for study. Clinical and serologic follow-ups of infants judged to be a high risk because of intimate maternal exposure to vaccine virus revealed no late manifestations of congenital rubella infection. A history of close maternal contact with vaccinees during the three months before and the three months following conception was not associated with an increased incidence of congenital anomalies or clinical features seen with congenital rubella infection. Thus, no evidence of vaccine virus transmission was found, providing further evidence of the safety of rubella vaccine under field conditions. A seroepidemiologic study of 8824 pregnant women revealed the expected decline in rubella susceptibility with increasing age. When age was controlled, the variables of race, parity, and educational achievement produced no major influence on immunity.


Seroepidemiologic survey of coronavirus (strain 229E) infections in a population of children. The indirect hemagglutination (IHA) test for coronavirus 229E antibodies was used for serodiagnostic and seroepidemiologic studies in a population of children. Subjects ranged in age from 5 to 19 years and lived in a home which participated in a longitudinal surveilance of respiratory illness (1960-1968). During this period 1477 respiratory illnesses were observed; 63 (4%) were associated with sero-response (fourfold or greater antibody rises) to 229E. An additional 105 sero-responses were associated with unreported or subclinical illness. The frequency of these infections was cyclical, and 229E and coronavirus OC 43 infections peaked in different years among the same population. Sero-responses occurred mainly in the fall, winter and spring quarters. Preexisting antibody was demonstrated in one-third of the children with 229E sero-responses. Clinical studies indicated that the most frequent complaints with 229E infections were sore throat, coryza and cough, and the most frequent findings were pharyngeal injection, coryza and fever.


Cardiac arrest due to oral potassium administration. Cardiac arrest developed in two patients after the administration of oral potassium. Neither patient had renal insufficiency, but both had underlying heart disease. In one patient fatal ventricular fibrillation developed 4 days after he received an aortic valve replacement for aortic stenosis and while he was receiving oral potassium supplements. The serum potassium level before cardiac arrest was 8.1 meq. The second patient had angina and was given 40 meq of potassium orally 15 minutes after an exercise test which produced chest pain and S-T segment depression. One hour later, ventricular fibrillation developed. Resuscitation was successful. Both patients had electrocardiographic evidence of hyperkalemia. Oral administration of potassium may produce severe cardiac toxicity in patients with heart disease even when renal function is clinically normal.


Hemodynamic effects of staged hematocrit reduction in patients with stable cor pulmonale and severely elevated hematocrit levels. Patients with cor pulmonale and high hematocrit levels are often subjected to phlebotomy in the belief that the adverse effects of high viscosity may outweigh the benefit of increased oxygen carrying capacity. To evaluate this, 12 patients with stable cor pulmonale and hematocrit values greater than 55 per cent were studied before and after a series of venesections. Right heart and aortic pressures, cardiac output and blood gases were measured at three mean hematocrit levels, 61 per cent (stage I), 50 per cent (stage II) and 44 per cent (stage III), with blood volume unchanged. From stages I to II, there were significant decreases in both man pulmonary artery pressure and total pulmonary resistance. Oxygen transport fell but not oxygen consumption. Right ventricular end-diastolic pressure and cardiac output did not change. Right ventricular work either fell or was maintained by increased output. Frank-Starling performance (supine exercise) improved. No significant changes occurred with further reduction in hematocrit to normal levels (stage III). The findings of this study support the concept of overcompensating erythrocytosis in cor pulmonale, and the effects of moderate hematocrit reduction should not be overlooked in these severely ill patients.


Reduction of prehospital, ambulance and community coronary death rates by the community-wide emergency cardiac care system. Initiation of quick prehospital cardiopulmonary resuscitation and emergency cardiac care completed the total system needed to provide emergency and convalescent coronary care for a community. Subsequently, annual community rates for coronary death during ambulance transport fell by 62 per cent and for prehospital coronary death by 26 per cent in people under 70 years of age. In cardiac arrest due to acute myocardial infarction, prompt successful prehospital correction of ventricular fibrillation and asystole yielded long-term survival in two thirds of cases. This 66 per cent success rate of prehospital cardiopulmonary resuscitation and emergency cardiac care is identical to contemporary international experience. Precordial thump-version with the fist and precordial fist pacing appeared logical additions to prehospital cardiopulmonary resuscitation and emergency cardiac care technics. Community lives saved yearly were 15.2/100,000 people aged 30 to 69 years and 6.4/100,000 total population. Simultaneously, annual community rates for coronary death as a cause of death and coronary death per 1,000 people fell significantly by 15 and 17 per cent, respectively. Unquantifiable influences included prehospital relief of ischemic chest pain; prehospital correction of acute dysautonomia; prehospital abolition of otherwise prefatal dysrhythmias; similar treatment for acute myocardial infarction in the emergency department, in the inhospital mobile coronary care unit and in the progressive intermediate coronary convalescent unit; and general community education through the media of newspapers, radio and television. The present frequency of coronary death during ambulance transport, 9 to 22 per cent of prehospital coronary deaths in this and other surveys, suggests that the prehospital cardiopulmonary resuscitation and emergency cardiac care component needs improvement in many communities. By reducing prehospital and ambulance coronary death rates, prehospital cardiopulmonary resuscitation and emergency cardiac care for acute myocardial infarction constitutes an essential component of the total system approach to emergency coronary care. Since prehospital cardiopulmonary resuscitation and emergency cardiac care have cheaply and effectively expedited and abbreviated hospitalization for acute myocardial infarction, and lowered community death rates from coronary artery disease, its adoption throughout the United States and the western world seems justified.


Intraaortic balloon counterpulsation in patients in cardiogenic shock, medically refractory left ventricular failure and/or recurrent ventricular tachycardia. Of the 27 patients described, 23 were in cardiogenic shock, 2 had severe left ventricular failure, and 2 had medically refractory ventricular tachycardia. Utilizing intraaortic counterpulsation, adequate systemic blood pressure was initially restored in 19 patients. Nine of these were subsequently weaned from circulatory assistance, but only three were discharged from the hospital and are currently alive. The remaining 10 patients who derived initial benefit from circulatory assistance were balloon-dependent in that they could not be weaned from circulatory assistance. Eight of these patients subsequently underwent cardiac catheterization; four had inoperable disease. The remaining four patients underwent surgery for either resection of the area of infarction and/or for myocardial revascularization; only one survived to subsequently leave the hospital. Ventricular volumes were abnormal and ejection fractions were below 30 per cent in all the patients in cardiogenic shock except one who underwent cardiac catheterization and ultimately died. Ejection fractions were greater than 30 per cent in the two patients with cardiogenic shock who were weaned from balloon support and survived to leave the hospital without surgery. Both of these patients had inferior myocardial infarction. The data obtained from this experience suggest that intraaortic counterpulsation is a very useful adjunct to currently existing medical measures to treat both cardiogenic shock and medically refractory left ventricular failure but that most patients have such extensive disease that they can neither be weaned from balloon support nor undergo successful infarctectomy or myocardial revascularization.


