Respiratory mechanics in upper airway obstruction. Respiratory mechanics were studied in 7 patients with vocal cord paralysis (Group A), 7 with laryngeal or sublaryngeal obstruction (Group B) an in 3 with intrathoracic tracheal obstruction (Group C). Group A showed decrease in FIV1.0, PIFR and VI50 when compared with corresponding expiratory parameters. Group B only showed a decrease in PIFR compared with PEFR. In all patients the high flow area near TLC in expiratory V/V curves was replaced by a flat flow pattern, extending variably into lower lung volumes. Predominant inspiratory flow reduction was present in Group A. Usually the normal expiratory plateau (IVPF curves) was absent even at very low lung volumes (about 25% VC) in the 8 patients studied (Group A, B, C). In Group B, inspiratory and expiratory resistances (IVPF curves) were similar up to about 50-60 cm H2O Palv; above this level inspiratory resistance was higher. The flow-pressure pattern (IVPF curves) of a normal subject with a relatively low resistance added at the mouth (9 mm i.d.) was very close to that of the resistance alone throughout inspiration. Above 60 cm H2O Palv expiratory resistance appeared to be lower, as in Group B. Calculated pressure drop due to convective acceleration across the resistance coincides with its pressure-flow relationship. These results do not support the hypothesis of inspiratory reduction in tracheal caliber as a contributing cause to inspiratory flow decrease. The difference PEFR-PIFR at highest Palv was inversely related to the degree of obstruction. Consequently, flow-volume curves of moderate sublaryngeal lesions may show disproportionate reductions in VI (like Group A) despite its fixed nature. Results obtained in six patients submitted to surgical treatment are discussed.


[Normal values of functional residual capacity (author's transl)]. The functional residual capacity (FRC) was measured in 24 healthy subjects, 1-by the helium dilution method using a closed system and an open system during washout, and 2-using a constant pressure plethysmograph. Results obtained with the three methods were not significantly different. Furthermore, FRC was determined by helium dilution in 177 healthy men and in 100 healthy women, aged between 18 and 77 years. In both sexes, FRC was dependent on age, height (H) and weight, being greater in the taller, older subjects. For a given height and age, FRC decreased with increasing weight. Correlation coefficients between logarithm of (FRC/H3) and age and/or weight were highly significant. From these allometric relationships, it was possible to calculate FRC reference values, and then, reference values for other functional tests such as steady state TLCO and lung compliance.


Small airways disease in coal miners. A longitudinal study. Seventeen of an original cohort of 25 non-smoking working coal miners and 6 age-matched controls studied in 1969 were re-examined in 1973. Measurements included lung volumes, maximal expiratory flow-volume curves, and closing volumes. Miners, when compared with controls, showed a marked decline in maximal expiratory flow at mid-vital capacity (V 50%) over the 4-year period which took place without significant change in the 1-second forced expiratory volume (FEV1). Frequency dependence of dynamic compliance (Cdyn) in association with an increased upstream airways resistance (Rus), and also loss of lung elastic recoil (PL(St)) which were present at the time of the original study led to similar declines in V 50%. An abnormally elevated closing capacity expressed as a percentage of total lung capacity (CC/TLC)% was found in 9 miners (53%) and none of the controls. Closing volume as a percentage of vital capacity (CV/VC)% was abnormal in 4 miners (23.5)% and no controls. Measurement of closing volume did not relate well to the variety of mechanical abnormality present on the original study; namely, loss of recoil or small airways obstruction. The presence of an elevated (CC/TLC)% and (CV/VC)% correlated mainly with the presence of hyperinflation as indicated by an elevated residual volume.


[Transcultural aspects of the clinical-psychiatric pictures of foreign workers (guest workers) and their significance for neurological practice]. Referring to a previous clinical and sociopsychiatric investigation on 130 foreign workers, the transcultural psychiatric factors determining forms and contents were studied. It is stressed that remains of magic thinking and rigid tribe-centered sociocultural structures are the main factors, in addition to the beginning of the loosening of these structures accompanied by initial assimiltion of occidental ways of life in the homeland, and integrational crises through collision of Old and New after immigration. Atypical psychosis, outweighting affective and somatic factors, obliteration of the limits between classic etiological units, and the possibility of confounding magic contents with psychosis are illustrated by case histories. New criteria for diagnosis and therapy of foreign workers are suggested.


[Bases or projection theory. I].

[Bases or projection theory. I]. In psycho(patho)logy the term "projection"marks both a series of characteristic phenomena and the model by which we interpret and explain them. The conglutination of describing and explaining may especially be observed in the psychoanalytic use of the notion. The present study does not perform a theory-suspending phenomenological analysis but receives the model of projection as a given one explicating its implications. Part I discussess its historical suppositions, while the following part II will expose the implications concluded within the model of projection as such. The purpose is to comprehend the possibility of projecting (e.g. as a mechanism of defence) within the dialectics (respective ambiguity) of the human I-world-relations.


Transformations of consciousness. A cartography. I. The perception-hallucination continuum. Self-awareness emerges from the evolutionary transformation of material structures into magical, mythical and mental structures of consciousness. Western varieties of conscious states may be mapped on a perception-hallucination continuum of increasing ergotropic or hyper-arousal. These levels of subcortical arousal are cortically or cognitively interpreted as normal, creative, hyperhrenic, cataleptic and ecstatic states. During increasing hyper-arousal (characterized by EEG desynchronization): (1) the variability of the EEG amplitude decreases in introverts whereas in extroverts, it increases; (2) exteroception is transformed into an experience of interoception, while willed motor activity becomes increasingly impaired and ultimately inhibited, and (3) information processing during these hallucinatory states is preferentially shifted from the speech dominant and motor-coordinating or "major" toward the nonverbal, gestalt-perceiving, the non-dominant or "minor" cortical hemisphere.


Acute versus chronic acoustic deprivation: effects on auditory evoked potentials and seizures in mice. C57BL/6J mice are not typically susceptible to audiogenic seizures, but temporary conductive hearing loss (via earplugging) can induce susceptibility in these subjects. The present study observed that a 40-dB hearing loss, beginning at 17 days postpartum, requires 2 days before it induces susceptibility to audiogenic seizures. When this hearing loss occurred only between 17 and 21 days postpartum, seizures were maximally severe 1-2 days after earplug removal. The peak-to-peak amplitudes of the auditory evoked potential (AEP) were also maximal at this same time. But mice deprived of acoustic input between ages 42-46 days exhibited equally large or even larger AEP amplitudes, while not exhibiting susceptibility to audiogenic seizures. Animals at this older age were shown to be capable of convulsing, in that chronic conductive loss from 17-42 days maintained susceptibility to audiogenic seizures. The acoustic deprivation produced both behavioral (audiogenic seizures) and neural (augmented AEP amplitudes) supersensensitivity to sound, but the former requires a critical period, whereas the latter does not. Some degree of residual hearing loss persisted at all ages for approximately 2 days after removal of the earplugs.


Acquisition and retention of an avoidance response by rats of different ages. Rats, 21, 120, and 480 days of age, were given acquisition training in a 1-way avoidance task and tested for retention of the response 1 and 30 days later. Whereas the 480-day-old rats showed poorer performance during acquisition, the 21-day-old rats showed the greatest impairment of long term retention. The results suggest that age differences in performance are due to intrinsic maturational processes.


Neonatal locomotor and long-term behavioral effects of d-amphetamine in the rat. Locomotor activity in the neonatal rat was found to increase from birth until the beginning of the 3rd week of life, at which time it peaked and then subsequently declined. Subcutaneous injections of both .25 and 2.0 mg/kg of d-amphetamine increased activity in rats 1-21 days of age, with the maximum effect observed at 4 days of age. No tolerance to d-amphetamine was observed after 6 daily injections beginning at 1, 7, or 14 days of age. The decline in the excitatory effects of the drug thus reflected maturational changes in response to it. Consistent with other observations from this laboratory, no persisting effects of the neonatal drug treatment was observed on adult 2-way avoidance learning.


Prenatal maternal d-amphetamine effects on emotionality and audiogenic seizure susceptibility of rat offspring. Dosages of 0, 5, and 10 mg/kg body weight of d-amphetamine were injected subcutaneously to gravid albino rats during Days 5-9 or Days 12-16 of gestation. Offspring were assessed for water-wading emotionality and audiogenic-seizure behaviors. No significant differences among groups were found in defecation scores from either test. The only animals to exhibit a considerable incidence of wild-running attacks or seizures were these whose mothers had received the placebo early in pregnancy. These differences are in agreement with most findings that indicate an enhancement of immunity to audiogenic seizures susceptibility as a function of prior stress. Maternal administration of d-amphetamine during pregnancy apparently can produce offspring who have less susceptibility to severe emotional responses but no protection against mild expressions of emotionality.


Defensive distance and immobility in young precocial birds (Gallus gallus). The manifestation and duration of the tonic immobility reaction in 3-day-old chicks (Gallus gallus) was found to vary reliably as a function of the spatial proximity between the hand of the experimenter and the immobilized chick. The results of this experiment indicate that young birds are susceptible to immobility and that the maintenance of close spatial proximity is the condition necessary for the occurrence of the reaction in young precocial birds.


Relationship between pure Schistosoma haematobium infection in Upper Egypt and irrigation systems. Part 1: methods of study. Four villages in Assiut Governorate were studied. They were matched for availability and time of introduction of medical services, the size of population and the socioeconomic status. One village had a basin system of irrigation. The other three villages had perennial irrigation introduced at different dates. A sketch map of each village was made showing the location of every house and the irrigation channels. Total coverage was intended in Gezirat El-Maabda (with basin irrigation) and Nazza Karar (with perennial irrigation-recently introduced). In El-Ghorayeb and Garf Sarhan (with older systems of perennial irrigation) systematic random samples were studied. The Study included a full, double check clinical examination of urine and stools samples and a social study. Data about educational level and activities that bring the individual in contact with canal water were recorded. Tables showing the age and sex distribution of the total population and the population studied in each village are presented and show validity of the samples taken from the population.


