Ventriculojugular shunt nephritis with Corynebacterium bovis. Successful therapy with antibiotics. A patient with hydrocephalus and a ventriculojugular shunt presented with acute nephritis, nephrotic syndrome (proteinuria 10 g/24 hours), decreased complement levels, circulating immune complexes and diminished creatinine clearance (41 ml/min). Seven blood cultures grew Corynebacterium bovis. A renal biopsy specimen revealed mesangiocapillary glomerulonephritis by light microscopy, and thickened glomerular basement membranes with areas of increased granular density by electron microscopy. Immunofluorescent examination of the biopsy specimen demonstrated 2+ granular glomerular basement membrane deposits of immunoglobulin M (IgM), with trace third component of complement (C-3), fourth component of complement (C-4) and immunoglobulin G (IgG). Rabbits immunized with C. bovis produced a line of partial identity in agar with patient serum against a sonicate of C. bovis. Indirect fluorescein staining of the biopsy specimen with the rabbit antiserum demonstrated 1+ granular glomerular basement membrane deposits. Potassium thiocyanate microelution of sections prior to examination markedly diminished staining with antihuman antiserum, but did not affect staining with rabbit antiserum. Following initial therapy with intravenous penicillin for six weeks the bacteremia cleared, serum complement levels returned to normal, proteinuria decreased and creatinine clearance increased. A relapse occured four weeks later with decreased complement levels, increased proteinuria and decreased creatinine clearance. Blood cultures were again positive for C. bovis. Following therapy with erythromycin and rifampin, the bacteremia cleared and there was a sustained improvement of all parameters. To our knowledge, this is the first time an association has been noted between C. bovis ventriculojugular shunt infection and glomerulonephritis. These findings support the potential role of C. bovis as an etiologic agent in human renal disease and further define the immune complex nature of shunt nephritis.


Brucella canis. A cause of undulant fever. Brucella canis, recognized in 1967 as a cause of canine abortion, is an uncommonly recognized human pathogen. Our patient, a 48 year old man, probably acquired his infection by contact with an infected dog. His clinical course was characterized by intermittent fever and bacteremia over a 4 month interval. His course, which expands the clinical spectrum of human infections due to Br. canis, is discussed in the context of the other reported instances of community and laboratory acquired cases.


Observations on the electrocardiographic changes associated with subarachnoid hemorrhage with special reference to their genesis. A 36 year old man presented with bizarre behavior and had abnormal electrocardiograms on two occasions. Because of ST-T wave changes, he was treated both times for a possible subendocardial infarction. A more complete evaluation during the second admission revealed a basilar artery aneurysm with subarachnoid hemorrhage as the cause of the central nervous system symptoms. While the aneurysm was successfully clipped, the patient's electrocardiogram was recorded. Several electrocardiographic changes characteristic of intracranial disease were observed during the procedure. These changes developed with distortion of the circle of Willis and reverted when such distortion stopped. We review the spectrum of the electrocardiographic changes associated with intracranial disease. This list of abnormalities was compiled from observations obtained by the impatient tracings of persons with various central nervous system pathology. The mechanisms used to explain the changes are based solely on work performed on laboratory animals. The results of our findings in our patient link electrocardiographic abnormalities directly with a central nervous system lesion.


Spontaneous remission of the nephrotic syndrome in diabetic nephropathy. A 28 year old woman, with diabetes since age 18, had the nephrotic syndrome, hypertension and renal insufficiency. The initial renal biopsy specimen revealed diffuse glomerulosclerosis with early nodular changes. After an initial decline in renal function, her creatinine clearance progressively improved and has remained normal. Within 2 years she had a spontaneous remission of the nephrotic syndrome despite the presence of more pronounced nodular glomerular lesions. Although the renal hemodynamic functions were normal, certain tubular functions were impaired. Since we found no etiology for the nephrotic syndrome other than diabetic glomerulopathy, the complete remission of the nephrotic syndrome and improvement in renal function were very unusual events.


Imported mucocutaneous leishmaniasis in New York City. Report of a patient treated with amphotericin B. A case of mococutaneous leishmaniasis in a patient referred to Memorial Sloan-Kettering Cancer Center, New York, with a presumptive diagnosis of lethal mid-line granuloma is described. The patient had lived in Bolivia and had been treated with antimony during and after which his mucosal lesions progressed. These lesions completely healed with 971 mg of amphotericin B. Mucocutaneous leishmaniasis is endemic in many areas of Central and South America and may occur in patients in the United States who have lived in or traveled to these areas. Organisms may be difficult to identify, and multiple biopsies and cultures may be necessary. The use of amphotericin B for the treatment of leishmaniasis is reviewed. It is an effective alternative to antimony therapy, and in some cases resistant to antimony, it may be the drug of choice.


PACP regional quality control program: a general survey. A regional quality control program operated by the Pennsylvania Association of Clinical Pathologists is described. About 120 laboratories in Pennsylvania and a few neighboring states participated in the program. Two 1000-liter lots of pooled normal and abnormal sera meeting or exceeding the specifications of the National Committee of Clinical Laboratory Standards and the College of American Pathologists were prepared and lyophilized. Participating laboratories determined each constituent in the sera every day for a year, from March 1973 to March 1974. The data was processed by a computer. The inter- and intra-laboratory reports containing the mean, standard deviation, coefficient of variation, Youden plots, etc. for each constituent were made available to all the participating laboratories. Practical applications of these statistical parameters in evaluating the quality of the performance of the laboratories are discussed.


Positive irregular antibody screen due to leukocyte antibody. A case is described of a multi-transfused, multiparous woman whose serum gave positive results in routine screening for irregular antibodies. No red cell antibodies could be identified, however, and apparently compatible units were crossmatched for this patient. Upon administration of a unit of whole blood, the patient exhibited severe chills and fever. Her serum was found to contain a strong anti-HLA 17, and possibly other white cell antibodies, as well. It is suggested that the positive irregular antibody screen detected the leukocyte antibody, because of expression of HLA antigens on the screening cells.


Red cell freezing by the American National Red Cross. Red cells, frozen in the presence of glycerol, can be stored for years at -80C with excellent post-thaw recovery and in vivo survival. In addition to the benefits of long-term storage, the extensive washing associated with deglycerolizing removes essentially all platelets, plasma, microaggregates of cells and cell debris and there is some evidence of a reduction in the incidence of post-transfusion hepatitis. The majority of the white cells are lost during the processing. Three deglycerolizing methods, based on the Haemonetics Cell Washer, the IBM Cell Processor and the Fenwal Elutramatic, have been evaluated and data on comparative performance and costs are provided. The experience of the Red Cross Blood Program in processing over 90,000 units of frozen red cells is summarized.


Severely retarded children as impulsive responders: improved performance with response delay. A community school-project class of 15 severely retarded children showed a high negative relationship between errors and response latency (r = -.92) when tested on a task which required selection of the one of six line drawings that matched a standard. Fast incorrect (impulsive) responders on the matching task had previously been unsuccessful in receptive-language color discrimination training while slow correct (reflective) responders had been successful on the same task. The four most impulsive responders were given additional color discrimination training for an extended period under conditions where (a) a response could be made immediately (no-delay) or (b) a 5-second delay was imposed between presentation of the stimuli and the opportunity to respond (delay). Performance of all four children was at chance levels during periods of no-delay trials, but high performance levels (80 to 90 percent correct) were achieved when delay trials were given. Upon changing from delay to no-delay, subjects' performance again fell to chance levels. Implications for training programs were discussed.


Ethological approach to delayed language acquistion. Language is initially a social or communicative event that develops from the nonverbal communication system existing between caretaker and child. While language in an adult speaker is used for reasons other than social communication, the communication function is the primary source for language acquistion, other language functions being derivatives of this basic function. A few studies were cited which suggest that the normal process of language acquisition may be conceived heuristically in terms of an ethological or psychosoical framework. This ethological approach to language acquisition suggests that noncognitive, interpersonal factors may be major contributors to the slow pace of language development among mentally retarded and autistic children. The implications of this approach were discussed in terms of the design of language-intervention programs.


Diets of handicapped children: physical, psychological, and socioeconomic correlations. Diets of patients at the University Affiliated Cincinnati Center for Developmental Disorders were evaluated in order to identify relationships between nutritional deficiencies and selected physical, psychological, and socioeconomic factors. Results showed primary nutritional and feeding problems to be: low ascorbic acid and iron intakes, lack of a daily source of fluorid, protein intake of borderline biological quality, and mechanical and postnatal feeding difficulties. Nutritional and feeding problems were correlated with various hematological, psychological, anatomical, and social factors.


Communication in retarded adolescents: response to listener feedback. Retarded adolescents' response to listener feedback was studied using an interpersonal description task. Thirty-six adolescent retarded speakers were asked to describe nonsense line figures for a confederate adult listener so that the listerner could select the same stimuli from an array. The listener responded to the descriptions with a predetermined random order of success and failure. Communication failure was reported to the speaker by three methods: gestural, implicit, and explicit feedback. Redescriptions given by the speaker following each type of listener feedback were counted and analyzed as to type of redescription. Significant differences were found among intelligence level groups for number of redescriptions after communication failure and also for type of redescription.


Differentials in characteristics between city and suburban admissions to a state clinic for retarded children. Characteristics of city and suburban admissions to a state-operated outpatient clinic for mentally retarded children were reported. City admissions tended to be overrepresented among lower socioeconomic groups and minorities. Suburban admissions tended to approximate the characteristics of the population of suburbia as a whole. A stepwise discriminant-function analysis between city and suburban admissions showed race to be the best predictor. Employment and occupational status, type of family structure, and certain referral agents also discriminated city and suburban admissions to varying degrees.


Sex knowledge and attitudes of moderately retarded males. In semistructured interview sessions, 18 moderately retarded men undergoing deinstitutional training, were questioned to determine their understanding of pictures of homosexual embrace, masturbation, dating, marriage, intercourse, pregnancy, childbirth, drunkenness, and their knowledge of anatomical terminology. The frequencies of various response categories revealed a range of comprehension, the lowest answering only 10 percent correctly, the median consisting of 28 percent correct, and only 1 subject correctly answering as many as one-half of the items. Correct conceptual responses significantly correlated with WAIS Full Scale and Verbal IQs and were also significantly related to the Adaptive Behavior Scale domains of Language, Socialization, and Responsibility. Serious errors of fact and conceptual confusion, though most prevalent in responses by the low comprehenders, were found in at least some responses by all of the men.


