A simple method for obtaining blood pressure in rhesus monkeys (Macaca mulatta). A relatively simple procedure was devised to obtain blood pressures in rhesus monkeys. This procedure utilized a polygraph, pulse transducer, pressure transducer, blood pressure mixer unit, and pediatric sphygmomanometer cuff. Previous attempts to auscultate the Korotkoff sounds by use of a sphygmomanometer cuff and stethoscope were unsuccessful. Blood pressure can be obtained by cannulation of the femoral artery, but repeated puncture may cause serious trauma to the arterial wall. This procedure was developed and used in our laboratory to obtain repeated blood pressures over a 90-da period. Results from using the cuff and polygraph have been shown to correlate favorably with cannulation of the femoral artery.


An aseptic peritoneal cell collection technic for small laboratory animals. Peritoneal exudate was collected by introducing a lavage medium (sterile saline or an equivalent) via syringe and needle into the peritoneal cavity of the anesthetized animal. The lavage medium was recovered by allowing it to flow through the needle into a sterile container. This method guards against contamination. Eighty to 90% of the initial lavage volume is retrieved.


Sheep: a model for testing spinal and epidural anesthetic agents. The sheep was utilized as a model to study local anesthetic agents used for subarachnoid and epidural anesthesia in human beings. Employing injection and evaluation technics similar to those used in human anesthesiology, the onset of anesthesia, development of maximum sensory anesthesia, regression of sensory anesthesia, and complete return of sensation and motor function were measured. Subarachnoid injection with 0.25% tetracaine and epidural injection with 0.25% bupivacaine produced regional anesthesia similar to that observed in humans.


A digital auto-recorder for measuring the drinking frequency of mice. An inexpensive, automatic digital recorder to measure the drinking frequency of mice was designed. When an animal licked the spout of the water bottle, it closed the path of the current of the amplifier input circuit and a module converted the closure signal into an electric pulse. A camera preset by a timer automatically photographed the counter which had accepted the pulse. The apparatus was inexpensive and estimated the drinking frequency of many mice individually and simultaneously. This system is applicable as a pulse-recorder to physical phenomena other than water intake.


Variations in serum calcium between strains of inbred mice. Serum calcium concentrations of C3H/Fg, C3H/HeJFg, AKR/Fg, A/Fg, and LCS/Fg mice were compared at 4 and 7 mo of age. In the C3H/Fg and A-strain mice, calcium levels did not differ significantly between the 2 strains nor between the 2 age groups. The C3H/HeJFg, LCS/Fg, and C57BL/Fg strains formed a distinct group with similar calcium levels, but at a significantly higher level than C3H/Fg and A/Fg group. Again there was no significant difference between the 4- and 7-mo groups. The AKR/Fg strain was distinct from both groups in that higher calcium levels characteristic of the second group (C3H/HeJFg, LCS/Fg, and C57BL/Fg, were seen at 4 mo of age, but lower calcium levels similar to those of the C3H/Fg and A/Fg strains were found at 7 mo of age.


Adenovirus and ileocecal intussusception. Intranuclear inclusion bodies were found by light microscopy in epithelial cells in more than one-third of the specimens from children operated on for ileocecal intussusception. Electron microscopic examination done on hematoxylin and eosin-stained slides showed the intranuclear inclusion bodies to be composed of viral particles in large and small crystalline arrays. Adenovirus of serotypes 2, 3, and 5 were isolated from the five cases with inclusions in which isolation was attempted. These findings strongly suggest a pathogenetic role for adenovirus in those cases of intussusception in which intranuclear inclusion bodies are found in the epithelial cells of the appendix or the terminal ileum.


Xenogeneic red blood cell degradation in a regional lymph node and dissemination of antigens by circulating lymphocytes. The degradation of intramuscularly injected autogenic and xenogenic red blood cells are studied with electron microscopy and immunoferritin technique. Autogenic red blood cells are phagocytosed and completely degradated by macrophages within the draining lymph node in a relatively short time. Phagocytosis and initial degradation of xenogeneic red blood cells by macrophages in the draining lymph node are similar; however, portions of the degradation products persist in macrophages as characteristic myelinic-like figures. After 4 days, identical figures appear in large numbers in the adjacent lymphocytes within membrane-bound vacuoles. With the conjugated ferritin antibody technique, these myelinic-like figures are shown to contain antigens of the xenogeneic red blood cells. Subsequently, lymphocytes containing the inclusions are found in the peripheral blood, the marginal zone of the spleen, other lymph nodes, and the bone marrow. As in the draining lymph node the number of plasma cells increases in these organs in areas adjacent to lymphocytes with the inclusions. In a parallel study, uncoated polystyrene spheres injected intramuscularly accumulate and remain localized in macrophages of the draining lymph node. When coated with xenogeneic hemoglobin and membranes, these spheres appear in lymphocytes of the draining lymph node and subsequently in lymphocytes of the blood and spleen.


Unilateral renovascular hypertension in rats. Measurements of medullary granules, juxtaglomerular granularity and cellularity, and areas of adrenal zones. To produce hypertension, the left renal artery was clipped in 20 rats. Six rats had a sham operation. After 4 months, some of the rats showed only a moderate increase in blood pressure, and a second clipping of the same artery was performed. When hypertension became severe in some of the rats, 2 to 4 weeks later, all rats were sacrificed. The "clipped" rats were divided into four groups depending on whether they had little change in blood pressure, acute hypertension, chronic hypertension, or chronic and superimposed acute hypertension. The average adrenal weights were increased in the two groups with acute hypertension. The area of the adrenal glomerular zone was increased in all three groups with hypertension. The groups with acute hypertension also showed increases in the combined areas of (1) the medullary and androgenic zones and possibly (2) the fascicular and reticular zones. The granules of the left juxtaglomerular apparatus were greatly increased in the group with acute hypertension, but were only slightly elevated in the group with chronic hypertension and the group with chronic and superimposed acute hypertension. An increased juxtaglomerular cellularity in the clipped kidney correlated best with hypertension. Renal medullary granular counts were decreased in the right and left kidneys of all clipped groups whether or not they had hypertension, but no changes were found in the amount of medullary interstitial space. The above results are consistent with the evidence in acute unilateral renovascular hypertension with the opposite kidney intact that the clipped kidney is responsible initially via a renin-angiotensin-aldosterone mechanism, with participation by the major adrenal zones. In chronic hypertension some other mechanisms, with participation by the major adrenal zones. In chronic hypertension some other mechanisms, which seem to be related to juxtaglomerular cellularity in the clipped kidney, are operating. Other evidence suggests that such mechanisms may depend on sodium retention, volume expansion, and increased sensitivity to vasoconstrictors.


Cell to cell transmission of virus in the central nervous system. II. Experimental rabies in mouse. Rabies virus replication in suckling and adult mouse brains inoculated with either fixed or street virus was studied by light and electron microscopy. Chronologic study of fixed virus-infected suckling mice showed that virus budded from the plasma membrane of neuronal cell processes and perikarya prior to the development of intracytoplasmic virus particles. Nucleocapsids and virions were observed exclusively in perikarya and cellular processes of neuronal cells and, on rare exception in an astrocyte indicating high neurotropism of rabies virus regardless of the strain of virus and the age of host animal. Virus transit between contiguous neuronal cell processes and perikarya was observed in suckling and adult mouse brain after both street virus and fixed virus infection. Nucleocapsids and virions were also found in myelinated axons in addition to the unmyelinated neuronal cell processes. The implication of cell to cell spread of virus within the central nervous system in rabies virus infection is discussed.


Freeze-fracture differences between plasma membranes of descending and ascending branches of the rat Henle's thin loop. Freeze-fracture of Henle's thin loop of the rat shows that the plasma membrane of epithelial cells in the descending branch has far more particles (approximately 4000 per sq. mum.) than the plasma membrane in the ascending branch (approximately 1000 per sq. mum). On the contrary, the tight junctions between epithelial cells in the two branches are equally developed. The large number of particles in the descending branch may be an important factor in the water permeability of this tubular segment.


Gentamicin nephrotoxicity in rats. I. Acute biochemical and ultrastructural effects. This investigation characterizes the acute biochemical and ultrastructural alterations within the rat kidney following the single injection of 10, 40, 80, or 160 mg. of gentamicin per kilogram of rat weight. Gentamicin was given intraperitoneally and rats were killed 80 minutes later. To assess a possible inhibitory effect upon protein synthesis 3H-leucine was injected 20 minutes postantibiotic and renal cortex was assayed for whole tissue and the protein fraction amino acid uptake. To exclude the possibility of gentamicin-induced lysosomal membrane instability with subsequent release of acid hydrolases, the activity of acid phosphatase was assayed in the supernatant and the residue of cortical homogenates containing the lysosomal fraction. Ultrastructural changes were concomitantly studied. To determine the intracellular localization of gentamicin, levels of the antibiotic were measured in subcellular fractions of cortical homogenates obtained from rats 2 hours following a single subcutaneous injection of 20 mg. of gentamicin per kilogram of rat weight. No gentamicin-induced alterations either of protein synthesis or of acid phosphatase distribution were demonstrated. Ultrastructural changes were most marked at 160 mg. per kg. consisting mainly of dilation of the endoplasmic reticulum, altered mitochondria, and increased cytosegresomes. Significant quantities of gentamicin were distributed within the nuclear, mitochondrial, and microsomal fractions. These studies indicate that although cytoplasmic alterations are prominent within the proximal tubular epithelial cells, they are not likely the result of either inhibition of protein synthesis or release of acid phosphatase from lysosomes.


Phagocytosis by muscle cells.

Phagocytosis by muscle cells. Electron microscopy of intact tissue and cultured smooth muscle suggested the occurrence of phagocytosis of necrotic cells by normal vascular smooth muscle cells. Phagocytosis was further studied in vitro in muscle cells from guinea pig aorta, guinea pig vas deferens, and striated muscle from chick embryo by light and electron microscopy. The uptake of yeast cells (approximately 2-mum. diameter) into living cultured smooth muscle cells from guinea pig aorta was observed with phase contrast microscopy and differential interference (Nomarski) optics. Periodic acid-Schiff staining showed the yeast cells lined up in the cytoplasm of the muscle cells. Electron microscopy confirmed the uptake of yeast cells by differentiated muscle cells. Some of the yeast in the smooth muscle cells showed signs of disintegration suggesting digestion within the phagosome. Spontaneously contracting cultured smooth, cardiac and skeletal muscle cells incubated with latex spheres (0.3-mum. diameter) showed uptake and sequestration of the spheres. The ability of muscle cells to phagocytose necrotic cells and other particulate matter may be important in atherogenesis and in the repair of tissue after injury.


