Confusion and controversy in the stress field. An attempt is made to further clarify present areas of controversy in the stress field, in response to a two-part article by Dr. John W. Mason which concludes in this issue of the Journal of Human Stress. The author tries to elucidate each source of confusion enumerated by Dr. Mason. The continued use of the word "stress" for the nonspecific response to any demand is deemed most desirable. The once vague term can now be applied in a well-defined sense and is accepted in all foreign languages as well, including those in which no such word existed previously in any sense. Subdivision of the stress concept has become necessary as more recent work has led to such notions as "eustress," "distress," "systemic stress" and "local stress." Confusion between stress as both an agent and a result can be avoided only by the distinction between "stress" and "stressor". It is explained that the stress syndrome is--by definition--nonspecific in its causation. However, depending upon conditioning factors, which can selectively influence the reactivity of certain organs, the same stressor can elicit different manifestations in different individuals.


Psychosocial factors in athletic injuries: development and application of the social and athletic readjustment rating scale (SARRS). The possible role of psychosocial factors in athletics, namely football injuries, is examined. Initially Holmes and Rahe's Social Readjustment Rating Scale (SRRS) was modified to the Social and Athletic Readjustment Scale (SARRS). Additions to the scale and differences in football players from the general population are discussed. Life change scores over one- and two-year intervals were obtained for college varsity football players. Players suffering major time loss injuries had significantly higher predictive scores than noninjured players.


Life change events, ballistocardiography and coronary death. Thirty-six men and women who experienced a documented myocardial infarction, half of whom ultimately died from their disease and half of whom survived over a six-year period, provided longitudinal recent life changes and ballistocardiographic data. The 18 patients who died from their coronary disease indicated a significant buildup in life changes which peaked approximately one year prior to death; their serial ballistocardiograms indicated a significant buildup in average force of contraction which was seen to peak approximately six months prior to death. The 18 post-infarction patients who survived the six-year follow-up showed neither a buildup in life change nor a buildup in the ballistocardiographic index of cardiac contraction force. These findings of a life change peak preceding ballistocardiographic evidence of an "overworked" heart are discussed in terms of their possible medical and psychophysiological significances.


Psychological management of the myocardial infarction patient. The acute coronary experience is divided into three parts. In the first, the pre-hospital phase, attention is devoted to the widespread phenomenon of patient delay. Evidence is given to indicate that the source of delay is entirely psychological and centers around the inability to decide whether or not to seek help. The second part, or hospital phase, describes the response of the patient to the various aspects of the coronary care unit, including monitoring, false alarms, witnessing and sustaining a cardiac arrest. The third phase, the post-hospital convalescence, centers on the principal psychological problem of this period, depression. Its causes, manifestations, and methods of management are discussed.


Some problems in the measurement of stress and social readjustment. Although the Social Readjustment Rating Scale has been a useful stimulant to the study of life change and illness, it has important limitations. The existing scale cannot be used to determine the role of varying types of life changes (e.g., favorable or adverse) in the occurrence of illness. Other problems discussed are ambiguity of items, the confounding of independent and dependent variables, and lack of item specification. Suggestions are made for improved measurement of life change and for more effective study of life change and illness.


Issues in patient adherence to health care regimens. This paper examines an important area of personal health behavior in which the possible link between stress and health status is not primarily a biological one but a behavioral one. The review of empirical literature is organized around four topics: 1) the limited payoff from the search for stable sociodemographic and personality correlates of adherence; 2) the inadequacy of our current theoretical formulations; 3) the role of the doctor; and 4) the doctor-patient interaction, which emphasizes mutual expectations rather than a one-way transfer of information. The concluding remarks address themselves to the need for a firmer linkage with the conceptual and empirical literature on stress and coping.


Relations between heart rate, reaction speed, and subjective effort at different work loads on a bicycle ergometer. The hypothesis concerning an inverted-U relationship between activation and performance was examined by comparing the performance of 25 subjects in a choice-reaction task at five different work loads on a bicycle ergometer. Heart rate was used as an index of activation. The results were in full agreement with the hypothesis, performance being more efficient at a medium activation level than at high and low levels.


Blood platelet aggregation and personality traits. Changes in blood platelet aggregation may precipitate episodes of arterial occlusive diseases. Little is known, however, regarding the influence of psychological traits, emotional states and other behavioral stressors on platelet aggregation phenomena. This study examined 46 healthy college men at rest and after submaximal treadmill exercise. Associations were found between the duration of platelet aggregation and a number of scores from the California Psychological Inventory and self-administered anxiety scales. The more socially adequate, poised and dominant persons--those with more mature ego development and less overt anxiety--had platelets with more prolonged aggregation reactions to the in vitro introduction of noradrenalin. Irreversible aggregation of platelets occurred more regularly to lower in vitro concentrations of noradrenalin in platelet samples drawn from subjects who were less anxious and tended to be more rigidly defensive. It is premature to attempt to derive clinical implications from this exploratory work, but some implications for the design of future research are discussed.


The role of activity in anticipating and confronting stressful situations. This paper is an analytical review of studies comparing stress reactions in threatening situations during which the person can or cannot take action. The studies reviewed were conducted mainly in real-life situations and involved diverse forms of coping activities under various conditions of danger and distress. To achieve a better understanding of the effect of activity on stress reactions, several distinctions are made: between various types of stress reactions; between various indices and measurements of stress reactions; between activity which is directly related to the source of threat and activity which is not; and between various personality dimensions. The adaptive potential of activity in stressful situations is discussed in terms of: the sense of mastery and control provided by activity; activity as a means of attention diversion; and activity as a means of discharging energy generated by mobilization. It is suggested that taking action under stressful conditions, as opposed to remaining passive, is a powerful coping tool.


[Oxidative phosphorylation, catecholamine content and contractile function of the myocardium in patients with acquired heart defects, operated on under artificial circulation]. A simultaneous determination of oxidative phosphorylation, catecholamines content and contractile function of the myocardium was conducted in patients with acquired heart diseases operated under extracorporeal circulation. The degree of conjugation of the oxidative phosphorylation has been found to depend on the severity of the initial state of the patient, and on the conditions of the surgical intervention: duration of cardiopulmonary by-pass before the excision of the mitral valve, duration of cross-clamping of the aorta, and the temperature regiment of the perfusion. Besides, it has been found that the conjugated oxidative phosphorylation is associated with the presence of catecholamines in the myocardium, while the dissociation of these processes is accompanied by a sharp fall in the content of adrenalin, noradrenalin and dophamine. The established parallelism of the catecholamines content and the oxidative phosphorylation indicates the existing correlation between them, which may determine the character of the contractile function of the myocardium.


[Auricular fibrillation in myocardial infarct]. Auricular fibrillation was observed in 17.8% of patients with large-focal myocardial infarction, mainly in females (p 0.01). The localization of myocardial infarction had no impact on the incidence of auricular fibrillation. The precursors of auricular fibrillation included atrial extrasystoli and an elevated electrolyte coefficient of the blood NaeKe. In the group of patients with myocardial infarction and auricular fibrillation mortality was more common among the females. Auricular fibrillation developing beyond the first postinfarction day worsened the prognosis considerably. The outcome of myocardial infarction did not much depend on the duration of auricular fibrillation and on the cardiac contraction frequency.


[Endomycardial biopsy in the diagnosis of various forms of cardiomyopathy in children]. An examination technique is described, including catheterizational endomyocardial biopsy of the left ventricle, used in 10 patients with cardiomyopathy, aged 9 months to 10 years.  On the basis of the obtained data it was concluded that the most frequently encountered form of cardiomyopathy in children above 1year of age is infectious-allergic myocarditis. Endocardial thickening is secondary to myocardial changes.


[Myocardial damage syndrome in allergic conditions]. Experimental and clinical studies were conducted that permitted to suggest a possible direct damaging effect of allergy upon the myocardium. Distinct types of allergic reactions of the myocardium were singled out in cases of the states being studied, namely infectious-allergic myocarditis and bronchial asthma. The reactions observed in infectious-allergic myocarditis pertain to hypersensitivity of a delayed type which morphological manifestation is embodied in cellular lymphohistocytic, monocytic perivascular infiltration and myocardial stroma damage. In bronchial asthma haemodynamic disorders are noted in the vessels of the microcirculatory bed, as well as oedema of the stroma and muscle fibers destruction.


[Clinical evaluation of delayed and immediate hypersensitivity to antigens of the connective tissue, myocardium and hemolytic Streptococcus in patients with rheumatic fever]. The results of a study of some humoral and cellular immunological reactions to antigens of the myocardium and connective tissues of cardiac vlaves, as well as to those of the haemolytic Streptococcus in rheumatic patients are presented. Antibodies to 4 antigens were deter mined, to cellular form of immunity was examined by the method of leucocytes migration inhibition. The studies have indicated that in rheumatism, hupersensitivity of a delayed and non-delayed type manifests itself. The activity of the inflammatory process, its severity, the nature and severity of carditis are to a great extent reflected by the connective tissue antibodies to the basic substance, especially to the structural glycoprotein of the valves. In cases of the most unfavourable clinical forms of the rheumatic process the signs of streptococcal sensitization and autoallergy to both musclular and connective tissue cardiac structures are especially vivid.


[Ultrastructure and plastic metabolism of the myocardium in allergic lesion of the heart]. Allergic damage was induced in the hearts of senstized rabbits by way of slow intravenous injections of permissible doses of an antigen. One to 20 days after such a weakened anaphylactic reaction of the walls of the left auriculum were examined by light and electron microscopy. After one day, the histological studies revealed in all layers of the ventricle and auriculum oedematous and discirculatory manifestations, and electron microscopy demonstrated a complex of reversible sub-microscopic changes in the myocytes of the myocardium, their contractile organells being damaged predominantly. The biochemical studies permitted to reveal an activation of the decomposition of the myocardial myofibrillar proteins that was not accompanied by a proportional decomposition of the sarcoplasmic and connective-tissue proteins. The inner architecture of the myocytes was restored at the expense of the intracellular regenerative processes with transient hyperplasia of the intracellular regenerative processes with transient hyperplasia of the protein synthesizing organells of the myocytes.