The effects of practolol on the dysrhythmias complicating acute ischemic heart disease. The cardioselective beta-adrenoceptor blocking agent practolol was used in the management of ventricular and supraventricular dysrhythmias associated with acute myocardial infarction in 134 patients, and in the management of these dysrhythmias in 19 atients with acute myocardial ischemia. Practolol was frequently effective in controlling ventricular dysrhythmias which occurred within the first 24 hours after the onset of symptoms of acute myocardial infarction. It was also effective in controlling the ventricular dysrhythmias which occurred after resuscitation from ventricular fibrillation. It was of particular value when therapeutic doses of lidocaine had been ineffective. Practolol was much less effective in controlling ventricular dysrhythmias which occurred more than 24 hours after acute infarction. Atrial fibrillation and atrial flutter were infrequently abolished by practolol in undigitalized patients after acute myocardial infarction. There was no correlation between the effectiveness of practolol and the blood concentration of the drug. One adverse effect of practolol was the occurence of sinus bradycardia with or without an increase in the frequency of ventricular ectopic beats. Bradycardia was sometimes accompanied by hypotension. Severe hypotension occasionally occurred in the absence of bradycardia.


Pathogenesis of hypertension in Cushing's syndrome. Steroid production, plasma renin activity (PRA) and plasma renin substrate (PRS) were measured in eight patients with hypertension due to Cushing's syndrome of benign origin. Despite elevation of cortisol secretion in all patients, hypokalemia and suppressed PRA was noted in the one subject with a functioning adrenal adenoma. PRA was normal in six patients on an unrestricted sodium intake but was markedly increased in the two patients on low salt diets. PRS was significantly increased during active disease, but decreased substantially with treatment. The absence of uniform hypokalemia and of suppression of renin indicates that mineralocorticoid production could not account for the increase in arterial pressure. It is suggested that glucocorticoid-induced hypertension may be initiated by alterations in vascular responsiveness to pressor agents and that elevated PRS levels may contribute to increase angiotensin formation.


A year's experience with tuberculosis in a private urban teaching hospital in the postsanatorium era. Because brief general hospital admission and extended ambulatory management have replaced sanatorium care for tuberculosis, we reviewed 41 cases admitted to a private urban hospital during 1971-1972 to assess the spectrum of disease and the problems created by the closing of sanatoriums. Almost half the cases were misdiagnosed, exposing an average of 35 hospital personnel to unisolated patients with positive smears. Clinical manifestations often were subtle. Of those with pulmonary involvement, 14 per cent denied having symptoms and less than half had positive sputum smears. Transfer to ambulatory care for half the patients was complicated by having different physicians manage their hospital and outpatient care, with poor communication between the two. Outpatient physicians were sent discharge summaries for fewer than two thirds of their patients, and then only after an average 2 1/2 month delay. Similarly, slowness in case reporting impaired contact investigation. Only three contacts were identified per patient, and only 71 per cent of these were investigated. Improved diagnostic ability, better communication with public health workers, and attention to details of transfer to ambulatory care are necessary for effectively integrating the present components of tuberculosis management.


The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy. A study of 36 necropsy patients. The natural history of the cardiovascular manifestations of systemic lupus erythematosus (SLE) have been altered by corticosteroids which exert their own cardiovascular effects. This study describes clinical and necropsy observations in 36 corticosteroid-treated patients with SLE and compares them to necropsy observations in patients with SLE reported before the use of corticosteroid therapy. The 36 patients averaged 32 years of age, and 33 were women. Systemic hypertension was present in 25 (69 per cent) and left ventricular hypertrophy in 23 (64 per cent) patients. Hypertension was twice as common in the 19 patients who received this drug for more than 12 months (average 38 months) than in the 17 patients who received this drug for less than 12 months (average 6 months), and was almost five times more common among our patients than in patients with SLE in the presteroid era. Congestive cardiac failure occurred in 15 patients (43 per cent), eight times more frequent than that reported in noncorticosteroid-treated patients with SLE. Subepicardial and myocardial fat was increased in all 36 patients. Lupus carditis was similar in frequency but differed morphologically in our patients compared to those not treated with corticosteroids. Libman-Sacks-type endocardial lesions, present in 18 (50 per cent) of our patients, were smaller, fewer in number, univalvular rather than multivalvular, and mainly left-sided. Most verrucae were either partly or completely healed, and some were calcified. Pericarditis, present in 19 (53 per cent) patients, was predominantly of the fibrous type. Myocarditis was present in three patients, each of whom also had endocarditis and pericarditis. The lumen of at least one of the three major coronary arteries was narrowed more than 50 per cent by atherosclerotic plaques in 42 per cent of the 18 patients who received corticosteroids for more than 1 year, but in none of the 17 patients who received corticosteroids for less than 1 year. Four of the eight patients with narrowed coronary arteries had myocardial infarcts. Although vital to the management of SLE, corticosteroids have an over-all deleterious effect on the heart. Systemic hypertension and left ventricular hypertrophy appear or, when present, worsen; congestive cardiac failure increases; epicardial apartment of Me


Hypertension corrected by discontinuing chronic sodium bicarbonate ingestion. Subsequent transient hypoaldosteronism. A 52 year old man with a long history of marked hypertension, peptic ulcer disease, nephrocalcinosis and intermittent hypercalcemia was referred to be evaluated for primary aldosteronism suspected on the basis of low plasma renin activity, hypokalemia and blood pressure responsive to spironolactone. Aldosterone excretion, however, was extremely low. Alkaluria, high urinary sodium excretion and hypercalciuria were observed. The patient admitted to chronic ingestion of large amounts of baking soda. Upon cessation of alkali abuse, his blood pressure fell dramatically; orthostatic hypotension, concomitant azotemia, hemoconcentration, hyperkalemia and weight loss occurred. Despite dramatic elevation in plasma renin activity, urinary aldosterone excretion remained low during this period. Adrenal glucocorticoid secretion was intact. All abnormalities of sodium, potassium and aldosterone subsequently returned to normal. A 10 day challenge with oral sodium bicarbonate was associated with a rise in blood pressure, but serum calcium remained normal. The patient remains normotensive 15 months after discontinuing alkali abuse.