Relationship between pure Schistosoma haematobium infection in Upper Egypt and irrigation systems. Part II: Host characteristics. The general prevalence of Schistosoma haematobium, age and sex distribution. The epidemiology of bilharziasis was studied in four villages in Assiut Governorate. These villages were almost similar with respect to their socioeconomic conditions, modes of living, availability and date of introduction of medical services. The first village, Gezirat El-Maabda, has a basin system of irrigation. The other three villages had shifted to the perennial system of irrigation for three years in Nazza Karrar, 26 years in El-Ghorayeb and 95 years in Garf Sarhan and were similar with respect to proximity to water courses. So the only variable of importance between the four villages was the mode of irrigation. Bilharziasis was diagnosed by detection of eggs in urine or faeces. A definitive relationship between the prevalence of S. haematobium infection and the type of irrigation system was further documented. A low prevalence was found in Gezirat El-Maabda (2.95%). In the other three villages a much higher prevalence existed (31.9%, 46.2% & 38.9% in Nazza Karar, El-Ghorayeb and Garf Sarhan respectively). The higher prevalence of S. haematobium in Nazza Karar (31.9%) only three years after introduction of perennial irrigation was a disappointing finding. It can be considered as an evidence against the elaborate measures and precautions planned and incompletely implemented before or after the establishment of Aswan High Dam. Not a single case of S. mansoni was encountered during this study. As regards the age and sex distribution of S. haematobium in the three villages irrigated perennially, a steep rise started at the age group 5-9 years reaching a peak at the age group 10-14 years. In Gezirat El-Maabda the peak was reached at later age (15-19 years). The cause of this difference was explained. Males showed a higher rate of infection than females in almost all age groups of the four village studied.


Relationship between pure schistosoma haematobium infection in Upper Egypt and irrigation systems. Part III: Host characteristics. The prevalence of S. haematobium in relation to religon, occupation, and habits. Study of the effect of religion on the prevalence of S. haematobium infection revealed that ablution and other Muslims rituals do not represent an important factor in the prevalence of S. haematobium. Data concerning the effect of education on the prevalence of S. haematobium show that it has no significant role when similar age groups were compared. Farming was shown to be  the occupation of leading importance with rest to exposure to S. haematobium infection, as farmers and farm labourer constitute a large sector of our rural population. Finishing, although forming a greater danger in this respect, is not a common occupation in the studied villages with the exception of El-Ghorayeb. The study showed that swimming in canal water is one of the most important activities causing infection with bilharziasis.


A study of the absorptive function of the small intestine in childhood malignant lymphomas. A study of the absorptive function of the small intestine in chidlhood malignant lymphomas was carried out at the Cancer Institute of Cairo University. The study comprised twenty-five children, with stage III or IV lymphoma. A complete lymphoma work-up was performed for each patient, comprising clinical, pathological, haematological, biochemical and roentgenological assessments. Evaluation of small intestinal function was done by means of mucosal biopsy, small bowel motor meal, xylose excretion test, and estimation of faecal fat excretion. These tests revealed evidence of malabsorption in 69% of the patients. The study provides a better understanding of childhood malignant lymphomas in Egypt, and shows that malabsorption may be more common in the disease than has been previously suspected.


Calcium and phosphorus metabolic changes in children with hepatic bilharziasis. Investigations were done to study the calcium and phosphorus metabolic changes in 35 children with hepatic bilharziasis, of whom 12 were ascitic. Thirteen normal children served as controls. Despite a normal serum level of both calcium and inorganic phosphate in the Bilharzial group, yet both were increased in urine. The mean values obtained from the ascitic fluid were 70% and 90.2% of their serum levels, respectively. The corrected creatinine clearance was significantly diminished, while PEI was significantly increased, and the % TRP significantly decreased, with still a more marked decrease in the ascitic cases. Following a phosphate lead the serum inorganic phosphate level showed a significantly more rapid lowering in both bilharzial groups, as compared to the control group. On the other hand bilharzial cases responded to the intravenous calcium load by a significant retention of calcium in the serum.


Fibrinolytic activity in haemophiliacs.

Fibrinolytic activity in haemophiliacs. The fibrinolytic activity was studied in 7 haemophiliacs, in comparison with 5 normals and 7 patients with disseminated intravascular coagulopathy, by determining the level of the fibrin(ogen) degradation products (FDP) in samples obtained as sera, clotting occurring naturally, and samples obtained as plasma and converted into serum by addition of thrombin-EACA. It was found that in haemophiliacs serum samples had normal FDP levels while plasma converted to serum showed high levels. This was explained by the fibrinolytic action of thrombin. Fibrinolysis was not prevented by EACA present due to the fact that it is an inhibitor of the plasminogen system but not of thrombin.


Intestinal mucosal changes in thalassaemia major. Ten infants and children suffering from Thalassaemia major, proven by clinical, hematological and biochemical criteria, were subjected to intestinal biopsy. Specimens were studied for histological and histochemical patterns. The histological picture showed shortening and fusion of villi with cellular infiltration. Reduced mucopolysaccharides and relatively normal alkaline phosphatase activity were demonstrated. The degree of histological and histochemical changes correlates with the degree of anemia. The effects of these changes on the iron absorption and the tissue hemosiderosis are aroused. The possibility of these changes, being non-specific and secondary to anemia and tissue hypoxia is also postulated.


Red cell membrane lipids in thalassaemia. Red cell and plasma lipids and their fractions were estimated in 20 cases of thalassaemia and 20 normal controls. In thalassaemia there was reduction in red cell lipids and their fractions, plasma lipids and their fractions, and derangement of liver functions. On the other hand, the intestinal fat absorption, morphology of intestinal mucosa and histochemical studies of fat absorption were normal. Hypolipidaemia may be possibly caused by deranged liver functions and is probably responsible for the diminution in erythrocyte lipids. A genetic factor producing reduction in red cell lipids may be also present.


Study of red cell membrane lipids in glucose-6-phosphate dehydrogenase deficiency anemia. Red cell membrane lipids and plasma lipids were studied in 20 patients with G.6.P.D. deficiency, during acute hemolysis and 45-60 days later-20 normal controls were similarly investigated. All lipids in G-6-P-D deficient cells were found to be diminished during the attack of hemolysis and to return back with the exception of lecithin to normal after recovery. Plasma cholesterol and phospholipids were markedly diminished during acute hemolysis, but slightly reduced on recovery.


Auto-hypnosis in haemophilia.

Auto-hypnosis in haemophilia. A pilot study to determine the use of adjunctive trance therapy in the treatment of haemophiliacs has been carried out. Over a period of forty months, twenty randomly selected males were assigned to a control and an experimental group. All received due haematologic care. The ten patients in the experimental group utilized medical hypnosis as well, in group suggestive sessions to train and sustain them, but primarily in self-induced trance states. Results were compared at intervals on the basis of the amount of transfused blood and blood products. This provided an objective measure of the efficacy of trance therapy. Statistical analysis of the data confirmed the clinical observation of a greater improvement among patients in the experimental group.


Platelet inhibition of human lymphocyte PHA-induced blastoid transformation. The reduced PHA responsiveness of human lymphocytes obtained from heparinized as compared to defibrinated blood has been shown to be due to platelet contamination in the former. Inhibition of blastoid transformation and lymphocyte death is directly related to the number of platelets added to a culture. Divalent ions partially reduce this platelet inhibitor phenomenon but do not block if completely. The "toxic" platelet components appear to be localized in the membranes and particulate matter after homogenization and hard centrifugation. Comparative studies of PHA transformation must control platelet contamination of the cultures in order to avoid severe difficulties of interpretation.


Rosette formation in acute lymphoid leukaemia. The capacity of leukaemic lymphoblasts and remission lymphocytes, obtained from 40 children with acute lymphoid leukaemia, to form sheep red blood cell rosettes was investigated. Lymphoblasts isolated from the peripheral blood of the patients prior to antileukaemic treatment showed greatly reduced numbers of rosette-forming cells as compared to controls (4.6% vs. 27.5%). The ratio of rosette-forming cells during intensive induction chemotherapy was still significantly lower than the control value (15.7%), while after the achievement of complete remission the number of RFC approximated the normal value (22.5%). The presence of leukaemic serum had no significant effect on the number of RFC.


Detection in serum of antilymphocyte-globulin administered in form of eye-drops. Rosette inhibition tests indicated that similarly as in previous animal experiments, anti-human lymphocyte horse globulin (AHLG) administered in the form of eye-drops entered the systemic blood circulation in man. In the eye into which the AHLG is administered, it is expected to exert a local immunosuppressive effect.


Immunization against avian proteins.

Immunization against avian proteins. A study of sera of pigeon breeders showed a higher ratio of antibodies with an anti-P1 specificity in those who show clinical signs of allergic origin. By absorption of anti-P1 antibodies it was revealed that there exist in the cells, serum and excrement of pigeons, substances with antigenic properties similar to those of human P1 antigen. Pigeon breeders, and particularly those who show clinical signs of allergy, possess also other antibodies which precipitate specific antigens of pigeon serum.


Erythropoiesis inhibitor in a patient with hereditary spherocytosis. The studies dealt with the effect of plasma of a patient with congenital haemolytic anaemia on the erythropoiesis in mice. The materials included the plasma from the patient before and after splenctomy and the spleen homogenate and the spleen subcellular fractions. The effect of the materials was evaluated with the amount of the 59Fe taken up by the erythrocytes of the mice. The erythropoiesis was found to be inhibited by the plasma before splenectomy and by the spleen homogenate and its subcellular fractions. The inhibition was the highest in cases when the mice was given the spleen homogenates previously incubated with plasma of healthy persons.