[Heart valves in rheumatic heart disease in the light of scanning electron microscopy]. In case of rheumatic sclerosis the micro-relief of the surface of the mitral and aortic valves changes considerably: the first order plicas disappear, a new chaotic micro-relief is formed that depends on the deep specific changes in the collagen-elastic structures of the valves. In rheumatic heart diseases the valves are characterized by focal disendothelization of the surface, which permits to examine the valve in layers, and to study not only its surface, but also its internal subendothelial structures. Scanning electron microscopy permitted to visualize for the first time in a full three-dimentional image the severely altered collagen structures of the disendothelialized portions of rhumatic valves. The changes in the micro-telief consisting in the appearance  of amall, irregularly located plicas, crossing each other under various angles, are caused by the development of new subendothelial collagen fibers. The initial forms of calcification are characterized by the appearance of micro-plates of calcination in the zones of the destroyed micro-relief, the subsequent forms -- by the formation of large clusters of calcination due to the fusion of the micro-plates. The destroyed micro-relief of the valves causes the adhesion of erythrocytes on their surfaces, which may be considered a factor halping thrombus formation.


[Characteristics of erythrocyte membrane permeability for potassium ions in rats with familial spontaneous hypertension]. The kinetics of 42K influx into the erythrocytes was studied in spontaneously hypertensive rats (SHR) during the prehypertensive and early hypertensive stages (aged 10 weeks), as well as in Wistar and Sprague-Dawley rats of the same age. The SHR displayed a significantly slower enhancement of the activity in the erythrocytes than in the Wistar and Sprageu-Dawley rats, which indecates a higher level of passive permeability of the erythrocytic membrane for potassium ions and an enhanced turnover of this ion in the erythrocytes of SHR. The revealed changes are interpreted as a fragment of a larger defect in the membrane of SHR that determines the development of spontaneous hypertension.


[Pericardial lesion in meningococcal infection]. The study was carried out in 52 patients with a severe course of meningococcal infection. In two of them having meningococcemia and in three with meningococcal meningitis and meningococcemia the disease was complicated by concomitant symptoms of allergic pericarditis. Complex therapy with steroid hormones, antibiotics, oxygen, cardiac glycosides and vitamins was effective in meningococcal infections complicated by myo- and pericarditis but failed to prevent their development.


[Functional state of the myocardium in chronic hepatitis and liver cirrhosis after acute strophanthin stimulation]. Thirteen patients with chronic hepatitis and 34 with liver cirrhosis, aged 15 to 68 years, were subjected to a study of myocardial contractility by means of phase analysis of cardiac contractions and roentgenocardiometric determination of the cardiac volume, to a study of total haemodynamics by means of radiocardiography, that of intrahepatic circulation -- by rheohepatography under acute strophanthin stimulation. The revealed peculiarities of cardiohaemodynamics can be used for a prognostic evaluation of the efficiency and expediency of the employment of digitalispreparations in such patients.


[Study of informative value of functional tests for identification of negative ECG T-waves with the use of mathematical analysis]. The informativeness of functional tests and of their combinations was studied with reference to the differential diagnosis of the functional or organic genesis of the repolarization ECG changes. The highest informativeness was found to be achieved with the potassium and Inderal tests that permit to establish unequivocally a functional or organic genesis. A combination of the potassium and Inderal tests significantly increases the informativeness of each of these tests taken separately. The Valsalva and the orthorstatic tests are practicallt noninformative in terms of the conducted study.


[Role of certain biochemical indicators in the pathogenesis of functional cardiopathy]. A study of a few biochemical parameters in 30 patients with functional cardiopathy (in comparison with 30 control persons) revealed significant differences in the indices of the acid-base balance, lactic acid concentration, and plasma electrolytes. These differences were noted both at rest and under physical exercises and hyperventilation tests, being even more evident during the above functional tests. A conducted comparison of physical endurance and increasing blood level of lactic acid revealed their reverse relationship. During the hyperventilation test, a relationship was noted between the amplitude of the T-wave of ECG and the reduction of the potassium plasma level. The revealed regularities may to some extent explain the origin of the symptoms observed in functional cardiopathy.


[Relationship between the rate of myocardial contraction and relaxation under the effect of neural and humoral factors]. The speed ratio of contractions and relaxations was studied on an isolated canine heart perfused via a donor dog under haemodynamic conditions closely resembling the natural ones, the stimulation being achieved by irritation of the sympathetic and vagal nerves, and by administration of adrenalin, noradrenalin, or acetylcholine. The contraction and relaxation speeds were determined by the first derivative of the left ventricular pressure curve. All the used types of nervous and humoral stimulation were seen to cause synchronous changes in these speeds, uniform in their direction, and closely correlating, which suggests the existence of a certain mechanism of autoregulation that maintains definite proportions of the myocardium contraction and relaxation speeds.


[Contractility of the right ventricle and pulmonary circulation pressure in young sportsmen]. The paper presents some data on the structure of the systole of the right ventricle obtained by means of kinetocardiography in 280 sportsmen, aged 12-14 years, with different functional states of their organisms (non-trained, poorly and well-trained, with chronic overstraining of the heart), as well as some data on the level of the systolic pressure in the pulmonary circulation system (by the Buzstin method) at rest and during the restorative period after exercises (test of the Leningrad Institute of Physical Culture, bycycle tests). The more the organism is trained, the more distinct the stages ofthe syndrome of regulated myocardial hypodynamia were found to be, a moderate hyperfunctionof the heart is noted during physical exercises that is accompanied by slight elevations of the pressure in the pulmonary system. In cases of chronic cardiac overstraining myocardial hypodynamia, stage I--II, was found, pressure elevation in the pulmonary circulation system -- in 21.4% of the examined persons at rest, its sharp elevation after exercises (up to 78.6 mm Hg) and prolongation of the restorative period. The obtained data demonstrate the perfection of the function of the right ventricle and of the pulmonary circulation under systematic training in the adolescents, and their deterioration in cases of chronic overstraining of the heart.


Isokinetic vs isotonic strength training in adult men. The differences in changes in strength, body composition, anthropometric measurements and selected motor performance tasks, between groups, trained isotonically and isokinetically were compared. Thirty-six male volunteers were randomly assigned to one of four groups: isotonic; isokinetic low speed contraction; isokinetic high speed contraction; and control. Strength training was conducted three days per week, 40 minutes per day for eight weeks. The results demonstrated a clear superiority of the isokinetic training procedures over the isotonic procedures relative to strength, antrhopometric measures and motor performance tasks. The three training groups exhibited similar changes in body composition. The isokinetic high speed group demonstrated the greatest gains overall. The significance of these results is discussed.


Severe steady state exercise at sea level and altitude in Olympic oarsmen. Respiratory and metabolic functions were studied at rest and during exercise in 13 Olympic oarsmen at peak of training at sea level and after one month's residence at 2350 m. At sea level each subject completed two severe five minute treadmill runs at 5 mph on a 20% incline inspiring 21% O2 for one run and 16% O2 for the other. Two more runs at the same speed and incline were carried out at altitude with F102's of 21% and 28%. Pulmonary function tests were carried out at sea level and altitude and steady state diffusion capacity was determined during rest and exercise while breathing 21% O2. Heart rates were monitored by direct electrocardiography. At altitude significant increases were found in MVV (10%), FEV1 (6%), MMEF (15%) and PF (9%) but not in VC. A rise of the DLCO during exercise from 64.8 to 75.4 ml/min/mm Hg was largely the result of increased ventilation. The response to acute hypoxia (16% O2) and to chronic hypoxia were as follows: VE from 113 to 135/122 1/min; VE/O2 from 2.55 to 3.14/3.08 1/100ml; and PETCO2 from 40 to 36/34 mm Hg. The effect of chronic hypoxia could be abolished by acute normoxia (28%O2) within five minutes; VE returned to 99 l/min, VE/Vo2 to 2.46 1/100 ml, and PETCO2 to 40 mm Hg. Vo2 for the standard exercise (5 mph - 20% grade) for normoxic and acute hypoxic conditions were similar; 4421 and 4301 ml/min, but this variable decreased significantly upon chronic altitude exposure; 3966 ml/min. This decrement in Vo2 was attributed in part to a lower work of breathing.


Isometric rowing strength of experienced and inexperienced oarsmen. The significance of isometric muscle strength for rowing performance was studied. The questions investigated were: A) Is the isometric rowing strength (IRS) of oarsmen which is two to three times the dynamic force applied on the oar at maximal power rowing, a ratio which is equivalent to the maximal efficiency of Hill's force/velocity relationship? B) Is IRS higher among successful oarsmen that among those less so? C) Is isometric strength of individual muscle groups correlated to IRS? From measurments on 40 oarsmen the results showed: a) IRS among the most successful oarsmen was 2.6 times the dynamic force indicated in literature; b) IRS was 21 kp higher in the 7 international competitive oarsmen than in 22 national oarsmen, and 42 kp higher than IRS of 11 club oarsmen; and c) of eight other strength determinations only hand grip strength was correlated to IRS. It is suggested that IRS, but not isometric strength of individual muscle groups limits rowing performance.


The gamma mass scanning technique for inertial anthropometric measurement. The validity of the gamma mass scanner in predicting center of mass and moment of inertia of biological tissue was tested using legs of lamb. The reaction board, immersion and pendulum methods were used to obtain one or both the center of mass and moment of inertia of the legs. The results from these methods were compared with those obtained from the scanner. Results indicated that the gamma mass scanner consistently predicted the mass of the legs to within a 1% error, the center of gravity within 2.1% and moment of inertia to within 4.8%. Within the limits of this investigation it was concluded that the gamma mass scanner shows promise as a valid and exact method for determining the center of gravity and moment of inertia of biological tissue.