Relational meaning and the facilitation of slow-learnign children's language. Through a modeling procedure, 24 slow-learning children acquired the use of two-word subject-verb utterances. The children were assigned to conditions designed to examine the effects of two variables: (a) the number of different semantic relations theoretically underlying the subject-verb utterances on which the children were trained and (b) the extent to which these semantic relations were associated with nonlinguistic events. Stimuli in the form of situational events proved facilitative in the children's subject-verb usage. Apparently, situational evidence may provide the child with useful relational information about his environment. Implications for intervention were discussed.


Identification by retarded and nonretarded children of stimuli varying along one, two, or three dimensions. The effects of number and type of dimension of stimulus variation, type of dimensional combination, and delay of response upon the identification performance of retarded and nonretarded children were examined. A retarded-nonretarded subject difference in identification ability and delay effects found in an earlier study (Smith & Kaufman, 1972) was replicated, and a developmental effect for nonretarded children was found as well. A retarded-nonretarded subject interaction was indicated for the effects of increasing number of dimensions of variation and for the effects of type of dimensional combination (figure-figure combinations as opposed to figure-ground combinations).


Utilization of redundant information by EMR and nonretarded adults. When stimuli differed on two dimensions (size and shape), either of which furnished enough information for a correct response, retarded subjects were faster to discriminate than when stimuli differed on only one dimension. This result was also found with nonretarded subjects, and the data were taken to support the argument that both populations process information in this type of speeded visual discrimination in similar ways; whatever feature-testing model accommodates the data from nonretarded subjects also describes the data from retarded subjects.


Effects of distinctive-feature training and instructional technique on letter and form discrimination. Techniques for facilitating alphabet letter discrimination were investigated within the framework of distinctive feature and attention theory. To compare the effectiveness of three instructional procedures for emphasizing distinctive features, experimenters gave separate groups of children either distinctive-feature training, high-lighting of the features, or distinctive-feature training plus fading-in of the letter forms, along with a control, for each of three dimensions. The horizontal-slant, open-close, and straight-curve dimensions were chosen for study. Training effects were assessed by presenting corresponding alphabet letter pairs (H-N, C-O, U-V) and two sets of generalization forms. Results indicated that the three experimental groups perfomed better than the control, but did not differ from each other. All groups except fade-in readily generalized to other forms. These findings were discussed in terms of the educational value of distinctive feature analyses and the use of instructional methods.


Effect of chronological age and mental age on the understanding of rules of logic. The relative difficulty of understanding the logical rules of conjunction and disjunction was studied. Because rules of logic must be viewed in the context of the attributes of information to which they refer, three attribute dimensions were also investigated: (a) positive-negative, (b) quantitative-nonquantitative, and (c) concrete-abstract. A further issue relevant to this research was the effect of CA and MA on the understanding of rules of logic. Subjects included four groups, one group of children with average IQs, one learning-disability group, and two mentally handicapped groups. The learning disability group was matched with the average group on MA and CA. The older mentally handicapped group matched the aveage and learning-disability groups on MA. The younger mentally handicapped group matched the average and learning-disability groups for CA and the older mentally handicapped group for IQ. A test was constructed to assess rule and attribute understanding. Results indicated that all groups perfomed similarly on the concrete level. On the abstract level, the average group performed significantly higher than the other groups. The results support a developmental interpretation of rule learning which maintains that once logical rules are learned, attributes of information acquire meaning within the context of those rules.


Comparison of speech discrimination in nonretarded and retarded listeners. An adaptive psychophysical procedure was used to determine the articulation functions for nonretarded and retarded subjects using Kindergarten Phonetically Balanced stimulus words. Merits of this procedure are: (a) it is efficient since stimulus intensity levels are well-placed with respect to the measures being obtained, and (b) estimates of intrasubject variability can be obtained from one test session. The slope of the articulation function based on the pooled data from the nonretarded subject (3.5 percent/dB) was greater than the slope of the function from the retarded subjects (2.1 percent/dB). No significant differences in intrasubject variability between the two groups were discovered. It is not clear whether the reduced slope of the articulation function from the retarded subjects was due to a familiarity factor and/or to a basic difference in auditory processing characteristics. Work is continuing in an attempt to clarify this issue.


Food satiation as a procedure to decelerate vomiting. A food satiation procedure was used in two experiments to decelerate the frequency of vomiting responses in two profoundly retarded adults who exhibited well-defined vomiting-ruminatory response chains. For several years prior to this study, the subjects had exhibited a history of vomiting behavior. Satiation was accomplished during regular meals and consisted of allowing the subjects to eat until a satiation criterion of food refusal was achieved. The results revealed a 94 percent reduction of vomiting in Experiment 1 and a 50 percent response reduction in Experiment 2. Ten-day follow-up sessions indicated that the response reduction was maintained in both experiments. In Experiment 1 the subject exhibited a 4.99 kg weight gain at the 10-day follow-up with a total of 13.61 kg weight gain at a 4-week posttreatment weight check.


Preinstitutional social deprivation, responsiveness to social reinforcement, and IQ change in institutionalized retarded individuals. Mentally retarded individuals who had been examined on a task measuring responsiveness to social reinforcement after 3 weeks and after 3 years of institutionalization were examined after 6 years of institutionalization. IQ changes were also examined. For familially retarded subjects, a linear decrease in responsiveness to social reinforcement and a linear increase in IQ was found from the 1st to the 6th year of institutional life. No changes in responsiveness to social reinforcement or IQ were found over the 6 years for nonfamilially retarded subjects.


Sound-induced frive, prior motion restraint, and reduced sensory stimulation effects on rocking behavior in retarded persons. Sound-induced drive, prior motion restaint, and reduced sensory stimulation effects on body-rocking rate were assessed in a group of 16 retarded subjects. Significant rate increases were associated with the presentation of high intensity sound and short periods of reduced sensory stimulation. Increases were not associated with prior motion restraint. The results suggest that reduced sensory stimulation operates as a drive variable, summating with other operationally defined sources of drive, e.g., high intensity sound.


Role-taking ability and interpersonal conflict resolution among retarded young adults. Observers of the interpersonal deficiencies of mentally retarded persons have failed to consider the role of social cognition in interpersonal behavioral repertoires. In the present study, the relationship between role-taking ability and interpersonal conflict resolution among 16 moderately and mildly retarded young adults was examined. Feffer's Role-Taking Task and the Role-Playing Assessment Technique were used as experimental measures. With IQ held constant the correlations between role-taking scores and interpersonal problem-solving assessments were positive and significant.


Changes in carbohydrate tolerance during long-term oral contraception. An intravenous glucose tolerance test (GTT) was given to 116 women--82 nondiabetic subjects (NDS) and 34 diabetes suspects--before they received Ovulen for oral contraception. Subjects were followed for 1 to 4 years during Ovulen therapy. Twenty women using an intrauterine device showed no changes in glucose tolerance. Prompt, significant decline in tolerance was noted in NDS, persisting for the duration of the study. At least one abnormal test, indicating chemical diabetes, was noted in 13 per cent of the NDS. Similarly, prompt decline in tolerance, although not statistically significant, was observed in the suspect group. Fifteen per cent of suspects had at least one abnormal test. Chemical diabetes persisted during Ovulen therapy in suspects but not in NDS. No overt diabetes occurred. Based on greater concern regarding suspects, a procedure for monitoring carbohydrate tolerance is proposed for this group.


Oral contraceptives and human cervical mucus lipids. Oral contraceptives containing estrogenic and progestational components caused a consistent increase in human cervical mucus lipids during the menstrual cycle. Cyclic variations in cervical mucus lipids occur during the normal cycle. Phospholipids, free cholesterol, and triglycerides in cervical mucus increase with the use or oral contraceptives.


D-norgestrel slow-releasing T device as an intrauterine contraceptive. A D-norgestrel slow-releasing T device was tried as an IUD in 100 fertile multiparous women for 6 months. The preliminary results were very encouraging. Not a single case of unintended pregnancy or removal due to excessive pain and bleeding was reported. The menstrual patterns and amounts of blood loss during menses did not reveal any marked variations. 3-H-D-norgestrel was used to study the in vitro release rate of D-norgestrel. The in vivo release rate was studied with the use of horseshoe-shaped silicone rubber capsules loaded with D-norgestrel as a temporary device. The uptake of intrauterine H-D-norgestrel in the circulation and genital tissues was estimated in two women.


Antibodies to spermatozoa. VI. Comparative studies of sperm-agglutinating activity in groups of infertile and fertile women. In order to evaluate the significance of sperm antibodies in relation to infertility, studies have been made on both infertile and fertile populations. The infertile population consisted of about 150 couples with long-standing infertility, predominantly of the unexplained type. The fertile population consisted of 78 antepartum women and 35 postpartum women. In all these individuals, sperm antibody was sought by two methods of serum testing, namely, the Kibrick (K-B-M) and the F-D methods of sperm agglutination. In the infertile group, the Kibrich test was positive for 23.1 per cent of the women and 9.6 per cent of the men, whereas the F-D test was positive in 16.4 per cent of the women and 5.0 per cent of the men. In contrast to these values, it was found in the fertile group that the Kibrick test was positive in 2.7 per cent of these women and the F-D test was also positive in 2.7 per cent of them. A number of technical details and precautions have also been emphasized. These principles are intended to minimize the occurence of nonspecific and false-positive results.


The ultrastructure of a feminizing granulosa-theca tumor. A 13-year-old girl with evidence of hyperestrinism had a right ovarian tumor removed. This neoplasm was composed predominantly of granulosa cells and exhibited some changes of luteinization. The neoplastic cells displayed an investment of basement membrane material which was closely related to fibrillar collagen within the tumor. Scattered throughout the neoplasms were small numbers of cells with charcteristics of the theca and a few cells had cytoplasmic features suggestive of smooth muscle. The ultrastructural findings of eight similar tumors have been described. In none is the basement membrane material fully appreciated; nevertheless, the production of this extracellular material is a major and distinctive feature of granulosa-theca tumors.