A-V conduction disturbances in Reiter's syndrome. High grade atrioventricular (A-V) block is a rarely described complication of Reiter's syndrome. This 65 year old man had recurrent episodes of arthritis, conjunctivitis and urethritis beginning at age 16. A prolonged P-R interval was first noted at age 32. The conduction distrubance progressed to intermittent episodes of high grade and complete heart block by age 65. His bundle electrograms located the site of block above the level of the bundle of His. Atrial pacing to rates of 150/min produced 5:1 A-V block, whereas exercise and atropine administration resulted in 1:1 A-V conduction. In view of these results, artificial pacemaker therapy is not indicated. The association of  conduction disorders and Reiter's syndrome is reviewed.


American Burkitt's lymphoma: a clinicopathologic study of 30 cases. I. Clinical factors relating to prolonged survival. The presenting clinical characteristics and the results of therapy in 30 cases of American Burkitt's lymphoma are described. Five patients presented with localized disease. The abdomen was the most frequent site of involvement (19 cases). Serum lactic dehydrogenase (LDH) levels closely correlated with extent of tumor mass. Of the 22 patients treated with large doses of parenteral cyclophosphamide, complete remission was achieved in 13 (59 per cent). Of these only four have had a relapse, all within 12 months of treatment. The remainder are alive, free of disease and have not received any treatment for up to 80 months or more. The site and volume of tumor mass predicted for prolonged survival. None of the six patients with bone marrow or central nervous system involvement remained tumor-free. A complete remission was achieved in 8 of 9 patients with presenting LDH levels of less than 700 IU/ml and they have remained free of disease, whereas only 4 of 13 patients with LDH levels greater than 700 IU/ml had a complete response and 3 of these had a relapse within 12 months. In six cases, the massive tumor regression following chemotherapy was associated with serious metabolid consequences including hyperkalemia (six cases), hypocalcemia, hyperphosphatemia (one case) and lactic acidosis (one case). There were four sudden deaths in less than 48 hours after chemotherapy; two of these were attributable to hyperkalemia. In all cases therw were large tumor masses and/or elevated serum LDH levels.


Capillary basement membrane width in diabetic children. The effect of juvenile onset diabetes mellitus on quadriceps muscle capillary basement membrane (QCBM) width has been examined by the electron microscopic morphometric method previously developed in this laboratory. The results demonstrate that in this age group QCBM thickening is strongly related to the age of the diabetic subject. As a result, in contrast to the almost constant thickening of QCBM that has consistently been documented in diabetic adults, QCBM hypertrophy is present in only 40 per cent of children with diabetes mellitus. As was previously shown to be the case in adults, in children, too, QCBM thickening is unrelated to the duration of the diabetes. Finally, the finding that QCBM hypertrophy is present at the time of acute onset of juvenile diabetes mellitus in 30 per cent of children, coupled with the fact that this lesion is not affected by duration of hyperglycemia, strongly supports our previous conclusion that diabetic microangiopathy is independent of the hyperglycemia of this disease. On the other hand, barring the possibility that microangiopathy in the pancreas precedes that in muscle, these results represent evidence against the suggestion that basement membrane hypertrophy represents the primary lesion of the diabetic syndrome.


IgA heavy chain disease. A case detected in the western hemisphere. IgA heavy chain disease (alpha chain disease) was detected in a 46 year old South American (Colombian) of mixed Spanish and Indian (Mestizo) descent. The clinical course was characterized by severe malabsorption, initially thought to be a variant of tropical sprue. Jejunal mucosal biopsy revealed marked villous atrophy with heavy infiltration of the lamina propria by a single monotonous cell type which, by light microscopy, had the appearance of either a large, abnormal plasma cell or a small histiocyte. Electron microscopy of the biopsy specimen demonstrated the presence of abnormal plasma cells, lymphatic distention and abnormalities of surface epithelial cells. At autopsy a 6 by 3 cm mass was found in the right para-aortic area along with many firm 2 cm mesenteric and para-aortic lymph nodes. Histologic examination revealed the presence of a monotonous cell type similar to that found in the jejunal mucosal biopsy specimen.


Ultrastructure of the lung in Loeffler's pneumonia. A case is presented fulfilling the diagnostic criteria of "Loeffler's eosinophilic pneumonia". No etiologic factors could be determined, and the chest roentgenogram returned to normal. Lung biopsy at the peak of the disease demonstrated an interstitial eosinophilic pneumonia without tissue necrosia or vasculitis. By electron microscopy, the alveolar capillary basement membranes were intact and exhibited no immune deposits. Normal appearing eosinophils were abundant in the alveolar capillaries, interstitium and alveolar spaces. Occasional eosinophils released their granules within the alveolar wall. Macrophages were increased in number in both the alveolar wall and alveolar spaces.


Use of stepwise regression computer program as an aid in the selection of medical technology students. To meet the problems encountered due to increased numbers of qualified applicants to the medical technology program, it was deemed necessary to devise procedures for student selection which might include additional measures for predicting the academic success of student applicants. The stepwise regression program utilized in this study is one parameter which is currently being explored in relation to the student selection process. Evaluation of the program will take a period of several years in order that the progress of successive groups of students may be carefully studied. It must be recognized that this type of program may have more value for a univeristy-based medical technology program wherein students tend to have a rather homogenous course background, than for programs in which students come from several affiliated colleges or universities and therefore have a diverse type of academic background.


Relative effectiveness of various letter discrimination procedures in directionality pretraining. Two investigations were conducted to provide information relevant to programming basic reading skills for retarded individuals. Both experiments utilized various procedures to teach subjects to discriminate between the letters b and d. The role of feedback and task format conditions was investigated in Experiment 1. Results indicated that two-choice discrimination learning was significantly more difficult than either oddity or matching-to-sample conditions. In Experiment 2 the effects of problem type and sample reduncancy were examined. Analyses indicated that simultaneous matching-to-sample procedures were significantly easier than successive matching-to-sample procedures. Performance with a delayed matching-to-sample transfer task did not reflect differential effects of training in either study.


