Deposition of aerosol particles in the human nose. About 2000 breathing experiments were performed, involving four breathing manoeuvres, four volunteers, a wide range of particle diameters and various breathing patterns. Monodisperse droplets of bis(2-ethylhexyl) sebacate served as aerosol particles. The deposition of particles in the nose was calculated from total deposition of particles in the whole respiratory tract for mouth, nose, mouth-nose and nose-mouth breathing. This method allowed the determination of nasal deposition and nasal efficiency for inspiration and expiration. Total deposition was determined from measurements of the particle concentration and the respiratory volume flow rate. Considerable scatter of nasal deposition in the four subjects was found. At a constant tidal volume it rose rapidly with increasing flow rate. The nasal efficiences were found to be independent of tidal volume. For inspiration as well as expiration the nasal passages removed particles very efficiently by inertial impaction. However, inspiratory and expiratory nasal efficiences were different. The scatter of individual inspiratory efficiency could be considerably reduced by employing a mathematical relationship to describe inspiratory nasal efficiency which makes use of the pressure difference across the nose and nasopharynx during nose breathing.


Influence of respiratory air space dimensions on aerosol deposition. Models used to estimate both total and regional deposition of aerosols in the human respiratory tract have been proposed by a number of individuals and groups. Although the values chosen by different investigators for dimensions of airways or other air spaces may differ significantly from each other, there is the common assumption that the normal human respiratory tract is structurally uniform and that dimensions and branching patterns may be considered as constants in the deposition equations. There has been, therefore, considerable emphasis on estimating the effects of particle size, size dispersion, tidal volume and respiratory frequency. Much less attention has been paid to the normal intersubject variability of the size of air spaces in spite of the obvious influence this would have on aerosol deposition. Work on deposition from our own laboratories, as well as published results of others on pulmonary anatomy, has lead to the conclusion that there is considerable anatomic variability among normal subjects. Aerosol deposition in individuals examined under nearly identical conditions has also shown considerable variability. This paper will discuss the similarity in range of anatomical differences and differences in deposition and the probable relationship between the two.


Pulmonary deposition of inhaled particles with diameters in the range 2.5 to 7.5 micron. Monodisperse polystyrene particles of 2.5,5 and 7.5 micron diameter, labelled with technetium-99m, were administered to mouth-breathing subjects respiring at a rate of 10 breaths min-1. Measurements of radioactivity, made with collimated coaxial detectors above and below the chest, were continued for 24 h, when it was considered that all particles remaining represented those deposited in the pulmonary region. Measurements, made following the ingestion of labelled particles, showed that material in the gut contributed to the counting rate in the chest region even after 24 h. The results showed that in healthy non-smokers, of the material deposited below the level of the larynx, 84% of 2.5 micron, 65% of 5 micron and 30% of 7.5 micron particles were deposited in the pulmonary region. Lateral scans of the chest were also made. These enabled the position of the maximum activity on either side of the midline to be determined. The significance of these measurements is discussed.


Experimental studies of the deposition of particles in the human lungs. Measurements of deposition, De, during steady breathing through the mouth of particles between 0.5 and 2.5 micons diameter and density 0.92 g/cm3 show that it is related to the tidal volume, VT, expiratory reserve volume, Vr, and a "normal" volume, Vro, by the formula 100 De= Vt/B+C/FD- E- Vr-Vro/A where B, C, D and E are constants which depend on particle size but do not vary from subject to subject enough to have much influence on corresponding values of De. A and and Vro are independent of particle size but relate to the individual subject, especially Vro. A new method is described of correlating the numerous experimental results, which involve six variables, and of evaluating the subject's 'normal' expiratory reserve volume, Vro, for any subject.


Lung deposition in freshly excised human lungs. An artificial chest wall was constructed which was large enough to hold a whole excised human lung. this device was connected to a modified Harvard Respirator which was capable of being programmed to produce any reasonable respiration rate. Freshly excised lungs free of any disease and cuts wer placed in the chest wall and challenged with both monodisperse and polydisperse aerosol particles. Total lung deposition was measured and extremely good agreement was obtained with a specially-developed theorectical model.


On the deposition of unipolarly charged particles in the human respiratory tract. The effect of unipolar electrostatic charges on the total deposition efficiency in the human respiratory tract has been investigated. Monodisperse carnauba wax particles of diameter between 0.3 and 1.1 micron were charged, in a corona discharge apparatus, with a number of elementary charges ranging from about 30 to 110 per particle, with a narrow distribution. The experiments were performed with volunteers breathing through the mouth at 12 resp/min at constant flow rate, without pauses. The increase in deposition was of the order of 15 to 30% relative to neutral but otherwise unchanged monodisperse aerosol. The increase depended on the charges carried by each particle, but was independent of the concentration. Therefore it may be concluded that the variation can be ascribed to the effect of electrostatic attraction between the particle charge and the image charge on the airway wall.


Bronchial deposition of free ions and submicron particles studied in excised lung. Direct measurements of bronchial deposition in ventilated pig lungs are reported for radon daughter ions and condensation nuclei. Comparisons are made with deposition calculated from the theory of particle diffusion in steady, laminar air-flow. In segmental bronchi, the observed deposition of condensation nuclei was within about 25% of that calculated. Deposition was greater by up to a factor 2 in main stem and lobar bronchi. Deposition in the trachea depended upon the entrance conditions set by vocal cords. For thorium-B ions, deposition in segmental bronchi was a factor 4 less than calculated, apparently due to rapid hygroscopic growth. Clearance rates by dissolution from bronchial epithelium in vivo for lead and bismuth ions are also reported. Approximately 10% of 212Pb ions diffused into blood with a half-time of about 70 min and 30% of 212Bi ions with a much shorter half-time of about 7 min. The implications of these data in the calculation of radiation dose from inhaled radon daughters are discussed.


Accumulation and retention of 137Cs-labelled fused aluminosilicate particles by beagle dogs after repeated inhalation exposures. A group of 12 beagle dogs was given weekly, individual, 10-min inhalation exposures to aerosols of 137Cs-labelled, fused aluminosilicate particles (AMAD approximately equal to 1.8 micron, sigmag approximately equal to 1.6). Whole-body counting was used to assess the pulmonary deposition associated with each exposure and the long-term retention after exposures. Groups of four dogs were removed from further exposures at the end of 10, 20 and 40 exposures, respectively. Two dogs in each group were sacrificed and the other two maintained for long-term retention measurements. The inhaled material was relatively insoluble in body fluids. In each of the sacrificed dogs, approximately equal to 96% of the body burden was in the lung and approximately equal to 1% in the tracheobronchial lymph nodes. The average pulmonary deposition was approximately equal to 20% of the inhaled aerosol for 10, 20 or 30 exposures, a value which was in agreement with previously reported single exposure data. Lower values observed for exposures 31 to 40 were apparently related to differences in respiratory patterns. The long-term, whole-body retentions appear to have effective half-lives ranging from 1200-1800 days in contrast to approximately equal to 400 days seen in singly exposed dogs. Possible reasons are discussed.


Species differences in aerosol deposition. A theory for scaling the collection efficiency of the lung and respiratory tract is developed by identifying the dimensionless groups of variables controlling the deposition of an inhaled aerosol. The theory predicts that collection efficiency is substantially independent of body size under physiologically equivalent conditions. Thus, total deposition depends primarily on differences in ventilation per gram body weight. Experiments on mice, hamsters, rats, rabbits and dogs simultaneously exposed to the same 198Au labelled 0.78 micron aerosol are in agreement with this prediction, but show wide variability of collection efficiency even in animals of nearly identical size.


Aerosol deposition in the dog respiratory tract. Respiratory tract deposition of monodisperse aerosols have been measured in the dog, both in vivo and in excised lungs. Three particle sizes, 0.35, 0.50 and 1.0 micron, were used, with respiratory frequencies from 8 to 25 respirations/min and tidal volumes from 100 to 600 ml. The deposition fractions measured were compared with deposition fractions for one normal human subject using the same aerosols. In vivo deposition fractions for the dog were greater than those for man at comparable conditions, and greater than those for the excised lungs at the same conditions. Although sites of deposition were not directly measured, some conclusions about the appropriateness of animal aerosol toxicity studies for assessing human risk are presented. The hypothesis of geometric similarity of mammalian lungs is examine for dog and man.


A study of the short-term retention and clearance of inhaled asbestos by rats, using U.I.C.C. standard reference samples. Rats have been dosed over a 6-week period with U.I.C.C. standard reference samples of amosite, crocidolite and chrysotile A, each at three concentrations: 1,5 and 10 mg/m3. Mass concentrations in the exposure chambers were monitored daily. Because the M.R.E. gravimetric sampler was found to undersample some of these dusts at high concentrations, a sampler with a vertical elutriator was developed. Data on other physical parameters of the dust clouds were also obtained and it was found that the fibre number (greater than 5 micron in length) vs. mass correlation varied markedly between asbestos varieties. After dusting, the rats were sacrificed in five batches over a period of 4 months. The lungs of some animals were retained for pathological examination. This did not reveal any fibrosis although large numbers of fibres were visible, mostly within alveolar macrophages. The remaining lungs were analysed for their asbestos contents by a method based upon infrared spectrophotometry. The clearance data confirm earlier published reports that for rats dosed at similar mass concentrations of chrysotile and amphibole, those dosed with chrysotile retain considerably less dust in their lungs. The data also suggest that the retention and clearance of amphibole abestos may be dose related. Some mathematical treatment of the clearance data has been undertaken.


