Effect of acupuncture on allergic rhinitis: clinical and laboratory evaluations. Of 22 subjects with allergic rhinitis who received a series of 6 acupuncture treatments, 11 (50%) were virtually symptom-free by the end of the series, 8 (36%) experienced a moderate reduction in symptoms, and 3 (14%) received no significant relief. Clinical assessment of symptoms was made on a 6-point scale before the first treatment and before each subsequent session. Laboratory tests included absolute blood eosinophils, percentage of nasal eosinophils, and radioimmunoassay of serum IgE, performed before the first treatment, at the end of the series, and 2 months later. A significant decrease in subjective clinical rating of symptoms correlated with a concurrent drop in absolute numbers of blood eosinophils and percentage of nasal eosinophils. IgE levels decreased in 64% of the subjects by completion of treatment and in 76% at 2-month follow-up.


Acupuncture for migraine prophylaxis: a prospective clinical study with six months' follow-up. The purpose of this study was to clarify the efficacy of acupuncture in the prophylaxis of migraine. 39 patients were treated by acupuncture given 5 times at weekly intervals. 92% of patients improved with acupuncture initially. Six months later 54% had relapsed to their pre-acupuncture state. The present study does not exclude the possibility that the results were due to suggestion.


Acupuncture in otolaryngology.

Acupuncture in otolaryngology. The enthusiastic acceptance of acupuncture by the people of the United States is partly indicative of the limitations of Western medicine. This paper is the result of a two year study using acupuncture in the field of otolaryngolgy to treat those patients whose illnesses have not responded to conventional Western medicine approaches.


The treatment of exogenous obesity employing auricular acupuncture. This article reports on the treatment of 21 obesity patients employing auricular acupuncture. The auricular points used were Mouth, Shen-men, Stomach, Hunger and Spleen, and the period of treatment lasted from two to six weeks. The weight loss in these patients varied from 2 to 16 pounds. The rationale for using these points and cautions for this type of treatment were discussed.


Pre-instrumental variables in coagulation testing. A number of variables thought to affect measurement of prothrombin time (PT) and partial thromboplastin time (PTT) were examined in an effort to determine more precisely their effects on these measurements. On the basis of these studies, it is proposed that blood specimens be anticoagulated with one part 3.8% (w./v.) sodium citrate solution to 19 parts whole blood to avoid excessive anticoagulation of blood samples drawn from patients with polycythemia. Because of the smaller amount of plasma in such samples, relatively larger amounts of anticoagulant are used, and spuriously prolonged PT and PTT measurements commonly result. No deleterious effect on anemic specimens is evident when the smaller amount of citrate is used. Studies of the stability of these specimens indicate that unopened, vacuum-drawn specimens do not noticeably deteriorate for as long as 6 hours, even when kept at room temperature. Prothrombin time measurements remain constant for as long as 24 hours. However, a 10--15% lengthening of the partial thromboplastin time is evident after 24 hours of storage.


Variable response of activated partial thromboplastin time to heparin therapy during hemodialysis. The consistency of the anticoagulant effect of intravenously administered heparin was studied. The activated partial thromboplastin time (APTT) was measured for six patients hourly during three consecutive hemodialysis sessions each. Cephaloplastin was the plasma-activating agent. The time required to form a clot was measured by a light-sensitive electronic timer and confirmed within +/- 5% by the tilt tube method. Results are reported in second relative to units of heparin given to patients per kilogram body weight. The range of APTT's measured 55 minutes after each heparin dose greatly exceeded the range of technical variability of the assay method. The probably mechanisms and consequences for this variability after a constant heparin dose are discussed. The anticoagulation effect of heparin during hemodialysis in an otherwise stable clinical situation is not constant. The risks of having too much or too little anticoagulation are not eliminated by having determined a therapeutic heparin dose during one dialysis rung.


Nitroblue tetrazolium test in patients with sickle-cell anemia. Forty-four patients who had sickle-cell anemia were examined to evaluate the reliability and usefulness of the nitroblue tetrazolium (NBT) test. The patients with sickle-cell anemia in painful crisis with bacterial infection often had low percentages of NBT reduction or negative results. The NBT test did not differentiate well between sickle-cell anemia with bacterial infection and without bacterial infection.


Vaginal adenosis. Analysis of 325 biopsy specimens from 100 patients. Biopsy-proven vaginal adenosis was found in 88% of a group of 100 asymptomatic young women with known or suspected to have histories of intrautering diethylstilbestrol (DES) exposure. Histologic features were roughly quantitated and were found to vary markedly from patient to patient, but the following proved to be the most consistent features: (1) variation in glandular configuration (simple, complex, cystic); (2) the presence of epithelium recapitulating all parts of the müllerian duct system (endocervical, endometrial and tubal); (3) limited involvement of the vaginal mucosa (no surface involvemtn in 23.8% of the patients); (4) extensive squamous metaplasia; (5) submucosal inflammation. There was no glandular dysplasia or coexistent adenocarcinoma. The squamous epithelium in many specimens contained little or no glycogen, and in some manifested cellular activity consistent with a regenerative response to inflammation. Sufficient atypicality to implicate vaginal adenosis as a premalignant lesion was not found in any biopsy specimen.


Wide-field electron microscopy. A rapid method for the study of histologic material that provides a bridge between light and electron microscopy. Wide fields of tissue can be rapidly examined by electron microscopy by use of Formvar films for the support of ultrathin sections on slot grids. The intervention of the grid bars of conventional mesh grids is avoided, and a continuous micrograph of the specimen at scanning magnifications can be obtained. Enough material is sublimed from the section and the supporting film by deliberate exposure to the electron beam to permit one to obtain an image with good contrast. This method of examination, which takes in all about two hours, permits examination of an extensive area of tissue in relation both to its topography at low magnifications and to its ultrastructural detail, and accordingly adds to electron microscopy a dimension characteristic of the lower powers of the light microscope. It offers the histopathologist the option of using micrographs taken during the scanning survey of a tissue to detect regions that can be readily re-examined at high magnification in the same ultrathin section.


Sclerosing mesenteritis. Report of two cases. Two cases of benign tumor-like mesenteric lesions are presented. The limited literature on comparable and similar lesions is reviewed, and the histologic findings are correlated. The lesions are composed of chronically inflamed adipose and fibrous tissue in various proportions. They probably represent different stages of a reparative process initiated by damage of the mesenteric adipose tissue of various etiologies. Whereas lesions in the younger age groups (mean 39.9 years) are predominatly characterized the fibrosis, those in the older age groups (mean 55.8 years) usually show a chronic inflammatory cell infiltrate rather than fibrosis. More than a dozen terms have been used for these lesions. The summarizing term "sclerosing mesenteritis" is proposed.


Endometrial and tubal involvement by squamous carcinoma of the cervix. A case of squamous-cell carcinoma of the uterine cervix, with involvement of the entire endometrium and both fallopian tubes, is reported. Tubal involvment due to direct spread from a cervical carcinoma is rare.


Postmortem demonstration of esophageal varices by a simple method. The usual methods available to demonstrate esophageal varices in postmortem material have met with little success because of their unreliability, difficulty to execute, or cost. A simple, inexpensive method, which consists in separating the esophageal mucosa and submucosa from the muscularis and stretching the former over a suitable absorbent paper, is described. In a few minutes, as the adherent membrane dries, the submucosal vascular pattern gradually develops, and after overnight drying, even the smallest venules are clearly visible. The specimen can be stored dry, photographed, or made into a more permanent preparation in a few days. The esophageal mucosal vascular patterns in groups of patients who died with a variety of hepatic diseases and other potential causes of esophageal varices were studied and compared with controls. A consistent pattern of prominent venous trunks located towards the distal third of the esophagus was seen in most specimens from cirrhotic patients, predominantly in micronodular forms with severe lobular distortion. Other potential causes of esophageal varices (hepatic tumors, congestion, etc.) resulted in less predictable vascular patterns.


Transportation delay and the microbiological quality of clinical specimens. An in-use study was done to determine the effect of transportation delay on the microflora of clinical specimens collected for microbiological analysis in a 1,000-bed university hospital. Portions of wound, respiratory, and urine specimens were planted for bacterial isolation on the wards immediately after collection. The remainder of each specimen was kept at room temperature without or without holding medium until it was picked up by messengers and taken to the bacteriology laboratory. The results of immediate planting on the ward were compared with those obtained by planting in the laboratory. Alterations in microflora were observed in all three types of specimens after averages of 2 to 4 hours of delay in planting.


An epidemic in a coronary care unit caused by Pseudomonas species. Five patients in a coronary care unit were involved in an epidemic caused by a nonfermenting Gram-negative bacillus, presumptively identified by our laboratory as Pseudomonas cepacia. All medications administered intravenously to these patients were cultured. Because morphine was the only such medication common to the treatment of all the patients involved, a vial used in the unit at that time was cultured, as were two previously-entered vials of saline solution and several sterile vials of distilled water used in the preparation of injectable medication. The Pseudomonas cepacia organism was recovered from one of the vials of saline solution. The epidemic ended as soon as the practice of re-entering the vials of sterile saline solution was discontinued.


Personality patterns of white, black, and Mexican-American patrolmen as measured by the sixteen personality factor questionnaire. The Sixteen Personality Factor Questionnaire was administered to 461 Los Angeles patrolmen to abtain a normative police profile. Multivariate analysis revealed that the average patrolman appeared brighter, more reserved, dominant, and tough-minded (p less than .001) than the average male. Comparisons were made for 29 black, 33 Mexican-American, and 399 white officers. Mexican-American officers emerged as more conservative and relaxed than whites, while black officers appeared more experimental, analytical, and group-oriented. A comparison with an idependent police sample revealed common traits of self-assurance and conservatism. Results were compared with a social workers' profile and discussed in relation to police officers' actual job activities and community needs.