The ultrastructure of acute atherosis in hypertensive pregnancy. Acute atherosis of the myometrial segments of the uteroplacental arteries from pre-eclamptic pregnancies was studied by electron microscopy. The lesions in their early stages are characterized by endothelial damage, insudation of plasma constituents into the vessel wall, proliferation of myointimal cells, and medial necrosis. Fat acculumation is seen first in myointimal cells and, later, macrophages engulf the lipid-rich debris released from disintegrating myogenic foam cells. Gross endothelial damage, massive intramural fibrin deposition, luminal thrombosis, and vessel rupture with hemorrhage are epiphenomena.


Folic acid deficiency in the United States: folate assays in a prenatal clinic. Tissue deficiency of folic acid, as measured by a red cell folate level below 150 ng. per milliliter, was present in 16 per cent of 110 sequential pregnant women at the time of their first prenatal visit to a municipal clinic. A further 14 per cent of subjects had red cell folate levels in the range "suggestive but not conclusive for tissue folate depletion" (150 to 199 ng. per milliliter). All of the subjects were from low-income families in New York City and most were black or of Puerto Rican origin. Serum folate levels showed good general correlation with red cell folate but were of less value as a diagnostic test, since they were below the lower limit of normal in 64 per cent of subjects, including many subjects who did not yet have low tissue folate. In contrast to their value in other folate deficiency states, neutrophil lobe counts showed no correlation with serum or red cell folate levels in pregnancy and thus appeared of little diagnostic value in pregnancy. It is suggested that surveys of folate deficiency in other pregnant population groups in the United States be carried out. These results support the recommendations of the Committee on Maternal Nutrition and the Committee on Dietary Allowances of the Food and Nutrition Board, National Research Council (U.S.A.)  that folic acid supplements (200 to 400 mug per day) should be taken throughout pregnancy.


Decreased carbohydrate tolerance in pregnant patients with an early menarche. Carbohydrate tolerance was studied in pregnant patients with no personal or family history suggestive of diabetes, but with a menarche before 12 years of age. The mean disappearance rate constant for glucose (k) in the intravenous glucose tolerance test was 1.68 in the group of patients with an early menarche. This value is essentially the same as that found in patients with the usual criteria for screening for gestational diabetes, where k equaled 1.61. Both values are significantly different from the remaining patients studied, where k was 1.94. The mean fasting blood sugars and the mean 2 hours past-100 Gm. glucose meal blood sugars in patients with a menarche before 12 years of age and the patients with the usual criteria for screening for gestational diabetes were also the same when compared to each other, and significantly different from those of remaining patients studied. There were no apparent reasons for the early menarche group  to have a decreased tolerance to glucose except their early menarche.


Childbirth education, maternal attitudes, and delivery. The purpose of this study was to evaluate the effects of a childbirth education program (patterned after the Lamaze procedure) on maternal attitudes and the delivery process. Dependent variables included axniety as measured by the anxiety scale of the IPAT, scores on the Maternal Attitudes to Pregnancy Inventory (MAPI), the duration of labor, and the amounts of premedication and anesthesia administered during delivery. Three groups of pregnant women were used as subjects: 70 primiparous and 48 multiparous women taking a 6 week childbirth education course and 41 multiparous women delivery at the same hospitals but not taking the course. In addition the data on labor duration and amount of medication administered to 1,400 multiparous and 1,015 primiparous patients delivery at one of the same hospitals as the other three groups were examined for comparison purposes. No differences were found between groups on the anxiety measure or on duration of labor. Some differences favoring women who had the childbirth education course were found on the MAPI and the medication and anesthesia measures. It was concluded that the childbirth education course had some beneficial effects.


The effect of prostaglandin F2alpha on the placental progesterone level in midtrimester abortion. A gas chromatograph method has been used for the determination of placental progesterone levels in 14 patients aborted at midtrimester by intra-amniotic instillation of prostaglandin F1alpha, also from a control group (five patients) aborted surgically by dilatation and suction. The results showed that the mean %/- S.E. of placental progesterone in the prostaglandin group was 1.45 mug +/- 0.09 per 1 Gm. of placental tissue, whereas the mean +/- S.E. of the placental progesterone in the surgically aborted group was 5.22 +/- 0.31 mug per 1 Gm. of placental tissue. The difference between the two groups was significant: P EQUALS 0.0001. This low level of placental progesterone in the prostaglandin abortion group could explain the sharp decline of the progesterone levels in the peripheral blood during abortion by intra-amniotic instillation of prostaglandin F2alpha, as observed by our group1, 2 and others.3(-5)


Acetazolamide, metabolic acidosis, and intraocular pressure. In order to investigate whether or not there is a causal relationship between the metabolic acidosis and the ocular hypotension induced by acetazolamide, we undertook to correlate over a period of time the blood-acidifying and ocular-hypotonizing effects of administering the lowest intravenous effective dose of acetazolamide; to treat the metabolic acidosis induced by acetazolamide by means of the intravenous introduction of bases, and pulmonary hyperventilation (respiratory alkalosis); to evaluate the effects on the intraocular pressure (IOP) by neutralizing the acetazolamide-induced metabolic acidosis by means of a continuous infusion of sodium bicarbonate; to determine the relationship between the metabolic acidosis induced by blood-acidifying agents, which do not inhibit carbonic anhydrase, and the IOP; and to determine the changes in the acid-base status of the aqueous humor induced by acetazolamide and other blood-acidifying drugs. We found that the hypertonic buffering solution of sodium bicarbonate could reduce the IOP by itself through an osmotic mechanism. On the basis of our results, we believe that a causal relationship exists between the metabolic acidosis induced by acetazolamide, and by other drugs that have a blood-acidifying effect as the result of other mechanisms, and ocular hypotension, bothin the animal and in the glaucomatous patient.


Cystoid macular edema associated with topically applied epinephrine in aphakic eyes. A 69-year-old man with bilateral open-angle glaucoma and nonfiltering iridencleisis scars underwent combined cataract extraction and glaucoma filtering operations in each eye. Later, he again required intensive medical therapy including topically applied echothiophate iodide, epinephrine, and acetazolamide to control his glaucoma. Topical instillation of epinephrine repeatedly resulted in reversible cystoid macular edema in each eye. The macular changes were documented by fluorescein angiography. The clinical and angiographic features of the macular edema in this patient did not differ from cystoid macular edema seen in other ocular conditions.


Ocular melanocytosis and melanoma.

Ocular melanocytosis and melanoma. The hypothesis that ocular melanocytosis is a precancerous condition that may lead to a choroidal melanoma should be seriously questioned for the following reasons: The incidence of malignant degeneration in a hyperpigmented eye is unknown and overreported. If the hypothesis were correct a bilateral melanoma would occasionally occur in patients with bilateral melanosis. No such case has been reported. In patients with unilateral melanosis the blue, unaffected eye may also develop a melanoma. A 67-year-old white woman with one dark and one blue eye provided the first such instance, although previous cases may not have been reported if their histologic picture was not unusual. The incidence of melanoma in our patients with unilateral melanosis was rare compared with the many melanomas developing in normal pigmented eyes (4/418). I found no statistically significant difference in the incidence of choroidal melanomas originating in the hyperpigmented or in the blue eye in patients with unilateral ocular melanocytosis.


Vascular occlusions in the eye from cardiac myxomas. Vascular occlusion in the eyes from cardiac myxomas was diagnosed in two cases, belatedly in one and not until after death in the other. Suspicion of a myxomatous origin should be aroused by the combination of unexplained retinal (or choroidal) vascular disease occurring with multifocal neurological symptoms and with systemic symptoms suggesting atypical subacute bacterial endocarditis. The first patient had unilateral retinal artery occlusion by embolic material believed to have been myxomatous. Removal of the cardiac myxoma resulted in disappearance of this material (although the eye remained blind). The second patient who had had evidence of retinal artery occlusion in the clinical course of her multisystemic disease was found at autopsy to have extensive myxomatous involvement of the posterior ciliary arteries and of the choroidal arteries of both eyes and of the retinal artery in one eye.


30-year observation of patients with Eale's disease. Of 135 patients with Eale's disease, two thirds of the patients were men around 20 years of age at the onset, while the women were older. The disease continued from six months to 51 years. Several patients were followed for 40 years. The prognosis for useful vision was good as only one patient became blind in both eyes.


The art of perimetry.

The art of perimetry. There is no single method of perimetric examination which is applicable to all types of visual field defects. Perimetry is a subjective psychophysical sensory examination. It is not an exact science unless one includes the objective measurement of visual evoked response in the optic cortex. Until such a method becomes clinically available it will be necessary for the perimetrist to determine which techniques to use in a given case and to apply these techniques with sympathetic understanding. This is the art of perimetry.


Ocular involvement in benign botulism B. In nine cases of botulism B infection due to food poisoning acute onset of accommodation paresis, mydriasis, and dry-eye symptoms were the prominent clinical findings. Impairment of salivary secretion as a further effect upon cholinergic autonomic innervation was detectable for months. Guanidine treatment had a beneficial effect, whereas administration of antitoxin in the late and benign form was not effective.


Optic nerve extension of intraocular neoplasms. Histologic examination of ten intraocular melanomas (eight choroidal and two of the iris and ciliary body) with dispersion of tumor cells into the vitreous body showed optic nerve invasion ranging from only a few collections of tumor cells lying in the anterior portion of the nerve, to invasion of the entire nerve and possibly the chiasm. Nine of the ten melanomas were partially necrotic. Orbital recurrence developed in four cases in which the tumors extended to the surgically cut margin of the excised optic nerve. All of the eyes had no light perception and had angle-closure glaucoma. In a companion retrospective study of 38 endophytic retinoblastomas with optic nerve invasion, 29 had angle-closure glaucoma. The posterior dispersion of tumor cells, and possibly their optic nerve head invasion, may have been enhanced by the obstruction of the normal anterior segment aqueous outflow channels and the associated glaucoma.