A comparison of heart rate methods for predicting endurance training intensity. Comparing results of various training studies is often confounded by use of different indices of exercise intensity. Two frequently used indices are: 1) the % HR max method (exercise at a HR corresponding to a chosen percentage of maximal HR), and 2) this study, % net VO2max was employed as the criterion measure of exercise intensity and a comparison was made between the prediction of % net VO2-MAXby the above two methods. Experiments were performed on nine males (M +/- SD age = 23.7 +/- 2.6 yrs) and consisted of double determinations of resting VO2 and multiple measurements of resting HR under five different conditions. Duplicate determinations of maximal VO2 and HR preceded a third treadmill test consisting of four, 5-minute workloads representing approx 25, 45, 65, and 85% net VO2max. The results demonstrated that the KM's prediction of exercise intensity was not significantly different (P greater than 0.05) from measured intensity at any of the four workloads. Additionally, the % HR max procedure yielded large, significant overpredictions of exercise intensity (29, 22, 16 and 8% overpredictions for the four submaximal intensities, respectively. These results suggest that the KM yields a training HR that reflects exercise intensity within reasonable limits of accuracy.


Effect of a season of ice hockey on energy capacities and associated functions. Two elite junior ice hockey teams with players ranging in age between 16 and 20 years were measured on an extensive battery of laboratory tests at the beginning and end of a season in order to determine adaptive changes in the energy supply systems and associated functions. Pre- to post-season changes in maximal aerobic power showed a significant increase of 3% (p less than .05) only when expressed in 1/min (4.30 vs 4.43). Additionally, when measurements were made on selected determinants of oxygen transport, no change was found in ventilation as reflected in VC (5.60 vs 5.52 /min), FEV1.0 (4.37 vs 4.44 l/min), MBC (185.1 vs 186.4 l/min) and maximum exercise VE (128.0 vs 128.1 l/min, STPD) or in the cardiovascular system as reflected in hematocrit (45.3 vs 44.4%), hemoglobin (16.4 vs 16.2 g%) and maximum exercise HR (192 vs 191 beats/min). On the other hand, indicates of change in the anaerobic energy supply systems were found. Maximal anaerobic capacity improved by 16.3% (p less than 0.05) when measured in terms of run time (64.3 vs 74.8 secs) and maximal anaerobic power by 4.7% (p less than 0.05) when expressed in m/sec (1.69 vs 1.77). Although comparable percentage increases were noted when peak lactate concentration and power (kgm/sec) were used as criterion measures for these tests respectively, statistical significance was not found. When the results were analyzed by position essentially the same changes were found.


Effects of stressful underwater demolition training on body structure. Antropometric measurements and Heath-Carter somatotype ratings were made on 32 subjects upon entry into a U.S. Navy underwriter demolition team training program. Twenty subjects successfully completed the 4-month program and were remeasured. Comparisons were made between initial and final scores for those completing training, and between initial scores for trainees who successfully completed the program and scores for those men who dropped from training, for the following variables: somatotype as a whole, three somatoptype components, height, weight, height/weight.33, sum of skinfolds, arm and calf girths, and bone breadths. No differences were seen between successful and unsuccessful trainees, on any variable, when results from the pre-training measurements were compared. Successful trainees did not change in height or bone breadths, but showed decreased skinfolds and height/weight.33, along with increased weight and girths. Successful trainees' somatotypes changed, with a decrease in endomorphy and ectomorphy, and an increase in mesomorphy.


The effects of smoking marihuana on physical performance. The purpose of the present investigation was to determine the effects of marihuana on physical performance as determined by six variables: heart rate, blood pressure, muscular strength, physical work capacity, forced vital capacity, flow rate of expiration. Twenty volunteer human marihuana smokers took part in three experimental testing sessions. Each subject reported to a laboratory on three different days. Day one was used as their control testing sessions. Day two and three were the placebo and marihuana sessions. On day three the subject smoked marihuana if he had placebo on day two, and vice versa. The test batter measures consisted of resting heart rate, resting systolic and diastolic blood pressure, grip strength, forced vital capacity and flow rate and a submaximal bicycle ergometer test. There were significant differences between the marihuana treatment group and the other treatment groups in heart rate, systolic and diastolic blood pressure and physical work capacity.


The interprofessional team as a small group. Conflicts in interprofessional teamwork may be as much explained by group process considerations as by the interaction of professional roles and statuses. This paper examines the interprofessional team as a small group, using a synthesis of sources from social psychology, social group work, T-group literature, management theory, and health team research. Eight issues are considered in relation to the team as a small group, namely, (a) the individual in the group, (b) team size, (c) group norms, (d) democracy, (e) decision making and conflict resolution, (f) communication and structure, (g) leadership, and (h) group harmony and its relationship to group productivity.


A club approach to social work treatment within a home dialysis program. This article discusses one approach to helping patients and their families cope with the stresses of a program where dialysis treatments are performed at home. The "Home Dialysis Club" includes many facets and levels of group work treatment. The need for support is unending for families with this difficult life-style. The club approach offers ongoing services with flexibility to change as needs change.


A systems approach to the provision of social work services in health settings: part 1. This paper , the first of a two-part presentation, offers a socialogical view of the hospital as an institution within the economic, political, and value systems of the community. Systems theory is the conceptual framework for projecting the potential role of the social worker in health setting. Part 2, in the next issue, will deal with impediments and barriers to effective social work in hospitals as well as solution finding based on systems work in combination with direct service skills.


Sample bias in patient evaluation of hospital social services. An exploration of methodology for a follow-up system focusing on hospital patients who received social services identified significant problems of sample bias in the respondent group. Implications are raised for administrative utilization of this type of biased findings in evaluation of the effectiveness of social services, and for implementation of an ongoing system to collect evaluative data. Standardized patient follow-up by mail was judged to be a feasible means of obtaining this data which may, even under optimum response rates, offer difficulty for generalizing and assessing validity.


Children's feelings about the hospital.

Children's feelings about the hospital. The concerned worker needs to know how children perceive the hospital. The institution, the illness, and the procedures evoke specific reactions in children. They fantasize about all of these, and question whether the hospital will help them. Through good communication, consideration, and sound information, it is possible to maximize the positive aspects of a hospitalization experience.


Community fieldwork collaboration between medical and social work students. This article describes an educational demonstration in interdisciplinary community field experiences between social work and medical students at the University of Kentucky Medical school, the hospital social service department, the school of social work, and community social and health agencies. The pilot program in which students from different professions lived for 6 weeks in outling rural communities served by the medical center, provided an opportunity: (a) to study the feasibility of combining a borad community health study experimence with casework services in a hospital-based educational program and (b) to assess the benefits of early interdisciplinary community and clinical work between future doctors and social workers. Students saw the advantages of cooperative teamwork in studying community problems, and were able to apply classroom theory about community organization to real community situations. The organizational structure and staff resources required to carry out such a demonstration are described, and the implications of the training project are discussed.


Adolescents with sickle-cell anemia deal with life and death. Confusion associated with the developmental problems of adolescence is intensified and prolonged for those suffering from sickle-cell anemia. Feelings of isolation and dependence due to a life-threatening disease can impede the transition to responsible, self-actualizing maturity. Weekly group meetings with nine young women suffering form sickle-cell anemia helped them move toward maturation and a sense of their own competence. The experience of closeness with other adolescents who shared the same vulnerabilities was mutually facilitating. These young women had been caught by a sense that it was impossible to progress to independent maturity, and so became resigned and passive. Yet an inner sense of vitality and their emerging sexuality occasionally sparked rebellion against this helplessness. Sexual senations and potential for family life were available counter-balances against recurrent association with pain and death. Through group support these linkages with hope were strengthened.


Mobile consultation: an integrative approach to mental health service to children. The authors describe the development of a consultation and education service in an inner-city catchment area. This service is unique in that its service pattern is integrated with a direct service component. It is implemented along a structural design incroporating a multidisciplinary mobile team responsive to variegated "consultation" requests from a dense population area with many first-line service providers of independent or insulated character. Satellite locations exist in specific neighborhoods to provide service. Consultation efforts are classified as services to individuals, groups, and the community at large.


Glucagon treatment of experimental acute pancreatitis. CFY male rats anaesthetized with pentobarbital were used in different groups for inducing acute pancreatitis by the retrograde injection either of 1 mg elastase, 5 mg trypsin, 4 mg lysolecithin, 10 mg Na-taurocholate in 0.2 ml volume or of 0.3 m. sunflower oil. In each group laparatomized animals served for control. The animals with pancreatitis were treated either with 15 mug/b.w.kg/hour glucagon or with physiological saline for 72 hours. Twenty-four and 72 hours after inducing pancreatitis glucagon did not influence the significant fall in blood pressure elicited by the intraductal injection of trypsin or elastase or in the plasma calcium level in pancreatitis induced by trypsin or sunflower oil. Neither did glucagon affect the significant increase of plasma lipase activity in pancreatitis induced by trypsin or taurocholate. It also failed to reduce the 24-hour mortality rate and the extension of fat tissue necrosis in the abdominal cavity of pancreatitic animals. In contrast, glucagon treatment significantly reduced the amount of abdominal exudate associated with bile salt induced pancreatitis and, probably due to its pancreatic blood flow increasing effect, seemed to moderate the degree of tissue damage elicited in the pancreas by detergents such as taurocholate or lysolecithin.


Failure of pentagastrin to potentiate the effect of histamine. The gastric secretory response to pentagastrin and histamine administered jointly in maxiumum does by the subcutaneous route and in intravenous infusion, and  in lower doses in infusion has been compared to the response to each of the two drugs administered by itself. No potentiating action was observed, some additive action was found on infusion of the drugs and even this action was confined to the lowest dose-levels.


Pernicious anaemia: its pathogenesis in the light of the beneficial effect of duodenal intrinsic factor. Oral ingestion of powdered duodenal mucosa with small doses of vitamin B12 proved efficient in four cases of untreated pernicious anaemia. The erythropoietic as well as the other responses were similar as those elicited by any reliable anti-pernicious drug. It has thus been confirmed that the growth factor demonstrated earlier in human duodenal juice by means of E. coli mutant corresponds in fact to the intrinsic factor. It is suggested that besides the deficiency of gastric intrinsic factor the duodenal intrinsic factor and the immune mechanisms neutralizing it are also involved in the pathogenesis. It has been shown that the aqueous extracts of hog stomach and duodenum differ in addition to their growth factor and nitrogen contents, also in aminoacid composition.