Renal function in polycythaemia.

Renal function in polycythaemia. In 23 patients with polycythaemia vera and symptomatic erythrocytosis, glomerular filtration rate and urine concentration ability see article were determined under conditions of antidiuresis. The restriction of fluid intake caused a significant reduction of GFR and modified the osmotic function of the kidneys. The results were similar in both types of polycythaemia.


Iron metabolism in polycythaemia rubra vera and secondary polycythaemia. Serum iron concentration, serum iron binding capacity and saturation coefficient were assayed in polycythaemia rubra vera and secondary polyglobulia. In the exacerbation stage of polycythaemia rubra, significantly lower Se Fe and SC values were found while in the remission stage and in secondary polyglobulias these values did not differ from those of the normal control.


Blood volume changes in "hypersplenic" rats. Blood volume in "hypersplenic" and normal rats was assessed by a simultaneous measurement of erythrocyte and plasma volumes by means of 59Fe-labelled erythrocytes and 131I-labelled human serum albumin, respectively. The "hypersplenic" condition was induced by prolonged intraperitoneal application of methylcellulose. Mean blood volume in normal rats was 6.3 ml/100 g body weight, the venous haematocrit being 48%. Mean blood volume in "hypersplenic" rats was 7.5 ml/100 g body weight, and the venous haematocrit lower by 22% than in normal animals. Compared with normal animals, the erythrocyte volume in "hypersplenic" rats was lower by 15% only. Plasma volume in "hypersplenic" rats exceeded the compensation in response to the reduction in erythrocyte mass. In addition to haemolysis, haemodilution due to plasma expansion seemed to be responsible for the anaemia in "hypersplenic" rats.


The fine structure of haemopoiesis in the human fetal liver. II. Origin and differentiation of the megakaryocyte. The differentiation of the megakaryocyte was studied at the ultrastructural level in the liver of human fetuses of between 49 and 134 mm crown-rump length. The development of the cells was traced from lymphoid elements with the features of haemopoietic stem cells and was divided on the basis of nuclear morphology into three stages. Granule formation commenced during the first stage and demarcation membrances could be demonstrated in the perinuclear cytoplasm early in the second stage. Late stage 2 cells often contained more than one nucleus, and the possibility that this was due to cellular fusion is discussed. The third stage was characterized by the appearance of cytoplasmic zoning and by the gradual extension of the demarcation system throughout the cytoplasm. There was evidence that the demarcation membrances were initially formed directly from the Golgi apparatus, but that their further development was due to the incorporation of elements of the agranular endoplasmic reticulum. The surface projections associated with platelet release were observed only in fully developed cells, and the formation of a zone of clear cytoplasm at the periphery was related to events occurring during the later stages of platelet release.


Synchronization of rabbit bone-marrow cells in vivo. The recovery of the rabbit bone-marrow from anaemia was investigated during an eight-day period of daily punctures of the tibiae after six days of phenylhydrazine treatment. A maximum of erythroid (range, 37.1 to 44.0%) and a minimum of leukoid cells (range, 8.4 to 13.4%) was observed on the fifth day of recovery. The rest, about 50% cells were reticulum cells. Signs of recovery were observed in peripheral blood as soon as on the first day after phenylhydrazine treatment. This led to the assumption that the tibiae became repopulated with active erythropoietic cells during anaemia, and that the reticulum cells might play a role as erythroid precursors in this process.


[Ultrastructural cytochemistry of peroxidase and acid phosphat in mouse eosinophils]. The distribution of peroxidase and acid phosphatase activity in the bone marrow of mouse eosinophils was investigated by electron microscopy. Peroxidase activity was found in the perinuclear space, the endoplasmic reticulum, the Golgi complex, non-mature and mature specific crystal-containing granules. In the course of development peroxidase activity disappears from the cisternal system. In mature eosinophils the enzyme is stored in specific granules, but some of these failed to reveal peroxidase activity. A hypothesis is offered concerning the complete condensation into crystal of the enzyme. In cells incubated in peroxidefree media some granular components stained weakly. Their activity probably depended on the presence of endogenous non-organic peroxidase. In developing eosinophils acid phosphatase was found in the Golgi complex and in non-mature specific granules. In the course of development, acid phosphatase disappears from the granules.


[Ultrastructural cytochemistry of peroxidase in mouse neutrophils]. The distribution of peroxidase activity of developing neutrophils in mice was investigated by electron microscopy. The enzyme was found in the rough endoplasmic reticulum, the Golgi complex and azurophilic granules. The heterogeneity of azurophilic granules and their endogenous non-organic peroxide content are discussed.


[A kinetic model of experimental leukosis. Regularities in the development of reticulosarcomatosis in mice]. The kinetics of development of a new transplantable reticulosarcomatosis was studied in CC57Br mice.. Tumour development was estimated from changes in the weight of metaplastic organs by means of kinetic curves constructed on the basis of changes of all parameters characterized by exponential and power functions. The kinetic model of reticulosarcomatosis is recommended for use in quantitative research in experimental oncology.


Lack of immune tolerance to hepatitis B antigen in offsprings of guinea pigs injected with HB ag during pregnancy. Immune tolerance to hepatitis B antigen has been examined in the guinea pig. The offsprings of guinea pigs injected with purified HB Ag during pregnancy were found capable of producing HB antibodies. Purified HB Ag is suitable for producing immune serum for the systemic screening of blood donors for HB Ag.


Tissue antigens and cytotoxic antibodies in polycythaemia rubra vera. The distribution of tissue antigens for 22 antigens was studied in 46 patients suffering from polcythaemia rubra vera (PRV), using antibody containing sera from 80 multigravidae. The incidence of HL-A5 was significant higher and that of HL-A7 significant, while the frequency of HL-A13 was remarkably lower than in the normal population. No antibodies against erythrocytes, thrombocytes or lymphocytotoxic ones could be demonstrated.


[Diffuse congenital goitre of the thyroid in the kid]. The macroscopic and histological appearance is described of diffuse congenital goitre found in two twin kids which were born alive but soon died. The changes described appear to represent an intermediate stage between parenchymatous goitre and colloid goitre, with the latter predominating. Morphological and functional explanations are suggested for the changes observed, with reference to the features of importance in comparative pathology.


[New surgical treatment for laryngeal paralysis in the dog]. Laryngeal paralysis is reported in 2 dogs which showed symptoms of dispnoea at rest, and also choking and vomiting after short exercise. Surgical removal of the mucosa of the lateral ventricles resulted in restoration of normal function and resumption of the animals' normal activities.


[The surgical treatment of intra-nasal tumours in the dog]. This paper describes the surgical treatment of fourteen dogs with intranasal neoplasms. Affected dogs were from ten breeds and their average age was eight years. Clinical signs included unilateral nasal discharge epistaxis and sneezing; later there was deformity of the face and/or palate. Diagnosis of intra-nasal tumour was made by radiological examination and by exploratory rhinotomy. Surgical excision of the tumour mass was attempted in all cases. Histological examination of resected nasal tissue revealed five carcinomas, six sarcomas and three examples of benign polypoid hyperplasia of the nasal mucosa. The average post-operative survival time was 11 months with a range from two weeks to four years.


[Quantity and frequency of pesticides in forage and animal foodstuffs in use in Italy]. The results of analytical investigations on pesticide residues in the forages and foodstuffs most commonly used in Italy are described. Examination of 9,056 samples, selected at random during the period spring 1970 to autumn 1974, showed that 17 pesticide residues could be identified by the gas chromatographic technique employed and described, with quite significant mean total concentrations. These residues, although not reaching levels to cause problems of acute toxicity, can upset the symbiosis balance in the alimentary tract and reduce the economic results from farm animals.


Studies on prolactin in human serum, urine and milk. Prolactin activity was measured in serum, urine and milk using a specific human prolactin radioimmunoassay (RIA). Serum, urine and milk were parallel with the human prolactin standard in the RIA. There was no correlation between serum prolactin levels and urinary prolactin activity. Dialysis of urine samples resulted in complete loss of human prolactin activity while the addition of human prolactin to the urine resulted in the recovery of over 50% of the hormone after dialysis. Thus it was concluded that prolactin is not present in urine. In additional experiments it was observed that the RIA prolactin activity in urine was significantly correlated with the osmolality of the urine and that Na+ and K+ were contributory elements. On the other hand, prolactin was found in human milk and correlated well with the expected serum levels of this hormone. This latter finding is interesting because prolactin receptors have been shown to exist on the serosal side of the mammary epithelial cells. The presence of prolactin in milk suggests the possibility of other sites of action for this hormone in addition to the cell membrane.


Steroid biosynthetic potential of gynaecomastic tissue in man. In vitro transformation of precursors to androgens and oestrogens was studied in breast tissues from 7 phenotypic males with gynaecomastia and 3 normal females. All the tissues studied showed formation of dihydrotestosterone and oestrogens, thus demonstrating the presence of 5alpha-reductase and aromatizing enzymes. The results on the values of urinary oestrogens before and after surgical removal of the breast tissue substantiate the biosynthetic potential of gynaecomastic tissue. The aetiological significance of these findings vis-à-vis gynaecomastia is discussed.


Prolactin-releasing activity of arginine vasotocin in vitro. A significant elevation in both luteinizing hormone (LH) and prolactin release was observed in the culture medium of hemipituitaries from castrated estrogen-progesterone (EP) primed female rats incubated for 5 h with arginine vasotocin (AVT) and luteinizing hormone-releasing hormone (LRH) compared to corresponding halves incubated with LRH alone. However, AVT alone did not significantly alter the discharge of LH or prolactin from hemipituitaries of EP-treated rats in vitro. Arginine vasopressin, a natural analogue of AVT, inhibited prolactin release using this same model system. Normal male rat hemipituitaries incubated with AVT released significantly more LH and prolactin into the culture medium than did their corresponding halves. A log-dose response curve indicated that any dose from 100 ng to 10 mug AVT significantly promoted prolactin release. However, the terminal tripeptide of AVT, Pro-Arg-Gly(NH2), failed to modify the discharge of LH or prolactin into the culture medium.