Experimental evaluation of sensorimotor patterning used with mentally retarded children. In the present study, a sensorimotor "patterning" program used with 66 institutionalized, mentally retarded children and adolescents was evaluated. The subjects were randomly assigned to one of three groups: (a) Experimental 1 group, which received a program of mobility exercises including patterning, creeping, and crawling; visual-motor training; and sensory stimulation exercises; (b) Experimental 2 group, which received a program of physical activity, personal attention, and the same sensory stimulation program given to the first group; or (c) Passive Control group, which provided baseline measures but which received no additional programming as part of the study. Experimental 1 group subjects improved more than subjects in the other groups in visual perception, program-related measures of mobility, and language ability. Intellectual functioning did not appear to be enhanced by the procedures, at least during the active phase of the project. The results were discussed with reference to other researchers who have failed to support the patterning approach, and some reasons were suggested for the differences between the present and past investigations.


Behavioral characteristics of habilitated retarded persons. An assumption that habilitated retarded persons had higher social competence than nonhabilitated persons was investigated by comparing 65 discharged residents of Lynchburg Training School and Hospital who had completed vocational training with 60 residents matched in age and IQ. The results obtained from the hospital record revealed that the habilitated group fought less but attempted to escape and cursed more than the nonhabilitated group. Social history indicated the existence of cultural-familial components in the majority of the habilitated group. Psychometric scores, the Emotional Index of the Bender Gestalt test, and an analysis of the medical diagnosis supported the above finding. Since interpersonal adjustment was an important factor in successful habilitation, an increased emphasis on counseling in vocational-training programs was suggested.


Utilization of position cues by retarded children in serial learning. The ordinal position hypothesis of serial learning was tested using a population of mentally retarded subjects (IQ=46 to 86). The subjects learned two serial lists by either the serial-recall of serial-anticipation procedures. One-half of the items from the first list retained their same serial positions in the second list (experimental items); the other half were switched to new positions (control items). Support for the ordinal-position hypothesis (faster learning of experimental than control items) was obtained only when the first serial list was learned by the serial-anticipation procedure. The results were consistent with earlier findings using nonretarded subjects.


Training EMR and intellectually average adolescents of low and middle SES for formal thought. This study was designed as an attempt to train EMR and intellectually average adolescents to achieve the stage of formal thought. The sample consisted of 120 white male subjects from secondary public schools. Sixty met the EMR criteria and 60 met the criteria for average intelligence. Thirty of each of these were of middle SES and 30 of low SES. Lister's (1970) training procedure was used. The results indicated that three was only negligible transfer. The results also indicated that the training was effective in helping the subjects' competence on the trained tasks. A significant interaction between SES and intelligence was also found. This finding was discussed in terms of the utility of the IQ test as a useful diagnostic tool with all SES levels.


Alternatives to the design of manipulating a variable to compare retarded and nonretarded subjects. In the design of manipulating a single variable to compare the performance of retarded and nonretarded subjects, the groups' response to the variable cannot demonstrate a loss of ability of retarded subjects. This is because tasks (measures at points on the variable) which differ on difficulty or on reliability also differ in power to distinguish subjects of differing ability. A solution is to hypothesize a differential deficit (greater deficit in response to one variable than another) and manipulate two variables. The tasks should be matched at all difficulty levels on reliability, mean, and variance of item difficulty and shape of the distribution of item difficulty.


Factors related to the attitudes of nonretarded children toward their EMR peers. Four hundred and twenty nonretarded children of both sexes attending grades five through eight in a suburban public school system were administered two attitude scales to determine the possible effects of contact, IQ, CA, and the educational level of the respondents' parents on attitudes toward their EMR peers. On one of the instruments, subjects who had contact with EMR peers reported more favorable attitudes, while on the other instrument, no differences were found. Of the subjects having contact, no differences were observed among high- and low-IQ groups. In general, the older the subjects, the more favorable were their attitudes. No differences were reported between male and female subjects. In all groups studied, the higher the level of educational attainment of the subjects' parents, the more negative were the subjects' attitudes toward their retarded peers.


Probability learning in retarded children with differing histories of success and failure in shcool. The effects of school-induced success and failure experiences on the probability-learning performances of retarded children were investigated. In previous laboratory research, the hypotheses has been suggested that failure experiences would lead to greater maximization, less patterning, and less shifting of responses than success experiences. Fifteen retarded children exposed to repeated failure in the classroom, 15 retarded children exposed to a relatively high level of success in special-education classes, and 15 nonretarded children served as subjects. All subjects were matched for MA. The hypothesis suggesting that the laboratory findings generalized to the classroom was confirmed. In addition, it was found that locus of control and need for achievement were significant correlates of probability-learning performance. However, only locus of control differentiated the subject groups.


Measuring adaptive behavior: the dynamics of a longitudinal approach. The  Adaptive Behavior Checklist was administered annually to the residents of the Miami (FL) Sunland Training Center for 4 consecutive years. As a means of assessing adaptive behavior, this checklist, was used to provide feedback as to the progress made by the residents, thus monitoring the effectiveness of the institution in achieving certain behavioral objectives. Data from a longitudinal study are presented along with the means by which the results were communicated to the staff. Correlations of the checklist with standard IQ scores were discussed as was the effectiveness of a revision of the Adaptive Behavior Checklist.


Employee satisfactions in agencies serving retarded persons. The work satisfactions of individuals employed by three agencies serving retarded persons were examined. The results contradicted the view held by most administrators that the individual's level of overall satisfaction is determined principally by his attitudes concerning employment in the field of mental retardation. Rather, the data suggest that satisfaction with the specific agency is the chief determinant of overall satisfaction. Extensive contact with clients and the perceived lack of client progress were found to be important sources of staff dissatisfaction. Finally, client-related dissatisfactions were often attributed to agency or staff deficiences. Implications for altering administrative practices were discussed.


Effects of temporal grouping and redundancy level on the paired-associate learning of retarded adolescents and nonretarded children. Institutionalized adolescents and nonretarded third-grade children were presented with sets of paired associates which differed in redundancy level and temporal grouping. Redundancy level (33 and 50 percent) was embedded in a list of paired associates by varying the number of repetitions in the response terms. The paired associates were presented temporally in blocks of twos (33 percent) or threes (50 percent). One-half of the subjects received the paired associates highly organized; i.e., all response terms of a temporal block were the same. During testing, all stimulus terms were presented simultaneously for the free-ordered recall of the response terms. For both groups, performance was superior following the more highly organized (congruent) presentation, with the performance of the nonretarded subjects exceeding that of the retarded adolescents. Comparisons were made with previous studies in this series.