Behavior modification consultation in a Mexican-American school: a case study. Following consultation by two psychologists with an elementary school populated primarily by Mexican-American students, absenteeism was chosen as the first problem area to attempt to change. A between-groups experimental design was used to evaluate the effect of contigent rewards on the students' attendance. Analysis of the data showed no improvement in attendance. The results of the study were discussed in terms of (1) a more thorough behavior analysis of the absenteeism problem, (2) methodological restraints of a between-groups experimental design, (3) the need for consultants to be familiar with the community in which they work, and (4) relatedly, the success of the local school psychologist in implementing behavior modification programs.


Mental health consumer survey on a shoestring budget-it is possible! Consumers of service in a decentralized unit of a county mental health services organization were surveyed. Two samples, one of 100 and one of 386 former clients, were selected for a questionnaire survey of satisfaction and perception of ensuing changes. This report is offered as an example of what a busy clinical team can accomplish in the midst of its basic task of providing therapeutic and diagnostic help.


Skull volume in infants. Methodology, normal values, and application. Skull volume was determined from measurements on roentgenograms in 53 infants with normally shaped skulls. A positive relationship existed between occipitofrontal circumference (OFC) and skull volume. Formulas related OFC to skull volume for each sex at different age intervals were computed. With these formulas and published data, percentile ranks for skull volume were calculated for age and sex. In seven infants with abnormally shaped skulls, the relationship between OFC and skull volume differed from infants with normally shaped skulls. The OFC was not a reliable indicator of cranial volume in infants with abnormally shaped skulls. Serial determination of skull volume is proposed as a method of following the brain growth of these infants.


Blood pressure studies in black children. Blood pressure measurements were obtained under office conditions by auscultatory method, using appropriate cuff sizes, in 1,668 healthy black children (827 boys and 841 girls) ranging in age from 4 to 17 years. We found no significant difference between the mean systolic blood pressure of black children in our study and that of whites as reported in the literature. However, mean diastolic blood pressure was lower in black children. Some black children (3.6%) were found to have blood pressure more than 2 standard deviations above the mean for their age and should be closely observed for developing hypertensive cardiovascular changes.


Diagnostic utility of white blood cell and differential cell counts. The white blood cell count, the differential cell count, and morphological changes in leukocytes can provide valuable diagnostic information that can aid the physician in determining the cause of illness. These simple laboratory tests, all too frequently either abused or ignored, when employed with precision can supplement but not supplant clinical judgment.


Hydrometrocolpos in a newborn.

Hydrometrocolpos in a newborn. Hydrometrocolpos was diagnosed in a neonate shortly after birth. A large collection of fluid was immediately removed from the distended vagina; hymenotomy was performed. The infant has remained well for more than a year following treatment. A simple technique for rapid diagnosis permits safe and appropriate management of this potentially serious disorder.


Hyperviscosity syndrome associated with necrotizing enterocolitis. Hyperviscosity, or decreased fluidity secondary to increased numbers of red blood cells, leads to tissue hypoperfusion. We report the case of an infant with hyperviscosity who died from necrotizing enterocolitis (NEC), and describe the presumptive association between NCE and hyperviscosity.


Pancytopenia in a patient with sickle cell anemia. An 11-year-old black boy with sickle cell anemia developed profound pancytopenia during the course of his disease, but fully recovered therefrom. The patient was receiving anticonvulsant drugs for a seizure disorder secondary to a "stroke," and, therefore, a drug-related marrow aplasia cannot be ruled out.


Complication of linear skull fracture in young children. The development of a leptomeningeal cyst following an otherwise uncomplicated linear skull fracture in a young child may result in a sizable cranial defect and irreversible neurological deficit months or years later. This complication most often follows parietal fractures but is also seen after occipital fractures or traumatic suture diastases. An underlying dural tear is a prerequisite to its subsequent development. Neurological deficit may be avoided by early diagnosis, surgical excision, dural closure, and cranioplasty. Early diagnosis depends on obtaining a skull roentgenogram four to six months following the original injury in any child where examination of the scalp and skull suggests and underlying expanding fracture.


Bartter syndrome. Typical facies and normal plasma volume. Two girls with hypokalemic and hypochloremic metabolic alkalosis and failure to thrive were found to have Bartter syndrome at ages 9 and 6 months. Both had normal blood pressures despite substantial elevation of plasma renin activity and evidence of secondary hyperaldosteronism. A similarity in facial features, including prominent forhead, a large head, triangular facies with drooping mouth, and large eyes and pinnae, was noted in these two infants and in published pictures of other infants with the syndrome. Although the normotension associated with substanital elevation of plasma renin activity and hyperaldosteronism in Bartter syndrome has been considered the effect of hypovolemia, a normal or slightly elevated plasma volume was found in these infants, suggesting that in certain cases an alternate mechanism for the depressed response to renin may be present.


Nonoperative treatment of meconium ileus equivalent. Intraluminal bowel obstruction secondary to inspissated feces is a known complication of cystic fibrosis. When seen in the older child, it is termed "meconium ileus equivalent." We studied a case in which nonsurgical resolution of the obstruction was obtained with N-acetylcysteine enemas and pancreatic replacement enzymes given orally and by enema. The pathogenesis of this disorder and the basis for the treatment are described. Recognition of this complication and familiarity with its medical management are important in caring for the older child with cystic fibrosis.


Congenital cutaneous candidiasis.

Congenital cutaneous candidiasis. Two cases of congenital cutaneous candidiasis are presented in order to call attention to this rarely recognized and infrequently reported condition. Clinical features and appropriate cultures are useful in differentiating the lesions from other more common dermatoses of the neonatal period. Microscopic examination of the placenta may disclose fungal funisitis or chorioamnionitis, thus defining the congenital nature of the disease. Topical antifungal therapy is sufficient unless systemic candidiasis is present. No evidence of impaired immunological responsiveness was found in the two infants.


Burkitt lymphoma in three American children. Clinical and cytogenetic observations. We observed the clinical aspects and cytogenetic findings of Burkitt lymphoma in three American children. The clinical manifestations vary widely, which makes early diagnosis difficult but important.


Sodium fluoroacetate poisoning.

Sodium fluoroacetate poisoning. We observed a case of poisoning with sodium fluoroacetate, and extremely lethal rodenticide that has had relatively strict controls placed on its use. The case was unusual in the very long time the rodenticide had been present in the home, the mild nature of the poisoning, and the remarkably delayed onset of serious central nervous system symptoms. It demonstrates the need for even stronger controls on the use of sodium fluoroacetate.


Congenital atresia of the duodenum with gastric perforation. Case report and review of the literature. Gastric perforation associated with duodenal atresia is a very rare condition. We are able to cure an infant with this complicated disease by using a two-stage operation. Of interest is the occurrence of massive subcutaneous emphysema in our patient.


Persistent fifth aortic arch in man.

Persistent fifth aortic arch in man. Persistence of the fifth aortic arch is a rare vascular anomaly of man, and in all cases reported thus far there has been an associated patent ductus Botalli (arteriosus). The present case is unique in at least three respects: lack of associated intracardiac malformation, the survival of the patient, and prenatal exposure to the possible teratogenic action of the anticonvulsant drug trimethadione (Tridione). Other noncardiovascular congenital defects were present in our patient. The dislocation of the hip and the patent ductus arteriosus have been corrected surgically.


Pneumococcal bacteremia associated with gingival lesions in infants. Five infants with fever, leukocytosis, and a cystic lesion superimposed on a swollen gingiva had pneumococcal bacteremia. Lesions were so characteristic that a presumptive diagnosis of pneumococcal bacteremia was made in the last three patients before confirmation by blood cultures. Infants who initially have these symptoms should be considered at risk for pneumococcal bacteremia.


Osteomyelitis in infants and children. A review of 163 cases. One hundred sixty-three cases of osteomyelitis in infants and children were seen at our hospital during the past 15 years. There were twice as many boys as girls. Staphylococcus aureus was the major etiologic agent, being identified in 61% of the cases. Gram-negative bacteria were responsible for only 14 cases (9%). The femur, the tibia, or the humerus were affected in 103 of the 152 patients with single bone involvement. Ostoemyelitis of more than one bone was seen in 11 cases (7%). Associated joint infectin was confirmed in 29 patients. There were no deaths. Surgical drainage was carried out in 81 cases (50%). Ten patients had recurrent or persistent drainage and one developed a Brodie abscess. Of the patients with S aureus osteomyelitis, chronic disease occurred in 19% of those receiving parenterally administered antibiotics for three weeks or less, but in only one patient (2%) of those who received parenteral antibiotics longer than three weeks.


Rational diagnostic evaluation of the child with mental deficiency. Evaluation of a mentally deficient child should be individualized, using findings from an appropriate history and physical examination. Depending on these findings the patient may be assigned to one of four subcategories, as determined by clinical indications and the patient's age at onset of the problem. These categories are (1) prenatal problem of morphogenesis, (2) perinatal insult to brain, (3) postnatal onset of brain dysfunction, and (4) undecided age at onset. This subcategorization has revelance to the type of diagnostic studies that may be indicated. Using this approach, a retrospective study of the diagnostic evaluation of 98 mentally deficient children was performed. Ninety percent of these children were considered to have had "nonrational" laboratory tests, and of these, none contributed to elucidation of the basic diagnosis. The only tests that were valuable had been indicated by a specific historical or physical finding in addition to mental deficiency.


Acute morbidity and physical growth in rural Guatemalan children. The relationship between morbidity and physical growth increments was investigated in 716 Guatemalan children ranging in age from 15 days to 7 years. The growth variables investigated were semestral and yearly increments in total body length and weight. The number of days ill with diarrhea, fever, and respiratory illnesses per semester or year was used as an indicator of morbidity. The morbidity data were collected through bi-weekly retrospective interviews of mothers. Children less ill with diarrhea had substantially larger increments in length and weight than children who were ill with diarrhea a greater percentage of the time. In contrast, fever and respiratory illnesses did not affect growth rates. These findings highlight the fact that diarrhea is a major public health problem in developing nations.


Giardiasis in childhood.