Melatonin inhibition of pineal antigonadotrophic activity in male rats. The influence of subcutaneous implants of melatonin on reproductive organ growth in neonatally testosterone propionate-(TP)-treated, blinded rats was investigated. The testes and accessory sex organs of rats that were TP-treated and blinded grew significantly slower than those of intact control rats. Either treatment of animals with melatonin or pinealectomy partially restored growth of the reproductive organs. In that the effects of melatonin treatment were similar to those of pinealectomy in this experiment model, it is speculated that melatonin may not be the principal pineal antigonadotrophic substance in the male rat.


Avian postovulatory follicle homogenate effect on the genital tract motility. The recently ruptured follicles of the avian ovaries were found to contain an oxytocic substance. The substance was found to be heat-labile, nondialyzable and not extractable by lipid solvents. The crude homogenate stimulated the frequency and amplitude of the chicken infundibulum, uterus and uterovaginal junction, if they were taken from hens 2 h before predicted oviposition. The homogenate was found to induce premature oviposition and to stimulate the uterine contractions of rats treated with progesterone. Uterine tissues taken from estrogen-treated rats either did not respond to the homogenate or were inhibited. Addition of phenoxybenzamine or propanolol did not inhibit the stimulatory effect of the homogenate. It is possible that this factor might be involved in regulating oviposition in the hen.


Metabolism of oestradiol-17beta by intestinal bacteria in rats. In vitro experiments were carried out in which [4-14C]oestradiol-17beta was incubated with a culture from caecal content from adult male rats at 37 degrees C in an atmosphere of nitrogen. Oestrone was identified as the only certain metabolite. Other metabolites, if present, were quantitatively unimportant. The conversion of oestradiol-17beta to oestrone was estimated to be 22-42%.


Hormonal influence on testicular lipids. The effects of progesterone and progesterone plus oestrogen (PPO) on testicular lipids of adult rats were studied. Treatment with progesterone over 7 days did not alter significantly the total lipids, cholesterol, glycerides and phospholipids. However, PPO administration brought about a significant elevation in total lipids, mainly contributed by the increase in triglycerides. The phospholipids and total cholesterol were not markedly affected by PPO treatment, but the individual classes of phospholipids showed marked alterations in their pattern of distribution. The esterified and free cholesterol fractions were found to be significantly altered by both the treatments. Progesterone appears to favour ester cholesterol accumulation by depleting the available free cholesterol. Oestrogen seems to increase the glycerides and change the concentration of phosphatidyl serine, phosphatidyl choline and phosphatidyl ethanolamine when administered with progesterone.


Hypertension as a disease of modern society. About 50 per cent of people in modern societies have blood pressure sufficiently elevated to result in increased mortality. This proportion is much smaller in undisrupted societies of hunter-gatherers. In most cases the elevated blood pressure in modern societies is associated with physiological changes characteristic of chronic stress. The difference between blood pressure in modern populations and that in undisrupted hunter-gatherer societies cannot be accounted for by genetic differences or differences in salt consumption. Two primary features of modern society which contribute to the elevation of blood pressure are community disruption and increased work pressure. Drug therapy and relaxation therapies for hypertension attempt to counteract the physiological effects of social stress. However, it is more appropriate to use the occurrence of hypertension as an indicator of fundamental social problems which need to be solved.


On the structural constraints to state intervention in health. This paper explores the general structural constraints which are imposed upon all states in capitalist societies in their problem-solving endeavor relative to health. The general argument is that capitalist industrial growth both creates specific health needs and institutionalizes solutions to these needs that are compatible with capital accumulation. The key mechanism in this institutionalization is the engineering model of modern scientific medicine, which transforms health needs into commodities for a specific economic market. When the state intervenes to cope with some health-related problems, it is bound to act so as to further commodify health needs, and without ameliorating the health status of the population.


The political context of health service regulation. Can regulation work in health services, given the present political context? General issues in the regulatory process are discussed, followed by a consideration of the relevance of these issues to the health care field. Regulatory processes are reviewed for the United States in four areas: credentialling of people, surveillance of delivery systems, quality of materials and technology, and rate-setting or cost control. It is concluded that the process cannot work. Four alternatives are presented and briefly evaluated: tinkering, centralized regulation, national health service, and general nationalization of most major economic sectors.


The health maintenance organization strategy: a corporate takeover of health services delivery. This paper presents a political economic framework for viewing the social organization of the delivery of health care servies and predicting a qualitatively different institutional configuration involving the health maintenance organization. The principal forces impacting American capitalism today are leading to a fundamental restructuring for increased social efficiency of the entire social welfare sector, including the health services industry. The method to achieve this restructuring involves health policy directed at raising the contribution to the social surplus from the delivery of health care services and eventual corporate domination. The health maintenance organization conceptualization is examined with suggestions as to how the HMO strategy promoted by the state leads to this corporate takeover. The mechanism and extent of the present corporate involvement are examined and implications of health services as a social control mechanism are presented.


The social nature of the definition problem in health. In this article it is argued that through the adoption of the appropriate theoretical approach and the derivation of suitable analytical categories, the definition problem in health can be seen as operational, nontrivial, and highly problematic to the determination of health care policy. Specifically, an attempt is made to isolate the social basis of the definition of health. Part one develops that theoretical approach to the problem. First, notions of health are traced paradigmatically, then a historical materialist approach is employed to develop the social basis of an operational, contemporary definition of health. This definition is then compared with other existing definitions, and part one concludes with a discussion of the possibilities of a normative definition. Part two applies the new definition by reinterpreting parts of the history of public health and medicine, and concludes with a discussion of how this definition is highly problematic to the major structural reforms currently under way in the American health care system.


A local maternity care system in South West England under review. Since the Cranbrook Report in 1959 there has been a steady increase in the proportion of institutional confinements in England and Wales and a steady decrease in perinatal mortality. This association should not be regarded as evidence of cause and effect nor as justification for continuing the Cranbrook policies for the provision of maternity care throughout the 1970s. Due weight must be given to other factors, including improvements in the general health and education of the population and advances in standards of medical care affecting all parts of the maternity services. The present study examines current performance of a local maternity care system and analyzes some 3700 confinements which took place in a Health Care District (formerly a Hospital Management Committee area) in South West England during 1970. The local resources consisted of a consultant obstetric unit, a Special Care Baby Unit, five general practitioner units and the associated medical and nursing staff, and two Local Authority domiciliary midwife services. An expectant mother may call upon a variety of resources in pregnancy, during delivery, and in the puerperium. The concept is developed of the "stream" of care received by the mother and the case histories are analyzed in these terms. The deliveries are classified in terms of nonintervention and intervention at delivery. Perinatal mortality is not in itself an adequate measure of the overall performance of a local maternity care system so other performance indices are used. These are based upon the extent to which the resources available diverge between booking and actual usage. Results obtained indicate that existing policies may be less than optimal and alternatives ought to be considered.


The minimization of travel effort as a delineating influence for urban hospital service areas. Using a study population of 16,080 live births occurring to residents of Baltimore City in 16 hospitals in 1969, this research measured the existing flow of these patients against the flow "expected" in an optimal accessibility model (where each birth would occur at the hospital with the shortest travel time to the residence of the mother). The results of the study indicate that there is a general pattern of distance minimizing in travel for hospital admission with 50 per cent of the births occurring to women who travelled to one of the four closest hospitals of the 16 alternatives. However, a surprisingly large proportion (20 per cent) of the study population exhibited extreme spatial inefficiency by traveling to those four hospitals of the 16 alternatives which were farthest from their residence. A stepwise regression analysis identified five variables which best explained variation in the spatial efficiency of these urban obstetrical patients: low hospital occupancy, high total hospital admissions, average extra travel time potential (a measure of the difficulty of "spatial choices" facing patients depending upon the location of their residence with respect to the alternative hospitals), race, and the importance of the hospital's obstetrical service (a ratio of births to total admissions).


Management of the borderline patient on a medical or surgical ward: the psychiatric consultant's role. The patient with borderline personality hospitalized on a medical or surgical ward has a disorganizing effect on the house staff, who may regress in response to the patient's impulsivity, dependency, entitlement, and rage. The psychiatric consultant's role in the management of such a patient should consist of a specialized type of consultee-oriented approach in which countertransference hatred and fear, typically generated in the staff by the borderline, are drawn away from the patient and strategically metabolized within the staff-consultant relationship. The consultant should actively promote a behavioral management practicum, placed in the medical chart for reference and as a symbol of the psychiatrist's helping presence, which discusses: a) clear communication with the patient and among staff, b) understanding the patient's need for constant personnel, c) dealing with the patient's entitlement without confronting the patient's needed defenses, and d) setting firm limits on the patient's dependency, manipulativeness, rage, and self-destructive behaviors. The consultant should work to counteract feelings of helplessness in the staff, to neutralize punitive superego in the staff, and to diminish fearfulness toward the patient.


Brief group therapy following myocardial infarction: eighteen-month follow-up of a controlled trial. Sixty post-myocardial infarction (MI) subjects have been followed for up to eighteen months' time following their MI. Thirty-eight of these subjects completed a brief series of four to six group therapy sessions during their early rehabilitation phase; the others received no group therapy. Both groups were placed on otherwise identical schedules of outpatient follow-up. Group therapy patients have, to date, experienced significantly fewer cardiac complications than controls. Only one death has occurred, and that one patient was in the control group. A coronary heart disease teaching evaluation questionnaire was given to a sample of group therapy patients, a sample of controls, and a comparison group of men without MI. Following their group therapy sessions, these men demonstrated significantly greater knowledge of their disease and its optimal rehabilitation than did control or comparison subjects. Control patients' questionnaire results proved to be insignificantly different from those of the comparison group.