Effects of verbal rehearsal on discrimination learning in moderately retarded and nursery-school children. In a simultaneous discrimination task with intradimensional shift, low-IQ and average-IQ children were required either to rehearse audibly a phase relating the positive cue to reward or not to rehearse audibly. A limited number of rehearsal trials substantially reduced discrimination errors and the facilitating effect transferred fully when new color cues were introduced and audible rehearsal stopped. Retarded subjects tended to need extra prompting to rehearse, but their discrimination performance showed no reliable deficit. It seems valuable to view the equal-MA deficit that retarded subjects have previously displayed on discrimination tasks as a consequence of deficiency in short-term memory strategies.


Low-IQ deficit in intradimensional discrimination shift despite overtraining and verbal feedback. One hundred and twenty low-IQ and average-IQ children (MA 5 to 7 years) were required to learn a 2-choice discrimination involving verbal and manual responses, with verbal correction of errors, before proceeding to an intradimensional shift with new color cues. One-half of each group also received 100 interpolated trials (overtraining) on the original task. Results disclosed a low-IQ deficit during original learning, which was absent during overtraining but recurred in the final phase, undiminished by either overtraining or verbal feedback conditions applied during the transfer phase. The findings oppose a theoretical explanation based on probability of attending to color, since the inference that this probability approximated 1 for all subjects was amply justified, thus emphasizing the need for alternative interpretations of the retarded subjects' difficulty.


Perceptual-motor testing of mentally retarded persons. The application of a restructured subtest of an intelligence scale to retarded persons, including those with Down's syndrome, led to no significant differences according to diagnostic group. With several subjects (10 percent of the total), more difficult tasks could be accomplished with success in contrast to simpler ones, and such findings were discussed in terms of increased structure and learning sets.


A black female with the 48, XXXX chromosome constitution. The case of a 19-year-old severly mentally retarded Black female with a 48,XXXX chromosome constitution is reported. She had low-set ears, minimum webbing of the neck, small inverted nipples, and tapering of the extremities. All ten digital patterns of the fingers were ulnar loops, resulting in a marked reduction of dermal ridge counts.


Hysteroscopic diagnosis of endometrial carcinoma. A report of fifty-three cases examined at the Women's Clinic of Kyoto University Hospital. This presentation defines the instrumentation and technique of hysteroscopy for diagnosis of endometrial carcinoma. Fifty-three patients with abnormal uterine bleeding were examined by hysteroscopy, followed by curettage which confirmed the diagnosis of endometrial carcinoma. It was felt that hysteroscopy not only could detect the existence and extent of endometrial carcinoma but also might depict histologic structures near the surface of cancerous lesions. Dilatation, hysteroscopy, and curettage should be an excellent method for diagnosis of endometrial carcinoma, perhaps replacing conventional dilatation and curettage.


The effect of legalized abortion on morbidity resulting from criminal abortion. In order to examine the effect of legalized abortion on the complications of criminal abortion, a surveillance system was established at a large urban hospital in Atlanta, Georgia. Between 1969 and 1973, legally induced abortions at this hospital increased logarithmically from 8 to 498 per quarter year. The number of women admitting to attempts at illegal abortion decreased significantly, but the decline began only after three years of increasing numbers of legal abortions. A slight decrease in the number of septic "spontaneous" abortions also occurred. Making legal abortion services available can result in a decrease in morbidity associated with illegal abortions, but the availability of legal abortion must be sufficiently broad to obviate having to resort to criminal means.


Perturbations of the human menstrual cycle by oxymetholone. The luteolytic activity of oxymetholone, and anabolic steroid, has been evaluated in 10 women. Administration early in the follicular phase of the cycle inhibited ovulation and prolonged the duration of the cycles in 2 of 3 subjects, but treatment beginning on Day 10 (3 subjects) did not prevent ovulation, although subsequent plasma progesterone concentrations were reduced. Treatment after ovulation (4 subjects) suppressed progesterone levels by 50 to 80 per cent and shortened cycle length by 6 to 8 days. Side effects were weight gain and bromosulfophthalein retention. The most likely mechanisms producing these perturbations are the inhibition of luteinizing hormone release early in the cycle and, later, inhibition of progesterone biosynthesis.


Maternal and fetal plasma levels of pyridoxal phosphate at term: adequacy of vitamin B6 supplementation during pregnancy. The effect of different amounts of vitamin B6 supplementation during pregnancy on maternal and fetal plasma levels of pyridoxal phosphate (PLP) at term has been studied. Ten of 13 subjects given 2 to 2.5 mg. of vitamin B6 daily exhibited plasma PLP levels lower than 4.7 ng. per milliliter (the lower limit of normal for nonpregnant subjects). In contrast, only 4 of 11 subjects given a supplement of 10 mg. of vitamin B6 daily had plasma PLP less than this value. The mean plasma PLP level (64.4 ng. per milliliter) of 10 cord blood samples from newborn infants whose mothers exhibited plasma PLP levels greater than 4.7 ng. per milliliter was significantly higher (P less than or equal 0.005) than that (34.2 ng. per milliliter) from 14 newborn infants whose mothers had abnormally lowered plasma PLP concentrations. In cord plasma, an average venous-arterial gradient of 10.6 ng. per milliliter was observed, indicating that the fetus retains and/or degrades PLP. These results suggest that more than 2 to 2.5 mg. of vitamin B6 supplement daily is required for most pregnancies to restore normal vitamin B6 nutrition in the mother and, perhaps, also in the fetus.


Plasma deoxyribonucleic acid concentrations of women in labor and umbilical cords. The concentration of deoxyribonucleic acid (DNA) in plasma from 30 women in labor and plasma from the umbilical cords was determined with a rapid, inexpensive, and simple fluorometric method. These concentrations of DNA were compared to the plasma DNA concentrations of nonpregnant women. The mean plasma DNA concentration of women in labor was significantly lower than the mean plasma DNA concentration of nonpregnant women in the use of 99 per cent confidence limits. The mean plasma DNA concentration of umbilical cords during the third stage of labor was significantly lower than the mean plasma DNA concentrations of women in labor with the use of 99 per cent confidence limits and of nonpregnant women using 99.9 per cent confidence limits.


A rapid method for the measurement of estradiol and hydrocortisone levels in maternal and fetal blood and amniotic fluid. Estradiol and hydrocortisone levels in maternal and fetal (umbilical cord) blood in human pregnancy can be simultaneously assessed by this method. Chromatography on microcolumns of Sephadex LH-20 with benzene:methanol (85:15) as developing solvent is used to separate estradiol, hydrocortisone, and isatin (a yellow-colored substance used as marker) from interfering steroids. Human late pregnancy plasma is used as the source of both sex hormone-binding globulin and transcortin for the competitive protein-binding assay of estradiol and hydrocortisone, respectively. The method is rapid enough to permit the monitoring of a high-risk pregnancy for plasma estradiol levels on a daily basis. The method is sensitive enough to permit assessment of perinatal adrenocortical function. Hydrocortisone levels can be measured in as little as 3 ml. of amniotic fluid obtained by amniocentesis and preliminary results indicated that hydrocortisone can be determined in as little as 0.1 ml. of fetal scalp blood or newborn baby blood.