Deposition and clearance of inhaled fibrous minerals in the rat. Studies using radioactive tracer techniques. The deposition and clearance of various fibrous materials have been investigated in the rat using radioactive tracer techniques. The materials used include the U.I.C.C. standard reference samples and synthetic mineral fibres. Measurements of total and alveolar deposition were correlated with the AMADs of the radioactive dust samples which ranged from 1 to 2.5 micron. Although total deposition increases steeply over this range, alveolar deposition is relatively constant only increasing from about 10 to 13%. Alveolar deposition is lower than in man, but the maximum in alveolar deposition appears to occur at a similar aerodynamic diameter. Half times of alveolar clearance, measured over a period of several months following single inhalation exposures, were in the range 60-90 days and no significant difference was observed between amphibole and chrysotile asbestos. Autoradiographs of lung sections indicate that alveolar deposition is relatively uniform and occurs right up to the periphery of the lung. Over a period of several months the uniform distribution alters to one in which fibres accumulate in foci which are mainly subpleural. These foci act as centres for the development of nodular fibrosis.


The distribution and clearance of inhaled uranium dioxide particles in the respiratory tract of the rat. The distribution and clearance of inhaled UO2 particles in the respiratory tract of the rat has been determined by track counting in histological sections of lung at various times after a single brief inhalation. The results do not agree with the I.C.R.P. lung model. An alternative model is proposed which is more consistent with the data.


Comparative measurements of the shortterm lung clearance and translocation of PuO2 and mixed Na2O + PuO2 aerosols in mice. Mice were exposed to aerosols of either plutonium dioxide alone, or mixed oxides of plutonium and sodium with atomic ratios (Na/Pu) in the range 1.5 to 16. In the case of the mixed oxides, the lung clearance of the plutonium was represented by the sum of two exponentials, of which the short-term component accounted for 27 +/- 8% of the initial lung content with a clearance half-time of 6.0 +/- 2.7 h. These measurements were made over a period of up to 35 days after exposure, and similar measurements for a plutonium dioxide fume indicated that any early clearance phase was obscured by data variability, but was small and probably accounted for less than 10% of the initial lung deposit. The translocation of plutonium to the liver and skeleton by 1 day after exposure represented about 0.05% of the initial lung content in the case of the plutonium dioxide fume, and 7% of the initial lung content for the mixed oxide particulate where the atomic ratio was 16. The results of the animal exposures are discussed briefly with respect to the physical characterization of the particulate by electron microscopy, and in vitro filtration methods.


Deposition of inhaled monodisperse aerosols in small rodents. Aerosols of five different sizes varying from about 0.05 micron to 3 micron in aerodynamic equivalent diameter were prepared from spherical aluminosilicate particles (p=2.2 g/cm3) labelled with 169Yb. Fifty hamsters and fifty rats were exposed, while anaesthetized, to these monodisperse aerosols under controlled laboratory conditions to determine quantitatively deposition in the respiratory airways with respect to particle size and volume of air inhaled. Ten animals of each species were exposed to each of the particle sizes. Five animals were exposed simultaneously for 20 min in an inhalation exposure apparatus which provided automatic recordings of respiratory rates and volumes using individual whole-body plethymographs; three were sacrificed immediately after exposure and the remaining two after 20 h had elapsed for radioanalysis of selected tissues to determine deposition quantities and organ distribution. Detailed results are given for the observed deposition fractions for the different aerosols in the various parts of the respiratory tract. The lowest fractional total deposition occurred for particles between 0.5 micron and 1 micron in aerodynamic equivalent diameter. Relative deposition among the various lung lobes showed remarkable consistency with respect to particle size. Based upon the results of morphometric measurements of replica casts of lungs of the two species, interpretations are made relating the observed deposition phenomena to tracheobronchial anatomy.


Effect of sulphur dioxide on tracheobronchial clearance at rest and during exercise. Exposure to pollutants may cause injurious effects by impairing mucociliary transport, one of the lung's most important defences. We have studied the effect of sulphur dioxide (SO2) on tracheobronchial clearance (a) at rest and (b) while exercising, by monitoring lung retention of an inhaled radio-aerosol. Clearance was measured in two sets of conditions. 99mTc-albumen aerosol was inhaled as a bolus in late inspiration under controlled conditions to achieve reproducible deposition in large airways. The studies showed: (1) Clearance was highly reproducible in individuals in repeat control studies. (2) Acute exposure to 5 ppm SO2 showed a small transient speeding of mucociliary clearance at rest. (3) (i) Exercise alone speeded clearance significantly (P less than 0.05). (ii) Exercising in 5 ppm SO2 showed a significant speeding of clearance (P less than 0.05) beyond that found in air breathing exercise controls. (4) Pulmonary function tests showed no significant change except a decrease in flow rate (MMEF) in both (a) and (b) studies (P less than 0.01).


The effects of selected air pollutants on clearance of titanic oxide particles from the lungs of rats. A procedure utilizing the lung clearance kinetics of titanic oxide (TiO2) particles was used to determine the effects of inhaled sulphur dioxide (SO2) and nitrogen oxides (NO x) on particle clearance. The procedure is reproducible and mainly tests clearance mechanisms involving alveolar macrophages and the mucociliary transport system at the alveolobronchial clearance pathway. At low SO2 or NOx exposures enhanced particle clearance was observed. Lung clearance was depressed at 15 and 24 ppm of NO2 after 22 exposures as well as at 20 ppm of SO2 after 11 exposures, and also at 1 ppm of SO2 after 25 exposures. Dose-response curves for the SO2 and NOx exposures showed differences explainable by the routes by which these gases reach the alveolar macrophages.


A theory of predicting respiratory tract deposition of inhaled particles in man. The respiratory tract deposition of inhaled aerosol particles is due to three principal mechanisms: inertia impaction, Brownian diffusion and gravitational settling. A theory is developed to predict the particle deposition and its distribution in human respiratory tract for any breathing condition. A convection-diffusion equation for the particle concentration with a particle-loss term is used to describe the transport and deposition of particles. In this equation, an apparent diffusion coeffcient due to the velocity nonuniformities in the lung is introduced and is found to be the dominant diffusion mechanism. Expressions for deposition by various mechanisms in dead-space airways and alveolated airways are alo derived. The governing equation is solved numerically with Weibel's lung model A. The airway dimensions, however, are scaled to account for the average lung volume. The total depositions in the lung for particle sizes ranging from 0.2 micron to to 3.0 micron are computed for various steady breathing conditions. The results agree well with recent measurements using bis(2-ethylhexyl) sebacate particles and are less than the previous theoretical predictions. The regional depositions as well as the detailed deposition profiles along the airways are also calculated and discussed.


Short-and long-term experimental study of the toxicity of coal-mine dust and of some of its constituents. The toxicity of various minerals (kaolin, muscovite, illite) was compared by tracheal tests on rats to that of reference dusts (quartz, titanium dioxide, coal). These minerals have various degrees of toxicity. Owing to their sometimes very high concentration in the respirable dust, their toxicity should be taken into consideration. In order to define the aggravating role of quartz more accurately, dust inhalation tests were also conducted on rats with coal and a coal-quartz mixture containing about 10% quartz. The difference in the toxicity of these two types of dust which is practically not detectable up to 12 months, then increases progressively after that period. In addition, in rats having inhaled either coal or a quartz-coal mixture for 24 months, there appear tumoral lesions, principally of epidermoid type.


Pathogenicity to animals of fine dusts from Ruhr mines. Twelve different groups of fine mine dusts were examined for their in vivo aggressivity by intraperitoneal injection. Twelve months after injection of the dust, quantitative morphometric analysis of the lymph nodes was carried out to determine (a) the extent of the typical quartz reaction, (b) the in vivo cytotoxicity, (c) the size of the lymph nodes. Different fine dusts showed significant variations in parameter (a) and (c). In the second part of the investigation, the results of the lymph node tests and of in vitro cytotoxicity tests, and also the quartz contents of the dusts were fed into a data matrix and subjected to correlation analysis and principal component analysis. The following hypotheses were arrived at to explain the effect of the fine dust in vivo: (1) The amount of fine dust which penetrates into the lymph nodes is dependent on its in vitro cytotoxicity (Factor A). This is not related to the quartz content of the dust and is not inhibited by PVNO. (2) The specific fibrogenic activity of the fine dust within the lymph node is primarily dependent on its quartz content (Factor B). It appears that this effect is inhibited by PVNO. (3) The total fibrogenic activity depends on a combination of Factor A and B.


The therapeutic action of aluminium compounds on the development of experimental lesions produced by pure quartz or mixed dust. The prophylactic and curative effect of aluminium salts administered as aerosols on the development of lung lesions caused by the dust inhalation of quartz, two coal-quartz mixtures with 17% and 8% silica, respectively, and pure coal, was studied experimentally on rats. It appears that the preventive treatment is very efficient either in the case of pure quartz or coal-quartz mixtures. The curation treatment with regard to pure quartz leads to constant lung weight and reduced rate of collagen formation; the effect is the more evident as the silica content of the dust is higher and becomes nil with pure coal. The effectiveness is slightly increased when aerosols at higher concentrations are used, but the difference is not proportional to the dose. Under these experimental conditions, the aerosols used showed no toxicity.


The action of quartz in the presence of iron hydroxides in the human lung. In 1932 Kettle reported that the fibrogenic action of quartz particles is inhibited when they are coated with iron. Many authors subsequently confirmed this finding. Reif et al., who studied the effect of different iron-ore mine dusts, showed that, like aluminium hydroxide, iron hydroxide has a strong effect in inhibiting the fibrogenic action due to quartz. The findings of this paper, based on an X-ray survey of a group of 7735 iron ore miners, on autopsy examinations, tissue dust analysis and physiological examinations, confirm the view that FeO(OH) is a most powerful inhibiting substance.


Particle deposition in systems of repeatedly bifurcating tubes. Deposition of half-micron particles from steady inspiratory flows was measured in the daughter branches of the second bifurcations in a symmetric airway model consisting of two successive generations of bifurcation. Two different configurations were studied: (1) both bifurcations in the same plane and (2) the second bifurcation normal to the plane of the first. The results indicate that the deposition in the daughter branches in configuration (2) is relatively uniform, while that in configuration (1) has a distinct second deposition hot spot, in addition to the one at the carinal ridge. The deposition velocities in the branch which has secondary flows in the opposite sense to those in its parent branch are about 50% lower than those in other types of branches. The deposition patterns are consistent with the observed flow profiles in these tubes.