Identification of premalignant hyperplasia in methylcholanthrene-induced mammary tumorogenesis. Mammary lobuloalveolar hyperplasia induced in rats by the administration of estradiol or progesterone did not evolve into advanced hyperplasia or cancer as was noted in animals that received these hormones and peroral instillations of methylcholanthrene. Although the early hyperplastic changes encountered in both groups were histologically indistinguishable, only cells from the lesions of the rats treated with methylcholanthrene and hormones exhibited significant numbers of aneuploid cells. This information indicates that, at least in the rat, not all instances of mammary hyperplasia possess the potential to develop into cancer. Chromosome analysis appears to represent a useful technique for the discrimination of these forms of hyperplasia. The significance of an appropriate inducer, i.e., methylcholanthrene, for the development of mammary carcinoma in this model system, as well as the well recognized proper hormonal milieu, is apparent.


Induction of squamous metaplasia (vitamin A deficiency) and hypersecretory activity in tracheal organ cultures. Maintenance of rat tracheal organ cultures in various nutritional environments was studied. In Waymouth's 752/1 defined, vitamin A-free medium the mucociliary epithelium, at the site of the original mucosa, changed to a highly active keratinizing squamous epithelium. Epithelial cells that migrated from the original mucosa and covered the underside of the tracheal explants developed into keratinizing squamous epithelium with in a few days. These transitions were accompanied by high rates of DNA synthesis as revealed by 3H-thymidine incorporation into the explants. Addition of 10 per cent horse serum to the Waymouth's medium completely inhibited squanous metaplasia. In this medium, the actively secreting mucociliary epithelium of the original mucosa slowly became quiescent, and the undergrowth epithelium usually remained undifferentiated. These explants maintained a lower level of DNA synthesis. When vitamin A (all trans retinol) was added to the serum-supplemented medium, 0.2 and 2.0 mug. per ml. induced hypersecretory activity in the original mucosa. Addition of 2.0 mug. per ml. also stimulated cellular hyperplasia and mitoses. A concentration of 20 mug. of vitamin A per milliliter of medium was toxic. It is concluded that a spectrum of epithelial cell types normally found in the tracheal mucosa in vivo can be induced and maintained in tracheal organ cultures in vitro by selection of the appropriate nutritional environment.


Scanning electron microscopy of murine macrophages. Surface characteristics during maturation, activation, and phagocytosis. The present report describes the surface architecture of critical point dried mouse peritoneal macrophages, after attachment and spreading on glass, and during maturation and active phagocytosis of rabbit erythrocytes and latex spheres. This study also compares the appearance of unstimulated cells with that of thioglycollate and endotoxin-stimulated cells. Activated cells, particularly thioglycollate-stimulated macrophages, showed more rapid and extensive spreading, a larger surface area, and more prominent ruffled membranes and filopodia. Many fine cytoplasmic pits were also evident and these may represent the sites of formation of numerous pinocytotic vesicles. The sequence of events during the various stages of phagocytosis was well visualized with the scanning electron microscope. Multiple large, round, and hemispherical craters were observed in these cells, and particles were engulfed through these structures and subsequently ingested. The findings are discussed in the light of current knowledge of the macrophage plasma membrane.


The pathogenesis of Vaccinia virus toxicity. II. An electron microscopic study. The intravenous injection of mice with toxic doses of vaccinia virus, prepared in the Ehrlich ascites carcinoma, usually produces fatal intravascular coagulation, within 24 hours. Light and electron microscope studies demonstrate occlusion of the microcirculation of lungs and livers by fibrin. Fibrin deposition appears to be prevented in mice injected with heparinized virus preparations. However, in lieu of fibrin deposition, within the microcirculation widespread intravascular platelet aggregation occurs. Platelets within these aggregates are in various stages of degranulation, and some platelets have phagocytosed vaccinia virus. Platelet aggregation was not observed in mice receiving injections of heparinized material prepared from uninfected tumors. In mice surviving longer than 12 hours, hepatocytes and endothelial cells of pulmonary capillaries are the sites of viral replication. Although many hepatocytes are infected in mice surviving longer than 12 hours, it is postulated that hepatocyte necrosis is in part due to the congestive effects resulting from obstruction of liver and pulmonary capillaries. These studies suggest that vaccinia virus may trigger in vivo platelet aggregation, and that obstruction of the lung and liver microcirculation by these aggregates is the initial lesion of vaccinia virus toxicity.


Vowel and nasal duration as cues to voicing in word-final stop consonants: spectrographic and perceptual studies. To determine durational differences between vowel and nasal segments preceding word-final /t/ and /d/, spectrograms were made of adult speakers' productions of minimal pairs of the type /pent/-/pend/. Vowel, nasal, and vowel plus nasal (vocalic nucleus) durations were greater before /d/ than before /t/. Assuming the voiceless context as a base, the increase in nasal duration in the voiced case was proportionately greater than the increase in vowel duration. This outcome suggests that nasal duration is a more powerful cue to the voicing characteristic of the following consonant than is vowel duration. To test this, adult listeners were presented synthetic CVNC utterances in which the nasal and vowel segments were independently varied in duration over a range of 40 msec to 200 msec and were instructed to label the final stop consonant as either voiced /d/ or voiceless /t/. Although changes in both vowel and nasal duration were sufficient to cue both voiced and voiceless judgements, listeners' categorization of final consonants shifted more rapidly as a result of varying nasal rather than vowel duration. Nasal duration, therefore, appears to be a stronger cue than vowel duration for the word-final voiced-voiceless consonant distinction in CVNC utterances.


Intelligibility characteristics of superior esophageal speech presented under various levels of masking noise. Broad-band masking of speech was used to assess the effects that broad-band masking noise had upon the recognition of consonants and vowels produced by esophageal speakers. Procedures were developed to compare the articulation functions of superior esophageal speech with those of normal speech under comparable levels of masking noise. Within the range of speech-to-noise ratios studied, articulation functions for vowels were essentially the same for esophageal and normal talkers (4% per dB). With respect to consonants, the intelligibility scores for esophageal speech were 12 to 14% lower than for normal speech under adverse noise conditions. Gains in the consonant articulation functions were 2.5%/dB and 4%/dB for normal and esophageal talkers, respectively. For adverse noise conditions, the lowered consonant scores for esophageal speakers were the result of poorer than normal intelligibility for liquid-glides and nasal and, secondarily, for stop consonants. Additional differences between the intelligibility characteristics of esophageal and normal speech were found in work-position and voicing features.


Averaged evoked potentials in cats with lesions of auditory pathway. Averaged evoked activity was recorded from needle electrodes placed at the vertex of the calvaria and adjacent to each bulla in anesthetized cats in response to click stimuli. The portion of the response from 0 to 10 msec was analyzed. Activity during the first 3 msec was greatly reduced on the side ipsilateral to a lesion involving destruction of the cochlea or section of the eighth nerve and its blood vessels. Activity after 4 msec was greatly reduced on the side ipsilateral to destruction of the cochlear nuclei. No effect was found with destruction of both inferior colliculi. The bulla-vertex evoked responses were also compared to those recorded from the round window. The results support the premise that change in the wave-form of the early evoked potential can be used to determine site of loss of acoustic information along the auditory pathway.


Effect of selected work attributes on preschoolers' speech disfluency: initial phoneme and length. This study was designed to determine whether preschool nonstutterers tend to be disfluent on words that begin with consonants or on words that begin with vowels and whether they tend to be disfluent on long or on short words. Analyses of the spontaneous speech of 10 four-year-old boys sampled both in their nursery school classroom and in an interview situation indicated that initial phoneme exerted no influence on the distribution of their speech disfluencies. Word length, however, exerted an influence in the interview situation where the children tended to be disfluent on monosyllabic words. These data raise questions with respect to the applicability of Bloodstein's (1974) model of the development of stuttering to the disfluency behavior of nonstutterers.


Static and dynamic acoustic impedance measurements in infant ears. Tympanometry and acoustic reflex threshold data are reported for a series of presumable normal infants ranging in age from 55 to 132 days. In general, tympanograms displayed single peaks between +/- 50 mm H2O. Susceptance tympanograms with a 660-Hz probe frequency were sometimes characterized by monotonically increasing susceptance as ear canal pressure was changed from -200 to +200 mm H2O. Static values of acoustic conductance, susceptance, admittance, resistance, reactance, impedance, and phase angle were computed from tympanograms using the values of ambient and +200 mm H2O (0/+200 procedure) and maximum and minimum tympanometric values (MAX/MIN procedure). Comparison of the data from the two computational procedures suggested that the MAX/MIN procedure produces means and standard deviations of static values which are more manageable for establishing confidence limits with which to evaluate potentially pathological subjects. The MAX/MIN procedure resulted in lower mean values of conductance and susceptance for infant subjects relative to previously reported adult data using a similar computational procedure. Acoustic reflex thresholds were clearly present in all testable infants at coupler sound pressure levels similar to adult data, suggesting that the relations between reflex thresholds and hearing sensitivity demonstrated in adult subjects are similarly applicable to infant subjects. Mild sedation to induce sleep without altering the reflex would make acoustic reflex threshold measurement a useful procedure for screening large numbers of infants.


Dimensions of consonant perception in normal and hearing-impaired listeners. Judgments of consonant similarity were obtained from subjects who had normal hearing, high-frequency sensorineural hearing loss, or relatively flat sensorineural hearing loss. The individual differences model through program INDSCAL was used to derive a set of perceptual features empirically from the similarity judgments, and to group the subjects on the basis of strength of feature usage. The analysis revealed that sonorance was the dominant dimension in the similarity judgments of the subjects with high-frequency hearing losses, while sibilance tended to dominate the judgments of the subjects with flat audiometric configurations. The normal-hearing subjects tended to weight these two dimensions approximately equally. These differences in similarity judgments were observed based upon audiometric configuration, despite the fact that the two hearing-impaired groups were not unique in word-recognition ability.