Giardiasis in childhood. Giardiasis is still regularly encountered in the United States, both as endemic cases from the local community as well as in patients returning from travel abroad. Giardiasis should be suspected in any child with steatorrhea, unexplained chronic diarrhea (especially if associated with growth failure), weight loss, or abdominal pain and bloating. Duodenal aspiration or small intestinal biopsy may be necessary to make a diagnosis because Giardia lamblia are not found by stool examination in 50% of symptomatic individuals. A diagnosis of giardiasis is important because the disease is curable.


Purtscher retinopathy in the battered child syndrome. Purtscher retinopathy is a hemorrhagic angiopathy that occurs after sudden compression of the thorax. Virtually all reported cases have been in adults who have decreased visual acuity, retinal hemorrhages and exudates, and no other neurological signs. By contrast, in infants, hemorrhagic retinopathy is rarely benign, and generally is considered to indicate intracranial hemorrhage, usually an acute subdural hematoma. Two battered infants had seizures and associated chest injury. There were retinal hemorrhages and exudates, unaccompanied by clinically important intracranial hemorrhage. At follow-up, the hemorrhagic retinopathy had resolved without sequelae; development was normal, and seizures had not recurred. Purtscher retinopathy thus should be added both to the differential diagnosis of hemorrhagic retinopathy in infancy and to the list of physical signs suggesting child abuse.


Chylous ascites. Manifestation of the battered child syndrome. A child had chylous ascites and other findings suggestive of child abuse. He had a spontaneous remission, with conservative therapy. A lymphangiogram showed the area of leakage into the peritoneal cavity. The discussion includes a brief review, a literature on chylous ascites.


Horseshoe lung in an infant with recurrent pulmonary infections. A case of horseshoe lung occurred in a 7-month-old infant, the first, we believe, to be associated with horseshoe kidney. This lesion should be considered in any infant with dextrocardia, recurrent cardio-respiratory distress, and pulmonary infections.


Potter syndrome. Nonrenal features induced by oligoamnios. A fetus with normal kidneys and the nonrenal features of Potter syndrome is presented. The case is made that these features resulted from uterine compression caused by premature rupture of the gestational membranes and subsequent leakage of amniotic fluid.


The Opitz trigonocephaly syndrome. A case report. This is the third report, to our knowledge, of a baby with Opitz trigonocephaly syndrome of multiple congenital abnormalities. The unusual facial and palatal abnormalities are diagnostic.


Rubella reinfection during pregnancy. A case of mistaken diagnosis of congenital rubella. A case of subclinical rubella reinfection during pregnancy with serologic findings in the offspring initially led to an erroneous diagnosis of fetal infection. Laboratory diagnosis of congenital rubella infection, based on finding hemagglutination-inhibition (HI) activity in immunoglobulin M (IgM) fractions of newborn's serum after sucrose gradient fractionation, was questioned when apparent IgM-HI activity was to be probably due to nonspecific inhibitors, which resulted from bacterial action on the beta-lipoprotein in the serum. These findings emphasize some pitfalls encountered in arriving at a diagnosis based soley on serologic data. This case also illustrates the importance of keeping serum samples sterile when performing serologic tests.


Compliance and self-medication in cystic fibrosis. Sixty-one patients with cystic fibrosis were studied to determine the relationship between degree of compliance with taking antibiotics and severity of the disease. The compliance rate was high in these patients, suggesting that perception of the severity of the disease and the potential consequences of discontinuing medication is a principal factor.


Amino acids and collagen-induced platelet aggregation. Lack of effect of three amino acids that are elevated in homocystinuria. Arterial thrombosis frequently occurs in homocystinuric children whose plasma levels of homocystine, homocysteine, and methionine are elevated. Since platelet aggregation is important in the pathogenesis of arterial thrombosis, we wondered whether the elevated concentrations of these amino acids might predispose to arterial thrombosis by enhancing platelet aggregation. Addition of the above amino acids to normal platelet-rich plasma to achieve concentrations within or above the range found in homocystinuric children had no effect on collagen-induced platelet aggregation. These data give no support to the hypothesis that the arterial thromboses of homocystinuric children are a result of enhancement of platelet aggregation by homocystine, homocysteine, or methionine.


Neonatal small left colon syndrome. Occurrence in asymptomatic infants of diabetic mothers. An unusually high incidence (40%) of maternal diabetes was observed in a series of 20 newborn infants who had low colonic obstruction and barium enema findings of a uniformly narrowed colon from the splenic flexure to the anus. This has been termed the "neonatal small left colon syndrome." We investigated the incidence of this colon configuration in gastrointestinally asymptomatic infants of diabetic mothers. Of 12 such infants examined by barium enema, six have shown this same narrowing of the left colon. The relationship of maternal diabetes to the small left colon is not yet clearly understood.


Intravenous metyrapone testing. Evaluation of growth hormone and adrenocorticotrophic hormone in children. An intravenous metyrapone tartrate test was performed on 26 children to assess growth hormone (GH) reserve and pituitary-adrenal axis. Results were compared to the response evoked by an estrogen-primed arginine-insulin tolerance test (ATT/ITT). Administration of metyrapone intravenously proved to be a reliable means of evaluating pituitary-adrenal function. However, a normal serum GH concentration (greater than or equal to 7 ng/ml) during the test occurred in only nine of 18 children who had an adequate response to the ATT/ITT, and in three of these, the peak GH level occurred at the start of the infusion. Therefore, this procedure does not appear to be a satisfactory test for GH reserve in children. Further, the discrepancy between time of the peak serum concentrations of compound S and GH following intravenous administration of metyrapone does not support the contention that the rise of GH level during stress is secondary to release of adrenocorticotrophic hormone.


Adolescent attitudes in a general pediatric hospital. A survey of 87 inpatient admissions. A study of 87 adolescent patients hospitalized in a large pediatric hospital was made to define their emotional, social, recreational, and educational needs. Open-ended questionnaires were given to the adolescents, their parents, and medical care personnel. Chronic diseases, prolonged hospitalization, multiple admissions, and severity of illness were prominent in the population surveyed. These characteristics were associated with critical patient attitudes toward the physical facilities and psychological atmosphere of the hospital. Knowledge of these attitudes aids in the recreational, vocational, and educational planning for adolescents.


Pediatric interviewing skills taught by nonphysicians. We cannot assume that medical students develop, through unstructured educational happenings, the skills of interviewing a mother about her child. Teaching these skills requires extensive one-to-one faculty-student involvement, which is almost prohibitive if pediatricians are expected to do this teaching. This article describes (1) a current pediatric interviewing teaching program that uses nonphysicians as teachers; (2) the selection and training of nonphysicians to teach the skill of pediatric interviewing to third-year medical students; and (3) an assessment of these teachers by comparing their techniques with those of three pediatric faculty members. The nonphysician teachers fared most favorably when their teaching methods were compared with those of three pediatricians. Acceptance of the program by the students, faculty, and administration has been most encouraging.


Acute transplacental ethanol intoxication. With the use of ethanol in hyperalimentation regimens and for the inhibition of premature labor, there is increased opportunity for exposure of the fetus to this potentially toxic substance. We reviewed the literature regarding the effects of ethanol on the fetus and neonate, and illustrate its potential toxicity by the report of a case of neonatal depression secondary to acute maternal ethanol ingestion.


I-cell disease. Report of three cases.

I-cell disease. Report of three cases. Clinical, radiological, histochemical, ultrastructural, and biochemical studies were conducted on three cases of I-cell disease. I-cell disease can be readily distinguished from Hurler syndrome (mucopolysaccharidosis I) by the presence of hypertrophic gums, vacuolated lymphocytes in peripheral blood, and a normal level of urinary mucopolysaccharides. Accumulation of proteoglycans was more prominent in the inclusion bodies of I-cell chondrocytes in comparison to cultured fibroblasts, which contained a large amount of glycolipids and a small amount of proteoglycans. An autosomal recessive mode of inheritance was suggested in two of the cases.


Death rates and causes of death among opioid addicts in community drug treatment programs during 1970-1973. Death rates and causes of death among opioid addicts in 52 community treatment programs in a national reporting network were compared for 3 consecutive years. The greatest proportion of patients in the base samples were male, 21 to 25 years old, black, and in MM programs. The 275 patients in the deceased sample presented essentially the same profile, with the exception that the older patients were more highly represented among the deceased. Death rates were particularly high during each year for patients over 30 years old. Over the 3 years, death rates increased for whites, addicts 21 to 25 years old, and patients in outpatient DF programs. Consistent decreases in rates each year were found for blacks, patients in the 26 to 30 age range, and patients in MM programs.


Metastatic disease involving the stomach. Metastatic disease involving the stomach is an unusual and difficult clinical problem. A review of 1010 autopsies of patients with cancer disclosed 17 cases of gastric metastases (an incidence of 1.7%), with breast cancer, lung cancer, and melanoma being the most frequent primaries. The clinical manifestations of epigastric pain, melena, and anemia are nonspecific, necessitating radiographic examination of the gastrointestinal tract. The radiographic findings are usually sufficient to suggest the diagnosis.


The butterfat absorption test in adults. The usefulness of the butterfat absorption test in assessing fat absorption has been studied in 89 adult patients. In 42 patients who were shown to have steatorrhea by the criteria of the fat balance studies, 33 patients (78.6%) had abnormally low serum optical density values following butterfat ingestion. In 8 patients, steatorrhea could not be clearly explained on the basis of their underlying disease. If these 8 patients are excluded from consideration, then 28 of 34 patients (82.4%) had an abnormal response following butterfat ingestion. A maximum increase of optical density of 0.25 or less is a useful indication of fat malabsorption in adult patients.


Effect of bombesin on extragastric gastrin in man. The effect of a protein test meal and a bombesin infusion on extragastric gastrin levels was studied in patients with truncal vagotomy, antrectomy, and gastroduodenostomy or gastrojejunostomy and in patients with total gastrectomy. In patients with vagotomy, antrectomy, and gastroduodenostomy and in patients with total gastrectomy the gastrin levels were raised by 33% and 35%, respectively, from basal after test meal, while during BBS infusion gastrin values decreased by 25% and 30%, respectively, from basal. In patients with vagotomy, antrectomy, and gastrojejunostomy, test meal and BBS infusion did not significantly alter basal gastrin values. It is concluded that BBS does not stimulate extragastric gastrin.