Comparison of in vitro corticosteroid response in pigmentary glaucoma and primary open-angle glaucoma. We used an in vitro assay utilizing corticosteroids to inhibit transformation of peripheral blood lymphocytes to evaluate a group of 20 patients with pigmentary glaucoma. The pigmentary glaucoma patient group did not manifest the markedly increased cellular sensitivity to corticosteroids associated with primary open-angle glaucoma. If increased sensitivity to corticosteroids plays an essential role in the pathogenesis of primary open-angle glaucoma, then pigmentary glaucoma appears to be etiologically, as well as clinically, a separate entity.


Comparative changes in the error of refraction between fixing and amblyopic eyes during growth and development. Measurements of the refractive errors in 55 strabismic patients--one eye with visual acuity of 0.8 or better and the other with reduced vision, 0.4 or less due to amblyopia, and performed at roughly two-year intervals during growth and development to approximately age 25 years--showed that the eye with normal visual acuity was significantly more myopic with age, whereas there was no appreciable change in the average refractive error of the amblyopic eye. Both eyes of a control group of patients of similar age having normal distant vision and orthophoria were more myopic with age. In this group there was an insignificant difference in the change in refractive error of one eye compared with its fellow during comparable periods of time.


Conjunctival squamous cell carcinoma combined with malignant lymphoma. A 31-year-old white woman with a poorly differentiated malignant lymphoma and a compromised immune system atypically contracted squamous cell carcinoma. Data obtained after her death indicate that her immune system was severely altered by either the primary disease or the chemotherapeutic regimen, or both.


The effect of corticosteroids in the treatment of experimental bacterial endophthalmitis. We evaluated the effects of the addition of corticosteroids to antibiotic therapy in the treatment of staphylococcal endophthalmitis in rabbits. Twenty-four hours after the induction of infection with Staphylococcus aureus, penicillin G, penicillin G and dexamethasone or prednisolone, or saline was injected retrobulbarly for ten days. Afterward, there was no ophthalmoscopic difference between the penicillin and corticosteroid-treated group and those animals receiving only penicillin G. At day 60, however, the fundus was visible in 64% of eyes treated with penicillin G with corticosteroids in contrast to 39% of those eyes treated only with penicillin G (P less than .025). The results between dexamethasone and prednisolone use were not significant. Retrobulbar corticosteroids in combination with effective antibiotic therapy effectively treated experimental bacterial endophthalmitis.


Modifications of the conjunctivodacryocystostomy procedure. I modified the conjunctivodacryocystostomy procedure in 36 patients (43 eyes) by directly threading the pre-flanged PE-190 polyethylene tubing over a No. 3 or 4 Bowman probe into and through the nasolacrimal duct, contrary to the original intranasal maneuvers. This simplified the procedure but caused minor amenable complications such as shortening the tubing postoperatively. In eight of 43 eyes, replacement or shortening the tubing was easily done in the office over a handleless Bowman probe. In three of the 43 eyes, polyethylene tubing was occasionally plugged, requiring cleansing or replacement. Of the 43 tubes inserted, 42 are still in place and functioning.


Brief hospital admissions for pediatric strabismus surgery. We performed strabismus surgery on 170 children on an outpatient basis. Endotracheal intubation was utilized in all cases as the means of delivery of the anesthetic agent. Atropine used alone as a preoperative medication reduced the incidence of postoperative vomiting. Parental acceptance of this method of surgery was best when the child was discharged from the hospital awake and alert in the shortest possible time.


Autotransplantation of retinal pigment epithelium in intravitreal diffusion chamber. Retinal pigment epithelial (RPE) cells were autotransplanted intravitreally in diffusion chambers in rabbit eyes. The RPE cells underwent transformation; first into macrophages, later into spindle-shaped cells with collagen production having epithelial cell characteristics. DNA replication, shown by autoradiography, and loss of pigment granules indicated proliferation of these cells. These results support the hypothesis that RPE proliferation and transformation play a major role in the formation of collagen containing membranes, such as are found in massive periretinal proliferation.


The effect of aspirin on rebleeding in traumatic hyphema. Often used as an oral analgesic in the management of pain associated with traumatic hyphema, aspirin has an inhibitory effect on the blood clotting mechamism by its action on platelets. We carried out a retrospective study of patients with traumatic hyphema treated with aspirin and showed that the incidence of rebleeding significantly increased with aspirin administration.


A laboratory animal model for phacoemulsification practice. A human cataract, removed in its capsule, and implanted in either the anterior or posterior aqueous chamber of a rabbit eye, provided a model system that simulated a clinical case of human senile cataract. Such a model can be used for practice surgery or for evaluation of an instrument designed to remove a cataract through a small incision.


A new portable applanation tonometer.

A new portable applanation tonometer. A portable applanation tonometer consisted of a Goldmann applanation doubling prism mounted on a dynamometer. Results obtained on 100 consecutive eyes showed a good correlation with the standard slit-lamp mounted applanation tonometer. This portable tonometer is small and easy to use, utilizing the same end point as the standard Goldmann tonometer. In addition, the patient may assume almost any position.


Treatment of band keratopathy.

Treatment of band keratopathy. Band keratopathy, caused by a variety of chronic ocular or systemic diseases, produces pain, photophobia, and decreased vision. A simple method for treating band keratopathy consists of scraping the cornea vigorously with a No. 15 scalped blade until the superficial calcium has been removed.


The asymmetrical tonic neck reflex in normal first and third grade children. Diminished inhibition of the asymmetrical tonic neck reflux (ATNR) is frequently used as a clinical tool when evaluating children with maturational lags, sensory integration deficits, and learning and behavioral dysfunction.  However, limited observations are available on the degree of integration of this primitive reflex in normal children at different age levels.  In this study, 44 first grade and 36 third grade normal children were tested in the quadrupedal position by right and left lateral rotation of the head both actively and passively.  Varying degrees of elbow flexion or muscle tone changes were elicited in all.  First grade children displayed significantly more evidence of this reflex, especially when the head was rotated to the left.  The results of this study indicate that frequent, visible muscle tone changes or elbow flexion to 30% in the arm ipsilateral to the skull position could be considered normal in children through the third grade.


A preliminary report: biofeedback training for early finger joint mobilization. Using a newly developed, small, portable EMG biofeedback device for facilitating training, restoration of finger function after surgical repair of tendons was quickly achieved in three patients.  Their case reports are discussed and are offered to encourage wider use of biofeedback in the therapy of such patients.


Feeding program for the institutionalized mentally retarded. A program using techniques from behavior modification and motivation theories was initiated to improve dining room behavior in a large residential center for the mentally retarded.  The program was graduated into three levels to deal with behaviors ranging from normal eating habits to total lack of self-feeding skills.  The effectiveness of this program, indicated by behavioral ratings taken both before the program began and eight weeks after the program was in operation, was shown in significantly improved eating habits.


A preliminary prosthesis for the partially amputated hand. The temporary preliminary prosthesis for the partially amputated hand is recommended to maintain hand function and independence in self-care for the patient and to assure patient acceptance of a permanent prosthesis.  The construction of an Orthoplast partial hand prosthesis is discussed and illustrated.


Student selectron of field work experience. This paper describes a survey administered to 78 junior and senior level occupational therapy students to determine their rationale for the selection of field work experiences.  On the 67 correct returns the major considerations for selection, by priority, were the geographical location, the reputation of the center, and the stipends offered.


Children's lateralizations of images of the self, others, and objects. Each of 90 kindergarten, second, and fourth graders was shown photographs of himself, another person, and a symmetrical television set. He was asked to point to one side of the image as specified, on himself, the person, and the object. When the three pointing tasks were made nearly equivalent by providing on example for each task, by not requiring verbal labels, and by requiring roughly the same cognitive level of relational judgment, there was a significant difference among school grades and image responses. The response of pointing to the side of the image diagonally across from the side of the example occurred more often in older children and most often for the object in all three school grades.


Behavioral skills for employment of the intellectually handicapped. Parents, teachers, and supervisors in competitive industry and sheltered workshops ranked the same behavioral items. Each group followed different directions. The items, thought to be basic requirements for successful employment of the intellectually handicapped, were sorted into four categories corroborated by university students. Chi-square analysis showed many significant differences in ranking among samples at p less than .0005. Parents and teachers emphasized items in the job-task category significantly less than did industry and workshop supervisors. Parents stressed basic reading skills more than other samples. Occupational therapists aware of the handicapped person's potential for employment could take the role of providing experiences stressing behaviors sought by employers.


Bilateral lower extremity dressing frame. Completely independent application of lower extremity prostheses and clothing is essential but often difficult to accomplish in optimal rehabilitation of the bilateral above-knee amputee. This paper suggests an occupational therapy treatment plan for above-knee amputations, discusses reasons for dependency and decreased use of lower extremity prostheses and clothing, and describes a bilateral lower extremity dressing frame designed for independent application of prostheses and lower extremity clothing. The cost of rehabilitation can be justified once independence in application of prostheses and clothing is accomplished and functional ambulation is achieved.


Marked accommodation, retinal stretch, monocular space perception and retinal receptor orientation. In recent years we have come to recognize that retinal receptors are probably aligned with the center of the exit pupil of the eye. It becomes crucial to define those factors influencing and determining photoreceptor alignment. Here, the effect of retinal stretch associated with marked accommodation has been considered. Assuming that a sense of direction is associated with a given retinal locus, we have used a classical monocular bisection test technique in order to see if marked accommodation altered bisection settings. Substantial changes in bisection settings were found when testing in the region of the posterior pole. These could be localized most probably in the retina and choroid. In separate studies, the effect of anterior retinal stretch upon cone receptor orientation in the region of the fovea was evaluated. Marked accommodation caused a transient nasal displacement of the peak of the Stiles-Crawford directional sensitivity function. These studies suggest that the posterior pole of the eye is routinely subject to stresses and strains. This point is of clinical significance. Our studies suggest that the presence of the blind spot influences the magnitude of change of measured parameters. We have only begun the important task of evaluating the nature of recovery processes following marked accommodation. Lastly, in order to obtain the necessary responses, we have had to train our young observers to voluntarily utilize nearly their entire accommodative capability.