Biotransformation of 4 [4-14C]4-androsteni-3,17-dione by healthy human skin in vitro. The metabolism of [4-14C]4-androstene-3,17-dione was investigated in vitro with healthy female and male abdominal skin slices. With a reverse isotope dilution method the following androgenically active metabolites were isolated and identified:5 alpha-androstane-3,17-dione, androsterone, epiandrosterone, testosterone  and 5 alpha-dihydrotestosterone. The quantitative relations of the metabolites produced revealed that the main direction of the metabolism of 4-androstene-3,17-dione in the healthy female and male abdominal skin segments is the 5 alpha-reduction of the delta 4-5 double bond. The other significant pathway is towards the biosynthesis of testosterone and 5 alpha-dihydrotestosterone. The importance of the androgenic steroids formed in the course of the biotransformation of 4-androstene-3, 17-dione in human skin is discussed.


The metabolism of [4-14C]5-androstene-3 beta, 17 beta-diol by normal human skin in vitro. Healthy female and male abdominal skin slices were incubated with [4-14C]5-androstene-3 beta, 17 beta-diol. With a reverse isotope dilution method the following metabolites were isolated and identified: 5 alpha-androstane-3,17-dione, 4-androstene-3, 17-dione, 5 alpha-dihydrotestosterone, dehydroepiandrosterone, androsterone, testosterone, 7-keto-5-androstene-3beta, 17 beta-diol, 7 alpha-hydroxydehydroepiandrosterone sulphate and 5-androstene-3 beta, 17 beta-diol-3-sulphate. The amounts of the metabolites formed showed that [4-14C]5-androstene-3 beta, 17 beta-diol was metabolized in different ways by healthy female and male abdominal skin slices. In female skin the main direction of metabolism leads to the formation of androgenic steroids, while in male skin the main biosynthetic route is the C7-oxidation of the substrate. The fact that 5-androstene-3beta, 17 beta-diol is transformed to a considerable extent to testosterone and 5 alpha-dihydrotestosterone proves that in human skin 5-androstene-3 beta, 1m beta-diol is a better precursor of the androgenic steroids than dehydroepiandrosterone or 4-androstene-3, 17-dione.


Seasonal variations in plasma corticoid level. Plasma 11-hydroxycorticoids have been determined in 25 normal young males in winter and in the hot humid summer days in Cairo. A seasonal variation could be detected with higher plasma levels in the summer.


Syphilitic hepatitis: clinical, immunological and morphological aspects. In 17 out of 176 cases of early syphilis (seropositive syphillis I; syphilis II) liver function tests yielded a positive result. In these patients a significant increase in the serum IgG, IgM and coeruloplasmin levels and a decrease in t4e transferrin level was found. The concentrations of alpha-2-macroglobulin and of beta-1-C-globulin were practically uneffected. Liver biopsy revealed hepatitis of variable severity in 13 patients with focal necroses or a proliferative process effecting the walls of the central veins, the arterioles and the branches of the portal vein. In 7 cases the presence of Treponema in the liver was demonstrated.


Critical flicker frequency series effect in epileptic and in neurotic patients. II. Difference in the variation range ratios of continuous and intermittent CFF series. In a previous study (1970) a lowering of the CFFSE (Critical Flicker Frequency Series Effect) level from morning to noon was shown. In a group of 18 neurotic subjects 17--34 years of age, an opposite learning effect in the CFFSE level variation, increasing from the first day of examinations to the third one and in a group of 17 epileptic subjects of similar age a decrease of the same was observed. The recent study has corroborated the findings in 195 neurotic and 73 epileptic patients of the same age groups with the following additions. The "negative" learning effect of the epileptics proved to be more intensive in females  than in males. The contrast in both positive and negative learning effects between neurotic and epileptic males of 17--34 age was most accentuated in the forenoon. Deviations in the variation range ratios of continuous and intermittent CFF series between the two groups occurred in each age group. The average variation of this ratio in 855 subjects with neurosis, epilepsy and some other diseases seems to point to the occurrence of systematic differences in the pathophysiological function of the brain, changing from organic cerebral lesions through neurosis to organ neuroses.


Endoscopic assessment of gastric polyps. The results of fibre gastroscopy in 100 patients with gastric polyp are reported. The polyps were removed in 38 patients. All cases were followed up. No  malignant transformation of the polyp was demonstrable in any of the cases. The polypous growth proved to be early gastric carcinoma in two cases, neurogenic sarcoma in one case. The polyp was associated with gastric carcinoma in 11 cases, with gastric sarcoma in one case, and with tumours of other digestive organs in five cases. It has been concluded that 1. diagnosis and correct assessment of gastric polyps rest on the evidence of endoscopy. 2. In the majority of cases polypoid lesions of the stomach are either benign or malignant from the very outset. Endoscopy coupled with biopsy directed at the representative sites of the polyp permits differentiation between benigh and malignant cases with a fair degree of accuracy. 3. Removal of polyps should be selective. 4. Association of gastric polyps with gastric carcinoma is far more frequent than malignant transformation of the polyp. 5. Endoscopic follow-up of polyps is imperative even in polypectomized cases. 6. Detection of a gastric polyp necessitates a search for tumours of other organs.


Effect of hypocalcaemia and lipid peroxidation on experimental acute pancreatitis. It has been studied whether hypocalcaemia increased the mortality rate of experimental acute pancreatitis in the rat, and whether lipids injected into the pancreas underwent peroxidation, damaging thereby the gland. Prolonged hypocalcaemia was induced by bilateral parathyrodectomy and intensified by a calcium-deficient diet. Parathyroidectomy significantly decreased also arterial blood pressure. Three hours after their intraductal injection, both 0.2 ml sunflower oil and 5 mg trypsin significantly decreased arterial blood pressure in the non-parathyroidectomized animals and so did 5 mg trypsin in the parathyroidectomized ones; sunflower oil decreased the blood calcium level below 5 mg/100 ml in parathyroidectomized rats fed a calcium-deficient diet. No differences were found in the mortality rates of nonparathyroidectomized normocalcaemic rats and parathyroidectomized hypocalcaemic ones, or in the extent and gravity of pancreatic injury and in the extent of fat tissue necrosis at 3 and 24 hours after the intraductal injection of 0.2 ml sunflower oil or 5 mg trypsin. Sunflower oil, oleic acid and linoleic acid injected by retrograde way into the pancreas in 0.2 ml volume each induced extensive danage to the acinar parenchyma, while liquid paraffin failed to do so. Among these agents, only linoleic acid increased, as a sign of lipid peroxidation, malonaldehyde concentration in the pancreatic tissue. Linoleic acid injected  into the submaxillary salivary gland in  0.1 ml volume induced extensive tissue damage, while sunflower oil, oleic acid failed to do so.


Effect of the protein-synthesis inhibitor actinomycin-D on the renin-angiotensin system in the rat. The effect of actinomycin-D on blood pressure and the renin-angiotensin system has been studied in the rat. Treatment with the drug caused blood pressure, plasma renin activity and plasma renin substrate level to decrease. The results suggest that in the blood pressure-decreasing effect a reduction of the activity of the renin-angiotensin system had a role. This contradicts the view that actinomycin-D has no influence on renin production in the kidney.


Blood glucose and insulin levels in thymectomized rats. The rise of blood glucose level under sugar load was much greater in thymectomized than in normal rats, whereas the insulin level remained practically unchanged. This suggests that the rise of blood sugar level is due to two factors, one being the accumulation in blood of a substance, corresponding to the blood glucose level stimulator stored in the thymus, the other the simultaneous inhibition of insulin production, or of insulin transport, into blood.


Corticosteroid receptors in the central nervous system of the rat. Corticosteroid receptors were demonstrated in the medial hypothalamus, the hippocampus and the parietal cortex of the rat while no such receptors were found in the hypophysis, the amygdala and the anterior hypothalamus. The findings suggest the role of extrahypothalamic regions in the perception of corticosteroid feedback as well as in the regulation of the hypothalamo-hypophysial-adrenal function and do not support the assumption that corticosteroids would inhibit corticotrophin secretion by acting directly on the hypophysis.


The physostigmine depolarization potentiating effect of salicylate in frog skeletal muscle. 1) The frog's sartorius muscle was depolarized depending on the degree of concentration 2--4 times more intensely by physostigmine salicylate than by physostigmine sulphate. 2) In normal Ringer's solution, 1 mM physostigmine salicylate decreased the sensitivity of the membrane to potassium depolarization by about 90%. Under similar experimental conditions, physostigmine sulphate and Na salicylate, respectively, decrease the sensitivity of the membrane to potassium depolarization by about 30%. 3) The difference manifested in the depolarizing effect of salicylate and other physostigmine salts (chloride, sulphate, phosphate, formiate, acetate, monochloracetate, benzoate and para-oxy-benzoate) is expressed already at 1 mM concentration (about 10-fold), if the muscle had been equilibrated in chloride-free glucuronate or sulphate milieu. 4) The depolarization develops slowly. It takes 30--60 minutes for the new steady state to develop even in the superficial sartorius fibres. If depolarization has reached its maximum on an average 100 mV, the membrane potential remains unchanged for hours. 5) Depolarization ensues at an unchanged degree in the presence of Na-free (choline) Ringer as well as in the presence of 2X10(-8) g/ml tetrodotoxin; therefore, it is not a Na-dependent process. 6) Under the influence of 1 mM physostigmine salicylate the membrane's resistance to the inward potassium current increased about twofold, while the increase was only 15% to the outward potassium current. It is assumed that the salicylate anion is characteristically capable of potentiating the decreasing effect of physostigmine on potassium permeability, though the role of the metabolic effect of salicylate cannot be excluded.


Effect of anaesthetics on the sympathetic reflex. i) In the awake animal, neither a late response nor a silent period could be evoked from the tibial nerve. Somatic afferentation with impulse trains failed to inhibit efferent sympathetic activity. On the other hand, vagal afferentation had an inhibitory action also in the awake animal. In the awake animal, the excitatory processes are dominant. ii) Urethan anaesthesia did not influence the sympathetic nervous processes; the reflex response were practically the same as in the awake animal. iii) Chloralose anaesthesia altered the sympathetic reflex observable in the awake animal. Somatic afferentation of low threshold voltage already elicited a late response and a silent period; in addition, a high degree of summation ability of silent periods was apparent. Thus, chloralose anaesthesia seems to raise the excitatory level of the sympathetic centres in the direction of inhibition. iv) Combined chloralose+urethan anaesthesia, under which investigations are usually performed, was seem to affect the reactivity of the sympathetic centres in the same way as did chloralose anaesthesia.