Brain stem auditory-evoked responses in premature infants. Brain stem auditory-evoked responses were recorded in 24 infants ranging in age from six-weeks premature to term. At a given age, the latency of the response increased with decreasing stimulus intensity. Further, as age increased, there was a systematic decrease in latency of the response at each sound intensity level. The response was shown not to be fatigue or sleep stage. It may, therefore, be of use for evaluating auditory function in high-risk newborn infants.


Self-retrieval and articulatory retention. The effect of training in self-retrieval on articulatory recall was examined. Elementary school children practiced the syllables /ciks/ and /colt/ under two conditions: imitation and self-retrieval. In the latter condition subjects were asked to say the test object rather than to imitate its name. Over intervals of one day and five days there was no difference in retention as a function of the type of pretraining. Imitative responses decayed little over time and were, in general, always higher than self-retrieval responses regardless of the type of training during acquisition (self-retrieval or imitation).


Punishment and negative reinforcement of stuttering using electric shock. Five adult male stutterers were subjected to electric shock under three conditions. After stuttering frequency was stable in base rate, three subjects were (1) presented electric shock continuously, but the shock was terminated for five seconds contingent on each stuttering (escape); (2) not presented electric shock continuously, but were given a burst of shock contingent on each stuttering (punish); and (3) allowed to choose the shock condition they preferred. Two other subjects followed the same procedure, except that the order of the escape and punish conditions was reversed. The five subjects behaved differently in the various experimental conditions. For three subjects, the percentage of words stuttered changed very little in the escape condition, whereas two subjects' stuttering increased in escape. In the punish condition, the percentage of words stuttered changed very little for one subject, increased for two subjects and decreased for two subjects. Little change in stuttering behavior occurred in the preferred choice condition.


Practicality of shortening the Porch Index of Communicative Ability. This study investigated the practicality of developing short forms of the Porch Index of Communicative Ability (PICA). Stepwise regression procedures were performed using data from 222 complete administrations of the PICA to determine the accuracy of prediction of overall scores on the basis of data from either fewer subtests or fewer items. Results indicated that the PICA is highly redundant and that it may be possible to develop useful shorter forms of it.


Most comfortable loudness for pure tones and speech in the presence of masking noise. Pure-tone and speech most-comfortable-loudness (MCL) levels were determined in noise and quiet. A Bekesy-type tracking task was used to determine the MCLs under all conditions. The subjects (N = 12) tracked their MCLs for five frequencies (250, 500, 1000, 20008, and 4000 Hz) in the presence of four white-noise levels (55, 65, 75, and 85 dB SPL) and in quiet. Speech MCLs were tracked under the identical noise conditions. The results indicated that the mean MCLs for tones between 500 and 4000 Hz, and for the speech stimuli, systematically increased as a function of the masking level. The rate of this increase was 7 dB per 10-dB noise increment for both stimulus modes when the level of the noise exceeded 65 dB SPL. At levels below 65 dB SPL, however, pure-tone MCL increases were only about 3 dB per 10-dB noise increment, while the slope of the speech MCL function remained relatively unchanged. The variability of MCL judgments for both stimulus modes decreased as a function of increased masking.


A reconceptualization and revised scoring procedure for the ITPA based on multivariate analysis of the original normative data. This research was conducted to (1) determine whether a factor analysis of the original normative ITPA data would support the dimensions of Osgood's psycholinguistic model which provides its theoretical base, (2) investigate the need for constructing psycholinguistic profiles based upon this empirical factor structure rather than upon a priori theoretical "facet structure", and (3) devise a weighted multiple regression formula for estimating psycholinguistic age based on subtest correlations with chronological age for the original normative group. Whereas five factors were anticipated, one of these split into two components. The factors represented the (1) perceptual process at the representation level, accounting for 8% of the variance; (2) perceptual process at the integration level, 6.5%; (3) organizing process at the representation level, 25%; and (4) expressive process at the integration level, 11%. The expected integration-organizing factor split into (5) auditory memory, 9%, and (6) visual memory, 9%. As anticipated, no emergent factor represented the expressive at the representation level. The emergent factor structure strongly suggests that the use of factor profiles would be more meaningful than the use of subtest profiles. A multiple regression formula is presented for computing psycholinguistic age equivalents.


Children's acquisition of idioms in the English language. Idiomatic comprehension was studied in four groups of 20 subjects each, ages six, nine, and 12 years, and adult. Each subject was read 10 sentences which could be interpreted literally or idiomatically. Following each sentence, the subject chose the two pictures that were closest in meaning to the sentence heard. This procedure generated 800 pairs of selections for analysis. The results indicated a (1) significant difference between literal and idiomatic choices regardless of the subject's age or the voice of the sentence, (2) significant difference between literal and idiomatic choices as a function of age regardless of the voice of the sentence, and (3) significant voice-by-choice interaction indicating that voice affected the choice of literal or idiomatic picture representations.


Observer agreement for marking moments of stuttering. Observers were asked to mark moments of stuttering on transcripts of tape-recorded speaking performances. Instructions to observers were varied in an attempt to maximize agreement. An index of agreement was developed to reflect word-by-word agreement for more than two observers. Results showed less word-by-word agreement than might have been expected, although intercorrelations among observers for total number of words marked as stuttering was high, as is usually found.


Development of the voicing contrast: perception of stop consonants. Perceptual development of the voicing contrast was investigated in two-year-old children, six-year-old children, and adults. Subjects were required to identify prevocalic stop consonants from synthetic speech stimuli--bees/peas, bear/pear, dime/time, and goat/coat. The stimuli differed with respect to the acoustic cue, voice onset time (VOT). Identification functions for labial, apical, and velar stops were plotted for each subject. Measurements of 50% crossover, lower and upper limits of the phoneme boundary, and phoneme boundary width were obtained from the identification functions. Significant age-dependent differences in perception of the voicing contrast were observed. The results were interpreted as indicating that the magnitude of VOT difference required for distinguishing between prevocalic stop cognates decreases as a function of the age of the listeners.


Tympanometric curves and otosclerosis.

Tympanometric curves and otosclerosis. Patients with clinical otosclerosis (28 ears) were examined audiometrically and with an electroacoustic impedance bridge. The results were compared to corresponding findings for normal ears. The tympanometric curves of surgically proven otosclerosis were found to differ characteristically from those of normal ears. A curve typical of footplate fixation shows a rapid increase in acoustic impedance as external auditory canal pressure is reduced from ambient air pressure.


Verbal coding strategies used by hearing-impaired individuals. A paired-associate verbal learning task was used to determine the type of perceptual coding strategies hearing-impaired persons use in auditory perceptual processing of language. Four lists of word pairs were devised, whereby the word pairs in each list were characterized as sharing either similar sign-similar meaning, dissimilar sign-similar meaning, similar sign-dissimilar meaning, or dissimilar sign-dissimilar meaning. Severely hearing-impaired subjects were required to replace the missing word associated with the word pairs. The results showed that, while the subjects were able to code the verbal material on both a sign basis and a semantic basis, the semantic coding strategy appeared to be more efficient than the sign coding strategy. The findings are related to earlier investigations and are explained according to a theoretical model of perception.


The measurement of critical masking bands. The characteristics of the critical masking band, that spectral region of a wideband noise that is effective in masking a pure-tone signal, were inferred by measuring detectability (d) for tonal signals as a function of the cutoff frequency of a low-pass or high-pass noise masker. As the cutoff frequency of a low-pass noise was decreased from the wide-band (100-7000 Hz) condition toward the signal frequency, (500, 1000, or 4000 Hz) dectability maintained a constant minimum until a further reduction in cutoff frequency increased detectability, presumably due to a reduction in masker power within the critical band. As cutoff frequency was reduced further, detectability increased monotonically until detection reached 100%. This usually occurred when the cutoff frequency is 0.04 to 0.06 octaves below the signal frequency. The range of cutoff frequencies over which detectability changes occurred defines the critical masking band. These ranges correspond closely to well-known critical ratio data. The dependence of d on noise cutoff frequency did not differ at the two signal levels (15 and 25 dB SL) used in this experiment. The critical band appeared symmetrical about the signal frequency for most subjects and most experimental conditions, although some subjects displayed a marked asymmetry in the high frequency direction for some conditions.


Lingual-palatal pressure measurement and analysis techniques. Peak lingual pressure magnitude measurements obtained during speech are related to the design of the pressure-sensing transducers. The results of one investigation (Appl and Leeper, 1973) suggest that the response of cantilever beam transducers used to collect lingual pressure data is dependent upon the location of the strain gages upon the beam. Some differences between prior investigations designed to study the role of lingual pressure in a feedback model of speech processing can be explained by the placement of the strain gages on the beam.


A miniature accelerometer for detecting glottal waveforms and nasalization. A lightweight accelerometer has been used to obtain a waveform related to the glottal acoustic output when attached to the neck of a speaker, and to provide an indication of acoustic coupling to the nasal cavities when attached to the external surface of the nose. Examples of signals produced by the accelerometer are shown, and possible clinical applications are discussed.


Studies on liver chromatin from rats treated with dimethylnitrosamine. Shortly after injecting a single low dose of N,N-dimethylnitrosamine into rats, the DNA, RNA and histones are methylated, the level in the DNA greatly exceeding that in the histones. The composition of the chromatin and the electrophoretic profiles of the histone and non-histone proteins are not detectably different from those obtained from control animals. Electric birefringence studies suggest that methylation may result in both interparticle cross-linking and some localised loosening of the DNA-protein complex complex.


On the mechanism for formation of RNA . DNA complexes from lymphocytes. Early intermediates in DNA synthesis by human lymphocytes were studied for the possible association of RNA with nascent DNA. Nucleic acid extracts from cells pulse-labeled with [3H] uridine contain RNA that is associated with DNA in Cs2SO4 equilibrium density gradients. The amount of RNA bound to DNA was greatly reduced by repeated denaturation and equilibrium centrifugation. An apparently similar complex between RNA and DNA was formed in reconstruction experiments in which purified [3H] uridine-labeled RNA was mixed with purified DNA. The association between RNA and DNA could be eliminated in the reconstruction experiments and greatly reduced in extracts from pulse-labeled cells by denaturation and equilibrium centrifugation in the presence of formaldehyde. These studies demonstrate that noncovalent bonding between RNA and DNA can account for most, and possibly all, of the RNA with density close to DNA in Cs2SO4 gradients of nascent DNA preparations. In addition, the results indicate that ribonucleotide, demonstrated by other methods to be covalently bound to nascent DNA, must constitute less than 1/5 of the total nucleotide in the molecule.