Studies of superobesity: I. Psychological characteristics of superobese patients. Close study of twelve superobese women revealed the following principal characteristics. None had a serious psychiatric illness, but most showed moderate personality disturbances with predominant passive-aggressive traits. Depressive features, though common, were not severe. Food typically had been used to allay feelings of emotional deprivation present since early childhood and historically associated with the unstable marriages of these patients' parents. The label "oral character" is not sufficient to provide even a capsule description; stubbornness, defiance, needs for autonomy and wariness of entangling relationships as well as conflicts over exhibitionism also were prominent. These characteristics contribute to the traditional reputation of the obese as "difficult" patients and deserve greater attention to help improve the effectiveness both of standard medical management and of psychotherapy.


The doctor's wife: mental illness and marital pattern. It is a clinical impression that physicians' wives present in disproportionately large numbers as psychiatric patients; that in the vast majority severe marital problems are present; and that the marital relationships show a similar pattern. The purpose of this paper is to ascertain whether the latter two impressions have any basis in fact. Accordingly, a random sample of twenty physicians' wives who had been in-patients in the University of British Columbia Health Sciences Centre Hospital during the period March 1, 1969 to May 31, 1973, and whose husbands had been interviewed, was selected. The records were reviewed to obtain personal data, pertinent psychiatric history, diagnosis, the personality of husband and wife and information on the marital relationship. These conclusions emerged: 1. Ninety per cent of the patients had a primary diagnosis of depressive neurosis. 2. Ninety-five per cent of the patients had a secondary diagnosis of personality disorder, hysterical personality and passive-aggressive personality in order of frequency. 3. In 90 per cent of the patients there was a history of suicidal preoccupation or attempt. 4. In 55 per cent of the patients there was a history of significant drug and/or alcohol abuse. 5. The patients were more frequently ward management problems. 6. A common marital pattern was noted: a dependent, histrionic wife and an emotionally detached husband. 7. The cases were characterized by their complexity, severity, long duration and difficulties involving the patient and spouse in an appropriate treatment plan. The authors discuss the implications of this study, particularly its significance in provoking examination of what measures might be utilized for early detection and intervention with those physicians and physician-marriages at risk.


Unified health services and family-focused primary care. Unified health and primary care services must focus on family health and the family as the clinical unit. Understanding the family as the basic social system and assessing its functioning from the standpoints of evolutionary family tasks, family health behavior and family coping capacities are as important as is knowledge of body systems and their functional evaluation, and of social and ecological systems which also can be pathogenic for individuals or families. The concept of psychosomatic medicine must include familio-somatic and somato-familial medicine. Families are involved in the pathogenicity of some diseases and psychiatric disorders, and in the treatment and management of all chronic disease. Coping with dying patients and mourning are also basic family tasks. Only unified clinical services, whether hospitals or health stations, can render realistic care and relate to the many relevant systems in the community, beginning with the patient's family. Clinicians must evaluate these systems as to their wholesome or unwholesome impact on a particular health issue or problem, seeking corrective as well as preventive measures.


The meaning of heart-valve surgery to the patient. Observations are presented about patients' psychological reactions to the experience of having a heart valve replaced or repaired. The importance of the patient's conceptualization of the cardiac valve and the surgical procedure is discussed. By understanding what such a procedure may mean to the patient, the medical staff can help make a terrifying experience more bearable.


Diagnostic errors in emergency room medicine: physical illness in patients labeled "psychiatric" and vice versa. Patients coming to general hospital emergency rooms often present mixed physical and psychological problems. An unfortunate tendency of physicians caring for these patients to "label" them as either "organic" or "psychiatric," based on initial impressions, may lead to inadequate diagnosis and improper treatment. Four case examples are discussed, in which diagnostic errors resulted either from ignoring psychological and social factors, or by focusing on emotional factors to the exclusion of organic disease. The provision of quality medical care in a hospital emergency room requires that attention be directed coordinately to both physical and emotional factors in each patient's illness.


Theme-focused group therapy on a pediatric ward. Hospitalization for children may be a traumatic experience which can result in varying degrees of depression and anxiety. To help children deal with their negative reactions to illness and hospitalization the departments of psychiatry and pediatrics at Beth Israel Medical Center in New York introduced a program of theme-focused group sessions for pediatric patients. The group concerned itself with issues of the hospital experience including 1) lack of, or distortion of, factual information, and 2) fantasies, fears and anxieties related to hospitalization. The group also served as a diagnostic tool by allowing the observation of children's reactions to their hospitalization; as an educational experience for non-psychiatric hospital personnel to learn about children's development and psychological functioning; and to reduce the anxiety level of the children, lessen hyperactivity, aggressiveness, and resistance to hospital procedures.


A woman with dermatitis and dissociative periods. A nineteen year old female with pustular eczema and dissociative spells is presented. The patient has a three year history of severe dermatitis beginning shortly after her marriage. Central dynamic issues appear to be difficulty separating from her mother and an ambivalent identification with a hostile father. The patient also describes fugue-like episodes which occur with emerging aggressive feelings. Psychological testing supported these hypotheses. The relevant literature describing the correlation between aggression and skin disease is reviewed. A final uniform formulation was tentatively proposed that this patient, in addition to a strong genetic component for atopic dermatitis, had her illness abetted by inability to cope with aggressive affects.


Reluctance to accept life-saving treatment. The patient is a twenty-three-year-old man with end-stage kidney disease who has major conflicts about receiving maintenance hemodialytic treatment. These conflicts stem in part from the patient's hospitalization at the age of seven and the witnessing of heroic medical procedures used in an attempt to treat his father's eventually successful suicide. His unconscious doubts of his manliness result in a pseudoindependent behavior and a pose of hypermasculinity which induce a rejection of passivity and the dependent position necessitated by being a patient on hemodialysis. Rejection of hemodialysis may be a conscious or unconscious suicide attempt. In  this patient, it may be a consequence of guilt in relation to his father's death and of other psycho-social factors. Effective treatment for this patient should include allowing him to exercise his independence in as many ways as is possible. Home dialysis and renal transplantation lend themselves to greater feelings of independence and may be preferable to center hemodialysis in this patient. The feelings surrounding the death of his father should be explored with a liaison physician or psychiatrist.


Revision of estimates of the molecular weights of tobravirus coat proteins. The molecular weights of proteins from several tobacco rattle viruses (or tobraviruses) have been determined by electrophoresis with 'marker' proteins in acrylamide gels of different strengths. Plotting KR, a measure of the effect of varying the gel strength, against molecular weight gave a value of 23,000 +/- 2,800 for tobacco rattle virus (TRV) strain CAM and similar values for other strains of TRV and pea early-browning virus. A value of 21,700 +/- 700 was obtained for TRV strain PRN by sedimentation to equilibrium in 6 M guanidine hydrochloride. These estimates are similar to those made by a statistical reappraisal of published data on amino acid composition, and a value of about 22,000 is proposed for TRV coat proteins.


Forecasting patient tray census for hospital food service. Five computerized forecasting models were tested with data on daily patient tray demand in a large medical center food service, and results were compared with intuitive forecasts made by the food service supervisor. All five models gave more accurate results than the intuitive procedure; an adaptive exponential smoothing model was most accurate. The effects of model complexity and data storage requirements are discussed, and simple exponential smoothing is suggested for forecasting patient tray demand in this setting.


[Culdoscopic sterilization].

[Culdoscopic sterilization]. Culdoscopic sterilization deserves to have a high place in the methods chosen for surgical sterilization. It has to be carried out in the operating theatre. Asepsis is essential. The process is simple and quick and is carried out under analgesia (Meperidine and Chlorpromazine) and a local anaesthetic. The patient is placed in the knee-chest position. A special speculum is inserted. Both fimbriae are removed after they have been brought down into the vagina from the Pouch of Douglas using Gutierrez-Najar's special forceps. On the average the operation takes about a quarter of an hour. The patient may go home with her husband six hours later. The convalescence is usually completely uncomplicated without any after-effects.


[Adaptation of a cervical cap for human artificial insemination]. The authors have designed a cervical cap in plastic throught which artificial insemination can be practised. The material allows prolonged contact between semen and the cervical mucus. Tests carried out 24 hours after insemination have shown that after 159 inseminations there were mobile spermatozoa in the mucus in 145 cases.


[The evolution of ideas about therapeutic interruption of pregnancy]. The author has analysed 77 therapeutic terminations of pregnancy carried out at the C.H.U. in Toulouse between 1959 and 1973. He concludes that ideas about the indications for therapeutic termination of pregnancy should be completely revised under the pressure of change in medical knowledge and in philosophical attitudes. He points out the danger of becoming tied up in this matter in too rigid a framework. He emphasizes that therapeutic abortion is just another variety of induced abortion and like the latter it carries many immediate and late risks.


[Clear cell carcinoma of the female genital tract]. Even though the existence of clear cell carcinomata is universally acknowledged at all levels of the female genital tract, the nomenclature and the pathogenesis are still controversial. Following the observation of several examples of these tumours, we have been tempted to define and state the origin of these tumours. In the light of urogenital embryogenesis we think that it is discretion that has led to purely descriptive terms to describe these carcinomata. A critical study of the hypotheses as to the pathogenesis that have been suggested about these tumours in the literature allows the summary of numerous arguments in favour of a müllerian origin or viewed in a broader aspect, coelomic origin for these tumours.