Circulatory regulation in anuric rats: anuria and haemorrhagic hypotension. In rats made anuric by ureteral ligation or by creating a bladder-caval venous shunt, cardiac index increased and total peripheral resistance decreased proportionally to the change in the serum NPN level. Circulating blood and plasma volume did not change. In ureteral-ligated or bladder-caval venous-shunted rats, cardiac output and its organ fractions were determined by SAPIRSTEIN'S technique. In the ureteral-ligated animals, vasoconstriction in the kidneys, and vasodilation in the skin were found. After bladder-caval shunt, vasodilatation developed in the myocardium, gut, skin and carcass. After ureteral ligation, posthaemorrhagic shifting decreased mainly the renal flow, while after a bladder-caval venous shunt, mainly the renal and intestinal flows.


Absorption, distribution and elimination of azidomorphine and related substances. The absorption, distribution and elimination of 14C- and 3H-azidomorphine, 3H-14-OH-azidomorphine, 14C- and 3H-azidocodeine and 3H-azidoethylmorphine were studied in comparison to 14-C-morphine. Whole body autoradiography of pregnant mice, quantitative estimations of tissue radioactivity in male mice, brain autoradiography, subcellular distribution in rat brain and elimination studies in rats were performed. Azidomorphine and morphine are absorbed from the gastrointestinal tract at the same rate but the absorption of 14-OH-azidomorphine, azidocodeine and azidoethylmorphine exceeds that of the formers. The azidomorphines pass across the blood-brain barrier more readily than does morphine. In rats treated with azidomorphines, 30--50% of the doses given were excreted with the urine the first 4 hours and about 90% within 48 hours; whereas 2--5% were recovered from the collected stools.


Objective measurement of human motor activity: a preliminary normative study. Motor activity values have been generated for a population of young adult subjects in order to develop normative values for motor activity levels. Using the large-scale-integrated (LSI) motor activity monitor, day and night motor activity have been continuously and noninvasively monitored for approximately 1 month on 13 normal subjects. Comparisons between measured and self-rated motor activity tend to validate this technique. The results are discussed in relation to ongoing motor activity studies showing definite changes in activity associated with fluctuations in mood and anxiety.


The problem of skin-electrode processes during medical electrography. The processes were studied which take place at the skin-electrode zone when surface electrodes are applied to the human body for the medical electrography (ECG, EEG, EMG, etc.). These processes were investigated from the point of view of their influence on the distortion-resistence and the precision of the biopotential registration; they were studied also as a possible source of bioinformation. The results of the experimental research are discussed.


The properties of bird feathers as converse piezoelectric transducers and as receptors of microwave radiation. I. Bird feathers as converse piezoelectric transducers. An investigation was made of the properties of bird feathers as piezoelectric transducers in the audiofrequency range and as dielectric receptors of electromagnetic radiation in the microwave region. In the first case, cartridges of the ceramic and magnetic type and an electromagnetic transducer probe were used as detecting devices. Results show piezoelectric resonances in the 1 to 20-kHz region for the calami of feathers.


Fluid input control in burned patients with the aid of ultrasonic arterial blood pressure monitoring. Arterial blood pressure is nowadays easily and reliably measured with ultrasonic equipment. It correlates well with blood volume, and may therefore be used to guide fluid infusion in burned patients. Monitoring of blood pressure, instead of application of old-fashioned recipes, helps to avoid dangerous situations of hypovolemia or overload.


The angry back syndrome: eczema creates eczema. False positive patch test reactions are common when the skin of the back is hper-reactive. Such reactions can obscure or invalidate observations of multiple specific sensitivity and of cross-sensitivity to contactants. The pathogenesis of the hyper-reactive skin ('angry back') is discussed and a mechanism postulated for the notion that eczema at certain sites can provoke an eczematous tendency at other sites.


Vegetables, international co-operation and journal space. Many salad and vegetable plants are allergenic. Screening patch tests are restricted to known allergenic plant families. Aimed patch tests include all environmental plant contactants. Taraxacum (Dandelion) yields a potentially allergenic sesquiterpenelactone. International co-operation in authorship can save journal space.


Value of a new technique of sensitization to dinitro-2, 4-chlorobenzene. Experimental sensitization to dinitro-2,4-chlorobenzene (DNCB) is being studied according to different techniques, the variable factors being the concentrations of DNCB, the number of applications and the time between the sensitizing application and the reading of the challenge test. The authors relate and discuss their technique (only one touch of a drop of 10% DNCB in acetone, covered with a cover-slip and left to evaporate), the results and the advantages: in particular, stanardization of the parameters of sensitization, (quantity of DNCB, area and time of application) and reduction in the risk of toxic effects inherent in excessively high concentrations of DNCB. In addition, the authors emphasize the fundamental significance of the length of time needed to acquire experimental sensitization.


Para-chloro-meta-xylenol allergic contact dermatitis in seven individuals. Seven individuals are discussed who developed allergic contact dermatitis following sensitization to the antibacterial agent parachlorometaxylenol (chloroxylenol, PCMX) contained in either medicated Vaseline or in electro-cardiogram paste. The hazard of PCMX sensitization is great in that this chemical is present in over 30 "across the counter" products. PCMX sensitive people may cross-react to chlorocresol.


Epidemiology of contact dermatitis in Geneva (1000 cases). Results concerning 1,000 cases of contact dermatitis with positive patch tests are presented. The allergens which are responsible for about 50% of our cases are: turpentine, nickel, hexavalent chromium and organic mercurial compounds. These results are compared with those of other countries. As in the industrial world there should be information given to the general public to reduce the incidence of contact dermatitis.


Allergic "contact" dermatitis from disulfiram implants. Two cases of allergic "contact" dermatitis to implanted disulfiram (tetraethythiuramdisulfide or TETD) pellets are described. This side effect has never been reported before. Other local complications from disulfiram implantations are reviewed.


Acute laryngeal obstruction presumed secondary to thiomersal (merthiolate) delayed hypersensitivity. A patient treated his slight score-throat with a thiomersal first aid spray. The next day, because of continued discomfort, he repeated its use. Laryngeal obstruction followed within hours. Emergency tracheostomy produced prompt improvement. Patch testing revealed an extreme spreading reaction to thiomersal. It is our interpretation that the acute laryngeal obstruction was delayed hypersensitivity to this first aid spray.


Contact allergy to Frullania and Laurus Nobilis: cross-sensitization and chemical structure of the allergens. Cross-sensitization between two plant allergens, Frullania and Laurus Nobilis (L.), has been demonstrated in Strabourg. A review of the haptens isolated from Frullania outlines the importance of the purification of allergen to ascertain the nature of the causative agent. New results on laurel oil point to the possibility of a common denominator (the a-methylene gamga-butyrolactone moiety) between this plant and Frullania; former results are re-interpreted and analyzed. In conclusion, the importance of physico-chemical methods used to purify and isolate haptens, and help in their definition, is stressed.


Updating the maximization test for identifying contact allergens. The maximization test for detecting contact allergens has proved to possess both sensitivity and specificity. However, modifications have become necessary because of excessive irritancy reactions to sodium lauryl sulfate. Fewer exposures are now recommended during induction and lower concentrations for challenge patch testing. Pre-testing of each subject in the panel is now standard procedure. The problem of interpreting challenge patch tests is discussed in detail.


Effect of some irritants on human epidermal mitosis. Studies on how irritant materials might induce epidermal hyperplasia were initiated by investigating their influence on epidermal mitosis. 5% hydrochloric acid, neat dimethyl acetamide and 1% benzalkonium chloride had no effect. 5% benzalkonium chloride, however, produced a 10-fold increase in mitotic activity, while a dose response curve was seen with sodium lauryl sulphate (SLS) peaking at 1%. 1% SLS produced a remarkably uniform response for this type of assay and it is suggested that it might provide a useful model for situations of increased epidermal cell turnover such as psoriasis. It is also noted that there was apparently no direct relationship between gross inflammation and the mitotic response.


The frequency of contact sensitivity in North America 1972-74. Three thousand subjects in North America were patch-tested with 19 allergens. The most frequent sensitizers observed include nickel sulfate, caine mixture, potassium dichromate, balsam of Peru, thimerosal, ethylenediamine hydrochloride, paraphenylenediamine and thiram. The prevalence data compared with an earlier study indicates that the initial allergens reported warrant their continued inclusion in a routine patch test screening series in North America.


Contact sensitivity in atopic dermatitis. With the exception of certain drugs, some contactants give positive patch test reactions less frequently in patients with atopic dermatitis than in all patients with dermatitis. Both among atopics and other dermatitis patients, women reacted positively to most drugs more frequently than men did. In Poland, positive patch tests to balsams are rare in atopics.


Contact sensitivity to Irgasan DP 300.

Contact sensitivity to Irgasan DP 300. Two persons had allergic contact dermatitis caused by Irgasan 0,2% in a deodorant foot-powder and 0,12% in a deodorant stick respectively. Both had positive patch test reactions to Irgasan 2% pet. One patient was further tested with Irgasan 1% pet. and 0,5% pet. She had positive reactions to these dilutions. In a blind half-sided usage test, a soap bar containing 0,5% Irgasan caused mild itching and a percepitble erythema, although the use of this soap was otherwise tolerated for one month. The soap bar without Irgasan caused no reactions. Although primary sensitization from Irgasan toilet soaps has not been reported, a previously sensitized person may react to the use of Irgasan in soaps.


Allergic dermatitis from a new pesticide. In four patients suffering from allergic contact eczema, the risk of sensitization to a new residue-leaving fungicide (Plondrel) used in spraying roses is considered. Two patients, however, were probably also sensitized to materials from the roses themselves. By gas-liquid chromatography the amount of the fungicide, especially in the leaves of roses, appeared to be rather high. The role of pesticides has to be considered when sensitizing agents of plant dermatitis are investigated.