The significance of meconium staining.

The significance of meconium staining. Meconium staining of the placenta and/or fetal body was present at birth in 10.3 per cent of 42,000 live-born infants, but present disproportionately in 18.1 per cent of 788 neonatal deaths. The neonatal mortality rate was 3.3 per cent in the stained group and 1.7 per cent in the nonstained group. Among infants who died, the incidence of erythroblastosis was quadrupled and that of cardiovascular malformation was doubled in the stained group. Meconium staining was associated with a decrease in the expected frequency of hyaline membranes and atelectasis even in premature infants; hypotheses for this phenomenon were presented. Meconium staining of the fetus or placenta requires several hours of exposure. As a hypothesis, the observed increase of deaths in stained neonates may be related to the stresses of cumulative or chronic hypoxia which may occur after the initial passage of meconium if delivery is prolonged.?23AUTHOR


Cord blood coagulation studies in infants of high-risk pregnant women. A prospective study of cord blood for coagulability, evidence for disseminated intravascular coagulation (DIC), and hematocrit was done in 106 infants who were offspring of mothers with high-risk pregnancies (pre-eclampsia, diabets mellitus, third-trimester bleeders, severe erythroblastosis fetalis, maternal hypertension, fetal distress, and spontaneous premature labor). Significant changes of hypercoagulability (low AT-III and abnormal TEG) were seen in the third-trimester bleeder and premature labor groups which also had the highest incidence of IRDS and necrotizing. Infants undergoing "stress" (pre-eclampsia, fetal distress) had elevated levels of factors V and VIII but were not hypercoagulable or AT-III deficient. Except for mild thrombocytopenia, infants of the diabetic mothers, a group with increased thrombotic complications, did not show any cord blood abnormalities. Offspring of third-trimester bleeders were anemic. The EBF infants were also anemic, severely hypercoagulable, and showed coagulation changes compatible with severe liver disease and/or DIC. Mild changes compatible with intravascular coagulation were seen in six infants and were not related to the the development of IRDS.


Correlation of fetal heart rate, maternal heart rate, and age of pregnancy. External fetal electrocardiography was performed in three groups of normal pregnant patients delivered of normal newborn infants. Maternal and fetal heart rates were compared and maternal heart rates in the three trimesters were analyzed. Mean heart rates, as well as standard deviations of the three groups, were compared in mother and fetus. The results confirm previous work establishing the independence of fetal and maternal heart rates in the absence of maternal hemodynamic changes mediated by various factors.


Cesarean section prevents placenta-to-infant transfusion despite delayed cord clamping. We have adapted and calibrated an accurate method for measuring residual placement blood volume (RPBV). We used this method in 33 normal vaginal deliveries and 18 cesarean section deliveries in which the umbilical cord was clamped from 5 to 118 seconds after delivery. Infants born vaginally received 10 to 20 ml. per kilogram of body weight of placental transfusion when umbilical cord was not clamped until 30 seconds or more after delivery. Equivalent delay of umbilical cord clamping in cesarean section infants produced no placental transfusion.


Intra-amniotic urea as a midtrimester abortifacient: clinical results and serum and urinary changes. Seventy-four patients, from 16 to 20 weeks pregnant, received intra-amniotic urea (80 Gm.) and intravenous oxytocin for the purpose of inducing abortion. Seventy-one of the 74 patients were successfully aborted by the primary method with a mean injection-to-abortion interval of 18.33 hours. There were no serious side effects, and the mean hospital stay was 32 hours. Following urea injection, the mean serum urea nitrogen rose to 33 mg. per cent at 4 hours. Maximum changes in serum electrolytes occurred at 8 to 12 hours after injection and included a decrease in the mean concentrations of sodium, chloride, and carbon dioxide and an increase in serum potassium. An increase in the urinary excretion of urea began within 4 hours, but significant diuresis did not occur in the presence of intravenous oxytocin administration. There was a significant increase in the leukocyte concentration while hematocrit values remained unchanged. Beginning approximately 8 hours following urea injection, the mean plasma fibinogen concentrations decreased by approximately 15 per cent and the mean platelet count showed a drop of approximately 18 per cent. Fibrinogen-fibrin degradation products were significantly increased in 36 per cent of the patients studied.


Ethnic differences in neonatal jaundice: comparison of Japanese and Caucasian newborn infants. The incidence of neonatal jaundice was compared in Japanese and Caucasian infants at The Roosevelt Hospital between January, 1970, and August, 1972. The Japanese group was found to have significantly higher neonatal jaundice of unknown etiology (57 .39 per cent) than the Caucasian group (16 per cent). Twenty-three per cent of the Japanese group and none of the Caucasian group developed hyperbilirubinemia exceeding 15 mg. per 100 ml. of serum


Estrogen potency of oral contraceptive pills. The estrogen potencies of 9 oral contraceptive pills, Enovid-E, Enovid-5, Ovulen, Demulen, Norinyl+80, Norinyl+50, Ovral, Norlestrin 1 mg. and Norlestrin 2.5 mg., were determined by bioassay. Relative estrogen potency was determined by analysis of variance. Enovid-5, the most estrogenic compound, had a potency of 4.88 compared to ethinyl estradiol, 50 mcg. equal 1.00; Ovral, the least estrogenic compound, had a potency of 0.81, a sixfold difference. Estrogen potencies at a fractional dose of 0.00155 correlate with reports of the incidence of minor side effects and thromboembolic disease. The effect of progestins on estrogen potency was purely additive (norgestrel and norethynodrel), purely antagonistic, or additive at low concentrations and antagonistic at high concentrations (norethindrone, norethindrone acetate, and ethynodiol diacetate). These results suggest that pills with a greater margin of safety might be developed by utilizing greater ratios of progestin to estrogen. In addition, differences in relative estrogen potency of oral contraceptive pills may be used as a basis for better clinical selection.