Central and peripheral corneal swelling accompanying the wearing of Bausch and Lomb SOFLENS contact lenses. Central and peripheral corneal thickness was monitored during the wearing of Bausch and Lomb SOFLENS contact Lenses. The results showed that a generalized and equal swelling occurred in the central and peripheral cornea. This generalized swelling explains the absence of significant spectacle blue and/or changes in corneal curvature.


Changes in corneal curvature and subjective refraction of soft contact lens wearers. Changes in corneal curvature and subjective refraction were found to occur in some wearers of N & N lathe-cut soft contact lenses. These changes appear to be the result of any one of a number of factors, including a relatively steep lens-cornea relationship, over-wearing of lenses and inadequate blinking habits.


Clinical tonometric measurements comparing three non-contact tonometers. Three American Optical Non-contact Tonometers were used to compare readings against each other. The attempt was to determine if all three tonometers were measuring the same IOP over a wide range of pressures. The assumption in practice is that all Non-contact Tonometers are manufactured within tolerance that should allow the examiner to find that same IOP on a patient regardless of the Non-contact Tonometer used. A preliminary study found no significant difference between the instruments.


Geriatric ophthalmic dispensing.

Geriatric ophthalmic dispensing. The aged have many problems peculiar to their longevity. One is the need for a visual correction. Often the prescription is high in power and needs special consideration, especially for low vision and aphakie patients. Always the materials supplied must provide comfort and whenever possible, cosmesis. This paper covers these aspects in detail.


Experimental Lassa virus infection in the squirrel monkey. Experimental Lassa virus infection was investigated in a nonhuman primate in order to elucidate the target organs of the viral infection and the course of pathologic events. Four squirrel monkeys (Saimiri scirreus) were inoculated intramuscularly with Lassa virus and sacrificed for organ titrations and histopathology, one each day, on Days 7, 12, 14, and 28 after inoculation. The animals showed a variable clinical course, with an incubation period of 8 to 18 days. The virus was demonstrated to be virtually pantropic; however, lymph node, liver, and kidney were key early targets. After the onset of overt disease, patterns of lymphoreticulotropism, hepatotropism, nephrotropism, adrenotropism, and persistent viremia were evident. Complement-fixing antibody failed to develop after 28 days of infection. Histopathologic findings included germinal center necrosis in spleen and lymph node; myocarditis; acute arteritis; renal tubular necrosis and regeneration; hepatocytic regeneration; chronic inflammation of choroid plexus, ependyma, and meninges; and cerebral perivascular cuffing. There is a relationship between many of these lesions and certain features of other arenavirus infections. The model offers the opportunity to pursue investigations of experimental pathogenesis, transmissibility, and efficacy of immunotherapy.


The Schistosoma japonicum egg granuloma. Although Schistosoma japonicum egg granulomas are generally considered to be similar to those of S. mansoni (which are largely immunologic reactions of the delayed hypersensitivity type) there are suggestions that the histopathology and perhaps the etiology of the lesions are different. In mice with light S. japonicum infections, at 5 weeks after infection (2 weeks after egg production began), the livers contained 36,000 eggs each, but there was no reaction to the eggs, nor any evidence of hepatosplenic disease. By 6 weeks, large abscesses replete with cosinophils occurred around some of the eggs, and there was periportal inflammation consisting predominantly of plasma cells. From this time on, major lesions occurred mainly around large aggregates of eggs, and there was hepatosplenomegaly and portal hypertension. Living S. japonicum eggs injected into the pulmonary microvasculature of mice did not evoke significant granulomatous reactions on either primary or secondary exposure. Even when the eggs were injected into the lungs of infected animals, which had large granulomas around egg aggregates in the liver, little or no inflammatory reaction was seen around the eggs distributed singly throughout the pulmonary vessels. When the priming dose of eggs or soluble egg antigens was injected subcutaneously with or without complete Freund's adjuvant, significant granuloma formation occurred around eggs subsequently injected into the lungs. On the basis, therefore, of differences in the parasite factor (eggs) and host factors (histopathology and responses to routes of injection) it is suggested that the immunologic factors responsible for granuloma formation around S. mansoni and S. japonicum eggs may differ significantly.


Studies on the synthesis of plasma membrane proteins of fibroblasts from patients with cystic fibrosis. The characteristic increased salinity of sweat and other abnormalities of exocrine secretions in patients with cystic fibrosis (CF) suggest the possibility of a disturbed functioning of the plasma membrane in this disease. Several lines of evidence indicate that fibroblasts express the presence of the CF genotype. Therefore these cells were used in an in vitro study directed at determining whether the manifestations of CF might be related to an alteration of one or more of the protein components of the plasma membrane. In order to evaluate the synthesis of these components, growing fibrosblasts from patients with CF and normal subjects were briefly exposed to either 14C- or 3-H-leucine. Their plasma membrances were then isolated and subjected to analysis in a nondetergent acrylamide gel system. Coelectrophoresis of differentially labeled preparations revealed the absence of a detectable abnormality in the synthetic rates of any of the more than 30 resolved protein species.


Proliferation of mononuclear phagocytes (Kupffer cells) and endothelial cells in regenerating rat liver. A light and electron microscopic cytochemical study. The proliferation of littoral cells in regenerating rat liver after partial hepatectomy has been investigated using endogenous peroxidase and uptake of large (0.8-mu) latex particles as markers of Kupffer cells. Female rats were subjected to 2/3 partial hepatectomy and sacrificed at intervals up to 11 days. Prior to sacrifice, animals were injected with latex and their livers were fixed by perfusion and were processed for cytochemical localization of peroxidase. The sinusoidal cells exhibited a marked regenerative response after partial hepatectomy. Peroxidase activity persisted in endoplasmic reticulum of Kupffer cells during mitosis. Furthermore, latex particles were exclusively localized in such peroxidase-positive cells, thus confirming their identity as Kupffer cells. Quantitative counts revealed that the peak mitotic activity of Kupffer cells occurred at 48 hours, whereas that of endothelial cells was at 96 hours after partial hepatectomy. Our findings indicate that Kupffer cells are capable of dividing locally in the liver; no morphologic evidence of transformation of endothelial cells or monocytes to Kupffer cells was found. The significance of these observations concerning the origin of Kupffer cells is discussed, and it is concluded that in the model of liver regeneration after partial hepatectomy the Kupffer cells are formed predominantly by local cell division.


Studies on the structure and permeability of the microvasculature in normal rat lymph nodes. The structure and permeability of the microvasculature in normal rat lymph nodes was studied by regional perfusion techniques. The results indicated that characteristic vascular units supplied each cortical lobule of lymphatic tissue. Numerous arteriovenous communications and venous sphincters innervated by unmyelinated nerve fibers were found in this vascular bed. These specialized vascular structures permitted regional control of blood flow through high endothelial venules. Lymphocytes migrated across these venular walls by moving through intercellular spaces in the endothelium and between gaps in the laminated, reticular sheath. No direct anastomoses between blood vessels and lymphatics were seen, but tracer studies with horseradish peroxidase suggested that functional lymph node-venous communications were present in the walls of high endothelial venules.


Concerning the role of mitochondria in cryptobiosis. The metabolic characteristics of the mitochondria of Agaricus bisporus are altered in the zygote by specific inhibitors that permit them to retain structural integrity in the dormant spore and enable them to initiate energy production, with apparent protein synthesis and replication during the initial phase of germination. The insensitivity of the earliest events of germination to selective cytoplasmic and nuclear inhibitors characterizes this as a transient period of unusual mitochondrial autonomy. To define the intrinsic metabolic potentials of the organelle and its role in cryptobiosis, mitochondria were fractionated aseptically from presporulating zygotes and were placed in dialysis chambers surrounded by nutrient media at 15 C. For periods through 48 hours, the isolated mitochondria manifested the capacity to incorporate labeled amino acids linearly into proteins and retained stable electrophoretic protein profiles for more than 5 days. They maintained fine structural integrity for at least 10 days, some developed septational membranes, and they increased numerically. These metabolic activities were dependent upon a nutrient substrate.


Critique of the "critical mass" hypothesis of the regeneration of liver cells. The hypothesis that the regulation of liver cell regeneration is triggered by the critical mass of the cells has been examined. However, examination of the steps in the mathematical formulation of this hypothesis as well as the experimental work performed in our laboratory and elsewhere concerning the proliferation and the volume of hepatocytes following partial hepatectomy does not support this hypothesis.


Effects of a diphophonate on calcium metabolism in calcium-deprived rats. Calcium metabolism was studied in growing rats, submitted to calcium deprivation ofvarious intensity.  A decreased intake resulted in decreased net absorption of calcium(V'na), no change in bone formation (V'o+), and an increase in bone resorption (V'o -).  In animals given dichloromethylene disphosphate (Cl'2MDP), a compoundknown to inhibit bone resorption, V'o+ was less than in the controls but again the same at all calcium intakes; V'na was below V'o+, V'o- still increased as the calcium intake was reduced.  The various kinetic parameters in rats receiving Cl'2MDPwere indistinguishable from published data in parathyroidectomized (PTX) animals, yetblood calcium was low in PTX rats but normal in Cl'2MDP-atreated rats.  It appears that the rat has an efficient mechanism for increasing bone resorption which is not inhibited by Cl'2MDP and does not require parathyroid hormone.


Uptake of lactate by dog skeletal muscle in vivo and the effect of free fatty acids. These experiments were designed to determine: 1) if lactate can be extracted from the arterial blood and utilized by resting skeletal muscle of the dog, and 2) if lactate uptake or production by skeletal muscle is influenced by the level of circulating free fatty acids. Skeletal muscle arteriovenous differences in lactate were measured at several arterial lactate and free fatty acid concentrations. With sodium pentobarbital anesthesia and a low concentration of free fatty acids, arterial lactate concentrations of 1-2 mM were associated with extraction of lactate; however, when circulating free fatty acids were elevated (greater than 1 mM), no extraction of lactate occurred at these lactate concentrations. The relationship between arterial free fatty acids and uptake or release of lactate demonstrated in these in vivo studies suggest that the inhibition of free fatty acid release from adipose tissue that occurs when the arterial lactate concentration increases may function facilitate the metabolism of lactate by skeletal muscle.