[Infant mortality according to the duration of gestation]. By studying the statistics given in the civil register, mortality tables of infants dying under the age of one year have been compared with the duration of the pregnancy (7 months, 8 months, 9 months). These tables show the probability of death day by day in the first week, week by week in the first month and monthly in the first year. They show the influence of the length of gestation on mortality. Furthermore the probability of the death of a foetus of more than 6 months gestation has been calculated.


[Experimental study of uterine hypoplasia. II. Effect of treatment with beta mimetics]. After we had made rats' uteri hypoplastic by surgical interference with their blood supply we carried out a second part of our study by treating the animals that had been operated on with a beta-mimetic substance in order to lessen or counter completely the effects of surgical devascularisation. From our results we can conclude in a statistically significant proportion of cases that the effects of devascularisation are cancelled out by the treatment. These facts are explained by taking into account the specific pharmacological effects on the uterus of beta-mimetic substances.


[Experimental study of uterine hypoplasia. I. Influence of the vascular factor]. The purpose of the experiment was to prove the importance of the vascular factor in uterine hypoplasia. The animal that was chosen was the rat. The method that was used consisted of devascularisation of one of the two uterine cornua. This was done without altering the blood supply to the ovaries when the animals were 7 weeks of age, which is the immediate prepuberty stage. The results that were obtained were significant whether they were looked at macroscopically, microscopically or by weight. In experimental conditons the hypoplasia was obtained solely due to interference with the blood supply which was carried out surgically.


[Estroprogestational drugs and the ultimate embyogenesis in the rat]. Cyclic female rats were fed with ethinodiol diacetate plus mestranol (EDM) for periods of 45 to 180 days. They were mated during prooestrus, on the first cycle following the end of the treatment. Results were as follows: 1. The cycle is blocked about eight days after starting E.D.M. The longer the treatment, the later rats resume their cycle. 2. Degeneration of the ova before implantation and embryonic mortality are slightly augmented when fecundation takes place within two days after stopping E.D.M.; whereas from the third cycle on, the quality of th ova is identical to the control group. The ova are euploid; they are more fragile to hypotonic shock than the ova of the control animals. No influence of E.D.M. upon meiotic or mitotic processes could be demonstrated. Those experiments do no allow any inference to the human species, but they are inkeeping with the observations of Boué et al. on women.


[Ovarian neoplasms. Immunoglobulin levels in patients with primary ovarian tumors]. The authors present a study on the immunoglobulins in 156 women who are divided into three groups: 81 with cancer of the ovary 54 normal controls and 21 controls who had some disease other than a malignant tumour of the ovary. The radio-immuno-diffusion technique of Mancini was used to estimate the levels of immunoglobulins. The authors conclude: that as far as immunoglobulins IgG and IgA go there is no significant difference in the groups that were looked at. As far as Ig M is concerned there is a significant rise in the level in women with primary malignant tumours of the ovary, whether they had clinical signs or symptoms or none. As far as the ratio between IgA and IgG is concerned there is a significant rise in the control group with malignant disease and in a sub-group of primary malignant tumours of the ovary who had clinical manifestations of the disease. This work fits into the framework of a larger study concerned with non-specific cellular immunity in patients who have a primary malignant tumour of the ovary. It is the first of the results that have come through and will be followed more deeply and more systematically.


[Extrauterine pregnancy and its obstetrical prognosis (apropos of 135 cases)]. The authors have studied 135 case histories of extra-uterine pregnancies which were operated on and followed up the years 1965-1973. They draw attention to: 1. At the clinical level atypical symptoms are found in 29% of cases, which means that the diagnosis is made late in many cases (36% of ruptured tubes) in spite of modern methods of diagnosis. 2. As far as the woman's obstetrical future is concerned they note the low level of further conceptions (51%), the rarity of pregnancies that go to term (24%), and the importance of complication (15%). Fertility after extra-uterine pregnancy is higher when the woman has already had children (43%) as against those women whose extra-uterine pregnancy is in their first pregnancy (25%). They suggest that these results can be improved if on top of surgical treatment further medical supportive treatment is given such as antibiotics, steroids and postoperative hydrotubation.


[An attempt at classification of the vaginal arteries. Functional and surgical implications]. It has been possible to attempt to classify the vaginal arteries after studying 10 specimens of total contents of the pelvis removed at autopsy. The classical descriptions are confirmed except for these features: The longitudinal vaginal artery supplies the anterior and inferior part of the vagina and probably also the bladder. The middle haemorrhoidal artery supplies, as far as we can see, mainaly the posterior portion of the vagina. Finally, in a last section, we discuss some surgical and functional implications arising from these deductions.


[The lecithin-sphynogomyelin ratio in the amniotic fluid in insulin dependent diabetic pregnancies]. A delay in the pulmonary maturation of the foetus of diabetic mothers assessed by the lecithin-sphingomyelin (L/S) ratio has been reported (2, 3, 5). A suggestion has been raised that the results of the L/S ratio should be viewed with caution in predicting lung maturity in pregnancies complicated by maternal diabetes (8). We report our findings on 52 insulin-dependent diabetic pregnancies which involved 90 estimations of the L/S ratio on the amniotic fluid. In all cases, the L/S ratio accurately reflected lung maturity, as no hyaline membrane disease (HMD) was observed with a L/S ratio greater than 2. There was no significant difference in the proportion of mature fetal lung between insulin-dependent diabetics and controls for each week of pregnancy between 32 and 38 weeks. There is no statistical difference in the mature L/S ratio between classes B + C and D + F diabetics.


[The hexosamines of the umbilical cord vessel walls]. Qualitative and quantitative compositions of hexosamines in arteries and veins of umbilical cord have been determined. The qualitative compositions of hexosamines in umbilical cord vessels are identical, namely they are composed of glucosoamine and galactosoamine. It has been shown that hexosamines occurred mainly as glycosoaminoglycans (GAG). Qualitative and quantitative compositions of GAG have been determined. It has been revealed that qualitative compositions of GAG of umbilical cord vessels are identical and they have been presented as follows: hyaluronic acid, heparane sulphate, chondroitine-6-sulphate, dermatane sulphate. Concerning the GAG, the difference between veins and arteries consist in higher content of hyaluronic acid and lower content of chondroitine-6-sulphate. The high content of hyaluronic acid in vein walls is probably connected with their permability.


[Autoimmune hemolytic anemia during pregnancy. Apropos of 1 case]. A case of auto-immune haemolytic anaemia during pregnancy is described. The different tests carried out on the patient make the diagnosis of idiopathie auto-immune haemolytic anaemic haemolytic anaemia in this case. Several theories have been reviewed in order to try and explain the possible role of pregnancy in the appearance of worsening of this kind of anaemia. The theory most likely to be true is that it is a slowly evolving process of auto-immunisation in which the haemolytic effect was accelerated by the pregnancy and showed itself clinically because of the haemodynamic factors occurring at the placental site.


[Induced hyperglycemia and its relationship to underweight fetuses: study on a newborn infant]. A study was carried out on hyperglycaemia induced by intravenous administration of glucose between the 1st and 4th day of life in healthy new-born infants and in underweight newborns. The blood glucose level in underweight infants is slightly lower than that in healthy new-born infants. The level of insulin in the blood is much lower in the underweight child after 30 minutes. Although the levels of insulin and Glucagon in the blood vary between the two groups the ratio of Glucagon to insulin is constant and evolves constantly. The ratio is higher the more underweight the child is. It is possible that this can help to maintain the level of blood glucose sufficiently high in the underweight new-born infant.


[Injuries to the upper extremities in the newborn diagnosed at birth]. Injuries to the upper limb vary in type. The overall incidence, including the form which is revealed by paralysis, is 2.6 per 1,000 (30 cases in 13,342 deliveries). In 90 per cent of cases it followed a dystocic delivery. The prognosis for these lesions is favourable when the diagnosis is made early and the correct treatment is started in the first days of life. All the same, sequellae are not rare, being in the order of 10 per cent, and this pathological condition should not be considered as a benign one. The pathology of these lesions does not depend only on the second stage of labour, nor entirely on the choice between hysterotomy and vaginal delivery, but equally on the prevention of the birth of large children and on the treatment of maternal obesity, as well as on a better estimation of the size ofthe foetus in utero by the development of measurements of the bi-acromial diameter with the use of ultra-sonic techniques.


[Ovarian hyperstimulation syndrome. Notes on the physiopathology and treatment apropos of 3 cases]. Hyperstimulation appeared in one case on the 10th 11th day after ovulation, allowing by its presence the very precocious diagnosis of successful fecondation. The study of blood coagulation revealed that hypercoagulability was mainly related to hyperactivity of the thrombocytes and of the coagulation proteins. The pathogenesis of the syndrome is discussed. Increase in the permeability of the capillary vessels and hypovolemia seem to be responsible for the main accidents. Unfortunately as we have no real mean of decreasing the permeability of the capillary vessels, the treatment can be directed only against hypovolemia and its results. The infusion of macromolecular fluids, the restriction of sodium and water intake, together with the prescription of spironolactone have been successfully employed in those three cases.


[The problem of systematic bacteriological examinations carried out early in premature infants]. Systematic bacteriological examinations of samples taken from the pharynges, the gastric juices and the meconium or the ano-rectal regions were carried out on 300 premature babies immediately on their admission to hospital. These examinations, which consisted in direct microscopic examination and in culturing the specimens, showed that usually a normal microbial flora was established in the mucous membranes of the digestive tracts but there were also abnormalities caused by contamination. There is therefore a limited but real value in the tests when they reveal massive bacterial contamination by the presence of microbes that could be at this stage of life dangerous to a premature baby. The results of the tests then suggest the necessity for antibiotic therapy.


Breast cancer detection today: an opinion. The family physician, more than most other physicians, is faced with rapidly increasing demands for breast cancer screening. The old standby, physical examination, is now accompanied by mammography, xeromammography, and, more recently, thermography. In this paper, we present our opinion, based on the collective experience at the Mayo Clinic, regarding the use and effectiveness of the several modalities, including mammography, xeromammography, and thermography, available for detection of breast cancer today.