The influence of testosterone on the synthesis and degradation rate of various RNA species in the mouse kidney. 1. The effect of a daily injection of testosterone on the in vivo rate of RNA synthesis and degradation in the kidney of castrated mice was determined. 2. Following the administration of testosterone there was a progressive increase in kidney weight, RNA and protein content in the castrated mouse kidney. 3. The rates of synthesis were calculated from the measured incorporation of radioactivity into various RNA species and acid-soluble nucleotides. The kidney RNA was labelled by the injection of a single dose of [5-3H] orotic acid. When the incorporation into ribosomal RNA was at the maximum (48 h), one group of mice was injected with testosterone (100 mug/day/20 g body weight) and the other served as the control. 4. The rates of synthesis and the turnover time were calculated on the basis of the half-life and the rate of decrease of specific radioactivity of RNA. The rates obtained were high in the first 5 days following hormone administration and then slowed down. 5. The results suggest that testosterone changes the rate of synthesis, not the rate of degradation of the mouse kidney RNA. This is consistent with the higher activity of RNA polymerase in testosterone-treated mice as previously observed and described (Avdalović, N. and Kochakian, C.D. (1969) Biochim. Biophys. Acta 183, 382-393; Avdalović, N. (1970) Biochem. J. 119, 331-338).


Photoreactivation of nitrate reductase production in Nicotiana tabacum var. Xanthi. Ultraviolet (254 nm) irradiation of liquid-cultured tobacco cells inhibited the production of nitrate reductase; subsequent illumination with white light allowed a partial restoration of the synthesis of the enzyme (photoreactivation). Ultraviolet irradiation of these same cells also inhibited their ability to incorporate labeled uridine and labeled amino acids. Subsequent illumination with white light gave a partial restoration of the ability of the cells to incorporate uridine while a similar post-ultraviolet-irradiation treatment failed to restore the amino acid incorporation. The system in tobacco known to repair ultraviolet-damaged viral RNA thus does not seem to repair ultraviolet damage to the protein-synthesizing system of the cell. The photoreactivation of nitrate reductase production is best explained by the action of a DNA photorepairing system.


Intermittent claudication in athletes.

Intermittent claudication in athletes. All reported cases have occurred in the anterior tibial or rarely peroneal compartments. Case I and V in this series follow this same pattern. Case II and III are unusual in that they are the first recorded cases of this syndrome occuring in the calf of a leg. In Case IV the syndrome was present both in the anterior compartment as well as in the calf. Case III in addition, demonstrated arteriographic evidence of impairment of blood flow preoperatively which was relieved by fasciotomy. It is this author's opinion that this syndrome develops due to obstruction of venous drainage by a rise in pressure in the myofascial compartment with exercise. Perhaps it occurs in athletes because the muscle hypertrophy in these patients in greater than that in the general public and the margin of safety is reduced. It is not necessary to perform complicated or painful investigative studies to make the diagnosis. Kennelly and Blumberg state that "a convincing history is all that is necessary," and the author is in complete agreement with this statement. Fasciotomy gives complete relief and is earnestly recommended both to relieve symptoms and to prevent the catastrophic consequences of muscle necrosis. In fact, in severe cases it is best to advise cessation of physical exercise until the operation can be done in order that this severe complication does not develop.


Weight control for high school wrestlers. Anthropometric measurements were obtained from 141 Nebraska State Tournament wrestlers in order to predict their ideal minimum wrestling weight via the Tipton-Tcheng predictim equation. An r of .93 was found between predicted weight and actual weight for 131 of the state tournament qualifiers (excluding heavy-weights). Data indicated that the winners more nearly approximated their predicted weight than did the losers. The mean percent difference between actual weight showed that the upper weight classes (138- 185) more closely approximated their predicted weight than the lower weight than the lower weight classes (98-132). The results indicate that a prediction equation can reliably predict a wrestlers ideal weight and could be used to eliminate unwise weight reduction practices.


Drug interactions: the effects of alcohol and meprobamate applied singly and jointly in human subjects. I. Theoretical considerations and literature review. The considerations necessary to describe the effects of combinations of drugs in a biological system are reviewed. The terms which express these effects-additive, potentiative, antagonistic, synergistic-have not had specific operations applied to them and mathematical models have been sought to define these operations. The models should (1) describe the nature of the action of single drugs, (2) classify the results of drug combinations, (3) provide a set of operations for deciding the outcome of combinations, and (4) predict all possible results of a combination from a knowledge of each drug acting alone. Research on the effects of alcohol and meprobamate and their interactions is reviewed, including behavioral and pharmacological studies and also some studies of the interaction of alcohol with other drugs. The task of characterizing the relation between the drug and response is formidable because complex physiological and biochemical processes determine the relationship between administered and effective dose and are further complicated by route of drug administration and various time relations. The descriptions of biochemical and physiological events seem well advanced; those of behavior are not. Much of the behavioral research assumes that a single dose is representative of all doses of the drug, and that combinations of the drugs and additivity of effects can be determined without a rigorous definition or means of application. [Bibliography of 249 items.]


Drug interactions: the effects of alcohol and meprobamate applied singly and jointly in human subjects. III. The concentrations of alcohol and meprobamate in the blood and their effects on performance; application of mathematical models. The relations between the levels of alcohol and meprobamate in the blood and performance on a visual-motor coordination tracking task were analyzed by a general system of mathematical models, using data from Experiment V by Carpenter et al. [J. Stud. Alc., Suppl. No. 7, pp. 54-139, 1975]. The derivation of the models is described. In general, the relationship between blood alcohol concentration (BAC) and performance was nonmonotonic: best performance occurred at BACS of 10 to 20 mg per 100 ml. The relationship between meprobamate concentration (BMC) and performance was monotonic: performance deteriorated with increasing BMC. The results of the reaction latency measure, howevr, showed no consistent relationship with BAC or BMC. The action of alcohol can be represented by a model which involves 2 distinct sites of action; that of meprobamate, 1 site. It could not be determined whether the site of action of meprobamate is distinct from those of alcohol because the blood levels of the drugs were not high enough. The implications of the results are discussed, with particular reference to the quantitative description of the joint action of drugs and the design of future experiments.


Drug interactions: the effects of alcohol and meprobamate applied singly and jointly in human subjects. IV. The concentrations of alcohol and meprobamate in the blood. The absorption and elimination of alcohol and meprobamate from the blood during Experiments IV (E-IV) and V (E-V) of Carpenter et al. [J. Stud. Alc., Suppl. No. 7, pp. 54-139, 1975] were studied by means of mathematical models representing the relation between doses, concentration in the blood and time elapsing since drug ingestion. The blood concentrations of samples taken 2 and 5.5 hr after beginning to drink in E-IV and 1, 1.5, 2, 2.5, 3.5 and 4.5 hr in E-V were analyzed. The presence of meprobamate did not affect blood alcohol concentration (BAC) in either experiment. At 2 hr the mean BACS after 0.25, 0.50, 0.75 and 1.00 g of alcohol per kg were 6.8, 20.9, 37.7 and 53.7 mg per 100 ml in E-IV; 5.0, 34.1, 42.0 and 72.0 mg per 100 ml in E-V; and 8.1, 32.6, 41.3 and 71.3 mg per 100 ml when calculated by regression from E-V data. The calculated elimination rate of the 2 highest doses of alcohol in E-IV was 6.0 and 7.1 mg per 100 ml per hr; in E-V the mean calculated rates after 0.25-0.75 and after 1.00 g of alcohol per kg were 6.6 and 11.0 mg per 100 ml per hr. The blood meprobamate concentrations (BMC) in E-IV were not affected by alcohol. In E-V, 2.5 and 5.5 hr after meprobamate administration, the combination of 28 mg of meprobamate per kg and 0.75 g of alcohol per kg resulted in significantly lower BMC (7.83 and 12.63 mug per 100 ml) than after same dose of meprobamate with the other doses of alcohol (14.23 and 20.02 mug per 100 ml). The differences between these results and the findings of Carpenter et al. are discussed.


Drug interactions: the effect of alcohol and meprobamate applied singly and jointly in human subjects. V. Summary and conclusions. The design, analysis and conclusions of the series of experiments by Carpenter et al., Ashford and Cobby, and Cobby and Ashford [J. Stud. Alc., Suppl. No. 7, pp. 54-176, 1975] are reviewed. Mathematical models of the joint action of drugs were developed and data obtained to test the models by studying the action of alcohol and meprobamate singly and in combination in human subjects. The data proved to be too limited in the range of drug concentrations in the blood necessary to identify the single most appropriate model. Carpenter et al. analyzed the data by analysis of variance, which involves assumptions about the structure of the observation and the form of the distribution of the error terms. The analyses of Ashford and Cobby and Cobby and Ashford used the mathematical models, which represented pharmacological and physiological actions of the drugs. The majority of the results of the two analyses agreed; however in Experiment V Carpenter et al. combined drugs, doses and blood samples in one analysis anf found a significant influence of meprobamate dose on blood alcohol concentration (BAC) and homogeneous error terms. Cobby and Ashford analyzed absorption and elimination phases of each alcohol dose separately and found no influence of meprobamate on BAC and significant heterogeneity in the residual error terms. Both sets of analyses found a complex interaction between the pattern of abosorption and elimination of meprobamate and dose of alcohol. Carpenter et al. related the results of behavioral measures to drug doses, Ashford and Cobby to the concentrations of the drugs in the blood. Theoretically the models can analyze the pattern of behavioral results at each combination of doses but the data available were insufficient for the purpose. The modifications in experimental design and analytical techniques necessary to continue research in developing mathematical models are discussed.