Cellular hypersensitivity in patients with squamous cell carcinoma of the cervix. A group of patients with squamous cell carcinoma of the cervix were tested for cellular hypersensitivity prior to the initiation of therapy. Fourteen of 15 patients manifested inhibition of leukocyte migration with homologous tumor extracts, and 13 patients showed inhibition with autologous tumor extracts. Lymphocytes from 10 to 11 patients exhibited cytotoxicity for a homologous cell line and lymphocytes from 4 to 5 patients, for autologous cell lines. These results indicate that the absence of cellular hypersensitivity is infrequent in patients with squamous cell carcinoma. A comparison of the degree of sensitivity detected by use of each test showed a good correlation in a group of 10 patients. The efficacy of both autologous and homologus antigens to react with sensitized leukocytes supports the hypothesis that these antigens are tumor related. Although no correlation was found among the immunologic tests, clinical status of the patient, or prognosis based on the evaluation of several histologic parameters, further studies are needed to determine the usefulness of these tests as a prognostic index in individual patients, especially in patients with Stage I carcinoma.


Significance of cervicovaginal cytology after radiation therapy for cervical carcinoma. During follow-up examinations; 1,338 cervicovaginal cytologic smears were obtained from 254 women who had irradiation therapy for cervical cancer. These specimens were meticulously searched for the various cellular phenomena that may characterize such preparations, and some of the findings were subjectively quantitated. Correlations were made with histopathologic diagnoses, clinical findings, and results of treatment. Patients with malignant postradiation cells who were promptly treated for latent new or recurrent tumors generally responded well to treatment of the secondary tumor. The presence of malignant cells at any time after completion of therapy is an ominous sign, irrespective of the clinical status, and should lead to intensive effort to identify the site of a new or persisting lesion. The significance of dysplasia in postradiation smears is not entirely clear, and in certain instances it is difficult to distinguish severely dysplastic cells from either repair cells or malignant cells.


Androgens in breast cancer. III. Breast cancer recurrences years after mastectomy and increased androgenic activity. To test the hypothesis that increased androgenic activity is involved in breast cancer, the urinary testosterone was assayed in 19 clinically cured breast cancer patients and in 22 patients developing metastases from breast cancer during the same period of observation (5 to 15 years after mastectomy). The levels in the clinically cured patients were near normal whereas those in patients with metastases were significantly above normal.


All vulvar lesions should be biopsied. Basal cell carcinoma--an example of the futility of diagnosis by gross appearance. Gross polymorphism of basal cell carcinoma of the vulva as well as all vulvar lesions calls for biopsy of any suspicious areas in that region. In most instances local excision is satisfactory treatment. Close follow-up is necessary as the recurrence rate is approximately 20 per cent even when the lesion is completely resected.


Ovarian response to exogenously administered human gonadotropins during the postpartum period. Eighteen normal puerperal women received a combined administration of human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG) and the ovarian response to these human gonadotropins was evaluated by the daily estimation of the 24 hour urinary excretion of total estrogens. Fourteen of the 18 subjects studied were responsive to the exogenously administered gonadotropins with a rise in the urinary estrogen excretion. Moreover, plasma follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels during the postpartum period were low compared to normal cycle gonadotropin levels. Thus, it might be concluded that puerperal anovulation and amenorrhea during lactation might be due to hypophyseal gonadotropic dysfunction rather than to ovarian refractoriness.


The coagulation mechanism in labor at term induced with prostaglandin F2 alpha. The prostaglandins, especially the PGE series, produce profound effects on platelet function in vitro. It has been reported that PGF2alpha and the PGE series do not affect the clotting mechanism when used to induce midterm abortion, in contrast to that induced with hypertonic saline but the effect of these drugs on the clotting mechanism when used to induce term labor has not been reported. Labor was induced with intravenous PGF2alpha in eight patients, at 32 to 41 weeks' gestation, with premature rupture of the membranes. Three samples were obtained: (1) anteceding the administration of the drug, (2) during the peak drug effect during active labor, and (3) approximately 12 hours post partum. No significant changes were seen in the prothrombin or partial thromboplastin times, platelet numbers or aggregation with ADP, fibrinogen levels, euglobulin lysis times, and circulating fibrin split products. The circulation of thrombin as shown by a specific test for fibrin monomer was not demonstrated.


The effect of plasma retransfusion on the blood pressure in the puerperium. Whole blood was collected from five patients with severe pre-eclampsia, three with mild pre-eclampsia, and three with normal uneventful pregnancies. The red cells were separated and replaced. The plasma was stored until after the patients were delivered and on the sixth postpartum day they were autotransfused with plasma. This caused a rise in blood pressure in the patients with pre-eclampsia but an aliquot which was stored for six weeks and then retransfused into these patients did not cause any change in blood pressure. No blood pressure changes were found in the normal control subjects at six days or six weeks post partum. It is postulated that patients with pre-eclampsia develop altered vascular sensitivity to normal amounts of circulating pressor substance and that his sensitivity lasts for a week after delivery but not as long as six weeks.


Results of 313 consecutive live births of infants delivered to patients in the New York City Methadone Maintenance Treatment Program. Patients characteristics, birth results, and follow-up status are described for the first 313 babies born live to patients on the Methadone Maintainance Treatment Program operated by the New York Department of Health. Data were derived from the birth certificates and methadone clinic and hospital records. Comparisons with reports in the literature are noted. No significant association was found between maternal dosage of methadone in the last trimester of pregnancy and lentth of gestation, birth weight, or the reported presence of withdrawal symptoms in the neonate. The infant mortality rate was identical to the over-all New York City rate, specific for ethnicity. After an average of 6 1/2 months following delivery, 86 per cent of the mothers remained on the program.


Serum human chorionic gonadotropin and progesterone patterns in the last trimester of pregnancy: relationship to fetal sex. Concentrations of human chorionic gonadotropin (HCG) and progesterone were measured in the peripheral sera of 101 normal pregnant women between 25 and 41 weeks' gestation. HCG levels rose significantly with advancing gestation in the 43 female-bearers (r equals 0.516, p less than 0.001), whereas the 58 male-bearers showed no change (r equals 0.168, p greater than 0.1). Mean HCG levels were significantly higher in female- than in male-bearers (10.7 plus or minus standard error 1.0 versus 8.0 plus or minus 0.9 International Units per milliliter; p less than 0.05). Progesterone levels rose significantly in both female- and male-bearers. The calculated regression lines and mean levels (female-bearers 9.1 plus or minus 0.5; male-bearers 9.8 plus or minus 0.4 mug per deciliter) were not significantly different. There was no correlation between HCG and progesterone levels in either sex or in the entire group independent of gestational age. It is postulated that the lower HCG levels observed at term in male-bearers may result from an inhibitory influence of the higher progesterone and/or androgen concentrations in the male umbilical arterial circulation.