Inertial deposition of particles in human branching airways. This paper concerns the inertial deposition of aerosol particles in models of human branching airways. Homogeneous monodisperse aerosols of known characteristics were generated using a spinning disc atomizer. These were paused through simple bend systems of differing geometries, and the fractional deposition measured by a fluorimetric technique. The parameter characterizing 50 per cent deposition in the bend was found to agree with that predicted theoretically. Deposition in five models of bifurcating airways having geometries generally compatible with existing anatomical data was studied using essentially the same experimental procedure. The magnitude of the inertial deposit was measured and the overall effect of fluid-flow rate, particle size, branching angle and size of model determined. The results were compared with exsting theoretical estimates of impaction in a bifurcating airway.


The influence of fibre shape in lung deposition-mathematical estimates. Inhaled fibres deposit by sedimentation, diffusion, impaction, and interception in airways of the respiratory system. Long straight fibres may exhibit periodic motiion with ordered orientation in those airways having laminar flow. We assume that irregular fibres are randomly oriented in airways. Mathematical models based on respiratory system architecture, respiratory airflow, and mathematical expressions for deposition mechanisms have been developed to predict deposition in respiratory compartments of fibres in ordered orientation and of various fibre confirgurations in random orientations. The size and shape characteristics of chamber aerosols generated with U.I.C.C. asbestos specimens have been determined. Combinations of the chamber aerosol data with mathematical estimates of deposition suggest that fibre shape as well as size influences the magnitude of deposition in pulmonary spaces. For size distributions such as those of the U.I.C.C. asbestos chamber aerosols, the mathematical models predict pulmonary spaces deposition for straight fibres in ordered orientation about twice as great as for irregular fibres in random orientation.


The human head as a dust sampler.

The human head as a dust sampler. A life-size model human head and shoulders was exposed in a wind tunnel to winds between 0.75 and 2.75 ms/s and particles up to 30 micron aerodynamic diameter, and the weight of material entering the nose and mouth at various breathing rates was compared with that caught by isokinetic samplers. When aspirated at a constant rate, the head behaved like a blunt sampler, showing a ten-fold variation in entry efficiency for different windspeeds and directions, and a two-fold variation even at 5 micron. Detailed facial structure had little effect. The efficiencies for various breathing patterns and minute volumes were calculated, and when averages were taken for all wind directions, to simulate a worker randomly oriented to the wind, the efficiencies lay within a fairly small range, and were all substantially less than 100%. "Total" dust standards and samplers should take account of these efficiency curves.


[Diaphragmatic rupture in thoracicabdominal blunt traumatisms]. The authors review the case histories in twenty patients with traumatic rupture of the diaphragm seen and surgically treated during the last eight years at the Central Hospital of the Mexican Red Cross. Automobile accidents were the most frequent cause and the diagnosis was made on the basis of the clinical history and X-ray examinations. In some patients the lesion is not incapacitating and may remain unrecognized for many years. The left hemidiaphragm is more frequently involved. The usual surgical approach employed was, first, anterior thoracic; second, abdominal-thoracic and third; abdominal. Among the secondary thoracic and abdominal lesions those affecting the liver were the most frequent. The stomach was the organ which most frequently had to be resected. Eight patients died and in seven the cause of death could be attributed to the secondary lesions.


[Morphological study of the hepatocyte in cirrhotic patients treated with phenobarbital]. The authors report on a comparative study of light and electron microscopy in the diagnosis of tissue obtained in 21 percutaneous liver biopsies in patients known to have cirrhosis. Using light microscopy twelve patients were ascertained to have post-necrotic cirrhosis and twelve had Laennec's cirrhosis. All of these patients were given phenobarbital, 65 mg. every twelve hours, during twenty-one days. A control group of five patients received placebos. With electron microscopic methods, in all of the cirrhotic patients both before and after treatment with phenobarbital, the authors observed bands of fibrous tissue made up of collagen fibers and fibroblasts which originate in the portal spaces and in the Kupffer cells. This makes up the mesenchymal reaction to the liver cell damage, which in the long run proves to be more important than liver cell regeneration. Phenobarbital treatment resulted in hyperplasia of the agranular endoplasmic reticulum in liver cells. The authors agree with other authors that this is related to metabolic activity of enzymes acting on extraneous drugs and chemical substances.


Energy dispersive X-ray microanalysis of zymogen granules of mouse pancreas using fresh air dried tissue spread. Electron microscopy of fresh air dried pancreas spreads revealed a well preserved ultrastructure of pancreatic exocrine cells. The zymogen granules were identified as homogenously electron dense round bodies of approximately 300 nm in diameter, the same as were seen in fresh frozen dried sections. Energy dispersive X-ray microanalysis of zymogen granules and spots 200 nm distant from the granules used as controls disclosed peaks for chlorine, potassium and sulfur in all of five granules examined and in three of them, phosphorus was found in addition to the above elements. The results seem to suggest that pancreatic juice may be contributed from the electrolyte content of secretory granules in contrast to the general assumption that enzymes and electrolytes are separately excreted in pancreatic juice.


Subcellular distribution of phospholipids in different types of skeletal muscle. Subcellular distribution of choline and non-choline phosphatides has been studied in tetanic (fast-twitch) and tonic (slow-twitch) muscles of rabbits. The choline phosphatide content of the subcellular fraction including the sarcolemma was greater in the tetanic than in the tonic muscle. On the other hand, the choline phosphatide content of the mitochondria-free sarcoplasmic fraction was greater in the tonic than in the tetanic muscle. A greater amount of non-choline phosphatide was found in each subcellular fraction of the tonic muscle as compared with those of the tetanic one. There was more fatty aldehyde in the non-choline phosphatides of each subcellular fraction of the tetanic muscle, than in those of the tonic one, of this type being much smaller in the tetanic muscle. There is not such an expressed difference in the fatty aldehyde contents of choline phosphatides of the subcellular fractions between the two kinds of muscle.


Effect of denervation on the phospholipid content in subcellular fractions of tonic and tetanic muscles. Four weeks after denervation, various changes were observed in the phospholipid composition of the sarcolemmal and sarcoplasmic fractions of skeletal muscles with different functions. Neurotomy also affected the innervated contralateral muscles and produced opposite changes in the phospholipid content of subcellular fractions. The increase in the amount of phospholipids in the sarcolemmal fractions of the denervated muscles was only apparent. The difference between the denervated and contralateral muscles was also due to the decrease of phospholipids in the contralateral muscles. These changes were more pronounced in the tetanic (fast-twitch) than in the tonic (slow-twitch) muscles. In the sarcoplasmic fraction of the denervated tetanic muscle an increase, while in that of the tonic one a slight decrease of phospholipids appeared. In contrast, the phospholipid content in the sarcoplasmic fractions of contralateral muscles did not decrease, while it increased slightly in the tonic muscle. The amount of plasmalogens (fatty aldehyde: lipid phosphorus ratio) decreased only in the subcellular fractions of the denervated muscles while there was no change in those of the contralateral muscles.


Specific baroreceptor control of vertebral and cardiac sympathetic activity. The effect of bilateral carotid occlusion (BCO) on the activity of the vertebral and cardiac sympathetic efferent nerves was studied in gallamine-immobilized and artificially ventilated cats under chloralose-urethane anaesthesia. Electrical activity of the vertebral and cardiac nerves (VNA and CNA), their integram, arterial blood pressure and respiration were recorded. BCO led to an increase in VNA persisting throughout the occlusion period, while merely a transient increase took place in CNA. When blood pressure was kept at a constant level or the depressor nerves was transected, CNA responded to BCO with a lasting increase. Electrical stimulation of the central stump of the left depressor nerve inhibited CNA much more than VNA. It is assumed that the selective inhibition of CNA, after a transient increase, arises as a consequence of a rise in blood pressure, i.e. of consecutive aortic baroreceptor excitation.


The immunology of asbestosis.

The immunology of asbestosis. Forty-one employees with varying degrees of asbestosis have been tested for any alteration in the immunological profile. Of these, twenty-two employees showed evidence of pleural thickening and nineteen parenchymal asbestotic fibrosis. Those employees showing pleural thickening gave a strong reaction to different skin tests and a few of those with a parenchymal asbestotic fibrosis showed depressed cutaneous reactivity. Lymphocytotoxic antibodies were present in the sera of 60% of those with pleural thickening and 94% of those with parenchymal asbestosis. An immunological screening schedule is suggested for those employees who show pleural thickening.


Topographic distribution of asbestos fibres in human lung in relation to occupational and non-occupational exposure. A topographic study of asbestos fibre content of lung and pleura of diversely exposed cases has been carried out. For heavily exposed cases with lung fibrosis, this study has stressed the distinctive behaviour of the peripheral lower lobe in the retention of asbestos fibres in the lung. In these areas were found the smallest asbestos concentrations but the largest fibres. For cases without lung fibrosis, the results clearly demonstrated an accumulation of asbestos fibres, especially of chrysotile type, in peripheral areas. These findings are to be related to the incidence of pleural mesothelioma associated with moderate or low exposure. The small variation of fibre concentration in the pleural plaques of diversely exposed subjects is pointed out.


The biological effect of asbestos and asbestos cement products. The importance of the physical characteristics, rather than the chemical composition of fibres, in relation to their alveolar deposition and biological effects is stressed. For alveolar deposition in the aerodynamic properties--depending on the fibres diameter--are decisive, whereas in the interaction between macrophages and fibres, fibre length is the decisive factor for cytotoxicity. Probably fibre length could, inter alia, be responsible for a pathogenic effect around the lung tissue. The results from measurements of the cytotoxicity of the UICC standard asbestos dusts and pure cement dust are presented and discussed.