Drug interactions: the effects of alcohol and meprobamate applied singly and jointly in human subjects. II. Five experiments. Five experiments were conducted to study the effects of alcohol and meprobamate, administered singly and in combination, at doses up to 1.20 g of alcohol per kg of body weight and up to 30 mg of meprobamate per kg. Most of the 158 men were of college age (range, 21-49). In all experiments it appeared to the subjects that both drugs were administered, alcohol as a 25% solution in orange juice and meprobamate as 10 tablets. One hour after the men took the meprobamate they had 1 hr to drink the beverage. Before and at 1/2 hr intervals after administration of the drugs blood samples were taken and behavioral response measured by means of a visual-motor coordination tracking task (Stressalyzer). An experimental session lasted 6 hr. In Experiment I (E-I) each of 12 men was tested on 2 days, after 0, 1.00 or 1.20 g of alcohol per kg and 0 or 25 mg of meprobamate per kg. In Experiment II (E-II) 56 men were tested (8 per group) after 0, 5, 10, 15, 20, 25 or 30 mg of meprobamate per kg and alcohol placebo. In Experiment III (E-III) 40 men were tested (8 per group) after 0, 0.25, 0.50, 0.75, or 1.00 g of alcohol per kg and meprobamate placebo. In Experiment IV (E-IV) 25 men (5 per group) received meprobamate 3 times a day (total daily dosage, 0, 7, 14, 21 or 28 mg per kg) for 12 days. On days 8 to 12 all subjects drank alcohol, as in E-III. In Experiment V (E-V) 25 subjects (5 per group) were tested on 5 days, drinking each day the same doses of alcohol as in E-III and all received the same doses of meprobamate as in E-IV.


A single moment roentgen contrast study of superior cava and its tributaries. The method of single moment roentgen study of the superior vena cava and its tributaries is presented. The roentgen anatomic data concerning occurring variants of normal mediastinal venous vessel branches and their layout are given. Some examples show the diagnostic value of the mediastinal phlebography using the method described above.


Fibrous dysplasia of the sphenoid sinus in an adolescent male. Fibrous dysplasia involving the sphenoid sinus and the entire left sphenoid bone, manifested clinically by left proptosis and frontal headaches, was diagnosed in a 13-year-old black male. The case is unusual since it is only the third reported instance of fibrous dysplasia of the sphenoid sinus, and because the disease became clinically apparent at the onset of puberty in the patient. Since previous reporters have suggested that fibrous dysplasia remains stable or progresses slightly after the onset of puberty, the patient was not treated with radical surgery, but instead was observed closely. At this point, one year following admission, the patient's proptosis has disappeared and his symptoms are markedly improved.


Migration inhibition test in lung cancer patients. Twenty patients with primary carcinoma of the lung were tested with migration inhibition test, using extract of cultured lung carcinoma of large cell type. Eight of 10 patients with localized disease had positive inhibition, while all 10 of the patients with disseminated disease had negative inhibition (x2, p less than 0.005). Two cases of large cell carcinoma (localized) showed extremely positive inhibition which may suggest the presence of cell type specific lung carcinoma antigen.


Fluorescence microscopy in tumors of central nervous system: a method of recognizing malignancy with acridine orange. Tumors of the central nervous system were stained with acridine orange. Photographs were taken during observation through ultraviolet light. Cellular detail was not recognizable but malignant tumors fluoresced more than benign tumors.


Ovarian cancer presenting as umbilical hernia. Six patients are reported whose presenting symptom was umbilical herniation. Upon exploration of the umbilicus with the intent to repair the hernia, ovarian cancer and malignant ascites were encountered in each individual. Cancer at the umbilicus, both metastatic and primary, is briefly discussed. The apperance of an acquired umbilical hernia in an otherwise asymptomatic patient should raise the suspicion of intraabdominal malignancy.


The effect of surgery and pretreatment or posttreatment adjuvant chemotherapy on primary tumor growth in an animal model. The Ca755 solid tumor in the C57B1 mouse has been used as a model to study the interrelationship of surgery and adjuvant chemotherapy on primary tumor growth. Surgery was performed on various days after tumor implantation. Surgical mortality increased with delay in surgery. The mean survival time (MST) was significantly increased by surgery. An increased cure rate in mice with late surgery may be due to immunological factors. Pretreatment cytoxan chemotherapy prior to a number of surgical days on the most effect schedule increased MST in the later surgical days primarily due to shrinkage of tumor and a diminished surgical mortality. Posttreatment chemotherapy significantly increased MST primarily on the basis of reducing tumor cell population after surgery and increasing both the cure rate and the time until death of those mice dying of regrowth of tumor. Optimal chemotherapy alone significantly increased MST compared to untreated controls. Optimal postsurgery chemotherapy increased survival longer than the additive increase of chemotherapy alone and surgery alone. This paper illustrates relationships between day of surgery dose and schedule of chemotherapy and effect on various measurable parameters. The results can best be understood in relationship to each other. It is suggested that adjuvant chemotherapy has specific definable benefits. It is apparent from human studies that carefully devised designs which consider these interrelationships are necessary if optimal therapeutic results are to be achieved.


Oxygen consumption by acrylamide polymerization: a method for rapid screening of anticancer agents. We have developed a rapid and sensitive method to measure oxygen consumption of tumor cells by acrylamide polymerization. This method could be used as an in vitro screen for potential chemotherapeutic agents. Previous techniques have lacked either the sensitivity or the speed required for use as an effective clinical tool. This method was modified from a technique previously developed in our laboratory for measuring oxygen in blood. Standard anticancer agents were tested against Walker 256 ascites tumor. Ascites was harvested from 20 rats on each of 50 days, incubated briefly with drugs, and acrylamide polymerization time was measured hourly. Individual controls were established for each drug-treated group, and oxygen uptake measured after one hour of incubation. Actinomycin, cyclohexamide, and cytosine arabinoside inhibited tumor cell oxygen consumption by 80%, 40%, and 30%, respectively. These results correlated with the known in vivo effects of these drugs on Walker carcinosarcoma. Therefore, this sensitive method could potentially be used directly on tumor cells removed from biopsy material so that the testing of anticancer drugs could be completed on the day of biopsy.


Chemotherapy of a murine neuroblastoma model. The C1300 murine neuroblastoma model can be readily maintained by serial passage in A/J mice. Characteristics of the tumor, such as weight of the primary lesion, days of survival after tumor inoculation, or the number of metastatic foci at death, are relatively reproducible and permit experimental evaluation of various modes of treatment, including chemotherapy, that are not possible in man. In the present study, single-dose adriamycin chemotherapy was of significant benefit. Multiple dose treatment was too toxic and lethal. Cytosine arabinoside in various doses was without detectable merit. These results, from an animal model, are of benefit in evaluating further possible drug combinations in ongoing clinical trials seeking to improve the results from chemotherapy in children with advanced neuroblastoma.


An inverse dose response of 5-methyl cytidine on multiple primary spontaneous tumors and their regressions in mice. Ten series mice of C3H/ST inbreds with spontaneous tumors have received 5-methyl cytidine (total 500 mice). Graded single doses of (1) 3.86, (2) 2.57, (3) 2.06, (4) 1.54, (5) 1.03, (6) 1.54, (7) 1.03, (8) 0.51, (9) 0.26, and (10) 0.13 mg/injection (three times weekly) were used. In series 1-5 the 5-methyl cytidine was dissolved in distilled water, and in series 6-10, the nucleoside was dissolved in physiological salt solution. In doses administered, series 4-5 overlapped with series 6-7. The number of mice that showed a regression of tumor increased in the successive series (48%-63% in series 1-5 and 25%-73% in series 6-10). As the number of mice with regressing tumors increased, the percentage of mice showing multiple primary tumors also increased. The administration of the nucleoside in physiological salt solution altered the inhibitory effect of 5-methyl cytidine on spontaneous tumors. For example, in physiological salt solution the 0.51 mg/injection gave as much inhibitory action as 1.03 mg/injection in distilled water. An inverse dose response is thus indicated between the amount of 5-methyl cytidine injected and the inhibition of spontaneous tumors in mice (percentage of regression and number of multiple primary spontaneous tumors are the criteria of inhibition considered).


The surgical implication of broncholithiasis. A calcified hilar or mediastinal lymph node can compress or erode the tracheobronchial tree and cause a variety of problems, including the "spitting of stones," hemoptysis, pneumonia, atelectasis, and bronchoesophageal fistula. From 1955 to 1975, 43 patients were evaluated for broncholithiasis. Nonsurgical management was carried out in 10 patients, whereas the remaining 33 underwent thoracotomy for the pathological process. Five patients had bronchoesophageal fistula as a result of the broncholith. Segmentectomy was the surgical resective procedure most commonly used. Conservation of pulmonary tissue is recommended when dealing with this problem. Surgical complications were minimal and no deaths occurred. The surgeon must be versatile in his technical approach and be prepared to carry out bronchoplastic procedures when indicated. A clinical awareness of the symptomatology of broncholithiasis leads the examiner to carry out the appropriate diagnostic studies of laminagraphy, bronchoscopy, bronchography, and esophagography. Early diagnosis and treatment will prevent the severe complications that can occur from continued observation.


Primary tracheal anastomosis after resection of the cricoid cartilage with preservation of recurrent laryngeal nerves. Resections at the cricoid level pose the problems of damage to the recurrent laryngeal nerve and loss of circumferential cartilaginous support. Strictures within the cricoid ring have usually been managed with keels or stents, whereas neoplasms have been managed by laryngectomy. This paper reports on 6 patients with lesions involving the cricoid who were successfully treated by segmental tracheal resection and removal of all but a thin shell of posterior cricoid plate. The distal trachea was anastomosed at the subglottic level within 1 cm. or less of the vocal cords. Two patients had traumatic transection at the cricotracheal level with disruption of cricoid cartilage and avulsion of both recurrent nerves. Of the other 4 patients with tracheal lesions involving the cricoid, 2 had postintubation strictures, another had chemical burns, and the fourth had adenoid cystic carcinoma. Primary healing and good clinical results were obtained in all 6 patients. In the 4 patients with intact recurrent nerves, nerve function was preserved. This technique provides a method for resection and reconstruction in one stage for selected lesions at the cricoid level.