Elastotic and citrine skin following an allergic photo-contact dermatitis in a child. A case of Phenergan-induced allergic photo-contact dermatitis in a boy aged 11 years is described. The condition produced a dermatological picture of senile-looking elastosis and citrine skin in exposed areas.


Allergic contact dermatitis to All-trans-retinoic acid; epicutaneous and leukocyte migration inhibition testing. Two male prison volunteers had severe cutaneous reactions to the initial patch testing of All-trans-retinoic acid containing products being evaluated for irritancy. Muliple patch testing procedures performed throughout one year, along with leukocyte migration inhibition studies, speak strongly for delayed hypersensitivity reactions in these subjects. The failure to document a previous exposure in subjects living in a controlled environment suggests that these responses were cross-reactions to a prior sensitizer, perhaps unique to this environment.


Contact sensitization of guinea-pigs with unsaturated and halogenated sultones. The sensitizing properties of unsaturated and halogenated sultones were examined in a guinea-pig model for contact hypersensitivity. The sensitization potential of 2-chloro-1,3-dodecanesultone was similar to that of 1-chloro-2,4-dinitrobenzene (DNCB). 2-bromo-1,3-dodecanesultone, 1-decene-1,3-sultone, 1-decene-1,3-sultone, 1-tetradecene-1,3-sultone and 1-hexadecene-1,3-sultone were stronger senistizers than DNCB. Ectensive cross-reactivity was observed among sultones of the same side-chain length, but differing from each other in being either unsaturated or halogenated. Extensive cross-reactivity was also noted among 4 unsaturated sultones of differing side-chain lengths. The inter-relationships among these sultones in regard to their immunogenic and tolerogenic properties are discussed.


Lauryl ether sulphate dermatitis in Denmark. Lauryl ether sulphate (LES), a synthetic detergent, may sometimes contain an allergenic impurity, which has given rise to several outbreaks of contact dermatitis. Such an outbreak occurred in Denmark in 1971. All cases diagnosed were confined to one household, while other cases may have passed unnoticed.


Allergic contact dermatitis from phenoxybenzamine hydrochloride: cross-sensitivity to some related haloalkylamine compounds. Contact dermatitis from phenoxybenzamine hydrochloride occurred in a woman laboratory technician. Sensitization to this chemical was produced in guinea-pigs. Cross-sensitivity to related compounds may be due to the chloroethylamine moiety of the molecule. No cross-sensitivity was observed to the dichlorodiethylamine compound, nitrogen mustard.


Occupational koilonychia from organic solvents. Occupational koilonychia of the finger-nails among cabinet makers is reported. Six cases occurred in workers in close contact with a mixture of organic solvents (thinners). The deformity involved particularly the thumb, index and middle finger-nails, due to a particular way of cleaning metal accessories in finished furniture. The possible mechanism is discussed.


Reactions to dental impression materials. In the department of prostheitc dentistry at Groningen, during the past four years, approximately 2,000 persons have been treated with Scutan, and epimine plastic for temporary crowns and bridges and Impregum, a polyether impression material. A total of ten patients complained of untoward reactions. Patch tests with the basic materials were performed on four of them. Positive allergic reactions were obtained to patch tests with the catalyst methyl p. toluene sulfonate 0.1% in dibenzyltoluol present in Scutan, and the catalyst methyldichlorobenzene sulfonate 0.1% in dibenzyltoluol present in Impregum. Four control subjects did not react to these concentrations.


Susceptibility to primary irritants: age dependence and relation to contact allergic reactions. Patch tests with three primary irritants were performed in 600 persons with eczema and in 33 healthy controls, The irritants assayed were: croton oil (20%) in mineral oil, thymoquinone (1%) in ethanol and crotonaldehyde (7.5%) plus sodium lauryl sulphate (4%) in aqua dest. The number of positive reactions to croton oil was found to decrease with age, while for thymoquinone and crotonaldehyde and for the total irritant score no age dependence was observed. No significant correlation was found between sensitization to common contact allergens and susceptibility to irritants. The incidence of positive reactions to common allergens proved to increase with age.


Echocardiographic differentiation of mediastinal tumors from primary cardiac disease. Three cases of mediastinal tumors (thymic cyst, fibrosarcoma, fibrolipoma) mimicking primary cardiac disease were studied by echocardiography. The echocardiographic findings of the thymic cyst are presented and the echocardiograms in the other two patients discussed. Intrinsic cardiac pathology was excluded and discovery of abnormal extracardiac echoes prompted further investigation. In each  instance, the echocardiographic interpretation of the nature and position of each extracardiac mass was confirmed by surgery or autopsy. We conclude that echocardiography is a useful noninvasive technique in differentiating between cardiac and extracardiac disease, and should be performed whenever an unusual or enlarged cardiac silhouette is encountered.


A simplified method for measuring helium closing volume. A simple method for delivering a constant volume of helium for the measurement of airway closing volume is described. Using a standard fiveway valve and PVC plastic irrigation pipe, a device was constructed which permits the delivery of a uniform volume of helium and avoids the troublesome valve change during inspiration. Results obtained when using this device were comparable to those with the use of conventional bag to contain the helium.


Amebic pericarditis.

Amebic pericarditis. Amebic pericarditis in a 40-year-old man who presented with insidious onset of symptoms is reported. Pericarditis is an infrequent complication of liver abscess and accounts for 4 percent of all extraintestinal amebiasis. Communication between the left lobe of liver and pericardium has been demonstrated in this patient.


Cardiac compression due to closure of the median sternotomy in open heart surgery. Following open heart surgery, approximation of the median sternotomy can compress the heart and produce cardiac tamponade. A proposed new technique to eliminate this compression by sternal traction is presented.


Pneumopericardium associated with bronchogenic carcinoma. A case of pneumopericardium associated with primary bronchogenic carcinoma is reported. This association between bronchogenic carcinoma and pneumopericardium has not been reported. The roentgenographic features of pneumopericardium are discussed.


Scleroderma heart disease with slow flow velocity in coronary arteries. A young woman with scleroderma heart disease is presented. Complete work-up including hemodynamic studies revealed biventricular dysfunction, left ventricular hypokinesia and normal coronary arteries with slow flow velocity in coronary arteries. This finding, though not diagnostic, is consistent with small vessels disease secondary to scleroderma. Favorable prognosis in our patient on medical management is encouraging. No conclusions can be drawn on the basis of one patient. Further work is warranted in scleroderma patients with cardiomegaly to define the status of the myocardial microcirculation and its possible role in their prognosis.


Surgical treatment of leukemic involvement of the mitral valve. A patient with severe mitral insufficiency due to infiltration of the valve and myocardium by leukemic lymphocytes is presented. Treatment was replacement of the valve with a prosthesis. The significance of this patient lies in the rarity of the clinical state and the novelty of treatment.


Active pulmonary hemorrhage localized by selective pulmonary angiography. Massive hemoptysis in a young woman with negative chest film findings is presented. By using selective pulmonary artery angiography during active pulmonary bleeding, the following findings were demonstrated: (1) intraparenchymal hemorrhage, (2) clearing of blood from the lung and bronchial tree by coughing, (3) early filling of the inferior pulmonary vein. Following lobectomy, specimen angiography suggests the presence of a small arteriovenous fistula. This experience demonstrates that selective pulmonary arteriography may be a useful adjunct in the management of selected patients with massive hemoptysis of obscure etiology.


Hyperventilation-induced T-wave changes in the limb lead electrocardiogram. Seventy-two healthy young individuals were subjected to controlled, moderate hyperventilation with room air and with 4.9 percent CO2 in air, and monitored electrocardiographically. Significant summed frontal T-wave changes with hyperventilation (sigmaT1,2,3 larger than or equal to 1.5 mm) were observed in 12 patients. Six subjects (8.3 percent) showed T-wave depression. It was reversed in five patients by hyperventilation with 4.9 percent CO2 in air. T-wave elevation, observed in six subjects, was reversed in four patients by hyperventilation with 4.9 percent CO2. A short period of hyperventilation with an air mixture containing 4-5 percent CO2 is suggested as a means of screening patients under suspicion of ischemic heart disease exclusively on the basis of ECG changes.


Primary lung cancer in a chest clinic: diagnosis and prognosis. This reports a retrospective study of primary cancer of the lung diagnosed in the chest clinics of the Odense and Assens counties in Denmark during the period 1960 to 1966. There were 212 patients, 171 of whom had been referred because of symptoms, and 41 who were found in group screening. Of the latter, 13 had no symptoms. The histologic diagnosis, the  diagnostic procedures on which the diagnosis was based, and the treatment are reported. Twenty percent of the patients were alive after five years, as compared with the calculated 13.5 percent for all cancers of the lung in the two counties. A close collaboration between general practitioners, chest clinics, and departments of thoracic surgery is stressed as a means of further improving the prognosis.


Cytology of respiratory epithelium as a predictor of respiratory complications after operation. A study of 111 patients undergoing elective surgery under general endotracheal anesthesia has shown that the pulmonary complication rate after operation is minimal in nonsmokers (7.9 percent) and that it rises steadily as smoking habit increases, reaching 43 percent in very heavy smokers. Peak expiratory flow rate and timed vital capacity (FEV1) were unaffected before operation except in very heavy smokers. The morphologic integrity of the ciliated tracheobronchial epithelial cells seen in smears obtained within ten minutes of the onset of anesthesia and quantitated by a scoring system, deteriorates progressively with increasing smoking habit and constitutes the most sensitive index for the prediction of diminished resistance to the stress of anesthesia and operation and of incipient chronic obstructive lung disease in smokers.