The influence of varying lengths of glass and asbestos fibres on tissue response in guinea pigs. Intratracheal injection of samples of naturally occurring and man-made mineral fibres into guinea pigs showed that while long fibre samples produced marked fibrosis, short fibre specimens produced only a macrophage reaction. In most cases the long fibre samples were administered in smaller doses than the short. The samples tested were crocidolite asbestos, a synthetic fluoramphibole and two specimens of glass fibre with different mean diameters. With all the minerals tested some short fibres, but not long fibres, were transported to the hilar lymph nodes. In some instances the numbers of short fibres found in these nodes appeared to be much higher than would be expected from the percentage of short fibres in the original sample, and it is suggested that this may be due to the breakdown of long fibres within the lung.


Immunological studies of experimental coalworkers' pneumoconiosis. A comparative immunological and microbiological study of experimental coalworkers' pneumoconiosis (CWP) was made in rats and mice subjected to long-term exposures of coal-mine dust aerosols. Such aerosols were realistically prepared at a concentration equal to the maximal level of respirable dust permitted by Federal standards and animals were exposed for lengths of time equal to human work contact. Among the factors studied were the production of IgA and lung reactive antibody, lung microflora and changes in pulmonary clearance. Additional experiments were concerned with the effects of passively administered lung antibody on the pulmonary clearance. It was found that both species responded immunologically in a similar manner to humans with CWP in that IgA levels were significantly elevated and lung reactive antibodies were stimulated. Coal-mine dust inhalation had little effect on the pulmonary inactivation of inhaled bacteria, but the concomitant occurrence of passively administered lung reactive antibody seemed to enhance the inactivation.


Investigation of alveolar macrophages from rats exposed to coal dust. Rats were exposed to the inhalation of coal dust from either Utah (low prevalence coalworkers' pneumoconiosis (CWP)) or Pennsylvania (high prevalence CWP). Rats were sacrificed, the lungs removed and lavaged to obtain free cells. The number of alveolar macrophages recovered from rats inhaling these two coal dusts (exposures up to 4 months) was not remarkably different from the number recovered from rats inhaling filtered room air. This is in contrast to results obtained after intratracheal intubation of the dust. The capacity of the lavaged cells to phagocytize and kill bacteria decreased after exposure to either dust. The activity of certain enzymes also decreased.


The effect of increased particles on the endocytosis of radiocolloids by pulmonary macrophages in vivo: competitive and toxic effects. We have developed a technique for measuring the rate of particle ingestion by pulmonary macrophages in vivo. This technique has been used to examine the impact of pre-exposure to ferric oxide, colloidal carbon, and coal dust on the endocytosis of a test particle, colloidal gold. Our technique for estimating endocytosis is as follows: Syrian golden hamsters received intratracheal instillations (0.15 cm3/100 g body weight) of a suspension of colloidal 198Au (approximately 30 nm diameter). Two hours following instillation, each hamster was sacrificed and its trachea cannulated. The lungs were lavaged 12 times with saline solutions, and the number of cells and gold particles in each wash determined. Analysis of the washout curves permits the calculation of the fraction, gamma, of the colloidal particles which has been ingested at a time, t. This method was then used to measure the influence of inhaled or intratracheally instilled particles on the endocytosis of the gold particles. Hamsters breathed ferric oxide aerosol spontaneously or were given intratracheal instillations of colloidal carbon or coal dust. Immediately following the exposure, the ability of the macrophages to ingest a test particle was assayed by the technique described above. In all instances, colloidal gold endocytosis measured at 2 h was significantly depressed. However, when challenged by the gold colloid 24 h after exposure to the inhaled or instilled particles, only the coal dust group exhibited depressed endocytosis. We conclude that all dusts studied competitively inhibit endocytosis, but only some exhibit a toxic effect on macrophage function.


Polonium-210: lead-210 ratios as an index of residence times of insoluble particles from cigarette smoke in bronchial epithelium. Lead-210 and its granddaughter polonium-210 are both natural constituents of cigarette smoke, the 210Pb being enriched in insoluble particles derived from sintered tobacco trichome tips. These particles are stripped of the polonium on combustion, and thus the polonium begins growth at the time of inhalation. Polonium-210 is found in bronchial tissues of smokers, and evidence shows that 210Pb is present at these sites in excess of the polonium. On the assumption that all polonium arises from ingrowth from the insoluble particles, one may calculate from the polonium-lead ratio the mean residence time of these particles. The half-life of polonium (138 days) is almost ideal for this purpose, and its alpha radiation makes measurements of very low concentrations possible. This technique is the first available to assess residence time for inhaled particles in the bronchial epithelium, an important datum because of the vulnerability of bronchial tissues to disease. Measurements from three smokers and two non-smokers show that 210Pb from natural aerosols also is concentrated at bronchial bifurcations, but little 210Pb is associated with this soluble lead. This fact makes estimates of residence time in bronchial epithelium of smokers (3-5 months in these preliminary data) likely to be low.


Lung response to localized irradiation from plutonium microspheres. Uniform spherical 10-micrometer diameter particles of ZrO2 ceramic, containing various concentrations of PuO2, have been injected into the jugular vein of Syrian hamsters with subsequent permanent lodgement in the lung capillaries. The number of particles injected has varied from 2000 to 2 000 000 and the specific activity has been from 0.16 to 59 pCi/sphere so that lung burdens range from 0.2 to 700 nCi. To date, approximately 3000 hamsters have been committed to the experiment and two-thirds have died--the expected rate for normal animals. Little biological damage has been observed, and only five primary lung tumours have been found that may be due to radiation delivered to the lung. To provide a comparison to more uniform radiation, soluble polonium has also been instilled intratracheally. Results from the microspheres suggest that localized lung irradiation alone is not sufficient cause for tumour induction and is much less hazardous than diffuse exposure.


Chemical and physical properties of British talc powders. An examination of bulk talc samples imported into Great Britain has shown that they are extremely variable in their talc mineral content. Major contaminating minerals present with the talc are chlorite, carbonates and quartz. The chemistry of samples examined varied with their mineralogical content which also accounted for observed differences in particle morphology. Tremolite fibres were found in three samples, one of which contained the mineral as a major phase. No other varieties of asbestos were detected.


Animal experiments with talc.

Animal experiments with talc. Italian talc has been tested on rats using three routes, intra-pleural inoculation, inhalation and ingestion. Groups exposed to superfine chrysotile asbestos and untreated controls were included for comparison. In all the experiments animals were allowed to live out their lives. The intra-pleural inoculation of talc produced no mesotheliomas in contrast to eighteen produced by the chrysotile asbestos. After ingestion, one leiomyosarcoma occurred with Italian talc and one with chrysotile asbestos. Whether these tumours are a consequence of the feeding is uncertain. The inhalation studies demonstrated that with equal dosage, talc can produce a similar amount of fibrosis as asbestos. However, the chrysotile exposed rats developed lung adenomas, adenomatosis and an adenocarcinoma, whereas the only lung tumour seen in animals exposed to talc was a small adenoma, which may have been an incidental finding.


Results of epidemiologicalm mineralogical and cytotoxicological studies on the pathogenicity of coal-mine custs. Risks of developing abnormalities on chest X-rays differ widely between collieries in the Ruhr, despite comparable dust exposures. Simple pneumoconiosis hazard indices have been determined for thirteen collieries, taking into consideration variations in miners' individual cumulative dust exposures, their ages at start of dust exposure, the residence time of dust in their lungs, and the mineral content of the dust. Fine dust samples were taken in five collieries at places selected as representative of seams worked during the past 20 years. They were used for mineralogical and physical analyses and for cell and animal studies. Cytotoxicity of dusts with comparable composition increased with geological age and rank of coal seams. This finding is consistent with results from epidemiological studies.


Chronic obstructive lung disease in gold miners. A survey has been made of 2209 gold miners in the Republic of South Africa. The result showed that there is a significant dose-response relationship between dust inhaled and both chronic bronchitis and airways obstruction. This is found in smokers, ex-smokers and non-smokers. The effect of smoking is more potent than that of dust but there does not appear to be a dose-response relationship in regard to smoking. The effect of smoking differs from the effect of dust in that ex-smokers show less bronchitis and less airways obstruction than smokers, but ex-miners do not show a similar advantage over working miners.


Smoking and coalworkers' simple pneumoconiosis. The attack rate of simple pneumoconiosis in 2723 British coal miners is considered in relation to the men's dust exposures and smoking habits. A complementary analysis is presented, using less precise radiological data, of prevalence and attack rates in an independent group of miners. One of the analyses suggests that, at high dust exposures, smoking may be associated with an increased risk of developing pneumoconiosis: but the most sensitive statistical test used reveals that the apparent effect might well be due to change factors (P not less than 0.09). The possibility is investigated that the net observed effect is the resultant of conflicting tendencies in sub-groups characterized by their responses to questions on phlegm production. There is no evidence to support this hypothesis. It is concluded that the main variable determining the development of simple pneumoconiosis is exposure to airborne dust, and that this effect is not modified appreciably by whether or not coal miners smoke.


Possible synergism of exposure to airborne manganese and smoking habit in occurrence of respiratory symptoms. The possible combined action of manganese exposure and smoking on the rate of respiratory symptoms was studied in three groups of male workers at various levels of exposure to manganese: occupational exposure (369 workers), relatively high ambient exposure (190 workers) and low ambient exposure (204 workers). The study was carried out by means of the standard epidemiological method. Between non-smokers in the different groups there was no difference in the prevalence of respiratory symptoms. In smokers the prevalence was significantly higher in workers occupationally exposed to manganese than in those with a low ambient exposure. The tendency of the prevalence of respiratory symptoms to increase with the extent of the smoking habit was also most pronounced in the groups of occupationally exposed workers. Since other relevant factors under control in the compared groups were more or less uniform, the results indicate that managanese exposure and smoking might have a possible synergistic effect on the occurrence and rate of respiratory symptoms.