Esophagogastrostomy. Analysis of 55 cases. At the New York University Medical Center from January, 1969, through December, 1973, esophagogastrostomies were performed in 56 patients. In 30 (Group A), fundoplications were combined with the esophagogastrostomies; in the other 26 (Group B), esophagogastrostomies only were performed. These two groups have been compared in an effort to determine the effectiveness of fundoplication in preventing gastric reflux following esophagogastrostomy. The operative mortality rate (10 per cent) and the 3 year survival rate (20 per cent) were approximately equal in the two groups. Clinical evidence of reflux was noted in 10 per cent of Group A and 47 per cent of Group B patients, while complications of reflux were noted in 5 per cent of Group A and in 33 per cent of Group B patients. The results of the present study suggest that fundoplication, while not prolonging survival, does prevent the symptoms and complications of gastric reflux and improves the quality of survival in these unfortunate patients. This leads us to recommend the routine use of fundoplication with esophagogastrostomy in patients with carcinoma of the esophagus and gastric cardia.


Columnar-lined lower esophagus: an acquired lesion with malignant predisposition. Report on 140 cases of Barrett's esophagus with 12 adenocarcinomas. The analysis of a series of 1,225 cases of reflux esophagitis shows the serious nature of this condition. A liberal use of antireflux operations therefore seems justified. Extensive columnar metaplasia of the distal esophagus, or columnar-lined lower esophagus (CLLE), represents a late irreversible stage of reflux esophagitis. Repeated esophagoscopies demonstrate the acquired nature of the lesion. It is caused by the progressive healing, from below upward, of peptic ulcerations on the squamous epithelium by metaplasia of columnar mucosa. Antireflux operations stop the progressive ascent of heterotopic epithelium and thus stabilize reflux esophagitis and cure complications such as ulcerations and strictures. The premalignant character of this condition is established by a 10 per cent incidence of adenocarcinomas in a series of 140 cases of extensive columnar metaplasia. The transition toward malignancy seems to be irreversible and cannot be arrested by an antireflux operation. Therefore, repeated esophagoscopic controls and biopsies are an absolute necessity in all cases of extensive columnar metaplasia, even after cure of active reflux esophagitis by Nissen fundoplication.


Isolated mitral valve replacement with the Kay-Shiley disc. valve. Acturial analysis of the long term results. During a five-year period the Kay-Shiley (K and T series) prosthesis was used for 83 isolated mitral valve replacements. There were 14 early deaths, for a 17.28 per cent mortality rate. Survival determined by the actuarial method revealed a 6 year cumulative survival rate of 39.8 per cent. Thromboembolism was a significant problem in this series, with 33 patients experiencing a total of 55 embolic events. This represented a rate of 24.7 emboli per 1,000 patient months at risk. From our experience, it is concluded that the Kay-Shiley prosthesis is associated with a high incidence of thromboembolism and late death.


Traumatic pulmonary arteriovenous fistula. The first case of traumatic pulmonary arteriovenous fistula in the English literature is reported. The case is reported to alert thoracic surgeons to the possibility of this lesion following penetrating chest injuries.


Systemic-pulmonary artery anastomoses in infancy. Over the last 10 years, 142 systemic-pulmonary artery anastomoses were performed in 134 infants under 1 year of age. These included shunts from the subclavian artery (46 per cent), ascending aorta (41 per cent), descending aorta (9 per cent), and superior vena cava (1 per cent) to the pulmonary artery. Ninety-six (72 per cent) of the infants were less than 4 months of age at the time of the initial procedure, and one half were less than 1 month old. When groups of patients were compared according to diagnosis and age at the time of operation, the immediate and long-term results of the subclavian-pulmonary artery (Blalock-Taussig) anastomosis were better than the results with the other procedures. In view of the ease of closure of this anastomosis at the time of corrective surgery, as well as the recent further improvement of vascular surgical techniques, the Blalock-Taussig shunt is the procedure of choice in most infants requiring a systemic-pulmonary artery anastomosis, even during the early months of life.


Pulmonary sequestration.

Pulmonary sequestration. Pulmonary sequestration is a congenital anomaly in which an aberrant systemic artery arising from the thoracic or upper abdominal aorta supplies part of the lungs, usually the lower lobe. The sequestered lung may be anatomically distinct from the remainder of the lobe (extralobar), or may be included in the substance of the lobe, in which case it may or may not have bronchial communication with the rest of the bronchial tree. The patients present, often in the first two decades of life, with recurrent and severe bronchopulmonary infections. Associated anomalies are present, especially in the extralobar variety. Nine cases of sequestration are reviewed, stressing significant clinical, radiological, and arteriographic findings. Preoperative demonstration of the anomalous vessel by aortography has contributed significantly to the planning and safety of the surgical procedure, which was generally a lower lobectomy. Eight out of nine patients survived the procedure.


Primary solitary lymphoma of the trachea. A case history is reported of an 81-year-old woman with progressively increasing airway obstruction and progressive stenosis of the intrathoracic trachea. Repeated endoscopic biopsies failed to establish a diagnosis. At thoracotomy, an isolated tumor mass was found originating in the trachea without grossly apparent mediastinal nodes. Biopsy of the tumor mass revealed lymphoma. Radiotherapy resulted in complete remission, which continues at 22 months.


Intraoperative unidirectional intra-aortic balloon pumping in the management of left ventricular power failure. Unidirectional intra-aortic balloon pumping (IABP) was applied to 28 adult patients undergoing open-heart surgery over a 35 month period. The patients were divided into three groups according to the temporal sequence of initiating IABP. Group A consisted of 4 patients who were in a low output state or in cardiogenic shock prior to study. All patients survived cardiac catheterization and surgery, and 3 (75 per cent) were long-term survivors. Group B included 15 patients who could not be weaned from cardiopulmonary bypass with the usual supportive measures. Twelve patients (80 per cent) were weaned from bypass with IABP, and 11 (73 per cent) were discharged from the hospital. Group C was composed of 9 patients who manifested a low cardiac output syndrome within the first 24 hours following surgery. IABP was initiated in the recovery room. Six patients (67 per cent) were discharged. The total experience with these 28 patients therefore includes 24 patients (86 per cent) who were weaned from IABP, 20 (71 per cent) who were discharged, and 18 (64 per cent) who were long-term survivors. The present criteria for the use of IABP in the cardiac surgical patient are defined.


Prosthetic replacement of the aortic arch. Four patients are reported in whom the aortic arch and variable portions of the ascending and descending aorta were replaced with a prosthesis. In three patients the preoperative diagnosis was dissecting aneurysm of the aortic arch and in one an arteriosclerotic aneurysm of the aortic arch was present. A combination of surface cooling and cardiopulmonary bypass was utilized to produce total body hypothermia. Arch replacement was carried out during a period of total circulatory arrest. Cardiopulmonary bypass was then utilized to warm the patient and resuscitate the heart. The average duration of cerebral ischemia was 43 minutes and the average duration of myocardial ischemia was 74 minutes. The average lowest esophageal temperature was 14 degrees C., and the average lowest rectal temperature was 18 degrees C. Three patients are alive and well 4 to 13 months following surgery. One patient died 4 days postoperatively of pulmonary insufficiency. This experience indicates that by utilizing total body hypothermia and circulatory arrest aortic arch replacement can be carried out with an acceptable mortality rate. Corrective surgery could be offered to patients with life-threatening enlarging aneurysms of the aortic arch.


Long-term morphologic and hemodynamic evaluation of the left ventricle after cardiopulmonary bypass. A comparison of normothermic anoxic arrest, coronary artery perfusion, and profound topical cardiac hypothermia. In order to assess the long-term effects of cardiopulmonary bypass (CPB) in combination with pupular methods of myocardial protection, 37 dogs were placed on CPB for 100 minutes with the use of a bubble oxygenator without hemodilution. A separate group (I) of eight normal dogs served as a control for assessment of hemodynamic changes. The operative groups were as follows: II, continuous coronary perfusion with an empty, beating heart for 60 minutes at 35 degrees C.; III, hypothermic anoxic arrest (aortic occlusion) for 60 minutes with topical cold saline lavage (4 degrees C.); IV, anoxic arrest for 60 minutes at 35 degrees C. Subgroups of Groups III and IV received intracoronary perfusion with Ringer's lactate or Sacks' solution during aortic occlusion and were compared with those animals receiving no perfusion. Survival in Groups II and III was significantly better than in Group IV (82 and 92 per cent vs. 45 per cent). Coronary perfusion with Ringer's lactate or Sack's solution did not influence survival. The 23 survivors from all groups underwent left heart catheterization and LV cineangiography 5 months after operation. All three operative groups had significant elevation of LVEDP and depression of maximum developed dp/dt when compared with normal dogs. Ejection fraction was significantly depressed in Groups III and IV, and there was evidence of left ventricular hypokinesia and/or akinesia in all three operative groups. Differences in function between Groups II, III, and IV were not significant. The use of intracoronary solutions during anoxic arrest did not significantly influence these functional alterations. Evidence of subendocardial fibrosis was found in each of the operative groups, with the most marked changes found in the normothermic arrest group. Moderate fibrosis was present, however, in some survivors in both the continuous coronary perfusion and topical hypothermic arrest groups. These data indicate that although survival is greatly enhanced when coronary artery perfusion or topical hypothermia is used, neither method prevents chronic deterioration in ventricular function nor the development of subendocardial fibrosis.


Surgery in pulmonary aspergillosis.

Surgery in pulmonary aspergillosis. Pulmonary aspergillosis is a rare disease, most commonly presenting as secondary invasion of pre-existing cavitary disease. In Toronto General Hospital 24 patients have been recognized as having this disorder in the 10 years from 1965 to 1975. The most common presenting symptoms were cough, sputum production, and hemoptysis, with the hemoptysis occasionally being massive. Tuberculosis and bronchiectasis were the commonest pre-existing diseases. Thirteen of these patients were treated by surgical resection because of major complications or progression of the aspergillosis. Five of these patients died following surgery, all of these having had major complications prior to surgical intervention. Of the eight surviving patients seven are progressing well, but one had developed further extension of his disease.