Evidence suggesting dual A-V nodal pathways in patients without supraventricular tachycardias. Electrophysiologic evidence for dual pathways of conduction through the A-V node is presented in three patients without history of supraventricular tachycardia. In case 1, abrupt spontaneous changes in the PR interval from 0.17 to 0.42 second were seen. His bundle electrographic studies showed two sets of A-H intervals during sinus rhythm and at several atrial pacing rates, although at rates over 100 per minute only the slow pathway conducted. Using the extrastimulus method, different refractory periods for the fast and slow pathways were documented. Cases 2 and 3 underwent His bundle electrography studies to evaluate intraventricular conduction defects. During atrial pacing studies abrupt changes in the A-H interval, from 220 to 470 msec and from 220 to 370 msec, were observed on increasing the pacing rate from 90 to 95 per minute in case 2 and from 120 to 130 per minute in case 3. In these two patients, dual A-V nodal pathways were suggested by the sudden changes in the A-H -interval at critical pacing rates. These findings indicate that evidence suggesting dual pathways of conduction through  the A-V node may not be an uncommon finding and may be present without the manifestation of recurrent supraventricular tachycardias.


Adams-Stokes seizures due to ventricular tachydysrhythmias in patients with heart block: prevalence and problems of management. One hundred and twelve patients with heart block and chronic tendency to syncope were ECG-monitored during syncope. Ventricular tachycardia and/or fibrillation (VT-VF) was observed as the cause of syncope in 11 patients: in 6 of 20 patients with chronic third degree A-V block, in 3 of 65 with paroxysmal A-V block and in 2 of 27 with S-A block. The R-R interval preceding the escape beat which initiated VT-VF varied between 1.2 and 2.2 seconds. The cerebral attacks were amenable to long-term pacemaker treatment. However, relapses of VT-VF were observed during pacing with a low rate of 55 per minute and during short interruptions in pacing, as produced by intermittent pacemaker failure or threshold determination. In one patient, supplementary treatment with a beta-blocking agent had to be given to suppress exercise-induced attacks of VT-VF after pacemaker implantation.


Cigarette smoking and arteriographically demonstrable coronary artery disease. Patients undergoing selective coronary arteriography were studied to determine whether the extend of their coronary artery disease (CAD) was related to cigarette consumption. Those without demonstrable lesions averaged 29.0 pack years. Patients with single vessel disease, 38.3 pack years, those with double vessel disease 44.9 pack years and those with triple vessel disease 67.5 pack years. Nonsmokers with significant CAD were ten years older than their smoking counterparts (p less than 0.01). Forty-seven percent of patients with no demonstrable disease were nonsmokers whereas only 18 percnet of those with CAD were nonsmokers (p less than 0.001). Sixty-nine percent of nonsmoking normotensive patients had no CAD whereas only 23 percent of nonsmoking hypertensive patients fell in the no CAD category (p=0.01-0.005). This study demonstrates a correlation between the number of cigarettes consumed and the severity of CAD as well as the accelerating effect of cigarette consumption on the development of CAD. It also suggests that symptomatic CAD in a normotensive nonsmoker is unusual.


Fibrinous uremic pleuritis: a surgical entity. Fibrosing uremic pleuritis is a newly recognized late complication of uremia. Extreme incarceration of the lining and chest wall can occur with disabling restriction of pulmonary function. Decortication of the chest wall and the lung can be carried out safely with minimal bleeding and restoration of pulmonary function.


Interstitial lung disease resistant to corticosteroid therapy. Report of three cases treated with azathioprine or cyclophosphamide. Three patients with severe progressive interstitial lung disease refractory to steroid therapy were treated with immunosuppressive drugs. Biopsy material of one showed mainly fibrosis, while that of the second showed interstitial pneumonitis as well; both patients received azathioprine. Cyclophosphamide was employed in the third patient with systemic vasculitis and massive hemoptysis. All patients had reduced lung volumes and abnormal gas exchange, which continued to worsen on high doses of steroids. In patients 1 and 2, there was long-term stabilization of lung function, while pulmonary physiologic abnormalities in the patient with vasculitis reverted to normal on five months of cyclophosphamide. Although the etiology of most forms of interstitial lung disease is unknown, several reports suggest at least a partial immunologic basis. Abatement in progression of disease in this small series would suggest that a trial of immunosuppressive drugs be considered in interstitial lung disease when steroid therapy fails.


Diagnostic value of blood pool and transmission scan in cardiovascular and tissue pathology of the thoracic midline. We reviewed 48 records of combined blood pool and transmission scans, performed in the last three years for mediastinal masses and cardiomegaly. The purpose was to investigate the diagnostic value of this radioisotopic examination, and in particular to compare it with the roentgenographic examination. The accuracy of both methods in visualizing mediastinal tumors or tissue pathology was very similar. The scintigraphic examination was superior for the diagnosis of cardiovascular pathology. False negative results occurred more frequently than false positives, especially in cases of tumors and aneurysms.


Intraventricular blocks in acute myocardial infarction. The electrocardiograms and clinical records of 171 patients with a first recognized myocardial infarction (AMI) were reviewed in order to study the incidence and clinical significance of intraventricular blocks (IVB), especially hemiblocks, when other conditions which could have influenced the prognosis were excluded. Patients with left anterior hemiblock had higher SGOT levels (p less than 0.01), higher incidence of arrhythmias (p less than 0.01) and congestive heart failure (p less than 0.01) compared to the control group without IVB. Isolated left posterior hemiblock was infrequent and did not appear to influence the course of AMI. Bundle branch and bifasicular blocks were associated with the highest incidence of complications and mortality (47 percent), but these patients were older (p less than 0.01) and also had higher SGOT levels than the control group (p less than 0.05). To some extent, mortality and incidence of complications appeared to be related to the degree of myocardial damage, which in turn produced the IVB rather than to the conduction abnormality itself.


High oxygen pressure-induced convulsions in suckling mice. Two hundred suckling mice from 20 litters were used for determining their functional development of the hyperoxic convulsion mechanism. It was found that 1 to 12-day-old mice did not develop convulsion when they were subjected to oxygen under high pressure. The hyperoxic convulsion was observed in 1 of 10 13-day-old (10%), 3 of 10 14-day-old (30%), 16 of 20 15-day-old (80%) and all of 16-day-old mice (100%). This finding indicates that the hyperoxic convulsion mechanism of the young mice takes 13-16 days for functional maturation. Besides, it was shown that hyperoxia could cause pulmonary damage, the incidence of which also increased with age of suckling mice.


Antigenicity of sperm: immunization of rabbits with pig's sperm. The state of antibody production and the tissue and species specificities together with the sperm immobilizing action of various antibodies in rabbits were examined after immunization with pig's sperm. Before the immunization, the titers of various antibodies against pig's sperm seemed to be generally higher in male than in virgin female, but they became no obvious difference between the two sexes after the immunization. Precipitins of the sera obtained by immunizing rabbits with pig's spermatozoa extract reacted not only with pig's spermatozoa extract but also with heterologous spermatozoa extract to moderate degree, but no cross reaction with pig's serum or heterologous serum was visible, and it was not associated with the sperm immobilization. The sperm-microagglutinin obtained by immunization with pig's spermatozoa showed strong species specificity and moderate tissue specificity. The motility of the sperm was not obviously inhibited by sperm agglutinin. The titer of it was the highest among the immune antibodies, but there are problems in detecting the specific antibody because spontaneous sperm agglutination is common and it is difficult to determine whether the agglutination is due to antisperm antibody or to a nonspecific factor. The evidence that strong tissue and species specific sperm-immobilizing antibody could be produced by immunizing rabbits with heterologous pig's sperm in both sexes gives us the confidence that sperm immobilization by immunization of both sexes with homologous sperm could contribute to human population control in the future.


The effect of diuretics on sodium transport across the mouse intestine. The effects of three natriuretic agents on Na transport across the mouse intestine were determined. It was found that ethacrynic acid at a concentration of 1mM, markedly reduced the net transmural transport of Na ion by decreasing themucosa-to-serosa flux with little or no effect on serosa-to-mucosa flux. Furosemide or amiloride at a concentration of 1 mM produced similar but less profound effects. A reduction of net Na22 flux was observed in the presence of either diuretic, but with furosemide and amiloride this inhibitory effect observed only if glucose was present in the bathing solution. It is, therefore, concluded that the intestinal transport of Na ion involves two processes, one is glucose or substrate-dependent, and the other glucose or substrate-independent. Ethacrynic acid inhibits the substrate-independent process while furosemide and amiloride affect only the substrate-dependent process of Na transport.


The mechanism of antibiotic-promoting effect in body weight gain of chicks. A series of 3 experiments was conducted on 3-day-old, single combed, white Leghorn cockerels for the purpose of studying the mechanism of aureomycin-promoting effects in body weight gain of chicks. In each experiment, 3 groups of chicks were fed for 4 weeks respectively on 1) basal ration, 2) basal ration supplemented with 25 ppm aureomycin and 3) basal ration with different amounts of alkali-decomposed aureomycin. At the end of each experimentation, 131I was injected intraperitoneally into the chicks. One hour later, the chicks were sacrificed by decapitation. The thyroid glands were removed immediately and weighed. The glands were prepared for radioactivity determination by the TraceLab multi/matic 501 counting system. The percentage of 131I uptake of the injected dose per mg thyroid gland was ascertained. The results indicated a significant increase of thyroid indices (mg thyroid gland per 100 gm body weight) after feeding aureomycin or decomposed aureomycin. The radioactivity determinations showed that the thyroid 131I uptake of the experimentals, especially those fed aureomycin, was significantly smaller than that of the controls. The present results, therefore, are in accord with the hypothesis of antithyroid effect of aureomycin propsed by Calesnick et al. in 1954. Furthermore, it suggests that such goitrogenic action might have resulted from aureomycin degraded under the influences of alkaline medium of the intestines and high body temperature of the chick. In addition to the functional change of the thyroid gland, aureomycin or decomposed aureomycin also promoted body weight gain and an increase in fat content in the chicks. These results suggest that body weight-promoting effect of aureomycin in animals may be attributable to an alteration of thyroid function which, in some way, is related to the products resulting from the degradation of the antibiotic in vivo.