How illness presents: a study of patient behavior. In 1972 McWhinney presented a classification of patient behavior which provided the physician with a framework in which to describe his assessment of the reason for the patient's visit. The present paper assesses the reliability of this classification schema involving seven categories of patient behavior comparing the assessments of the investigators with those of the cooperating physicians. There was agreement in 75 percent of the cases. For a random sample of women, 389 visits over a six-month period were classified. Signal behavior was noted in 14 percent of all visits and psychosocial problems were presented frankly in another 22 percent. The distribution of patient behaviors differed for patient and doctor-initiated visits and differed among the five participating physicians. Characteristics of the doctor, rather than those of the patient, had the greater influence on the degree to which patients used frank presentation rather than signal behavior to provoke discussion of psychosocial problems.


Care of the patient with hematologic malignancy: a point of view. The patient with hematologic malignancy is nowadays afforded longer periods of remission through appropriate chemotherapy and, while this provides comfort and encouragement to the patient, the usual outcome is death. The problems that face the patient, the families of patients, and the primary care physician during the course of malignant disease are discussed. Perspectives on the reactions of all concerned are presented for three phases of illness: The Initial or Diagnostic and Remission-Induction Phase, The Treatment Phase with its remissions and exacerbations, and The Final Phase, or dying process. Case presentations are used to illustrate the problems which affect patients, their families, and the physician. While pharmacologic treatment is important and essential, emphasis is placed on emotional support to be offered by the physician and his team throughout the three phases of illness.


Serum immunoglobulin levels in healthy adults of various ethnic groups in a rural family practice in Israel. A study on the immunoglobulin levels of five ethnic groups in a rural population in Israel was carried out. The ethnic group comprised Yemenite, Cochin, Kurd, North African,  and Ashkenazi Jews. Yemenites have a low level of IgA, Ashkenazis have a high IgM level, Cochins and North Africans have high levels of IgG and IgA, and Kurds show low IgM levels. Females have higher IgM levels than males. No positive correlation between immunoglobulin levels and age could be demonstrated. A connection between these levels and exogenous and endogenous factors in the various ethnic groups is discussed.


The intellectual basis of family practice. Although progress is being made toward defining the family physician and the specialty of family practice, there remains a need to describe more clearly a conceptual base for family medicine as an academic discipline. This paper explores common misconceptions and fallacies which have confused or prevented greater understanding of the intellectual basis for family practice. A thesis is presented and defended which holds that patient management is the quintessential skill of clinical practice and the unique field of knowledge of family physicians. The sine qua non of family practice is the knowledge and skill which allow the family physician to confront relatively large numbers of unselected patients with unselected conditions and to carry on therapeutic relationships with patients over time.


Primary care- whose responsibility?

Primary care- whose responsibility? The increasing recognition of the importance of the primary care concept which has taken place in the past ten years has been accompanied by the rapid and successful development of family practice as a major response to marked deficits in primary care. More recently we are seeing more varied and fragmented approaches to this need by other specialties which have previously concentrated their efforts on secondary and tertiary care. Instead of competing for the primary care banner, the medical profession should give high priority to better understanding the nature of primary care and specifically training primary care physicians with a sufficiently broad range of knowledge and skills to provide primary care of high quality for patients of any age and their families.


Intellectual and attitudinal characteristics of medical students selecting family practice. Family practice residents were compared with residents in internal medicine, surgery, obstetrics-gynecology, and pediatrics in terms of cognitive and non-cognitive characteristics. Family practice residents were in most instances significantly different from the other four groups. On non-cognitive measures they scored higher on affiliation need and lower on aggression and materialism. Their scores on several cognitive measures were among the highest of the five groups. These results were contrary to others from earlier studies. However, if the trend reported here is confirmed on other samples, it is the more intellectually gifted and idealistic physician who is currently being attracted to the practice of family medicine.


A core course in family medicine for first-year medical students. This article, the second in a series on a predoctoral curriculum in family medicine, describes in detail the processes involved in planning, implementing, and evaluating the first-year medical school core course at Hershey. The major teaching methods described are seminars, clinical correlation conferences, and practice tutorials. Student involvement in curriculum planning and teaching, flexibility and variability  in modalities used, development of close relationships between faculty and students, pairing of seasoned and neophyte teachers, weekly review-preview conferences of students and faculty, and oral examinations are cited as key factors in acceptance of this curriculum by both faculty and students.


Continuity of care in family practice. Part 4: implementing continuity in a family practice residency program. Although continuity of care is an important goal of family practice residency programs, there are many factors which inevitably prevent its full achievement by individual residents in any program. Each resident is frequently faced with conflicting responsibilities involving the Family Practice Center, inpatient clinical services, and other parts of the residency training program. This paper explores this dilemma and suggests a variety of positive approaches to resolve the issue. All family practice residents must necessarily be intimately involved in providing continuity of patient care and develop the requisite skills and attitudes. However, full continuity of care must ultimately be provided on a program and group level, not exclusively by the individual resident.


The survey in family practice research.

The survey in family practice research. The survey is a method that can be employed in family practice research. It is an adaptable tool that can be used with good results by those not sophisticated in research. General guidelines for survey research are discussed in this article, and an illustrative example of a survey conducted by the authors is presented.


Ribonucleic acid-dependent ribonucleic acid polymerase in the immune response. Ribonucleic acid (RNA)-dependent RNA polymerase activity was demonstrated in the microsomal and ribosomal fraction from the spleen cells of immunized mice. The enzyme activity was solubilized by Triton X-100 from the fraction and partially purified by Biogel A 1.5 m column chromatography. The RNA-dependent RNA polymerase activity was eluted in a single peak from the column. High activity was demonstrated with an RNA polymerase activity was eluted in a single peak from the column. High activity was demonstrated with an RAN preparation (iotaRNA) as template made from the spleens of immunized mice but very low activity was found with an RNA preparation made from the spleens of normal mice. Incorporation of 3H-UTP markedly decreased in the presence of RNase but not in the presence of DNase. DNA preparations made from the spleens of immunized mice were inactive as template for this enzyme. The iotaRNA preparation was fractionated by sucrose density gradient centrifugation. A fraction corresponding to 12-13 S was most active as a template. It was followed by a fraction corresponding to 6-7 S. Sucrose gradient analysis of the 3H-UTP-labeled product was attempted. Some properties of this enzyme are described.


Synchronous cell differentiation in Caulobacter crescentus. The growth of a stalked bacterium, Caulobacter crescentus, has been synchronized easily and reproducibly by a new method. When this bacterium is grown to a late log phase in nutrient broth at 30 C with aeration, swarmer cells are accumulated in the culture to 80% of the whole cell population. When this culture is inoculated into fresh pre-warmed broth at twentyfold dilution, it immediately initiates synchronous cell growth. Simultaneously, synchronous cell differentiation is monitored by the susceptibility of the cells to RNA phage infection. The swarmer cells accumulated in the late log phase of growth possess nearly the same susceptibility to RNA phage infection as those in the early log phase of growth while RNA phage-adsorbing capacity is lower in such swarmer cells. It is suggested that the swarmer cells accumulated in the late log phase of growth have lost some pili.


[Study of the role of mitochondrial creatine phosphokinase isoenzyme in the process of energy transport in cardiac cells]. The kinetic properties of creatinephosphokinase connected with the mytochondria of the heart were studied. The following kinetic parameters were measured: the Michaelis constants for all substrates -- MgATP, MgADP, creatine and creatinephosphate, and the maximal reaction rates for the direct and reverse reactions catalized by the mytochondrial iso-enzyme of creatinephosphokinase. The peculiarity of this iso-enzyme was demonstrated to consist in the independence of binding adeninenucleotides and guanidine substrates. The kinetic characteristics of this iso-enzyme are such that ATP synthesis from ADP and creatinephosphate is preferable: the Michaelis constant for MgADP is 0.05 mM, for creatinephosphate -- 0.5 mM, for MgATP -- 0.7 mM, for creatine -- 5.0 mM. It was also demonstrated that in the presence of all substrates and products of the reaction the ratio of the speeds of the direct and reverse reactions is regulated by Mg ions: with a low concentration of Mg (below that of ATP) the reaction of creatinephosphate synthesis takes place, with the Mg concentration growing the speed of ATP synthesis increases. Thus, an increase of Mg concentration can, depending on the conditions of the reaction, result in its complete reversal. The regulatory role of Mg is also demonstrated for the case in which ATP is synthesized in the reaction of oxidative phosphorylation, creatinephosphokinase-controlled reaction.


[Role of adrenaline in the changes of ion and energy metabolism in the cardiac mitochondria in experimental myocardial infarct]. The changes in the content of K+ ions, in the respiration and oxidative phosphorylation were studied in the mytochondria of canine hearts 5 and 30 min following the ligation of the left descending coronary artery. The gradual changes in the content of intramytochondrial K+ in the mytochondria of the ischaemic zone is attributed to the decreasing rate of phosphorylating respiration and dissociation of respiration and phosphorylation. Similar, but less distinct changes were noted in the mytochondria of the non-ischaemic zone. In cases resulting in ventricular fibrillation a higher dispersion of the metabolic indices was noted: decrease in K+ content, respiration and oxidative phosphorylation in the mytochondria of the ischaemic zone is nore distinct, while in the mytochondria of the non-ischaemic zone it did not differ from what is observed in a favourable course of an experimentally induced myocardial infarction. Propranolol, given in a dose of 1 mg/kg, under normal conditions decreased the respiration rate in the mytochondria and at the same time reduced the activity of succinatecytochromium-C-oxydoreductase, producing no effect on the conjugation of respiration and phosphorylation. In case of myocardial infarction Propranolol prevented the decrease of K+ and dissociation of respiration and phosphorylation. The changes in the ion and energy exchange in the cardiac mytochondria during the acute phase of myocardial infarction are attributed to the activation of the sympathoadrenal system.