Thyroid hormone-induced changes in body temperature and metabolism during exercise in dogs. Changes in serum total thyroxine concentration (TT4) and the effects of thyroxine (T4) and 3,5,3'-triiodothyronine (T3) injection on plasma free fatty acid (FFA) level and rectal temperature (Tre) responses were measured in six dogs at rest and during 1 h of submaximal treadmill exercise. At rest there were no increases in FFA level or Tre up to 72 h after thyroid hormone treatment. During exercise, 5 h after a single T4 injection (0.1 mg/kg), there was a) a significant increase in TT4, although the resting level was markedly elevated, and b) a significant increase in FFA concentration and Tre above control values. Seventy-two hours after T4 injection there was a similar increase in TT4 during exercise and both FFA and Tre levels were greater than 5-h values. The elevated Tre was not associated with increased plasma Na+, K+, or osmotic concentrations. Compared with T4 data, T3 injection (0.1 mg/kg) resulted in greater increases in FFA level and Tre during exercise; two animals reached 43.1 degrees C. There were no significant differences in the respiratory exchange ratio (R) or O2 uptake between the control and T3 experiments. It was concluded that thyroid hormones markedly enhance FFA mobilization and elevated Tre during exercise, but not a rest. The hyperthermic response appears to be due to an increase in the level of regulated body temperature rather than to a depression of heat dissipation.


Major and collateral components of blood flow to pregnant sheep uterus. In vivo measurements of vessel diameter, latex injections, and acrylic-cast studies indentified the middle uterine arteries as the main source of blood supply to the pregnant sheep uterus. Collateral circulation stemmed from the dorsal uterine arteries, and the ovarian arteries, and small cervical branches derived from the external iliac arteries (in decreasing order of importance). These morphological observations were related to estimates of collateral flow obtained during isolated, in situ perfusion of the pregnant sheep uterus carried out through the cannulated middle uterine arteries. Collateral blood flow was estimated from the shift of the flow-pressure curve produced by inflation of a balloon catheter advanced into the aorta below the renal arteries. Middle uterine artery flow to one horn increased from 162 +/- 23 ml/min in midgestation to 323 +/- 44 ml/min near term. Collateral uterine blood flow did not change significantly: 82 +/- 15 ml/min in midterm, 74 +/- 9 ml/min near term. Collateral flow consituted a larger fraction of inflow to the horn containing the fetus in 9 of 10 single pregnancies.


Reflex sympathetic changes in aortic diastolic pressure-diameter relationship. In anesthetized vagotomized cats with the chest opened and artificially ventilated, aortic blood pressure (AP) and external diameter (AD; ultrasound technique) were measured in the proximal third of the descending thoracic aorta. Slow sinusoidal oscillations (0.2-0.3 Hz in aortic volume were produced by a piston pump connected to a femoral artery. Diastolic pressure-diameter relationship (PDR) curves were obtained during control conditions and during stimulation of either the cut central end of the left inferior cardiac nerve (ICN) or the decentralized thoracic sympathetic chain (SC). In six cats with both carotid arteries occluded ICN stimulation reflexly shifted the PDR curves to lower diameters for any given pressure (mean deltaAD 3.2% at control AP). A smaller response to ICN stimulation was obtained in five cats with one patent carotid artery (mean deltaAD 2.3% at control AP). Stimulation of sympathetic efferents to the aorta (SC) caused similar responses in five animals (mean deltaAD 3.4% at control AP). This reflex control of the thoracic aorta may be involved in cardioaortic coupling and may influence the sensitivity of aortic mechanoreceptors.


Hepatic bile acid transport: effect of conjugation and position of hydroxyl groups. The hepatic transport of five bile acids was studied in the bile-fistula rat. Pairs of labeled bile acids were injected simultaneously into the portal vein as a sharp pulse and the secretion of radiolabel in bile was measured over the nex 15 min. Six bile acid pairs were tested, and it was found that both conjugation and the number and disposition of hydroxyl groups influenced hepatic transport. Taurocholic acid was transported most efficiently, followed in order by glycocholic acid, cholic acid, deoxycholic acid, and chenodeoxycholic acid. Sampling aortic blood immediately after portal vein injection of labeled bile acid pairs demonstrated differential rates of hepatic extraction. In every comparison, the bile acid that was more efficiently extracted by the liver had a faster overall transport rate. This suggests that the differing rates of biliary secretion are, at least in part, determined by the efficiency of hepatic uptake.


Lack of a direct effect of efferent cardiac vagal nerve activity on atrial receptor activity. Experiments were carried out to determine the extent to which the efferent cardiac vagus may modulate the discharge from atrial receptors when heart rate was not controlled. Stimulation of the vagus increased atrial pressure and the discharge from type-B atrial receptors. In order to determine the extent to which the increase in atrial receptor discharge was the result of the associated hemodynamic changes, studies were done in which the vagus was stimulated while heart rate was maintained constant using atrioventricular pacing, as atrial pressure was varied over a wide range by volume expansion. In paced hearts vagal stimulation depressed atrial contractile force but did not alter atrial receptor discharge when compared to paced hearts without vagal stimulation. These results indicate that the effect of vagal stimulation on atrial receptor discharge is an indirect one mediated through the rise in atrial pressure due to cardiac slowing rather than a direct effect on the atrial stretch receptor itself.


Influence of poststimulation potentiation and heart rate on the fetal lamb heart. Isolated cardiac muscle techniques and studies of the chronically instrumented fetal lamb heart were employed to evaluate the ability of fetal myocardium to exhibit poststimulation potentiation. Isometric tension development and the response to paired electrical stimulation were significantly reduced in isolated fetal ventricular myocardium when compared to the adult (P less than 0.001). As in the adult, increasing stimulation frequency raised fetal isometric tension via an increase in the rate of rise of tension development in the presence of reduction in time-to-peak tension. In seven fetal lambs the left ventricle was chronically instrumented with endocardial ultrasonic crystals and a high-fidelity micromanometer. After a 2-wk recovery period, heart rate was increased by atrial pacing from an average control level of 150 to 300 beats/min. Left ventricular dP/dt increased progressively and then fell beyond a heart rate of 270/min. When comparable pre- and immediate postpacing beats were analyzed, a step-wise increase in the velocity of left ventricular shortening and the mean rate of circumferential fiber shortening was observed in association with an increase in the extent of shortening. Thus, increases in the frequency of contraction exert a significant positive inotropic effect on the fetal heart.


Reversibility of mechanical and biochemical changes in smooth muscle due to anoxia and substrate depletion. The effect of temporary glucose and oxygen deprivation on isometric tension as well as content of glycogen, creatine phosphate (CP), adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), and adenylate pool (AP) were  studied in potassium-contracted guinea pig isolated taenia coli. Under aerobic conditions glucose removal caused a decrease in tension, glycogen, CP, ATP, and energy charge; ADP and AMP increased, keeping the adenylate pool size unchanged. During rigor caused by additional anoxia, there was an increase in tension associated with further decrease in ATP and marked reduction of adenylate pool. Restoration of oxygen supply caused only a small increase in ATP that, though sufficient for abolishing rigor, was insufficient to support potassium contraction. Restoration of both glucose and oxygen did not restore tension even though ATP stores were increased further. Elevation of extracellular calcium caused partial restoration of tension, suggesting that the defect was in calcium metabolism rather than energy metabolism. During recovery AP remained low, possibly due to deamination of AMP. Anoxia in the presence of glucose reduced ATP to a concentration similar to that due to aerobic glucose deprivation but tension decreased much less. This result is consistent with different degrees of ATP depletion in various functional (Ca pump vs. contractile mechanism) compartments.


Effect of KCl infusion on renin secretory rates and aldosterone excretion in dogs. The effects of unilateral intrarenal arterial KCl infusion in dogs (12 mueq/kg per min) on bilateral renal function, renin secretory rates, and aldosterone excretion were studied. During KCl infusion, infused-side renal arterial plasma [K+] increased by 2.2 +/- 0.6 meq/liter. Systemic plasma [K+] simultaneously rose by 0.6 +/- 0.1 meq/liter. Plasma renin activity decreased 29 +/- 9%, and the decrease correlated with the increases in plasma [K+]. Renin secretory rate decreased bilaterally, the decrease being greater in each experiment on the infused side. Aldosterone excretion increased during KCl infusion by 72 +/- 17%, despite a decrease in plasma renin activity. With KCl infusion there was a bilateral increase in K+ excretion, and a positive correlation was observed between the net alterations in K+ and Na+ excretion. No significant alterations in systemic blood pressure, glomerular filtration rate, total renal blood flow, or intracortical renal blood flow distribution were observed. These studies suggest that K+ inhibits the release of renin by an intrarenal mechanism, which may be related to a K+-induced alteration in Na+ absorption.


Catecholamines and exercise-induced glucagon and fatty acid mobilization in the rat. Physical exercise in rats provokes an increase in plasma glucagon and free fatty acid concentrations. The persistence of exercise-induced glucagon stimulation in adrenodemedullated animals and conversely, its inhibition by immunosympathectomy, (-)-ropranolol, and pindolol substantiate the conclusion that stimulation of the alpha2 cells in exercise involves sympathetic stimulation of the beta-adrenergic receptors. The reduction of free fatty acid mobilization by immunosympathectomy and (-)-propranolol and its persistence after adrenodemedullation suggest that it is similarly mediated, at least in part, by adipose cell beta-sympathetic receptors.


A linked oscillator model of electrical activity of human small intestine. The electrical slow-wave activity of the human small intestine has been simulated by a chain of 64 coupled electronic relaxation oscillators. The model simulates the frequency gradient of recorded patoentials in the human small intestine and when transected, behaves in a similar way to the transected canine small intestine. The model exhibits a spontaneous effect whereby several adjacent oscillators periodically are in the same state. This effect travels down the model in the time of 20-30 min.