Evaluation of endoscopic examination of colon tumors in rats. This study is an evaluation of the use of endoscopic examination to detect MNNG-induced large-bowel tumors in rats. The smallest human fiberbronchoscope was used as a colonoscope for the rats and the full length of the distal large bowel was visualized. The correct diagnosis rate in all rats with and without large-bowel tumors was 94%. Of rats with colon tumors, 85% were correctly diagnosed endoscopically. Even tumors 1 or 2 mm in diameter were detected. The examination was easy and reliable. This procedure may be an adjunct in experimental work with this and other animal models of colon cancer.


Altered bile acid metabolism in vegetarians. Bile acid kinetics were studied in a group of healthy vegetarians and a matched group of healthy control subjects. The daily fractional turnover rate of cholic acid was significantly smaller in the vegetarians than in the controls and deoxycholic acid pool size was significantly smaller in the vegetarians than in the controls. The data suggest that enterohepatic conservation of cholic acid is more efficient in vegetarians than in control subjects resulting in decreased deoxycholic acid input in vegetarian subjects. The possible significance of these data to intestinal oncogenesis is discussed.


Etiology of strictures of the colon associated with pancreatitis. Colonic strictures are an uncommon complication of pancreatitis. Three new cases are described and in each case the histological features strongly resemble those seen in strictures of ischemic origin. It is postulated that ischemia and not encircling pericolic inflammation, is the cause of strictures associated with pancreatitis.


Gastric acid secretory differences in patients with Heineke-Mikulicz and Finney pyloroplasties. To study gastric emptying and secretion, liquid meals of 10% glucose lasting 15 and 30 min, and physiological saline meals lasting 30 min, all containing phenol red as a gastric nonabsorbable marker, were given to postvagotomy patients with Finney or Heineke-Mikulicz pyloroplasties. No differences in emptying were found. A small but statistically greater amount of acid was found in the stomach with the 15-min glucose meal after Heineke-Mikulicz pyloroplasty. This represented greater acid secretion into glucose meals generally after Heineke-Mikulicz pyloroplasties, because of the larger volume contained in the stomach at 15 min. 15-min glucose meal acid secretion correlated with basal acid concentration but not with insulin-stimulated gastric acid output. The small excess of acid in the Heineke-Mikulicz group's 15-min glucose meals may represent a small, maintained excess of gastric acid in this group detected only in the brief glucose meals due to rapid and erratic gastric emptying of liquids after vagotomy.


Esophageal cancer in Israel: selected clinical and epidemiological aspects. Records of all patients diagnosed as having carcinoma of the esophagus in Israel between 1960 and 1966 were reviewed. The mean annual incidence was 2.3/100,000, with a male/female ratio of 1.6:1. Incidence was higher among the Asian-born segment of the population below 60 years of age. The most frequent localization was in the middle third of the esophagus, followed by the lower third. More than two thirds of the patients were considered unsuitable for surgery. Overall 5-year survival was 5.8%.


The antidiarrheal action of bismuth subsalicylate in the mouse and the rat. The antidiarrheal effectiveness of bismuth subsalicylate was determined in two species of laboratory animals. Doses of castor oil were, at first, found to accelerate significantly the movement of a charcoal test meal along the small intestine of the mouse and rat and also to increase both the fecal output (dry or wet weight) and the frequency of diarrhea in mice. Bismuth subsalicylate significantly prevented the enhancement of charcoal-meal transport induced by castor oil in both mice and rats. Increased fecal outut (dry or wet weight) and increased frequency of diarrhea in mice were also significantly reduced by bismuth subsalicylate in a dose-related fashion. The findings in these experiments lead to the definitive conclusion that bismuth subsalicylate exerts antidiarrheal activity in the mouse and in the rat and support its use in therapy of common clinical diarrheal states.


The effect of manometric assembly diameter on intraluminal esophageal pressure recording. Recent studies indicate that lower esophageal sphincter pressure is influenced by manometric assembly diameter. This study determines the effect of assembly diameter on both esophageal sphincter pressure and peristaltic pressure in the esophageal body. We performed esophageal manometric studies in 6 normal subjects using graded assembly diameters. High-fidelity recording was achieved by using a noncompliant catheter-infusion system. The results indicate that increases in assembly diameter cause significant increases in peristaltic pressure amplitudes and in resting sphincter pressure in both the smooth and striated muscle portions of the esophagus. This phenomenon is best explained by the length-tension characteristics of esophageal muscle, increased stretch causing greater contraction force.


Meal interference with antibiotics administered orally in hospitals. A study of 132 hospitals in New York City was conducted to determine: (1) The usual drug administration and meal serving time schedules used; (2) if oral antibiotics recommended to be given on an empty stomach are actually administered with or near meals; and (3) who is responsible for establishing drug administration time schedules. A structured-disguised questionnaire was used and administered via telephone. Results revealed a wide variation of drug administration time schedules and meal serving times. Meal interference with oral antibiotic absorption was defined as a meal that is served less than one hour before or two hours after an oral antibiotic is scheduled to be administered. The incidence of meal interference ranged from 35 percent to 64 percent. The pharmacy and therapeutics committee, more often than any other group or individual (19.2 percent), was responsible for establishing drug administration times. A formal dosage schedule for orally administered antibiotics is recommended as an effort to reduce the incidence of meal interference with antibiotic absorption. Such a schedule developed at one hospital is presented.


Drug usage review in a community hospital. A simple and effective manual drug usage review program in a community hospital is described. Fifteen randomly selected charts are screened each month by a drug information pharmacist. Charts demonstrating questionable drug therapy are forwarded to a physician member of the pharmacy and therapeutics committee; those showing questionable drug administration practices are referred to the nurse member of the committee. These committee members screen the questionable charts and refer to the entire committee those cases which require further follow-up. The committee categorizes the problems and communicates its recommendations to the individual practitioners involved. Recommendations focus on the legal ramifications of FDA-unapproved drug usage. During the first two years of the program, 341 charts were screened for drug usage; 62 of these were referred to the pharmacy and therapeutics committee for further review. In 20 cases, the committee sent a letter to the prescribing physician or his department chairman; in 16 cases, letters were sent to nursing administration.


Economics of institutional pharmacy services under national health insurance in Australia. The development and effect of the National Health Scheme on institutional Health Scheme on institutional pharmaceutical services in Australia are discussed. Government control over drug costs and the provision of pharmacy services, with its effect on both community and institutional practice, is assessed. Methods of improving the present system of health insurance under the Pharmaceutical Benefits Scheme in Australia are suggested, including their relevance to health care in the United States.


Establishment of a nuclear pharmacy.

Establishment of a nuclear pharmacy. The University of Michigan Regional Nuclear Pharmacy is described. The scope of operation of the nuclear pharmacy includes radiopharmaceutical formulation and dispensing, quality control, inventory control, research and development of new radiopharmaceuticals, and consultation. Also discussed are program objectives, pharmacy location, organizational structure, budget and staff, economic considerations, facilities and equipment, and legal considerations.


Yttrium-90 citrate colloid for radioisotope synovectomy. The preparation of an yttrium-90 citrate colloid is described. This formulation localizes in the synovial membrane and thereby eliminates any irradiation received by extra-articular tissues. Yttrium-90 is eluted from Sr-90 bound to a sulphonic acid ion exchange resin. The colloid is prepared using a 3:1 ratio of carrier yttrium and citrate. Contamination with ionic 90Y and ionic 90Sr was less than 1 percent and 0.001 percent, respectively. In the 28 patients studied, all of the injected dose of 90Y remained in the region of the joint. Brief clinical results are presented.


Filling vials aseptically while monitoring for bacterial contamination. An aseptic system for prefilling radiopharmaceutical kit vials or syringes is described. The system combines ultrafiltration with a method for monitoring for bacterial contamination. It could be used in any vial or syringe prefilling operation and is not restricted to radiopharmaceuticals.


Comparison of the bioavailability of cyanocobalamin from capsule and liquid dosage forms. Comparative in vivo absorption of cyanocobalamin from two dosage forms, gelatin capsule and liquid, was studied. Forty-two subjects received simultaneous doses of cyanocobalamin in capsule and liquid form, labeled with cobalt-57 and cobalt-60, respectively. Excretion, a measure of absorption, was between 2 percent and 66 percent greater with the liquid form. In vitro dissolution studies showed that the capsules had a tendency to collapse into a stringy mass and to dissolve slowly.


Pharmacy information system for a health maintenance organization. A computerized pharmacy system developed for a health maintenance organization (HMO) is described. The system has been operational for nearly three years. It is based on a coding scheme for (1) all drugs in the HMO formulary and (2) prescribing information. The information is processed by a computer which generates a variety of usage information. The system produces reports on frequency of drugs dispensed, number and percentage of patients obtaining each drug, and age-sex distribution of patients using a particular drug. The special characteristics of an HMO pharmacy as they relate to computerized systems are discussed. System requirements, maintenance procedures and cost estimates are also presented.


Clindamycin prescribing patterns in a university hospital. A study was conducted at a university hospital to determine the patterns of clindamycin prescribing, to assess the appropriateness of clindamycin usage and to quantitate the drug's toxic reactions. Three evaluators (two pharmacists and a physician) reviewed clindamycin usage data for 65 patients who received 67 courses of clindamycin therapy during the period January 1, 1975, through March 20, 1975. Forty-eight courses were parenteral, three oral, and 16 a combination of parenteral and oral. Fifty-four courses were intended for therapeutic use rather than prophylactic use. Of these 54 therapeutic courses, 23 were considered rational and 26 irrational; insufficient data existed to make a judgment in five cases. Three adverse reactions (diarrhea in each case) were observed. The time relationship of this study with the changing clinical status of clindamycin is discussed. Identification of clindamycin's toxicity appears to have reduced oral use at the study hospital, but parenteral usage of the drug remains high.