Renal trauma in the multiple injured patient. Immediate radiological evaluation of renal injuries by a large dose or infusion excretory urogram resulted in a definitive diagnosis in 87% of the cases. Further radiological evaluation or exploration was required to make a definitive diagnosis in the remaining 13%. Blunt external trauma was responsible for 94% of the renal injuries. Less morbidity and a sharp reduction in delayed renal operation followed the introduction of immediate surgical management with the more severe types of renal injury. Clamping of the renal vessels prior to opening Gerota's fascia prevents reactivation of hemorrhage and allows for a deliverate operation with conservation of undamaged renal tissue. Associated injuries were present in 73% of the patients, including intra-abdominal injuries in 42%. The over-all nephrectomy rate of 5% in this study compares favorably to the nephrectomy rate in studies reporting the expectant management of renal injuries.


Ethambutol regimen in renal tuberculosis. A 10-year experience with an ethambutol regimen for renal tuberculosis is presented. Precaution must be taken with ethambutol since optic nerve atrophy can occur. This oral therapy is now given as a single, daily dose before breakfast and has proved successful in therapy and patient acceptance. No  urine reversions have occurred in the 10 years. The regimen of ethambutol, isoniazid, cycloserine and pyridoxine may now be considered a first choice in therapy for renal tuberculosis.


The riddle of Randall's plaques.

The riddle of Randall's plaques. Randall described a pre-calculus lesion of the renal papilla in the 1930s and this was substantiated by others during the next decade and then largely ignored. This insignificant subepithelial calcification of the renal papilla. Randall's plaque type I, becomes the nucleus of at least 15% of calcium oxalate calculi, as demonstrated by apatite nuclei existing in papillary depression on the external stone surface. Cross section study of the stone demonstrates the peripheral nucleus with eccentric lamination postulating a mural origin. Contrariwise, study of the stone developing upon a nucleus originating in the papillary ducts (without producing obstruction) or out in the calix demonstrates a central nucleus surrounded by concentric laminations or lack of a mural origin, the more common type of calcium oxalate stone structure. Obstruction of the papillary ducts by hyperexcretion of stone salt may result in anemic infarction and sloughing of the apex of the papilla. Data concerning the prevalence of Randall's plaques in the population have been reviewed. Evidence of the incidence of calcium oxalate calculi that have developed upon Randall's plaques has been presented. A plea for further study of the pathology of the renal papilla has been voiced.


Radiolucent filling defects of the renal pelvis: classification and report of unusual cases. Eight cases of unusual radiolucent filling defects in the renal pelvis and calices are reported. With reference to the literature and these cases, such defects have been classified etiologically as tumors, calculi, blood clots, air bubbles, congenital anomalies, vascular phenomena, infections and associated conditions, foreign bodies and miscellaneous conditions. Most of these conditions are rare but their accurate delineation with modern diagnostic techniques will allow for more conservative surgical procedures and for maximal preservation of renal substance.


Therapeutic experience in renal hypertension: response treatment in 47 cases. We report our experience in the treatment of 47 cases of renal hypertension patients with renovascular hypertension or hypertensive reno-parenchymal disease surgical therapy is essential and non-surgical therapy has its limitations. The necessity for an operation can be based on the determination of bilateral renal vein plasma renin values. Blood should be drawn from both renal veins in patients in an upright position. Surgical treatment usually produces excellent results in patients in whom renin activity on the side of the lesion is more than normal and more than 2 times that on the uninvolved side. It is advisable to perform an operation within 4 years of the onset of renal hypertension. Complete surgical cure of renal hypertension is accomplished more frequently in patients with fibromuscular dysplasia than in those atherosclerosis. The therapeutic effect of an operation in correcting hypertension is virtually the same, regardless of whether the arterial stenotic lesions are in the main renal artery or in the intrarenal arterial branches. We have found nephrectomy or dacron bypass graft to be the surgical procedure of choice in renovascular hypertension cases.


Percutaneous renal biopsy with localization by retrograde pyelography. We describe the use of retrograde pyelography for renal localization during percutaneous biopsy in 6 patients. Since we have had no major complications with this procedure and have obtained adequate tissue in all cases we conclude that this method of localization for renal biopsy is the procedure of choice in the severely uremic patient.


Obstructive jaundice complicating pyeloplasty. The development of obstructive jaundice associated with the formation of a renal pseudocyst in 2 patients undergoing pyeloplasty on the right side is discussed. We emphasize the importance of proper drainage of the retroperitoneal area to prevent this complication.


Early, aggressive management of intraoperative ureteral injuries. Most urologic surgeons prefer proximal urinary diversion as an initial step in the repair of intraoperative ureteral injuries but an early direct attack on the injured area is being attempted more often. Our report concerns 36 ureteral injuries in 24 patients during the least 5 years. In 19 patients 20 injuries were  recognized and managed during postoperative convalescence. Repair consisted of ureteroneocystotomy in 8 patients, ureteroureterostomy in 6 and ureteral deligation in 4. Ureteral catheter manipulation alone was successful in 2 cases. Satisfactory ureteral repair was achieved in 23 patients. Definitive management was initiated upon diagnosis in all but 1 patient. We recommend an early, direct, aggressive approach to the injured area whenever possible.


Catheterless cutaneous ureterostomy.

Catheterless cutaneous ureterostomy. New procedures for tubeless cutaneous ureterostomy are described. The fundamental principles of the methods are 1) an everted ureteral nipple formation combined with a triangular skin flap as a permanent stoma and 2) a 2-stage operation to obtain a viable ureteral nipple against slough and retraction.


Intravesical formalin for the control of intractable bladder hemorrhage secondary to cystitis or cancer. Between November 1971 and December 1973, 10 patients with intractable urinary bleeding secondary to radiation or cyclophosphamide cystitis, or to primary or secondary bladder cancer were treated with intravesical formalin. Good results were obtained in 8 of the 10 patients, with control of bleeding for 3 to more than 36 months. There were 2 failures, both with cancer.


Parametal cysts of the glans penis: a report of 9 cases. Nine cases of cysts on the male urethral meatus are reported. These cysts are easily traumatized, occur early in life, enlarge slowly and apparently are not associated with infection, circumcision or trauma. These round, smooth, symmetrical and usually unilateral cysts do not interfere with urinary or sexual function except for an occasional irregularity of the urinary stream. Simple aspiration of the cyst results in recurrences. Marsupialization or unroofing  of the cyst, especially if it is large, results in a gaping sinus, which is cosmetically unsatisfactory and should be avoided. Complete excision of the cyst is cosmetically excellent and there have been no recurrences in my cases. The cause of these cysts is postulated as a blockage of the paraurethral ducts.


Bilateral testicular tumors of germ cell origin. Four cases of primary testicular tumor of germ cell origin are reported. Three  cases were bilateral, while the remaining case involved a unilateral tumor in a non-twin brother of 1 patient with bilateral tumors. Because of the increased likelihood of a second primary tumor developing in a patient who has had a malignant germinal cell tumor and because the changes may be subtle, localized to the testis and occur after a tumor-free interval of many years, careful examination of the contralateral testis and long-term followup are indicated even when systemic chemotherapy for malignancy has been used. This is the seventh time familial occurrence of testis tumors in non-twin brothers has been reported but the first time that one of the brothers had bilateral tumors.


Semen analysis: a review of samples from 225 men seen at an infertility clinic. The results from 225 men attending an infertility clinic are presented. The percentage of oval, viable and active sperm cells, and the motility scores were lower in samples with counts less than 10 times 10(6) per ml., increased in counts or 10 to 40 times 10(6) per ml. and again increased in counts more than 40 times 10(6) per ml. The percentage of semen samples with abnormalities in measured parameters dramatically increased as the sperm count decreased. The percentage of samples  with significant numbers of white blood cells was higher in samples with sperm counts less than 10 times 10(6) per ml. and in the azoospermic patients, while viscosity problems seemed to be associated with counts less than 10 times 10(6) per ml. Agglutination was more of a problem in samples with counts more than 40 times 10(6) per ml.


The effect of pharmacological agents on ejaculation. Infertility in a patient on pharmacological agents with sympatholoytic activity was found to be caused by ejaculatory failure owing to absent contraction of the seminal vesicle, ampulla and ductus deferens, rather than the previously accepted reason of retrograde ejaculation. These findings suggest that pharmacological agents producing alpha-adrenergic blockage may produce temporary interference with ejaculation, suggesting investigation of their use as reversible male contraceptives.


Wound dehiscence in urological patients. The causes of wound dehiscence in urological patients are discussed. In 576 patients undergoing 672 consecutive transperitoneal urological operations there were 9 instances of complete dehiscence (1.3%). All 9 cases involved male patients. Postoperative abdominal distnsion, wound infection, enterocutaneous fistula and simple layered closure with chromic catgut were associated with an increased incidence of dehiscence.


A mechanical device for improved exposure in kidney surgery. A mechanical device for optimal costal margin retraction, applicable to renal surgery, and the physiologic basis for its atraumatic use are presented. Use of the instrument relieves the surgical assistant of the exhausting work of retraction for exposure of the thoracoabdominal space and obviates lower rib resection in most cases.


Cutaneous transureterostomy in children. Cutaneous transureterostomy was done on 18 patients with chronically dilated upper tracts. The operation is simple with minimal immediate complications. Long-term results are good despite the frequent persistence of chronic urinary infection and dilatation of the ureters, which are attributable to their persistent damage. We believe that cutaneous transureterostomy represents a good type of urinary diversion for these children.


Pressure measurements in ileal conduits. To study the dynamic properties of ileal conduits and to attempt to diagnose obstruction at an early point in time, that is prior to the development of conduit or upper urinary tract dilatation, a continuously perfused catheter  technique was used to measure pressures within the conduit during filling and emptying, and to measure the resistance to flow at the stomal level. The mean values of residual urine, resting pressure, voiding pressure and stomal profile pressure were significantly higher in obstructed than in non-obstructed conduits. However, there was an overlap between values in each parameter, thus necessitating  analysis of the entire pressure data in any given case. The data also show that even a small increase in residual urine above normal, 4.0 plus or minus 0.9 cc, may be an indication of early obstruction and that stomal caliber does not necessarily correlate with the degree of obstruction.


Intrathoracic ectopic kidney: report of a case. A case of intrathoracic ectopic kidney is reported and the literature is reviewed. Intrathoracic ectopic kidney is a rare developmental anomaly. The surgeon should be fully aware of this anomaly in order to make a correct diagnosis before an ill-advised thoracotomy is performed.