Carcinomas in the superior pulmonary sulcus. Carcinomas in the superior pulmonary sulcus produce a clinical pattern peculiar to their location. Pancoast (1932) defined tumors in this precise location and described a characteristic group of clinical findings now known as the Pancoast syndrome. Experience with a total of 92 patients with primary carcinomas in the superior pulmonary sulcus treated by combined preoperative irradiation and extended resection in 61 patients (66 per cent) reveals 16 of 46 patients eligible surviving over 5 years (34 per cent) and eight of 30 patients alive over 10 years (29 per cent). Stage of nodal involvement, extent of the tumor, cell type, and pathological effects of preoperative irradiation in the resected specimens are the important factors in prognosis.


Ischemic contracture of the left ventricle. Production and prevention. Ischemic contracture of the left ventricle ("stone heart") is a recognized complication of prolonged periods of interruption of the coronary circulation during open-heart surgery. We have examined the effects of moderate hypothermia (28 degrees C.) and preoperative beta-adrenergic blockade (propranolol, 0.5 mg. per kilogram; 1.0 mg. per kilogram) on contracture development during ischemic arrest of the heart. Four groups of 8 dogs each were placed on total cardiopulmonary bypass, and ischemic arrest of the heart was produced by cross-clamping the ascending aorta and venting the left ventricle. Intramyocardial carbon dioxide tension was continuously monitored by mass spectrometry. When anaerobic energy production ceased, as indicated by a final plateau in the intramyocardial carbon dioxide accumulation curve, the ischemic arrest was terminated and the contractile state of the heart observed. These results are given in the text. We conclude that beta-adrenergic blockade delays, but does not prevent, the onset of ischemic contracture of the left ventricle under normothermic conditions. Moderate hypothermia appears to prevent this complication completely.


Drip retrograde coronary sinus perfusion for myocardial protection during aortic cross-clamping. Moderate hypothermia is one of the methods utilized for myocardial protection when the aortic root is cross-clamped but not opened. A combination of low-pressure, low-flow retrograde coronary sinus perfusion (RCSP) with oxygenated blood at moderate hypothermia (29 degrees C.) was demonstrated to yield significantly better protection to left ventricular function in dogs than does moderate hypothermia alone. Ventricular function was recorded before and after 1 hour of aortic cross-clamping at identical preloads and heart rates. Aortic pressure was returned to a level as close to base line as possible by constriction of the descending aorta. The average mean aortic pressure of the animals perfused retrograde at 29 degrees C. was returned to within 4 per cent of base line. By contrast, in the animals protected with moderate hypothermia alone, the pressure could be returned only to a level which was 37 per cent lower than base line. In animals protected with moderate hypothermia alone, cardiac output dropped 62 per cent, left ventricular stroke work (LVSW) 75 per cent, and peak dp/dt 44 per cent. In the animals protected with RCSP and moderate hypothermia, the cardiac output dropped 6 per cent, LVSW 9 per cent, and peak dp/dt 5 per cent. The differences in the changes noted between these two groups were significant for LVSW and dp/dt at a level of p less than 0.01 and for cardiac output and aortic pressure at a level of p less than 0.05. These results suggest that RCSP may be indicated when moderate hypothermia is otherwise chosen to be the sole source of myocardial protection.


Depressed postoperative cardiac performance. Prevention by adequate myocardial protection during cardiopulmonary bypass. Depressed postoperative myocardial performance (low output syndrome) requiring inotropic drugs or balloon counterpulsation is due to subendocardial ischemic damage. Before July, 1972, we needed inotropic drugs in 30 to 52 per cent of 189 patients undergoing coronary revascularization or aortic or mitral valve replacement in whom we used ischemic arrest, profound topical hypothermia, and ventricular fibrillation. The mortality rate ranged from 10 to 17 per cent. Our experimental studies show that morbidity and death in such cases are caused by ischemic injury to the heart resulting from inadequate myocardial protection during bypass. Based on these experimental studies, we have, since July, 1972, employed the following principles clinically: (1) Maintain beating empty heart whenever possible; (2) maintain adequate coronary perfusion pressure (less than 80 mm. Hg); (3) avoid extreme hemodilution; (4) avoid ventricular fibrillation; (5) avoid prolonged hypothermic arrest, limiting ischemic periods to less than 15 minutes; (6) repay myocardial ischemic oxygen debt with total (vented) bypass; and (7) optimize DPTI/TTI (supply/demand ratio) pre- and postoperatively. These principles were followed in 189 consecutive operations, and postoperative inotropic drugs were needed in only 12. The principles were violated in 4 of the 12 patients (6 per cent), and 5 others had identifiable causes of myocardial depression; low output syndrome was unexplained in only 3 patients (1.7 per cent).


Investigation of the conformations of four tetrapeptides by nuclear magnetic resonance and circular dichroism spectroscopy, and conformational energy calculations. Proton nuclear magnetic resonance and circular dichroism studies were carried out on aqueous solutions of the tetrapeptide Asp-Lys-Thr-Gly (which appears as a bend at residues 35-38 of alpha-chymotrypsin) and its sequence variants Gly-Thr-Asp-Lys, Asp-Lys-Gly-Thr, and Lys-Thr-Gly-Asp; the N and C termini of all four tetrapeptides were blocked with CH3CO and NHCH3 groups, respectively. The spectroscopic data suggest that bend conformations may exist, to some extent, among the distributions of conformations in the first, third, and fourth, but not in the second, tetrapeptide. This result is consistent with empirical probabilities for the prediction of bend conformations in proteins. Conformational energy calculations on these four tetrapeptides support the indications from the experimental data. It thus appears that, because of short-range interactions, the tendency toward bend formation exists in short peptides, provided that both the composition and amino acid sequence are energetically favorable for bend formation.


Calculation of the characteristic ratio of randomly coiled poly(L-proline). Allowing for rotation about the Calpha-C' bond (i.e., variation of psi) and for some degree of freedom about the peptide bond (i.e., small variations of omega), the characteristic ratios, (R2)o/nl2, of the form I (cis) and form II (trans) poly(L-proline) chain have been calculated by a Monte Carlo method in which the conformational energies were used as weighting factors. The Monte Carlo method enabled short-range interactions (beyond those involved in a single residue) to be taken into account. The effect of the presence of a small amount of one form (say cis in a trans-rich chain) on (R2)o/nl2 was also investigated. The results for the trans-rich form are in good agreement with values observed experimentally in solvents in which the poly(L-proline) chain is predominantly in form II; the presence of a small amount of cis residues reduces the characteristic ratio of the trans-rich form of poly(L-proline) significantly.


Chronic inflammatory polyradiculoneuropathy. The diagnostic criteria, natural history, nerve conduction characteristics, pathology, laboratory features, and efficacy of corticosteroid treatment have been evaluated personally in 53 patients with chronic inflammatory polyradiculoneuropathy (CIP) who were followed up for an average of about 7.5 years. These were patients whose monophasic neurologic deficit had not crested by 6 months, patients with recurrences, and patients with a steady or stepwise progression. The typical features of CIP include absence of an associated disease, frequent history of preceding infection or receipt of foreign protein, and tendency to involve cranial, truncal, and proximal as well as distal limb structures and to have diffusely slow conduction velocity of peripheral nerves. The most marked slowing is often very proximal. The pathologic features include serous edema, mononuclear cell infiltrates (especially in perivascular areas, but without evidence of vasculitis), macrophage-induced segmental demyelination, and hypertrophic neuritis. If our patients are representative, complete recovery occurs only infrequently; about 60% of patients are able to be ambulatory and work, 25% become confined to a wheelchair or become bedridden, and approximately 10% die from their disease. Although the bulk of the pathologic changes affect spinal roots and proximal nerves, the brain and spinal cord may be involved also. Degeneration into linear rows of myelin ovoids is the predominant type of myelinated fiber degeneration of the sural nerve at the ankle.


The observation of cis residues in poly(L-proline) in aqueous solution. Proton Fourier transform NMR spectra at 270 MHz were obtained for three different molecular weight samples of poly(L-proline) in D2O. A weak, but clearly discernable, resonance at 4.3 ppm was observed in each case with an integrated intensity about 2-3% of the Calpha trans proton resonance. Based on the Torchia-Bovey assignment this resonance is attributed to the Calpha cis proton. The presence of cis residues, even in this small concentration, necessitates a reexamination of the conformational properties of this polymer. Definite conclusions cannot be reached from spectra obtained in organic solvents because of the much smaller separation between the cis and trans resonances.


Benign breast lesions and subsequent breast carcinoma in Rochester, Minnesota. Case histories of 444 female patients (Rochester residents) with benign breast disease pathologically diagnosed between 1935 and 1949 were studied prospectively for the development of breast cancer. After exclusion of unsuitable cases, 370 remained for review of pathologic diagnoses and statistical analysis. Breast cancer developed in 14 (3.8%) within a median period of 13.5 years after the diagnosis of benign breast disease. Most of these malignancies occurred within 10 years after the original diagnosis. Patients in whom the original diagnosis was chronic cystic mastitis developed breast cancer 2.9 times more frequently than expected. Breast cancer developed 10 times as often as expected in those patients of ages 40 to 49 at the time of diagnosis of breast malignancy. This evidence shows that a more intensive follow-up of patients with confirmed chronic cystic breast disease is justified, especially among those of ages 30 to 49 years.


Theoretical determination of helix-coil parameter sigma from a model of partly helical polypeptide chain. The Zimm and Bragg parameter sigma is calculated numerically for poly(L-alanine), polyglycine, and the copolymers of L-alanine and glycine using the molecular theory of s and sigma as developed by Go, Go, and Scheraga in a modified formulation. In this formulation, sigma is obtained from the partition function of the whole chain in the helix-coil transition region and represents therefore the contributions from the ends of helical and coil sequences and from the interactions between atoms in a coil sequence with those in the neighboring helical sequence. When the parameter sigma is calculated numerically from a hard-sphere potential, it appears that steric intractions between atoms in the coil sequence with atoms in the neighboring helical sequence, which have been neglected in previous calculations, contribute significantly to the value of sigma. Owing to these interactions the entropy of the coil sequence as well as sigma decrease, but the decrease of sigma is larger in poly(L-alanine) than in polyglycine, because of the higher flexibility of the monomer in polyglycine. The numerical value of sigma for polyglycine compared with that of poly(L-alanine) might be overestimated however by the model presented here due to approximations inherent in the hard-sphere treatment and because only regular helical sequences are considered.