Treatment of thyrotoxicosis during pregnancy with propranolol. The treatment of two pregnant thyrotoxic patients with propranolol alone is discussed. One patient had a spontaneous remission during pregnancy wile taking propranolol. In the other patient treatment with propranolol allowed postponement of definitive therapy until after delivery, when the fetus was no longer at risk. There were no complications of therapy in either patient and both infants were normal. The use of propranolol in thyrotoxicosis is discussed and the pertinent literature is reviewed. Regional anesthesia is preferred over general anesthsia in patients taking propranolol. Patients taking propranolol who require general anesthesia for delivery should have continuous monitoring of electrocardiogram and central venous pressure. To this date no method of therapy has been free of fetal side effects. Surgical treatment is associated with occasional abortion or premature labor; antithyroid medication occasionally results in fetal goiter or cretinism.


Restricting legal abortion: Some maternal and child health effects in Romania. The dramatic rise of the Romanian birth rate in 1967 following the restrictive abortion decree of late 1966 is well known. Less well known are significant changes in key maternal and child health indicators in the period after 1966. Possible reasons for these changes are discussed as are the implications of the Romanian experience for population policy and abortion research in the United States.


Antenatal fetal growth from the nineteenth week. Ultrasonic study of 12 head and chest dimensions. Fetal head, chest, and heart cross-sections obtained by ultrasonic diagnostic techniques were used for several measurements: circumference, area, and two diameters, i.e., 3,388 different measurements from 767 healthy fetuses in normal pregnancies. The mean growth for 12 fetal sizes between the nineteenth and the forty-third weeks after the LMP was computed by determining the best adjusted polynomial according to Tchebitcheff. Compared with similar measurements made previously by others on premature neonates, the sizes of healthy fetuses of the same gestational age are larger, but almost identical after the thirty-sixth week. Growth standards based on the sizes of premature neonates may be influenced by the factors responsible for premature birth.


Propionate metabolism in fetal livers of 15 to 19 weeks' gestation. Extracts of hepatic tissue obtained from saline-induced abortuses were analyzed for methylmalonyl CoA carbonylmutase (MM) and propionyl CoA carboxylase (PC) activity. MM activity was similar to control values, which suggests that abortion material may be used to confirm the prenatal diagnosis of methylmalonic acidemia. Confirmation of a presumptive propionic acidemia diagnosis is more tenuous due to the instability of PC and the possibility that saline may induce PC activity.


Midtrimester abortion induced by serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha. Midtrimester abortion was successfully induced in 35 patients by serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha. The dose schedule in this series was an initial injection of 250 mug of 15-ME-PGF2alpha followed by another 250 mug in 2 hours, then 500 mug every 2 hours up to 24 hours; in patients who did not abort within 24 hours the dose was raised to 750 mug every 2 hours until abortion. The mean abortion time was 15.98 hours in this series and 86 per cent of the patients aborted in under 24 hours. Parous patients aborted faster (mean 14.81 hours) than nulliparous patients (mean 17.02 hours) and patients with lower gestational age, 13 to 16 weeks, aborted more quickly (mean 13.98 hours) than patients with gestational age 17 to 20 weeks (mean 16.35). These differences in this series, however, were not statistically significant. Gastrointestinal side effects occurred in 32 of the 35 patients and eight patients had a temperature elevation of more than 1 degree F. during the treatment period. The mean estimated blood loss was 137 plus or minus 42 ml. Thirty patients passed the fetal-placental unit intact, the placenta was removed by sponge forceps in three patients, and by surgical intervention in two patients. There were no failures of technique in this study and none of the patients developed endometritis.


Serum androstenedione levels during normal and human menopausal gonadotropin-induced human pregnancies. 17-Hydroxyprogesterone (17-OHP) and androstenedione (A) were measured frequently during the first trimester of five human pregnancies. Two were normally conceived and three were HMG induced. Of the HMG induced, two showed signs of hyperstimulation and one did not. 17-OHP and A patterns were very similar in the HMG-induced pregnancies from about days 25 to 60, after which the 17-OHP levels continued to drop. The A remained fairly constant after that time. In the normally conceived pregnancies the 17-OHP showed its characteristic rise and fall from about days 25 to 60, but A remained relatively constant throughout this period of time. The pattern of A in normal pregnancies is in marked contrast to that observed in HMG-induced pregnancies. Results from HMG-induced pregnancied may not, therefore, be always applicable to normal ones.


The circulating vasopressinase of pregnancy: species comparison with radioimmunoassay. A vasopressin substrate radioimmunoassay (RIA) system is described for the measurement of the vasopressinase elaborated during pregnancy. Results show that vasopressinase activity increases in the sera of pregnant women throughout gestation. At term, under the in vitro conditions described, pregnancy serum degrades vasopressin (Pitressin) at a rate of 53 mU. per milliliter of serum per minute. Serum obtained from paired umbilical cord samples had an activity of 9.2 muU per milliliter per minute; amniotic fluid obtained at delivery had an activity of 16.6 muU per milliliter per minute. Pregnancy serum obtained from sheep, rabbits, and rats, ovine umbilical cord serum, and ovine amniotic fluid had no detectable vasopressinase activity. Normal human male serum, nonpregnant female serum, and serum from women taking contraceptive agents also exhibited no activity.


Effects of blood or meconium on the determination of the amniotic fluid lecithin/sphingomyelin ratio. Increasing quantities of maternal and fetal serum were added to amniotic fluids with orignal high or low lecithin/sphingomyelin (L/S) ratios. It was found that serum contains an L/S ratio of approximately 1.31 to 1.46 and therefore its addition lowered high L/S ratios and raised low L/S ratios. The addition of meconium to amniotic fluid decreased the L/S ratio.


Extraovular prostaglandin F2alpha for early midtrimester abortion. Twenty patients who were 13 to 15 weeks pregnant received extraovular prostaglandin F2-alpha (PGF2a) in dosages of 3 mg. every 1 to 3 hours. Ninety-five per cent of the patients successfully aborted and 30 per cent of the patients had retained placental tissue. The mean abortion time was 17 3/4 hours and the average total dose used was 29.2 mg. The abortion time appeared to decrease with parity and had no relationship to weeks of gestation. Only one patient failed to abort after 31 hours of therapy. She required a curettage and was the only patient to develop a postabortion infection. The technique appears to compare favorably with the results of intra-amniotic PGF2a. Extraovular prostaglandin may therefore be of particular value in inducing abortion in patients who are in the early midtrimester of pregnancy, i.e., when intra-amniotic instillation is technically infeasible.