Kidney and urinary bladder functions of the rainbow trout in Mg and Na excretion. Magnesium concentration in the urinary bladder of marine teleosts is high and [Na] is low. The inverse relationship may be due to the coupling of Mg secretion to Na reabsorption through a common tubular transport system or coupling may be indirect. Unanesthetized sea-water-adapted Salmo gairdneri were infused with saline or MgCl2, and ureteral urine was collected. Over a wide range of Mg excretion rates, tubular Mg secretion and Na reabsorption show no clear correlation as might be expected from an obligatory tubular Mg/Na exchange. Instead ureteral Mg and Na concentrations and excretion rates are positively correlated. These data are not consistent with the presence of a tubular exchange system. When ureteral urine was allowed to remain in the urinary bladder before being analyzed the inverse relationship between [Mg] and [Na] developed because the bladder reabsorbed Na and H2O, thereby concentrating Mg. Hence, tubular Mg/Na exchanges do not produce the inverse Mg/Na relationship in bladder urine. Instead, Mg is secreted in the nephron, while Na and H2O are reabsorbed from the bladder.


Effect of exercise on lipoprotein lipase activity in rat heart and skeletal muscle. Lipoprotein lipase activity was measured in the three skeletal muscle fiber types of untrained rats and in those of rats subjected to a 12-wk program of treadmill running. Lipoprotein lipase activity in slow-twitch red fibers was approximately 14- to 20-fold higher (P less than 0.001) than that in fast-twitch white and approximately 2-fold higher (P less than 0.001) than that in fast-twitch red fibers in the untrained animals. These results suggest that, in sedentary animals, mainly slow-twitch red and fast-twitch red fibers are capable of taking up plasma triglyceride fatty acids. Regularly performed endurance exercise resulted in significant increase (2- to 4.5-fold) in lipoprotein lipase activity in the three muscle fiber types examined. The increase in lipoprotein lipase activity in response to treadmill running suggests that exercise increases the capacity of these fibers to take up and oxidize plasma triglyceride fatty acids. Cardiac muscle did not undergo an exercise-induced increase in the levels of activity of lipoprotein lipase similar to that seen in skeletal muscle.


Comparison of hilar and capsular renal lymph. The sites of origin of renal lymph were studied by analysis of simultaneously collected samples of lymph and plasma. The samples included renal hilar (HL) and capsular lymph (CL), thoracic duct lymph (TD), renal venous (RVP) and arterial plasma (AP), and were analyzed for Na+, Cl-, K+, urea, glucose, inulin, and PAH concentrations. The glucose concentrations of HL (76 mg/100 ml, SE +/- 1.9), and CL (92 mg/100 ml, SE +/- 2.5) were significantly different (P less than 0.01) from that of RVP (86 mg/100 ml, SE +/- 2.2). Concentrations of both inulin and PAH in CL and HL fell between the AP and RVP values. The concentration of inulin in CL (CL/RVP = 1.27) exceeded that in HL (HL/RVP = 1.10), but no such difference was detected for PAH. The Na+ (152 meq/liter) and Cl- (129 meq/liter) concentrations in HL were significantly (P less than 0.01) higher than those in CL (Na+ = 148 meq/liter; Cl- = 120 meq/liter), in TD (Na+ = 146 meq/liter; Cl- = 121 meq/liter), and in RVP (Na+ = 144 meq/liter; Cl- = 114 meq/liter. These differences remained highly significant when the electrolyte concentrations were converted to milliequivalents per kilogram H2O. In contrast, no significant differences were detected between the concentrations of urea in the various fluids sampled. It is concluded that CL and HL do not drain a perfectly homogeneous intrarenal pool, and that they do not equilibrate with RVP or AP within the kidney. The results also indicate that CL and HL derive a small component from tubular reabsorbate; that for CL stemming from the cortex, and that for HL from the deeper cortex and outer medulla.


Rates of lactic acid permeation and utilization in the isolated dog brain. The rate of lactic acid (LA) permeation from brain tissue to venous blood and utilization in brain tissue was investigated in 13 isolated dog brains before and after an ischemic period of 3 min. LA concentration in the brain, cerebral blood flow, as well as the arteriovenous differneces of LA, glucose, and O2 were determined. LA concentration in cerebral tissue increased from a control value of 254 +/- 42 to 1,606 +/- 177 mumol/100 g brain tissue in the 2nd min after ischemia (mean values +/- SE). Before ischemia no release of LA was found, whereas in the 2nd min after ischemia LA permeation rate had increased to 25.1 +/- 8.5 mumol/100 g brain tissue per minute (P less than 0.005). Up to the 4th min after ischemia no net LA utilization was observed. Thereafter LA utilization increased rapidly and exceeded the LA permeation rate by a ratio of maximally 10:1 between the 12th and 21st min after ischemia. The O2 equivalent of the cerebral metabolic rate for lactate maximally amounted to 2.82 +/- 0.42 mumol-min-1-g-1 or 181 +/- 28%. LA output may be limited by passage of LA across the brain cell and the blood-brain barrier.


Water and electrolyte transport by rabbit esophagus. The nature of the transmural electrical potential difference and the characteristics of water and electrolyte transport by rabbit esophagus were determined with in vivo and in vitro studies. The potential difference of the perfused esophagus in vivo was -28 +/- 3 mV (lumen negative). In vitro the potential difference was -17.9 +/- 0.6 mV, the short-circuit current 12.9 +/- 0.6 muA/cm2, and the resistance 1,466 +/- 43 ohm-cm2. Net mucosal-to-serosal sodium transport from Ringer solution in the short-circuited esophagus in vitro accounted for 77% of the simultaneously measured short-circuit current and net serosal-to-mucosal chloride transport for 14%. Studies with bicarbonate-free, chloride-free, and bicarbonate-chloride-free solutions suggested that the net serosal-to mucosal transport of these two anions accounts for the short-circuit current not due to sodium absorption. The potential difference and short-circuit current were saturating functions of bathing solution sodium concentration and were inhibited by serosal ouabain and by amiloride. Thus active mucosal-to-serosal sodium transport is the major determinant of the potential difference and short-circuit current in this epithelium.


Interaction of O2 diffusion and O2 metabolism in cat urinary bladder tissue. We measured oxygen exchange across the inside surface of excised urinary bladders that were inflated with gas mixtures. By using a range of Po2 differences between the two sides of the tissue and relatively simple mathematical models, we could infer the exchanges across the outside surface and the total O2 economy of the tissue so that we could evaluate the interaction between diffusion and metabolic O2 consumption. The estimate of the Krogh diffusion constant or permeation coefficient with this preparation avoids errors due to O2 consumption and unstirred layers. At 37 degrees C, the value of bladder tissue O2 consumption was 4.4 times 10(-3) min-1 and the value of the Krogh constant for O2 was 2.22 times 10(-5)cm2min-1atm-1.


Effect of heparin on chronically induced intravascular coagulation in dogs. When intermediate-strength thromboplastin was continuously infused into dogs for 10 days or more, platelet counts decreased sharply and factor VIII concentrations decreased by more than 50%. There was little change in plasma fibrinogen, prothrombin, factor V, antithrombin III, plasminogen, prothrombin time, and thrombin time values. When heparin was infused (25-50 U/kg per h) along with the same thromboplastin, there was no change in onset or degree of thrombocytopenia. However, the decrease in factor VIII was abolished and there were significant increases in fibrinogen, prothrombin, and factor V. The absolute concentrations of the various clotting factors seemed to give no indication of their turnover rates. Unexplained is the remarkable heparin tolerance that developed in these dogs.


Graded activation in rabbit mesotubarium smooth muscle. The outer margin of the mesotubarium superius, an accessory ligament from the femal rabbit reproductive system, contains a long and slender bundle of smooth muscle fibers well aligned with the long axis of the tissue. Very little connective tissue is present. Massive alternating-current electrical field stimuli (variable in frequency, amplitude, and duration) applied to isolated mesotubaria from mature, nonpregnant animals produced contractions in which isometric force (P) and its first derivative (dP/dt) could be continuously graded; an optimum existed for stimulus frequency and amplitude, but not for its duration. Twitchlike contractions could not be produced. Isometric contractions in which P was plotted against dP/dt to generate a phase-plane trajectory were used to predict the ultimate (time = infinity) force (Po) in graded contractions; this value agreed with the Po derived from isotonic force-velocity curves fitted to the Hill equation. Quick stretches applied during the rise of contractile force revealed a slow onset of the ability to bear the Po force.


Plasma amino acid levels and development of hepatic gluconeogenesis in the newborn rat. The metabolism of endogenous and exogenous amino acids has been characterized during a 16-h fast after birth in the rat. Eighteen of 22 amino acids showed a decrease in plasma concentration up to 16 h, the most profound and sustained changes affecting those quantitatively important in gluconeogenesis. The hepatic accumulation of injected [14C]aminoisobutyric acid showed a progressive rise after birth. The in vivo conversion of 14C-labeled lactate, alanine, serine, and glutamine to [14C]glucose increased for 6 h, but all except glutamine showed a decline by 16 h. The in vitro conversion of several gluconeogenic substrates (10mM), however, increased with time in each instance. These data confirm that the capacity for hepatic gluconeogenesis and maintenance of blood glucose concentration appears immediately after birth. Nevertheless, profound hypoglycemia recurs at 16 h and responds only minimally and transiently to exogenous gluconeogenic substrate loads. In contrast, the fed newborn maintains normoglycemia, higher endogenous amino acid levels, and the capacity for substrate conversion at this time. The mechanism for stimulation of hepatic gluconeogenic pathways thus is present in both fasted and fed neonatal rats. However, owing to insufficient energy sources to sustain gluconeogenesis and to inadequate gluconeogenic substrate, the rat is unable to maintain normoglycemia if fasted 16 h.