Physiological changes in asbestos pleural disease. This paper reports the findings of a study of lung function at rest and during progressive sub-maximal exercise in a group of men with varying degrees of asbestos-related pleural abnormality. The results show that pulmonary fibrosis is accompanied by more adverse functional change than pleural abnormality, diffuse pleural thickening is associated with more functional abnormality than non-calcified pleural plaques, and pleural calcification is not associated with significant functional defects. The relationship between lung function and asbestos exposure in this selected group is discussed. It is also suggested that VE1-0 is as useful an index of the ventilatory cost of exercise as VE1.5.


Differences in lung effects resulting from chrysotile and crocidolite exposure. Crocidolite asbestos exposure may carry a greater risk for the development of lung and pleural tumours than chrysotile exposure, although differences in regard to lung fibrosis have not previously been demonstrated. Clinical, radiographic and physiological indicators of lung disease were related to qualitative and quantitative estimates of past total dust exposure in two groups of workers who had spent 20 to 30 years in the asbestos cement industry. One group had exposure to chrysotile, silica and crocidolite in the pipe-making area; the other group had no crocidolite exposure. Crocidolite exposure was related to the prevalence of small irregular opacities and pleural thickening but not to small rounded opacities. The "crocidolite" group had significantly small lung volumes, lower forced expiratory flows, and reduced pulmonary diffusion. Finger clubbing was the only clinical fineing significantly more prevalent in the crocidolite-exposed workers. It is suggested that crocidolite exposure has a greater fibrogenic effect on the lungs than a similar total exposure to chrysotile asbestos.


Radiological changes over 20 years in relation to chrysotile exposure in Quebec. Radiological changes in 267 male Quebec chrysotile mine and mill workers, each with five chest films spanning an average of 20 years, were related to age, smoking habit, mining area, duration of employment and average dust concentration before and between films. (1) Abnormality in the earliest film was related mainly to the time since first employment. (2) In 45 (30%) of the 150 men completely normal at earliest film, some radiological abnormality developed during the period of observation: incidence was weakly related to age; in Asbestos, the risk of developing small opacities was lower in smokers than in non-smokers. (3) There was an irregular pattern of correlation, more evident in Thetford Mines than in Asbestos, between radiological progression and various stimulus variables. That associations between radiological responses and measures of asbestos exposure were, as always, weak, despite powerful methodology, indicates that effects are obscured by other factors (including susceptibility) uncorrelated with exposure.


[Treatment of amebic hepatic abscess with tinidazole]. The patients reviewed in this study are thirty individuals with acute amoebic hepatic abscess. They were given tinidazol, two grams a day in one dose, for three days, with the object of ascertaining if this would be adequate treatment and without important side effects. The clinical diagnosis was confirmed by X-rays of the thoraz and abdomen, laboratory studies and liver scans. This latter as well as the laboratory tests were repeated at 10 and 20 days. Several of the patients were considered to be gravely ill. In 43% of the patients there was hepatomegaly grade II or II, in 30% there was jaundice, in 64% the abscess was very large and in 30% there were several abscesses. In keeping with the guide lines previously agreed on, 28 patients were cured, or that is 93%. There were no important side effects.


[Peptic ulcer in adolescents].

[Peptic ulcer in adolescents]. The author reviews three cases of adolescents who had peptic ulcer of the duodenum and at the same time were known to be not content at school. These emotional problems can be explained by a lack of understanding on the part of the parents insofar as their children's conduct is concerned and one result is a functional dependency. Methods which would tend to alter this mother-son dependency are recommended.


[Lithiasis of hepato-cystic-choledochal confluence. Surgical treatment]. The author reviews the case histories of ten patients who had gallstones at the confluence of the cystic and common bile ducts. These were found within a total group of 1,388 patients operated on at the Hospital La Raza between 1971 and 1973 for biliary tract and gallbladder disease. In all of these cases a reconstruction of the common bile duct over a T catheter and extending to the cystic duct was carried out. The usual technique for cholecystectomy could not be used. The satisfactory results were due to the careful dissection of the area, adequate irrigation of the small cystic duct segment used for the reconstruction and to cholangiographic control carried out during surgery. Even though this type of problem in infrequent (0.7%) among biliary tree digestive tract fistulas, we must keep it in mind because it may bring about iatrogenic lesions of the biliary tree which may be fatal. In this small series there were no deaths and the postoperative evolution was satisfactory.


[The foot in leprosy].

[The foot in leprosy]. The more frequently occurring bone lesions of leprosy of the foot are described with illustrations from patients with leprosy seen some years previously in Sardinia. These cases are classified into groups depending on the presence of osteoporosis, osteitis, lesions with predominantly inflammatory manifestations, those with a spindle-shaped appearance and lastly those with pathological fractures. The anatomical relationship between cutaneous and bone lesions is outlined.


[Surgical treatment of epiphysiolysis of the hip]. Surgical treatment of aseptic necrosis of the femoral head is discussed. Results of 30 hip procedures performed in 26 patients, followed up for a variable period from 8 months to 8 years after the first visit, are reported. The importance of early diagnosis is stressed. Surgery is recommended as the only suitable treatment. It aims to reduce and re-form the femoral head in acute cases and to stabilize and correct the displacement in the less rapidly progressive forms. Cases were divided into 3 groups according to the degree of displacement (less than 30 degrees, from 30 degrees to 45 degrees and greater than 45 degrees). Fixation in situ was carried out in the first group and Imhauser's three-dimensional intertrochanteric osteotomy and osteotomy of the head and neck of the femur in the second and third group respectively. Good results were obtained in 23 (76.6%). In the other 7 cases (23.4%) the outcome was unsatisfactory.


[Preliminary studies on the ultrastructure of osteoid osteoma]. The ultra-structural appearance of osteoid osteoma is described. Significant features are; a well-developed endocytoplasmic reticulum, dilated cisterns in the cytoplasm of the osteroblasts, mineralized mitochondria from the cytoplasm of the osteoblasts and crystalline agglomerates on the vesicles rather than on the collagen network. The increased bone forming activity of the tissues of the osteoid osteoma is confirmed by the appearance of the osteoblastic cytoplasm. The presence of needle-like endomitochondrial crystals are further proof of enhanced osteoblastic function of the osteoid osteoma. Granular crystals appear when degenerative processes take place.


[Tibial osteotomy in the treatment of static gonarthrosis]. Results of 35 cases of subcondylar tibial osteotomy performed for static osteo-arthritis of the knee from 1072-75 are reported. The surgical procedure consists of an oblique osteotomy followed by the removal of a wedge of bone with an internal or external base depending on the presence of "genu valgum" or "genu varum" respectively. Bone ends are united by screws. Major advantages of this operation are solid bony union of the osteotomy sections by screws and simplicity of execution.


[Behavior of articular cartilage under stress]. The functional principles are described of an electromechanical method for the in vitro determination of microscopic deformities of the articular cartilage under stress. A first series of experiments of human and bovine cartilage obtained from different localizations and by different methods are described. The behaviour of the cartilage can be adequately assessed by means of this test which could be used to devise a mathematic model for the analogic simulation of tissue. By this method, together with other histological and physico-chemical investigations, a more complete formulation of the structure of cartilage is proposed.


[Immediate surgical treatment of supracondylar fractures of the elbow in childhood]. The results of surgical treatment, in children, of 10 supracondylar factures of the humerus, complicated by vascular and neurological disturbances were so satisfactory that open reduction is proposed for all those cases with severe lesions and oedema requiring a prolonged period of continuous trans-skeletal traction even without neurological and vascular problems.


[Primary surgical treatment of congenital hip dislocation]. After discussing some technical aspects of the surgical treatment of the congenital luxation of the hip, the Author reports on 148 of his own cases operated over a period of 8 years. He then goes on to evaluate the follow up also with regard to the age when treated and to describe the more unsuccessful cases. Also in the light of bibliographical data, he then considers the different indications for the treatment of the congenital luxation of the hip, pointing out in his conclusions that among the many reasons that have made him a firm upholder of the primary surgical treatment of the congenital luxation of the hip is the very small percentage of postreductive osteocondrosis which, as is known, often gives rise to serious, irrevocable invalidation.


[Dysplasia of the hip and pre- and postnatal posture]. Recent publications stress the importance of exogenous or environmental factors in the aetiology and pathogenesis of dysplasia of the hip. For this reason ante- and post-natal postures were studied in detail especially intra-uterine malposition and the so-called "forced" or "adaptation decubitus" (Zwangshaltung, Schrägseite-Lage Syndrome, Congenital pelvic obliquity). Even with the data obtained from very early (neonatal) diagnosis no distinction can as yet be made between dysplasic alterations of the hip which are sometimes associated with the above-mentioned anomalies and true congenital dysplasia. Furthermore, intra-uterine malposition and consequent breech presentation would seem to be a result rather than the cause of congenital dysplasia which only rarely occurs without underlying primary hip-joint pathology.


[Medical gymnastics in "surgical scoliosis"]. After simple premises on scoliosis and on physiotherapy, we design the evolution of the illness in: physiotherapic, orthopaedic and surgical scoliosis, connected with the therapeutic moment. Then we underline the necessity of surgical scoliosis to sustain it adequately with a careful physiotherapic treatment either for the preparation to the operation or in the stage following the operation.


[Hospital design: technical organizational devices and solutions facilitating the orthopedic traumatologic patient]. Taking the institution of a new Hospital as a hint, the author underlines the need for the newly realized Hospitals to be planned, equipped and organized in a rational way so that they may offer a "quality leap" in the sanitary assistance raising it to the levels already reached in other Countries. For this purpose some planning devices and technical innovations are to be suggested (in services of medical interest) which aim at making the stay in hospital of an orthopedic-traumatologic patient more advantageous. Next to the constructive solutions, passive, it is necessary to underline the utility of the stay in hospital to become "active". With this term the author means both the way of conceiving the stay in hospital, characterized by the so-called "bed physical exercises", organized by a "ward physioterapist", and a real "active" participation of a patient in the life of the ward in its daily aspects even the smallest ones.