[Cardiovascular effects of direct action of potassium and calcium ions on the hypothalamus]. In experiments on adult rats, using the stereotaxic technique of cannulas implantation, the changes in arterial pressure, contraction rate and bioelectric activity of the heart were studied by means of introducing small doses of potassium and calcium chlorides into the zones of the anterior and posterior hypothalamus and into the CSF of the 3rd ventricle of the brain. The injections of potassium chloride were found to produce an elevation of the arterial pressure, tachycardia and irregular changes in the voltage and pattern of the waves of the ventricular complex of ECG; similar injections of the structures of the anterior hypothalamus to the action of calcium was noted, while the posterior appeared more sensitive to potassium. It was concluded that direct stimulations of the posterior hypothalamic structures with potassium and calcium ions produce a more lasting tonic effect on the haemodynamics than their effect upon the anterior hypothalamus. It is suggested that the hypothalamus is an important level of not only the reflex, but also of the direct neurogenic regulation of the haemodynamic parameters.


[Organization of rehabilitative treatment of patients with myocardial infarct]. Purposeful continuous comprehensive rehabilitation of myocardial infarction patients is impossible without centralization. The authors share their long-term experience in arranging and running such a centralized stage-wise system of rehabilitation and secondary prophylaxis. All the stages (specialized hospital department -- post-hospital center -- sanatorium -- outpatient dispensary center) are manned with cardiologists, specialists in kinesitherapy and functional diagnosis, psychologists. All the measures are coordinated by persons responsible for the particular stages of rehabilitation. When the patients return to their professional activities, the state of their cardiovascular system is controlled at work, and ECG is recorded during the working hours. The well-coordinated work of all the links of this rehabilitation system permitted to achieve 91.7% restoration of the capacity for work in patients of a pre-retirement age who have survived myocardial infarction. In order to make scientifically substantiated conclusions on the effect of rehabilitation and secondary prophylaxis on the prognosis of the patients joint efforts of several centers are necessary, as well as standardizing all the studies, unification of the criteria of assessment of the patients' state and of the efficacy of the measures taken. This would serve as a foundation for the creation of a rehabilitation system suitable for the practical health services.


[Mechanism of presystolic intensification of mitral diastolic murmur in auricular fibrillation]. On the basis of a study of the sound pattern and of the data of right and left heart catheterization it has been established that the presystolic accentuation of the mitral diastolic murmur in atrial fibrillation is predisposed by the peculiarities of the dynamics of the left ventricular diastolic pressure. When the diastole is becoming shorter, the diastolic pressure does not grow gradually, as it happens under normal conditions, but progressively decreases during the whole period of the diastole which causes the appearence of a pressure gradient across the atrioventricular orifice, increasing during the diastole, an increasing diastolic blood flow rate through the mitral valve and, as a consequence, an accentuation of the mitral diastolic murmur during the diastole.


[Pathogenesis of disorders of cardiac rhythm and conductivity in acute organophasphate insecticide poisoning]. A dynamic examination of ECG and K and Na level in plasma and erythrocyte was conducted in 73 patients during the acute period of poisoning with phosphorus-organic insecticides -- thiophos, chlorophos, carbophos. In 18.6% of the cases severe rhythm and conductivity disorders were revealed that caused cardiac arrest and death in 29 patients. Besides, a sharp increase in the electric systole on the ECG was noted in all the patients during the acute period of poisoning. A study of the electrolytes revealed hypokalemia, hypernatremia and an increased content of K and Na in the erythrocytes. The authors believe that the disturbances in the cardiac activity during acute poisonings with phosphorus-organic insecticides are due to the effect of the excessive acetylcholine upon the ion permeability towards increasing intracellular potassium.


[Hemodynamic parameters and oxygen regimen of the body in the early postresuscitation period]. In experiments on dogs subjected under light narcosis to a 12--16-minutes full circulatory arrest produced by means of electrotrauma the parameters of the central haemodynamics and oxygen regimen were studied during the early postresuscitational period. Irrespectful of the method of reanimation conducted for 1 hour (closed cardiac massage combined with artificial pulmonary ventrilation or a heart-lung machine), a progressive reduction was noted during the restorative period (3--6 hours) in such indices as the cardiac output per 1 min., stroke volume and left ventricle work. The development of arterial hypotension was prevented by the increased total peripheral resistance. After 9 hours following the reanimation the main parameters of heamodynamics displayed a tendency towards normalization. The circulatory insufficiency was compensated for by an increased oxygen utilization from the blood supply.


[Quantitative evaluation and grading of physical state of patients with cardiovascular disease]. The important role of quantitative assessment of the physical state of cardiovascular patients is emphasized in terms of determining the severity of their pathology, the efficiency of the treatment and rehabilitation. Five groups of physical state of cardiovascular patients were distinguished on the basis of the results of sub-maximal exercises tests, judged by the value of maximal oxygen uptake, physical endurance and threshold exercises. The rationale of the employment of such grouping is illustrated by the data concerning the risk of prosthetic valve replacement according to the group of the physical state of the patient before surgery and by the quantitative data on the dynamics of the functional state of these patients during postoperative rehabilitation.


[Medical rehabilitation of patients having undergone cardiovascular operations]. Among the measures of medical rehabilitation of patients who survived cardiovascular surgical procedures an important place belongs to the problems of physical readaptation. Its degree is determined by exercise tests, among which veloergometry has gained wide recognition. The methods of bicycle tests are discussed with reference to this category of patients. A study of the exercise tolerance and of the nature of the response conducted according to several cardiovascular functional indices in patients following closed mitral commissurotomy and surgical correction of non-cyanotic congenital heart diseases indicated that a certain discrepancy exists between the commonly accepted evaluation of the results of surgery and the degree of physical readaptation. The latter depends on several factors: the duration of the history of the disease, relapse of rheumatism, pulmonary hypertension, atrial fibrillation. In order to evaluate the effect of physical training on the degree of readaptation a comparative study is necessary between the rehabilitation group and a "control" group. In patients operated for symptomatic hypertension (renovascular, adrenal, coarctation of the aorta) the assessment of the results of surgery should not be limited by the determination of the decrease or normalization of the arterial pressure alone, but should be supplemented by a general clinical evaluation of the state of the patients. Rational hypotensive therapy significantly improves the results of surgery. The exercise tests permit to establish the functional reserves of the patients, to properly determine the tactics of their treatment and their occupational prognosis.


[Problems of physical training in the therapy and rehabilitation after myocardial infarct (hospital stage)]. Data are presented as to the effects of physical training on the process of rehabilitation of patients surviving myocardial infarction. Not only the restoration of physical activity was taken into consideration, but also the changes in the cardiovascular system, the course of its functional restoration. The observations were conducted in 380 patients during the hospital stage of rehabilitation. The advantages of individual programmes of rehabilitation over standard ones are demonstrated. The criteria for grouping the patients according  to the severity of their state are given, as well as those for transferring the patients from one regimen to another. The importance of control of both the immediate, and late reactions to the exercises is emphasized.


[Rehabilitation of patients with acute uncomplicated myocardial infarct according to 3 1/2-week program]. The study was conducted in 220 patients with uncomplicated localized primary myocardial infarction, aged 30 to 65 years, rehabilitated according to the 3 1/2-week programme. The control group was composed of 110 patients rehabilitated according to the 5-week programme. At the hospital stage of rehabilitation it has been established that the contractile activity of the myocardium is the same in both groups of patients and is characterized by hypodynamia. On this basis it was concluded that further physical rehabilitation of these patients should be conducted at a moderate pace with an obligatory control of exercise tolerance. The dynamic observation 1--2 years after myocardial infarction has demonstrated that the physical capacity for work is higher among the patients rehabilitated according to the 3 1/2-week programme, than among the control group patients. The 3 1/2-week rehabilitation does not increase the number of complications, either in the acute period of the disease, or 1--2 years after it. This permits to recommend the 3 1/2-week rehabilitation programme for the patients with acute uncomplicated primary infarction.


[Physical rehabilitation of patients with myocardial infarct during the restorative period]. In the in-patient rehabilitation department of the Leningrad cardioheumatological dispensary 276 patients with large-focal and transmural myocardial infarction were kept under observation. The programme of physical rehabilitation envisaged the employment of kinesitherapy with increasing workload, dosaged walking up to 2--3 km, mounting the stairs within 3--5 floors. The reaction to the prescribed exercises was determined by the figures of pulse rate, arterial pressure and electroacrdiographic indices. The patients were transferred to the rehabilitation department from the city hospitals and clinics 3 1/2 to 8 weeks after the infarction, depending on the severity of the lesion. In 87% of the patients the term of treatment in the rehabilitation department ranged from 20 to 30 days, the rest of the patients were discharged at a later date. Over half of the patients fulfilled the complete programme of physical rehabilitation, the rest -- in an incomplete form.


[State and perspectives of development of rehabilitation trends in cardiology]. On the basis of the experience of rehabilitation of 500 myocardial infarction patients recommendations are given for the development of rehabilitation in cardiology. It is indicated that the problems of rehabilitation should be solved with the participation of the existing medical establishments, i. e. hospitals, sanatoriums and out-patient clinics, that should function as successive stages of rehabilitation. The main person responsible for the rehabilitative measures at each particular stage should be the attending pyhsician who had mastered the appropriate methodological principles. In choosing the rehabilitation program the attending physician should be assisted by a special rehabilitation team (commission that brings together at the patient's bedside the necessary specialists--kinesitherapy physician, psychologist, functionalist, sociologist. These organizational principles permit to arrange an extensive rehabilitative work within the existing pattern of medical institutions, without any significant changes in its structure.