Multiple sclerosis and its etiopathogenesis. Information available about the etiopathogenesis of multiple sclerosis is reviewed. It is concluded that multiple sclerosis is a chronic inflammatory disease, which usually has fluctuating manifestations. Oligoclonal and individual-specific humoral antibody responses suggest the existence of a continuous antigenic stimulus in the CNS tissue, which may vary in intensity from time to time. The best explanation for this antigen suggests, that is has a viral origin,  but the available evidence for this hypothesis is, however, only indirect. More sophisticated methods are proclaimed to characterize specifically the humoral and cellular immunity to virus antigens and the interactions between viruses and cells in patients with demyelinating diseases like multiple sclerosis.


Deamination of biogenic amines and other nitrogenous compounds in granulation tissue from experimental wounds. In the granulation tissue of skin wounds an increase in the content of hydroxyproline was accompanied by changes in lipid peroxidation products. At the same time deamination of 5-hydroxytryptamine, tyramine or adenosine-5'-monophosphate decreased, but the ability to deaminate histamine, putrescine and lysine appeared. Pargyline prevented the appearance of these new deaminating properties. Adenosine-3'-monophosphate slowed down to the weight increase and lowered the content of hydroxyproline in the growing granulation tissue; it also changed the dynamics of deamination of tyramine or 5-hydroxytryptamine and significantly inhibited the deamination of histamine, lysine and adenosine-5'-monophosphate. The patterns of changes in deamination of nitrogenous compounds and the effects caused by pargyline and adenosine-3'-monophosphate suggest that qualitative alteration (transformation) in catalytic properties of monoamine oxidases may occur in the growing granulation tissue from wounds.


Platelet monoamine oxidase in children with infantile autism. Platelet monoamine oxidase activity was measured in 9 autistic subjects and 9 controls. There were no significant differences in the rates of metabolism of 5-hydroxytryptamine, dopamine or tyramine between the two groups, although the rate of metabolism of tyramine was more rapid than 5-hydroxytryptamine or dopamine within each group. It is concluded that the data presented do not support the view that measurement of platelet monoamine oxidase can be used as a biochemical index to aid in the clinical diagnosis of infantile autism.


Cardiovascular effects of amitriptyline, nortriptyline, protriptyline, and doxepin in conscious rabbits after subacute pretreatment with protriptyline. Conscious rabbits which had been permanently catheterized into their aortas and posterior caval veins, were injected daily with 10 mg/kg of protriptyline subcutaneously, divided in 3 doses. The blockade of the membrane pump in sympathetic nerve terminals by protriptyline was checked by pressor tests with noradrenaline (NA) and tyramine. In the presence of the membrane pump blockade 2.5 mg/kg of amitriptyline, nortriptyline, or protriptyline, or 3.0 mg/kg of doxepin was injected i.v. The antidepressants lowered blood pressure transiently and increased the heart rate, doxepin and amitriptyline being more effective than nortriptyline and protriptyline. Amitriptyline and doxepin provoked more severe cardiac arrhythmias on ECG than nortriptyline, and protriptyline caused no arrhythmias. Intravenous infusion of NA (11 mug/min) raised the blood pressure and lowered the heart rate. Injection of antidepressants during NA infusion resulted in more pronounced depressor and tachycardic effects than occurred without NA infusion.  Major ECG changes were only slightly more apparent than without NA infusion. The rank order of toxicity of the antidepressants was the same. It is concluded that the NA potentiation by tricyclic antidepressants is not the main reason for their cardiotoxic effects.


An approach to the adolescent patient.

An approach to the adolescent patient. We desire to approach adolescent patients by liking them, being ourselves, trying to establish trust, and maintaining confidentiality. We want to help them grow well physically and develop normally emotionally. If we are concerned about them, take the time to listen to them, and let them know they are important to us, we will find that they are rewarding patients, and that they will educate us and increase our medical effectiveness.


Hormonal changes of adolescence.

Hormonal changes of adolescence. Pubescence is characterized by many physical, emotional, and hormonal changes. The hypothalamic-pituitary-gonadal system is maintained in a dormant state (with a low level of activity) during prepubertal years by higher central nervous system inhibition. With the onset of adolescence, the reproductive endocrine system becomes increasingly active. The attainment of sexual maturity in terms of secondary sexual characteristics, the production of spermatozoa in the male, and the cyclical female pattern with release of ova are end-points of the developmental process.


Adolescent nutrition.

Adolescent nutrition. We have briefly reviewed the nutritional requirements of adolescents and the significant difficulties in establishing nutrient requirements for this period of rapid growth. In general, although there are data for specific nutrients in adolescents on which to base recommendations for nutritional requirements, by and large, most requirements are extrapolated from data on infants or adults. There is still a large void to be filled in determining the physiological requirements for nutrients during the adolescent growth spurt. Until this is accomplished, many of our data, as presented in the report, are extrapolated. For specific recommendations for individual adolescents, the reader is again referred to the FAO/WHO publication and the National Research Council Publication.


Caring for the adolescent drug user.

Caring for the adolescent drug user. Adolescence as a social and individual process provides a challenge to the teenager with subsequent situational and maturational crises. The discomfort of change promotes alleviation, and in the limited resource of the adolescent, this may involve drug use. The physician must understand the adolescent and his adolescence in order to effectively intervene. This may be accomplished through a systematic evaluation of the problem, the teenager, and subsequently himself.


Spinal deformity in adolescence. Early detection and nonoperative management. Scoliosis and kyphosis, as diseases, can be prevented by early detection of scoliosis and kyphosis as conditions. Nonoperative management is usually successful when its main aim is the prevention of progression. By the time the condition has reached the point where correction is necessary to produce an acceptable end result, nonoperative methods often fail. Scoliosis and kyphosis are frequently missed on routine school physical examinations because they are not specifically looked for or because the examiners are not aware of the early physical findings. The most efficient and effective way for early detection is through school screening clinics in the 10 to 13 year age group.


[Esophagojejunostomy anastomosis technique (author's transl)]. To overcome the specific problems of esophagojejunostomy, leakage and reflux, a method of end-to-side anastomosis completely surrounded by the proximal jejunal stump was developed. A proximal jejunal loop is isolated and used for isoperistaltic interposition between esophagus and duodenum. About 15 cm of the jejunal segment are left orally to the proximal anastomosis which is performed end-to-side using a single layer of interrupted sutures. The blind loop is then wrapped completely and symmetrically around the anastomosis and sutured to itself and the esophagus to keep it in place. Complete envelopment of the leakage-prone anastomosis is thus achieved. The distal end of the jejunal segment is anastomosed to the duodenum end-to-end. The technique in addition provides protection against reflux into the esophagus by gaseous distension of the proximal jejunal segment surrounding the anastomosis without impeding the passage due to a valve-like action which allows unidirectional flow. Clinical results so far are promising and show absence of leakage and/or stenosis in all cases of esophagojejunostomy operated according to the method described.


[Plication of small bowel by the baker-tube for operative treatment of ileus secondary to adhesions (author's transl)]. As an alternative to the extraluminal methods of Noble and Childs-Phillips, the intraluminal splinting of small bowel with the Baker-Tube offers a new possibility in the operative treatment of ileus secondary to adhesions. We report our experiences in 28 patients, using this procedure. An unselected group with severe adhesions was treated with the Baker-Tube, in the majority of the cases at the time of the emergency operation. The immediate postoperative course as well as the results of follow-up examinations 1/2 to 3 1/2 years after the operation are reported. Our experiences can be summarized as follows: 1. Generalized, extensive adhesions are the best indication for the intraluminal splinting. The Baker-Tube should be used with reserve in cases of early and often complicated relaparotomies, especially in the presence of diffuse peritonitis, because of the danger of bowel perforation at the tip of the Tube. 2. The procedure is less time consuming than Noble's operation and in addition allows immediate decompression of the small bowel while advancing the tube. A careful technique is important to prevent complications:--tight closure of the jejunostomy at the insertion point.--fixation of the jejunal loop to the abdominal wall with non absorbable sutures.--in cases of compromised lumen at the insertion point, an entero-entero-anastomosis between afferent and efferent loop should be done. With these precautions, fistulas, detachment of the jejunostoma and stenosis of the jejunal loop can be prevented. 3. Postoperative bowel function is usually rapidly restored, a distinct advantage when compared to the Noble procedure. 4. The rate of complications in our patients is lower than in a reported comparable group with Noble technique. 5. The recurrence rate is much lower than in a reported comparable group with Noble technique. Intraluminal splinting with the Baker-Tube can be recommended as an effective procedure in the treatment of ileus secondary to adhesions.


[The diagnostic value of the 67gallium-scintigraphy in malignant melanoma (author's transl)]. In 24 melanoma patients body regions with suspicion of metastatic spread were scanned with 67Ga-Citrate. Twenty-two out of 28 melanoma metastases (79%) could be scintigraphically visualized. Falsely negative scans were particularly frequent with small, indurated skin metastases, whereas falsely positive scans were not observed in this study. By means of in vitro experiments it was shown that the uptake of 67Ga into a human melanoma cell line was temperature dependent and reached a maximal value at 37 degrees C after 2 hrs of incubation. Furthermore, it was found that under the same in vitro conditions our melanoma cells bound and released 67Ga differently from 51Cr. From the release studies it was concluded that 67Ga unlike 51Cr does not form a stabile intracellular complex with cell proteins.


[Gastric neurinoma (author's transl)].

[Gastric neurinoma (author's transl)]. The pathologic, symptomatic, diagnostic and therapeutic characteristics of gastric neurinoma are demonstrated on the basis of 5 cases of the author's own case material. This rare gastric tumour accounts for 0.2% of all gastric tumours and has it's special importance for the diagnostic differentiation of gastric carcinoma and sarcoma. The maximum incidence is between age 50 to 60. Typical symptoms are acute gastro-intestinal bleeding, chronic gastric pain and palpable tumour in the epigastrium with relatively good general condition. Laboratory findings are not specific, X-ray examination and gastroscopy can be at best tentative. Resection is the therapy of choice, because potential malignancy accounts for 10 to 15% and the complications as bleeding and perforation can be dangerous. The prognosis is good even in cases of sole local excision, no recidives were found.