[Current orientations in the surgical treatment of pluriligamentous lesions of the external knee compartment]. Present orientation on surgical treatment of pluriligamentous lesions of external knee compartment. Author faces the problem of serious external knee loosening treatment. Reports some data on functional anatomy and physiopathology in order to entroll the single elements, capsule and ligaments, in complex articular function. The author dwells upon the method used in the treatment of recent and inveterate lesions, describing the technique and concludes reporting the results obtained after operation.


[Thompson's endoprosthesis in the treatment of recent fractures of the femoral neck. Long-term results]. This paper provides a long-term review of 38 elderly patients with fracture of the neck of the femur. They had been discharged well and ambulant after application of Thompson's intra-articular prosthesis. Death supervened in 5 within an interval of 3-6 years after the operation. Twenty-six complained of pain in the joint. Another three had reduced mobility from ossification around the prosthesis. It is concluded that the insertion of an intra-articular prosthesis for fractures of the femoral neck does not give good long-term results and is not the ideal treatment for this injury in elderly patients.


[Osteoid osteoma of the vertebral column as a cause of scoliosis]. After reminding how difficult it is to reach the diagnosis for an osteoid osteoma of rachis, the Authors report of a patient who was put under their observation after having been treated as lumbar scoliosis and discitis for one year. As they removed the osteoid osteoma, the painful symptomatology punctually disappeared and the rachis, after few months, was in its normal order.


[Neurogenic osteo-arthropathies due to chronic alcoholism]. Recognised forms of neurogenic osteo-arthropathy, their aetiology and pathogenesis are reviewed. Seven unusual cases are presented. Chronic alcoholism was a possible pathogenetic factors in these cases of neurogenic osteo-arthropathy from persistant drunkeness and not osteo-arthropathy occurring in alcoholics. Thus a new clinical entity is proposed.


[Comminuted fractures of the distal part of the femur]. The Authors discussed the problem of femoral over intracondylar structures, that industrial and highway accidents have increased we consider as necessary a perfect anatomical repair of articular surfaces, in order to avoid any rigidity or secondary artrosys. It's considered essential on such purpose surgical reconstruction, which, thanks to new methods and antibiotics it's to be considerate much more sure than once. After short recollection of functional anatomy one stops on surgical treatment adopted at the orthopedic clinic of Verona, separated office of Padua University, and reporting at the end obtained results in 18 cases of such fractures.


[Diaphysary resection using Colzi's method in the treatment of Volkmann's syndrome]. The AA, report one case of Volkmann's contracture in a patient 8-1/2 years old treated by shortening of the ulna and radius according to Colzi's procedure. The reasons why such method was chosen are explained and the excellent result obtained described. In the light of their experience the AA. deem that the Colzi's procedure is still valid, also on the account that does not preclude the possibility to perform other procedure.


[Completely interchangeable joint prosthesis for the hip]. The Authors present a total hip arthroprosthesis studied at Verona Orthopaedic Clinic. This prosthesis presents a complete interchangeability of wear components, not only socket or head. Advantages and premises of this solution are examined and clinical evaluation is referred.


[Reconstruction in loss of bony tissue]. The aetiology and pathogenesis of wide loss of bony tissue are discussed. Methods of treatment are described. Five cases thus treated and cured are reported.


[Use of intraosseous implants in joint prosthesis of the hip]. The authors examine actual problems in total hip endoprostheses fixation and dwell upon solutions used up to date. The authors propose a new technique of prosthethic socket fixation based on endosseous implantology. This method should increase long term stability utilizing at the same time the immediate stability offered by methyl-methacrylate cement.


[Current orientations in the treatment of bone metastases]. Bone metastases are the most frequently occurring tumours of the skeletal system. Clinically, diagnosis is important but more so the treatment, taking into account the type of lesion, its localization and diffusion. Early and combined treatment by general surgeon, radiotherapist and orthopaedic surgeon will provide a longer survival rate and relative physical and psychological well-being for the patient. Following the diffusion on surgical techniques designed to cope with tumor in different bones the wait-and-see attitude of the past has been abandoned. More vigorous attempts to excise metastatic tumours and aims at reconstruction and substitution of weightbearing bones by means of modern methods of osteosynthesis and application of prostheses, can be achieved. The more controversial clinical and radiological aspects and the results of 281 cases, seen at the Clinica Ortopedica of the University of Padua, are illustrated.


[Chemical synovectomy with osmic acid].

[Chemical synovectomy with osmic acid]. The authors face the problem of the treatment in chronic arthrosynovitis. After some general premises they dwell upon the use of osmic acid in such cases and report the results and casuistr of Verona Orthopaedic Clinic.


[Obesity and articular tropho-mechanic disorders]. Obesity represents an accelerating factor in the development of osteoarthritis, mainly of the lumbar spine and knees. Overweight patients undergo, earlier than normal people, to painful syndromes which usually affect the elder. The mechansims through which joint degeneration gradually develops are analized; special reference is made to the rôle of mechanical and postural stresses. Some considerations are made about orthopaedic treatment in obesity and about orthopaedic surgery in selected cases.


[Combined treatment of Ewing's sarcoma]. Twenty cases of Ewing's bone tumor, seen at the Orthopaedics Clinic of Padua from 1958 to 1975, were classified into two groups on the basis of results obtained from different schemes of treatment. In the first group of patients, treated during the period 1958-69 by surgery and irradiation, the mean survival rate was one year with two exceptions still surviving since 17 and 11 years respectively (treatment: only amputation). The mean survival rate was prolonged to 5 years in the second group. Here, combined treatment included irradiation (4.000-6.000 r), medical treatment (Adriamycin, CCNU, Vincristine) vaccine therapy and surgery. In the Author's opinion it is more convenient to use the latter therapeutic approach because of the promising results, the improved survival rate and the more effective control of relapses and metastases.


[Solitary bone cysts].

[Solitary bone cysts]. Fifty-eight cases of solitary bone cyst are reported. Clinical and radiological features and the results of surgical treatment are discussed. In the evolution of bone cysts and in particular those of the humerus two forms of the disease can occur; that of the metaphysis and that of the diaphysis with pecliar features and indications for treatment. Permanent repair of a cyst is possible only after internal reconstruction of the involved segment.


[Hepatic complications in the postoperative of cardiac surgery]. In a study of fifty patients subjected to cardiac surgery nine (18%) had immediate post-operative liver complications. These included persistente jaundice, an increase in hepatomegaly and elevation of the alkaline phosphatase. In these and the rest of the cases there were extra-hepatic complications such as hyposystole, infarct, the post-pericardiotomy syndrome as related to the heart. Pulmonary complications were of infectious nature and a general complication was sepsis. These complications were sufficiently important to relate them etiologically to the hepatic disorder. Especially important is right hyposystole and it or tricuspid insufficiency can be blamed for the hepatic disorder in some of these patient. Nonetheless, these hepatic complications are seen less frequently now that we are giving effective treatment to the tricuspid insufficiency during the surgical intervention. We observed the clinical picture known as "benign postoperative cholestasis" in only two patients. Hepatitis with jaundice was seen in four patients during one to three months postoperatively. This was HB hepatitis and its course was more prolonged than that usually seen in Mexico, and it turned into chronic hepatitis in four patients. Biopsies done in one case a six months and in the other at nine months post-operatively showed the picture of chronic aggresive hepatitis. In those patients who did not have hepatic complications a late liver evaluation showed an improvement as compared to the pre-operative condition which was parallel to the hemodynamic improvement.


[Spontaneous esophageal perforation (Boerhaave syndrome)]. A review of the literature reveals that the prognosis is unfavorable in the presence of spontaneous rupture of the esophagus, since approximately 50 per cent of the patients die. It is also generally true that the mortality will increase in a direct relationship to the time elapsed between the onset of the clinical syndrome and the arrival at a correct diagnosis and adequate treatment. The author presents a case review of the so-called Boerhaave's Syndrome in which the correct diagnosis was made and surgical treatment instituted within eight hours of onset. He emphasizes the importance of a careful consideration of the clinical and radiologic findings and especially that of mediastinal and subcutaneous emphysema.


[Spontaneous rupture of the esophagus after hematemesis from gastric ulcer. Report of a case]. The authors discuss a case of spontaneous esophageal rupture consequent to hematemesis associated with gastric ulcer. This is known as Boerhaave's syndrome. The present case was seen in a male patient of 54 years of age. The diagnosis was suspected on the basis of the clinical history and was confirmed by radiologic studies both with and without contrast medium. The patient was treated surgically through a left anterior thoracotomy. In the immediate postoperative period there was an episode of bloody pleural effusion which was corrected by two thoracocenteses. At the present time the patient leads a normal life with no restrictions. He has not had signs or symptoms of gastric ulcer and two esophageal-gastroduodenal series have only shown the esophageal scar.


[Surgical treatment of carcinoma of the esophagogastric junction]. The results obtained from diagnosis and treatment of six patients with cardioesophagic junction cancer, diagnosed by histopathologic study during surgery, are presented. Three patients presented with diaphragmatic hernia as well. Esophagogastroduodenal roentgenological study was interpreted as neoplasia in three patients only; it was supposed that the other three patients had a benign esophageal stricture. Endoscopy oriented the malignity diagnosis in four patients, and for benign lesion in the other two. Biopsy showed malignant lesion in three patients and it was negative in the other three. Exfoliative cytology was positive in four patients and negative in two. Esophagogastric resection was done in four patients. One of them died post-operatively. The other have survived 36, 22 and 16 months.