Drug usage review and inventory analysis in promoting rational parenteral cephalosporin therapy. Drug usage review and inventory analysis data on the cephalosporin antibotics were presented by the pharmacy to a hospital pharmacy and therapeutics committee in an effort to promote rational use of these drugs and decrease drug costs. The committee recommended that cefazolin be the parenteral cephalosporin of choice. Cephalothin was placed on a limited formulary status for ophthamology patients and patients with renal impairment. Efforts by the committee to promote physician compliance with its recommendations are discussed.


Missing medications associated with centralized unit dose dispensing. The reasons for missing medications in a centralized unit dose system were studied, and means of improving the situation were recommended. Reasons for missing medications included: insufficient or incorrect medications dispensed by the pharmacy, differences in interpretations of orders by pharmacists and nurses, administration of extra medication or incorrect doses, waste of medication, administration of medication to patients other than for whom it was dispensed, delivery to wrong nursing unit, pilferage, and requests by nurses for medication before the orders were received by the pharmacy. A procedure for checking medications in unit dose carts by pharmacy and nursing personnel was implemented. Before this procedure, the rate of missing medications was 0.93% of the doses dispensed; after the procedure, the rate was 0.33%. Other recommendations designed to prevent missing medications in this unit dose system are presented.


Distribution accuracy of a decentralized unit dose system. Unit dose medication carts in a 500-bed university hospital were monitored for accuracy and completeness after delivery to the nursing station. The contents of the cart were compared with the nurse's patient medication record. Discrepancies were recorded for evaluation. All medication cart distribution errors found were analyzed to identify the source and were tabulated to determine error rate. Three major categories of errors were discovered: pharmacy technician errors not corrected by the pharmacist, errors associated with nurse's patient medication records, and errors resulting from lost orders.


Respiratory therapy unit dose medication distribution. A unit dose system for distribution of respiratory therapy medication is described. One unit dose cart, containing respiratory therapy medication for each patient and equipment for administration of the medication, is used for each floor. Syringes are prefilled by the pharmacy for unit dose use. Storage and stability data are given for normal saline, isoproterenol, acetylcysteine, and combinations of these drugs. Cost factors of this respiratory therapy medication distribution system are discussed.


Stability of sodium oxacillin in intravenous solutions. The influence of concentration, vehicle, dextrose and temperature on the stability of sodium oxacillin solutions was determined using a chemical kinetic approach. Sodium oxacillin degraded faster in dextrose solution than in sodium chloride injection. This finding was attributed to the catalytic effect of dextrose on sodium oxacillin hydrolysis. Solutions of 1-50 mg/ml oxacillin in each vehicle were found to be stable for 24 hours at 23 C. The degradation of sodium oxacillin in various dextrose solutions was independent of oxacillin concentration, and followed first order kinetics.


Detection of particles in intravenous fluids using scanning electron microscopy. A study was conducted to compare the particles in intravenous solutions found in glass and plastic containers, and to investigate the use of scanning electron microscopy in detecting and identifying such particulate contamination. The method used was to filter one liter of each fluid from glass and plastic containers through a membrane filter, attach the membrane to aluminum studs and coat the specimens with a thin layer of gold-palladium in a vacuum evaporator. Scanning electron microscopy was then used to examine the specimens, and photomicrographs were prepared. The results showed that the particles found in glass and in plastic containers have distinctive differences and that scanning electron microscopy is useful in detecting and characterizing these particles.


Vial retention of technetium-99m sulfur colloid in commercial kits. Vial retention of technetium-99m sulfur colloid in five commercial kits used for the preparation of this radiopharmaceutical was studied. Radiochromatography and microscopic particle sizing were performed on all products; the biologic distribution in rats of two products was tested. Loss of activity attributable to vial retention was evident with only two products. The resulting loss of specific concentration did not affect biologic distribution. The cause of the "plating-out" of the radiopharmaceutical on the interior reaction vial surface was not determined, although the gelatin component of the product was suspected to be a factor.


Etiological factors of the Stevens-Johnson syndrome. Etiologic factors of the Stevens-Johnson syndrome, both drug-related and nondrug-related, are discussed. A description of the Stevens-Johnson syndrome as a symptom complex is presented. Available literature is reviewed and critiqued as to its contribution in helping to define the role of drugs as specific etiologic factors in the syndrome. A patient case history is presented to demonstrate the difficulty of determining the causative agent for the syndrome, and to emphasize the need for a complete drug history before specific agents are implicated. The need for caution and discretion in reporting and implicating agents without the availability of a complete patient history is discussed.


Comparison of the clinical utility of four drug information services. The clinical utility of International Pharmaceutical Abstracts, Iowa Drug Information Service, deHaen Drugs in Use, and deHaen Drugs in Research was compared. The number of references obtained for questions in five different clinical areas, and the amount of time for each search, were studied and compared. The Iowa Drug Information Service appeared to have the highest overall relative utility for obtaining clinical information. The two deHaen services offered broad coverage of the primary clinical literature. International Pharmaceutical Abstracts was effective in locating many useful references.


Bioavailability of acetaminophen suppositories. Urinary excretion of acetaminophen after rectal administration of three suppository formatulations obtained from hospital and commercial sources was compared to that after oral administration of a tablet dosage form. The absorption of acetaminophen from the suppositories was extremely variable and showed relative bioavailabilities of 68.4 to 87.5% when compared to the oral absorption of the drug from the tablet. The rate of bioavailability differed markedly between products and, in one case, the suppository dose of acetaminophen was so slowly absorbed that the clinical effectiveness of the product is doubtful. The study points out the need for in vivo evaluation of hospital pharmacy manufactured products.


Development of a computer-based controlled substances reporting system. A computer-based system of reporting the disposition of controlled drugs is described. An automated posting system, of which this system is a byproduct, is also described. The primary advantage is that no separate effort is involved in compiling the reports which provide information on the inpatient and emergency-room disposition of controlled substances.


Pharmacy-nursing communications in an intravenous admixture program. A centralized pharmacy admixture program is discussed, with emphasis on the forms used to communicate between pharmacists and nurses. Aspects of the programs described include the patient intravenous profile folder, preparation and delivery of i.v. solutions, preparation of piggyback solutions and prefilled syringes of reconstituted antibiotics, and emergency intravenous solution stock.


Combined volume control set-piggyback system for intermittent intravenous therapy. A new method for intermittent administration of i.v. fluids which maintains the advantages of the piggyback system but at a lower cost than the piggyback system is described. The system uses a volume control chamber as a replacement for a minibag or minibottle to deliver doses of different medications. The volume control set, when attached in the prescribed fashion, permits the flow from the primary i.v. solution to resume automatically when the volume control chamber is empty. One large-volume container of i.v. fluid can be used to dilute many doses of different drugs in the volume control chamber rather than one small-volume container per dose. No significant difficulties have been encountered with the mechanics of the system, and nursing response has been favorable.


Quality of care evaluation applied to assessment of clinical pharmacy services. Drug information supplied in a clinical setting was evaluated to determine the quality of care provided by a group of clinical pharmacists. Both process and outcome were assessed to determine the pharmacists' effectiveness in supplying clinical pharmacy services as well as to determine the relationship between these services and patient outcomes. Evaluation was conducted by a group of five physicians and the coordinator of the clinical pharmacy program. The method of evaluation seemed to contain a very high degree of interviewer reliability. Results indicate a moderate correlation, significant beyond the 0.01 level, between intermediate outcomes and the clinical pharmacy care process. The review group judged approximately three-fourths of the drug information communications as having at least a "significant" potential for benefiting the patient. Outcome measurement indicated, however, that only 14.5% of these communications were judged as actually benefiting the patient while 25% were judged as probably benefiting the patient.


Judgmental questions processed by a drug information center. The number of judgmental questions handled by a pharmacy-operated, university-based drug information center was studied. Judgmental questions were defined as those requiring the integration of data or knowledge and experience in the process of making a decision regarding a specific therapeutic problem. Less than 5% of 720 questions handled by the drug information center during a three-month period were of the judgmental type. Based on this result, and because of the need to use resources most efficiently, it is suggested that it may be advisable to develop more regional (and fewer hospital) drug information centers.


Pharmaceutical services for skilled nursing facilities in compliance with federal regulations. A program of providing dispensing, clinical and administrative pharmaceutical services to three skilled nursing facilities is described. Medications are provided to patients from a community pharmacy through a centralized unit dose drug distribution system. Features of the system include pharmacy review of the physician's original order, medication histories obtained by a pharmacist, patient medication profiles, and a 24-hour exchange of drug cabinets containing individual patient drawers. The time requirements for administrative and clinical functions, and the calculation of a fee for these services, are described. Over a four-year period, the average number of medications per patient was reduced from 7.7 to 6.1. Two factors believed to be related to this reduction are an effective automatic stop order policy and careful review of patient medication profiles by the pharmacist.


Evaluation of preparations of patent blue (Alphazurine 2G) dye for parenteral use. The stability and the behavior of patent blue (Alphazurine 2G) dye in a vehicle such as lidocaine hydrochloride injection were studied with regard to medication orders which may be prepared by hospital pharmacists. The patent blue family of dyes are sulfonated diaminotriphenylmethane, vital, acid dyes which have been used as diagnostic aids in both lymphography and burn debridement. A literature review, including some toxicological information, is presented. The occurrence of the sodium salt form and the equilibrium solubility of the patent blue sample studied are reported. Some implications of patent blue injections include: Clinical literature reports of toxicities, the unapproved status of patent blue by the Food and Drug Administration, results of stability studies, and the formation of viscid, water-insoluble precipitates of patent blue in combination with lidocaine hydrochloride. The extemporaneous preparation and subsequent use of parenteral prescriptions of patent blue dye in vehicles containing lidocaine hydrochloride and methylparaben are not recommended.