High-output heart failure in the dog: systemic and intrarenal role of angiotensin II. Dogs with experimental high-output heart failure (HOF) exhibit marked retention of salt and water secondary to hypersecretion of both renin and aldosterone. The present study was undertaken to evaluate the systemic and intrarenal arteriolar action of angiotensin II (AII) in dogs with HOF and to provide additional information about the role of AII in low-output states. The intravenous infusion of a specific AII antagonist, [Sar1, Ala8]AII (6 mug/kg min-1), into conscious dogs with HOF decreased the mean arterial pressure (AP) from 101 +/- 7 to 83 +/- 7 mmHg (P less than 0.01) after 45 min of infusion. Intrarenal arterial infusion of the AII antagonist (0.2 and 2.0 mug/kg min-1) into anesthetized dogs with HOF also decreased AP and produced a marked increase in renal blood flow (RBF) with no changes in either creatinine clearance or sodium excretion. Similar results were obtained during the intrarenal infusion of the antagonist into sodium-depleted dogs and dogs with thoracic vena caval constriction, but not in normal dogs. The data demonstrate an important role for AII in the regulation of AP and RBF in high- and low-output states.


Effect of secretin on electrical activity of small intestine. The effect of intravenously administered secretin (0.5, 2.0, 6.0 U/kg-h) and intraduodenal acidification (13.2 meq/h HCl) on the electrical activity of the small bowel of three conscious dogs with gastric and duodenal cannulas was observed. Electrical activity was recorded in fasted as well as fed conditions through silver wire electrodes implanted along the entire length of the small bowel. Intravenous infusion of secretin in all dosages and in all dogs delayed the onset of the interdigestive myoelectric complex and reduced the total percentage of slow waves with superimposed spike potentials. Intraduodenal acidification also inhibited the interdigestive myoelectric complex, which developed incompletely with fewer action potentials on slow waves. Secretin did not produce any alteration in the fed pattern of activity, slow-wave frequency, or the caudal migration of the interdigestive myoelectric complex. The present study indicates that the nuerohumoral mechanisms responsible for initiation of the interdigestive myoelectric complex may be different from those responsible for its caudal migration.


Phosphatemic action of 1,25-dihydroxyvitamin D3. The action of a single intraperitoneal injection of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) was investigated in thyroparathyroidectomized (TPTX) vitamin D-deficient phosphate-depleted rats. After 14 h, plasma inorganic phosphorus (Pi) was significantly greater in animals receiving 1,25(OH)2D3 than in D-deficient controls, but urinary Pi excretion was very low in both groups and not significantly different in the rats given 1,25(OH)2D3. Clearance studies indicated that the D-deficient controls reabsorbed more than 99% of their filtered Pi. Avid Pi reabsorption continued even after the infusion of sufficient phosphate to raise the plasma and filtered Pi to approximately 3 times normal. Fractional calcium excretion (FECa) exceeded fractional sodium excretion (FENa) by severalfold, but FECa decreased strikingly during phosphate infusion. In animals that manifested a substantial elevation of plasma Pi after 1,25(OH)2D3, FECa was significantly less than in D-deficient controls. Therefore, the increase in plasma Pi following 1,25(OH)2D3 administration occurs independently of any effect on renal Pi reabsorption and may be responsible, at least in part, for the amelioration of hypercalciuria after 1,25(OH)2D3 treatment.


Hydrogen ion transport in the rabbit esophagus. The lumen of the rabbit esophagus was perfused in vivo with solutions (one solution per esophagus) containing 0-160 mM HCl by a constant circulation technique for 5 h. During the 1st h, net H+ flux out of the lumen (efflux) was minimal at H+ concentrations of 80 mM or less, but increased linearly with increase in luminal H+ concentrations above 80 mM. After 3 h, the net H+ efflux increased proprtionately to increasing H+ concentrations above a threshold of 20 mM. At the 5th h a linear relationship between net H+ efflux and luminal concentration was seen at all concentrations. Histological damage accompanied increase in H+ efflux and correlated with luminal acid concentrations and duration of exposure. We conclude that the rabbit esophageal mucosa is essentially impermeable to H+ below a threshold concentration of 80 mM for up to 1 h of exposure. When exposure is prolonged, this threshold steadily decreases with time. The occurrence of passive H+ diffusion above threshold concentrations most probably results from an increase in mucosal permeability, possibly an initiating event in the genesis of esophagitis.


Hyporesponsiveness to glucoprivation during postnatal period in the rat. 2-Deoxy-D-glucose (2-DG), a glucose analogue, blocks glycolysis and induces intracellular glucoprivation. In the adult rat intraperitoneal administration of 2-DG or its injection into the lateral ventricle (IVT) of the brain induces hyperglycemia which is divorced from a rise in plasma insulin (IRI). In the present study, responsiveness to 2-DG-induced glucoprivation, after central or intraperitoneal injection of the drug, was studied in rats of 7, 14, 21, and 28 days of age and compared to that of the adult rat (50 days old). In 7-, 14-, 21-, and 28-day-old rats, the overall blood glucose (BG) response to IVT-injected 2-DG was equivalent to 4, 3.3, 17, and 33%, respectively, of the BG response present in the adult rat. Following intraperitoneal injection of 2-DG , the BG response evoked in the same age groups corresponded to 27, 31, 41, and 93%, respectively, of the adult response. Base-line plasma IRI levels were significantly lower in pups than in adults and increased progressively with age, but no difference was present in IRI levels between 2-DG-treated and control pups whether the 2-DG was given via the laterl ventricle or intraperitoneally. These results demonstrate the presence in the infant rat of clear-cut hyporesponsiveness to 2-DG-induced glucoprivation. The different response pattern between experiments involving central and peripheral 2-DG administration supports the existence of separate peripheral glucoreceptors for 2-DG and their earlier ontogenic activation. Since the infant mammal glucose is of minor relevance as an energy substrate, an interrelationship appears to be present between requirements for fuel(s) and homeostatic response to fuel deprivation.


Effect of bile salts on amino acid transport by rabbit intestine. The effect of bile salts on alanine absorption across four regional sites of rabbit intestine was examined using an in vivo single-pass perfusion technique. Na-deoxycholate at a concentration of 3 mM reduced alanine absorption across all levels of the intestine, and a higher concentration (10 mM) of Na-taurodeoxycholate (TDC) caused only a minimal reduction of alanine absorption in the jejunum. TDC, however, was more effective in in vitro experiments, causing an incrase in transmural serosal-to-mucosal flux of alanine and phenylalanine, particularly when present in both the mucosal and serosal media. It also reduced the mucosal-to-serosal alanine flux rate when present only in the mucosal medium. The influx of these amino acids across the mucosal brush border membrane was also decreased by TDC. These amino acid transport changes correlated fairly well with some observed histological changes of the intestinal epithelium. This suggests that bile salt inhibition of amino acid absorption is nonspecific in type and can be mainly explained as being the result of an injurious action of these surface-active agents on the rabbit intestine.


Fifteenth Emil A. Gutheil Memorial Conference. The range of therapies in the treatment of severely depressed suicidal patients. The treatment of patients with suicidal drives and ideas is often less than adequate due to theoretic and technical prejudices. This paper describes the requirements that one who treats suicidal patients should meet. The phases of treatment and aims of each phase are outlined. Finally the combined antidepressant drug-psychotherapy thechnique and electroshock procedures are described in detail.


Growing up dead: student suicide.

Growing up dead: student suicide. This article discusses the psychodynamic significance of suicide in the young, the family constellations that produce such suicides, the psychosocial forces contributing to the dramatic rise in the suicide rate of young people, and the special problems in the treatment of the severely suicidal young person.


Suicide in children and adolescents.

Suicide in children and adolescents. Suicide figures are generally underestimated, more so for children and adolescents than for adults. Yet suicide among adolescents has shown the greates rise for any age group. Every youngster who attempts or threatens suicide should have a thorough psychiatric evaluation. Most of them require intense therapy, either individually or in a group.


Psychotherapeutic strategies in the management of depressed and suicidal patients. This paper examines the Crisis Intervention Therapy developed by Dr. Kiev's Cornell Program, for the management of depressed and suicidal patients. Combining chemotherapy with supportive psychotherapy, he emphasizes the acquisition of Life Strategy Skills, using motivational audiotaped material. The therapeutic rationale is also explored and related to the explosive and unpredictable interpersonal world of suicidal patients and attiudes of patients and significant others toward the sick role.


The phenomenology of depression.

The phenomenology of depression. The article attempts to identify the basic mechanism of depression as implied by various clinical formulation of depression. In this context, depression appears to result from a faulty system of thinking, developed during the individual's formative years. The depressed person perceives reality based on either absoluted social moral values or distorted evaluations of his limitations and expectations.


The use of suicidal motives in the psychotherapy of attempted suicides. Patients' reasons for their suicide attempts were categorized and related to levels of hopelessness and depression. The findings are discussed in the light of the psychotherapy of suicidal individuals.


Psychiatry and psychotherapy as political processes. Therapy is applied politics. From hospitalizing a patient to offering psychoanalytic insight, a therapist's every action reflects his own attitudes toward political issues, including individual freedom vs. state control, or capitalism versus socialism. Ultimately every therapy implements some utopian political vision against which the client will measure his own success and failure in the therapy.


Interaction in hospitalized patient-led and staff-led psychotherapy groups. Psychotic patients' participation in two kinds of inpatient group therapy, one staff-led, and the other patient-led with staff observing, revealed that patients talked more in the patient-led group than in the traditional staff-led group. Discussion explored the importance of peer, self-help influences in groups for stimulating psychotic patients to take more responsibility for themselves and other patients.


Management of unethical behavior in a psychiatric hospital staff. Several interrelated instances of unethical conduct in mental health professionals, occurring at a psychiatric hospital, serve to highlight the importance of the traditional ethical canons in our field. The impact of ethical breaches upon psychotherapy are exemplified and discussed; suggestions for appropriate administrative measures in dealing with such incidents are outlined.


Implications of the behavioral approach to hypnosis. The findings of behaviorally oriented research regarding the importance of cognitive-motivational variables in hypnosis are examined and some clinical and theoretical implications are explored. Hypnosis seems usefully conceptualized as a complex configuration or gestalt of interacting variables on several different levels, for example, cognitive, motivational, social, physiologic.


Interpretation and working through.

Interpretation and working through. The function of insight is independent of content. Insight is the result of the assignment of meaning as distinct from finding meaning. Interpretation leads to insight which binds anxiety and lifts repression, thus providing relief of symptoms. Working is learning to apply the assigned meaning to new situations.