[Diagnosis and treatment of chronic hepatitis]. The authors review twelve cases of chronic hepatitis seen at the IMSS hospital in Puebla in a span of three years. They analyze and compare clinical, laboratory and biopsy data with special emphasis on the microscopic evolution of the disease and the response to different therapeutic regimes. Gamma-globulins were elevated in 80% and hepatitis B antigen in 50%. RIA is more sensitive than contra-immune electrophoresis. In six cases the diagnosis was of active chronic hepatitis and two of these developed towards cirrhosis; one became chronic persistent hepatitis and the other three are stationary and well controlled with prednisone. One patient died with a clinical picture of portal-systemic encephalitis. The six cases of persistent chronic hepatitis evolved towards a spontaneous cure.


Enzymatic preparation of 20 beta-hydroxysteroids in a two-phase system. The behavior of 20 beta-hydroxysteroid dehydrogenase in a two-phase system consisting of an emulsion of water with an immiscible organic solvent was investigated. The effect of several organic solvents on the stability, activity, and kinetic profile of the enzyme was considered. The most suitable system for carrying out the enzymatic reaction proved to be water-butyl acetate. The production of high quantitied of 20 beta-hydroxysteroids in 100% yield using catalytic amount of cofactor was achieved by coupling the 20 beta-hydroxysteroid dehydrogenase-and the alcohol dehydrogenase-catalyzed reactions.


Thermophilic anaerobic digestion of solid waste for fuel gas production. Anaerobic digestion offers a potential means of converting organic solid waste into fuel gas and thereby provide a supplemental and readily utilizable source of energy. We are particularly interested in the use of thermophilic digestion over a mesophilic operation for it can achieve higher rates of digestion, greater conversion of waste organics to gas, faster solid-liquid separation, and minimization of bacterial and viral pathogen accumulation. Our results comparing mesophilic (37 degree C) and thermophilic (65 degree C) anaerobic digestion of domestic solid waste confirm the increased rate and conversion of waste to methane. In addition, utilizing radioactive labeling of glucose and acetic acid, we have measured the volumetric rates of volatile acid production and disappearance under both mesophilic and thermophilic conditions.


Dynamic and steady state studies of phenol biodegradation in pure and mixed cultures. The microbial degradation of phenol by pure and mixed cultures of Pseudomonas putida was studied in batch, phenol-stat, and continuous culture systems. In the continuous culture runs, both steady state and transient experiments were performed. From these experiments, a model for the kinetic behavior of the organisms was evolved and an analysis performed on the stability and dynamic behavior of pure and mixed cultures. The results indicate that it should be possible to achieve phenol removal from wastewaters down to levels of 1-2 ppm in a single state system. However, because of the effect of substrate inhibition on kinetic behavior of the microorganisms, long lasting transients can occur. The transient behavior of such systems cannot be solely determined from mumax or Ks parameters, but must include a consideration of the transient size and response characteristic of the organism.


[Radiologic and clinico-functional correlations in chronic lung diseases during congestive heart failure]. Two groups of patients were studied with serial correlated radiological functional analysis. Each group had a previous history of chronic obstructive pulmonary disease; however, on admission, only one group exhibited the clinical signs of this superimposed disease. The results of this research showed that chronic pulmonary disease is better defined by functional studies while cardiac failure (even in early stages) is always revealed by radiological examination.


[Ovarian tumors (clinical cases)].

[Ovarian tumors (clinical cases)]. The A. expose three cases of ovarian tumors: the first of a malignant teratoma with metastasis inside abdominal wall, the second of Brenner's tumor, the third of an estrogen-producing ovarian hypernefroma.


[Cases of endocrinological psychiatry. Hypothalamic primary amenorrhea with paraphrenia]. A case of association between hypothalamic primary amenorrhea, obesity and paraphrenia is presented in a 53 old woman. Neurological investigations, showing a diencenphalic involvement possibly on a malformative basis, lead to the hypothesis of a common pathogenesis for both endocrinological and psychiatric features of the syndrome.


The flexure and toricity of best, flat and steep fitting hydrogel lenses on the eye. The flexure and toricity of Bausch and Lomb Soflens fitted to seven eyes in best, flat and steep fitting relationships were measured by photoelectric keratoscopy and keratometry. Irrespective of the fitting relationship lenses were found, generally, to conform to the cornea and to transmit through to their front surfaces the whole of the corneal toricity.


Fixation disparity and learning disabilities. This study was conducted at the Massachusetts College of Optometry in 1974 to determine if there is a relationship between binocularity and learning disabilities. A fixation disparity test was administered to 53 learning disabled and 61 normal children in a blind study. The results indicated no statistically significant differences in binocularity between the two groups as measured by the fixation disparity technique.


Derivation of the angle of torsion of the eye. The angle of torsion of the eye, that is the amount by which the eye rotates about its anterio-posterior axis, changes with the direction of the line of fixation. If the eye can be considered as a rigid body under an elaborate system for constraints its motion can be described by the laws of kinematics. The techniques of linear algebra can then be used to derive an explicit relationship between the angles defining the direction of fixation and the angle of torsion of the eye. The angle of torsion can then be expressed as a function of the angle of rotation of the eye and the direction cosines of the axis of rotation. However, under conditions in which Listing's Law holds these angles, are well defined functions of the angles defining the direction of fixation, and so the angle of torsion, in this case, can be expressed as an explicit function of this direction.


Derivation of the space horopter.

Derivation of the space horopter. The horopter--the locus of those points in space that would stimulate corresponding points on the retinae of the two eyes--has been previously considered to be a plane curve lying in the horizontal plane. The two-dimensional character of this curve arises as a consequence of limiting all considerations to two dimensions only. However, by considering the retina as a two-dimensional surface in 3-space, geometric analysis reveals the horopter to be a non-planar curve: a twisted cubic curve in space. The classical horopter experiments can then be seen to be plotting self-corresponding lines rather than self-corresponding points, and these lines are found to be the chords of this cubic curve. The equations determining the horopter curve in parametric form have been found expressing each point of the curve as a function of the coordinates of the point of fixation.


Properties of the space horopter.

Properties of the space horopter. For general points of fixation the space horopter has been found to be a twisted cubic curve, which, when fixation is in the median plane, degenerates into a conic curve inclined to the plane of fixation. The inclination of the plane of this conic is found to be a function of the angles of torsion of the two eyes. If these angles are zero and fixation is horizontal the space horopter reduces to the Vieth-Müller circle. Previous experimental techniques for plotting the horopter curve do not in fact determine the locus in space of those points that will stimulate corresponding points in the two retinae: they are, locate the position of certain chords of the space horopter. The Hering-Hillebrand deviation coefficient is found theoretically to be a linear function of the fixation distance. This had been shown experimentally by previous workers, but without any satisfactory explanation.


Psychological considerations in historiography. The author discusses the interrelations between historiography and modern, dynamic psychology. The latter tries to understand psychological phenomena and human behaviour within the context of the individual's historical development. Similarly, the historian seeks to understand social structures, events and tendencies of a given epoch as evolving from the antecedents of the social entity under consideration. Historical consciousness, expressed in remembering the past, is one of the factors contributing to the inner security, self-confidence and sense of identity of the individual as well as of the group. Both disciplines assume that events are set in motion by irrational forces and they share the tendency to ascribe inherent meaning to occurrences. They occupy borderline positions between the natural sciences and the humanities, and actually belong to both. The author believes it would benefit historians to acquaint themselves with the methods and results of modern psychology.


Universal and cultural features in the delusions of a black urban group. Conflicting views as to the form and content of delusions among African psychotics, notably the influence of cultural factors in the preliterate, led us to devote special attention to this area in a recent study of Bantu psychiatric patients. Our sample was drawn chiefly from Baragwanath Hospital serving the South Western Townships of Johannesburg, and smaller samples were drawn from mental hospitals, mental health society clinics, an old age home, and a middle class township in the Witwatersrand area. The degree of systematization and fixity of delusions in the sample as a whole, and in schizophrenia and manic-depressive psychosis in particular, were assessed. On the side of delusion content, cultural features such as witchcraft, animals as instruments of witchcraft, familiars, and ancestor worship are described. In conclusion, the relationship of cultural content of delusion to class, education and income are evaluated, with special attention to the influence of an early tribal background in our urban professional group, as illuminating the general issue reflected in our title.


Jewish alcoholics and addicts in the London area. Throughout the ages and throughout the world alcoholism has been noted, among Jews, by its relative rarity, and this despite the virtual absence of teetotallers among them. On the other hand, misuse of other drugs has in recent years been described as not uncommon among Jews. In fact a London report in the early 1960s gave the proportion of nearly 20% Jews among the drug addicts seen by two general practitioners. Studies among our own patients, however, indicate that in the London area at present the proportion of Jews among alcoholics seems not as low as generally described - the proportion of Jewish drug addicts, on the other hand not as high as initially suspected. The common denominator amongst the great majority of these alcoholics and drug addicts was alienation from the background of their Judaism and their family - possibly thus leaving them without their former stabilizing anchorage. It is interesting to speculate, however, on the reasons for the usually-described relative rarity of alcoholism among Jews, and the relatively higher incidence of abuse of other drugs. In theory, it would seem that much useful information about the causation of alcoholism and drug dependence in general could be derived from studying, comparing, and contrasting, the factors at work in causing or preventing alcohol and (other) drug abuse, respectively, among Jews.


A minority under the microscope - the American Indian reaction. The cultural diversity of approximately 500 Indian tribes in the United States defies a base for uniform measurable criteria and developed standards cannot be uniformly applicable. Moreover, anthropological and sociological scientific studies focus on the Indian's failure to assimilate with the dominant society; their studies fail to relate the non-Indian's historical, social, legal, political, educational, and religious impact on idigenous people who should be America's treasure but are, as seen under the microscope, her tragedy.