Chemical structure and purity of dyes used in lymphograms. Because of confusion in the literature, studies were performed on several samples of patent blue violet and Alphazurine 2G to determine their chemical structure and purity. Nuclear magnetic resonance studies revealed that three distinct compounds and one mixture had all been labeled as the same compound. The purity of the dyes varied from batch to batch, as shown by thin-layer chromatography. Caution should be exercised in the use of these dyes for lymphograms.


Prevention of post-transfusion hepatitis. Role of sensitive hepatitis B antigen screening tests, source of blood and volume of transfusion. Aliquots from units of blood were screened by radioimmunoassay (RIA) and reverse passive hemagglutination (RPHA) shortly after transfusion. Recipients of positive units, as well as control subjects, were followed prospectively for evidence of either post-transfusion hepatitis (PTH) or exposure to hepatitis B (HB). There was a significant correlation between receipt of either an RPHA-positive or RIA-confirmed positive unit and the subsequent development of PTH or HB exposure. Recipients of all volunteer units had a lower incidence of PTH than did recipients of all commercial units. The frequency of PTH and HB exposure was not statistically different in groups receiving 1 to 5, 6 to 10, 11 to 20 and greater or less than 21 units of blood. The PTH seen in the study presented over a wide clinical spectrum, but it was usually anicteric and frequently asymptomatic.


Impaired cell-mediated immunity in systemic lupus erythematosus (SLE). A controlled study of 23 untreated patients. Cell-mediated immunity was evaluated in 23 patients with systemic lupus erythematosus (SLE) prior to therapy and in 23 control subjects. The patients with SLE who had moderate to severe disease activity had significantly fewer positive delayed skin tests to streptokinase-streptodornase (SK-SD) and Candida than the control subjects, and a higher frequency of anergy than either the control subjects or the patients with mild SLE. Significant impairment of lymphocyte transformation to all common antigens tested was found in patients with SLE as compared to both normal subjects and control subjects with disease. Phytohemagglutinin response was reduced in patients with SLE as compared to normal subjects but not to the control subjects with disease. Lymphocyte transformation responses to SK-SD and Candida were also significantly lower in patients with moderate to severe SLE as compared to patients with mildly active SLE. Primary immune response to keyhole limpet hemocyanin (KLH) was impaired in patients with SLE as measured by lymphocyte transformation and total KLH antibody, but not 2-mercaptoethanol resistant antibody. The data indicate defective T-cell function in SLE, and suggest that the impairment relates in part to disease activity.


Angio-immunoblastic lymphadenopathy. Diagnosis and clinical course. The clinical and pathologic findings in 24 patients with "angio-immunoblastic lymphadenopathy with dysproteinemia" (AILD) are presented. The patients' ages ranged from 44 to 80 years, with a median age of 68 years. The disease has an acute onset. In many respects, the clinical presentation is suggestive of malignant lymphoma. Generalized lymphadenopathy was always present. Hepatomegaly was found in 20 patients, splenomegaly in 17, constitutional symptoms in 20 and skin rashes in nine. Twenty patients had anemia, with positive Coombs' test in eight of 14 tested. Polyclonal hypergammaglobulinemia was found in 17 of 22 patients. Two patterns of evolution were recognizable: (1) long survival (24 to 67 months) without treatment or after the administration of intensive combination chemotherapy; and (2) rapid progression (one to 19 months) regardless of the treatment given. Sixteen patients died; postmortem examination in 10 cases showed the cause of death to be attributable to severe infection in eight patients, to renal disease in one and to cardiovascular disease in one. No evidence of malignant lymphoma was seen in any of these autopsies. Histologically, the disease is systemic, with specific lesions in the lymph nodes. The spleen, liver, bone marrow, skin and lung are also involved, but the changes are less characteristic than in the lymph nodes. In the patients in whom sequential biopsies were performed, a trend toward restoration of the nodal architecture was observed. AILD is a clinical-pathologic entity in a spectrum of yet to be defined immune reactions. The clinical, laboratory and pathologic manifestations of AILD are consistent with an autoimmune disorder, in which a deficiency of the T-cell regulatory functions probably predisposes to an abnormal proliferative and autoaggressive reaction of the B-cell system. Surgical staging procedures do not appear to be indicated. Intensive cytotoxic treatment may be hazardous in some patients, precipitating their death, but long survival after such therapy has been observed in others. Supportive therapy and small doses of steroids appear to be a safer therapeutic approach.


The Jeune syndrome (asphyxiating thoracic dystrophy) in an adult. A 32 year old American Indian man with the Jeune syndrome (asphyxiating thoracic dystrophy), a condition previously reported only in children, is described. The patient exhibited a cardiomyopathy of unknown etiology and evidence of hepatic and renal disease in addition to characteristic osseous malformations of the thorax, pelvis and extremities. The identification of an established syndrome in this patient permits one to view the combination of abnormalities present in a more coherent manner.


Platelet hypersensitivity and intravascular coagulation in paroxysmal nocturnal hemoglobinuria. The patient described had paroxysmal nocturnal hemoglobinuria associated with recurrent arterial as well as venous thrombosis. Study of platelet function revealed hypersensitivity to epinephrine, adenosine 5'phosphate (ADP) and collagen as judged by their ability to aggregate platelets as well as to release 14C serotonin. The release of total nucleotides was also markedly increased over normal with all aggregating agents. The abnormality was localized to the platelet since aggregation occurred when the patient's platelets were resuspended in normal plasma but not when normal platelets were incubated in the patient's plasma. Presumptive evidence for ongoing intravascular coagulation was an increase in fibrinogen derivatives of heavier molecular weight than the native protein presumably a result of thrombin action. However, factor XII was not activated and fibrinolysis was not increased. Complement component levels and antithrombin concentrations were also normal. The findings in this case suggest that hypersensitive platelets may contribute to the intravascular coagulation that is manifested by the increased incidence of thrombosis in patients with paroxysmal nocturnal hemoglobinuria.


Primary empty sella, galactorrhea, hyperprolactinemia and renal tubular acidosis. Discussed here is a 41 year old woman with galactorrhea associated with the empty sella syndrome and mild renal tubular acidosis. Basal serum prolactin (PRL) levels were normal, but a 24 hour serum PRL secretory profile demonstrated an increased mean PRL concentration. Serum PRL was appropriately suppressed by the administration of L-dopa; however, chlorpromazine stimulation resulted in a blunted serum PRL response. Pituitary luteinizing hormone, follicle stimulating hormone, ACTH and thyroid stimulating hormone levels were normal. Thus, galactorrhea associated with an enlarged sella does not establish the diagnosis of a pituitary tumor, and pneumoencephalography must be performed to exclude the empty sella syndrome.


Hypomagnesemia due to renal disease of unknown etiology. A young man, investigated because of tetanic convulsions and arthritic pains, was shown to have hypomagnesemia, hypermagnesuria, hypokalemia, hypercalciuria, progressive nephrocalcinosis and chondrocalcinosis. In this syndrome, renal function was normal except for the abnormal excretion of electrolytes. Renal sodium conservation was normal. Light and electron microscopic studies of renal biopsy specimens showed the presence of several abnormal tubules. Immunofluorescent staining showed deposits of immunoglobulins in the glomeruli and tubules. Magnesium therapy was started under balance study conditions and resulted in decreased calciuria and complete remission of subjective symptoms. The progression of nephrocalcinosis was halted, and there was some decrease in the intra-articular calcium deposits after two years of continuous oral magnesium therapy. The administration of spironolactone decreased urinary magnesium but did not normalize it, whereas triamterene administration was without effect in this respect. The results of the morphologic and electrolyte balance studies are discussed. The patient was found to exhibit several features which have not been described before in connection with hypomagnesemia of unknown origin.


A novel, convenient, multiple test system for detection of bacteriuria. A novel, convenient, multiple test system for the detection of bacteriuria is described and evaluated. The system consists of a small plastic strip with three dry reagent areas. One rapidly detects the presence of nitrite in urine and the remaining two quantitate total and gram-negative bacterial urine population after 18 to 24 hours of incubation. Quantitative accuracy was evaluated in two blind studies. In the first, known concentrations of 18 different organisms were compared and in the second, unknown concentrations of 218 randomly collected urine specimens were quantitated by both the calibrated loop streak method the new system. Overall correlation was 96 per cent for growth reagent areas. The nitrite area detected 84 per cent of the urines positive for bacteriuria. The advantages of the system over conventional bacteriuria detection systems are described.


Comparison of three methods for determining oxygen saturation in arterial blood. Oxygen saturation was determined by direct measurement with the Van Slyke method, an oximeter, and by indirect measurement with a pO2 electrode with conversion of oxygen tension to oxygen saturation. All three methods correlated well when the oxygen saturation was above 94 per cent. Below this value both the oximeter measurement and the saturation value calculated from the oxygen tension significantly overestimated the oxygen saturation as determined by the Van Slyke method. It appears from our data that when the saturation is less than 94 per cent, the absolute values for O2 saturation continue to be accurately determined with a Van Slyke, but the other two methods in this range are, at best, only useful in detecting gross changes in oxygen saturation.


Chromatographic differences in serum amylase among species. Chromatographic analysis of amylase in human, dog, rabbit, rat and chicken sera were performed and species differences recorded. Iodide, rather than chloride, requirement for optimal activity was demonstrated for one amylase fraction separated from rabbit sera.


A multi-purpose laboratory light box.

A multi-purpose laboratory light box. A multi-purpose, inexpensive laboratory light box is described which can be used for observing and photographing results of a diversity of laboratory tests using either white or ultraviolet light.


Development of cooperative and competitive play responses in developmentally disabled children. A behavior management procedure for training cooperative and competitive social play was investigated. Subjects were 5 EMR children who had marked behavior and communication disorders. Baseline data indicated that the subjects exhibited no competitive responses and low levels of cooperative play. Upon instituting a token-praise-feedback procedure, the experimenters observed increases in cooperative play as well as small increases in competitive play. Reinstating the token-feedback procedure after reversal resulted in high levels of competitive play with no change in cooperative play. Several explanations were offered to account for these results.