Crime in the changing Greek Society. Reflections on statistical data. Crime is a complex phenomenon. Statistics related to crime in a given milieu reveal nothing in substance and they are not amenable to comparisons. For one thing they are classified differently in different countries. For another, statistics are related to processes that are the outcome of all the interrelated variables which operate in the given milieu. It is within the context of the transaction of these variables: cultural, social, economic, technological, psychological, and biological, that these statistics may become meaningful and may lead to valuable interpretations. In Greece, for instance, during the last ten years, crime has decreased. (In 1960, there were 82,649 convictions and in 1970 there were 72,393. The population, seven years of age and above, increased from 7,289,130 in 1960 to 7,796,850 in 1970. Moreover the number of recidivists for the same years increased only from 28,988 to 31,540.) And yet, from impressionistic observations one notices that violence has increased significantly. The modus operandi of the criminals as well as the motives that instigate criminal behavior have changed. Those changes are alarming. Crime statistics, although they present a picture of decrease in crime rate, do not help us to focus on the real problem and search for measures of prevention and control.


Conflict, negotiation and cooperation: an analysis of these parameters in international relations. Ways in which political conflicts may be stimulated, reduced, enhanced, and managed are discussed. Human political space and time concepts are explained, while distinct ways of perceiving, exploring, and affecting the world are developed in detail. Everyday communication as opposed to political communication is described, as are their dimensions, effectors, and/or the events that they effect. The thesis is suggested that political communication demands a special morality and a special understanding of interaction at a political level. A taste of the range and delicacy of the interlacing flow of conflict, negotiation and cooperation is given and  the final contention is that j order to be a true and competent leader of an effective modern state these delicate tools must be immediately evocable.


A report on six months experience of committee for the control of abortion. During the first six months experience of a committee for the control of abortions, within the framework of Kupat Holim (Workers' Sick Fund of 'Histadrug' in Israel), 70 pregnant women sent by their physicians appeared before the committee for the interruption of their pregnancies. The reasons brought before the committee were of a medical, genetic, psychiatric or social nature. Discussed here are the socio-psychiatric cases, under the heading of the country of origin, age of the women, their cultural background and social situation of their families. Some conclusions are drawn in connection with the motivations which seem to have determined the positive or negative position of the committee and some possible implications are discussed concerning the legislation of the whole subject.


A follow-up of 72 cases referred for abortion. Whilst the medical indications for therapeutic abortion and the legal limitations set vary enormously from one country to another there is in general an undoubted trend towards giving the pregnant woman herself a greater say in the decision. During the first year of the operation of the Abortion Act, 1967, in England some 72 pregnant women were referred to the author and his colleagues for a recommendation on abortion. A psychiatric examination and follow-up over a period of one year was made both in those cases where abortion was performed as well as in those cases who were refused therapeutic abortion. In this communication a comparison is made between the reactions and outcome in the two groups. A provisional conclusion is reached that no significant psychiatric disturbance could be attributed to the performance of the operation or on the other hand to refusal of the woman's request.


Counselling the adolescent girl in a time of changing values. The position of the adolescent girl has always been somewhat ambiguous in western culture. No more a little girl and not yet a woman, she remained in limbo waiting for the time when she would marry and no longer be the responsibility of her family. Counsellors who work with adolescent girls have been expected to reinforce a value system which prized 'innocence' in young women, emphasized the romantic view of love and looked upon marriage as an eternal bond. Developing trends in the Women's Liberation Movement, the ability of contraceptive information and easy abortion, experiments by young people with varied forms of interpersonal relationships anf family structures, all indicate that the traditional value system is changing. There is a new reality; women are now free to follow more than one way of life. For the counsellor this presents the same dilemma which faces the adolescent girl: how to leave the security of the known and prepare for the potential choices which are inherent in the unknown.


Spontaneous group drawing.

Spontaneous group drawing. The results presented here are of an experiment performed by the team of an open ward composed of psychiatrists and an occupational therapist to provoke verbal communication by means of group drawing. The experiment was carried out with a group of patients who are suffering from difficulties in making contact with others. Drawing being a means of primary archaic communication enables the patient to express himself within the framework of the group by participating in discussions, and thus contribute to the process of socialization among the patients.


Eating disorders in adolescence.

Eating disorders in adolescence. Primary anorexia nervosa presents with severe disorder of eating behaviour occuring predominantly in young women. The aetiology is unknown and treatment ranges from psychoanalysis to leucotomy. Management is difficult because of the patient's inability to accept traditional methods of psychiatric treatment and also because of family attitudes which result in perpetuation of the condition. Because it was noted in a study of patients suffering from anorexia nervosa that response to conventional methods of psychiatric treatment was limited, further investigations were made: (1) A comparative study of 12 patients with anorexia nervosa and 12 patients suffering from psychoneurotic illness was made. Patients were matched for age and intelligence. (2) The fact that significant differences emerged indicated that the concept of anorexia nervosa as a psychoneurotic condition was in question. (3) Group therapy, recently introduced, is mentioned.


Some current issues in primary preventive psychiatry. This paper deals with some of the issues that seem to be involved in conceptualizing, constructing, communicating and operating a program of primary psychiatric prevention. It is based on a series of visits to Nova Scotia, February through August 1970 and Israel, August 1971. Some of the issues discussed include difficulties in conceptualizing, defining, hence in teaching, learning and practicing the subjects involved. Cognitive and affective issues among the four groups usually involved in such programs, and some of the ultimate effects of these on the final content and operation of programs, are discussed. All the individuals involved, Sr. Professional Staff, planning and hiring, Jr. Staff, field implementation, authorizing and funding government officials, and the two groups of community residents, participating and non-participating, periodically manifested ambivalence, perceptual, cognitive and affective distortion, resistance, value, method and goal conflicts in every area of program conception, construction, dissemination, funding, staffing and operation.


Social integration and the therapeutic community. The therapeutic community should be defined as an environment which is enabling but not directive. The staff need to become aware of their therapeutic as well as anti-therapeutic potential. Conflict should be overt rather than covert. That society now sees the delinquent as 'sick' is two-edged: Abdication of responsibility is encouraged, and the sick role rewarded. This paper shows how the therapeutic community is effective in encouraging the delinquent to take responsibility for himself and for others. It shows what features make the therapeutic community effective for neurotics for schizophrenics.


A psychiatric ward with its specific attitudes as a social system within the community of a General Hospital. The establishment of a psychiatric ward in a general hospital with modern therapeutic milieu orientation will necessitate certain changes and create problems of the following nature: (1) The psychiatric ward as a 'deviant' department within the social system of the general hospital. (2) The transition of the traditional approaches to the modern trend within the team of the department. The patient is required to develop an attitude of active participation. (3) The group setup of open ward groups in contrast to the more familiar orthodox out-patient groups are discussed. (4) Ward life discussed as a time-limited experience taken out of life situation. The change in attitude of the doctor will have to be more integrative by being able to deal with various levels and depth of behavior and functioning in multiple ways as related to the patient and his community.


Psychiatric nursing: a view from within. There are several recurrent themes that reflect the concerns of nurses who seek entry into graduate programs in psychiatric nursing. Four of the themes that will be presented are an emphasis on mental health, a desire to seek varied points to entry into health care, increased interaction with other health workers and participation in social change. The themes are interrelated and reflect a view of nursing responsibilities and an awareness of the needs for a comprehensive approach to health care. These views are typical of a range of concerns within the nursing profession. Although nursing comprises the largest number of prepared health care workers, nursing is a marginal group within the system. There is considerable discussion of a need for revision of health care systems and of need to utilize manpower resources most effectively. System change is a difficult process and one can only speculate about the outcomes. It is difficult to predict whether the beliefs and values of nurses and nursing a marginal group, can be shared within the health care system.


The strategic function of attempted suicide. Attempting suicide is regarded as a strategy for getting out of emotionally troublesome situations. This strategy is a bodily and risky 'cry for help', but also a cry for help with almost certain success as the bodily self-damage forces significant others to show indulgent behaviour. As this indulgent behaviour has the actual function to relieve significant others from feelings of guilt and from real social pressures, it very often diminishes with time, so that the effect of the 'attempted suicide strategy' proves to be very short. The relation between this concept and some epidemiological findings is discussed and the consequences of this approach for the management of attempted suicides are pointed out.


Procoagulant activity of platelets in recalcified plasma. High-spun platelet-poor plasma (HSPPP) and platelet-rich plasma (PRP), prepared with minimal contact activation and pH shifts, were recalcified with little dilution in the presence of phospholipid prepared from chloroform-extracted, acetone-dried brain tissue. The clotting times of HSPPP and PRP were the same whether or not the platelets in PRP were first incubated or aggregated with ADP or with collagen. This suggests that platelet procoagulant activity in normal recalcified plasma derives only from provision of platelet phospholipid.


Plasma heparin levels after low dose subcutaneous heparin in patients undergoing hip replacement. Plasma heparin levels were measured at 2 and 8 h after 5000 iu of heparin subcutaneously in 43 patients awaiting total hip replacement. At 2 h, 37 patients had plasma levels between 0.05 and 0.15 iu/ml, three patients had more than 0.2 iu/ml, and three had only trace levels. At 8 h, most patients had less than 0.1 iu/ml, and six patients had no detectable plasma heparin. There were no correlations between plasma heparin levels and age, sex, body weight or use of analgesics. Patients with high 2 h plasma heparin levels may bleed at operation, whereas those with very low plasma heparin concentrations may be at risk of post-operative venous thrombosis; it may therefore sometimes be necessary to monitor plasma heparin levels in order to determine the optimal regime in individual cases.


Quantitative measurement of splenic and hepatic red-cell destruction. A method has been developed by means of which independent measurement can be made of the amount of red-cell destruction occurring in the spleen and the liver. The technique involves a standard red-cell survival study and surface-counting measurements together with quantitative scanning of the spleen and liver with 113mIn colloid in order to calibrate the surface counter. The rate of destruction in each organ is obtained by fitting the measured uptake curve for the organ to a theoretical uptake curve by computer. In addition, if whole body counting is also performed, the amount of red-cell destruction occurring in the rest of the reticuloendothelial system may be deduced. Results are given for measurements on a series of 11 patients.