Effects of auditory and pictorial-auditory stimulus enrichment on the verbal abstracting abilities of low-SES children. Sixty-four low-SES Caucasian children, mean age 8.3 years, with high- and lowintellectual ability, were given a verbal similarities task. One-half of the subjects (the control group) received nonenriched items (2 exemplars of each concept on Presentation 1, which were repeated on Presentation 2), and half (the experimental group) received enriched items (2 exemplars of each concept on Presentation 1 and 4 exemplars on Presentation 2). Stimuli were presented in either the auditory or pictorial-auditory mode. The low-ability experimental group achieved abstracting gain scores greater than those of the lol-ability control group and greater than those of the high-ability experimental group. The low-ability experimental group achieved scores equivalent to those of the high-ability group under the pictorial-auditory enriched condition. Implications of these findings were discussed relative to academic performance of EMR children.


Action-concept learning in retarded children using photographic slides, motion pictures, sequences, and live demonstrations. The inadequate use of action concepts by mentally retarded children has been reported in several recent studies, but little is yet known concerning the level of performance that might be expected to result from direct instruction designed to remedy this deficit. In the present study, it was found that three different instructional approaches yielded higher adjusted posttest scores. The highest adjusted posttest score was yielded by an instructional program in which motion picture sequences were used. This program was significantly more effective than two paralled programs, one using photographic slides, and the other using live demonstration by a teacher. An explanation for these findings was suggested.


Response-stimulus interval performance of moderately retarded institutionalized subjects. Based on previous dual reaction-time research with nonretarded and mildly retarded subjects, the expectancy- and capacity-limit hypotheses for the psychological refractory period effect were tested with moderately retarded subjects. The design included regular-irregular procedure, response-stimulus interval, signal, and hand-preference variable levels. The finding of a psychological refractory period effect at the 250-msec response-stimulus interval was consistent with past related research. The moderately retarded subjects indicated a capacity limitation, resulting in the psychological refractory period effect at the rapid response-stimulus interval. Previous researchers working with nonretarded and mildly retarded subjects have suggested an expectancy explanation for the psychological refractory period. This inconsistency in study findings was interpreted on the basis of an organismic confound. Methodological issues were also presented.


Extinction by retarded children following discrimination learning with and without errors. Four groups of retarded children (N = 4 in each group) were trained to respond to a triangle with apex up (S+) and not to a triangle with apex down (S-), with and without errors. A free-operant procedure in which responding to S+ was intermittently reinforced and a trial procedure in which all responses to S+ were reinforced were compared. An extinction procedure in which responses were no longer reinforced was then introduced. Extinction resulted in substantial responding during S- for all groups, except the free-operant errorless group. S- responding during extinction did not differ between the errorless and error-trial groups and was maximum for the free-operant error group.


Comparison of two sets of Piagetian scales with severely and profoundly retarded children. Corman and Excalona's (1969) scales for Object Permanence and Spatial Relationships and the corresponding scales of Uzgiris and Hunt (1975) were administered to 64 severely and prfoundly retarded children. Most of the findings applied equally to both sets of scales: the scoring reliability was very high; the total scores did not vary as a function of subject characteristics (except IQ) or testing conditions; differences in the difficulty of the items did not correspond closely to those reported for nonretarded infants, and the scalability of the items was much lower. Less time was required to administer the two scales constructed by Uzgiris and Hunt, but their Object Permanence scale showed a pronounced ceiling effect and the internal consistency of their Spatial Relationships scale was unacceptably low.


Stimulus persistence in retarded and nonretarded children: a signal detection analysis. Nine institutionalized EMR and 9 equal-CA nonretarded children were tested on a visual backward masking task. Signal detection analysis was used to separate the sensory and nonsensory aspects of behavior, and the presentation of stimuli was randomized to minimize the formation of effective strategies. Two sets of instructions, strict and lenient, and two stimulus durations, 10 and 30 msec, were used in a repeated measure design. No differences were found between the intelligence groups on interstimulus interval threshold or measures of stimulus sensitivity, criterion placement, and false positive rate. Retarded subjects showed significantly greater intersubject variability in criterion placement but failed to raise their criterion in response to strict instructions. The results suggest that (a) stimulus-trace concepts of retardation have been confounded by retarded subjects' inability to compete effectively with nonretarded subjects in the experimental situation, and (b) signal detection procedures are a useful alternative to traditional psychophysical techniques in such comparative research.


Role-taking ability and the interpersonal competencies of retarded children. The relationship between social role-taking ability and competencies of 46 retarded children in dyadic interaction was examined. Subjects were rank ordered on Feffer's (Note 1) Role-Taking Task and assigned to dyads according to rank-order position. A specially designed two-person game, involving the delivery of differential reinforcements (pennies) to self or other, was used to operationalize the competencies of dyads in maximizing joint profit and in establishing a reciprocal exchange strategy. Analyses revealed discrepancies in performance over the course of the game for high and low role-taking ability dyads.


Long-term transfer of a mediational strategy by moderately retarded children. Moderately retarded children were instructed to produce prepositional mediatros by physically manipulating PA objects in learning three nine-term PA lists. Mediational training, distributed across days or weeks, consisted of one or three different prepositions supplied for two-thirds or for all of the items. It was found that mediation subjects performed significantly better than control subjects on an unaided test list administered 2 weeks after training, regardless of distribution of training, degree of aid or number of prepositions provided during training sessions. The degress of transfer, which was larger than in previously reported studies, was attributed to the instructional procedures requiring active production of prepositional mediators, coupled with an emphasis on their value. It was suggested that individual variability in mediational transfer should be considered in future research on mediational transfer.


Effects of stimulus familiarity on the rehearsal strategies transfer mechanism in retarded and nonretarded individuals. The possibility that the familiarity value of stimuli might be a component of the rehearsal strategies mechanism in Ellis' (1970) multiprocess theory of short-term memory was investigated. Retarded and nonretarded subjects of equal CA were given either PA pretraining of nonsense pictures with colors or were presented with nonsense pictures alone. They were then compared in their performance on either an experimenter- or subject-paced serial memory task in which the nonsense pictures were employed as stimuli. It was expected that pretraining would increase the familiarity value of nonsense stimuli for nonretarded and, to a lesser extent, retarded subjects, facilitating transfer of information from primary to secondary memory in both groups. Although predictions about the effects of pretraining on retention were not substantiated, the results of the experiment did support the hypothesis that a production deficiency in active encoding can account for the poor secondary memory of mentally retarded subjects.


Influence of reinforcement on the paired-associate learning of retarded and nonretarded children. The effect of presence and types of reinforcement (tangible, social, control) on PA-learning performance was investigated using 24 retarded and 24 nonretarded public-school subjects. A pictorial PA list (pictures used as stimulus and response items) was used. Stastical analysis of the data indicated that the influence of reinforcement on task performance was highly significant. Post hoc comparisons of cell means showed that the use of tangible reinforcement did significantly increase the performance of both retarded and nonretarded subjects. The results also indicated that the nonretarded subjects performed significantly higher than their retarded counterparts.


The efficacy and safety of intramuscularly administered 15(S) 15 methyl prostaglandin E2 methyl ester for induction of artificial abortion. The practicability of an intramuscular dose schedule of 10 mug of 15(S) 15 methyl prostaglandin E2 methyl ester [15(S) Me PGE2] administered every 4 hours was evaluated in 42 subjects from 7 to 20 menstrual weeks' gestation. Half of the subjects served as controls (Group I) and half of the subjects (Group II) were treated with a medication regimen of prochlorperazine, acetylsalicylic acid, diphenoxylate hydrochloride, and atropine sulfate to evaluate the regimen's effects. Although the 15(S) Me PGE2 dose schedule appeared to be effective (74 per cent aborted in 24 hours and 95 per cent aborted within 48 hours in a mean time of 18.9 hours), Group I (control) subjects frequently had side effects: 62 per cent had emesis, 86 per cent had diarrhea, 76 per cent had shivering, and 76 per cent had fever (greater than 100 degrees F.). Fewer Group II (medicated) subjects had side effects: 43 per cent had emesis, 19 per cent had diarrhea, 52 per cent had shivering, and 43 per cent had fever. The medication regimen did not appear to interfere with the abortifacient or oxytocic effects of the 15(S) Me PGE2 dose schedule, since Group I and Group II subjects had similar cumulative abortion rates, mean abortion times, and uterine activity. Although this 15(S) Me PGE2 dose schedule is effective in first-trimester patients, it is probably less satisfactory than the conventional method of vacuum aspiration. While intramuscularly administered 15(S) Me PGE2 with medications to attenuate side effects may be practicable for inducing midtrimester abortion, especially between 12 and 16 weeks' gestation, large controlled comparative studies of the intramuscular 15(S) Me PGE2 method and other experimental and conventional methods will be necessary to determine the most satisfactory method of performing midtrimester abortions.


Inadvertent injection of corticosteroid into the choroidal vasculature. A 21-year-old woman with pars planitis was treated with a subtenon's depot corticosteroid injection that was complicated by the appearance of the corticosteroid suspension within the choroidal vasculature. White, flocculent material was observed in the anterior chamber and 24 hours later this settled on the iris surface. Similar material was located in the major choroidal vessels. Two months after the incident, the choroid was normal appearing but the pars planitis was unchanged.


Surgical removal of nonmagnetic foreign bodies. A microsurgical technique for the removal of nonmagnetic foreign bodies in eyes with opaque media incorporated the simultaneous use of the foreign body forcepts with a vitrectomy machine equipped with fiberoptics. The superb viewing system provided by the operating microscope combined with the excellent illumination from intraocular fiberoptics offered precise surgical control. Nonencapsulated nonmagnetic foreign bodies in eyes with clear vitreous cavities were removed by using the operating microscope, corneal contact lens, and foreign body forceps introduced through a pars plana location. Vitrectomy was not performed. The surgical techniques allowed early removal of the foreign body and, in a preliminary series of cases, improved visual results in what is usually a devastating ocular injury.


The reproducibility of the intraocular pressure response to dexamethasone. The reproducibility of the intraocular pressure response to topical dexamethasone was investigated in 162 persons previously classified as low (NN), intermediate (NG), or high (GG) responders. The concordance of first and second test results was 71% for NN, 74% for NG, and 79% for GG responders, exceeding chance significantly for the NG and GG categories. Quantitative assessment revealed significant correlation of final pressure achieved on first and second tests (r equals .747, P LESS THAN .001). In the course of the study applications of dexamethasone to one eye were noted to have no effect on the intraocular pressure in the contralateral untreated eye, nor did testing of one eye influence the response of the contralateral eye in simultaneous bilateral testing. Using our data to estimate the reproducibility of topical testing in a general population, a value of 73% was obtained. That value was similar to the 65% concordance reported in an identical twin study, suggesting that the limited precision of topical testing accounts for the relatively low concordance found in that study.


The histopathology of pigmentary dispersion syndrome with glaucoma. Iris tissue and trabecular meshwork, obtained at time of trabeculectomy, was studied using the light and electron microscope in a 54-year-old woman with pigmentary dispersion syndrome with glaucoma. The specific defect was a loss of the outer epithelial cells of the iris with marked thinning of the remaining outer layers so that the two-cell architecture of the iris epithelium was maintained. In addition, the radial muscle layer was increased in both number and size of muscle fiber. It would appear that the pigmentary dispersion syndrome may represent a congenital or developmental abnormality of the iris epithelium, or both, and that the glaucoma which occasionally occurs in conjunction with this syndrome is of the usual open-angle type.


Spontaneous regression (autoinfarction) of proliferative sickle retinopathy. Of 45 patients with proliferative sickle retinopathy in stages III, IV, and V, nine patients (eight with hemoglobin SC disease, one with sickle cell thalassemia) showed spontaneous regression (autoinfarction) of retinal sea fans. One mechanism involved in autoinfarction of neovascular tissue is progressive, centripetal retraction of the anterior vascular arcade of the peripheral retina. In addition, vitreous traction on feeder vessels may result in sluggish blood flow and occlusion of these vessels, or may tear the sea fan completely away from its feeder vessels. In view of the many incidences of vitreous hemorrhages that occur in patients with proliferative retinopathy, however, we recommend treatment of neovascularization rather than prolonged observation.


Amblyopia screening with random-dot stereograms. A stereoscopic test was developed for the visual screening of preschool children. The TNO test for stereoscopic vision utilized the same principle as the Julesz random-dot stereogram, and provided a simple and unequivocal test criterion understood even by young children. The results of a comprative evaluation of the TNO and Titmus stereoscopic tests proved the TNO test to be the more reliable of the two, particularly in the 2- to 4-year-old age range. Failure to pass this test at the 240 seconds of arc disparity level yielded an excellent screening criterion, as attested by the results of a validation experiment employing 81 patients (2 to 7 years old) with known visual health records. Furthermore, the screening results obtained from 129 preschool children (2 to 5 years old) tested in the classroom by a nonprofessional examiner, suggest that, under these more realistic conditions, the TNO test yields at least 60% less overreferrals than the Titmus test.


Horizontal saccadic velocities in Duane's syndrome. Horizontal ocular saccadic velocities were measured by electro-oculography in 33 patients with Duane's syndrome. In 28 patients with limited abduction associated with retraction on adduction (Type 1), abduction saccadic velocity was markedly reduced while adduct-on saccades were moderately slow. In three patients with exotropia and good abduction but associated limited adduction and retraction on adduction (Type 2), abduction velocity was good, while adduction saccadic speed was slow. In two patients with limited abduction and adduction with retraction on adduction (Type 3), abduction and adduction saccadic velocity was appreciably slow. Ocular electromyographic testing selected patients indicated that slow abduction saccades could be explained by absence of lateral rectus muscle recruitment, while slow adduction saccadic speed could be explained by paradoxical innervation of the lateral rectus muscle.


Ring scotomata in fundus flavimaculatus. Ring scotomata were associated with fundus flavimaculatus in six patients. The demonstration of ring scotomata in patients with fundus flavimaculatus helps to explain persistent visual complaints that may exist in the presence of normal central visual acuity. In many instances, ring scotomata cannot be predicted on the basis of the ophthalmoscopic findings. The presence of ring scotomata appears to be an ominous finding, even when associated with normal central visual acuity, for in three of our patients it preceded loss of central vision by 1 1/2 to four years.


Cystic retinoblastoma.

Cystic retinoblastoma. A grossly cystic retinoblastoma, presumably a form of the diffuse infiltrating type, mimicked uveitis in an 81/2-year-old boy. A review of 44 cases indicated that grossly (clinically) detectably cysts are rare in this neoplasm, although microcysts are relatively common. Lesions of this nature, especially if presenting with a history of trauma, as in our patient, may lead the ophthalmologist to diagnose uveitis. The diagnosis of retinoblastoma may thus be unduly delayed.


Retinal fat emboli as sequela to acute pancreatitis. A clinical picture of Purtscher's retinopathy was observed in three patients with acute pancreatitis. In two patients, fluorescein angiography revealed arteriolar obstruction. Since fat emboli occur in pancreatitis, and since fat emboli may produce the picture of Purtscher's retinopathy, we proposed that fat emboli caused the retinal findings in these patients.


Posterior vortex vein and congenital glaucoma in a patient with trisomy 13 syndrome. A 4-month-old infant boy presented with a mild manifestation of trisomy 13 syndrome. The severe ocular findings usually associated with this syndrome were not seen. Rather, the patient had bilateral congenital glaucoma with glaucomatous optic disk cupping and, in one eye, a posterior vortex vein. Such findings are unusual in the trisomy 13 syndrome. The posterior vortex vein is a particularly unusual finding previously occurring in myopic eyes.


Paranasal sinus carcinoma causing orbital mucocele. Three patients presented with typical orbital mucoceles. However, subsequent histopathologic study revealed paranasal sinus concomitant squamous cell carcinoma in all three cases. Careful histologic investigation is necessary before considering orbital mucocele a benign process.


Metastatic carcinoma of the iris.

Metastatic carcinoma of the iris. Of three women and one man with metastatic carcinoma of the iris, the average age of the four was 50.2 years. Two of the tumors originated in the breast and two in the lungs. The average survival from time of diagnosis of the iris lesion was less than six months. Each patient presented with characteristic grayish-white translucent nodules on the iris or in the anterior chamber angle. The patients displayed other features of iris metastases such as secondary glaucoma, rubeosis iridis, iris atrophy, anterior uveitis, hypopyon, and hyphema. As an aid in the clinical evaluation, anterior segment fluorescein angiography was performed, revealing vascular details not seen clinically. Leakage of dye was a constant feature of the angiogram.


Visual effects of peripheral and sector iridectomy. Twenty-five patients had bilateral cataract extractions: one eye with peripheral iridectomy and the fellow eye with sector iridectomy. They were followed from four months to two years. No significant differences in visual acuity between the two eyes were found. No patient reported any subjective difference between the right or left eye.


Surface epithelium of the developing ovary. Possible correlation with ovarian neoplasia. The surface epithelium of the fetal ovary undergoes diffuse proliferation during the fourth and fifth months of gestation, after which it reverts to a single layer separated from the developing cortex by a tunica albuginea. The proliferation is associated with marked nuclear irregularity and pleomorphism similar to that seen in surface epithelial neoplasms. The epithelial changes occur during the same time period that interstitial cells with ultrastructural and histochemical properties of steroid-secreting tissue appear in the ovarian stroma. The possible role of steroid hormones in stimulating surface epithelial proliferation is discussed.


The resistance of certain tissues to invasion. III. Cartilage extracts inhibit the growth of fibroblasts and endothelial cells in culture. Extracts of bovine dermis and cartilage inhibit the growth of bovine endothelial cells more than that of most of the fibroblast types tested. Extracts of cartilage, a tissue rather resistant to invasion, inhibit the growth of endothelial cells more than extracts of dermis do. Since such extracts contain antiproteolytic activity, it is suggested that the inhibition of cell growth they induce is effected by protease inhibitors native to connective tissues.


Congophilic angiopathy complicated by surgery and massive hemorrhage. A light and electron microscopic study. Three autopsied cases of congophilic angiopathy have been studied by means of polarized light microscopy and in 2 of these, biopsy material is available for electron microscopic study. All 3 patients had a surgical procedure and a subsequent massive hemorrhagic episode. Two of these patients had clinical evidence of dementing syndrome, for which shunts were performed. Ultrastructural studies have confirmed the amyloid nature of the congophilic material in the 2 biopsied cases. The deposition of amyloid in these cases is believed to be a primary event and is related to a generalized body disorder. The distinction of congophilic angiopathy from Alzheimer's disease is discussed.


Acute hyperuricemic nephropathy in rats. An electron microscopic study. Hyperuricemia and uricosuria were induced in rats fed uric acid and oxonic acid. Kidneys then were studied by light and electron microscopy. After 1 day of hyperuricemia, animals had deposits of uric acid and urate crystals within collecting tubules of the renal papillae, and tubular cells were altered. By 10 days, there was an exudative response with further injury to epithelium. Clear spaces within lumens, epithelium, and neutrophils suggested the presence of crystals; however, there was no direct ultrastructural evidence that neutrophils or epithelial cells ingested crystals and suffered injury. Presumably, crystals readily seen in frozen, unfixed tissue were lost during preparation for electron microscopy. Nonetheless, the ultrastructural findings indicated that hyperuricemic nephropathy was initiated in a fashion analogous to urate arthropathy. Urate crystals formed within collecting tubules, epithelial cells were altered, and most likely there was chemotaxis of neutrophils which underwent degranulation and vacuolation followed by lysis freeing any ingested urate. Release of ingested crystals plus precipitation of new crystals both might serve to sustain the nephritis.